January 31, 2013

DRC 2012 © Sven Torfinn

An MSF staff member meets new arrivals to a displacement camp in eastern DRC in late 2012.

Recent examples from DRC and Liberia.

Planned or not, there always comes a time when MSF has to close a project. An emergency may have passed, a suitable partner might have been found to take over, or the conditions on the ground might have made it categorically unsafe. Whatever the circumstance, it is a complex procedure.

Nurse Carissa Guild and mental health officer Athena Viscusi were both part of teams that closed projects recently. In April 2012, Guild was with MSF in Nyanzale, in DRC’s North Kivu province. It was “kind of a forgotten district,” Guild says, a deeply impoverished place with minimal health systems. Their task was to support a local hospital so it could serve the local community and nearby health centers, then turn it over to the Ministry of Health. “It took a long time to get it going,” she recalls. Security was a constant issue for the team. Progress was visible, however: “Everything was open. Pediatrics was open. It was really working.”

But then a group of army soldiers that came to be known as M23 mutinied, rendering an already unstable area even more so. Following a series of armed robberies of MSF personnel and facilities, the expats were ordered to return to Goma. “We basically threw everything into our cars and took off not knowing when we’d be back,” Guild says. “I gave the key to the pharmacy to the people in Nyanzale, and then just made a lot of phone calls, trying to figure out how to get medications to the other three centers, trying to sort out how we were going to support them.”

She put together kits for each health center so they’d have supplies for the short term. The team hoped they’d return soon, but the worsening conditions suggested otherwise. During an earlier mission in Burkina Faso, Guild had seen how preparations for handing over a project can last months, even years. But in North Kivu, the abrupt departure meant making contingency arrangements on the fl y. Staff in the health posts they’d left was fretting about what would happen next. People were calling Guild asking, “Now what do we do?”

“It was terrible to leave,” she says. “There was so much need there,” and the staff “were super motivated and had been doing everything exactly as we asked.” They didn’t have the resources or training that the now-departed teams had, however, and the systems that had been set up—for cold chain, for instance—started slipping as supplies dwindled. It was hardest on area residents because they were losing access to care that had been made briefly available to them. MSF may return if circumstances allow, but this is part of working in highly insecure environments.

Athena Viscusi also left her project earlier than expected but under better circumstances. Dispatched to Liberia in 2011 to support a project for refugees fleeing violence in Ivory Coast, she and her colleagues counseled people struggling with what they’d seen and experienced. Their work, she feels, “had become a part of the healing process in the camps.”

But the flow of refugees slowed, many started going home as the fighting eased in Ivory Coast, and MSF decided to hand over its projects. Unlike Guild’s experience, where there was no one to pick up where MSF left off , this was, Viscusi recalls, “an exceptional closure because we were able to hand everything over to other NGOs operating in the camps.” Viscusi helped train staff from other organizations to provide mental health services, and MSF donated drugs and supplies to the local hospital and the Ministry of Health, the International Rescue Committee, and Merlin, three groups present in the area.

“I learned a lot about closing a project in Liberia,” Viscusi says. “It’s always difficult, but it’s important to maintain the capability to be the first responders in conflict zones and not have our resources tied up providing primary care. You get attached to the staff , you get attached to the patients, but it’s important that MSF is able to maintain the capacity to do what we do.”

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