For the past nine years, retired surgeon Dr Bernard Leménager has willingly flown to war-torn regions around the world to offer his medical expertise as a doctor with arguably the best-known French charitable organisation, Médecins sans Frontières (MSF).
“I am 69 now. I used to work in a public hospital in France,” he said. “I decided to retire when I was 61 so I could work for Médecins sans Frontières.
“For the past nine years I have taken part in five or six missions a year. Half have been in Africa, and half in the Middle East – in Iraq, Syria and Yemen.”
Dr Leménager has recently returned from seven weeks operating and saving lives in Yemen, where civil war has raged since 2014 when Houthi rebels, a group of Shi’ite Muslims from the north, overran the capital and forced President Hadi to flee. The President had been supported by Saudi Arabia, which set up a coalition and began air strikes.
The conflict, which has become known as the Forgotten War as it has had little media coverage in the west, has left the country’s infrastructure in tatters.
MSF calculates that half its medical structures have been destroyed. In 2017, the United Nations estimated that – out of a population of around 27million – more than 20million were in need of humanitarian aid.
In October 2018, the UN said the country was about to face one of the biggest famines for 100 years, with 13million on the verge of starvation.
MSF has since said that, though there are huge problems in Yemen, the disaster is not on that scale. They point out that it is difficult for journalists to access the country and for facts to be verified and there are many no go zones because of continuous bombing.
The medical charity is one of the few to have been able to gain access to the country. It has centres in Houthi territory to the north, as well as the Saudi coalition-controlled south.
Between March 2015 and May 2018, MSF treated 81,633 war casualties and 835,333 people in its casualty departments in Yemen, and carried out 64,659 surgical interventions. Another 108,032 were admitted to Cholera Treatment Centres.
That is just a fraction of the work it does. In 2018, MSF France undertook operations in, among others, Gaza, Central African Republic, Syria, Libya, Chad, Uganda, and Iraq. It helped the ship Aquarius save refugees in the Mediterranean and cared for Rohingya refugees in Bangladesh. Doctors treated a new Ebola outbreak in Congo.
In total, it dealt with 10.6million out-patient consultations and admitted 749,700 patients for treatment.
Dr Leménager has been to Yemen several times and described the hospital he worked in the last time he was there:
“I was in an MSF hospital constructed out of tents in Mocha, a small town on the Red Sea coast which gave its name to the coffee it used to export from its port up to the 18th century.
“It is about four hours from the main city of Aden in the south and this is the nearest hospital to the front line of the war, about two hours to the north. It was opened in August with an operating theatre, a casualty service, an intensive care unit and three wards, two for men and one for women and children.
“In all there are 35 beds and, once treated, patients either stay with us or are transferred to the bigger 100-bed MSF hospital in Aden. Though it is under canvas, conditions are good; there is air conditioning and it is well equipped.
“Two surgeons and two anaesthetists share the work, and though we can be called on at any time, night or day, we do have time to relax, which is important so that when we do work, we can do it well.”
Not all the hospital’s patients are a direct result of the conflict: “We look after both military and civil casualties, as there is no longer any other hospital in the region with facilities for surgery.
“Some patients are war wounded, either by bullets, shrapnel or by mines, as there are several of these around. We have operated on a man for bullet and shrapnel wounds who was 110, and a seven-month-old baby who had been shot in the stomach.
“One young boy arrived with a tourniquet around his leg, following a shrapnel wound. We were able to save his leg and afterwards he was able to return to his home. We have Yemen staff and there was a wonderful physiotherapist, Farouk, who took great care of him. We also do other, ‘classic’ surgery for the local population, such as removing appendix and caesareans so the work is varied.”
Despite the constant threat of violence, Dr Leménager said he rarely felt in any danger while working in the war-torn nation: “There are never too many dangerous situations, though when you go into the town there are two problems. One is crossing the road, because the way they drive is hair-raising and the other from the fact that they say that in Yemen there are more Kalashnikovs than there are homes. Every family owns at least two or three and the men walk about with their guns and fire into the air at random, for fun, which causes lots of accidents. It is a tradition to do so at weddings and once, three bullets pierced our tents from one such occasion. Luckily no-one was hurt.”
In 2015 Dr Leménager was in Aden during a battle in the city which lasted three months: “The hospital was right in the middle of the two front lines.
“We received a hundred wounded a day.
“I was also in Mosul, Iraq, just after it had been liberated from Daesh (ISIS). We were just six or seven kilometres from the fighting. We took in a great number of wounded and it was pretty risky.
“On another occasion I was in Syria, but we did not stay very long, because it was very dangerous. The problem with ISIS / Daesh is that we, as doctors could be a potential target and there is a real possibility of being kidnapped.
“When you are in places like this there is always a risk. We leave it to the MSF organisers who know what is happening on the ground to assess the situation and they make sure we are never in too much danger. We are there to cure, not to fight.”
Dr Leménager may have made light of the dangers, but it only takes one look at the facts to realise the risks he and his colleagues take. In 2016, four medical units supported by MSF were attacked in Yemen. One, a hospital in Abs, in the north-west, was hit by an air attack which left 19 dead and 124wounded. One of those who died was an MSF employee.
He agrees that not many people in France know about the extent of the conflict in Yemen. “There has been very little about it in the media. Not about the war, nor about the repercussions.
“The health system has been completely disrupted so that there is very little access to health care.
“There is immense malnutrition and cholera epidemics. I think it is a crisis which is getting more and more dramatic.”
And he said the work of MSF was making an incalculable difference to the lives of people in Yemen: “If the hospital in Mocha was not there, there would be no surgery, no help for the wounded, no caesareans. There would be more deaths.
“The people in Yemen are really kind and adorable. They do everything they can to make us welcome. And, when I was in Iraq, just after the towns had been freed, they thanked us everywhere we went.”
Médecins sans Frontières is arguably the best-known French international charity. It was founded in 1971 in Paris and for more than 40 years it has been giving medical aid to people whose life and health is threatened, mostly by war, but also by epidemics, natural disasters and lack of health care. It operates in 72 countries and prides itself on being independent as it is funded by private rather than government money.
“I did not sign up just to help people,” Dr Leménager said. “If I had only wanted to do good works, I could have stayed in France because there is plenty of misery here that needs addressing.
“Working for MSF is interesting on a professional, personal and humanitarian level. As a doctor you extend your skills because you see different kinds of pathologies, and for me it is interesting because you meet people from all over the world with different experiences.
“There are MSF staff from the UK, Armenia, Pakistan, Australia, the United States and though we are not tourists in the usual sense it is fascinating to get to know about people’s way of life in the different countries we work in.”
Charities are often criticised for the way they spend their money, but Dr Leménager feels the MSF does its best: “It is a huge organisation, but it keeps its administrative costs to a minimum.
“The fact that 97% of its money comes from private donors means the money is on hand so the charity can react rapidly to any new crisis and stay neutral. It always tries to have medical centres in areas supported by both sides of a conflict. It does not have to waste time persuading public bodies to hand over cash.
“Amongst the medical staff there are a great number of young retired but also working doctors who take time out of their annual leave to work for MSF.
“When we do a mission all our expenses are paid, including air fares, board and lodgings, and we are given a small sum to cover extra expenses. MSF also employs local people, so that in Mocha we had 150 staff, including medical and administrative workers, and only 10% of us came from outside Yemen.”
He is 69, so surely it is a huge commitment and physically exhausting? “I will not be able to keep on doing it for ever, but while I can, I will.”