MSF was the only provider of medical care in Srebrenica as the violence intensified. MSF wondered if our role had become more like de facto prison doctors in the besieged city. Was MSF inadvertently contributing to the Bosnian Serbs' strategy of ethnic cleansing? Would calling for the evacuation of Bosnian Muslims actually result in aiding the Bosnian Serb’s ethnic cleansing policy of driving the people out and claiming the land? And what if Bosnian Muslims wanted to leave? What should the position of MSF have been?

Srebrenica fell to the Bosnian Serbs in July 1995 and approximately 8,000 Bosnian Muslim men and boys were massacred. How could this happen in the presence of United Nations (UN) peacekeepers in this so-called ‘safe zone’? What mechanisms did MSF put in place to speak out over the UN’s inability to protect the people of Srebrenica? 

Following the fall of Srebrenica, thousands were dead, missing or relocated to refugee camps. MSF questioned what could be done to ensure that peace did not take precedence over justice. Where did the responsibility for these actions and inactions lie?

Many nations were not taking responsibility for their (in)actions in the enclave. MSF France decided to put pressure on the French parliament to investigate France’s role in the fall of Srebrenica, by issuing an appeal for an investigative parliamentary commission. Should a humanitarian organisation speak out and advocate for official government inquiries in order to place responsibility, document events, seek justice and defend human rights?

As the instability of the region increases, MSF and other humanitarian organisations are eventually forced out of eastern Zaire entirely.  MSF suspects that thousands of refugees are suffering and at risk of dying. The organisation decides to launch an appeal for an armed international intervention and communicates about the plight of the population, predicting a health catastrophe, if access for aid agencies is not provided.

In November 1996, the offensive led by the ADFL and Rwandan forces empties the camps in eastern Zaire of their population. Some refugees were repatriated to Rwanda and others fled into the neighboring forest. MSF denounces the repatriation conditions and is reproached by the press for "catastrophic" forecasts made a few weeks earlier.

Finally allowed into South Kivu, a province in eastern Zaire, the MSF teams discover that refugees are being massacred by the ADFL and its allies, particularly in the Massisi and the Shabunda regions. MSF realises that MSF teams are used as bait by the ADFL to lure the refugees out of the forests and kill them.

The ADFL takes control of all of the Kivu province and refugees continue to flee their rapid advance eastwards through the forest.  MSF struggles to maintain access to the refugees amidst the violence, restrictions, and threats to team safety, while receiving continued reports about refugee massacres.

MSF's exploratory mission teams complete their reports on their Masisi and Shabunda visits. Details of mass graves, massacres, and the fact that the ADFL used humanitarian teams as bait to lure refugees out of the forests, sent shock waves through MSF offices. A debate about the use of the information collected ensued: should it be made public or not?

In May 1997, MSF published a new study describing the movements of refugees in the Great Lakes region of Africa and the fate of refugees. MSF planned to distribute the report to a small group of journalists, asking them not to cite MSF as the source of the information. However, a lack of communication between MSF offices and with the teams in the field, exacerbates tensions.

From mid-1997, MSF teams try to work together again. The organisation publishes retrospective studies that trace the odyssey of the Rwandan refugees through the Zairean jungle and contributes testimony to international investigations on human rights violations in the region. 

In 1999, while the country and its people are still struggling to recover, the Russian authorities start bombing Chechnya again. The Russian Federation President, Boris Yeltsin talks publicly about a peace plan but his forces carry out a ruthless bombing campaign on rebel-held villages in southern Chechnya. MSF sections are united in wanting to speak out about what their staff witnessed before being forced out of the region. So what is the best way to draw the world's attention to the plight of the Chechen population, without endangering the national staff who continue to work in southern Chechnya?

With hostilities in Chechnya flaring up again in what the Russian Federation terms as “anti-terrorist operations”, MSF leaders decide to take advantage of the ceremony of the reception of Nobel Peace Prize to call on the international community to intervene. But MSF teams are struggling to work in a Chechnya facing all-out war and dangerous security problems. Instead, MSF starts support refugees in the neighbouring republics where they collect first-hands accounts. Inside Chechnya, operations are run through staff members from the Caucasus who are trained, supported, and managed from afar by international teams in the region. MSF is in a difficult situation that raises many questions: Should MSF be speaking out based on refugees’ testimonies if there are no operational activities with international staff permanently on the ground sin Chechnya? When dealing with a regime in denial of the realities of a war, why is it important to use the word ‘war’? Is it up to MSF to call for this qualification? 

Throughout the year 2000, MSF seizes every opportunity to raise the alarm on the Chechen’s fate with governments and institutions around the world, but to little concrete effect other than general condemnation. With still no international staff in the country, MSF sections resort to so-called ‘remote control’ management, using locally hired employees to deliver aid on the ground. Concerns over the organisation’s legitimacy in speaking out remain and soon one of the sections starts making unauthorised and dangerous trips over the border into Chechnya from Dagestan where they ran distributions of basic care items. Under attack in the Russian media, MSF wonders whether it should ignore or address the accusations of espionage regularly thrown at the organization?

MSF’s operations in Chechnya are slowly starting back up again after 3 years of being run remotely. Although the bombing stops, general insecurity is pervasive and restarting these programmes is not without risks.
With an international team back on the ground in Chechnya, everyone agrees on the need to document the situation more thoroughly. A collection of patients’ accounts in the report “Chechnya: The politics of terror” is handed over at a press conference. The various MSF sections agree on a coordinated media strategy for getting news out of Chechnya and into the press, in particular the Russian media.

Kidnappings are becoming more commonplace in Chechnya and closer to home for MSF as various staff members are held for questioning. At the start of 2001, a key member of the team in the North Caucasus is taken hostage and questions are asked as to whether there's a causal link between MSF’s decision to speak out in the media and the kidnapping? MSF is faced with the following dilemma: should the organisation speak out in the media to create visibility and hopefully bring their colleague some much-needed protection? Or should MSF be as discreet as possible to avoid a rise in the hostage’s so-called ‘market value’? Is it wise to take active steps to secure the hostage's release, such as publicly denouncing the responsibilities, negligence or even complicity of the government controlling the territory where the kidnapping took place?

MSF’s operations have been closed down in Chechnya in response to the MSF Coordinator’s kidnapping. After his release, three weeks later,  MSF tries to restart its operations in Chechnya but there are delays due to security issues, and for now, the only programmes in the country are run through remote control management from Dagestan, on Chechnya eastern border. Most of MSF’s Caucasus staff are behind the return and support MSF speaking out in the media. Meanwhile and in a statement after the September 11th 2001 attacks in New York and Washington, Vladimir Putin, President of the Russian Federation links Russian military operations in Chechnya with the anti-terrorist combat launched by the American government. 
After the events of 11 September 2001, the West's attitude and view of Russia became more complacent, which weakened the impact of MSF's efforts to raise awareness of the plight of the Chechen population.

The situation in the North Caucasus is becoming increasingly violent. The Russian federal authorities are forcing Chechen refugees to return to Chechnya, where they reign terror. They are also putting pressure on humanitarian organisations to stop helping refugees in 'Ingushetia, which would encourage them to return. When colleagues at other organisations are kidnapped in Chechnya, MSF closes down all operations in the country again. With a diminishing international presence in the warzone, MSF is once again faced with dilemmas - should it continue to speak out about human rights abuses its staff haven't witnessed? How can they help those in need and in danger in the region? And how long will it be before one of their own staff is once again held hostage?

In August 2002, the threat to MSF becomes a reality and another Coordinator, a Dutch national for the MSF Swiss section, is kidnapped in Dagestan. The organisation is once again faced with the dilemma of how and when to speak out on the situation in the North Caucasus while one of its members is held hostage. MSF opts to keep quiet at first, but as the weeks turn into months and the MSF Coordinator is still not released, MSF starts questioning whether it should take active steps to secure the hostage’s release by publicly pointing out a government’s responsibilities, negligence, or even complicity when a kidnapping occurs on its soil, or should it not enter into these conversations to avoid the potential for a government to dig in its heels? Tensions are running high, especially between MSF, the Dutch authorities and the family of the hostage, and some feel the structures within the organisation are not helping the situation.

In Myanmar an increasingly authoritarian regime is taking shape, inhibiting the return of refugees and making the lives of the Rohingya who’ve remained in Rakhine State increasingly difficult. MSF documents systematic persecution but is divided over how to approach the dilemma of access versus speaking out. While from 1994, MSF Holland opts for “silent diplomacy” in order to expand its malaria and HIV/AIDs programmes in Myanmar, MSF France decides to withdraw in 2006, denouncing the authorities lack of transparency.

In 2006, following MSF’s internal reorganisation, MSF Operational Centre Amsterdam (OCA) refocuses advocacy on the Rohingya marking a shift in its approach to testimony. To bypass Myanmar’s restrictions, strengthened through violent crackdowns on protesters after 2007’s Saffron Revolution, most of the speaking out concerns the fate of unregistered refugees in Bangladesh. Nonetheless, in Myanmar, MSF OCA speaks out on the humanitarian consequences of state-sponsored discrimination, repression, and lack of access to healthcare for both the Rohingya and people living with AIDS.

In 2008, Cyclone Nargis devastates Myanmar’s Irrawaddy Delta, killing over 130,000 people. The crisis opens a humanitarian space. From 2009 onwards, MSF intensifies its public advocacy on the Rohingya including the “Fatal Policy: How the Rohingya Suffer the Consequences of Statelessness” report that highlights the health consequences of restrictive policies in Myanmar. Though never publicly published, it becomes a key tool in diplomatic exchanges. Throughout, MSF balances the need for advocacy with operational access, gradually developing a comprehensive regional strategy that highlights the Rohingya crisis as a major humanitarian and political issue.

In 2012, violence breaks out in Myanmar’s Rakhine State between Buddhists and Rohingya after a Buddhist woman is allegedly killed by Rohingya men. Retaliatory attacks displace tens of thousands and create widespread insecurity. MSF struggles to provide healthcare amid harassment, access restrictions, and arrests of Rohingya staff, forcing a suspension of operations. MSF faces ethical challenges in maintaining neutrality and impartiality while being seen by other communities in Rakhine as biased toward Muslims. With the regime detaining two MSF staff members, the organisation finds itself once again in a difficult position when it comes to speaking out.

In January 2014, in Du Chee Yar Tan, Rakhine State, MSF OCA treats wounded Rohingya after a violent attack and issues a public statement. The Myanmar government denies the violence, pressures MSF for patient details, and accuses it of exaggeration. Over the following weeks, MSF issues cautious public statements emphasising neutrality and commitment to medical needs. Teams face harassment, protests, and accusations of misinformation from the Myanmar government. Negotiations over the renewal of MSF’s Memorandum of Understanding in the country collapse. On 27 February 2014, MSF OCA is ordered to close all programs in Myanmar. 

Eventually, the Myanmar Government backs down and limits the ban to MSF activities in Rakhine. This still leaves the organisation with a dilemma: speaking out on Rohingya persecution versus preserving life-saving programmes in other states. After tense debates, MSF OCA leadership decides to withdraw from Rakhine to retain access elsewhere. Many argue that this compromises principles for access. In 2017, mass violence drives Rohingya into Bangladesh with thousands killed, which MSF documents and publicly denounces. International legal cases accuse Myanmar of genocide, while abuses persist. MSF continues to question its 2014 choices and the balance between speaking out and access.