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Skip to 0 minutes and 13 seconds ABUBAKR BAKRI: Most of the research nowadays on conflicts and humanitarian deliveries suggests that the risks in the field are far less than what it used to be 30 or 40 years ago. However, there is increasing need to keep our stuff safe in the field. There is less tolerance of any loss of any of our staffs, whether they are national staff or expatriates, whether it’s due to kidnapping, or due to killing, or targeting. However, we’ve noticed in the recent years that the risk to the staff moved from being just collateral damage to deliberate targeting.

Skip to 1 minute and 0 seconds Managing risk in MSF can be done in different steps like, for example, we insist on that the keeping the safety of staff is individual responsibility of the staff as well as it’s the organisational responsibility. So we brief the staff very well before departing to a mission, about all the dangers, about all the risks, and how to keep themselves safe in the field. We also– from the beginning, we try to identify the authorities with whom we should negotiate safe access and also to negotiate the safety of our staffs. We don’t have something called no man’s land. There is always someone in control, whether it’s a government, whether it’s community, whether it’s individual or a militia.

Skip to 1 minute and 53 seconds So we need to identify these people in control, negotiate with them, explain what we do and why we are here, and also the way we are going to provide these services. That means we can negotiate with people who might be perceived as outlaws, for example. The second thing is we try to choose the team that suits the context. For example, in certain areas, we can’t send certain nationalities. We can’t send certain people with specific backgrounds, for example, cultural or religious backgrounds. So we try as much as possible to choose the people that we think that they’re best to this context or that context.

Skip to 2 minutes and 48 seconds So the individual and organisational responsibilities– identifying the authorities, choosing the teams, and developing tools to manage security are the traditional way of managing risk in MSF. However, we know that humanitarian aid has changed a lot recently, and it’s becoming more professionalised than ever before. Part of this professionalisation is the professionalisation of security itself. So it moves from being managed by field staff, who were merely the logisticians who provide the tools of security, like for example, communication equipment, like providing bomb shelters or safe havens or evacuation plans, and the coordinators who usually do the communications, the contact, and the risk and the context analysis.

Skip to 3 minutes and 45 seconds Now it moved to be handled by professionals, like security professionals who used to work in police forces or intelligence or even the army before. There’s a lot of debate inside MSF, specifically, and outside the bigger humanitarian sector about whether this is the right move to do or not. This trend of professionalising security comes with costs as well, because it usually tends to keep staff in fortified humanitarian compounds, high walls, which keeps them safe, but also keeps them away from the community. And this is a kind of segregation between the aid workers and the community. So we lose the relationship that is based on trust, which is very essential to develop a successful humanitarian intervention.

Skip to 4 minutes and 44 seconds Another mark on this approach as well is it’s true that it puts the humanitarian worker at the centre, and their safety at the centre, but also, it undermines the safety of patients, because it doesn’t consider them at all in this equation. We have patients who cross borders , either ethnical borders or religious borders or even physical international borders. An example of the traditional way of managing security in MSF, as I explained, the golden rules. Actually, this happens in most of our missions. One of the examples I’ve passed through in my time with MSF is Nigeria, for example, which I worked there for three years.

Skip to 5 minutes and 31 seconds At that time, northern Nigeria has outbreaks every now and then– meningitis, cholera, measles outbreaks, in addition to the malnutrition as well. So MSF formed an emergency response team which it uses to go to the field, do field investigations, outbreak investigations, and keep in touch with the officials and the communities in these areas. This team also managed to create lots of contacts in the local government areas with the community leaders and with the religious leaders as well. That was back since 2006, and the team continued to work regularly in these areas. And it also intervened in managing many outbreaks.

Skip to 6 minutes and 27 seconds When the situation changed in 2009, and then the escalation of the conflict between the Nigerian government and Boko Haram, well, at the beginning of 2012, 2013, we found that we had a very good basis of working there. We already found that the communities know us very well because either we recruited some of their sons and daughters in our teams to respond to the outbreaks, or they have seen MSF cars with the logo going on. So it’s something familiar to them, and they were able to create this visual link between the logo and the type of work we provide. So these kind of valuable services we provide to the community managed to keep us safe most of the time.

Skip to 7 minutes and 19 seconds However, as I said, situations change a lot. Context changes, and also people change on the ground. So you have to keep up with your contacts all the time. You have to update them frequently. You have to be visibly on the ground all the time. And this is the right time to mix or to have a hybrid approach between the golden rule, the traditional golden rule approach, and the professional security management. So I think this is like a very good recipe to keep your staff safe at that time.

Safety and security in humanitarian settings

Delivering healthcare in humanitarian settings is becoming increasingly more complex and in some cases hostile, with many staff facing both personal and organisational risks to their own safety.

In the video we hear Dr Abubakr Bakri discuss the Médecins Sans Frontières‎ (MSF) approach to managing safety and security in the field and how these approaches have changed over time, ending with a concrete example of how to mitigate risk from a project in Africa.

In your opinion, are healthcare workers still protected in crisis settings, and particularly those affected by conflict? Do you think this has changed over time?

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This video is from the free online course:

Health in Humanitarian Crises

London School of Hygiene & Tropical Medicine