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Care in conflict zones: MSF's medical aid on the frontline


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Care in conflict zones: MSF's medical aid on the frontline

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They go where most of us would never dare, leading the battle against the Ebola crisis, working where conflict rages: in Syria, Iraq, Nigeria, Central African Republic, Ukraine to name but a few. Médecins Sans Frontières are on the frontline of emergency care. To discuss some of the world’s emergency hotspots, Isabelle Kumar spoke to MSF’s International President Joanne Liu.

MSF International President Joanne Liu

  • Doctor Joanne Liu joined MSF in 1996, and became MSF International President in 2013
  • She is a trained doctor who has further qualifications in paediatric emergency care
  • She has extensive hands-on field work experience with MSF
  • It was her childhood dream to join a group such as MSF
  • She is from Quebec in Canada

IK
MSF recently slammed the International Community for its response to the the ebola crisis, warning of a double failure. On the one hand for a too slow response initially, and then, possibly, an inadequate and patchy response following that. So, right now are you satisfied with the international community’s response to the crisis?

JL
I think being satisfied would be a very generous word. What I would like to say is that people have heard our message, some organisation has happened. Right now what we would like is some flexibility and adaptability in the response because a lot of the response that is deployed today is responding to yesterday’s needs, it’s tailored to that. And now we are saying things have changed you need to adapt. We are not building any more of those big centres of 100 or 200 beds of Ebola isolation. But we need smaller centres in the country side. That is the challenge.

IK
You have been on the ground, what does it feel like to have Ebola?

JL
I think I will never get over those images in my life. During my last visit I visited a ward where there were seven patients and we saw that three of them were in really, a really advanced stage of the disease, they were unconscious bleeding from the mouth, bleeding from the stools. We were very concerned about the medical situation. What I thought was the most distressing and really hard thing to witness was just to see them being all by themselves, with no loved-ones and us in space suits running around and caring from them. I always tell myself that the human being is not meant to die alone.

IK
How many people will have to die before this begins to turn around, because more than 6,000 people have died and thousands more are infected. Where do you think this will run to?

JL
It is very difficult to make a projection. Everyone who has tried to to make projections… we had the worst case scenario where people were saying that by 2015 we might 1.4 million cases. I don’t think we will reach that, but the reality is.. I think the key message for me today is that although in some areas the number of cases has slowed down, we should not cry victory, we have maybe won a few little battles but we have not won the war against Ebola.

Ik
You’re now trying out new treatments in some of your clinics. Can you tell us about that? How’s it going? When can we expect to have results?

JL
Hopefully, this month we will start two of our trials of anti-viral medicines for patients who are infected, at two of our centres in West Africa. This will run for a few weeks and hopefully in the first trimester of 2015 we will have the first results.

IK
And in terms of a vaccine – that’s also being tested in the US, I believe – is that our best chance for containment of this or do you think it can be contained, technically, physically on the ground?

JL
When I look into the future, what will stop,at the high-scale chain of transmission of ebola is a vaccine. And we do hope for that tool to be available as soon as possible.

IK
And when is as soon as possible?

JL
We hope that in 2015 we will have a vaccine available for the most in need in West Africa.

IK
We’ve asked our online community to get involved in this interview and we’ve received a lot of questions on social media. We’ve received this question from Jen Schradie who asks: are you getting the support you need – and I think you’ve answered that part already – but which country is providing the best and most helpful support to combat Ebola.

JL
The United States in Liberia has been heavily involved and is the one that has provided some centres. I think if we compare it to the first pledge by President Obama, we’re a bit far from what he has pledged in September, but they are deployed and they are invested. We are asking everyone who has been funded by US funds to make sure that they will be flexible, because today we don’t need those 17 centres of 100 beds but we probably need a few centres of 25 beds in the countryside, so we just need to tailor it to meet the needs.

Ik
So what’s going to be the long-term impact of this virus. Because we are seeing that schools are closed, economies have basically shut down. What’s going to be the impact?

JL
It’s going to take years to get over this. Loss in terms of life, loss in terms of infrastructure. I think that we are…. we actually can’t fully measure the impact of it. It’s really important that we do not focus ourselves – because we’re starting to see some positive results in the field – to put all our energy in creating a response for tomorrow’s future when we still have outcrying needs today.

IK
This is one of the major emergencies you’re involved in, but MSF is involved in some 67 countries around the world. I know you have teams in Syria
. It’s been very difficult for you to stay in Syria, the government there, President Bashar al Assad, has not allowed your teams to operate, you’ve managed to negotiate in some of the rebel-held areas. What are seeing there? What are your teams witnessing?

JL
Right now we have very few accounts because our presence is quite limited. And that’s really distressing and disturbing because we know today that Syria is one the biggest humanitarian crisis and for us it is
an operational priority, but right now we are not able to to respond to the magnitude of the crisis. That’s the sad reality.

IK
Why are they not allowing you’re teams in?

JL
Well, the thing is, we’re not able to get the security warranty to provide a safe environment for teams to deploy.

IK
Your group must be faced with great moral dilemmas because I know that in the past MSF has had to pay tax to Al-Qaeda-linked militants to be able to operate in certain areas. How do you evaluate a situation like that?

JL
Well, the reality is that wherever we work we are paying tax. If we are working with a government and we want to import goods, like anti-retroviral medicine in a country in Africa you will not import it free of tax. Everywhere we pay something. At one point it is a governing government that is there, the authority, or it can be another type of authority. That’s the reality in the field.

IK
It must be very difficult to weigh the good and the bad because you know that this money they are reaping from organisations like yours probably won’t be used for the best purposes.

JL
We are always weighing what is the action we want to do with what would be the impact, and when we think we can have a real impact and save lives we negotiate a presence with the party in place.

IK
‘Ray likes a boss’ is another member of our social media and he asks: how do you manage to arrive in conflict zones?

JL
We have to build an understanding of the geopolitical situation and after that when we go on site – because I’ve done in the past what we call ‘exploratory missions’ – when you go it’s to talk to everybody and try to explain who you are and try to get warranty for your work that you would like to deploy, making sure the work you’re going to do is going to have an impact and will respond to specific needs in the field, so that’s how it goes most of the time.

IK
You’re also operating in Europe, on our doorstep, in Ukraine, for example. What’s been the impact on your work since the government stopped medical service in eastern Ukraine.

  • JL*
    Since the action of the government and the start of the conflict in May we’ve been providing aid in different facilities on both sides of the conflict, mainly in terms of mental health because one of the things we’ve been confronted with is the fact that the population has been highly traumatised by what they’ve been going through with the different attacks.

IK
If you had a message for President Poroshenko what would it be?

JL
I think that right now he needs to allow access for aid to come in and as well facilitate all the administrate red tape that is necessary to… (Isabelle interrupts)

IK
…. because your work is being hampered?

JL
A little bit, yes.

IIK
The responsibilities of your job must be enormous, and here I’d like to bring in this question from Lulu Nurrahmah who asks: what is the most difficult problem you’ve ever met and how did you solve it?

LJ
What is the most difficult is when in some areas we don’t have acceptance from the population. Sometimes what we’ve seen in West Africa is that people do not understand what we’re going to come and do, they are scared. At one point with Ebola, they thought we were bringing Ebola to them and people we’re rejecting us, physically rejecting us. And so this is difficult because we realise that sometimes we need time to be accepted. But when you have, for example Ebola, a disease that has a 50% case fatality rate and you want to act quickly you don’t have the luxury to wait that long. But we know that community acceptance is key to making our work a success.

IK
Dr Joanne Liu, many thanks for being with us on the Global Conversation.

JL
Thank you.

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