Trauma surgeon and veteran field worker, Christos Christou, has taken over the Médecins Sans Frontières (MSF) reins as International President, following his election by the organization’s International General Assembly last June.

Christou, former president of the MSF Greece Board of Directors, will be faced with the leadership challenges of an organization that has grown from a grassroots volunteer movement into a sprawling multi-billion dollar operation with a presence in 74 countries worldwide.

Hailing from a small town in central Greece, Christou joined MSF in 2002 working as a field doctor with migrants and refugees in Europe, followed by field stints in Zambia, and later in conflict zones including South Sudan, Iraq and Cameroon, MSF said in an announcement of the leadership change.

Christou replaces the Canadian physician Joanne Liu, who served as international president for six years, an unprecedented two terms of three years each.

The period has been marked by a non-stop series of humanitarian and health challenges that ranged from old and new conflicts in Afghanistan, Syria, Iraq and Yemen to a unprecedented wave of refugees and migrants fleeing Africa, the Middle East and Central America; and two Ebola outbreaks, including the one still ongoing in the Democratic Republic of Congo.

“As our President, Joanne made sure the reality of people caught in crises was brought directly to the attention of the authorities and public around the world,” said Christopher Lockyear, Secretary General of MSF International, in the MSF statement.

“Joanne worked relentlessly through the West Africa Ebola outbreaks of 2014-2016, and the [US] bombing of our trauma centre in Kunduz, Afghanistan in 2015…Joanne was also particularly vocal on the brutality of inhumane migration policies that MSF teams witness around the world, from Mexico, to Libya and Europe.”

In a recent interview, Liu said that the DRC Ebola crisis was a kind of milestone in the history of relief work.

As the DRC national government asserted its control over both strategy and operational Ebola response, MSF and other humanitarian groups were compelled to recognize that they were not in the drivers seat, or in the words of Liu “…at the end of the day we are a guest wherever we are.”

However, that should be seen as a positive trend, she told the New Humanitarian. It signals a shift away from a “neocolonialist” mindset where health and relief workers came to the rescue of powerless countries.

“MSF is most of the time a great responder, a fairly good doer, a very bad partner,” Liu said, in the interview. “We deeply need to improve. Our survival and our success in the next decade is [going to be dependent on] how meaningfully we partner with local agencies or local [health ministries].”

The outgoing president also acknowledged the huge internal management challenges of the present-day MSF, which treats some 11 million people a year and wields a budget of $US 1.6 billion.

The decentralized structure of the organization, employing 68,000 people at field level, as well as in 48 offices and five operational centres, has created huge internal strains and new leadership challenges, Liu admitted.

“At times, the Game of Thrones seems to be a baby playground compared to what MSF can be,” she quipped.