Association between triage level and outcomes at Médecins Sans Frontières trauma hospital in Kunduz, Afghanistan, 2015

BackgroundFive million people die annually due to injuries; an increasing part is due to armed conflict in low-income and middle-income countries, demanding resolute emergency trauma care. In Afghanistan, a low-income country that has experienced conflict for over 35 years, conflict related trauma is a significant public health problem. To address this, the non-governmental organisation Médecins Sans Frontières (MSF) set up a trauma centre in Kunduz (Kunduz Trauma Centre (KTC)). MSF’s standardised emergency operating procedures include the South African Triage Scale (SATS). To date, there are few studies that assess how triage levels correspond with outcome in low-resource conflict settingsAimThis study aims to assess to what extent SATS triage levels correlated to outcomes in terms of hospital admission, intensive care unit (ICU) admission and mortality for patients treated at KTC.Method and materialsThis retrospective study used routinely collected data from KTC registries. A total of 17 970 patients were included. The outcomes were hospital admission, ICU admission and mortality. The explanatory variable was triage level. Covariates including age, gender and delay to arrival were used. Logistic regression was used to study the correlation between triage level and outcomes.ResultsOut of all patients seeking care, 70% were triaged as red or orange. The overall mortality was 0.6%. In total, 90% of those that died and 79% of ICU-admitted patients were triaged as red.ConclusionThe risk of positive and negative outcomes correlated with triage level. None of the patients triaged as green died or were admitted to the ICU whereas 90% of patients who died were triaged as red.

Naming and Shaming the Bombers

This chapter recounts how Médecins Sans Frontières (MSF) failed to turn the tide against the attacks on hospitals through its approach of naming and shaming the perpetrators of hospital bombings. It speculates that the failure to stop the attacks was either caused by the way in which the international humanitarian law (IHL) is wired to provide exemption for warring parties or MSF’s inability to deliver consistent messages necessary to generate pressure on offending nations. It also mentions the Syrian government’s denial of assistance to the population and disrespect to the laws of war that centered the state as both perpetrator and aid responder. The chapter looks at the Syrian government’s ability to deny and allow access to services that served to amplify its control and project its sovereignty. It elaborates how the Syrian state centered its own sovereign control by being the focus of diplomatic efforts to ensure humanitarian access.

“Where is home?”—“Doctors Without Borders”, doctors without a homeland?

Are “Doctors Without Borders” (MSF) doctors without a homeland? Based on fifty interviews, statistical data and a participatory observation, this articledescribes humanitarian mission conditions limiting local integration and suggests three forms of attachment: home (“break expatriates”), elsewhere (“multi‑homeland expatriates”) or nowhere (“duty‑free expatriates”). For the latter, MSF plays, until their departure from the organization, the role of substitute homeland. Son los “Médicos sin Fronteras” (MSF) médicos sin patria? Basado en cincuenta entrevistas, datos estadísticos y una observación participante, este artículo describe condiciones de misión humanitaria que limitan la integración local y propone tres formas de apego: en casa (“expatriados paréntesis”), en otros lugares (“expatriados multipátridos») o en ninguna parte (“expatriados duty‑free”). Para estos últimos, MSF desempeña el papel de patria sustituta hasta que dejen la organización. Les « Médecins Sans Frontières » (MSF) sont‑ils des médecins sans patrie ? Basé sur une cinquantaine d’entretiens, des données statistiques et uneobservation participante, cet article décrit des conditions de mission humanitaire limitant l’intégration locale et dégage trois formes d’attachement : chez soi (« expatriés parenthèse »), ailleurs (« expatriés multipatrides ») ou nulle part (« expatriés duty‑free »). Pour ces derniers, MSF joue, jusqu’à leur départ de l’organisation, le rôle de patrie de substitution.

La comunicación digital de Médicos Sin Fronteras en España durante la crisis de la COVID-19

This article analyzes the digital communication of Médecins Sans Frontières (MSF) during its intervention in Spain due to the emergency caused by COVID-19. Using content analysis techniques, the text engages with a number of the messages posted on the MSF website, emails sent to partners and publications on Facebook and Twitter. The material (a total 58 messages) is categorized by subject, sender, format, and objective, as well as the presence of informative or emotional approaches. Complementarily, items such as intensity, positive or negative undertones and the terms most frequently used are also examined. Our conclusion points towards the use of digital communication with a view to reinforce MSF's public image as an entity specialized in health care in emergency situations. The unprecedented intervention in Spain during the COVID-19 crisis has also shown MSF to be accountable to its audiences, showing how the organization usually works in other countries.