Hello all UMAT-ers from across the country! I hope this finds you all well, and you are ready to delve into the realities and current debates surrounding the medical personnel on the frontline of war zones. Sadly, we are currently seeing an eruption of conflicts across the globe, especially concentrated in Africa and the Middle East, and doctors from across the world are heading to these unstable areas to provide crucial treatment to injured combatants and civilians caught in the crossfire. Médecins Sans Frontières (MSF or Doctor Without Borders) is the most widely known international medical humanitarian organisations in the world, and they have been crucial in providing these aforementioned services into areas besieged by conflict. This blog will centre on what it means to be a doctor working for MSF, and some of the current controversies relating to MSF operations. Obviously, for many of you, working for MSF is still some way down the line, but as is the philosophy of this blog, we always look to give you some light as to what awaits you at the end of journey through the UMAT® Exam!
Following the mass starvation and violence seen in the Nigerian civil ‘Biafran’ War of the late 1960s, Bernard Kouchner and his French medical colleagues, who had been providing care to civilians in besieged Biafra, were angered by the political/religious constraints of the non-governmental organisations they were working for, and decided to form what was to be shortly known as Médecins Sans Frontières (Doctors Without Borders). Since this time, MSF has been operating in conflict zones across the world, often at great risk to the individuals who volunteer to provide care in these locations, and in 1999 the organisation won a Nobel Peace Prize for their humanitarian work.
MSF recruits not only medical doctors, but also nurses, technicians, midwives, pharmacists, epidemiologists, and laboratory workers. Focusing on the medical aspect here, MSF doctors will need to commit at least 9-12 months to a placement and have completed at least a residency program with some training in infectious disease, public health, or tropical medicine. MSF is constantly looking for new recruits to bolster their workforce, as humanitarian situations deteriorate across the world and many of the areas that are currently requiring immediate medical assistance are conflicts that are seldom heard of through Western tabloid media: South Sudan, Haiti, Niger, Afghanistan, and the Democratic Republic of Congo for instance. (
http://www.msf.org.au/stories-news/news-from-our-projects).
Medical personnel who work with MSF, along with all medical staff who are associated with parties to a conflict (i.e. warring sides), are specifically protected from attacks through formal instruments in international law, such as the Geneva Conventions and International Protocols laid down by the United Nations, but also through customary international law; which are rules that are generally regarded by the entire international community to be crucial to international law and order (
https://www.icrc.org/customary-ihl/eng/docs/v1_rul_rule25). However, this is no guaranty of safety and very concerningly, several attacks have occurred recently on hospitals staffed and run by MSF. One of the largest of such attacks, which received a blunted media response world-wide, was the United States strike upon an MSF hospital in the Afghanistan city of Kunduz in 2015. 42 people, including 14 staff members, were killed in that airstrike, which destroyed the MSF hospital building and prompted widespread condemnation from human rights groups, yet relatively little attention from Western media.
Such attacks on medical staff constitute a grave war crime in direct breach of the basic tenets of international law, as described above. The United States military, although provided with the coordinates of this MSF-staffed hospital, have stated that they bombed the facility accidentally and thus should be regarded to have not committed a war crime (
http://www.aljazeera.com/news/2016/04/afghan-msf-hospital-air-strike-war-crime-160429182003792.html). However, MSF themselves, along with a host of international not-for-profits agencies, international lawyers, and other international institutions have expressed disgust at the United States military’s attempt to brush off this breach of international law through the questionable results of an internal investigation that has no basis in international law (
http://www.latimes.com/world/afghanistan-pakistan/la-fg-doctors-without-borders-20151004-story.html). Indeed, the survivors of the air-strike have also expressed outrage at the immunity that appears to have been allotted to the United States over this violent strike (
http://presstv.ir/DetailFr/2016/05/02/463553/Afghanistan-MSF-hospital-US-raid).
The debate on this point rages on, and I encourage my interested readers to do their own reading and research on this, as it is a vital point for those considering taking on placements in humanitarian medicine around the world. Knowing the rights and protections awarded to you as future doctors in war zones is obviously crucial to the decision of committing to humanitarian placements. Again, I hope that this article has kept you interested and motivated during the depths of either your interview preparation or early UMAT® Exam study! Catch you next time
