copyright msf caption © Alexis Huguet
A farmer being treated for a gunshot wound in Paoua hospital, Central African Republic.
04 Apr 18 05 Jul 18

Central African Republic: One Canadian's efforts to help MSF deliver impartial care amid conflict

Neutral and impartial medical action: How a logistician from Montreal sought to put MSF's humanitarian principles into practice in a country still divided by violence.

From the Spring 2018 issue of Dispatches, the MSF Canada magazine.

When Salameh Huneidi, a logistician from Montreal, first arrived in Alindao, a town in the south of Central African Republic (CAR), he had some basic tasks to accomplish in order to help MSF establish an emergency medical intervention.

But operating in CAR is not always straightforward. The small, landlocked nation has been afflicted by a violent conflict since 2013 that has split the country along sectarian lines, and has displaced close to a quarter of the population both internally or externally. MSF is operating almost alone in parts of the country, providing emergency care in a context where nearly half the population is in urgent need of humanitarian assistance.

“With so much tension and volatility,” Huneidi says, “the way we are perceived can be the difference between life and death for both ourselves and our patients. If we are only accepted by one group of people, we cannot reach people in other groups who also need our help. We are impartial and neutral. These principles are the reason we are able to do the work we do in difficult situations all around the world. And the little things can be just as important as the bigger ones.”

That point was made clear to Huneidi during an incident when one group set up a blockade in protest against what they considered one-sided aid efforts. The protest meant that MSF teams would be unable to reach patients on the other side of the barrier. “But they let MSF’s vehicles through,” Huneidi says. “When we talked to different people in the community to find out why, they brought up the hiring of the guards.”

The guards in question were members of a team that Huneidi had recruited to help get MSF’s operations up and running when he first arrived in Alindao, where deadly clashes between different factions had forced thousands to flee their homes. Huneidi was part of an MSF emergency team sent to support the displaced population, evaluate medical and humanitarian needs, carry out a preventive vaccination campaign and treat people in need of medical attention.


Working with both communities

“Alindao was an area where the conflict was particularly bad,” says Huneidi. “Many of the houses in town were abandoned and burnt. Most of the people were displaced, unable to go back to their homes, in makeshift camps housing between 15 to 20 thousand people. There was insufficient clean drinking water, barely any food, no sanitation and inadequate shelter.”

But before MSF’s medical teams could begin addressing some of the most critical health needs, Huneidi had to set up an operations base. One of his priorities was to identify local people who could be hired as guards for MSF’s compound. Even this seemingly straightforward task was made more complicated by the nature of the conflict in CAR, in which most of the violence has been between members of the country’s Christian majority and their Muslim minority neighbours. Both sides were present in Alindao, but initially only members of the Christian community came forward to be hired. “So one of the first things I did was visit the mosque and speak to the imam, and explain that we were looking for help from civilians from the local community to work as guards,” Huneidi says. After a short selection process, Huneidi hired two Muslims and two Christians as MSF’s guard team in the area.

“At the time, it didn’t seem like that big of a deal,” Huneidi says. “It’s just part of the way that MSF works, and how our principles are ingrained in even the smallest decisions we make.”

But that small decision made an impact. It was cited by the protestors who allowed MSF’s vehicles through their blockades. “They said it showed that MSF really is there for the two sides and we were the only ones with guards from the two communities,” Huneidi recalls. “They also brought up the fact that when we did a vaccination campaign, even though on one side there were 15,000 people and on the other hardly any, we made the effort to set up sites for both sides.”

MSF was founded more than 45 years ago on the principle that no boundaries should be allowed to prevent humanitarian medical care being delivered to those who need it most. Neutrality, impartiality and independence lie at the heart of the organization’s core values, and allow MSF medical teams access to people who are in urgent need of care, whatever their identities may be. Understanding how to apply those principles in practice while responding to a constantly evolving humanitarian crisis — or simply while working in any of the nearly 70 countries where MSF operates — is among the challenges our international field workers often have to face.

“It’s straightforward in theory,” Huneidi says, “but in reality can be extremely complicated. Working and acting according to a set of principles requires a deep understanding. It can be subtle and encompassing work to apply these principles in the difficult and changing contexts and environments where we operate.”


'We really do work on all sides'

The ongoing conflict in CAR is a humanitarian disaster, and MSF remains one of the only providers of essential medical care in parts of the country, including in areas where fear and continued violence have left many people traumatized and vulnerable. With no immediate resolution expected, MSF teams continue to try to access people on both sides of the conflict in dire need of help.

“We have been in CAR since 1997, and people know that we really do work with all sides,” says Huneidi. “We are perceived as neutral and independent. Because our donors around the world trust us and the work we do, and enable us to operate without any external influences, we can get better access to patients who need us.”

While Huneidi was helping MSF begin operations in Alindao, his MSF medical colleagues began treating patients, including many with gunshot or knife wounds. MSF also vaccinated 5,675 children against measles and 2,555 with a multi-antigen vaccine.

During that time, Huneidi’s guard recruits also had to come to new terms with some of CAR’s worst divisions. “Those four guys were great to work with, and had a lot in common,” he says of the cross-community guard team he hired. “It was wonderful seeing a relationship develop between them and seeing them become friends. The larger situation did not get any better, but seeing those guys gave me hope. If they can start those conversations, then maybe the same can happen for other people in this conflict and for CAR as a whole.” 

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