Médecins Sans Frontières vehicle in a displaced camp in Mogadishu where the organization runs medical activities. From January to June 2013, MSF medical teams performed nearly 150,000 consultations in Somalia's capital city. The international medical humanitarian organization announced that it will be pulling out of the country due to attacks to its staff. Photo by: Yann Libessart / MSF

Médecins Sans Frontières on Wednesday announced the closure of its programs in Somalia after 22 years due to conditions that prevent the organization from delivering medical care independently and safely.

MSF cited extreme attacks on its staff in an environment where armed groups and civilian leaders increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers as reason for its departure. Recent incidents include the abduction of two Spanish aid workers in the Dadaab refugee camps in Kenya that ended only last month after a 21-month captivity in Somalia.

The pullout will not only impact the hundreds of thousands of Somalis who relied on MSF medical supplies and attention, but also over 1,500 employees that will all lose their jobs.

“Although we will try to minimize the impact we realize this loss of livelihood will be extremely difficult for them,” MSF USA press officer Tim Shenk told Devex. “We do regret this as they have been very committed to our work, many of them for a very long time.”

Connivance with armed groups was ‘last straw’

Despite the abruptness of the announcement, the organization insisted that the decision to leave the country was not triggered by one final incident but many since 1991, according to MSF President Dr. Unni Karunakara.

“Over the last 22 years, we have accepted the risks that Somalia has presented, and did our best to adapt our operations in order to ensure that people receive the care they needed, but … we’ve had 16 killings and dozens of attacks against our workers and our vehicles,” Karunakara said during a conference call with reporters.

However, he explained, “the final straw was of course the realization that authorities, armed actors and community leaders were actively supporting or tacitly approving the attacks, abductions, killings of our staff.” Unlike other aid groups, MSF does not accept security provided by the U.N. and arranges for its own protection through community-negotiated agreements that also determine which areas they can access and which are off-limits for their staff.

But even that policy is no longer a guarantee for them in Somalia.

“We are not able to send out our teams and keep them safe. We are not able to do independent assessments, and ensure that … the medical care goes to those who need it most,” said Karunakara. “We are not in a position to provide assistance in a way that’s independent and impartial.”

He noted that all employees were informed in advance, but lamented that “of course our staff and patients will pay the price” of the withdrawal.

The new donor darling

MSF’s pullout was announced at a time when most of the aid community seems to be warming up to Somalia, widely seen as a new “donor darling” after decades of neglect.

Top donors such as the European Union and the United Kingdom said they weren’t shaken even after the recent attack on a U.N. compound in Mogadishu, although the Japan International Cooperation Agency has been scaling back its deployment of international aid workers inside the country for security reasons and training Somalis in Japan.

Just this week, the U.K. Department for International Development came under fire after it confirmed that almost half a million pounds of its humanitarian supplies were pillaged by al-Shabab, a militant group linked to al-Qaida. DfID responded that incidents like this are the risk of working in fragile states.

But for a country ranked second in the Humanitarian Outcomes’ list of nations with the highest rate of deliberate acts of violence against aid workers, MSF’s withdrawal could not have come at a worse time, especially with a new outbreak of polio reported in April.

MSF just doesn’t share donors’ optimism over Somalia.

“We can only talk from our own experience, but our decision … shows that … the exceptional humanitarian needs in the country have pushed MSF and its staff to tolerate unparalleled levels of risk — much of it borne by MSF’s Somali colleagues — and to accept serious compromises to its operational principles of independence and impartiality,” said Arjan Hehenkamp, general director of MSF Holland. “[But] the situation in the country has created an untenable imbalance between risks and compromises.”

No transition process

The situation on the ground was so extreme that the organization decided to just pack up and go, without a transition process.

That means that practically overnight, patients will no longer be able to receive pediatric intensive care in Mogadishu or any type of medical attention in most suburbs and towns around the country. The closure will also put an end to free primary health care, malnutrition treatment, maternal health, surgery, epidemic response, immunization campaigns, water and relief supplies.

“This is one of the toughest decisions that MSF has had to take,” noted Hehenkamp, who explained that their priority now is to pull out of the country “in a responsible manner” and do the utmost to minimize the consequences of the withdrawal for Somalis currently under their care.

In 2012 alone, MSF teams provided more than 624,000 medical consultations, admitted 41,100 patients to hospitals, cared for 30,090 malnourished children, vaccinated 58,620 people, and delivered 7,300 babies in Somalia.

As for if they are willing to return in the future, the organization is ready to engage in negotiations for acceptable conditions for humanitarian aid to resume, but they are aware this will not be an easy process with quick solutions and will take time.

“We [will] need to see all actors in Somalia demonstrating through their actions a willingness and ability to facilitate the provision of humanitarian assistance to the Somali people and respect for the safety of the humanitarian aid workers who risk their lives to care for them,” said Hehenkamp.

Kelli Rogers and Carlos Santamaria contributed reporting.

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About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.