Chapter 1 explains the initiation of the anthropological research in 2017, when the MSF programme in Amman entered its tenth year. Multiple questions about the patients’ wellbeing both in the hospital and after they returned home required answers. Simultaneously, the concept of a “patient-centred approach” was flourishing at MSF, and the RSP had declared it one of its main preoccupations. The chapter details the qualitative-research methodology used in my research. In-depth interviews with ninety-nine MSF staff members and seventy-four patients from Syria and Iraq were transcribed, coded, and analysed using a thematic-analysis approach. Furthermore, extended observations of participants both inside the MSF hospital and in patients’ homes, and internal MSF documents provided information used in the process of triangulation. I describe how my observations over the six months I spent in the RSP hospital grew out of my integrated position, embedded in the hospital microcosm. My constant presence there facilitated my formal and informal interaction with staff. The chapter concludes with reports from my fieldwork in Jordan and Iraq. My vantage point – inside the home countries and literally inside patients’ homes – gave me the unique opportunity to observe the intimate physical and social environments of my participants.
Chapter 4 looks at patients’ reflections on the care they received in the RSP, told years after being discharged from the hospital. Aside from reporting on programme strengths, particularly in providing a healing environment, patients shed light on the gaps that need to be addressed if the programme is to achieve its goal of delivering patient-centred care. The reader is presented with patients’ expressions of relief and gratitude for the care they received at the hospital. They describe beneficial aspects of the treatment that extend far beyond medical care, encompassing the relationships developed in the hospital setting. Furthermore, the chapter re-examines the notion of “unrealistic” patient expectations. When framed from the patients’ perspective, this notion appears flawed. In contrast to staff perceptions, the vast majority of patients report being fully satisfied with their treatment. For those patients who did express some degree of dissatisfaction with the programme, it was mostly related to a mismatch of priorities they have with the RSP. They spoke primarily about what they perceive as a neglect of the aesthetic dimension of care and the RSP’s emphasis on functional improvements. These perceptions highlighted gaps in the patient-centred approach and questioned the dominant assumption that functional outcomes alone improve patients’ lives.
The Introduction opens with a description of the book’s intent and my position as an anthropologist examining the humanitarian field. I introduce the story of one war victim – Ismael – who presents in microcosm the unique aspects of the patients in the MSF Reconstructive Surgery Programme (RSP). I go on to explore the invisibility of the war-wounded, especially those who have never participated in combat. The Introduction continues with a discussion on the delivery of humanitarian surgery, a specific field in the larger world of humanitarian aid. I touch briefly on the history of MSF surgical programmes and capture some of the history of MSF’s surgical practices, which go back to the very origins of the organization itself. RSP is a programme that reflects the cumulative MSF experience. The Introduction concludes with an in-depth description of MSF’s RSP in Amman, Jordan. Currently, patients in the RSP, who often sustain critical injuries years before they are admitted to the hospital, have various levels of disability or have lived with significant post-surgical complications. The Introduction explores several of the aspects that make the RSP unique. Among them are surgical procedures focused on functional improvements, the months and sometimes years-long rehabilitation undergone by patients away from their home countries, the scale of the programme, and the multi-disciplinary treatment provided.
being proposed. As a medical
anthropologist I would be given the unique opportunity to carry out
independent research centred on MSF’s ReconstructiveSurgeryProgramme (RSP) for the victims of war in the Middle East.
Working as an anthropologist in the humanitarian field, I
would be joining a group of authors who have critically examined
humanitarian practice, including those researching MSF. The