MSF Live with Avril Benoît: Responding to emergencies and cascading crises

Kavita Menon (00:01):

I am Kavita Menon and I'm the director of Communications for Doctors Without Borders. I'm joining you live from New York City and I will help moderate the discussion with Avril. And we're going to go for about 30 minutes. I just want to give you a few notes. Some of you may know us by our French name, Medecins Sans Frontieres, or MSF. Wherever you're tuning in from today, you can submit questions in the chat or the comments. And we also have MSF team members online ready to answer your questions directly or pass them on for Avril to answer them live, and live captions for this event are also available on all channels. So Avril, before we get into what you're doing in South Sudan, could we start with MSF response to the growing humanitarian catastrophe in Gaza and what our teams are witnessing there?

Avril Benoit (00:53):

It's been an incredibly difficult time. Certainly we have worked in Gaza for a long, long time and when we watched what happened with the Hamas attacks on Israel on October 7th, we were shattered and really horrified to see the suffering there. Our projects have always been in Gaza and so as I have relayed in a previous webinar for our supporters, that's one of the main reasons we're bearing with us to the situation in Gaza right now. We have more than 300 staff there under very difficult conditions. We often lose contact with them. We are doing the best we can to make it possible for them to find some shelter in our offices. Many of them are displaced right now. They have gone with their families to different locations. We recently learned that one of our dear colleagues had died, a lab technician, who had worked with us for a few years and really are feeling the difficulty of the situation as our own staff are trying to survive with their families as best they can.

Avril Benoit (02:01):

Some of them in refugee camps, some of them having displaced to the South and some having made the really harrowing choice to stay at the bedside of patients in some of the hospitals where there is some attempt to at least keep providing whatever care they can amid a dire shortage of medical equipment, of supplies, of basic medicines such as anesthesia. So as we have been communicating loud and clear, our main call to action, the one thing you can do to support us through the suffering that we're seeing and trying to address in our trying to pull it together under very difficult circumstances in Gaza is for a ceasefire. A ceasefire. Now a ceasefire might allow us, we hope to be able to provide the humanitarian aid for people to bring in enough supplies, not just the small trickle of trucks, but really bring in the food, the water, the fuel to run generators and water treatment plants, the medicines that we need to allow the doctors to do more than just watch people die.

(03:10)
A lot of the wounds that are coming in, the people who are injured have open fractures, bones sticking out. There's a lot of shrapnel to the body, to the face. They are reporting that many people already have infections by the time they come in. And the one thing that is so gut wrenching is that so many of the victims, billions coming into the hospitals that are trying to function are children and women. They're civilians. And so that to us is the great necessity for a ceasefire. And so if anyone watching wants to join us beyond providing donations for our independent humanitarian action around the world and for our emergency response in places like Gaza, demanding a ceasefire now is the main thing we're looking for.

Kavita Menon (04:00):

Thanks for that Avril. I mean, it's really been tough. I know worrying about our colleagues also trying to get aid in, but we had a glimmer of good news this week that some of, and one of our aid shipments actually was able to make it across the border to Gaza. I just heard about that this morning. So at least we can be confident that some of that relief is getting in, although it's too little too slow. But so with this emergency happening in Gaza, what brings you to South Sudan?

Avril Benoit (04:32):

Well, this is a place I used to work a long time ago. Many years ago I was asked to participate in an assessment visit to the border area with Sudan in Upper Nile when some refugees from Blue Nile State in Sudan were crossing over. And then I ended up becoming years later, a couple of years later, the project coordinator of this huge project. So it's the kind of place where once you've worked here and really spent a lot of time, you become so attached and you try to follow what's happening over the years. And one of the things that really has concerned us is to see the effect of the climate crisis on people in South Sudan. So this new country, which never really has had much of a chance to develop properly suffered, went through years of neglect, lack of development, lack of investment when it was together with the whole of Sudan, when it split off and became independent still there was infighting factions, civil war, very difficult times.

(05:39)
And despite all the efforts of MSF, over 40 years we've been running operations in South Sudan, we can see that there's just this dire gap in terms of healthcare response and the climate crisis, just adding on top of that, adding on top of the insecurity, which is still sporadic despite a peace agreement, the low income subsistence livelihoods for many of the people in the country, a lot of divisions regionally. So it's not so for people to move from one place to the other because of their ethnic identities. A lot of issues around gender equality, women really don't have a whole lot of rights. They often don't get to go to school in some of the rural areas, high birth rate, high maternal mortality rate. A lot of the issues have always compounded here. And it's one of the reasons that it's always been in the top three of the great financial budgetary investments that MSF makes around the world with the other two being Democratic Republic of Congo and Yemen at the moment.

(06:51)
So to come to South Sudan at a time when the climate crisis is creating this incredible flooding in one of the areas in the state of Jonglei. And I don't know if we can maybe show a picture here, if you don't mind. I know we have some photos that we took this past week. The area is so completely flooded, it was always a little bit of a marshland around old Fangak, but in recent years when we have the rainy season, which runs mostly from June, usually wraps up by September, then you have a receding waters. And so people are planting their crops, they have their cattle. Cows are a very important part of not only the diet but the economy here normally. And in recent years, the floods have been so catastrophic that the cattle have died, the crops washed away, a lot of people lost their compounds where they were living just as the waters encroached. And you can see that they become these little islands that you can see from above where more and more people are living in congregate settings and the water is just not receding, it just stays. Now we think it's mostly climate change in certain terms of torrential rainfalls, and the season is not when people thought it would be. So it's November, it's still raining quite hard sometimes in when I was there I arrived. It was a huge downpour.

(08:22)
And so that brings with it a lot of health concerns. So vector-borne diseases, mosquitoes, malaria, you've got also snakes in the water. So as people are trying to wade through in order to collect water lilies, which is one of the few food sources that is now naturally growing, and then they have to spend hours and hours pounding it and drying it and making it edible. But there are snakes in the water. So we have this huge problem of snake bites. MSF has advocated aloud for many years about the need for anti-venom to be available in South Sudan. That's appropriate to the snakes that are here. We also have other kinds of waterborne diseases. I mean certainly all kinds of children come in with diarrhea, but there's also schistosomiasis, that neglected tropical diseases in the area. And all this together is really adding to malnutrition. So we have many, many situations where children are coming in having traveled really far because of all the water.

(09:26)
It's difficult to get from here to there. The mothers are bringing in children who really should have been brought in a lot earlier. And we have another photo here. This is a child that I met, two years old in old Fangak. And her mother told me the story of how she's a mother of six from that area originally, and she had gone in recent years to Sudan, so she and her husband could make a living in Khartoum. And with all the fighting that's happening in Sudan right now, there's huge war. It's a massive humanitarian crisis. More than 5.5 million people displace horrific violence happening right now in Darfur. And even a lot of the active fighting is coming closer to South Sudan. So she decided this mother to come with her six children. She was separated from her husband. She hasn't been able to get in contact with him for a couple of months already.

(10:29)
And when she brought her children across to the border area, she wasn't even able to register as a returnee or a refugee in order to receive some cash assistance because the line was so long in rank, which is a place that I'm going to be going tomorrow actually. So I'll have more on that after I go and see. But basically in rank MSF is decrying the lack of aid, the lack of registration, the lack of assistance to support people that are coming with severe malnutrition among many of the children. So she finally makes it her way to old Fangak where she has some relations. She locates her mother-in-law who is visually impaired, an elderly woman, not well. So now she's looking after her six kids and the mother-in-law. And this child is malnourished and has malaria and it's compounded the diarrhea, ear ache, ear infection, vomiting, all the things that go with it.

(11:33)
And so as I was listening to her story, just realizing the importance of the advocacy and the public awareness raising that MSF does because this is a situation where it was conflict that pushed her into the zone, but now she finds herself in a situation surrounded by water. She has no place to grow crops. They're all living together in very crowded conditions. In one Hutt, they do have mosquito net, but they all have to sleep under one. So the conditions are just appalling in terms of water, clean drinking water is in short supply because the wells have flooded. I mean, the latrines that might've existed in schools nearby, the village completely flooded. And so the health situation is really, really serious. So we can go to the next

Kavita Menon (12:18):

Yeah, I wanted to ask you also, I mean you described the situation of compounding crisis and layers of crisis, acute needs. What is the international response? I mean, I know MSF has been there for decades, but what does the international response look like in South Sudan?

Avril Benoit (12:35):

Yeah, it's a really difficult one, Kavita, because budgets are being cut in the international aid community. Just yesterday we had an event to mark the 40 years of MSF operational activity in South Sudan, and we invited the big donors from the governments, like U-S-A-I-D is usually a big donor here. We invited the International Committee of the Red Cross, which relayed that they were cutting their budget by 60%. The US is cutting its budgets severely. Other agencies, 50% budget cuts for Sudan. Why? Because of all the other crises around the world, the humanitarian system is stretched so thin. We're very thankful for the independent funding from individual donors that we have at MSF, which allows us to be very responsive to emergency. But this is not what we're seeing among many of our colleagues who are fully engaged in Ukraine as we are really trying to support in the Middle East right now, we've got Sudan where MSF is really stretched thin.

(13:42)
One of the few organizations continues to be operational and active in so many states responding to the health needs of this population in Khartoum, in Darfur, in other states where they're really under pressure from the violence. And so the portrait for the situation in South Sudan looks grim. The next photo is actually of a malnourished child. And the food distributions have been cut so much from the World Food program because of funding. So normally they would get monthly distributions, general food distribution, and now it's three months and people only get half. So in addition to the burden here of malnutrition, we've got these waterborne disease vector-borne disease, hepatitis E, we've got a hepatitis E outbreak, which is a fecal oral disease. It can kill even when I was there, a mother who had just given birth to a preemie child died of her hep E. And the child actually contracted hep E somehow along the way. And so I mean really dark scenarios for South Sudan, which is of the reasons that it's so important for us to be there to bear witness to speak aloud of the needs that we're seeing.

Kavita Menon (15:00):

Yeah, I mean definitely a lot of neglected crises there. And you talked about going to rank next where you're going to see meet, have a chance to meet with some of the returnees and refugees from the conflict in Sudan. That's another major emergency that MSF is responding to. So I'm going to give you a chance to talk a little bit about that, but I also want to invite the audience to submit questions if you have them. We're kind of doing a little bit of a run through some of the big emergency responses, but there have been many this year. It's actually been a really challenging year on many levels. So you may have questions about other contexts. Feel free to put them in the chat and we'll get to as many as we can. But yeah, Avril, if we can talk about Sudan.

Avril Benoit (15:46):

Yeah, Sudan is a difficult one because you've got essentially two factions of the military that have been fighting. It's now in its seventh month or we've just passed six. It is caused so much displacement. And in the hospitals in Khartoum that MSF is supporting, they're in the capital where there have been airstrikes really pounding people, splitting people from one side to the other. They flee to one side to the city, they flee to the other. And tremendous restrictions for MSF to be able to support the hospital. So for example, there's one hospital where we haven't been permitted to bring in the surgical supplies in another area of the city. We're not allowed to even go. There's a restriction on movement because they say security is not assured and therefore staff cannot go in. We have a lot of colleagues also working in Darfur right now and in pockets of Darfur.

(16:45)
And it shifts from here to there. Right now, west Darfur is the main focus. What has happened is that there's violence against villages often suggesting that there's ethnic targeting going on, that people are being identified because of their background, their cultural identity. And these stories that we're hearing are so awful. And sometimes the warnings are so awful. Commanders will say, Hey, we advise you to clear out MSF, you should probably get moving if you want to spare yourselves. Tremendous violence. And so we have had to reduce teams and then they're on standby. They try to support from another location, then they go back in. And meanwhile, we really scaled up in Chad. Chad is one of the bordering countries where so many refugees from Sudan have fled and 400,000, I don't even know what is the latest figure now, something like 400,000. And the camp conditions are, as you would expect in wide open planes, we need to build latrines for these people. We need to make sure that they have clean drinking water set up. The medical facilities. Aid agencies have tried the best they can to respond to the violence in Sudan, but it should be said that it's one of those places that is not necessarily a priority as it should be.

Kavita Menon (18:14):

I think it's interesting to see how MSF has managed to scale up in Chad. And one of the examples you might want to talk about is that our build, we set up a field hospital in kind of record time. I don't know if you want to share that example of how we can make an impact even in really difficult circumstances.

Avril Benoit (18:39):

Yeah, it's one of those places where we have a long history and we will continue to work and we will continue to do everything we can to work safely, obviously, but to respond to where the needs are greatest. And that's one of the things that I really appreciate about MSF is that we have that independence. You might see a certain place in the news, a certain natural disaster. And of course we are always responding to those kinds of things when there's a need. But in other places, you have fewer actors that are able to actually take the risks that we do, quite frankly, that have the community relationships that we've forged over the years, the acceptance of the local population that warns us that things are about to blow. And so that's one of the reasons that I so respect the operations teams that are on the ground in place.

(19:33)
The other place I can just mention is Haiti. A year ago, remember I was in Haiti, and it's a place that I've been visiting for years, since 1990, back in the days when I was a journalist. And to see what has happened to Haiti over the last few years. I mean, that's an example where the world, the caravan of aid kind of moved on after earthquake. And then when the gangs, the armed groups, the criminality of the city pushed so many people to be displaced within Port-au-Prince. The Capital, MSF has been there running a trauma center, burn center, a sexual violence center, really stepping up, scaling up at a time when the people have tremendous needs. And it's a country right next to the United States. You would think that we would be paying a lot more attention to that in the general news, but it's just not the case. And yet in Haiti, we're seeing malnutrition. We are seeing people succumb to violent wounds. It's really a difficult situation. We're still able to work, which I think is incredible, but the situation, our staff and for the patients is really difficult. The access just to be able to get to the hospital for a patient or a staff member is incredibly challenging and it really hasn't improved unfortunately in the last year.

Kavita Menon (21:02):

Thanks for reminding us about Haiti. That is another priority context for us is the US office because we feel so close to the people there. We have a question from the audience asking if this is from Kevin watching on Vimeo, and he asked if you can talk a little bit more about MSF call for a humanitarian ceasefire in Gaza in order to bring in medical supplies.

Avril Benoit (21:30):

Yes. Well, the main thing about the ceasefire, and one of the reasons that it's so important to us is that you hear sometimes about a pause, humanitarian pause. That's what many politicians are arguing should happen. And for us, that's not enough because if you're working in a hospital, you are treating people who have been bombed, they've experienced indiscriminate attacks, war gas is safe, you patch them up as best you can, you stop the bleeding, you've got nothing for their pain, no anesthesia. A pause would allow people to presumably move to a safe place. And yet where in Gaza is really safe, they could go somewhere, use those few hours of a pause to reach another place that they imagine would be safe, such as what's happening now where so many people just end up on the grounds of hospitals and then they get bombed again or suffer violence again. So for us, it's not really the solution. The ceasefire call is resoundingly the voice of the humanitarian community. It is the voice of people around the world just asking for the violence against civilians to stop. And we appreciate that there's a military operation ongoing, but so many children are dying, so many civilians are dying. And that's the main concern and that's why humanitarians, there is just no option really than a ceasefire, a proper ceases.

Kavita Menon (23:09):

Thank you for that. We have a question from Tanya asking, is there another way to help MSF besides donating?

Avril Benoit (23:19):

Well, I mentioned earlier this question of ceasefire now is one that if you have any connections, if you have any leavers, if you want to write a letter to the editor, if you want to call somebody in authority in public office to convey it, there's a lot of very intelligent analysis about why a ceasefire is important right now. Share it with your friends, help others understand why this is important. The advocacy, of course, goes beyond Gaza, and that's maybe one of the reasons that we're mentioning all these other places. One of the reasons I'm in South Sudan is to not forget the other places around the world. We do tend to have a kind of focus on one news story or one emergency at a time. And it's hard to hold suffering in many other places in our minds, in our hearts. It's so overwhelming. I understand why as humans we're deluded with all kinds of negative news, especially in our line of work.

(24:24)
You follow all the operational updates and you just, wow, when does it stop? I mean, it really can get under your skin and keep you up at night as it does. But at the same time, just don't forget that there are many other places in the world and really not to mention or not to forget about Ukraine, where we still have teams on the ground trying to provide, especially mental health supports, because the Ukrainian physicians and nurses, the hospitals are doing the best they can. They're hanging on really making things run. But we have provided a lot of support, supplies, expertise in triage. We continue to provide lots of technical support, and mental healthcare is a priority because we can see how important that is for people to be able to carry on with their lives even when they're in danger.

Kavita Menon (25:13):

I think we have time for one last question. We have Sarah on Vimeo asking how does MSF maintain its neutrality while working in complicated political context and conflict zones?

Avril Benoit (25:30):

Well, neutrality to us, it's obviously a tricky word because what's in your heart, your background, how you were educated, where you're from. I mean, nobody's really neutral on an individual level, but as an organization like many other humanitarian organizations, the International Committee of the Red Cross comes to mind. We have to maintain neutrality and impartiality as a means of building the trust of all parties to conflict. So even think about these trucks that are coming in to Gaza, the small, tiny, not enough trucks that are carrying a few supplies. They have to be inspected by Israeli authorities before they go into Gaza, before they go into Egypt and then cross through the Raffa crossing, right? So you have to make sure that Egypt has agreed, Israel has agreed, Hamas has agreed not to attack the trucks, to let them through. It's an incredibly difficult line to walk when there's so much conflict and so much polarization in the midst of a conflict like that.

(26:40)
So the importance for us in conveying this neutrality is to say, look, we have no influence over the outcome of this. We're not siding with one of you or the other of you. We are for the people. We're for the people suffering in a situation. We are on the side of humanity and you'll do what you need to do and so forth. But leave us out of it. We have no business really commenting on how this should all play out, what the political structure should look like, what a peace agreement should look like. That's really not our lane. We are humanitarians. We're operational. We're on the ground with people taking tremendous risks. And so sometimes that means that we have to really think through what it is that we're conveying to the various parties of the conflict when we're negotiating. And one of the best ways to do that is to let them see that through our actions, we are neutral.

Kavita Menon (27:38):

Absolutely. I think that is all the time we have. So is there anything else you want to add? Any last words?

Avril Benoit (27:48):

I just appreciate that we've gotten through this, despite me hearing a tremendous echo. I'm talking and also hearing that the delay of an echo, so technical things aside

Kavita Menon (28:01):

Live from Juba has its challenges.

Avril Benoit (28:05):

There are limits, but I just want to say thanks everyone. Really appreciate your support. We've received a lot of messages of support in the recent times. It's been difficult for us. There are many losses all around from people's individual relations in Israel and in Gaza and West Bank. People worried about relatives in Lebanon, lots of heartache. And we really appreciate all the support for the work that we are trying the best we can under really difficult circumstances to get the operations coordinated again, because right now we're counting on really dedicated and courageous Palestinian colleagues who are doing incredible work under extreme circumstances without the normal apparatus of the organization of MSF, to really be able to fully support them. And we appreciate that. You can see that, that you can recognize the dedication involved to saving lives and alleviating suffer.

Kavita Menon (29:18):

Thank you so much. I'll just add my thanks and invite you all to stay in touch and stay connected with MSF. You can follow us on social media, learn more on our website in the US. We are doctors without borders.org, and our international site is msf.org. So thank you very much. Thank you so much, Avril and goodbye to all.