Aid workers who have seen patients with injuries that are the result of torture, state brutality or indiscriminate warfare have a tricky problem of whether it is better to speak out or to remain silent.

While speaking out could result in more aid, political intervention and media support, it could also cause more harm to patients.

Doctors of the World UK joined MSF and the British Red Cross for a debate on this topic at Cambridge University in January 2011.  Doctors of the World UK's director Susan Wright spoke about the balancing act that is needed: “If you speak out in a way that makes it impossible for you to get in the country, get around the country, get medical equipment and goods in the country, then, you shut down altogether which means that you don’t just alienate those patients, you lose them entirely and you lose your ability to deliver anything to them.”

“You've got to figure out what is appropriate to say, given the ends you want to achieve,” she said. “On the other hand, you've got to figure out what you're giving up when you keep silent, whether or not you can find a way to influence things in a positive way other than giving that witness.”

To find out more about this issue and to hear the debate, listen to the podcast (above) by Neil Hallows from BMA News.