With author Truls Øhra, Rome.
Pictures from WHO, and own recordings.
Norwegian Elisabeth Hoff from the World Health Organization (WHO) is in Rome to meet with Libya’s Minister of Health, who is visiting the Bambino Gesù Children’s Hospital. This is one of the largest pediatric hospitals in Europe. The meeting with the Libyan minister is taking place there because Italy is assisting with spinal cord transplants for several hundred Libyan children. But many of them cannot be saved – they die from the cancer they have contracted.
When Hoff arrived in Libya in 2019, after seven years in war-torn Syria, she assumed that the work there would be easier than it had been in the country she came from. Libya is large, but its population is about the size of Norway’s. Syria’s population is around 23 million. But Hoff mentions that the infrastructure there was far better than in Libya, especially before the war – they had good medical studies and nurse coverage. In Libya, she encountered a small healthcare system that had completely collapsed. According to Hoff, they used to send patients abroad for treatment: «That’s how I got involved. I initiated the project with my team in Libya, with support from regional offices and several headquarters. 720 children are receiving cancer treatment for the first time in history.»
But dear reader, ask yourself why these children have developed severe cancer: Is it the bombing of Libya in 2011, including the use of many tons of uranium-containing explosives, in which Norway played a significant role? When we ask Hoff about this, she diplomatically responds that they are an organisation that relies only on what can be proven.
Nevertheless, we repeat the question about why the children have developed severe cancer and ask her to elaborate: «I know it is not up to me to say why. There are also oil refineries in these areas. But there is so little research, so I am trying to conduct a research project on background, history, and causes with my staff in Libya. But at present, I cannot say anything more.»
Many will speculate whether the radiation from the Norwegian bombing in 2011 was one of the causes: «I don’t have the expertise to say anything about that. We can only conduct thorough research because we work in an evidence-based organisation. We do not speculate about such things as it can lead to rumours and other issues. It is important to establish facts.»
Hoff is a trained nurse and midwife and has held senior positions in Afghanistan, Syria, and Libya. Her calling has been to care for lives. In the hospitals in the aforementioned three countries, she has helped many war victims.
Over 25 years ago, Hoff went to Afghanistan: «I was there while President Mohammad Najibullah ruled, but when he fell, we had to evacuate. I then worked for The Swiss Committee of the International Red Cross for almost a year.» As a health coordinator in Kabul, she led the work of ten clinics for maternal and child health and states that she was more concerned there than during her later work in Syria and Libya: «Poverty hit me hard. People had to choose between buying food or fuel to heat their homes. They had to choose between freezing or starving. And many came with large wounds from burning themselves as they sought warmth from fires. We also treated frostbite.»
We wonder if the political climate was also difficult then: «This was after the war, with the Mujahideen, who paved the way for the Taliban. Then we had all those injured by mines, which resulted in many amputations. Every fourth man was missing an arm or a leg. They came to the clinic. I became almost an expert in helping amputees – including how to use prosthetics.»
In Afghanistan, Hoff also benefited greatly from her midwifery education: «It helped me in situations where one had to act quickly – you never know when childbirth will happen. I was quite active, perhaps somewhat hyperactive. Then I learned to find calmness, even in emergency situations – I could act quickly and slowly at the same time – which has been very useful for me during all these years working in emergencies.»
What about the political Taliban, now 25 years later – also how women are once again suppressed after Taliban leaders regained power? «It is much worse in Afghanistan now. Especially where women are hardly allowed to leave their homes – not even when shopping, they can move freely. They are not even allowed higher education. Old friends in Afghanistan tell me how depressing the situation is. They have lost all hope.»
We mention the Norwegian Refugee Council, which had to terminate much of its work in the country as women were not allowed to work with men: «I think the Norwegian Refugee Council took a right stance. They could not continue their work with the many women who were necessary.»
Hoff also points out that removing female healthcare workers from hospitals reduces women’s access to healthcare: «Women suffer on many levels in Afghanistan, including at home. They are in an impossible situation, where they have no freedom of expression or human rights.»
When we talk about women, we ask Hoff if she has feminist views in connection with her work as a top executive, where she confronts women’s oppressed situations in countries like Afghanistan, Syria, and Libya:
«It is perhaps sad that I have to say that I don’t see this as feminism. It is about human rights. Thank God I grew up in a country like Norway and did not have to fight for rights in the same way as here. It may sound strange, but I have never really thought about being a woman. In our family, we were two brothers and two sisters, and I never experienced being treated differently. Neither at school nor home – so for me, it was something I took for granted. But when I first came to Egypt in my first overseas job in 1987, what I had taken for granted was no longer present.»
Hoff adds: «But I can say something about women: The important thing was the freedom that came around 1962 with the birth control pill so that women could take control of their bodies and decide how many children they wanted to have. This was truly liberating – instead of being dominated by risk and male dominance.»
What about the freedom back in the more ‘progressive’ years when Hoff was in Egypt and Syria? «Yes, I remember when I came to Syria and the Red Crescent there. The pictures of women on the walls were striking; from the 50s, 60s, and 70s, they did not wear the hijab. The last decade has changed this; now, all the pictures have hijabs.»
What about some of the Taliban leaders who send their daughters out of the country so they can receive higher education? There seems to be a double standard regarding the oppressive policies they enforce: «I must admit that every day I thank God that I was not born in that part of the world. As Norwegian women, we do not really know how lucky we are.»
She adds that many men also suffer under the oppressive policies, seeing their daughters being suppressed by those in power: «It’s the same in Iran. They send their daughters out of the country. I believe the religious exercise of power is completely wrong.»
Syria and Death
We ask Hoff to describe Syria, where she worked for the WHO. The plan was initially to be there for only two months, but it turned into seven years. What are the differences, for example, compared to Libya, including corruption?
«For me, it is heartbreaking to see the warlords who became powerful during the war in Syria and all those who profited from petrol, diesel, and power generators in Aleppo. Especially during the war, there was a lot of corruption. But we should remember that many countries have a certain degree of corruption. In Libya, everything is corrupt and is largely accepted as long as it does not affect your family or tribe. They almost congratulate each other if they get hold of some funds – otherwise, such public funds end up in someone else’s pockets. There is no accounting for these funds. But in Syria, they had a strong infrastructure. Perhaps that was why they could keep things going despite the war.»
Hoff lived in constant danger in the conflict zones she stayed in, year after year. Few would endure such ongoing risk: «Yes, it was constant. But in Syria, I could mostly walk back to the hotel in the evening, even though I had the option of being driven in a bulletproof car. That is impossible in Libya – there, I am almost trapped like a ‘hospital hostage’ because the security regulations are so strict. One can hardly move or meet the people one wants to.»
Once, a bomb hit so close that the windows shattered. The pressure threw me out of my chair.
But what about truly dangerous situations? «I remember the fall of 2013 when shots were fired into the office where I was sitting, over my shoulder and right into the wall behind me. Bombs could also fall 50 meters away. But it was worst in Aleppo – where we were surrounded. 110,000 people had to move from east to west in the city. Aleppo had been subjected to massive bombing until then. There were sandbags in front of all the windows – it was impossible to see outside, and the building shook several times while I was there. Once, a bomb hit so close that the windows shattered. The pressure threw me out of my chair. Well, I brushed off the dust, sat back down, and finished that day’s report on my computer. Perhaps it’s a kind of trauma – for me, it was mostly about getting the job done. We all have our survival mechanisms.»
Here we are sitting in Rome in February-March. Hoff reminds us of the recent earthquake in Turkey and Syria, which was particularly heartbreaking for her: «These people already had nothing after becoming refugees. There are about a million people in Gaziantep and Aleppo; the latter was the hardest hit during the war. I first contacted WHO’s office in Aleppo to check if our staff was alright. But in the earthquake-affected areas, the Syrians lacked equipment and had to dig with their hands!»
Syria and Assad
Returning to her years in Syria: Hoff and WHO were granted permission to move around Syria by Assad’s authorities, so they mostly saw the war from one side. We ask about this: «I don’t know. I have always been honest and said what I think. For me, as a midwife, it is about saving lives. I believe both authorities and ministers accepted hearing my opinions expressed directly rather than behind their backs. When invited to have tea with the authorities, I often chose to avoid it – I would say I was travelling. I also kept my meetings with Assad to myself. In these countries, including Afghanistan, I could do nothing but be honest about what I thought, including about the political leadership.»
Few civilians in Norway have been exposed to dangerous war zones for decades like Hoff. What does she think about the risk of being killed herself? «I had carefully considered what would happen if that occurred, and it helped me. I was never afraid of dying because, after death, you don’t suffer. I was more afraid of being seriously disabled and becoming a burden to others by losing my mobility.»
Hoff explains that the most important thing was the help they provided, as they supplied millions with medication – which she describes as her survival strategy. But how some people can live such privileged lives while others experience immense suffering is difficult for her to comprehend. She has spent 30 years in such distressing circumstances, so one can wonder if it is some sort of calling for her: «I have always been strong, with a strong will. But I also have a strong Christian faith that supports my humanitarian work. But many do the same without having faith. For me, perhaps the story of the Good Samaritan is descriptive, as he helped those he encountered on his way.»
But how can one believe in a good Christian God when witnessing all the evil happening in the world? This must be a problem for Hoff, right? «I don’t know. Yesterday, after the earthquake, I asked myself if God actually exists, something I would like to believe. But what about those already suffering, having to suffer even more – with some walking around afterwards almost naked in the cold? That they would die? Can one really say that this comes from God?»
War, Libya, and the Media
We ask about pacifism – if Hoff herself is a pacifist in case a larger conflict were to arise. «I cannot imagine that a single bullet can achieve peace. People must be brought back to the negotiation table. At the same time, it would also be too simple to say that I am one hundred percent pacifist. There are powerful individuals, especially men, who intervene and disrupt peaceful situations. But in my heart, I am a pacifist. I don’t think a single military conflict can solve a problem.»
Regarding warfare determined by politicians, Hoff’s comment is straightforward: «Many of these politicians, like Putin, are so far removed from human suffering that they mainly think about power and power games and how they can benefit from those ideas. Power games that often reinforce different alliances.»
What about Norway’s contribution to the bombing of Libya? Couldn’t the politicians in Norway understand what they were causing so far away? «This is difficult for me to understand. I asked myself why my homeland got involved and let 700 bombs fall on Libya – it makes absolutely no sense. And around Libya, I am constantly asked about this among the people, why Norway did this. Scandinavian countries have long been peaceful role models.»
Hoff explains that in the centre of Benghazi, Libya, the city looked like the bombed-out city of Homs in Syria: Everything was destroyed, including the old town. She has spoken to many of the people who had to move. At the same time, she points out that Libya is a rich country compared to Syria because of oil and 90 percent of the population receives all or part of their salary from the state. Therefore, the same level of malnutrition as she found in the hospitals in Syria or Afghanistan is not seen in Libya: «But a larger part of the population in Libya suffers from anxiety due to long-term oppression during Gaddafi’s time. Still, they also say that back then, they could speak more freely than they can today.»
Italy now sends doctors, nurses, and pharmacists to Libya to train Libyans in comprehensive care for children and their families. Such psychosocial treatment is rarely heard of in Libya – they have never had any concept of palliative care. Hoff emphasises the importance of ensuring that children do not feel pain. They also assist families in following the treatment of seriously ill children.
But in my heart I’m a pacifist.
Shaking Hands with the Devil
Having seen most things firsthand in war zones, one may wonder what perception Elisabeth Hoff has of the media’s coverage of war or how the media influences people’s psyche. She clearly sees a difference between what happens on the ground and what is reported in the media: «Not only in Libya and Syria but also in Afghanistan, people have lost trust in the media’s one-sided coverage of the situations. It is quite difficult to believe what is said or presented – but this also applies to the rebel side in Syria.»
We touch on how today there is a mentality of fear in society, where politicians strengthen themselves and the military-industrial complex by creating enemies, greatly aided by the media: «Yes, but I also believe that the media have played an important role in promoting the good values. I have always invited the press to my WHO seminars to inform them about our impartiality and humanitarian principles.»
We reach the end of this long conversation. What does Elisabeth Hoff think about the future of international cooperation with today’s new major political conflicts? «I am fortunate to have worked for an organisation dedicated to healthcare, as we can stay even after power shifts in the places where we operate. You remain impartial and achieve a lot through negotiation. Although, as Jan Egeland once said, it is like shaking hands with the devil. For us, the goal is better health for everyone, including on different sides of a conflict.»
I don’t think people are good from the start
Who can endure dealing with so much suffering, and how does one maintain sanity amid such catastrophic conditions over time? «The destruction is overwhelming. It is incredible what people do to each other – and what do politicians actually do? But I have had to focus on one main goal to maintain sanity and think about how I can best help.»
And she adds, «After seeing people with severe burns from bombing, there were times when I couldn’t sleep – but at the same time, I was so impressed by doctors and nurses who gave everything to help alleviate others’ suffering. When that is said, I am always affected by suffering, no matter who it affects. Not only children. I remember when I was in the besieged Aleppo in Syria, where I met elderly people who had not eaten for several days because they gave the little food they had to their children – it was part of their culture. This is also heartbreaking, but also where parents see their children suffer or die. It is difficult to differentiate suffering.»
In this long conversation, we also hear that even a strong woman like Elisabeth Hoff has had to confront her own limitations: «After staying in Afghanistan at a young age, I had a breakdown when I returned to Norway. I stopped believing and stopped being an idealist. I stopped believing in the goodness of humanity. I don’t think people are good from the start. Often, I think that one must be cultivated from childhood. There, I was fortunate with my family, the Norwegian school, where we were shaped with good values.»
The journey to Rome and the short film is supported by Fritt Ord.
Also see a film excerpt at nytid