In early september 2015, I submitted my resumé to the Toronto office of Médecins Sans Frontières. Not long after, the NGO’s hospital in Kunduz, Afghanistan, was attacked. The international humanitarian-aid organization deploys in areas marred by conflict and disaster, and it had been targeted in the past. On this occasion, US forces killed forty-two medical staff and patients and injured more than thirty others via bombs and bullets sent from a warplane. It was the deadliest attack the medical organization had suffered from a Western government, and MSF general director Christopher Stokes quickly dismissed the United States’s “fog of war” excuse. Not long after, MSF-supported hospitals in Homs, Syria, were bombed by Syrian forces, and two facilities in Yemen were targeted by members of the Saudi Arabia–led coalition. In each case, many were killed and hundreds were left without access to medical aid. These attacks horrified me. They also served as reminders of why I wanted to work for the organization in the first place.

My interest in MSF began in 1984, when I was fifteen. From the yellow couch in my family’s home in Oakville, Ontario, I watched news coverage of the famine in Ethiopia. Against a backdrop of hollowed faces crawling with flies and thin-legged children running after grain-delivery trucks, white-coated doctors working with MSF made pleas for governments around the world to intervene. These images roused in me a nascent political consciousness, and my passion was strengthened a year later, when the organization announced that it had been expelled from Ethiopia for speaking out against President Mengistu Haile Mariam’s forced resettlement of hundreds of thousands of people from the antigovernment north to the government-controlled south—an action that cost thousands of lives. I had the impression that MSF workers were the rock stars of the NGO world. It’s an impression that stuck with me as I grew older and fuelled my decades long dream to join them.

When I submitted my application to MSF, I was wrapping up my job as senior manager of official languages at the 2015 Toronto Pan and Parapan American Games. I am not a doctor—I applied to the role of finance-HR-admin manager in the hopes of using my skills to support the organization’s essential work in the field.

Founded by French doctors and journalists in 1971 as a response to the Biafran War, MSF, also known as Doctors Without Borders, has been the poster child for humanitarian do-goodism ever since. The organization has provided medical aid to millions of refugees and internally displaced peoples. It has stemmed tides of malnutrition and epidemics and coordinated massive inoculation campaigns under seemingly impossible conditions. For these efforts, the organization won the Nobel Peace Prize in 1999. Today, the non-profit has approximately 8,000 international workers who are sent to seventy-two countries around the world, where they work alongside 38,000 national staff members. To fund this massive effort, MSF raises huge sums of money—more than 1.5 billion euros in 2017 alone—though it remains resolute in its political neutrality and pursuit of unearmarked funding.

I knew all about MSF’s history and accomplishments, and I saw myself as one of their “type”—a risk-taking idealist. When I went for my interview, my recruiter asked me why I wanted to work with the organization. I gave the predictable answer: “Because I want to make a difference.” The response seemed to make him nervous. He deliberated, then rolled his chair back a few inches and looked me in the eyes.

“Okay,” he said, “but you know we’re not really about saving the world, right?”

Msf’s orientation program, called Welcome Days, quickly disabuses one of any naive assumptions about life in the field. The purpose of the intense two-day session I attended at the Toronto office in November 2015 was to help shape “realistic expectations” about our future roles.

My cohort was made up of about two dozen people from across the country, a mix of medical and nonmedical personnel. None of us were youngsters. The organization seems to recognize that life experience and level-headedness are good indicators of success in working conditions where compassion and calm are in high demand.

On the first day, I met Anna (whose name has been changed to protect her privacy), a psychologist from Toronto who sat at the table beside mine. She was in her early thirties and appeared to be the youngest of our group. Her smile was infectious, but the questions she asked of our instructors were sobering. She was itching for adventure and a new context in which to apply her skills. I liked her immediately.

During our daylong sessions, we learned about MSF’s charter principles of neutrality from all political, economic, or religious powers. We discussed operational protocols and the mental and physical challenges that we might encounter on missions. During our security session, we discussed how to behave in the event of a compound breach, a carjacking, and a kidnapping.

“Don’t run,” warned our security trainer, a tall, thin man with rebellious brown hair. “Most kidnappers are nervous, so don’t make them more jumpy then they already are. They’re more likely to kill you if you run.” “Oh,” he added, “and make sure you fill out your proof-of-life form. It has questions on it that no one else knows the answers to. This way we’ll know you’re alive when we make contact with your kidnappers.”

A Vancouver emergency nurse who was heading to Pakistan right after training raised her hand. “Wait, I’m supposed to fill out a form while I’m blindfolded in a trunk?”

We all laughed—the forms are typically filled out and submitted as a precaution before a mission starts—but it was evident from the look on her face that she had said it in earnest.

The trainer assured us that MSF has a host of negotiating protocols that it relies on should such an event come to pass. “We’ll negotiate,” he said, “as long as there is someone willing to negotiate with.”

“Jesus,” I whispered.

As an organization, MSF deftly navigates the tension between personal risk and societal reward, and it requires the same of its staff. It’s common for MSF staff to come down with malaria, and many have suffered the effects of one parasite or another. Then there are the less quantifiable injuries, including the psychological effects of fieldwork. Staff are expected to work six days a week—long days that often go until around eight at night. And the work is draining: MSF teams can be small, their resources are tight, and the need that they see can feel endless.

At the end of Welcome Days, my group stood proudly behind MSF’s legendary red-and-white flag for a photo. Anna and I arranged to meet for coffee the following week, and as I made my way to leave, I expressed my excitement to one of our trainers. “Well, you’ll either love it or you’ll hate it,” she said, grinning.

Illustration by Clay Rodery

Then came the wait for a posting. Missions tend to be six- to twelve-month commitments, and I had to stand by until I was needed on a project. I began binge watching MSF YouTube videos from the Central African Republic and South Sudan, which showed staff responding coolly to the horrors of conflicts, epidemics, and droughts. I wondered whether I had the requisite mettle.

My family was proud of my new job. “That’s really amazing, Mom!” said my daughter, who had spent one summer working for the Canadian Coast Guard and had her eye on a career in wilderness search and rescue. My son was more reserved when we spoke over Skype. He asked a lot of questions, including about how quickly MSF staff could be evacuated if something went wrong. When I sent an email to my sister explaining what I wanted for my memorial service if the worst should happen, she phoned me in tears. “You’re being dramatic,” I chided. “It’s just a precaution.”

At the beginning of December, I received the call: an admin-finance manager posting had opened in Peshawar, Pakistan. I gave notice at my consulting job, packed up my cherished apartment near Toronto’s Trinity Bellwoods Park, and put almost everything I owned into storage. The rest—summer clothes and whatever else I thought I would need on my posting—I crammed into a seventy-litre backpack. Ten days before my anticipated departure, however, I received a call from my pool manager: the MSF desk had decided that they needed someone with more experience and linguistic and cultural familiarity with the region. I was disappointed, jobless, and homeless. I knocked on my ex’s door and asked for a bed.

The waiting game for MSF’s nonmedical staff is often taxing, as staff are only paid while in the field. Doctors and nurses tend to have a practice or a clinical position that they can return to between missions, but admin managers and logisticians usually leave jobs and scramble for new ones once a placement ends. The destabilizing effect of the wait, as well as the loss of my apartment and income, had me despondent. Emergency relief doesn’t follow a schedule.

It took another four months, and one other cancelled assignment, before I received my long-awaited posting. On April 10, 2016, I departed from Toronto for Lulingu, a small town of fewer than 30,000 located in the jungle of the Democratic Republic of Congo.

Over the past three years, MSF has spent more money in the DRC than in any other country. In 2017 alone, 102 million euros were invested into the program there, much of which went to infrastructure, staffing, and medical supplies. The country faces ongoing violence and political chaos, legacies of its colonial past as well as the war in Rwanda in the early nineties, which occurred just across the border and led to the arrival of nearly 1 million Hutu refugees. Government forces are now fighting militia factions, and militia factions are fighting one another. Ethnic massacres, sexual assaults, and the forced recruitments of child soldiers are common.

The Lulingu project that I was assigned to had been established in May 2013 as a response to a deadly malaria outbreak in the area. The mission later widened after more than 100 women in the area were raped by militants in a single day. By the time I received my posting, the conflict had moved into the northern part of the region, and MSF’s focus had expanded to include treating malnutrition and reducing infant mortality rates, which were the highest in the country in 2014.

I journeyed via Kigali into the DRC. When I saw the white vehicle with the iconic MSF logo parked just across the border, I cried. My wait was over, and every lingering doubt I’d had about my decision to go on a mission evaporated.

Lulingu is located 140 kilometres west of Bukavu, the capital of South Kivu province. The town is isolated, set into misty hills that are blanketed by dense jungle, and as I entered, dirt bikes, goats, and men pushing bicycles strapped with enormous loads all competed for space along the main road. The town had a school, a textile market, and a soccer pitch. Children were everywhere. This was to be my home for the next year or so.

The MSF hospital, a compound about the size of a high-school campus, was made up of red-brick colonial remnants. It sat on the hilltop at the edge of the village. Small wards were demarcated by hand-painted signs above their doors, and there was a courtyard where women with relatives in care often cooked over open fires. The starkness of the space—the paucity of equipment and supplies—was striking to me as a person who had just arrived from Toronto. In the maternity ward, women had to share beds, and though there were power lines around the compound, the grid was unreliable and generators were expected to kick in throughout each day.

Within a few days of arriving, I had gotten into the rhythm of life in the field. My workday began at eight in the morning with a staff meeting called a point info (the lingua franca on many MSF projects remains French). During these gatherings, we received news from the HQ in Bukavu, operational plans for the day, and a security-status briefing.

Eleven of us—a mix of medical and nonmedical staff, both expat and national—worked in a cramped, sweltering office that was attached to our sleeping quarters. Chickens wandered in and out of the space, and huge waxy beetles that flew with the grace of garbage trucks frequently landed on our clothing and in our hair while we worked. My tasks involved overseeing the project budget and staff salaries and paying local vendors. I managed HR records, benefits, and the occasional employee grievance.

Pens and paper were at a premium—all our supplies, including medical equipment and food, had to be flown from Bukavu to a nearby airstrip and then transported by dirt bike through the jungle. The pencil I used to check my ledger was one of the few pencils in the office, and I kept it in the locked cabinet behind my desk. I whittled it each morning with a long knife borrowed from our cook, Zaina.

I soon found that my interactions at the actual hospital across the road from my office were limited, and the work I did could feel utterly disconnected from the humanitarian impulse that had brought me to the DRC. My service, it turned out, was not always directly related to the patients being served but rather to the national staff who worked on the mission. I tried to support them in any way I could, whether it was getting additional resources for the housekeeping workers or exhorting the expats to be more respectful of their labour. I did an audit of our kitchen supplies to determine what needed replacing; I waterproofed the security documents of the motards—the dirt-bike-taxi drivers who were essential to our mission and drove for us in all manner of weather. These actions were small and did not save lives, but they made me feel useful in practical and immediate ways.

There were few comforts on the compound, and privacy was all but nonexistent. In the conjoined shower-bathroom stall, the doors came up to just above my shoulders. At night, even the sizeable rats that scratched and scurried in the walls occasionally peered out at me from holes in the ceiling of our bedroom quarters.

Our security grid—our designated perimeter of movement—was limited to the ring of a rust-coloured dirt road that circumnavigated the village centre. We were given two hours after work—before sundown—as well as Sunday afternoons to walk beyond the compound gates. There were a few shops where we could buy soap, fabric, and warm beer. The edges of the circular road fell away to open sanitation ditches, along which were houses constructed of ochre-coloured waddle and daub, with low, thatched roofs, on which clothing often was spread to dry.

The people who lived beyond our compound’s bamboo fencing were circumspect but friendly enough. We exchanged greetings with them in Swahili whenever we passed each other on the road. And wherever we walked, throngs of children followed us smiling and shouting, “Mzungu”—the colloquial term for “white person” in Swahili. Some wanted their picture taken. Others wanted to hold our hands or to practise their French. The more aloof stood back and watched.

At our point info staff meeting on May 19, we were told that a two-car MSF convoy had been attacked in Kouki, in the northwest of the Central African Republic. The occupants—which included staff and patients—had been made to exit the vehicles and lie face down on the ground. The attackers fired rounds into the dirt near their heads. The local driver of one of the vehicles was killed. National humanitarian staff—the local workers who live in the troubled regions—are killed much more often than international workers and tend to be more at risk in areas where fighting is ethnicity based.

All around me, my colleagues’ heads bowed and their tongues clicked. I tamped my sadness and fear into my chest and worried myself with thoughts of a militia attack on our compound. Now that I was in the field, I had a real understanding of our collective vulnerability—hearing about this attack on my coworkers felt nothing like being back home and watching news reports of faraway bombings.

While this event hit close to home, it wasn’t the worst information we received that month: not long after, we learned that in Beni, near the DRC’s border with Uganda, Congolese women and children had been hacked to death with machetes by unidentified assailants. Later, I received an email from Anna, my psychologist friend from Welcome Days. She was also working in the DRC, about 150 kilometres southwest of Beni, where she was counselling women and men who had been subjected to extreme violence that included rape and sodomy with sharp objects, torture, mutilation, and, in some cases, forced cannibalism. I fell involuntarily to my knees as I read her accounts on my phone. She wrote that she was doing her best but was reaching the end of her own psychological rope.

My colleagues in Lulingu had all walked with death, and their experiences seemed to have become a part of them. Nuria, an emergency-response nurse who had worked in the camps on the border between Rwanda and what was then Zaire in 1994, recalled the Kagera River running with blood. Our logistician, Jamal, slight in build and soft in temperament, told me at dinner one evening that he was in Bangui, Central African Republic, at the height of fighting between Muslim and Christian forces in 2014. He said that he still could not get the sight and stench of hundreds of rotting bodies left in forty-degree heat out of his head. Marta, a visiting finance coordinator who smoked from waking until sleep, had also been in Bangui that same year. She told us a story about how, during one outbreak of gunfire, she and the other staff had spent days hiding in a tiny safe room on her project while most of her team waited to be evacuated.

Not everyone responds to the stresses of fieldwork the same way. Exposure to trauma, lack of sleep, insecurity, and long hours all have an impact on a person’s resilience. During my mission, my colleagues and I combatted the tedium of our constrained existence by doing tough physical exercises in the evenings. “Insanity” workout videos are common on personal laptops and USB sticks on most MSF projects. For those who can withstand it, the punishing combination of interval training produces a powerful endorphin rush—a salve for the emotional and psychological demands of the job. One day, I was told that there had been an attempted hanging of a young boy from our village and that the perpetrator had been subsequently stoned and beaten not far from our compound gates. That evening, I worked out for nearly two hours before falling into bed. You can’t sweat out trauma, though; I started sleeping more and eating less. After a time, the workouts stopped working.

Stories like these don’t end up in the MSF donor newsletters. People need to believe that their dollars make a difference and that, with their help, change for the better can happen. And change does happen, but the journey there is often not tidy or redemptive. As a result, MSF workers tend to be careful about which stories they tell.

It’s no secret that some MSF lifers have similar problems to what some members of the military experience when re-entering “civilian” life. Witnessing things that are beyond the ken of most people back home can make returning difficult. As a result, many staff simply don’t go home—or, at least, they don’t go home for long. This is what Anna did. From her mission in the DRC, she travelled to Syria. Later, she was posted to the island of Lesbos in Greece to work in the migrant camps. She’s spent only a few weeks in Canada between her missions, and each time we saw each other in Toronto, I thought she seemed more hopeless and alienated from her life here.

Anna’s latest posting was in Mosul, Iraq, the former stomping grounds of Islamic State militants. This summer, two years and three continents after our first meeting, we talked over WhatsApp. Against the echoes of the afternoon call to prayer, she told me how, for women in Syria and Iraq, even a single hourlong counselling session with her can have a positive impact. She explained that the women she had spoken with seemed grateful that their feelings were being heard—they were finally safe to talk about their experiences.

“But how are you doing?” I asked.

An extended silence followed. “I am hearing the most horrible stories ever, and I know it sounds terrible, but I just don’t care anymore. I’m totally numb,” she replied.

In the field, the brain suppresses, immunizing itself against overwhelming trauma. It’s a protective shield, but it has consequences. In 2012, the Antares Foundation, which provides mental-health training and support to aid organizations, funded a study on depression and anxiety among humanitarian workers. It found that chronic stress during deployments can increase the risk of emotional burnout for workers after they return.

Soon after our conversation, Anna’s contract in Iraq ended. This time, rather than going back into the field as a psychologist, she moved into an HR position with MSF in western Europe, where she received a lengthy debriefing and sought counselling. Where MSF demands “flexibility without borders” of its staff, its responsiveness to its workers’ needs is also unstinting. On some projects, psychosocial support is accessible 24/7 via Skype. Extensive pre-mission briefings and post-mission debriefings are designed to prepare staff for what lies ahead and to help them decompress when they reach home. These resources, along with time, can be effective healers.

Three weeks into my mission in the DRC, I suffered a concussion. In torrential rain, I was running head down and at full tilt from the kitchen to the small gazebo at the back of the compound. I hit my head against a jutting roof beam and fell backwards, hitting my head hard against the ground. I got up, dizzy and nauseated. I worried about what those symptoms might mean.

I didn’t say anything to anyone, though, because it had taken so much time and effort to get precisely where I was —working for MSF was what I’d wanted to do since I was a teenager. But over the following three weeks, I realized that I was struggling with tasks that were once simple. I could not follow verbal instructions easily, count money, or rely on my memory. I had to tell someone.

Straight away, the project coordinator arranged for an airlift to Bukavu, where I was taken to the hospital for an MRI and a CAT scan to rule out the presence of a blood clot. Through a Skype session with the MSF psychosocial unit in Barcelona, I took a range of tests to assess my cognitive function. It was determined that I had to go home. I had been in the DRC for six weeks by that point; my mission was only just beginning. I was given a few days in Bukavu to decompress and come to terms with the sad ending before flying home. I felt no sense of accomplishment, only tremendous guilt.

Before joining MSF, I had thought that humanitarian work was straightforward: you see a crisis, you react. But, in practice, that principle becomes complicated, and helping often means doing what is needed. On the same day I secured the rape reports of three women over the age of sixty, I also recorded staff vacation days and changed the office printer paper. After the concussion, my being on the project had become a risk for the team; maybe the noblest thing that I did in Lulingu was admit that I needed to go home.

Since returning to Toronto in 2016, the call to do humanitarian work remains strong. Going back to MSF as an admin no longer makes sense for me, though. After my experience in the DRC and all my conversations with Anna, I decided that I wanted to do more to directly help parents and children who are coping with war. I entered a doctoral program in the Department of Applied Psychology and Human Development at the Ontario Institute for Studies in Education, and I am now developing a community-based supportive parenting program for families living amid extreme violence or in displaced-persons camps. My goal is to support the well-being of parents and small children who have experienced the traumatic effects of war.

I now understand what my recruiter meant when he told me that MSF is not about saving the world. But I do know that the world needs people willing to do whatever they can to make it a better place, in big ways and small. I still think of my hard-working national and expat colleagues in Lulingu, and I jealously follow the paths of those friends, like Anna, who remain with MSF. I still have the red-and-white T-shirt I was given during my mission. I keep it neatly folded in my dresser, just in case it’s ever needed.

Sidney Coles
Sidney Coles lives in Toronto. She is working on her doctorate at the Ontario Institute for Studies in Education.
Clay Rodery
Clay Rodery has drawn for the New York Times, The Atlantic, and HBO.