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‘A War Without Limits Leads To A Battlefield Without Doctors’

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By Christopher Stokes:

Today, Médecins Sans Frontières (MSF) is remembering one of the darkest moments in its history. On October 3 2015, U.S. airstrikes killed 42 people and destroyed the MSF trauma hospital in Kunduz, Afghanistan.

As we grieve the loss of our colleagues and patients, we are left with the question: is it still possible to safely provide medical care on the front line? In the past year, there have been 77 attacks on medical facilities run and supported by MSF in Syria and Yemen. Hospitals are being continually dragged onto the battlefield, and patients and their doctors and nurses are sacrificed in the process.

It was the destruction of the Kunduz Trauma Centre and the devastating assault on health facilities in Syria and Yemen that led to the UN Security Council Resolution 2286 being passed in May 2016. The resolution strongly condemned attacks on medical facilities and demanded that all parties to armed conflict comply fully with their obligations under international law.

And yet, five months later and on the same day as two health facilities were hit in Syria, we returned to the chambers of the Security Council to decry the hypocrisy of States – particularly those involved in the wars in Syria and Yemen. With one hand, States sign a resolution to protect health facilities and with the other they continue to be directly involved or complicit in the ongoing onslaught of health workers and patients in conflict zones.

What is clear is that with every attack on a health facility the chasm widens between the rhetoric from governments about their respect for International Humanitarian Law and the way they wage wars in reality.

October 3, 2015 will forever remain a black day in MSF’s history. In the early hours of the morning, MSF’s trauma hospital in Kunduz, Afghanistan came under precise and repeated airstrikes. Under attack, our colleagues fought for their lives and for the lives of their patients with extraordinary determination and courage. Fourteen MSF colleagues lost their lives that tragic day. All of MSF grieves with the victims’ families. They will be tremendously missed and never forgotten.
No government has ever said it intentionally bombs hospitals, but they are bombed nonetheless. More often than not, these attacks occur under the umbrella of the ever-expanding ‘war on terror’ – a label used with increasing frequency including today by all military coalitions in Syria. Attacks are either dismissed as tragic ‘mistakes’, denied outright, or become political footballs as States desperately point fingers at each other while claiming at the same time that their bombs are the smartest and that their airstrikes are the most ‘humanitarian’.

There have been no impartial investigations carried out by an independent international body into any of the attacks on hospitals that have occurred over the past year. This is because there is zero political will among governments to have their military conduct examined from the outside.

In the case of Kunduz, the U.S. carried out an internal military investigation and made a heavily redacted report available to the public in April. It is more than we have received from any other military force that has been involved in bombing an MSF facility.

This investigation undertaken by the U.S. has allowed us to gain a deeper insight into the events that occurred in Kunduz on the night our hospital was attacked. Some of what we have learnt from the U.S. investigation report is deeply worrying.

The ground troops in Kunduz falsely assumed that “all civilians had fled and only Taliban remained in the city.” They made no effort to find out if this was actually true and did not take the necessary precautions to avoid civilian casualties. The entire city of Kunduz was deemed hostile. While invoking ‘self-defence’ rules, U.S. forces in Kunduz were opening fire pre-emptively in a ‘shoot first, ask questions later’ military operation. No one in the chain of command consulted the no-strike list in the hours leading up to the attack. The report determines that our hospital was misidentified. This led to the 211 artillery shells from an AC-130 being unleashed on our hospital without any hostile threat being confirmed.

MSF continues to engage with the highest levels of the U.S and Afghanistan governments to gain assurances that this will not happen again.

The responsibility for the protection of hospitals – in whichever conflict they operate – does not lie with us moving healthcare away from the battlefield. At the core of the law of war is the responsibility that militaries have to distinguish legitimate targets from protected civilian sites. If there is no distinction made between a civilian and a combatant, then everyone becomes a potential target.

For more than 40 years MSF has negotiated the protection of its medical facilities in conflicts around the world. Our work in convincing warring parties to respect health facilities will continue. For example, to this day, some Afghan officials attempt to justify the attack on our trauma centre by falsely claiming that the hospital was “full of Taliban”. We are left to wonder: does following medical ethics and treating everyone who needs it, including the wounded from all sides, transform our hospitals into ‘enemy bases’?

 

 

 

We cannot accept that we might be targeted for treating the wounded enemy. We will take our message to those with the fire-power in all of the places where we work. We will continue to demand of the most powerful and their allies that they turn their rhetoric into reality. And we will denounce those who seek to erode the laws of war.

A war without limits leads to a battlefield without doctors. We will not sit silently by and let this happen.

About the author: Christopher Stokes is the General Director MSF US.

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Image source: Andrew Burton/Getty Images
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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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Find out more about the campaign here.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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