The Czech branch of Doctors Without Borders (MSF) has just marked its tenth anniversary. Today it has a team of 125 doctors, nurses and logistics experts active in crisis regions the world over. To find out more about what they do, the challenges they face and their role in the migrant crisis I spoke to the head of the Czech branch Pavel Gruber and Nurse Jitka Kosíková, who is just back from an MSF search and rescue mission in the Mediterranean.
“Well, ten years ago, the main aim of the office in Prague was recruitment; it was driven by the growing number of experts from the Czech Republic and Slovakia who wanted to know why we should have to use other European offices and why not open an MSF office in Prague. And this coincided with expansion plans within the whole movement – at the time MSF decided to enlarge its global footprint and that was when more offices – among them Prague, Argentina or Seoul were opened.”
I believe that the Prague office of MSF is still the only one in the post-communist block and that Slovakia is represented as well, is that right?
“Yes, we represent the Czech Republic and Slovakia and it is correct that we are the only MSF office in Central and Eastern Europe.”
Was it difficult to generate interest among Czech and Slovak doctors?
“I would not say it was so difficult. I can say that over the past ten years we have done well – 125 people have joined our missions, around 300 missions, where they spent 112 years altogether. So the interest is constant. It definitely requires a lot of effort also from our side because there are many obstacles that people can face, difficulties with their employer, so we try to have memorandums of understanding with different hospitals so that the hospital is supportive of this activity. And we still have dozens of people applying every year.”
“The Mediterranean has become something like a mass grave- we are not a rescue organization, but our obligation is to save lives and so that is what we do in the Mediterranean.”
So these are regular doctors and nurses who occasionally go on a mission?
“They normally work in their home hospital in the Czech Republic and Slovakia and once a year or once every two years they take unpaid leave and go on a mission.”
Where have you helped and where are you helping now?
“Kind of everywhere, the places where most Czechs and Slovaks go is where we have the biggest projects, so it is the Democratic Republic of Congo, South Sudan and Afghanistan.”
I believe you also sent doctors to Syria?
“Yes, we had logisticians, doctors and administrators there.”
Obviously this is one of the most dangerous places to go. I believe that Iraq is in the pipeline sometime soon. What can you do to protect your people once they are out there in such situations?
“Well, Syria is a very specific case. I must say that since the beginning of 2014, when five of our colleagues were abducted in northern Syria, we cannot send our people there anymore. So all our projects in Syria are now managed by our local colleagues, but we have big teams in Iraq, Lebanon and Jordan and there is a scale of measures undertaken starting with explaining who we are and how we work, the principle of neutrality and impartiality and so on. Moreover, every project has a person responsible for security, and this person has the duty to follow what is happening on the local scene, predict trouble and it is this person who decides whether to stay or to go. Other measures can be technical measures, such as restricted movement, so there is a big scale of security measures.”
The migrant crisis is now a big priority - how is MSF helping in this respect and are Czech doctors and nurses involved?
“With the migrant crisis there are two aspects -it is a very visible part of our work in the media, but globally it is still a very small part. MSF has been working with migrants for 40 years so for us this is nothing new. One of the first missions was helping refugees from Cambodia; we work in Mexico, Africa…so for us this is nothing new. However now the crisis has reached Europe and it is very visible and –in line with what we have done for 40 years –we save lives. A big part of our work takes place in the countries which migrants are leaving in Syria, Afghanistan, Bangladesh, in South Sudan. We support them in the refugee camps in Jordan and elsewhere and we also try to support them on the way. When the Balkans route was open we provided medical aid along the route and now when the people are pushed to use the dangerous route over the Mediterranean Sea where more than 20,000 have drowned - and the Mediterranean has become something like a mass grave- we stepped in in a way that is not typical for us because we are not a rescue organization but our obligation is to save lives and so that is what we do in the Mediterranean.”
Nurse Kosíková, you are recently back from one of these search and rescue missions at sea –can you tell us what it entailed?
“If the work is intense, like on the boat, we cannot afford to let our emotions get the upper hand, so we push them to the back of our mind and don’t feel them, but when our work is done there is a lot of talking, crying, laughing….”
“It was a very difficult mission, very unusual and very sad. On returning you just feel deep sadness, I would say. It is an unusual situation, we are not sailors, none of us, and we were on a vessel, close to the Libyan coast, in international waters searching for the small boats – either rubber or wooden boats – which migrants use to flee from Libya and the people on these small boats are in very bad condition. Physically you can see the scars, evidence of beatings, psychologically they are not in a good condition either, although the minute they reach our vessel and are on board they are very happy because they say it is scary to be in a small boat on the Mediterranean Sea. We see people drowning, people who have deep burns from chemicals –because when fuel mixes with sea water you get a chemical substance that burns the skin, we had people with gunshot wounds, not fresh but maybe a few days old, and since it is difficult to provide complicated medical care on a ship some of them had to be evacuated by helicopter…so it is very intense. When we did these rescue operations I would always say that in a single second you feel all the emotions you can have, you feel happiness that the people are on board, you see them singing, dancing praying, thanking God that they are safe, but at the same time you feel angry and very stressed because lots of people at still in the sea. It is an unfinished situation.”
What happens to them then?
“Of course, that is not coordinated by Doctors Without Borders but in cooperation with other NGOs and especially with the Italian authorities we get them to a port and a reception centre in Italy.”
Was there any dramatic moment that sticks in your mind?
“During every rescue operation there were dramatic moments. A happy one was when we had a delivery on board – a very emotional moment for the mother and for us as well – everything went well, so we were very happy. I heard lots of stories from the people, from their travels, every single person has a unique story and it is not a happy story.”
You have been to a great many places before – can you tell us where you -have been?
“I have been on the Jordanian-Syrian border before, in Afghanistan, in South Sudan, in Bangladesh.”
How long do you stay on average – three weeks, a month?
“It depends –it can be from one month to a year, it depends on the type of project, intensity of the project, for instance on the boat the intensity is such it is not possible to stay for very long. In some places the work is intense, difficult, we work not twelve hours but almost 24 hours, sometimes we only have a few hours of sleep, so the length of the missions can vary. I was on a mission for one month, but also on one that lasted nine months.”
What makes you go back? It is hard, traumatic, you see terrible things – what is it that makes you go back, again and again?
“Well, my motivations vary and for everyone it is different –why we go back or why we do not go back. I need a time to recover after every mission, I cannot go back directly. I need time to settle my emotions. But I believe I have knowledge that I can share. On most of the missions we work together with the locals and we can transfer that knowledge to them and also learn from them, which is very rewarding. For me it is like giving them another chance to improve their lives.”
“Missing Maps is a nice project because one would think that today –with all the satellite mapping and such – you would have maps of every location, but that is not true. We work in many places where you have no maps.”
When you are there in the middle of the action what do you do to keep those emotions in check and get through one day to the next?
“Well, we have a team, I am not there alone, so when the going gets hard we talk about it. If the work is intense, like on the boat, we cannot afford to let our emotions get the upper hand, so we push them to the back of our mind and don’t feel them, but when our work is done there is a lot of talking, crying, laughing….we need to ventilate, so naturally you talk about the stress you went through, with the people you shared the stress with, with your family, with your friends. So that’s what everybody does.”
Mr. Gruber, I believe that the MSF is no longer accepting financial contributions from the EU in protest against it policy on migration – is that correct?
“That is correct. For a long time MSF was mainly dependant on private donors, for years 90 percent of our financing came from private donors. I believe we have more than 5.7 million donors globally. However for certain projects where there is no political burden –like HIV epidemics -we had been accepting donations from the EU and EU countries, mainly from Scandinavia. We decided to stop this in reaction to the EU-Turkey deal for several reasons –we believe the deal is deeply anti-humanitarian and there were technical aspects, because some of the EU humanitarian finding was supposed to push people back and, on a personal level, I find the deal very frustrating because we are telling the country which is currently hosting the highest number of refugees in the world to close its borders towards Europe and keep them open towards Syria and Iraq – that simply doesn’t make sense.”
Are you able to cover the fall-out from private sponsors?
“We hope so. Our organization has a certain amount of reserves and we can cover the gap in 2016 with these reserves, because when we were considering the decision it was crucial for us that it would not lead to a reduction of projects or people we support, so in 2016 we have reserves to close the gap and in 2017 we will intensify our efforts in fundraising and getting private donors.”
You use volunteers, both out in the field and here in the Czech Republic if they do not feel up to the challenges of a mission. You have a project called Missing Maps –can you explain what that is?
“It is a very interesting project and, as you say, an option for those who want to help here. I always say if you want to support us come with us on one of our missions or support us financially but I understand that there are people who cannot afford either of those. Missing Maps is a nice project because one would think that today –with all the satellite mapping and such – you would have maps of every location, but that is not true. We work in many places where you have no maps. One of the most striking is a city in the east of the Democratic Republic of Congo, a city with a population of over one million people which simply has no maps. So once a month we invite people to a Map-a-thon and they come and based on satellite images they map the streets and houses. These maps are then verified by teams in the field and once all is matched then we slowly develop a map of unmapped areas of the globe.”
And is there interest in this?
“Oh, yes, the interest is big. Every month when we open a Map-a-thon because of the limited number of places it is quickly filled. But once you go through this and you have the software which is for free you can do the mapping at home. So you do not need to join the Map-a-thon. People can do it in their free time –map a small part of South Sudan or Bangladesh or some other country.”
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