Transcript Medical care under fire

NO SANCTUARY IN TIMES OF CONFLICT:
A systematic analysis of security incidents affecting MSF’s medical
mission from 2009-2013 in four highly insecure contexts
Maya Sibley
AAU analyst for MCUF
June 13, 2014
www.msf.be
BACKGROUND
• MSF works in highly unstable contexts, and faces frequent
acts of violence against its beneficiaries and medical mission
• Typology of violence against MSF is poorly understood –
increasing violence is perceived, but not evidence-based
 Launch of three-year project:
THREE RESEARCH QUESTIONS
1. How many and what are the trends in security incidents in
Afghanistan, DRC, South Sudan and Kenya?
2. What are the consequences of security incidents in these
four contexts?
3. What are the opportunities and limitations of SINDY reports
with regards to the data needs of the MCUF project?
SINDY reports & semi-structured interviews for Q3
Data collection
RESULTS & FINDINGS
MCUF INCIDENTS IN SINDY REPORTS
INCIDENT TYPOLOGY
Trend over time
Baseline not established, but no increase observed over study period
MCUF hotspots
Most perpetrators are unknown
Locations
From those identified, the most common perpetrator is
Reflect security
strategy taken
State Security Forces
(25% overall)
Most frequent types of aggression
Afghanistan
Armed entry
DRC
Robbery
South Sudan
Threats
Kenya
Robbery/Death threats
42%
34%
38%
38% (each)
VICTIM TYPOLOGY
Afghanistan
N
Total number of victims
32
Incidents without victims
10
%
DRC
N
%
123
20,83%
5
South Sudan
N
%
167
8,62%
15
Kenya
N
%
9
18,07%
1
Incidents with unspecified victim #
11,11%
29,2%
13
22,4%
30
36,1%
3
33,3%
National staff are the most14common
victims
in absolute
numbers
but
international staff are 5.1 times more
(p-value <0.0001, CI: 3.9-6.7)
at risk
•
Males are more frequently victims in Afghanistan (59%) , DRC (73%) & S. Sudan (6%)
•
Women are more frequenty victims in Kenya ( 67%, but sample size is small)
INCIDENT TRIGGERS & CONSEQUENCES
The most common triggers and consequences of incidents were
mapped (N, %)
Trigger:
•Financial constraints
•Active conflict & civil unrest
60 (30%)
30 (15%)
General consequence:
•Financial loss
•Compromised quality of care
•Interruption of services
•Compromised neutrality
64 (32%)
45 (23%)
37 (19%)
32 (16%)
Types of consequence per victim:
•Psychological
206 (62%)
•Physical
65 (20%)
IMPACT HEALTHCARE DELIVERY & USE
Trigger
Not impacted
N
16
12
50
12
3
8
19
28
Active conflict/unrest
Military/police activity
Financial constraints
Lack of respect HR & IHL
Avengement
Perceived lack of respect
Other
Unknown
Perpetrator
%
53,3%
63,2%
83,3%
75,0%
50,0%
100,0%
82,6%
77,8%
Intentional
Lack of Precaution
N
14
7
10
4
3
0
4
8
Not impacted
Security forces & public authority
Armed non-state actors
International armed forced
Ex-MSF
General civilian
Intention
Impacted
N
39
11
4
3
31
%
69,6%
55,0%
80,0%
100,0%
86,1%
Not impacted
N
139
7
%
76,8%
50,0%
%
46,7%
36,8%
16,7%
25,0%
50,0%
0,0%
17,4%
22,2%
Impacted
N
17
9
1
0
5
Impacted
N
42
7
%
23,2%
50,0%
P-value
RR
95% CI
0,002
0,06
0,4
0,05
0,2
0,9
0,5
2,8
n.s.
1
n.s.
3,0
n.s.
n.s.
n.s.
1.4-5.5
1.1-8.0
-
P-value
RR
95% CI
0,2
0,6
0,3
0,07
1
n.s.
n.s.
n.s.
n.s.
-
%
30,4%
45,0%
20,0%
0,0%
13,9%
P-value
RR
95% CI
0,03
1
2,2
1.2-3.9
SINDY REPORTING
 Half had not reported to SINDY a recent MCUF incident (4/8) 
TOP 4 REASONS FOR NOT REPORTING
“Incidents
occur
so
frequently
that
if which
wewas
didreport
“Managing
the
security
situation
a
is used only
fordue
reporting
incidents
directly
“I“SINDY
feel
demotivated
to lack
of SINDY
systematically
report,
wereporting”
would
be constantly
or indirectly
have
an impact
on MSF
activities.”
priority
over
feedback
and
no
security
analysis
from HQ.”
reporting!”
MAIN SINDY SHORTCOMINGS FOR MCUF
•Descriptive narrative
•What should and shouldn’t be reported unclear
•SINDY fields are vague
BIAS & LIMITATIONS
BIAS & LIMITATIONS
•Data quality / Partial data
•Inconsistent reporting
•Lack of denominators
•Victims
•Time sensitive
•Highly subjective
•Limited capacity & know-how
CONCLUSIONS
1. First evidence-based mapping of violence directed
against MSF and its beneficiaries.
2. Context-specific and general patterns of violence were
identified, allowing development of more appropriate
tools for the monitoring of “Medical Care Under Fire”.
3. Such monitoring is vital to sustain MSF operations in
such contexts.
THANK YOU