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SUSTAINABILITY| 25.11.2022

“Companies and foundations have tremendous potential to raise awareness of pressing issues”

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Raquel González, coordinator of Doctors Without Borders Spain, gave this interview on the day that the NGO he collaborates with received an award from Fundación MAPFRE, a recognition of the work and dedication of people and projects generating positive changes and helping make the world a better place.

The award-winning project is an innovative medical train that the organization rolled out in Ukraine as soon as the war broke out. Since March, it has made 60 trips and transferred 1,851 patients and 78 children from an orphanage. The award particularly recognizes the NGO’s in-country workers, 80% of whom are local and provide aid under tremendous pressure, as well as the healthcare workers in the Ukrainian healthcare system, who have been working tirelessly for months. In this interview, Raquel González recognizes the power of groups like MAPFRE to raise awareness of important issues in society as well as its social impact and work in favor of sustainability.

What is the situation like in Ukraine today? Where is Doctors Without Borders currently focusing its efforts in the country?

Right now, there are millions of people who still need help. I’ll start with the last part: we are an international movement with 24 sections and a network of branches and satellite organizations that support them. Among them, only six are capable of carrying out operations; that is, their objective is to coordinate and support interventions on the ground. The other sections conduct a wide variety of tasks aimed at recruiting international staff, raising much-needed funds, or getting the word out about people who are suffering the consequences of humanitarian crises and how Doctors Without Borders is addressing them. One of the five operational sections is Doctors Without Borders Spain.

Five of the six sections are working in Ukraine, and a few weeks ago we conducted a review about whether or not we should continue there. For now, we have decided to stay because we’re extremely worried about the coming winter. Temperatures can be as low as 20 degrees below zero in the Donetsk and Lugansk area. This will obviously impact the population, which is already in an extremely precarious position, because there are many people living in unsuitable buildings and homes damaged by power outages or interruptions in the water supply. Sometimes there’s no power. Sometimes there’s no coal. Imagine how bad the situation can get, even without being attacked… That’s why we’ve decided to stay for the time being, because this winter could get very complicated. 

So, what’s happened after almost seven months of war?

The whole country isn’t affected in the same way; the eastern area is the one under the most military pressure. On the one hand, there are displaced people; that is, people who have fled their homes and are living in very precarious conditions. There are also people in especially vulnerable situations, such as the elderly and individuals with disabilities, who are being impacted by power cuts and water shortages, and sometimes there are food shortages and medical care is more difficult to access than before.

According to United Nations figures, more than half of civilian deaths and injuries have occurred in the eastern regions of Donetsk and Luhansk—which are the hardest hit—but it’s estimated that there are more than 11,500 civilian victims in the country. The numbers, which are only the tip of the iceberg, show more than 5,000 dead and 6,500 injured.

What are we doing in the areas we can access?

There are some parts in the east of the country that we can’t access due to security conditions, although we’re as close to the front lines as possible. We’re helping people who have been injured in the war in the two medical trains for which we won the award. We are also assisting groups in extremely vulnerable situations, such as patients with chronic illnesses or severe mental health problems, because people are devastated by what is happening, by the uncertainty and the fear. They are experiencing panic attacks, anxiety and have great trouble sleeping. This is quite common, and at Doctors Without Borders Spain, we’re emphasizing mental health, whether people are in the areas under attack or they have fled the conflict. We also conduct medical activities related to primary care; that is, outpatient care. We are currently getting ready for winter by preparing kits with coats and sourcing fuel for families.

Through training, we are supporting some surgical teams in Ukrainian hospitals who have never treated a shrapnel wound before, or have never had to triage a large number of seriously injured people before.

We’re also working with networks of volunteers, local institutions and not-for-profit organizations to identify people living in areas highly affected by the conflict and near the front lines, which we can’t access, to see if we can send them material or provide online training or support of some kind.

In Ukraine, the hospitals and health centers in the areas closest to the conflict, especially in the eastern and southeastern parts of the country, are overwhelmed, and proper medical care is essential if we want to increase the chances of survival for the injured. It was therefore fundamental to have a system to transfer patients from saturated Ukrainian hospitals in areas close to the front lines to hospitals in the west that were farther away and had more capacity. And that’s how the medical train idea came about. 

How important are recognitions like the one received from Fundación MAPFRE’s for projects like yours? Why is it important for other companies and society to collaborate with NGOs that, like Doctors Without Borders, have accumulated a tremendous amount of experience handling emergencies like this one?

We are thrilled to receive the award for the best social impact initiative, and it’s a project that has indeed been very innovative. It’s a huge recognition of the work of the more than 600 Doctors Without Borders workers in Ukraine, where 80% are local staff: Ukrainian men and women who are providing aid in their own country in response to this war, also under additional pressure because their family, friends and whole lives are there. We would also like to extend this award to all of the personnel in the Ukrainian healthcare system who have been working tirelessly over these months.

The mobilization in Ukraine has been significant, and this is great news, because it shows that people care about what’s happening to other people who are in a difficult situation. Channeling this drive to help through initiatives or institutions with some experience in conflicts helps a lot. The important thing is to have compassion for other people’s pain and take action.

I would like to stress the role that companies have in society. Companies like MAPFRE are actors with a growing capacity to make changes happen in terms of internal policies, the treatment of workers, the climate etc. In the case of Ukraine, but also in other conflicts, companies and foundations have tremendous potential to raise awareness in society of issues that are of great concern to us.

MEDICOS SIN FRONTERAS ESPAÑA

What results have you achieved in terms of providing care thanks to the network of medical trains?

Since we started the first train—there have been two: one that began at the end of April and another in mid-May—we’ve managed to transport more than 1,800 patients and 78 orphans from an orphanage. We have done 60 trips in total.

Right now, we have two medical trains with different capacities. The first one is treating less serious cases, with capacity for 50 people. And the second one is equipped to handle serious cases, as it is equipped with an intensive care unit that can treat five patients of the 26 that it can transport. And we’ve managed to evacuate seriously injured people from Kharkov, Mariupol, Donetsk and Luhansk.

We have seen positive results, because it’s helping to alleviate the burden on hospitals located close to the front lines. And at the same time, it’s ensuring that patients receive better care in the west, away from the fighting.

It’s a new project, in collaboration with the National Railways of Ukraine and the country’s Ministry of Health, with whom we refurbished the trains to prepare them for the country’s railway infrastructure. The entire design of the train was undertaken with the war in mind. We have reinforced the windows to prevent damage in the event of explosions, we have specialized trauma equipment, in case the train is attacked at any point, although fortunately this hasn’t happened yet.

What we’ve learned is that humanitarian medicine is constantly evolving, and it’s our duty to adapt to the reality of each context to achieve the maximum impact. In this case, we have significantly increased the transport capacity compared to regular ambulance transport.

In most contexts where we work, there is no strong railway transport network across the region, but coming to a country like Ukraine has enabled us to innovate to meet this need, which no other organization was addressing, and we may be able to replicate this in other contexts. 

What is the priority treatment needed on your trains? Medical, nursing or psychological care? 

The train takes around 30 hours to complete a round-trip journey. On the train for less serious cases, all patients on board must be in strong enough health to withstand the entire journey without the need for medical care. In general, the patients on this train are suffering from traumatic injuries to their arms or legs, for example, or other less serious issues. This train has a team of eight or nine people, including medical, nursing and psychological staff, capable of caring for all patients during the trip.

The level of medical care is basic, but we can provide a good level of nursing care; we administer medication and provide pain relief, antibiotics and dressing changes. The second train has eight cars and can transport up to 26 patients. It has a larger medical team and a psychologist prepared to treat patients.

In this more specialized medical train, we can accommodate patients in beds who would normally be admitted to a hospital. We can also cater for up to five patients who need level-1 ICU care. This is highly specialized medical care needed to keep the patient stable. 

What other initiatives can you tell us about to help people in need? Is there any other project, aside from the one that won the award, that you feel especially proud of?

There have been many initiatives, but speaking of innovation, I’d like to highlight the use of 3D technology. We’ve been working since 2016 to improve access to prostheses, which are usually expensive and one-size-fits-all, and that’s where 3D printing comes into play.

The team in Amman, Jordan, has been doing 3D printing of prostheses since June 2017. And this is a tool that can be taken to the field. It’s accessible and can be adapted to patients’ needs, because the design can be customized for each patient, and it’s inexpensive compared to a traditional prosthesis.

The team can quickly and cheaply design (with a combination of plastics) these personalized prostheses for patients who have been injured in wars. Traditional prostheses can cost hundreds of dollars and need to be maintained. In contrast, those made with 3D printing can be obtained for just 30 dollars, and they can be made in 24 hours.

Above all, we use them for the upper limbs, where there are few options. This project was then extended to create face masks for severe burn victims. We also used it in Haiti in 2019 and Gaza in 2020. Facial burns can have many serious effects. You have to use compressive masks and exhaustively monitor them. Above all, 3D printed masks allow treatment to be provided sooner.

Another innovative project started this summer in Mali, the Central African Republic, Jordan and Yemen, with an app called Antibiogo. This is a diagnostic tool we developed at Doctors Without Borders to meet the needs of low and middle-income countries. It’s free, it doesn’t require an internet connection to be downloaded, and it represents a very significant advance to curb antibiotic resistance, which is a public health problem.

It’s geared toward all healthcare workers in those countries. And in 2023, the year when we’ll obtain certification, microbiology laboratories will also be able to download this app. This tool makes it easier for laboratory personnel to measure and interpret antibiograms, the test that determines bacteria’s sensitivity to different antibiotics. This test is essential in prescribing more effective antibiotics. In general, the test needs to be interpreted by microbiologists, which you don’t find in low and middle-income countries. However, using this app, the microbiology lab tech personnel in any middle-income country, regardless of whether they have a lot of knowledge, can directly interpret it on their phone and determine the level of resistance of the bacteria responsible for the infection.  

How have the challenges and contribution of organizations like yours evolved during the war?

Well, in fact, we celebrated our 50th anniversary last year, and there are challenges that we continue to face, and others that have gotten worse a half-century later. Unfortunately, the reasons for which Doctors Without Borders was created still exist. The international community is still incapable of responding to the humanitarian crises that are causing the most suffering, and therefore medical and humanitarian action remain necessary in places like Syria, Yemen and Afghanistan.

Over the past five decades, the conflicts have changed. The contexts have evolved, and the challenges have multiplied: the scenarios change, but the situations continue and have gotten worse, such as attacks on medical missions, the criminalization of NGOs for providing medical care, or the lack of access to populations. In recent years, the war on terrorism has caused the protection of civilians and humanitarian organizations to be relegated to second place. In short, it’s increasingly difficult to access populations; this is what we call the erosion of the humanitarian space.

Working in acute crises and with high rates of violence forces us to be better every day in all aspects. In other words, negotiating with the authorities to gain access, developing operational models that guarantee the best medical impact, and at the same time, agility and adaptability, increasingly fine-tuning our security management, having effective human resources team in place that can solve complex situations.

Working in these areas challenges us to be more proactive in connection with other needs of the population, such as access to food and shelter or very harsh security aspects such as torture or rape. For this reason, although we are an emergency organization, we are incorporating security components into some projects.

What role does the media play in reporting atrocities such as those committed in Ukraine and provoking a wave of generosity, as has happened in this case, compared to overlooked conflicts, or those receiving less media coverage?

The media play a very important role, especially when major news outlets put a crisis on the front page, choosing to put the spotlight on one or the other. Beyond Ukraine, we’re seeing a significant increase in the number of acutely malnourished children joining our nutrition programs in countries like South Sudan, Somalia and northwest Nigeria. These are crises that do not appear in the media because they seem distant to us, and they don’t provoke the interest of the audience or of the most powerful governments.

Food security, with the rise in prices of grain, fuel, transport and inflation, has been deteriorating for some time. Conflicts and displacement are on the rise, and constant droughts, especially in the Sahel belt and in East Africa, have decimated crops.

Malnutrition is being exacerbated by deadly infectious diseases such as measles, which is rising sharply in some areas following a drop in childhood vaccination during the COVID-19 pandemic. This is happening in Somalia, which is experiencing the largest measles outbreak in the world. In short, the storm is raging far beyond Eastern Europe, and it’s hitting the most vulnerable communities much harder.