The Île de Lumière
In 1978, somewhere on the South China Sea, a boat was drifting off course. On board were 2,564 Vietnamese refugees no country wanted to accept. In despair, they hoisted a banner which read: “We are threatened with hunger and epidemics. United Nations, save us!” A team of doctors - including Bernard Kouchner - intellectuals and journalists set off on a hospital ship, the Île de lumière, not only to provide medical assistance but also to bear witness to the plight of the boat people.
On 1 February 1980, Doctors of the World - Médecins du Monde - was born. The organisation set itself the threefold objective of going where others did not go, of bearing witness to the intolerable and of working on a voluntary basis. In the words of one of its founding doctors, the organisation was above all about “creating a structure ready to address emergency situations in the shortest possible timescale, something which is not always feasible for international institutions”.
In December 1979, Soviet troops invaded Afghanistan. Already at a natural disadvantage and challenged by successive famines, the country was now faced with war. The health situation rapidly became critical: no doctors, no hospitals and the war-wounded abandoned to their fate. Doctors of the World decided to secretly intervene in 1980. This was the beginning of a lengthy venture in which more than one hundred doctors worked in relays, organising vaccination campaigns, training local nursing staff and taking part in reorganising schooling and agriculture.
Summer of 1980; the situation in El Salvador was seriously deteriorating. The army was scouring and tightly controlling the countryside, with guerrilla forces giving as good as they got. Peasant farmers fled the massacres. To assist these people, refugees in their own country, Doctors of the World organised “a plane for El Salvador”, laden with foodstuffs, medicines and clothing, and set up Bethania, a refugee camp.
The brazilian Yanomami
In the 1980s, the balance of indigenous societies living in the Amazonian forest was seriously disturbed by the beginnings of rampant deforestation and the intrusion of settlers and gold diggers. Contact with these peoples was violent, women were kidnapped and raped and sexually transmitted infections spread… Catholic priests on a mission discovered around forty bodies of indigenous people floating in the river and approached Doctors of the World to intervene in Yanomami territory. On the basis of a worrying diagnosis – infant malnutrition, tuberculosis, sexual infections, measles and malaria – a clinic was built on Yanomami territory with a rear base in Boa Vista, the large city in the north of Brazil.
A vaccination campaign against measles was immediately organised and those ill with tuberculosis were evacuated and treated in specialist centres. The organisation was expelled from the country in 1985 and, on our return in 1990, the health and environmental situation had deteriorated. Following tough negotiations with the Brazilian authorities, an emergency medical plan was finally put in place, as a result of which, ten years on, the tuberculosis epidemic was eliminated, the incidence of malaria reduced, measles eradicated and children’s weight returned to normal.
In apartheid South Africa, good quality medicine did exist but not everywhere nor for everyone. The fight against this regime was part and parcel of the struggle for human rights. Founded “to care for and to bear witness”, Doctors of the World started working in the country in 1985 alongside the most oppressed populations of the townships and in the most isolated rural areas. While dispensing care, the doctors also offered training, set up lab facilities and introduced running water and electricity in clinics.
In the worst year from 1987-88, 30,000 political prisoners were locked up and subjected to torture. While no one had access to the prisons, Doctors of the World, working in secret with a local organisation of anti-apartheid doctors, provided clandestine consultations for prisoners following their release. When Mandela was freed in 1990, we began to train health workers before the new regime took matters in hand and created a fair healthcare system for Black people and White people alike.
In 1988, almost 10 years after the fall of Pol Pot and his ignorant and murderous regime, Cambodia finally opened up to international aid. Doctors of the World played its part in the venture to rebuild the country, working at Calmette Hospital, the former French hospital in Phnom Penh. Having been abandoned, this prestigious medical establishment was renovated and re-equipped and one hundred Doctors of the World doctors took part in an ambitious training programme designed to establish a new Khmer school of medicine. This was also where Dr Foussadier, who had come to participate in renovating the hospital, launched Operation Sourire in 1989.
The Krakow charter
On 31 March 1990, Doctors of the World, along with doctors gathered in Krakow, contributed to the adoption of a European Charter of Humanitarian Aid, according to which “the principle of non-interference ceases to apply where there is a risk of failure to provide assistance”.
Programmes in France
A few years before the fall of the Berlin Wall, Doctors of the World turned its attention to exclusion on its own doorstep with the opening in 1986 in Paris of its first healthcare, advice and referral clinic (Caso). For the first time, the key premise of humanitarian aid as being about otherness, about elsewhere, about somewhere distant was brought into question. Looking was no longer about the exotic but about introspection. Up until then essentially “third world-ist” and claiming to be “border-less”, we have since been constantly at the forefront of the struggle to care for the most disadvantaged here at home.
In 1986 the first mobile facility of the French Operations was set up: a van criss-crossed Paris distributing medicines. A few months later, the first fixed clinic opened in Paris , in rue du Jura. From the following year, centres opened their doors in Bordeaux, Toulouse, Marseille, Le Havre, etc. With these first Casos, Doctors of the World was creating genuine observatories of poverty in France, even identifying new forms of exclusion and responding appropriately.
In 1991, we went beyond the Paris ring road to set up the first “project suburbs” in Gennevilliers, before extending our action to Colombes, Saint-Denis and La Plaine-Saint-Denis. Finally, in 1993, a homeless project was set up with all-night staffing and outreach patrols organised to meet people living on the streets or in makeshift shelters. We have a watching brief and carry out medical and social consultations on the street and in emergency accommodation centres. We provide evidence of the harmful effects on health of being homeless or poorly housed.
The fall of the wall
The period which followed the collapse of the Berlin Wall marked the beginning of a transformation in international relations. Conflicts have developed; wars of extermination are on the increase. The humanitarian landscape is becoming more complex: the presence of groups other than regular armies, States and the UN intervening in the name of humanitarian aid, machinations by some and aggression by others… The civilian populations have become the primary victims of these new conflicts, increasingly taken hostage, assassinated and displaced.
In receipt of funding in response to geostrategic and economic considerations, the increasingly numerous NGOs are manipulated just like the media which widely covered “State humanitarian aid” operations and shape both political issues and public opinion. Positioned at the heart of issues of human rights and international humanitarian law and rooted in the idea of a duty to intervene, Doctors of the World has initiated mental health provision in conflict settings and has participated in the fight against impunity.
Doctors of the World was the first humanitarian organisation to enter Romania in December 1989, the day after Ceausescu fled. The surgical and medical team which moved into Bucharest on 22 December discovered orphanages which were simply places where children were brought to die and were crammed in, most of them infected with HIV. We sent thousands of screening and confirmation tests and sterile syringes and needles as well as paediatric medicines to combat opportunistic diseases. The work carried out by psychiatrists revealed the so-called “irremediable” dramatic situation of children which had been abused, subject to violence and rendered feeble through a lack of care.
In 1992, Somalia, which had experienced a widespread state of war for many years, suffered unprecedented famine. The country was a testing ground for the “new world order” of American President George Bush. This operation, a caricature of a humanitarian operation, represented a textbook case of the “stay or go” question, illustrating a humanitarian exercise held to ransom and supporting the war effort in spite of itself. As a result of the security situation on the ground, NGOs , which had difficulty reaching the populations, had to surround themselves with armed guards. Doctors of the World tried to stay despite everything: we were intervening in cases of emergency and had to be there to support a convalescing country which would have crumbled if the forces tearing it apart had been given free rein. For reasons of security, we nonetheless had to leave the country a few months later. Teams returned in 1993, but the question remained as to whether to stay or go and not impose a presence which was unwelcome or useless.
Somalia would illustrate the meaning of power when it forgets about the law: criminal injustice.
From 1991, Yugoslavia was in the process of a violent and bloody break-up. Doctors of the World intervened in Croatia and Bosnia from the first year of the Wars of Independence, organising deliveries of medicines to besieged towns and cities and to the first refugees. It arranged the first international convoy which, on 10 June 1992, opened up the route to Sarajevo, two months after the start of the siege of the city. Faced with the systematic brutality of ethnic cleansing, a campaign was organised in December of the same year to condemn the Serbian detention camps and the crimes against humanity.
Our action in Bosnia lasted 6 years, moving from emergency to mother-and-child and mental health programmes from 1993-1994. In 1995, we published a collection of eyewitness accounts of ethnic cleansing, which was submitted to the International Criminal Court for Ex-Yugoslavia: this contribution placed Doctors of the World at the heart of the fight against impunity.
The dramatic events in Rwanda turned a harsh spotlight on the century in which States became murderers of their own citizens. Dispensing care remains the primary mission of Doctors of the World, but our work in Rwanda more than anywhere else was concerned with analysing, understanding and condemning the causes of evil. While the massacres were raging, the NGOs present on the ground during this tragedy were few and far between. Doctors of the World immediately came to the aid of genocide victims: an emergency surgical team arrived in Rwanda a few days after the start of the massacres.
In July, as soon as the situation stabilised, post-emergency teams stepped in, renovating rural clinics and supplying them with equipment and medicines. An operation, comprising a large mental health component, was equally speedily arranged to support children who had been orphaned by the death or disappearance of their parents. Lastly, from 1996 onwards, our teams arrived to strengthen health facilities overwhelmed by the return of vast numbers of refugees.
The psychological suffering associated with the genocide remains a significant factor in Rwandan society.
On 11 December 1994, Russian troops entered Chechnya. Doctors of the World quickly took charge of the 6 camps in Chechnya itself and in neighbouring Ingushetia, where the population sought refuge. In order to deal with the population’s post-traumatic stress disorders, particularly among children, a mental health component was added in 1996 to the range of basic healthcare offered by the organisation. When, in 1999, the Russian army again invaded the country, Doctors of the World was the only NGO present on the ground. Although the team in Grozny was obliged to evacuate the city, we continued working actively with the 250,000 Chechen refugees in Ingushetia. While the international community gave up reacting to the atrocities committed by the Russian troops, we undertook a campaign mobilising and collecting testimony concerning human rights violations on a vast scale.
Doctors had to leave Kosovo when NATO decided to bomb the country. We established our operations on the border in neighbouring Macedonia, Albania and Montenegro, to care for refugees. We re-entered the country with the Kosovars as soon as was feasible to care for the victims who had stayed behind. Doctors of the World’s position is clear: air strikes is not enough to protect civilian populations; only action locally on the ground, dictated by the duty to intervene, can ensure their safety.
Aids and harm reduction
The 1986 breakthrough represented by the French Operations opened the way to development of a host of issues raised by new forms of poverty, exclusion and vulnerability, particularly around the notion of harm reduction. Aimed at limiting the risk of contamination by the AIDS and Hepatitis viruses in people who inject drugs, the policy of harm reduction has progressively established a whole structure of prevention, care and also reintegration into the health service for people using drugs in particular.
In 1987 we therefore created the first anonymous and free testing centre in Paris for HIV and subsequently Hepatitis C and, in 1989, the first needle exchange programme. It was not until 1995 that the programme ceased being illegal, as the result of the publication of a ministerial circular. Likewise, responsibility for the screening centres was finally taken on by the government via public health facilities. In 1992 Doctors of the World also created the first prevention kit for injecting drug users. Comprising 2 needles, sterile water, a condom and a health prevention message, it was later imitated by others, and the organisation freely granted the licence to replicate it to the Ministry of Health. From 1994, we began offering methadone treatments in our centres and then on board a health bus as part of a mobile service reaching out to marginalised users on the streets. At that time in France, heroine substitute treatments were reserved for the better integrated drug addicts.
Other harm reduction programmes rapidly emerged in France and across the world, beginning with Myanmar in 1996 and Saint Petersburg in 1997. The first “condom café” opened in Vietnam in 1996. While the AIDS epidemic was raging, innovative, pilot programmes were launched in Africa: health prevention work in rural areas in Uganda and Tanzania showed that it was possible to offer care and treatment to people living with AIDS and in precarious situations. In 2001, drug users, like sex workers, were recognised by the UN as populations at risk from HIV. Aware that medical provision alone could not meet the needs of the populations encountered, we backed our medical teams up with psychologists, social workers and, on occasion, legal advisers. We offered practical training, particularly about injecting (ERLI programme), analysed the quality of the substances consumed and worked on the streets directly with drug users and also sex workers and homosexual people.
In 1996, Doctors of the World set up an internal “emergency department” to enhance its responsiveness to crisis settings, while formalising a methodological approach. From 1998, this discussion and advisory body was strengthened with the addition of an “emergency desk”, an operational facility with human and financial resources at its disposal and with the capacity to fulfil the organisation’s strategic ambitions and to respond to its concern for effectiveness and increasing professionalism. This has enabled us to respond extremely rapidly to dramatic events affecting civilian populations, whether relating to conflicts or natural disasters.
On 28 September 2000, Ariel Sharon’s visit to the Temple Mount sparked the Second Intifada. Working in Palestine since 1995, Doctors of the World immediately responded by sending teams and medical and surgical equipment to the hospitals in Gaza and the West Bank to assist local personnel with treating the wounded. Having then observed that the conflict was going to drag on, we reconfigured our presence on the ground midway between an emergency and long-term response.
In the wake of the tsunami which devastated Indonesia on 26 December 2004, 240,000 people died or disappeared. Doctors of the World was involved in re-establishing access to primary healthcare, in reconstructing health centres that had been destroyed and in providing epidemic monitoring – all actions which were easily and rapidly accomplished as a result of the effective and responsive structure in place.
On 12 January 2010, Haiti was shaken by a violent earthquake which resulted in 250,000 deaths, 300,000 injured and 1.3 million made homeless. Two days later, Doctors of the World was on the spot with surgical teams and mobile primary healthcare clinics. A few months later, fixed clinics were set up in Port-au-Prince and collaboration established with the Ministry of Health before the cholera epidemic, which suddenly emerged in October, could spread and require a fresh emergency response.
The Syrian crisis
Since 2011, Syria is consuming itself in an endless war that is always throwing more civilians on the roads. According to UNHCR figures, nearly 13 million Syrians need humanitarian aid. Violence, fear, destruction of infrastructure fuel a large-scale exodus from Syria and neighboring countries. Thus, 6.6 million people are internally displaced, while 4.3 million are refugees outside Syria.
Air strikes on hospitals, violence against health professionals and supply problems are contributing to the collapse of the Syrian health system. Médecins du Monde is continuing its efforts to maintain access to care and provides constant support to Syrian doctors who help the wounded and sick throughout the country.
The Philippines typhoon
In November 2013, when typhoon Haiyan hit the archipelago of the Philippines, Doctors of the World was already on the spot, developing a health and environmental risk reduction programme linked to recycling electronic waste. Our presence in Manila enabled us to provide emergency medical aid to victims: more than 3 million people were displaced and health facilities devastated.
The Ebola epidemic
To tackle the Ebola virus epidemic raging across West Africa in 2014, Doctors of the World intervened in 8 countries affected or bordering the epidemic: Liberia, Mali, Côte d'Ivoire, Guinea, Sierra Leone, Burkina Faso, Benin and Democratic Republic of Congo. We sought to respond to the twofold challenge posed by Ebola : that of preventing the spread of the devastating epidemic and that of supporting the already fragile healthcare systems to deal with the epidemic while continuing to care for the population.