Doctors Without Borders

Doctors Without Borders/Medecins Sans Frontieres (MSF) is an international medical humanitarian organization that assists people whose survival is threatened by violence, neglect, or catastrophe. Its mission is to provide medical relief to the victims of war, disease, and natural or man-made disaster, without regard to race, religion, or political affiliation. The organization's work is based on the humanitarian principles of medical ethics and impartiality. MSF does not take sides in armed conflicts, provides assistance on the basis of need alone, and advocates for independent access to victims of conflict and other disasters.
Feb 18, 2015

Update from Central African Republic

Andre Quillien/MSF
Andre Quillien/MSF

February 05, 2015

 

Jean Philippe Garcia de la Rosa recently returned from a mission as logistics coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF) in Central African Republic (CAR). In 2014, he witnessed the evolution of a conflict that first hit the headlines in late 2013, as renewed fighting between opposing militias launched a new chapter in a war that has left most of the country’s population in poverty and displaced thousands from their homes. Here, he describes his experience.

 

After the hard clashes in early 2014, has the situation in the country improved?

CAR has the same problems it had a year ago and prospects have not improved at all. No solutions have been found to the underlying problems, such as the ancestral confrontation between shepherds and farmers, and now more and more people resort to violence to solve them.

 

People’s daily life is still fraught with difficulty. You just have to look at the rise in the price of basic commodities. Civilians continue to suffer and that is fueling the armed conflict. The anguish and despair felt by many young people lead them to join armed groups. Many young Muslims who fled Bangui after the persecution unleashed a year ago will end up holding a weapon.

 

The large international presence and United Nations (UN) decision to hold crisis level three (the highest possible) in CAR are clear signs that the situation has not significantly improved.

 

What are the main challenges from a logistics point of view in such a difficult context?

Many problems in CAR are somehow the same as in other MSF missions, only to a higher degree. And many of these challenges are interconnected. In the last year, supply problems have grown because of the closure of some borders and the difficulty of finding local suppliers.

 

One factor that has complicated things even more is the fuel shortage, which has gotten worse following the deployment of the new UN contingent (started in September). This has led to an increase in fuel demand while supply has remained the same because of the limited capacity of the local provider.

 

Despite all the hurdles, our mission managed to improve the supply system through a joint effort of all our teams. In particular, we have responded to our priority of strengthening our performance in hygiene and sanitation in the health structures where we work. Training of our staff was key to meeting the challenges in this regard.

 

How has the ongoing insecurity affected the transportation of MSF supplies and teams?

The ongoing armed conflict greatly affects movements all over the Central African territory. We have to negotiate continuously with the various armed groups to facilitate access through the checkpoints, which became more and more difficult to cross by the end of last year.

 

The instability has even forced us to stop some airlifts of supplies and teams because of the lack of security, and that obviously affects our activities. In addition, this year there are expected to be even more fuel shortages due to the security situation in the country.

 

Has there been progress in rebuilding the country?

The country is small but it poses many difficulties for reconstruction. The Seleka and anti-Balaka militias have tried unsuccessfully to become political groups, in part because they are very heterogeneous, with different factions right from the origin. In addition, each region and each city have their own problems and their own leaders, making it very difficult for political groups to grow at a national level.

 

Moreover, the international community is too concentrated in Bangui [CAR’s capital] and cannot see well what happens in the rest of the country. The intervention could have been more determined from the start, a year ago, but maybe that would have triggered a conflict more difficult to control. Now local people are asking who is responsible for the lack of solutions and the continued insecurity. And, last but not least, if you act against one of the warring parties then you have to do it against the other, and the international community has not known how to manage this need for balance.

 

How far has the "religious war" discourse spread in CAR?

What we see in CAR is also found in other countries in conflict. The population is the main victim of the conflict. They have to survive with almost nothing and people end up looking for someone to blame. The easiest scapegoat is simply “the others,” whether he is a foreigner or someone with a different religion. Two years ago, after the coup by the Seleka (militia made up mostly of Muslims that forced a coup in March 2013), the idea that the villains were the Muslims grew very fast among Christian communities. Then the government fell and many Muslims had to flee Bangui, but the problems for the rest did not disappear. People saw it was not a matter of Seleka or anti-Balaka (the opposing militia), or Christian or Muslim. Many realized that the conflict had nothing to do with religious issues.

 

What should the focus of the humanitarian community be in this scenario?

We must focus on getting aid to people in the best possible way. In this country, if you lift a stone you immediately see lots of unaddressed needs. The problems go beyond the conflict, but we must not lose focus of what our priority is.

 

From MSF’s point of view, I think our work is well-recognized by all the stakeholders. One of our greatest assets is our local colleagues, who are also part of the local community and allow us a better understanding of the reality. We have to remain focused on reaching people wherever they need us, beyond the cities, anywhere.

 

MSF has been working in CAR since 1997. Since December 2013, in response to the crisis, MSF has doubled its medical assistance in CAR and is running additional projects for Central African refugees in neighboring countries.

 

Jan 27, 2015

Tending to South Sudanese Refugees in Sudan

MSF
MSF

Starting in February 2014, Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing medical assistance to more than 30,000 South Sudanese refugees who fled their homes and sought sanctuary in Sudan’s White Nile state. Most came from Upper Nile state, which borders Sudan to the southeast, part of the large population of South Sudanese who’ve been displaced from their homes, fearing for their lives, since conflict erupted in their homeland in December 2013.

Working with Sudan’s Ministry of Health, MSF is providing medical care and nutritional support to refugees in White Nile State. To date, teams have conducted more than 36,174 consultations and vaccinated 2,333 children under 5 years old for polio and 8,566 children under 15 for measles (following a positive diagnosis). This preventive care approach has helped curb disease outbreaks in the area.

“Most of those arriving are women, children and the elderly,” says Dr. Amir Osman, MSF medical team leader in White Nile State. “They are coming on foot or by public transport. Since some of them are in poor health and nutritional condition, we are conducting medical consultations and nutritional screening on arrival. Severely malnourished children are immediately enrolled into the therapeutic feeding program, while supplementary food is provided for those moderately malnourished.”

Currently, there are 3,230 people enrolled in MSF’s therapeutic feeding program. They receive regular medical check-ups and supplementary food, particular attention is paid to malnourished pregnant and lactating women. Thus far, MSF has conducted 2,111 antenatal care consultations and assisted 152 safe deliveries.

Most of those in White Nile come from the towns of Waddakona, Kaka, Al-Renk, Malakal. All left due to insecurity. Some managed to salvage a few of their possessions while others left with nothing. “I walked for three days from Waddakona, Upper Nile State to North Kweik, in Sudan, where I had to sell my cows, sheep and goats to get money for other necessities,” says one woman. “I used to be a government employee and self-dependent, now I’m in another country and dependent on aid.”

Most people entered Sudan through the western area of the Nile and settled around Um Jalala, an area commonly known as “Kilo 10.” They’ve since been relocated to three transitional areas, namely Jorai, El Kashafa and El Rades. Others entered from the eastern side of the Nile settled in an area called Al-Alagaya.

These areas are near the Nile, which facilitates water transportation, which is crucial during the rainy season when roads become impassable and only boats can be used to transport patients with complicated medical cases to hospitals in Kosti. In the El Kashafa area, MSF has constructed a 20-bed clinic to be able to respond rapidly to critical cases while using mobile clinics to reach those in the two other transitional areas in the vicinity.

The medical needs of the population are apparent; on average, MSF conducts some 4,300 consultations per month and refers about 15 cases to Kosti. Moreover, living conditions are very congested, with six or seven people living in Tukuls (huts) meant for three or fewer. The congestion increases the spread of communicable diseases—respiratory tract disease, in particular—one of the main illnesses that MSF teams in White Nile are treating. To prevent the spread of communicable diseases and diseases associated with water, hygiene and sanitation, MSF has identified groups of community health workers to carry out health education activities.

Heavy rains have likely prevented some people from coming into Sudan, as most people cannot cross the river when it floods. However, whenever renewed violence erupts in parts of South Sudan bordering Sudan, numbers automatically go up. Despite the border that divides them, the commonalities and mutual relations between those arriving and the host communities have allowed the two populations to coexist peacefully.

Dec 2, 2014

"The Last Few Days Have Been Extremely Chaotic"

Jean-Pierre Amigo/MSF
Jean-Pierre Amigo/MSF
October 31, 2014

Dr. Erna Rijnierse is currently working with Doctors Without Borders/Médecins Sans Frontières (MSF) in Bentiu,South Sudan, which has been the scene of heavy fighting for several days now. Here she discusses the situation on the ground.

We’ve been able to provide emergency medical care to 12 people so far since heavy fighting started several days ago, stabilizing patients with gunshot wounds and related injuries. We’ve carried out nine surgical interventions. Several patients arrived in a critical condition, including a pregnant woman, who had a gunshot injury to the chest. We inserted a chest tube, and, for the moment, she and her unborn baby are stable. One nine-year-old boy was shot in the chest and he died upon arrival at our hospital.

The last few days have been extremely chaotic. It’s difficult to move around safely inside the camp or even in the hospital, stray bullets are flying around from all directions. We’ve seen empty shell cases in our hospital. At any time the shooting and shelling can start, which means we have to run to the bunkers.  We don’t really know what is happening outside or who controls what. The atmosphere is tense and very unpredictable.

It’s hard to provide meaningful medical care when you’re worrying about stray bullets and having to spend long periods of time in the bunker. As a doctor, I feel helpless, very frustrated, and even angry hearing the heavy pounding of shelling outside but being unable to reach those who are injured.

For the time being, we’ve been forced to suspend our mobile clinics outside the area under UN control. It’s simply too dangerous to go outside the camp due to heavy fighting. The primary health care clinics inside the camp have been closed for the last two days, but we hope they will be able to open again today.

The outreach team suspended activities for one day but the next morning they were there, ready to go and spread health messages in the camp. We have a positive case of hepatitis E in the camp so it’s vital that the outreach team continues to spread the message about hand washing and refers sick people to our hospital.

We’ve been able to continue staffing the hospital and aim to do so for as long as it is possible, security-wise. There are currently around 40 patients, 15 of whom are children.

MSF teams are providing health care to tens of thousands of people sheltering in the UN "protection of civilians" site near Bentiu, a town in South Sudan’s Unity state, one of the areas most affected by the ongoing conflict. MSF currently runs a hospital within the camp with maternity, pediatric, and tuberculosis wards. There’s also an emergency department and surgical care. Outside of the camp, MSF runs twice-weekly mobile clinics into Bentiu town itself.

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