Doctors Without Borders

From building site to operating table

It only takes the charity Doctors Without Borders a few days to erect a treatment camp with its own small hospital – almost anywhere in the world. Thanks to a sophisticated logistics system and the dedication of its staff.

To care for casualties, inflatable hospitals are erected in crisis regions. (Image: Benoit Finck/MSF)

In June 2015, 21 women and men set out to rescue 80,000 people in the middle of the desert. Andreas Karden was a member of the team that the charity Doctors Without Borders had dispatched to South Sudan. As he sat in the aircraft, Karden tried to envisage the situation awaiting him. The civil war in South Sudan was heating up. A refugee camp already holding 40,000 had been veritably flooded by people displaced from other parts of the country. Some 80,000 had already arrived, making a total of 120,000. Karden and his colleagues would be trying to maintain supplies to the camp, thereby preventing a humanitarian disaster. But how much can such a small team really achieve?

Well, Karden is used to moving mountains. The 36-year-old is responsible for logistics at Doctors Without Borders. He has already worked for the aid organization in Chad, Yemen, the Democratic Republic of the Congo and the Central African Republic – on assignments sometimes lasting eight or nine months. Karden – a trained fitter, paramedic and construction engineer – also has an MBA in Project Management. When problems need solving and resources need locating, he becomes the fixer. No matter how complex the problems, no matter how dire the situation, we always start out with one question, Karden says: "What do the people need?" When Karden reached the grossly overcrowded camp in South Sudan, he immediately identified his first priority: satisfying the residents' most basic needs. That meant getting hold of wood to build lavatories. There were shortages of potable water, food and medicines – not to mention electricity. Where could he lay his hands on them?

The Doctors Without Borders organization available to Karden is divided into three separate tiers. One takes action at the heart of the crisis: the emergency team. In South Sudan, this means Karden and his crew. They are backed by a national coordination team stationed in the capitals and major cities of the target countries. And they, in turn, liaise with the project directors who are based at the organization's headquarters in Europe. If Karden needs something that is not available locally, he turns to the coordinators in the capital, in this case in Juba. "My colleagues then try to buy what I need in the shops and markets and then forward it on to me. You can always get hold of things like wood and buckets here. We would never fly those in from Europe," Karden says.

If the city-based staff still can't fill the gap, they contact the top tier of the network: the operational directors in Europe. It is at this point that the charity's global network delivers. Its sheer size translates into a reach that few other organizations can match. Its annual spending totals almost 1.3 billion euros. Currently Medécins sans Frontières, the international name of the charity that won the 1999 Nobel Peace Prize, manages projects in over 60 states around the world, in some cases with more than 1,000 staff in a single country. It stores medicines, relief supplies and prepacked emergency kits at one of its logistics centers in Brussels. This alone has 6,500 square meters of space, enough to store 20,000 different items ranging from the tiny chlorine tablets used to make drinking water through to all manner of medical instruments and inflatable hospitals, and even power generators weighing several metric tons. The organization owns only a handful of planes, jeeps and boats for transporting goods – leasing them when and as they are needed is cheaper.

In the South Sudanese camp, Karden and his team can successfully satisfy the most basic needs locally, or by obtaining goods and provisions from Juba or Nairobi, the capital of neighboring Kenya. But they also tap any existing resources – and any infrastructural groundwork that has already been laid. For example, in addition to then nine boreholes already sunk inside the camp, a 200-meter deep hole had also been drilled a short distance away. If they could get hold of pumps and pipes, they could create a dependable new water supply. Despite the existence of these wells, providing drinking water for 120,000 people remains a huge challenge. But Karden's team was not left to fend alone. "Thirty other staff from Doctors Without Borders had already arrived at the camp months earlier, at a time when it only housed 40,000 refugees. Additionally, and this has been crucial, we managed to hire lots of locals quickly," explains Karden. These new employees are what make the charity so effective – not only because of their numbers, but because of the knowledge they contribute. Soon Karden and his team had taken on some 500 people, mainly from South Sudan, who brought various and valuable skills and expertise to the table. They ranged from simple laborers through to expert surgeons, making up another crucial link in the aid chain that is a mutual give-and-take. Basic supplies and services are only the first step.

Just a few weeks after Karden had arrived, Doctors Without Borders had already built a small hospital, with 50 staff, 180 beds and even one of the charity's operating rooms! When the doctors took up their work on day one, there was a line of patients several hundred meters long at the door. It looked more like a production line than a healthcare center.

Medical supplies can be very difficult to transport. Exceptional standards of hygiene need to be maintained and some supplies – such as vaccines – require refrigeration as well. The logistics managers therefore need to take even more care when planning than normal. Given the material value of many consignments, finding reliable partners is vital. The fact that the charity has operated in so many countries over several decades means that it already knows who it can trust.

Sometimes, as a consequence, fully-functioning infrastructures are up and running just a few days after a project has begun. Small transport planes, for instance, fly to and from Juba and the camp, much like the regular services between big cities. The medicines and materials needed in South Sudan are ferried in from Europe via Nairobi, either on scheduled flights or by sea. In this way the most urgent needs of the 120,000 refugees in South Sudan are met with goods transshipped through warehouses in Belgium and Holland.

With their efforts, Karden and his team gradually made a crucial contribution to creating humanitarian conditions in the overpopulated camp. In some projects, however, there is far less time to respond. Rather than weeks, he might only have days or even hours to ring in the changes. "If there's a cholera outbreak, every minute counts," he points out. "Quite literally, the basic supply systems need to be in place within hours." The situation was similarly critical following the earthquake in Haiti, when hundreds of thousands lost their homes in a matter of minutes. If they work quickly, teams like the one run by Karden and his colleagues can save hundreds or even thousands of lives. Fast intervention would be unrealistic without the ready-to-go emergency kits stored in Europe. Some contain the basic supplies needed to sustain 1,000 people. Others package sterile instruments for operations, sufficient for even complex abdominal surgery.

The political situation is often volatile in the war zones where Doctors Without Borders operates. The organization is extremely experienced when it comes to protecting its staff. Whatever the project, the national coordinators and project directors draw up estimates of the conditions and risks involved. "Our safety is in their hands," says Karden. Despite precautions, colleagues often feel ill at ease when travelling in crisis regions. But they do know they are representing an organization that is highly respected – by all of the warring factions. Why? Doctors Without Borders helps everybody, regardless of their religion, political standpoint or ethnic origin. The charity's logo, a human figure depicted using red and white lines, is displayed prominently on all its vehicles. Almost everyone knows what it means. If Karden is travelling in a jeep, children often gather around and cheer, because they know that aid organizations like Doctors Without Borders represent their best hope of surviving the crisis without lasting harm. "When I get out and about, I'm often reminded that I really am needed here, most probably more than anywhere else in the world," he muses. "And that helps cement the conviction that you are doing the right thing." However busy he might be, Karden always welcomes moments like that. Even if they don't occur until the evening, when everybody is sitting around exhausted. Then they have the satisfaction of knowing that their day really has been spent making a difference.


Dr. Christian Heinrich works as a freelance journalist and writes about medicine, business and society, travel and current affairs.

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