On the day Lloyd Cederstrand’s tiny bush plane touched down in a remote area of South Sudan, he watched six children die. He wasn’t surprised, then, when other expats decided this MSF mission wasn’t for them. “I saw people get off the plane and, twenty-four hours later, they would get back on it. It was overwhelming to come in and see such high mortality rates.”
Cederstrand stuck it out for three months as a logistician during the 1998 famine in South Sudan, one of the worst of the decade. Like so many food shortages in Africa, this one was caused by a combination of warfare, drought and economic factors, and it left as many as a quarter of a million people dead from starvation and illness. One of Cederstrand’s duties was supervising the food drops that regularly arrived as part of Operation Lifeline Sudan, the huge international relief effort. “It’s very dangerous: people have been killed, cattle have been killed, villages have been flattened when they miss the drop zone. An X literally marks the spot — you have a massive X made of plastic sheeting. You’ll pick your drop zone in the driest area you can find, and then you have a lot of national staff keep the area clear, because as soon as people know a food drop is going to happen they congregate in the area. When the Hercules comes over, it slows down, the back comes open, and the pallets just roll out of the plane and free-fall onto an area about the size of a football field.” Cederstrand says only 6 or 7 percent of the bags break, and almost nothing is wasted. “When security lets the people come in, you have thousands converging on the drop zone with their little gourds and their little bowls, scooping up dirt or mud just to get ten pieces of maize.”
MSF is not usually involved in general food distribution — that’s the domain of the UN’s World Food Programme — but in famine-stricken areas it sets up feeding centers to treat malnourished children, pregnant women, nursing mothers and the elderly. At therapeutic feeding centers (TFCs), severely malnourished kids under five stay with a family member and receive feedings of high-protein powdered milk. Supplementary feeding centers provide moderately malnourished children with meals and an extra ration to take home.
There are few sights more heart-rending than a starving child, but those who are admitted to a TFC in time can recover within 30 days. In the critical first phase, the child receives six or more feedings a day of therapeutic milk that includes oils, vitamins and sugar and is designed to kick-start the metabolism. “That will take a few days, and it’s a really risky period,” says Christine Nadori, who was a nutritional coordinator in South Sudan in 1998. “You might lose some if they’re anemic and have a weakened heart — you’re increasing their blood volume, and the heart starts going wild. Or they may not have enough hemoglobin left to bring oxygen to the tissue. Usually they spend two or three days in a critical period, where we give them small quantities of milk, based on how much they weigh already, and then we increase it as their muscle mass starts to increase. They may spend a month in a TFC, until they reach a certain weight, and then they’ll graduate to a supplementary feeding center.” Here they’ll receive solid food — porridges, beans, high-protein biscuits or Plumpy’nut, a kind of therapeutic peanut paste.
The feeding centers set up by MSF and other organizations in Sudan saved tens of thousands of lives in 1998. Still, Cederstrand’s project forced him to confront one of the limits of humanitarian aid. “For me, it can be overwhelming to be treating someone in a TFC so you can send them out into a situation that you can’t change. That child I’m discharging today is probably going to be right back here six months later.”
In addition to conflict zones, refugee camps and feeding centers, MSF hangs out its shingle in tiny health outposts in remote communities, in mobile clinics that travel from village to village in a Land Cruiser, and in areas hit by floods, earthquakes, eruptions or other natural disasters.
The first step in most of these projects is an exploratory mission, or explo, which involves sending a small team into an area to assess the medical needs and to judge whether an intervention is necessary. These short-term projects measure mortality rates, morbidity rates (the local prevalence of disease), and the level of malnutrition in a population. The medical team may set up sentinel surveys, which monitor the rate of measles, malaria, diarrhea or cholera at selected sites and quickly identify an outbreak when it occurs. An explo will also look at the medical infrastructure to see if the local health ministry has things under control. It will determine whether other NGOs are planning to work in the area. And if MSF decides to intervene, it will find out who is in charge and get permission to work there.
This last point may be one of the most misunderstood aspects of MSF. The sans frontières ethos that’s enshrined in the organization’s name suggests a willingness to ignore sovereignty and governments wherever people are suffering. Even the Nobel committee, when announcing the Peace Prize, commented that a fundamental principle of MSF is that “national boundaries and political circumstances or sympathies must have no influence on who is to receive humanitarian help.” In its presentation speech, the committee reiterated that MSF “reserved the right to intervene to help people in need irrespective of prior political approval.”
These statements caused some uneasiness among the new Nobel laureates. Joelle Tanguy, then executive director of MSF-USA, said in a November 1999 speech: “At MSF, we have trouble recognizing ourselves as the standard bearers of this ‘right to intervene,’ which a number of interviews and articles seem to indicate as having been finally acknowledged and sanctioned by the award … We cannot let such a serious misunderstanding become entrenched.” MSF was worried that the line was blurring between the right to deliver medical aid to victims — something enshrined in the Geneva Conventions — and what had taken place in Kosovo earlier that year. As David Rieff writes in A Bed for the Night: “Many humanitarians supported the war on moral grounds. But just because individual humanitarians and, for that matter, some humanitarian NGOs were for the war, this did not make what took place a humanitarian intervention, although that was precisely what major NATO powers tried to claim it to be.”
So, what exactly does “without borders” mean to MSF? “It’s a very malleable concept which has changed in significance over time,” says Austen Davis, former head of MSF-Holland. “In the Cold War, when MSF started in the seventies, it was a provocative statement, saying we’re going to help people, and it doesn’t matter if they’re Communists.” The organization entered Afghanistan without the permission of Soviet forces in 1980, and more recently launched a clandestine cross-border mission into southern Iraq, retreating back into Kuwait every evening. But these activities were confined to areas outside the direct control of the Soviet and Iraqi armies, respectively. “Of course you’re going to require a yes from whoever is in control of an administrative area,” Davis says. “You have to, because they’ve got guns and they can shoot you otherwise. All we’re saying is that if, say, South Sudan is for all intents and purposes administered by rebels and the government says, ‘We don’t recognize them, and we are a sovereign state and you have to get your visas from us to go into the south,’ we say, ‘Nonsense,’ and we don’t. We will if that helps, but if that is going to be the barrier to helping people, we will not respect that requirement.
“I think frontière implies other things as well. In Bunia [in eastern Congo], a town we’ve had a long relation to, we insist on working with the Hema and Lendu, and both sides tried to stop us working with the other, so that’s an ethnic frontière. Now it’s extremely important for us, somehow, to be able to cross the Christian-Islamic frontière. These borders that distinguish people, that allow the demonization of the other — that is, in part, what humanitarianism is against. It is against the dehumanization of people in crisis.”
“On the practical level, you do things legally if you can,” says Kenny Gluck of MSF-Holland. “Only when it becomes impossible to assist people would you transgress in that way. Being in touch with authorities is one of the foundations of humanitarianism. Unlike charity, humanitarianism doesn’t exist in a vacuum, it operates in a dirty reality, and that forces you to struggle with your principles. It’s not a pure exercise. Sans frontières is a mentality — it’s always about engaging with ugly realities so that you can get something done. It’s aspirational in some ways, it represents a mindset that we think is important, because the world of aid is dominated by big institutional actors — the Red Cross, UN, big NGOs — who often become integrated into governmental politics and lose sight of individual suffering. Sans frontières is not a cowboy mentality, but there is a rebellious element to it, which we think is an essential part of humanitarianism. You have to be willing to cross a border to attend to suffering.”
The white Toyota Land Cruiser has become the standard vehicle of MSF and many other aid agencies, but sometimes projects in remote areas are inaccessible even to rugged four-wheel-drives. In the 21st century, it’s easy to forget that there are still pockets of the globe that have virtually no contact with the outside world. In the summer of 2003, the Spanish section sent a doctor and nurse to do an explo in a remote area of Bamiyan province, in central Afghanistan, where they encountered people who had never seen a car before. They did part of the trip on donkeys, echoing MSF’s first mission in the country two decades before, which used the same mode of four-legged transportation. One local staffer wasn’t surprised by the story. He’d been part of an earlier explo mission to an area where people jumped back in fear when they heard the vehicle, calling it a monster. In South Sudan, where flooding can make roads impassable for vehicles, MSF nurses and their assistants make four- or five-day trips on bicycles to treat malaria patients. Other MSF projects have sent medical staff deep into the Congolese jungle on motorbikes or into the South American rainforest in tiny boats.
When a project involves remote terrain and a clandestine element, it can take on a cloak-and-dagger flavor. Thirteen days after returning from his first mission in Kosovo, Patrick Lemieux was back on a plane, this time headed for Congo, where MSF-Spain had just completed an explo and was setting up a new project. “They say it will be about a two-day trip to there, and after that you’ll take a small plane there, and someone by the name of X will meet you, and the password is this, and they smuggle you in. It sounds much more scary in hindsight, but the idea was that we were going in on the rebel side. You can’t obtain a visa — you arrive there and deal with the ‘customs officers.’ They want money and you tell them you don’t have any.”
In August 2003, Lemieux also organized an exploratory mission in Sindh province, Pakistan, which had been hit with massive flooding. MSF’s plan was to reach the victims with mobile clinics: a pair of Land Cruisers that travel to remote areas to deliver medical care. As well as a doctor and a nurse, these hospitals on wheels may include a drug dispenser, a registrar to look after the paperwork and a “lady health visitor,” the charming name given to women who do basic health care and outreach in rural areas. The cars are loaded with medication, intravenous fluids, health cards and stationery, foam mattresses, plastic sheeting, emergency lights, flags and stickers with the MSF logo, and jerry cans of drinking water. They set up in schools or mosques, or under a shady tree, sometimes in nameless villages that don’t appear on maps and are found only with the help of a local guide. Because security wasn’t an issue in Sindh province, the mobile clinics could stay overnight in the communities they visited, and the convoy could follow a more or less linear route. In dangerous regions, the cars return to a base each night and often wait until late morning before setting out again.
Whether the health clinics are permanent buildings or four-wheel-drives, medical care in rural Africa has few dull moments. During a mission in Ethiopia with MSF-Belgium, physician Marie-Jo Ouimet was based in Deghabur, in the Ogaden region of the country, which is inhabited by ethnic Somalis. It’s a polygamous culture, and Ouimet treated several men who had been anointed with boiling water by their jealous wives. Some of the children had serious burns from upsetting cooking pots or falling into fires. Ouimet also regularly made journeys of six hours or more to visit far-flung health posts and train local staff. On one of these overnight stays, some villagers arrived before supper with a man who had been bitten by a snake. “The health post didn’t have antivenin medication, and we didn’t have anything to transfuse him with,” Ouimet says. “There wasn’t much we could do. He wasn’t very symptomatic at that point, but we kept a close eye on him at the clinic. We knew we had to take him to the referral hospital, but we had to wait until the next day, because we had strict rules never to be on the road after four o’clock for security reasons, and we had to respect that, even though we knew he might not survive. We managed to stabilize him until the morning — we were up all night adjusting the IV and giving him analgesics — and we got on the road as soon as the sun was up. Just before we left, the villagers brought the snake they thought had bitten him — I don’t know if it was the actual snake, or if they just killed a snake as a kind of revenge. But after about an hour and a half, he just died in the car.”
In acute emergencies, medical aid can save hundreds of lives in days or weeks. In rural health projects, however, success is far less dramatic. And while outbreaks of disease can be brought under control, doctors doing primary health care in places like Ogaden have nagging doubts about the long-term prospects of their patients. From the beginning, Ouimet wondered just how much good MSF was doing in the area. “Our project didn’t make much sense, and I thought it wasn’t worth taking such high risks for something that had absolutely no impact.”
The risks were certainly high. There’s a constant military presence in the region, as the rebel Ogaden National Liberation Front (ONLF) fights to annex the region to Somalia. In September 1999, when Ouimet arrived, the project had just reopened after having been shut down following direct attacks on aid agencies by the ONLF, including the kidnapping of an expat with a French NGO. “Right before the kidnapping, the rebels had intercepted an MSF car and threatened the occupants — they pointed their guns at them and told them to undress and dig their graves. Then they set the car on fire and left. I was worried, but we had a lot of rules and were very conscious about security, so I thought the risk of anything happening was pretty low. It almost became a bit of a joke. We had ‘kidnapping bags’ — every time we went on the road we had little backpacks with some food, mosquito repellent, matches. This was something you were supposed to be able to survive with if you were stuck in the bush without a vehicle or if you were kidnapped. It was a little bit silly, but it was part of our security guidelines.”
In the new year, with elections planned, there were other security incidents in the area, and Ouimet’s team talked about pulling out. Then came reports about a possible famine in the south of the region, and she was selected to fly out and do a nutritional survey. When the car dropped her off at the airport on February 7, 2000, she said goodbye to the driver, his brother, and the team’s French logistician, Stéphane Courteheuse. Shortly after three in the afternoon, the staff in Deghabur tried to contact the car by radio but got no response. They dispatched a second car to investigate and discovered that Courteheuse’s vehicle had been ambushed on the return drive from the airport. The driver was killed instantly by five bullets to the head, while Courteheuse was shot once in the chest during the ambush, then dragged from the car and shot again, with one of the bullets shattering his eighth dorsal vertebra. The attackers then stole his watch, his passport and his electric guitar. (The driver’s brother managed to hide in the back of the car.) When the Deghabur staff arrived on the scene, the logistician was lying on the side of the road, taking water offered by some villagers.
Courteheuse was driven back to Deghabur for treatment, then to a Nairobi hospital, before eventually being evacuated home. After five months in the hospital, and now confined to a wheelchair, he returned to work in MSF’s Brussels office in January 2002. Twenty-nine years old at the time of the shooting, Courteheuse was already a veteran of seven previous MSF missions, most recently in the Democratic Republic of the Congo, where he had been imprisoned. He had hoped the Ethiopia mission would be a relatively easy one by comparison, but irony is another of humanitarianism’s ugly realities.
In an ill-equipped health clinic with no lab, where the only diagnostic tools are your eyes and hands, it’s easy to feel you’ve been cast adrift. “The first thing you realize is that the people who are going to save you are your staff,” says nurse Leanne Olson. “There are nursing schools everywhere in Africa. All of the nurses I worked with were trained, they had their degrees, they had studied, but we underestimate their diagnostic capacities and their ability to treat people, and we do that at great risk. They’re perfectly capable of taking care of their own people — much better than I can, because they know the diseases, they know the parasites, they know what schistosomiasis looks like inside and out. They can tell me whether this is a surgical emergency or not. I learned so much by working with and understanding my national staff.”
Of course, incompetent and indifferent people can hold important positions too, and, while that’s true everywhere, in developing countries they can often act with impunity. In 2000, Olson was in Mile 91, a town in northern Sierra Leone, where about 40,000 displaced people had settled. MSF had set up clinics there, but the referral hospital was a couple of hours away. The man in charge of health care in the area had the habit of borrowing the MSF car whenever he pleased. “One day he took off for Freetown and I thought he would be gone for two days. Well, he was gone for fifteen days. I had seventeen people die from correctable surgical problems. Maybe all of them, maybe only some of them, would have lived if they had received surgery. I tried everything — I was trying to put them on buses, I was trying to find other agencies that could take them. When he came back, he didn’t care.”
You don’t have to be a doctor or a nurse to know that countless people die in the developing world from senseless violence, or for lack of basic drugs, or because medical staff don’t have the training or tools they need. But it’s something quite different when those patients die on your watch. Even after eight years in the field, Olson never got used to it. “In Sierra Leone, I sent a mom to the hospital for surgery who had a four-month-old baby, which I didn’t know, and they contacted me and said, ‘The mother died. What do you want us to do with the baby?’ They sent us back a four-month-old baby — and then he died of meningitis. I took a woman who desperately needed a C-section to the hospital, but the doctor was away at a meeting, so she died. And her baby died. I had to bring her husband back the next day to the village and say I was really sorry. That kind of thing is the hardest to accept in MSF.”
On her first mission in Burundi, nurse Carol McCormack was part of a team that supported eight health centers in the remote Moso region, along the Tanzanian border. Each center was run by a nurse, but the rest of the national staff were just laypeople who had trained in basic procedures like hygiene and dressings. McCormack learned a little Kurundi —Where does it hurt? Do you have a fever? Are you throwing up? — but couldn’t get over some of the cultural hurdles. “Trying to introduce condoms was one of my crusades, but it’s almost crazy. They just laughed when I pulled out the wooden penis and tried to demonstrate how to use the condom.
“It was so overwhelming. We were just starting the project, and putting down on paper everything that needed to be done. Then you try to put that plan into action, and it’s impossible. Every day we would go out and try to fix things, try to make the health centers better. At the beginning, people would tug on my sleeve and I would say, ‘Leave me alone, go see the other nurse, I’ve got to organize your immunization plan.’ Then one of our managers said to me, ‘You know, you have to deal with the patient who’s in front of you. You can’t fix everybody, you can’t fix the injustices and the disease, but you can help that old lady who’s pointing to her son who’s going blind because of vitamin A deficiency.’ That really helped me get through the last few months of the mission.”
Like many MSFers who have long since returned home, McCormack stills sees her patients when she closes her eyes. “Children with gunshot wounds are the ones that really stick in my head. The one I remember the most was Cesar. He was a little boy I had seen at the hospital in Ruyigi. There had been fighting in the Moso and he was shot in the elbow. He walked all the way to Ruyigi, which was probably hours and hours of walking. When he was discharged from the hospital he didn’t have any place to go. He showed up at our gate, and I was going in and out that day, seeing this kid there. Finally one of the guards tapped me on the shoulder and said, ‘This kid wants to talk to one of you. He doesn’t have anywhere to go.’ His parents had been killed in the fighting, and then his neighbors, who were his guardians, were killed too. He was twelve years old, and he didn’t know where to go.
“There was a lady in town named Maggie, who ran an orphanage. So Cesar asked us if we would talk to her and see if she would let him stay with these orphans. We went to see Maggie, and of course she said he could stay. As I left, he was standing there thinking, ‘Sure, I’m in this orphanage, but what do I do now? I don’t know anybody.’ I had to just walk away. I can deal with medical things. But a child who has nowhere to go was something I could not get my head around.”
When Médecins Sans Frontières was nothing more than a good idea waiting to happen, Raymond Borel was already urging French doctors to aid victims of earthquakes, hurricanes and tsunamis. But MSF’s earliest interventions in natural disasters failed — first in the Nicaraguan earthquake of 1972, and then in Honduras during Hurricane Fifi a year later — because it arrived well after rescue efforts by other agencies were already under way. Almost four decades later, MSF is faster and more experienced, and it is still on the ground following natural disasters. But many in the organization wonder if it should be involved in this kind of work at all.
“There’s precious little that an organization like MSF can do in an earthquake,” says Nabil al-Tikriti, who was part of a relief team that went to Turkey after the devastating quake of August 17, 1999. “In an earthquake, people are dead or alive within the first three days, and you can’t get much going in three days. You need to get rescue teams in there, and that’s not what we do. There are other groups that are far better at it. Unless there’s a public-health breakdown, there’s not much of a role for us.”
Of course, there are always ongoing medical needs in the wake of a disaster like the Turkey earthquake, which killed more than 16,000 people and left some 600,000 homeless. MSF had four teams in the hardest-hit cities within a week, along with 30 tons of medical supplies, tents and other shelters. The teams included specialists in treating kidney failure, a common and potentially fatal ailment in people who have survived “crush syndrome” — internal injuries from collapsed buildings. MSF also installed huge bladders to supply some 15,000 people with fresh water. So even if its staff isn’t pulling victims from the rubble, MSF can play a useful role in disaster relief. But with limited resources, the question is whether funds and staff might be better deployed elsewhere. As al-Tikriti points out, even an organization that can afford to snub institutional donors can still be influenced by the well-meaning citizen who asks that her check go to help the people she’s seen on the news.
“Private donors are very trusting of MSF to be stewards of their funds,” al-Tikriti says, “and they should be, because MSF has a good record, and I would vouch for that.” While donors can earmark their money for certain crises, he says, most do not, except when something dramatic like a natural disaster dominates the news for several days. When that happens, ad hoc donations can dramatically exceed what is needed for a relatively short-term relief effort.
The South Asian tsunami in December 2004 was hardly a short-term crisis, but MSF knew quickly that bringing medical aid to the survivors would not require the huge sums that immediately poured in from donors. Within a week of the disaster, MSF posted a notice on its website asking the public not to direct money to tsunami relief because they had sufficient funds already. When it became clear that there would be no mass outbreak of cholera or other water-borne disease, MSF recognized that its post-tsunami role would be relatively limited. They chose to focus on Aceh, Indonesia, where medical needs were most acute, and to leave the long-term rebuilding to other organizations better equipped to the task.
Nonetheless, by the end of March 2005, donors around the world had sent MSF more than €105 million (about $130 million) for tsunami victims, while the budgeters believed only a quarter of that total would be needed to extend its efforts to the end of the year. This left the organization with a dilemma: was it ethical to spend these excess millions on another crisis? MSF decided the right move was to contact the donors and ask them for permission to direct their contribution to underfunded projects in Africa. Overwhelmingly, the donors said yes — more than half the money was redistributed, and less than 1 percent was refunded.
While MSF has no intention of getting involved in reconstruction after natural disasters, it has found an ongoing role in psychosocial programs: its post-tsunami projects, for example, all had mental-health components that continued past the emergency phase. Long after victims are buried and destroyed homes are rebuilt, the psychological wounds of survivors linger. Following an earthquake, up to 60 percent of adults and 95 percent of children may suffer from post-traumatic stress disorder, so MSF sends psychologists to counsel victims and, more often, to train local counselors to deal with the aftermath. Still a relatively new part of MSF’s fieldwork, mental-health programs have had limited success. Some have stretched the mandate of a medical organization, involving community artists, storytellers, even gardeners and expat drama therapists. Indeed, there’s some controversy as to whether mental-health programs should be part of emergency relief at all, or, instead, a low priority that can be tackled after more acute medical needs have been met. Few would deny, however, that an effective mental-health program will not only help people rebuild their lives in the long term but also reduce the strain on the medical system in the weeks and months after an emergency.
Adrienne Carter, a psychologist who has worked with MSF in Kosovo, Sri Lanka and Kashmir, says that outpatient doctors in crisis zones often deal with patients for only a few minutes before hastily prescribing drugs. “Valium is given like candy,” she says, as people show up with headaches, stomach pains, sleep problems and other psychosomatic symptoms. One MSF doctor working with long-time refugees says that up to 40 percent of the ailments he saw at his outpatient clinic had a psychological basis.
For people uprooted by war, forced to live on the run or in crowded camps, psychological problems go far beyond aches and pains. “Sri Lanka was one of the worst situations we had seen,” Carter says. She was in the country in 2002, working with minority Tamils, who are still recovering from two decades of war with the Sinhalese-dominated government. The conflict claimed some 64,000 lives and displaced hundreds of thousands of people. Many Tamils had been kidnapped, detained and beaten, had faced starvation or seen family members burned alive inside their homes. In one MSF survey of displaced people in the town of Vavuniya, 88 percent said they felt constantly unsafe.
In the Tamil camps, Carter saw the consequences of this insecurity. “It was a complete breakdown of moral values. Everything that could happen did happen. Normally in Tamil communities, families are very strong and very supportive of each other, but the breakdowns among the internally displaced were just brutal. A lot of them turned to a home-brewed liquor that was widely used in the camps, and many became addicted, which meant that even if they were able to find jobs, they couldn’t work, so families broke apart with amazing ease. Fathers just deserted their families and shacked up with another family, so children had absolutely no stability. Food wasn’t coming regularly, so everything was extremely unstable, and these people had lived like that for the past ten to fifteen years. And their environment was so horrible. Tiny, tiny places that were separated from the next family by plastic sheets, so there was no privacy at all.
“There was a school in the camps, but often kids did not attend, and there wasn’t enough supervision from the parents or anyone else. These were some of the things that our workers were trying to help. One of the huge issues was that people had no problem-solving ability whatsoever — if an issue came up, they would turn to suicide before trying to solve it. Suicides were committed or threatened for what we might think of as very mild issues like, ‘I had a fight with my aunt, so I’m going to kill myself.’”
Perhaps no type of project requires more cultural sensitivity than one that addresses mental health, and MSFers admit they’ve made many mistakes, though they’ve also pioneered some successful techniques. Carter was surprised when a phone-in show MSF arranged on a local radio station in Kosovo was so popular — despite having to use an on-air translator — that it continued for weeks. The anonymity of the radio allowed people to ask freely about sexual dysfunction, a common symptom of stress. As a bonus, the psychologists’ answers were heard by far more people than MSF could hope to counsel in person.
In Kashmir, the disputed Muslim area between India and Pakistan, Carter remembers there was an outcry when her team wanted to train male and female sexual-abuse counselors together. Eventually they agreed to divide the group by gender, though Carter ended up being the only woman in a room of 15 or 20 men. As is usual in crisis areas, those being trained were almost all victims themselves. “You couldn’t even look them in the face — I did it without any eye contact. There was complete quiet in the room. And then one man started very haltingly to speak about his own torture and abuse. Then another, and another. It was an incredibly heavy two hours, as they chose to share their experiences. This would never have happened if there were women there.”
Even when MSF psychologists have the opportunity to counsel patients directly, they can’t always get the same gratification as a surgeon who removes a bullet or cures a baby with malaria. There are no quick fixes for traumatized people. “In this work, you grow so close to the people that you can’t just leave them, arrive back home, and let them out of your heart,” says Carter. “Each time I vow that I’m not going to become attached, I’m just going to do my job. It never works.”