A year in review
DR JOANNE LIU
Almost one-third of Médecins Sans Frontières (MSF) projects in 2016 were dedicated to providing assistance to populations caught in wars, such as in Yemen, South Sudan, Afghanistan, Iraq, Nigeria and Syria. MSF also provided assistance to people on the move, fleeing repression, poverty or violence, and in many cases subject to new forms of violence, exploitation or danger as countries closed options for safe and legal routes. Our teams responded to other emergencies caused by epidemics and natural disasters and provided care and improved treatment for patients with diseases such as tuberculosis (TB) and HIV.
PEOPLE IN CONFLICT
In many conflict zones, civilians and civilian infrastructure – including medical facilities – came under indiscriminate or targeted attacks. Millions of people had to flee their homes, sometimes multiple times. Our teams provided assistance to those caught in conflict and fleeing. They cared for pregnant women and newborns, treated the wounded and people with medical emergencies, managed chronic illnesses and responded to disease outbreaks, notably through vaccination campaigns. MSF also worked to meet other vital needs, such as for drinking water and essential relief items. From Lebanon to Tanzania, MSF teams mobilised to assist hundreds of thousands of people who had fled violence and conflict to other countries in search of safety.
In Nigeria, the armed conflict between Boko Haram and the Nigerian military displaced an estimated 1.8 million people in Borno state alone, with many communities cut off from the rest of the country for extended periods of time due to the conflict. In June, with only limited access due to widespread insecurity, MSF teams discovered shocking situations in villages such as Bama, where two out of 10 children under five were at risk of death due to malnutrition. Thousands of people regrouped in different villages were entirely reliant on aid. By the end of the year, the humanitarian situation had improved in areas that were still accessible. However, the widespread insecurity and military restrictions presented a significant challenge to MSF and other humanitarian actors: the number of people in need of lifesaving assistance in inaccessible areas is unknown.
The armed conflict in Nigeria took on a regional dimension in the Lake Chad Basin, expanding across borders to Cameroon, Chad and Niger, with direct consequences for civilian populations. The crisis aggravated an already dire situation in a region suffering from poverty, food insecurity, recurring outbreaks of disease and almost non-existent health systems. MSF teams stepped up medical and humanitarian assistance in Chad, Cameroon and Niger for people fleeing Nigeria, as well as for local and displaced populations affected by the crisis.
In South Sudan in July, intense fighting erupted between government and opposition forces in the capital, Juba. MSF opened clinics to provide emergency treatment for patients with gunshot wounds and injuries, as well as ongoing healthcare for conditions such as malnutrition, malaria and diarrhoea. Between August and December, we intensified our response to help South Sudanese refugees as the number of people fleeing violence increased, with hundreds of thousands arriving in Uganda, as well as in Ethiopia and Sudan.
In areas hit by violence, adapted solutions have had to be found. In South Sudan, to ensure continuity of care during instability for patients receiving HIV antiretroviral treatment, three-month emergency patient kits were prepared and distributed in the event of imminent displacement.
In Syria, MSF medical activities continued to be significantly constrained due to insecurity in opposition areas and a lack of authorisation by the Syrian government. MSF operated six medical structures in northern Syria in 2016. In inaccessible zones, such as besieged areas, our teams provided distance support to medical networks inside the country, through training, technical support and donations to medical facilities. This remains an extraordinary approach for MSF, made necessary by people’s extreme level of need and suffering and our lack of direct access. The level of violence, and need, and lack of assistance led to sustained public communications by MSF through the testimonies of Syrian medical staff we supported, particularly in East Aleppo city and in besieged areas around Damascus.
Following the closure of the border between Syria and Jordan in June, around 75,000 Syrians were left stranded in the Berm/Rukban area. MSF teams and other aid actors were no longer able to reach the population. The border closures also prevented people from seeking assistance and protection outside Syria, a situation that is emblematic of a growing, pervasive reality across war zones, particularly in Syria.
In Yemen, indiscriminate attacks against civilians and civilian infrastructure had a devastating impact on a country that was already one of the poorest in the region. To address the lack of healthcare and treat the increasing number of war victims, MSF scaled up its activities, making the response in Yemen our largest in the Middle East in 2016. MSF teams directly provided healthcare to patients in 12 hospitals and supported at least 18 other facilities. On 15 August, an airstrike on Abs hospital in northern Yemen killed 19 people, including an MSF staff member, and wounded 24. MSF withdrew its staff from six hospitals in the north of the country following the airstrike, but continued to support the facilities. MSF resumed activities in northern Yemen in November 2016.
In May, the United Nations Security Council unanimously adopted Resolution 2286, condemning attacks on medical facilities and pledging to protect staff and patients in conflict settings. Yet airstrikes and shelling against health facilities continued, often by military coalitions acting with the direct or indirect involvement of Security Council members France, Russia, UK and USA. In 2016, 34 different health structures managed or supported by MSF were attacked in this way in Syria and Yemen.