Moving forward: Responding to the climate emergency

Avril Benoît: 

Hey everyone. Welcome and thanks for joining us for this discussion series that we've been running all year called Moving Forward. It's a four parter running all year to explore how aid workers and humanitarians are tackling some of the world's biggest challenges today while preparing for future emergencies. My name is Avril Benoît, I'm the executive director of Doctors Without Borders joining you from New York City. And some of you might know us by our international name, the original French name, Médecins Sans Frontières, which brings us to the acronym that you will hear throughout the conversation today, MSF. 

So today we're going to be looking at how the climate emergency is affecting the people we help around the world. From the Sahel and Horn of Africa across South Asia, Central America, MSF is providing medical care to people who are already fleeing the effects of climate change. They are feeling it, they are sometimes forced to flee. There is environmental degradation where they live and where they've gone to. And today we're going to look at a few of the places where we as an aid organization are adapting our ways of working, our preparedness in the consideration of the environmental factors around us. So, we have some great experts with us today who can answer your questions and help us better understand what we have learned so far in doing this kind of work and adapting our medical humanitarian work to the impact of the climate crisis. 

So, before we get to all of that, the Q&A, here's how the webinar will work over the next 45 minutes or so. Wherever you're joining from, you can submit questions to our panelists live. If you're watching on Zoom, you'll see that you can submit questions and comments in the Q&A feature. And if you're watching on live stream via YouTube, LinkedIn, or Twitch, you can also send your questions into the comments or chat section. And there are also live captions if you want to follow along that way on all the channels. So, joining us today we have Dr. Ana Gabriela Gutierrez Zamudio, who is the MSF deputy medical coordinator joining us today from Mozambique where she's been working for many years. And Dr. Simba Tirima, he is MSF's country representative in Nigeria. So welcome to both of you. It's so great that you could connect with us today. 

Dr. Ana Gabriela Gutierrez Zamudio: 

Thank you, Avril, for the welcome. Nice to be here. 

Avril Benoît: 

It's good to see you. Yeah. Maybe you could describe a little bit the climate effects or the environmental situation where you are in Mozambique and the things that are concerning you there. 

Dr. Ana Gabriela Gutierrez Zamudio: 

Sure. Well, I'm currently in Mozambique as Avril has just said. Right now, in Maputo, the capital city, which is at the southern part of Mozambique. Mozambique is a very big country with a very long coast, and it has always had a tropical weather, very hot summers. Not that hot winters, but still hot. Rain season for more or less four to five months. And during the past years, Mozambique has been greatly affected, especially by extreme weather events like tropical storms and cyclones that we will discuss later for sure. But populations are for sure feeling the difference now and you can hear how people are talking about it, they can feel the difference of the weather as it used to be a few years ago now. 

Avril Benoît: 

Yeah. And there are also in Nigeria, many, many changes in the last decades. Maybe you can describe that for us, Simba, what are the climate issues you're facing there? 

Dr. Simba Tirima: 

Yeah, I've been in and out of Nigeria for 12 years now. So even within that period of time we've seen dramatic rainfall pattern disruptions that we did not expect at all as well as a conflict that is partially driven by climate change. We know... Well Nigeria struggles a tropical rain forest in the south and maybe you can say Sahelian sort of feel in the north. And we've seen that over a period of time, the  lifestyle has been greatly affected because pastures have been much, much drier for longer periods of time. And even when we get rainfall, it's a lot of it within a very short time. That actually of course coupled with the increase in population has completely threatened that lifestyle. And so, people who are  for the most part have turned into criminality as a way of survival. Kidnapping. And of course, the Libyan war did not help us much because now the proliferation of small arms is huge. So, you are talking about a very deadly situation now. People don't have access to their farms cause they're displaced. 

Of course, we know post pandemic shocks. Some people think, and I believe, the pandemic is not quite yet over. The grain speculation has really dramatically increased the prices of very necessary commodities. I'll give you an example. In 2020 around there, a stack of grain... And I've not worked how much that cost, costed about 16,000 naira. Today it's 40,000 naira. So, people cannot afford because again of post pandemic shocks or in speculations. Secondly of course, the fact that people don't have access to farming and markets have been disrupted again by the conflict. It's a very, very dire situation. We'll talk about that later. 

Avril Benoît: 

Yes. Well, we'll get into also how MSF positions itself as a medical organization when you've got so many economic political displacement shocks involved as repercussions of the climate impact. Take us a little more deeply into Mozambique then, Ana Gabriela. What is the impact on people's health of the climate crisis now? 

Dr. Ana Gabriela Gutierrez Zamudio: 

So, Mozambique is one of the poorest countries in the world and one of the most unequal countries. Approximately 64% of the population is living below the poverty line. So, let's say baseline, there are a lot of needs in the population, and this does not exclude help of course, but also Mozambique is one of the two countries in southern Africa and one of the 10 countries worldwide that are more at risk for extreme weather events. 

So, during the rainy system, we usually have cyclones and tropical storms. But as we already said, in the past years they have been intensifying. And this of course affects a lot of people, especially living nearby the coast now where there are metal destruction but also floodings that affect in long term the living ways of the people, but not only also in the more continental provinces of Mozambique they have been experiencing over the past year severe droughts. 

So, population that relies mainly in agriculture, as Dr. Simba was explaining in Nigeria is the same case. They are also affected by these changes. They used to have very clear patterns of rain and they would rely on that for agriculture. So also, Mozambique, it's highly endemic for many diseases. What I mean is that there are many diseases, especially infectious diseases that are present in Mozambique, mostly in the northern parts of Mozambique. And these diseases is what we can call vector transmitted diseases. So, there are diseases that need a vector or an intermediate, for example, an insect like the mosquito to be transmitted. We're talking about malaria for example, Dengue and other diseases like neglected tropical diseases. Some of you might have already heard about them. These kind of diseases are more prevalent in the tropical areas and they are neglected because they do not receive so much attention or financing as they do not pose an immediate threat to mortality. 

But they provoke disability, and this is extremely bothersome for the people. This diseases affect mostly the poorest people because they are secondary to a lack of access to clean water and sanitation. And these diseases that are transmitted by vectors are more likely to be affected by climate change. So, when there are differences in the patterns of rain, humidity, temperature, these vectors also get affected or get altered. And these diseases get more and more and more prevalent, affecting more and more and more people. So, as you can see there are so many factors on how Mozambique is very affected. 

Avril Benoît: 

Can you describe the project you're involved in, a very special program where MSF has created an adapted response? Given everything you've described, what makes it different? 

Dr. Ana Gabriela Gutierrez Zamudio: 

Yeah. So yes, indeed it's a very, very new project. We just started on January this year, but the medical operations just started three months ago and it's a project that has three main pillars, the medical, water and sanitation, and the community pillar. We are trying to provide care for populations suffering from severe malaria mainly. And some of these diseases I was mentioning, neglected tropical diseases. And we are also working to be able to be more prepared for attention to emergencies. These emergencies can be, as mentioned already, extreme weather events, but also outbreaks or epidemics. 

If you see these activities are not very different from the activities that MSF is doing in other parts of the world, or we have been doing for 50 years. I think the difference is the way of how we are looking at these problems. So, we are trying to see these problems as a whole. Not only the effect that they cause and the attention we can provide to mitigate that effect, but we are trying to focus more on the prevention, on the adaptations so that the populations can be more prepared and anticipation of some of these diseases. For example, doing more surveillance, implementing what are called early warning systems, systems that integrate climate and temperature information with epidemiological information and can predict an outbreak for example. So, we are trying to look at the same disease, the same problems, but in a different angle now basically we want, or we are looking at how can we best respond to the needs of tomorrow knowing that actually tomorrow is now. It's getting here. 

Avril Benoît: 

Absolutely. This is what you are describing. You're bearing witness to the realities of today. And so, Simba, to go a little more into what you're seeing in Nigeria, we do have questions starting to come in from those who are watching us live. First one is from Frieda watching on LinkedIn asking, "How do the climate challenges in your country in Nigeria impact how you organize and coordinate your work? How is MSF adapting its approach in Nigeria?" 

Dr. Simba Tirima: 

Of course, Nigeria is one of the largest country in terms of population in Africa, close to 250 million people. And MSF has been here on a continuous base since 1996 responding to the classic MSF diseases. Outbreaks of nteresting that a country like Nigeria still needs the world to come in terms of humanitarian aid while it really is of the largest economy in Africa, 422 billion US dollars during a pandemic situation. 

And therefore, really as MSF, we've been questioning ourselves, why in the world are we in Nigeria? While it's clearly hands down... The second largest economy is Egypt, followed by South Africa. I say this because in many ways it's quite a conundrum for many of us, but we still continue to do business as usual to respond. More nutrition, which is by far the largest programing we have all across all Nigeria. 

For example, in Katsina, and this we believe climate change is a big, big driver, we have 650 beds which are fully occupied with severe malnourished kids. In the northeast, we have over 350 beds. Now add cholera, add measles. So, I would say unfortunately that we haven't really reject the way we approach our programing, but there is an increasingly loud calling that there are a couple things that we need to do. 

We need to understand that some of the diseases that we see are exacerbated by global climate change and they will even get worse. So, what are we doing as MSF to rethink in terms of e-prep so that we are not only always running around, "Oh we have this. We don't know what to do." And we've seen this in particular, this. 

Avril Benoît: 

You used the language that we use internally, "e-prep" for emergency preparation. Preposition stocks or people or trainings and things that we would do in advance, in anticipation of a potential emergency.  

Dr. Simba Tirima: 

Yes, in our programming planning, we need to think ahead. What will the cholera situation be during... If you look at the increase in flooding in many places that we do not see at all. Because of this conflict that is driven partly and I'm thinking to a large extent by climate change. We know the corporates focus on malnutrition, vaccinations, all these preplanning and some of them can be prevented as well. 

But unfortunately, what we see globally, not only for MSF, is a space that is so crowded by the pandemic and the Russo Ukrainian war that also now is a threat. We have a real threat of a nuclear war. So somehow the priorities, because I don't think climate deniers anymore have an upper hand. It is clear that we have a problem with global warming, but the global space is so crowded, and I don't know, and we need to do a lot as MSF as well. The theology and German theology and Dietrich was healed by the Nazis once said, "Look, it is not enough to try and heal and soothe those people who are under the wheels of injustice. It is equally important to drive a spoke in that wheel." Sorry, maybe I'm going a bit too far, but of course I can answer questions as well later. 

It is important as an organization that is really... One of the hallmarks is-  

Dr. Simba Tirima: 

When we seek justice, we speak about it in the aim of driving a spoke in those fields of injustice. So, we have a long way to go, but I'm heartened to see even something like this that we are having a webinar which is forcing the discussion that it is as important to prepare ahead because of what we see. Also, it is equally important through our testimony to throw a spoke in those rules of injustice. Otherwise, history will judge us harshly. 

Avril Benoît: 

And that is a change, I must say. As somebody who's been with the organization for 16 years, one of the sticking points many years ago was the attribution. Yes, we all know that the climate change, global warming is going to be a driver of suffering, a compounding factor in suffering. But the suffering is multifaceted, it's layered, it's governance, it's economics, it's war, it's many, many things. And how can we know that climate change should be the message that we carry as MSF when we bear witness to what we are seeing in our medical projects? 

But it is definitely a change that we're much more comfortable to attribute the effects of the climate crisis as a driver of the work that we're doing in our operations. So that definitely is something that over the last three, four years or so, I definitely see us naming this much more clearly, openly, forcefully and trying to make our contribution as best we can, even though we're not experts necessarily in what the cops should be doing or what the policies should be to be what stops the wheel from continuing to turn in terms of the acceleration of the climate crisis. 

We have personal opinions but that's not our expertise. And so, the best way we can contribute is to bring to the fore what's happening in terms of people's health. So, let's go back into it and I just also want to encourage those who are watching to please put your questions into the comment or the chat or the Q&A depending on the platform you're using. Our guests are here to share their knowledge and their perspectives, and we'd also just love to hear what's on your mind with respect to this topic. Let's go back to Mozambique here because you've been talking to us, Ana Gabriela, about this special pilot project and you had mentioned earlier about an important aspect of this new model, a different way that we are working as Doctors Without Borders or MSF has much more of the capacity building in the community baked into the program design, much more of that collaborative approach. Describe what that looks like on a day-to-day level. What is the difference there? 

Dr. Ana Gabriela Gutierrez Zamudio: 

Sure. First maybe I can say that MSF has a long history of working in Mozambique. We have been here for nearly 30 years. So, we have always collaborated and worked with local authorities, health authorities. And they have always been very receptive of our work. And when we talk about planetary health or climate change and health, it's nothing new for them now. So, in general, the authorities have also started working in this sense now. It's not new. In 2017, the Ministry of Health together with the World Health Organization did a scientific study about climate change and health vulnerability and the impact on diarrhea and malaria disease. So, they started opening and building the ground for these topics. So, they are very much aware, constant and looking forward now. 

Within the structure, they have a platform for weather, environment, and health. And yes, you can see that at all levels they are ready for these discussions, these kind of interventions. And so, the collaboration has been quite, let's say, good and easy. 

If we go down to the community level, since we started the preparations for this new project, we always tried to involve the community. So here in Mozambique, most of the communities are already organized. They have different kind of community organizations like health committees or co-management committees, women committees, or different ones. And we have been trying to approach to them and to the local leaders so that we can as much as possible have the population as co-designers of the project now. We want to hear from them what are their needs and how can they be more prepared. So, this is a little bit of what we were discussing before, trying to be more adapted, more preventive. 

So instead, even of just giving mosquito nets, I will work with the community to understand first or... Yeah, to understand the way they see these diseases, the way they see the prevention of these diseases and that they can be better prepared now. So, in a day-to-day basis, our teams go to community, as I already said, we have a big community team. They go to the community, and they meet with all these different group's leaders. There are places where there is no already formal structure. So, they try to create, they try to involve as many different leaders as possible and have these regular discussions with them and then to centralize to the team and together with the local health authorities. 

At the same time, we are using, let's say, a different model of the way we work. We have our MSF mobile teams that go to all these different communities. We cover a full district with 11 health units, but our MSF team is not the one providing directly the care to the patients. So, we are providing support or technical support. We are implementing algorithms, flows, tests that the local health workers can use to provide this quality attention to the patients. So, we want to be closer, not only to the communities, but support as much as possible the local structures. And these will give also some sustainability that is part of this whole new approach or new way of seeing this kind of diseases. 

Avril Benoît: 

Yeah, it's definitely an evolution of things and we have different community-based approaches in all kinds of locations. And I'd love to take it back to you Simba, when you heard what Ana Gabriela was talking about, I saw a bit of a reaction on your face. What are you thinking when you hear of a project like this? Is something that you could maybe replicate or try in Nigeria, do you think? 

Dr. Simba Tirima: 

Well, it's music to my ears. Because our model has always been we go in there ourselves and do it directly, direct action, which is understandable. Increasingly, access is a big issue in Nigeria, cause of conflict. And in fact, in one of our projects we are doing remote management, which is very new to us in Nigeria. And there was a bit of resistance. But knowing MSF after a while we learned our lessons and actually. And so, I think we could borrow a big leaf from Mozambique. We have our Interdesk meeting in Dakar next week. 

I am going to bring this up. And I'd love to... Let's stay in touch. I want to glean as much from you because the practical reality on ground is either we don't have access to those patients, or they don't have access to us because the road to help is almost impossible. So that's why my reaction was really... It spoke exactly to what I was thinking. And let me say this also about MSF and why I'm in MSF. I'm an academic. Actually, my area is environmental health and environmental toxicology with philosophy. And I was poached, and MSF is good, in 2015. And something very attractive, something that I'd like to do. And then later on I saw the worthwhile presence in some of these places. Yes, we cannot stop the wheel of injustice. We can be a part of one of that spoke because God knows how many spokes need to be how long? I don't know. The world is the way it is. And so, a doc, thank you. I really, really appreciate. 

Avril Benoît: 

Well, I would like to also hear a little bit more about something that you mentioned earlier, Simba, you had said that the war in Ukraine was now influencing how aid is allocated, delivered, prioritized, how the international community, I guess, is responding to major crises including the climate crisis. And we do have a few questions coming in from those who are watching us live asking how the war in Ukraine is actually affecting the work that you think needs to be done in Nigeria and in Mozambique. So maybe we could start with you on that one. 

Dr. Simba Tirima: 

Yeah, of course. The space is really crowded. The debates and also the funding stream is very clear. 

Avril Benoît: 

Okay, so when you talk about space, you mean at the international dialogue? 

Dr. Simba Tirima: 

Yes. 

Avril Benoît: 

Meetings and things. Well, the UN General Assembly is going on right now in New York City and for sure they're talking about Ukraine as a major. 

Dr. Simba Tirima: 

Yes. I met the head of emergency, Griffiths, not too long ago when he was here for a short time. He said, "I'm literally going around with a begging bowl to even raise a fraction of the money that should be addressing humanitarian needs around the world." It's falling om deaf years. A few countries, very interesting, the US has responded dramatically on the needs around the north, the Horn of Africa with a very swift response of 1.3 billion because really the needs are real there. But that's very specific. 

But generally speaking, the world is not looking. The donors not looking very vividly. And so, my response then is, look, we have to face a reality. We have what we have. How can we most effectively utilize that? One of the things that doc talks about is this model that reduces a very heavy footprint of international aid workers and surgically really work with the communities. And in many ways also becomes sustainable. So anyway, we have to live with that reality. That's how things are. Yeah. 

Avril Benoît: 

It's always a bit of a struggle. And here we are talking about the climate emergency and how it's affecting people's health. But the question of the Ukraine war, and also if I can just jump to another question, actually, Ana Gabriela, coming in from Dominique on Zoom, says they're struck by the recent testimonies of people having survived the catastrophic flooding in Pakistan. People are hesitant to return home if policy changes aren't made to protect them from future natural disasters and just an ongoing experience of losing their homes and having everything covered in mud even when the water recedes. So, I'd like to put Dominique's question to you, Ana Gabriela, what do you think are the priorities or strategies for humanitarian advocacy in the face of the climate emergencies? How can we contribute toward addressing the problems at the larger global level when what we are seeing is very specific on the ground? Like what you see in Mozambique? 

Dr. Ana Gabriela Gutierrez Zamudio: 

Well, I think it's a quite broad question and subject. I think all these effects of climate change we are seeing and the way the health systems are getting affected by it now because we as Doctors Without Borders, we are medical organizations. So, we are looking at the impact on health now. And if we look on this impact on the health systems, I think mainly we will need to adapt. We need to find a way to adapt to these changing and especially growing needs. Knowing that there are these countries that are more vulnerable to these kind of extreme weather events, for example. Either it's high rains and tropical storms but also, they are also part of these extreme weather events now. So, we will have to focus our efforts in trying to find those places, evaluate which are the most prone, the most likely to get this kind of severe events and to see how can we support in adapting the health systems to the growing needs. 

Because they are going to grow in not only in quantity. People are going to need them more and more and more, but also maybe the needs are going to be different now. So, they need to get adapted. We need to work more in what we were previously discussing in the prevention, the surveillance to set up strategies, and to build capacity to be more prepared. Basically, health systems need to transform. They need to become more sustainable. They need to be more resilient and population themself also need to be more aware. Now we need to talk more about this problems until the community level. They need to be aware of the risks, they need to be aware of how can they be prepared, which kind of activities allow them to be more flexible in terms of mobility, for example. And in terms of health, which kind of things are essential, even if population needs to mobilize, how can they maintain their health in the meantime until they can receive our humanitarian medical attention or medical attention already from the system in place. 

Avril Benoît: 

You have actually anticipated a question that we had received from somebody ahead of the event through Event Bright. We had one from Abigail during the registration asking us, "Can you explain how climate change is going to affect the healthcare system as a whole?" And you're saying sustainable, resilient... We said this about the pandemic as well, that these were some of the lessons of the pandemic. Do you have anything to add on that, Simba, when you are thinking of the health system as a whole in Nigeria for example, what do you think needs to change in order to meet the needs of those affected by the climate crisis? 

Dr. Simba Tirima: 

First and foremost, the healthcare system in Nigeria is appalling. There was a budget declaration amongst all African countries at one point that nation states should spend at least 15% of their GDP or annual budget in healthcare. One of the few countries that has been successful in that is Rwanda. Nigeria spends less than 3.7% on healthcare. So, the health system is, I think, teetering on the brink of collapse, let me say. And I don't say that lightly because what we see is that without interventions from externals- 

Avril Benoît: 

Like us. 

Dr. Simba Tirima: 

Yes. Yeah. Imagine 650 beds in just one location. 

Avril Benoît: 

In the malnutrition center for the children. 

Dr. Simba Tirima: 

Yes. 650. And it's completely overwhelmed. These are the only lucky ones who make it to these facilities, whether it's the northeast, whether it's in the northwest. So, in terms of healthcare systems' resilience, I don't see that working very well. Now I will not give it up completely because Nigeria responded very well to the Ebola problem because I think it threatened the rich, the poor, whoever. 

I'll tell you a very interesting story. I was traversing through one of the areas where they don't know MSF at all. So, the border officials stopped us, and they say, "Where are you going? Who are you? No, we need to see all these things. Yeah, what do you do? Blah blah blah." And I just casually, and I didn't mean it to have an impact, I said, "We also deal with Ebola." 

Let me tell you, that public official jumped I don't know how many meters and said, "Let them go. Don't go near to them." It's something that was a real threat to everybody. And healthcare in Nigeria really always favors the rich people. We saw during the pandemic, they propped up our facilities just like that and immediately aimed at addressing the pandemic, especially the rich and the powerful were not allowed to travel abroad for treatment. 

So, I'm concerned about that and of course we are not here to change the system, but we believe also that MSF has a very powerful voice. We don't condemn anybody, but we say you can do better. We are no longer here. It doesn't help anybody to condemn at all. And in some aspects, we've seen some very, very slight move on that needle. And so, I cannot again over emphasize what MSF is doing in Mozambique as a model that creates a real partnership and says, "Okay, we know you don't have all your ducks in a row. We know that there are things that you can do." And we saw that actually during the lead poisoning outbreak they mobilized resources that I'd never could have imagined that Nigeria would. 

Avril Benoît: 

And this is the lead poisoning in Nigeria from the artisanal gold mining? 

Dr. Simba Tirima: 

Gold mining, yeah. And that's actually- 

Avril Benoît: 

-were exposed to high levels of lead, making them sick and killing them. And MSF came in and responded to that with a quite a lot of help putting together a coalition to try to respond. But it's true that we all can improve, and we all have things that we're trying to do better all the time. 

And of course, with our organization, globally speaking Médecins Sans Frontières, MSF, we are not only responding to the medical burden of the climate crisis and changing our ways of working and our ways of discussing the topic and of bringing this into those global advocacy spaces where we can offer our firsthand experience, but we're also looking at our own carbon footprint because that seems to be the least, we can do. Not just our carbon footprint, but also the impact of all of our operations in everything from the procurement to the flights, to how we ship things from here to there, implementing solar panels and greener technologies for waste management. And everything that we can look into, we are considering and beginning to roll out and have been doing so for the last few years. And even our offices are trying to monitor our contribution to the carbon emissions and try to minimize both. So, we're trying to approach it from different angles. 

But as we come to the end of our time here on this special program with you discussing the climate crisis and the impact on global health, if I could ask you both one last question that has come through. Just reflect a little bit on the uneven burden of those who are most affected by climate change, especially the increasing number of displaced people around the world. They are in lower income countries, often they are in countries that are already burdened by many other issues. How do you see this inequity impacting the needs of our patients in the future? Maybe just a few final words on that and rouse us to action. We'll start with you, Ana Gabriela. 

Dr. Ana Gabriela Gutierrez Zamudio: 

Well, I think just to wrap it up, we have already said that in the terms that the poorest people in the world are the most affected by this kind of problems. Not only the ones related to climate change, many of the diseases because of lack of water, lack of sanitation, lack of very basic human needs, that on top, when we put these differences or this climate change, when we put the changes secondary to it, this gap is just growing and growing. 

So, it's the right moment to continue working because we have just began adapting ourselves. I strongly believe that this change or this adaptation comes from the individual. No, it goes from the individual to the group, all communities, organizations, and we have all a part of it. So, if we don't try our best in whenever we are, whatever we work, whichever activity we do, we are just supporting or not doing anything for this gap to become wider and wider. 

Avril Benoît: 

And for you, Simba? 

Dr. Simba Tirima: 

Yeah. While really things at the moment look big. I am heartened to see that there are very many young female global climate justice individuals really pushing the world. In fact, we invited one of them in one of our MSF... We call it cafes. One of the beautiful things about MSF is that we bring the debate to ourselves, and we bring people also to challenge of who we are, what we are, why we're doing whatever we're doing. 

Well, people can call them Twitter warriors or whatever, they have a group of platforms. Greta is doing a great job. But these young and mostly female activists are just doing a great job. And you see them everywhere, including big global forum. They were at the core - are making very powerful statements. I think these are people that we should encourage as MSF, continue to work with them and to see how we can support them. Not with maybe more standards, but also clinical data is showing certain trends that are very, very disturbing. 

They need that information. They need to go out and say, "Listen, we have actors on ground, and this is ironclad evidence, clinical evidence that's happening." And as for us as a movement, we believe injustice anywhere is a threat to justice everywhere. And we need to continue amping our voice and being less shy of, "Oh, we are not this, we are not that." No. We witness many things that we don't have a hundred percent evidence, but we have indicators. So, this is happening, and this is unjust. The very who are saying what they experienced are the least contributory factors to the problem that we see. So, thank you so much. This is just a - For me, it's heartening too. 

Avril Benoît: 

And I think I speak for all of us who are listening to the two of you just wanting to express our appreciation to you and the teams for the work you're doing and really hoping that we can hear of your work even more in the future. So, thank you so much. 

Dr. Ana Gabriela Gutierrez Zamudio, she is MSF's Deputy Medical Coordinator in Mozambique. And Dr. Simba Tirima, MSF Country Representative in Nigeria. Fascinating discussion. Thanks to all of you for joining us and contributing your questions. 

Our next webinar in this series that we're doing is Thursday, November 3rd. We will be bearing witness with communities caught in crisis. So, this work that we do of not only medical action but also speaking out. So, thanks to all of you for joining us. Apologies if we didn't get to your question, stay in touch so you can email us anytime event.rsvp@newyork.msf.org. And for more information, of course, come to our website, doctorswithoutborders.org and the international one is msf.org. You can find out all the news about us on the various social media channels, Twitter, Facebook, Instagram, and all the rest. And from all of us, I'm Avril Benoît, wishing you a great day. Thanks a lot. Take care.