MSF urges for protection of civilians and medical staff amid Israeli bombardment in Lebanon

MSF urges for protection of civilians and medical staff amid Israeli bombardment in Lebanon

Beirut, Lebanon, 10 October 2024 – As Israeli attacks intensify in Lebanon, healthcare facilities in areas most affected by airstrikes are being forced to close. This is leading to devastating consequences for civilians and their access to healthcare.

Médecins Sans Frontières (MSF) teams are working tirelessly to ensure the continuation of care in our existing facilities, while also scaling up our activities to address the needs emerging from the ongoing conflict. However, due to the intense Israeli airstrikes, we were forced to suspend some activities in highly affected areas. We continue to adapt our activities to provide people with much needed healthcare.

MSF urges all warring parties to spare civilians, medical facilities, and medical personnel in Lebanon to ensure that vital healthcare services can adequately address people’s urgent medical needs.

Given the intensity of the violence, road damage, and the lack of guaranteed safety, we are currently unable to reach all affected areas in Lebanon despite the increasing medical and humanitarian needs.
François Zamparini, emergency coordinator for MSF in Lebanon

Last week, MSF was forced to completely close its clinic in the Palestinian camp of Burj el Barajneh in the southern suburbs of Beirut. We also had to temporarily stop our activities in Baalbek-Hermel, northeast Lebanon. These are both areas heavily affected by the strikes

“We partially reopened our clinic in Hermel this week to ensure that patients receive their medications, providing them with a two-to-three-month stock of essential drugs, depending on the severity of their condition and medical risks,” says François Zamparini, emergency coordinator for MSF in Lebanon.

Patients in these areas are already vulnerable, struggling to access the healthcare they desperately need. The closure of medical facilities has left them, specifically people living with chronic diseases, without the essential services they need.

MSF medical teams also remain unable to operate properly in southern Lebanon due to a lack of safety guarantees for our medical personnel.

“One of the hospitals we planned to support and had donated medications and trauma kits to, in Nabatiyeh, only a few kilometres away from the active frontlines, was hit on 5 October,” explains Zamparini.

An MSF mobile medical team, which had been actively supporting general healthcare centres in Nabatiyeh and other areas closer to the Lebanese border since November 2023, has been forced to stop its activities. The team, which was once able to reach areas near the border, can no longer do so and is currently limited to operating only as far as Saida, which is about 50 kilometres north of the southern border, where needs are highest.

In the last two weeks, Israeli strikes have claimed the lives of at least fifty paramedics. This brings the total number of healthcare workers killed since October last year to over a hundred, as reported by the Lebanese Ministry of Public Health[1]. The heavy Israeli bombardments have also severely disrupted access to medical care across Lebanon. As of 1 October 2024, six hospitals and 40 general healthcare centres have closed their doors as the intensity of the fighting made it impossible to work without safety guarantees, according to OCHA. [2]

The armed conflict is worsening an ongoing humanitarian crisis, aggravating existing needs. Lebanon’s healthcare system was already overburdened by the country’s economic crisis, which has caused the emigration of many medical staff and strained the capacity and resources of medical facilities. Local health centres, already at capacity, are now facing increasing pressure as they try to meet the growing medical needs of displaced people.

The scale of displacement in Lebanon significantly surpasses the country’s ability to provide adequate shelter, with over a million people displaced according to UNHCR[3]. The majority of shelters people are seeking safety in are in dire conditions. To respond, MSF deployed 12 mobile medical teams across various regions of the country, including Beirut, Mount Lebanon, Saida, Tripoli, Bekaa, and Akkar. These teams are providing psychological first aid, general medical consultations, and mental health support, in addition to donating mattresses, hygiene kits, hot meals, and clean water. Nevertheless, people’s needs are far greater than what we are able to cover.

[1] Health workers in Lebanon describe deadly Israeli attacks on colleagues and fear more | AP News

[2] https://www.unocha.org/news/todays-top-news-lebanon-occupied-palestinian-territory-and-israel-syria-haiti-ukraine-eastern

[3] UNHCR’s Grandi appeals for urgent humanitarian support and an end to the bloodshed in Lebanon | UNHCR

We must ensure the continuation of care for those in need. We urge all parties to respect international humanitarian law. Civilians and civilian infrastructure, medical facilities and medical personnel must not be targeted. Their safety must be guaranteed
François Zamparini, emergency coordinator for MSF in Lebanon

MSF response to the humanitarian crisis in Lebanon

In response to the ongoing escalation of conflict and intense Israeli bombing in Lebanon, Médecins Sans Frontières (MSF) has deployed 12 mobile medical teams across various regions of the country, including Beirut, Mount Lebanon, Saida, Tripoli, Bekaa, and Akkar. These teams are providing psychological first aid, general medical consultations, medication, and mental health support. MSF is also distributing essential items such as blankets, mattresses, and hygiene kits, as well as supplying water by trucks to schools and shelters where displaced people have gathered. Additionally, we are offering hot meals and drinking water to hundreds of displaced families. MSF has also donated fuel and trauma kits to several hospitals, prepositioned 10 tons of medical supplies and trained over 100 healthcare workers in trauma care and mass casualty management across the country.

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Israeli forces pushing people from north Gaza to the south will only worsen the humanitarian catastrophe

Israeli forces pushing people from north Gaza to the south will only worsen the humanitarian catastrophe

Israeli evacuation orders for parts of northern Gaza, issued on 7 October, are pushing tens of thousands of people to immediately flee south as the area is targeted by airstrikes and a ground offensive. In this latest forced mass displacement, residents of Beit Hanoun, Jabalia and Beit Lahia have been urged to move to the overcrowded, so-called humanitarian zone between Al-Mawasi and Deir Al-Balah, where one million people are already living in inhumane conditions. The zone also remains unsafe for civilians and aid workers, as Israeli forces continue to repeatedly strike the area.

These forced mass evacuations of homes and bombing of neighbourhoods by the Israeli forces are turning the north of Gaza into an unliveable wasteland, effectively emptying out the whole north of the Strip of Palestinian life. To make matters worse, no humanitarian supplies have been allowed to enter the area since 1 October.

MSF calls on the Israeli forces to halt evacuation orders, which are causing the forced displacement of people, and to ensure the protection of civilians. They must also allow desperately needed humanitarian supplies to enter the north as a matter of extreme urgency.

“All of a sudden, I was told that we had to move from the north,” says Mahmoud, a Médecins Sans Frontières (MSF) watchman, who left Jabalia at night to find refuge at the MSF guest house in Gaza City. “We left our home in despair, under bombsleave , missiles and artillery. It was very, very difficult. I would prefer to die than to be displaced to the south; my home is here, and I do not want to leave.”

Israeli forces also called for the evacuation of the three main hospitals in northern Gaza, namely Indonesian, Kamal Adwan and Al-Awda hospitals. These are operating at minimal capacity and have a total of 317 patients still hospitalised, with around 80 people in intensive care and unable to move, according to the Ministry of Health. These three medical facilities, as well as those that remain partially functional across the Strip, must be protected at all costs. 

The MSF clinic in Gaza City received 255 patients on Sunday and Monday alone, as options for people to access medical care shrink by the day. For some people, accessing the few existing health facilities is impossible; our teams have received reports of wounded people who have died as they were unable to seek medical care.

Among those facing evacuation orders in the north are seven MSF staff who managed to find shelter in Gaza City. Five others remain blocked in Jabalia, where the Israeli forces are on the ground carrying out attacks.

“The latest move to forcefully and violently push thousands of people from northern Gaza to the south is turning the north into a lifeless desert, while aggravating the situation in the south, where more than one million people have already been squeezed into a small portion of the Gaza Strip and live in deplorable conditions,” says Sarah Vuylsteke, MSF project coordinator in Gaza.

“Access to water, healthcare, and safety is already almost non-existent, and the thought of more people fitting into this space is impossible to imagine,” says Vuylsteke. “People have been subjected to endless displacement and relentless bombing for the past 12 months. Enough is enough, this must stop now.”

While the Israeli authorities have recently declared a minimal expansion of the so-called humanitarian zone, the area remains subject to evacuation orders and is unsafe due to regular Israeli bombardment. Many people living in the zone are suffering from skin diseases and respiratory infections because of the dire conditions. The situation is even more worrying with the approach of winter and the cold temperatures that people will be exposed to.

Israeli forces must urgently halt evacuation orders in the north of Gaza. The relentless killing of people in Gaza must stop now, and an immediate and sustained ceasefire must be implemented.

MSF colleague Mahmoud shares his testimony of how he had to evacuate northern Gaza
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Israel’s all-out war on Gaza must end and its allies must stop enabling it

Israel’s all-out war on Gaza must end and its allies must stop enabling it

Jerusalem, 2 October – For almost a full year now, Israel has carried out unmitigated slaughter in the Gaza Strip, Palestine. Since the Hamas unprecedented attacks on 7 October 2023, killing up to 1,200 people and taking around 250 hostages, Israeli forces have pursued an all-out war on people in the Gaza Strip, killing more than 41,500 people[1], and wounding over 96,000. People have been repeatedly displaced and forced into smaller and smaller areas under bombardments and increasingly inhumane conditions.

For a year, Israel, Hamas, and their respective allies have catastrophically failed to reach a deal on a sustained ceasefire in Gaza, while the risk of a full-blown regional conflict is now increasing. Israel must immediately stop the indiscriminate killing of civilians in Gaza and urgently facilitate the delivery of aid to alleviate suffering inside the Strip, including through the reopening of vital border crossings, in compliance with the measures requested by the International Court of Justice.

Médecins Sans Frontières’ (MSF) medical staff have treated patients on a daily basis with wounds caused by massive bombings. People have extensive burns, crushed bones, and have been dismembered. Since the beginning of the war, MSF teams have treated over 27,500 patients for violence-related injuries, with more than 80 per cent of the wounds linked to shelling.

[1] Source OCHA: https://www.ochaopt.org/content/humanitarian-situation-update-224-gaza-strip

Israeli bombardments of densely populated areas have repeatedly caused injuries on a massive scale. Our teams have been forced to perform surgeries without anaesthesia, witness children die on hospitals floors due to a lack of resources, and even treat their own colleagues and family members. Meanwhile, the healthcare system in Gaza has been systematically dismantled by Israeli forces.
Dr Amber Alayyan, MSF medical programme manager

MSF teams were already treating the effects of Israel’s 17-year blockade and recurrent attacks on people in Gaza, including treating patients for long-lasting injuries, mental health conditions, and severe burns, inflicted before 7 October. Since that date though, while needs have soared as a consequence of Israel pummelling the Strip, access to healthcare has been reduced to shreds.

Today, only 17 out of out of 36 hospitals are partially functional[1] due to the systematic dismantling of the health system by Israeli forces. Warring parties have conducted hostilities near medical facilities, endangering patients, caretakers, and medical staff.

In the past year, Israeli forces have routinely surrounded facilities, given evacuation orders in extremely dangerous conditions for patients and caretakers, fired upon facilities and upon patients and medical staff, many of whom have been killed, raided facilities and proceeded to arbitrary arrest medical staff. Six MSF colleagues have also been killed. From October 2023, staff and patients from MSF have had to leave 14 different health structures, due to serious incidents and ongoing fighting. Each time a medical facility is evacuated, thousands of people lose access to lifesaving medical care. This will have consequences on people’s health, not just in the immediate term, but in the weeks and months to come.

The lack of access to healthcare is compounded by the dearth of enough humanitarian supplies in Gaza. Israeli authorities have routinely imposed unclear, unpredictable criteria for authorising the entry of supplies. Once supplies cross into the Gaza Strip, they often do not make it to their destination, due to an absence of safe and accessible roads, ongoing fighting, and looting of food and basic supply items.

“As the medical needs in the Strip increase, our capacity to respond continues to be limited; we just cannot get enough humanitarian and medical supplies into Gaza,” says Dr Alayyan. “The field hospitals we set up as a last resort are simply a bandage to fix the devastation caused by the war and destruction of the healthcare system. Even their setup has been hampered and delayed by restricting our ability to procure materials and equipment. As it stands, the medical facilities that remain operational cannot cope with the vast needs.”

As the availability of medical care has shrunk so too have the options for people to seek out desperately needed healthcare in Gaza. Repeated evacuation orders have displaced 90 per cent of people into so-called safer zones which Israel has nonetheless bombed over and over again. People are now urged to stay within a tiny patch of 41 square kilometres[1], with limited shelter, food and water. There is an increased risk of disease due to overcrowding. Out of the two million people in the Gaza Strip, at least 12,000 people desperately need to be medically evacuated[2]. The medical evacuation of those in need, and the right of Palestinians simply seeking safety for themselves and their families to leave the Strip, must immediately be facilitated, without prejudice to their right of return.

While the past 12 months have been marked by destructive actions, they have also been defined by shameful inaction.

[1] Source OCHA: https://www.ochaopt.org/content/humanitarian-situation-update-209-gaza-strip

[2] Source WHO: Microsoft Power BI

[1] Source OCHA: Humanitarian Situation Update #221 | Gaza Strip | United Nations Office for the Coordination of Humanitarian Affairs – occupied Palestinian territory (ochaopt.org)

For one year, Israel’s allies have continued to provide their military support to Israel, as children are killed en masse, tanks fire on deconflicted shelters, fighter jets bomb so-called humanitarian zones. This has been accompanied by a consistent public narrative dehumanising people in Gaza and failing to distinguish between military targets and civilian lives. The only way to stop the killing is with an immediate and sustained ceasefire.
Chris Lockyear, MSF Secretary General

Time and again, political allegiances have been put before human life.  While Israel´s allies publicly speak on the importance of a ceasefire and need to facilitate humanitarian aid into Gaza, they continue to provide arms to Israel. The United States in particular, while recently espousing calls for ceasefire, has frequently worked to obfuscate, block, and undermine ceasefire efforts through its role in the United Nations Security Council.

Meanwhile, the war in Gaza is fuelling regional tensions, which are reaching disastrous heights. Israeli attacks have surged in the West Bank, and now in Lebanon, with already devastating consequences on civilians.

MSF’s calls:

  • A sustained ceasefire must immediately be implemented.
  • The mass killing of civilians must stop immediately.
  • The destruction of the healthcare system and civilian infrastructure must halt.
  • The blockade on Gaza must end.
  • Israel must open vital land borders, including the Rafah crossing, to ensure massive scaled up humanitarian and medical aid can reach those in need as a matter of urgency.
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Lebanon: Israel’s bombardment causes unprecedented mass displacement of people, urgent humanitarian needs

Lebanon: Israel’s bombardment causes unprecedented mass displacement of people, urgent humanitarian needs

Beirut, October 4 – Lebanon is experiencing the most significant escalation of conflict since the 2006 Lebanon War, with close to 1,300 people killed over a span of 16 days, between Sept. 16 and Oct. 1, according to Lebanon’s Ministry of Public Health. The intense Israeli bombardments have forced more than one million people to flee their homes, according to national authorities. Médecins Sans Frontières has scaled up our emergency response and mobilized teams across the country to provide urgent medical and psychosocial support to people who have been displaced.

In the early hours of Monday, Sept. 23, the Israeli army launched a large-scale military operation, targeting dozens of towns across Lebanon’s governorates, including South Lebanon, Nabatieh,  Baalbek-Hermel, and the densely populated southern suburbs of Beirut. Further bombardments on Sept. 27 led to mass displacement from these areas, as well as parts of Mount Lebanon, as residents sought safety elsewhere.

As of Sept. 29, Lebanese authorities estimate that more than one million people have been displaced, primarily from southern Lebanon and Beirut’s densely populated southern suburbs. The intense bombardments have forced many people to flee multiple times, including since clashes began in October 2023, often with little time to gather essential items.

Across Lebanon, there are currently 875 shelters, with over 70 per cent already full, according to national authorities. Most displaced people urgently need assistance, having fled without basic necessities, while the communities and shelters hosting them are also in dire need of support.

“Families are fleeing their homes in search of safety. Many of them are seeking refuge in underprepared and overcrowded shelters,” says Dr. Luna Hammad, MSF medical coordinator in Lebanon. “People who have been displaced are very vulnerable—children, women, elders, and people with physical disabilities—living in terrible conditions including limited access to clean water, sanitation, and basic healthcare services. The needs are huge.”

MSF’s response: Mobile clinics, essential aid, mental health support

In response to the dire situation, MSF has scaled up our emergency response and sent various mobile medical teams, including doctors, nurses, psychologists, counsellors and health promoters, to schools and other shelters across the country. These teams have already provided over 1,780 general medical consultations over the past week and continue to provide assistance to displaced individuals and families, and more teams are on the way to reach areas in need of support.

Additionally, MSF is donating essential items such as mattresses, blankets and hygiene kits to displaced families in locations including Saida, Tripoli, and several sites in Beirut and Mount Lebanon. We are also distributing meals and drinking water, as well as delivering large quantities of washing water to shelters in Beirut and Mount Lebanon to ensure basic hygiene standards in structures that are often not equipped to house people. As of Oct. 2, we have donated  6,523 hygiene kits,  16,118 liters of drinking water, 643 mattresses, 699 blankets, 7,000 litres of fuel to hospitals, and 713,000 litres of water to shelters across the country.

“My children tell me they would rather die under bombing than to live like this. The school was shaking all night. We consider ourselves safe here for now, but what if Israel decides to target schools?” says Alia (name changed to protect anonymity).

To support healthcare facilities, MSF has previously prepositioned over 10 tonnes of medical supplies in hospitals since the beginning of last November. MSF has been sending a mobile medical unit to provide primary healthcare, psychological first aid, and health promotion to displaced and affected communities in south Lebanon. Our teams have also conducted mass casualty preparedness training to 117 healthcare staff in hospitals across the country.

Displaced communities facing trauma

In Baalbek-Hermel, where MSF has been running a project for over 13 years with two primary healthcare clinics, the recent escalation in violence forced the closure of one clinic due to heavy bombardment, while the clinic in Arsal continued to operate at limited capacity. Despite the challenging conditions, teams provided essential medications for chronic disease patients, aiming to supply a two-month stock. Many of our staff in the governorate, like thousands across the country, are still sheltering as airstrikes fall around them. Our clinic in Burj al Barajneh, south of Beirut, has also been closed due to bombardment of the area.

MSF mobile medical teams on the ground in Beirut, Mount Lebanon, and Tripoli are seeing patients with chronic diseases who fled their homes without their medications and have been unable to access treatment for days.

“Many of the displaced individuals are children,” adds Dr. Hammad, “dealing with trauma from the violence, fear of bombings, and the loss of their homes.”

MSF’s mental health teams are witnessing immense needs for psychological and psychosocial support. Our psychologists and counsellors are providing psychological first aid to people who have been displaced, while our mental health helplines are receiving over 100 calls daily from individuals struggling with rising mental health challenges amid the fear and displacement.

Protecting civilians and healthcare workers

MSF is gravely concerned about the ongoing bombing campaign, much of which targets densely populated urban areas. We urge the protection of civilians, healthcare workers, medical facilities, and ambulances. According to the WHO and the Ministry of Public Health, over 50 health personnel have been killed in the clashes since last October. Many MSF staff in Lebanon are displaced themselves; some have lost loved ones or have family members who have been injured.

“We risked our lives to get out,” says Jabine, a citizen who fled from Jibsheet in southern Lebanon who is now taking refuge in an abandoned office building near Beirut’s downtown. She is one of over 3,500 individuals currently sheltering in these structures, where up to 30 people share a single bathroom, and many are still waiting to be assigned rooms. Many of the shelters people are residing in are abandoned structures or makeshift schools that lack basic amenities, with some having no doors or windows to shield the people within from the elements.

The current crisis has put immense pressure on Lebanon’s healthcare and humanitarian response capabilities, already strained by years of economic crisis.

 With many people still on the streets, in open areas, and even seeking refuge on the beach in Beirut, humanitarian needs continue to grow. As winter approaches, the harsh conditions put these people at even greater risk. MSF teams in Lebanon remain committed to providing urgent medical and psychosocial support to those affected.

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Stories of the displaced in Lebanon

Stories of the displaced in Lebanon

As the large-scale Israeli bombardment continues in Lebanon, nearly 1 million people have been forced from their homes in a desperate search for safety.

Doctors Without Borders/Médecins Sans Frontières (MSF) is providing support to displaced people in shelters, including schools, in Saida (south of Lebanon), Akkar, Tripoli, (North Lebanon) mount Lebanon as well as in and around Beirut. Our teams are delivering water, psychological first aid, and medical consultations, while also donating essential items such as mattresses, blankets, drinking water, and hygiene kits to displaced people, in some locations, we are providing hot meals.

Below are testimonies from three displaced people, including MSF’s field communications manager in Beirut.

View of people fleeing after a night of aggressive Israeli bombardment on densely populated areas in South Beirut.

“I hope we can return to our houses; if there are houses to go back to”

Testimony collected on 25 September in a school in Barja, Mount Lebanon.

Alia* sits on the pavement of the school’s humble garden in Barja, a small town located in Mount Lebanon, her face perplexed, as if she doesn’t know what to do. Her mother-in-law, who has just undergone eye surgery, is trying to avoid the harsh sun rays.

The school Alia* is sheltering in is overflowing with displaced people like herself. Sounds of children playing fill the air, yet it cannot mask the blasts of airstrikes falling on the surrounding hills and shaking the building.

“We’re from the southern border town of Khiam. We were forced to leave our home around a year ago when clashes started. And now, we were forced to leave yet again from the house we were sheltering in. We had barely started adapting, registered our kids in a nearby school, and all of it went away.” says Alia*.

Before being forced out of her house in October 2023, Alia* was working as a nurse. Since then, she has been unable to work, and the family has lost their source of income.

In the last quarter of 2023, she spent two months trying to find a safe home for herself, her husband, and her two boys. They would move almost every ten days from one town to another, desperately trying to find a more permanent place to stay. Eventually, a former colleague found her a house in the southern town of Kfartebnit, located 20 kilometres away from her hometown.

On Monday, September  23, 2024, a large-scale Israeli bombardment of south Lebanon started, soon spanning beyond to different other densely populated areas of the country. Alia* had only the time to pack up a few things and the family went on the move.

“We left the house at 1:30 am under heavy bombing from all around us. The traffic in the south was insane. We went to two towns first, but their schools were full to the brim. We ended up sleeping that night in our car. The next morning, we came to this school and thankfully we found a classroom to house us. However, we have nothing to sleep on. Fortunately, I managed to bring two blankets with me.”

The scale of displacement in Lebanon is unprecedented, which surpasses the country’s capacity to house the displaced.  The main pressing needs people express are mattresses, pillows, blankets, and hygiene products, on top of medical care.

“This displacement is by far tougher than the first one. My children tell me they would rather die under bombing than to live like this. The school was shaking all night. We consider ourselves safe here for now, but what if Israel decides to target schools?”

When Alia* last visited her house in Khiam three months ago, it was heavily damaged, with all the windows shattered but at least it was still standing. She is afraid that with the latest waves of Israeli strikes, her house might have been reduced to rubbles.

“I hope one day we can return to our houses – our original houses – if there are houses to go back to.”

An MSF truck transporting non-food item kits for people fleeing from southern Beirut.

“That night was like a horror movie”

Testimony collected on 30 September in Ramleh El-Bayda, Beirut.

“My name is Hassan*, and I come from Nabatieh governorate, in southern Lebanon. I used to live with my wife and three children in the southern suburb of Beirut.

Four days ago, we decided to leave our home with my family because we were worried about our safety. That night felt like a horror movie; warplanes, airstrikes—you name it. While we were in the car, we could feel the ground shaking.

We spent the first two days in a house in another neighborhood of Beirut, but then the owner asked us to vacate the apartment.

Now, we are here in Ramleh El-Bayda in Beirut. We are 20 members of my family,stranded on the beach. All the shelters and schools are full. Where should we go? We have no place to stay. It seems that nowhere is safe now.

The situation is far worse than anyone can imagine. We have so many needs. When we left, we only took a couple of clothes and our documentation. We couldn’t even bring a mattress or a pillow. Last night, we slept on chairs. No one is helping us.

All I care about is the kids. The youngest is a year and a half old. How can I look out for my family?”

*Name was changed based on request to protect privacy.

MSF colleague Maryam shares her testimony of a night marked by displacement and escaping airstrikes in the southern suburbs of Beirut
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MSF is stepping up its response to the Israeli bombing in Lebanon

MSF is stepping up its response to the Israeli bombing in Lebanon

Beirut, 26 September – MSF is gravely concerned about Israel’s bombing campaign in Lebanon, much of which is taking place in densely populated urban areas. We call for the immediate de-escalation of hostilities to prevent further suffering, injury, and loss of life.

Following the widescale Israeli bombings of multiple areas in Lebanon on Monday 23 September, MSF is gradually stepping up its response to the escalating humanitarian needs by delivering primary healthcare and essential relief items to the displaced population.

According to Lebanon’s disaster risk management unit, over 104,000 people have been displaced by the latest ongoing escalation. Many have lost homes and loved ones. In addition to medical support, people are in need of basic supplies like mattresses and hygiene products.

Since 23 September MSF mobile clinics visited two locations in Mount Lebanon where displaced people have taken shelter. We are providing medical and mental health consultations. We have donated essential items including mattresses, blankets, and hygiene kits to displaced people in 8 sites in Saida and Tripoli. We are actively assessing the needs in order to scale up support.

We have reopened our clinic in Baalbek-Hermel to provide patients with much-needed medications for their chronic conditions. Simultaneously, our mental health helplines are receiving over 60 calls a day from people experiencing rising mental health needs.

We continue to coordinate closely with our partners and hospital networks, offering support where possible as the situation develops.

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UN Political Declaration on antimicrobial resistance essential step, but concrete action from governments now critical

UN Political Declaration on antimicrobial resistance essential step, but concrete action from governments now critical

Press release – 25 September 2024 – AMR remains a leading cause of death worldwide nearly a decade after UN member states agreed to make it a priority.

Ahead of the second-ever United Nations (UN) High Level Meeting on antimicrobial resistance* (AMR) tomorrow, where world leaders will come together to agree on commitments to advance the global response to AMR, Médecins Sans Frontières/Doctors Without Borders (MSF) called on governments to take swift, bold action to translate this political declaration into meaningful progress against drug resistance. Headway against AMR since the first declaration nearly a decade ago has been inadequate and inequitable, with low- and middle-income countries – and humanitarian contexts, in particular – least equipped to respond despite bearing the highest burdens of drug-resistant infection. Drawing on years of experience tackling drug resistance around the world, MSF urged governments to build on the commitments made and take an ambitious set of follow-on steps to empower those most affected by AMR to prevent, detect, and respond to it. AMR is a leading cause of death worldwide, and contributed to 4.95 million deaths in 2019 alone, with recent estimates showing the threat is still growing at alarming rates, possibly contributing to 8.2 million deaths annually by 2050.

We are seeing staggering rates of drug-resistant infections in many of the low-resource and humanitarian settings where we work, in large part because healthcare workers don’t have what they need to prevent, detect, and respond to AMR. The UN Political Declaration on antimicrobial resistance is a welcome step towards strengthening the global AMR response and expresses important aspirations for global equity and solidarity. Considering the magnitude of the challenge of AMR though, and how few of the hardest-hit countries have been able to fund and implement national action plans, the declaration text should have been much more concrete and ambitious. The declaration must now go beyond words on paper: governments must not only enact and be accountable to the commitments they’ve made, but they must also build on and refine them to ensure low-resource and humanitarian settings are no longer left behind.
Dr Christos Christou, International President of MSF.

People in low- and middle-income countries experience the highest rates of AMR and infectious diseases globally, but are the least likely to have access to healthcare, including the medicines, vaccines, and diagnostics they need. In humanitarian settings, other factors compound the AMR crisis. Conflicts or natural disasters, for example, can result in traumatic injuries that can easily become infected and force people to take refuge in overcrowded settings where resistant bacteria can spread easily.

In the political declaration, governments acknowledged the importance of addressing AMR in humanitarian settings like those in which MSF works, as well as several issues that MSF has highlighted as key priorities in responding to AMR. However, the commitments made to address these issues should have been bolder and more precisely calibrated to address global inequities. MSF recommends that governments build on and refine these commitments in the following ways:

  • The declaration’s commitment to include affected communities and humanitarian organisations in the governance of platforms and mechanisms to address AMR must now be put into practice. Only by ensuring the inclusive participation of these groups in global AMR initiatives can an effective roadmap for reaching the most underserved settings take shape. For example, if established, the proposed Independent Panel on Evidence for Action Against AMR must adhere to principles of impartiality, transparency, and accountability to all countries, and prioritise research in and for communities most affected by AMR. This is important, because communities in conflict-affected, fragile and humanitarian settings are more vulnerable to AMR, but evidence needed to inform the response in these settings is acutely lacking.
  • The declaration recognizes the need for strengthening laboratory capacity and commits to “improve access to diagnosis and care,” but this broad commitment must be made more specific and precise in follow-on agreements and accountability frameworks to ensure expanded and equitable availability of quality-assured microbiology laboratories. Access to microbiology laboratories is a critical foundation for preventing, detecting and controlling AMR more effectively, but many places with high rates of AMR do not have quality laboratories.
  • The commitment to increased international financing and technical assistance to enable low- and middle-income countries to implement national action plans to address AMR must result in stronger and more ambitious funding, as the currently proposed US$100 million to see 60 per cent of countries achieve funded plans to tackle AMR by 2030 is not sufficient to address a health issue of this magnitude.
  • The commitment to ensure timely and equitable access to affordable medical tools, including antimicrobials and diagnostic tests, must translate into concrete action. The significant global gaps in access to medical tools must be tracked and quantified to guide efforts to achieve more equitable access, and resources allocated accordingly for both access strategies and antimicrobial stewardship programs. Furthermore, when governments provide funding for research and development for new antimicrobials, they should prioritise public and nonprofit initiatives, as these facilitate access, stewardship, and collaborative approaches to research. Funders must also attach upfront conditions ensuring equitable global access to any resulting medical tools into agreements when providing the “push” and “pull” funding called for in the declaration.
To effectively combat AMR globally, governments must address the significant discrepancies in the amount of evidence for action available in high-income and low-resource settings. This means that the Independent Panel on Evidence for Action Against AMR proposed in the declaration must prioritise research in communities most affected by AMR, which are often in humanitarian or low-resource settings where there is currently the least evidence to guide action. This panel is in a great position to inform a response to drug resistance in the hardest-hit areas based on interventions that work, but to do so it must operate with transparency, accountability, and impartiality, backed by ambitious financial means of implementation, and in close collaboration with affected communities.
Dušan Jasovský, Antimicrobial Resistance Pharmacist with the MSF Access Campaign

*AMR — when microbes like bacteria, viruses, and fungi evolve and survive despite the antimicrobial medicines, such as antibiotics, used against them — can make medical care less effective and much more difficult, prolonged, and costly for patients and treatment providers.

MSF is a leading actor in preventing, detecting, and responding to AMR in humanitarian settings, with infection prevention and control, and stewardship initiatives across multiple contexts and 50 sites with planned or existing access to diagnostic microbiology in 20 countries worldwide. MSF has developed an interdisciplinary approach to addressing AMR which includes targeted training and support for infection prevention and control, and antimicrobial stewardship, and in some cases also efforts to provide access to microbiology lab-based diagnosis.

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Catastrophic situation in Zamzam camp, Sudan: “we’re running out of time”

Catastrophic situation in Zamzam camp, Sudan: “we’re running out of time”

Paris, 13 September – As the results of a nutrition screening carried out by the Sudanese health authorities and Médecins Sans Frontières / Doctors Without Borders (MSF) earlier this month in Zamzam camp, North Darfur, indicate a catastrophic nutritional situation that is only getting worse, MSF urges the UN and international stakeholders involved in negotiating broader humanitarian access to consider all options to quickly deliver food and essential supplies in the area, including by airdrops.  

Not only do the results confirm the disaster that we and other stakeholders have been observing and alerting on for months, they also indicate that every day things are getting worse and we’re running out of time. We are talking about thousands of children who will die over the next few weeks without access to adequate treatment and urgent solutions to allow humanitarian aid and essential goods to reach Zamzam.
Michel Olivier Lacharité, head of emergency operations for MSF

Despite announcement that gave hope for positive developments, for instance following Geneva peace talks, no significant amount of humanitarian relief has reached the population in the Zamzam camp and the nearby, war-stricken city of El-Fasher since the IPC Famine Review Committee concluded that famine conditions were prevalent in the area on 1 August this year. Most supply roads are controlled by the Rapid Support Forces (RSF) who have made it all but impossible to bring therapeutic food, medicines and essential supplies into the camp since the intensification of fighting around El Fasher last May. 

There’s no more time to waste if thousands of preventable deaths are to be avoided. Among the more than 29,000 children under five years old screened last week during a vaccination campaign in Zamzam camp, 10.1 percent suffer from severe acute malnutrition (SAM), a life-threatening condition, while 34.8 percent suffer from global acute malnutrition (GAM), which will evolve into more severe form of malnutrition if not treated effectively and in timely fashion. 

The malnutrition rates found during the screening are massive and likely some of the worst ones in the world currently. It’s even more terrifying as we know from experience the results are often underestimated in the area when we use only the mid-upper arm circumference criteria like we did here instead of combining it with measuring weight and height.
Claudine Mayer, MSF medical referent

An MSF mass screening carried out in March 2024 had revealed an 8.2 percent SAM rate and a 29.4 percent GAM rate, which was already twice as high as the 15 percent alert threshold of the World Health Organisation. 

The only food available is from pre-existing stocks, which is not sufficient for people living in the area, and food prices are at least three times as high as in the rest of Darfur. Fuel prices are soaring as well, making it very difficult to pump water and run clinics that rely on generators for electricity. Our staff on site report that for many, it’s impossible to rely on more than one meal per day.  

“In such a dire situation, we should be scaling up our response: instead, running critically low on supplies, we are reaching breaking point and were recently forced to reduce our activity to focus solely on children in the most severe conditions” says Claudine Mayer. “This means we had to suspend treatment for the less severe forms of malnutrition, who represented an active cohort of 2.700 children, and to put an end to consultations provided to adults and children over five years old, who represented thousands of consultations every month”. 

Zamzam camp is estimated to host between 300.000 and 500.00 people, many of them displaced many times over, who are trying to flee the war that has been tearing up their country since last year. In El Fasher, where many of the displaced used to live, only one hospital remains partially standing after the others were damaged or destroyed in the conflict. 

“Due to these unconscionable blockages on supplies, we feel like we are leaving behind an increasing number of patients who already have very few options for getting lifesaving medical care” adds Michel Olivier Lacharité. “If the roads are not an option for getting massive quantities of urgent supplies into the camp, the United Nations should look at every available option. Delaying these supplies meaning causing more deaths – thousands of them, among the most vulnerable.” 

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Trapped and forgotten: where can Rohingya people seek safety?

Trapped and forgotten: where can Rohingya people seek safety?

 As Rohingya become increasingly trapped by raging conflict in Myanmar’s Rakhine state, those who cannot pay their way across the border into Bangladesh are being left without protection or assistance.  

 “We heard explosions, gunfire and people screaming,” says Ruhul, describing the moment when his township, Buthidaung, was attacked on the evening of 17 May. “My family and I fled our home in the chaos, seeking safety in the nearby hills.”

 “I became separated from my parents and spent several days hiding in the jungle with my cousins and other young people, in hunger and fear. I stepped on two landmines; the first time I was unharmed, but the second explosion blew my foot off.” Ruhul, a young Rohingya man, who didn’t receive medical care for nine days until he was able to cross the border into Bangladesh and reach a Médecins Sans Frontières/Doctors Without Borders (MSF) hospital in Cox’s Bazar.

 Since November 2023, Myanmar’s northern Rakhine state has been devastated by intensifying conflict between the Myanmar Armed Forces and the Arakan Army. Extreme violence, including the use of heavy weaponry, drone strikes and arson attacks, has razed entire villages, killing, injuring and displacing civilians. Both sides to the conflict are forcibly recruiting civilians and stoking ethnic tensions between communities.

The violence is impacting various ethnic groups living in Rakhine, however as one of the most historically persecuted groups over decades, the Rohingya community often finds themselves caught in the middle of this violence.

On 17 and 18 May in Buthidaung, civilian homes and property were burnt to the ground, and thousands of Rohingya people (including many who had been previously displaced from other areas) fled the township.

 Mojubullah is another Rohingya man who was displaced from Buthidaung on the same day. “A mortar shell struck our home, killing my wife and injuring several others,” he says. “We made the heartbreaking decision to leave for Bangladesh. Leaving behind our home, livestock and crops was incredibly difficult.”

 In Maungdaw, 20km to the west of Buthidaung, intense clashes between the warring parties spiked in May and have again escalated in August. They were characterised by violent attacks on groups of Rohingya people – some of whom are survivors of the attacks in Buthidaung.

 Between 5 and 17 August, MSF teams in Bangladesh’s Cox’s Bazar camps treated 83 Rohingya patients with violence-related injuries; 48 per cent were women and children. They reported fleeing an attack in Maungdaw and crossing the border.

 These patients that arrived at MSF’s facilities are suffering from gunshot wounds, maimed from landmine injuries, and in critical condition due to a lack of medications to manage life-threatening illnesses such as HIV or tuberculosis. These medicines are no longer available in Rakhine. 

 Several people described the journey across the border, which includes crossing the Naf river, as perilous. As the border is officially closed, people are forced to pay huge bribes to authorities, armed groups or smugglers to cross.

 “The journey was marked by challenges at every turn,” says Mojibullah. “We encountered smugglers demanding exorbitant fees for a dangerous boat ride and we faced hostility from border guards upon arrival in Bangladesh. Despite our pleas for help, including the urgent medical needs of my grandchildren, we were pushed back to Myanmar.”

 In northern Rakhine, access to healthcare is almost non-existent. Health facilities are non-functional, having been damaged by the fighting, stripped of medical staff who fled violence, or left without supplies due to conflict dynamics and inability to gain authorization to move supplies as needed. 

 In June, MSF was forced to indefinitely suspend our medical humanitarian activities in Buthidaung, Maungdaw and Rathedung townships, after our office and medical store were burnt down. Before this suspension, MSF witnessed attacks in highly populated civilian areas like markets and villages as well as attacks on healthcare facilities which threatened the lives of patients and healthcare workers.

 Efforts, if any, taken by the warring parties to protect civilians and uphold their obligations under international humanitarian law are negligible. 

 The toll of this disregard for human life is immense. MSF teams in Bangladesh received 115 war wounded Rohingya patients in MSF facilities since July 2024 including men, women and children sustaining injuries from extreme violence. While newly-arrived Rohingya people in Cox’s Bazar have managed to escape the conflict zone and access some level of medical care, they are forced to constantly hide for fear of deportation back to Myanmar while also facing an increasingly precarious situation in camps where 1.2 million people are living behind barbed wire fences. Aside from rising violence and kidnapping in the camps, including for forced recruitment to armed groups in Myanmar, many people live in fear and anxiety about what they have experienced, and the fate of their families in Bangladesh and back home.  

Having finally reached Bangladesh, Mojibullah has not yet found a reprieve from hardship. “My family and I are struggling to come to terms with the loss of loved ones and the uncertainty of our future.”

 According to UN figures, approximately 327,000 people have been displaced in Rakhine state and Paletwa Township in Chin state since the conflict in Myanmar resumed in November 2023. In addition to those already displaced, this brings the total number of displaced in Rakhine State and Paletwa Township in Chin to over 534,000 people. MSF is calling parties to this conflict to comply with their obligations under international humanitarian law and the principles of distinction, proportionality and precaution. This includes protecting civilians from direct attacks and the effects of attacks, as well as the prohibition of indiscriminate attacks. We also ask the authorities and all actors on both sides of the border to urgently prioritize increased, impartial humanitarian and medical assistance to those in need.

 *Names have been withheld. 

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Eastern DRC: Mpox is just another challenge amid a torrent of vital problems

Eastern DRC: Mpox is just another challenge amid a torrent of vital problems

On Wednesday August 15th, the WHO declared the surge in mpox cases a Public Health Emergency of International Concern (PHEIC) due to rising infections in several countries, particularly in Africa. The WHO emphasized the urgent need for enhanced surveillance, vaccination, and public health measures to control the outbreak.

In DRC, mpox is endemic in several provinces. Last year, reported cases increased significantly, and already the number of cases reported so far this year has exceeded last year’s total, with more than 20,000 suspect and confirmed cases, and over 630 deaths, from January to September 2nd, 2024.

MSF has set up operations to address the mpox epidemic in 4 provinces of the DRC (North and South Kivu, South Ubangi and Equateur) as well as in neighbouring Burundi for prevention and treatment of mpox, awareness raising and infection control.

Dr. Tejshri Shah, General Director of MSF and a pediatrician specializing in infectious diseases, recently returned from North Kivu, an eastern province of the Democratic Republic of Congo (DRC), the country at the epicenter of the current mpox epidemic in Africa. In this short piece, she emphasizes that containing the virus in eastern sites for displaced people will be impossible unless efforts are made to listen to people’s needs and improve the appalling living conditions they are struggling with for too long.

In Goma, many people I talked to seem to sense that something new, uncertain, and frightening is coming. But no one can yet predict what it will mean for them or how deeply it will impact their lives.

Mpox is not new in the DRC. The disease is endemic in several parts of the country, and notifications of cases have been on the rise for the past decade. However, in the Kivus, the virus has mutated into a form that seems to be more transmissible between humans, which is a significant concern as cases have been reported in very densely populated areas like Goma – a city of two million people – and in sites where hundreds of thousands have sought refuge due to the ongoing armed crisis in North Kivu.

While the lethality of this new strain remains limited, there is still reason to worry. Why? Because conditions necessary to prevent it from spreading in and around Goma are simply not in place, and the capacity to provide care for patients at risk of complications – young children, people with advanced HIV – remains limited.

How can we expect families living in tiny shelters, without adequate water, sanitation facilities, or even soap, to implement preventive measures? How can malnourished children have the strength to ward off complications? And how can we expect this variant – which is notably transmitted through sexual contact – to not spread in displacement sites given the dramatic levels of sexual violence and exploitation affecting girls and women living there?

MSF has repeatedly denounced the inhumane living conditions that people face in the camps, and the glaring gaps in the humanitarian response. More than two years after the start of the so-called “M-23 crisis” and the mass displacement it triggered, families living in the overcrowded camps still lack the essentials: food, water, safety, basic hygiene items, as well as access to sanitation and healthcare.

During a counselling session that I attended with survivors of rape, a woman told me she lives with her seven children under a plastic sheet. Her partner abandoned her after the rape. For women like her, the tried-and-tested solutions to prevent the spread of the epidemic are unimaginably difficult to implement. If she develops a rash due to mpox, she will be told to change her linens, wash everything thoroughly, disinfect her belongings, and isolate herself until she heals. But how can she wash without soap and with only a few liters of water available each day?  How can she isolate herself and protect her children while living together under their minuscule plastic sheeting shelter? If she isolates, who will get food for the kids? Who will collect firewood? Who will comfort the newborn?

For her and all those who have sought refuge in the displacement camps, the mpox epidemic feels like just another challenge amid a torrent of problems. And, frankly speaking, not the most urgent one given the daily struggles they face, including outbreaks of other life-threatening diseases such as measles or cholera.

Yet, mpox is there and needs to be tackled. To address this new, additional challenge, we need to make survival easier for people through a response that is tailored to their specific needs and real-life challenges. This starts by listening to people, understanding their needs and providing them with basic supplies for infection control: water, soap, disinfectant, sanitary installations. These are simple but essential. We cannot rely solely on the arrival of vaccines to fix the problem. Improving people’s living conditions is also a critical factor in fighting such outbreaks.

Together with health authorities, our teams do their best to provide care and raise awareness for those living on the sites, as we do in other parts of the country affected by the outbreak. Like many others, we hope that the long-awaited vaccines will arrive in the country as soon as possible. Yet, they will not be magic bullets: governmental and non-governmental actors must also urgently address the foundations of the mpox response, which must be adapted to the needs and realities of the people.

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