Conflict and War
In conflict situations, Doctors Without Borders (MSF) works to provide treatment to those most in need of medical care, whether they are people directly injured in the conflict or people trapped in by the violence who require other care – from delivering babies to treating infectious diseases, setting up therapeutic feeding programmes for malnourished children to ensuring continuity of care for people dependent on on-going treatment such as anti-retroviral treatment for HIV.
MSF does not take sides. We provide medical care based on medical needs and work hard to try and reach the people who need help most. If warring parties see aid organisations as being on one side of a conflict, we are less likely to gain access to those in need and more likely to be attacked.
One of the ways in which we are able to demonstrate our independence to warring parties is to ensure that all our funding for work in conflicts comes from private individuals – we do not accept government grants.
Conflicts can start or escalate quickly, leaving populations trapped in warzones and others fleeing in search of safety. Based on extensive experience, MSF teams are able to respond quickly and, particularly when MSF is already active in the country, scale up activities.
Conflicts, be they international wars or internal disputes, can have many consequences. Fear of violence or persecution uproots entire communities and, for those who stay, many are often left without access to medical care.
Conflicts normally lead to a rise in trauma injuries, but also lead to problems for people needing normal medical care, such as for complications with pregnancy or chronic diseases such as diabetes. Psychological distress and mental illnesses also generally rise. Sexual violence is sadly all too common in conflicts too.
We try to fill these gaps with highly experienced doctors, nurses and logisticians who provide specialised medical care and logistical support.
“MSF was running the emergency department, operating theatre, inpatient and maternity ward in what grew to become a 93-bed hospital in Sa’ada City. We were receiving a lot of patients with severe injuries, including traumatic amputations – people would come in missing feet, hands and with severe abdominal and head trauma. Many of the wounded had travelled from four to five hours away, given that it was the only hospital with emergency surgical capacity in the province, in fact in most of northern Yemen. There were lots of patients: we were seeing over 2,000 emergency cases a month and more than 100 surgeries a week. If you combine that with the security situation keeping people awake, it was quite challenging, especially for our medical staff many of whom were on call 24-hours a day due to staff shortages across the country.
“Despite the volatility of the conflict, life goes on, and as always pregnant women need somewhere safe to deliver their babies. The maternity ward, supported by MSF, delivered over 100 babies a week in the hospital. This was a source of pride for them but also reassuring for the wider population to know that while lives were being lost new life was being created.” - Michael Seawright, Project Coordinator, Sa’ada, Yemen, 2016.
During times of intense violence, our teams often have to work with a great deal of flexibility. In 2011, with ongoing violence engulfing medical facilities in Misrata, Libya, an MSF team had to find a way to safely and quickly evacuate a large number of severely wounded patients from the city.
The team chartered a fast passenger ferry, stripping it of its seats so that plastic sheeting and mattresses could be laid and IV lines set up. “The violence caused an influx of wounded people and it was fortunate we could be there and get them onboard,” said Helmy Mekaoui, an MSF doctor who coordinated the medical evacuation.Despite the rough seas, the boat safely arrived in Tunisia the following day with 20 ambulances waiting to take the 71 patients to hospital.
MSF logistician, Annas Alamudi, said: “As far as I’m concerned, it was a successful operation and I’m glad we could help. There were sick people who needed to get out, and we got them out. Job done.”
Highly Experienced Staff
Working in a warzone can be an extremely frightening, stressful and disturbing experience. Because of this, we only allow highly trained and experienced staff who have volunteered themselves to work in such situations.
Paul McMaster, a surgeon who has worked extensively with MSF, still finds high security missions challenging.
After returning from a mission in Syria where he treated the wounded in an operating theatre set up in a cave, he said: “I've worked in many difficult places with MSF – war zones like Sri Lanka, Ivory Coast and Somalia – but while in those countries it was dangerous on the ground, in Syria the danger always comes from the air.
“It’s a much more oppressive type of danger, having a helicopter hovering in the sky above you.”
Although we accept that it is impossible to exclude our staff from every form of risk, we do our utmost to manage risks through our strict security measures.
Before starting a new project, and for as long as it is running, we continually assess risks. Each field mission has specific and detailed safety regulations in place, outlining strategies to limit risks and specific security measures and responsibilities.
Among these regulations, MSF holds a strict ‘no-weapons’ policy in all of our clinics, vehicles and health centres. For the safety of our staff and patients, it is crucial that no armed people enter into our hospitals. Naturally we will treat fighters who need medical help, whatever side they are on – but they and their colleagues must leave their weapons outside. The presence of anyone who is armed heightens the chances of our facility becoming a target of violence.
We have found that when running an effective life-saving humanitarian intervention that is visibly impartial and neutral – and if everyone in the local area fully understands this – the MSF logo on a T-shirt often offers more protection than a bullet-proof vest.
When armed forces or other local powers see the MSF logo, they should recognise – thanks to regular engagement, communication and interaction from MSF project coordinators – that this is a neutral, independent, impartial medical humanitarian organisation. Such humanitarian organisations should always be spared from harm in conflict under International Humanitarian Law. Find out more about International Humanitarian Law and the protections it provides.