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.
Jul 1, 2014

Syrian Doctors-Turned-Refugees Working with MSF

MSF/Karem Issa
MSF/Karem Issa

Early in the morning, a crowd of Syrian refugees, mostly women and children, stand outside the Doctors Without Borders/Médecins Sans Frontières (MSF) clinic at the Kawargosk camp in northern Iraq, waiting to see a doctor who knows their situation all too well. Dr. Muhammed Selim is himself a refugee, someone who was forced from his home by the war in his country just as they were forced from theirs. He stayed behind as long as he could, trying to provide medical care for people injured by the fighting. But then it became, he says, "too dangerous," and he had to undertake the same journey as the patients he now treats.

He is a refugee who tends to his fellow refugees, and he is not the only one. At the health centers it runs in Kawargosk and Darashakran camps in northern Iraq, MSF relies on a host of skilled staff members who have crossed over from Syria as refugees. Nine Syrian doctors and 15 Syrian nurses, in fact, are employed at the two camps.

MSF and the patients it treats are benefiting from the work of such doctors in Iraq and in several other countries. Throughout its history, the organization has been bolstered by the efforts of professionals who were determined to keep working even after being displaced.

To commemorate World Refugee Day, MSF is highlighting the stories, sacrifices, and contributions of three Syrian refugees working with us in Iraq. These are doctors who didn’t escape the fighting immediately, but tried to fulfil their medical duties in Syria until it was no longer possible, and who continue to contribute productively to their fellow refugees today. They were forced to flee, to leave behind much of their previous life and belongings, but they did not leave behind their medical mission.


Dr. Muhammed Selim, 41, Kawargosk Camp

Selim, a general surgeon from Qamishli, had been working in Al-Safirah district, in Aleppo governorate, since 2006. He worked at a government hospital in the morning and at his private clinic in the evening.

“Before 2011, life was happy and work was good," he says. "I would work hard and after work I would enjoy visiting friends all around Aleppo.”

But when conflict started in rural Aleppo, Selim found himself and his clinic in the midst of battle: “My clinic was situated in the vicinity of three strategic positions which were being fought over by multiple groups. I was stuck for eight months, unable to leave my clinic for Aleppo or anywhere else, and there were snipers all around.

“When Al-Safirah was attacked with barrel bombs there were body parts and blood all over the streets. I would work into the night. Vegetable carts piled full of men, women, and children would arrive at my clinic, some with their hands gone, their legs gone, their eyes gone. We had very basic surgical capabilities, no general anesthetic, and we were just three doctors, myself and two pediatricians, but the neighbors were very helpful.”

With fighting continuing every day, there was a large exodus of people leaving Al-Safirah. Selim managed to escape with his life, under fire. “We escaped as the bombs were falling. That day, my clinic was hit and destroyed," he says.

“I retreated 12 kilometers [7.2 miles] away from the town and set up a small field hospital. Although we had a good supply of medicine and equipment, I was the only doctor. There were no nurses, only the youth among the neighbors helping. We worked hard, but there was fighting and kidnapping on the ground, and barrel bombs falling from the sky. We were caught between two fires.

“I promised myself to continue working and stay until the end. I was not fearing the planes, but I was the only Kurd in the area, and Kurds were being targeted.”

Selim decided to leave in January 2014, as the threat of kidnapping was becoming too great. And once again he left just in time: “The morning after I left, barrel bombs were dropped on the field hospital. The whole place was destroyed. The medicines in it would have been enough to equip a full hospital.”

He recalls a long and perilous journey through Ar-Raqqah and Al-Hasakah, passing numerous checkpoints at which he had to hide his Kurdish identity, until he reached the town of Qamishli. From there, he tried to cross the border to Iraq three times, but it was closed. He had to endure an 11-hour journey on foot through mountains and valleys from Qamishli to another part of the border, where he was finally able to leave Syria.

After settling in Darashakran refugee camp, Muhammed was struggling to continue practicing as a doctor. He worked as a painter for two weeks in the camp. Then one day, while walking in the camp feeling depressed, things changed for him. “I had lost hope. I was thinking about my next painting job when I came across some MSF expat staff in the camp by chance. They told me there was an opening in Kawargosk camp and that I could apply. I had heard about MSF before, and had dreamt of working with them in the past.”

After a written test and interview, Muhammed began work as a general doctor for MSF in Kawargosk camp. “Work is good,” he says. “I’m very happy to be working in my field, with all my energy. The people here are happy with our service, especially that I share their language and dialect. I know about their suffering and their way of thinking. Sometimes the only treatment they need is through words, not drugs.”

Muhammed still lives in Darashakran camp, commuting every day to Kawargosk camp, ten kilometers [6.2 miles] away. Despite escaping with his life on two occasions, and continuing to provide medical care to his fellow Syrian refugees, Muhammed still struggles with his conscience. “Even till this moment I have feelings of guilt that I left Syria. Working with MSF here is some consolation, but sometimes I tell myself that I should have served my people better and stayed even if I was killed. Maybe I could have fulfilled my duty better.

“My wish is for the crisis to be solved as soon as possible and for the people to return home.”


Dr. Hamza Issa, 56, Darashakran Camp

Dr. Hamza Issa is a general doctor from Qamishli in Northern Syria. He was working at a health center in rural Al-Hasakah in 2012 when it was attacked and ransacked by an armed group who told him he could no longer provide his medical services. “We tried to continue working despite the escalation of fighting between the different groups,” he says, “and we tried to tell the groups who attacked us that we had sworn a medical oath which obliged us to treat all patients, but it made no difference. The threats continued and we were arrested and interrogated several times.”

Determined to keep working, Issa moved to the town of Al-Qahtaniyah, where he resumed his work at a clinic, but the situation was not much better.

“There was a wave of doctors fleeing for their safety. I was one of just two doctors remaining in the town, and the pressure on us increased as we tried to help large numbers of wounded.”  Medical staff in the area were still under threat, and after someone informed Issa that his name was on a list of targets, he decided to leave, “having tried to stay to the final breath.”

He left Syria on New Year’s Eve 2013, to start 2014 in Iraq. He had heard of MSF and got in touch through the internet. He has worked with MSF since the opening of the project in Darashakran.

“As Syrian Kurdish doctors it is easier for us to communicate with the patients. The most important thing for us is to provide a high-quality level of care from one Syrian refugee to another.”


Dr. Media Rasheed, 28, Darashakran Camp

Having graduated from Damascus University in 2009, Dr. Media Rasheed was in her fourth year of specialization in hematology when she had to stop and leave the country.

Rasheed’s family had already fled Damascus, while she had stayed behind, determined to complete her training. But her family convinced her that there was credible danger to her life and safety if she stayed, and so she left for Erbil in June 2013.  After looking for work for six months, Rasheed started working for MSF as a general doctor, first in Kawargosk camp and then in Darashakran camp, where she sees around 50 patients per day.

“As a Syrian doctor working in a Syrian refugee camp, my relationship with the patients is not limited to being a doctor. Some patients just want to talk. I listen to their stories of suffering and feel their pain, especially those escaping the conflict in rural Damascus and Aleppo. One of the stories that affected me the most was of a Syrian lady who lost her husband after heavy shelling in Aleppo, and didn’t have the opportunity to say goodbye or bury him before fleeing.

“Before the conflict started in 2011, I had heard a lot about MSF. I remember when I was at school with my friends, we dreamed of working for MSF in Africa after graduating, and seeing the world. But never for one moment did I imagine I’d work for MSF treating Syrian refugees!

“I often feel guilty for leaving my country, as we doctors have pledged not [to] leave at times of war, but the security situation left us no choice. The day the war ends I will return to Syria.”


There are currently over 225,000 Syrian refugees in Iraq, the vast majority of whom are in the autonomous region of Kurdistan. In Erbil province, which hosts around 90,000 of these refugees, MSF opened projects in Kawargosk camp in September 2013, and Darashakran camp in March 2014, providing primary healthcare and mental health services. So far, over 50,000 consultations have been conducted.

MSF also works in Dohuk province, which hosts over 100,000 refugees, providing primary health care and mental health and reproductive health services in Domeez camp, where it has conducted over 200,000 consultations. Meanwhile, the needs in the area are growing further, with the influx of internally displaced people to Kurdistan from other parts of Iraq following the recent escalation of violence. MSF is conducting mobile clinics to provide medical care, and is exploring additional ways of supporting the displaced populations.

Jun 9, 2014

"We are already getting ready for the next peak"

Ramon Pereiro/MSF
Ramon Pereiro/MSF

Côme Niyomgabo, a 40-year-old Burundian, has finished his nine-month mission coordinating the Médecins Sans Frontières (MSF) project to reduce child mortality in Bouza, in the Tahoua region in Niger. Here he shares his experience with us.

What is the situation like in Bouza at present?
We have just lived through the most difficult time of the year: the hunger gap (food shortage period) and a high prevalence of malaria due to the rainy season. The time interval between June and October is in fact a critical period for young children. Since the beginning of November, the number of children being admitted has decreased: the most difficult period is about to end. However, it is a chronic crisis coming back year after year after year, which is the reason why we are already getting ready for the next peak. Based on our experience, we know that anticipation is an important factor; we need a well-trained team ready to intervene. Precisely in Bouza, a very rural area, the lack of qualified human resources poses a real challenge, as does access to health facilities. Villages are often remote and during the rainy season roads are usually impractical.

What are the main activities carried out in the project in the past few months?
Two of the main causes of child mortality in Niger are malaria and malnutrition. During the most critical months, we have tried to make high-quality treatment available to sick children at the earliest possible time. In Bouza, the health system depends on health posts called cases de santé, where there is a health agent whose medical training is very basic; then there are integrated health centres suffering from a chronic scarcity of qualified nursing staff, and then the district hospital located in Bouza town. In 2013, in many places, MSF carried out a programme known as PECADOM, consisting of getting as close as possible to the patient using simplified tools to diagnose and treat malaria as well as other childhood diseases. Furthermore, ‘malaria agents’ were trained to work in remote villages and cases de santé were reinforced. This should help to detect early malaria cases, treat simple cases and refer the complicated ones.

We have also started seasonal malaria chemoprevention, consisting of giving children between 3 months and 5 years medication once a month to prevent malaria. This is spread over the four months where malaria transmission is at its highest, from July to October. The children concerned are much more likely not to develop malaria or to develop a milder form of the disease. This strategy has been well received by the population. The number of children treated has increased from one round to another; the next ones will visibly spread across the most remote villages. Today, when we discuss it with the population in each area, people confirm that the number of cases as well as the number of admissions have decreased.

How does MSF involve the community in the project?
We carry out a lot of awareness-raising activities amongst the community. Our teams work with 140 volunteers in the villages who convey messages about malnutrition, malaria, what to do when a child is sick, etc. The role of these volunteers is very important to gain access to the population and to spread the messages.

We have also defined a strategy known as mamans lumière (mother light), addressed to children at risk of contracting severe acute malnutrition. The mothers of these children become part of a group of mothers trained by MSF, who explain to them how to prepare the food so as to make the most of it and thus cover their children’s nutritional needs. Mothers bring their own foods, cook them together and then feed their children. This strategy involves the community in malnutrition prevention and treatment, integrating respect for their community and culture. Different decision-makers, traditional or religious leaders also collaborate in community mobilisation activities.

Can you summarise your experience in Bouza through an image or a story?

When we really try and make the effort we can make a difference changing things for the better, and in a very fast way. Seeing children arrive seriously ill due to malnutrition or other pathologies and later witnessing their rapid recovery and watching them smile at their mothers… that is probably the most deeply ingrained image that I will most likely keep of my experience here.

Apr 16, 2014

Central African Republic: One Year of Violence

Central African Republic  Sarah Elliott
Central African Republic Sarah Elliott

Massacres, killings, torture, mass displacements, misery, urgent medical needs—these have been regular features of life in Central African Republic (CAR) in the year since a coup d’etat triggered recurring waves of violence in the country that continue to this day.

Doctors Without Borders/Médecins Sans Frontières (MSF), which has been on the ground in CAR for many years and has significantly scaled up its operations in the country in response to this ongoing emergency, has released a report called “Central African Republic: A Year of Continuing Violence Against Civilians,” in which MSF teams and patients speak about the atrocities they have witnessed.

Ever since armed members of the former Séléka rebel coalition seized Bangui, CAR’s capital city, on March 24, 2013, this already troubled, long-ignored, and underdeveloped country has been wracked by interwoven political and military crises that have had tragic consequences for the entire population.

”What is happening in the CAR is absolutely shocking,” said Marie-Noëlle Rodrigue, MSF director of operations, when she returned from CAR. “We are used to operating in very violent situations, but in this case even our most hardened members have rarely seen such levels of violence.”

The events of the past year are playing out against the background of the country’s dire health situation, which was already extremely fragile. CAR’s health indicators are amongst the lowest in the world, and even in peacetime, mortality rates in parts of the country were well above the emergency threshold.

“The humanitarian and medical situation was already horrendous before the coup d’état, but it has been getting even worse over the last 12 months,” says Rodrigue. “We know the crisis in CAR is set to continue for some time. However, on the ground, today, there are still not enough of us to address the clamor [for] needs. And yet, the urgency continues.”

In spite of deteriorating security conditions, critical needs have to be met. This is why MSF considers CAR one of its most pressing priority contexts and why MSF is increasing its activities in the country.

MSF now has some 2,200 people working in 16 projects throughout CAR. Since the escalation of the conflict last December, which triggered a mass exodus of the minority Muslim populations and affected numerous other communities as well, teams have treated 4,000 injured people in CAR and continued to run programs that offer a full complement of medical services.

With the number of displaced people in CAR nearing 1 million, including nearly 300,000 people who have fled to neighboring countries, MSF has also dispatched additional teams to Chad, Cameroon, and the Democratic Republic of Congo.  

The one-year anniversary of the coup cannot just be an occasion for looking back. The international community must work in the future to find ways to provide concrete and effective assistance to civilians whose urgent needs are not being met.

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