August 24, 2016

Doctors Without Borders/Médecins Sans Frontières (MSF) expresses its deepest sympathy to Kayla Mueller’s family and friends. Her death was a terrible and tragic loss. She was dedicated to helping people suffering in crisis, the kinds of people MSF staff dedicate themselves to helping every day in nearly 70 countries around the world.

"From everything that I have learned from speaking with Kayla’s parents, Carl and Marsha, and from her passionate writing and advocacy about people in crisis, whether in Darfur, the Occupied Palestinian Territories, Tibet, or India, she exhibited the same incredible compassion and connection to neglected people that I see in my colleagues every day," said Jason Cone, executive director of MSF-USA. "All of us at MSF share our condolences and sympathies for the horrific experience that the Mueller family has lived through. No one should have to endure such an experience."

MSF would also like to explain decisions it made following Kayla’s abduction in August 2013.

At approximately 4:00 p.m. on August 3, 2013, Kayla arrived at an MSF hospital in Aleppo, Syria, accompanying a satellite internet technician, a Syrian national, who had been hired to repair the hospital’s internet communications network.

They came together from southern Turkey. Kayla was not expected and no one at the hospital had any indication she was coming. If they had, they would have stated in no uncertain terms that she should not come, or canceled the visit altogether. This was because Aleppo was well known to be a very dangerous place, a city at war, where the risk level for westerners, and Americans in particular, was very high. MSF’s security policy therefore forbid people from certain countries, including the US, from working at or even visiting the hospital. It did not matter how many prior field assignments they had completed, or how much experience they had in conflict zones, or how good their intentions were. The prohibition was total and absolute at this project location.

The technician and Kayla arrived late in the day, however, which did not give the technician enough time to complete his work. There were few to no options for secure lodging in the Aleppo neighborhood where the project was located, so MSF staff had them stay inside the hospital compound. After completing his work the following day, the technician requested assistance to get to the city’s bus depot and the staff arranged for a hired car and driver. The car had only a small placard with an MSF logo on the right-hand side of the dashboard; it was not marked in any other way. The driver set off along a road that had been used regularly by the MSF team (including earlier that same day). En route, however, the vehicle was stopped by unknown armed men who seized Kayla, the technician, and one MSF staff member who was traveling with them. The driver was released an hour after the incident and returned to the MSF hospital, where he informed MSF project leaders of the incident.

MSF next informed the company that had sent the technician that he had been taken along with a woman who was travelling with him. The company spread the word about the abduction in southern Turkey. The information apparently reached a nongovernmental organization based in southern Turkey, which then called MSF asking about the young woman, saying that she had been working with them. This was when MSF learned about Kayla’s background and where she had been working. MSF then shared everything it knew about the incident with the organization.

The organization told MSF that they would contact American government authorities and share the information with them. MSF also reached out to the various authorities and armed groups known to be active in the greater Aleppo area in an effort to gather information about who might have taken them and why—information we would have passed along to the company that sent the technician and the organization with which Kayla had been working.

The technician and the MSF staff member taken were released approximately three weeks later, on separate days, with no one claiming responsibility for the abduction.

Approximately five months later, in another part of northern Syria, five international MSF staff members (three women and two men) were abducted from an MSF project in Idlib Governorate. We later learned that they were being held by the Islamic State group.

The three women were released several months later, on April 4, 2014. When they were safely out of the country, MSF first made sure they received all necessary care and support and then conducted thorough debriefings with them. During these debriefings, they shared the fact that they had been detained in the same location as Kayla Mueller and a number of other prisoners. Additionally, Kayla had given them a letter intended for her parents that the women had smuggled out with them, at personal risk. The captors had also given the women a letter that they wanted delivered to Kayla’s parents, but Kayla herself asked the women not to pass along this other letter. The captors also told the women to memorize an email address and told them they should use it to engage in efforts to obtain Kayla’s release once they were back home.

After MSF had debriefed its released staff members, the organization contacted the Mueller family to inform them that Kayla had been held with along with its staff members and that she had been in good health when they had last seen her. MSF then sent the letter Kayla had written to her parents. MSF made a decision to share the email address at a later time out of concern for the safety of still-detained prisoners.

MSF had two more staff members who were still being held. There was never a doubt that all information would be shared with the Mueller family, but the captors had all the leverage at the time and we felt that doing anything that surprised them could destabilize an extremely delicate and dangerous situation. We believed that if the captors—who were well known to harm or kill people almost at whim—received any indication that our staff members had smuggled out a separate letter, it would increase the risks for anyone still detained. This included a scenario in which people other than our released female staff members used the email address that had been dictated to them. We therefore felt it most prudent to wait before sharing the email address with the family.

The two male MSF staff members were released on May 14. After ensuring they first got out of the country safely and were provided the care they needed, they were debriefed, in part to determine if any additional threats had been made by the captors against the several hundred MSF staff members in Syria or in neighboring countries, or against anyone involved in the discussions surrounding their release. When the debriefing process concluded, MSF shared the email address with the Muellers on May 23, 2014. We regret the fact that Marsha Mueller had to reach out to MSF first before we did so; we should have reached out to the family first, and we have apologized to the Muellers for that.

Seven months later, on February 6, 2015, the terrible news of Kayla’s death was released. After seeing reports saying that Kayla was an MSF employee, we released a statement that said she was not affiliated with the organization. Given the gravity of events, the lives involved, and the family’s grief, it was a terse and insensitive statement. For that, too, MSF has apologized to the Muellers in person, at their home in Arizona.

Apologies have their limitations, however, particularly in the face of such anguish and considerations of what might have been. As an organization that works in conflict zones and has had several colleagues and friends killed while trying to provide emergency assistance, we know this all too well.

The Muellers had asked MSF to actively intervene to help achieve Kayla’s release and we did not do so. There are several reasons for this:

The risks go beyond any one location. If MSF were generally considered by would-be abductors to be a negotiator of release for non-MSF staff, there is no doubt that this would increase the risk levels in many locations, put our field staff, medical projects, and patients in danger, and possibly force us to close projects where needs are often acute. It would limit MSF’s ability to provide lifesaving care to people caught in dangerous conflicts.

Furthermore, MSF is an emergency medical organization. We are not hostage negotiators. If staff members get abducted, we deputize senior MSF staff members to concentrate fully on working towards their release. This comes with significant concerns for the people involved; some of the people who worked to secure the release of the MSF staff members in Syria put themselves at great risk in so doing.

There is risk inherent in humanitarian work in conflict, but we rely on people who are willing to take those risks to help us reach people in need around the world. It’s awful to know that people like Kayla Mueller, who carried a very similar spirit into the world, died during efforts to reach some of those same people.

MSF is confronted daily with difficult and complex choices in the places where its 30,000-plus staff members work to provide lifesaving medical care. The principles of medical ethics, which call on practitioners to provide the best possible care to patients in all circumstances, can clash with the need to protect staff from harm in conflict zones—or, say, in the treatment of highly infectious diseases. This can lead to moral dilemmas that seem impossible to reconcile. Often, our patients are men, women, and children in crisis who have nowhere else to turn, and we must try to maintain the precarious balance between doing all we can to reach them and attempting to mitigate the risks our field staff face. 

Some decisions have to be made in incredibly difficult circumstances, situations in which there are no good options. Sometimes this results in awful outcomes. We have felt those outcomes at times ourselves with the violent death of staff in the field, and we mourn now and will continue to mourn the devastating and horrible outcome for Kayla Mueller and her family.

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