Under medical ethics, the denial of lifesaving aid is non-negotiable. Patients brought into our hospital emergency rooms should be treated, regardless of who they are, or what side of the frontline they’re on or happen to live. This view is unfortunately not shared by all, and we are working to counter the ‘criminalisation’ of medical care on the battlefield. On the one hand, under many domestic counter-terrorism laws, any aid provided to areas where so-called “terrorists” operate is grounds for prosecution and those areas are typically very hard to access.

But on the other hand, where we are able to reach difficult areas (and some areas that aren’t difficult to reach), armed groups attack, abduct and kill humanitarian and medical workers. While the threat to medical humanitarian organisations is double and different in nature, the root of why we try to access these areas is the same – to provide much-needed medical care to people. To that end, we engage all parties to the conflict to enable us to provide medical care in war and conflict zones safely. We re-affirm to all sides that our only objective is to provide care to people and to not interfere with any political or military agenda.

We also employ mechanisms such as ensuring we’re clearly identified, and that groups know who and where we are. In places like Yemen and Afghanistan, our logo is very clearly marked on our ambulances and on the roof of our hospitals, and we proactively share the coordinates of our medical structures. These negotiations and mechanisms require constant maintenance and vigilance through dialogue with parties to the conflict.

Following attacks on our health care facilities, MSF conducts our own internal review and assessment of the event, often making our own findings public. But sometimes – regardless of whether the circumstances were clear or not – we decide it’s simply too dangerous for our patients, our staff, or both, to continue working in a context where there has been an attack. On a number of occasions, this has led to the extremely difficult and heart-breaking decision to withdraw – the consequences of which often means people are left without adequate access to healthcare.