War and conflict

More than one third of our projects are dedicated to providing assistance to people living in areas of war and armed conflict.

Armed conflict devastates lives. Targeted, harassed and trapped within hardship and poverty, people are often forced into flight. In other cases, people live under siege or in constant fear of indiscriminate or even targeted attacks. In addition, people are often left impoverished without sufficient access to basic needs like food and medical care.

The consequences of war can be vast and catastrophic; from death and violence; to long-term lifechanging injuries and post-traumatic stress disorder; destroyed infrastructure and healthcare systems; as well as people being uprooted and forced to leave everything behind.

In conflict settings, depending on the priorities, we may set up operating theatres, clinics, nutrition programmes, epidemic control, medical care for victims of sexual violence, and maternity wards, among other services.

Dr Ameen Naji I have worked as a general surgery consultant at Al-Salam Hospital in Khamer, in Amran Governorate, since 2012. There has been a noticeable increase in the number of patients visiting the hospital. This is due to people’s trust in the services provided by the hospital and because the government hospitals in Sana’a have become crowded with patients, both war injuries and other cases. There have also been increases in the costs of treatment in private hospitals, so people prefer to come to Khamer to receive treatment in Al-Salam Hospital, where we provide them with free treatment and services. Many women needing caesarean deliveries also come to us from Sana’a, as they cannot afford the costs of the operation there and because of the good medical care provided by the hospital. Most of the cases that reach the hospital are either gunshot wounds, burns, bowel obstructions or appendicitis surgeries. The number of patients with burns that come to the hospital is increasing because of how petroleum products are stored in homes and not kept out of reach of children. We perform six to 10 operations each day. د أمين ناجي: أعمل كاستشاري جراحة عامة في مستشفى السلام في خمر في محافظة عمران منذ عام 2012. يوجد تزايد ملحوظ في الحالات التي تصل إلينا وذلك بسبب ثقة المواطنين بالخدمات التي يقدمها المستشفى، بالإضافة إلى أن المستشفيات الحكومية في صنعاء أصبحت مكتظة بالحالات سواء كانت نتيجة حرب أو حالات أخرى. كما أن هنالك ارتفاع بتكاليف العلاج في المستشفيات الخاصة، لذا يفضل المواطن أن يأتي إلى خمر لتلقى العلاج في مستشفى السلام حيث تقدم لهم المنظمة علاج وخدمات مجانية. كما تأتي إلينا أيضاً حالات ولادة قيصرية كثيرة من صنعاء إذ أنهم لا يستطيعون تحمل تكاليف العملية في صنعاء بالاضافة إلى الرعاية الطبية الجيدة التي يقدمها المستشفى. أغلب الحالات التي تصل إلى المستشفى إما تكون إصابات عيارات نارية، أو حروق، أو انسداد في الامعاء، أو عمليات زائدة وغيرها. حالات الحروق التي تصل إلى المستشفى في تزايد والسبب في ذلك تخزين المشتقات النفطية في المنازل وعدم حفظها بعيداً عن متناول الأطفال. يتراوح عدد العمليات التي نقوم بها في اليوم من 6 إلى 10 عمليات جراحية مختلفة.

Trauma injuries surge during armed conflict, calling for increased emergency care. Today, our teams focus on treating both fresh war wounds and long-lasting injuries, through emergency trauma care as well as reconstructive surgery.

During war and conflict regular medical needs climb as healthcare services collapse. Pregnant women, or people with chronic diseases such as diabetes or HIV, are left particularly vulnerable. As commodities become scarce, the price of basic food and domestic items soar, while fear, insecurity, and loss generate psychological distress. We also regularly see an increase in sexual violence during conflict. Sometimes, rape is used to subdue a community.

Conflict often uproots people from their homes. Our teams provide medical care to those who are displaced by conflict and see the direct consequences of violence on the health of individuals and entire communities we serve. Treacherous journeys and precarious conditions at the place of destination jeopardise health and well-being. In such settings, people stuck in limbo without access to proper education, medical care, or even water and sanitation services, are dangerously exposed to various conditions and risks, including mental health issues, violence, and diseases.

Ebola outbreak in Uganda, Mubende Ebola Treatment Center

Conflict and displacement can be catalysts for epidemics and disease outbreaks, due to a lack of access to water, sanitation and medical care. Living in cramped and unsanitary conditions can be an ideal breeding ground for cholera or measles. Insecurity and collapsed health systems cut people off from receiving preventative healthcare, including vaccinations.

Whether treating children who have been uprooted and witnessed horrific conflicts, or people who have survived torture and sexual violence, our teams strive to address the pressing mental health needs for people affected by war and conflict. In many areas of the world there are very few if any providers of comprehensive mental health services – this often means we have to create our own programmes. In addition to the lack of services, come taboos, stigmas and suspicion surrounding mental health. We therefore have to work with communities to spread awareness regarding the importance of mental health.

Rwanda

Rwanda, 20 years later: “I am left with a great sadness”

Voices from the Field 28 Apr 2014

South Sudan

MSF condemns unspeakable violence in Bentiu

Press Release 28 Apr 2014

Rwanda

Twenty years after the Rwandan genocide: “We don’t talk about things that are hard to recount”

Voices from the Field 25 Apr 2014

Journal article

Optimal Evidence in Difficult Settings: Improving Health Interventions and Decision Making in Disasters

22 Apr 2014

Journal article

Mali

“MSF was in Ansongo throughout the crisis, the population appreciates our work”

Voices from the Field 17 Apr 2014

Central African Republic

Thousands of people flee fighting in Boguila town

Project Update 12 Apr 2014

We don’t take sides

In conflict zones, we do not take sides. It’s crucial for us to talk with all parties in a conflict to obtain access and provide assistance to affected communities. We will speak out about the suffering we observe, as well as any gross violations we may witness while providing assistance to people caught up in war and conflict.

One of the ways we can maintain our independence is to ensure that all our funding for work in conflicts comes from private donors. Globally we accept very few government grants – three per cent of our total funding – and in war zones we do not use funds from governments that have any sort of tie with the conflict.

Despite not supporting any of the warring parties, we are not always present on all sides of a conflict. This may be either because access is not granted to us by one or more of the parties, or due to insecurity, or because the main needs of people are already covered.

Our teams do not always have the capacity to fill every gap, however, we always put people in need first and provide them with the best medical care possible, no matter where they are from, what they believe in, or who they support.

The remnants of an MSF hospital after an aerial bombing. Between December 1981 and December 1982, four MSF hospitals were bombed by the Soviet air force. As a result, MSF teams were forced to adapt by changing location frequently, and to operate in hospitals at night. Hazarajat, Afghanistan, 1982.

A man injured by rocket ammunitions used in the American Embassy compound bombing runs towards the MSF clinic for help. Liberia, June, 2003.

An MSF doctor checks the pulse of a girl killed by shelling in Monrovia, Liberia. A fresh round of shelling terrorised Monrovia early in the morning, as government forces and rebel troops battled for control of the Liberian capital. Liberia, July 25, 2003

A young boy is treated by an MSF doctor for first aid at a general healthcare centre in Sadr City, north Baghdad, during the Iraq War. Iraq, 2003.

Journalists and MSF staff transporting medical suppllies — An MSF convoy transporting emergency medical supplies and fuel remained stuck north of the Litani river after an air strike destroyed the last bridge where crossing was possible. Four tonnes of supplies were carried by hand over a distance of 500 metres thanks to a huge human chain. A tree trunk spanning across the river was used as a makeshift bridge. To speed up the process, some journalists present at the scene helped out. Lebanon, 2006.

A man watches as an MSF plane distributing goods takes off. Eastern Chad had been affected by both internal conflict between government forces and rebel groups, and by a war between Chad and its neighbour, Sudan, through armed militias. The violence led to massive people displacement along the border. MSF operated through mobile clinics to provide healthcare to thousands of villagers and displaced people in and around Adé. Chad, 2007.

A wounded man waiting in the Masisi hospital. Since August 2007 MSF has been supporting Masisi hospital, about 80 km west of Goma, North Kivu province. The MSF team carries out war surgery for both soldiers and civilians, and supports all other services in the 170-bed hospital. DRC, 2007.

Gaza Strip ruins — The Philadelphia corridor on the border with Egypt was bombed repeatedly by the Israeli air force with the hope of destroying the countless smuggling tunnels running underneath. On the 18th day of the Israeli operation in Gaza, one and a half million people had been deprived of electricity and basic supplies, as well as being unable to flee from the densely populated combat zone. Gaza, 2009.

Patients recover after receiving surgery at Abobo Sud hospital. What is normally a 12-bed hospital had to expand to host more than 130 patients. A week after the end of the military standoff in Abidjan, very few hospitals were left open. People were stuck in their homes for up to a month without access to healthcare. At the peak of post-election violence, MSF was treating 25-30 conflict-related wounded people every day from mid-March to 11 April. Ivory Coast, 2011.

MSF HOSPITAL, IDLIB Region, SYRIA — A surgeon operates on a patient in an inflatable operating theatre that was erected inside this MSF makeshift hospital in Syria (a converted chicken farm) in order to maintain a sterile environment. Syria, 2013.

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What we see in times of war and conflict

1 June 2018

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