"The state of humanitarism today": Dr Christos Christou

"I would like to begin today by acknowledging the Ngunnawal and Ngambri peoples, the Traditional Custodians of the land on which we are meeting today and pay my respects to their Elders past and present. I extend that respect to Aboriginal and Torres Strait Islander peoples here today – both in the room and online.

It’s a privilege to be here and I express my thanks to the National Press Club for the opportunity.

I am honoured to speak to you today about the limits of humanitarian action. I will focus on two critical humanitarian crises of our time: the wars in Gaza and Sudan.

As I speak, Médecins Sans Frontières teams in Gaza are responding to the latest attack. An Israeli airstrike on tents in a camp for displaced people in Rafah. This is unimaginable. These are people who followed evacuation orders to leave northern Gaza, only to be bombed in the south. What could more clearly show that there is nowhere safe in Gaza?

MSF is doing what we can to care for 180 people injured in this attack. We are working from a very small clinic, in a shed. What we can do is limited, because the Gazan healthcare system has been dismantled: piece by piece, hospital by hospital by hospital. There were 36 functional hospitals in Gaza before the war. Now only nine are partially functioning.

MSF is a humanitarian organisation. But in Gaza, that has offered us no protection. Instead, we have faced a pattern of attacks. We have endured 23 violent incidents since 7 October. Our teams were repeatedly told to move south, and when we did, our convoy was fired upon – killing two people. Tanks have fired at our shelters. Our vehicles have been bulldozed.

Over 260 humanitarian workers have been killed in this war, including the tragic loss of Australian aid worker Zomi Frankcom, who was working for World Central Kitchen.

Many humanitarians were killed while providing care, or while sheltering with their families.

We are also mourning the loss of five MSF colleagues who have been killed in Gaza since 7 October:

• Mohammed al Ahel, lab technician
• Alaa Al Shawa, volunteer nurse
• Dr Mahmoud Abu Nujaila
• Dr Ahmad Al Sahar
• Reem Abu Lebdeh, physiotherapist and MSF UK board member

I share the names of our colleagues with you because they deserve respect and recognition. They are parents, doctors, carers. We are outraged and saddened that they have been killed, and we demand accountability for their deaths.

Sadly, these attacks on healthcare are not isolated to Gaza.

Our teams in the West Bank have also witnessed repeated instances where healthcare has been hindered during raids by Israeli forces. They have witnessed the targeting of ambulances and medical staff and acts of violence and killing, even within hospitals.

I visited the occupied territories of Palestine in December. I visited Jenin, Nablus and Ramallah and worked closely with my colleagues in Gaza.

I was in Jenin when an incursion started. I was shocked to see the hospital’s entrance blocked by Israeli soldiers, preventing anyone – including the injured – from entering. There’s nothing worse for a doctor than to know that people need medical care, and you cannot reach them. Or they cannot reach you!

These raids are happening more regularly. Just last week there was another incursion on a hospital in Jenin. This time, it lasted two days and two nights, and killed 12 people.

Israel has offered no accountability for any of the attacks on healthcare facilities.

In Gaza, the systematic destruction of the healthcare system means people are unable to receive the medical care they need for chronic conditions, or pregnancy. While more than 35,000 people have been directly killed in Gaza, there are thousands of other ‘silent deaths’. People escape the bombs only to be killed by infected wounds, chronic diseases, or malnutrition.

More than 79,000 have been injured, and an estimated 10,000 remain trapped under rubble.

The Israeli government is pursuing a policy of deliberate deprivation, only allowing a trickle of food and water to enter Gaza. People are unable to access adequate food. They are simply starving.

MSF has worked in Gaza for 36 years and this is the first time we’ve seen cases of malnutrition. Our teams have had to rapidly retrain, as they haven’t treated malnutrition before.

It's also important to recall that prior to 7 October, there was already a humanitarian crisis in the Gaza strip, caused by Israel’s 16-year blockade. The day before this latest escalation of war, MSF was tending to patients wounded in previous escalations. This included patients with long-term injuries sustained in the Great March of Return in 2018 and 2019.

The current siege by Israel is stopping the entry of fuel and medicines. Since the closure of the Rafah border in early May, barely any essential humanitarian and medical aid has been able to enter.

The situation in Gaza has never been so dire. The food, water, and medical supplies so desperately needed are sitting just across the border in Egypt, of use to no one.

The US has also recently announced a temporary floating pier to bring aid in. But this is a glaring distraction from the real problem: Israel’s indiscriminate and disproportionate military campaign. There would be no need for such creative solutions if Israel stopped its bombardment and punishing siege. There would be no need, if Israel opened its borders and allowed for the safe distribution of aid within Gaza.

We are working in two hospitals (Al-Aqsa hospital, Nasser Hospital), one clinic in Gaza City and five primary healthcare facilities including three in Al Mawasi, in Rafah area, and two in Gaza’s Middle Area. We also recently opened a trauma stabilisation point in Tal Al Sultan, Rafah. 

We are supporting thousands of patients each week with primary healthcare, mental healthcare and maternal healthcare. Every wound that we stitch, every baby that we deliver safely, every child that we vaccinate makes our presence worthwhile. And yet the work that we are doing is less than a drop in the vast ocean of need. Let us not have the illusion that there is any meaningful humanitarian response in Gaza right now.

The International Court of Justice ruled in January that Israel needs to take steps to prevent plausible genocide in Gaza. The court said Israel must take all measures to stop killing Palestinians in Gaza, and must allow sufficient humanitarian assistance. But what we are witnessing is that this ruling is being blatantly ignored.

Recently the ICJ issued another ruling, for Israel to halt its offensive on Rafah. Within a few days, Israel bombed the tents for displaced people in Rafah, in the news we all woke up to yesterday morning.

Frankly, I have run out of words.

I wish I could find the words to express the smell of infected wounds. The cries of mothers who’ve lost their children. The constant sound of drones. The level of desperation of my colleagues.

Instead, I will rely on the words of my Australian colleague, psychologist Scarlett Wong. Scarlett is here today, having just returned from Gaza last month. She has told me the story of one of our Palestinian colleagues – a psychologist who lost her entire family.

She was the last one with their name. Her father, mother, sisters and brothers, nieces and nephews – all gone. She still showed up to work the next day. She said working was better than sitting alone in her tent grieving.

MSF is frankly horrified by Israel’s assault on Gaza. And we remain horrified by Hamas’s attack on Israel on 7 October. We feel the pain and the suffering of people in Israel whose family members were killed or taken hostage on 7 October. We feel the suffering of families of those arbitrarily detained from Gaza and the West Bank.

What is needed is an immediate and sustained ceasefire. A ceasefire is crucial to prevent further civilian deaths. It’s crucial to allow aid in.

In Australia and New Zealand, more than 85,000 people have added their voices to our statement of support for a ceasefire in Gaza and Israel. Globally, MSF spoke at the United Nations Security Council, demanding an immediate and enduring ceasefire.

While the UNSC has finally voted for a ceasefire, Israel is blatantly ignoring this resolution. It continues its attacks on civilians and medical personnel and is expanding attacks in Rafah. This is about impunity, a total disregard for the laws of war, and now it must become about accountability.

Australia has an important role to play here. Beyond words, Australia must take immediate concrete actions to hold Israel to account. Australia must apply appropriate sanctions on Israel, as it would to any other global State that refuses to comply with UNSC resolutions.

The Australian Government’s expressed support for a ceasefire rings hollow when they are supplying the weapons that continue to kill and maim in Gaza.

Even if – and when – a ceasefire in Gaza finally happens, the road to recovery will be long and uncertain – spanning years, if not decades. Gaza’s health system is shattered.

On a different continent, we see parallels in Sudan as it is ravaged by a brutal civil war.

The conflict has compounded extreme levels of suffering across the country. Needs are growing by the day. The humanitarian response is deeply inadequate, with assistance systematically blocked by the authorities.

Almost 7 million people have been internally displaced, and over 2 million have sought refuge in neighbouring countries. In Darfur, there are reports of ethnically targeted violence, with mass graves discovered. Refugees describe horrific violence including looting, burning of homes, and sexual violence.

More than 745,000 Sudanese – mostly women and children – have fled this extreme violence over the past year and found refuge in eastern Chad.

As our teams respond on the ground, it was important for me to see for myself to grasp the reality of the situation. In March, I visited Sudan and Chad. It was eye-opening.

I started my visit in Adré, in eastern Chad, the entry point for most of the refugees from Sudan. I followed the journey they go through. At every stage, MSF teams provide medical assistance as close as possible to refugees, Chadian returnees, and the local communities.

I was surprised to see that after more than a year MSF is still the main organisation providing water and sanitation – there's just not enough humanitarian response. And people are receiving far less water than they need.

People often arrived with gunshot wounds and other violence-related injuries. At times, our colleagues treated hundreds of war-wounded patients each day.

Like other towns along the Chad-Sudan border, Adré has been struggling to accommodate the high number of newly arrived refugees. Access to food and medical care was already limited before their arrival. This little village in the middle of the desert has seen its population quadruple since the outbreak of war. Today, more than 120,000 refugees are living there. They struggle to access basic services and live in unacceptable conditions which exacerbate their health risks.

I took the time to speak with the communities, including our patients. The suffering and hardship they endure is heartbreaking, but they show great resilience and strength in the face of such adversity. They shared with me how they used to have a “normal life before”.

A man in tears explained to me that “after all the horror we’ve been through, I imagined we’d find comfort here, but we’re reduced to begging every day for food”. 

These words echoed in my mind. What more can we do? This crisis may not grab headlines or trend on social media, but it demands our attention and action.

The humanitarian response is woefully inadequate. I describe what I saw as a humanitarian desert because there’s a palpable lack of aid organisations on the ground.

We have persistently called for an escalation of the humanitarian response, yet commitments continue to fall short. The funding projections for this year are not optimistic.

Much more needs to be done in eastern Chad. It is part of our moral duty. There is no excuse for the international community not to act and stand in solidarity with the Sudanese who fled extreme violence and provide them with the respect they deserve.

A few days later, I crossed the border from Chad into Sudan. After just a 30-minute drive into Darfur, you immediately see the horrific amount of destruction that has taken place in El Geneina. Entire neighbourhoods have been destroyed. There are houses without their roof and bullet holes in buildings. Part of the city looks like a ghost town.

In Zalingei, people shared with me a horrific story of a patient and surgeon getting shot at while the doctor was operating. Although the doctor survived, the patient died. Armed men stole all the equipment from the hospital. They even threw patients out of beds, just to take the beds with them. I heard stories from the dialysis unit, where the machines people relied on for lifesaving care were unplugged.

These are blatant breaches of International Humanitarian Law, and yet shockingly they are not unusual incidents. MSF has experienced looting and violence across Sudan.

For a year, MSF has seen the systematic, political obstruction of lifesaving humanitarian assistance. Very few international staff have been given visas to enter Sudan to support local staff. Lifesaving supplies are blocked from entering Khartoum, the capital. In Wad Madani, we’ve been left no choice but to halt our work because we can’t get life-saving supplies in.

Humanitarian assistance from Chad to Sudan is not being properly facilitated and allowed through. And yet people are dying from being unable to access healthcare. We see catastrophic rates of malnutrition in places like Zamzam camp, where one child dies every hour from a lack of food. This exceptional crisis requires an exceptional response by the international community, not the brazen ignorance we’re seeing.

Before the start of the war, there were dozens of international organisations responding across the country. Now, there are almost none. For a crisis of this scale, this is unfathomable. It is unacceptable.

There is no doubt that there are enormous challenges in Sudan, but they are not insurmountable. We have a moral obligation and responsibility to continue to do everything we can to bring attention to this.

As the world faces numerous, complex humanitarian tragedies, humanity itself is under attack.

MSF will continue to stand by our patients to alleviate their suffering and restore their dignity. We will continue our work as doctors, as humanitarians, and as human beings.

We will continue to bear witness and speak out, always based on our medical humanitarian action.

But there are limits to humanitarianism. We can call for a ceasefire, but we cannot stop war. We cannot stop attacks on hospitals and patients. We cannot open borders to allow aid in.

These are political responsibilities.

More than being protected, these rules need to be rebuilt. We need to see stronger measures for holding states and warring parties to account when they are breached.

We will continue to call for the protection and amplification of voices both within our teams and independent and impartial journalists who report on these atrocities far beyond the headlines.

The complete indifference to humanitarian laws in Gaza and Sudan, without any accountability, makes our world a terrifying place. A place where violence is uncontested, and civilians unprotected.

The ramifications of this impunity will echo across generations, and across the world. We have a collective responsibility to do all we can to stand on the side of humanity.