Médecins Sans Frontières (MSF) is one of the Guardian and Observer’s three 2024 charity appeal partners (along with War Child and Parallel Histories). It employs thousands of medical workers in conflict zones in 70 countries. Here, three MSF staff talk about the risks and challenges of their frontline work and what motivates them.
Some days, Noura Arafat can’t stop crying. In her job at MSF’s mental health service in the city of Nablus in the West Bank, she witnesses extreme suffering – before going home to be confronted with the reality of living under Israeli occupation.
Arafat, 33, facilitates psychotherapy sessions between patients and international MSF staff by interpreting and mediating. She says: “I’m basically the tongue of the patient and the tongue of the psychologist. I try to mediate between two different cultures.”
She says that people’s mental health is inextricably linked to the occupation. “Have you ever thought these symptoms exist because people live in this context of limited freedom and limited access to basic healthcare and education? Imagine this long-term. Of course it’s going to create lots of frustration and depression.”
Every day, Arafat sees five or six people who are offered between six and nine months of psychological support. One patient personifies so many of the issues women face in the West Bank, she says. The woman lives close to an Israeli settlement and next to a checkpoint. Her husband was imprisoned, leaving her to raise their son alone. When he was released, he was killed at a checkpoint by Israeli soldiers. Her son later died the same way.
“This woman is a representation of the whole Palestinian story,” says Arafat. “When I see these patients, I say, ‘Oh my god, how are we going to help them?’ I have this feeling of responsibility to help, and this fear that I will have the same destiny because I’m Palestinian as well.”
Arafat gains some comfort from her job. “With psychotherapy and the multidisciplinary support that MSF is providing, you can see at least a glimpse of hope,” she says.
“It’s not a change that happens overnight. Sometimes these mothers never heal but at least they can live, they can survive, they can continue their life.”
Thok Johnson Gony, medical coordinator, Yemen
In 1983, when Thok Johnson was seven years old, he fled the second Sudanese civil war with his mother and siblings and embarked on a perilous year-long journey across the desert. When his family reached Ethiopia, they settled in Itang refugee camp.
There, two of his brothers died from measles and diarrhoea. He too almost lost his life to measles but survived because of the care he received from a humanitarian worker. “Even now, I don’t know who that person is,” he says. “But he was one of the people who motivated me.”
The experience sparked a desire to help others, and Johnson went on to study nursing. He began working for MSF in 2000 and has served in Nigeria, Myanmar, Yemen, Bangladesh, Papua New Guinea, Afghanistan, and South Sudan.
In his current role as medical coordinator in Yemen, Johnson ensures people can access health services and gives technical advice and support to medical teams working in the field. “My experience as someone who has suffered before helps me connect with people,” he says. “Such empathy is crucial in my humanitarian work, where individuals often face extreme poverty, displacement, violence and loss.”
Dr Fatima Mohamed Alfatih, medical activity manager, Sudan
Most people Dr Fatima Mohamed Alfatih sees in her job have – as she herself has – fled active conflict in Sudan. Since the country was plunged into war in April 2023, more than 11 million people have been uprooted inside the country while three million have fled across borders. The resulting humanitarian crisis has been labelled the worst of the decade.
Alfatih, 32, works in a cholera treatment centre in River Nile state. Cholera is an acute diarrhoeal infection caused by eating or drinking contaminated food or water. It affects both children and adults and can kill within hours if untreated. Sudan has faced outbreaks of the disease since the start of the war.
People arrive at health services dehydrated and hungry after walking for days. Most of them are traumatised after having fled conflict. “You don’t know where to start,” she says. “They come without clothes or anything on their feet. We call people to donate clothes, we buy them sanitary pads with our own money. It’s really sad, and the worst part is that, when we discharge the patient, they refuse to leave because they have no place to go.”
Alfatih can empathise because she knows the feeling of having no home; she first fled conflict about a month after violence broke out in 2023 in Khartoum, the capital city.
She feels lucky to work for MSF where she has access to medicine that she can provide for free. “Last week, we had five children come in at once. In 15 minutes, we managed to treat them because everything was in a cupboard next to my table.
“The parents were really grateful because usually they would have to go and buy the medication.
At that point I was thinking: ‘Thank God we have MSF and I’m working with them’.”
Anthony Caswell Pérez, MSF deputy country representative, Bangladesh
For someone who doesn’t like hospitals, it might seem strange that Anthony Caswell Pérez has ended up working for MSF, an organisation that provides medical assistance. While he is not directly involved with patients, he lobbies the Bangladeshi government and other humanitarian organisations on their behalf. “At a very basic emotional level, I feel useful in helping other people and doing it the way that I can do,” he says.
Caswell Pérez, 47, is currently based in Cox’s Bazar, home to the world’s largest refugee settlement. The majority of people who live in the camp belong to the Rohingya, a Muslim minority group, and have fled conflict in neighbouring Myanmar.
He visits the camp, housing about one million people, once a month. “What strikes me is the frustration and hopelessness about the uncertainty of their future,” he says. “There is this focus on just trying to get by day-to-day.”
His main role is supporting MSF medical and operational teams and building relationships with government officials, diplomats and other humanitarian organisations.
In August, there was a rise in war-wounded patients arriving from Myanmar with injuries caused by gunshots, shrapnel and explosions. His team put out a press release calling for access to humanitarian services and medical attention for all people, regardless of where they were coming from.
Behind the scenes, Caswell Pérez was sharing details of what MSF staff were seeing, meeting with different Bangladesh government representatives to persuade them to reverse the policy of refusing entry to refugees. “I would go and say, ‘It’s not a scenario any more, this is happening … and the current policy of pushing people back is not the right thing to do’,” he says.
MSF was the first organisation to publicly point out that people were coming over the border, he says. Four months on, the policy remains in place – but he says individuals are getting better access to health services.
