In December 1899 Honolulu-based physicians attributed two deaths to bubonic plague, and a local paper duly announced that the ‘scourge of the Orient’ had arrived. Within months a first plague fatality was reported in continental U.S. as Chinese-American Chick Gin (Wing Chung Ging or Wong Chut King depending on the transliteration) succumbed to the disease in San Francisco. The cause of death was based on a classic plague symptom of swelling around the groin, but was disputed even after rudimentary bacterial analysis.

Knowing about the discussions in progress at Médecins Sans Frontières, as well as the actions it intends to implement to adapt to climate change, provides precious insight. Though they speak in their own names, the five authors – from the Swiss and Canadian sections – say a lot about the ongoing debates within the movement, about the actions taken and about the possibilities for procrastination. Lessons that apply to the entire humanitarian community.

Reaching drug users in urban contexts is as much a challenge as it is a social and health requirement. In Maputo, the capital of Mozambique, Médecins Sans Frontières has developed a medical approach adapted to a population at high risk, stigmatised and criminalised.

Whilst there is indeed a trend towards the strengthening of State sovereignty, this concept is more multifaceted and ambivalent than it might appear. The author invites us to take stock of its developments, its complexity and the implications for humanitarian work.