Reasons for intervention
At its core, the purpose of humanitarian action is to save lives, relieve acute suffering and help restore the potential of individuals who find themselves in life-threatening circumstances. In each country where MSF is working, one or more of four events has taken place, triggering a medical-humanitarian response and speaking out to assist those in need.
This classification does not imply that realities are simplistic or mechanic, or that MSF operates blindly and systematically. Inherent limits exist in the exercise to deliver aid and MSF does not intervene in all conflicts or respond to all natural or man-made catastrophes. Our actions always reflect an analysis of potential added value and we question the pertinence of our presence or absence in a given context on a daily basis.
Populations affected by armed conflict require comprehensive medical and humanitarian support. These are victims of violence, civilian populations harassed and affected directly or indirectly through attacks, rapes and killings. They are weakened, instrumen talised and may be forcibly displaced from their homes, looking for refuge within or outside their home countries.
Medical, surgical or psychological care is needed - daily help in an environment of massive destruction and disruption of health systems. Suffering arises also from the indirect effects of conflict and instability, including a collapse of general infrastructures and a ruined economy. De facto, people are excluded from essential medical care and services, and can be devastated by epidemics of AIDS, tuberculosis or malaria, but also lesser known diseases such as sleeping sickness.
MSF operations are based on medical teams working in health structures/hospitals and are devoted to offer medical services and to cover the range of medical crises inherent to a conflict, such as malnutrition or mental healthcare. When needed, MSF also constructs wells and dispenses clean drinking water and offers shelter materials.
Populations affected by endemic/epidemic disease arise in variable contexts of stability or conflict. Emergency capacity and innovative medical actions are imperative to ensure a viable response in complex environments.
These people live in precarious regions, remote and/or underdeveloped areas, suburbs of capitals or cities, camps or shantytowns, and do not receive strong support from local and international authorities. They are often minority groups, refugees or nomads. They are at increased risk in situations of economic and social dependency or fragile independence.
Women and children are the most worrying categories. Exposed to infectious and communicable diseases, immunocompromised in pregnancy, and traditionally with less space to express their pains and concerns, women's realities go unnoticed in many countries. The dependency of infants and children increases their vulnerability.
MSF works in existing medical structures and also establishes structures as needed. Raising awareness about the risks of an epidemic; training, and prevention initiatives are essential. Collaboration with local governments and concerned ministries is a condition for implementing activities and rapidly improving the situation. Engaging in advocacy to support medical action, as in the case of HIV/AIDS, appears crucial to identify responsibilities, understand political intentions and mount effective responses.
Social violence and health care exclusion
Populations affected by social violence and health care exclusion suffer from what they are as a group and the characte ristics that create their shared identity. They are minorities, ethnic groups, migrants, displaced people or refugees. Particularly at risk are children such as street kids or the night commuters. They are socially excluded as prisoners or the unemployed; medically excluded because of a drug addiction or mental illness; they may be sex workers or simply a contagious patient with AIDS or tuberculosis.
Living in environments where their conditions and rights are limited or nonexistent, they cannot expect adequate support from the local authorities and suffer the limits of international support.
MSF becomes directly involved to alleviate victims' daily suffering with medical, psychological and social activities. Healthcare exclusion requires projects that bring attention to healthcare access and the absence of medical services. MSF's identity includes the act of speaking out, and united with patient care is a commitment to bringing attention to the causes of suffering and the obstacles to providing effective assistance, raising the concerns and the realities of our patients to national and international bodies.
Populations affected by natural disasters require an immediate medical-humanitarian response. They find themselves in desperate conditions, having suddenly lost homes and material goods, family members and relatives. They are highly traumatised, in need of rapid and diverse medical and social support.
Access to the disaster area and the victims is usually complex and demands fast identification of multiple needs.
The poorest people are particularly affected, having precarious habitats and living conditions. MSF supplies a large range of answers: numerous required medical supports such as surgery, psychosocial and nutrition programmes - provided in existing hospital structures or through the erection of temporary buildings - as well as preventive actions addressing potential epidemic risks. Material relief items such as blankets, tents and cooking oil may also be distributed.
These operations are developed through intensive collaboration with national actors, taking into account the importance of local efforts and strategies, and the limitations of an international intervention in time, quantity and pertinence.