Pat Breen (Clare, Fine Gael)
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I remind members and those in the Gallery to ensure that their mobile phones are completely switched off for the duration of the meeting. This is because they cause interference with the recording equipment, even when switched to silent mode. I would appreciate it if people would co-operate, particularly as some interference has been caused by mobile phones at recent meetings.

The main business of the meeting is to discuss the humanitarian work in Syria of Médecins Sans Frontières. I am delighted to welcome Professor Paul McMaster, chairman of Médecins Sans Frontières UK, and Ms Jane-Ann McKenna, head of the Dublin office of Médecins Sans Frontières. Professor McMaster has had a long and distinguished career in medical surgery. He joined Médecins Sans Frontières in 2004. He has undertaken emergency surgical work in disaster and conflict settings across the world. He recently returned from Syria and is here today to talk about his experience in delivering emergency medical assistance there, where conditions must be horrific. Ms McKenna is well known to all of us and she addressed the committee in September last in respect of the situation in the region of South Kordofan and the Blue Nile. Ms McKenna also briefed us on the work in which Médecins Sans Frontierès is involved in Syria.

The committee has taken a particular interest in Syria and members remain determined to do what they can to ensure that the dreadful events there remain in the public eye. We have prioritised matters relating to Syria at our regular sessions with the Tánaiste and Minister for Foreign Affairs and Trade in respect of EU Foreign Affairs Council meetings. We have placed particular emphasis on the need to continue contributing to humanitarian relief efforts. It is disturbing to note that the recent intensification in the conflict in Syria, which has already cost an estimated 40,000 people their lives. The risk of the conflict spilling over Syria's borders and leading to neighbouring states being drawn into it remains very high. This makes it all the more essential that political progress be made, especially in consolidating the unity of the opposition groups in Syria. However, the prospects remain somewhat bleak at this stage and it is difficult to be optimistic. Above all else, this conflict is a terrible human tragedy for the world and for the region in general. In the absence of political progress being made, the humanitarian response becomes even more important. We wish to focus our deliberations today on the humanitarian situation in Syria, where Professor McMaster recently spent five weeks attending to the wounded. He has, therefore, visited the front line in a number of areas in Syria.

Before I ask Professor McMaster and Ms McKenna to make their presentations, I wish to advise them that they are protected by absolute privilege in respect of any utterances they make before this committee. If, however, they are directed to cease making remarks on a particular matter and they continue to so do, they will be entitled thereafter only to a qualified privilege in respect of their remarks.

They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person, persons or an entity by name or in such a way as to make him, her or it identifiable.

I call on Ms McKenna to make the introduction and Dr. McMaster will follow.

Ms Jane-Ann McKenna:

I thank the Chairman and members for inviting Dr. McMaster and me to appear before it. As Deputy Pat Breen mentioned, I made a presentation to the committee last September. Members will be familiar with the work of Médecins Sans Frontières and the places in which we intervene. As the crisis in Syria intensifies daily, humanitarian needs in Syria and surrounding countries are increasing significantly. Many people have been killed and wounded and hundreds of thousands displaced, leaving behind everything they own. Medical and humanitarian assistance in Syria is very limited and aid from international organisations, including Médecins Sans Frontières, has been extremely restricted. Médecins Sans Frontières has strengthened its response to the refugees who are flowing across Syrian borders to neighbouring countries such as Lebanon, Jordan, Turkey and Iraq. In spite of an increase in its activities, Médecins Sans Frontières's response is and remains limited in terms of the range and scale of needs involved. We are very keen to try to do more.

My colleague, Dr. McMaster, will give an account of his recent work in Syria.

Professor Paul McMaster:

I thank the Chairman and members for their generosity and allowing me to come before the joint committee. It is difficult to know what to say, although my role in Médecins Sans Frontières during the years has been in devising strategy, management and preparation. I went into the field as a simple surgeon to help the teams working in it. One of the things I have learned is that one loses sight of the big picture when one is stuck in a cave performing surgery for five weeks. Ms McKenna is the person with a broader view of the problem.

I have been in many settings, but I do not think I have been anywhere that has felt so oppressive for the people. We are running clandestine operations in Syria because we have not been able to access all of the areas we wish to. We are dealing with civilians wounded in bombings and by rockets. As members may know, many have fled to the camps in Turkey, Lebanon, Jordan and Iraq, in which areas Médecins Sans Frontières, MSF, is working hard.

I have seen a devastated population. Civilians in the north west of Syria where three of the surgical field teams are working are living in basements, usually in buildings that have been bombed. There has been no electricity in the area for eight or nine months and winter is coming fast. Before I left a few weeks ago, it was extremely cold at night and I can only imagine that conditions will become very difficult. The only cooking facility in a basement is an open camp fire in the middle of the floor. They burn wood and rooms fill up with smoke. As a consequence, the children are wheezing and access to medication is limited. Médecins Sans Frontières is trying very hard to get medication to the few medics who are still there.

I come from the field as an angry doctor, which is not really what members want to hear. My anxiety is caused by reports from colleagues who have been able to get into the east of the country, to which I did not go, which suggest the needs there are every bit as great as what I experienced. The field teams feel humbled by the inadequacy of what we have been able to do in the country and we are fearful of what the winter will mean for the people and what the future will bring. We are immensely grateful, however, for the interest and support given to Médecins Sans Frontières Ireland in the past.

Pat Breen (Clare, Fine Gael)
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I thank Dr. McMaster. What are the worst injuries he has seen and are the medics able to cope with the limited resources available?

Professor Paul McMaster:

Nearly 80% of the wounded with whom the surgical teams are dealing are civilians. However, we see young fighters with gunshot wounds. The injuries of civilians are largely inflicted in bomb and rocket attacks. The system in the area I was in is that helicopters drop what are called barrel bombs loaded with explosives and fine shrapnel. They explode over a wide area and women and children are being caught in the midst of them. We have been presented with babies with shrapnel wounds which are not medically life threatening but deeply distressing and disturbing for the family. The team I was supporting was working in a cave, which became untenable because of the bombing. We then moved to a chicken farm - that is progress - which we were converting rapidly to an emergency field hospital. There we started to see many more members of the general population who had run out of medication to treat blood pressure, diabetes and asthma and were struggling to gain access to basic health care. I performed Caesarian sections and other emergency obstetrics procedures. I took out a tooth for a person with an abscess as there was no dental service available to the community. Although many had fled, I was truthfully surprised by how many were still there. It tends to be the old who cannot or will not leaves their homes, the women and the children who stay. We were seeing fighters and predominantly treating their gunshot wounds. Although it was very rudimentary, we were using an inflatable operating theatre inside the cave. Some of the other teams have more sophisticated facilities. We were able to perform basic war surgery and treated many hundreds of patients. In general, we cannot evacuate our patients; we must care for them where they are, although I hear some are able to cross the border. It is a challenging environment, medically and surgically. For me, as a grandparent, I find it most difficult to see the wounded children and babies. Médecins Sans Frontières is not a political but a medical organisation. We want to access any area in which people are struggling. It is hard to treat children and babies who have been injured in these circumstances.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I, too, welcome Dr. McMaster and Ms McKenna. We can read reports and briefing documents, but their vivid recollections of the awful challenges and difficulties facing courageous people such as they and their colleagues in delivering a service in difficult circumstances give us a picture of the awful problems facing so many in Syria. It appears that there has been a further escalation of the conflict rather than an easing of the problems faced.

Ms McKenna has mentioned the hundreds of thousands being displaced. I saw a figure that 2 million people had been displaced. I should know the answer, but I do not know what is the population of Syria and the percentage 2 million people represent. Dr. McMaster recounted the effects of having no electricity for eight or nine months. Here, if some people are without an essential utility for an hour or more, they seem lost. It was an understatement to say it was challenging to have to try to deliver a medical service in very trying circumstances. It is an really picture.

My understanding is the United Nations evacuated non-essential staff and that the European Union closed its delegation offices in Damascus. That gives a picture of the difficulties facing organisations and agencies in trying to deliver a service to those who need assistance.

The OSCE plenary session was held in Dublin last week. The US Secretary of State, Hilary Clinton, met some key players. The Syrian situation is terrible and very worrying. More than 2 million people are displaced. There is an ongoing displacement of hundreds of thousands of people within the country. I extend to the organisation my sincere appreciation for the work done by the delegates and all their colleagues and also the work of sister organisations, in such trying circumstances.

Ms Jane-Ann McKenna:

I will do my best to answer the questions from members. The humanitarian situation within Syria is extremely complex. The UN and EU have pulled their staff out of the country. For more than 18 months, MSF has been involved in ongoing negotiations with the Syrian authorities in order to be able to work within the areas controlled by them. As Dr. Paul McMaster said, we are only working in opposition-held areas. There is a clandestine air to the operation. We have informed the authorities that we are there. They know we are there but they still have not given us permission to be there. From our perspective it is an extremely insecure position in which to work. Only yesterday, we publicised a region in eastern Syria which is further removed from the focus which is mostly on the western front. The eastern area is vast and it has no assistance whatsoever. In a town of 300,000 people, only 50,000 remain there. They are under constant attack. It was even too dangerous for us to set up our operation there. This is only one example of a number of places in Syria where no one knows what is the current situation. No one has any idea of the severity of the situation nor the number of civilians caught up in this type of conflict.

Professor Paul McMaster:

Perhaps Ms McKenna is glaring at me. The teams on the ground are very angry. We are not able to do enough. We are very worried about the people we cannot reach. We encourage all parties to create a safer environment in those critical areas. It is not for us to judge how that is achieved, although some of us have quite strong views, as the members can imagine. We have reports of colleagues who have gone into areas and found 50,000 people. I can just close my eyes and imagine what it will be like for those people this winter, even aside from the conflict around them. We are very anxious to get access to those areas and very anxious to work in all areas in Syria where people are in distress. That is our only remit.

Maureen O'Sullivan (Dublin Central, Independent)
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We are all in awe and are full of admiration for people who knowingly and willingly put themselves in physical danger in order to do the job they know needs to be done. So many situations are at the mercy of the media. I do not think the media are giving Syria the attention it deserves. This is certainly the case with regard to the humanitarian aspects of the conflict. We hear about the political situation but not about the humanitarian situation. We are at the mercy of the media as to what they choose to report.

I have a question about how the organisation plans to access the other areas of Syria. Is there some hope that it will be possible to do so? I refer to the psychological distress suffered by children. Physical care is the priority but the psychological effects are equally if not more demanding and the organisation does not have those resources. What are the conditions in the camps on the Syrian border? Some countries are concerned about them. I am particularly interested in the Kurdish issue. Some refugees have fled to Iraq. Are these Kurdish Syrians in the main? A group of doctors told the committee about the issue of getting medical supplies. They were looking for the support of the committee and the Department of Foreign Affairs and Trade to help them get the supplies to where they are most needed. They did not suggest that the Red Crescent was not a neutral organisation but some civilians are afraid to avail of those services. I understand the delegates may be limited in what they can say.

Professor Paul McMaster:

I will first comment on the psychological distress. We in MSF have strong opinions about this. We have mental health officers, psychologists and even psychiatrists. We are doing significant work in the camps in Lebanon in this particular health area. I am sure we will need to scale up that work as time goes by. What we have learned in other conflicts over the years is that, as Deputy O'Sullivan says, the immediate physical impact is clear but the long-term distress to these youngsters is immeasurable. We need to support the Syrians to help them to help their children. It is very difficult for us to help because of culture and communication issues. The real heroes in this situation are the Syrian medics and nurses who have stayed behind and who continue battling day in, day out. Our task is to support them.

I reiterate that MSF takes psychological distress seriously. We still run a clinic in Haiti and in one or two other post-disaster conflict areas because in the long term that distress will have the bigger impact than the immediate injury.

Ms Jane-Ann McKenna:

On the question about the Syrian Red Crescent, the majority of the aid distributed through that organisation is distributed in the areas controlled by the Syrian Government. A number of months ago we sent medical supplies through the Syrian Red Crescent. We have received confirmation that these supplies reached the intended hospital. Apart from that, we do not have much to say about the Red Crescent because MSF does not work alongside it. We are not working in the same areas. Therefore, it is very difficult to comment on the activities of the Red Crescent. I believe it is now working in co-operation with a number of other organisations to try to deliver assistance in those areas.

MSF has a presence in a camp which is in the Kurdish region of Iraq. I am not certain of the ethnicity of those Syrian refugees who have gone to that camp. We provide basic health care and psychological consultations in that camp.

Professor Paul McMaster:

Access is a major challenge for us. The teams in some parts are literally walking over the hills to get into the country, sometimes crossing the border at night. In other areas they have been able to negotiate access with Turkish authorities and the local militia. The question of how to maintain our service is a real anxiety to us as this winter approaches. We will be redoubling our efforts to negotiate secure access for our materials. Surgery is very demanding on materials. We need to support the teams in every way we can but it is a real worry.

Bernard Durkan (Kildare North, Fine Gael)
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Like other speakers I welcome our guests. I thank them for their attendance and for giving us their views and insights on the conflict areas. Dr. McMaster referred to the anger of the people in the field, which is understandable. Unfortunately, anger does not solve the problem either. The committee needs to pick the brains of the delegates as to how best we can assist from outside, with a view to focusing on the areas where assistance is most likely to have an impact. MSF has worked in many conflict areas such as in Somalia and DRC, for example. We can encourage the international community to take various initiatives.

From our own visits to the field, it is the magnitude of the problem that strikes us immediately on setting foot in such a place. We had particularly tragic experiences in Somalia and Bosnia in the western Balkans. What in Professor McMaster's opinion could we do that would be for the best?

I note that in recent days the authorities in the United States have recognised the opposition in Syria. What impact is this likely to have? Would an international arms embargo be of any help? I do not know if it would because people seem to be able to circumnavigate them and continue their activities.

What about the concept of a safe haven which, unfortunately, failed in Bosnia? I do not know how successful it might be in Syria, but it is a possibility.

What about the role that could be played by the United Nations? We know the difficulties around which it has worked in the past. It does not have the heavy artillery required to frighten people in a conflict. Even without intervention, its presence is not sufficiently authoritative to intimidate, for want of a better description, the opposing forces.

What does Professor McMaster think should be done having regard to his experiences in the area? How can we influence the international community in a way that will be of positive assistance to his organisation?

Pat Breen (Clare, Fine Gael)
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Some of those questions may be a little political for Professor McMaster to deal with, but he might do his best.

Professor Paul McMaster:

I was hoping the Deputy would tell me the answers to those questions. He is right that anger gained in the field does not solve problems. I normally wear another hat in headquarters, but I come here very much as a field doctor. A medical organisation needs to be very careful in these situations. I was in Somalia for six months where I saw the best efforts come to very little. I have worked in the Democratic Republic of Congo and various other spots and it was extremely difficult. It is very important that we look to people with wide experience who are involved in the wider dimension in Geneva and elsewhere. What I say to the Deputy from a medical and humanitarian point of view is that we look to the international community to do all it can to facilitate access to medical care. That is the plea I make. There are ways of doing this and different models; in some areas one is more likely to be successful, but as humanitarians, we press the international community to do this. Ireland will shortly hold the Presidency of the European Union and I know with its generous history of support of humanitarian action, that it will consider this option.

On a personal level, I am almost more worried about the peace rather than the fighting in Syria. I do not want to be misunderstood, but when one listens to the people there, they say they are going to win the war and when one asks what will happen then, there is silence. I encourage members to use their wisdom and experience to look at the peace model. We have been in Sudan for 13 or 14 years and my fear is that if we are not very careful, we could be in Syria for a long number of years unless folk can find a way to ensure peace means real peace for all Syrians. I know I have not answered the Deputy's questions, but-----

Bernard Durkan (Kildare North, Fine Gael)
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Professor McMaster focused on the issues involved.

Professor Paul McMaster:

I hope, if time permits, the Deputy will share with me some of the visions he has.

Ms Jane-Ann McKenna:

As Professor McMaster mentioned, from our perspective, it is important to increase the areas we can cover and access to get independent humanitarian aid to those who need it. The most vulnerable are the people who have been left behind in towns and villages and they usually are the elderly and younger children. It is those who will be most affected this winter.

Eric Byrne (Dublin South Central, Labour)
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The delegates are very welcome. We welcomed a delegation from Doctors Without Borders previously. It will not do the delegates' cause much good to simply express our congratulations and admiration for their work and tell them they are walking saints, but we do applaud their work. Having said that, we must come to terms with what can we do. Deputy Maureen O'Sullivan has mentioned that a delegation of medical personnel from Syria has come before us previously to plead with us to release medical equipment and appliances to them in the field. They were disappointed that the Irish State would not release equipment to them as "fighters" or people involved in the struggle. However, we made an extra special fund available to the United Nations or one of the agencies recognised as a reliable funding channel.

Do the delegates' organisation receive any funding made available by Irish Aid? If we were to plead with the Minister concerned to provide further support for Doctors Without Borders, are the delegates preparing themselves should that happen? I understand scud missiles are being dropped and that there is a huge international fear that chemical weapons might be used. Is the delegates' organisation being pre-emptive in that respect? Have they examined the possibility that they will require appliances, equipment or medicines in the event that there is chemical warfare?

Professor Paul McMaster:

I will respond first and Ms McKenna might then comment.

Médecins Sans Frontières, in general, has been immensely appreciative of the support the Government has given through Irish Aid, but we would not come to members looking for support in any conflict country in which we are engaged. The safety of our personnel on the ground is based on everyone seeing them as neutral, impartial and apoliltical. That means that in countries in which Médecins Sans Frontières works where there is significant conflict we do not accept funding from any institution, whether it be the DFID, ECHO or the United Nations. We use funds very generously given by individuals across the world. I repeat that we are immensely grateful for the support Irish Aid has been able to give for vaccinations against TB, malaria and cholera and without that help we could not have done so much, but in our work in conflict areas such as in Somalia, Syria and Afghanistan, Médecins Sans Frontières will not ask for or accept support from any institution. That allows us to use the jargon that our organisation is neutral and impartial. This allows our medics to say the medical needs of a community are A, B and C. They can say: "Paul McMaster, sort yourself out medically to deliver it." We will not be influenced by the Syrian authorities. If they say we can do this and that and our medical teams do not say is the priority, we will not do it. Neither will we be influenced by the fighters who say they want us to do this or that. We are there to support the civilians caught up in the midst of the conflict, as people are in places such as Syria. I ask Ms McKenna to forgive me if that is not the right answer, but I want to say how generous people in this country have been and we hope this will continue in the future. We would not ask members for support for Syria because the safety of people on the ground can only be based on it being understood they are neutral and impartial. Whatever views the teams may hold privately, they are not ones espoused by the organisation.

Ms Jane-Ann McKenna:

We have had many discussions with the members' colleagues in Irish Aid on this issue. Unfortunately, on previous occasions, for example, in our work in Somalia, we had to turn down offers of assistance. It was not a reflection on Irish Aid as a donor, it was more of a policy decision. As we are primarily funded by private donors, 85% of our funding comes from private donors, which gives us a level of flexibility and comfort to adhere to these principles, particularly in conflict settings.

The scale of our operations is very narrow. We are supplying a network of doctors. I know the representatives of the group mentioned and spoke to them many months ago to collaborate with them on the doctors with whom they were working in Syria. We have a network of individuals, locals on the ground, on all sides whom we are supplying with relevant medical supplies.

For us, this is not necessarily an issue about capacity and having adequate medical supplies, it is more a case of being able to ensure we can continue to get such supplies into the country, particularly as winter is approaching, and transport them to where they are needed. We had four hospitals up to one week ago, but one of them had to be shut down because circumstances had become too dangerous. The situation was very precarious and we were obliged to remove one of our teams. However, we are continually trying to go to new areas such as the town in eastern Syria to which I refer in order to assess the situation and discover whether it would be feasible for us to set up temporary hospitals.

Pat Breen (Clare, Fine Gael)
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I thank Ms McKenna. I call Senator David Norris.

Eric Byrne (Dublin South Central, Labour)
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I wish to ask a supplementary question-----

Pat Breen (Clare, Fine Gael)
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I am obliged to allow all members to contribute. I will return to the Deputy.

David Norris (Independent)
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I echo what my colleagues said. Like them, I am filled with admiration for the work our guests do. Professor McMaster seems to be of the view that being angry is inappropriate. Anger is a highly appropriate emotion, but it depends on how one directs one's anger. Professor McMaster does not come across as being angry, although I accept that there may be a touch of Swiftian saeva indignatio about him. Both of our guests come across as being extraordinarily balanced, rational and level headed.

The name Médecins Sans Frontières says it all. Our guests referred to access. If there is any way the committee can assist on a diplomatic level, I am sure it will do so. We will make that one of our primary points in our communications with the Tánaiste, Deputy Eamon Gilmore, who will take a leading role when Ireland holds the Presidency of the European Union in the new year. We should place particular emphasis on the need for access.

I am struck by the fact that Médecins Sans Frontières uses inflatable operating theatres. I was not aware of that fact. Professor McMaster described working in a cave which was dusty and difficult to access but in which was to be found a perfectly functioning hospital. I presume the use of inflatable operating theatres allows the organisation to respond quickly and in awkward situations.

I wish to ask a number of questions, some of which have been posed, but I am not sure that they were answered. Médecins Sans Frontières has adopted the admirable position of not being political; it maintains a disconnection - or disinfection - from political aspects in so far as that is possible, and is neutral, etc. Does this permit it to make records of violations of international and human rights protocols and compile lists relating to the use of prohibited or illegal munitions such as white phosphorus, cluster bombs, flechettes and other examples of the machinery of war, or is the organisation of the view that doing so would involve straying into political territory? From my point of view, information in this regard would be highly useful. Some of my colleagues referred briefly to the possibility of chemical warfare occurring. I understand a strong political warning has been issued by the European Union and the United States to the effect that there will be certain unspecified consequences if chemical weapons are used. It has been stated Scud missiles are already being used. I think some may have been fired at the city to which Ms McKenna referred and the population of which has been reduced from 300,000 to 50,000. That must be appalling. Given that the targeting systems for Scud missiles are so imprecise - at least they were in the past, but they may have improved enormously since we last came across them - I presume the intention behind their use is for them to have a psychological impact rather than anything else.

I was very impressed to read the information supplied on a particular family. There were two women and a small baby involved. The women were hysterical and the child had shrapnel wounds which appeared to be superficial and certainly not life-threatening. What caused the women to be so upset was the helicopters hovering overhead and dropping devices containing shrapnel.

I wish to pose a couple of questions which are political in nature and intended to elicit answers in respect of how we can help. I suggest we push the idea of access which appears to lie at the heart of the ethos of Médecins Sans Frontières. It also appears to be at the core of the practical difficulties the organisation is encountering in Syria. Is it in a position to advise the committee or the world at large on the use of prohibited weapons, particularly chemical weapons, or is it obliged to avert its gaze from such matters?

Professor Paul McMaster:

I have the highest respect for politicians who grapple with some of the biggest problems in very difficult circumstances. I would not want to disinfect this in any way. Our strength is that we are medics in a medical organisation. We become nervous when we step into areas in which we do not have expertise.

David Norris (Independent)
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The organisation's stance is admirable.

Professor Paul McMaster:

What we try to do is provide the very best care we can for those in the most unstable condition and who are most vulnerable. It is frequently the case in warfare that there are rumours and accusations. I have experienced this in Sri Lanka, Somalia and Afghanistan. It is often stated truth is the first casualty of war. When I was in the field, I heard concerns being expressed. Médecins Sans Frontières' role is to look carefully at the condition and injuries of our patients. Should we see a pattern which gives rise to concern, we would be anxious to raise the matter with the appropriate authorities. My medical colleagues who are operating on the ground in Syria have seen no evidence of weapons that fall outside the normally accepted conventions. The Senator used another term to describe them.

David Norris (Independent)
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Prohibited munitions.

Professor Paul McMaster:

Yes. My medical colleagues and their teams have not seen evidence of their use. However, they have heard the rumours.

One of Médecins Sans Frontières' strengths is that its volunteers who come from many countries, including Ireland, can scale up very quickly. Our medical teams have thought a great deal about what might happen in Syria and about how we might respond. I will say no more than that for now. Our task is to be able to respond to the medical needs of the people of Syria. We have given careful thought to what those needs might be.

Michael Mullins (Fine Gael)
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I welcome our guests. I express my admiration for the tremendous work done by the organisation they represent. We can only imagine what the people of Syria are experiencing. This places our own problems and difficulties with budgetary issues in perspective, particularly when one thinks of children living in camps, wheezing, burning wood to warm themselves and without access to electricity, when a very severe winter is approaching. A previous speaker inquired as to what the committee might do. Médecins Sans Frontières has issued a statement to the effect that it has not yet received authorisation from the authorities in Syria to work there in an official capacity. Has progress been made in this regard or is such authorisation likely to issue in the near future?

Reference was made to funding and the fact that, in the main, Médecins Sans Frontières only accepted funding from individuals. How adequate is the funding it is able to raise in covering its requirements in the current crisis? Would it have the necessary manpower on the ground to deliver additional services if extra funding was to become available? Will our guests indicate what we might do to best assist their organisation? Our Presidency of the European Union for the first six months of next year will I hope provide us with a platform to help the people of Syria and assist Médecins Sans Frontières in addressing some of the issues under discussion.

As Deputy Maureen O'Sullivan indicated, what is really remarkable is the lack of media coverage of this matter. Very few people in this country are aware of the horrific crisis and tremendous challenges with which the people in north-west Syria are trying to deal. As Christmas approaches, everyone here is spending a great deal of money on unnecessary things. We would all be well advised to consider where there is real poverty and where the real challenges are to be found in the world. We should pay particular attention to the plight of the people for whom Médecins Sans Frontières is trying to provide some hope.

When I heard MSF had its operating theatres underground in caves, I could not visualise the success rate one could have in such facilities. The fact that there is an inflatable facility is helping. Are the delegates satisfied with the facilities they have available? How can they hope to improve their circumstances?

Professor Paul McMaster:

Doctors are never satisfied with what they have, as I am sure is the case in this country.

Michael Mullins (Fine Gael)
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In Ireland we believe we have a good medical system, yet there are crises or circumstances where we are not happy.

Professor Paul McMaster:

I probably should not say this, but the inflatable facilities are fantastic. We can move them very quickly and the logistics teams are stunning in their ability to do so. If I had a slight grumble, it would be that if our inflatable operating theatre were to leak slowly, it would gently descend and my anaesthetist would tell me I had 20 minutes in which to finish the procedure. I exaggerate slightly. We can gain access very quickly and create adequate facilities to perform major war surgery. It is not complex neurosurgery or major thoracic surgery, but it is life-saving and prevents the infective complications that so often arise.

People ask me why on earth I, as a retired surgeon, do what I do. They say I see the worst of some parts of the world. However, I also see the very best. That young people from Ireland volunteer, in a difficult time, to work in places that are uncomfortable, at best, and very dangerous gives great hope. That individuals will, in difficult circumstances, give funding to us offers great hope for the world. It is a great privilege to work with and help young teams.

MSF can call on hundreds of volunteers if it must scale up rapidly. There are always contingency plans in the background. If we believed we were being restricted financially, we would consider urgently our priorities and ensure we released sufficient resources to allow emergency teams to be deployed. We will not be inhibited by a lack of funds. If this means we must make appeals to the general public, we will do so.

During the years MSF has developed techniques that allow it to respond to emergencies such as the effects of a tsunami or an earthquake, as in Haiti, if necessary. Part of the problem is public awareness. At Christmas time people do not want to watch the horrors of Syria on television. I do not want to do so with my grandchildren either. Members and their committees can play a valuable role in drawing attention to the circumstances that obtain and I remain optimistic that we can respond. If access becomes available, we will be in the conflict zone with alacrity. We have the capacity to do to so owing to very generous and committed young people in this country and mine.

Michael Mullins (Fine Gael)
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With regard to access and official recognition, what are the prospects?

Ms Jane-Ann McKenna:

Last June we deployed teams on the ground clandestinely. Once we are set up for a couple of months, we inform the authorities of our presence. I refer to opposition-held areas primarily. Until approximately two weeks ago, we were having discussions with the authorities in Damascus on gaining access. As yet, we have not seen further developments regarding what we can do on the ground. It is still proving to be very difficult. My office, in addition to the international organisation, does not take sides in the conflict. We do not necessarily want to work on just one side. There are civilians caught up in the conflict on both sides. Our objective is to try to work where there is a need. However, we are very conscious of the fact that we are working on only one side of the conflict.

David Norris (Independent)
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Both of our distinguished guests have spoken about our usefulness in drawing the attention of the Irish people to the conflict. This is difficult in the complete absence of the media. There is no media presence here today, about which we should be really worried. The conflict is a stark humanitarian situation and there is a political powder keg that could blow up in our faces, with disastrous consequences. Even from a humanitarian perspective, I would have believed the stories being brought to us and documented would have been of some interest to the media. However, there is absolutely no media presence.

Pat Breen (Clare, Fine Gael)
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I hope "Oireachtas Report" will transmit some of today's proceedings. That would be important for us.

David Norris (Independent)
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I would not hold my breath; it does not often do so.

Pat Breen (Clare, Fine Gael)
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Those who have seen the documentary "Access to the Danger Zone" will have seen MSF volunteers and doctors from a number of countries. What are the dangers staff face when working? The documentary showed that a number of doctors were kidnapped. Their location was unknown at the time in question and there was no request for a ransom. Have there been casualties in Syria or other areas of operation recently?

Bernard Durkan (Kildare North, Fine Gael)
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What is the best way to protect MSF personnel in war zones? What is the most appropriate means of securing their position and defending the people in their care?

Pat Breen (Clare, Fine Gael)
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Could the documentary be made available to members at some stage? It is a great account of the bravery of the personnel and shows how they work in very difficult and hostile circumstances.

Professor Paul McMaster:

We take the safety of our international and national staff immensely seriously. There is one incident - a major security incident - in our movement per week somewhere in the world, be it in the Democratic Republic of Congo or the Central African Republic. Incidents can be relatively minor such as the robbing of a car or the loss of equipment or very major. We take great steps to try to protect the safety of all our staff, particularly our national staff. The protection is provided by the people with whom we are working, the population around us. They understand what we are doing and warn us about certain areas that we should not enter or about where there has been a incident. They advise us. Our security and safety depend on the support of the populations with whom we work. Sadly, we sometimes pay a high price. We lost two of our international staff in Somalia last Christmas. I am sorry to report that we have not managed to secure the release of two women who were kidnapped in Somalia over one year ago. We brief very strongly our staff who go to the field, but we are very open with them about the fact that in some of our projects, although not all, there is a high level of risk. We have individuals in our organisation who examine the security situation very carefully. That obviously involves a political dimension. It is a great privilege to work with young people who are prepared to take risks. They believe they will sort out the world and will not settle for the mess I have left behind for them. They may be a little naive, but my task is to help to facilitate them.

Ms Jane-Ann McKenna:

On the security element, particularly in Syria but also in a number of other conflict areas in which we work, we are very conscious of separating the military and humanitarian elements of conflict.

A distinct separation is crucial to being able to deliver humanitarian aid to people on the ground. We have found that if there is military intervention in the delivery of aid, aid can become a target in conflict settings. The independence of that aid is crucial to being able to provide assistance to those who need it most.

As Professor McMaster mentioned, it is a question of being able to talk with every side. Going in and making sure that all parties to a conflict are fully aware of our independence, what we are doing and that we are not there for any political reason is our greatest source of security and protection. We are taking a large risk in Syria, as we are not authorised to be there.

Bernard Durkan (Kildare North, Fine Gael)
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Have there been instances in which the organisation’s presence in an area, albeit for positive and genuine reasons, has been used by either side in a conflict as a shield to cover up their atrocities or proposals?

Professor Paul McMaster:

Wherever we are in the world, someone does not want us there.

Bernard Durkan (Kildare North, Fine Gael)
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Exactly.

Professor Paul McMaster:

We always tell our teams that, if it is easy, we should not be there and that, if everyone wants us there, it is time for us to go home. The locals, be they militia or M23, have agendas in which they want to involve us. I understand that my responses to the Deputy’s question may seem naive, but we must take this approach. We must do all that we can to ensure that we are not being manipulated. We do not succeed in every situation, as shown by Rwanda and so forth, but we try desperately hard. For this reason, we make what I am sure sounds to the Deputy like a naive and artificial separation in the real world. I do not need to tell him that many of the world’s militaries now claim to deliver humanitarian aid. The boundaries are rapidly blurring.

In countries where we get into trouble, it is usually owed to a breakdown in people’s understanding of who we are and what we are doing. For this reason, young people are vital. They can look at me and wonder what I am, but it is obvious what a 33 year old Irish nurse working in the Congo is, namely, a young humanitarian worker.

Pat Breen (Clare, Fine Gael)
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There are no further questions. Will the documentary be screened shortly?

Ms Jane-Ann McKenna:

As far as I am aware, we have pitched it to the Dublin film festival and are waiting to hear back before we screen it again. I would be happy to share it with the committee, but I need to check with our communications manager.

Pat Breen (Clare, Fine Gael)
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Seeing it would be worthwhile. I will take this opportunity to thank Professor McMaster and Ms McKenna for meeting us. We have had a frank, open and interesting discussion on the Syrian situation. The committee will continue to focus on Syria. In particular, we will continue to ensure that, in our discussions with the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore, Ireland maintains its commitment and support to humanitarian relief. During the Irish Presidency of the EU, we will put to the fore of our discussions with the Tánaiste the question of the protection of people such as our guests who work on the front line.

Professor Paul McMaster:

I thank the committee for allowing us to present today.

Pat Breen (Clare, Fine Gael)
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Is it agreed to suspend the meeting for two minutes? Agreed.