- 4 weeks ago
- #considerthis
As ASEAN leaders prepare to meet this week, humanitarian crises around the world continue to unfold, with devastating human consequences. What more can this region, and countries like Malaysia, do to help? On this episode of #ConsiderThis Melisa Idris speaks with Dr Javid Abdelmoneim, International President of Médecins Sans Frontières, also known as Doctors Without Borders.
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00:00Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show
00:25where we want you to consider and then reconsider what you know of the news of the day. As Azy
00:29leaders prepare to meet for the ASEAN Summit early next week, humanitarian crises around
00:38the world continue to unfold with devastating human consequences. What more can this region
00:44do to help, including countries like us, Malaysia? Today on the show, I'm joined by Dr. Javid
00:51Abdul-Munim, who is the new international president for Medicines on Frontier, also known as Doctors
00:58Without Borders. Dr. Javid, thank you so much for being on the show with me today and congratulations
01:03on the appointment to the role recently. I understand that your connection with MSF goes
01:11way back to your days as a medical student. And I'm just wondering, you know, what drew you to the
01:20organisation back then? And how has this long journey with MSF, how will it shape your role going
01:28forward? Thank you for having me, Melissa. Yes, I first came across MSF in the year 2000, while still
01:35at medical school. And what drew me was this sense of refusal, refusing to accept that patients and
01:41communities can be violated or neglected around the world. And that sense of refusal, which then
01:48compels us as a collective, as a group of individuals that manage the organisation, to get up and go
01:55across the world and join our colleagues and staff who are living through these conflicts or contexts, to
02:03make teams to bring around a little bit of care through the Medical or Humanitarian Act. And that's what kept me
02:07going. So after medical school, I then joined the organisation in the year 2009. And I went to Iraq and
02:14Haiti in that first year. And on and off, I've been working with the emergency teams of MSF all the way
02:21through, whilst also keeping a career in emergency medicine in the UK National Health Service, because I
02:26was in Sudan this year, I was in Gaza last year. So bringing that experience into the boardroom, I think, is
02:32really vital right now, because we're seeing changes around us in the humanitarian and global health
02:37sectors. And we need to prepare ourselves and get better at what we do to be able to meet more needs.
02:44What do you mean by changes in humanitarian needs? Could you elaborate a little bit?
02:50Yes, indeed. I mean, we're seeing massive reductions in humanitarian and global health funding
02:56over the last few years. And whilst we're financially independent, Melissa, we're part of a wider aid and health
03:03ecosystem. So if you imagine UN agencies such as the World Food Programme or UNICEF are having major cuts,
03:12and that has a ripple effect outwards. So not only would other agencies that are dependent on that funding or
03:19on those UN agencies, that they're falling away and we're increasingly finding ourselves alone or one of the few
03:28things that we do there. So we're having to do more with what we have. Or even, for example, to give you a really
03:34concrete example, we would have been receiving donations of therapeutic foods from UNICEF or from the World Food
03:42Programme to use in our own programmes. And now we're having to purchase that ourselves. So the cost for us
03:49has gone up to just stand still. And whilst we're seeing greater and greater needs around us,
03:55it's a very difficult time. You mentioned that before the appointment to this international
04:03presidency, this role, you were in Sudan, you were in Gaza. Can we talk a little bit about the humanitarian
04:10crises that are happening there, what's happening on the ground? Let's begin with Gaza. There's a fragile
04:15ceasefire in place. What are your teams telling you about what they're seeing on the ground, what the current
04:20situation is? Are we seeing aid come in, supplies being allowed in?
04:28Yes, I mean, the ceasefire really brings around a feeling of hope, but also a huge amount of
04:34uncertainty, Melissa. You know, for nearly two years, there was an extreme amount of violence,
04:40bombardment, real unsafety for the population, and food used as a weapon of war during this genocide.
04:49And so the ceasefire brings a relief for this exhausted population. The issue here now is that
04:55we need to see that sustained. We also need a massive, massive increase in the aid and supplies
05:02being allowed in by Israel. There hasn't been the type of quantity and volume increase that we'd like to
05:09see going in. And it's not just medical supplies. We're talking food, shelter, equipment, fuel,
05:16everything is needed for the population right now. So yes, the cessation of overt violence is a good
05:22thing, but that needs to be accompanied with so much more. Another thing that we're actually really
05:28asking for is that, you know, the health system was destroyed actively by Israel and its forces.
05:35Attacks on hospitals, attacks on staff who have been killed, detained, and tortured. One of our
05:41orthopaedic surgeons is still detained for longer than a year, and also blockades on supplies. So
05:47there are more than 15,000 patients, cancer, chronic diseases, who are complex injuries patients,
05:57who can't be treated in the health system as it stands right now, and they need medical evacuations.
06:03So in this moment of ceasefire, this is when we need open passage and massive increase in medical
06:08evacuations. So a moment of hope, but still a huge amount to do, and a real urgency to have a sustained
06:17ceasefire. All right. Given how the previous ceasefires weren't sustained, how is MSF working through the
06:28uncertainty, with the hopes of the crossings being opened, with medical evacuations being allowed,
06:34with more supplies and aid to come in, are you planning for that, or are you
06:41dealing with the current situation as it is, with whatever is available now?
06:47We're doing what we can. We've been in Gaza working uninterrupted since the start of all of this.
06:55And so we have two field hospitals. We work in two Ministry of Health hospitals, supporting there
07:01as well with maternity, trauma and burns. We also have primary healthcare clinics and water
07:08distribution sites. But the issue here is it's just simply not enough. No one agency and no one NGO
07:15can do what's needed. I mean, there has been a wholesale destruction of all the pillars that are needed to
07:22sustain life in Gaza. This was a genocidal campaign. So the water and sanitation system, the health system,
07:30shelter, transport, these are all crippled. And we're going into winter. And winter in Gaza is difficult.
07:38There are storms. People have been crowded in to a sandy enclave within the enclave. Right on the beach,
07:45people are living in tents at the waterline. It's really unpleasant. And we will have a greater increase
07:52in all the illnesses that you often see in winters. And when you have a starved, hungry population
08:00that's already beleaguered through two years of war, then any small illness can just tip you over.
08:07So we're seeing about a quarter of pregnant and lactating women are malnourished in Gaza at this
08:16time when we did a survey in our clinics in July. So this is not a normal, healthy population coming
08:24into winter. And they're going to need absolutely every amount of support from all regions in the world.
08:30So we're looking to ASEAN. We're looking to Malaysia as the chair of ASEAN at this moment to really convert
08:38that political support that we've seen coming from Malaysia especially, which is really valued, into action.
08:45And something concrete that Malaysia and ASEAN can do is the evacuations. There are 15,000 patients
08:52waiting for medical evacuations. This is simple and straightforward to do. Many regional countries have taken thousands.
08:59That's something we're calling for as MSF that ASEAN could do, but also to bring their full diplomatic
09:05pressure, you know, to sustaining that ceasefire, open and unrestricted aid entry and large numbers
09:13of medical evacuations, please. Can I ask you, Dr Javid, I mean, in the past two years, in this past two years of genocide,
09:24I'm sure there have been countries that have been open to receiving medical evacuations. But what are
09:30the barriers? What makes it so difficult to receive medical evacuees, not just to evacuate them from the
09:38Gaza Strip, but for countries to receive them? What are the barriers? It baffles my mind to think about why
09:45people will not accept. It is a very complicated and difficult process, not only because of the
09:52restrictions put in place by Israel in terms of visas passage. They actually approve who is allowed
10:01to be evacuated at what time and with only one caregiver. So it also can separate the families.
10:07And of course, with Palestinians leaving the occupied Palestinian territories, what is the right to return?
10:13Right? So there are states that are anxious, rightly, that if you bring Palestinians out, how will they be able
10:23to go back, if at all, or to where? But these are things that must be called for. This is a safe passage out
10:30with a right to return, a caregiver of your choice, and support. Some of the clinical care that's needed
10:38for these patients really is complex, and we understand that. But at the same time, we have
10:44countries in the region of ASEAN that have very developed medical systems, and countries like
10:49Malaysia especially, that are politically really in support of Palestine. And so this is something
10:56concrete and easy to do. Right. So definitely calling for more support from ASEAN, both diplomatically and
11:03both in terms of accepting medical evacuees. Can I also look to Sudan, which is another humanitarian crisis
11:14unfolding? You were team leader, medical team leader in Sudan until recently. So can you give us
11:22an understanding of what's happening, the humanitarian situation in Sudan currently? What's missing from
11:27media, international media attention? Well, it's just that actually. Melissa, Sudan is the largest
11:34humanitarian crisis ongoing at this time, and it feels invisible to the outside world. It's been going
11:41since April 2023 as a conflict between two forces, the Sudanese Armed Forces and the Rapid Support Forces,
11:50so SAF and RSF, and it's pretty much divided the country in half. What that has meant is there are very
11:57few organizations, international organizations or even agencies that can operate with any form of
12:04sustained and large humanitarian response that can work across the lines on both sides of the territories,
12:12and that has left huge swathes of the population without any sort of needs, without any sort of support
12:20and care. But one thing that's really defining about this conflict, other than the fact that there's no
12:25political will internally or internationally to see its end, and the media really doesn't show a great
12:31amount of interest, despite us trying. What's really important about this conflict to understand is that
12:40acts of violence against civilians, against hospitals, against infrastructure, drone warfare means that
12:47very few places are actually very safe, even if there is a front line. There are besieged areas with hundreds of
12:54thousands of thousands of people in, for example, El Fashir, a city in North Darfur that has been besieged for months,
13:01and also violence that's ethnically targeted and sexual violence that are used as weapons of war.
13:07It's a really extreme, extreme situation with outbreaks, cholera, measles, with violence, as I've said,
13:16malnutrition, maternal mortality. It really is staggering.
13:20Right. Why do you think that Sudan's crisis isn't getting the same attention as Gaza, as Ukraine,
13:29as other areas? I mean, I'm just wondering what is needed to keep these crises in view,
13:37and what risk is there if the world continues to look away?
13:41It's a really good question, and it's hard to gauge. I mean, we at MSF can't really gauge why there's interest or
13:50no interest in a political scenario or conflict. I think what we do see is that we are trying very hard with our
13:59advocacy and our humanitarian diplomacy. In fact, we have more meetings about Sudan than we do about Gaza as MSF, with regional and
14:09international actors, both whether they're non-governmental or governmental. So we're trying our best.
14:17But how to gauge why there's that disinterest? How can I? I can't comment as MSF in that sense.
14:25So it's not for want of trying is all I can say. But you said, what's the effect? The effect of ignoring this
14:32and there being no political pressure externally or internally to resolve this conflict is you very
14:38much have this divided country and millions upon millions of people living in dire, dire circumstances.
14:47And that is falling outwards. So you have in Chad, in South Sudan, a large number of refugees now and
14:55cholera has broken out in Chad. It creates a large number of needs in regional countries as well.
15:01So the effect is directly on the people of Sudan who are not getting, who have nowhere safe and are not getting
15:11care. Well, you mentioned a key ethos of MSF, which is medical neutrality. Is that under attack? Is the space
15:25for human, for neutral humanitarian work shrinking? Is everything being politicised at this moment,
15:32including humanitarian aid? It feels as though it does. It feels as though the space for
15:40humanitarianism feels like it's shrinking, does it not? There's, there is, as I observe, a rightward
15:49trend in politics, certainly around Europe and North America. And a shift away from global solidarity,
15:57I feel. And, and so in that sense, yes, it feels like it's harder to even gain access to the populations
16:06of communities that need support. And so, yeah, it's concerning. But at the same time, we also see
16:15the opposite somehow. For example, when we launched our sort of global campaign for, for Gaza to bring
16:22to attention through the month of August and September, that it is a genocide and that world leaders need
16:29to do what they can do to stop this. We saw a huge uptake across 30, 35 MSF offices, the populations
16:37wanting to sign petitions, wanting to go out and demonstrate. That's hopeful, right? So, so yes,
16:45we see both, you know, there is, there's hope there. Populations, the wider public, they, they see,
16:51they see what's, what's happening and they want to support and help in the good cause, so to speak.
16:56Well, from your bird's eye view, what are we not seeing? Are there other emergencies that worry you?
17:03Places where MSF is working, but the world isn't watching?
17:07Absolutely. I think, you know, when you say that, a couple of places come to mind. Firstly,
17:12a country, Haiti. Haiti is having a lot of armed conflict between armed groups, especially in the
17:20capital, where nearly 80 percent of the health system is actually non-functioning. And we've
17:26treated in the first six months of this year, over 2,700 survivors for sexual violence. Sexual
17:33violence there, between front lines, again, it sounds like Sudan as I describe it, between front lines
17:39within the city of Port-au-Prince, with these armed groups fighting, populations are exploited and
17:45controlled with violence and sexual violence at times. So this is a context that doesn't get the
17:52attention that it needs. And another, I would say, is a region, which is the Sahel. So the Sahel is a band
18:00to the south of the Sahara that runs sort of east-west. And you have Mali, Benin, Burkina Faso,
18:07northern Nigeria, Niger, and then in the east, Somalia, even Ethiopia, rates of malnutrition, conflict,
18:18instability. And these are all magnified by climate breakdown and climate change that's putting real
18:25pressure on the populations. And so we, again, going back to the aid cuts and humanitarian and global
18:32health cuts, we've seen, for example, a double the number of patients in our clinics in Somalia and
18:39Ethiopia this year than we normally would. Right. Well, you talked a little bit about urging ASEAN leaders who
18:46are preparing to converge in KL in Kuala Lumpur for the summit, you are urging them to respond more to
18:56humanity in crisis. Can we break that down? For ASEAN country members, for Malaysia as ASEAN chair,
19:04what are the concrete things that we can do, both in terms of ASEAN leaders, but also the public
19:11watching and maybe pushing our leaders to do more?
19:17Thank you, Melissa. It's a good question. I mean, first and foremost, to ensure the ceasefire
19:22holds, right? We need the ceasefire to hold and also humanitarian aid to be massively expanded at
19:31scale to reach the people that need it the most. And that, as I said, includes food, medical supplies,
19:37shelter, fuel and clean water. The other thing that we're calling for, and that's something that's very
19:44concrete is for ASEAN with Malaysia to lead a regional mechanism that can expand the number of
19:52medical evacuations at scale. It's something that is very concrete and is manageable. We've seen it
19:59in countries like Turkey, Egypt, Qatar. So regional countries have taken hundreds, even thousands of
20:07patients and would like to see that in Southeast Asia also. Well, and then the call there is for ASEAN to
20:13continue its role that we've seen, right, as a moral block and as a humanitarian block, right? To
20:20project unified leadership, to uphold international humanitarian law, because we've seen egregious
20:27breaches of those laws and we would like the ASEAN block to really continue to call for the upholding
20:34of that law. Well, one of the reasons I, on this show, we speak often to MSF representatives, and I
20:44think one of the reasons why is this really strong ethos in MSF to bear witness. And I really appreciate
20:52that. And I do wonder whether you can maybe share with us a little bit about why it's important for MSF
20:58MSF to bear witness when, you know, for us, for us who cannot access these areas. What role do you see
21:07storytelling as part of humanitarian work today? I think it's really important because, you know,
21:15on one level it humanizes and quantifies the need. So if, for example, I tell you that
21:25four million people are displaced and there's violence in Khartoum and sexual violence and
21:31crossing front lines is difficult. That's hard to understand. But if we're able to, and as I said,
21:38I've been there and I tell you that I speak of a mother who had to collect money through sexual work
21:45just to pay off the checkpoints to cross the front line where her child then got abused in any case,
21:52to then arrive at the hospital and they arrived too late and they were bringing cholera patients
21:59from the village and then some of those patients didn't even survive the journey.
22:05that tells you something a little bit more and hopefully with with quantifying that and personalizing and
22:12humanizing that that story, one story of millions in all of Sudan, then it might motivate the listener,
22:21whether the listener is someone who sits in parliament and has a chance to maybe really change something or a general
22:28member of the public who's then motivated to do, go on a demonstration, sign a petition,
22:33write a letter to your member of parliament. These things, these things matter and it's good to,
22:40it's good to be able to just pay attention and have that sort of translated for you in that way.
22:45But then I don't also doubt and I always want to say, you know, in MSF, only one in about 10 of our
22:52members of staff are from outside and go in and come back. You know, nine, eight to nine members of
22:58staff from MSF are from that area and we're increasingly really want to see our own staff
23:03members tell their own stories because not only are they doing the work, but they're living through
23:07it as well. And you have some very powerful testimony that really lands when you understand.
23:12I mean, my guards and colleagues, imagine living in tents, explosions happening that, you know,
23:19they'd have to move overnight with a displacement, with an evacuation order and then coming to work the
23:25next day and doing psychological counseling for the patients, if you're the counselor, or doing
23:31physiotherapy for the amputated child, you know. And so these are human dignified stories that need to
23:41be told, preferably by people who are going through it themselves. And that's the power of testimony.
23:47Well, you've been in so many crisis zones. You've spent so many years working in the field. Do you ever
23:56lose hope or how do you remain hopeful about humanity? You talked a little bit about
24:01how the global solidarity that you're seeing gives you hope, but when you are on the ground and you're
24:07living through it, are there, what have you learned about resilience from the people that you're serving?
24:15Oh, I mean, so much, Melissa, and it's one of the things that really, it's a golden thread that runs
24:20through everything that I've ever done with MSF, that because, you know, make no doubt that the first
24:25responders or the responders that can really stay even in the hardest of circumstance are usually
24:32local communities, right, doing it for themselves. In Khartoum, the emergency rooms, if you've ever
24:38heard of the emergency response rooms, you've now been twice nominated for the Peace Prize, but not been
24:43given it. Or in Ukraine, the civilians that would cross front lines and take medications across to elderly
24:49patients of diabetes who didn't have their medicine across the front line. So that's the first thing,
24:56that communities, more often than not, are doing it for themselves. They're there, they're reacting,
25:01and they're the first humanitarians ever. And we just come in and want to support, to be honest. So
25:06that's, that's genuinely the beautiful thing. But also my colleagues, as I've mentioned, you know, I go,
25:14I remember the first time I really felt it so strongly was in Ebola in West Africa, huge epidemic,
25:21flights closed, we fly in, those countries were under blockade. And, and the staff members sat me down
25:27and were like, are you, can we just check? Are you, are you, you know, you've, you're coming here,
25:34there's no cure. Do you know what you're doing? This means so much. Are you crazy? It's like, no,
25:38but this is what we do. And you sit there with your colleagues, and then you actually,
25:42they tell you stories of how they'd been ostracized, and their children bullied at school,
25:48because the children know that their parents, or, you know, the parents of their friends are
25:54working with Ebola, and Ebola is so frightening, they didn't want them in the school. So they're
25:59doing this under huge pressure, and still coming to work each day. And as I said, in Gaza, in Sudan,
26:05and it's so it's really also about my colleagues as well.
26:08Yeah. And I'm so sorry to hear about the loss of some of your colleagues, particularly recently in,
26:13in Gaza as well. I'm sorry.
26:15Too far for the loss.
26:16Thank you. Thank you for saying that. I mean, it's not really a loss, right, Melissa? They were
26:21killed. They were murdered.
26:22Yes.
26:23By Israeli drone strikes, these last two colleagues. Abud especially is a physiotherapist who I worked
26:28very, very closely with. And he, again, that ethos of refusal, he refused to accept a poor quality of
26:34care. And we had no crutches, we had no wheelchairs, because of the blockade. And he was having them
26:39made, and he made compression garments, he brought in a tailor. And he was like, let's make, we can do
26:45this because burns victims need very special sort of, you know, and he just refused to accept that we
26:51had no supplies. He found a way and he worked day in, day out. And, you know, doing burns and trauma
26:57care rehabilitation in Gaza for 18 years, as he did through how many wars? He got killed by Israeli drone
27:05strike. And he used to be an educator of MSF physiotherapists abroad. He, he, it's not just the, the loss to
27:15his family, and to his colleagues, and to his patients in Gaza, it's to the MS, he was an expert
27:22physiotherapy for trauma and rehabilitation in burns and trauma. And yeah, you know, and he's just one of 15
27:29colleagues, and they're 15 of 1700 more than that have been killed. And so yes, it's a it's a huge
27:37loss. So thank you for your condolences. Well, thank you for telling us about him and his story. And
27:43thank you for sharing some of your the insights of your work. Dr. Javid, I really appreciate your
27:48time. Thank you. Thank you for having me. That was Dr. Javid Abdul-Munim from
27:52Médecins Sans Frontier MSF Doctors Without Borders. Wrapping up this episode of Consider This,
27:58I'm Melissa Idris signing off for the evening. Thank you so much for watching, and good night.
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