24/12/2012 07:55 GMT | Updated 20/02/2013 05:12 GMT

Not With a Bang But a Whimper

The world did not end today. At least, not for you. Not for me. In places like Syria and Pakistan, individual worlds will come to an end because of hatred, greed and violence.

Earlier this week the United Nations launched its largest appeal ever, for nearly £1 billion, to address the crisis caused by the war in Syria. The months of fighting have provoked supply shortages, mass migrations and huge numbers of wounded against a background of intensifying cold, grief and devastation. The UN's appeal notwithstanding, the multi-billion pound international humanitarian community is virtually locked out of Syria by security risks, lack of authorisation from the government, and an insufficient ability to negotiate and maintain access in such circumstances.

Medecins Sans Frontieres/Doctors Without Borders (MSF) has struggled enormously to open hospitals inside Syria, vitally important to those we reach and yet insignificant compared to the larger needs. Put simply, in the midst of such epic crisis, and despite the Herculean efforts of Syrian doctors and nurses, ordinary Syrians have very little access to drugs or medical care.

In our hospitals in Syria, we are seeing patients injured in war - mostly civilians, like older people, women, children, and babies. These people have been wounded in bombings and have shrapnel injuries. Sometimes the injuries aren't physically serious, but emotionally and psychologically they are very damaging indeed. But we are also seeing patients who are suffering, fading out slowly, of the most banal of chronic conditions, unable to get the care they need: diabetics who have run out of medication, children with asthma, and women who need caesarean sections.

Earlier this week in Pakistan, people staffing a polio immunisation campaign were killed in a series of targeted attacks. No medical work can be carried out effectively in the atmosphere of mistrust caused by years of deliberate misinformation, rumours, or the blatant abuse of the integrity of the medical act.

Faced with the threat of a measles outbreak, MSF's normal response would include a vaccination campaign to prevent the spread. But would you risk sending teams out in such an environment, where a nurse "armed" with nothing more than a life-saving syringe might end up between the crosshairs of a weapon? The pursuit of political and military objectives erodes trust in healthcare itself, and children fall ill and die of diseases - diseases for which prevention is simple in theory, but dangerous in practice.

Syria and Pakistan lie far apart on the map. The common denominator of much of the suffering in these nations, as in so many others, is the space between people who need care and people who can provide it. This lack of access - and the deaths that result - is as preventable as polio; it is not the doing of cosmic forces beyond our control. The world does not end in one big bang - it blinks out in the bits and pieces of human lives.