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無國界醫生 Médecins Sans Frontières

A day in the life of the Syrian conflict

Borderline

06 Nov 2014

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The Ebola Outbreak and Beyond

 

At the time of writing this article, MSF is deploying its full capacity in responding to the Ebola outbreak in West Africa, which is the most severe Ebola epidemic ever in terms of the number of confirmed cases and deaths. As a medical humanitarian organisation, MSF has now more than 2,000 staff on the ground, treating Ebola patients in five treatment centres.

 

But we do more than that. MSF has been ringing the alarm bells and mobilising state leaders and the United Nations to be part of the response since the onset of the outbreak. While some states are willing to lead by example and join the battle, others should follow suit. We have been losing the battle for too long and we must reverse the tide in the coming months.

 

Although the Ebola outbreak gets most of the headlines, it should not overshadow humanitarian crises unfolding in other parts of the world, especially in conflict areas where MSF is struggling to provide much needed assistance.

 

In troubled Syria and its neighbouring countries, the Syrian people are suffering from the terrible physical and mental consequences of the ongoing war. To bring the personal toll of this brutal conflict into the spotlight, the Cover Story of this issue of Borderline features a day in the life of our field workers in Lebanon, Iraq and Jordan, where MSF is providing medical care to Syrian refugees.

 

Meanwhile, despite the Gaza ceasefire announced in August 2014, exposure to violence has serious psychological impacts on the populations in the West Bank. The Photo Feature uncovers the medical needs there and MSF's work to respond to them.

 

Today, MSF teams are overwhelmed in dealing with the large volume of crises in Central African Republic and South Sudan, as well as emergencies in Ukraine, Syria and the Ebola outbreak. We are only sustaining our efforts with the enormous commitment from our field workers and supporters like you. This is a special moment of celebration for MSF's 20 year presence in Hong Kong and we want to express gratitude to our supporters. THANK YOU HONG KONG!

Remi Carrier

Rémi Carrier

Executive Director, Médecins Sans Frontières Hong Kong

Cover Story

The reach of war: A day in the life of the Syrian conflict

Into its fourth year, the war in Syria has killed more than 150,000 people. More than 6.5 million are displaced inside its borders, and more than 2.8 million have fled the country.

 

Like a disease that spreads far beyond the initial point of infection, the reach of Syria's war is visible in many places at once. MSF humanitarian workers of different backgrounds experience "a day in the life" of this brutal, relentless conflict in Jordan, Lebanon and Iraq.

 

Jordan: A long road of rehabilitation ahead

 

As the day begins, surgeons in two different places in Jordan have started their work. 

 

Dr. Haydar Alwash, a surgeon originally from Iraq, works in Ramtha Hospital in northeastern Jordan. He starts his rounds around 8:30 this morning, dealing with the consequences of bombs or gunshot. "All our patients are newly injured in this conflict," he says. "Our work mainly concentrates first on surgical procedures that can save lives or save limbs." 

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Dr. Alwash reaches the bedside of a girl named Rukaya, 14, who was hit by a shell. She did not realise that she had lost both legs and her mother was dead until she woke up in the hospital. Seven operations followed, and another tomorrow to prepare her for the prosthetics. Rukaya smiles when she talks to Dr. Alwash, asserting her determination to be happy again one day. Her smile helps the doctor to cope with seeing the maimed arrive one after another.

 

At the same time in Amman, Dr. Ashraf Bustanji, an MSF maxillofacial specialist, is stepping into the operating theater to perform surgery on a Syrian man who has suffered extensive facial injuries. "Most of the cases here undergo multiple reconstructive surgeries," he says. "Most of the time the treatment cannot be completed in a single stage, or within a couple of weeks, or one month."

 

It's not just the surgery. There is also the physiotherapy and rehabilitation. They have to re-learn how to use damaged limbs or the prosthetics. Patience, perseverance, and pain management are crucial, because the road back to health from injuries like these is guaranteed to be a long one. “The cases here are challenging, but along with the medical treatment, the project is giving hope to these patients, by trying to alleviate their pain, their suffering.” says Dr. Bustanji.

 

Lebanon: The search for shelter

 

On the same morning, people are already assembled outside four different MSF clinics in Lebanon's Bekaa Valley. These projects in clinics are only one facet of MSF's work in the area. 

 

As there are no organised camps for refugees, Syrians fleeing to Lebanon have to find their own shelter, for example in empty schoolhouses or an abandoned prison. Local medical services are limited, particularly for refugees not registered with the UN. To make matters worse, the area occasionally gets hit by shellfire.

 

Too often, people do not know where they can access medical attention so it is not enough to wait for people to come to the clinics. Hanane Lahjiri, an MSF community health worker, has to seek them out, driving from one refugee settlement to the next. The first stop on this day is the Abu Ismael settlement, where Lahjiri wants to check in on a woman whose baby died shortly after being born. 

 

The roads in the Bekaa wind through valleys and hills, but wherever MSF staff travel, they find people seeking assistance.

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Iraq: A painful limbo

 

It is also a busy morning for Dr. Mustapha Khalil, a specialist in emergency medicine in the Domeez refugee camp in northern Iraq. Soon after entering the ward he sees two boys, one with ear and respiratory infections, another scalded by boiling water when a pot toppled over. There are also a baby with urinary tract infection and a girl who needs stitches for a large cut on her finger. "Every morning is like this," he says.

  

MSF's mental health teams in Domeez also conduct seven to nine sessions per day. They hear of depression and anxiety from adults, and nightmares, problems sleeping, and bedwetting among children. "People have suffered a lot in Syria. A lot of families were torn apart.” says Henrike Zellman, an MSF psychologist who worked in the camp. Many people were injured, lost loved ones or their homes. They don't know how long they will be in exile or if there will be anything to return to should the war ever end.

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By nightfall, hundreds of patients were seen and treated in MSF's projects. Several surgeries were performed as well, while people still have to be in the face of ongoing violence. MSF will continue doing what it can in the hope that at some point in the future, a day in the life of the people affected by the war in Syria will look very different. 

 

Visit Reach of War website for more stories: http://msf-seasia.org/reachofwar

Worldwide Work

Care for sexual violence survivors in Honduras

 

This service aims to provide sexual violence survivors with the medical and psychological care they need in one location, in the course of one visit, for free, and with confidentiality guaranteed. Between January 2013 and June 2014, MSF provided treatment for 1,008 survivors of sexual violence and 1,230 mental health consultations.

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A new displacement crisis in Iraq

 

The recent conflict in the north of Iraq has led to the displacement of over 250,000 people. MSF runs mobile clinics in the region to provide primary healthcare services, mainly for communicable diseases in children and for chronic diseases in adults.

 

Treating malnutrition in South Sudan

 

In July 2014, alarming malnutrition rates are recorded in Leer, as the conflict forced people into the bush without anything to eat other than wild roots or whatever else could be gathered from the land. MSF admitted over 1,800 children into the ambulatory therapeutic feeding centre.

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Supporting the health system in Ukraine

 

MSF provided medical materials for treating more than 6,200 war-wounded to hospitals in the Donetsk and Luhansk regions since mid-May 2014. 

Medical Info

Busting the Myths about Ebola

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The biggest Ebola outbreak in the history has already claimed more than 2,600 lives. The high fatality rate has created a lot of fear not just in the affected parts of West Africa, but also outside the region. It is a very dangerous disease, but not all of the fears are medically justified. 

 

1. Is it transmitted through air?

 

No. Ebola is not an airborne disease. It is transmitted through: 

  • contact with infected animals; 

  • direct contact with infected body fluids of an infected patient, such as blood, sweat, excreta, vomit, saliva, sperm and mother’s milk;

  • contact with infected corpses (human or animal) which have high levels of virus.  

 

For the safety of our staff, MSF implements strict infection control measures inside our medical facilities, such as the personal protective equipment and clear separation of low-risk and high-risk areas inside the treatment centres.

 

2. Do all infected patients have haemorrhagic symptoms?

 

No. Early on, symptoms are non-specific, making it difficult to diagnose. The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches, painful throat and difficulty in swallowing. This can be followed by vomiting, diarrhoea, rash, impaired kidney and liver function. Haemorrhagic symptoms like nosebleeds, bloody vomit, bloody diarrhoea, internal bleeding and conjunctivitis are seen in less than 50 percent of cases.

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3. Is the person infected with Ebola contagious during the incubation period?

 

The incubation period for Ebola from the time the pathogen enters the body until signs or symptoms first appear, is 2 to 21 days. 

 

During this period even the patient is infected with the virus, he is not contagious as long as he does not have any symptoms and hence can lead a normal life. But once he develops any symptoms, he should immediately go to a hospital.    

 

4. Is Ebola untreatable?

 

At the time of writing, there is no specific treatment or vaccine available that has proven efficacy in humans and is registered for use in patients. Supportive treatment, such as hydrating the patient, maintaining their oxygen status and blood pressure, providing high quality nutrition and treating them with antibiotics for any complicating infections, can help the patient survive longer. And the extra time may be just what the patient's own immune system needs to start fighting the virus.

Photo Feature

Healing Occupied Minds

The conflict in Gaza in the summer of 2014 provoked hundreds of violent incursions and arrests all over the West Bank, resulting in deaths and injuries. Demonstrations, clashes and demolition of houses took place on a daily basis, and the mental health of the population has further deteriorated.

 

To help people overcome problems such as anxiety, depression, terror and post-traumatic stress disorder, MSF has been providing psychological supports to patients in Hebron and the surrounding areas, with many of them recovering following treatment.

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