MSF The Pulse Winter 2025 NZ

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WINTER 2025

OUR DANGEROUS FUTURE:

When humanitarian law fails to protect

HIV: Ending the epidemic

LEBANON:

‘Moments of humanity keep me going’

Cover: Ali Almohammed, MSF medical coordinator in Lebanon. “I dream of a world where families, including my family, aren’t torn apart by violence,” he says. Read more about Ali on page 12.

© Jinane Saad/MSF

MEDECINS SANS FRONTIERES

Médecins Sans Frontières is an international, independent, medical humanitarian organisation that was founded in France in 1971. The organisation delivers emergency medical aid to people affected by armed conflict, epidemics, exclusion from healthcare and natural disasters. Assistance is provided based on need and irrespective of race, religion, gender or political affiliation.

Today Médecins Sans Frontières is a worldwide movement of 24 associations, including one in Australia. In 2023, 138 Australians and New Zealanders filled roles in our medical humanitarian projects.

Nāu te rourou, nāku te rourou, ka ora ai te iwi - With your basket and my basket, the people will thrive

This whakataukī encompasses the idea that when people work together and combine resources, we can all flourish. It was chosen by our Māori partners Deborah Harding and Tracey Poutama.

CONNECT WITH US

Call 0508 633 324

Email contact.us@nz.msf.org

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@msf_anz

@MSFAustralia

Using every means we have to protect humanity

Facing a dangerous new reality, humanitarians need to find effective approaches while holding on to our principles.

In an increasing number of contexts where we operate, MSF and other humanitarian organisations can no longer assume that states and armed groups will facilitate our safe access to conflict-affected communities. We can no longer trust states and armed groups to consistently respect international humanitarian law (IHL).

And we can no longer have faith they will take corrective action when confronted with evidence of violations, such as attacks on hospitals and medical staff. The reasons for this are simple.

With the record number of humanitarian colleagues killed last year – 377 –and nearly 80 reported killed as of May this year, it is evident that in many environments, humanitarian aid workers, medical personnel and civilians are unprotected and at high risk.

Between October 2023 and the end of 2024, there were 651 attacks on healthcare facilities and personnel in Gaza alone, according to the World Health Organization (WHO), with only 16 of Gaza’s 36 hospitals partially functioning. The March attack by Israeli forces on an emergency medical convoy near Rafah in southern Gaza stands out as an outrageous violation in a conflict that has been full of them. Eight Palestinians from the Red Crescent Society, five from the Gaza Civil Defence and one from the UN were found in a shallow grave a week after going missing. Some appeared to have been shot at close range, execution-style.

The political architects behind today’s conflicts increasingly treat compliance with IHL as optional in their pursuit of military or political gains.

Gaza may be the most visible example of a terrible new reality, but it is far from the only crisis. Violations of IHL have been more numerous and more severe than ever before. We have witnessed the brutal targeting of civilians by armed groups in Sudan, and severe restrictions on humanitarian access and medical supplies by Myanmar’s armed forces. Between February 2022 and January 2025, the WHO verified 2,236 Russian attacks on healthcare facilities in Ukraine, primarily with heavy weapons. It is the highest number of such attacks ever recorded by WHO in a conflict.

The lack of political will and resources to investigate and hold perpetrators to account is glaring. It is civilians, predominantly women and children, who suffer for it. The IHL violations we are seeing today appear to stem not from a lack of awareness or discipline, but from a growing contempt for IHL itself, and the knowledge that mechanisms for compliance and accountability are weak.

The UN Security Council’s lack of decisive action has not helped. States fail again and again to hold actors accountable for violating UN resolutions and international agreements, and they refrain from taking concrete measures following rulings from international courts — in what UN Secretary-General Antonio Guterres has described as the “age of impunity”.

Some of the same states that condemn violations of IHL, meanwhile, have continued to ship weapons to conflict zones — contributing directly to indiscriminate bombings and the systematic dismantling of healthcare systems.

With the weakening of UN authority and legal frameworks, apparent impunity for violators of IHL, and the massive reduction in support for aid, what recourse is there for humanitarians in this more dangerous new world (dis)order?

In the past, the humanitarian sector has tried to promote universal compliance with IHL through initiatives aimed at strengthening national legal systems, expanding the role of human rights law and training military forces in reducing civilian harm and enabling humanitarian operations. But these efforts overlook a critical reality: the political architects behind today’s conflicts increasingly treat compliance with IHL as optional in their pursuit of military or political gains.

The paths available to us to better protect humanity, curb violations of IHL and ensure unimpeded humanitarian access are few – which is why it is critical we use every means we have.

Drawing from half a century of global humanitarian experience, MSF advocates for consistent application of the rulings of the International Court of Justice and the International Criminal Court to protect humanitarian efforts.

As a medical humanitarian organisation, MSF urges reconsideration of siege warfare tactics and advocates for broad protections for civilians, encompassing physical and mental well-being, beyond just casualty counts. Civilians in conflict endure profound suffering through separation from loved ones, deprivation of access to health care (for maternal health, chronic health issues and infectious disease) and deprivation of access to basic requirements like food, fuel, water and adequate shelter.

While new approaches can supplement IHL mechanisms, they must work alongside the core principles of humanity, neutrality, impartiality and independence. Strengthening protections for civilians, aid workers, and medical personnel demands strong civil society advocacy and bold political leadership.

Five MSF vehicles parked in front of our clinic in Gaza city were destroyed by Israeli forces in 2023. © MSF

Crisis within a crisis

The 7.7 magnitude earthquake that struck Myanmar on 28 March caused widespread death and destruction. With prolonged armed conflict and political instability having eroded the healthcare system, the earthquake created a crisis within a crisis. Two million additional people are now in need of assistance, joining 4.3 million receiving aid support before the quake.

MSF teams prioritised providing medical assistance, safe drinking water, sanitation, shelter, and mental health support.

Dr Za Za Lin Aung, who helped treat infections and noncommunicable diseases as well injuries, said: “We also see people with signs of PTSD who were emotionally affected by the earthquake – our mental health team currently offers counselling sessions for them.”

Myanmar earthquake: Around 3,800 people were killed, 5,100 injured, and more than 200,000 displaced.

Globally, more men than women have TB, but in Afghanistan in 2024, 66 per cent of patients diagnosed with TB were adult women and children under the age of 15, while 34 per cent were adult men.

Dr Zar Zar Lin Aung listens to Kaung Pyae Khant’s lungs at MSF’s mobile clinic in Mandalay. Brother Kaung Pyae Kyaw holds him, while their mother Zin Mar Win stays close by.

AFGHANISTAN

Keeping up the fight against TB

MSF continues to tackle barriers to treatment of tuberculosis in Afghanistan, where widespread poverty and lack of public awareness prevent access to care.

MSF’s TB hospital in Kandahar, with a laboratory, an outpatient clinic, and a 24-bed inpatient department for patients diagnosed with drug-resistant TB, is the only such facility in southern Afghanistan. Close collaboration with the national TB program and other medical facilities in the region facilitate referrals, as patients face insufficient medical infrastructure, lengthy treatment, and financial obstacles. Some patients come from more than 350 kilometres away. MSF helps with transportation costs and offers health promotion and psychosocial support to them and their family. Patients who require more complex treatment can stay at the facility as long as they need.

“Women and children stay at home in poorly ventilated rooms for longer periods of time than men,” says Purity Kinyua, MSF project medical referent in Kandahar. “And if a woman gets infected, the children are likely to catch the disease as well.”

“I’m improving and recovering with each passing day,” says Zainab. Here she receives medication from an MSF nurse for drug-resistant TB at MSF’s hospital in Kandahar. | Afghanistan 2025 © Noor Ahmad Saleem/MSF

SYRIA

A lifeline amid shrinking healthcare services

After 13 years of war in Syria and the fall of the Assad regime, more than 7.2 million people in Syria remain displaced, living in camps without basic services like heating and electricity. As a result, burn injuries from unsafe heating methods are common. MSF opened a burns unit in 2012 to treat the many displaced people injured by fires and boiling water. Since then, it’s transformed into a surgical and rehabilitative hospital. In 2024, the unit received 8,340 burn-related emergencies – an average of 23 patients a day.

With the severe cuts to US foreign aid this year, conditions have worsened. As of the end of February, 4.4 million people in nine governorates in Syria were affected by US funding cuts, which shut down more than 150 health facilities.

“There used to be health centres and hospitals,” says Mohammed, who received burns care at MSF’s unit. “Now, most have stopped. Even the maternity and children’s hospital closed after its support was cut.”

With few alternatives, the MSF hospital in Atmeh remains a critical lifeline. It provides surgery, physiotherapy, mental health care, and even 3D-printed facial masks that reduce scarring and improve recovery.

IMPACT OF US FUNDING CUTS

711 health facilities across Syria suspended or at reduced capacity (40% of the total)

49 hospitals

572 primary healthcare centres 41 mobile clinics

Every day, Congolese refugees, mostly women and children, arrive at the Musenyi site. The site has a capacity of 10,000 people, but by the end of April it was hosting more than 15,000 refugees.

BURUNDI

Preventing outbreaks in refugee communities

MSF launched an emergency response to reduce the risk of measles and malaria in a refugee camp in Burundi, where thousands of Congolese refugees fleeing violence in the Democratic Republic of Congo (DRC) have been living in extremely precarious conditions.

Since the beginning of the year, thousands of people fleeing fighting and insecurity in North and South Kivu provinces in the DRC have crossed the Rusizi river into Burundi and set up camp in schools, sheds, churches and stadiums in Cibitoke province, bordering South Kivu. The UN refugee agency estimates more than 71,000 people have arrived in Burundi from DRC since Jan 2025, 53 per cent of them children.

“There is an urgent need to improve the living conditions on this site, as all the elements for serious health problems are present,” said Barbara Turchet, MSF emergency coordinator in Burundi. “Given the hygiene conditions, we have started to set up isolation units as a preventive measure in case of a cholera outbreak. And to reduce the risk of malaria, which is exacerbated by the amount of stagnant water everywhere, we have distributed more than 8,000 mosquito nets and are planning long-term mosquito spraying at the site.”

A member of the 3D-printing team takes a facial scan of a young patient with severe facial burns. The scan will be used to print a compressive mask, which is used to treat scarring and swelling, and enhance patients’ movement and recovery. © Abdulrahman Sadeq/MSF

The end of the HIV epidemic is within reach

MSF has started to roll out a new HIV prevention tool: a long-acting injectable pre-exposure prophylaxis. If we can get this drug to more people, and they accept it, this will be a turning point in ending the HIV epidemic.

Around 40 million people live with HIV globally. Although the burden of the epidemic continues to vary between countries, the African region remains severely affected, with one in 30 adults affected.

In Africa, HIV is a generalised epidemic, mainly concentrated in women; and affecting key populations.

Over the last few years, progress has been made in the fight against HIV using some new tools. A vaginal ring and oral pre-exposure prophylaxis (known as PrEP) have given people ways to protect themselves before becoming exposed to the virus. But oral PrEP has its challenges.

“One of the main barriers to people using oral PrEP currently is the fact that they have to take tablets every day,” says Antonio Flores, MSF senior advisor on HIV and TB at the Southern Africa Medical Unit. This ‘pill burden’ has contributed to HIV prevalence remaining high.

Understanding the social landscape

In Eswatini, HIV remains the leading cause of death. An estimated one quarter of the population lives with HIV. Nearly a third of women aged 15-49 are HIV-positive. Social stigma exacerbates the problem, resulting in low uptake of the oral PrEP: only 11 per cent of eligible people take it. And only a quarter of those enrolled on PrEP come back for refills.

“In a qualitative study we did we learned that it’s gender and social norms that influence health seeking behaviour,” says Sinikiwe Dlamini, MSF’s data entry operator at Sitsandziwe Clinic in Eswatini. “Eswatini, being quite a traditional and cultural country, where men are the leaders in society, means everything for a woman, especially having a male partner, will have to be agreed upon with the male partner.”

Majuba Mambo, MSF nurse at Sitsandziwe says, “The packaging of the oral PrEP that we have in the country is almost the same as the ARV [antiretrovirals for treatment of HIV]; and when going with the tablets, people start discriminating.” Some women feel they have to hide their medication bottles.

Antonio Flores (right), MSF senior advisor on HIV and TB at the Southern Africa Medical Unit trains colleagues to use long-acting injectables for HIV prevention. © MSF

The potential of long-acting injectable HIV prevention

CAB-LA (Cabotegravir) is one of the new long-acting injectables, which provides pre-exposure protection for two months. (A six-month option is currently awaiting FDA approval and World Health Organization recommendation.)

The roll-out has started in a number of countries supported by PEPFAR (the US President’s Emergency Plan for AIDS Relief). MSF is supporting the roll out of CAB-LA in four countries in southern Africa, including Eswatini. “MSF secured a number of doses of CAB-LA, but the plan is that once the MSF roll-out is ready, it will be handed over to Ministry of Health,” says Flores.

The dismantling of aid and withdrawal of funding from programs like PEPFAR that support HIV testing and treatment has brought uncertainty to the global roll-out of CAB-LA. “This is a very rapidly evolving situation, and our role is changing as a result,” says Flores. Yet the initial response to the injectable PrEP is excellent. “In the first month more than 20 clients started on CAB-LA, which shows people are happy about it,” says Mambo. “They are saying it is private, and they can take it discreetly.”

The two-month window means that people don’t have to worry about daily adherence. Plus, long-acting prophylaxis is 80 per cent more effective than the oral alternative, says Flores.

We now have the tools to end HIV It is hard to overstate the potential impact of the long-acting injectable PrEP.

“We expect injectable PrEP to be a game-changer, and we don’t use this term lightly,” says Flores. “Injectable PrEP has the potential to end the HIV epidemic, but it will only end the HIV epidemic if people are getting it. We know from the study data, and we know from early implementation that we would reduce new infections drastically.

“We already see the impact of oral PrEP in places where it has been rolled out en masse, where the uptake was greater. And of course, that’s normally high-income countries or even very specific places: London, Amsterdam, Sydney, Sao Paulo.

“We have seen over the years a decline in HIV incidence among high-risk populations. So we know that there is a potential in PrEP. We have ended other diseases with vaccines, we can end this epidemic with an injectable drug that is given every few months. But people have to have access.”

Injectable PrEP has the potential to end the HIV epidemic, but it will only end the HIV epidemic if people are getting it.

Advocating for access

“We need to focus on the populations at high risk and remember that some of these populations are actually criminalised. You do have a higher burden of HIV in key populations: men have sex with men, transgender women and men, sex workers. So, these are very vulnerable populations to HIV but are very vulnerable to criminalisation,” says Flores.

“Paradoxically, although the burden of HIV is much greater in Africa and the region, the epidemic is in a way better controlled than in other regions. Cost (sometimes more than €1,000 per vial/UA$1,800) is one of the main barriers that we have now in terms of rolling out to regions where actually HIV incidence is going up, and that is the Americas, Latin America, Eastern Europe, and the Middle East. This is something we have to factor in when planning implementation where we don’t have certainty about PEPFAR anymore. Our role as MSF is really to support countries where possible to advocate for access. And engage in discussions about how to make access sustainable.

“If there is wide access to injectable prep, we can definitely end the epidemic because we’re going to control it. Twenty-five years ago, ARVs did change the epidemic, and now we can really stop the epidemic, if people have access to these new tools. Injectable PrEP is a turning point in the history of HIV. But we need to get it to people.”

Left: A box of CAB-LA vials. © Joanne Lillie/MSF. Right: Majuba Mambo, MSF nurse at Sitsandziwe Clinic. © Joanne Lillie/MSF

Who will stand up for humanitarian law?

Civilians are facing deadly violence and aid workers are at extreme risk, as the system meant to protect them fails. MSF teams in many environments are witnessing the impact of this frightening new reality.

On 4 April, Russian military forces struck a residential area of Kryvyi Rih, in the Dnipropetrovsk region of Ukraine. The attack killed 18 people, including nine children. Dozens more people were injured.

MSF teams worked alongside state paramedics providing emergency medical assistance — stabilising the wounded, delivering urgent care, arranging referrals to hospitals.

“People were burned alive in their cars near their homes,” MSF paramedic Yevhen Blinnikov said. “On the playground, we saw the lifeless bodies of many children –it was heartbreaking.”

It was the highest number of children killed in a single attack in Ukraine since the start of Russia’s full-scale invasion in 2022, according to UN human rights monitors.

“This merciless war continues to cause immense suffering to civilians. It must end — civilians must never be a target,” said Thomas Marchese, MSF’s program director in Ukraine.

But in the conflict zones where MSF operates, attacks on civilians, as well as on those trying to help them, have become all too familiar. Violations of international humanitarian law (IHL) are happening with little if any consequence for the perpetrators – and horrific consequences for civilians.

The four Geneva conventions that form the core of IHL have been universally accepted by UN member states, including Israel, Russia, Sudan, Haiti and Myanmar. They set out guidelines that all participants in combat – state and non-state groups alike – must observe.

This includes prohibiting attacks on civilians and ‘civilian objects’ (any non-military infrastructure such as homes, schools, places of worship, and markets), and respecting medical personnel, facilities and transport.

A system that took decades to build now looks to be vanishing when it is needed most.

Earlier this year, MSF Secretary General Christopher Lockyear addressed the UN Security Council on the situation in Sudan, which he called a “war on people”.

“This Council has repeatedly called for an end to the conflict, for adherence to international humanitarian law, for the protection of civilians, and for the unimpeded delivery of humanitarian aid,” Lockyear said.

“Yet your calls ring hollow.”

Men sweep rubble inside the Emirati hospital in Rafah city, southern Gaza, 22 January 2025. © MSF

Hard questions

After a fragile ceasefire in Gaza collapsed in March, Israeli forces resumed and expanded their military offensive, forcibly displacing people and deliberately blocking essential aid.

“Gaza has been turned into a mass grave of Palestinians and those coming to their assistance,” says Amande Bazerolle, MSF emergency coordinator in Gaza.

Civilians must never be a target.

“We are witnessing in real time the destruction and forced displacement of the entire population in Gaza. With nowhere safe for Palestinians or those trying to help them, the humanitarian response is severely struggling under the weight of insecurity and critical supply shortages, leaving people with few, if any, options for accessing care.”

In May, two helicopter gunships bombed an MSF pharmacy at Old Fangak hospital in South Sudan, burning it to the ground – the only hospital in remote Fangak county of Jonglei state, serving a population of more than 110,000 people who already had extremely limited access to healthcare.

“People will now be even further cut off from receiving lifesaving treatment,” said Mamman Mustapha, MSF head of mission in South Sudan.

It was the second attack on an MSF hospital in South Sudan in a month. In April, dozens of armed men stormed an MSF hospital in Upper Nile State, threatened staff, and looted supplies and equipment at the only functioning health facility in the area. Medical services had to be suspended.

It’s part of an emerging pattern of insecurity affecting healthcare in the region.

In January, armed men in Upper Nile state attacked two marked MSF boats carrying six staff returning to Ulang after delivering medical supplies to Nasir County Hospital.

In Sudan’s capital of Khartoum, MSF ceased operations at two hospitals in the last year due to violence and insecurity.

“It is devastating to have to stop supporting lifesaving medical care at this hospital, particularly in the face of such great and growing medical needs,” said Claire San Filippo, MSF emergency coordinator, upon the suspension of medical activities at Bashair Teaching Hospital in Khartoum in January.

“Hospitals must be places where people can seek healthcare without risking their lives and where medical professionals can safely deliver care.”

Abandonment to violence

At the UN Security Council, Secretary General Lockyear explained that for MSF colleagues and patients in Sudan, the failure by the Council to take action “feels like abandonment to violence and deprivation”.

The same can be said in many places. To change the course of this trend, we need to speak out and continue to bear witness to what is happening, call out offences, and appeal to governments and international bodies to hold perpetrators accountable.

The mechanisms exist to strengthen the protection of civilians in conflict and promote adherence to the laws of war. If the will no longer exists to enforce them, the world will become a frightening place indeed.

Flames erupt at the MSF hospital in Old Fangak, South Sudan, after it was bombed on 3 May 2025. © MSF

Civilians under threat

When civilians, their communities and humanitarian workers become targets, the world becomes a very dangerous place.

In the last few years, MSF has seen not only an alarming escalation in war and violent conflict in the places we work, but also an alarming increase in attacks targeting our staff, vehicles and buildings, along with the organisations we work beside. When we cannot do our work safely, our action is under threat.

We continue to call for ceasefires and for access to medical humanitarian aid for all.

A surgical team at work at the MSF-supported Salama hospital, in Bunia, Ituri province in the Democratic Republic of Congo. MSF is witnessing escalating violence against civilians –and horrific injuries. In February 2025, attacks in Djugu territory left more than 100 people dead and dozens injured, many of them women and children. MSF has treated children as young as four years old with multiple machete wounds. © Camille Marquis/MSF

MSF teams, working alongside state paramedics, provided emergency medical assistance to people injured when Russian forces struck residential areas in the city of Kryvyi Rih in Ukraine’s Dnipropetrovsk region in April 2025. Among the most seriously injured was a seven-year-old girl with shrapnel wounds, a fractured hip, and haemorrhagic shock. An MSF ambulance took her to a specialised facility for treatment. “We strongly condemn this horrific attack. This merciless war continues to cause immense suffering to civilians. It must end — civilians must never be a target,” said Thomas Marchese, MSF’s program director in Ukraine. © MSF

A war-ravaged girls’ orphanage in Lebanon, one of more than 90,000 destroyed buildings. “The scale of the destruction is massive. Towns have been reduced to rubble, with homes, schools, and farmlands wiped out,” says Francois Zamparini, emergency coordinator for MSF in Lebanon. In early 2025, MSF expanded activities in southern Lebanon deploying three new mobile medical units to towns in the Nabatieh governorate, to add to the two units already operating in the South governorate. © Maryam Srour/MSF

MSF Secretary General Christopher Lockyear shows an image of a destroyed MSF shelter in Khan Younis, Gaza while briefing the UN Security Council, February 2024. An MSF staff member’s family was killed, and six others injured, when an Israeli tank fired on an MSF shelter the same month. Lockyear called for an immediate ceasefire in Gaza and for the unequivocal protection of medical facilities, staff and patients. He briefed the council again in March 2025 on the crisis in Sudan. © UN Photo/Loey Felipe

A displaced Palestinian family rides a tuktuk to where their home used to stand in Beit Lahia city, in the north of the Gaza Strip. © Nour Alsaqqa

Increasing violence close to the Turgeau Emergency Centre in Port-au-Prince, Haiti, forced MSF to suspend activities and evacuate all teams as a precautionary measure. During one of the evacuation movements in March 2025, this vehicle, which was part of a clearly marked MSF convoy, was repeatedly and intentionally fired upon, despite prior coordination with authorities. © MSF

‘Why I cannot turn away’

Ali Almohammed, an MSF doctor from Syria, working as MSF medical coordinator in Lebanon, shares a heartfelt reflection on life in conflict.

Beirut is a city that holds so much of my personal past. I lived and worked many times here between 2019 and 2021, and its streets and people became deeply connected with my memories. Now, those memories are clouded by people’s suffering. The war has upended lives, turning schools into temporary shelters for families forced to flee their homes.

Once lively classrooms now hold children and parents, struggling against the cold and the weight of uncertainty. These children sleep on school floors, wondering why they can’t return to their homes, while parents fear the next airstrike and its unknown consequences.

Each day, I visit these shelters, offering what help we can. Yet, the people I meet share a common plea: they don’t just want aid – they want to return to a life of peace.

I became a medical doctor because I believed in treating and saving lives. But after more than 10 years of responding to crises, I have seen lives beyond repair in ways I never imagined. With MSF, I’ve gone to many conflicts and emergencies that most people only hear about in the news, including Syria, South Sudan, Ukraine, Iraq, Ethiopia, Sudan and Lebanon.

Each assignment, each new crisis, has become a chapter in a long story of resilience amidst unbearable pain. But now that resilience is wearing thin, not just for those I serve, but for me as well. I am tired – tired of witnessing suffering, and tired of the systems that perpetuate it.

Yet, amidst this heartbreak, I find reminders of why I cannot turn away. Even when the path is difficult, even when hope feels distant, I know that our humanitarian efforts can make a difference, offering a small light in the darkness.

A decade of humanitarian practice

For more than a decade, I’ve poured everything I have into this work. But every assignment has reminded me of the fragility of life and the limitations of humanitarian aid.

We heal wounds and provide relief, but the root causes of many crises remain unaddressed. I’ve sat at negotiation tables with armed groups many times, trying to secure access for lifesaving aid, only to watch bureaucratic red tape or political agendas stall the help we are desperate to deliver.

The constant struggle to provide healthcare in the face of political resistance is a kind of exhaustion that no amount of rest can ease.

The exhaustion I carry is also reflected in the faces of the people I meet. I see people who are beyond tired – they are broken. They have survived bombs, violence, outbreaks, natural disasters and displacement, and the psychological scars have left them shadows of who they once were.

I am tired of seeing children die from preventable diseases. I am tired of watching families flee their homes, only to find themselves with no safe place to go. I am tired of walking through cities reduced to rubble and wondering how many more generations will grow up in the shadow of destroyed schools instead of in classrooms.

Medical coordinators like Ali play a crucial role in shaping and executing the medical strategy of MSF projects, ensuring the highest standards of care. © Jinane Saad/MSF

The weight of trauma

The psychosocial trauma isn’t just something I witness in others – it’s something I carry within myself. I remember the faces of patients and friends I could not save in Kobani in Syria, all the children whose lives were cut short by conflicts.

But in those darkest moments, there are also moments of humanity that keep me going. A mother’s grateful smile after I treated her ill child. An elderly woman, who despite losing everything, thanked me as I handed her diabetes medicine. These small acts of resilience and gratitude remind me there is still light amidst the darkness.

Tired, but not defeated

What I hope for, more than anything, is not just an end to my own fatigue, but an end to the need for humanitarian workers like me to work in war zones. I dream of a world where families, including my family, aren’t torn apart by violence, where children can grow up in peace, where doctors like me can focus on curing people – not just surviving.

I dream of a world where I can finally be with my son, with the love of family and friends, in a place where peace is no longer just a hope.

Robert Toller

Location: Taupo

I started giving to MSF about nine months ago. I’ve known about MSF for a long time, but I hadn’t got around to making a donation. I was in Lyttleton one day, and there was a face-to-face fundraiser on the street talking to people about MSF. That’s when I signed up.

As far as what I see in the way MSF works, it’s doing what I expect in the way I expect. What I like is that MSF is apolitical and it’s non-religious. Human life is what matters.

I live out in a remote place, but I tune in to what’s happening in the world. I travel a lot, which is when I read. Gaza has been a big focus, of course, and other places, too.

Because I’m working in the medical industry, I think there’s probably a stronger awareness about MSF than in the general community. It’s definitely something I plan to stick with.

To learn more about our Philanthropy program, please visit msf.org.nz/major-donors or contact our team at philanthropy@sydney.msf.org

Khadija, a Syrian refugee, and mother of five, seeks shelter with three of her children in a parking lot in Lebanon. “She’s fading right before my eyes,” Khadija says, pointing to her seven-year-old daughter, who is suffering from stunted growth. Khadija received care with MSF at a clinic in South Lebanon. © Dalia Khamissy

BEN MEATES

Project coordinator

Home: Christchurch

MSF experience: Libya, 2024-5

Parts of this story first appeared in The Press

Carolina, protection activity manager, speaks with a patient in one of the centres where MSF works in the city of Zuwara, Libya. © Shouqi Benarabi/MSF

What drew you to humanitarian work?

There has always been a pull to help others. I did a master’s after my law degree, I went to Lebanon to work with Syrian refugees, and to Iraq to help reintegrate people into communities after the war. After that I went back to New Zealand to run a rehabilitation centre for torture survivors and refugees.

Can you share a bit about the conditions for people in Libya?

Libya is rife with violence and abuse, detention centres and torture, and an ongoing lack of healthcare. Nowhere’s safe in Libya. Most people experience some forms of abuse – abduction, extortion, trafficking practices, assault or sexual abuse. Access to healthcare is severely limited at a time when they desperately need it.

Last year, there were around 787,000 migrants and refugees in the country, and many attempt the treacherous Mediterranean Sea crossing to find safety in Europe.

What was the focus of your work in Zuwara?

I was in Zuwara for eight months, a coastal city near the border with Tunisia. In my role as program coordinator, I oversaw responding to disembarkations, infectious diseases, protecting women and unaccompanied minors, psychological interventions and primary healthcare.

A lot of the people our teams saw had been detained and tortured in Libya.

We responded to a few disembarkations and you see people that are either dead or in very, very horrible circumstances. You see people that are just surviving.

How do you manage the mental health impact of what you witnessed in Libya?

Being able to switch off the mental images of what I’ve seen is tough. You see some pretty hectic stuff and you’re working with communities at their worst. Staying grounded, and remembering that we have any ability to support people in their most complicated states reminds me of the privilege I have to be able to work in the places I have, and a reminder of the privilege I have to be able to return home to New Zealand.

What’s really hard is knowing how unaware people in New Zealand and Australia are. It makes coming home difficult. You realise how deep the injustice runs. When you come back, it’s not often well understood … that those things are actually happening there. I urge people to think about what they can do to help, such as looking into how they could help refugee communities in their towns, even if it is just making people feel welcome.

What’s one thing you would like people here to now about the situation in Libya?

Libya is a huge centre for migration, with many of the detention centres/detaining authorities being funded by EU institutions. It’s important to remember we have an ability to work with and continue to humanize the experiences that many migrant and refugee groups face. It is fundamental that we do not just think of refugees and migrant groups as numbers but as people like us who have been forced to leave their homes in search of safety - access to healthcare, freedom from discrimination, mistreatment and torture are fundamental basics we all deserve.

What were some of the positives of your assignment?

Learning about cultures and working with an amazing team. In Zuwara we had a very committed team, working in tough conditions. It’s always heartening seeing people from the communities we are working in engaged in humanitarian work.

It’s definitely a glimpse of sunshine when someone is able to get to safety. And knowing that I’m helping people is what has keeps me going six years after my first humanitarian trip overseas.

Project coordinators with MSF

Project coordinator is a diverse and challenging role which includes ensuring compliance with MSF’s ethical and operational principles across all activities and supervising and supporting the team on the ground. They also maintain communication with all project stakeholders, supervise project execution, and oversee safety and security protocols for staff.

Recruiting paediatricans

Watch our recent webinar to find out more about the role of paediatric healthcare in our humanitarian projects, and the skills and experience we look for in paediatric specialists.

Scan the QR Code

Are you a paediatrician?

We are recruiting paediatricians and paediatric/neonatal nurses.

Interested? Please apply at msf.org.nz/join-our-team

ON ASSIGNMENT

Staff from Australia and New Zealand on assignment with MSF in the last quarter

This list of project staff comprises only those recruited by MSF Australia. We also wish to recognise other Australians and New Zealanders who have contributed to MSF programs worldwide but are not listed because they joined the organisation overseas.

Afghanistan

Specialised medical doctor NSW, AU

Central African Republic

Surgeon SA, AU

Ethiopia

Deputy head of mission NSW, AU

Haiti

Medical coordinator NSW, AU

Surgeon VIC, AU

Humanitarian affairs manager ACT, AU

Project finance/HR manager WA, AU

Infection prevention and control manager VIC, AU

India

Mental Health activity manager VIC, AU

Project medical referent SA, AU

Iraq

Logistics manager NSW, AU

Kazakhstan

Project medical referent VIC, AU

Kenya

Logistics manager QLD, AU

Kiribati

Project coordinator QLD, AU

Nursing activity manager NT, AU

Midwife activity manager QLD, AU

Logistics manager VIC, AU

Medical coordinator SA, AU

Lebanon

Project finance/HR manager NSW, AU

Medical doctor QLD, AU

Head of mission VIC, AU

Libya

Head of mission VIC, AU

Protection activity manager QLD, AU

Malawi

Obstetrician gynaecologist NSW, AU

Multiple countries

Regional advocacy representative QLD, AU

Myanmar

Epidemiology activity manager NSW, AU

Medical coordinator QLD, AU

Medical coordinator NSW, AU

Nigeria

Doctor anaesthetist SA, AU

Nursing activity manager VIC, AU

Project coordinator VIC, AU

Pakistan

Nursing activity manager NSW, AU

Logistics manager VIC, AU

Logistics manager QLD, AU

Palestine

Nursing activity manager NZ

Midwife activity manager NZ

Nursing activity manager QLD, AU

Medical activity manager NSW, AU

Nursing activity manager VIC, AU

Logistics team leader VIC, AU

Nursing activity manager NSW, AU

Logistics team leader QLD, AU

Medical activity manager QLD, AU

Project coordinator WA, AU

Mission finance/HR manager VIC, AU

Papua New Guinea

Project coordinator QLD, AU

South Sudan

Doctor anaesthetist VIC, AU

Nursing activity manager NSW, AU

Midwife activity manager QLD, AU

Intersectional legal advisor VIC, AU

Obstetrician gynaecologist VIC, AU

Nursing activity manager NZ

Project finance manager NSW, AU

HR coordinator NZ

Sudan

Hospital director WA, AU

Medical coordinator QLD, AU

Project coordinator TAS, AU

Energy manager QLD, AU

Operational deputy head of mission NSW, AU

Midwife activity manager NSW, AU

Operational deputy head of mission NSW, AU

Project medical referent WA, AU

Syria

Epidemiology activity manager NSW, AU

Sexual violence program activity manager NZ

Head of mission NSW, AU

Uganda

Project finance/HR manager SA, AU

Yemen

Paediatrician NZ

Logistics manager NZ

Midwife activity manager VIC, AU

Logistics manager QLD, AU

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MSF vests drying on a clothesline at the Aweil project base in South Sudan. © Frederic Seguin/MSF

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MSF The Pulse Winter 2025 NZ by Médecins Sans Frontières (MSF) Australia - Issuu