International Activity Report 2013

In August 2013, Médecins Sans Frontières (MSF) pulled out of Somalia after working in the country continuously for 22 years. The last year has been one of exceptional circumstances, decisions and compromises, particularly with regards to Somalia and Syria. We have again seen profiteering from humanitarian organisations, in the form of robberies and the looting of medical structures, but the most striking thing we have witnessed is the failure of the global humanitarian aid system in countries such as Central African Republic (CAR) and South Sudan.

Since its founding, MSF has faced different forms of violence against its patients, staff, health facilities and medical vehicles, and has also witnessed targeting of health systems in general. The situation in Somalia, however, became untenable in 2013 as the balance could no longer be found between the risks involved, the compromises we had to make – such as hiring armed guards and implementing remote management to support national staff – and our ability to provide medical care to the Somali people.
Staff members had been threatened, attacked, kidnapped and even killed during our time in Somalia, but it was when it became apparent that the parties with whom we were negotiating were in some cases actively involved in, or complacent towards, violent actions directed against MSF that we had no choice but to draw the line. A lack of respect and deliberate violations of medical humanitarianism for political and financial profit were putting the lives of our patients and staff at risk.
We withdrew with heavy hearts. In Syria, the civil war continued into its third year and it is estimated at present that nine million people are internally displaced in the country or have fled abroad as a result of cent of Syrians have been forced from their homes. Those remaining in Syria have had to endure ongoing and incessant violence, and entire cities have been decimated.
The healthcare system has collapsed, resulting in outbreaks of preventable diseases such as measles and polio. Countless Syrians are desperate to access medical treatment, and are without services for everyday requirements like antenatal care, immunisations and the management of infections or chronic diseases. MSF operated aid programmes where working agreements could be negotiated, namely in opposition-held areas where instability was a constant challenge, and support was given to Syrian medical networks. Inpatient wards, outpatient consultations, surgery, and maternal and obstetric care were provided by MSF and vaccinations were undertaken.
However, in a country where we should have been running some of our largest medical programmes, the opportunities to reach people and to respond in a timely manner to the enormous needs remained xtremely limited; a forceful reminder of how access to medical care was by and large not respected and in many cases directly targeted by those involved in the conflict and used for political purposes. In Lebanon, Iraq, Turkey and Jordan, MSF continued to provide healthcare for Syrians inside and outside the refugee camps. The year was punctuated by numerous acute crises that left entire communities vulnerable, with little skilled medical help. In some cases, external assistance was their only lifeline and yet MSF often found itself alone tackling not just the medical but also the other humanitarian needs of the people affected.
Political events marked a descent into instability and brutal violence in both South Sudan and CAR, displacing thousands. In CAR, there was a presidential coup in March and subsequent political clashes spread throughout the country and inflamed religious divisions. By January 2014, it was estimated that over one million people had fled their homes, 245,000 of them crossing the border into neighbouring countries such as Chad and Cameroon. Hundreds of thousands of people were sheltering in the bush and others were living in displacement sites.