From briquettes to smartphone apps: How we're adapting to provide medical care

In August 2017, one of the largest modern exoduses began as 700,000 people fled horrific violence in Myanmar. Today nearly one million Rohingya refugees live in precarious makeshift settlements in southeast Bangladesh.

As the emergency unfolded, international organisations arrived, health centres were constructed, distribution points created. But how much do the organisations providing relief really know about the refugees?


Smartphones for surveying refugee camps to rethink activities. Photo: Daphne Tolis/MSF

“In July 2018, we carried out epidemiological surveys in two refugee camps in Cox’s Bazar, Bangladesh. The goal was to find out the birth and death rates, the levels of child malnutrition and what the main diseases are in the communities,” explains María Simón, emergency coordinator with Doctors Without Borders (MSF) in Bangladesh

“We also wanted to know whether people were using our health facilities and what was keeping them away if they weren’t.”

Using a smartphone app, MSF teams managed to centralise a swathe of data while visiting households across the camps.

The surveys’ findings led our teams to open a new mobile clinic in a large settlement where long distances and the ground conditions, particularly during the rainy monsoon season, were undermining access to healthcare.

“It is important that we try to overcome the obstacles we face in delivering healthcare”, says Silvia Moriana, MSF’s Innovation and Transformation lead in Barcelona. “It’s why we constantly strive to find new ideas and ways of doing our work as efficiently as possible.”

In the case of Bangladesh, user-friendly technology allowed a more consistent data collection. Technology has become increasingly important for MSF over the last few years. It is applied in e-health projects such as telemedicine to overcome geographical barriers and to boost the availability and quality of services.

Technology is also used to better map often very inaccessible areas through satellite and drone imagery.

However, the use of technology entails constraints in an organisation that has tripled the budget in a decade and currently operates in around 70 countries worldwide, with a workforce of 42,000 staff.

“The first phase of implementing technology projects is very resource-heavy and triggers resistance. It’s only afterwards that we can see the benefits”, explains Conor Prenderville, head of the Apps4Ops (Applications For Operations) team of MSF in Spain, which was created last year to increase the tech involvement in MSF’s mission of providing medical care.

“Using technology can adversely affect the proximity to our patients, so we need to be careful in balancing its use. We need to ask ourselves difficult ethical questions. The technologies we use and promote as an organisation need to be in line with our principles.”

The ultimate objective, adds Prenderville, is that by putting more technology at the service of our operations “there will be a bigger medical humanitarian footprint in the field”, the same way that we leverage our human and financial resources today, in contexts affected by crises, natural disasters and conflict.

But innovation isn’t just the development of new technology. Experimenting with existing tools, or adapting them, also provides answers to problems that arise when assisting people in need.

For example, our team in northeast Nigeria converted the popular local three-wheeled vehicles, known as keke-napeps, into ambulances in Gwoza, where bigger vehicles like cars were banned by the military due to the conflict.

In this volatile context, MSF also developed an alternative cooking tool: briquettes.

“By leaving the enclaves controlled by the army to search for firewood, people were exposing themselves to attacks, kidnapping or sexual abuse,” says Ana Santos, head of the Displacement Unit, a department headquartered in Nairobi focusing on providing assistance to displaced people.

Briquettes in Nigeria, Innovation
Bio-briquettes instead of firewood to allow populations to stay safe in conflict areas. Photo: Igor G. Barbero / MSF

Briquettes are blocks of fuel made by pressing bio-waste, like sugarcane peel or groundnut bark, with paper.

“Today about 600 households have replaced firewood for briquettes and many more people in the community are replicating the process on their own,” says Ana Santos. “This keeps people safer.”

“The briquette initiative is a nice human-centred example. The challenge is how to replicate something that works in one area somewhere else,” says Silvia Moriana. She adds that the risk of failure is always present in every initiative. “If you don’t fail, you are not innovating. You have to learn something in the process.”

For instance, ahead of this year’s monsoon season in Bangladesh, the Innovation department launched a call for designers to conceptualise a special stretcher that would work in muddy refugee camps with reduced mobility and a high volume of cholera cases.

“The designers provided ideas, some of them original, in a very short space of time, but none of them were fully satisfactory,” says Silvia. “In the end you need to adapt, and ask the question: Is there added value in the impact of the proposed solution versus the existing one? Does it improve the medical work, the experience of the patient or the knowledge of the situation?”

The answer is not always easy.