Beyond Borders

Surviving war, and what comes after

The loss of a house, livelihood and possessions is a narrative that has become distressingly familiar in recent years. Every day headlines tell us of the many millions who have left their country in search of safety, sanctuary and freedom. But what of those who remain within their own borders, but are displaced? They too, are worthy of our attention and care.

Unlike refugees, there is no international day to mark the plight of internally displaced people (IDPs). While they remain within their own borders, they have been forced from their homes and communities, and often into camps with poor living conditions and a lack of access to essential services. These people are strangers in their own countries, with little recourse but to accept their circumstances, and they go largely unrecognised and unlamented by the international community.

The lack of compassion is hard to accept, so too is the lack of urgency. At the end of 2015, there were more than 40 million people internally displaced worldwide – the Strangers in their own countries highest figure ever recorded. This is a global issue, and we must respond to it as such.

As of 2016, almost a third of the entire Syrian population was internally displaced. For many, the option of fleeing or obtaining refugee status has ceased to exist.

The plight of IDPs in Syria is perhaps seen more clearly through the lens of medical care. In 2012, MSF established a hospital in Atma, on the border with Turkey. Initially, this was a trauma hospital, and catered to those in need of treatment following armed conflict, aerial bombardments and the collapse of buildings. But in 2013, the hospital became a surgical facility specialising in burn care. The majority of these burns were not sustained in skirmishes however, but the result of poor living conditions – many simply do not have access to adequate heating or cooking facilities, this coupled with a shortage of clean, refined fuel has resulted in an enormous number of burn injuries. In 2016 alone, 2,613 people were treated for burn wounds in Atma, less than 10% of these injuries were a direct result of violence. Some 75% of all patients treated were women and children.

The situation on the Jordanian border is little better, where tens of thousands of would-be refugees have languished in the mile-long strip of no-man’s land between Syria and Jordan. With a distinctive raised barrier of sand, this area is known as the berm. For more than a year, between 60 and 70 thousand people have resided there, refused entry to Jordan due to security concerns, but unable to retreat into Syria with any hope of safety. Humanitarian groups are denied access and some are using industrial cranes to deliver food and supplies over barriers and fences to those in makeshift camps beyond the berm.

Sadly, Syria is not the only country where the wars of today will curtail the futures of many. In Anbar province, Iraq – both Ramadi and Fallujah were ‘liberated’ from the so-called Islamic State (IS) more than a year ago. Yet the citizens who fled the fighting still live in tents and makeshift shelters, unable to go home for fear of the many improvised explosive devices and booby traps left behind by IS. Even with security and safety, the IDPs of Fallujah and Ramadi remain without adequate services or medical care. In Amriyat Al Fallujah IDP camp, MSF has set up a clinic to provide medical assistance for physical injuries, but also for psychological healthcare.

It is telling that mental healthcare services are expanding in Iraq – for those whose lives have consisted of survival, and fleeing war since 2003, the outlook is bleak. Recent reports and testimonies force us to consider difficult questions – how, when a child cries for home, should an IDP parent answer? How, when so many are growing up without essential services, education and nutrition, can children expect a safe, happy and successful future?

The 1951 refugee convention confers refugee status on someone who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear is unwilling to avail himself of the protection of that country…” This status outlines the right to safety, as well as economic and social rights, rights that states are obliged to grant – at least in theory.

In contrast to the protection refugees should receive, IDPs do not constitute a distinct legal category and therefore do not benefit from any specific protection under international law. And, in a political climate that places less and less value on the lives and prosperity of refugees, even with laws enshrined to protect them – what assistance can an IDP expect?

IDPs around the globe need and deserve our recognition and compassion. This is not a problem that can be remedied overnight, but it is clear that the international community must urgently respond to the needs. Needs like sustained access to medical care, guaranteed and lasting protection from violence and the need for hope, hope that one day, they may be able to live in a place they call home.



MSF regional branch office in UAE
MSF has been in the UAE since 1992, under the patronage of His Excellency Sheikh Nahyan Bin Mubarak Al Nahyan and is a member of International Humanitarian City (IHC). MSF’s work in the UAE includes support for medical humanitarian assistance and operations in Iraq, Syria, Jordan, Turkey, Yemen and Lebanon. In addition, MSF UAE is the primary logistical hub providing medical assistance to people based in Afghanistan, which remains one of MSF’s largest operational programmes, with 2,303 full-time staff and 366,000 outpatient consultations held in 2015.



Date of upload: 22nd Sep 2017

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