MSFA The Pulse March 2023

BRINGING MEDICAL HUMANITARIAN ACTION TO YOU

MARCH 2023

MEN’S CHANGING ATTITUDES: A community responds to sexual violence PAKISTAN: Treating an age-old skin disease AFGHANISTAN: Female staff speak out

EDITORIAL

CONTENTS 02 Editorial: Sexual health 04 News in Brief 06 A new response to sexual violence 08 Photo essay: Care in cold climates 10 Letter from Bangladesh 12 The erasure of Afghan women 14 Staff profile: Logistics manager 16 On Assignment

Cover: Two brothers at the Médecins Sans Frontières satellite clinic in the Badaber rural health centre, where they are receiving treatment for cutaneous leishmaniasis in Peshawar, Pakistan. © Saiyna Bashir

MÉDECINS SANS FRONTIÈRES Médecins Sans Frontières is an international, independent, medical humanitarian organisation that was founded in France in 1971. The organisation delivers emergency medical aid to people affected by armed conflict, epidemics, exclusion from healthcare and natural disasters. Assistance is provided based on need and irrespective of race, religion, gender or political affiliation.

Today Médecins Sans Frontières is a worldwide movement of 24 associations, including one in Australia. In 2021, over 100 field positions were filled by Australians and New Zealanders.

Médecins Sans Frontières Australia acknowledges the Gadigal peoples of the Eora nation, the traditional owners of the land on which our office is located. We recognise their ongoing custodianship of land, waters and culture. We pay our respects to Elders past and present.

Championing support for young mums Good sexual and reproductive health is essential to women’s and girls’ wellbeing, but across many societies there are barriers to them achieving this. For International Women’s Day 2023, social worker in Zimbabwe, Relative Chitungo, speaks with head of the Sydney medical unit, Dr Claire Fotheringham, about the Médecins Sans Frontièresrun Teen Mums’ Club supporting young mothers to gain agency over their sexual health and lives.

Relative: Working with adolescents here in Mbare, I have noted many taboos that affect them. Sexual and reproductive health is not discussed openly in the community, especially between parents and their children. The moment an adolescent tries to approach a parent about these issues, they are blamed for being ‘mischievous’.

Their choice to independently seek sexual and reproductive health services is often compromised, because most services cost money, and they need a parent or guardian to pay. The caregiver wants to understand why they are going to the clinic—and most would want to escort them there, even into the consultation room!

When a young girl becomes pregnant, often the partner runs away. The girl is facing stigma from their peers at school, and the community, while they’re trying to adjust. Many girls have experienced sexual violence. They might not know where to turn. So there comes the importance of the Teen Mums’ Club, to ask, “How can we support?”

Claire: I think what’s unique about the Mbare project compared to many of Médecins Sans Frontières’ other sexual and reproductive health programs, is that its focus goes beyond pregnancy and birth. While maternal mortality is often the critical need in many places where we work, this project supports the needs of the girls and their families from several angles: covering healthcare during pregnancy and safe delivery care; post-birth support for the mother and baby; psychosocial care; sexual health education; training in income-generating skills…

CONNECT WITH US Call 1300 136 061 Email office@sydney.msf.org msf.org.au facebook.com/MSFANZ @MSFAustralia 2

Relative Chitungo

Dr Claire Fotheringham

When you are empowered, no one can take advantage of you.

You can stand for yourself.

Teen Mums’ Club peer educator and participant Marvellous Nzenza, 18, with her baby. © Dorothy Meck/Afro Vision Trust

Relative: That’s right. We want to empower the adolescents to speak for themselves, and our program is guided by what they tell us. Because of the relationship we have formed with the teen mums, they can open up with us about the stressors they’re facing in the community.

Relative: We are having success with engaging caregivers and partners with the project, too. Fathers do not usually talk to their daughters about these topics, but the sessions are helping them to be more open. We also encourage the girls to bring along their partners.

It’s important to include men in these conversations.

Most of the clubs now are being chaired by ‘teen mum champions’, who Médecins Sans Frontières has trained and hired to work as peer educators. They are taking the lead, running sessions on everything from parenthood to HIV testing, supported by our team of midwives, social workers, counsellors and health promoters.

They act as a bridge between the community and our services—spreading the information and flagging girls who need support.

For our community here, we need to accept that adolescents are engaging in sex. And the best thing we can do is empower them to access correct, consistent information, and give them the platform to seek the health services they choose.

Claire: It’s a wonderful example, Relative, of how a project can really listen to people, respond to their needs, and deliver care in a non-stigmatising way. In the past, sexual health education was quite fear-based (for example, telling young people, “You shouldn’t be having sex!”), but as health providers we need to recognise the reality of people’s lives, and for that we need to understand their experiences.

At one of our maternity facilities in Nigeria, we surveyed female patients who were pregnant, but didn’t want to be. We asked them for the reasons why they weren’t on contraception, if they didn’t want a pregnancy. We expected access to and cost of contraception to be the barrier, but around half of the women said they didn’t think they could get pregnant. Other factors were not having the consent of a husband to take contraception, or being worried about the side effects. With that information we could plan how to better assist women with prevention of unwanted pregnancies.

Claire: The patient’s right to choice, and respect for their decision, is something Médecins Sans Frontières has been emphasising across our work with women and girls—particularly in regard to contraception. That means ensuring lots of options are available; it means open discussions about those options, the potential side effects, and opportunity to try another option if one doesn’t fit. It also means being open to the idea that someone might not want to use contraception.

Relative: Yes. In this project, we are advocating for the rights of the girl-child and her ability to make choices that are good for her health and the health of her baby.

Now, the girls are coming regularly for antenatal care consultations without fear, they are encouraging and checking on each other. They are developing some financial independence, and some are going back to school. Parents are coming on board, saying to the community, “Let’s be there for our children.”

When you are empowered, no one can take advantage of you. You can stand for yourself.

For our International Women’s Day feature story from Democratic Republic of Congo, see page six.

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NEWS IN BRIEF

HAITI

Patient killed in Port-au-Prince Médecins Sans Frontières has suspended activities in the Raoul Pierre Louis public hospital in Carrefour district, Port-au-Prince, after armed men entered the emergency room on 26 January, taking a patient from a stretcher and killing him. A similar incident occurred in the same hospital in August 2022. “We are again shocked by this act of brutal retribution, which violates all humanitarian principles and the protection this patient should have had inside a medical structure,” said head of mission in Haiti, Benoit Vasseur.

A patient is transported to the Médecins Sans Frontières emergency centre in Turgeau. © Johnson Sabin

People in Haiti are facing severe economic and social crises, combined with insecurity and violence. Médecins Sans Frontières is calling for anyone bearing arms to respect our medical work, including patients, staff, medical facilities and ambulances. In Haiti, we continue to provide trauma and burns care, primary healthcare for people affected by urban violence and sexual and reproductive healthcare, and to respond to cholera.

KENYA

Community mobilisation against malnutrition One-third of children under five years of age in Illeret, Marsabit county, Kenya, is malnourished. Since mid-March 2022, Médecins Sans Frontières has been supporting local health authorities to tackle the acute malnutrition crisis by strengthening the medical component of the response. Our teams have set up an inpatient therapeutic feeding centre for children with severe acute malnutrition and medical complications at Illeret health centre, and we are working with community health educators and volunteers to run weekly active case-finding and surveillance activities in the community to reach malnourished children. Between March and the start of December 2022, these outreach activities identified 117 of the 137 children admitted to the centre for care.

The community health educators and volunteers also run health promotion activities with families to improve the medical outcomes for children with malnutrition. The topics include nutrition, personal hygiene, safe drinking water and immunisation. Families continue to face several challenges linked to the drought in Illeret.

Community health volunteer Fozia feeds Plumpy’Nut (a therapeutic food enriched with vitamins and minerals for treating malnutrition) to a young boy during a Médecins Sans Frontières outreach activity in Illeret. © MSF/Lucy Makori

BETWEEN MARCH AND DECEMBER 2022, OUR TEAMS:

Screened 24,182 children under five years of age for malnutrition 4

Enrolled 1,354 children in the malnutrition program

SYRIA AND TÜRKIYE

Unmet needs after earthquake A 7.8-magnitude earthquake hit Syria and Türkiye (formerly Turkey) on 6 February, the deadliest to hit the region in more than 20 years. The earthquake and hundreds of aftershocks killed 46,000 people (as reported 19 February) and caused the displacement of 180,000 people in northwest Syria and 100,000 in Türkiye.

Ministry of Health dermatologist Dr Maria Saleem examines a lesion on an eight-year-old patient at the Badaber rural health centre. Dr Saleem refers patients with suspected cutaneous leishmaniasis to the Médecins Sans Frontières satellite clinic at the health centre. © Saiyna Bashir

PAKISTAN

Treating an endemic disease A Médecins Sans Frontières project is providing medical and mental healthcare for patients with cutaneous leishmaniasis in two regions of Pakistan, in collaboration with health authorities. Cutaneous leishmaniasis is caused by a parasite transmitted by the bite of a female phlebotomine sandfly and affects people’s skin, causing lesions or ulcers on the body. Although not life-threatening, it can cause severe physical disfigurement, leading to functional difficulties as well as stigma and discrimination for patients. In Balochistan, Médecins Sans Frontières is the largest diagnosis and treatment provider for the disease at three locations in the city of Quetta.

In Khyber Pakhtunkhwa, we deliver diagnosis and treatment services in a hospital in Peshawar. We also run satellite clinics in Badaber and Telaband with the aim to increase access to cutaneous leishmaniasis care for people who would otherwise need to travel long distances into Peshawar.

Médecins Sans Frontières teams in northwest Syria launched an emergency response within hours. In Idlib and Aleppo governorates, we supported 38 hospitals and health facilities with donations of emergency and trauma kits, medical supplies, laboratory equipment, medicines and blankets. Our medical staff assisted hospitals receiving influxes of injured people and supported the transport of wounded patients via ambulance. We are running mobile clinics to provide medical care and essential items (such as tents, water, bread, blankets and mattresses) for people in reception centres and camps.

In Türkiye, Médecins Sans Frontières is coordinating with local organisations to provide assistance. By the end of February, we had donated relief items such as hygiene kits, electrical stoves and baby food to people in a camp in Adiyaman city, one of the worst-hit areas.

The first Médecins Sans Frontières convoy entered northwest Syria from Türkiye on 19 February, carrying over 1,200 tents and winter kits for displaced families in collaboration with Al Ameen, a Syrian non-governmental organisation.

To treat cutaneous leishmaniasis, a medication is injected daily for 20 to 28 days, either into the lesions directly or a muscle.

In 2022, Médecins Sans Frontières started a clinical trial to investigate alternative treatment modalities to the current first line drugs, meglumine antimoniate and sodium stibogluconate, which for decades have been the only proven effective treatment for the disease. The drugs are not widely available in public health facilities in Pakistan.

Syria: A Médecins Sans Frontières team delivers essential medical emergency kits and medications to hospitals and health facilities in Aleppo, northwest Syria, following the 6 February earthquake. © MSF THE PULSE: MARCH 2023

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FEATURE: DRC

Men champion a new response to sexual violence Sexual violence has torn apart the artisanal mining area of Salamabila in the Democratic Republic of Congo.

Thanks to a Médecins Sans Frontièressupported community initiative, men are now challenging social norms to better support women victim-survivors.

Left: The école des maris in Salamabila is one of two that have firmly established themselves since 2021 in Maniema province. © RTVE/MSF Right: Médecins Sans Frontières’ project in Salamabila focuses on building community level care to improve people’s access to healthcare overall. © Michel Lunanga/MSF

For the people of Salamabila in eastern Maniema province, the rich gold deposit of nearby Mount Namoya is the main source of work and income. This mining wealth is also one of the triggers of the spiralling violence in the territory, often targeting women.

Data from Médecins Sans Frontières’ Salamabila project estimates that nearly 80 per cent of incidents of sexual violence have been perpetrated by armed men, and the majority of victim-survivors in the community are women, predominantly between 18 and 30 years old.

Sexual violence is highly stigmatised in many parts of the world, and in Maniema province women who have been raped are often blamed for the attack, then publicly shamed by being kicked out of their homes.

Broken families are left behind, and the women are left with no recourse to medical attention, their previous lives, or justice.

“We were used to saying that if a woman is raped, it shows maybe she made a big mistake,” says one community member who attended a men’s gathering in Salamabila town. “If someone was raped, it was made public and the victims didn’t receive any care,” says Agata Bindi, a woman from Matete, another mining area in Maniema.

“The change is very clear now in the conversations in the écoles des maris. And the women have started attesting to great change in the men.”

IN SALAMABILA: Nearly 80% of incidents of sexual violence have been perpetrated by armed men 6

The majority of women victimsurvivors of sexual violence are between 18 and 30 years old

Since September 2022, an average of 70 women have sought care for sexual violence weekly

The school for men

Dynamic women

Médecins Sans Frontières has been supporting the Ministry of Health to improve the quality and reach of its care in the designated Salamabila health aire, or zone, since 2019. The overall insecurity, distant health facilities and lack and cost of transport are all major obstacles to people’s access to healthcare.

As part of our extensive program, Médecins Sans Frontières has been engaging closely with different local communities to adapt services to their needs, and thus avoid preventable medical complications in the absence of care.

In Salamabila, Médecins Sans Frontières has trained sexual and reproductive health ‘agents’ in villages to provide the first-line response as part of a holistic approach to care that extends up to the health centres and hospitals. These grassroots carers have built such trust that more than 80 per cent of victim-survivors who seek care have done that within 72 hours of the attack, allowing them to be protected from HIV, avoid pregnancy, and start rebuilding their sense of dignity and self with psychological first aid.

Although women are often the traditional target audience in healthcare promotion, men are key decision-makers in their homes and communities, and typically gate-keepers of access to care. In Salamabila, Médecins Sans Frontières wanted to harness their influence in a positive way. The result was the pilot project, launched in 2021, of école des maris, or ‘school for men’, whether the husband, the father or another man in charge at home.

Two écoles are now firmly established in their communities in Salamabila. “They’re organised by local leaders, who’ve formed committees. They hold debates, and we try to help orient them through the discussion,” explains Loukou. The men gather in earthen-floored meeting halls, canvassing issues relating to health, healthcare and social norms, and how they affect women’s and community wellbeing. How to respond to sexual violence as individuals, families and neighbours is a particular focus in the schools.

Invited for the first time, one man reflects: “I am grateful because I have heard information that I did not know. A woman may be raped but, instead of starting to quarrel and chase her away, as her husband, I should take her quickly to hospital.”

A different way of thinking “Now, people are starting to think differently,” says Loukou. “For example, I know a man whose wife was brutally raped. He stayed by her bedside, he fought left, right and centre for full support for her. We see husbands who are able to listen, they’re able to provide support, and they’re able to accompany their wives when they’re needed.

These agents and members of local women’s associations such as Les Femmes Dynamiques—many victimsurvivors themselves—have been pivotal to the écoles des femmes, or ‘schools for women’, also established by Médecins Sans Frontières in 8 out 18 health areas in Salamabila health zone.

In the face of cultural norms preventing women from speaking up, “it’s a platform where women have the freedom to express themselves. They have the chance to express their lived experience in the community, and we try to convey the reality, and orient them based on their needs,” explains Loukou.

In Matete, Bindi concurs: “The information sessions open our wisdom, they open our thoughts, they open our ideas.”

Agata Bindi, a participant in the écoles des femmes. © RTVE/MSF

“The change is very clear now in the conversations in the écoles des maris. And the women have started attesting to great change in the men where the schools have been implemented.”

Considering that some 80 per cent of the incidents of sexual violence treated by Médecins Sans Frontières in Salamabila are perpetrated by armed men, our team is also looking at how to connect with them. “We’re working on a strategy to address this challenge, hoping to achieve a change of behaviour among armed groups and get to the point where women do not suffer any type of abuse anymore”, says Loukou.

Meanwhile, Médecins Sans Frontières’ team continues to respond to growing demand for the écoles program, looking forward to the day when the schools are embedded across Maniema, and the results can be measured by the communities themselves in women’s wellbeing.

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PHOTO ESSAY: WINTER

Care in cold climates While summer months have stretched on in Australia, on the other side of the world Médecins Sans Frontières patients and staff have been facing the unique challenges brought on by harsh winter conditions.

From maternity care in a weatherbattered refugee camp on the Greek islands, to a mother seeking assistance for her daughter after shelling in a Ukrainian city, these images examine the intricacies of how care is provided when temperatures plummet.

Ukraine: Alla* hugs her daughter, who she brought to the Médecins Sans Frontières mobile clinic in Lyman, Donetsk Oblast. The young girl became unwell after the family was forced to shelter in a cold, damp basement during the fighting. © Hussein Amri/MSF 8

*Names have been changed.

Central Mediterranean: Survivors rescued from an overcrowded rubber boat are brought on board the Médecins Sans Frontières search and rescue ship Geo Barents, while the medical team assesses people for hypothermia, fuel burns and trauma injuries. © Mohamad Cheblak/MSF

Lithuania: Rescuers prepare to transport a man to hospital after he was found in the forest in Kabeliai, near the border with Belarus. Médecins Sans Frontières provided medical and mental health support to migrants and asylum seekers who had crossed into Lithuania between September 2021 and December 2022, in registration centres and at state border guard posts. © Vidmantas Balkunas/BNS

Syria: A Médecins Sans Frontières team delivers essential medical emergency kits and medications to hospitals and health facilities in Aleppo, following the 6 February earthquake. With houses and apartment buildings destroyed on a massive scale, hundreds of thousands of people became homeless in the freezing temperatures in northwest Syria. © MSF

Greece: Farizeh*, four months pregnant, attends an antenatal care consultation at a Médecins Sans Frontières clinic on Lesbos, where she lives in a camp. “It is so cold that we do not go outside our tents even during the day anymore. We only have some blankets to cover ourselves from the cold... there is no electricity to cook. You cannot even imagine how hard it is for a pregnant woman to live in this situation.” © Dora Vangi/MSF

Kyrgyzstan: A mother brings her baby to a consultation at the Médecins Sans Frontièressupported Aydarken hospital in Kadamjay, a stunning but harsh region where the long distances between homes and health centres can make it difficult for people to reach care. © Maxime Fossat THE PULSE: MARCH 2023

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LETTER FROM: BANGLADESH

“We are the most persecuted people in the world, but we can overcome this if we have enough education.”

Muhammad Hubaib is a humanitarian affairs liaison volunteer with Médecins Sans Frontières in the Rohingya refugee camps in Cox’s Bazar. As a Rohingya person himself, he brings a unique skillset to the role.

In 2017 (when the Myanmar military campaign forced 700,000 Rohingya people out of the country), I was a student. We came to Bangladesh with nothing, to save our lives. We didn’t have a place to call home. We were welcomed to Cox’s Bazar by the Bangladeshi government and host community.

We had only shelters of tarpaulin and bamboo, and we slept many nights with empty stomachs. We were relying on local donations; then, NGOs (non-governmental organisations) started coming to the camps to provide humanitarian assistance.

I joined Médecins Sans Frontières in 2018 and now I work in a team with five other Rohingya colleagues, as paid volunteers. The core part of my role is to monitor the humanitarian situation of the camps here in Cox’s Bazar, and to identify the gaps. I work with community leaders, authorities and other organisations in the camps, and with external agencies and donors, to assist our delivery of services in the camps and to advocate for a change for the better for our people.

Above right: Hubaib speaks with Mohammed Solim, an epidemiologist data collector and fellow Rohingya paid volunteer, about the water and sanitation situation in one of the camps. © MSF 10

Persecuted and forgotten Rohingya families in the camps are struggling to get by. Our daily needs are not fully met by humanitarian support, and people face challenges to access healthcare, safe drinking water, latrines and food, as well as being blocked from education and work.

Lack of clean water and sanitation is a huge issue.

Médecins Sans Frontières ran a community feedback study with 399 households last year, and we found that there is still inadequate sanitation infrastructure and insufficient water in the camps. These days, almost every family in the camps is suffering from skin infections such as scabies, because they can’t wash themselves, their bedding or clothing.

Patients with chronic diseases, such as hepatitis C, are not receiving sufficient treatment. We refer patients to private facilities as there is not enough capacity in public hospitals. During COVID-19, increased restrictions have made it harder for people to travel to reach private facilities outside of the camp for their treatment, in Chittagong and Cox’s Bazar.

Violence, extortion, kidnappings and other incidents are making the camps unsafe for people to live in. There is a lack of protection support and information on accessing it.

This difficult situation is why some Rohingya people take risky decisions to leave the camp through Malaysia or India, and why some become vulnerable to criminal groups.

We are the most persecuted people in the world, but we can overcome this if we have enough education. Yet the education services in the camp are only basic. I am a volunteer teacher to try to help empower our people.

SUPPORTER PROFILE

ANNE SHEARMAN

Home: Melbourne, VIC (Woiworung and Boonwurrung Land) Anne has been a Médecins Sans Frontières field partner since 2018, when her son, Ben Shearman, joined the organisation as a logistician in Iraq.

I had known of and admired Médecins Sans Frontières from afar. Through Ben’s work, I learned how innovative, extensive and comprehensive their work is. They act swiftly in emergencies, providing essential and acute care but also mental healthcare, post-surgery rehabilitation, training for local medical staff and much more.

I am both proud and in awe of the choices my son and his colleagues make every day working with Médecins Sans Frontières. Ben has now worked in seven countries (Iraq, Afghanistan, South Sudan, Palestine, Nigeria, Ukraine and Uganda). Like Ben, I have a real heart for people and their health and wellbeing, and I wanted to show my support by becoming a field partner.

The many facets of support As a Rohingya person working with Médecins Sans Frontières, we are always asked by the community for support. Some people are coming to our health clinics for the first time, and they don’t know the doctors and other staff, or how to seek care.

It is helpful for them to communicate with a familiar person.

There have sometimes been trust issues, or misinformation and rumours that spread about the work that Médecins Sans Frontières does. But we have successfully explained what we do so people feel safe.

Since we are persecuted as Rohingya, we often hesitate to share our stories and suffering with others. It is easier for the community to share with their own people, so whenever our team arranges any discussion with the community, we always clarify that we are Rohingya. It can be hard for me to hear the stories from my people. My team is like a family for me— whenever I face challenges, they support me.

We take so much for granted in this country and my life is privileged! Having enough food for your children is a basic human right, yet many children in our world are suffering from severe and life-threatening malnutrition. My heart is also with the children and their families living under conflict in Gaza and Ukraine.

The more I learn about the work of Médecins Sans Frontières, the more my appreciation and admiration grows and the more inspired I am to continue with my contribution. I would encourage anyone who is considering supporting to give generously. They will use your money wisely, while respecting and empowering the patients they work with.

I pray that not even an animal would have the life of a refugee, in any condition. It is almost the sixth year since we took refuge in Bangladesh, and we are still seeing no light on the horizon to return home. We are struggling and surviving in a challenging situation, while the world is forgetting our wish for repatriation to Myanmar, for safety and for our rights.

We need support; we need the attention of the international community to live, at least, a human life.

PASS THE MIC As part of our commitment to greater diversity and inclusion of voices within The Pulse, each issue we are ‘passing the mic’ to a staff member locally hired in the countries in which we work.

FOR MORE INFORMATION ABOUT BECOMING A FIELD PARTNER, PLEASE VISIT: donations.msf.org.au/donation/ monthly-donation THE PULSE: MARCH 2023

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FEATURE: AFGHANISTAN

51% of our 1,700 medical staff in Afghanistan are women

The erasure of women from public life As women’s and girls’ freedoms in Afghanistan are progressively stifled, Médecins Sans Frontières staff share their present and future challenges.

“The recent ban has already caused psychological problems for many women and their families. We fear that every day at work can be our last,” says Benesh*, a female Afghan staff member with Médecins Sans Frontières.

Benesh is referring to the decree announced by the Islamic Emirate of Afghanistan (IEA) in December 2022, which prohibits women from working for non-governmental organisations (NGOs) in the country. While health workers including Médecins Sans Frontières staff are currently exempt from the ban, there is no formal guarantee they will be able to continue to work unhindered.

“There are seven people in my family that I provide for,” she continues. “If I become unemployed, no one will be able to support the family.”

“Many women in Afghanistan are the breadwinners for their families because the men are unable to work, have fled the country or have died. Every day I think a lot about what I would do if I were not allowed to work anymore.”

Incremental pressure The ban on women working with NGOs is the latest in a succession of new restrictions placed on women and girls in Afghanistan, blocking their participation in education, work and everyday life. In 2022, the Ministry of Higher Education closed secondary schools and announced that women were forbidden to attend public and private universities.

These restrictions are creating layers of difficulties and challenges—not only for women, but for the entire society. Women play a critical role in the provision of humanitarian and healthcare services in Afghanistan, a country which has become increasingly dependent on humanitarian aid while being crippled by skyrocketing unemployment and sanctions imposed by foreign governments.

Already, many aid organisations have been forced to suspend their operations, removing access to essential services such as food, water and hygiene and protection.

This is having an impact on people’s health, and many fear that the health system itself—already underfunded and under-resourced for many years—will be impacted by the ban next.

Médecins Sans Frontières’ own medical workforce in the country is made up of mostly Afghan staff, over half of them women: “We are talking about nearly 900 doctors, nurses and other professionals who strive every day to give thousands of Afghans the best care possible,” says Filipe Ribeiro, country representative in Afghanistan.

“Médecins Sans Frontières’ operations couldn’t exist without them. This newest directive [upon the NGO workforce] is just another step in a systematic attempt to expunge women’s presence from the public domain—to everyone’s detriment.”

Médecins Sans Frontières staff walk down the corridor of the female inpatient department at the Boost hospital, Lashkar Gah, Helmand. © Oriane Zerah 12

333,000 deliveries supported

by Médecins Sans Frontières in Afghanistan since 2014

88% of patients and caretakers have delayed, suspended or foregone medical care due to reported barriers such as cost (Médecins Sans Frontières survey in four provinces, 2022)

“If I become unemployed, no one will be able to support the family.”

The impacts on women’s and child health Culturally in Afghanistan, women should only access services, including healthcare, that are provided by other women. “In the hospital, we have lots of patients who are women,” says Farzaneh*, a female Afghan staff member. “When they fall sick or need to deliver a child, they must have a place to go. If the Taliban (IEA) prevents female staff from working, no one will be able to take care of them.”

“A woman’s health affects the health of her whole family: if there is no access to antenatal and postnatal services, children’s lives will be put at risk as well. This ban will not affect just women. It will affect the country.”

Renata Viana, humanitarian affairs and advocacy manager for Afghanistan, says the needs remain clear in our maternal and paediatric health facilities across the country.

“Women have difficulty finding food, feeding their families,” she says. “Sometimes they say they are only feeding themselves with old pieces of bread.

Then we see [in the hospitals] the babies are delivered so small, and the mothers don’t have the milk to breastfeed… We are there to help with a small part of a very big problem.”

In addition, no one has forgotten the threat of violence targeting women, children and medical facilities, since the attack on the Médecins Sans Frontières Dasht-e-Barchi maternity wing in Kabul in May 2020 in which 16 mothers and a midwife were killed. The incident led Médecins Sans Frontières to suspend services in the hospital.

“Locals are [still] living under fear and not able to find services for themselves or their family members,” says Viana. “[There are] colleagues who fear they may be targeted again in future. I cannot speak for them, but it’s heartbreaking, this feeling of hopelessness. But we still see our colleagues finding the motivation… they still find the strength.”

Médecins Sans Frontières’ Afghan female staff have a clear message. “I would like to say one thing to people who might be reading this: please do not forget the women in Afghanistan,” says Soraya*. “No society can do well without both women and men. We all need to be involved in our communities to make things better.”

A woman and her child at the Médecins Sans Frontières drugresistant tuberculosis hospital in Kandahar city. © Lynzy Billing

Where is Médecins Sans Frontières working in Afghanistan?

Bamiyan: maternal healthcare Herat: malnutrition care

Kunduz: trauma care

Kabul: paediatrics

Helmand: maternal healthcare, malnutrition care

Khost: maternal healthcare

Kandahar: tuberculosis

*Names have been changed.

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STAFF PROFILE

From pastoralist to humanitarian ERIC W BOON

Logistics Manager Home: Perth, WA (Whadjuk Land) Médecins Sans Frontières experience: Nine assignments 2015-2023, to South Sudan, Nigeria, Syria, Yemen, Kiribati and Lebanon.

A Médecins Sans Frontières team vaccinates people against cholera in a camp in Bekaa Valley, Lebanon. © MSF/Mohamad Cheblak

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What inspired you to work with Médecins Sans Frontières?

My background isn’t in humanitarian work—I’ve managed a cattle station and a boat yard, been a pilot and served as a local councillor, among other things. But it had been in the back of my mind for many years. Then, a few years back, a surgeon colleague of my wife came to get some advice about his dog. He had worked with several Médecins Sans Frontières doctors over the years and in the course of our conversation, he said: “You can do almost anything; you should put your hand up for Médecins Sans Frontières!” and that got me thinking!

Tell us about your most recent assignment in Lebanon.

We were working with people living in the Bekaa Valley in northeast Lebanon. There was a cholera outbreak so much of our effort was focused on trying to get ahead of the curve, through vaccination campaigns and other preventative measures. Much of my role was supporting the medical team by acquiring and managing the cholera vaccines, taking special attention to keep them at a stable temperature so they wouldn’t degrade while being transported to communities before being administered. The second element was supporting the collating and distribution of hygiene kits to the most vulnerable people in these communities, who mostly don’t have access to hygiene items in the context of the economic crisis in Lebanon.

Could you share an example of the impact of the project?

The first batch of vaccines enabled us to vaccinate over 44,000 people.

The second round was still going when I left in early January, but we were looking to vaccinate a further 25,000 people. Over 10,000 household received hygiene kits. These kits cost US $22 each (a huge sum of money for vulnerable people in the country) and are a very practical, preventive measure; if you can maintain your personal hygiene and keep your immediate environment clean, then you are much less likely to get cholera.

What were some of the challenges you faced establishing this project?

With any assignment you have to be flexible, but for a bloke of my vintage—I’m 72 years old—the learning curve was pretty steep. I’d not worked with vaccines and cold chains before, so it took me a while to get my head around it. There were also initially, as is common in the contexts Médecins Sans Frontières works, some supply issues. We didn’t have enough ice packs, so I was starting at 4.30am and knocking off at 11 at night to make it work. There are frequent power cuts, so we were often relying on generators to keep the freezers going.

What stood out for you most from this assignment?

Our colleagues in Lebanon and the community itself were so welcoming, it made all the difference to our time there. There are many English- and Arabicspeaking nurses and people with degrees in public health who go in a regular rotation around the camps and collect data which can then inform what we do.

So, if there is a trend—for example of watery diarrhoea cases—these teams will alert us so we can go and test for cholera, and hopefully act fast enough to prevent a full-blown outbreak.

JOIN OUR TEAM Find out about working with Médecins Sans Frontières at one of our upcoming online recruitment information evenings. Hear from returned field workers, meet our field human resources staff and learn about the recruitment requirements and process.

Head to msf.org.au/join-our-team/ work-overseas/recruitment-events to register, or to watch our 14 March webinar for finance and HR professionals.

Do you have any advice for others interested in this work?

Firstly, do it! It is a wonderful way to contribute to the wellbeing of the world. You will not only help people in need, but you will gain knowledge and a different perspective on the world. I believe that I benefit from the service at least as much as I contribute.

What do you do when you are not on assignment with Médecins Sans Frontières?

We have a large yard, so a lot of my time goes into looking after that. We also have a beach cottage about an hour north of Perth and I try to disappear there to write things, look after the garden and go for swims. I also spend a fair bit of time in my shed making things and maintaining my 1972 750 Commando [motorcycle], which I ride whenever I can, in the company of a desperate band of other foolish old men.

Logisticians provide daily technical support to all activities in our projects. Their work may include vehicle maintenance, the procurement and transport of supplies, construction and maintenance of facilities, management of water supply and hygiene facilities, or management of electricity supply and equipment.

© Zahra Shoukat/MSF

There are many facets to Médecins Sans Frontières logistics and there is always some way to find your niche.

One can’t study for the role but if you are a practical person, so long as you are willing to be flexible and to learn, you can become part of a wonderful organisation.

Urgently needed!

Logisticians Finance/HR managers Interested?

Visit msf.org.au/yes THE PULSE: MARCH 2023

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ON ASSIGNMENT Community health educator Ambrose Nyakoo talks to community members during a Médecins Sans Frontières malnutrition outreach activity in Illeret, Kenya. © Njiiri Karago/MSF

Staff from Australia and New Zealand currently on assignment with Médecins Sans Frontières.

AFGHANISTAN Project Coordinator Specialised Doctor Specialised Doctor Nursing Activity Manager HR Manager Logistics Manager BANGLADESH Paediatrician Specialised Doctor Paediatrician

VIC, AU NSW, AU NSW, AU VIC, AU SA, AU QLD, AU ACT, AU VIC, AU NSW, AU

CENTRAL AFRICAN REPUBLIC Project Coordinator NSW, AU CHAD Epidemiology Activity Manager

VIC, AU

DEMOCRATIC REPUBLIC OF CONGO Project Coordinator NZ ETHIOPIA Midwife Activity Manager SA, AU Head Nurse QLD, AU Medical Activity Manager SA, AU Mental Health Activity Manager NZ

msf.org.au facebook.com/MSFANZ @MSFAustralia

IRAQ Medical Coordinator NSW, AU Anaesthetist QLD, AU Nursing Activity Manager NSW, AU Specialised Doctor VIC, AU Mental Health Activity Manager NSW, AU JORDAN Regional Technical Advisor

TAS, AU

KENYA Regional Technical Advisor Logistics Manager Psychiatrist

NSW, AU QLD, AU VIC, AU

KIRIBATI Midwife Supervisor Finance/HR Manager Paediatrician Finance/HR Manager

WA, AU VIC, AU NSW, AU NZ

LIBYA Logistics Coordinator

NSW, AU

MALAWI Logistics Manager

QLD, AU

NIGERIA Epidemiology Activity Manager QLD, AU Supply Chain Coordinator NSW, AU

PAKISTAN Medical Advisor Project Coordinator

QLD, AU QLD, AU

THE PHILIPPINES Deputy Medical Coordinator Medical Coordinator

NSW, AU NZ

SIERRA LEONE Logistics Team Leader Obstetrician Gynaecologist Finance Coordinator

VIC, AU WA, AU WA, AU

SOUTH SUDAN Hospital Nursing Manager NSW, AU Regional Communications Coordinator NSW, AU Field Communications Manager NSW, AU Anaesthetist WA, AU SUDAN Project Coordinator

QLD, AU

SYRIA Operational Deputy Head of Mission Project Coordinator

QLD, AU WA, AU

UGANDA Logistics Coordinator

VIC, AU

UKRAINE Logistics Manager Nursing Activity Manager Nursing Activity Manager Nursing Team Supervisor

NSW, AU NT, AU NZ VIC, AU

YEMEN Nursing Team Supervisor Hospital Nursing Manager Hospital Director Nursing Team Supervisor

VIC, AU NSW, AU WA, AU QLD, AU

VARIOUS/OTHER Mobile Implementation Officer Finance/HR Coordinator

VIC, AU NZ

This list of field workers comprises only those recruited by Médecins Sans Frontières Australia. We also wish to recognise other Australians and New Zealanders who have contributed to Médecins Sans Frontières programs worldwide but are not listed here because they joined the organisation directly overseas.