Emergency: people at the centre
Arunn Jegan is the advocacy coordinator at Médecins Sans Frontières Australia and has previously worked as a head of mission and emergency coordinator.
Arunn has been with MSF since 2016, having done nine field placements in Bangladesh, Yemen, Syria, Venezuela, South Sudan and Tajikistan.
What was your path to applying with Médecins Sans Frontières?
I first encountered Médecins Sans Frontières as a teenager during the Sri Lankan Civil War. It was after the ceasefire agreement, and NGOs were able to operate in Tamil-controlled areas.
Médecins Sans Frontières was supporting surgical care and mother and child healthcare in Kilinochchi, where there was high mortality due to malnutrition, and a lot of people with war wounds including from all the landmines in the area. They later made the decision to withdraw from Tamil-controlled areas after a directive from the government.
Years later while working with another organisation in the Syrian war, I saw the Médecins Sans Frontières E-team (emergency team) going to all lengths to gain access to people needing care. That really inspired me.
In Sri Lanka, it had become a war without witnesses— as humanitarian organisations and others withdrew, Tamils didn’t have anyone to speak out with us on the atrocities we experienced.
The role of NGOs in supporting witnessing and protection of populations during conflict is vital.
You later joined the E-team—how did you make the transition?
I had to prove myself! I enrolled in a ‘horizontal integration program’, for heads of missions, or country representatives, coming from other organisations to go directly into project coordination roles with Médecins Sans Frontières.
In 2017 I was sent to the Kamrangirchar project in Dhaka, Bangladesh, and when Rohingya people began streaming over the border from Myanmar in August, fleeing a violent military campaign, I joined the E-team in Cox’s Bazar to help coordinate that response.
What skills are in your emergency response toolkit?
Good leadership in an emergency looks like keeping teams centered around the needs of the patients and communities. You can have every issue pop up, from trauma injuries to a disease outbreak, and you need to prioritise where to put your resources.
It’s also essential to coordinate well with other responders, to ensure Médecins Sans Frontières is filling appropriate gaps and not working in a siloed approach. Even in an emergency setting, you need to do community engagement, to build trust with the people and to understand local health-seeking behaviours to shape your response. It’s often overlooked, because of the idea that people need things immediately.
Even in emergencies, we still need to ensure our services are fit for purpose for the people who are going to use them.
One example is a maternity hospital we built in the Cox’s Bazar refugee camps in 2018. Almost no patients came to that hospital in the first months because we hadn’t properly understood the community’s ways of seeking care.
You were just back in Cox’s Bazar for the third time. How has the context there changed since 2017?
I’ve had the opportunity to see how the situation has developed, how Médecins Sans Frontières’ decisions have affected our patients, and now—five years on— how we can do better for them. We are running a huge program in Cox’s Bazar, providing maternity services, water and sanitation, mental healthcare and more, alongside other responders.
But as a stateless people, and one that has been subjected to decades of violence and persecution, the Rohingya will have no real solution to their suffering until they can access resettlement, safe and voluntary repatriation, or
integration. That’s where Medecins Sans Frontieres’ work advocating and influencing systemic change for the Rohingya is important. As well as fighting the everyday ‘fires’, it’s essential for the teams to stay connected to a bigger vision of our work with the community, and that’s been a large part of my role.
Could you share your advice for anyone starting out?
Keep the patients at the forefront in all your decision-making.
Take your time—both in building your experience before jumping into Médecins Sans Frontières work and, later, in understanding the people you’re working with and the culture and systems of the context you’re in.
Trust in the wisdom of the local staff in a project, who have been there long before, and will be there long after, you.
And lastly, I’d say that perfection is the enemy of the good in most cases; if you have the right process and involve whole teams in your decision-making, this will safeguard against many mistakes.
What feels important for you in humanitarian work right now?
We have the climate crisis drawing down upon us, 29 countries facing cholera with a shortage of vaccines to protect against it, complex crises like Ukraine, and the global pandemic is still here.
There’s a huge strain on resources as we enter a period of economic recession, and the health situation is changing because of these different factors.
I think amongst all of this, and big global (political and media) agendas, Médecins Sans Frontières has a challenge to remain true to our core purpose: providing lifesaving healthcare for communities in low-resource settings, often in forgotten crises, where our impact is very important.
Aside from this, we must decolonise humanitarian aid work. This means acknowledging the colonial legacies of our system and shifting power and resources, and it starts with me/us.