January 31, 2013

Iraq 2012 © Fayçal Touiz/MSF

Syrian refugee children gather together late last year at a camp in northern Iraq that is home to at least 15,000 people who fled the grinding war in their homeland.

Johanne Sekkenes is MSF Head of Mission in Mali, which has been gripped by conflict for the past year, and where the risk of attack or kidnapping remains high in certain areas.

We try to understand the context as best as possible, conducting extensive analysis, studying previous incidents and insecurity problems. This could be anything from a snake bite to an attack or kidnapping— absolutely everything. Then we try to assess the level or probability of each security problem, the relative risk in each area, the dangers posed to specific people. A threat might be "high risk" in one part of the country and "low risk" in another. Risks in capital cities will likely differ from risks in the more remote project locations, or risks on the route to those locations.

The Head of Mission is responsible for the overall evaluation, and he or she works with the logistics coordinator to constantly re-evaluate and monitor the evolution of the context. The project coordinator and the logistician implement and enforce guidelines and recommendations. Actually, the whole team is involved in some way, contributing to the analysis, making suggestions, or simply following our security rules and recommendations.

Events that can affect security include political changes like coup d’états, wars, violent attacks, banditry, population movements, and more. A population’s perception of our work will also have an impact.

In any situation, we have to keep an open dialogue with the various sides of a conflict and often to negotiate in one way or another. We explain our medical and humanitarian mission and make sure we act according to those principles. We explain who we are and also who we are not, making it clear that we are independent and neutral, not part of any government or international system. We negotiate to create space where we can implement independent programs, setting up a medical facility, for instance, or running mobile clinics. The more the parties understand what we’re doing and how, the better.

Safety can never be guaranteed, but it can be improved, so we also do a lot of outreach with local communities, dress and conduct ourselves in an appropriate manner for the location and the culture, make sure our HR policies refl ect our principles and don’t favor any one group over another, and, of course, make it clear to all, especially the warring parties, that no weapons are allowed inside our facilities.

In some cases, national staff may not run the same risks as international staff. In some, they run greater risks. In many settings, working for or being associated with an international organization can be a risk for national staff, as we saw in Iraq and elsewhere, and as we see in Pakistan now.

If the threats reach a certain level, we adjust our rules and our activities accordingly. From what I’ve seen, deteriorating security usually makes the teams more motivated to find solutions and ways to maintain activities. If needed, we can reduce the team, keeping only personnel who work on direct lifesaving procedures and refocusing activities on the most urgent needs. If a kidnapping does occur, or a project is robbed or a staff member attacked, our response will depend on the situation and the specifi c circumstances involved.

It is difficult to prepare someone to work in an insecure setting if he or she never experienced it before. We want people with experience, curiosity, and common sense, and we provide briefings and as much information as we can. MSF staff are volunteers and they must be clear about the risks before and during their mission.

There is an advantage to being an emergency medical organization rather than a development organization, I think. All populations have medical needs, and medical care can show results quickly. And in many contexts, armed groups respect MSF’s activities even in the midst of war, because they see the benefit for them and their communities of having free, high-quality, and impartial medical health care available. That’s why we try to make clear that we’re there to deliver care to whoever needs it, as our medical and humanitarian ethics dictate. That’s our best security measure!

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