States supporting Israel’s military operations are complicit in the massacre of civilians

States supporting Israel’s military operations are complicit in the massacre of civilians

On 26 May, Israeli forces killed at least 49 Palestinians in airstrikes on a displaced persons camp in Tal Al-Sultan in Rafah, Gaza. More than 180 injured people were taken to a nearby stabilisation point supported by Médecins Sans Frontières/Doctors Without Borders (MSF). Two days later, Israel bombed a camp for displaced people in Al-Mawasi, west of Rafah, killing at least 21 Palestinians and leaving 64 wounded. These massacres are taking place just after the International Court of Justice (ICJ) ordered Israel on May 24 to “immediately” halt its military offensive in Rafah, in application of the Convention on the Prevention and Punishment of the Crime of Genocide.

Caroline Seguin, MSF’s head of emergency programmes in Gaza, describes the ongoing apocalyptic situation there.

 

What happened following the Israeli airstrikes on the camp for displaced people in Tal Al-Sultan on 26 May?

MSF was supporting a stabilisation point operating round the clock right next to where the Israeli airstrikes took place. Our teams treated more than 180 people with complex injuries, including shrapnel wounds, fractures and extensive burns. We also received 28 people who were already dead on arrival at the stabilisation point or died of their injuries soon after. The teams worked throughout the night to stabilise the patients and transfer them to health facilities located further west near Al-Mawasi. They were forced to flee the following night as fighting intensified in the area, once again putting an end to vital medical activities for Gazans.

Women and children were among the victims. There are entire families, often consisting of several dozen people, sleeping in tents and living in extremely difficult conditions. These are civilians who, once again, are being injured and killed by Israel’s bombing of densely populated areas.

This strike illustrates once again the total disregard for Palestinian lives by Israeli forces. The area where the airstrikes took place is a camp for displaced people and the civilians there had not received any order to evacuate. There is no safe place in Gaza for civilians.

Long spared from ground fighting, more than 1.3 million Palestinians had been sheltering in Rafah, the vast majority of whom have been forcibly displaced multiple times in a war without respite for the civilian population. What conditions have displaced people been living in since the beginning of the Israeli offensive on Rafah on 6 May?

More than 900,000 people have fled Rafah since the beginning of the Israeli offensive on the city and its surroundings. They have been forcibly displaced for the umpteenth time, this time to Al-Mawasi, a stretch of sand along the Mediterranean coast, Deir al-Balah and Khan Younis.

The Israeli military continues to push Gazans inexorably into areas that it declares safe but which are in reality exposed to bombing and fighting. On 16 May, 78 per cent of the Gaza Strip was ordered by Israeli forces to evacuate. Palestinians in Gaza are now caught up in the fighting and crammed into a tiny, unlivable area, trying to survive in impossible conditions with no guarantee of safety.

Massive and indiscriminate Israeli bombings continue to devastate northern and central Gaza including repeated airstrikes on the Palestinian refugee camp of Nuseirat and in the south with the current offensive on Rafah. Since the beginning of the war, more than 35,000 Palestinians have been killed and at least twice that number have been injured and are in need of treatment, including complex surgical operations. MSF teams have been forced to evacuate 12 health facilities over the last seven months, including nine that were attacked. It is worth repeating that our colleagues have suffered 23 violent incidents — direct attacks, sometimes being rounded up, arrested and tortured by Israeli forces.

This is a massacre that has been going on for almost eight months, in which women and children are the main victims. Today in Gaza, the whole population is within range of bombs, gunfire and tank shelling, and anyone can be killed, including humanitarian workers in a clearly marked convoy, as was the case for MSF in November 2023 and World Central Kitchen in April 2024.

No MSF trucks have entered the Gaza Strip since 6 May. On 26 May, around 130 vehicles carrying humanitarian aid were allowed through the Kerem Shalom crossing, controlled by the Israeli military. The supply operation was interrupted by fighting, forcing around 70 trucks to turn back. What are the consequences for Palestinians in Gaza and how are MSF teams continuing to work?

Since the total closure of the Rafah crossing on 7 May, we have been witnessing a further strangulation of the Gaza Strip, a new collective punishment for Palestinians. We have had to reorganise the hospitals in which we work, closing facilities and transferring patients from the Indonesian and Emirati hospitals in Rafah to Nasser Hospital in Khan Younis, where we treat trauma and burns and provide follow-up care.

Water supply is critical throughout Gaza. Due to a lack of fuel, desalination plants are operating at reduced level. This week we were only able to distribute 50,000 litres of water due to the lack of fuel, compared to 400,000 litres the week before. There is more imported food available in some markets, where it gets through in private company trucks, but it is unaffordable for most Gazans.

Israel is continuing its policy of obstructing humanitarian aid; we are seeing this obstruction of aid combined with a charade designed to make people believe that aid can enter the Gaza Strip via the floating pier built by the United States or through the Kerem Shalom crossing. In reality, nearly eight months on, we are still seeing blockade, obstruction, and appalling delays in the transport of equipment patients need for treatment, such as generators, water pumps, scanners, X-ray equipment, oxygen, sterilisation equipment, and more. Aid, when it is not completely blocked, comes in dribs and drabs, and can in no way adequately meet the immense needs of Palestinians in Gaza.

MSF could save more lives if the Israeli government stopped intentionally blocking humanitarian assistance. In addition to the bombings, people are dying every day because of Israeli obstruction of aid.

The only way to get aid into Gaza today is to increase the number of road entry points into areas where the lives of humanitarian workers are not in danger — areas that are not on the front lines, as is currently the case for Kerem Shalom, which is not a viable solution. Humanitarian aid must enter Gaza in sufficient quantities to meet the immense needs of a devastated population. We must have the means to distribute the aid and we must be able to do so unhindered and in safety. It should also be remembered that more than 220 humanitarian workers have been killed in Gaza since the beginning of the war. 

The International Court of Justice (ICJ) has ordered Israel to “immediately halt its military offensive, and any other action in the Rafah Governorate” which could bring about “the physical destruction” of the Palestinians. What does this ruling change in concrete terms on the ground?

For Palestinians who are being bombed and are trapped in the fighting, the ICJ’s ruling does not radically change their daily lives. The measures ordered by the Court are legally binding, but it has no means of enforcing them. On 26 January, the ICJ issued provisional measures ordering Israel to prevent and punish acts of genocide and ensure that basic services and aid reach people in the Gaza Strip. The Court’s rulings, both in terms of the pressure they exert on Israel and the media coverage they generate, highlight the systematic and manifest nature of the destruction of civilian infrastructure in Gaza, including attacks on hospitals — which we have documented in recent months — as well as schools, mosques, universities, roads, farmland, and more. These are being deliberately and methodically destroyed. The entire social fabric of Gaza is being annihilated.

Hospitals in the north of Gaza continue to be targeted in attacks and have undergone massive destruction, as is the case for Al Awda and Kamal Adwan hospitals. There is no longer a fully operational hospital in Rafah since the Kuwaiti Hospital was taken out of service following an airstrike that killed two of its staff. Since the beginning of the war, the health system — hospitals, ambulances, medical personnel and patients — has been the target of deliberate and systematic attacks by the Israeli military. Currently, Israel refuses to take in patients, particularly children, who cannot be treated in Gaza, and medical evacuation to Egypt has not been possible since Israel took control of the border.

There is vital and urgent need to force Israel to immediately cease its policy of destruction of all sources of life in Gaza. The United States, which systematically opposes UN Security Council resolutions calling for a ceasefire, is complicit in this policy of destruction and fueling it, as do the United Kingdom and European states allied with Israel. These countries must stop supporting Israel’s military operations in order to protect civilian lives and prevent the genocide of the Palestinian people.

Gaza: Israel must end its campaign of death and destruction

Gaza: Israel must end its campaign of death and destruction

Jerusalem, Paris, Brussels, Barcelona, 28 May 2024 – As the United Nations Security Council meets today after Israel struck tent camps sheltering displaced people in designated “humanitarian zones” in southern Gaza, Médecins Sans Frontières/Doctors Without Borders (MSF) calls for an immediate end to the Rafah offensive and the ongoing atrocities across the Gaza Strip. Israel’s military strategy of repeatedly launching attacks in densely populated areas inevitably leads to the mass killing of civilians.

Civilians are being massacred. They are being pushed into areas they were told would be safe only to be subjected to relentless airstrikes and heavy fighting. Entire families, made up of dozens of people, are crowded into tents and living in extremely difficult conditions. Over 900,000 people were forcibly displaced again as Israeli forces intensified their offensive on Rafah in early May.
Chris Lockyear, MSF Secretary Genera

Today, 21 Palestinians were killed and 64 injured, according to local health authorities, after Israeli forces bombed another tent camp for displaced people in Al-Mawasi, west of Rafah in southern Gaza.

Medical staff and patients at an MSF-supported trauma stabilisation point in Tal Al-Sultan in Rafah were also forced to flee on the night of 27 May, as hostilities in the area intensified, effectively stopping all medical activities in the facility. This forced evacuation of yet another healthcare facility comes 24 hours after Israeli forces carried out an air strike on what they had designated as a “safe zone”, killing at least 49 people and wounding over 250 others. Staff at the stabilisation point recorded a mass casualty influx of 180 wounded people and 31 dead, with patients suffering from severe burns, shrapnel wounds, fractures, and other traumatic injuries. These patients were stabilised and referred to field hospitals located towards Al-Mawasi, further west, as there are no remaining functional trauma hospitals able to cope with such a mass casualty event.

“All of last night we heard clashes, bombings and rockets being fired. Nobody knows what exactly is happening,” says Dr Safa Jaber, an MSF gynaecologist who is living in the Tal Al-Sultan tent camp with her family. “We are scared for our children, scared for ourselves. We were not expecting this to happen suddenly. Where shall we go? We are struggling to find the basics that every human being needs to stay alive.”

Just last week, the International Court of Justice (ICJ) ordered Israel to “immediately” halt its military offensive in Rafah and to let in desperately needed humanitarian aid, and ensure it reaches those who need it. But Israel’s offensive in southern Gaza has since escalated, no amount of meaningful aid has entered the enclave since 6 May, and the pattern of systematic attacks on healthcare has continued. All countries supporting Israel’s military operations in these circumstances are morally and politically complicit. We call on countries, particularly the United States, United Kingdom, and allied European Union Member States, to do whatever in their power to influence Israel to stop the ongoing siege and continued attacks on civilians and civilian infrastructure in Gaza.

Nearly eight months into this war, there is no longer a single healthcare facility in Gaza that has the capacity to handle a mass casualty event such as the one on 27 May. The closure of the MSF-supported trauma point in Tal Al-Sultan follows an air strike on the same day on Kuwaiti hospital in Rafah, which killed two staff and put the hospital out of service. Nearly all hospitals in Rafah have been forcibly evacuated, and are either out of service or barely functioning, leaving no possibility for the provision of or access to medical care.  

Hundreds of thousands of civilians are being subjected to a brutal and relentless demonstration of collective punishment. Along with the bombings, the severe blockages of aid are making it impossible for us to help in a meaningful way. People are also dying because humanitarian workers are being prevented from doing their jobs.
Karin Huster, MSF Project Medical Referent in Gaza

Israeli bombardments and heavy fighting also continue to devastate the north of the enclave, which is almost inaccessible for humanitarian workers. Hospitals in the north are under fire and have been subject to extensive destruction, including Al-Awda and Kamal Adwan hospitals, the latter of which was bombed by Israeli forces just today. Other hospitals such as Al-Aqsa hospital in Deir al Balah and Nasser hospital in Khan Younis have reported fuel shortages and may soon no longer be able to function.

We call for all warring parties to respect and protect medical facilities, their staff, and patients.

We call for Israel to immediately halt its offensive on Rafah and to open the Rafah crossing point to let in humanitarian and medical aid at scale.

We call for an immediate and sustained ceasefire throughout the Strip.

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Yet another hospital in Gaza forced to close amid the intensified Israeli offensive in Rafah

Yet another hospital in Gaza forced to close amid the intensified Israeli offensive in Rafah

The intensification of the onslaught by the Israeli forces in Rafah, Gaza, has forced Médecins Sans Frontières/Doctors Without Borders (MSF) to stop providing lifesaving care at Rafah Indonesian Field hospital on 12 May. The 22 patients who remained in the hospital have been referred to other facilities, as we can no longer guarantee their safety. MSF has seen a pattern of systematic attacks against medical facilities and civilian infrastructure since the beginning of the war. In light of this, as well as the advancing offensive, we have made the decision to leave Rafah Indonesian Field hospital.

“We have had to leave 12 different health structures and have endured 26 violent incidents, which include airstrikes damaging hospitals, tanks being fired at agreed deconflicted shelters, ground offensives into medical centres, and convoys fired upon,” says Michel-Olivier Lacharité, MSF Head of Emergency operations.

The health system is being dismantled resulting in devastating consequences for people trapped in Gaza. According to OCHA, 24 out of the 36 hospitals in Gaza are now out of service. MSF is trying to establish field hospitals elsewhere in the Gaza Strip, but these few structures will not be able to cope with a massive influx of wounded civilians, on top of overwhelming medical needs. They can in no way replace a functional health system.

Prior to evacuating the hospital, MSF had been offering post-operative care for war-wounded patients since mid-December 2023. Our teams worked on providing care to people in the 60-bed hospital, where surgeons undertook approximately 35 procedures per week in the operating theatre. Inpatient and outpatient care ran six days a week, with about 130 consultations a day, with teams providing dressing changes, physiotherapy, and counselling. The Ministry of Health has also been forced to move its activities from Rafah Indonesian Field hospital, resulting in the closure of the entire hospital.

Alongside this closure, prolonged blockages of aid are further crippling the humanitarian response and endangering the lives of people trapped in Gaza. Supplies of fuel, needed to run everything from hospitals to bakeries, and other necessities, are running dangerously low while people cannot leave or enter the enclave.

MSF has reopened our activities at Nasser hospital in Khan Younis with outpatient and inpatient departments focusing on orthopaedic surgery, care for burns, and occupational therapy services; maternity services will open in the coming days. MSF staff were forced to flee Nasser hospital in mid-February and leave patients behind after a shell struck the orthopaedic department and Israeli forces ordered the evacuation of the facility before raiding it.

As the people in Gaza again face another onslaught of bombing, missiles, shooting and violence, we again call for an immediate stop to this offensive, which is displacing hundreds of thousands of people and depriving them of essential aid. At least 360,000 Palestinians have fled Rafah, according to the United Nations, since Israeli forces have expanded their offensive and evacuation orders, which make it impossible to provide lifesaving humanitarian and medical assistance amid this campaign of indiscriminate death and destruction.

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Sudan: MSF forced to suspend work at the only functional hospital in Wad Madani

Fadasi Camp Wad Madani - Al Jazirah state

Sudan: MSF forced to suspend work at the only functional hospital in Wad Madani

Port Sudan/Barcelona, 9 May 2024.- Médecins Sans Frontières (MSF) has been forced to suspend work and withdraw staff from Madani Teaching Hospital, the only functional hospital for the hundreds of thousands of people in dire need of medical assistance in the capital of Al Jazirah state, Sudan. This extremely difficult decision comes after more than three months of relentless challenges trying to provide care at the hospital, including the growing insecurity; the inability to bring new staff and medical supplies into the area due to the denial of travel permits; and repeated security incidents, such as looting and harassment, affecting our ability to provide medical care.

MSF calls on the warring parties to stop violating health facilities and guarantee the safety of medical personnel and to grant the necessary travel permits for our staff and supplies.

The health system and basic services in Al Jazirah state have collapsed as a consequence of the fighting and the systematic blockade on supplies and personnel entering the area, MSF was the only international NGO providing some support in Wad Madani. Our departure leaves a deep void for people struggling to access healthcare and living in a very insecure environment without transportation to move around.
Mari Carmen Viñoles, MSF Operations Manager in Sudan

In mid-December, fighting reached Wad Madani—the capital of Al Jazirah state located about 136 kilometers southeast of Khartoum—at least 630,000 people were forced to flee Al Jazirah towards other parts of Sudan according to the International Organization for Migration[1]—many of whom had already been displaced. At the end of that month, MSF evacuated all staff from Wad Madani following the offensive from the paramilitary group Rapid Support Forces (RSF) in the city, which until then had been controlled by the Government led-Sudanese Armed Forces (SAF).

By January 13, MSF was able to send a team back to Wad Madani, where several hundred thousand people remained in which used to be one of the most populated cities of Sudan.

Since then, MSF has been supporting the emergency room, operation theatre, maternity, inpatient department—including pediatrics, the therapeutic feeding center, and adult and surgical wards—and pharmacy at Madani Teaching Hospital. We also provided mental health support and care for sexual violence. On top of this MSF also provided training, salary incentives to 240 Ministry of Health (MoH) staff, and food for patients.

Between mid-January and the end of April, MSF provided nearly 10,000 outpatient consultations—malaria was the most common illness treated—2,142 antenatal consultations, and care to 16 survivors of sexual violence. During this period, there was a constant influx of patients into the emergency room, totaling 2,981 admissions. A significant number of these admissions involved physical injuries sustained in the ongoing violence.

MSF has now suspended all support to the facility, and we have relocated our staff to safer areas of Sudan. Over the last three months, our team and the supported MoH staff have faced repeated security incidents that have been either carried out or tolerated by the RSF, including looting of the hospital, stolen vehicles, and staff being retained, among multiple other incidents and pressures. Since January, Sudanese authorities have persistently denied travel permits to bring new staff and medical and logistic supplies into the city.

[1] One Year of Conflict in Sudan: Visualizing the World’s Largest Displacement Crisis | Displacement Tracking Matrix (iom.int)

While the humanitarian and medical needs in Wad Madani and Al Jazirah are immense, we have no other option than to stop our work immediately and leave the area, the deliberate administrative blockages, the increasing insecurity, and the constant violations of the hospital as a neutral space made it impossible to continue providing services.
Mari Carmen Viñoles, MSF Operations Manager in Sudan

MSF is willing to return to support the Madani Teaching Hospital to support people in Al Jazirah if the warring parties commit to respecting our medical work and ensure safe and uninterrupted access to the area. MSF calls on the RSF to stop violating medical facilities and guarantee the safety of MoH and MSF personnel. MSF also calls on the Government of Sudan-led military and civilian authorities to grant the necessary travel permits for our staff and supplies.

MSF currently works in and supports more than 30 health facilities in nine states in Sudan: Khartoum, White and Blue Nile, Al Gedaref, West Darfur, North, South and Central Darfur, and Red Sea. We run programs in both SAF- and RSF-controlled areas. Our teams provide trauma care, maternal and pediatric care, and treat malnutrition alongside other healthcare services. MSF teams are also supporting Sudanese refugees and returnees in South Sudan and eastern Chad.

Alzahraa Camp, Wad Madani, Sudan. 5 June 2023.

Celebrating Midwives: The Unsung Heroes of Maternal Health

Celebrating Midwives: The Unsung Heroes of Maternal Health

Amidst the hustle and bustle of hospitals and clinics, a cadre of diligent workers labour tirelessly to ensure the safe passage of new life into the world. As the world observes International Midwives Day, Médecins Sans Frontières/ Doctors Without Borders (MSF) takes a moment to honor the unsung heroes behind countless safe births and healthy mothers—midwives. Join us as we shine a spotlight on the incredible journey of Nour Al Sayyed, a passionate midwife making a difference in the Baalback-Hermel project.

It was a bright sunny morning when Nour arrived at the MSF-run primary healthcare clinic in Arsal, a border town on the outskirts of the Baalback-Hermel Governorate. As she stepped through the doors, a sense of purpose enveloped her, energizing her for the day ahead. Inside, the clinic hummed with activity. Doctors and nurses attended to the patients while expectant mothers sat patiently in the waiting area, their faces alight with a mixture of excitement and trepidation. For Nour, each day brought with it a new opportunity to make a difference, to be a source of reassurance in the lives of these women. With a smile on her lips and a gleam in her eyes, she embarked on her rounds.

Globally, maternal mortality remains a significant concern, with a death occurring almost every two minutes in 2020 according to the WHO. In Lebanon, the fight against maternal mortality remains a crucial one and midwives like Nour stand at the forefront, offering vital support to women and families during the vulnerable journey of pregnancy and childbirth. In 2023 alone, MSF assisted more than 2,900 expecting mothers to deliver their babies safely under medical supervision.

Nour’s journey into midwifery was driven by a deep-seated desire to make a difference in the lives of others. “What attracted me initially to the field of midwifery was the opportunity to provide support and assistance to women and families during pregnancy and childbirth,” the 28-year-old shares. Her commitment is fueled by the satisfaction of witnessing the surge of happiness on a mother’s face when hearing her baby’s first cry after birth. After starting as a midwife in MSF’s Mother and Child Center in Arsal, Nour became a full-time midwife in the MSF clinics of Arsal and Hermel, where MSF provides primary healthcare services to patients with non-communicable diseases (such as hypertension, diabetes, asthma, epilepsy), sexual and reproductive health services for women, paediatric medical consultations, and mental health services to vulnerable communities in surrounding areas. Throughout the day, Nour’s schedule is packed with everything from counseling women and providing family planning services to conducting clinical examinations, assisting during childbirth, and offering support throughout the pregnancy, childbirth, and postpartum periods. In MSF’s primary healthcare clinics of Arsal and Hermel, Nour provides comprehensive care and health advice for pregnant women. Beyond clinic walls, Nour and her colleagues extend their services, venturing into the many camps of Arsal, where pregnant women cannot easily access health care services. Currently, MSF extends outreach activities to tens of camps and informal tent settlements in and around the Arsal vicinity. A traditional town in the mountainous region on the border with Syria, Arsal is home to 50,000 residents and over 20,000 refugees, according to UNHCR. Our midwives conduct daily educational sessions and offer family planning services to approximately 40-50 women a day within these camps.

MSF midwife Nour surrounded by a group of women during a community outreach session in Arsal, northeast Lebanon. In addition to their clinic duties, MSF's dedicated midwives engage in fieldwork, promoting sexual and reproductive health among vulnerable communities. Copyright MSF/Kholoud Othman

Among the challenges Nour faces in her daily work, there are moments that stand out. “One defining moment that reignited my dedication to midwifery occurred during a night shift at MSF’s Mother and Child Center in Arsal. The mother was severely anaemic and fully dilated. As I prepared to assist her delivery, I discovered a critical situation endangering both the mother and the baby.” With the urgency of the situation pressing upon them, Nour and the nurse on her team had to embark on the delivery. The baby emerged in a critical state, and Nour swiftly began resuscitating, while simultaneously ensuring the mother doesn’t bleed out. After those testing minutes, Nour and the nurse on call stabilized both the mother and the child for eventual referral to a specialized hospital for recovery. “I’ll never forget those few moments, though” reflects Nour. “Witnessing the baby’s eventual recovery and the mother’s relief was both humbling and exhilarating. Especially since the mother had lost two babies immediately after delivery during previous pregnancies… It’s moments like these that remind me why I chose this profession – to bring hope and ensure the well-being of both mothers and babies.”

Nour holding a pair of twins she helped deliver during her time at the MSF's Mother and Child Center in Arsal. Copyright MSF

But it’s not just the critical moments that define Nour’s journey; it’s the gratitude that lingers long after. “I love it when mothers come in with their children and refer to them as ‘my’ babies,” Nour shares.

As we celebrate International Midwives Day, MSF acknowledges the invaluable contribution of midwives like Nour. They are not just healthcare providers but pillars of support, guiding women through one of life’s most transformative journeys. To all midwives, MSF extends a message of support and appreciation for their tireless dedication to women’s health and well-being. Your commitment enriches lives and strengthens communities, embodying the essence of compassion and care.

MSF midwife Nour Al Sayyed laughs with a mother and child she is consulting while on a community outreach visit in a camp in Arsal. MSF/Kholoud Othman.
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Gaza’s silent killings: The destruction of the healthcare system in Rafah

Gaza’s silent killings: The destruction of the healthcare system in Rafah

Under the threat of aerial bombardment, an estimated 1.7 million men, women and children have been forcibly displaced to Rafah, a tiny sliver of land in the south of the Gaza Strip, in Palestine. However, even in Rafah people have not found safety.

Military operations are ongoing in Rafah and the confirmed threat of a full-scale imminent military incursion by Israeli forces looms over people there, who now face the risk of death by disease or starvation in a place where the healthcare system has been decimated.

On 13 October 2023, our medical teams, alongside civilians, were forced to evacuate from north to south Gaza, where they rapidly established emergency medical responses in Rafah and Deir Al-Balah.

This Médecins Sans Frontières report, Gaza’s Silent Killings: The destruction of the healthcare system and the struggle for survival in Rafah, draws upon medical data and the testimony of patients to demonstrate that even in Rafah, conditions for survival are not in place.

Gaza’s entire healthcare system has been decimated and people are under siege. Without access to medical care, thousands more lives will be lost, beyond those killed in the Israeli bombardments seen in the news – these are Gaza’s“silent killings”.

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Sudan: a colossal man-made catastrophe; MSF calls for an urgent, rapid scale-up of the humanitarian response

Sudan: a colossal man-made catastrophe; MSF calls for an urgent, rapid scale-up of the humanitarian response

After one year of war, the aid provided to millions of people is a drop in the ocean due to political blockages created by the warring parties and lack of action from the United Nations and international humanitarian organisations.

Port Sudan/Darfur, 12 April 2024 – In one of the world’s worst crises for decades, Sudan is facing a colossal, man-made catastrophe one year after the start of the war between the Government-led Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF). It is a matter of life or death for millions of people to urgently enable safe humanitarian access. As governments and officials, aid organisations and donors meet on 15 April in Paris[1] to discuss ways to improve the delivery of humanitarian aid, Médecins Sans Frontières (MSF) is making an urgent call for them to immediately scale up the humanitarian response.

Millions of people are at risk, yet the world is turning a blind eye as the warring parties intentionally block humanitarian access and the delivery of aid. The United Nations (UN) and member states must redouble their efforts towards negotiating safe and unhindered access and to scale up the humanitarian response to prevent this already desperate situation from deteriorating any further.

People in Sudan are suffering immensely as heavy fighting persists —including bombardments, shelling and ground operations in residential urban areas and in villages—, and the health system and basic services have largely collapsed or been damaged by the warring parties. Only 20 to 30 per cent of health facilities remain functional in Sudan, meaning that there is extremely limited availability of health care for people across the country.
Jean Stowell, MSF head of mission in Sudan

In areas close to hostilities, MSF teams have treated women, men and children directly injured in the fighting, including shrapnel wounds, blast injuries and gunshot injuries, and from stray bullets.  Since April 2023, MSF supported facilities have received more than 22,800 cases of traumatic injuries and performed more than 4,600 surgical interventions, many of them related to the violence which occurred in Khartoum and Darfur. In Wad Madani, a town surrounded by three active frontlines, we see currently 200 patients per month with violence related injuries.

According to the UN, more than eight million people have already been forced to flee their homes and been displaced multiple times, and 25 million – half of the country’s population – are estimated to be in need of humanitarian assistance. “Every day we see patients dying because of violence-related injuries, children perishing due to malnutrition and the lack of vaccines, women with complications after unsafe deliveries, patients who have experienced sexual violence, and people with chronic diseases who cannot access their medicines,” Stowell continues. “Despite all this, there is an extremely disturbing humanitarian void.”

Although MSF works in good cooperation with the Ministry of Health (MoH), the Government of Sudan (GoS) has persistently and deliberately obstructed access to humanitarian aid, especially to areas outside of their control: it has systematically denied travel permits for humanitarian staff and supplies to cross the front lines, restricted the use of border crossings, and established a highly restrictive process for obtaining humanitarian visas.

“Today, our biggest challenge is the scarcity of medical supplies. We’ve run out of surgical equipment, and we are on the brink of stopping all work unless supplies arrive,” says *Ibrahim , an MSF doctor working in Khartoum, a city that has been under a blockade for the past six months. A similar situation has been impacting the city of Wad Madani since January.

Millions of people are at risk, yet the world is turning a blind eye as the warring parties intentionally block humanitarian access and the delivery of aid. The United Nations (UN) and member states must redouble their efforts towards negotiating safe and unhindered access and to scale up the humanitarian response to prevent this already desperate situation from deteriorating any further.

In RSF-controlled areas, where many different militias and armed groups also operate, health facilities and warehouses were frequently looted in the first months of the conflict. Incidents such as carjackings continue on a regular basis and medical workers, particularly from the Ministry of Health, have been harassed and arrested.

In hard-to-reach areas like Darfur, Khartoum or Al Jazirah, MSF often finds itself the sole or one of the few international humanitarian organisations present, while needs far exceed our capacity to respond. Even in more accessible areas such as White Nile, Blue Nile, Kassala and Gedaref states, the overall response is negligible: a drop in the ocean.

One example is the catastrophic malnutrition crisis in Zamzam camp in North Darfur, where there have been no food distributions from WFP since May 2023. Almost a quarter (23 per cent) of children we screened there in a rapid assessment in January were found to be suffering from acute malnutrition – seven percent were severe cases. 40 per cent of pregnant and breastfeeding women were suffering from malnutrition, and there was a devastating mortality rate across the camp of 2.5 deaths per 10,000 people per day.

The situation in Sudan was already very fragile before the war and it has now become catastrophic. In many of the areas where MSF has started emergency activities, we have not seen the return of the international humanitarian organisations that initially evacuated in April.
Ozan Agbas, MSF Emergency Operations Manager for Sudan

Khadija Mohammad Abakkar, who had to flee her home in Zalingei, Central Darfur, in search of safety, recounts how difficult it was to survive without humanitarian assistance: “During the fighting, there was no access to health care or food in the camp. I sold my belongings to earn some money for food.”

While these are difficult conditions in which to operate, the response should have increased, not diminished, especially in the areas where access is possible. Increased efforts are urgently needed by all humanitarian actors and organisations to find solutions to these problems and scale up activities across the country.

“The United Nations and their partners have persisted in self-imposed restrictions on accessing these regions and, as a result, they have not even pre-positioned themselves to intervene or establish teams on the ground when opportunities arise,” Agbas continues.

MSF calls on warring parties to adhere to International Humanitarian Law and the humanitarian resolutions of the Jeddah declaration[1] by putting in place mechanisms to protect civilians and to ensure safe humanitarian access to all areas of Sudan without exception – including stopping blockages. MSF also calls on the UN to show more boldness in the face of this enormous crisis and to focus on clear results related to increasing access so that they actively contribute towards enabling a rapid and massive scale-up of humanitarian assistance. MSF also urges donors to increase funding for the humanitarian response in Sudan.

[1] https://www.state.gov/jeddah-declaration-of-commitment-to-protect-the-civilians-of-sudan/

*Name changed to protect identity

Happy Mother’s Day from MSF Lebanon

Happy Mother’s Day from MSF Lebanon

This mothers day, we're sharing the voices of expecting and new mothers attending our clinic in Wadi Khaled, who've allowed us into their lives during the most precious moments of motherhood. MSF has been present in Wadi Khaled, Akkar since 2016, providing access to primary healthcare for communities in need. In 2023 alone, we have been a part of over 2,000 new beginnings and provided more than 12,000 consultations to ensure the health and happiness of both mothers and babies.

Published on March 21, 2024

Lebanon: Five months into border conflict, displaced people’s needs are on the rise

Lebanon: Five months into border conflict, displaced people’s needs are on the rise

Five months of armed conflict along Lebanon’s southern border have resulted in hundreds of deaths and caused huge disruption to people’s lives, forcing more than 91,000 people from their homes and exacting a significant toll on their financial stability and psychological wellbeing.

Exchanges of fire across the border between Israeli forces and Hezbollah and other groups began on 8 October 2023 and show no signs of abating, while the conflict has recently spread to northeastern Lebanon with Israeli forces bombing Baalbek-Hermel governorate.

Many of the displaced people left their homes with no possessions and struggle to get hold of basic necessities such as food and blankets. More than 60 families are living in an abandoned hotel repurposed into a shelter in Al-Merouaniye, some 60 km from the border. One of its residents is Ali Hammoud, a barber and a father of three from Rab Al-Thalathine, who fights back tears as he recounts his family’s ordeal.

“My older son has had three mental crises,” he says. “We go to sleep, wake up, and repeat this every day. We are worried that our kids will develop mental problems from this situation. The same routine, day in and day out, is more burdensome to a child than an adult.”

Teams from Médecins Sans Frontières/Doctors Without Borders (MSF) are providing displaced people who fled the border region with psychological first aid. Felicitas Steinhoff, MSF’s mental health activity manager, warns of the psychological toll of prolonged displacement: “We’re seeing an increase in depression and anxiety disorders,” she says. “In terms of mental health, I think people are really good at coping with short-term stress, but what we see here is families who have been displaced from their homes for over five months now and who are living with a lot of uncertainty around when and even if they might be able to go back.”

An MSF mobile medical team also provides people with care for chronic diseases and makes regular visits to a clinic in Nabatiyeh governorate, alongside the border. The team provided 373 consultations since the start of 2024 in both locations.

Manahel Rammel, who fled her home in the border town of Oudaisseh on 8 October, says that children and young people are suffering the most. “Young people aged between 18 and 20 sit around without any idea of what they want to do,” she says. “Their future is gone. The future of youth is gone.” Manahel’s own daughter is fortunate to be studying in Beirut, but Manahel is unable to visit her there due to the high cost of transport. Like many people across Lebanon, Manahel already struggled to make ends meet before the current crisis, but being displaced has exacerbated her financial difficulties.  

Lebanon is grappling with its fourth year of severe economic turmoil, which has seen two-thirds of its population pushed into poverty. The current violence has halted or severely impacted many people’s livelihoods, leaving them unable to meet even basic needs.

Ali, initially sought refuge in Beirut but, after his savings were exhausted, he moved to the shelter in El-Merouaniye. “We left our homes with nothing but the shirts on our backs,” says Ali. During the truce [a four-day truce in November 2023], we went back to pack some essentials and clothes just to warm ourselves… I had some savings, but they all ran out. I stayed in Beirut for two months and I spent all my money before eventually moving to this shelter.”

While the walls of the abandoned hotel offer some safety and warmth to the families sheltering there, they – like thousands of other displaced people across Lebanon – are clearly in need of comprehensive and sustained assistance as they face an uncertain future.

“If I could rub a magic lantern right at this moment, I would wish to be back home in my village,” says Ali Hammoud. “We have no solution, only God knows where we’re headed.”

Gaza: MSF UK Board member killed during Israeli offensive in Khan Younis

Gaza: MSF UK Board member killed during Israeli offensive in Khan Younis

5 March 2024 – Médecins sans Frontières/Doctors Without Borders (MSF) is devastated about the death Reem Abu Lebdeh, an associate trustee of the MSF UK Board and former staff member in Gaza, whom we believe was killed sometime in December 2023.

Though the exact circumstances and date of Reem’s death remain unclear, we believe she was killed along with members of her family at their home in Khan Younis in southern Gaza. Some members of her family remain unaccounted for.

When the Israeli military campaign moved more extensively into Khan Younis over two months ago, we know Reem was sheltering with her parents and siblings. Regrettably, contact with Reem was lost shortly thereafter and all attempts to regain it failed due to telecommunications networks being cut off.

However, news of Reem’s death and that of her family members gradually emerged in the following weeks. To this day, the zone around the house, which was heavily bombarded by Israeli forces, remains too dangerous to approach.

Reem worked as a physiotherapist for MSF in Gaza from 2018 until 2022, and last year was appointed as an associate trustee of the MSF UK Board.

Reem is the fifth MSF colleague killed in Gaza since the beginning of the war and several members of our staff remain unaccounted for. We are still mourning the loss of lab technician Mohammed Al Ahel, killed in an airstrike with members of his family; volunteer nurse Alaa Al-Shawa shot in the head during a planned evacuation MSF convoy; doctors Mahmoud Abu Nujaila and Ahmad Al Sahar, killed following a strike on Al Awda hospital. All these MSF colleagues were killed in November 2023.

Thousands of people in Gaza are losing their families, their homes and their lives. Gaza’s Ministry of Health has reported over 29,000 people have been killed and over 69,000 wounded.

MSF teams continue to provide medical care in various locations in southern Gaza, including in Rafah where 1.5 million forcibly displaced people are living in dire conditions with extremely limited access to medical care and humanitarian aid. 

We reiterate our urgent call for an immediate and sustained ceasefire to spare the lives of civilians and allow for substantial aid to enter the enclave. 

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