On the front lines of conflict

Yemenis survey the damage caused by a Saudi-led airstrike on an MSF-supported cholera treatment center in Yemen’s Abs region in June. No staff or patients were killed or injured in the attack.

YEMEN 2018 © Essa Ahmed/AFP/Getty Images

This article is part of the Winter 2018 issue of Alert—2018: The Year in Photos—featuring some of the most striking images and stories from our work around the world.

Doctors Without Borders/Médecins Sans Frontières (MSF) teams work in some of the most difficult and dangerous places in the world. Approximately one-third of the medical humanitarian assistance provided by MSF is for communities caught in armed conflict. War affects every aspect of life, often plunging societies into poverty and forcing people to live under siege or flee for their lives. Violent conflict can devastate essential health infrastructure, disrupt the flow of medical supplies, and exacerbate outbreaks of deadly diseases.


Help save lives.

A child waits in the emergency room of the MSF-supported Al-Salam hospital in Khamer, Amran governorate, Yemen. As ongoing conflict in Yemen causes prices of commodities and fuel to rise precipitously, many people cannot afford to travel to hospitals. In response, MSF runs outreach clinics to serve isolated communities in the region.
YEMEN 2018 © Agnes Varraine-Leca/MSF


Yemen’s brutal war has decimated the country’s health system, leaving more than 22 million people in need of humanitarian assistance, according to United Nations estimates. Health facilities and other civilian structures have been hit by bombs, grenades, and artillery fire by the warring parties—including members of the Saudi- and Emirati-led military coalition backed by the United States, and Ansar Allah (Houthi) fighters and their allies. An economic blockade coupled with high inflation have led to chronic shortages of essential goods, including medical supplies. Even where medical facilities remain operational, most people can no longer afford the cost—and associated risk—of transport to reach them. Some delay care until their condition becomes critical. Pregnant women, for instance, generally receive no prenatal care and often arrive at health facilities with life-threatening complications during labor and delivery.

Despite growing international pressure for a ceasefire toward the end of the year, increased fighting across many parts of the country in November took a heavy toll on civilians. MSF has massively scaled up operations in Yemen since the conflict began in 2015, with 1,797 staff members in the country in 2017. Teams currently provide support to more than 12 hospitals and health centers in 11 Yemeni governorates, offering services ranging from trauma surgery to care for patients with chronic diseases.

YEMEN 2018 © Agnes Varraine-Leca/MSF
YEMEN 2018 © Agnes Varraine-Leca/MSF
YEMEN 2018 © Agnes Varraine-Leca/MSF
MSF opened its 60-bed SICA Hospital in Bangui in 2017 to provide specialized orthopedic and visceral surgery, physiotherapy, and mental health support to trauma patients. Twenty-eight-year-old Haroun is being treated at SICA after being stabbed multiple times in the chest. Physiotherapy has helped him recover his lung capacity. “The support I received at the hospital allowed me not to sink; not to lose my head,” he said.

Central African Republic

Years of bloody conflict in Central African Republic (CAR) have resulted in thousands of deaths and the displacement of millions of people both within the country and across borders. MSF teams here address the consequences of the violence on the health of individuals and entire communities: conflict-related trauma; barriers to medical care; poor vaccination coverage; and more.

In the physiotherapy department of SICA Hospital in the capital city, Bangui, an MSF team performs an average of 150 consultations weekly for trauma patients, many of whom have been wounded by bullets or knives. Our physiotherapists aim to provide as much time as possible for patients to recover from their injuries, many of which are complex.

Eleven-year-old Mace-Grace recovers in a hospital in Bunia, DRC, in early March. She lost her mother, three siblings, and her left hand in an attack on her village in Ituri Province. Conflict in the region has displaced thousands, many of whom gathered at a temporary shelter site at the regional hospital. MSF provided basic health care, mental health support, and referrals for severe cases to two nearby hospitals.

Democratic Republic of Congo

MSF responds to disease outbreaks and other emergencies across Democratic Republic of Congo (DRC)—and there is no shortage of need. We run some of our largest projects worldwide here, with thousands of staff working in 20 of the country’s 26 provinces. Long-simmering armed conflict has triggered massive population displacements, most notably in North and South Kivu, the greater Kasai region, Ituri, and Tanganyika.

MSF teams address the consequences of violence, providing lifesaving health care services to people displaced by fighting and mental health support for those suffering invisible wounds of war. We care for people displaced outside the country too, including tens of thousands who crossed Lake Albert into neighboring Uganda after fleeing intense violence in Ituri in early 2018.

Active conflict and insecurity have recently hampered the response to an outbreak of Ebola in North Kivu and Ituri provinces

DEMOCRATIC REPUBLIC OF CONGO 2018 © Diana Zeyneb Alhindawi
Patients chat outside MSF’s Khan Yunis clinic in Gaza. About half of the thousands of patients treated by MSF from March 30 to October 31 suffered open fractures, and many suffered severe soft tissue damage. The consequences of these wounds—especially if untreated—can be lifelong disability, amputation, or even death.

Palestinian Territories

MSF provides medical aid to people affected by ongoing conflict in the Palestinian Territories with long-running mental health programs in the West Bank and specialized care for victims of burns and trauma in the Gaza Strip. Our patients have witnessed violence, experienced the arrests or deaths of friends or family members, and endured raids on their homes. As a result, many have developed anxiety, stress, and sleeping problems.

In the Gaza Strip, MSF teams also treat patients for burns and trauma in four hospitals and five postoperative clinics. From March 30 to October 31, MSF teams treated 3,117 patients injured during clashes between Israeli troops and Palestinian protesters, many of whom were shot in the legs. Gaza’s fragile health system is struggling to cope with the huge numbers of patients still in need of care for the serious wounds they sustained earlier this year, at the height of the Great Return March demonstrations, leaving thousands in danger of infection and permanent disability.

PALESTINIAN TERRITORIES 2018 © Heidi Levine/Sipa Press