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Health in Flight: Medicine and Migration at the MSF Scientific Days

Rebecca Lockhart, PLOS Medicine Publications Assistant, reflects on Médecins Sans Frontières (MSF) Scientific Days 2016.

At this year’s annual scientific conference held by Médecins Sans Frontières (MSF) the dominant theme was clear from the programme cover: the now ubiquitous photograph of a boat packed with refugees. Flight from conflict and the search for refuge are central topics for an organisation that aims to transcend borders and improve health worldwide; I was struck by how many of the Scientific Day attendees who signed up to the PLOS mailing list stated their home country as ‘global’.  Many of the presentations over the two days accordingly centred on projects that aim to better understand and meet the needs of migrants.

For me some of the most powerful messages came from Friday’s keynote speaker Zaher Sahloul, Head of the Syrian American Medical Society (SAMS) Global Response.  Sahloul addressed the appalling targeting of medical personnel in the Syrian conflict, highlighting the almost unimaginably dangerous and challenging circumstances in which doctors there carry out their work.  This was a tragically inevitable topic for a year in which MSF hospitals in Syria have been repeatedly subjected to military offensives, to the extent that the organisation now rejects claims that the attacks are collateral damage, seeing them instead as war crimes. Sahloul noted the recent change in advice to health professionals in the region: previously, ambulances displayed symbols identifying them as medical vehicles to ensure their safe passage through conflict zones; now, drivers are advised to hide such signs to avoid being targeted.  Similarly, MSF no longer provides GPS coordinates of its facilities to the parties involved in the Syrian conflict on the basis that they are used to target the facilities rather than to avoid them. The images which accompanied Sahloul’s speech, including a child’s drawing of the dead and wounded and their grieving families, served as powerful reminder of the human suffering and loss of life that is an everyday reality for Syrian civilians and medics.  And yet, Sahloul’s message was one of determination and not despair: his call for ‘action, not tears’ was illustrated by photographs of the underground hospitals that doctors in Syria have built to defy the aerial bombardment that has destroyed so many of their former facilities.  The courage of doctors who continue to provide much needed care as they increasingly become the targets of armed forces in Syria perfectly demonstrates Sahloul’s closing comment: ‘humanitarianism is a citizen’s response to political failure’.

Responses to a different aspect of this crisis came in the subsequent session on the consequences of conflict and migration on mental health.  Research presented in this session included a cross-sectional survey of the health problems and violence endured by inhabitants of the migrant encampment in Calais, France (nicknamed the ‘jungle’) on their journey across Europe.  A retrospective analysis of the mental health disorders and traumatic events suffered by migrants treated at MSF outpatient clinics in Greece and Serbia on the Balkan route through Europe offered insight into the mental health care needs of these patients. Possible models for meeting mental health needs were offered by presentations on the programmatic data generated by an integrated mental health programme in Domiz refugee camp in Iraq, and a stepped-wedge randomized controlled trial of individual counselling in a MSF mental health programme in Grozny in the Republic of Chechnya.

The second day’s keynote speaker, Kilian Kleinschmidt of Switxboard, also tackled the topic of migration.  Kleinschmidt reflected on his experiences as former head of the Za’atari refugee camp in Jordan, describing how inhabitants of the world’s second largest refugee camp have found enterprising ways to establish normality against the odds.  On the camp’s so-called ‘Avenue des Champs-Élysées’, myriad small businesses have sprung up, even including a wedding dress hire shop which attracts customers from outside the camp with its reputation for cheap prices. Kleinschmidt argued that allowing people the autonomy to create their own solutions, and giving them the tools to be able to do so, is necessary in order to respond to humanitarian crises.  He stressed that people are the greatest resource in any setting, and that knowledge and resources should be made available to all, in order to maximise the potential both of human creativity, and of technology.   Kleinschmidt termed this ‘the democratisation of knowledge’, which seems perfectly to capture the goals of PLOS Medicine’s Open Access ethos: making scientific progress accessible to the widest possible audience.  In Kleinschmidt’s view, ‘the world has an answer to everything’, and the more universally we can share research, the better the chance that those answers will be found.

 

Featured image:  An Aerial View of the Za’atri Refugee Camp, Jordan.  Public Domain.  Source: https://www.flickr.com/photos/9364837@N06/9312291491. 

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