Pakistan

MSF has been present in Pakistan since the early 1980s and today still provides emergency medical care to vulnerable populations, including Afghan refugees and displaced persons.

Sarah Dina, MSF mental health officer in Pakistan: “For many people, telling the story is half the healing. We can’t take the pain away completely. But we can be there for people. Be there in their sadness, their guilt and their fear.

Imagine making the decision to leave your home country, the place of your birth, your childhood, your people, your land... Imagine leaving your home locked but fully furnished, with boxes and suitcases of your things that you can’t carry with you. You can’t carry them with you because you are leaving on foot. You can’t travel across the mountains by car. The roads aren’t good, and even if they were, you might get stopped. Imagine that you are leaving because you are scared. Scared you will be killed. Scared your sister will be raped. Scared your brother will be shot.

Imagine that before you left, you saw the dead bodies of multiple family members. Imagine these bodies weren’t intact. They were in pieces. A leg, metres away from the body it belongs to; an arm in the other direction. Imagine the fear you would have if you were to stay behind. Imagine the guilt you feel about leaving. Imagine that on your month-long trek across the mountain to safety, you have little food and water. You have blisters on your feet from your shoes at the start; you have cuts on your feet from walking barefoot at the end. Imagine walking through the snow, up a steep incline, hiding in the shrubbery when you hear a blast.  Just imagine that as you walk, you see small children along the way who have been abandoned by their parents because it was impossible to carry them any longer through such rough terrain and in such harsh conditions. I tried to imagine how these parents felt. But I stopped myself. It’s too painful to think about their pain.”

Haiti

Four years after the earthquake, tens of thousands Haitians are still living in insecure makeshift camps around Port-au-Prince. Teenage girls are particularly exposed to sexual violence.

Mildrène, 14 years old: “My family lived in Solino before the earthquake. Not well but we had a roof and could sleep without fear. On January 12, 2010, our house was destroyed. We only had the time to run out and we later retrieved what we could from the rubble. My parents could not find the money to rent another house. After that night we lived in a displaced camp called Accra.

One day I went out to buy food for my dad. On my way a man asked where I was going and gave me money to buy him a meal too. When I came back with his plate, he took my hand and told me he would kill my parents if I did not do whatever he asks. I knew one of his friends had already killed a man in the camp and I was very scared. Then he raped me.

I went home covered with shame and fear. I said nothing to my parents, thinking I had to protect them. A few days later the same man called me to his home but I refused to let him do the same thing.  In the evening he and his friends came to my house and threatened my family. I had to tell my mom what had happened. No one blamed the man but we eventually left the camp and I have not seen him since.

A few months later I was not feeling well and my mom took me to the hospital. The doctor was embarrassed to tell her that I was 5 months pregnant. I suffered a lot throughout my pregnancy until I gave birth shortly before the due date.

My mother sells soap bars and my dad has no job. They are trying to take care of me and my baby but things are not great. I would like to go back to school but that’s impossible. I feel lucky only because I am alive”

South Sudan

South Sudan has faced an outbreak of violence since mid-December, displacing hundreds of thousands of people as the humanitarian situation deteriorates. Lack of access to routine care puts pregnant women and their babies at risk, but lack of emergency care can be life-threatening.

Rhoda, 24 years old: “I was always attending the health clinic in Bor town during my pregnancy. When we had to flee the area, I ran for my life, but being 8 months pregnant, it was not easy. This was the toughest time of my life. My husband was stuck in Juba and I was in the bush convinced I was going to lose our child.

One night, my mother and I got into one big boat with 100 others crossing to Awerial County. People travelled with very basic things, although some came with their animals. The journey was awful, lying in dirty water mixed with animal feces. When we arrived to Minkaman, my mother found a small area with a few trees, big enough for the two of us to settle. Soon I started having some persistent pains and my mum helped me deliver a baby boy. Two days later he started having high fever and convulsions. My mother went to look for help and by chance met a team from MSF who referred us to the clinic. The baby had an infection of the umbilical cord that spread to his whole body. He is fine now.”

Philippines

In November 2013, Typhoon Haiyan killed around 6,000 and left millions without a home in Philippines. MSF intervened to provide emergency relief to the victims and re-establish hospital facilities for the population, especially pregnant women and young children. 

Margaret Barclay, MSF midwife: “In the Philippines the disaster destroyed everything and people did not know whether healthcare was accessible or not. The first woman who delivered with us in Tacloban would have died if she had not received care. She was very sick, had been displaced by the typhoon and was living in a tent. But in fact she hadn’t had proper access to healthcare even during her pregnancy. Her labor was obstructed and she had also developed pre-eclampsia, a hypertensive disorder, which is a severe complication of pregnancy.

When we delivered the baby, he was 4.1 kilos, bigger than average, so we checked and discovered that the mother had actually developed diabetes, for which she’d had no management or treatment. That made for a very vulnerable baby, needing its own specialised care as well. What was difficult was that the mother and father wanted to take their baby home, up north, even though he was unwell, because they had two other children who no-one was looking after.”

Mauritania

Since 2012, the war in Mali has pushed thousands across the borders into neighbouring countries, including Mauritania. MSF supports basic healthcare centres in Mbera camp and at the Fassala border crossing and an operating theatre in the town of Bassikounou.

As the ambulance screams across the Sahara, Taghry Walet Tokeye lies anxiously on the back seat with her husband Masaya by her side. Taghry has gone into labour. Before leaving Mbera refugee camp for MSF’s operating theatre in Bassikounou, the team tells Taghry that she is expecting not one, but possibly four children.

On arriving in Bassikounou, an ultrasound confirms that Taghry is pregnant with quadruplets. The MSF medical team makes the quick decision to perform a caesarean section. Taghry gives birth to three healthy boys and one healthy girl, weighing between 1.8 kg and 2.45 kg. At the moment, the children are simply called Baby 1, 2, 3 and 4, as names are traditionally given when a child is baptised. 

Taghry and Masaya, along with their six other children, were among the 15,000 people who fled the conflict in Mali in January 2013 to seek safety in neighbouring Mauritania. They arrived with nothing other than the clothes on their backs and are now completely dependent on humanitarian aid. “My family left our village near Léré because we were afraid of the war,” explains Masaya.

In the three weeks since they have been born, the four babies are doing well. They are being closely watched in the neonatal room and the MSF team has provided Taghry and Masaya with all the supplies necessary – clothes, layette kits and milk – to keep their children healthy as they grow.

While the team is overjoyed at the quadruplets’ progress since their dramatic entry into the world, the father has some cause for concern. “At the announcement of his four unborn children, the helpless husband did not know what to say or do,” says Karl Nawezi, MSF’s head of mission in Mauritania. “With now 12 mouths to feed and little prospect of returning home, he wonders how he would ensure the survival of his family.”

Kenya

Since 1991, successive crises in Somalia have triggered several waves of human displacement. In Kenya, MSF provides medical care to 125,000 persons at Dagahaley camp, in Dadaab, and assisted more than 2,500 deliveries in 2013.

Rukia Mohamed Abdi, MSF Nurse in Dagahaley: “Daily life for refugee women here at the camp includes fetching water and looking for firewood. They often walk long distances even while pregnant, which increases the risk for complications. As a nurse I do routine checkups and explain to pregnant women how to notice any sign of problems. We see a lot of pregnancy complications, abnormal deliveries and vaginal bleeding. Many newborns are brought with neonatal infections related to poor hygiene. Since most refugees have no source of income, we support them with soap and basins.

To reduce mortality and morbidity rates related to pregnancy, MSF is actively involved in providing information on reproductive health and family planning. The latter is not always well accepted. Some women want to give birth each year while others are scared of the potential side effects of contraception. Another cultural challenge is the consent required for some interventions. Most of the time, I need to explain the case and negotiate with the community or the husband because they first have to agree. It thus might take some time before performing an emergency caesarean section, with potentially very serious consequences for the woman or her child.”