8/18/2019 Violence Policy Revision.ocba-2011 En

1/3

  1

December 2010

OCBA Policy Paper: Response for Victims of Violence

1. Genesis:Over the past few years, MSF OCBA has attempted to come to terms with the different patterns of conflicts and theassociated violence.1 The analysis of these trends has identified a need for OCBA operations to adjust from a limited

intention to assist victims of conflict-related violence towards a more open ambition to respond to victims of violence-related phenomena.

Heightened awareness of the humanitarian consequences of various forms of violence has led to a steady increase in MSFaction for victims of violence beyond the habitual scope of war surgery and response to displacement. Noted investment has been made in psychological care for violence related trauma and comprehensive care for victims of sexual violence.

In OCBA, there is a confluence of this heightened awareness and an increasing presence in contexts where violence, ofdiverse nature, is a leading cause of morbi-mortality and displacement. One welcome effect of all of this is a wide range ofinterest and initiatives from various missions to respond to diverse consequences of violence. This means more projects orcomponents geared towards victims of different types of violence in different kinds of settings.

The wide variety of interventions feeds and extends awareness leading to debate and questioning. This creates a desirablereflection on our willingness to assist populations affected by a wide range of violence, on our ability to access populationsmost affected by violence, on what approach is more adequate to meet their needs, on how to improve the quality of ourresponse, on when and for how long our response is most relevant, and a long list of other relevant questions and challenges.

Recognising this continued momentum, acknowledging the new patterns mentioned above, and capitalising on the recent

reflection and debate, a newly revised violence policy is formed.

This policy addresses the wide parameters of interventions for victims of violence. It is not a how-to guideline and does notaddress our ability to access populations most affected by violence nor the quality of our interventions (except by virtue of itsdispersion-limiting effects). It does not substitute case-by-case analysis of our own operational capacity, securityconsiderations or specific contextual factors such as timing and location.

2. Approach and parameters:

The policy’s modest approach is to facilitate the operational route from conception to action. The policy outlines the criteriathat might justify an intervention and provides a list of the most frequently encountered consequences and humanitarianneeds that are most consistent with our identity and specificity.

2  By identifying -again based on identity and specificity- the

most appropriate actions for these needs it helps us to determine the scope of the intervention in question.

When contemplating new interventions3, action must be conceived from beginning to end with defined expectations of

achievable results and outcomes for the population. The beginning should be defined by the justification criteria noted belowand the end is defined by either an improvement/change for the affected population in one or more of these criteria or an endto the violent phenomena in the context. According to this, all interventions should have a defined beginning and end, and aretherefore of temporary nature.

Justification for engagement includes the following criteria:

1.  The magnitude in quantity or nature of the violence & medical-humanitarian impact on the population is significant.4 

2.  The violence perpetrated  is of an organized nature. Organization implies some or all of the following characteristics:

violent actors / perpetrators acting in a collective manner with centralized leadership; are potential “political” actors; have

some level of control of population; are known or can be identified; and engagement may be possible if needed.3.  That the current system5 in place does not have the capacity to respond to the consequences, is unwilling to respond to the

consequences, or is in itself a / the threat to the population.

 NOTE: Preconditions for MSF intervention  access to the victims; security (threshold of acceptable risks); capacity of theorganization, and MSF added value

1 For practical reasons, and assuming the risk of oversimplification, we have limited this exercise to situations of physical violence, as opposed to conceptssuch as moral or structural violence. In contemplating different “violence” definitions (1) rough or injurious physical force, action or treatment ; (2)unjust or unwarranted exertion of force or power , we will submit to the former more than the latter in prioritizing our direct humanitarian assistance.

2  For example, a frequent misunderstanding is that MSF assumes responsibility for the protection of populations. Though protection (physical, legal, fiscal

or other) is a need frequently encountered among and/or expressed by populations we assist, it is not and cannot form a part of our direct assistance.Protection is a legitimate concern for which we are compelled to advocate in many cases; while its provision is clearly the mandate of other actors (e.g.

states, security forces, UNHCR, etc).3  Beyond contemplation of new interventions, it is important to understand that in ongoing projects not conceived for victims of violence, the appropriateactions for specific needs should be considered for any victim of violence. In some cases a high prevalence of these needs may justify the introduction of

new components or an evolution of project design 4  Magnitude of the violence should be based on the concept of proportionality including prevalence and incidence measurements. 5  In this context, the “system” refers to Government institutions, community resources, local coping mechanisms, aid groups, etc. 

8/18/2019 Violence Policy Revision.ocba-2011 En

2/3

  2

3. MSF Interventions in response to violence: New interventions might respond to different types of violence, ranging from armed conflict to organized crime, which mayhave a range of distinct patterns of causalities and consequences. We must therefore analyze both causality of the violenceand consequences on the population and adapt appropriate strategies to maximize improvements for the affected population

with direct assistance and advocacy. The direct assistance and advocacy will prioritize the immediate (direct) consequencesof the violence in a holistic manner. However, interventions and programs will be defined in order to provide assistance for

 both immediate and complementary consequences to populations directly and indirectly affected by the violence, thusincreasing the impact of MSF presence.

The following tables are a reference for identifying6

:1.  Direct consequences and needs of victims of violence2.  Indirect consequences and needs of victims of violence

3.  Actions appropriate for victims of violence encountered

Direct medical and humanitarian consequences:7 

  Wounds by fire arms or explosives (including shrapnel) requiring surgery or that can be treated without surgery  Blade wounds  Contusions

  Burns  Purposeful physical mutilations  STI/ HIV infection  Post traumatic disorders 

Displacement   No access to basic services including health services

  Loss of shelter   No / precarious access to land/food   No / precarious access to water and sanitation facilities  Loss of coping mechanisms   No / limited freedom of movement  Exclusion of the health system due to perceived affiliations or ethnical background

Indirect medical and humanitarian consequences:8 

•  Lack/precarious access to health assistance due to non-functional health systems, lack of qualified medical staff and

medical supplies

 

Access constraints to reach basic services  Generalized fear  Food insecurity  Low vaccination coverage  High maternal and child mortality rates

MSF action considered:9 

  Emergency health care (OPD/IPD)  Surgery (especially war wounds, emergency obstetrics and other emergency procedures)  Sexual violence package  Trauma related psychological support  Water and sanitation

 

Emergency nutritional services  Food distributions (blanket)   NFI distribution, including shelter  Advocacy/lobby  Provision of basic health services (through hospital, decentralized structures, and/or mobile support) which should

include at least:

-  Mental health support-  Under 5 medical care (OPD & IPD) including EPI and nutritional support)-  Women’s health package including emergency obstetric care

  Establishment / improved referral systems

6  These tables are necessarily an oversimplification of very complex realities. However, in order to prioritize, we consider it adequate to make a distinction

 between different types of effects of the violence in a population. 7  The list included here is a broad scope of consequences of violence but is by no means meant to be exhaustive.8  The list included here is a broad scope of consequences of violence but is by no means meant to be exhaustive.9  This checklist is to ensure that the essentials are contemplated when formulating a response to needs generated by violence. There is no universal

“minimum package.” These should also be considered “a la carte” for victims of violence seeking assistance in existing programs. Further, the identified

needs merit due consideration whether or not they are generated by violence. 

8/18/2019 Violence Policy Revision.ocba-2011 En

3/3

  3

Policy:

In contemplating the consequences of violence for a given population, MSF-OCBA will prioritise interventions for

those affected by violence;

That has significant magnitude in terms of medical-humanitarian consequences in the identified context10;

  That is organized in nature; “organized” violence implies: violence due to armed conflict; violence due to

political, ethnic or religious persecution; and certain forms of violence due to organized crime / banditry. The

concept of “organized violence” does not include individual acts of violence such as domestic violence.

  That is insufficiently, or not responded to, by the actors responsible for / in charge of providing basic services and

assistance to the population.

NOTE: MSF will not consider a priori specific interventions for victims of domestic violence. YET always consider

specific case-by-case assistance for victims of any kind of violence encountered in ongoing healthcare

programmes.

Preconditions for MSF intervention   access to the victims; security threshold of acceptable risks; capacity of theorganization to respond, and MSF added value 

10 Magnitude of the violence should be based on the concept of proportionality including prevalence and incidence measurements.