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Medicine Under Attack

April 29, 2013
by Michael Greenwood

The international president of Médecins Sans Frontières outlines a spate of violence against his organization and a growing human toll.

Each year, Médecins Sans Frontières provides essential medical services to the world’s most underserved populations in some of the most remote, and often dangerous, locations.

They do it to relieve human suffering and to promote humanitarianism. The organization helps anyone in medical need regardless of political affiliation, religious beliefs or any other factor. It refuses to take sides in any conflict. It is neutral—always.

Despite their approach, Médecins Sans Frontières (also known as MSF or Doctors Without Borders) is being targeted in some countries that it serves. The organization has suffered a spate of violence against both its personnel and its facilities within the past 18 months, forcing it to curtail services, which, in turn, denies ordinary people of the medical care that they desperately need.

“It is safe to say that humanitarian medical action is in danger,” Unni Karunakara, a Yale School of Public Health alumnus and MSF’s international president, said during a Dean’s Lecture this month at his alma mater. “[This] means thousands of people who need medical attention do not get it, because they are too afraid to seek it, or because it is not safe for medical staff to deliver it.”

Karunakara, M.P.H ’95, outlined a long and grim list of murder, abductions, threats, vandalism, intimidation and looting that has been directed at MSF staff and patients within just the past few years. They include:

  • In Somalia, two MSF aid workers were abducted more than 560 days ago and remain in captivity. The organization continues to work for their release. Two other MSF staff were killed in Mogadishu in 2011. MSF’s medical assistance has been curtailed as a result.
  • Syria’s government has refused to allow MSF personnel into government-controlled areas of the country despite requests. MSF currently operates three field hospitals in areas of the country not under government control, meeting a “small fraction” of the need. Syria is in the midst of a civil war.
  • In Mali recently, MSF personnel were not allowed to cross front lines during fighting and injured people could not get to heath clinics. Civilians and others died as a result.
  • In Yemen, an MSF-supported hospital was forced to close last September after armed intruders entered the grounds and opened fire.

Created in 1971 by French doctors in response to the conflict in Biafra, MSF today has some 35,000 personnel working in 70 countries around the world. It provided medical care to some eight million patients last year, Karunakara said.

It was while studying public health at Yale that Karunakara became interested in working with underserved people. He was on his way back to Yale from a Downs Fellowship in South Africa in 1994 when he met an MSF worker at the airport in Brussels. He learned about a tuberculosis control program that was being started in Ethiopia and was eager to join it. He finished his studies at Yale, but was so excited to start work on the project that he missed Commencement. Friends created an effigy of him, complete with graduation regalia, for the ceremony.

“At Yale, I learnt that medicine had very little to do with health and that it had everything to do with society, politics, economics, the law, and the environment,” Karunakara told a large audience gathered in Winslow Auditorium. “Here, I became concerned about the health of the disadvantaged, the neglected, and the voiceless. It was here that I learned about the notions of equality and equity. Here that I came to believe that all human beings, no matter their race, creed, or beliefs had the right to health care. Here, I became a humanitarian.”

If the practice of medical humanitarianism is to prevail, Karunakara outlined what he believes must be done, including the preservation of the moral principles and medical ethics of health work. He noted a vaccination program allegedly carried out by the CIA in Pakistan to gather information on the whereabouts of Osama Bin Laden. Such activities, or even the perception of them, breed mistrust and have likely played a role in subsequent violence in Pakistan and elsewhere, he said.

It is also vital that the meaning of medical humanitarianism—humanity, impartiality, neutrality and independence—be stressed and that ongoing dialogues be maintained with all communities, authorities and leaders.

Karunakara said that it is also important to highlight the consequences of violence against organizations such as MSF and the toll that it takes on everyone.

“People … are being denied health care because of the lack of respect for humanitarian medical action,” he said. “We need to act.”

Submitted by Denise Meyer on April 29, 2013