By Sheila Burt
In the fall of 2018, Doctors Without Borders (Médecins Sans Frontières or MSF) held the interactive exhibition “Forced from Home” in the Daley Plaza to educate the public on the global migration and refugee crisis and to describe the many push factors causing people around the world to flee their homes. A year later, the organization estimates that a record number of people around the world — 70.8 million people — are still forcibly displaced. Below we describe the field work of an MSF nurse and medical coordinator, Francesco Di Donna, who has a master’s degree in public health. The following interview was conducted in September 2018 and has been edited for clarity.
Francesco Di Donna, MSF Medical Coordinator from Italy who has done work in Sudan, Syria, and other countries.
I started to work for MSF in 2008. I started as a nurse and in the last few years have become a medical coordinator. I have a master’s in public health. I joined because I always wanted to travel and discover the world but at the same time to be able to connect with people. When I became a nurse, I found this more and more interesting and wanted to help the people who are affected by war, conflict, or environmental disasters.
My first mission was in Darfur, Sudan. We talk about it less now but it’s still a big crisis. Then I went to Pakistan and worked in Haiti after the earthquake. I’ve also worked in Syria and Afghanistan.
Each location has its own public health issues. When you’re in tropical countries, you’ll find more tropical diseases or chronic diseases that haven’t been treated. In other countries, chronic diseases like cardiovascular problems or diabetes are prevalent. For example, in countries like Syria or Afghanistan, people usually have access to medical care but when conflict starts they can’t be treated anymore for chronic diseases.
When they become a refugee, the health system collapses most of the time. The majority of the time, when you are in a refugee camp there’s a lack of healthcare facilities or staff. And then in the living conditions you’re exposed to new diseases or have more probability of getting sick.
Among forcibly displaced persons, upper and lower respiratory conditions are very common. There is also risk of tuberculosis or infectious diseases because people are forced to live in close quarters and hygienic conditions are very poor. For example, in a detention center in Libya, people live so close together in a place without ventilation. You have high risk of diarrhea, cholera, or measles.
Another high-risk disease in refugee camps is malaria. Malaria is still the main killer disease in the world and in some tropical countries, when the rainy season starts, it’s called malaria season because the peak is high and a lot of people die from malaria, especially children. So the important thing to do is to try and screen the population for malaria and to do mass distribution of mosquito nets to avoid transmission of these diseases.
If you’re at a large refugee camp, we might implement a field hospital with some different units like pediatric, maternity, or general medicine. When the area is big we also try to implement a mobile clinic, which is a small team that goes around that does primary care and refers patients to the field hospital.
Treating mental health: Mental health is becoming more important to treat and becoming part of our core health initiatives. Refugees develop symptoms like anxiety, sadness, and depression, and I think it’s really important to have mental health support for these people. In the last two years I’ve worked in Italy where we treat people who have been tortured in the past. We use a multi-disciplinary approach with doctors, therapists, social workers, and psychologists. We try to reintegrate the person and restore dignity to them. We also do a type of psychosocial first aid to persons traumatized by the journey in the Mediterranean Sea. For example, maybe there was a boat sinking or someone lost a family member in a drowning.
Message from Forced from Home campaign: For me, it’s important that people learn from this exhibition the lack of choice that people have when they are forced from home. The majority of us have the freedom to decide where we want to live or work. People who are forced from home, they become a victim of the system of immigration that is so bureaucratic and complex.
I think the dream of everyone is to come back home. All of us. Even when I travel, my dream is to come back home. And often the majority of these people (refugees) will never come back home. So I think it’s really important to have humanity in this situation. I know it’s difficult for countries to implement new rules and manage large numbers of people, but we need to stay human and understand what is behind the refugee crisis.
Memorable story: In Haiti after the earthquake, people in the village were so happy to have us there and shared the few things they had left with us. We treated the village for cholera. They were so thankful for our intervention. In that situation, we have to do everything, such as training the staff and coordinating the team. I was also unpacking boxes in the pharmacy. You really have to try and do everything.
2019 update: MSF estimates that about 50,000 people attended a Forced from Home event since its inception in 2016. Although the fall 2018 tour of Forced from Home has concluded, many materials from the exhibition can be viewed online.
Sheila Burt is a science writer at the Shirley Ryan AbilityLab in Chicago. She received her bachelor’s degree in journalism from Northwestern University and a master’s in science writing from The Johns Hopkins University.