Although the Geneva Conventions have been successively revised since 1864, norms regarding the protection of medical care have been frequently disregarded. Despite current claims of international humanitarian law in crisis, comparing historic levels of violations with contemporary incidents is quantitatively challenging. Reviewing past reactions and justifications used by perpetrators of attacks on medical care can, however, be revealing.

In December 1899 Honolulu-based physicians attributed two deaths to bubonic plague, and a local paper duly announced that the ‘scourge of the Orient’ had arrived. Within months a first plague fatality was reported in continental U.S. as Chinese-American Chick Gin (Wing Chung Ging or Wong Chut King depending on the transliteration) succumbed to the disease in San Francisco. The cause of death was based on a classic plague symptom of swelling around the groin, but was disputed even after rudimentary bacterial analysis.

Knowing about the discussions in progress at Médecins Sans Frontières, as well as the actions it intends to implement to adapt to climate change, provides precious insight. Though they speak in their own names, the five authors – from the Swiss and Canadian sections – say a lot about the ongoing debates within the movement, about the actions taken and about the possibilities for procrastination. Lessons that apply to the entire humanitarian community.

Reaching drug users in urban contexts is as much a challenge as it is a social and health requirement. In Maputo, the capital of Mozambique, Médecins Sans Frontières has developed a medical approach adapted to a population at high risk, stigmatised and criminalised.