2015 By the Numbers:
- 8,132,100 outpatient consultations
- 594.900 patients admitted
- 83,500 major surgical interventions, including obstetric surgery
Kunduz. Haydan. Idlib. Boguila. Malakal. And more. The list of places where MSF-run or MSF-supported facilities were bombed, shelled, or otherwise attacked in 2015 is frighteningly long. In that regard, it was a year unlike any other for the organization, with repeated incidents both causing immediate casualties and damage while also, in the aftermath, depriving people of vital medical care at the precise moment they needed it most.
This speaks to an existential threat to the practice of humanitarian action. This threat was present from the start of MSF’s work in conflict zones and will persist into the future. That is true. But last year was beyond extreme, highlighting like never before the challenges inherent in our efforts to establish safe medical spaces for our beneficiaries and staff.
Without a safe medical space, we cannot have confidence that our staff and patients are not assuming excessive risk in order to provide or receive care. We cannot plausibly claim that our work is independent, neutral, and impartial—core tenets of our organization. We cannot be sufficiently certain that our work will not be co-opted for the political or military purposes of another group.
This is something we must reaffirm every time we open a new project, or when the context changes around an existing one. Mostly, we accomplish this by negotiating with all parties to a given situation, particularly when that situation is a conflict zone.
First, small exploratory teams assess the medical needs and the practicality of setting up a project. Then, team leaders meet government representatives, community leaders, military commanders and others to describe what MSF is and does. They talk about the services we provide and the assurances we need if we are, in fact, going to set up a project. We need to know, for instance, that all parties will respect our “no weapons” policy and that that they won’t prevent our staff from providing care based solely on medical needs.
These conversations are not endorsements and do not suggest any sort of affinity with one group or another. They are a means to an end—an avenue through which we can establish safe humanitarian spaces and provide people in need with the care they deserve.
Is it foolproof? No. We’ve had hospitals and clinics attacked and robbed throughout our history. We’ve had staff members kidnapped and even killed. Each of these incidents is a profound tragedy felt deeply throughout the organization. And after each, we try to understand what happened so that we can learn and adapt as needed.
But in 2015, the scale and nature of attacks against medical facilities was astonishing. Even our most experienced aid workers were taken aback.
We had to find the best operational, communications, and advocacy responses to these incidents, each of which differs in important ways. The attack on our hospital in the Afghan city of Kunduz last October that killed 42 patients and staff was particularly fraught, given the involvement of the United States military. But in all cases, we demand that combatants uphold their obligations under international humanitarian law and the Geneva Conventions, and take every conceivable measure not to inflict damage upon medical facilities. On our side, we do everything we can to prevent our projects from being used by anyone for any purpose other than humanitarian medical care.
These efforts continue. Speaking out, publishing op-eds in top-tier publications, negotiating bilaterally with states and others, and maintaining dialogues with everyone from low level militias to the largest militaries in the world—these are our tactics.
We also took a lead role in pushing a United Nations Security Council resolution through which states re-affirmed their commitment to the principles described above (it passed unanimously and with the co-sponsorship of 85 member states in May 2016). And we are doing the same regarding international conventions around refugees—crucial accords in this time of ever greater population movements—and other issues, such as drug and vaccine pricing.
We will keep informing you about what we are doing in this regard and why we are doing it. We also want to tell you what it meant in 2015. You can read all about it in this Annual Report. But we can say, in short, that your support—along with the groundwork and negotiations we carried out for our medical projects—allowed us to perform more than 8.1 million consultations, carry out more than 83,000 major surgical interventions, and assist more than 219,000 deliveries, among other services, in nearly 70 countries last year.
And we will continue to fight to establish and maintain safe medical space, for our field teams and for our patients, now and into the future.
Deane Marchbein, President, MSF-USA Board of Directors
Jason Cone, MSF-USA Executive Director