Dispatches: Winter 2021

103 Winter 2021

2 Situation report | 4 ‘Treating patients is our responsibility’ MSF staff in Afghanistan recount the desperate days of conflict and their aftermath | 6 Lives uprooted Dispossessed and driven from their homes – three MSF staff recount lives displaced | 12 Controlling mosquitoes to prevent malaria MSF heads to the swamp to fight malaria | 14 ‘The wicked disease’ Bringing medical care and dignity to those affected by noma

SITUATION REPORT Pierre Fromentin/MSF Anna Bylund/MSF 2 | DISPATCHES

Pacom Bagula/MSF

Sandra is treated for meningitis at Banalia hospital in Tshopo province, where a meningitis epidemic has killed almost 200 people since May 2021.

“We arrived in Banalia when the epidemic was confirmed and set up a meningitis treatment centre in the hospital,” says MSF’s Dr Jean-Pierre Badibanga. MSF and the Ministry of Health have launched a vaccination campaign to bring the disease under control.

2. IRAQ Hameeda, aged 65, looks at an X-ray of her lungs at her home in Baghdad. With MSF’s help, she is the first person in Iraq to be cured of multidrug-resistant tuberculosis with a new treatment that involves taking medication orally. Previously, the only available treatment for the disease was lengthy and toxic.

“After almost 18 months of taking medication, I’m thankful I have finished my treatment and got rid of the disease and its hardships,” she says.

1. HAITI

95%

MSF’S UK VOLUNTEERS

percentage of children aged between six months and 15 years that MSF plans to vaccinate against measles in the Jebel Marra region of South Darfur.

5 2

3 3. SUDAN Kenny the camel is loaded with measles vaccines and medical supplies in preparation for transporting them through the Jebel Marra region of Darfur state, a mountainous and politically volatile region that has seen over a decade of conflict.

MSF is one of the only international organisations able to operate fully in this area, where many communities are cut off from healthcare and depend heavily on humanitarian assistance. In July 2021, MSF launched a measles vaccination campaign to prevent an outbreak of the disease from spreading.

5. KYRGYZSTAN

4

230

seriously injured people provided with surgical and post-operative care by MSF in the aftermath of the Haiti earthquake.

Maxime Fossat

1

Chloe Sharrock

A young man injured in the earthquake in Haiti walks with crutches with the help of an MSF physiotherapist outside Hôpital Immaculée Conception in Les Cayes, in the south of the island. The 7.2 magnitude earthquake struck Haiti on 14 August 2021, killing more than 2,200 people and injuring 12,000. MSF teams are providing surgical and post-operative care to people with severe injuries at hospitals in Les Cayes, Jérémie and Port-au-Prince.

4. DEMOCRATIC REPUBLIC OF CONGO

MSF health promoter Toktosun Asanov travels to Uch-Dobo family medical centre in Batken Oblast, where MSF teams are providing medical care following violent clashes between Kyrgyz and Tajik armed forces in April 2021.

Afghanistan: Rebecca Ferguson, Nurse; Thomas Casey, Field communications manager Bangladesh: Jo Westwood, Water & sanitation manager; Saira Butt, Epidemiologist Belarus: Rebecca Welfare, Deputy head of mission Brazil: Michael Parker, Head of mission Central African Republic: Prudence Jarrett, Doctor; Hanna El Hafidi, Pharmacist Democratic Republic of Congo: Nicos Vrahimis, Paediatrician; Bryony Hopkinshaw, Doctor; John Boase, Logistician Egypt: Elizabeth Wait, Health promoter Ethiopia: Rebecca Kerr, Advocacy manager; Daniel Roberts, Doctor Haiti: Michael Barclay, Project coordinator; Ruth Zwizwai, Epidemiologist Honduras: Roisin Bainbridge, Mobile health activity manager India: Sakib Burza, Head of mission; Melissa Chowdhury, Doctor Iran: Timothy Hammond, Medical team leader; Gillian Fraser, Medical team leader Iraq: Milena Beauvallet, Head of mission support Kenya: Paul Banks, Procurement manager Lebanon: Leila Younes, Health promoter Libya: Chloe Marshall-Denton, Protection manager Lithuania: Georgina Brown, Medical team leader Mozambique: Alison Antunes, Health promoter Myanmar: Ben Small, Field communications manager Nigeria: Davina Aidoo, Mental health manager Pakistan: Vincent Evans Gutiérrez, Finance manager; William de Glanville.

Epidemiologist Palestinian Territories: Helen Ottens-Patterson, Head of mission Sierra Leone: Christine Tasnier, Midwife; Rachel Crozier, Nurse manager South Sudan: Melissa Perry, Project coordinator; Katherine SmeatonRussell, Nurse; Jason Dunnett, Finance manager; Mylene Appere, Midwife Sudan: Mark McNicol, Doctor Syria: Rebecca Roby, Advocacy manager; Melissa Buxton, Activity manager United Kingdom, Asylum seeker mental health project: Keith Longbone, Project coordinator; Shwan Faraj, Cultural mediator; Susanna Eldridge, Mental health specialist; Vivienne Monaghan, Medical team leader; Lindsay Solera-Deuchar, Mental health specialist; Atefeh Mehraein, Cultural mediator; Meklite Balcha, Cultural mediator Uzbekistan: Beatrice Blythe, Anthropologist; Gabriella Bidwell, Doctor; Christopher Thompson, Mental health specialist Venezuela: Wendell Junia, Lab manager; Laura Holland, Water and sanitation manager; Davina Hayles, Project coordinator Yemen: Adeyemi Lawal, Medical coordinator; Elma Wong, Anaesthetist; Harriett Earp, Midwife

WINTER 2021 | 3

AFGHANISATAN PHOTOGRAPHY ORIANE ZERAH

‘Treating patients is our responsibility’ STARTING IN MAY, FIERCE CLASHES BETWEEN AFGHAN FORCES AND THE ISLAMIC EMIRATE OF AFGHANISTAN (IEA, ALSO KNOWN AS THE TALIBAN) TOOK PLACE IN AND AROUND PROVINCIAL CAPITALS, CLAIMING THOUSANDS OF LIVES. NOW, WITH THE FIGHTING OVER AND A CHANGE OF GOVERNMENT, THE HEALTHCARE SYSTEM IS ON THE BRINK OF COLLAPSE.

T

hroughout the crisis, MSF has continued to provide lifesaving medical care to the people of Afghanistan in five locations across the country. Here, MSF staff recount the desperate days of conflict and their aftermath.

Dr Sayyid (not his real name), Herat, August 2021: “At the beginning of August, we received a lot of patients wounded in the fighting. Our staff had little rest. When patients came in, we would wake up and run to the emergency room. We stayed in the hospital to treat our patients. It was very dangerous outside.”

Dr Habibullah (not his real name), Boost hospital, Lashkar Gah, August 2021: “When people heard about casualties or bombs, they would get on their bicycles and come to the hospital and say they wanted to donate blood. I find it inspiring that during the fighting there were people running towards the hospital to help.”

Dr Imad (not his real name), Kunduz trauma centre, September 2021: “That first evening, there was continuous bombardment and shooting, so we

4 | DISPATCHES

had to rush to the bunker. We stayed there all night, without any sleep. The following morning, we got news of multiple victims arriving at the trauma centre, but we could not get there because there was fighting in the street. Our colleagues were asking for our help very urgently because they had a patient with a gunshot wound in his chest and stomach.”

Dr Sayyid: “Treating patients is our responsibility.

Right now, MSF is the only international organisation working in Herat. Before, we could refer people to other health providers, but now, when people come to us, it feels like we are their last option. Compared to the time before, there is more responsibility, more challenges.

There is a lot of work on our shoulders.”

Dr Imad: “A moment came when the guns were quieter and it was possible to move. Three of us ran to the other side of the road to the operating theatre.

The patient had just lost their pulse, so we started chest compression while the anaesthetist was looking for an airway. I cut two holes in the chest to make sure blood could drain out and to allow the lungs to expand.

Meanwhile another colleague was trying to stop the bleeding below the sternum. We could tell pretty quickly that the bullet had probably hit part of the heart, and it rapidly became clear that there was no way that we could save him. That was the start of our day of hell.”

Sarah Leahy, project coordinator, Helmand province, September 2021: “For a time, the frontlines ran right by our hospital. We were located in between strategic buildings and there were rockets going over the hospital, explosions occurring and bullets hitting the buildings all the time. We were exposed to the crossfire and twice we were hit by rockets. It was very intense, but through all the fighting we carried on working. It’s a huge hospital, one of MSF’s biggest projects, and is an absolute lifeline in Helmand province.

We’re not the main trauma hospital in the city, but during the fighting we were getting 30 to 40 people in for surgery each day with bullet wounds and injuries from shelling and explosions.”

Maria Fix, nurse, Boost hospital, October 2021: “At the moment, we are the only major hospital in the region that is functioning. We’re no longer seeing war-wounded patients – that stopped when the fighting stopped. But our paediatric department is overwhelmed. We’re treating a lot of malnourished children and their number is increasing.

I don’t think you ever get used to seeing malnourished children. Often they arrive dehydrated and in shock. We work to stabilise them in the emergency room before moving them to intensive care and then to the inpatient therapeutic feeding centre, where we feed them and slowly build up their strength.”

Sarah Leahy: “The health system in Afghanistan has essentially collapsed. It wasn’t in great shape in the first place, but now the situation is desperate.”

Maria Fix: “It’s very moving to see a child who has been so sick and malnourished recover and come back to life. But it’s challenging at the same time, particularly when you know that, even if we stabilise

A pregnant woman is prepared for an emergency caesarean at MSF’s maternity hospital in Khost, 18 October 2021.

them here and they recover, they’re going to face the same problems – the same lack of food – as soon as we discharge them. But we do what we can and it’s important that we do.”

Dr Adel (not his real name), Khost maternity hospital, October 2021: “The work we are doing is vital, but we are concerned about the future. Will we be able to get enough medicines and supplies and medical equipment into the country? At the moment we have enough, and the MSF projects in Afghanistan are able to share supplies. But eventually we will be affected.”

Prue Coakley, head of programmes, August 2021: “Will MSF continue here? Of course we will. We have absolutely no intention of leaving Afghanistan.”

‘The health system in Afghanistan has essentially collapsed’

Dr Adel: “Through everything, our staff morale has been high and everybody has kept coming to work.

The community expected it of us, and we expected it of ourselves. I am so proud of the team we have working here. The cleaners, the administrative staff, the midwives and the doctors –we are all so proud to provide services to this community.”

Sarah Leahy: “I felt terribly sad leaving – it’s hard to let go when you’ve worked so closely alongside people and been through so much together. It’s vital that Afghanistan and the people who need our help are not forgotten.”

Maria Fix: “It’s so important that MSF is here.

When I was preparing to travel to Afghanistan at the end of August, people asked me why I was going there just as everybody else was leaving. When you’re here, it does feel like Afghanistan has been abandoned – so many international organisations have left. But I’m so happy and proud that MSF has stayed. The people here are suffering and it’s vital for us to be here, providing medical care to people who so desperately need it.”

READ MORE AT MSF.ORG.UK/AFGHANISTAN WINTER 2021 | 5

Paul Odongo/MSF

LIVES

An MSF Land Cruiser approaches a compound in Kenya’s Dadaab refugee camp, home to thousands of mainly Somali refugees who fled war and drought, May 2021.

DISPLACED, DISPOSSESSED, DRIVEN FROM THEIR HOMES – EVERY YEAR, HUNDREDS OF THOUSANDS OF PEOPLE AROUND THE WORLD ARE FORCED TO FLEE THE LIVES THEY KNEW IN ORDER TO FIND SAFETY AND SECURITY. IN MANY OF THE PLACES WE WORK, OUR STAFF HAVE EXPERIENCED FIRST-HAND WHAT THAT JOURNEY ENTAILS.

6 | DISPATCHES

WINTER 2021 | 7

KENYA

F WORDS FOWSIA

owsia, 31, is a nurse at MSF’s 100-bed hospital in Dagahaley camp in Kenya – one of three sites that make up Dadaab refugee camp, which hosts more than 430,000 refugees, mostly from Somalia. Like many people in Dadaab, Fowsia has been a refugee for most of her life. In April, the Kenyan government and the UN Refugee Agency (UNHCR) announced plans to close the camp

by June 2022, leaving many people uncertain about their future.

“I was two years old when I left Somalia. I don’t remember anything about it, but my mother has told me tales. After the civil war broke out, my 8 | DISPATCHES

Fowsia is a nurse in Dagahaley camp, Kenya.

‘TREAT US AS HUMAN’ BANGLADESH

N WORDS NUR BOSHOR (NOT HER REAL NAME)

Vincenzo Livieri

‘THERE IS NOT ONE PERSON WHO WANTS TO STAY IN A REFUGEE CAMP FOREVER’

A Rohingya boy stands on the roof of a hut in a refugee camp in Bangladesh’s Cox’s Bazar district, November 2018.

uncle was killed in the fighting. So my family decided to migrate to Kenya to seek asylum. It took about four days on foot to reach Kenya. The journey was hectic. On our way to Kenya, we were robbed of our belongings. When we arrived, we were registered by the UNHCR, given some food and a tent to construct, and got settled in Dagahaley camp – which, at the time, was just trees and dust.

I completed my primary and high school education here. I have a diploma in community development and am currently doing a degree in educational studies. I like what I am studying right now – education transforms societies; through education everyone’s future gets brighter.

I’ve worked with different organisations in the camp since high school – as a warehouse assistant, as a child protection officer, and now with MSF as an auxiliary nurse in the maternity department.

What motivates me is serving the community. It is important to hire people from the local community.

If you hire someone from a different community, they may have communication barriers. It also creates job opportunities and gives us a means to sustain ourselves.

Being in the camp is like being a bird in a cage. After being here for so many years, you don’t belong to anywhere, so I welcome the idea of closing the camps. There is not one person who wants to stay in a refugee camp forever. But the announcement that the Kenyan government plans to close Dadaab has created a lot of concern in the community and uncertainty for the future.

There are no good options. I don’t want my children to grow up in a refugee camp. If you are resettled in a third country, you just go from one country where you don’t belong to another. If you go back to Somalia, you have to start afresh – you don’t have a place to stay; you don’t have a home.

For my children, Somalia has no quality education, no medical services, no basic amenities. There are people who went back to Somalia when the first wave of repatriation started in 2016, but because of the insecurity, drought and famine, those people are coming back to the camp.

Being a refugee is not a choice, it is by circumstance. People like me are forced to flee their home countries because of civil wars.

We would not like to remain as refugees forever.

We cannot be stateless for any longer. I would like to be someone who has a place to call home.”

ur Boshor was one among hundreds of thousands of Rohingya people who fled from Myanmar to Bangladesh in 2017 following a targeted campaign of violence against them led by the Myanmar security forces. Four years later, nearly 900,000 Rohingya are living in what has become the world’s largest refugee camp, in a series of sprawling settlements in the Cox’s Bazar district of Bangladesh.

Rohingya refugees are not allowed to hold jobs and can only earn a very small wage as volunteers with organisations working in the camp. Nur Boshor works as a daily volunteer with MSF’s outreach team.

“In 1962, the army took power in Myanmar and enacted martial law. From that time, gradually they started neglecting us and torturing us. In 1974, for the first time, they denied our citizenship status. Torture and ethnic cleansing increased. My family tolerated it until 2017, when we finally decided to leave. We left our belongings, land, houses – everything. The Myanmar army at that time established checkpoints on the route and indiscriminately fired at us. We lost many souls back there while fleeing.

The situation in the camps is getting worse day by day. People have no jobs. People depend on rations from WINTER 2021 | 9

A Syrian man collects essentials to help stay warm through the winter in a camp for displaced people in northwest Syria during winter 2020.

‘We are refugees, yet human. We have dreams. We need food when we are hungry.’

Nur Boshor (not her real name) is an MSF outreach worker at Cox’s Bazar, Bangladesh.

10 | DISPATCHES

‘WE LIVE AS IF WE ARE IN A PRISON’

H Abdul Majeed Al Qareh/MSF

food programmes and are given only 1,017 Bangladeshi taka [about £9] per month for a family. How can a family survive with this small amount? We can only afford rice and lentils – fish, meat or much-needed medicines are far too expensive.

I worked in the development sector back in Myanmar. A few days after I arrived in Bangladesh, I joined MSF as a daily volunteer. Rohingya people have their own language and culture. Only a Rohingya can understand what another Rohingya says and wants.

When we were in Myanmar, many pregnant women died in the hospital just because they could not express their feelings and condition properly to non-native speaking doctors. Gradually, people became afraid of hospitals and clinics.

Now in Bangladesh, Rohingya volunteers with MSF go door to door and discuss health issues, try to explain the importance of seeking medical assistance, and try to remove their long-held fear of doctors and hospitals.

Many people I know want to go back to Myanmar, as they face insecurity in the camps. I am also keen to go back to my soil. But not now, as the situation is not under control there. We would be facing horror again if we go. We are refugees, yet human. We have dreams.

We need medical assistance when we are sick. We need food when we are hungry. We need shelter. I beg everyone from the outer world to treat us as human.

We want repatriation as soon as possible. We want to go home.”

work towards the end of 2015. At that time, Idlib came under heavy bombing. My children were at school and were traumatised because they couldn’t find each other.

I was extremely frightened until they made it home. My brother lost his two children in bombings within 35 days of each other. My daughter, who witnessed that, developed nervous episodes and started fainting constantly.

In 2016, my son, who was still very young, couldn’t sleep and used to say: ‘The plane is here!’ He lived in horror and fear and had psychological problems due to the bombing. I started working with MSF in 2016 as a logistics specialist – before the war I worked for an electric company. Soon after, I moved from Idlib to Al-Dana [23 miles north of Idlib]. There we had to go to the fields during the day to take shelter from the bombing. Sometimes we had to sleep at nearby chicken farms to escape airstrikes. My wife, my children and I slept outside under the trees.

In 2020, just before Ramadan, the bombing became unbearable, so we moved on the first day of Eid Al-Fitr.

My children were supposed to enjoy Eid, but instead we SYRIA had to move. We lived in two rooms underground in a WORDS place that doesn’t see the sun. We stayed for a whole HASSAN month. I currently live in Al-Dana city. The biggest problem we face as a family is that although my oldest son is studying dentistry and my two daughters are studying medicine, they will not have any certificates because their universities are not recognised. There is no support for education. When I had children, I could no longer see the future through my own eyes, only through theirs. I see them go out there to study and work hard, but in the end, what kind of a future can they plan? We live as if we are in a prison.

At work we visit the tents where displaced people are staying – mostly for two or three months, although some of them have been in the camps for seven or eight years. They live under a piece of cloth that doesn’t protect them from the summer heat or the winter cold.

There are 400 camps without water. Bread has become a dream for many people.

I’m in constant communication with the displaced assan, 47, people who live in the camps. They feel comfortable and his family have been displaced multiple times within with me, because who are these people? My brother, my Syria since war broke out 10 years ago. He currently works cousin, my uncle. I consider them my family. Even when I can’t help, they still express their concerns to me. for MSF in Idlib province, where we provide displaced Sometimes I feel helpless in the face of what I see. people with medical care, distribute hygiene items and Their pain is mine. When I go to the camps and I don’t build latrines in the camps where they are sheltering. see any latrines, I imagine my family and myself there, “In 2012, I had to flee my home for the first time. and this breaks my heart. When I tell my managers at That same year my mother passed away. But I couldn’t work about the situation in the camps, I see the tears in be there at her funeral because the Syrian army was their eyes. I’m 47 years old, but people would think I’m bombing the area. I was about 10 miles away from my village and couldn’t lay my eyes on her for the last time 55 or 60. We’ve had a very tough life.” and say goodbye.

In 2015, I went to Iraq for work, where I was arrested and locked up for 18 days. While I was in Iraq, my family – who stayed in Syria – had to flee for a second time. So I never returned to that home.

The third time, we took refuge in a house on a farm.

We ate together with insects – the locusts were sharing our food. We remained there for one and a half months.

Hassan is a During the month of Ramadan, the village was bombed logistician for MSF in and the houses where my brother and I lived were hit, Idlib province, Syria. so we moved to Idlib city. I had to travel to Turkey for WINTER 2021 | 11

CONTROLLING MOSQUITOES TO PREVENT MALARIA

“We go to lakes and streams to collect mosquito larvae,” says biologist Melfran Herrera. “We need to do this so we can estimate the number of mosquitoes that are breeding and understand how this could impact local communities.”

samples and confirm the presence and density of Anopheles larvae.

Next, the team go to local people’s homes to follow and trap mosquitoes so they can study them. The information they are after includes which species are present, their number, their average lifespan, the time of day or night when they bite, and whether they enter houses and rest on walls.

Once the team has all this information, they analyse the results to develop effective and sustainable vector control strategies. This might include treating ponds with biolarvicides [bacteria-based substances which kill mosquito larvae without harming other organisms], spraying the inside walls of people’s houses and distributing mosquito nets.

The work of vector control teams runs alongside that of medical teams at local health centres and health promotion teams. The combination of these measures has seen malaria cases in Sucre state decrease by 80 per cent since 2019 in the areas where MSF works.

STAGE 2: CONFIRMING PRESENCE OF LARVAE The teams examine the samples taken from lakes, swamps and streams to confirm the presence and prevalence of mosquito larvae.

12 | DISPATCHES

“By analysing the data we’ve collected, we can then plan the best way to control the mosquitoes,” says Herrera. “That could be spraying pesticides, applying biolarvicides in ponds, using mosquito nets, or a combination of the three. All these activities have an impact on reducing the spread of the disease.”

STAGE 1: COLLECTING WATER SAMPLES

STAGE 3: COLLECTING MOSQUITO SAMPLES “In the evening we head out to study the behaviour of malaria-transmitting mosquitoes,” says Herrera. Mosquitoes are trapped, identified and studied. “We determine the time of night they like to bite, whether they rest on walls, whether they enter houses, and whether those that bite are risky, which depends on their age.”

Illustration: Richard Wilkinson

ach year, some 200 million people worldwide are diagnosed with malaria. In Venezuela, the disease was almost brought under control in recent decades, but in the past 10 years it has made a major comeback.

In 2017, more than 400,000 cases were recorded, making Venezuela one of the hardest-hit countries in Latin America.

Sucre state, in the northeast, has the highest incidence of malaria in the country, and it’s here that MSF is devising innovative new ways to combat the resurgence of the disease.

“Our fight against malaria is based on three pillars,” says MSF biologist Melfran Herrera. “Early diagnosis and treatment, health promotion, and vector control.”

Vector control means preventing the spread of diseases through the insects that carry them – the so-called vectors, in this case Anopheles mosquitoes. It can be complex as the teams need to know absolutely everything about these mosquitoes for the measures to be effective.

The first step is to locate possible breeding sites. MSF teams visit streams and lagoons near malaria hotspots to collect water

STAGE 4: SPRAYING OF PONDS

WINTER 2021 | 13

Watched by MSF nurse Lady Bello, 20-year-old noma survivor Bilya rests in the recovery room of Sokoto Noma Hospital after a first round of reconstructive surgery to his face, November 2016.

NIGERIA

WORDS VERONICA EMEH PHOTOGRAPHY CLAIRE JEANTET

‘THE WICKED DISEASE’ MSF’S TEAM IN SOKOTO, NIGERIA, WORKS EVERY DAY TO ENSURE THAT PEOPLE AFFECTED BY NOMA GET THE LIFESAVING CARE THEY NEED. BUT THIS IS JUST PART OF THE BATTLE, SAYS NURSE VERONICA EMEH...

Claire Jeantet – Fabrice Caterini/INEDIZ

“

14 | DISPATCHES

always say noma is a wicked disease. Noma, or cancrum oris, is an infection that affects the face, eating the soft tissues and often destroying the bones completely. Sometimes it destroys the nose or even the eyes. Mostly it affects children under the age of seven.

There are many contributing factors to noma: malnutrition, a lack of vaccinations, poor oral hygiene – and ultimately poverty.

First the gum bleeds and gets inflamed. Then the soft tissue and the oral cavities are affected. The cheek starts to decay from the inside. All these problems set in fast.

Children’s cheeks become so swollen and painful.

Before you know it, they just burst.

I talk to parents who have been left wondering what has happened. With most children, before the disease gets to the outer surface, it has damaged the tissues inside the mouth.

Stage 1 noma (acute necrotising gingivitis) can be treated quite easily with antibiotics and therapeutic food. After a week in hospital, the child should be fine.

But when noma reaches stage 2 (oedema) or stage 3 (gangrene), the child’s condition deteriorates quickly.

Many parents don’t know what noma is. When they start to see the symptoms, they don’t know what to do.

Many patients come from poor communities, and from the poorest households within those communities.

When the symptoms start, they don’t always have the money to travel to see a doctor. Sometimes they believe the cause is spiritual and therefore do not seek medical care, or else they seek care from traditional healers. So when they do bring their child in, the damage is already terrible.

We cut off the damaged tissue and we dress the wounds and we continue doing this until the damage is healed. The child then has to wait anything from months to years until they are eligible for reconstructive surgery. In some cases, because of the level of damage, children get trismus, also known as lockjaw. The tissues in the mouth become hard and sometimes their bones are affected too. Children with trismus can become very unwell. They struggle to eat due to the limited opening of the mouth and may become malnourished.

Children often find it hard to understand that they need to go through the pain of physiotherapy to be able

to open their mouths. It is difficult seeing children with this disease. Even before I became a mother, I found it hard. But the one thing I try to do is not to let these feelings show in the presence of my patients, because it could make them lose hope.

Hardest of all is when surgeries fail, because children have gone through so many stages to get there: going to the operating theatre; experiencing painful procedures; and then not being allowed to move their heads for a few weeks, which is even more difficult for a child than for an adult.

But although noma is a wicked disease, we do have success stories. Sometimes a child has a cheek defect due to noma, but after surgery they begin to recover – with some patients you would not even know what caused the scars.

Other children had trismus, their mouths locked shut for years, but after trismus relief procedures, they can talk, eat and move their mouths with ease.

For me, one of the most memorable patients was a child whose nose was completely gone. That was my first time seeing nasal reconstruction. Afterwards, we went to the child’s village on a follow-up visit. When we arrived, everybody gathered around us as if they had seen God, because they realised who did this work for this boy.

Before, the boy was discriminated against in the community; he stopped going to school and people bullied him because of his condition. When he arrived back in his village, most people didn’t recognise him.

It sends a good message to the community. If a child like that can come to hospital and get that kind of beautiful reconstruction, why wouldn’t others?

To me, there is nothing more joyful than when you see a patient who came to us with facial deformities and, like magic, has had aesthetics and function restored. Before I joined MSF, I knew there was a disease called noma, but I had never seen it. It’s a neglected disease. Here in Sokoto, we are doing our best, reaching out to people with the disease, taking care of them, helping them reintegrate into their communities. But there are thousands of patients that we have yet to reach.

Patients come to us from as far as Delta state, 1,000 km away, which shows the great need in this country for noma treatment. Right now, MSF is trying to go into preventative mode. It’s very challenging, because how do you prevent noma? One of the contributing factors is poverty. How do you alleviate poverty? Can MSF do that singlehandedly? No. That is why the world needs to join in.”

Veronica Emeh is an MSF operating theatre nurse at Sokoto Noma Hospital in Nigeria.

READ MORE AT MSF.ORG.UK/NOMA WINTER 2021 | 15

TEL 020 7404 6600 ADDRESS Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London EC4A 1AB @msf_uk msf.english Eng Charity Reg No.1026588 Cover image: MSF anaesthetist Wais Mohammad checks Esa, aged 63, prior to surgery at Boost hospital, May 2021.

Photograph © Tom Casey/MSF

ABOUT Dispatches is written by MSF staff and sent out quarterly to our supporters to keep you informed about our medical work around the world, all of which is funded by you. Dispatches gives our patients and staff a platform to speak out about the conflicts, emergencies and epidemics in which MSF works.

It is edited by Marcus Dunk. It is printed on recycled paper and costs £0.61 to produce, package and send using the cheapest form of post. It is an important source of income for MSF and raises three times what it costs to produce. We always welcome your feedback. Please contact us using the methods listed, or email: dispatches.uk@london.msf.org

People gather at an MSF mobile clinic for children under five in southern Madagascar, where the worst drought in 30 years has caused crops to fail and led to large numbers of children suffering from severe acute malnutrition.

SIGN UP TO EMAIL Get the latest MSF news delivered to your inbox. Sign up at msf.org.uk/ signup

CHANGING YOUR ADDRESS Please call 0207 404 6600 or email: uk.fundraising@london.msf.org

MAKE A DONATION You can donate by phone, online or by post. If possible please quote your supporter number (located on the top left-hand side of the letter) and name and address.

CHANGING A REGULAR GIFT To increase or decrease your regular gift, please call us on 0207 404 6600 or email: uk.fundraising@london.msf.org with your request. Please also get in touch if your bank details have changed.

LEAVING A GIFT IN YOUR WILL Have you thought of remembering MSF in your will? Any gift is welcome, however large or small. For more information, contact Jack Ithell at: jack.ithell@london.msf.org or call us on 0207 404 6600.

If you would like to stop receiving communications from us please contact our Supporter Care team on 020 7404 6600 or email uk.fundraising@london.msf.org and we’ll be happy to help.

Thank you for your support.

Erwan Rogard

Médecins Sans Frontières/Doctors Without Borders (MSF) is a leading independent humanitarian organisation for emergency medical aid. In more than 70 countries worldwide, MSF provides relief to the victims of war, natural disasters and epidemics, irrespective of race, religion, gender or political affiliation. MSF was awarded the 1999 Nobel Peace Prize.