ALL QUOTES TRANSLATED TO ENGLISH FOR SUBTITLING
IN GREEN HIGHLIGHT
“Access to the Danger Zone”
(Including Time Codes, all quotes translated to english, start/end titles)
TC 01:00:09 Voice over:
In all armed conflicts it is civilians - men, women and children – who are the main victims.
Forced to bear the unbearable consequences of violence, they flee their homes, are shot at, bombed, maimed, raped, tortured and killed.
If infrastructure and healthcare services then collapse their chances of survival are even more drastically reduced.
This is the moment when humanitarian aid is most vital.
Yet reaching the victims of conflict is a difficult and dangerous endeavour in which humanitarian organisations take enormous risks to alleviate suffering and to save lives.
TC 01:00:56 Access to the Danger Zone
TC 01:01:08 A film by Eddie Gregoor and Peter Casaer
TC 01:01:18 Narrated by Daniel Day-Lewis
TC 01:01:30 Vittorio Oppizzi, Field coordinator, MSF:
What happened? Half an hour ago a carjacking. The car was stopped at gunpoint. The driver was shot and the two expatriates were kidnapped. At the moment we don’t have any other information. So now we stopped the movements, except to the hospital, keeping emergency care there. Health posts which are in the camp are being closed for today.
TC 01:01:49 MAP KENYA DADAAB
TC 01:01:56 Voice over:
Dadaab, a small Kenyan town, about 100 kilometres from the Somali border. Surrounding the town is the world’s largest refugee camp, now home to more than 450.000 people. Every day, more than 1,000 new refugees stream in - fleeing civil war and drought in Somalia.
TC 01:02:22 Voice over:
The international medical relief organisation Médecins Sans Frontières, Doctors without Borders, also known as MSF, has just had two of its staff kidnapped and is stopping all its activities.
TC 01:02:36 Unnamed Woman:
I think everybody knows we are here in a real security situation in this moment. And we’re thinking now to reduce the team. Not for today, but maybe tomorrow in the morning. I’d like that everybody of you pack your stuff.
TC 01:02:51 Unnamed woman:
Do as if maybe you will not come back.
TC 01:02:55 David Michalsky, Operational Coordinator, MSF:
After we determine whether we can move people, usually we would be looking to evacuate from that location.
TC 01:03:02 Vittorio Oppizzi, Field coordinator MSF:
It’s a preventive measure that gives us the time to understand the situation, how it will evolve. So then we will see. The idea is to go with a very skeleton team, and then, if the situation allows, to gradually return to normal. But for the moment we do like if we don’t come back.
TC 01:03:22 Voice over:
Following the decision to reduce the team, most start to pack their bags. They realise that they themselves could have been the victim of a kidnapping or another serious security incident.
TC 01:03:33 David Schrumpfany, Medical doctor, MSF:
Moi, je m’inquiète surtout pour les deux personnes en fait. Moi là pour l’instant j’ai assez confiance. Il n’y a pas de ... Je ne ressent pas un risque direct en tout cas pour moi. Mais voilà.
Si il y a une des choses qu’on nous a enseigné à MSF, c’est que quand il y a un incident de sécurité normalement on ne discute pas, on doit faire ce qu’on nous dit.
Actually,I ’m very worried for the two persons .
For the moment, I feel quite confident.
There is no...
I don’t feel a direct threat, at least not for myself. That’s it.
If there’s one thing that we’ve been taught at MSF, it’s that when a security incident occurs, one does not argue. We do what we are told to do.
TC 01:03:58 Christopher Stokes, General Director, MSF:
Aid workers in these environments have become much more valuable and therefore more valuable as targets. We are seen as assets which leads to a high number of kidnappings and also crime against aid workers generally.
TC 01:04:12 Unnamed Woman:
This message is already spread around. I’d like that everybody..., not “I’d like”: everybody of you has to call the family to inform a kidnapping happened, but you’re safe.
TC 01:04:24 Unnamed woman calling her son:
Eric, give me a call when you get this message. I just need to give you an update about a little security issue that’s gone on here. We’re all fine. Everything is fine, but there may be some things hitting the media soon. And so I didn’t want you to get alarmed. So, just give me a call when you get this message. Bye !
TC 01:04:52 Voice over:
Suddenly, the coordination team hears that the Kenyan authorities have taken action, but without informing MSF. Headquarters in Europe are immediately called.
TC 01:05:01 Vittorio Oppizzi, Field coordinator MSF:
Apparently the police is following with helicopters. The car was abandoned. And the two hostages and the four kidnappers continued on foot. Apparently two helicopters, Kenyan army and police are closing the border and so on. So this is the last thing we just got. Thank you, bye bye.
TC 01:05:24 Voice over:
In headquarters a special crisis team is set up to manage the kidnapping.
That evening, final decisions on new security measures are shared with MSF staff on the ground.
TC 01:05:34 Vittorio Oppizzi, Field coordinator MSF:
So, we’re going for a skeleton team, taking some people from the emergency team, some people from the regular project. All the others will be evacuated by airplane tomorrow morning, going directly to Nairobi.
TC 01:05:47 Unnamed man :
Do you know if other NGO’s are also evacuating?
TC 01:05:50 Vittorio Oppizzi, Field coordinator MSF:
The ones that I contacted, Médecins du Monde, .. is all going. They are all going out. They had a smaller team and of course they were already...-some of you may not be aware- there were already some NGO’s that after the CARE carjacking strongly reduced their movements.
On the other side, for us: we are providing life saving interventions, so that’s why this reduction to a skeleton team. It’s a temporary measure.
TC 01:06:13 Unnamed woman:
So tomorrow you are going to leave by plane from Dadaab airstrip. You have a bus picking you (up) tomorrow morning, departure at 6.30 from the compound.
So please be ready at 6 because you are many people. You are 30 people leaving tomorrow, so all with the luggage and all that. It will take some time.
TC 01:06:34 Jerome Oberreit, Director of Operations, MSF:
When the team actually -even though rationally they do think: “well that’s probably the right thing to do”- on an emotional basis they know what they are leaving behind. They know what they are leaving behind in terms of health gaps, in terms of clear provision. It’s life saving work, day in day out. It’s also a strong bond that get’s created with their colleagues on the ground. So it’s actually very difficult for a lot of these individuals to just pack up one day, leave, and know that behind, there’s not going to be much provision. Or there’s going to be no provision in terms of some of the key skilled staff. If you pull out the only surgeon that is in a given area, well, you might have the 70 percent or 80 percent of health capacity that still remains there, but you don’t have that act that can happen any more.
So it’s a very difficult situation and quite often lived in a very difficult way by the individuals.
TC 01:07:27 Rolf Helmrich, retired Security Officer, United Nations:
In case an incident happens, international organizations evacuate or relocate their staff, leaving those who are in need behind, unattended. Is it logic to do that?
I think we should be more flexible in the sense to understand what the real issue is.
TC 01:07:47 Woman:
TC 01:07:48 Man:
“Yes, take care of you”
TC 01:07:49 Rolf Helmrich, retired Security Officer, United Nations:
In other words you would have to do a quick analysis on the issue, and then determine: does this justify the departure of our staff, or should we continue, with of course mitigating factors and measures put into place, and continue working on the ground.
TC 01:08:09 Jerome Oberreit, Director of Operations, MSF:
This will be very dependent on a case by case basis. There’s no one solution or one guideline fits all for any security incident. It really is based on a reading of the situation, the reasons behind, and the ability to ensure that this kind of situation doesn’t reoccur in the same area again.
TC 01:08:30 Voice over:
MSF stays in Dadaab, but for two weeks the organization limits its activities to emergency medicine only. This kidnapping reveals the risks aid organisations face when trying to assist populations in distress.
TC 01:08:45 Jerome Oberreit, Director of Operations, MSF:
If you’re talking about a kidnapping, or loss of life by one of your team members, this has impact way beyond the project.
TC 01:08:59 Voice over:
Only a few days after the kidnapping, Kenyan troops move into Somalia to combat the islamist al-Shabab forces. Tensions across the region escalate further.
TC 01:09:11 Christopher Stokes, General Director, MSF:
The humanitarian enterprise has never been easy, I mean, working in conflict settings has always been a high-risk activity.
You ‘ve always had to negotiate with warring parties. They have never, sort of, welcomed us with open arms in conflict. They have always tried to use humanitarian assistance to fill their objectives.
TC 01:09:29 Jan Egeland, former U.N. Under-Secretary-General for Humanitarian Affairs:
Too often humanitarian organisations, doctors and others, are prevented access to civilians and the civilians die, while we, the international community, are passive observers. For two reasons: there is no access, we are blocked from getting there, or the other one, there is no security, the humanitarian relief workers lose their lives in trying to reach the victims. And that’s not a natural disaster preventing that, it’s people: it’s generals, it’s military people, it’s politicians, preventing us from having access to those in greatest need.
TC 01:10:13 Voice over:
Since the turn of the millennium, incidents involving aid workers have become far more frequent. The last decade has been the deadliest on record for humanitarians, in fact. More than 230 national and international aid workers have been killed, and 150 have been wounded.
TC 01:10:32 Jan Egeland, former U.N. Under-Secretary-General for Humanitarian Affairs:
Humanitarian action has been in the crossfire, our humanitarian colleagues have been deliberately targeted. They have been killed, they have been kidnapped, they have been shot at, they have been wounded and they have been maimed, just because they wanted to help civilians, the wounded, the sick in battlefields.
TC 01:10:55 Voice over:
Afghanistan has known conflict and insecurity for more than 30 years.
The current war started after 9/11 when the United States and NATO launched a major military offensive against the Taliban and al Qaeda.
It has since become the most dangerous country for humanitarian workers, who’ve been attacked by armed opposition groups and criminal gangs, while international forces have raided medical clinics as well.
All this insecurity severely hinders humanitarian access. The ultimate victims are the civilians.
TC 01:11:28 Pierre Krähenbühl, Director of Operations, International Committee of the Red
Every single day we see people having to make very tough choices between the different sides. They will receive a night visit from an opposition group, the next day they will have to account towards the official Afghan forces or will have to give explanations to international forces. The civilians are really there caught up in these incredibly difficult circumstances.
TC 01:11:51 Reto Stocker, Head of Delegation, ICRC:
The conflict is one which is particularly strong in rural areas. Primary health care clinics, also secondary health care structures are a challenge. The staff do not feel safe to go and work in structures. Patients cannot or do not feel comfortable to go to health care structures.
I’ll give you an example. 2006, a couple of hundred roadside bombs. In 2010, there were 14,000.
TC 01:12:23 Kargar Norughli, spokesperson Ministry of Health, Afghanistan:
TC 01:12:25 Sometimes our doctors are kidnapped, killed or face political actions.
TC 01:12:30 That creates a problem for us.
TC 01:12:34Our doctors don’t want to go to the remote conflict areas of Afghanistan.
TC 01:12:39 MAP AFGHANISTAN
TC 01:12:40 Voice over:
One of the regions most affected by the war is Helmand Province in the south, the scene of much of the fighting between NATO, Afghan government forces and various armed opposition groups.
TC 01:12:52 Stefano Argenziano, Field Coordinator, MSF:
It is definitely one of the homelands together with Kandahar of the Taliban movement.
TC 01:13:03 Voice over:
In Lashkar Gah, the provincial capital, MSF supports Boost hospital. It is one of only two functional referral hospitals in all of southern Afghanistan.
TC 01:13:13 Stefano Argenziano, Field Coordinator, MSF:
The hospital where MSF is working is a weapon-free area where no armed person is allowed to enter unless they leave their weapons at the entrance in a weapons locker. This creates a place where people who are being traumatized by war can access health care without the presence of armed people around.
TC 01:13:38 Reto Stocker, Head of Delegation, ICRC:
Hospitals do not have any weapons carriers inside and provide thereby an environment where patients irrespective of their background feel fine and are entitled to receiving health care.
TC 01:13:54 Voice over:
Both MSF and the International Committee of the Red Cross or ICRC have a policy of barring all weapons from their hospitals. Through constant dialogue with all armed groups, they explain their humanitarian mandates and intentions.
TC 01:14:09 Stephan Goetghebuer, Head of Mission MSF:
On accepte de travailler dans une zone de guerre et on accepte de travailler en proximité avec la population qui est victime de cette guerre. C’est totalement illusoire d’imaginer que nous puissions être complètement exempt d’incidents de sécurité ou complètement épargné par la violence. C’est absurde. Mais par contre on peut dans le cas de ces négociations obtenir, et exiger peut-être, que si nous devenions une cible, ces gens nous informent.
We accept to work in war zones and with the victims of those wars.
It's an illusion to think that we can avoid security risks or be completely safe from violence.
But on the other hand, we can – in case of these negotiations -- obtain and perhaps demand that if we become a target, these people will notify us.
TC 01:14:42 Voice over:
As in every other country where they work, MSF team members follow strict internal security guidelines and respect the local culture. In Lashkar Gah, for instance, alcohol is strictly prohibited. But it is only one of the self-imposed restrictions.
TC 01:14:58 Stephan Goetghebuer, Head of Mission MSF:
On restreint les mouvements. On ne peut pas se promener en Afghanistan. On ne peut pas se promener à Kabul et dans les villes dans lesquelles on travaille. En général on se déplace de l’hôpital à la maison et de la maison à l’hôpital.
We limit our movements.
You can't go out for a walk in Afghanistan.
You can't out go for a walk in Kabul aor the other cities.
In general, we go from the hospital to the house and back.
TC 01:15:11 Voice over:
Outside their compound, female staff wear veils and travel separately from their male colleagues. These are small gestures, but honouring local cultures and traditions helps MSF and ICRC gain acceptance from the local population, which is a crucial factor for the teams’ security.
TC 01:15:31 Stefano Argenziano, Field Coordinator, MSF in car (radio).
TC 01:15:33 Radio Operator:
You are leaving?
TC 01:15:36 Stefano Argenziano, Field Coordinator, MSF in car (radio).
Yes, we are going out. We’ll be the first car, over.
TC 01:15:44 Stephan Goetghebuer, Head of Mission MSF:
Le danger est partout et principalement dans les mouvement, sur la route, avec ces explosions, ces bombardements.
Danger is everywhere. Especially on the road...
with all the explosions and bombings.
TC 01:15:54 Voice over:
To reduce risks, the team only leaves the compound twice a day: to go to the hospital and to return home.
TC 01:16:05 Stefano Argenziano, Field Coordinator, MSF:
Thinking about 100% guarantee of security in a context where a conflict is going on is just an illusion. MSF is negotiating the space to carry out its work, and having agreements to be present here, but I can offer no guarantee to my team that today or tomorrow a rocket will not be falling into our compound or in the hospital.
TC 01: 16:41 Voice over:
That same night, the armed opposition attacks the city.
The constant threat and tension cause extra psychological pressure for those working and living here.
TC 01: 16:53 Voice over:
Through dialogue with all the warring parties, MSF and ICRC seek to be recognised and accepted as truly neutral organisations. This is one of the key elements of their approach to security.
TC 01:17:07 Christopher Stokes, General Director, MSF:
In the hardest countries to work in you are seeing a kind of split and you’re seeing two schools basically in their approach to conflict. One school, which is still the one defended by MSF and ICRC and a few others, which is to negotiate your access, to negotiate your security, talk with both sides, that’s the best way to be able to ensure that you are going to be able to work, to explain your humanitarian purpose.
Then there is a second school, which seems to be more about a lower exposure, improving your protection, going for technical measures basically, rather than negotiating with both sides of the conflict.
So in some key wars in the last few years, you have seen that second school, the western aid actors following that second branch, only talking to one side in the conflict, usually the government or the forces supported by the west.
TC 01:17:59 Voice over:
Today, there are more than a hundred international organisations present in Afghanistan.
TC 01:18:04 Anne Garella, Director, Agency Coordinating Body for Afghan Relief
Un élément qui reste à travailler de manière collective au sein de cette communauté d’ONG, c’est l’accès négocié. Négocié auprès de toutes les parties en présence, auprès de tout les acteurs armés.
Je crois qu’on peut craindre qu’il reste énormément de besoins humanitaires qui ne sont pas aujourd’hui pris en considération par les ONG, non pas par manque de volonté, mais réellement par manque d’accès.
One issue that still needs to be addressed collectively within the NGOs is the negotiated access.
Access negotiated with all parties, with all armed actors.
There are still enormous humanitarian needs that the NGOs don’t take into consideration today. Not for lack of will, but really for lack of access.
TC 01:18:31 Voice over:
Only a few organisations negotiate their access with all the warring parties. Others move even farther away from the fundamental humanitarian principle of neutrality.
TC 01:18:43 Laurent Saillard, Head of European Commission Humanitarian Office : Afghanistan.
Some of them working closely with military actors and so on and so forth. I guess one of the most critical mistakes we did is not to talk to all the parties involved in the conflict.
TC 01:18:55 Christopher Stokes, General Director, MSF:
One of the things that has really changed in many of these environments is, if I compare to when I was working in Afghanistan in the mid nineties for example, 1996, 1997, until recently when I’ve gone back in the last few years, is that you have got a confusion or perfusion of actors on the ground, new people who have come into the environment, especially private companies.
TC 01:19:16 Voice over:
Private commercial firms are mostly contracted by the government of the United States and other Western countries. They operate like paramilitary outfits, travelling with armed escorts and living in fortified compounds.
The programmes they implement aim to win the hearts and minds of the population. And often, aid is provided only in return for strategic military information.
TC 01:19:40 Christopher Stokes, General Director, MSF:
The risk for aid agencies has increased because of this risk of confusion, because of the risk of confusion between private security companies and private companies and aid agencies.
TC 01:19:54 Voice over:
The coalition forces themselves have also been involved in delivering aid. But are their initiatives based on the real and most urgent needs of the population?
TC 01:20:04 Reto Stocker, Head of Delegation, ICRC:
A lot of actors working in Afghanistan and other conflict contexts do claim the word ‘humanitarian’ these days. Not all are.
It has to be however made very, very clear what is humanitarian, impartial for all those in need of services and what is rather more part and parcel of a strategy of winning hearts and minds which has very little to do with fundamental humanitarian principles.
TC 01:20:33 Pierre Krähenbühl, Director of Operations, ICRC:
As we saw in Afghanistan in certain cases, the collaboration of people, Afghans in different villages, where the army said: in exchange for information on our enemy and his whereabouts, you will receive humanitarian assistance. So, where humanitarian assistance becomes part of the counterinsurgency strategy. That makes the work of humanitarians very dangerous, because it associates it with political and military strategies. That’s where we see an absolute redline.
TC 01:21:02 Soldier:
We will be here, once in a week, and we can talk. You can tell me anything. What he needs to... maybe something important about the security of the village and the villagers.
TC 01:21:16 Jan Egeland, former U.N. Under-Secretary-General for Humanitarian
It can never be a strategic, political tool for any party to any conflict to use humanitarian relief. If and when humanitarian relief, food items, medical supplies are given in exchange for loyalty, for information, in exchange for political support, it’s wrong, it’s totally wrong. The humanitarian relief has to be given according to needs. If women, children, civilians have a need of humanitarian assistance, they should be given that without any conditions.
TC 01:21:53 Christopher Stokes, General Director, MSF:
When armed forces start building hospitals and clinics in a conflict, basically they are turning health care into a kind of battlefield. We have seen in Afghanistan for example, patients being threatened or targeted and warnings being given to those patients, saying do not go to this clinic or do not go to that hospital because it has been built or supported by NATO for example.
TC 01:22:14 Voice over:
MSF and ICRC strictly adhere to principles of independence and neutrality and bases its interventions on clearly identified needs only.
Since MSF started working in Boost hospital in 2009, the number of patients has risen from 30 to 400 or more every day, despite the high insecurity in the region.
TC 01:22:37 Jomar Staverløkk, Emergency Room nurse, MSF:
We definitely see patients that come very delayed to the emergency room because of security.
TC 01:22:45 Jomar Staverløkk, Emergency Room nurse, MSF:
It’s a 15 year old boy. He’s been having fevers for five months and bloody diarrhea, bloody stool. Since yesterday he started vomiting fresh blood so it’s obviously something wrong with the upper part of the intestines. We will take him to the wards for blood transfusion.
TC 01:23:08 Voice over:
An indirect consequence of war is that common medical conditions can become life threatening. Women and children pay the highest price.
TC 01:23:17 Pierre Krähenbühl, Director of Operations, ICRC:
We have numerous examples of babies being lost, because the checkpoint blocked for too long, delayed the passage and questions like that.
TC 01:23:26 Voice over:
Fatima, head of the midwifes, is assisting a woman whose baby was stillborn.
TC 01:23:32 Fatima Murad Ali, midwife, MSF:
They don’t want to come out at nighttime, because there are a lot of mines on the road. They don’t want to come.
There are a lot of police and other stations, so it’s not safe to come here.
TC 01:23:52 Voice over:
There are also many patients who are direct victims of warfare.
TC 01:23:57 Abdullahi Wallat:
TC 01:23:57 I can’t speak well.
TC 01:24:02 I only speak a little.
TC 01:24:06 I was shepherding.
TC 01:24:08 There were three sheep.
TC 01:24:11 Then the bullet hit me and I don’t remember anything.
TC 01:24:15 I don’t remember who took me or started the work on me.
TC 01:24:41 Voice over:
Many unexploded devices and land-mines lie scattered in the countryside, ambushing their victims in the most indiscriminate and cruel way.
TC 01:25:00 Georges Alain Behle, surgeon, MSF:
Il a vraiment beaucoup souffert. Maintenant il a perdu deux doigts.
A priori, il a marché sur une mine puisqu’il a perdu sa jambe.
Et toutes les autres lésions c’est les éclats de la même mine.
He really suffered tremendously.
He has lost two fingers.
Presumably, he stepped on a mine. As you can see, he has lost his leg.
All the other injuries are caused by that same mine.
TC 01:25:22 Georges Alain Behle, surgeon, MSF:
Ca fait toujours mal de voir des enfants souffrir de la sorte du conflit. Voir un enfant continuer sa vie avec un handicap majeure comme celui-ci. C’est toujours triste.
It's always hurts to see children suffer from conflicts in this way.
To see a child live with a major disability like this is always sad.
TC 01:25:46 Georges Alain Behle, surgeon, MSF:
OK. Ben, il va guérir. Ca va prendre du temps, ça va prendre quelques semaines, mais il va guérir. C’est l’essentiel.
He will get better.
It will take some time. A few weeks. But he will get better,
that is the main thing.
TC 01:26:03 Christopher Stokes, General Director, MSF:
I was in Lashkar Gah hospital in 2009 when we started. In the morning there were a few patients. In the afternoon the hospital was completely empty. Everybody went home the doctors went home as well. So, it wasn’t functioning as a hospital at all.
Patients come to Lashkar Gah hospital for two reasons now. One is that it has been demilitarised, there are no weapons inside the compound and no soldiers there, which before made them very unsafe, especially for women and children and families, they refused to go, and secondly, there are doctors and there are drugs.
TC 01:26:52 Voice over:
Some specialised treatments are not available in Lashkar Gah. Patients who need specific rehabilitation are referred to ICRC’s orthopaedic centre in Kabul.
TC 01:27:04 Reto Stocker, Head of Delegation, ICRC:
We treated 10,000s of mine victims, people having their legs, sometimes both of them ripped off by anti-personnel mines.
TC 01:27:14 Voice over:
The collaboration between the organizations ensures that patients can gain access to a greater number of urgently-needed medical services.
TC 01:27:22 Alberto Cairo, head of the ICRC orthopaedic programme in Afghanistan:
This gentleman comes from Lashkar Gah. There is no treatment for him there, unfortunately, no rehabilitation is possible. So he has to be moved to Kabul.
TC 01:27:33 Voice over:
Mohammed Nabi was just referred. His oldest son will now wash, feed and care for his paralysed father through many months of rehabilitation.
TC 01:27:43 Mohammed Nabi: (translated)
TC 01:27:43 The Americans came from their base and the Taliban from the other side.
TC 01:27:49 I was watering my land and I got caught in the crossfire.
TC 01:27:52 When the fighting started, I hid next to a wall.
TC 01:27:55 The rocket landed on the wall and it collapsed on me.
TC 01:28:01 I fell into the water.
TC 01:28:03 Three people pulled me out and brought me to the hospital.
TC 01:28:15 Voice over:
Alberto Cairo has run the orthopedic program in Afghanistan for over 20 years. With his team, he assists patients who have lost limbs due to land mines or suicide attacks or who have other disabilities.
TC 01:28:30 Alberto Cairo, head of the ICRC orthopaedic programme:
This is a prosthesis belongs to Mister 34.957. Now we have reached 100.000. It’s a big number.
TC 01:28:43 Alberto Cairo, head of the ICRC orthopaedic programme:
This is the place where people learn to walk again, to use the prosthesis. In some cases it’s very difficult. Especially for people with severe disability.
TC 01:29:01 Alberto Cairo, head of the ICRC orthopaedic programme:
I saw something wrong immediately. There is something there to correct immediately.
For some people like this gentleman with both legs amputated, this moment is very critical. I would say almost a dramatical moment because they understand that they can walk again but also that life will not be the same at all. Because to walk with prostheses sometimes is not easy at all. So it’s a difficult moment. Very important. We have to be a team, ready to support them psychologically and also with.. trying to make for them good legs.
They have to practice, walking up and down for hours until we are sure that the prosthesis is good, they can use it properly and then that it works.
TC 01:29:44 Reto Stocker, Head of Delegation, ICRC:
Everybody in peace times or in war is entitled to receiving health care. It’s a human right. Conflict, of course, makes access to health care extremely difficult.
Access will remain the single biggest challenge for humanitarian actors in Afghanistan. I think that’s clear now and I’m afraid it won’t change so rapidly.
TC 01:30:07 Alberto Cairo, head of the ICRC orthopaedic programme:
The situation is getting worse. It’s clear. Despite all the declarations, whatever the people are saying, no, the situation is not getting better.
TC 01:30:21 Voice over:
Another continent, another conflict.
The east of the Democratic Republic of Congo has been a conflict zone since the war and genocide in neighbouring Rwanda spilled over the border in 1994. More than two million Hutus fled into Eastern Congo. Among them were the militia groups responsible for the genocide. This plunged the country into the deadliest conflict since World War II, one characterised by numerous armed groups, many of which are supported by neighbouring countries.
TC 01: 30:53 Meinie Nicolai, President, MSF:
All kind of militias have been created. The formal army is implicated. There is a UN peacekeeping force. And all the different militias broke up in different parts; and in fact the driving force for the conflict today is more into gain control over the natural resources of Eastern Congo.
TC 01:31:12 Stéphane Hauser, Field Coordinator, MSF:
C’est une situation très particulière avec pas mal d’acteurs de différents groupes armés dispersés en brousse et qui ont leur propres interactions, donc c’est assez difficile de cerner ce qu’ils vont faire prochainement, quelles vont être leur prochaines interactions vis-à-vis les uns des autres vu que c’est très, très mouvant en fonction des circonstances.
This is a very unique situation.
Many armed groups are dispersed in the bush and interact in specific ways.
It's pretty hard to figure out what they will do next.
Or how they will interact. The situation depends on the circumstances.
TC 01:31:32 Eliane Duthoit, Head of Office for the U.N. Coordination of Humanitarian Affairs, D.R.C.:
Je compare cela souvent à différents feux dans une forêt que nous éteignons les uns après les autres mais dès qu’il y a un souffle de vent tout repart et on recommence.
I compare this to a series of forest fires. We put them out one by one, but as the wind picks up, it starts all over again.
TC 01:31:43 Soldier:
Objectif atteint !
TC 01:31:44 Meinie Nicolai, President, MSF:
It’s one of the longest during humanitarian crisis in the world. It’s the largest African war, and I don’t think people have understood that.
TC 01:31:52 Antoine Grand, Head of Goma Subdelegation, ICRC:
Ca fait une dizaine d’années que je travaille dans l’humanitaire. Je n’ai jamais vu une population civile qui souffrait autant qu’ici.
I've been working in humanitarian aid for about 10 years. I've never seen a civilian population suffer as we see here.
TC 01:31:58 Stéphane Hauser, Field Coordinator, MSF:
La population en a ras-le-bol de toute cette violence , la population en a marre de toutes ces années de conflits, ces guerres, etc.. donc les gens n’aspirent qu’à une chose, ils n’aspirent qu’à la paix.
The population has had it with the violence.
They are tired of the war.
The people only want one thing... peace.
TC 01:32:09 MAP CONGO
TC 01:32:11 Voice over:
More than five million people are believed to have died since the war started, mostly from starvation and disease. Worst affected are the Kivu provinces in the east.
Here, the government -in theory at least- is responsible for providing health care to its population.
TC 01:32:32 Julien Muhima-Mikiki, Deputy Head of Loashi Health Center:
La table ne fonctionne pas, puisque la table est en panne. La table d’accouchement est en panne.
The table doesn't work. The delivery table is broken.
TC 01:32:39 Voice over:
The clinics run by the Ministry of Health face major problems.
TC 01:32:49 Julien Muhima-Mikiki, Deputy Head of Loashi Health Center:
Aujourd’hui nous n’avons qu’un seul patient. Comme aujourd’hui nous avons un problème de recouvrement de coûts. Les patients n’arrivent pas puisqu’il y a recouvrement des coûts. Ils se dirigent vers Masisi là où il y a la gratuité.
Today, we have only one patient.
We have a cost recovery problem right now.
Patients are not coming in, because they will have to pay.
So they go to Masisi where it's free.
TC 01:33:05 Dominique K. Baabo, M.D., Head of Provincial Health Division, North Kivu:
C’est sur base du recouvrement des coûts , des recettes faites que la structure doit payer, les primes de personnel , se réapprovisionner en médicaments et assurer l’entretien de l’infrastructure. On n’as pas assez de ressources et parce qu’on n’a pas assez de ressources on ne se réapprovisionne pas. Et parce qu’on n’a pas des entrants, les malades ne viennent pas et parce que les malades ne viennent pas on n’a pas de ressources. Donc ça devient un cercle infernal et on ne sait pas comment s’en sortir donc le système de santé n’étant pas subventionné , n’a pas de possibilités d’offrir, de faciliter l’accès aux soins à ces populations.
It’s through cost recovery or generated income, that the facility can pay its employees, restock its drug supplies and cover the maintenance costs.
We don't have sufficient resources, so we can’t resupply our stocks. Therefore, patients don't come in and we don't have resources.
It’s a vicious circle that we can’t break out of. The health system isn't subsidized.
It can't provide access to medical care for these populations.
TC 01:33:42 Voice over:
This lack of free, quality health care has dire consequences.
TC 01:33:52 Radio operator:
Il y a une urgence qu’il faut transporter toute de suite. A toi.
We have an emergency that needs immediate transport. Over.
TC 01:33:57 Stéphane Hauser, Field Coordinator, MSF:
Oui, on va venir la chercher, à toi!
We will come and get her. Over.
TC 01:34:00 Radio operator:
TC 01:34:01 Voice over:
Every day, MSF teams penetrate deep inside the province, often crossing the front-lines. They provide medical care on site but transport urgent cases back to Masisi hospital. There, as in all MSF-run structures, health care is provided free of charge.
TC 01:34:21 Silvia Dallatomasina, surgeon, MSF:
Ils n’avaient pas les moyens pour arriver à l’hôpital avant et ils arrivent ici déjà très compromis avec des ulcers qui sont vraiment difficiles à traiter, avec des masses gigantesques qui n’ont jamais été vu par des médecins. Et aussi on a des patients avec des blessures très anciennes. Ils arrivent avec des blessures infectées qui ont besoin d’intervention chirurgicale pour nettoyer la plaie et éviter des infections très compliquées.
They don't have the money to come to the hospital sooner.
When they arrive their health is already compromised. Ulcers that are difficult to treat... Huge masses that doctors have never seen before. We also have patients with very old wounds. They arrive with infected wounds that require surgery to clean and to prevent further complicated infections.
TC 01:35:03 Voice over:
Following an upsurge in fighting, MSF began assisting Masisi hospital in mid-2007.
The hospital has seen a rapid increase in patients. Recognised as a neutral place, it is filled with patients from different ethnic groups and even from numerous warring factions.
Critical services on offer include surgery for war-related trauma and care for victims of sexual violence.
TC 01:35:45 Rafiki Ntirivamundi:
TC 01:35:45 I sold boots with my colleagues. We went to Katoyi market and sold a lot.
TC 01:35:49 When it was time to come back, my colleagues and I were talking.
There were three of us and I was in the middle.
TC 01:35:52 That's when we heard a soldier. When he heard us, he hid himself.
TC 01:35:57 The firing started and I saw that my leg was completely shattered.
TC 01:36:03 I looked and saw him come out of his hiding place.
TC 01:36:12 He came and took my money pouch. It was the money I had earned that day.
TC 01:36:17 Silvia Dallatomasina, surgeon, MSF:
Des blessés par balles, ça se passe plus ou moins toutes les semaines.
Every week, we see people with bullet wounds.
TC 01:36:27 Silvia Dallatomasina, surgeon, MSF:
De toutes les missions que j’ai faites, ici au fait c’est le contexte le plus difficile au niveau professionnel que j’ai affronté, parce que au fait ce n’est pas facile de recevoir les patients et pour soigner les patients jusqu’à la fin.
Of all of my missions, this is the most difficult professional setting.
It is not easy to get the patients here and care for them until they recover.
TC 01:36:40 Voice over:
Once discharged from hospital, many patients never return for follow-up. Road conditions are too bad, insecurity is too widespread.
TC 01:36:52 Ahmed Tijany Dem, Medical Coordinator, MSF:
Les gens ont peur d’être pris en tenaille entre les combats. Il y a des factions qui sont là en train de se rebeller, il y a d’autres aussi qui sont là en train de se défendre, donc la population est prise entre les deux feux.
People are scared to get caught up in the fights.
There are factions, some rebelling, others defending...
People are caught in the cross fire.
TC 01:37: 07 Voice over:
In North Kivu, the presence of rebel factions, the national army and UN blue helmets is a lethal combination. Complex and dangerous not only for the population but also for humanitarian agencies.
TC 01:37:22 Fidèle Sarassoro, Deputy Special Representative of the Secretary General,
United Nations Stabilization Mission, Democratic Republic of the Congo:
Souvent il y a des conflits, des opérations militaires, des groupes armés qui constituent des menaces pour l’accessibilité des humanitaires , les humanitaires eux-mêmes par moment sont l’objet d’attaques de ces groupes armés.
There are often conflicts. Military operations and armed groups threaten the access of humanitarian aid workers. But the workers themselves are also targeted by the groups.
TC 01:37:38 Meinie Nicolai, President, MSF:
And it has happened. I mean, we have been fired on by the regular army during a vaccination campaign. It upset us a lot. We were used as bait in fact, because the army, with support of the UN peacekeeping forces, where trying to wipe out one of the groups, where we were vaccinating. And while our teams were vaccinating, the army opened fire.
TC 01:38:00 Voice over:
Such incidents can reveal the real limits of trying to negotiate access with all parties. Nevertheless, it still remains essential to the humanitarian approach in conflict zones worldwide.
TC 01:38:13 Jan Egeland, former U.N. Under-Secretary-General for Humanitarian
I remember as very young relief worker there was a veteran relief worker who told me that “of course you have to negotiate with the Devil if you are seeking access to the depths of Hell”. That’s what we have to do in certain situations, and we have to be allowed to do that.
TC 01:38:32 Pierre Krähenbühl, Director of Operations, ICRC:
Being in dialogue with all of the parties doesn’t mean that you have full guarantees in security terms, neither does it mean that you have guarantees of access. But because that dialogue is, in a way, the ICRC’s only weapon, well, that’s the method that we use to engage, to try and convince of our good faith, of the way in which we work to generate trust so that the access increases over time.
TC 01:38:59 Voice over:
Not all relief organisations have the same approach. Some NGO’s and often the United Nations’ agencies use military escorts when delivering their aid.
TC 01:39:09 Fidèle Sarassoro, Deputy Special Representative of the U.N. Secretary General:
Si du fait de cette escorte on a un plus grand accès à ces populations et une capacité de les assister d’une façon plus efficace, il n’y a aucun doute qu’il faut avoir accès, qu’il faut les utiliser.
If these escorts mean having greater access to the population and provide more assistance, then we must use them.
TC 01:39:23 Stéphane Hauser, Field Coordinator, MSF:
C’est une aberration totale du rôle des humanitaires et à partir de là, il ne faut pas s’étonner si les humanitaires se font shooter à droite ou à gauche, parce qu’il y a confusion maximum.
Avec ce petit T-shirt MSF qui ne mesure même pas 1 mm d’épaisseur je me sens plus en sécurité qu’avec un gilet pare-balles.
That is a total distortion of the role of humanitarian aid workers.
Humanitarians will be shot at, because there is a total confusion.
I feel safer wearing this little MSF T-shirt, than a bulletproof vest.
TC 01:39:45 Voice over:
The United Nations’ mission in Congo blends political, military and humanitarian roles.
TC 01:39:51 Meinie Nicolai, President, MSF:
For us, the UN having it next to us, with these confusing mandates, is problematic. We want to remain independent, being able to work with all sides in the conflict.
TC 01:40:04 Eliane Duthoit, Head of Office for the U.N. Coordination of Humanitarian Affairs, D.R.C.:
Il y a des ONG, des organisations non gouvernementales internationales, qui ont leur propre système de fonctionnement et qui ne souhaitent pas adhérer -pour des questions de mandats- qui ne souhaitent pas faire partie intégrante du travail fait avec les Nations Unies.
There are certain NGOs that have their own way of operating.
For reasons of mandate they are not interested in being seen as part or the United Nations.
TC 01:40:22 Meinie Nicolai, President, MSF:
I think the United Nations often will choose for the political ambition first. And military action in general follows a political choice. And then the humanitarian objectives follow after that.
TC 01:40:36 Eliane Duthoit, Head of Office for the U.N. Coordination of Humanitarian Affairs, D.R.C.:
Nous devons faire extrêmement attention à ne pas être aspirés par des raisons politiques qui nous sembleraient plus importantes que nos principes.
We have to be careful not to choose political arguments over our principles.
TC 01:40:57 Voice over:
A large part of the population was forced to flee their homes to escape the violence. They seek refuge in displacement camps throughout the region.
TC 01:41:02 Meinie Nicolai, President, MSF:
The population generally is in survival mode, being on the move, being on top of that looted, raped, and pushed out from their houses and their villages.
TC 01:41:14 Eliane Duthoit, Head of Office for the U.N. Coordination of Humanitarian Affairs, D.R.C.:
Il y a des mouvements qu’on peut appeler pendulaires, c’est-à-dire que certaines personnes qui ont été déplacées pendant une certaine période reviennent chez elles, jusqu’à ce que malheureusement il y a un autre groupé armé qui pour des raisons diverses et variées viennent les chasser. Donc on a globalement toujours un groupe à peu prêt de 1.500.000-1.700.000 personnes qui sont en mouvement.
Some population movements can be described as a pendulum.
People who were displaced for a certain period of time return home.
Until they are driven out again by other armed groups for various reasons.
There are about 1,500,000 – 1,700,000 people who are always on the move.
TC 01:41:44 Voice over:
The vast majority of these displaced people are in camps in the two Kivu provinces.
TC 01:41:59 Voice over:
Several times a week, MSF organises medical consultations.
TC 01:42:05 Edoardo Fanti, medical doctor, MSF:
Dans l’équipe de cliniques mobiles, on fait des consultations curatives, on fait la consultation prénatale pour les femmes enceintes et on fait les consultations en soutien pour les femmes victimes de violences sexuelles, on donne aussi les traitements.
The mobile clinic provides treatment, prenatal consultations for pregnant women and consultations to support women who are victims of sexual violence.
TC 01:42:21 Voice over:
No other form of health care is available to the camp population.
In one year, over half of the more than 40.000 medical consultations MSF provides are for children under five years of age who are suffering from basic illnesses - bronchitis, parasite infections, diarrhoea, malnutrition.
There are many pregnant women as well.
TC 01:42:50 Edoardo Fanti, medical doctor, MSF:
C’est une femme qui est en travail, qui ne peut pas accoucher ici parce qu’elle a des problèmes. C’est depuis la nuit qu’elle n’arrive pas à accoucher alors on va la transporter à l’hôpital.
La force de faire des cliniques mobiles c’est aussi d’avoir des voitures, donc s’il y a des cas qui nécessitent d’être référés à l’hôpital on peut les transporter.
This woman is in labor, but cannot deliver due to problems.
She hasn't been able to deliver since last night. So we bring her the hospital.
Being able to send out mobile clinics, also means having vehicles. If people need a hospital, we can take them.
TC 01:43:11 Voice over:
The number of Congolese women who die during delivery is alarming.
Because hospitals are so far away, women who need surgical care often die on the road.
To assist, MSF developed a unique project inside Masisi hospital.
TC 01:43:21 SIGN: “VILLAGE D’ACCEUIL” (Welcome Village)
TC 01:43:27 Stéphane Hauser, Field Coordinator, MSF:
Il y a beaucoup de cas de grossesses compliquées qu’on peut trouver sur le territoire. Les mamans sont référées au village d’accueil de l’hôpital de Masisi . Elles vont rester quelques jours voir quelques semaines dans ce village d’accueil avant l’accouchement et là elles sont prises en charge par MSF pour faire toutes les analyses nécessaires, pour voir quel est le problème et assurer une grossesse la plus facile possible.
There are many complicated pregnancies here.
The mothers are referred to the welcome village at Masisi hospital.
They stay for a few days or weeks before giving birth. MSF performs all the necessary tests to determine the problem and ensure that the pregnancy goes as smoothly as possible.
TC 01:43:52 Agathe Farini Sena, facilitator MSF Women’s Village, Masisi:
Maintenant nous avons 49 personnes ici, 49 femmes enceintes. Mais le mois passé elles étaient nombreuses. Elles étaient au delà de 50, 60. 58.
Now, there are 49 pregnant women here. But last month, we had a lot. The numbers were around 50, 60.
TC 01:44:08 Agathe Farini Sena, facilitator MSF Women’s Village, Masisi:
A part nos femmes enceintes, on héberge aussi des femmes victimes de viol. Elles restent ici pendant la durée de leurs soins.
We also have rape victims here. They stay here during their treatment.
TC 01:44:16 Voice over:
Rape and gang rapes have a devastating impact in this conflict.
TC 01:41:22 Meinie Nicolai, President, MSF:
In Eastern Congo, the number of women raped is amongst the highest in the world, if not the highest. Rape is used as a weapon of war. Women are raped by different groups. Women have been raped in front of their children, in front of their husbands, and so on.
TC 01:45:13 Agathe Farini Sena, facilitator MSF Women’s Village, Masisi:
C’est une fille de 14 ans victime de viol. Il parait qu’il y avait un camp de militaires, là au sommet de leur village. Et puis, sa maman l’a envoyé puiser de l’eau à la rivière. Maintenant, quand elle puisait de l’eau, c’est à ce moment là qu’on la violée.
C’est aujourd’hui qu’elle vient de mettre au monde un garçon.
This is 14 year-old girl . She is a rape victim.
There was a soldiers camp above their village.
Her mother sent her to fetch water from the river.
When she was fetching water, she was raped.
Today she gave birth to a baby boy.
TC 01:45:43 Meinie Nicolai, President, MSF:
We see different victims in our clinic, different types of rape, not only by armed people, it’s not only militia who rape, but the fact that there are so many weapons has definitely an effect on the women and their safety.
TC 01:45:57 Dominique K. Baabo, M.D., Head of Provincial Health Division, North Kivu:
Il faut dire de manière claire que souvent c’est des militaires qui sont impliqués et également tout ces groupes armés, rebelles, je ne sais pas comment les qualifier, mais de manière générale, c’est ces groupes là qui sont cité en premier lieu comme auteur de violences sexuelles. Mais au-delà de ça, il faut le dire peut- être qu’aujourd’hui on parle de plus en plus de violences sexuelles mais les violences sexuelles ont toujours existé.
It should be said that often it’s the soldiers who are involved. But also the armed groups, the rebels, or how should I describe them.
These are the primary groups involved in sexual violence.
Today we talk more about sexual violence. But it has always existed.
TC 01:46:23 Voice over:
Many perpetrators are angry that their victims receive medical certificates that could be used against them in court.
TC 01:46:42 Stéphane Hauser, Field Coordinator, MSF:
Même au niveau du staff de MSF à Masisi, là aussi la responsable de ce volet violences sexuelles à l’hôpital, oui, elle a déjà reçu des menaces et il y a beaucoup de pressions qui pèsent sur elle .
Even among the MSF staff in Masisi, the person responsable for the sexual violence program at the hospital has been threatened and is under a lot of pressure.
TC 01:46:45 Dominique K. Baabo, M.D., Head of Provincial Health Division, North Kivu:
De manière générale, je peux quand-même dire que ce sont des cas suffisamment isolés et nous pouvons dire à ce jour sans peur de nous tromper qu’il n’y a pas eu de cas de pertes de vies humaines de quelqu’un ou d’un infirmier qui aurait été agressé dans sa structure, qui est décédé du fait qu’il était là juste pour soigner les malades.
I can state that these cases are fairly isolated. Up to now, no lives have been lost. No nurse has been attacked at the workplace. No one has died for treating patients.
TC 01:47:04 Agathe Farini Sena, facilitator MSF Women’s Village, Masisi:
Cela ne peut pas m’empêcher de bien travailler. Moi je dois travailler pour.. Je dois me donner à mes femmes.
That can't prevent me from doing my job properly. I have to dedicate myself to my women.
TC 01:47:40 Voice over:
Several hours drive to the south-east lies Goma, the capital of North Kivu province, and an epicentre of unrest and fighting over the past two decades.
In the chaos and panic, countless children have been separated from their families.
TC 01:47:57 Prosper Sebuhire, Senior Field Officer, ICRC:
Il y a eu pas mal de mouvements de population, surtout depuis l’exode ruandais en 1994.
There have been considerable population movements. Particularly since the Rwandan exodus in 1994.
TC 01:48:04 Voice over:
These traumatic separations continue to this day. The ICRC set up a program to trace lost children and reunite them with their families.
TC 01: 48:22 Antoine Grand, Head of Goma Subdelegation, ICRC:
Ca peuvent être des enfants qui ont été séparé de leurs parents lors d’un déplacement de population, lors d’une attaque sur un village, un pillage; soit des enfants soldats, qui ont été recrutés, qui ont été démobilisés qu’on doit aller réunifier avec leur parents. Avec là aussi toute la difficulté parfois de réinsérer ces enfants dans une communauté.
Children got separated during a population displacement, during an attack or pillaging of a village. Or child soldiers who were recruited and demobilized. They must be reunited with their parents. Sometimes there are problems with the reintegration of these children.
TC 01:48:41 Voice over:
Tracing a lost child or family member is painstaking work in such an insecure region, but ultimately very rewarding.
TC 01:48:55 Prosper Sebuhire, Senior Field Officer, ICRC:
C’est une séance de réunification familiale d’un enfant qu’on a retrouvé au fait. Puisque l’enfant était recherché par la maman. La maman s’est présentée à nos services et aujourd’hui, voilà, on a ramené la maman ici pour une réunification familiale.
C’est une joie énorme. C’est comme redonner de l’espoir à des gens qui n’en avaient plus. Parce que avec la séparation, c’était déjà une vie en fait terminée.
This is a reunion involving a child we traced.
The mother had been looking for the child. She came to our offices and today we can reunite her with her child.
This is a tremendous joy.
It's giving back hope to people who no longer had any. With the separation it was as if a life had ended.
TC 01:49:35 Pierre Krähenbühl, Director of Operations, ICRC:
The importance of the re-establishment of family links is very crucial because I think any family around the world can instantly identify with what it means to be separated from a relative: child, mother, husband.
I think the emotions around that level, that activity, are huge and we consider it as a very fundamental part of our work.
TC 01:49:56 David Michalsky, Operational Coordinator, MSF:
We are in high-risk places because there are a lot of needs. We are not just there because it’s high risk. We are not cowboys.
We have learnt a tremendous amount on how to manage high-risk situations, how to mitigate the risk of these sort of things.
TC 01:50:12 David Michalsky, Operational Coordinator, MSF:
In the Dadaab camp we reduced the staff substantially within 24 hours, because we thought the risk was still very high there. However, we did not evacuate people from Mogadishu at that point or from Guri-el. Because, we looked at the situation and we
decided that it was a completely different set of risks.
TC 01: 50:33 MAP SOMALIA
TC 01:50:35 Voice over:
Somalia is the poster boy for failed states. The country has experienced almost constant conflict since the collapse of its central government in 1991.
After years of fighting between rival warlords, failed foreign interventions, droughts and major famine most of its territory -bar Mogadishu, the capital- is controlled by the islamist Al-Shabaab militants.
TC 01:50:59 Yves Van Loo, Communication Delegate, ICRC:
La Somalie, c’est une situation de conflit quasi in-interrompu depuis 20 ans, avec très très peu d’accalmies entre les différents combats. En 20 ans, le pays a considérablement regressé, dans tout les domaines.
Somalia, it’s a situation of continuous conflict since 20 years.
There have been very few calm periods.
Over those 20 years, the country has taken huge steps backwards.
TC 01:51:13 Mohammed Kalil Filanwa, Coordinator Operational Relations, MSF:
The situation in Somalia today, especially South and Central Somalia, is unpredictable. There are a lot of warring parties in many different regions that are fighting in the country.
TC 01:51:31 Voice over:
Years of violence and lawlessness have left the country in ruins. Coping mechanisms of traditional Somali clans are exhausted.
TC 01:51:41 Christopher Stokes, General Director, MSF:
What’s clear is that, for the population anyway, seeking any kind of safe secure life with health care inside of Somalia has practically become impossible, and that’s why you have seen a huge amount of Somalis leave the country.
TC 01: 51:56 Voice over:
Survival is only possible through outside assistance provided by the Somali diaspora and by international aid organisations. Or by the use of guns to fight over resources - whatever that resource may be.
TC 01:52:10 David Michalsky, Operational Coordinator, MSF:
Kidnapping is a huge industry now, it has always been there in Somalia, but not to the extent it is now. Between 6 and 700 foreigners are being held hostage for ransom in Somalia right now. It’s a huge, huge industry.
TC 01:52:25 Rolf Helmrich, retired Security Officer, United Nations:
The amount of ransom being asked these days could reach by now one million, one million US.
TC 01:52:32 Voice over:
MSF coordinator Kalil travels from Kenya to one of the projects inside Somalia. Due to the major kidnapping risk, the project is run by regional staff of Somali origin.
TC 01:52:44 Mohammed Kalil Filanwa, Coordinator Operational Relations, MSF:
There is no law and order in the region. There is no police. There is no military from the community.
TC 01:52:51 Voice over:
MSF only sends international staff to a limited number of locations inside Somalia.
TC 01:52:56 Mohammed Kalil Filanwa, Coordinator Operational Relations, MSF:
Now we are in Guri-el airstrip, on which we landed now, and we are meeting our team. The community, what they are telling us is “the only way that we can protect you is to give you this number of guards to make sure that you are safe.”
TC 01:53:13 Rolf Helmrich, retired Security Officer, United Nations:
I don’t think it is advisable to work without armed guards. You have to have your protection, because if you leave your compound as an international, you become a prey.
TC 01:53:28 Mohammed Kalil Filanwa, Coordinator Operational Relations, MSF:
Always the escort goes in front of us.
TC 01:53:32 Yves Van Loo, Communication Delegate, ICRC:
Sans ces gardes du corps nous n’aurions pas accès. On serait un petit peu comme un pompier qui rentrerait dans une maison et qui resterait brulé à l’intérieur.
Without these guards, we wouldn't have access.
We'd be like fire fighters entering a house and getting burned inside.
TC 01:53:40 Voice over:
Since the civil war began, aid organisations including MSF and ICRC have protected themselves with armed guards. For both agencies, Somalia is the rare exception to the rule they apply in other conflicts worldwide.
TC 01:53:56 Pierre Krähenbühl, Director of Operations,ICRC:
It’s a big dilemma, but we feel in the Somali context, in view of all the needs and the risks otherwise, it is for the moment the only way of implementing those programs.
TC 01:54:06 Jerome Oberreit, Director of Operations, MSF:
When you look at Afghanistan today, if we were working in Helmand with a protection of the coalition forces, we would clearly be seen by the Taliban or by the opposition groups, any armed opposition groups, as being part of the provision of the coalition to rebuild Afghanistan.
Now, when we’re being protected in Somalia by an amalgamation of different elders groups that form the community we’re clearly seen as actually having individuals that are there to protect the assets and the individuals. We’re not seen as actually having individuals that are protecting some kind of political agenda, some kind of reconstruction agenda for the benefit of one armed group as opposed to another.
TC 01:54:55 Voice over:
But even this protection system never fully guarantees safety. For more than ten years, Somalia has ranked in the top three countries for security incidents against humanitarian workers.
TC 01:55:10 Mohammed Kalil Filanwa, Coordinator Operational Relations, MSF:
We can say (for) the international staff, the risk is kidnapping. But for the Somali ethnic Kenyans, the risk is to be killed. Because there is a feeling that they are the right hand, that they are -how can I say- collaborators and all that kind of things. So they also have their own risk. So in that case, they are doing their job with very very low visibility of MSF. They don’t take MSF vests, they don’t take handsets, they don’t anything that’s showing that they are different than the locals that are on the ground.
TC 01:55:39 Jerome Oberreit, Director of Operations, MSF:
It is really the most extreme environment and where we do have to make a lot of compromises in order to be able to remain on the ground, and to provide the care that is simply not existing there.
TC 01:55:50 Voice over:
The insecurity and the lack of food, water and medical care mean nearly one million Somalis have fled to neighbouring countries, and some 1.5 million huddle in makeshift camps in major cities or towns like Guri-el. MSF is the only international organisation in this region, providing medical and nutritional care.
TC 01:56:27 Unnamed man:
The first procedure is to weigh her and see if she has increased any weight.
We can see that she has increased the weight.
She has been here for seven weeks and is due for discharge in the coming weeks. Now we are going to do the appetite test. To see if she can take the plumpy’nut and be seen by a doctor.
Then she can probably proceed home.
TC 01:56:54 Voice over:
But going home, for those who have lost everything, means continuing to endure camp life and struggling to survive.
TC 01:57:02 Casha Mahamed Geele:
TC 01:57:02 I ran away from Mogadishu because of Al-Shabab fighting.
TC 01:57:06 I left Mogadishu in December 2006.
TC 01:57:12 I came all the way to Bal-Ad on foot, clutching my children in my arms.
TC 01:57:21 Then a car picked us up and dropped us here.
TC 01:57:30 Thank God, as you can see we are still alive in this camp.
TC 01:57:34 There is a lot of hunger in the camp.
TC 01:57:38 My family is hungry. My husband and I have no job. We have 10 children,
TC 01:57:47 so we depend on the camp.
TC 01:58:01 Yves Van Loo, Communication Delegate, ICRC:
La population elle souffre bien entendu. Elle est retournée à un système de support plutôt au niveau clanique ou au niveau familial. Elle est fatiguée. Elle essaye malgré tout de survivre à cette situation.
The population is suffering.
It has returned to a support system that is clan based.
People are tired, but are trying to survive.
TC 01:58:17 Jerome Oberreit, Director of Operations, MSF:
There’s a huge frustration in terms of how to do more, how to deploy more. We have the resources, we have to a certain extend the knowhow. But it’s just a complication, of security and so on, it just keeps the activities very limited at the end of the day, compared to the needs. And that is very frustrating.
TC 01:58:37 Voice over:
Not far from the camps, MSF runs Guri-el hospital. Once, more than 15 international staff were based here. But they had to be withdrawn due to security threats.
Somalis employed and trained by MSF now run the hospital.
It is a rare haven of peace in a country where weapons and violence abound, and medical care is scarce.
TC 01:59:10 Abdirahman Hussein Osoble, Medical Doctor, MSF:
Here is the paediatric ward. It’s full every day.
The majority are malnutrition cases.
Nowadays, we have cases of measles. There are also infectious diseases as diarrhea. Watery and bloody diarrhea.
We also have cases of lower respiratory tract infections, gastroenteritis. And malaria.
TC 01:59:45 Abdirahman Hussein Osoble, Medical Doctor, MSF:
We have five isolation tents here. Two of them are used for isolation cases of diarrhea. Two other tents are used for cases of measles.
TC 02:00:01 Abdisalan Mohamed Maalin, Paediatrician, MSF:
Measles, whooping cough, malnutrition, ... These are all conditions that could have not have a reason if there was a good structure of health care in Somalia.
TC 02:00:11 Abdirahman Hussein Osoble, Medical Doctor, MSF:
Here are six children with measles.
TC 02:00:16 Voice over:
Because of the collapse of the healthcare system, a large proportion of the population has not been vaccinated against measles and other diseases. The deadly combination of acute malnutrition and measles is the main child-killer in Somalia.
TC 02:01:31 Yves Van Loo, Communication Delegate, ICRC:
La grosse difficulté pour les populations, c’est l’accès à un médecin. Il y a très très peu de médecins dans le pays.
The huge problem is that there are very few doctors in this country.
TC 02:00:36 Abdirahman Hussein Osoble, Medical Doctor, MSF:
You can’t find a doctor here.
It’s far away.
You can’t find a doctor for 150 kilometers. Except here.
The only doctor is in Guri-el.
TC 02:00:58 David Michalsky, Operational Coordinator, MSF:
Because of these constraints that we have we also have to adapt and some of those things have been very good. The very first tele-medicine project was started in Somalia because we didn’t have an experienced paediatrician in our project in Guri-el.
TC 02:01:15 Abdirahman Hussein Osoble, Medical Doctor, MSF:
This child is 8 months old. His skin is burned by boiled water.
I planned to discuss it yesterday on telemedicine. The doctor of telemedicine requested a hemoglobin test.
The child is getting better.
TC 02:01:39 Abdirahman Hussein Osoble, Medical Doctor, MSF:
Hello doctor, I’m going to do the set-up. I will call you back afterwards through telemedicine.
TC 02:01:48 Voice over:
Telemedicine allows a specialised paediatrician in Nairobi to follow the medical consultations of his Somali colleague some 1300 kilometers away, and to provide expert advice on treatment.
TC 02:01:59 Abdirahman Hussein Osoble, Medical Doctor, MSF:
This is the camera and the monitor.
It’s connected now.
The remote doctor is online now.
TC 02:02:12 Abdisalan Mohamed Maalin, Paediatrician, MSF:
TC 02: 02:13 Abdirahman Hussein Osoble, Medical Doctor, MSF:
Yes, Dr Abdi. I’m Osoble.
TC 02: 02:15 Abdisalan Mohamed Maalin, Paediatrician, MSF:
You can bring in the patients now?
TC 02: 02:24 Abdirahman Hussein Osoble, Medical Doctor, MSF
This is the patient. Can you see the patient?
TC 02: 02:25 Abdisalan Mohamed Maalin, Paediatrician, MSF:
Yes, I can see the patient very well.
TC 02: 02:26 Abdirahman Hussein Osoble, Medical Doctor, MSF:
TC 02: 02:28 Abdisalan Mohamed Maalin, Paediatrician, MSF:
Acute malnutrition, okay.
TC 02: 02:31 Abdirahman Hussein Osoble, Medical Doctor, MSF
And this is a snake bite.
TC 02:02:35 Abdisalan Mohamed Maalin, Paediatrician, MSF:
OK. When was she bitten? When did that happen?
TC 02: 02:37 Abdirahman Hussein Osoble, Medical Doctor, MSF
Three days ago.
TC 02: 02:38 Abdisalan Mohamed Maalin, Paediatrician, MSF:
Three days ago. OK. You know that whenever a snake bites you, there is an area.. there is a lot of inflammation. You can put on the inflammation. Make sure you give good pain-killing. Pain is a big issue in children.
TC 02: 02:49 Abdirahman Hussein Osoble, Medical Doctor, MSF
TC 02:02:50 Abdisalan Mohamed Maalin, Paediatrician, MSF:
The reason for coming to the hospital is a snake bite, but of course the malnutrition was also discovered. While malnutrition is not the reason why they bring them to the hospital, normally when you check them, almost all of them are malnourished. If not severely, then they are moderately malnourished.
TC 02:03:04 Voice over:
The doctors also see extremely dangerous tropical diseases common to this region.
TC 02:03:09 Abdirahman Hussein Osoble, Medical Doctor, MSF
Doctor, this is a kala-azar patient.
TC 02:03:14 Abdisalan Mohamed Maalin, Paediatrician, MSF:
Kala-azar basically is a disease that is transmitted by the sand-fly. This is a disease that, if not treated, basically is fatal. It’s fatal. It can cause death.
TC 02:03:23 Abdirahman Hussein Osoble, Medical Doctor, MSF
The father of the child thinks there is a problem with the uvula. You know this?
TC 02:03:29 Abdisalan Mohamed Maalin, Paediatrician, MSF:
Yes, but try to discourage the father from to go and cut the uvula. The father basically what he is planning to do is what we call uvulectomy. He wants to cut the uvula that is in the mouth, saying ‘you know, my child is coughing because of that’. So, what will happen most of the times, we have seen is that: This child will be OK. They will go with the child home. Or sometimes even abscond the treatment. Do that. And bring back the child now in a very bad state. So, as a doctor who’s on the ground, then he has to do a lot of education. Yes, next patient please.
TC 02:04:04 Abdisalan Mohamed Maalin, Paediatrician, MSF:
I’m a paediatrician by profession, so I’m able to bring that experience from paediatric side to the doctor who’s in Somalia, that means, help the patient get a correct diagnosis.
But also another factor that it is contributing to, since we started the tele-medicine, is that people have been talking about it, so people have got to know that there is a programme of telemedicine going on here, and now we’re getting children as far as from very far places, even from countries like Ethiopia who bordering Somalia. You know, they are just moving across. It’s the word that is going around that there is telemedicine going on, and we’re getting many cases of different conditions now.
TC 02:04:39 Voice over:
Despite innovations and efforts made by MSF and others, the needs of the Somali people remain enormous and, far too often, unaddressed.
Here, and in many conflicts worldwide, access to populations in distress remains unforgivably limited.
TC 02:04:57 Jan Egeland, former U.N. Under-Secretary-General for Humanitarian
Somalia, and the Congo and Afghanistan are the kind of places where the world sort of says: “well, we are not willing to sit together, east, west, north and south, and fix it”. It’s like as if we say: “no, we are giving up”. We are sort of throwing in the towel. It can not be fixed. This is fundamentally wrong. It’s an outrage. Of course these countries can also be helped to help themselves.
TC 02:05:30 Jerome Oberreit, Director of Operations, MSF:
When you see the needs and the situation in countries like Somalia, Afghanistan, the Kivus, you are really talking about the extreme side of need. When you are there, the level of satisfaction of being able to provide is clear. It’s not an in-between where you are saying “OK, fine, I am providing something, but don’t they have an alternative somewhere else?” I mean there it’s clear cut.
TC 02:05:53 Voice over:
War and conflict will continue to destroy lives. And if it becomes even more difficult for relief agencies to be accepted by all parties in order to gain access, the results would be disastrous.
TC 02:06:07 Jan Egeland, former U.N. Under-Secretary-General for Humanitarian
I’m not pessimistic about the future of humanitarian relief, because I know the humanitarian workers, I know the organisations. It is the instinct of the relief organisations to never give up.
TC 02:06:24 Meinie Nicolai, President, MSF:
We’re a bunch of doctors and nurses and logisticians and other people who decided we want to be with the most vulnerable in this world, it’s our choice, we have to measure the risks, we want to be there where the others are not, we want to be able to cross front-lines, we want to remain neutral, of all political implication. It is difficult. But I think the need of the population will drive us forth.
TC 02:06:50 Pierre Krähenbühl, Director of Operations, ICRC:
In terms of the future, questions of access, will remain just as acute as they are today. The burden of proof will be on organisations themselves to demonstrate the way in which they work, that they are entitled to the confidence. Confidence of the populations in need, confidence and respect by the different parties, it is a day to day effort.
TC 02:07:14 Christopher Stokes, General Director, MSF:
The lessons of these last few years are that all humanitarian approaches are fragile. But nevertheless, we believe that the neutral, independent, humanitarian access approach that we have developed, and that we have continued, is the only really hope to be able to deliver assistance in the future.
texts on black screen
Four months after filming in Masisi, armed men forced their way into the MSF compound and opened fire. One international staff member was seriously wounded.
MSF suspended its mobile clinics to the camps and continues its medical work in Masisi hospital with a reduced team.
Two months after our visit to Somalia, two MSF international staff were shot dead in the MSF compound in Mogadishu.
MSF closed its largest medical center in Mogadishu.
Its continued assistance in other districts of the city and across Somalia is dependent upon the respect for personnel, patients and medical facilities.
A month later, Al Shabaab militants banned the ICRC from the areas they control in south and central Somalia.
This leaves large parts of the population without assistance.
Six months after the kidnapping, the two MSF staff abducted from Dadaab, Kenya, have still not been released.
Eddie Gregoor & Peter Casaer
Written and Produced by
Perry Levy (Gigantic Post, New York)
Tom Van Ham (Video House, Brussels)
- Annelies Vandenbosch
Etat d’Urgence Production
Médecins Sans Frontières
Afghanistan : Kate Ribet
Democratic Republic of Congo : Patient Ligodi and Robin Meldrum
Kenya : Sally McMillan
Somalia : Mohamed Kalil Filanwa
Special thanks for their participation and support to
Médecins Sans Frontières (logo)
International Committee of the Red Cross (logo)
The MSF and ICRC teams in
Afghanistan, D.R. Congo, Kenya and Somalia
With thanks to
Carla Haddad Mardini
Niamh Nic Carthaigh
Brice de le Vingne
Max von Massenbach
more information on the contexts
TC 02:08:59 end