Annual Review 2008 by Medair

Committed to the Worldâ&#x20AC;&#x2122;s Most Vulnerable Annual Review 2008

â&#x20AC;&#x153;We have been hearing on the radio since the end of the war that the whole world has responded to the problems of Afghanistan. The government is receiving help and so are the people. No one has come to help us! But now Medair is here and you are the first NGO that has ever come to help our communities. We are very grateful and thank you for coming.â&#x20AC;? Hagi Hussein Dad, village elder of Boz Morda in Wardak Province, Afghanistan

MEDAIR Annual Review 2008

Medair delivering food aid and medical supplies in Afghanistan.

Table of Contents 12

2008 Medair summary

CEO letter

Who are the world’s most vulnerable? 14

Core competency—emergency relief

Core competency—rehabilitation

Sector of expertise—health services

Sector of expertise—water and sanitation

Sector of expertise—shelter and infrastructure

Country programmes

2008 at a glance

Country programmes

The faces of commitment

In the words of our partners

Funding partners 2008

Accreditations and affiliations

Credits

35 3

AFGHANISTAN •

Sudan • (Northern States)

Southern Sudan • • Somalia • UGANDA INDONESIA •

D.R. CONGO •

• MADAGASCAR

2008 Medair Summary •2 ,794,250 total beneficiaries •8 country programmes •7 countries of operation • 1 international headquarters in Switzerland, 66 positions • 5 affiliate offices in France, Germany, the Netherlands, U.K., and U.S. • 1 18 internationally recruited staff (IRS) positions in the field • 1 ,093 nationally recruited staff (NRS)

Countries

Crises

Afghanistan

Conflict Natural disaster Other crises

D.R. Congo

Conflict

Other crises Indonesia

Natural disaster

Madagascar

Natural disaster Other crises

Somalia

Conflict Natural disaster Other crises

Challenges • Post-conflict recovery (in areas where Medair works) • Earthquakes • Drought • High general population vulnerability • Disease epidemics • Food crises • Sporadic ongoing conflict • Post-conflict recovery • Significant IDP population • High general population vulnerability • Disease epidemics • Tsunami • Earthquakes • Volcano • Cyclones • Flooding • High general population vulnerability • Food crises • Insecurity • Population displaced from homes • Drought • High general population vulnerability • Food crises • Disease epidemics

MEDAIR Annual Review 2008

Countries

Crises

Challenges

Southern Sudan Conflict

• Sporadic ongoing conflict • Post-conflict recovery • Significant IDP and returnee population Natural disaster • F looding • Drought Other crises • High general population vulnerability •D isease epidemics • F ood crises Sudan Conflict •O ngoing conflict (Northern States) •P ost-conflict recovery •S ignificant IDP population Natural disaster • F looding •D rought Other crises • High general population vulnerability •D isease epidemics • F ood crises Uganda Conflict • Sporadic ongoing conflict • Post-conflict recovery • Significant IDP population Natural disaster • D rought Other crises

• High general population vulnerability •D isease epidemics • F ood crises

Letter from Randall Zindler, CEO In every country, north or south, life-changing crises can strike without warning. Jobs and livelihoods can be lost, relationships can falter, diseases can take hold in the blink of an eye. We are all vulnerable to such crises, and at those times, we all need support. At Medair, we are committed to the world’s most vulnerable people. Our beneficiaries are people whose lives have been thrown into complete upheaval by conflicts, disasters, and other crises; people who live in remote, difficult-to-access communities where the most basic services like health care and safe drinking water are unavailable; people who, for a host of reasons, need compassionate support as much as, if not more than, anyone else on earth. When we work with people who are in such crises, it makes us mindful of our own vulnerability, and our own need for support during crises—even when those crises may seem banal in comparison. As Jesus taught in the Sermon on the Mount, we strive to do unto others as we would have them do unto us. And so, we do not travel to distant countries to impose on beneficiaries the support that we think is best; rather, we work alongside beneficiaries as partners, listening to their needs, and providing them with the support and expertise that helps them recover from their crisis with dignity. In 2008, Medair was able to reach more people with emergency relief and rehabilitation services than in any year since our inception. This success was a testament to the commitment of our staff, some of whom faced extremely challenging working conditions during the year— considered the most dangerous year for aid agencies on record. It was also a testament to the steadfast commitment of our donors in these difficult economic times.

In these pages, you will read about our ongoing commitment to deliver significant, practical results in partnership with our beneficiaries, such as in West Darfur, where we supported 20 primary health care clinics and more than 300,000 outpatients. Our commitment to integrity meant that we made ourselves accountable to our beneficiaries, and that we acted swiftly to correct any concerns that arose. In a crisis, children and pregnant women are often the most vulnerable of all. For this reason, Medair actively supports conflict-affected children, and seeks to reduce rates of maternal mortality among young women. As you read on, you will meet Gul Bibi, one of the first women to receive a Caesarian section at our new obstetric facility in remote Afghanistan. And from Uganda, you will read about young Alex, a former child abductee of the Lord’s Resistance Army, now rebuilding his life with renewed hope for the future. In 2009, Medair enters its 20th anniversary year. This provides us an opportunity to celebrate the life-saving impact we have made on tens of millions of people and to reflect on valuable lessons learned along the way. One thing we have learned is that commitment to the world’s most vulnerable is never an easy task. True commitment requires an abundance of time, energy, and often money. It requires that high standards of quality be communicated, enforced, and realised by those who need it most. But even more than that, true commitment requires the will of each and every person—staff, donor, or beneficiary—who chooses to stand in partnership with us, and refuses to waver in support of the world’s most vulnerable.

Randall Zindler

But what exactly does it mean to be committed to the world’s most vulnerable? In this 2008 Medair Annual Review, we take the opportunity to examine this question through photographs, statistics, and stories of achievement from our countries of operation. You will read about our commitment to reach the most vulnerable even when we face major obstacles to access. For example, in Southern Sudan and Madagascar, our teams travelled through severe flooding to provide emergency relief in 2008. In D.R. Congo, our staff criss-crossed the very limited roads of this vast country so many times to reach isolated village health clinics that they ended up travelling a greater distance than from the earth to the moon.

Randall and TsoTso, NRS, in Madagascar in July

Who are the World’s Most Vulnerable? Year after year, Medair brings emergency relief and rehabilitation to some of the world’s most vulnerable people. But how do our beneficiaries become so vulnerable? Wars, earthquakes, famines, insecurity, destruction of homes—the list of major crises goes on and on. In many countries, the initial crisis is just the start of a deadly series of problems—problems that combine with disastrous results to overwhelm populations and leave them in desperate need of support.

MEDAIR Annual Review 2008

At Medair, we are committed to people who have been devastated by conflict, natural disasters, and other crises.

Photo: D isplaced family in conflict-ravaged D.R. Congo: a country where

more than 5.4 million people have died since 1998, most from war-related disease and hunger.

When major crises hit, deadly health risks follow fast in their wake. When homes are damaged or destroyed, people need proper shelter or else they risk death from exposure to the elements. In many crises, people are uprooted from their homes altogether and forced to live in overcrowded camps for their safety—often losing all but what they can carry on their backs. Internally displaced people, or IDPs, may live in the same makeshift shelter for years at a time. People in such circumstances have difficulty maintaining a sense of dignity. With no way to earn a living and very few rights, they are forced to rely on others for support —which in turn leads to greater hardship for the surrounding communities. A congested IDP camp is ripe for outbreaks of infectious disease. The world’s most vulnerable often lack access to safe drinking water, latrines, or hygienic living conditions. This deadly combination can lead to diarrhoeal disease—which kills almost two million people a year and is the second-leading killer of children under five.

Photos, from top to bottom:

Drought in Somalia leads to difficulty finding adequate water. Woman at her home ruined by Cyclone Ivan in Madagascar. Woman living in camp for displaced people in Southern Sudan.

The world’s most vulnerable face a multitude of problems which are only made worse by the onset of conflict, disaster, and other crises. Half a billion people are afflicted by malaria every year; one million of them die as a result. In fact, every 30 seconds a child dies from malaria. Survivors face repeated occurrences of malarial fever every year, disrupting their ability to get an education or earn a living. Pregnant women face staggering health risks in vulnerable countries—they have about 100 times more risk of dying during pregnancy or delivery than do women in Europe. Health clinics are few and far between, staff are not always well-trained, antenatal care is minimal, and emergency obstetric care is often unavailable. Under-nutrition is responsible for over one-third of all child deaths worldwide. Children who are malnourished are often physically stunted, with poor brain development and learning difficulties. The world’s most vulnerable also face a stifling lack of opportunities to improve their living situation. When crisis strikes, many people lose their ability to earn a living. Educational opportunities are extremely limited, especially for girls, due to poor school conditions and a lack of money for school fees or supplies. Photos, from top to bottom:

Indonesian family comes to Medair mosquito net distribution, seeking protection from malaria. Under-nourished Sudanese child just starting treatment in Medair nutrition programme, with his grandmother. Somali girls carry water for their family. Such burdensome chores can take hours a day, another reason many children have few opportunities for schooling.

MEDAIR Annual Review 2008

The worldâ&#x20AC;&#x2122;s most vulnerable are often the hardest to reach. Ongoing conflicts lead to major security risks that inhibit our ability to access the people who need our support the most. Harsh weather conditions like winter snowfall or flooding in rainy seasons can cause major access problems as well. A countryâ&#x20AC;&#x2122;s geography often presents tremendous access challenges. Mountainous terrain makes access very difficult, but sometimes it is also the vastness of a country that contributes to its inaccessibility.

Poor road infrastructure compounds these problems immensely, requiring a range of creative transportation solutions including planes, boats, 4x4s, horseback, foot, motorcycles, bicycles, and donkey carts. Photos, top: Travelling to remote Medair project areas is a slow, laborious

process in Afghanistan.

bottom left to right: Medair staff traverse a bridge that offers the only

access to a village in Madagascar. The vast territory of D.R. Congo, with its few roads, often presents logistical challenges for Medair staff.

Emergency Relief In an emergency, Medair mobilises quickly to protect the lives and health of people in desperate situations, such as when natural disasters strike or when people get caught up in the violence of civil conflicts. In September, the Lord’s Resistance Army (LRA) initiated vicious attacks on innocent residents of D.R. Congo’s Dungu territory. Tens of thousands were displaced from their homes, many requiring urgent medical attention. Our teams immediately began providing free medicine and emergency health care for the most vulnerable, sending shipments of medicine by 4x4 from our base in Isiro.

With over a decade of experience in the region, Medair’s supervisors knew the area under attack very well. We have been supporting almost 500 health posts and collecting monthly data on population numbers and diseases. As a result, we were able to act with confidence, supplying the appropriate health posts with enough medicine to avoid disease outbreaks that often occur in displacement areas. Indeed, for over a month, Medair was the only international NGO providing humanitarian aid in Dungu town, as the LRA continued its terrorising attacks on people throughout the region. “We are very thankful for the medical supervisors of Medair who are willing to risk their lives by coming to the health zones of Doruma, Dungu, and Niangara, which are currently very insecure,” the chief nurses of three health structures wrote in a joint message during the midst of the crisis. “Without this help, our population would not get any medical health care during this difficult period. This is a testimony of your great compassion!” Photos, top: Family in Dungu takes temporary shelter after fleeing from

LRA attacks.

bottom: Man receives treatment in Dungu clinic.

MEDAIR Annual Review 2008

Core Competencies

Rehabilitation Once the crisis stage of an emergency situation subsides, vulnerable people need a different kind of Medair support—one that shifts away from urgent needs towards establishing infrastructure, systems, and services that will sustain them through future crises. Photos, from top to bottom:

New irrigation canal in Marak, Afghanistan, built by Food-for-Work participants. Participants receive food and cash as their well-earned payment for work on roads and canals. Afghani man using the new Marak road built in the Medair Food-for-Work project.

Improving Food Security In drought-stricken Afghanistan, Medair began a Food-for-Work project in 2008 to help address acute food needs of the local population. Almost 5,000 people rehabilitated irrigation canals and built roads and bridges. They were paid with cash and food for their hungry families. For the longer-term food security needs, Medair distributed high-quality wheat seeds, vegetable seeds, and fruit trees, along with training on how to grow them, since such farming is rarely practiced here. Education was a major component of the project. Families learned about nutrition and the importance of a balanced diet. “We have seen some really encouraging changes in behaviour after six months,” said Dr. Habib, Medair Project Manager. “People have a better understanding about how good fruit and vegetables are in the diet, and how these can help prevent sickness.” The Food-for-Work project had many benefits over and above increasing food security in the region. The resulting new roads, bridges, and irrigation canals will have a long-lasting impact on the people. “I am very thankful to Medair,” said Nawroz Ali. “What used to be a two-hour walk to take our animals to the field is now a thirty-minute walk because of our new road!”

Health Services Our health teams provide access to high-quality, sustainable health care for the most vulnerable in Africa, the Middle East, and Asia. Crises such as violent conflicts and natural disasters kill and injure innocent and vulnerable people each year. Medair provides emergency medical support in crisis situations in some of the most insecure and remote regions of the world.

and on building, rehabilitating, and equipping health facilities. We also maintain a flexible approach, providing specialised health care as it is needed.

Medair Health Services Sector (examples) What few realise is that much of the suffering in conflicts and disasters results from the illnesses and disease outbreaks that follow in the path of major crises. Furthermore, health risks multiply when these threats strike in areas that lack access to basic health services. Medair puts great emphasis on providing quality primary health care, with special attention to the treatment and prevention of infectious diseases. We understand that long-term sustainability depends on working diligently to increase the skills and capacities of local health workers 12

MEDAIR Annual Review 2008

• Primary health care clinics • Emergency responses to disease outbreaks • Vaccination campaigns • Health and hygiene promotion • Reproductive health and safe motherhood activities; antenatal and postnatal clinics • Psychosocial support for conflict-affected people • Care for victims of sexual violence • Mosquito net distributions (malaria prevention) • Nutritional support and emergency food distributions • Food security, including seed distribution and agricultural support and training • Capacity building and support to the basic health care system • Training, supervision, and monitoring of clinics and staff • Surveys, assessments, field studies, and operational research

Sectors of Expertise

The Clinic under a Tree Medair’s health teams provide nutritional assessments and treatment for malnourished children in Southern Sudan. “Please, can you please come see my son?” pleads the man, out-of-breath, as he rushes toward Medair’s health staff. The health team is just packing up their car after a long, hot day in Paloich. They quickly ask the man whether he can bring his son to them. He turns and runs and returns moments later with his two-year-old son Ahmed. The boy has a swollen belly, high fever, and is breathing rapidly. “One in five children in Southern Sudan dies before the age of five,” says Rhonda Eikelboom, Medair’s Medical Coordinator, “and I was just hoping that Ahmed wouldn’t be one of them. But I was standing under some trees, with nothing more than a stethoscope to make a diagnosis!”

The Value of Mobile Health Clinics In Melut County, Medair’s health teams travel from village to village, assessing children for malnutrition. On this day, Medair’s team drives the bumpy, dusty road from Melut to Paloich. As soon as the health team arrives, mothers and their children start appearing on foot from every corner of the village. There is no health facility in town, so Medair sets up a makeshift clinic in the shade of a tree. Alice Wyatt, Medair’s Nutritionist, begins weighing the children with a scale that is slung from the sturdy tree branch.

child with some immediate treatment. “I urged his mother to come to the clinic in the next village if Ahmed does not get any better soon,” says Rhonda. Medair’s temporary clinic works well for assessing nutritional status and treating common ailments, but cases like Ahmed’s point out the need for access to more permanent heath facilities in villages throughout Southern Sudan. And so, in May of 2008, Medair opened a Primary Health Care Unit (PHCU) in Paloich, replacing our intermittent clinic under the tree with a health building that is open five days a week and sees 40 to 50 patients every day. “When I started working for Medair, it was quite a challenge at times, especially at this PHCU in Paloich, because it was so busy,” said Liselotte Eberhard, Medair’s PHCU Manager. “But it has been worth every minute, especially when I see people walking home having received their treatment.”

Photos, left: Medair nurse treats a woman in Melut health centre,

Southern Sudan.

right: Medair staff measure the muscle mass of Sudanese children to

determine their nutritional status.

“How are your children feeding?” she asks every mother. “Are there any problems?” Alice listens closely and offers the mothers practical advice on breastfeeding and complementary feeding practices, while also answering any nutrition-related questions. Meanwhile, Rhonda checks the children for diarrhoea, fever, and other medical problems. Children with a fever receive a finger-prick to check for malaria, while first-time admissions to Medair’s “clinic under a tree” are given deworming tablets and vitamin A droplets.

The Need for Permanent Health Clinics As the day draws to a close in Paloich, Medair’s staff are met by the worried father of sick Ahmed. Rhonda checks Ahmed for key clinical signs, and despite the limited equipment and time available, she is able to provide the 13

Water and Sanitation Water and Sanitation (WatSan) is a critical component of Medair’s efforts to save and improve the lives of people living in desperate situations—people without access to safe water or sanitation facilities for their daily needs. After years of global attention to the problem, over one billion people still have no access to safe drinking water and over two billion people lack access to adequate sanitation as well. Climatologists tell us that the problem will only worsen with increased global warming. The risk of contracting deadly diseases increases dramatically in the absence of safe water and sanitation. Every year, almost two million people die from diarrhoeal diseases like cholera. Over 5,000 children under five die each day due to lack of sanitation and hygiene; diarrhoea is the second highest cause of child mortality in the world. (1) Medair works alongside the most vulnerable to reduce the risk of deadly illnesses by improving access to safe water and sanitation facilities. We also make hygiene promotion a major focus to help people understand the risks associated with poor hygiene and to motivate them to change their behaviour from risky to safe hygiene practices. Providing safe, clean water sources near people’s homes and villages not only preserves their health by preventing 14

MEDAIR Annual Review 2008

waterborne disease, but it is a major factor in protecting women and children from violent crime as well. Women and children who often walk for hours across insecure territory to collect water are especially vulnerable to attack by marauders and roaming bandits. In numerous ways, Medair’s WatSan efforts contribute significantly to restoring and preserving the health and dignity of our beneficiaries. (1)

UNICEF: International Year of Sanitation, 2008.

Medair WatSan Sector (examples) • Hygiene promotion, with focus on drinking safe water, hand-washing, and safe stool disposal • New water points: drilling boreholes, digging wells, protecting springs • Rehabilitation and maintenance of existing water points • Installation of rainwater harvesting and gravity-fed water systems • Installation and operation of stationary and mobile water treatment systems in emergencies • Provision of household ceramic filters • Latrine construction • Installation of hand-washing and bathing facilities • Rubbish collection campaigns in camps for internally displaced persons • Training of village water committees and pump mechanics

Sectors of Expertise

Being Accountable to our Beneficiaries Medair works alongside residents of Madagascar to help improve access to safe drinking water and sanitation. Madagascar lies in the path of seasonal cyclones that perpetuate a cycle of poverty on the island. One of Medair’s priorities is to re-establish access to clean water after cyclones, to disinfect and improve water points already present, and to reduce vulnerability to future cyclones. As part of our programme here, we strive to remain accountable to the people with whom we work—our beneficiaries. Our main water project is called Rano Tsara, which means “Good Water.” From its onset, we have sought a fully consultative and participatory approach with beneficiaries. We wanted them involved at every level, especially with the decision-making process. This has meant workshops for all levels of community representatives, focus groups, and traditional Malagasy Loa Bary an Dasy—community meetings where the entire affected group meets to validate choices that are being made. The sites for the water points are selected by the villagers themselves, and once construction of the pumps begins, we have direct participation from the beneficiaries in labour, materials, and money. Drilling teams are local enterprises that receive training from Medair.

Beneficiary Accountability in Action “We regularly visit construction sites to ensure smooth running of the work but also to be an encouragement for the local drillers,” says Matthias Lampert, Medair’s WatSan Manager. “We do not act as if we know everything or as if we are necessarily the ones who will make the good decisions. They do not expect that we give them all the answers and solutions to their problems, but that we listen to them and be sensitive to their drilling problems, so that we encourage and understand them in their daily work.” “Accountability does not necessarily imply a judgmental behaviour,” concludes Matthias. “Accountability can be a supporting attitude that allows us to increase the quality of service for beneficiaries.” The majority of Madagascar’s people still lack access to clean water and sanitation. As Medair works to improve water and sanitation access on the island, we know that people need to be part of the process that gets them these essential services. By working alongside beneficiaries, and by seeking their feedback or complaints, we make ourselves accountable to them. Photos, left: Trying out a new village hand-washing facility in Madagascar. right: Working hard for a new clean water source in Madagascar.

Shelter and Infrastructure Medair’s Shelter and Infrastructure sector provides life-saving shelter in emergencies, as well as vital infrastructure during the rehabilitation process, critical for any community hoping for a brighter future for its children. In a natural disaster or conflict situation, people are often violently wrenched from the safety and familiarity of their own homes. The immediate provision of emergency shelter and household goods (blankets, clothes, cooking utensils, etc.) can be essential to saving lives. Once the situation stabilises, Medair shifts its focus to rehabilitation—restoring what was lost and hopefully improving the basic infrastructure that existed before the crisis. We never come into a situation to do all the work for the beneficiaries. We come in with materials, technical advice, and training support, so that beneficiaries themselves can gain invaluable experience and expertise that will serve them well for years to come, long after Medair leaves. 16

MEDAIR Annual Review 2008

Many of our beneficiaries also receive support to develop new practical livelihoods that enable them to bring in cash to support their families. We also provide support for children so that they can receive a proper education and a better opportunity for a brighter future.

Medair Shelter and Infrastructure Sector (examples) • Temporary and semi-permanent shelter distribution • Distribution of essential non-food items • Construction or rehabilitation of permanent shelters • Construction or rehabilitation of schools, health units, roads, bridges • Implementation of disaster-mitigation strategies • Training in earthquake-resistant construction techniques • Livelihood support • Educational support hoto: B P ricks and the people to build with them—two indispensible aspects of Medair’s clinic reconstruction projects in D.R. Congo.

Sectors of Expertise

An Opening to the World In Karamoja, Uganda’s most vulnerable and insecure region, Medair runs an infrastructure project that benefits the residents in more ways than one. For many years, life in Karamoja’s remote Natorokokito village has been extremely tough. Successive droughts have led to major crop failures and a severe scarcity of food. However, with no road access, the vulnerable population has not received food distributions either– usually key for survival during times of drought. Instead, people forage on greens from the bush and subsist on one meal a day.

the money,” said Michelle Wilson, Deputy Country Director. “It also creates a valuable asset in the form of a road.”

“Our local leaders told us that the truck that carries food has got no access road to our village, so we have been abandoned for six years,” said Dedeng Locham, a 42-yearold mother of eight children in Natorokokito.

A nine-kilometre community road was built, constructed mostly by beneficiaries in the surrounding parishes, with supervision, design, and materials provided by Medair. The new road directly benefits over 4,000 people in the region, who now have better access to villages, markets, and health services.

Without a road, ambulances have not been able to reach the community either. The only means of transporting people to the hospital has been on the back of a bicycle or a donkey.

A Road to Recovery In 2008, Medair—one of the only international NGOs working in the remote, insecure Kaabong district in Karamoja—initiated a Cash-for-Work infrastructure project to build an access road connecting villages to one another, while also giving much-needed employment to the most vulnerable. “Giving cash in return for labour retains the dignity of the individual, allowing them to choose what they want to do with

“I worked for two weeks and got 30,000 shillings,” said Dedeng, one of the Cash-for-Work participants. “I used part of the money on treatment when I got sick, part of it to buy food for the family, and I also bought a hen on market day that is already laying eggs.”

An ambulance now comes to the Natorokokito health centre once a week and donkeys no longer transport the sick. Insecurity has also decreased in the area, as the road has become increasingly busy. As a result, more NGOs are travelling to provide aid to this underdeveloped, once-forgotten region. “Because of the road we also got some food yesterday, distributed by World Vision,” said Dedeng. “Long live Medair for the good services we are enjoying!”

Photo: Beneficiaries build the Kaabong district road in Medair’s

Cash-for-Work project.

C.A.R CAMER.

SUDAN

Isiro Congo

REP. OF CONGO

GABON

Equator

UG. R.W

Lual

BURU.

Kinshasa

Dem. Rep. of Congo

Bunia Kisangani

TANZ.

ANGOLA

0 0

200

400 km 200

D.R. Congo

• Recovering from years of conflict that killed more than 5.4 million people, mostly from war-related hunger and illness • Almost 1.4 million people internally displaced • Eruption of deadly new conflicts in 2008 • Vast region with villages isolated by limited road infrastructure

ZAMBIA 400 mi

A Centre of Hope As the longest-serving NGO in the region, Medair supported post-conflict recovery for more than a million people in 2008, while also responding to sudden emergencies. In 2008, Medair staff visited the small village of Gombe and found an old, broken-down health centre. “Sick people have to cross a river and then walk ten or more kilometres to reach the next health centre,” said Basanopee-Bakjabe, an elder of the village. Medair saw the potential to rehabilitate the old building, but the village residents were unenthusiastic. “The old health centre reminds us of very difficult years,” explained the elder. “With a new building, a new chapter of our history would start.” We were forced to make a difficult decision: restore a building associated with an emotionally traumatic past or spend more money on a new health centre?

Greater than the Distance to the Moon

Reaching our beneficiaries was a major challenge, with so many isolated villages spread over a massive region. In 2008, our staff travelled 449,110 kilometres by land, greater than the distance to the moon!

In 2008, the rehabilitation of health structures was a “It is by God’s grace that Medair has come to our remote major priority for Medair—29 buildings begun and village to construct a new maternity building for our health 20 completed—with latrines and rainwater collection centre,” said Masumauko Goba in systems. We also supported a the village of Likopi. “Because of broad range of health services the bad roads, our village became in almost 500 health structures “Medair’s project has extensively almost inaccessible. It’s been a long across vast northeastern time since any organisation came D.R. Congo. As a result, more reinforced our knowledge and to help us.” than three million people had understanding of health care access to quality health care, management, as well as the with more than 1.2 million people Building a Brighter Future abilities of our health workers.” receiving treatment. In Gombe, the Medair team listened to Dr. Didace Tolima, Bili Health Zone Medical Authority the concerns of the village residents, In April, Medair responded to a and agreed that the wishes of the deadly meningitis outbreak in Goria, where the only community outweighed the economic considerations. Building health centre was a mud hut lacking essential medicines. a new health centre would help restore dignity to a population “I thank God for sending Medair,” said Biyoni, a Goria that had suffered far too much. “We are very joyful that we resident, holding her son closely. “No other NGO came into can construct a new building together with Medair,” the our remote region. Without Medair, my child would already elder told us. “This health centre will be a centre of hope for be dead.” the whole region.” 18

MEDAIR Annual Review 2008

Crisis in Dungu!

Programme Highlights Total beneficiaries in 2008

1,238,243

In September, Dungu territory was attacked by the Lord’s Resistance Army (LRA). Thousands of people fled their homes, many to Dungu town. The displaced people quickly overcrowded the host population and strained limited resources. The vicious attacks were traumatic for people recovering from a decade of conflict.

Medair personnel

10 internationally recruited staff 104 nationally recruited staff

Health Services Emergency Relief • 31 health structures treating IDPs supported • 13 outbreak responses (cholera, dysentery, meningitis) Rehabilitation • 497 health structures supported

Medair was challenged by the abrupt shift from rehabilitation back to emergency response in Dungu. Fortunately, our experience in the area allowed us to respond swiftly to the crisis, providing health care and medicine to the most vulnerable.

• 890,822 new patient consultations with 114,023 admissions

“Medair was the first NGO that reacted to our appeal for help,” said District Commissioner Kyoni Ngoie. “They sent important humanitarian assistance by providing medical care for our battered brothers and sisters.”

• 15 2-stance latrines for health centres in Ituri

For a month, Medair was the only NGO in Dungu town, as the LRA continued to terrorise the region. In November, an attack on Dungu forced Medair staff to evacuate, but we were back in less than a week.

• 29 health centres and hospital wards and 2 health admin buildings begin construction or rehab (20 in Ituri, 11 in Haut Uélé), with 20 projects completed

“We appreciated very much that Medair returned so quickly to Dungu,” said Felicien Balani of the Civil Society in Dungu. “Many nurses from our health centres had to flee Dungu themselves. Medair has proven once again that they stay with us even in difficult situations.”

• 244,008 antenatal appointments, 63,998 births • 373,721 vaccinations administered • 112 midwives and nurse trainers trained • 1,690 victims of sexual violence treated Water & Sanitation Rehabilitation • 13 4-stance latrines for health centres in Ituri and Haut Uélé • 28 health centres receive rainwater collection systems, disposal pits, placenta pits, and 56 handwashing kits Shelter & Infrastructure Rehabilitation

• 31 community-involvement tool kits distributed • 31 health centres provided with furniture Photos, left: Medair staff deliver essential medicine in Dungu during

the LRA crisis.

right: Beneficiaries and Medair staff work together to build a new

health clinic.

F or more information about D.R. Congo and Medair’s work there, please visit www.medair.org/congo 19

UZBEKISTAN TAJIKISTAN

CHINA

Yawan

TURKMENISTAN

Faizabad

Kabul

Jalâlâbâd

Ghazni

Kandahâr

dus

Afghanistan

Behsud

Bamian

PAKISTAN 0 IRAN

100 200 km 100

INDIA 200 mi

Afghanistan

• Almost 30 consecutive years of conflict • Communities isolated by harsh weather, insecurity, poor road infrastructure, and hazardous terrain • Neglect and underdevelopment throughout the country - Very limited access to primary health care - Some of the highest maternal mortality rates in the world • Years of devastating drought

The Impossible Made Possible In 2008, Medair overcame major access challenges to improve health care, respond to drought conditions, and expand water and sanitation (WatSan) provision in some of the most isolated communities in the world. By the second day of her labour, it was obvious that Gul Bibi needed to be seen at the health centre in Zeriaki, an hour’s walk away. But in Zeriaki, the midwife was able to diagnose the problem but unable to perform a C-section. Gul Bibi was urgently referred again, this time to the new facility in Yawan. Medair had made major improvements to the referral system between distant villages during the year, so that referrals just like this could happen.

In October, Gul Bibi went into labour with her sixth child, but the baby was in a bad position for delivery. Without intervention, the child would die and Gul Bibi would likely bleed to death. Her only chance for survival was a Caesarean section, something not readily available in remote Badakhshan province, let alone in her small village of Ghojan.

After a long, nervous ambulance ride, Gul Bibi arrived at the emergency clinic, where Dr. Gulsara swiftly performed the procedure and delivered a healthy baby boy. Gul Bibi’s family and all the clinic staff were filled with joy. “I know that you saved my life and the life of my little boy,” said a grateful Gul Bibi. “I feel very well and very happy. Thank you!”

Drought Response

Drought and high food prices led to a desperate food crisis in 2008. For years, Medair has been Medair sought to improve long-term “You are the only improving health care for mothers food security by distributing quality organisation that really in Badakhshan, home to the seeds, and providing agricultural serves the communities that highest maternal mortality rate and nutritional training. In the are isolated and far away ever recorded. In 2008, we worked Food-for-Work programme, we also from health services. You in four of its most inaccessible employed 4,913 workers for short really work hard to serve the districts, providing a range of periods of time to construct roads communities in need.” primary health care services for the and irrigation canals, and paid them most vulnerable. We responded to with cash and 189 tonnes of food for Statement from Houz-e-Shah community leaders, Khwahan District disease outbreaks and trained over their families. One of the new roads 200 health workers. Four new or now provides access to a health improved clinics were opened, including a reproductive facility for almost 10,000 people. “This is really good,” health facility in Yawan, where we hired a much-needed said Dr. Habib, Medair Project Manager. “They are helping female obstetrician. This new facility most likely saved to improve things for the future while earning food they Gul Bibi’s life. need now for their families.” 20

MEDAIR Annual Review 2008

Success in Arduous Conditions Afghanistan can be a demanding work environment, and 2008 was no exception. Insecurity led to increased volatility around project areas—areas that were already difficult to access due to the terrain and the long winter. Our staff spent countless days trekking on foot or horseback to reach the most isolated villages. Another challenge was finding qualified staff who were willing to work in such arduous conditions. To their credit, Medair staff rose to meet challenges with such a spirit of determination and teamwork that others took notice.

Programme Highlights Total beneficiaries in 2008

140,289

Medair personnel

10 internationally recruited staff 145 nationally recruited staff

Health Services Emergency Relief •8 disease outbreak responses (anthrax, pertussis, ARI) treating 1,555 beneficiaries • 1 89 tonnes of food distributed to 4,913 households (34,391 people) in Food-for-Work activities Rehabilitation • 7 health facilities, 55 health posts supported, accessed by 79,531 people • 295 births, 63 patients with major Ob/Gyn complications treated successfully in Yawan clinic • 50 times more referrals over 2007

“Medair has a team of dedicated staff who have a high level of respect for one another and work well together,” said Sarah Adams, with the Mennonite Central Committee. “They work hard in the field by day, enjoy good fellowship together in the evenings, and serve the communities with respect and dignity for all.” Medair’s WatSan team also made major progress this year, particularly in the isolated Central Highlands region. Over 50 wells were established in these valley communities, along with hygiene promotion, and hundreds of new latrines.

• 4 new or improved health facilities opened in Sheldan, Shingan, Patir, and Yawan • 80 health staff trained, 178 community health workers (CHWs) trained • 2,349 patients in supplementary feeding programme • 27,802 people received health/nutrition/hygiene training Water & Sanitation Rehabilitation • 57 wells dug, 2 gravity-fed water-supply systems constructed, and 87 spring protections put in place • 389 public latrines, 161 household bathrooms built Shelter & Infrastructure Rehabilitation • 49 km of road and 30 km of irrigation canals rehabilitated • 4,913 workers hired to construct roads and canals

In Badakhshan, an opportunity arose to provide water in the struggling mountain community of Zulazma. Past experience had convinced villagers that digging wells would be impossible in this dry, mountainous region, but when Medair engineers dug five metres down, they found water. In short order, the team dug four wells for the surprised residents. “Long live Medair!” exclaimed Ali Ahmad. “Medair is the NGO that can make impossible work possible.”

• 964 households (6,748 people) received vegetable and/or crop seeds, oxen, or fruit trees Photos, left: Gul Bibi with her mother-in-law and newborn son. right: Food-for-Work road construction in progress.

F or more information about Afghanistan and Medair’s work there, please visit www.medair.org/afghanistan

Indonesia

Banda Aceh MALAYSIA

• Vulnerable to frequent natural disasters • Still recovering from the Asian tsunami • Nias Island also recovering from 2005 earthquake, one of the most powerful quakes in history • Limited access to health care or safe drinking water in remote areas

Gunung Sitoli NIAS ISLAND

Teluk Dalam

Indonesia

Jakarta 0

500 310

1000 km 620 mi

Persevering through Adversity In 2008, Medair actively worked alongside Indonesia’s most vulnerable, providing multisectoral aid in the neglected southern region of Nias Island, and repairing and improving sanitation units on the west coast of Aceh province. Medair also installed latrines and hand-washing facilities on the island, and made a focused effort to increase awareness about the importance of proper hygiene.

“A Delegation from God” In 2008, Medair also improved health care provision on Nias Island. In total, 13 new traditional birth attendants were trained for work in remote areas. Medical equipment and supplies were distributed to several isolated health clinics: two required river crossings, and another two required the team and community members to carry the equipment on foot for six hours because of the lack of roads. In addition, more than 9,000 mosquito nets were distributed to protect people against malaria. In the village of Hiliotula, Norima Bu’uolo, a widow near 60 years of age, was unable to use the water springs very near her house before this year, because the water was unsafe to drink. “Although there were plans to repair these springs a long time ago, the village did not have the ability to do it,” said Norima. Indeed, southern Nias Island has received little international or government assistance over the years, despite repeated natural disasters, perhaps because the villages are so isolated. In 2008, Medair completed improvements to water and sanitation (WatSan) access in several island villages, including Hiliotula, where we restored the springs as viable sources of water for Norima and other residents. “This project was needed in our village because water is the source of life,” said beneficiary Fatima Ndruru. “The staff of Medair are very kind and friendly. It looks like they can understand our needs. We only can pray for you, may God bless you, and thank you for supporting us and our village.”

MEDAIR Annual Review 2008

“After using this mosquito net, I feel younger than before,” said Norima. “By using it, I can sleep very well, without the disturbance of mosquito bites, and with the knowledge that it will prevent me from getting malaria.” Medair built five new health clinics to replace old clinics that had been damaged in the earthquake. These construction projects were particularly challenging, with conflicts arising with some unscrupulous contractors. However, Medair persevered through adversity and completed all the planned construction projects. The team also designed, manufactured, and installed two incinerators for the disposal of medical waste, which is vital for public health. “I feel that Medair is a delegation from God,” concluded Norima. “In my family, and in the village, hygiene practice has improved and continues to get better. Families are using the health clinics, the latrines, as well as the clean water provided by Medair.”

Committed to Integrity In 2008, Medair commissioned an external evaluation of household sanitation facilities that we had installed in 11 Aceh Jaya villages. The evaluation found that Medair had improved clean water access, but it also identified quality issues: 583 facilities demanded remedial action. Medair committed to correcting the situation immediately.

Programme Highlights Total beneficiaries in 2008

36,022

Medair personnel

10 internationally recruited staff 72 nationally recruited staff

Health Services Rehabilitation • 1 ,500 hygiene kits distributed • 1 3 traditional birth attendants trained •9 ,144 mosquito nets distributed • 1 1 emergency cases handled • 1 22 items distributed to health clinics

Our focus was not only on repairs but also on design problems caused by the facilities being installed in swampy areas. To improve the facilities, Medair installed new septic tanks and added a concrete replacement tank that was more resilient in an earthquake-prone area. A compost bin was also added to each site. These alterations were made by reputable contractors under close Medair supervision. Our team also conducted training to ensure that homeowners understood how to maintain and operate their systems. By the end of 2008, 210 households had received the repairs, with the remainder to follow in early 2009. “I am very grateful that Medair came all the way back to Aceh Jaya to fix what was wrong,” said H.T. Imran, sub-district leader in Aceh Jaya. “This is very good for our people, as sanitation is new to them and they need a good system to use.”

• 1 8 “posyandus”–village primary health structures–revitalised through training and supervision Water & Sanitation Rehabilitation • 4 village spring-protection projects completed • 5 village gravity-fed water systems introduced or repaired • 210 households received remedial work on their sanitation units • 15 latrines built; 5 septic tanks built • 144 beneficiaries trained in general hygiene and to maintain their sanitation systems • 7 rainwater harvesting systems completed • 4 monitors, 1 engineer, and contractors given WatSan training before remedial work began Shelter & Infrastructure Rehabilitation • 1 puskesmas (large clinic), 4 pustus (small clinics), and 1 staff house constructed Photos, left: One of the five new Medair-built clinics that opened its doors in

2008.

right: Woman surrounded by village children as she takes advantage

of a new clean-water source.

F or more information about Indonesia and Medair’s work there, please visit www.medair.org/indonesia 23

Maroantsetra

MOZAMBIQUE CHANNEL

Madagascar

• Frequent cyclones cause extensive damage and flooding • More than 85 percent of the population are impoverished, living on less than the equivalent of US$ 2 per day • Very limited access to safe water or latrines

Fénérive-Est Toamasina

Antananarivo

Madagascar INDIAN OCEAN

100 200 km

100

200 mi

Tetezana: A Bridge for the Most Vulnerable In a country so routinely struck by cyclones, Medair works year-round to respond rapidly to emergencies, establish long-lasting water and sanitation (WatSan) infrastructure, and build capacity within communities. On 17 February, Cyclone Ivan slammed into Madagascar with winds of 230 km/hr and torrential rains that lasted for five days. More than 80 people died and 147,000 were left homeless. After six years on the island, Medair was well-prepared for a cyclone like this, and a team left immediately for the affected area in Fénérive-Est. “Our first impression as we arrived was a devastated landscape,” said Catherine Shimmin, Hygiene Promotion Manager. “We saw houses completely flattened, fields covered with mud, trees broken, and rubbish everywhere.”

20,000 households, disinfecting more than 1,500 wells, and providing hygiene promotion to thousands of people.

“It was great to see the effect of our work on diarrhoea statistics, especially among children,” said Catherine. “After the cyclone, diarrhoea was on the rise. But after just two weeks of distribution, disinfection, and hygiene “It was during meetings promotion, cases fell back down to suggested by the Medair normal levels.”

teams that we realised the gravity of the situation. These meetings really awoke us about hygiene and health.”

In less than a month, Medair’s emergency phase was nearly finished, while some agencies were still getting set up in the area. “It is clear that Mrs. Justine, President, Antakotako Women’s Medair has an advantage as we are Association here the rest of the year,” said Andrew Shimmin, WatSan Manager. “We have a good understanding of the area and local knowledge, so Medair and a local NGO partner initiated a swift emergency we can react quickly.” response, distributing safe water and hygiene kits to In 2008, Medair continued to play a leadership role within the WatSan sector, receiving major accolades for our work, including the knighting of Country Director Christophe Roduit. “In the Malagasy language, the word tetezana means ‘a bridge,’ but it equally evokes a transition, the passage from one state into another,” said Jean-Claude Boidin, E.U. Ambassador. “We appreciate the presence of Medair here, because they have established a ‘bridge’ between emergency response during cyclones and rehabilitation, which must follow. It’s essential to connect the two.”

MEDAIR Annual Review 2008

Good Water, Good Protection In October, Medair initiated the Fiaro Tsara (Good Protection) project, designed to mitigate the risk of future cyclones through intensive capacity building. We also made significant progress with our Rano Tsara (Good Water) project, with more than 100 new flood-proof boreholes drilled and almost 200 new latrines. Hygiene promotion was delivered to 100,000 people through radio, film, and in-person training sessions. In August, Medair ran hygiene clubs for children, using games, puppet shows, and competitions to make the learning more memorable. “Our activities bring many positive changes to the beneficiaries, because our target groups are now very well informed–such as women within their associations and children at school,” said Patricia Razafindrafara, Deputy Hygiene Promotion Manager. “Women’s water-fetching duties are easier, thanks to the pumps, and access to drinkable water is available in the villages. Statistics testify to a reduction in diarrhoeal illnesses.” Medair also established a network of partnerships and discussion forums to ensure participation of all actors. In Antakotako, participants were enthusiastic at discussion forums, because they had never been directly consulted before.

Programme Highlights Total beneficiaries in 2008

245,410

Medair personnel

9 internationally recruited staff 78 nationally recruited staff

Water & Sanitation - Emergency Relief • 1,540 open wells disinfected • 23,796 families (95,000 people) received WASH kits • 47,500 people in 3 communes received emergency hygiene promotion Rehabilitation • 118 new flood-proof boreholes drilled and fitted with hand-pumps and drainage (14,160 beneficiaries) • 1 gravity-fed water-supply system built for village (1,000 beneficiaries); 1 gravity-fed water-supply system in construction • 1 97 family latrines installed (beneficiaries: 2,410) • 5 3 women’s associations trained in hygiene promotion; another 170 hygiene volunteers trained • 15,000 adults attended 219 hygiene sessions • 25,000 children attended 118 school hygiene sessions; 270 school teachers trained • 66,000 people reached through 172 puppet or cinema hygiene promotion sessions • 41 workshops on WatSan policy and technical issues • 7 communes and 51 community-based water-user associations trained • 480 households surveyed about disaster risk-reduction issues • 7 training workshops for disaster- and risk-management committees Shelter & Infrastructure Emergency Relief • 19,000 metres of evacuation channel rehabilitated • 323 vulnerable families received plastic sheeting Rehabilitation

Many of the meeting participants took the initiative to improve the hygiene in their villages. “The villagers were really motivated as they noticed that these changes had a direct impact on their health,” said Mr. Jocelin, a village chief. “March is generally the disease period, following cyclones and inundations. This year, we had flooding, but no epidemics!”

• 3 bridges rehabilitated for access to 9 villages and 20,000 villagers Photos, left: Beneficiaries get WASH kits for Cyclone Ivan. right: Village hygiene promotion activity.

F or more information about Madagascar and Medair’s work there, please visit www.medair.org/madagascar 25

2008 at a Glance A June outbreak of Hepatitis E in Uganda’s Pader District galvanised Medair’s Health and WatSan teams to take action to contain the spread of the deadly disease. By year’s end, Medair had worked with over 20,000 households to ensure a safe supply of drinking water, latrine access, and hygiene awareness.

January was a time to celebrate the first month for Medair’s first female OB/GYN doctor at our Yawan Community Health Clinic. Her presence makes a major difference for pregnant women in Afghanistan, where women are more likely to consult with a female doctor.

In joyful ceremonies in March, Medair officially handed over responsibility for health care in the villages of Abu Safifa, Lagori, and Tesi in Southern Kordofan, Sudan (Northern States). Nine fully functioning Medair-supported health facilities in Southern Kordofan were handed over during 2008.

January

February

March

February saw Cyclone Ivan hit Madagascar with a vengeance. Medair took immediate action with a swift emergency response that distributed safe water and hygiene kits to 20,000 households, disinfected wells, and provided hygiene promotion.

April

May

June

May saw the opening of the new operating theatre and building for the Yawan CHC in Afghanistan, just one of several Medair clinic openings in 2008.

In April, Medair’s Emergency Response Teams (ERTs) travelled to Maban, S. Sudan, where returnees were living in a reception area with no latrines or hand-washing facilities. We assisted beneficiaries in digging latrines, and trained hygiene promoters to teach people how to protect themselves from disease. Our ERTs responded to seven disease outbreaks, provided emergency water supply and latrines, and reached more than 125,000 people with vital health education in 2008.

MEDAIR Annual Review 2008

In October, Medair initiated the Fiaro Tsara (Safe Water) project in Madagascar, designed to mitigate the risk of future cyclones in the most vulnerable communities.

In November, the Medair team opened a programme in Burao, Somaliland, where the humanitarian situation is dire due to local drought and conflict to the south. The programme consists of nutrition support for malnourished children, as well as emergency responses to outbreaks of diseases like measles and cholera among displaced populations.

In Indonesia, Medair distributed medical equipment and supplies to several isolated health clinics. Two required river crossings, and another two required the team and community members to carry the equipment on foot for six hours because of the lack of roads. More than 9,000 mosquito nets were distributed to protect people against malaria.

July

August

September

October

In August, more than 800 people were working in the Cash- and Food-forWork labour projects building roads, irrigation canals, and bridges in Afghanistan.

November

December

Thousands of orphans are subjected to abuse and neglect in post-conflict Uganda because of a lack of community structures in place to support these very vulnerable children. In December, Medair carried out 181 community education sessions across five sub-counties on child rights and protection in an effort to build a base of community support for these children.

In September, the Lordâ&#x20AC;&#x2122;s Resistance Army (LRA) initiated attacks on residents of the Dungu territory in D.R. Congo. Tens of thousands fled their homes to the tenuous safety of the surrounding villages and jungle. Our teams responded immediately by providing medicines and emergency health care for the most vulnerable.

EGYPT

LIBYA

SAU. AR.

Northern States Omdurman

CHAD

Geneina

Khartoum

ERITREA

Sudan

West Darfur

Kadugli

Southern Sudan

C.A.R 0 0

300 km 300 mi

DEM. REP. OF CONGO

UGANDA

ETHIOPIA

KENYA

Sudan (Northern States)

• Recovering from long civil war that ended in 2005 • Ongoing conflict and volatile security situation in Darfur West Darfur • Insecurity threatens the population and restricts humanitarian access • 2.7 million internally displaced persons Southern Kordofan • Post-war neglect and underdevelopment with very limited access to health services or water and sanitation Khartoum State • 1.2 million internally displaced persons

Handing Over Sustainable Programmes In 2008, Medair provided humanitarian aid for 420,000 in Sudan’s Northern States through quality health services and improved access to water and sanitation (WatSan). In Sudan’s Northern States, Medair’s goal is the successful handover of services to the community and in this respect, 2008 was a remarkable year. We conducted training sessions throughout the year for local staff and invested time with the Ministry of Health (MoH) and Secretariat of Health (SoH) to ensure their ownership for handed-over services. Nine of 20 fully functioning health facilities in Southern Kordofan were handed over during the year with plans to hand over the remaining 11 by early 2009. In Khartoum State, Medair assisted the community of Navasha with establishing a permanent clinic staffed by the state MoH. We also handed over our Primary Health Care Centre in Khartoum State to a national NGO at the end of 2008. Joint planning for this handover received

praise from the state MoH: “You are the first NGO to find out our plans and share your own,” said Dr. Abdel Hafeez Osman of the Umbaddah Health Area. WatSan access improved in 2008 with the addition of 13 new boreholes and the training of pump mechanics, rehabilitation of hand pumps, and establishment of rainwater harvesting systems.

A Difficult Year Despite these successes, 2008 was a difficult year in Sudan’s Northern States, particularly in West Darfur. Medair’s operations were constantly hampered by insecurity and other challenges. There was insecurity along the border with Chad, attacks on communities, and also an increase of incidents targeting NGO facilities. Medair continued to rely on flying in and out of insecure West Darfur locations by helicopter, but often the visits allowed only a few hours on the ground for clinic supervision and water-point maintenance. Even small projects took many weeks to complete. However, we made notable contributions in this uneasy climate, not only by achieving our humanitarian objectives but also by playing a leading role in the capital city of Khartoum, representing the humanitarian community as a whole at the highest levels of government.

MEDAIR Annual Review 2008

Handover Celebrations in Southern Kordofan Five years ago, health care was virtually non-existent in the villages of Abu Safifa, Lagori, and Tesi, but by 2008, quality health care had become available and sustainable. In joyful March ceremonies, Medair ceded health care responsibility in the villages. Speeches, drama, and dancing marked these significant achievements. “Handing over these facilities has been very encouraging,” said Janneke Blok, Medair’s Health Coordinator in Kadugli. “The gratitude expressed toward Medair, and the enthusiasm of the communities to take care of their health facilities, have convinced me that the work we are doing here can really make a difference—especially if the communities are so committed to it themselves.” At the handover ceremony, the umda (village leader) of Abu Safifa said, “The fact that Medair is leaving Abu Safifa feels as if a relative has died.” In Lagori, the feelings were equally strong: “The next baby born in Lagori should be called ‘Medair’,” said the umda, “to express our gratitude towards the work Medair did for the community of Lagori.”

Programme Highlights Total beneficiaries in 2008

420,000

Medair personnel

26 internationally recruited staff 225 nationally recruited staff

Health Services - Emergency Relief Khartoum State •2 ,531 monthly average number of patient consultations at PHCC • 1 ,417 average monthly household visits for health promotion •4 50 pregnant and lactating mothers each month enrolled in 12-week health education programme West Darfur •3 21,872 outpatient consultations in 20 PHCCs • 1 0 medical assistants, 35 community health workers, 56 midwives, and 86 clinic assistants received annual refresher training South Kordofan • 9 of 20 Medair-supported clinics handed over to MoH and SoH •4 9 community teaching sessions conducted Water & Sanitation - Emergency Relief Southern Kordofan •2 09 latrines in 5 locations • 1 0 new boreholes drilled West Darfur • 1 08,000 people provided with sufficient water supply •9 ,000 people provided with water through emergency water system • 1 ,135 household latrines • 3 new boreholes drilled to recommission a water tower Rehabilitation Southern Kordofan • 4 rainwater harvesting systems installed Khartoum State • 19 sets of community latrines handed over to the community Shelter & Infrastructure - Emergency Relief Khartoum State

“The Nuba Mountains have been in darkness for a long time. Medair was a light in the mountains. Thanks to Medair, we now have good health services.”

•7 10 plastic sheets provided to assist 355 households after shelters damaged by heavy rains Photos, left: Medair staff with helpers installing an electrical submersible pump. right: Village women dance in celebration of the handover of their

new health clinic, seen in background.

Bashir Mahdy, local chief in Al Kook

F or more information about Sudan and Medair’s work there, please visit www.medair.org/sudan-northern-states 29

EGYPT

LIBYA

SAU. AR.

Northern States

CHAD

Khartoum

Sudan Aweil

ERITREA

Renk Melut Malakal

Southern Sudan

Akobo

ETHIOPIA

C.A.R

Yei 0 0

300 km 300 mi

DEM. REP. OF CONGO

Juba UGANDA

Southern Sudan

• Recovering from long civil war • Fragile peace amid rising insecurity • Some of the world’s worst indices for nutrition, education, access to water, mother/child health, and outbreaks of disease • Vaccination and antenatal care coverage are lowest in the world • Resources strained by return of displaced populations

KENYA

To See Hope Return With thousands of previously displaced people continuing to return to Southern Sudan, Medair worked throughout 2008 to improve access to health care and water and sanitation (WatSan) and responded to emergencies across the region. Medair’s Wendy van Amerongen was amazed at the effect the training made in just two days. The camp was totally cleaned of rubbish, with the residents collecting anything that was lying around, including Wendy’s bags (which they hung in a nearby tree). She also saw people washing their hands with soap before taking food. “This place has my heart,” said Wendy. “After years of war, I see a people willing to work hard to build up their lives again.”

In April, Medair’s Emergency Response Teams (ERTs) travelled to a reception centre in overcrowded Maban County to conduct an assessment of the area’s hygiene conditions. We found that the reception centre, where many returnees were living, had no latrines whatsoever, no hand-washing facilities, and the low land around the centre created a flooding risk that could lead to a cholera outbreak.

Medair’s ERTs acted swiftly in several emergencies across Southern Sudan in 2008. We responded to seven disease outbreaks, provided emergency water supply and latrines, and reached more than 125,000 people with vital health education. Indeed, hygiene promotion was a major component of our work. “During the cholera outbreak we were suffering, we had poor sanitation and hygiene,” said one of three women trained as hygiene promoters in Parajok. “Medair brought clean water and trained 15 people, and after that we started to teach the community.”

“We give thanks to Medair for teaching us how to stay healthy and ways to teach our children so they will grow strong.”

A Multi-Sectoral Impact

Medair played a leadership role The teams trained members of the within the greater humanitarian community in latrine digging and community, working closely with the hygiene promotion. The latrines U.N. to coordinate health services, made an immediate improvement, David Deng, Director of Police, Pariak but people also needed training and with the Ministry of Health to about general hygiene to prevent support capacity development. We the spread of disease. “Although we did hear some were the sector lead for non-food item distributions in the of these things along our way of travelling,” said Upper Nile, benefitting more than 25,000 vulnerable people beneficiary John Moses, “we didn’t know all of the things with essential items like blankets and mosquito nets. you taught us. We will bring it into practice immediately.” 30

MEDAIR Annual Review 2008

Operations were disrupted by rising insecurity during the year, with outbursts of conflict in Abyei, and attacks by the rebel Lord’s Resistance Army. An intense rainy season brought flooding that led to outbreaks of cholera. Our staff braved oppressive heat, storms, mud, snakes, and scorpions—but continued to work, even when they had to walk for hours through the floods. Our WatSan teams drilled boreholes, constructed wells, and trained water committees to maintain their water supply. We also made a major health impact, particularly in Melut County, where we supported seven primary health care facilities. In July, we responded to a desperate need by opening a tuberculosis (TB) clinic in Melut Town. “I thank Medair because of the treatment,” said former TB patient, Jalhak Chol Deng. “You treat me without me having to pay. This is good, otherwise I couldn’t have gone for treatment. The first thing I will do is tell people who have signs of TB to go directly to Medair!” To combat deadly malnutrition, Medair also opened a therapeutic feeding centre in Melut Town, along with four supplementary feeding centres in the region. One young boy, John, looked like a skeleton when he was first carried in for treatment. After a long battle to survive, and times when Alice Wyatt, Nutrition Manager, believed him too sick to recover, John’s condition thankfully improved. “We rejoiced to see him so healthy,” said Alice. “John was discharged from the programme after exceeding his target weight, looking chubby and happy. It is a privilege for us to see hope returning to families who thought their children would never recover.”

Programme Highlights Total beneficiaries in 2008

280,000

Medair personnel

32 internationally recruited staff 239 nationally recruited staff

Health Services - Emergency Relief • 7 disease outbreak interventions (meningitis, cholera, and measles) • 1 25,746 people received health and hygiene education •3 05 community members trained in interventions such as vaccination, health promotion Rehabilitation • 1 PHCC, 6 PHCUs in Melut County, improving health care access to 100,000 people • 1,817 antenatal visits; 1,726 deliveries by birth attendants • 648 women immunised with TT2; 545 children immunised with DPT3 • 124 clinic patients with severe malnutrition, 45 discharged cured • 353 children and women, moderate malnutrition in non-clinic programme; 62 discharged cured Water & Sanitation - Emergency Relief • 8 water treatment systems installed; 2 more re-installed • 98 emergency latrines constructed • 50 hygiene promoters trained, reaching 6,067 with health/hygiene education Water & Sanitation - Rehabilitation • 6 boreholes drilled and developed for safe drinking water • 8 water committees trained; 15 committees had refresher training • 30 health/hygiene promoters trained; 38 refreshed • 5 shallow wells constructed and commissioned for community use Shelter & Infrastructure - Emergency Relief • 25,475 people benefitted from distribution of non-food items Photos, left: Medair staff conduct hygiene lessons with families staying in

Maban reception centre.

right: Waiting patiently to be seen at the Medair clinic in Melut.

F or more information about Southern Sudan and Medair’s work there, please visit www.medair.org/southern-sudan

0 0

Uganda

100 km 50

SUDAN

100 mi

Kaabong Patongo

Abim

DEM. REP. OF CONGO

Uganda Kampala

KENYA

TANZANIA RWANDA

• Post-conflict transition after 20 years of civil war • Hundreds of thousands of internally displaced persons (IDPs) returning home to devastated villages • 56 percent of the population under 18 • Insufficient local capacity to deliver essential services • Lord’s Resistance Army (LRA) fails to sign peace deal in 2008 • Ongoing insecurity and drought in Karamoja region

Wandering No More In a year of major transition for Uganda, with 50 percent of the IDP population returning home, Medair maintained a constant focus on the most vulnerable among them. made friends with them. They played football and shared stories together. Over the year, Alex received regular counselling from Medair to address his post-traumatic stress, and showed signs of significant improvement. In 2008, protecting Uganda’s conflict-affected children was a priority for Medair. We provided counselling and educational materials to thousands of children, and provided goats as livelihood support to child-headed households. We also trained 150 volunteer counsellors, and coordinated with other actors to establish stronger child protection in the region. “The energy of Medair’s [child] protection team, coupled with its technical knowledge and first-hand field-based realities, has greatly contributed to the work,” said Stephanie Schwarz, United Nations Children’s Fund. At 10 years of age, Alex was kidnapped by the LRA. He was forced to live in the bush for two years before he managed to escape. Upon returning home, Alex learned that his father had been killed by the rebels and his mother’s whereabouts were unknown. Alex soon reunited with his mother, but she had married a new man, an abusive alcoholic, and she was now unsupportive to her son. A traumatised Alex left his mother and became what is known locally as a “wandering child,” drifting from camp to camp. Medair connected Alex with a group of fellow returnees, and he quickly 32

MEDAIR Annual Review 2008

Returning Home

“Medair’s legacy is an improved water supply and construction of latrines; water user committees are in place and managing their water sources. Overall the picture is one of former IDPs returning to their villages of origin with knowledge of the benefits of improved water supply and sanitation.” Richard Carter, external evaluator, Professor of International Water Development, Cranfield University, U.K.

The most encouraging development of 2008 was the mass return of people to their villages of origin. However, many villages lacked essential services. In response, Medair trained and supported over 700 village health team workers to provide basic primary health care in numerous remote locations. In Pader district, Medair maintained water systems for 60,000 people in the camps, while also initiating Water and Sanitation (WatSan) projects to ensure that returnees had access to safe drinking water. Sanitation improved dramatically. “I cannot say enough about how impressed I was with the team when

we visited,” said Ian Moise, WatSan Technical Specialist with USAID. “What I liked best is that they feel the community can take responsibility, both financially and for labor and maintenance. ... The way that they talked about this issue showed that they really respect the beneficiaries and treat them as equal partners.”

A Significant Impact In 2008, an outbreak of Hepatitis E galvanised Medair’s Health and WatSan teams to act swiftly. Medair worked with over 20,000 households to ensure a safe supply of drinking water, latrine access, and hygiene awareness. Medair continued to be one of the few international NGOs working in Karamoja’s insecure Kaabong district. In 2008, we strengthened the region’s capacity to withstand drought through the creation and maintenance of water sources. We also ran a successful Cash-for-Work programme to support local families. Our community road project directly benefitted over 4,000 people and developed the region by joining remote populations with other villages, markets, and health centres. Security increased, and more NGOs began travelling to Karamoja to provide assistance. Meanwhile, in Pader district, Medair’s social workers helped Alex and his mother to be reconciled during the year. His mother left her abusive husband, and Alex now lives with her and attends school regularly. Despite his traumatic past, Alex is no longer haunted by nightmares—a prayer we share for all Uganda’s children.

Programme Highlights Total beneficiaries in 2008

366,286

Medair personnel

17 internationally recruited staff 171 nationally recruited staff

Health Services Rehabilitation • 1,399 antenatal care sessions • 590 children received counselling from social workers • 150 community volunteer counsellors trained, 13 community health workers trained • 2,500 child counselling sessions held by trained community volunteers • 952 patients transferred for life-saving treatment • 700 individuals trained to form village health teams Water & Sanitation Emergency Relief • 20,000 households received soap, chlorine tabs, hygiene promotion during Hepatitis E outbreak Rehabilitation • 8 new boreholes, 3 hand-dug wells for water to 10,000 people • 5 water distribution systems maintained for 60,000 people • 85 boreholes rehabilitated • 1,000 latrines constructed, 85 bathing shelters rehabilitated Shelter & Infrastructure Rehabilitation • 4 community roads completed • 4,158 individuals benefitted from Cash-for-Work initiatives • 225 child-headed households received goats for income generation • 18,741 children in 56 schools received educational materials Photos, left: Ugandan children receive livelihood and psychosocial support

from Medair.

right: New clean water source in Nyakwae is a popular spot.

F or more information about Uganda and Medair’s work there, please visit www.medair.org/uganda

GULF OF ADEN

DJI.

Hargeisa

Somalia

ETHIOPIA

INDIAN OCEAN

Mogadishu KENYA 0 100 200 km 0

100

400 mi

Somalia

• One of the worst humanitarian crises in the world • 3.2 million people (42 percent of the population) require emergency assistance, with more than one million displaced persons • Deadly food crisis caused by relentless drought and high food prices • Persistent and deteriorating conflict and insecurity, including attacks on aid agencies • Very limited access to health care, clean water, sanitation • One of the worst maternal mortality rates in the world

On the Brink In 2008, Medair launched a new programme in Somalia and Somaliland to provide life-saving emergency relief, especially for mothers and children alone in the face of deadly crisis. drought, escalating food prices, and increasing insecurity. Iftan travels the streets of Burao asking for money or However, the insecurity forced Medair’s international staff food. Most days she gathers just enough to pay rent to leave the area and find new ways to and feed her two small boys. “It deliver aid in Cadale, mainly through is my only income,” she says. a local partner. “Sometimes I manage to collect 15,000 shillings [about US$ 2]. “Medair’s feeding programme In November, the Medair team That is when I am lucky.” in Burao is one of the ‘centres opened a second programme in of excellence’ in Somalia.” Burao, Somaliland, where security Somalia and Somaliland are in the Mathieu Joyeux, Nutrition Officer, conditions were better, but the grips of a rapidly escalating crisis that UNICEF Somalia humanitarian situation was still threatens millions of lives. The region dire. Thousands of drought- and has known years of insecurity and conflict-affected people have fled to Burao, straining the drought, but in 2008, the situation worsened. The number resources of the existing population. of people urgently needing emergency aid across Somalia, Puntland, and Somaliland rose from 1.83 to 3.25 million, more than forty percent of the entire population. Abandoned Mothers and Children Iftan fled to Somaliland from Mogadishu to escape from A New Programme insecurity, only to find that life in Burao was still a constant Somalia is a difficult place to work in the best of times struggle to survive. She now pays rent equivalent to about and Medair’s first year was filled with challenges. We US$ 25 per month for a small patch of land with a hut made began by working in Cadale District in Somalia’s Middle of branches and knotted rags. After the birth of her second Shabelle region, one of the most affected areas due to child, Iftan’s husband abandoned her. “Now I am left with the two children,” she said. “It’s very hard to manage a family of this size with so little money each day. I wonder, can I survive with my children?” Iftan’s desperate situation is shared by thousands across this region. “It’s a story I have heard again and again,” said Henrieke Hommes, Health Programme Manager. “Mothers with six or seven children whose spouses walk away and leave their families to survive on their own... There’s no question that women and children are the most vulnerable in Somalia.”

Medair’s Immediate Impact Although much of the year’s efforts were needed for launching the two programmes, we managed to achieve significant 34

MEDAIR Annual Review 2008

results. We began rehabilitating health posts and training health staff, and responded to a measles outbreak in Burao where we vaccinated almost 4,000 people. Our WatSan team also responded to outbreaks of cholera by chlorinating wells and providing hygiene promotion. Water is a scarce commodity in this desert region, and people are reluctant to use water for hygiene when they need it for drinking. So Medair rehabilitated wells to provide a more abundant water supply, while training people about the need for proper hygiene to prevent disease. Our main achievement in the year was the opening of nutrition programmes in both Cadale and Burao to combat the serious food crisis. In Burao, we enrolled more than 1,000 malnourished children in the first month for supplementary feeding and vaccinations. “We are happy to see that once the children are in the programme, their weight goes up very quickly,” said Henrieke. That is a relief to mothers like Iftan, who remain in desperate straits.

Programme Highlights Total beneficiaries in 2008

68,000

Medair personnel

4 internationally recruited staff 59 nationally recruited staff

Health Services - Emergency Relief • 1 measles outbreak response in Burao, vaccinating 3,910 beneficiaries • 2 nutrition programmes operating (total of 11 sites and 1 stabilisation centre) • 1,045 children admitted to nutrition programmes • 16 nutrition staff, 2 community mobilisers, and 24 nutrition volunteers trained • 1 ,188 mothers received nutrition education to improve health of children Health Services - Rehabilitation • 5 health staff trained Water & Sanitation - Emergency Relief • 1 cholera outbreak in Jowhar with 6 wells sanitised and 2,300 households in 9 villages reached with hygiene awareness • 1 acute watery diarrhoea outbreak in Cadale with 2 wells shockchlorinated and 22 households reached with hygiene awareness Water & Sanitation - Rehabilitation • 2 shallow wells rehabilitated and fitted with hand-pumps in Cadale town • 4 WatSan staff trained • 1,375 people reached through hygiene promotion campaigns Shelter & Infrastructure - Rehabilitation • 1 health post rehabilitated in Cadale • 3 health facilities began rehabilitation

While 2008 brought some emergency relief for mothers and children in crisis, much more still needs to be done. “Our Somalia/Somaliland programme is still very young,” said Henrieke, “but we hope that we have now set a good foundation that will allow us to continue our life-saving work and also expand to new areas of critical need.”

Photos, left: Iftan with Amir, the younger of her two boys. right: Child being treated for malnutrition in the Burao

nutrition programme.

F or more information about Somalia and Medair’s work there, please visit www.medair.org/somalia 35

The Faces of Commitment More than 1,200 people from 23 different countries worked for Medair in 2008. Here are eight of their extraordinary stories...

and green. Lovely ocean and beaches. This is something I do not get to witness living in Iran.” Reza Tabasi Clerk of Works Indonesia

Reza was running a taxi service in Iran when a major earthquake struck Bam in 2004. He was hired to drive Medair staff to the site of the earthquake: “After working with Medair in Bam for a week, they asked me if I would want to continue full-time as a driver.” It didn’t take long for Medair to notice Reza’s talent for logistics. After a few months, he was assigned to the housing construction project to do quality monitoring and control, and proceeded from there to get involved as a translator and a liaison with government agencies. Reza’s eagerness and ability to rise to these challenges won the respect of not only the Medair staff, but also the contracting staff and the authorities. In 2008, Medair offered Reza an opportunity to work as an Internationally Recruited Staff (IRS) in our Indonesia programme: “Moving from an NRS (Nationally Recruited Staff) position in my own country to become an IRS in Asia was a whole new experience for me. I’ve had to learn to manage staff and contractors, which took some time. I still have a lot to learn but I appreciate the challenge very much.” Reza brings the same dedication and professionalism to the Indonesia programme that he displayed in Bam. Despite all his responsibilities, he sometimes gets a little free time for after-hours table tennis, swimming, or helping the local NRS to find crayfish. For Reza, this is the first time he has left his home country. Although he misses his family dearly, he appreciates many aspects of the job: “The area where we work is so beautiful

MEDAIR Annual Review 2008

Reza is glad of the opportunity to improve his skills with Medair, especially in management and leadership: “Working with Medair has given me self-confidence. I have learned so much, and all this has made me a better person. Professionally, I now have the confidence to work anywhere else.”

Claire Hutchinson Psychosocial Manager Uganda

Before joining Medair, Claire worked as a registered social worker in a charity in the U.K., and also with the Royal British Navy welfare team, supporting bereaved families and traumatised soldiers: “My training and experience in social work has given me the opportunity to articulate the love I have for vulnerable children and adults in a way that may really benefit them and give some hope in desperate situations.” Now managing Medair’s psychosocial programme in Patongo, Claire relies on all of her past experience to help address the emotional needs of a deeply wounded population: “I manage a team of six social workers, and we aim to meet the needs of orphans, child-headed households, formerly abducted children, and other children suffering from years of abuse and neglect.” Claire measures her team’s successes according to the sincerity and depth of relationships they are able to build: “Not only has Medair developed a genuine and trusting relationship with the local community and district officials, but my programme has also enabled us to build personal relationships with the most hopeless and vulnerable children. Getting alongside people, listening to their pain, and giving them a voice to empower them to move forward into the

Behind the Scenes

future... There isn’t anything more rewarding for me.” Working in Uganda has had a profound impact on Claire, both professionally and personally: “Living a simple rural lifestyle with few material possessions has helped keep life in perspective. I will be changed forever by the amount of knowledge I’ve learnt about psychosocial work in an emergency setting. “What I love most about the job is the opportunity to live and work amongst people who teach me the true meaning of resilience, and seeing God at work in individual lives. It gives me a lot of hope knowing that God is present in even the most forgotten of places.”

Jeri Westad Programme Support Manager Southern Sudan

A U.S. citizen, Jeri worked in the corporate sector in the U.S. and the U.K. for almost twenty years, most recently as an I.T. director. However, she felt led to make a career switch to emergency relief work, and chose to work with Medair because of how closely our values aligned with her own. She now works in the Juba and Nairobi offices and has the challenging task of managing all of the operations that support field teams in Southern Sudan: “The great part of my job is that it is really different every day.” Despite being new to the humanitarian sector, Jeri’s corporate experience and her leadership and management training prepared her well for the job: “Most of my management skills have been directly transferable. I have not had to learn new skills per se, except how to use a radio!” In fact, Jeri was most concerned about integrating within the team environment and being able to quickly contribute. To her delight, she fitted right in: “The people are so helpful and supportive that I’ve felt part of the team right from the beginning. Team life amazes me—especially when we have eight women in one house with one bathroom and everyone gets their turn before we all leave for the office at 7:30 a.m.!” Jeri is most impressed by the dedication of her fellow workers: “There are some really tough places that our

teams have to get to and they still press on, even when the logistics are not working out.” She has also experienced some significant personal changes: “This experience strengthens my faith every day. Relief work has challenged me in terms of what personal needs I prioritise. It’s made me aware of human suffering in a real way—very different to the understanding I had from limited media coverage.” Jeri has some wise advice for future Medair staff: “See each new experience as a blessing. Find something to enjoy or laugh about every day, and help your teammates do the same.”

Jamie Eyre Country Director Afghanistan

“No two days are the same as a country director,” says Jamie. “One minute you could be discussing a potential new grant with an international donor representative, the next reviewing staff regulations, followed by responding to a change in security in a project location. You constantly juggle conflicting demands and move seamlessly from one task to the next.” Jamie’s prior corporate work experience in the U.K. was a solid preparation for his work with Medair: “While I needed to adapt and learn many new skills, my project management beginnings were a great place from which to build.” As a student, Jamie took an internship in Washington, D.C., working for the Asia programme director at Human Rights Watch: “I was exposed to U.S. politics first-hand, and while I didn’t realise it at the time, the seed of a calling to work with the disenfranchised, displaced, and less fortunate was forming.” At a church in London, Jamie met a number of people who had joined Medair and returned to speak passionately about their experiences: “I realised I needed to follow up on Medair and step out of my comfortable London life. Medair was a perfect entry point.” Life can often be less than comfortable in Kabul. For security reasons, much of his time was spent exclusively

with the team, and there was little opportunity to unwind outside the compound. Insecurity affects the work as well: “The amount of effort and background work required to travel safely to project locations is immense.” Still, this inconvenience is outweighed by the rewards of the work itself: “It takes effort to fully engage a community and win their trust. On the days when this happens, and their imagination is captured, the work really feels worthwhile. Being partners with beneficiaries and seeing a community mobilised alongside you to address an urgent need is an amazing thing to be part of.”

Jitske Brouwer Health and Nutrition Advisor Somalia

It takes a special person to embrace the rigours of Medair’s work. Dutch citizen Jitske Brouwer’s first assignment in 2000 in Kenya was quite different from her expectations: “I had worked in Nairobi and travelled a bit in Kenya, but I had no clue that I would be based in a desert, surrounded by camels!” Over the next several years, Jitske worked as a nutritionist on many assignments for Medair. Meanwhile she also obtained a nursing degree. Today, with years of experience in different country programmes, she is one of our most valued contributors. Based in Nairobi, Jitske works parttime for Medair, allowing ample time to mother her two young children. “It is amazing how much has changed between my first and current jobs with Medair,” says Jitske. “In 2000, we could communicate by radio and only in very urgent cases would we send emails or make phone calls with an expensive satellite phone. Everything else would be put on a disk and flown to Nairobi once a month. Today we can use mobile phones or email, making life a lot easier in the field!” Jitske has experienced some challenges while working for Medair: “Living in a tent, open-air showers, snakes and scorpions, eating tinned food every day, and hearing gunshots of drunken soldiers outside the compound.”

MEDAIR Annual Review 2008

Nevertheless, Jitske sees the positive side of things: “Who would not want to trade a townhouse for a tent under an unpolluted night sky full of stars?” Successful interventions are Jitske’s true reward. In places with no health care, Jitske and her teams have worked to provide food for malnourished children and to care for seriously ill people. She finds her work with children in the feeding centres especially gratifying. Some arrive in a severely malnourished state, carried by their mothers, and are able to depart, “dancing out the gate with a few extra kilos and big smiles on their faces. It’s very satisfying to go to bed exhausted, but knowing you have made a huge difference.”

Hermann Chelo Ngadjole Base Manager Isiro - Democratic Republic of Congo

Chelo recalls his appointment as base manager for Medair in Isiro as a beautiful memory: “It was great because I was the first Congolese to assume such a function since Medair began its work in our country.“ Chelo, who is now 37 and married with five children, has a lot of responsibility. He has worked for Medair since 1999, earning his current position through natural leadership ability and ease in working cross-culturally. Most of all, Chelo is respected as a hard worker with great integrity. His loyalty to Medair was so strong that it initially created tension between himself and the tribal armed groups in Bunia. For his own safety, he and his family had to leave Bunia for Isiro, where he has worked since 2005. That wasn’t the only time Chelo demonstrated great courage. Chelo once decided, after much praying, to join an overnight excursion to the needy village of an opposing tribe from his own. “Despite overhearing threatening discussions about his tribe,” says colleague Marian Wetshay-van der Snoek, “Chelo just kept working, presenting himself only with his first name so that he could not be identified by tribe, before taking a plane out the next day. He did not get much sleep that night, though.”

Behind the Scenes

Another thing that makes Chelo special is the way he relates to all of Medair’s beneficiaries in the region, seeing them as people in need, regardless of tribe. “I work to ease or relieve the suffering of the victims of the wars,” he says, “because I appreciate the philosophy of Medair’s approach. I have Medair in my heart and will never forget it. Even if I go to work for other NGOs to gain experience, my wish will be to come back to serve the population through Medair, which I consider my home.”

Dr. Yahia Khames Ahmed Assistant Medical Coordinator Sudan (Northern States)

Dr. Yahia, a Sudanese citizen and devout Muslim, began working in 2002 for Medair, then the only international NGO in West Darfur. When the Darfur crisis began in 2003, openings for doctors were available with many other NGOs. With his Medair experience, Dr. Yahia could easily have taken a better paying position. “He could have doubled his salary at least, but he chose to stay with Medair,” says Fabienne Laurenzio, Dr. Yahia’s colleague. “At one point he had an offer to work in Saudi Arabia. He had the contract in his hands, then suddenly he tore it up.” The staff were amazed that he turned down the chance to earn so much more money, and his family were angry at him about it. When asked why he remained with Medair, Dr. Yahia said, “The atmosphere in Medair is very good. I have never experienced this elsewhere, just like in a family.” “Dr. Yahia loves his people and his country in a way that we don’t understand in our culture,” explains Fabienne. “He is part of it, not just an individual in the community. And this is the way he relates to all the people he deals with, not just Medair beneficiaries. He has a passion to treat the sick, but even more to train the health workers he supervises in a way that they also can do a good job.” Dr. Yahia counts his greatest success as being able to train all of Medair’s health staff in a life-saving integrated approach to child health care. His current duties keep him very busy, but Dr. Yahia has a thirst for knowledge and is always looking to learn more. Medair was recently able to sponsor him in a three-month

evening course on HIV/AIDS, and is providing some financial support as he starts evening classes toward a master’s degree in Public Health and Tropical Health. “I know I can call him at anytime to ask his advice if someone is sick at the house and I’m not sure what to do,” concludes Fabienne. “This is extremely precious.”

Christophe Roduit Country Director Madagascar

In August of 2008, the government of Madagascar honoured Swiss citizen Christophe Roduit by making him a Knight of the National Order of Merit, in recognition of the work he accomplished with Medair. “We had a very official ceremony in the Medair guest house with representatives of the state, an honour guard, army trumpets, speeches,” says Christophe. “It was a grand honour to see Medair’s work in Madagascar recognised and to receive the official thanks for all that was accomplished.” Christophe and his team overcame many difficulties on the road to this achievement and gained immensely by facing these challenges: “I learned a great deal, that’s the big advantage. I had a lot more responsibilities than I had in Europe. I finally learned from experience that when faced with situations or crises, you have to make decisions. You just must not panic, but be ready to assume the responsibility if you make a mistake.” Christophe’s work with Medair has focused on respecting the dignity of every beneficiary: “We don’t regard people as poor victims who we’re going to teach how to get out of their situation. Instead, we seek to understand who they are and what they know, so that we can work together to improve their future.” During his time with Medair, Christophe was no stranger to crisis: “In D.R. Congo, I found myself in the middle of the war, then in the middle of a cyclone in Madagascar – two events that completely run you over. In a cyclone, you see the water rise, tiles that fly away. The violence of the elements is terrifying. You realise that your small life depends on God. To live through such events with the population, that motivates you twice as much for these interventions.”

In the Words of our Partners Dominique Demaurex is CEO of Aligro, a private Swiss to Aligro’s quality system. I was also involved in the corporation, and is married and father to five boys. Dominique final selection of Medair’s CEO, and I can attest that it worked for Medair in Uganda in 1989, helping was done very professionally. The change distribute relief materials in IDP camps, and again of CEO was a challenging time, but also a in Iraq in 1991-92, where he provided life-saving valuable learning experience. aid to people severely impacted by the Gulf War. Why did Aligro make such a significant Subsequently, Dominique served for many years as President of the Medair Association. Over commitment to supporting Medair’s work, and the past 20 years, Dominique has helped guide what does Aligro gain? Medair toward increased professionalism and Medair is an NGO that does really good work, quality of service, while Aligro has funded our but its private support base is too small. Dominique Demaurex programmes with generosity. We have been supporting Medair by closing funding gaps. Aligro gains nothing concrete by supporting Medair – only the joy of giving. What was your personal motivation to work with Medair? I wanted to help save lives and reduce suffering in dangerous places. Do you have any distinct hopes for the future and work of Medair? I hope Medair will one day close down, once the violent What have you learned from your association with Medair? suffering on this planet is over. Until that time, I hope I helped set up Medair’s quality management system, Medair will remain a dynamic and efficient NGO. and I profited from some good ideas that I then applied

“I cannot say enough about how impressed I was with the [Medair Uganda] team when we visited. What I liked best is that they feel the community can take responsibility, both financially and for labor and maintenance. I thought the way that they talked about this issue showed that they really respect the beneficiaries and treat them as equal partners. Their staff is energetic and forward-looking. All in all, I would definitely support this group on the basis of their team.” Ian Moise, WatSan Technical Specialist , USAID Washington

“Carried out with a competence, a dynamism, and an enthusiasm that my colleagues and I observed, your work enables the quality of life of the population to substantially improve. I am persuaded that the exemplary integration of Medair’s expatriate staff into local community life that we witnessed is in no small measure tied to your success, and I can only encourage you to continue in the same direction.” Jean-Claude Boidin, Ambassador and Head of Delegation for the European Union, Madagascar

MEDAIR Annual Review 2007

“It’s relatively straightforward for Medair to measure its outcomes around service provision, such as vaccinations and water supply. But it also measures the work it does around behavioural change... It has been excellent at tracking beneficiaries’ feedback and sharing results with the rest of the NGO community.” Nigel Harris, former Chief Executive of New Philanthropy Capital, U.K., and member of Medair U.K. Board of Trustees

Funding Partners 2008

By order of donation size, in excess of US$ 20,000

United Nations Partners

Institutional Partners

•U nited Nations Development Programme

•C atholic Organisation for Relief and Development AID

•U nited Nations Children Fund (UNICEF)

(The Netherlands) •S wiss Solidarity •G lobal Alliance for Vaccinations and Immunizations (C.H.) •M ennonite Central Committee (U.S., CAN) •D emaurex & Cie SA - Marchés ALIGRO (C.H.) •D iakonia Leiden (The Netherlands) •F oundation Pierre Demaurex (C.H.) •T earfund New Zealand •T earfund United Kingdom •C are International (U.S.) •M anagement Sciences for Health (U.S.)

•U nited Nations Fund for Population Activities •U .N. Office for the Coordination of Humanitarian Affairs

Government Partners •M inistry of Foreign Affairs (BUZA, The Netherlands) •F rench Ministry of Foreign Affairs (DGCID) •T he European Commission’s Humanitarian Aid department •E urope Aid (E.U.) •D epartment for International Development (U.K.) •S wiss Agency for Development and Cooperation •U nited States Agency for International Development •C entral Bureau of Coordination (BCECO, World Bank, COD) •S wedish International Development Cooperation (SIDA) •D epartment for International Development (DFID via

ARCADIS, U.K.)

We are also very grateful to our private donors. We wish to thank all of them for their generous support, without which we could not fulfil our mission. Photos, right: Medair staff meet with village leaders in Somaliland. far left: WatSan work in Uganda. left: Medair staff with children in Madagascar.

Accreditations and Affiliations ISO 9001:2000 certification Worldwide ISO 9001:2000 quality certification worldwide signifies that Medair effectively delivers goods and services with a focus on beneficiary needs. ZEWO Switzerland ZEWO certification, only available to stateapproved Swiss organisations, testifies to the intended and effective use of private donations. ZEWO certification testifies to the integrity of Medair’s publications and, in particular, its fund appeals. ZEWO standards call for optimal accounting and operational transparency, confirmed by continuous independent monitoring. RfB The Netherlands The RfB certification gives donors a high degree of certainty that resources received by the Dutch office of Medair are used for the purpose for which they were given.

HAP-I Medair is a member of HAP International, whose purpose is to achieve and promote the highest principles of accountability, through selfregulation by members linked by common respect for the rights and dignity of beneficiaries. ImpACT Coalition, U.K. Medair U.K. is a member of the ImpACT Coalition, which promotes better understanding of how charities work and the benefits they bring to society. People in Aid Medair is a member of People in Aid’s “Code of Good Practice in the management and support of aid personnel.” This code reflects the growing attention of aid groups on issues of health and safety, diversity, and equality, and is relevant for agencies engaged in development and advocacy as well as emergency response.

Awards I ntelligent Giving, U.K. In 2008, this independent organisation, which aims to help donors give more effectively by researching and ranking charities for transparency and quality of reporting, placed Medair U.K. no. 1 out of 195 U.K. charities of its kind. Memberships ASAH, France ASAH is a collective of faith-based organisations dealing in international solidarity in fields such as humanitarian aid, international cooperation and development, fair-trade, and societal re-integration. CONCORD Medair’s EU-CORD membership gives it membership into CONCORD, the European confederation for relief and development.

The Fundraising Standards Board, U.K. The Fundraising Standards Board (FRSB) is the self-regulatory body for fundraising in the U.K., members of which agree to adhere to the highest standards of good practice with their fundraising activities. VOICE Through the membership to EU-CORD, Medair is a member of VOICE, a network of NGOs throughout Europe that are active in the field of humanitarian aid, including emergency aid, rehabilitation, disaster preparedness, and conflict prevention. European Interagency Security Forum (EISF) EISF is a security collaboration mechanism consisting of Security Focal Points of European international humanitarian agencies concerned with security of humanitarian relief operations. Medair is represented in the steering group. Principles

Solidarité Urgence Développement

Coordination SUD, France Medair France is a member of this coordinating body of French NGOs, whose aim is to promote their values to private and public institutions, both in France and abroad. EU-CORD Medair is a member of the EU-CORD, an EU network of organisations in relief and development, formed in 1998 with the goal of serving the poor more effectively and improving the conditions of disadvantaged people in the world.

MEDAIR Annual Review 2008

Sphere The Sphere Project was launched in 1997 by a group of humanitarian NGOs and the Red Cross and Red Crescent movement. Sphere issued a handbook, a broad process of collaboration, and an expression of commitment to quality and accountability. International Committee of the Red Cross Medair is a signatory to the “Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief.”

Medair staff with villagers in D.R. Congo.

Editor-in-Chief: Randall Zindler Managing Editors: Lynn Denton, Mark Wallace Copywriter: Mark Wallace Content Consultant: Mark Screeton Image Editor: Lynn Denton Contributors: Medair staff around the world Graphic Design: Brain4You, Belgium Printing: Brain4You Photo Credits: Images were taken by Medair staff, with the exception of: pp 7, 12, 26 SDS April image, and pp 30-31, © Medair/Odile Meylan; p 27 SOM November image and cover photo © Medair/Jan-Joseph Stok. Names of people and places in articles were changed when deemed appropriate to protect the identity of beneficiaries and staff. Internationally recruited staff are reported as number of positions, and nationally recruited staff are reported as number of people in 2008. © Medair, 2009 The information contained herein may be reproduced with the prior, written approval of Medair. Medair requires a copy of the publication in question. An electronic version of Medair Annual Review 2008 – Committed to the World’s Most Vulnerable (available in English, French, and German) is available for download at www.medair.org. Disclaimer: The presentation of maps in this review does not imply on the part of Medair the expression of any opinion whatsoever concerning the legal status of any country or territory, or its authorities, or the delimitation of its frontiers. Detailed and up-to-date information on Medair’s programmes can be found at www.medair.org. Consolidated financial reports for 2008 are available at www.medair.org as of October 2009. Information can also be requested in writing to the international headquarters. For more information, please contact Medair using the contact information on the back cover of this report or visit www.medair.org.

New Medair well and hand pump in Khushkab, Afghanistan.

Medair France 2 place de la Poste 26120 Chabeuil France Tel: +33 (0) 475 59 88 28 france@medair.org

Medair Germany Köhlerstr. 3 82110 Germering Germany Tel: +49 (0) 89 82 00 09 73 deutschland@medair.org

Medair Netherlands Amsterdamseweg 16 3812 RS Amersfoort The Netherlands Tel: +31 (0) 87 874 11 10 nederland@medair.org

Medair Switzerland Chemin du Croset 9 CH-1024 Ecublens Switzerland Tel: +41 (0) 21 695 35 00 suisse@medair.org

Medair U.K. Unit 3, Taylors Yard 67 Alderbrook Road London, SW12 8AD, U.K. Tel: +44 (0) 20 8772 0100 united.kingdom@medair.org

Medair U.S. PO Box 4476 Wheaton, IL 60189 United States of America Toll Free 1-866-599-1795 united.states@medair.org

Charity registered in England & Wales no. 1056731 Limited Company registered in England & Wales no. 3213889

Photos, front cover: Medair’s nutrition manager in Burao, Somaliland, feeding an under-nourished child. back cover: Children in D.R. Congo gather with curiosity around Medair truck at clinic building site.

Medair brings life-saving relief and rehabilitation in disasters, conflict areas, and other crises by working alongside the most vulnerable.

www.medair.org

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Medair International Chemin du Croset 9 CH-1024 Ecublens Switzerland Tel: +41 (0) 21 694 35 35 info@medair.org