Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2023 November 23; Volume 5 (Issue 2); 53-59.; DOI:10.7227/JHA.110
L’Homme M
Journal of Humanitarian Affairs. 2023 November 23; Volume 5 (Issue 2); 53-59.; DOI:10.7227/JHA.110
In March 2022, intercommunal fighting forced Médecins Sans Frontières (MSF) to suspend its activities after nearly fourteen years of operating in Agok, a small town located in the disputed Abyei Special Administrative Area (ASAA) on the border between Sudan and South Sudan. After the shock of having to close a 185-bed hospital unexpectedly came questions about the unintentional consequences of MSF’s presence. With the benefit of hindsight, the organisation deemed it important to examine the potentially destabilising influence it might have had on the local environment. This article builds on an internal capitalisation exercise conducted with the aim of documenting MSF’s experience and critically reflecting on the potential of aid being a factor in disrupting local balances, or worse, a factor in fuelling violence. By exploring the premises that MSF was an anchor factor for the population and that the economic fallouts made Agok a place worth fighting for, the author investigates the long-term, unintended impact of MSF’s presence on the local political economy of conflict, as well as the organisation’s possible share of responsibility for aggravating intercommunal grievances. Based on the observation that aid inevitably benefits some more than others, the author also asks to what extent MSF was aware of the adverse consequences of its presence and whether more awareness would have led to different operational choices and mitigating measures. This questioning does not detract in any way from the project’s achievements in terms of providing high-quality secondary healthcare in a context where there was none, in one of the poorest countries in the world.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2023 November 23; Volume 5 (Issue 2); 24-29.; DOI:10.7227/JHA.107
Leyland J, Tiller S, Bhattacharya B
Journal of Humanitarian Affairs. 2023 November 23; Volume 5 (Issue 2); 24-29.; DOI:10.7227/JHA.107
While health misinformation is important to address in humanitarian settings, over-focusing on it can obfuscate a more holistic understanding of a community’s needs in a crisis. Through Médecins Sans Frontières’ experience of deploying a platform to tackle health misinformation during the COVID-19 pandemic, this field report argues that, while important, health misinformation became a diversionary topic during COVID-19, which represented a lack of trust between communities, humanitarian organisations and health institutions, rather a fundamental obstacle to effective humanitarian interventions.
From our practitioners’ viewpoint, we reflect on the deployment of the ‘MSF Listen’ platform in our programmes and how it evolved from a purely misinformation-focused digital tool to a broader workflow and approach to understanding community needs in crises through accountable management of community feedback.
From our practitioners’ viewpoint, we reflect on the deployment of the ‘MSF Listen’ platform in our programmes and how it evolved from a purely misinformation-focused digital tool to a broader workflow and approach to understanding community needs in crises through accountable management of community feedback.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 32-39.; DOI:10.7227/JHA.072
Mendiharat P, Rahmouni E, Salumu L
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 32-39.; DOI:10.7227/JHA.072
Despite a concerted international effort in recent decades that has yielded significant progress in the fight against HIV/AIDS, the disease continues to kill large numbers of people. Although there is still no definitive cure or vaccine, UNAIDS has set an ambitious goal of ending the epidemic by 2030, specifically via its 90-90-90 (‘treatment cascade’) strategy – namely that 90 per cent of those with HIV will know their status, 90 per cent of those who know their status will be on antiretroviral therapy and 90 per cent of those on antiretroviral therapy will have an undetectable viral load. These bold assumptions were put to the test in a five-year pilot project launched in June 2014 by MSF and Kenya’s Ministry of Health in Ndhiwa district, where an initial NHIPS 1 study by Epicentre (MSF’s epidemiology centre) in 2012 revealed some of the world’s highest HIV incidence and prevalence, and a poor treatment cascade. Six years later, a new Epicentre study, NHIPS 2, showed that the 90-90-90 target had been more than met. What explains this ‘success’? And given the still-high incidence, is it truly a success? MSF Deputy Director of Operations Pierre Mendiharat and physician Léon Salumu, Head of MSF France Kenya programmes, discuss the political, scientific and operational challenges of the Ndhiwa project in an interview conducted by Elba Rahmouni.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 25-31.; DOI:10.7227/JHA.071
Di Lollo MX, Cocina EE, Gisbert FdB, Juarez RG, García-Mingo A
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 25-31.; DOI:10.7227/JHA.071
When the COVID-19 pandemic struck in early 2020, it rapidly became apparent that older individuals were at greater risk of serious illness and death. The risk was even greater for residents in care homes, who live in close proximity and may be suffering other comorbidities. Such facilities also saw a high turnover of staff and visitors, meaning an increased risk of transmission. Data has suggested that care home residents may account for up to a half of all COVID-related deaths in Spain.
As morbidity and mortality for COVID-19 was increasing in March 2020, MSF offered support to Spanish care homes during the first wave of infections. Our intervention included different axes: advocacy, knowledge sharing, training and implementation of measures for a reduction in transmission and for infection prevention and control (IPC).
The situation for care home residents was dire, with many people dying alone, away from loved ones and without access to palliative care. Staff were overwhelmed and ill-equipped to deal with the scale and complexity of this tragedy.
Although technical interventions to reduce transmission were crucial, it became clear that other people-centred activities that supported residents, their families and staff, were of equal importance, including facilitating contact between families, providing emotional support and offering adequate pain management and palliative care.
Residents in care homes have the same rights as everyone else. In the event of future crises, the most vulnerable should not be neglected.
As morbidity and mortality for COVID-19 was increasing in March 2020, MSF offered support to Spanish care homes during the first wave of infections. Our intervention included different axes: advocacy, knowledge sharing, training and implementation of measures for a reduction in transmission and for infection prevention and control (IPC).
The situation for care home residents was dire, with many people dying alone, away from loved ones and without access to palliative care. Staff were overwhelmed and ill-equipped to deal with the scale and complexity of this tragedy.
Although technical interventions to reduce transmission were crucial, it became clear that other people-centred activities that supported residents, their families and staff, were of equal importance, including facilitating contact between families, providing emotional support and offering adequate pain management and palliative care.
Residents in care homes have the same rights as everyone else. In the event of future crises, the most vulnerable should not be neglected.
Journal Article > EditorialFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 1-3.; DOI:10.7227/JHA.068
McLean D, Neuman M
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 1-3.; DOI:10.7227/JHA.068
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 14-23.; DOI:10.7227/JHA.070
Roberts N
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 14-23.; DOI:10.7227/JHA.070
This article explores the actions of Médecins Sans Frontières during the 2018–20 Ebola outbreak in Nord Kivu, in the Democratic Republic of Congo. Based on the experiences of practitioners involved in the response, including the author, and on the public positioning of MSF during the first year of the epidemic, it argues that although the actions of response actors were usually well intentioned, they could rarely be described as lifesaving, may have exacerbated disease transmission as much as limited it and had the perverse effect of fuelling corruption and violence. The article documents and analyses contradictions in MSF’s moral and technical positioning, and the complicated relationship between the organisation and the international and Congolese institutions leading the response. It argues that the medical and social failure of the response was the result of an initial belief in a strategy designed at a time when the only realistically attainable outcome was to relieve suffering, and of the later inability of the organisation to convince the authorities in charge of the response to adjust their approach. It suggests that for future success new protocols must be elaborated and agreed based on a better social and political comprehension and a better understanding of the tools now available.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 40-42.; DOI:10.7227/JHA.073
McIver L, Guevara M, Alcoba G
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 40-42.; DOI:10.7227/JHA.073
The COVID-19 pandemic has exposed multiple fault lines in the performances of health services at every level – from community to national to global – in ensuring universal, equitable access to preventive and curative care. Tragically, this has been to the detriment of those who have suffered and died not only from COVID-19, but also from the myriad other ailments affecting people around the world. Of those, we wish to highlight here some key categories of diseases that have caused a greater burden of illness and deaths as a consequence of the policies and political decisions made in relation to the COVID-19 pandemic. In our view, these should be considered epidemics or, more accurately, syndemics – the clustering and interactions of two or more diseases or health conditions and socio-environmental factors – of neglect.