Winter 2015: War comes to the hospital


The October 3 bombing of MSF’s hospital in Kunduz, Afghanistan, which killed 30 of our colleagues and patients, sent waves of shock and sadness through the MSF community.

For those of us who regularly work in war zones, International Humanitarian Law (IHL) isn’t an arcane set of rules and the Geneva Conventions aren’t just aspirations. They are binding compacts that we depend on, that protect health care workers and assure medical access for the populations we aim to assist.

To see them violated so flagrantly, with such a devastating loss of life, was gut wrenching and heartbreaking. It was a huge loss for us all. Personally, I thought immediately of the Afghan colleagues with whom I worked last year in Khost. We often discussed the nature of our work and they spoke of their commitment to one of the core principles of both IHL and MSF’s mission: that we treat patients according to need without regard for ethnicity, religion, or political affiliation. Our colleagues in Kunduz—13 of whom died in the attacks—felt the same way. These were highly trained professionals who had families and who had easier and safer job options, but chose to work with us.

The bombing was more shocking because of the circumstance. Our fully functioning, well-marked hospital wasn’t struck in error or by some rogue militia that destroyed the whole town. It was specifically targeted by a US military gunship, despite the fact that the US and Afghan governments knew about and agreed to the principles by which the hospital operated, and despite the fact that we had repeatedly shared the hospital’s GPS coordinates with them, including just days prior to the attack. We must understand how this happened and why. To that end, we called for an independent investigation into the attack, for reasons we explained more fully in an October 24 op-ed published in The New York Times.

We want to communicate our motives and rationale with all of you as well. This Alert further examines the Kunduz attacks, as well as the crucial relationship between IHL and our work—not just in Afghanistan, and not just as it pertains to the US military, but everywhere, with all parties to conflicts in places our teams aim to provide emergency lifesaving care.

IHL also addresses the status of refugees and asylum seekers, something very much in the news. The ongoing flight of millions of people from war, privation, and oppression has resulted in a visible humanitarian crisis in the Mediterranean and less visible, but no less significant, crises in Asia and Central America. So many perished on their journeys, and governments did so little to respond, that MSF made the extraordinary decision to conduct rescues and offer care at sea, while other teams assisted populations in numerous other locations and contexts. You’ll find more information about this work in these pages.

You’ll also learn about our Access Campaign’s “A Fair Shot” campaign, which shines a light on the secretive world of global vaccine pricing—and aims to pressure vaccine manufacturers to make vaccines affordable to all who need them.

Finally, we want to tell you about the Missing Maps project, an initiative through which MSF and other organizations are harnessing the power of crowd sourcing to draw new maps that can facilitate more effective and rapid responses in times of crisis.

All of these efforts have the same goal: to help us reach patients in need. As ever, we thank you for your interest and support, and we welcome your comments.

Sincerely Yours,

Deane Marchbein, MD

President, MSF-USA Board of Directors