2022: A year of bearing witness

Alert is a quarterly magazine published by Doctors Without Borders/Médecins Sans Frontières (MSF-USA) that features ground reporting from our work around the world. This article appears in the Winter 2022 issue (Vol. 23, no. 4), A year in photos.

Since we were founded in 1971, Doctors Without Borders/Médecins Sans Frontières (MSF) has always been guided by the belief that everyone should have access to high-quality health care. We provide medical aid to the people who need it most, regardless of gender, race, religion, or political affiliation. Core to this work is the act of bearing witness—or témoignage. We stand in solidarity with communities and speak out against abuse and injustice.

Bearing witness is not without its challenges and risks. MSF often has to walk the line between speaking out and maintaining access to places where patients urgently need care. But as our movement has grown to nearly 63,000 staff providing over 10 million medical consultations in more than 70 countries every year, we remain committed to our activist roots. We continue to advocate for our patients, challenge the actions of governments and armed groups that put people’s health at risk, and share stories with the world about the daily struggles and triumphs we witness.

This year was no exception. Here, we asked MSF staff across our various projects to reflect on what bearing witness means to them.

Haiti: Cascading crises

Medical consequences of the violence in Port-au-Prince — Firmin Herline, 18 years old, suffered a bullet wound to her legs when armed men opened fire on the bus she was riding. She receives follow-up physiotherapy at an MSF clinic in Port-au-Prince.

In Haiti, a new cholera outbreak is growing amid an unprecedented political, economic, and security crisis. Port-au-Prince, the capital, is now a city surrounded and suffocated, with its main routes to the rest of the country controlled by armed groups. Conditions are comparable to a war zone. Fuel supplies were blocked for weeks and remain too expensive for most people to afford. Health facilities and ambulance services have been forced to cut back services or shut down entirely. People also struggle to access clean water, crucial in the fight against cholera.

MSF is calling for the urgent scale-up of the humanitarian response in Haiti. In Port-au-Prince, our teams manage more than 60 percent of the city’s bed capacity to treat cholera patients. Water and sanitation specialists and health promoters are working to educate people on how to prevent spread of the disease. We have also organized chlorination at approximately 100 water points and installed eight oral rehydration points where basic commodities and clean water are distributed. MSF stands ready to begin implementing a cholera vaccination campaign in support of the health authorities and to complement other water and sanitation and health promotion activities.

Cholera MSF Community response — A child walks through the neighborhood of Cité l'Eternel, where inadequate treatment of sewage and lack of access to clean water poses cholera risks.

Mumuza Muhindo, MSF Head of mission in Haiti MSF

“The [capital] is full of garbage that hasn't been collected for months, and there is no water distribution in neighborhoods like Brooklyn in Cité Soleil, where roads are cut off by garbage and flooded by clogged canals and sewers, causing massive flooding.

Along the only road into Brooklyn, we have encountered corpses that are decomposing or being burned. They could be people killed during the clashes or people trying to leave who were shot—it is a real battlefield. It is not possible to estimate how many people have been killed.

We are calling on all belligerents to allow aid to enter Brooklyn and to spare civilians. We also call on the humanitarian community to respond to the urgent needs of the population in Brooklyn and other neighborhoods affected by the fighting, including for water, food, and medical care."

Alexandre Michel, MSF Field communications officer

“In the majority of neighborhoods in Port-au-Prince, you cannot let your kid play outside because of stray bullets. We have dozens of people who come to our health facilities who have been wounded by a stray bullet while they were in bed inside their homes. You can get shot at any moment. On a daily basis, people can get hurt or get killed. Until now, they keep going.”

Afghanistan: Maintaining a lifeline

MSF team in Bermal — A temporary clinic set up by MSF in Bermal, Paktika province, to treat victims of the two earthquakes that hit Afghanistan in June.

Following the withdrawal of United States military forces and the government takeover by the Islamic Emirate of Afghanistan (also known as the Taliban) in 2021, international support for medical and humanitarian needs in the country declined sharply. After 20 years of war, Afghans now face economic collapse, food insecurity, and high rates of malnutrition.

Against this backdrop, MSF teams continue to provide essential health care across the country. We opened a newly constructed trauma center in Kunduz. Our maternity hospital in Khost expanded its admission criteria to accept all pregnant women. This year, our teams began treating severely malnourished children in Kabul. In June, we swiftly mobilized an emergency response team to help people affected by an earthquake that shook Khost and Paktika provinces. MSF now works in six provinces across Afghanistan—including Helmand, Herat, and Kandahar—providing a range of health services, including pediatric, trauma, maternal, mental health, and drug-resistant tuberculosis care.

Dr. Waliullah Hatam Khan, Deputy medical coordinator

“Advocating for better access to quality health care is a key part of our work. It requires close proximity to patients, proper understanding of their situation, and thorough context analysis. If done right, speaking out on behalf of the communities we serve can bring more attention and resources to neglected humanitarian crises, ensuring that overlooked problems will be addressed. To me, bearing witness also means informing MSF supporters about the pressures and limitations we face in our daily work.”

Noor Ahmad Saleem, Field communications officer

“For me, bearing witness is what we see happening in front of us—the challenges people are facing. It can save lives in communities where people need urgent health services. With testimonies from patients, caretakers, and the community, MSF can communicate about problems, challenges, and services [for] people in need.

Currently, a significant number of people have lost their jobs because of the ongoing economic crisis. They want to have access to quality health services in remote districts of the country where people are poor and there is no clinic or health center to provide quality services to patients.

It is also important for MSF to raise awareness about the challenges of the health system, the health policies in a country, and the lack of access to medical care or medicines. For example, in early 2019, we raised awareness about Herat’s Shaidayee camp, where hundreds of displaced families were facing lots of challenges. Speaking out helps win the attention of the world and other international organizations, which can lead to more funding for quality health services and more projects that serve the community.

In a country like Afghanistan, where people have suffered from decades of war and violence, there are certainly lots of challenges. Security is still a big concern for international organizations. Another concern is instability in the community, as nobody knows what will happen tomorrow. My country’s cultural sensitivities can be a big challenge when bearing witness too. Sometimes, it is difficult to speak out about some issues we see and challenges people are facing in the country."

MSF doctor Solveig Köbe tends to Nyayesh, eight months old. Nyayesh was severely malnourished and had pneumonia when she was admitted to the instensive care unit of the MSF-supported pediatric department of Herat Regional Hospital. Afghanistan 2022 © MSF

Somalia: Responding to malnutrition and other emergencies

Dadaab - Refugees from Somalia — Borow Ali Khamis was a farmer and livestock keeper in Somalia who lost everything due to the long drought and now lives in this makeshift shelter with his family at the Dagahaley refugee camp.

Somalia is in the grips of an unrelenting drought—the worst in 40 years. The country is now bracing for a fifth consecutive failed rainy season. Many people lost their livelihoods when their crops withered and farm animals died, leaving few options for people to earn money and feed their families. Many describe a state of desperation—not knowing where they will get what they need to survive and relying entirely on humanitarian assistance.

MSF teams are caring for approximately 500 malnourished children each week in Baidoa city, in Somalia’s South West state. Many of the children we see have cases made worse by other deadly infectious diseases such as measles. In hundreds of informal makeshift shelters and sites all over the city, poor water, and sanitation services are also contributing to the spread of waterborne diseases such as cholera. These outbreaks are spurring a vicious cycle, increasing the risk of malnutrition.

Fatumazahra Khalif, MSF Health promotion manager

“Since I was a child, I always wanted to help others, and my mother inspired me. Those days, few girls were going to school, and many ended up not making it into professional jobs. My mother wanted me to work hard and go to higher education so that I [could] become a meaningful person in the community.

When I completed college in health promotion, I wanted to work in hospitals or join health organizations. Luckily, I got a job with MSF last year in September. My role in MSF involves working with the community, patients, and families towards better health.

In Somalia, access to health care is limited, so some people end up seeking help from traditional health practitioners. Traditional products can
further endanger the health of the child or mother. Misinformation is also common—people spread wrong information about the effectiveness of vaccinations and getting care in hospitals.

[Recently] I had the opportunity to lead as the health promotion manager. During the last measles outbreak in one of our projects in Somalia, there was a lot of misinformation and rumors going around in the community that the disease was not measles but just a fever and it was treatable with traditional herbs. I mobilized my team of community health promoters to engage with community leaders, women, and youth groups to correct health misinformation. I prepared posters with Somali messages to sensitize the community. Some mothers had agreed to bring their children to the hospital for a diagnosis and their children were treated and discharged. Other mothers started to follow.

We continue to listen to the community and share health information, and let them know [about] the importance of seeking treatment from health care facilities.”

Djoen Besselink, MSF Country representative, Somalia

“Sometimes, witnessing is as simple as sharing a patient’s story by really showing the impact of an outbreak or violence on a family that lives in Somalia. Here, the challenges with speaking out [are the] layers of complexity and violence that you see. International violence, but also communal violence. If you want to speak out about what you see, you might really create friction which could put your staff at risk and thereby endanger your project.

In choosing to bear witness, we really ask what is best for our patients—what's best for the people that come to our facilities, what's in their best interest? In this case, it's often very powerful to show what hunger means for someone living in Somalia, or what it means to have measles.

The important thing for Somalia: Let's keep discussing it. Let's bring it up at the dinner table. Let's make sure that what's going on in Somalia and Haiti and Pakistan, in the Horn of Africa, the malnutrition that we see, doesn’t slip away unnoticed. The discussion needs to be there. People are in extreme need for our support.”

Bay Regional Hospital, Baidoa, Somalia — Measles patients receive treatment at Bay Regional Hospital in Baidoa, Somalia.

Nigeria: Surviving conflict and disease

Nurses — A team of MSF nurses weigh recovering malnourished children at an infant therapeutic feeding center in Sokoto. In collaboration with the Nigerian health authorities, MSF has treated close to 100,000 children for acute malnutrition in 34 outpatient facilities. 2022 © KC Nwakalor

In recent years, violence and insecurity have led to an increase in humanitarian needs in northern Nigeria. Thousands of people have been killed in fighting in the northeast and many more by malnutrition, measles, and malaria. MSF’s support for displaced people and host communities includes maternal and pediatric care, mental health support, treatment of malnutrition, support for survivors of sexual violence, provision of water and sanitation, non-food items, and shelter.

This year, MSF teams in the northwest have also witnessed extraordinarily high numbers of children with malnutrition. In collaboration with the Nigerian health authorities, we have treated close to 100,000 children suffering from acute malnutrition in 34 outpatient facilities. We have also admitted about 17,000 children requiring hospital care in 10 inpatient centers in Kano, Zamfara, Katsina, Sokoto, and Kebbi states. We’ve called on the humanitarian community to respond to the emergency needs of people in the region, and for northwest Nigeria to be included in the United Nations humanitarian response plan, enabling a broader and more sustained response.

Since 2014, MSF has also supported the Sokoto noma hospital with a program of activities for people affected by the disfiguring infectious disease noma, including survivors and their families.

Ajamah Samuel, Nursing team supervisor, Sokoto noma project

“Bearing witness is a humanitarian duty: It is something I have to do. For me, bearing witness is telling it as it is. It helps to bring [attention to the needs] of a community—or on their behalf. At times the community doesn’t have a voice. MSF helps in voicing out whatever the communities cannot say themselves. For example, if there is abuse of any kind, and [MSF] comes to know about it, they need to speak out so that people [become] aware of it.

Noma is a neglected disease. Children who are suffering from this disease need help. When you see the way this disease is destroying their future, destroying their dignity, destroying their humanity—we need to speak out. The government needs to be part of it because MSF cannot fight noma alone. I would like the community, the traditional rulers, the faith leaders, the government, other NGOs, and world leaders to be aware that there is a disease that is destroying the lives of children, reducing their humanity, taking their happiness from them, taking quality lives from them. I want them to be part of this fight to eliminate noma.”

The Occupied Palestinian Territories: Enduring Ongoing Trauma

Spreading awareness about mental health in West Bank, Palestine — Yvette Aiello, an MSF psychologist, and Layali, an MSF translator, spread awareness about mental health in the West Bank. 2018 © MSF/Yuna Cho

Humanitarian needs across the Occupied Palestinian Territories continue to mount, especially when it comes to mental health and access to urgent medical care. In the West Bank, systematic repression and discrimination by Israeli authorities against Palestinians continue, with home demolitions, forced relocations, and violence on the rise.

Gaza: reconstructing lives after amputations

Mohamad Soliman Mohamad Saad, 39 years old, was injured at the the Great March of Return in 2018. He went there after hearing that his fifteen-year-old son had been wounded. Moments after finding him, he was shot in the leg. 2022 © Giles Duley

MSF is the only medical organization present in the H2 area. Staffed by an all-female team, MSF’s clinic provides outpatient consultations, sexual and reproductive health services, and mental health care—focusing on women and children. In Gaza, the political demonstrations from 2018-2019, along with the 2021 bombing of the Gaza Strip, resulted in 152 amputations. MSF continues to provide surgical and post-surgical care including mental health care to victims of burns and trauma.

Shorouq Madmouj, MSF social worker, Nablus, West bank, Palestine

“Bearing witness as a social worker is so important—someone who assesses how people are influenced by their environment and the society they live in. It is necessary to raise awareness about people’s struggles in Palestine because people here put so much trust in us to do that: We have to tell the truth about what it’s like to live here. We feel their trust and we live with the responsibility of their trust.”

Colombia and Panama: A deadly crossing

Migrants at the San Vicente Migration Center wait for a bus that will take them to Costa Rica.

While much media attention is focused on the US-Mexico border, less is known about the treacherous journey some migrants and refugees endure to get there. In recent years, there has been a surge in migrants crossing from Colombia through the Darién Gap. The dangerous journey through the jungle can take up to 10 days, during which people on the move face horrific violence and other risks.

In May 2021, MSF launched activities in southern Panama. The major health issues our teams see include skin infections and lacerations, as well as dehydration and diarrhea. Children often suffer from fever, diarrhea, and malnutrition. Many women report that they’ve been sexually assaulted on the route. In 2022, MSF has treated more than 100 patients for sexual violence. Our teams see an average of seven patients per day for mental health issues related to violence and other hardships of the journey.

Our teams are also helping to improve local health infrastructure. After hearing from patients about the extreme violence experienced along the route, MSF has called on Panamanian and Colombian authorities to create safe routes to protect people in transit.

Ana María Cerón, MSF Advocacy manager for Colombia and Panama

“The story of a person who walks to the north of the continent, crossing several countries, or of someone who grew up in a region where armed actors decide the [fate] of a community, gives clues about how these big things called ’migration’ and ’war’ are lived. We see the marks of these experiences on people's bodies. We witness the consequences they have on their lives, and we see the strength with which they face them.

Our responsibility to them is to bring their stories closer to the actors who can make decisions to improve their living conditions and to civil society, which is often unaware of what is happening to them or sometimes loses sight of its importance. Transmitting the testimonies that these people have shared with us is the way in which we tell the world what they are experiencing. That is our obligation.”

South Sudan: An emergency worsened by climate change

Flooding in Old Fangak — A MSF boat passes the dike that protects a town from flood waters in Old Fangak, South Sudan.

Years of conflict in South Sudan have forced millions of people from their homes. Hundreds of thousands are unable to access necessities such as food, water, and health care. MSF runs some of its biggest programs worldwide here, providing basic and specialized health care and responding to emergencies and outbreaks affecting isolated communities and internally displaced people.

In recent months, fighting between armed groups in the north of the country has led to the death and serious injury of hundreds of people and displaced tens of thousands from their homes. Catastrophic flooding and barriers to access for humanitarian organizations to deliver lifesaving aid has made the situation even more dire. MSF is calling on armed groups to immediately cease targeting civilians and to guarantee humanitarian access for the delivery of aid to civilians in urgent need of help.

Emmanuel Ladok, Doctor at the MSF hospital in Malakal

“It's important that MSF shares the stories of the communities that we are working in. Currently, ordinary citizens of South Sudan are not getting essential services due to political issues and the conflict—health services are not maintained in the way that they should be. It is good that MSF is trying to reflect on this suffering with people around the world, so they learn how dire the situation is. It is important for vulnerable citizens to have a voice talking about their issues on a platform that they cannot reach [themselves].”

Patient transferred by plane for medical treatment

Nyamal Duop Gatluak is returning on an MSF flight to Old Fangak after receiving treatment for a fracture at the MSF hospital in Bentiu.

South Sudan 2022 © Florence Miettaux/MSF

A man on a self-made boat floats on the flood waters in Bentiu, Unity State.

South Sudan 2022 © Peter Caton/MSF

Pakistan: Responding to the effects of catastrophic flooding

Dera Murad Jamali - Mobile clinic — An MSF mobile clinic provides consultations in Dera Murad Jamali.

In summer 2022, monsoon rains caused devastating flooding across Pakistan, leaving one-third of the country under water. Millions of people lost their homes and were forced to sleep in makeshift shelters without access to clean drinking water or health care. Many health structures were left damaged and nonfunctional. All of this came on top of already dire health needs: MSF has been providing medical humanitarian aid in Pakistan since 1986, including health care for women, children, and newborns. Our teams responded quickly to the floods, distributing emergency supplies and safe water and providing medical care for health issues related to the disaster—all while working to keep existing projects running.

MSF outreach counselor Akeela checks a child for malnutrition.

Pakistan 2022 © MSF

Akeela, MSF Outreach counselor, Balochistan province

“It was the month of August and oddly we were receiving more continuous rains than normal years. On August 17, the water started coming towards our village and we were asked to leave immediately.

In the rush, my parents and younger siblings left the village and thankfully we had our uncle’s home in Dera Murad Jamali, so they shifted there. One brother and one sister were left behind to take care of our cattle, as my family had a herd of cows and goats. They took the cattle to higher ground but when they saw the flood water start to cover the village, they had to flee. My siblings took shelter and climbed up the rooftop of a nearby house. They watched as the water started to rise, and our cattle, houses, and farm all washed away. The water came up to eight or nine feet high. It was so heartbreaking to see our house and village underwater.

I initially took leave for a week to support my family. But when I saw that so many people needed help, and I received a call from MSF requesting support for the emergency response, I couldn’t stop myself from saying yes. Within two days, I was on duty conducting assessments in flood-affected villages. We reached faraway villages and found families living without shelter.

We set up a mobile clinic in my flood-affected village—Mir Gul Hassan Manju Shori Barun Naseerabad [among others]. As we were moving towards my village, I felt a sense of satisfaction. The people of my village know my work with MSF well, as I also visited them many times during our outreach activities. I was part of MSF’s emergency team providing support to the communities and my community was one of them. All the houses in my village, including my house, are still in water and they will take up to a month to completely dry out.

Many people in other more remote villages are still waiting for help to arrive. I can feel their pain as many have left their houses and are living in camps without help. Some of them are also cut off from the cities and access is difficult.

They are a reminder of why we continue our daily mobile clinics and provide clean drinking water to the displaced families.”

Treating cutaneous leishmaniasis in Peshawar, Pakistan — In Peshawar, an MSF health worker treats a young patient for cutaneous leishmaniasis, a skin disease transmitted by the bite of the sand fly.

Search and Rescue: Seeking safety by sea

Rotation 19 - Rescue 5 — In October, the MSF team conducted another rescue and saved 103 people from a wooden boat in distress, including 22 children and a man with a broken leg. After this rescue, there were 371 people aboard Geo Barents. 2022 © MSF/Candida Lobes

One of the most dangerous migration routes in the world is by sea. Many of the people who survive this treacherous passageway already carry significant trauma as the result of violence and abuse (including sexual abuse and forced labor) faced in their home countries or along the way. They are urgently in need of safety. MSF has run search and rescue (SAR) activities in the central Mediterranean since 2015, working on eight different vessels independently or in partnership with other nongovernmental organizations.

Since launching SAR operations with the Geo Barents in May 2021, MSF has rescued 5,497 people and recovered the bodies of 11 people who died at sea. This summer, Italian authorities initially only allowed some people to disembark, leaving hundreds of others on board as hostages to a fierce political debate. The selective disembarking was unlawful and prevented survivors on board from receiving much needed assistance and protection. The psychological and physical state of some of the people on the boat deteriorated significantly. Following calls for urgent action by MSF and other international organizations, Italian authorities finally permitted all remaining passengers to disembark.

Jana Ciernioch, SAR Advocacy Manager, currently on board the Geo Barents

"To me, bearing witness is both a moral and a practical commitment. Onboard the Geo Barents, we witness the dreadful but powerful stories of [people], who often had no other choice than to take to the seas for safety. Bearing witness goes beyond retelling people’s often tragic stories. It is a means to restore dignity by amplifying people’s voices and to show the human cost of reckless policies that create or exacerbate human suffering in the first place.

In the Central Mediterranean, as in many other humanitarian crises that MSF works in, injustice and human suffering are human made. We witness how European Union migration policies exacerbate deaths and human suffering on a daily basis. Our role as frontline workers—besides the lifesaving care we provide—is to call attention to the scale of human suffering caused by these reckless policies and to push for positive change.

Earlier this year, I worked in Ukraine, witnessing both the unimaginable suffering of civilians affected by hostilities but also the incredible response by EU states to refugees from the war. This has shown that better and more humane policies for those fleeing are possible."

Rotation 16 - Disembarkation — In September, after 18 requests were sent to authorities of Italy and Malta, seven days of standoff, and one additional day of navigation to reach the assigned place of safety, the 267 children, women, and men rescued finally disembarked in Taranto. 2022 © Michela Rizzotti/MSF

Central African Republic: The consequences of conflict

EMERGENCY INTERVENTION IN IPPY — Annie, a mother of 10, fled the village of Djadé for the Yétomane internally displaced people site where she and three of her children await news about the safety of her others.

Largely ignored by the international media, armed violence continues to rage in many parts of Central African Republic (CAR), forcing entire communities from their homes. People in CAR continue to face one of the world’s most critical situations in terms of maternal mortality, malnutrition, and lack of access to health care. Life expectancy is the lowest in the world. According to the latest UN figures, almost 30 percent of people in CAR are now either refugees or internally displaced, and more than 60 percent need humanitarian assistance.

In many regions, MSF health facilities are the only places for people to seek free medical care. Our teams provide general and emergency care; trauma surgery; maternal and pediatric services; assistance to survivors of sexual and gender-based violence; and treatment for malaria, HIV, and tuberculosis. In early 2022, the region surrounding the town of Ippy was the site of renewed clashes between armed groups and government troops, causing thousands of people to flee to camps with miserable living conditions. MSF sent in an emergency team that installed water points to increase access to drinking water from just 1.6 liters per person per day to 15 liters. Also, in just two months, nearly 400 children were treated for malaria.

In early May, MSF launched a vaccination campaign to provide basic protection for diseases including measles, polio, yellow fever, meningitis, and tuberculosis for nearly 20,000 children under the age of 10, and 9,000 pregnant women.

Adèle Guerde-Sewïen, Midwife, Bangui, Central African Republic

“[In Central African Republic], people recognize MSF as access to free health care in places where there is sometimes nothing. So, our patients want to tell their story and talk about the care they received. Bearing witness has a positive impact in the communities—it encourages people to understand what MSF does and how we do it.

I always say, ’You have to lead by example.’ Sharing the photos and stories of our patients allows us to show the reality of what is happening in such a country, such a region, and for such a person.

In Central African culture, it is important to have children. Some women cannot have [children] or experience obstetrical complications, which impacts their entire life. I remember a 16-year-old girl in critical condition who was cared for in our maternity ward, to whom we provided surgical care to survive. I thought to myself: If people knew her story . . . it would also help other girls.

This is why it is essential to tell the stories of our patients; that they are disseminated; that people are informed and understand what we are doing. Witnessing is also raising awareness: By hearing the stories of others, women now come to us for care, [such as] prenatal, sexual violence, and HIV. It enables us to inform communities and show another reality of things more human.”

Alert Winter 2022: The year in photos

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