photo by Juan-Carlos Tomasi

Darfur: “Every Time You Are Able to Save a Patient it Gives You the Motivation to Save Another Life”

“We received about 34 injured people the first instance of violence, on February 8. The hospital did not have surgical supplies and the MSF medical cargo had not arrived yet. We had one emergency box for the MSF team’s personal use, just in case. We used all of the surgical supplies in that box, including material for dressings and drugs for surgeries. We also used all the drugs in the hospital. The hospital’s doctor and I performed the surgeries, we worked as a team. We also had to carry out a blood transfusion for one of the patients; we did not have a fridge, so it was done immediately. - Read more at http://www.doctorswithoutborders.org/news/article.cfm?id=6813&source=ads120000R01

Photo: Syria’s Idlib Governorate. 2012 © Google

MSF Treats 44 Wounded in Bomb and Rocket Attacks in Northwestern Syria

After aerial bombs and a rocket struck localities in the west of Syria’s Idlib governorate, 44 wounded patients received emergency treatment in a field hospital operated by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) on January 15.

Thirty-six wounded patients arrived early in the afternoon, after several barrels of explosives were dropped on a village, with one landing close to a bakery. One patient died of her wounds while being evacuated to Turkey.

“Most of the patients we received were men, women, and children wounded by debris or metal fragments from the explosions,” said Marie-Christine Férir, MSF emergency program manager and nurse, who was on site and helped treat the wounded. “There were also people with eye wounds and one with an open fracture, who went into surgery. A little girl who suffered a skull trauma died while being transferred to Turkey.”

Later on January 15, MSF’s field hospital received eight more patients injured by a rocket in another location, four of whom were dead on arrival.

The mountainous region of Jabal Al-Akrad, east of the city of Latakia, has been under almost daily bombings for months. While most residents have left the area, those who remain live in constant fear of the barrels of explosives that are dropped by Syrian Army helicopters.

“Apart from the people wounded in the conflict, we continue to see an increasing need for medical care,” Férir said. “We treat around 500 patients every week, including for respiratory diseases and chronic illnesses such as hypertension and diabetes. We are also assisting more women to give birth safely. The health system in Jabal Al-Akrad’s mountainous region collapsed around two years ago. Now the winter cold and snow are reaching the region and medical needs are growing.”

MSF is working in three hospitals in northern and northwestern Syria in areas controlled by armed opposition groups. On January 13, another MSF hospital treated 20 wounded patients, including five children, after a market was bombed in the town of Azaz, in Aleppo governorate.

Photo: An MSF surgeon operates on a patient in northern Syria. Syria 2012 © MSF

Syria: “A War Against Health Workers and Services”
This article originally appeared in French in Le Monde.

In June, Doctors Without Borders/Médecins Sans Frontières-France (MSF) opened a hospital in the Idlib region in northern Syria, an area under rebel control. Located behind the front lines, the hospital has 15 beds and a staff of approximately 50, including 10 international MSF workers. Designed to perform war surgery, the facility also offers medical and surgical emergency care as the front moves further away. MSF’s Belgian and Spanish sections managed two other hospitals in Syria.

Fabrice Weissman, MSF’s operations advisor, returned from a mission in Syria in early December. He was particularly struck by the breadth of the needs and the lack of international response.

What are the conditions facing MSF’s medical staff in the Idlib region? 

As soon as you cross the border, you are vulnerable to aerial bombing by the Syrian air force, even behind battle lines. Hospitals are at particular risk, as they have become one of the government’s preferred targets. As a result, public hospitals are deserted. Temporary field hospitals that do perform surgery tend to be hidden in individual houses and abandoned public facilities or are buried underground. When they are spotted, the doctors change location. 

This makes it difficult to organize medical treatment. Some Syrian medical professionals have gone into exile and dentists and pharmacists are providing emergency medical care. Their skills are improving but they are rarely trained in war surgery, which presents specific complications such as bone infections, and in triaging victims during mass influx of wounded. Even so, they are managing quite well given the conditions and increasing stock-outs of medical supplies such as anesthetics. Syrian doctors from the diasporas are coming to help out, too. 

What struck me most profoundly about this conflict is the way health facilities have became part of the war zone. The Syrian army is waging a war against health workers and services operating in opposition-controlled areas. Using health care denial as a weapon of oppression, the government has de facto transformed health care provision as a weapon of resistance.

Do international humanitarian aid organizations like MSF have a significant presence in Syria?

You don’t see the traditional aid actors—such as the United Nations agencies and the major humanitarian NGOs—in Syria. Acting officially in support of the Syrian government, the UN does not have Damascus’ authorization to provide cross-border assistance into rebel-held areas, which have significantly expanded over the past six months. However, precedents do exist, as in South Sudan in the 1980s, where the UN intervened in areas that were not under the legal government’s control, based on a Security Council resolution or following direct negotiations with the parties. 

With regard to nongovernmental organizations, very limited funds are allocated to those that want to work in rebel-held areas. There’s a paradox here because the European Union and the US support the opposition, but are providing minimal financial and diplomatic support to humanitarian organizations ready to operate in rebel territory. Most international aid is allocated to the government-held areas, through the ICRC, the World Food Program, the UNHCR, all working with the Syrian Arab Red Crescent Society. The needs in the rebel-held areas are not being met. 

However, there is an aid network organized by Syrians in the country and in the diasporas, with the help of neighboring countries and Gulf nations. But it’s not enough. Traditional international aid would be more than welcome to support the efforts of this local network. That would require diplomatic courage on the part of the UN agencies and the states that support them—whether the European Union, the US, Russia, China, and others. 

What needs did you observe on site? 

There are extensive treatment needs in the area of chronic illnesses, which are the primary cause of mortality (specifically diabetes, kidney failure, hypertension and heart problems, and cancer). The organization of medical care has virtually collapsed and there are shortages of specialized medicine, as 90 percent of drugs were produced previously in Syria. Fatal respiratory illnesses are also a source of concern, given winter conditions. Children and the elderly are of course the most vulnerable. The weakest members of the population are experiencing mortality rates and suffering that could be prevented. 

The number of wounded has increased significantly over the last six months as a result of the intensification of fighting (among the 60,000 deaths counted by the UN Human Rights Commission, more than 40,000 occurred since June alone). At the same time, the types of wounds are changing, with growing numbers of people injured by ammunition fragments during aerial and artillery bombing. Among the 500 wounded treated in MSF facilities so far, 70 percent presented extensive soft tissue and bone damage due to shrapnel. Some need major reconstructive surgery that requires hospitalization abroad, in Jordan, Lebanon, or Turkey, where 700 hospital beds are currently dedicated to Syrian patients. On the other hand, we have not seen any illnesses related to the use of combat gas.

Beyond medical assistance, there are other major needs. Daily life has become very difficult. There is a housing crisis resulting from the internal population displacement. The Office for the Coordination of Humanitarian Affairs (OCHA) estimates that some two million people are displaced. Most are living with relatives living further away from the frontlines or in tent camps, most located close to the Turkish border. The conditions in those camps are very precarious, particularly given the arrival of winter, with freezing temperatures at night. There is also an energy crisis. Diesel, which was subsidized before the war, is hard to find and of poor quality. Its price has increased twenty- or thirty-fold, triggering a dramatic increase in transport and food prices. There is an acute shortage of baby formula, milk, and flour. Bread is becoming scarce in several towns. The situation calls for large-scale food assistance by the World Food Program and other humanitarian agencies. 

Photo: People who have fled shelling are living in precarious conditions without access to medical care. Syria 2012 © MSF

Wounded and Sick Trapped in War-Torn Syrian City

Tens of thousands of people, many of them wounded, are trapped by intense fighting and bombing in Deir Azzour, a city in eastern Syria. MSF called for the evacuation of the injured and sick to safety and for international medical teams be allowed to work in the war-torn city.

An MSF team unofficially visited Deir Azzour governorate in late November to evaluate needs in the isolated, war-ravaged region. It was too dangerous for the team to enter the city of Deir Azzour, home to a reported 600,000 people prior to the conflict. Local residents reported that tens of thousands of people remain trapped in the city, which is shelled and bombed daily. Those remaining are predominantly poor and elderly, unable or unwilling to leave and now extremely vulnerable. Despite support from an organization of Syrian doctors, it is virtually impossible to obtain medical supplies in Deir Azzour.

“Deir Azzour now has just one makeshift hospital with only four doctors working there,” said Patrick Wieland, an MSF coordinator who recently returned from Syria. “The doctors are completely exhausted after six months of working in a combat zone. But they refuse to leave the city and are continuing to treat the wounded around the clock.”

Evacuating patients on stretchers is particularly risky because of aerial bombings and sniper fire.

MSF teams are working in three hospitals in northern and northwestern Syria, in areas controlled by armed opposition groups. MSF provides emergency medical care, including surgery. Since late June 2012, MSF teams have treated more than 2,500 patients and carried out more than 550 surgeries. In Jordan, Lebanon, and Iraq, MSF has been providing medical care to Syrian refugees and its teams are prepared to address additional needs arising from the conflict in Syria

Photo: MSF surgeons operate on a patient in a hospital in northern Syria. Syria 2012 © Rachael Craven

Treating the Wounded in Syria

Inside Syria, MSF teams are striving to meet the needs of people caught up in the conflict, but restrictions and insecurity prevent the teams from extending our work or gaining an overview of the humanitarian and medical needs in all the affected regions.

Fighting has also displaced people from their homes. The population in one Syrian town where MSF is working has increased to 30,000 people over the last few months. Many of the displaced families are sheltering in schools and public buildings. In one site, MSF teams are providing people with clean water and are evaluating additional relief activities.

In response to the increasing medical needs in Syria and an overall lack of medical supplies, MSF has donated tons of medical and relief items to field hospitals and clinics in Homs, Idlib, Hama, and Deraa governorates and to the Syrian Red Crescent in Damascus.

Syria: Safety of Wounded and Medical Workers Must be Prioritized

Wounded people and medical workers remain targeted and threatened in parts of Syria, preventing people from receiving life-saving emergency medical care MSF said today, following recent visits to parts of Syria by MSF medical teams.

After reaching the governorates of Homs and later Idlib, MSF teams found patients and doctors at risk of attack and arrest. MSF first reported in early February on the abuse of health facilities and the targeting of patients and medical workers. All parties to the conflict must fully respect the safety and integrity of wounded people, doctors, and healthcare facilities, MSF said.

“Being caught with patients is like being caught with a weapon,” said an orthopedic surgeon whom MSF met in a village in Idlib governorate. “The atmosphere in most medical facilities is extremely tense; health care workers send wounded patients home and provide only first aid so that facilities can be evacuated quickly in the event of a military operation.”

Photo:A burned out medical center in Idlib.
Syria 2012 © MSF

Performing Reconstructive Surgery in the Gaza Strip

My name is Mateja Stare. I’m 38 and I am from Slovenia. In Ljubljana, the capital, I work in the country’s largest hospital. I am an operating room nurse. I’ve just come back from the Gaza Strip, where I spent a month on mission with MSF.

To say that you want “to help people in need” can sound a little superficial, and even frivolous, but it’s also true. I really believe that after you’ve organized your life and everything is going well, the time comes when you need to share your expertise and your experience with other people—with people who haven’t had the same luck. So why not join up with a humanitarian organization?

I worked as the operating room supervising nurse in Gaza. I managed, directed, trained, evaluated, coordinated, organized, and planned everything in coordination with the surgical activities. We worked in an MSF field hospital, in tents set up in front of Nasser Hospital in Khan Yunis, a city 20 kilometers south of Gaza City, where MSF has its office and house.

Because of the events, we were only able to operate during for four days of that month-long mission, but we decided to do the maximum number of operations per day. There are posters hanging all across the Gaza Strip with information about this program inviting potential patients to consult our teams. The day before the surgeries began, the surgeons—both Palestinian and expatriate—carefully examined 200 patients. In the end, we operated on 25 people and dressed the wounds of two additional sedated patients.

Read the rest of Mateja Stare’s account from the his time in the Gaza Strip.

Photo: Palestinian Territories 2012 © Mateja Stare/MSF An MSF staff member tends to a young burn victim.

MSF Blogs: Yin A Mat Po? (Are You Happy?)

The woman came to us with no living children. She had been pregnant twice before, but both pregnancies resulted in stillbirths. In the first pregnancy, she had labored for days, and the baby died during labor, but delivered vaginally. In the second pregnancy, she had pushed and pushed, but the baby did not deliver. A C-section was done, but the baby died anyway.

I cannot imagine what that must feel like. In the United States, a stillbirth at term is a huge event. Privacy is paramount. A subtle sign is placed on the patient’s door so that the staff knows not to enter unnecessarily. A sympathetic nurse is chosen, one who will comfort the patient. Aggressive pain control is offered, because pain can only make grief worse. And the woman carries that loss with her for the rest of her life.

In South Sudan, it is unusual for a woman not to have lost at least one child. They die in childbirth, or they die later of malnutrition, malaria, infection, unexplained illness. I have seen women who have delivered seven children, only to have three of them die; or delivered four children but having only one living child. When a woman comes to us, the first question asked is “How many children have you had?” The second question is, “How many are alive?”

Read the rest of the blog from Veronica Ades here.

Photo: South Sudan 2012 © Lisa Jones MSF OB-GYN Veronica Ades examines a patient.

Emergency Response Scaled Up as Violence Continues in South Sudan

Tensions and hostilities continue unabated between South Sudan and its northern neighbor Sudan, and MSF is scaling up its emergency response by treating people injured in the latest violence, giving material and staff support to local clinics and hospitals, and providing relief to people displaced by the fighting.

MSF currently provides life-saving surgery in Aweil and Agok for patients wounded in the recent violence. The organization also reinforced its surgical response capacity in case of a general degradation of the situation.

MSF has also donated medicines and medical supplies to local hospitals in Abiemnom and Bentiu in Unity State, both of which have received high numbers of wounded from the recent clashes. Two of MSF’s medical staff have been temporarily seconded to support the Bentiu hospital.

Photo: South Sudan 2012 © Robin Meldrum/MSF Refugees from Blue Nile State in Jamam refugee camp