Why aid workers put their lives on the line

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The recent kidnapping of Canadian nurse Laura Archer and four colleagues serves as a stark reminder of just how dangerous this work can be. Steve Dennis of Médecins Sans Frontières sheds light on why he keeps revisiting the world's most troubled places
Article Video Comments (14) STEVE DENNIS

From Saturday's Globe and Mail

March 21, 2009 at 12:05 AM EDT

When I first applied six years ago to work overseas with Médecins Sans Frontières (Doctors Without Borders), I wrote on my application that my goal was to help the world become a better place. I didn't really know what that meant or how I would do that, but it sounded like a good answer at the time.

I hadn't even arrived at my first project location before I started seeing the dark side of my chosen line of work. A month before I left on my first mission in 2002, MSF worker Arjan Erkel was kidnapped in Dagestan, a troubled Russian republic on the Caspian Sea. For the next 20 months while he was held hostage, I met anxiously with my team members to discuss the weekly updates about either progress on his release or silence about his fate. I felt outraged and betrayed because the risk Mr. Erkel faced went beyond what I had expected when I signed up.



This feeling came back to me last week when I heard about the kidnapping of Canadian nurse Laura Archer and four other staff with MSF in the Darfur region of Sudan.

How could this happen to people bringing aid to a country in distress?


Laura Archer is seen in a July, 2007 photo.

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Canadian nurse kidnapped in Darfur

Laura Archer one of the first westerners ever kidnapped in troubled part of Sudan

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When Arjan Erkel was finally released, I breathed a sigh of relief, as did many of my fellow aid workers. Still in my early years of humanitarian work, I felt order had been restored. But that feeling was short-lived.

Just two months later, five MSF staff members were ambushed and killed in Afghanistan. My outrage turned to disbelief and cold numbness. For me, the illusion I had been living of bulletproof principles had been shattered, and order would not be restored this time.

As aid workers have increasingly fallen victim to kidnappings, sexual assaults and killings over the past decade, it's only natural to wonder how we justify taking such risks. The answer is far from simple.

THE PAYOFF

One fact that many aid workers will tell you is that being part of an organization that is in the business of saving lives and restoring dignity feels good; you are reminded that success is possible. This was reaffirmed for me in 2006, when I was in Ivory Coast working on a large hospital project.

Since the prevalence of HIV is as high as 15 per cent in some parts of the country, MSF started many HIV activities there. We established a voluntary counselling and testing centre, but in the first couple of months, fewer than a dozen people came. We worked hard to tell the community about these services, and this number quickly rose. We optimistically set the budget for an average of 300 consultations per month over the year. We reached that number in March, and by October more than 900 people were visiting the centre for counselling each month.

The demand for other activities related to HIV/AIDS rose as well.

We started a program to stop mother-to-child transmission of the virus, so HIV-positive mothers could safely deliver and care for their HIV-negative babies. And antiretroviral drugs were offered to an increasing number of patients, turning around their deteriorating conditions.

In the town, we made contact with people at school assemblies, orphanages, rebel battalions and local groups providing non-medical care for people living with HIV/AIDS. And on Dec. 1, World AIDS Day, more than 600 people came out for the events, including races, speeches from local authorities, live music, dramas and game-show-style quizzes all about HIV.

I believe that our HIV/AIDS intervention in that community significantly improved the lives of thousands of people.

But after working in various projects for six years and seeing the longer-term results of what I had been part of, I realize that it isn't always apparent how our efforts make a difference. I remember one cold day on vacation when I received three e-mails with disheartening news about how my previous work had been erased. One described how a compound I had helped build in south Sudan was looted and destroyed, another how the international team of a tuberculosis project I had started had to be evacuated for their safety, and the third one reported that fighting had broken out, ending a four-year ceasefire in Sri Lanka, where I had earlier helped wrap up our mission in peaceful times. The world I had worked so hard to make a better place had taken two steps backward.

I had a similar feeling when I heard that MSF withdrew staff in Darfur after the kidnapping of the MSF staff members last week. This act will be a devastating blow to the survival of hundreds of thousands of people there.

To many people in towns, villages, refugee camps and city slums, aid organizations do more for the populations than provide food, clean water or health care. For many people defeated by the effects of a conflict, the presence of aid organizations gives hope and restores some dignity by recognizing their plight. Conversely, the evacuation of an aid organization from an area needing its service and recognition, can extinguish that light.

TOO GREAT A RISK

In my most recent posting with MSF, I took over as co-ordinator of an emergency surgical program in Kismayo, Somalia, when three MSF staff had been killed there. In the months after the incident, after the memorials and funeral services, the organization made the difficult decision to end the project. The risk was too great.

The surgical program had given women with labour complications life-saving Caesarian sections. During the eight-month duration of the project, more than 400 (principally obstetric) surgeries and 1,200 emergency consultations were performed by the MSF team of six international and 35 Somali staff.

After MSF closed the program, patients had to pay $350 U.S. for a Caesarian section. For many Somalis, this lifesaving service became financially inaccessible, so a population of 100,000 people were left without this essential service.

We feared that many women would probably die.

Imagine in your home country a collapse of all systems and structures of authority and governance. Imagine violence chasing you and your family out of your homes to walk 100 kilometres to a safer, but desolate area. Imagine carrying some clothes, some food and a cooking pot. Imagine food running out. Imagine drinking water from a dirty river. Imagine children dying from diarrhea. Imagine simple infections leading to amputations or death. Imagine women dying in childbirth. Imagine that all of this is happening while people with the power to do something hold meetings and decide not to intervene.

People shouldn't die from the lack of a 50-cent medication or vaccine. People shouldn't die from the lack of clean water or soap. People shouldn't die from the lack of a proper shelter. But they do.

Over the years, I have seen that a medical and logistics team of just five people supplied with basic medicines, and materials can save the lives of thousands of people.

I have begun to realize that our simple actions do change the world from the perspective of each individual patient who is carried into a clinic and walks out some days afterwards.

The troubles of the world will continue, and my contribution is to be engaged in bringing life-saving aid to individuals in desperate need. The reason for taking action couldn't be any clearer. I accept a degree of personal risk, because I can't accept standing aside in the face of another person's suffering.

I fear that Laura Archer and her colleagues may not be the last aid workers to be kidnapped or harmed, but fortunately their ordeal ended with their release. For most of the aid workers going overseas every year, no critical security incidents will occur and they, too, will return home safely. Though, because of the risks they take, millions of people in precarious situations will be given a better chance of surviving that year. Walking away from this kind of accomplishment would be too hard for many people to justify.

Steve Dennis is an aid worker with Médecins Sans Frontières. When he is not working abroad, he lives in Toronto.