As a specialist in reconstructive surgery, Dr Shazeer Majeed has spent much time in bunkers near conflict zones. “That’s where the services are most required,” he says, speaking from Beirut, Lebanon. Majeed is a war surgeon with Doctors Without Borders, also known as Médecins Sans Frontières (MSF).

It’s been 50 years since the international humanitarian organisation was set up (1971) to reach medical aid to people affected by man-made and natural disasters. In 2022, the need for doctors on the frontline, literally, does not seem to have reduced. Nor have the attacks on hospitals and healthcare workers.

In a grim milestone from Ukraine on World Health Day (April 7), the World Health Organization said that it has verified more than 100 attacks on healthcare since the start of the war on February 24. The attacks were on facilities, transport and ambulances. The Mariupol maternity hospital attack is one such casualty of war.

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Since January 1, 2022, WHO has verified 160 attacks on healthcare in 11 countries and territories that led to 97 deaths and 74 injuries. Outside of Ukraine, Sudan is also witnessing a recent increase in attacks on healthcare, it said.

MSF, too, has “borne the brunt”, says Majeed, referring to the hospital attacks in Kunduz, Afghanistan (2015), among others. “Over the last five years, our staff have lost their lives in Ethiopia, Afghanistan, South Sudan, Yemen, and the Central African Republic... we have mourned the deaths of 97 colleagues, who have been killed in 59 separate events, the first recorded event occurring in 1989,” the MSF site said.

‘Challenging context’

As Majeed explains, MSF’s activities include tackling multiple drug-resistant tuberculosis, anti-microbial resistance, and mass immunisation to bolster the local healthcare administration. In Iraq, he recalls, the medical infrastructure was in place, but not the technical knowledge, as doctors could not upgrade their skills for years amid an ongoing conflict. MSF is also involved with a 3D printing project and occupational therapy for those who lost limbs in conflict. Its Amman project has used 3D technology to design and print prostheses for those affected in the region.

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“We work in a highly challenging context,” says Majeed, and, often, it’s the children and women who are worst impacted in conflicts. “They stay in your mind and never leave,” he says, recounting incidents involving a young group of children or pregnant women who were badly injured in explosions.

Care, and move on

Ashok Sankpal, a deputy medical coordinator with MSF, says that, as doctors, the need is to impart medical aid, uninfluenced by the crisis. “It’s not our job to know who is right or wrong. We give patients the care they need and move on,” he says. In the field for 13 years, Sankpal has been on 10 missions in South Sudan, Zimbabwe, Uzbekistan, Ethiopia, Jordan, Belarus, Syria and Sierra Leone.

Recalling his first stint in South Sudan, he says that the hospital was on marshy land, could be approached only by air and it remained inaccessible during the rains. It was the only hospital within a 300-km radius, he adds.

A mother brought her seven-year-old child with tetanus to the hospital, “holding the child like wood”, he recalls. She also brought her malnourished baby. The older child passed away, but the year-old infant got better. Whether it’s external or internal conflict, “it is the women and children who suffer,” he says.

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There are happy stories, too, he says, recalling the young girl with cerebral malaria who woke up from coma after three days of medical care.

Low-resource learnings

Majeed is the Surgical Care Referent for MSF-Belgium and has worked in missions in South Sudan, Iraq, Yemen, Syria and Jordan. Exhorting young doctors, nurses and paramedics to volunteer with medical humanitarian missions, he says there’s much learning from working in low-resource settings. There isn’t the “luxury of investigation”, just reliance on basic clinical skills, he says. Besides, he adds, these missions are intensive and need physical and mental fitness.

Staying impartial

MSF has contingency plans and red flags when they have just hours to decide on the course of action. “You never know when things can go wrong in a conflict,” says Sankpal, recalling his stint in Syria, where the hospital capacity had to be halved. The hospital that was destroyed by ISIS was almost deserted, he recalls.

Besides military attacks, there are kidnapping threats and violence from armed groups. “But there is a humanitarian need... so we pull up (our) socks and get back,” says Sankpal, reflecting the spirit that drives the medical frontline warrior.