While military borders are entrenched through siege and country borders are challenged by conflict, Médecins Sans Frontières

(MSF) and entire populations are confronting these shifting borders by, in the case of MSF, attempting to defy siege in order to provide assistance, and in the case of people caught up in such situations, by fleeing areas under siege and crossing borders.  

The Middle East is home to the biggest number of refugees in the world. However, when those refugees attempt to reach Europe they encounter yet another entrenched border. Fortress Europe has created, through legislation, insurmountable hurdles to safety and refuge, forcing thousands of people to take to the sea.

‘The War on Terror’ stretches across the borders of the region; it is depicted as cause and consequence, poison and cure. Syria is fighting ‘terrorists’ in Aleppo, Homs and around Damascus; the Saudi led coalition is fighting the Houthi ‘terrorists’ in Yemen; Egypt is fighting ‘terrorists’ in Sinai; Israel is ‘defending’ itself against Palestinian ‘terrorists’, while Europe is preventing ‘terrorist’ refugees from landing on their shores. At the same time, the US is conducting a drone war against ‘terrorists’ throughout the region. However, the designation of who constitutes a terrorist is a fluid concept depending on who is justifying its belligerence.

It is therefore not only the geographic hurdles of borders and blockades, but also the way in which the fight against the ‘terrorist other’ is constructed that all impede the ability of humanitarian aid to reach the most vulnerable who often fall through the cracks of the geopolitical fractures of the region.

Contextualising chaos

The colonial administrators, Mark Sykes and Francois Georges-Picot, marked one of the deepest fractures of the region on a map in 1916. They came to a closed door agreement to divide the land that had been under Ottoman rule since the 16th Century into new countries that would fall under different spheres of influence: Iraq, Transjordan and Palestine under British influence and Syria and Lebanon fell under French influence. The colonial carving up of the region entrenched sectarian divides and fuelled regional tensions.

Although it is a popular narrative for understanding the region’s turmoil to pit Sunni Muslim groups versus their Shia rivals, this is often a gross oversimplification of a complex reality. The late Bassem Chit referred to sectarianism as a form of distorted class struggle, while Dr Fawzi Salloukh has made sense of sectarianism in the region as a form of geopolitics by other means. And the current geopolitics of the region cannot be separated from the devastating US-led invasion of Iraq in 2003 and the ongoing military occupation of Palestine.

The Palestinian struggle is at the centre of the political consciousness of the Middle East region. The occupation of Palestine is in its sixth decade and is therefore, according to the International Committee of the Red Cross (ICRC), “one of the longest sustained military occupations in modern history”. However, the illegal land grab of Israel’s settlement programme has gone largely uncontested – and has even been facilitated – by major political powers, most notably the US. Israel continues to violate international law with no consequences.

The lack of consequences for military occupation can also be seen in the case of the US-led invasion of Iraq, which fragmented the country and triggered a geopolitical confrontation that has taken the form of ‘a Saudi–Iranian contest over regional dominance’, which has played out across the region. These two regional hegemons squared off in the Syria war and again more recently in the war in Yemen. “Riyadh’s determination to re-orient Syria away from ‘the axis of resistance’ toward the Saudi–US camp developed into an overlapping regional–international geopolitical contest pitting Saudi Arabia, the US, France, Turkey, Qatar and Saad al-Hariri’s Future Movement [in Lebanon] against Iran, Russia, China and Hezbollah,” Salloukh says.

According to former UN secretary general, Kofi Annan, “The folly of that fateful decision [to invade Iraq] was compounded by post-invasion decisions. The wholesale disbandment of the security forces, among other measures, poured hundreds of thousands of trained and disgruntled soldiers and policemen on to the streets. The ensuing chaos has proved an ideal breeding ground for the Sunni radical groups that have now coalesced around the Islamic State (IS) label.”

In fact, the creation of IS and their announcement of an Islamic caliphate has brought us full circle back to Sykes Picot. The group released a video titled The End of Sykes-Picot. IS’ caliphate project challenges not only the borders between Syria and Iraq but has ambitions to redraw the entire map of the Middle East.

These political dynamics form the background to the unravelling of borders through the rise of IS and the entrenchment of other borders through military sieges in conflicts that pit regional hegemons against each other with the backing of global powers, be it in Yemen, Syria or Gaza. The historical context of the region does not diminish the responsibility of those states, armies and militias that are fighting today’s wars. However, it does contextualise their atrocities.

What are the concrete implications of the military entrenchment of ‘borders’ through the tactic of siege on the lives of individuals and the ability of organisations to respond to emergency needs? “If sieges and urban operations have proved difficult for military forces, they have been disastrous for civilian populations. Historic sieges, Troy and Aleppo, Vienna and Paris, Liège and Leningrad, are a litany of humanitarian catastrophes. Turning to recent memory, the human toll is little changed. Sarajevo, Grozny, and now the Syrian cities of Homs, Ghouta, and Aleppo have joined (or in the sad case of Aleppo rejoined) the unfortunate litany.”

Squeezed from all sides in Syria

The Syrian war has been raging for over 4 years. The Syrian government – backed by Iran and Russia and militarily supported on the ground by Hezbollah – has been battling against a fragmented armed uprising supported by Gulf states and western powers. With the rise of the Islamic State in Syria, the already murky battle lines were redrawn. Those who pay the biggest price in this war are those trapped within the ever changing conflict, and especially those that have come under military siege. “… some areas have been deliberately besieged or blockaded by both government and opposition forces. Civilians in these areas may voluntarily stay for family or political reasons, or stay out of fear of being killed or detained by the other side if they leave. Depending on the viewpoint, they could be regarded as human shields or victims of collective punishment, or both”.

Throughout the Syrian crisis, Eastern Ghouta witnessed some of the strongest confrontations between armed opposition groups and government troops. In June 2012 the armed opposition was able to drive the Syrian army out of East Ghouta, launching a long siege by the government with varying levels of severity. During notable peaks in violence it was impossible for people to go out or any supplies to enter; this had a lasting and devastating impact on the medical humanitarian situation in the area. Chronic shortages of food, water, fuel and medicine are part of the daily reality for people living in East Ghouta.

In February 2014 the United Nations Security Council passed resolution 2139 on Syria that called on “all parties to immediately lift the siege of populated areas… and demands that all parties allow the delivery of humanitarian assistance… and enable the rapid, safe and unhindered evacuation of all civilians who wish to leave”. But in reality, nothing has changed for the better. As the Syrian crisis enters its fourth year, realities like the scarcity of basic resources and sky-high inflation all powered by the political and military dynamics of this war, continue to dictate who receives assistance and who doesn’t.

“During one of the peaks of the siege, like animals, we were eating plant leaves. What do we eat now? Whatever we find, whatever is available. Today it is spinach or cauliflower, but tomorrow I don’t know. Things are only getting worse.”

In areas under siege, field hospitals and small medical points of varying capacities and resources are the only options for a trapped population. Some of the field hospitals have been established in abandoned buildings of governmental or private hospitals, but most have been set up in any building whose infrastructure was deemed able to withstand the constant shelling. Schools, factories, homes have all been transformed to field hospitals. In the logic of war, a field hospital is only as safe as its fortified basement; departments of the same facility are usually spread out across different buildings. When possible, some facilities are able to expand their activities to include specialties like ophthalmology, dentistry, obstetrics and even dialysis.

All hospitals in East Ghouta are running on generators, and the area has been cut off from central electricity and water provision for more than two years. One street recently started receiving government water once a week. Otherwise, for the overwhelming majority of residents, clean water is not an option; they have to manually draw untreated water from improvised wells that did not exist before.

The hospitals supported by MSF in Syria regularly have to contend with mass influxes of casualties due to bombing and shelling, the surge of internally displaced people as well as outbreaks of communicable diseases like measles. All of this while coming under almost constant fire. At least half of all the medical structures supported by MSF since 2012 have reported one or more incidents of targeted or indiscriminate violence. Hospitals – whether they are informally set up on kitchen tables or well-established government facilities – should be safe places for doctors to treat patients. Clearly, hospitals are increasingly drawn into the conflict where the provision of medical care is considered an act that challenges and defies the parties to the conflict. Health workers are assassinated and forced to operate under fire.

Although 2014 was a year that delivered three critical UN resolutions that were meant to resolve assistance blockages in Syria, the only change on the ground is a further deterioration in the humanitarian situation across most besieged areas. Meanwhile the aid system is bogged down in the absurd semantics of whether areas are ‘hard to reach’ or ‘besieged’ and whether ‘cross-border aid delivery’ is more effective than ‘cross frontline aid delivery’, once again emphasising the deadly consequences of borders in a region in turmoil.

The political complexity of the crisis is mirrored in the limited humanitarian response. The majority of aid that can be provided in Syria is provided in the bunkers on either side of this war. This means those who provide aid are affiliated with one side or the other depending on whether they are allowed to deliver their aid officially in Damascus or by crossing the border from neighbouring countries. The result is that both sides contest aid and not enough assistance is reaching all of those who need it.

This control of aid and use of siege as a tactic of war is not new, and it is not unique to the Syria war.

Turning off the taps in Yemen

Yemen is currently divided between the Iran backed Houthi movement, which controls substantial parts of the north and is advancing southwards, and the Saudi Arabia backed anti-Houthi coalition based mainly in the South. President Abd Rabbuh Mansur

Hadi of the transitional government, which was set up after widespread protests pushed previous President Ali Abdullah

Saleh to step down left Yemen at the end of March 2015 when the Saleh-supported Houthi consolidated their power in the capital Sanaa and moved to take the southern city of Aden. A coalition of Gulf States, supporting Hadi and led by Saudi Arabia, started airstrikes against the Houthis on the 27 March 2015.

During the war on Yemen the Saudi-led coalition imposed a blockade of vital imports, including food and fuel. The Saudi-coalition airstrikes devastated vital infrastructure including airports, seaports, roads, bridges, water tanks and gas stations. In Taiz, a fuel depot was hit on the 25 May by the bombing; resulting in over 200 burned people being transferred to one of the MSF supported hospitals.

In Yemen, without fuel – there is no water. In many cities water has to be drawn from deep wells, using pumps often powered by diesel fuel. MSF teams on the ground in Yemen surveyed the price of water in several areas of the city between March 2015 and the first week of May 2015 and found the price of water had on average more than doubled.

In addition to this, the lack of fuel made it extremely difficult for patients to move around. Most MSF patients would arrive at the hospital on foot. Many health facilities were forced to close when their generators ran out of fuel. The MSF emergency co-ordinator during the offensive pointed out that “The coalition and its allies must assume responsibility for the toll this military offensive is exacting on Yemen’s civilians now. And they must immediately lift the blockade on the essentials of life”.

In May 2015, the coalition announced it would target Yemen’s Saada Governorate. The coalition gave the inhabitants of the province four hours to leave. Llanos Ortiz, MSF medical co-ordinator in Yemen, reacted to the announcement by saying, “The bombing of civilian targets, with or without warning, is a serious violation of international humanitarian law. It is even more serious to target a whole province. It is impossible for the population of the entire province of Saada to leave within a few hours. Many people have neither vehicles nor fuel due to the coalition’s blockade. Many others have no access to information, as the phone networks are barely operational in the province. If the Coalition proceeds with the threat of bombing the province massively, many people will die under the bombs. We call on the coalition to avoid attacking civilian targets, especially hospitals and water distribution systems. There is also the risk of creating an exodus of thousands of people towards the mountains south of Saada, where humanitarian aid will not reach them in time. Together with the blockade, all airports in the country have been destroyed by coalition air strikes, which could provoke an even greater humanitarian disaster than the one we are already facing.”

An endless siege on an open-air prison

To understand the impact of a sustained siege one needs only to look at the Gaza strip that has been under Israeli military siege since 2007. In Gaza an entire population is trapped in what is essentially an open-air prison. They can’t leave and only the most limited supplies – essential for basic survival – are allowed to enter.

Gaza is one of the most densely populated parts of the world, with 1.8 million people living in the strip. “Since 2007, Israeli authorities have imposed a devastating land, air and sea blockade on the Gaza Strip, amounting to the illegal collective punishment of its 1.8 million Palestinian inhabitants. It leaves them isolated from the outside world, denied access to their own resources and facing a 45% unemployment rate.” Military boats have attacked Palestinian fishermen; Israel restricts Palestinian boats from three to six nautical miles from the shore; seaports have been attacked, as have airports; and fuel supplies have been blocked.

According to the ICRC, “[T]he social and economic situation of the population living in the Gaza Strip represents one of the most depressing sights in the region. Even though Israel has not had a permanent presence in Gaza since its official disengagement in 2005, it has in fact maintained effective control over the Strip and its borders since 1967. In addition, it has employed various coercive measures that continue to impede the Strip’s development. These closure measures have severely limited economic and social contacts with the West Bank, and undermined efforts to stabilise the social situation. They have also impeded efforts to build proper democratic institutions across areas under Palestinian administrative authority”

Limited humanitarian assistance is still allowed to enter Gaza and there is the possibility for an independent organisation like MSF to provide emergency care to the population – even though medical teams are often denied access. But the doors to the prison remain firmly locked in the sense that people are not able to flee, to find safety away from the immediate danger of a large scale offensive or a sustained siege. Everyone pays the price for living under siege and for their acts of resistance. Medical workers have been killed and health structures damaged.

The brutal siege on Gaza is largely maintained through the complicity of Europe and US as well as regional powers. And although European states are known to fund large parts of the humanitarian response to the crisis of occupation in Palestine and the effects of war in the broader region, they have done little to push for the lifting of siege or the freedom of movement of refugee populations.

Fortress Europe

The Middle East is experiencing both the historical repercussions of externally imposed borders as well as the imposed realities of siege as a tactic of warfare. Millions of people across the Middle East are refugees – Palestinians and Syrians are the two largest groups of refugees in the world. Many are hosted in neighbouring countries of Jordan, Lebanon and Turkey, where not only is assistance limited so too is the ability to get a job, live in a house and build a future. Those who try to find refuge outside of the region and in Europe, have to face the Mediterranean Sea and the policy made blockade on their ability to enter fortress Europe.

In May 2015, MSF launched a search and rescue programme in the Mediterranean in the absence of a willingness from European states to save the lives of people caught on boats in distress. This project came after 10 years of MSF response to the needs of migrants and refugees attempting to enter Europe. In launching the search and rescue project, MSF once again loudly called for European states to take their responsibility to provide search and rescue capacity and to provide safe alternatives for people to enter Europe without having to resort to smuggling networks.

Not only does Europe have a legal responsibility to provide such alternatives for refugees, but it also has a historical duty considering its role in contributing to the conditions from which refugees and migrants flee. But instead Europe announced the launch of a campaign targeting the smuggling networks and boats bringing refugees to European shores. MSF president Joanne Liu slammed the decision. “Based on our experiences of the past few weeks in rescuing thousands of people in distress at sea, we can only condemn the twisted logic of launching military operations against smugglers while still failing to provide legal alternatives – essentially entrapping and leaving stranded thousands of people in a life threatening situation in Libya, a country at war”.

The accumulative results of Europe’s history in the region – from Sykes Picot, to the war in Iraq and the ongoing support to the occupation of Palestine – combined with its current blockade on people trying to find safety in Europe, undermine its claim to promote and defend human rights.

As pointed out by the MSF president, “The cruel irony of this decision by Europe is that it has announced a war on the smuggling networks that have been created as a direct result of European states decisions to close their borders. The smugglers are just a symptom, the lack of safe and legal channels to Europe is the problem. And while a disproportionate attack is launched on the symptom of the problem and not its cause, the lives of people are put at danger in order to reinforce the walls around states that claim to project a human rights culture. The response from Europe to the existence of the abusive and exploitive smuggling networks should rather be to understand why they exist in the first place and what can be done to provide safe alternatives”.

The crackdown on refugees entering Europe is justified from some quarters as a part of a war on terror. The Egyptian ambassador to the UK warned Britain, “boats full of terrorists’ would enter Europe if action were not taken against the Islamic State in Libya. But this politically expedient argument was as disingenuous as it was dangerous. Fear mongering about refugees being ‘terrorists’ is a populist tactic to draw Europe into a conflict that it has in fact never left. In 2004, Tony Blair signed ‘the deal in the desert’ with Gaddafi that ended the Libyan leader’s international isolation and opened the door for Italy and other European states to discuss with Gaddafi on how to keep refugees out of Europe.

Border controls became outsourced to North Africa and migrants and refugees were kept in detention facilities in transit countries, including Libya. When Gaddafi fell out of favour in 2011, these same European states sponsored a Nato war for regime change in the guise of a ‘humanitarian’ intervention. It was immediately ensured that the new government respected the previous agreements signed by Gaddafi – who was painted as an irrational tyrant in all matters except in how he approached the question of refugees and migrants.

The humanitarian concerns of Nato did not extend to providing support for refugees attempting to enter Europe. Just as Gaddafi was considered a tyrant on all things except his refugee agreements, so too was Europe concerned with all things humanitarian except the refugees trying to reach their shores.

Since the Nato intervention, Libya has slowly descended into chaos, with multiple factions fighting for control of the oil fields all over the country. Filling the cracks in this chaos, the Islamic State has extended its reach into Libya. While Egypt has publically launched airstrikes on Libya following the mass execution of 21 Egyptians, which was claimed by supporters of IS, some European countries seem once again to be readying themselves for military intervention. However, at least part of the rationale seems to have always been the same: preventing refugees from entering Europe. While this remains the ultimate goal, ‘humanitarian’ concerns might again be used to justify military intervention and ‘terrorist threats’ are used to excuse the poor humanitarian response. Meanwhile, thousands more people fleeing conflict risk their lives to navigate the policy-made obstacle course to Europe.

Where to from here?

What do Saudi Arabia, Israel, the Syrian government, European states and IS all have in common? Each have used borders, both real and imagined – whether through military force or policy tools – to restrict the movement of people and to deny them the access they need to humanitarian assistance and protection.

For an organisation such as Médecins Sans Frontières, the notion of ‘san frontierism’ or ‘without borders’ – is increasingly about implementing a radical impartiality by responding to needs wherever they may occur and in defiance of the borders – both real and imagined – that result in people being denied access to life-saving assistance. It is for this reason that MSF’s medical act is in solidarity with those of our patients who are defying siege by crossing borders or by finding ways to survive in the most unimaginable conditions.

Governments and armed groups must exercise their responsibilities to ensure that people are able to flee to safety and that assistance is able to reach those who are trapped. In the context of the Middle East, this requires states to acknowledge the role they have played, and continue to play, in the conflicts of the region. It also requires those governments and armed actors in the region to assume the responsibilities for their actions under International Humanitarian Law. This might seem idealistic, but the alternative is continued chaos, decontextualised from its historical roots, and justified on the grounds of a never-ending ‘war on terror’. While governments and armies see ‘terrorists’, we see patients. DM

Photo: An armed Houthi supporter shouts anti-Saudi-US-Israel slogans and holds up a gun during a rally marking Al-Quds Day (Jerusalem Day) in Sana’a, Yemen, 10 July 2015. EPA/YAHYA ARHAB