NO SANCTUARY IN TIMES OF CONFLICT:

Maya SibleyAAU analyst for MCUF

June 13, 2014

www.msf.be

A systematic analysis of security incidents affecting MSF’s medical mission from 2009-2013 in four highly insecure contexts

BACKGROUND

• MSF works in highly unstable contexts, and faces frequent acts of violence against its beneficiaries and medical mission

• Typology of violence against MSF is poorly understood – increasing violence is perceived, but not evidence-based

Launch of three-year project:

THREE RESEARCH QUESTIONS

1. How many and what are the trends in security incidents in Afghanistan, DRC, South Sudan and Kenya?

2. What are the consequences of security incidents in these four contexts?

3. What are the opportunities and limitations of SINDY reports with regards to the data needs of the MCUF project?

SINDY reports & semi-structured interviews for Q3

Data collection

RESULTS & FINDINGSRESULTS & FINDINGS

MCUF INCIDENTS IN SINDY REPORTS

INCIDENT TYPOLOGY

LocationsReflect security strategy taken

Trend over time

Baseline not established, but no increase observed over study period

MCUF hotspots

Most frequent types of aggressionAfghanistan Armed entry 42% DRC Robbery 34%South Sudan Threats 38%Kenya Robbery/Death threats 38% (each)

Most perpetrators are unknownFrom those identified, the most common perpetrator is

State Security Forces(25% overall)

VICTIM TYPOLOGY

  Afghanistan DRC South Sudan Kenya  N % N % N % N %Total number of victims 32   123   167   9  Incidents without victims 10 20,83% 5 8,62% 15 18,07% 1 11,11%Incidents with unspecified victim # 14 29,2% 13 22,4% 30 36,1% 3 33,3%

• Males are more frequently victims in Afghanistan (59%) , DRC (73%) & S. Sudan (6%) • Women are more frequenty victims in Kenya ( 67%, but sample size is small)

National staff are the most common victims in absolute numbers but

international staff are 5.1 times more at risk (p-value <0.0001, CI: 3.9-6.7)

INCIDENT TRIGGERS & CONSEQUENCES

Trigger: •Financial constraints 60 (30%)•Active conflict & civil unrest 30 (15%)

General consequence: •Financial loss 64 (32%)•Compromised quality of care 45 (23%)•Interruption of services 37 (19%)•Compromised neutrality 32 (16%)

Types of consequence per victim: •Psychological 206 (62%)•Physical 65 (20%)

The most common triggers and consequences of incidents were mapped (N, %)

Trigger Not impacted Impacted P-value RR 95% CI

  N % N %      Active conflict/unrest 16 53,3% 14 46,7% 0,002 2,8 1.4-5.5Military/police activity 12 63,2% 7 36,8% 0,06 n.s. -

Financial constraints 50 83,3% 10 16,7% - 1 -

Lack of respect HR & IHL 12 75,0% 4 25,0% 0,4 n.s. -Avengement 3 50,0% 3 50,0% 0,05 3,0 1.1-8.0Perceived lack of respect 8 100,0% 0 0,0% 0,2 n.s. -Other 19 82,6% 4 17,4% 0,9 n.s. -Unknown 28 77,8% 8 22,2% 0,5 n.s. -

Perpetrator Not impacted Impacted P-value RR 95% CI

  N % N %      Security forces & public authority 39 69,6% 17 30,4% - 1 -

Armed non-state actors 11 55,0% 9 45,0% 0,2 n.s. -

International armed forced 4 80,0% 1 20,0% 0,6 n.s. -

Ex-MSF 3 100,0% 0 0,0% 0,3 n.s. -General civilian 31 86,1% 5 13,9% 0,07 n.s. -

Intention Not impacted Impacted P-value RR 95% CI

  N % N %      Intentional 139 76,8% 42 23,2% - 1 -

Lack of Precaution 7 50,0% 7 50,0% 0,03 2,2 1.2-3.9

IMPACT HEALTHCARE DELIVERY & USE

SINDY REPORTING

Half had not reported to SINDY a recent MCUF incident (4/8)

TOP 4 REASONS FOR NOT REPORTING

MAIN SINDY SHORTCOMINGS FOR MCUF•Descriptive narrative•What should and shouldn’t be reported unclear•SINDY fields are vague

“SINDY is used only for reporting incidents which directly or indirectly have an impact on MSF

activities.”

“SINDY is used only for reporting incidents which directly or indirectly have an impact on MSF

activities.”

“I feel demotivated due to lack of SINDY report feedback and no

security analysis from HQ.”

“I feel demotivated due to lack of SINDY report feedback and no

security analysis from HQ.”

“Managing the security situation was a priority over reporting”

“Managing the security situation was a priority over reporting”

“Incidents occur so frequently that if we did systematically report, we would be constantly

reporting!”

“Incidents occur so frequently that if we did systematically report, we would be constantly

reporting!”

BIAS & LIMITATIONSBIAS & LIMITATIONS

BIAS & LIMITATIONS

•Data quality / Partial data

•Inconsistent reporting

•Lack of denominators

•Victims

•Time sensitive

•Highly subjective

•Limited capacity & know-how

1. First evidence-based mapping of violence directed against MSF and its beneficiaries.

2. Context-specific and general patterns of violence were identified, allowing development of more appropriate tools for the monitoring of “Medical Care Under Fire”.

3. Such monitoring is vital to sustain MSF operations in such contexts.

CONCLUSIONS

THANK YOUTHANK YOU