Around one-quarter of our projects are dedicated to providing assistance to people living in areas of war and armed conflict such as in Yemen, South Sudan, Central African Republic, Iraq, Nigeria and Syria, among many others.
The consequences of war
Despite international laws that should protect men, women and children during armed conflict, we often see the heavy price they pay. After over four years of war, Yemen illustrates the devastation wreaked by indiscriminate or targeted attacks that kill and injure people, and shatter civilian infrastructure.
The emergency rooms and operating theatres were overflowing with wounded people. They received approximately 70 patients on one day. We treated people with bullet, shrapnel and landmine wounds. It was an extremely shocking scene to arrive at.Arunn Jegan, project coordinator, Taiz, Yemen, February 2018.
In extreme cases communities may be deliberately deprived of assistance or collectively ‘punished’ if they are seen as linked to an ‘enemy’ group.
Trauma injuries surge during armed conflict, calling for increased surgery and emergency care. Likewise, 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 relief items soar, while fear, insecurity, and loss generate psychological distress.
We regularly see an increase in sexual violence during conflict. Sometimes, rape is used to subdue a community. For example, a group of at least 10 women were gang-raped in February 2018 near Bossangoa, western Central African Republic. With ongoing conflict in the area, it took them a month to get medical care.
Between May 2017 and September 2018, our teams treated 2,600 victims of sexual violence in the town of Kananga in Kasai Central province, Democratic Republic of Congo (DRC). Eighty per cent reported having been raped by armed men.
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.
Forced from home
Conflict often uproots people from their homes, leaving them displaced in their own country or as refugees in another. We provide medical care to those who are displaced by conflict, often in refugee and displaced people's camps.
Treacherous journeys and precarious conditions at the place of destination jeopardise health and well-being. Children miss their vaccinations, women continue to have babies, seasonal diseases such as malaria relentlessly kick-in.
Conflict and displacement can be catalysts for epidemics and disease outbreaks. 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 health care, including vaccinations.
In CAR, for example, routine vaccination coverage plummeted after the country plunged into violence and instability in 2013. The vaccination coverage rate for measles fell from 64 per cent to 25 per cent. In response, in 2016 we organised a mass vaccination campaign with the Ministry of Health, immunising 220,000 children under five years old.
We don't take sides
In conflict zones, MSF does not take sides. We provide medical care based on needs alone, and work hard to try and reach the people most in need of help. It’s crucial for us to talk with all parties in a conflict so as to obtain access and provide assistance to affected communities.
One of the ways we can maintain our independence is to ensure that all our funding for work in conflicts comes from private individuals in the general public. Globally we accept very few government grants, and in conflict 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 to the 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 the population are already covered.
In Syria, for example, we are only able to work in some areas controlled by armed opposition groups. Violence and insecurity, attacks on health facilities and medical workers, and the absence of government authorisation to work in Syria have been some of the main obstacles to extending direct medical activities to all areas.