Annual report 2014 Médecins du Monde by Médecins du Monde

annual report Doctors of the World 2014 edition

CONTENTS » 02

A word from our chair

Priority themes

Advocacy and campaigns

» 20

International programmes

Emergency and long-term programmes

24 Map

North Africa and Middle East

Sub-Saharan Africa

Latin America and the Caribbean

46 Eurasia 54 Opération Sourire

Programmes in France

Regional delegations

Adoption

The international network

90 Funding

» 100

Board of Directors Our thanks to

» 102 Glossary

‘Man is what I am, who I live with and who is like me, and at the same time as different from me as it is possible to be.’ Claude Lévi-Strauss

Iraq © Guillaume Pinon

a word from our chair

» Dr Thierry Brigaud

Chair, doctors of the world France

Describing Doctors of the World’s activities for the 2014 annual report is like making a list of the world’s problems and how they have evolved. The multiplication of humanitarian crises and the ongoing economic crisis in Europe have meant continued growth in our humanitarian operations. This growth is necessary, but only possible thanks to the unfailing support of our individual donors and successful grant applications to institutional funders. Our donors know and recognise the quality of MdM’s work on the ground as well as the resilience and relevance of its associative model. In December, Doctors of the World presented a budget for 2015 showing growth for the third year running. This increase

in resources creates the right environment for our staff to deal with the expansion of activities. It also allows for more investment to rally new donors in France and across Europe. This will enable Doctors of the World to continually adapt to global turmoil and open new programmes in countries faced with major public health crises or war. Intervention is needed in the ever expanding list of grey zones. When states crumble, so does the law and a climate of violence reigns. The health of the most vulnerable is merely seen as insignificant, collateral damage. We are faced with the pressing challenge of giving more meaning to our work, more power to our testimony, and greater emphasis on our solidarity.

Contagious chaos

force in summer 2014. The situation remains unstable, particularly in Bangui. As soon as the security situation allowed, Doctors of the World teams began to care for the disEbola placed population. Then in a second phase, The three countries that were affected by in partnership, they worked on refurbishing the Ebola epidemic, Sierra Leone, Liberia and reopening health centres. We wanted to and Guinea, had neither the means nor the balance our activities by also working with resources to confront it. In this context, NGOs Central African refugees in the south east of worked according to their areas of expertise: neighbouring Cameroon. A sexual and reprosupporting and reinforcing the health sys- ductive health programme in Moloundou distem’s capacity to respond, setting up isolation trict will open shortly. centres, and community based health educaMali tion (awareness and information). In Liberia, Doctors of the World supported five The Sahel zone remains fragile and dangehealth centres caring for 600,000 people in the rous. Last March the shooting in Bamako, capital, Monrovia. In the south west of neigh- Mali was a sad reminder. We chose to contibouring Côte d’Ivoire, we delivered education nue with our ambitious projects and not to and prevention messages in 125 centres in give up, but vigilance is still called for. Further In this context of sustained civil conflict, San Pedro, Sassandra, Gueyo and Soubre, conflict is to be feared if the peace agreement currently taking shape comes to nothing. Doctors of the World uses its accumula- covering around two million inhabitants. ted resources to better respond to those in need. It is proximity, partnership working, and In Sierra Leone, MdM Spain began by sup- Palestine knowledge sharing that help us to get our porting local teams, and then opened up a 2014 also saw a new Israeli army intervention interventions right. We continue to deliver pri- care and isolation centre with the help of in the Gaza Strip—an asymmetric intervention mary care and mental healthcare in Jordan MdM UK. The latest figures show a decline in that makes the prospect of peace between and Lebanon, where our partnership with the the epidemic. This crisis demonstrated once Israelis and Palestinians even more remote. Lebanese association AMEL is exemplary. again that strengthening health systems, Health structures have been destroyed, but We are developing our activities in Turkey with local actors and adequate resources, is this did not prevent our teams from bringing where more than two million refugees are the only way to see a real improvement in the care rapidly to those in need. Following a summer of mourning, Gaza still resembles an now living. In the Iraqi Kurdish zones, with the health status of the population. outdoor prison in need of reconstruction. support of former partner organisations, we are looking after displaced Yazidis. Our medi- Central African Republic cal teams are themselves mainly made up of Conflict in the Central African Republic in Burma displaced professionals. The testimonies and 2013 led to French army intervention, fol- Bad news from Burma. In Kachin region, accounts of escape are terrifying. Security lowed by an UN-mandated international mired in low intensity conflict where an armed

At last year’s general assembly forum, Collège de France Professor Henry Laurens introduced the idea of a ‘refugee factory’ to our debates in the context of the Syrian conflict. The testimonies of our teams working in Syria confirm that this factory is still working at full speed, four years after the conflict began. The humanitarian crisis is terrible. No one dares predict the end. What is worse is that, by exporting itself, the turmoil in Syria has caught up with the failure of Iraq. Some armed groups have made the violation of fundamental human rights their calling card. The staging and recording of barbaric acts spread fear and terror. People are fleeing in ever greater numbers, with no prospect of return.

constraints are enormous, and I would like to express my admiration for those who take these risks on a daily basis to help others.

group claims independence, two peer workers were arrested, then judged and imprisoned because Burmese law penalises people who use drugs. We continue to support them and we are trying to shorten their sentences with the help of lawyers. The upcoming elections in Burma account for some of these tensions. In this country democracy remains a battle, as does the right to health.

where surgical teams from different countries can be twinned with each other.

France - a wealthy country in the grip of a long term crisis

Showing solidarity in times of austerity is to focus on our activists’ values. It means insisting that delays in care are not inevitable, that it is in all our interests to provide care for everyone, whatever their status, because they Colombia have the right. It is a matter of dignity for those A glimmer of hope from Colombia. concerned and, moreover, for our society. Negotiations in the Havana peace process seem to be progressing well. Following 50 On 17 October, the Doctors of the World years of conflict, stakeholders from both Observatory presented its findings on access sides are confident in the process. If peace to care. We reiterated that the number of childfinally arrives a new intervention strategy will ren being seen at our Healthcare, Advice and be required. For many years our mobile teams Referral Clinics continues to grow. We restahave cared for people in conflict zones. Our ted our indignation at the lack of resources and hope as healthcare professionals is now to shelter to protect them. The bone tests which build peace alongside the Colombian people. the administration forces them to undergo to determine their age only serve, all too often, Opération Sourire to send them out on the street and they do Opération Sourire celebrates its 25th birthday. not have any scientific merit. So what if they François Foussadier’s bold initiative has pro- took a test — does life on the streets become ved its worth. Since 1989 our surgical teams acceptable at 18 years and one day? have shared the pride of beneficiaries who The Observatory data show that food insecucan once again look at themselves in the mir- rity is not an abstract concept. Families and ror and rediscover their dignity. children are going hungry on the streets of France. They also show that vulnerable preDutch, Japanese and German MdM teams gnant women are often forced to go through have joined the project. We are focusing on pregnancy alone, and that they are frequently follow up and evaluation of the reconstruc- forced to move from one hostel to another, tion process, and on training and mentoring, during the nine months. Late monitoring of so that in the future the countries where pregnancy is common, even when it is often we work will become centres of excellence these pregnancies that are most at risk.

Through a portrait exhibition held on the Hotel de Ville square in Paris we wanted, symbolically, to put faces to our statistics. We were able to show that behind the latest Observatory data there are human stories full of dignity and resilience. For our upcoming advocacy the central question of 500,000 undocumented migrants living in France is not only a question of a right to health; it is a broader question of human rights and dignity. MdM calls for the creation of a group to lobby for regularisation of undocumented migrants living permanently in our territory, the only seemingly sure route to access to care and rights. To complete Doctors of the World France’s advocacy, it is important to note all the work done in shantytowns. Shelter and housing, seen as a continuum, will allow us to avoid disruption and support families towards lasting housing solutions. Doctors of the World will continue to reach out to vulnerable people, offering them healthcare and ensuring they know their rights so that they benefit like anyone else from the care provided for by mainstream services. We must stop pitting the poor against each other. It is crucial that we pull together in this time of crisis!

At home and abroad: the same fight In countries with limited resources our patients suffering with hepatitis C die while there are effective new treatments.... but these are prohibitively expensive! We are

seeing exactly the same financial barriers as we saw for HIV at the end of the 1990s with triple-therapies. That is why Doctors of the World has decided to campaign on the price of new antivirals. But unlike Aids it is no longer just a ‘Southern’ problem: the prohibitive price of sofobuvir, the first of these treatments authorised for sale in France, threatens our social security system and could lead to rationing of care and ‘triage’ of the sick. Of those suffering from hepatitis C, 85% live in low and middle income countries and 15% in wealthy countries —all are confronted with the same danger of being denied life-saving treatment. Our advocacy is organised in three phases: • In 2014, we produced and widely disseminated a report setting out strategies for effective access to new hepatitis C treatments. It documented the financial barrier at a global level and pointed to the economic consequences of the cost of medicines for our health systems. • Next, we asked the French government to use the ex-officio licence procedure, which enables the use of a generic version if it is in the interest of public health. The Government did not have the courage to do this, but within this context did negotiate a price reduction of around 30%. • Noting that the price of this drug was determined more by financial considerations than the actual research costs and that the patent

system was abused, we decided as a last offices and sister organisations becoming resort to challenge the patent in court. The associated members, can be seen as a pilot. decision to oppose the patent also serves to launch a public debate on the mechanism • This associative project suggests opeused for fixing drug pricing and underlines ning up Doctors of the World’s governance, the key question of transparency. which would entail a review of our statutes and convening at an extraordinary annual Whilst this advocacy work is specific to general meeting. France, it is also part of a global strategy to call for equal access to testing, treatment and • Doctors of the World’s future projects must care for people who present a high risk of involve users and interested parties. Based on hepatitis C infection at an international level, in our experience of working in harm reduction, particular drug users, who represent 80% of it is important to strike a balance between lay new infections globally. In this way our battles knowledge and medical knowledge. in France give us the opportunity to develop In conclusion a strategy for global action. Our organisation has strengthened and staAssociative project bilised its social mission, finding a balance Following a long and inclusive consultation between emergency and long-term proprocess we have crafted an associative grammes and between projects in France and project for the years to come: to care, bear international projects. The Friends of Doctors witness, advocate for and accompany social of the World Foundation can supplement the change. The autumn seminars in Nantes organisation’s operations and facilitate the gave us the opportunity to finalise the draft development of civil society in the South. prior to scrutiny at the AGM. We must work towards a more harmonious There are four important new points: development of the network to ensure that in • Social change becomes one of Doctors of the future other Doctors of the World associathe World’s core values. tions can become key international players. By stabilising its social mission and redrafting its • The associative project recommends a plan Doctors of the World’s associative model horizontal structure in the form of a linked demonstrates its vitality and robustness. By nodal network model. The example of the facilitating this model and ensuring we stay European model developed by Doctors close to beneficiaries in project planning, tomorof the World’s international network, with row we can help to build the right to health.

Haiti © Benoît Guenot

priority themes Because Doctors of the World is an organisation that supports social change it acts not only in emergencies, but also creates long-term programmes. Four priorities guide our fight for access to care for the most vulnerable and our work across the world: crisis and conflicts, sexual and reproductive health, harm reduction, and migrants.

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Crisis and conflicts A conflict or a natural disaster leads to an interruption in access to care. In order to respond to the immediate health needs of those affected, Doctors of the World swiftly sends emergency teams and supplies to the field. Interventions are planned in partnership with civil society and health ministries, and if there are already colleagues present in the country working on long-term projects they are called on for support. Emergency programmes almost always include support for the health system and reconstruction when needed, long after press interest has faded. The organisation has a joint committee, the

CUI. This group ensures a swift response, acting as a short cut to bring together six people to agree on intervention and launch the emergency mission. On a permanent basis a group entitled ERUC brings members together to reflect on emergencies and crises, meeting regularly to discuss cross-cutting issues. In 2014, Doctors of the World responded to typhoon Haiyan in the Philippines, floods in BosniaHerzegovina, displaced populations in Iraq, Gaza bombings, crises in Syria and Central Africa, and the fight against the Ebola epidemic in West Africa.

Sexual and reproductive health Sexual and reproductive health (SRH) covers various aspects of womenâ&#x20AC;&#x2122;s and couplesâ&#x20AC;&#x2122; health: maternal and child health; prevention and management of unwanted pregnancies; the fight against sexually transmitted diseases; responses to gender-based violence, etc. The organisation runs more than 25 MdM projects on this theme. The organisation is keen to increase its focus in order to give women control over their choices and free access to quality sexual and reproductive health services. In this context MdM adopted a multi-year

strategy in 2014 and reaffirmed its intention to promote sexual and reproductive rights of women and girls, reduce gender inequalities and promote universal access to SRH services. Our focus has been on prevention and care for unwanted pregnancies (contraception and termination of pregnancy), mainly in Latin America and the Caribbean and, most recently, in French speaking Africa. Work has also begun on strengthening our capacity to respond to violence carried out in the conflict zones where we work.

Liberia ÂŠ MdM

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Calais ÂŠ Sarah Alcalay

Migrants For almost 30 years MdM has been working with migrants in France, Europe and, most recently, Africa and the Middle east with the aim of assessing and testifying to the negative impact of European policies on the health of migrants. To do this Doctors of the World has developed a number of projects, mobilised primary healthcare centres and outreach

teams that reach out to migrants where they are living, and specific projects that take account of mental suffering and post-traumatic stress. The projects offer a place to rest, talk, the chance of a therapeutic break, holistic care and welfare guidance. They also provide an opportunity to bear witness to the diversity of migrant journeys as well as the main obstacles encountered.

Harm reduction For many years Doctors of the World has worked with at risk populations, including people who use drugs and sex workers. Subject to discrimination, marginalisation and criminalisation, these people are exposed to numerous risks, including disease, violence and police harassment. Since 1989, to meet these challenges, MdM has run harm reduction programmes, related on the one hand to the use of psychoactive substances, and on the other to sexual practices, providing medical, psychosocial and community responses.

In this context, for the past four years MdM has been developing a cross-cutting programme to improve the quality and visibility of harm reduction projects and to strengthen the involvement of beneficiaries, civil society and the authorities, with social change as the ultimate goal. The priorities are to promote harm reduction in Africa, where services are virtually non-existent, and to increase advocacy for access to diagnosis and treatment of hepatitis C.

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France ÂŠ Valentin Fougeray

ADVOCACY CAMPAIGNS Doctors of the World has led major advocacy and communication campaigns to ensure the voice of those marginalised by exclusion or by poverty is heard and their human rights are upheld. Whether by campaigning on access to care for all, promotion of sexual and reproductive health, or harm reduction policies, the organisation was more active than ever in 2014.

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» France

Face up to poverty Guided by data gathered in its reports on access to rights and healthcare, Doctors of the World maintains its commitment to promoting vulnerable people’s rights. On 17 October, International Day for the Eradication of Poverty, the organisation held a major exhibition in Paris. In the Hotel de Ville square, 12 portraits of ‘heroic figures’ taken by photographer Denis Rouvre were displayed on a series of totems, inviting the public to look poverty in the face, in order to better fight it. Amongst the faces Imre, Armelle,

Najat, Marco, Jean-Michel and Constantin agreed to be the ambassadors of all those who share their fate. Each illustrates both a personal journey and a flaw in our healthcare system and access to care. Here, absence of healthcare coverage and delays in care for migrants, asylum seekers and homeless people. There, the loneliness of foreign minors or the high rates of mental health problems and hepatitis amongst vulnerable people.

A series of posters, films and radio adverts gave back the gravity to words of popular songs.

» France

Doctors of the World also treats injustice

Doctors of the World’s 2014 year end campaign spoke out against the injustice that deprives one in five people in the world of healthcare, and limits access for one in six people in France. Conceived with the support of three great figures from the French music scene — Maxime Le Forestier, the group IAM and Serge Gainsbourg’s estate — a series of posters, films and radio advertisements use words from popular songs set against the backdrop of the harsh reality of poverty. ‘Are people born equal in rights, in the place they are born?’ This is the question posed by a young pregnant woman through lyrics by Maxime Le Forestier. Serge Gainsbourg’s

words challenge us on ‘the guy who we see and but do not look at’, the homeless people that Doctors of the World teams help on a daily basis. Finally, IAM reminds us that ‘we are not born under the same star’, that the injustice that affects many children around the world remains. Two films and two radio advertisements, shot in France and Haiti, give voice to Luka, a nine year old boy living on the streets and Myriam, seven months pregnant living in a shantytown, who sing a capella extracts from these famous songs. They remind us that ‘more than words, it’s their reality’ that is explored through these words from popular music.

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Âť HEpatitIS c

Pills cost nothing, profits cost lives Following the campaign launched by MdM in 2013, WHO adopted a resolution in 2014 on viral hepatitis and directives for testing and treatment of people with hepatitis C (HCV). At the same time, new, more effective and better tolerated medicines have arrived on the market. But their price is exorbitant. Sofosbuvir, for example, is marketed in the USA by Gilead at $84,000 for three months supply and is inaccessible for the majority of sick people. A generic version would cost just $101 to manufacture, but the Gilead patent prevents reproduction of the medicine. MdM defended universal access to treatments against hepatitis C by publishing a report on strategies to put in place and by co-hosting the first international meeting of the community-based consultation group on hepatitis C, during which civil society groups met pharmaceutical industry representatives to discuss access to treatment. In 2014 MdM also published a report on the importance of integrating drug users into HCV treatment programmes. For more than 20 years MdM has been developing a harm reduction approach among people who use drugs and sex workers.

ÂŠ DR/MdM

Following the campaign launched by MdM in 2013, WHO adopted a resolution in 2014 on viral hepatitis and directives for testing and treatment of people living with hepatitis C.

» Sexual and reproductive health

Names Not Numbers: for the right to abortion Globally, there are 80 million unwanted pregnancies every year and close to 22 million unsafe abortions. These risky abortions are one of the main causes of maternal mortality. Close to 50,000 women die every year. In 2014, ahead of the Cairo+20 meeting focusing on health and sexual and reproductive rights to empower women and girls, MdM ran a campaign on prevention and access to care for unwanted pregnancies. A campaign entitled “Names not Numbers” was launched on 8 March, calling for the public to get involved through a dedicated website or by joining in events organised in four towns in Europe and in New York. 20,000 people signed a petition for women’s right to choose whether or not to have children. It was sent to United Nations General Secretary Ban Ki-Moon, who backs the protection of women who choose to have an abortion. Following Doctors of the World’s appeal 416 doctors also signed a manifesto calling for the worldwide right to abortion, published in Le Nouvel Observateur. At the same time, a constructive dialogue was developed with key French stakeholders involved in healthcare and sexual and reproductive rights, good relationships established with ministries and technical advisors and the integration of MdM’s key messages in official communication documents.

In spite of real progress achieved in the last 20 years, the universal access to contraception promised in Cairo and at the United Nations millennium summit is far from becoming a reality. The overwhelming majority of governments continue to oppose the right to abortion and refuse to take into consideration public health concerns posed by illegal abortions. MdM continues to lobby for sexual and reproductive rights to be recognised, so that prevention and access to care for unwanted pregnancies forms part of the priorities of the post-2015 process.

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Jordan ÂŠ Thierry du Bois

international programmes

» 22

Emergency and long-term programmes

» 24 Map » 26

North Africa and Middle east

» 32

Sub-Saharan Africa

» 40

Latin America and Caribbean

» 46

Eurasia

» 54

Opération Sourire

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EMERGENCY and long-term programmes The year 2014 was beset by natural disasters linked to climate change, and by armed conflict. In every country where we operated — in Bosnia, Palestine and in Syria where working conditions continue to deteriorate — Doctors of the World has endeavoured to remain true to its values.

To promote access to healthcare for vulnerable populations

Develop the population’s capacity to take action

This is our primary aim. It is absolutely crucial in emergency situations and it is fundamental to our development programmes. However, the security situation in the countries where we operate is often unstable and the way we work varies. Thus, in the Gaza Strip during operation ‘Protective Edge’, as soon as it was possible to move around we deployed mobile teams to reach the civilian population. When there were floods in Bosnia we were able to work with the support of the civil protection service. Thanks to long standing and reliable partnerships, we were able to develop our project in Iraq, working with displaced populations. In Syria we have continued to provide medicines and medical equipment for the civilian population with the support of medical solidarity networks within the country. We must emphasise the solidarity of Syrian civil society. Men, women, teachers, employees, clerics, shocked by the situation in which people find themselves, all take risks to sustain the delivery of aid and medicines, despite the difficulties.

We were taken by surprise by the rapid spread of the haemorrhagic fever epidemic due to the Ebola virus. Overwhelmed by the outbreak of this disease and by the heavy toll paid by health personnel, the health systems had difficulty in dealing with the epidemic. Doctors of the World opted for a community approach and for strengthening the health system to enable populations to cope. Likewise, in Haiti the surveillance system has enabled cases of cholera to receive early care and treatment, and thereby has helped to contain recurrence.

Encourage a joint approach to common causes The development of cross-cutting approaches (over several countries) in sexual and reproductive health and harm reduction has allowed us to forge partnerships and to develop advocacy organisations in civil society, which, working shoulder to shoulder with us, form a legitimate lobbying voice.

Doctors of the World opted for a community approach and for strengthening the health system to enable populations to cope.

increasingly, Doctors of the World’s work is in emergency situations.

Liberia © MdM

In Latin America, under the auspices of our regional programme on unwanted pregnancies, we rely on locally obtained results — especially in Uruguay — to enhance healthcare delivery, to improve population information and to support regional and national advocacy activity. In a different context, our support to help recyclers in Manila form a group and enabling them to meet with the local authorities, gave them a genuine status. The project’s prevention phase can now realistically begin.

is institutional donors (ECHO, British and German government aid, etc.) who put their trust in us when there are these ‘forgotten’ crises.

cies of countries in the northern hemisphere is more valid than ever. We are committed to fighting institutional violence against people who find themselves in these vulnerable situations. Programmes Because of the growing number of operations, for migrants have been developed in Algeria, however, and our launch of more needs assess- Turkey, at the gates of Europe — in Serbia and ment missions abroad, we really must endeavour Romania — and soon will be underway in Mexico to diversify our funding sources so that we are and Guatemala. Doctors of the World’s internatioable to maintain our independence. nal network has been approached to work on a project in the Mediterranean to bear witness to the Commitment and activism inhumane conditions of migrant crossings. The projects developed by Doctors of the World Political and financial independence allow us to conduct advocacy activities. This In the countries where Doctors of the World has Increasingly, Doctors of the World’s work is in is particularly true of Sexual and Reproductive chosen to come to the aid of vulnerable populaemergency situations. This includes protracted health programmes. We defend, therefore, the tions, adaptability is an important factor. We must conflicts, particularly in Syria, recurring conflicts right to choose to be pregnant or not by pro- remember to retain this strength when the time such as Palestine, and lower profile disasters like viding treatment for incomplete abortions and comes to write our strategic plan. the floods in the Balkans or in Madagascar. It working on preventing unwanted pregnancies, also encompasses the sudden expansion of cer- especially amongst young women. Furthermore, tain conflicts — from Central African Republic to our programmes to prevent the spread of the Cameroon and, more recently, in Iraq with civilians hepatitis C epidemic amongst people who use fleeing from Islamic State fighters... The public are drugs has enabled us to lobby robustly in favour less generous when faced with these events than of access to healthcare for all. in the case of large-scale natural disasters. So it Our positioning vis-a-vis the anti-immigration poli-

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MAP

OF INTERNATIONAL PROGRAMMES

Mexico

Haiti

Colombia

Peru

Long-term programme (One colour for each region) P Emergency programme

Uruguay

Russia

Moldova Bosnia Romania Bulgaria

Georgia

Turkey

Syria

Lebanon Tunisia Palestine Algeria

Egypt

Iraq Jordan

Pakistan

Nepal India

Mali Guinea Liberia C么te d'Ivoire

Niger Burkina Faso

Chad CAR

Burma Laos

Philippines

Ethiopia Somalia

Rwanda Kenya DRC Tanzania

Madagascar

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Lebanon ÂŠ Thierry du Bois

our programmes in

North Africa Middle East Marked by the bombardment of Gaza throughout the summer, by Islamist crimes in Iraq and by the Syrian civil war, the news from this region was especially violent in 2014. Still working alongside displaced Syrians, Doctors of the World took the decision to go into Iraqi Kurdistan and to provide medical support for Palestinians in Gaza.

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RUSSIA IRELAND

BELARUS POLAND

NETHERLANDS

UNITED KINGDOM

GERMANY BELGIUM CZECH REP.

LUX.

UKRAINE SLOVAKIA

FRANCE SWITZERLAND-

AUSTRIA

MOLDOVA

HUNGARY ROMANIA

CROATIA BOSNIA ITALY

SERBIA

Black Sea

BULGARIA

MONTENEGRO

GEORGIA

MACEDONIA SPAIN

ALBANIA

ARMENIA AZERBAÏJAN

GREECE

PORTUGAL

Tunisia

Turkey

CYPRUS

Mediterranean Sea

Syria

Lebanon

IRAN

Iraq

ISRAËL

Palestine

MOROCCO

Jordan Algeria

Egypt LIBYA

SAUDI ARABIA

MAURITANIA

Djibouti

NIGER

Red Sea

MALI ERITREA

CHAD SUDAN

YEMEN

BURKINA FASO NIGERIA

ETHIOPIA

SOMALIA

» AlgEriA » Egypt » IraQ » Jordan » LEbanON » Palestine » SyriA » TunisiA » TurKeY

KEY EVENTS

» syriA An ongoing humanitarian crisis In 2014 the Syrian conflict entered its fourth year. For over three years, violence against the civilian population appears to have been intensifying and becoming more complex with no sign of a resolution. Thanks to strong ties with Syrian medical organisations, Doctors of the World continues its work in the north of the country but also in the bordering countries and stresses the need to remain vigilant whilst neighbouring Iraq also flares up.

For detailed fact sheets on the various programmes in North Africa and Middle East see our website: www.medecinsdumonde.org

Throughout Syria many regions are subjected to bombings and human rights violations under the cross-fire between government forces, the Free Syrian army and extremist factions like Islamic State. The humanitarian situation remains extremely shaky throughout the country, and especially in the north where displaced people and refugees converge en route to Turkey. People have enormous difficulty in gaining access to health, water and food as well as sanitation, shelter and other basic needs. In 2014, with the help of nine Syrian partners, Doctors of the World supported 70 healthcare

facilities in the governorates of Idlib and Aleppo in the north and Daraa and Damascus in the south. Supply of medicines and other equipment was thus guaranteed. The organisation also directly provided primary healthcare in clinics in Idlib province. Some 150,000 consultations were provided over the year, of which 8,000 were specifically for sexual and reproductive health. Doctors of the World also supports two postoperative care centres, one in the east of Turkey, in Reyhanli, and the other in the north of Syria. Staff are trained in the care of victims of conflict, who have been injured and traumatised but want

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to rebuild their lives. Over 17,000 post-operative consultations took place in 2014. In Lebanon and Jordan, the Syrian refugee situation is deteriorating. Return to Syria is not possible. Refugees are struggling to survive — the goods that they brought with them have usually been sold and they are not allowed to work. At the same time, any aid that they receive is diminishing and host countries are less welcoming. In Jordan, for example, since November 2014 treatment in public healthcare centres has no longer been free. In these two countries Doctors of the World, working with its partners, decided to keep up a significant response. Thus almost 200,000 consultations have been provided in eight health centres.

Doctors of the World is helping displaced populations in Syria and also refugees in Turkey, Lebanon and Jordan.

» iraq Aid for displaced people Since the start of 2014, violent clashes have affected the north and west of the country. They mark the rapid spread of Islamic State and have led 2.1 million people — Kurds, Yazidis, Christians and Muslims — to flee. Almost half of them have taken refuge in Kurdistan and in the neighbouring regions. Constantly exposed to

violence and fear, they face an appalling humanitarian situation: unsanitary conditions, poor hygiene and great difficulty in accessing care. Despite the extremely complex and dangerous situation, Doctors of the World works with the most at-risk people in camps and communities of displaced people in Dohuk in Iraqi Kurdistan.

Medical teams provide basic healthcare in fixed and mobile clinics in 10 different locations. The organisation also established a clinic, working in partnership with a Turkish NGO, to provide medical care to Yazidi refugees on the other side of the Turkish border in a camp in the town of Sirnak.

» Egypt Mental health

During 2014, Doctors of the World launched a programme in Egypt to improve the psycho-social wellbeing of at-risk populations — disabled children, women who are victims of violence and are living with HIV/Aids — and to promote the integration of mental health services with primary healthcare. In fact, mental health problems are relatively common in this country. Doctors of the World has started to train social workers and other members of the psychosocial staff from five Egyptian NGOs who work with the target groups, notably on counselling and case management. The objective for 2015 is to strengthen co-operation with the government by training health and social personnel in seven primary healthcare centres in Cairo and Giza and to bring mental health services closer to the people.

» AlgEriA Tens of thousands of migrants from sub-Saharan Africa transit via the Algerian coast, where they sometimes spend several years, waiting to leave for Europe. They are stigmatised, often victims of violence and, despite an effective national social security system, have difficulty in accessing healthcare. In the districts where these migrants live Doctors of the World works

» Palestine

Emergency aid in Gaza

During summer 2014, the Israeli military operation known as ‘Protective edge’ caused the death of 2,131 Palestinians on the Gaza Strip, of whom 70% were civilians. A further 11,000 people were injured and around 110,000 displaced. The healthcare centres in Gaza were unable to cope with this humanitarian and health emergency, having been subject to unprecedented damage themselves: 17 hospitals (out of a total of 32 in the Gaza Strip) and 58 (out of 97) healthcare centres have been affected. Already

working in Gaza on a programme of preparing healthcare structures to deal with emergency situations, Doctors of the World was able to react very quickly, when the worst affected area was inaccessible to provide medicines, supplies and equipment. Mobile clinics were then set up take over from healthcare centres that had been destroyed. Doctors of the World also worked with the Palestinian NGO Culture and Free Thought Association to provide psychosocial and mental healthcare for the affected population.

Working with Sub-Saharan migrants with peer educators who refer women to health centres where they can be screened for Aids and have their pregnancies and the health of their young children monitored. Teams from the organisation also educate staff in the centres so that migrants are given a better

reception and they are involved in the setting up of a ‘migrants’ platform’, with local and international NGOs, to improve their access to rights in Algeria. These activities enabled a significant improvement in migrants’ access to care in public health facilities.

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Burkina Faso © Mylène Zizzo

our programmes in

Sub-Saharan Africa The year 2014 was marked by the Ebola epidemic which struck West Africa. Doctors of the World quickly intervened in Liberia, one of the worst affected countries, and in Mali, as well as in bordering countries (Côte d’Ivoire and Burkina Faso). In all, almost 30 programmes were run by the organisation in sub-Saharan Africa, from Guinea to Somalia and from Niger to Madagascar.

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ALGERIA

LIBYA

WESTERN SAHARA

EGYPT

MAURITANIA

Mali Niger

GAMBIA GUINEABISSAU

ERITREA

Chad

SENEGAL

SUDAN

Burkina Faso

Guinea

BENIN

SIERRA LEONE

C么te d'Ivoire

NIGERIA TOGO

Ethiopia

Central African Republic

GHANA

Liberia

CAMEROON

Somalia EQUATORIAL GUINEA

UGANDA

Kenya GABON

RWANDA

Democratic Republic of Congo

CONGO

BURUNDI

INDIAN OCEAN

Tanzania

ATLANTIC OCEAN

COMORES ANGOLA

MALAWI ZAMBIA

ZIMBABWE NAMIBIA

BOTSWANA

SWAZILAND

LESOTHO SOUTH AFRICA

MOZAMBIQUE

Madagascar

» Burkina Faso » car » chad » Côte d’Ivoire » drc » ethiopia » Guinea » Kenya » Liberia » Madagascar » Mali » Niger » Somalia » Tanzania

key events

» west africa

Fighting against Ebola

For detailed fact sheets on the various programmes in Africa see our website: www.medecinsdumonde.org

After the first recorded case in December 2013 at Guéckedou in Guinea, the Ebola virus epidemic quickly gained ground in 2014. Infection levels reached a peak in July and continued for four months. With over 20,000 confirmed cases and almost 8,000 deaths in 2014, this is the most significant Ebola epidemic ever recorded since the virus was discovered in 1976. Liberia, Sierra Leone and Guinea have borne the brunt of this major humanitarian emergency, which has also affected Nigeria, Senegal and Mali, and raised the fear of an international pandemic. In Liberia Doctors of the World was preparing to launch a programme providing psychological support for child soldiers in the ghettos of Monrova

when the epidemic broke out. The programme was then suspended in favour of an Ebola response programme. MdM’s work here was focused on two main areas of activity. The organisation supported five healthcare centres with prevention and control of the epidemic but also with help to continue providing primary healthcare in the centres. With hospitals closed and health workers among the first victims, these facilities needed help and the staff needed psychological support so that pregnant women or patients suffering from various diseases other than Ebola could continue to receive treatment. Furthermore, the people of 28 communities in the capital were educated on transmission and prevention of the virus

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36 | thanks to the assistance of 400 volunteers who were mentored by peer educators and community workers from Doctors of the World. With a presence in Mali, Burkina Faso and Cote d’Ivoire as well, Doctors of the World worked alongside the local health authorities to strengthen the healthcare systems by delivering prevention advice (sorting and disposal of medical waste, etc.). Community workers were trained in advising the public on risks and what to do in case of an outbreak. Doctors of the World also provided specialist protection equipment in the health facilities that it supports, in order to improve their response capacity.

» CAR

» Burkina Faso

Aid for Malian refugees Malian refugees have been pouring into Djibo district, in the north of Burkina Faso since 2012. The 32 health centres and the only hospital in the region are unable to cope with the new populations who are also seeking treatment. We are seeing an increase in the number of cases of malaria, meningitis and measles as well as many maternal deaths. This is why Doctors of the World intervened among refugees in Mentao

camp and with inhabitants of the surrounding villages to provide care completely free of charge. Family planning education, monitoring pregnancies and delivery, vaccination of pregnant women and babies, care for children suffering from malnutrition, treatment of STIs and prevention of HIV were all provided by our teams. At the end of 2014, the project was handed over to the UN High Commissioner for Refugees (UNHCR).

Five healthcare facilities around Bangui were renovated.

Restoring access to healthcare Profoundly affected by clashes between anti-Balaka militias and the Séléka coalition, the Central African population is becoming poorer and poorer and is having great difficulty in accessing healthcare. At the end of 2014, 2.7 million people were considered to be in need of humanitarian assistance. Ranked 179th in 2011 on the human development index, CAR has fallen to 185th out of 187 in 2014. Following an emergency response at the beginning of the year, with the establishment

of mobile clinics in various camps for displaced people, Doctors of the World shifted its focus to public sector facilities. The organisation supported healthcare centres in Malimaka, Gobongo,

Bégoua and Bouboui as well as the maternity wing of Bégoua hospital, which has been renovated. Over 100,000 consultations were provided by MdM.

» Harm

reduction Doctors of the World continues its harm reduction activities in Africa. After Tanzania, Kenya and Côte d’Ivoire are the next countries to benefit from the organisation’s expertise in this area.

Kenya Because Kenya has a significant number of people who use drugs intravenously, many of whom have HIV or hepatitis, in 2014 Doctors of the World launched a programme of harm reduction in the deprived area of Kawangare, 15 km from the centre of the capital, Nairobi. A team of outreach workers has been recruited and a reception centre has opened. It offers vaccinations against hepatitis B, sterile injection kits, screening for sexually transmitted infections, psychosocial support and a referral service to healthcare facilities for treatment of HIV and tuberculosis. In parallel with this field activity, MdM lobbies for the development of national policies on harm reduction. The organisation is also supporting the government in setting up targeted communication, and educational workshops are organised, mainly around substitution treatment. Kenyan partners were also invited to Tanzania to find out about methods used in Doctors of the World’s pilot programme.

Tanzania The harm reduction programme run by Doctors of the World in Kenya was based on the Tanzanian model. Tanzania, a key route for heroin trafficking from central Asia, has seen such growth in intravenous drug use that almost 300,000 people are affected, and consequently, there has been an increase in the spread of HIV and hepatitis. Since 2010 Doctors of the World has been working in the country to raise awareness of harm reduction nationally. Now in its fifth year, the programme has four reception centres across Dar es-Salaam, run by our partner MUKIKUTE, with technical assistance from MdM. An MdM drop-in centre, open six days a week, advises on prevention activity, provides screening for infectious diseases, new syringes, psychosocial activities and referrals to healthcare facilities. Up to 200 people who use drugs go there every day. The MdM bus still goes out to the most at-risk users to provide them with prevention materials as well as screening. 2,755 drug users were screened in 2014 and 185 were followed up in

treatment centres. Moreover, a resource and training centre is available for medical personnel from partner health facilities and relevant NGOs, not only from Tanzania but from the whole of sub-Saharan Africa. Côte d’Ivoire In 2014 Doctors of the World conducted research amongst 450 drug users in Abidjan. The prevalence of HIV is particularly high amongst this population, which is also affected by tuberculosis and hepatitis B. This situation is further exacerbated by stigma and extremely poor living conditions in squalid areas. This research should form the basis for the launch of a new project at the beginning of 2015 to improve access to care for drug users and to build their capacity through the establishment of self-help groups. Advocacy should also be undertaken with the authorities, to improve protocols for supporting drug users within the health system and to enhance the harm reduction approach nationally.

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» sahel

Treating malnutrition Malnutrition represents a major public health problem in various countries in the Sahel region. This is why Doctors of the World included it in their community approach to improving mother and child health in Niger, Burkina Faso and Mali and also supports malnutrition treatment centres.

Niger In Niger, the prevalence of global acute malnutrition has been a concern for around 15 years and mostly affects low-income social groups. This is accentuated by the high level of poverty, demographic pressures and the prevalence of infectious diseases. Doctors of the World has been working for several years supporting Ilea health district in the Tahoka region to improve access to health services for mothers and children. In this context the organisation supports Outpatient Centres for Nutritional Recovery for Severe Malnutrition (CRENAS in the French acronym) for those with severe acute malnutrition, Intensive Nutritional Recovery and Education Centres (CRENI in the French acronym) for those with severe acute malnutrition with complications and Outpatient Centres for Nutritional Recovery for Moderate Malnutrition (CRENAM in the French acronym). This project relies upon a high level of community involvement and is combined with family planning

activities. The organisation is campaigning with civil society so that children suffering from acute malnutrition can be treated free of charge. Burkina Faso The Djibo, Gorom and Dori health districts, in Burkina Faso, encounter recurring food security problems. The health facilities there are under developed and suffer from shortages of equipment and staff. Too often, children are brought to the healthcare centre at the last minute, which limits their chances of being cured. Against this backdrop, Doctors of the World helped to reinstate the local CRENI, particularly by recruiting and training personnel. The centre was also stocked with generic medicines, therapeutic foods, bedding and hygiene kits. The cost of referring children to the centres is covered, as is the cost of laboratory tests. Furthermore, MdM lobbies in favour of prevention and the treatment of malnutrition at district health level.

Mali The political crisis which Mali has been going through since 2012 has caused the collapse of the health system and worsened the nutritional situation in the north of the country. In Tenenkou and Youwarou health districts, Doctors of the World, therefore, added a nutritional element to its projects for the improvement of access to healthcare in the health facilities that it supports. In line with national protocol, it supports the organisation of screening and treatment for severe acute malnutrition in children aged 0 to 59 months and in pregnant and breast feeding women. Training and community education sessions were completed, as well as support provided to the network caring for cases of acute malnutrition, in nutrional centres (CRENAM, CRENAS and CRENI).

» Unwanted pregnancies

» EthiopiA

Because access to sexual and reproductive healthcare services is restricted and laws regarding contraception and access to abortion are especially restrictive in many African countries, unwanted pregnancies frequently occur and are a key factor in maternal morbidity and mortality. Doctors of the World works on this topic in order to help reduce maternal mortality and morbidity associated with unwanted pregnancies.

Taking action against genital mutilation

Burkina Faso In the Sahel province of Djibo, access to contraception and family planning is complicated, owing to difficulties in accessing healthcare in general and to social and cultural reasons. There are many unwanted pregnancies and abortions are often risky. They are carried out in poor sanitary conditions and cause very high levels of mortality. Doctors of the World, which has worked in the region since 2010, has managed to obtain free assisted deliveries and free medical evacuations. Currently the organisation is focusing on the prevention of unwanted pregnancies and on improving family planning in general. Community workers educate and inform teenagers and religious leaders and healthcare teams receive medical training, specifically on post-abortion complications.

The extreme genital mutilation suffered by women from the Afar people in Ethiopia, in the first week following their birth, causes urinary problems and infection and also an absence of periods or infertility. It also places the life of the mother and her child in danger at the time of birth. In 2014, working alongside ACISDA, a local organisation, Doctors of the World started raising awareness in the community of the risks of female genital mutilation (FGM) following a study of these practices. Working groups were formed to bring together school children, young mothers and pregnant women. Five anti-FGM committees were created. Moreover, during the first months of the programme, health workers, primary school teachers and around 50 mediators were trained on the dramatic consequences of FGM.

Democratic Republic of Congo In DRC, although sexual violence is common access to contraception is illegal for minors and abortion is only permitted for medical reasons. In Kinshasa, the capital, one in four girls is pregnant for the first time before the age of 19 and almost one in two pregnancies are unwanted. It is there that Doctors of the World works with teenagers

to inform and educate them on questions of sexual and reproductive health. The organisation tries to improve access to family planning, to offer care to those who have aborted or to look after those who have suffered sexual violence. Thus 10,000 young people were seen in 2014. Families, educators, community and reli-

gious leaders are involved with the awareness building activities. Doctors of the World supports civil society in its dealings with the authorities for contraception for minors and for legalisation of abortion.

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Haiti © Benoît Guenot

our programmes in

Latin America and Caribbean In 2014, Doctors of the Worldâ&#x20AC;&#x2122;s work in Latin America and the Caribbean was marked by a continued focus on sexual and reproductive health (SRH), in particular prevention and management of unwanted pregnancies, both regionally and in various countries of the region where we work. 2014 also saw the cholera epidemic in Haiti recede and a consolidation of the transfer of skills to Uruguayan organisations.

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42 | UNITED STATES

THE BAHAMAS CUBA

Mexico

DOMINICAN REPUBLIC

JAMAICA BELIZE

Haiti

HONDURAS

EL SALVADOR

ATLANTIC OCEAN

NICARAGUA

COSTA RICA

VENEZUELA

PANAMA

GUYANA SURINAME

Colombia

ECUADOR

Peru BRASIL

BOLIVIA

PACIFIC OCEAN

CHILE

PARAGUAY

Uruguay ARGENTINA

FRENCH GUYANA

key events » Colombia » Haiti » Mexico » Peru » Uruguay

Patients are rehydrated in cholera treatment centres.

» haiti

Success in tackling cholera

With fewer than 900 cholera cases recorded in 2014 in Grande’Anse district and a fatality rate of 1.4%, Doctors of the World’s efforts in the fight against the epidemic are bearing fruit, though we must still remain vigilant.

For detailed fact sheets on the various programmes in Latin America and the Caribbean see our website: www.medecinsdumonde.org

Cholera was collateral damage of the earthquake which struck Haiti in January 2010 and continues to ravage the whole country. In Grand’ Anse district, efforts made in the fight against the epidemic by Doctors of the World teams, who have taken care of over 60% of cases, are bearing fruit. Thanks to the strengthening of Haitian health facilities on surveillance and, to co-ordinated emergency responses to outbreaks (with the technical cooperation and development aid agency (ACTED in its French acronym)) and also to awareness campaigns run

by the organisation’s community mediators, the number of suspected cases recorded in Grand’ Anse has fallen dramatically. Between January and September 2014, this fell to 225, compared with 2,613 for the same period in 2013. The teams continue to lobby at national level for deployment of the necessary human and financial resources by donors and the ministry of health to combat the epidemic. This work will continue in 2015 to enhance the response capabilities of the health department and minimize the effects of the epidemic.

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» boliviA Co-construction with our partners

» Latin America and the Caribbean

A workshop was organised in 2014 with the co-operation of local organisations, Bolivian health services and representatives of future users. The objective: to work together to define the strategy for a sexual and reproductive health project focusing on the promotion of rights for teenagers and indigenous Ayoreo populations who live in the outlying areas of Santa Cruz.

tions such as haemorrhage or septicaemia and can also have long-term effects on the health of women. At a regional workshop in March 2014, Doctors of the World set up training on management of unwanted pregnancies with our teams from Colombia, Mexico and Peru and with our Uruguayan partner, Mujeres en el Horno. Training sessions were also planned out in the field with staff from MdM and allied organisations in Colombia, Uruguay and Peru. In order to facilitate sharing of experience and practices, Doctors of the World’s regional programme on SRH in Latin America exchanges between health professionals in and the Caribbean entered a new phase in 2014. In order to give Uruguay and Colombia were organised. priority to better support for unwanted pregnancies, the capabilities The year 2014 was also marked by being involved of the teams, care provision and activities to inform people have in regional conferences on sexual and reproductive rights, particularly that of the Latin American been enhanced. There has also been a focus on involvement in Consortium against high-risk abortion (CLACAI advocacy on the subject at a national level. in its Spanish acronym). In addition, a website intended to promote sexual and reproductive Although use of contraceptives has increased mation. The poorest groups, people who live in health in the region was launched during the year. in Latin America these past years, many rural areas and teenagers are most affected by this It aims to inform the public about the issue and women do not have access to modern situation. It leads to unwanted pregnancies and its consequences, as well as telling them about methods, often because of a lack of infor- unsafe abortions, the cause of serious complica- Doctors of the World’s experience in the region.

Regional action on sexual and reproductive health

» COLOMBIa

Providing care in remote areas With the on-going peace negotiations between FARC and the Colombian government, which are as yet unresolved, and in the absence of a ceasefire, people living in the rural areas of Nariño, Meta and Guaviare districts continue to be seriously affected. In order to respond to the changes in the conflict, which is paralysing access to healthcare, Doctors of the World is rolling out mobile health services to new areas which are cut off. Thus, © Nadia Berg in 2014, indian and Afro-Colombian populations living in isolated areas of Nariño, which can only In total, MdM provided 25,000 health consul- received filtering equipment to improve water be reached by boat, were able to benefit from tations (primary healthcare, psychological quality and 12 community health posts were set medical consultations and psychological support. and SRH) in Colombia. Around 1,000 families up and equipped.

» mexico

» uruguay

Since 2014 Doctors of the World has concentrated its efforts on migrant women in Tapachula, southern Mexico, who work in areas (mainly bars) where sex work is tolerated. 25 health promoters, trained in self-esteem and upholding migrants’ rights, worked throughout the year in 19 areas to spread health education messages and to speak on behalf of these women to health authorities, the anti-trafficking department and the migration department.

In 2014, Doctors of the World supported three Uruguayan organisations committed to bringing down the barriers to sexual and reproductive health services and to abortions which, although legal in Uruguay since the end of 2012, many gynaecologists refuse to carry out. So, the Uruguayan feminist organisation Mujer y Salud, organised a national day for sexual and reproductive health and rights, then presented a paper to the political parties ahead of the presidential elections. Iniciativas Sanitarias organised three workshops to build awareness amongst health personnel and three training courses on abortion. Lastly, Mujeres en el Horno, set up a telephone helpline for women before, during or after an abortion. Many challenges remain before all women can access legal abortion but Doctors of the World’s partners are capable of continuing this work independently. The programme will therefore come to an end in 2015.

Supporting migrants

These women are now at the stage of being able to form themselves into an association of sex workers, which will strengthen their capacity for action, and develop their ability to exercise their rights. This process is supported by Doctors of the World, which has also developed a partnership with Brigada Callejera, a Mexican NGO that specialises in combating sexually transmitted infections and HIV/Aids in particular.

Towards the end of a programme

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Pakistan ÂŠ Kris Pannecoucke/Consortium 12-12

our programmes in

Eurasia Doctors of the World has a presence in 12 countries of Europe and Asia. The focus is primarily on women and children or people who are at risk. Its programmes also reflect the crises which shake the Eurasian continent. This is the case in India and Pakistan where the organisation provides support to displaced tribal peoples. Similarly in Bosnia, where medicines and equipment where sent following the floods in May, and in the Philippines ,where teams continued to support populations who were cut off following the typhoon in November 2013. In 2014 needs assessments were also conducted, notably in Moscow and Ukraine.

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SWEDEN

Russia

FINLAND

ESTONIA LATVIA LITHUANIA BELARUS POLAND UKRAINE KAZAKHSTAN

Moldova

MONGOLIA

Romania Bosnia

Bulgaria

Georgia ARMENIA

GREECE

TURKEY

AZERBAÏJAN

CYPRUS SYRIE LEBANON L IRAQ PALESTINE JORDAN JO ISRAËL

EGYPT

SAUDI ARABIA

UZBEKISTAN TURKMENISTAN

KYRGYZSTAN NORTH KOREA

TAJIKISTAN

SOUTH KOREA

AFGHANISTAN IRAN

BHUTAN

Pakistan

U.A.E.

Nepal India

TAÏWAN

Burma Laos

OMAN BAN B A ANG NGLADE ADE DE ES SH H YEMEN

CAMBODIA CAMBODIA

INDIAN OCEAN

JAPAN

CHINA

VIÊT VIÊTN ET TN NA A AM M LANKA LANKA LA ANK A A MALAYSIA

IN ND NDO ND DO ONÉSIA ON ONE

Philippines

PACIFIC OCEAN

key events » BOSNIa » BULGARIa » BURMA » GeORGIa » INdia » LAOS » MOLDova » NePAL » PAKISTAN » PHILIPPINES » ROMANIa » RUSSIa

» nepal

Support for childbirth For detailed fact sheets on the various programmes in Europe and Asia see our website: www.medecinsdumonde.org

Doctors of the World has been working in the Sindhupalchok district, in Nepal, since 2007. Because this rural area is very isolated and roads are poor, the vast majority of pregnant women living there do not have their pregnancies monitored and they give birth at home. In 2014 Doctors of the World continued to train local

health workers and continued its prevention projects with women who have formed microfinance groups. Around 8,000 women have taken part in education sessions on mother and baby health and over 300 gave birth in the 10 health centres which are supported by MdM.

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» bulgaria

With the Roma

The opening ceremony of Doctors of the World’s SRH programme in the Nadejda walled area of Silven, in east-central Bulgaria, took place in February 2014. Over 20,000 Roma live there in extremely insecure conditions. Isolated and discriminated against,

these people who are in extreme financial difficulty, also have problems accessing healthcare. So the organisation has set up a team of peer mediators who live in Nadejda, to run awareness-raising activities in the community and in an information and advice centre.

Residents can obtain modern contraceptives free of charge, as well as information on family planning and on their rights to public health services. Doctors of the World also provides referral to gynaecologists who are funded by Silven town council.

» pakistan

Confronting violence While it is handing over the running of safe and well protected Dar-ul-Amans to the Pakistani authorities MdM is continuing to work with displaced people from Khyber Pakhtunkhwa Province (KPK). Aid for women In 2004, Doctors of the World launched an aid programme for women victims of domestic violence, in the Dar-ul-Amans of Punjab in eastern Pakistan. Created by the government, these ‘Houses of Peace’ are intended to protect women and children who have suffered economic, social, physical and psychological abuse and have been forced to leave their homes. Thanks to MdM and the support of 500 volunteers — doctors, psychologists and lawyers — the women receive appropriate care. A medical consultation is organised within a fortnight of their arrival and they are offered a mental health check to assess their psychological suffering. This kind of protection has been developed over time to turn the Dar-ul-Amans into safe and secure refuges. It includes management of the centre, residents’

protection and well-being, as well as medical, legal and psychosocial services for the women. Consequently, violence is increasingly rare and the women consider these centres to be the only places where they are genuinely safe. At the same time Doctors of the World has helped to develop Mumkin, a platform of Pakistani women’s rights organisations. Since 2011, Doctors of the World has gradually been withdrawing and working to develop the skills of staff in the Dar-ul-Amans and the department of social affairs so that the services offered will continue and basic standards will be upheld. This phase of transferring the project to the Punjab authorities continued in 2014 and will end in April 2015. A study will be undertaken to quantify the knowledge and skills that have been acquired.

Mobile health in KPK In 2014, the military operations conducted in North-Waziristan caused almost one million people to flee to KPK, where MdM has been providing primary healthcare for internally displaced persons (IDPs) since 2009. Despite the conflict, seven mobile clinics were kept going in 2014. They enabled the organisation to react swiftly in the IDP camps, treating mainly women and children (25% of consultations dealt with questions of sexual and reproductive health). Vaccination and nutrition programmes were also conducted and health education workshops were attended by over 65,000 people.

» serbia

Tamil women are amongst the main victims of violence in Sri Lanka.

Preparing a migrants programme

As the gateway to Europe, the Balkans sees undocumented migrants in transit from Afghanistan, Syria, Somalia or Eritrea. These are the same migrants that Doctors of the World meets further along their migratory journey, in the camps at Dunkirk, Saint-Omer and Calais: jungles, where the Nord-Pas-de-Calais teams work. Following an exploratory project in Serbia, Doctors of the World was concerned by the lack of access to healthcare for these men, women and children fleeing from conflict zones. A Serbian migrants’ defence organisation — Asylum Protection Centre — was identified as a suitable partner. In 2015, thanks to Doctors of the World’s technical support, it should add to its aid programme for the right to asylum, a medical component with information, primary care and referral to local public health facilities.

» russia

Towards a sex-workers programme in Moscow

An exploratory project conducted in Moscow with the help of the Nantes sex workers programme (the Loire regional delegation) helped to identify the needs of migrant women working in the sex industry. In fact, these women have no access to social security and they are outcast both as migrants by the authorities and as sex workers by their community. Although they are screened for certain diseases (HIV, hepatitis,

tuberculosis, syphilis), the law demands that the doctor passes their names to the immigration services so that they can be deported. Furthermore, harm reduction programmes are considered by the authorities to encourage prostitution or drug use, which are illegal. This is why Doctors of the World should run a programme supporting Russian activist organisations that operate such programmes with people working in the sex industry.

» sri lanka

Combating sexual violence

Since the end of the civil war in 2009, the north of Sri Lanka has remained a highly militarised zone. The Tamil population suffers from violence and stigma, especially single women who are in sole charge of their homes. In the tea plantations, the Tamils are cheap labour and are reduced to a state of exploitation, with no access to health services. This is why, in 2014, Doctors of the World launched a development project to identify two local partners prior to the launch, in 2015, of a programme to combat violence against women and to prevent unwanted pregnancies. In parallel, the organisation intends to lobby for a change to the law regarding family planning, which currently is reserved for married couples, and for universal access to the right to treatment.

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» burma

High-risk practices Doctors of the World has been working in Burma for over 20 years and in 2014 continued its ambitious harm reduction programme with sex workers, LGBT people and drug users in Kachin State and Rangoon. Since the start of the programme, 1,889,685 condoms and 2,389,833 syringes were distributed, 2,001 patients have been prescribed ARVs and 1,078 drug users were given substitution treatment with methadone. Doctors of the World operates three clinics in Kachin and one in Rangoon, assisted by health professionals and peer educators. Social and cultural activities are provided to restore confidence to excluded populations and to enable them to be accepted by their community.

» Philippines

Unregulated recycling of electronic waste is extremely dangerous.

‘‘Our environment is their health’’ Launched in summer 2013, Doctors of the World’s project with recyclers in Manila entered a new phase in 2014. Alongside activities to minimise health risks associated with handling electronic waste and, with the support of community workers, the training of groups of dismantlers, dedicated recycling centres opened. Thereafter,

oil recycling vats, extractor fans and access to — which, for the first time, brought together the water should help reduce respiratory problems environment minister, epidemiologists from the and lead poisoning, which are common amongst University of Manila, staff from the Philippine poithe inhabitants of the capital’s shantytowns. son control centre and various local authorities In June 2014, Doctors of the World organised the — to present its project and to raise awareness of first civil society forum on electronic and electrical the question of informal dismantling. waste. The organisation also set up a workshop

» The end of three programmes Philippines Access to care after the typhoon The first emergency programme began in November 2013 after Typhoon Haiyan, which was one of the most powerful ever recorded and devastated the Philippines on 8 November. Doctors of the World was already working on the archipelago on its long-term project with recyclers in Manila, so was able to react quickly and efficiently to the Philippine population’s need for medical assistance. Once the emergency was over, MdM stayed on Leyte to help people who were still beset by the devastating effects of the typhoon. The organisation continued its work to restore the health system with material aid, including medicines and equipment, for 62 healthcare centres and hospitals. It was also involved in re-establishing epidemiological monitoring, to prevent the risk of spreading infectious diseases, and provided medical consultations in five mobile clinics for the inhabitants of around 30 isolated © Sébastien Duijndam villages. The programme came to an end in May 2014: 275 community leaders had been trained in first aid and 65 members of the medical teams from the emergency unit to assess the level of births are without medical assistance. This is why need and to assist with distribution. In this way, Doctors of the World set up ‘outreach brigades’ received mental health training. 40,000 people received emergency medical aid. to get closer to the inhabitants of the district, Bosnia-Herzegovina trained personnel in antenatal care and in family Supporting Balkan populations Chechnya planning, and distributed booklets and posters In May and June 2014, Doctors of the World An outreach model adopted by the state to raise awareness of SRH. intervened in Bosnia-Herzegovina following The sexual and reproductive health programme With Chechen protocols now in line with internaextreme bad weather in the Balkans. The equi- started by Doctors of the World in 2012, which tional standards such as those of WHO, and the valent of three months rain fell there in three works with women from Vedeno district, was authorities having adopted the tools and recomdays, causing floods and landslides, which left handed over to the Chechen authorities in 2014. mendations of Doctors of the World, the organimany casualties. Around 100,000 people were The inhabitants of this mountainous region of sation withdrew from the country in August. displaced. At the request of health ministries in Chechnya have difficulty in reaching healthcare the affected areas, Doctors of the World deli- centres. In addition, women from rural commuvered three tonnes of medicines and medical nities have little or no knowledge of sexual and equipment, assisted on the spot by a team reproductive health or family planning and most

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Madagascar © Mylène Zizzo

our programmes

Opération Sourire In 2014, Opération Sourire celebrated 25 years of plastic and reconstructive surgery putting a smile back on the face of many affected by congenital or acquired medical problems, particularly children and young adults. Twenty-five years of promoting training for national medical staff and of encouraging social and physical reintegration of people operated on into their communities. Today, Opération Sourire volunteers are working in 10 countries in Africa and Asia.

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Restoring faces and encouraging social re-integration Operation Sourire’s longevity is testament to Doctors of the World’s commitment to disadvantaged people affected by changes to their appearance. Several times a year, teams from four members of MdM’s international network (Germany, France, Japan, Netherlands) help to rebuild patients’ confidence and promote social reintegration.

In 2014, the teams operated on more than 1,400 patients during 25 surgical missions in 10 countries. MdM France conducted 13 missions in five countries: Benin, Cambodia, Madagascar, Mongolia and Pakistan. These teams treated more than 400 patients suffering mainly from cleft lips or palates and burn injuries. MdM Germany, MdM Japan and MdM Netherlands organised surgical operations in Bangladesh, Burma, Burundi, Cambodia, GuineaBissau and Tanzania. Thanks to them, more than 1,000 people had surgical operations. In 2014, © Mylène Zizzo

around 140 volunteers (surgeons, anaesthetists, » outlook and challenges nurses) took action to operate on 1,400 patients. In 2015, the Operation Sourire teams are planning 25 field visits. The idea remains to promote » 2014 patients missions in countries where MdM is already 40% of people operated on were under the age working on a long-term project, with a base of 10. These 551 patients were mainly operated on the ground. This helps facilitate the logistics, on for cleft lips/palates (40%) and burns (22%), recruitment and follow-up of patients, the perusually caused by domestic accidents which are missions and partnership agreements and also often common in low-income countries. the security and supervision of teams. Doctors of Over a quarter (26%) of Operation Sourire the World is also working to continue the devepatients were aged 10-20 years, equivalent to lopment of the quality of the programmes and to 376 persons operated on for burns (30%) and promote its particular approach to plastic surcleft lips/palates (17%). gery and reconstruction in operating countries. Highly complex operations were also carried out in patients suffering from noma (Cambodia, » 25 years of Opération Sourire Guinea-Bissau) or meningoencephalitis Since 1989, Opération Sourire’s volunteer (Cambodia) and women affected by acid burns medical teams provide reconstructive surgery (Pakistan). Lastly, two surgical missions were to those who do not have access. In 25 years, carried out on 50 young children (Madagascar). more than 13,000 patients have been operated

co-ordinators

» Programme: Dr Isabelle Barthélémy, Dr François Foussadier, Dr Frédéric Lauwers » Headquarters: Sophie Poisson

countries

» Bangladesh, Benin, Burma, Burundi, Cambodia, Guinea-Bissau, Madagascar, Mongolia, Pakistan, Tanzania

on. The number of cases treated has significantly increased since the other network members (MdM Japan, Germany then Netherlands) joined MdM France. In the 10 years between 2005 and 2014, 228 missions were conducted. Between 2008 and 2014, more than 7,000 patients have been operated on in Asia and Africa by around 100 volunteers each year. The 25th anniversary of Operation Sourire was the occasion to thank our teams and our partners by organising gathering and communication events (film, press, photo exhibitions, etc.).

BUDGET

» € 622,117 partner

» L’Oréal Foundation

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Calais ÂŠ Sarah Alcalay

Programmes in France

» 60

Programmes in France

» 62

Map

» 63

Observatory of access to healthcare

» 65

Shantytowns

» 66

Migrants

» 67

Health and housing

» 68

Harm reduction

» 70

Prevention HIV-hepatitis-STIs-tuberculosis

» 71

Prostitution

» 73

Buddying of children in hospitals

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Programmes in France Three million people suffer from poverty in France, representing 14.3% of the general population.1 Since 2008, the number of vulnerable people continues to rise and social inequalities in health keep widening. In such circumstances, MdM programmes which cater for the most vulnerable (e.g., rough sleepers, squatters or shantytown inhabitants, sex workers, people who use drugs, migrants in transitâ&#x20AC;Ś) have seen increasing numbers in the last few years with a significant increase in the number of unaccompanied minors.

Fighting social exclusion and discrimination In most cases, service users face multiple financial problems and poor housing conditions and 80% of households are food insecure due to a lack of income.2 Coming up against multiple obstacles (misunderstanding of their rights, complexity of the health insurance system, language barrier, etc.), the most vulnerable groups struggle more and more to access healthcare. With other organisations, MdM denounces the complexity of the system which is further impaired by regular abusive practices or dysfunctional bureaucracy. Such administrative obstacles deter applications and generate delays in accessing healthcare. In some cases they even prevent people from seeking care at all: more than a third of the service users who come to the Healthcare, Advice and Referral Clinics (36%) are late in accessing healthcare and 20% of them have given up on receiving any healthcare in the last 12 months. These benchmarks demonstrate a worsening in access to healthcare for the most vulnerable groups. In 2014, vulnerable migrants, who represent the majority of the MdM service users, were still victims of a repressive immigration policy which aims to push them out of the French territory, and even endangers their lives or discriminates against cer-

tain communities. Migrants in transit on the NordPas-de-Calais coast, irregular migrants in Mayotte or vulnerable Roma migrants experience serious oppression which impacts badly on their living conditions and access to healthcare. The Pluriannual Plan against Poverty and for the Promotion of Social Inclusion, officially passed in January 2013, demonstrates a political will to fight social and geographic inequalities in health. However, the concrete impact of such measures is taking a long time to manifest itself and remains inadequate. For example, although the threshold of the complementary Universal Health Insurance (CMU-c) has been slightly raised, it still excludes many of those living below the poverty line.

Protection and housing As far as housing is concerned, the government has promised, among other things, to abolish seasonal accommodation arrangements. This measure, however, has not yet been translated into concrete action in certain regions. Once again, MdM calls on the government to urgently abolish the seasonal management of housing and to provide enough adequate, long-term, concrete and innovative solutions to housing for rough sleepers. Furthermore, the policy of shantytown reduction announced in early 2014 must

more than a third of service users (36%) of the Healthcare, Advice and Referral Clinics encounter delays in access to healthcare and 20% of them have given up seeking any healthcare in the last 12 months.

The most vulnerable groups face increasing difficulties in accessing healthcare. Paris © Véronique Burger/Phanie

respect the wishes of people living there. MdM is waiting to hear the outcomes of the pilot projects ingeniously put together with Adoma. At a time when the right to asylum is under discussion MdM, in unison with other organisations, is calling for a policy change away from an approach based on control and oppression towards one based on protection and which complies with international law and disregards the concerns of immigration management. It is also particularly urgent and necessary to re-instate the full protection of seriously ill migrants: non-deportation and a right to remain when the necessary treatment for their condition is not appropriately accessible in their country of origin, as stated in the 1998 legislation.

Mobilising for better legislation in 2015 MdM plans to use the debate about public health

policy in April at the French National Assembly to advocate for more effective action to tackle health inequalities, in response to the inadequate content of the current bill. Despite certain measures, like the widening of the third-party payment or trials for low-risk drug consumption rooms, the draft law does not go far enough to streamline bureaucratic processes to access healthcare (e.g., no proposal to merge the State Health Insurance (AME) and the complementary Universal Health Insurance CMU-c). Furthermore, the text does not provide enough safeguards to protect current healthcare services (mother and child protection, healthcare centres, healthcare access offices) which face many difficulties and are, in some cases, under threat. In addition, the overseas territories are not taken into account. As far as health prevention is concerned the text

neglects, among other things, the support needed in terms of health mediation and interpreting services. With the arrival of prohibitively expensive treatments, it is also urgent and necessary—contrary to what the bill currently suggests—that we have a public debate about price fixing and the introduction of transparent mechanisms to ensure the principles of health democracy are respected. MdM wants the bill to better reflect the objectives set in the national health strategy and hopes, though this political debate, to be able to fight more effectively against health inequalities.

1. INSEE, Les revenus et le patrimoine des ménages, Edition 2014. 2. MdM, L’alimentation des personnes en situation de grande précarité en France: quel impact sur leur état de santé, June 2014.

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Nord-Pasde-Calais

Rouen

BELGIUM

Dunkirk

Calais

Hénin-Beaumont Valenciennes

GERMANY LUX.

Saint-Denis

Le Havre

Metz

Normandy Colombes Île-deFrance

Paris

Lorraine Nancy

Strasbourg

Alsace FrancheComté

Pays de la Loire Angers

Projects in rural areas, on the streets, in shantytowns, with migrants...

Besançon

Nantes

SWITZERLAND

Healthcare Referral and Advice Centres

Poitiers

Paediatric care centre

Rhônes-Alpes, Bourgogne, Auvergne Combrailles Lyon

PoitouCharentes

Buddying of children in hospital

Angoulême

Sex worker projects

ITALY

Grenoble

Projects with people who use drugs

Bordeaux

Project with prisoners

Aquitaine

MidiPyrénées

Outreach projects Projects in MdM premises

Languedoc-

ProvenceAlpesCôte d’Azur

Nice

Toulouse

Bayonne Pau

Montpellier SPAIN

Aix-en-Provence Corsica Marseille

Saint-Denis Mayotte Reunion

Cayenne

Mamoudzou SURINA AM A

Saint-Pierre

Guiana BRAZIL

Ajaccio

Observatory on access to healthcare » programmes in France

MdM’s Observatory on Access to Healthcare was created in 2000 in order to bear witness to the difficulties in accessing mainstream healthcare services experienced by our service users. The Observatory is a tool to help develop understanding of the vulnerable groups (who are often left out of official public health statistics) and also to steer our programmes and advocacy activities. It enables us to develop proposals on the basis of objective data and our experience on the ground. MdM uses these proposals to lobby politicians, officials and/or health professionals to improve access to healthcare and other rights for vulnerable and excluded groups.

Healthcare, Advice » 19 and Referral Clinics out of the 20 1 programmes in France saw a total of

28,517 service users in the course of 61,829 visits. 40,790 medical consultations were carried out » 3,703 dental consultations

» more than 11,000 social consultations.

» The average age of service users is

33 years old

» 13% are under 18 years old » 94.5% are of foreign origin » 95.4% live below the poverty line

Bearing witness to obstacles to healthcare for vulnerable and/or excluded groups » activities The Observatory on Access to Healthcare supports all the programmes in France to develop data collection and/ or specific surveys with the aim of collecting objective information for communication and advocacy. Every year the Observatory produces a report, published on 17 October (International Day for the Eradication of Poverty). This report presents a review of the clinics’ activities and our service users. It is developed on the basis of medical and social data collected in the clinics, testimonies collected by the field teams, observations on the health system and existing difficulties with access, along with changes in legislation or rules.

» outlook • Continue the Observatory activities in liaison with the programmes in France in order to harmonise data collection tools and consolidate the data collected. • Carry out surveys on specific topics. • Continue Doctors of the World advocacy activities based on objective data collected on the ground.

The centre for paedriatric care in Mayotte saw

808 children

and carried out 1,007 medical consultations

»5 1.7% of children are under three years old

1. Data for the Healthcare, Advice and Referral Clinic in Ajaccio were not availlable in 2014.

funding

» MdM’s own funds, French Ministry of Health and Ministry of Social Cohesion.

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ÂŠ Constance Decorde

Shantytowns » programmes in France

Despite the 2012 circular on the planning and management of evictions from shantytowns, in 2014 evictions were carried out without the provision of any housing alternatives and without any prior social assessment. Sometimes accompanied by violent tensions, evictions uproot shantytown inhabitants from mainstream health services, interrupt continuity of care and make prevention and the fight against epidemics difficult. In order to be granted the State Medical Aid or the complementary Universal Health Insurance, inhabitants face, on top of language barriers and poor understanding of the French health insurance system, many other requirements for access and very long administrative delays.

BEneficiaries

» more than 4,000 people

Prioritise continuity of care among shantytown inhabitants

Number of volunteers

» 156

funding

» MdM’s own funds, regional public health agencies, district councils, regional councils, town councils… Partners

» activities Doctors of the World carries out many activities in shantytowns: child immunisation, provision of healthcare and referral to mainstream health services. Women are provided with information about contraception and family planning and with antenatal care throughout their pregnancy.

» Romeurope, support committees, homeless shelters, mother and child health protection services…

Our mediators work in partnership with other organisations and mainstream health services. Their collaboration aims to improve care for shantytown inhabitants and to raise awareness about the importance of continuity of care.

programme locations

Since about half of the settlements do not have any waste collection services in place, Doctors of the World also carries out sanitary activities. At the same time, the organisation lobbies the local authorities to improve sanitary conditions and to offer suitable accommodation.

» Saint-Denis, Bordeaux, Hénin-Beaumont, Lyon, Marseille, Montpellier, Nancy, Nantes, Strasbourg and Toulouse.

Supporting a policy of shantytown reduction which does not infringe on people’s dignity, Doctors of the World highlights the importance of health and social assessments and of offering sustainable housing alternatives before implementation. When no satisfactory provisions are made the organisation supports the maintenance of existing settlements, enabling inhabitants to realise their rights and access care.

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Migrants » programmes in France

Access to healthcare for vulnerable migrants who reside in France is very difficult. They face many obstacles which prevent them from accessing healthcare: excessive demands for documentary proof by Local Health Insurance Offices, proliferation of new requirements to access State Medical Aid and problems in having an address. Migrants, however, suffer from many medical conditions. Physical problems are often accompanied by serious psychological conditions (e.g., depression, anxiety, somatic disorders). In MdM clinics 94.5% of service users are of foreign origin.

» 94.5% of first-time service users in the clinics are foreign nationals. » 30% of first-time service users in the clinics have sought, or are in the course of seeking, asylum (whether they have applied or not and whether their application was successful or not). » 88% of migrants did not have effective access to health coverage when they came to the clinic for the first time. » Nearly 3,500 contacts were made with migrants in transit on the Channel coast and more than 200 contacts were made with agricultural workers in Berre. Number of programmes

» All programmes

Number of volunteers

» 2,120

Partners

» Member organisations of ODSE, MOM collective, CFDA, local and regional voluntary sector co-ordination bodies.… funding

» MdM’s own funds, regional public health agencies, district councils, regional councils, town councils…

Supporting vulnerable migrants and advocating for their rights » activities Migrants can access our clinics free-of-charge and in total freedom. They are cared for, supported in their administrative procedures when applying for the free health insurance to which they are entitled and referred to mainstream health services. Outreach activities are carried out in places where migrants live. Doctors of the World provides them with nursing care, medical consultations, information on the risks of infectious diseases, screening tests, etc. The organisation also takes into account how their migration journeys affect their physical and psychological health. Doctors of the World collects social and medical data and also case studies to bear witness to the conditions experienced by migrants. The data is used to lobby institutions for better and more services to ensure that everyone can use local healthcare access offices (PASS), etc. Doctors of the World advocates for a streamlining of access to rights (suspending address requirements, merging State Medical Aid with the complementary Universal Health Insurance ) and care for vulnerable migrants. Finally, Doctors of the World will call for its recommendations to be considered in the reforms of asylum and migrants’ rights in 2015.

Health and housing » programmes in France

Since 1993, Doctors of the World has been tackling health problems caused by poor accommodation. Housing conditions, whether rough sleeping or poor accommodation, directly affect health. There was an advance on the right to housing in 2007 with the passing of the DALO law which requires public authorities to demonstrate effective outcomes. However, 72% of service users who visited MdM clinics claim to face housing problems. In 2014, the government proposed new measures which represent some progress but remain an inadequate response to the needs of the most vulnerable groups.

Promoting health in situations of poor housing Number of volunteers

» 371

CONTACTS WITH HOMELESS and poorly housed PEOPLE

» activities

» Only 9% of services users are in private accommodation

Doctors of the World teams reach out to those who have no or poor accommodation. They provide medical and social consultations, inform service users of their rights to access health insurance and advocate on their behalf in administrative procedures. They also provide outreach sessions, visits to accommodation, and medical consultations in shelters and day centres.

» Nearly 17,000 contacts with approximately 5,300 beneficiaries

» 47.5% of service users are in temporary accommodation with family or friends » 11% of service users live in squats or shantytowns » 30% of service users in our clinics are sleeping rough (14.6%) or in voluntary sector accommodation for at least two weeks (10%) or in emergency housing (for less than a two week period) (5.4%) » 23.3% of minors are homeless (16.7%) or in emergency housing for less than two weeks (6.6%) » 72.8% of services users live in insecure accommodation.

Tackling medical conditions which are caused by the lack of, or poor quality of, accommodation requires the intervention of different types of actors (medical, social and housing) in order to ensure effective outcomes. Doctors of the World is working on the root of the problem, mobilising and raising awareness among those working on the ground to encourage collaboration and a global approach. Throughout its activities, Doctors of the World highlights the impact of housing on health and bears witness to the difficulties faced by homeless people or poorly housed people in order to advocate for their right to access healthcare. Besides its activities on the ground, the organisation lobbies institutions to provide suitable housing.

funding

» MdM’s own funds, ARS, regional councils, district councils, town councils… key Partners

» Member organisations of the Collective for a new housing policy, local organisations (La Péniche, les Amis de la rue, le Fournil, le GAF, Enfants du Monde Droits de l’Homme…), homeless people self-help support groups, mother and child protection services…

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Harm reduction » programmes in France

Stigmatised and criminalised for consuming drugs, users are particularly at risk of contracting HIV and hepatitis. However, France is slow to implement harm reduction approaches such as drug analysis, education on risks, consumption rooms and access to naxolone for users. The health bill to be discussed in 2015 will shape harm reduction in France and should support implementation of such approaches.

Reducing drug related harm Types of drugs

» Alcohol, cannabis, ecstasy, cocaine, LSD, amphetamines, heroin, anaesthetic substances, etc. Number of beneficiaries

» Nearly 9,000 contacts for approximately 1,400 beneficiaries. » 412 analyses by the drug analysis programmes in Marseille, Toulouse and Paris. Number of volunteers

» 98

funding

» MdM’s own funds, regional public health agency, regional councils…

» activities Doctors of the World has been active in harm reduction since 1989. Since 1997 the organisation has been carrying out actions more specifically in raves and, since 2004, in squats to talk about drug use practices and provide drug analysis and harm reduction material (injection kits, inhalation kits, condoms, etc.). Since 2010 Doctors of the World has also started a project in Île-de-France educating about the risks associated with injection (ERLI). People who use intravenous drugs can take part in educational sessions which are both theoretical and practical, and which provide an opportunity to talk about the risks associated with their practices. Doctors of the World has also developed drug analysis with thin layer chromatography to determine the quality of substances.

Partners

» AFR, ANRS, Techno Plus, Aides, Espace Indépendance, Sida Paroles, Bizia, Gaïa Paris, Bus 31/32, La Case...

» outlook Naxolone — when directly administered by users or the people around them — provides an effective and simple solution to fight lethal overdoses with few side effects. Doctors of the World proposes, therefore, to reduce drug deaths by providing this product to people who use drugs and to educate and train them on how to use it. Doctors of the World continues to advocate for the opening of a low-risk consumption room in Paris.

Programme locations

» Four rave programmes: Bayonne, Mediterranean, Montpellier and Toulouse. » Two programmes in squats in Bayonne and Paris. » Six drug analysis programmes (Bayonne, Colombes, Marseille, Nice, Paris and Toulouse) and one national coordination body based in Paris. » One project on education on risks associated with injection (ERLI) in Ile-de-France.

ÂŠ Maxime Couturier

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Prevention project HIV-hepatitis-STIs-tuberculosis » programmes in France

MdM teams see vulnerable patients, mainly migrants, who come from regions which have high prevalence of HIV, hepatitis and tuberculosis and who are, therefore, particularly exposed to these conditions. In France this population makes up 47% of those testing positive for HIV. The prevalence of hepatitis B and C is three times higher among vulnerable patients who are covered by the complementary Universal Health Insurance. Tuberculosis is nine times more likely to occur among those born abroad than those born in France (36.1/100,000 vs 4.1/100,000).

Beneficiaries

» The 28,088 service users attending the pilot programmes funding

» Ministry of Health, Sidaction and MdM’s own funds

pilot project locations

» Healthcare Advice and Referral Clinics: Bordeaux, Cayenne, Lyon, Marseille, Nantes, Nice, Paris, Rouen, SaintDenis, Strasbourg, Toulouse » Sex workers programmes: Lotus Bus in Paris, Funambus in Nantes » Homeless programmes: Metz, Lyon, Angoulême » Projects working with drug users : Education of risks associated with injection programme (ERLI), Paris and Colombes, Bayonne rave programme

Tackling HIV, STIs, hepatitis and tuberculosis » activities • Strengthening prevention: supplying programmes with prevention materials (flyers, condoms etc.), individual interviews and group sessions. • Improving access to screening: encouraging service users to go for testing, partnerships with free, anonymous testing services and local laboratories, offering rapid HIV and hepatitis C testing in certain MdM clinics. • Facilitating access to care: partnerships with mainstream health services, physically accompanying service users. • Collecting testimonies of case studies in relation to these diseases. In 2013, MdM launched some new initiatives: • The Healthcare, Advice and Referral Clinics in Rouen and Marseille introduced rapid HIV testing. The MdM clinic in Marseille also offers rapid hepatitis C testing. • There are now nine domestic programmes which offer rapid HIV testing: Cayenne, Nice, Strasbourg, Bordeaux, Nantes, Metz, Bayonne, Rouen and Marseille, some of them working in partnership with AIDES. The Rave mission in Bayonne also offers hepatitis C rapid tests for people who use drugs, in the premises of the harm reduction facilities run by the organisation Bizia.

» outlook • Continue to introduce rapid HIV and hepatitis C testing in mainland France and in French Guiana, as part of a wider screening strategy and to develop access to screening in appropriate and innovative ways. • Develop screening for other sexually transmitted infections (other than HIV and hepatitis B). • Strengthen our partnerships with the free, anonymous testing centres.

Prostitution » programmes in France

Since the 2003 Internal Security law1 came into effect sex workers’ conditions have worsened. Pushed underground, they have become more isolated, increasingly exposed to abuse and violence and forced towards unsafe practices. A new bill that aims to penalise more harshly the procurement of prostitution is currently being debated. However, the criminalisation of the client and soliciting in the streets still endangers sex workers’ access to rights and care.

Beneficiaries

» Around 1,600

Promoting protection and access to healthcare for sex workers

Number of volunteers

» 127

funding

» MdM’s own funds, regional public health agencies, district councils, regional councils, town councils… Partners

» Aides, Arcat, CDAG, Cimade, Droits d’urgence, Strass, the collective of Rights and Prostitution practising fixed fees… programme locations

» Montpellier, Nantes, Paris, Poitiers, Rouen

» activities Since 1999 MdM teams regularly conduct outreach in places where prostitution takes place and, in Paris and Nantes, there are also clinics to receive them. Sex workers are provided with harm reduction material that they need for their work and one-to-one medical and social consultations. Referrals and accompaniment to STI screening (Aids, hepatitis, etc.) services are also provided. Advice information is translated into as many languages as possible in order to ensure that all the sex workers know their rights and the potential harms linked to STIs, HIV, hepatitis or that they are referred towards mainstream health services. The Lotus Bus, run by many volunteers who speak Chinese, has supported Chinese sex workers in Paris since 2004. The approach, expertise and competency of health promotion workers are informed by their knowledge of prostitution. Their collaboration enables sex workers to access health services and receive quality of care and ensures that the messages they receive reflect the reality of practices.

1.LSI: Legislation n° 2003-239 issued on 18 March 2003 on internal security.

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ÂŠ Virginie de Galzain

Buddying

children in hospitals » programmes in France

Many children are regularly admitted to hospitals in Paris, French Guiana and Reunion for conditions that cannot be treated closer to home. Some of them, often from disadvantaged backgrounds, do not have their parents by their side. However, all doctors today agree that emotional support is paramount to maintain the psychological balance of such isolated and sick children.

A comforting support Number of children buddied in 2014

» activities

Number of volunteers

In order to help sick children away from their families to deal with the separation or to help parents who are present but often overwhelmed by the difficulties they meet, Doctors of the World mobilises volunteers. First started in 1988 at Necker children’s hospital in Paris, the buddying programme for children in hospitals has been developed in several health centres in Paris, French Guiana and Reunion.

funding and support

Linking the isolated child, the family and the healthcare team While they stand in for parents who could not come with their children, volunteers also help to maintain or restore links, sometimes damaged, with the family.

» 145 » In the Parisian region: 100 » In Guiana: 33 » In Reunion: 12 » 108 » In the Parisian region: 76 » In Guiana: 22 » In Reunion: 10

» MdM’s own funds, Air France

Unfortunately, in 15% of the cases volunteers accompany the child to the end of his or her life. In such sad moments the complementary work between volunteers and the healthcare team is strengthened.

partners

» Hospitals and health centres in Île-de-France » With a written agreement: Hospitals in Paris: AP-HP Necker-sick children hopsital, AP-HP Armand-Trousseau hospital, AP-HP Robert-Debré hospital, Curie Institute, Centre des Côtes - Les Loges-en-Josas, Margency Red Cross Children’s Hospital, Bullion paediatric and rehabilitation hospital, Paul-Parquet Foundation-Neuilly-sur-Seine, Montreuil medical centre for young children, Édouard-Rist medical and pedagogical clinic » Without written agreement: AP-HP Saint-Louis hospital, Antony re-habilitation centre for very young children, Saint-Maurice re-habilitation centre, Gustave-Roussy Institute in Villejuif, Kremlin-Bicêtre hospital » In French Guiana Andrée-Rosemo hospital in Cayenne, Franck-Joly hospital in Saint-Laurent-du-Maron, West Guiana. » In Reunion Félix-Guyon hospital in Saint-Denis

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Nantes © Coralie Couëtil

regional delegations Doctors of the Worldâ&#x20AC;&#x2122;s 14 regional delegations operate across two thirds of metropolitan and overseas French territories. Responsible for the unity of the organisationâ&#x20AC;&#x2122;s activism and policy actions at home, they had a very busy year in 2014.

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doctors of the world’s voice in the regions Regional delegations carry out Doctors of the World’s activities in France. They also mobilise members and support strategic positions.

Mobilising our members Regional cohesion is less rooted in the number of volunteers than in the extent of their involvement. Taking this into account, delegations have focused on the induction of new volunteers and the daily support of teams by offering many skill building activities, such as tailored training (entitlement regulations to care and rights, community health, communication skills, legislation and healthcare, etc.), knowledge sharing workshops and debates about cross-cutting themes. The organisation of events—such as exhibitions, forums, concerts, jumble sales, training or any other activity which brings people together—is also central to mobilising members. This human value is celebrated and accounted for in our systematic calculation of volunteers’ in kind contribution, which is becoming easier to

Regional delegations continue to lobby local institutions and political actors.

estimate at the regional level. In 2014 MdM esti- programmes (Healthcare Advice and Referral mates that volunteers gave more than 160,000 Clinic in Marseille, rave programme in the South). hours in France. On-the-ground expertise legitimises regional delegations’ activties, especially their lobbying Caring, advocacy and bearing witness of local institutions and political actors (in supMdM teams witnessed growing health needs port of the winter shelter arrangements, the introamong vulnerable groups as well as the ten- duction of specific and additional health access sions brought by the financial crisis. They tackled offices (PASS), on the law concerning prostituthese new challenges efficiently, adapting to tion, providing access to water, and ensuring a them and reflecting on their activities (particu- civilised welcome for migrants). larly through the self-evaluation of clinics). They In 2014 during the local elections, MdM teams focused on referring and accompanying services canvassed citizens and candidates using a ‘soliusers to mainstream health services, by working darity handbook’. closely together with city general practitioners, Raising awareness among health and social for example, thus ensuring the organisation’s workers about MdM’s values and the interconhealthcare activities are in tune with its advocacy. nectedness of health and deprivation is another As watchdogs and advocates for social inno- challenge. This is being tackled by: making more vation, delegations support the implementation presentations in nursing, midwifery, medical of new initiatives (such as activities focusing on and healthcare schools; coordinating university unaccompanied minor migrants) and in under- degrees (‘health and deprivation’, ‘access to served geographical locations such as so-called healthcare’, ‘public health practice’); proposing rural zones, sensitive urban zones or even prisons. internships to nurses, specialty and GP registrars Delegations also support the transfer of certain and master students.

The organisation is also represented during job Turkey, Romania and Tunisia. Exchanges with MdM forums and solidarity weeks in order to reach UK and Belgium, for example, on issues such as different type of audiences and raise awareness migrating journeys, knowledge sharing between of MdM’s activities and job opportunities within emergency programmes (Mali, Ebola, Syria) and the organisation. the recruitment of experienced volunteers for international programme are examples which Balancing ‘at home’ and ‘abroad’ help towards this balance. Involving regional delegations in the running of international programmes bridges international and Challenges to face in 2015 regional activities and maintains cohesion within If 2015 requires the same intense rhythm as the organisation. MdM has developed a discussion 2014, delegations will be faced with the proto facilitate working relationships and exchanges blem of exhaustion in the teams. Small delegaacross the distance. Links with international activi- tions, which are particularly at risk, will be able ties are also created beyond those already existing to implement the territorial reform and join forces with regionally-managed international programmes with neighbouring delegations. Regional delega(MIR in the French acronym) in Guinea, Palestine, tions will have to overcome the challenges of the

future, and more particularly demonstrate they can adapt their operational activities to new circumstances, in order for Doctors of the World to ensure the viability of its activist and cohesive force to pursue its social mission.

As Watchdogs and social innovators, delegations support the implementation of new initiatives.

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Directory of regional delegations » Alsace / Franche-Comté

» Lorraine

» PACA

24, rue du Maréchal-Foch 67000 STRASBOURG T: 03 88 14 01 00 F: 03 88 14 01 02 alsace@medecinsdumonde.net

5, rue de l’Armée-Patton 54000 NANCY T: 03 83 27 87 84 F: 03 83 28 42 55 lorraine@medecinsdumonde.net

4, avenue Rostand 13003 MARSEILLE T: 04 95 04 59 60 F: 04 95 04 59 61 paca@medecinsdumonde.net

» Aquitaine

» Midi-Pyrénées

» Loire

2, rue Charlevoix de Villers 33300 BORDEAUX T: 05 56 79 13 82 F: 05 56 52 77 69 aquitaine@medecinsdumonde.net

5, boulevard Bonrepos 31000 TOULOUSE T: 05 61 63 78 78 F: 05 61 62 04 15 midi-pyrenees@medecinsdumonde.net

33, rue Fouré 44000 NANTES T: 02 40 47 36 99 F: 02 51 82 38 09 pays-de-la-loire@medecinsdumonde.net

» Corsica

» Nord-Pas-de-Calais

» Poitou-Charentes

Boulevard Danielle Casanova 20 000 AJACCIO T: 04 95 51 28 93 F: 04 95 10 25 49 corse@medecinsdumonde.net

25, rue Henri-Kolb 59000 LILLE T: 09 72 38 88 14 nord-pas-de-calais@medecinsdumonde.net

169, rue Saint-Roch 16000 ANGOULÊME T: 05 45 65 07 47 F: 05 45 61 18 85 poitou-charentes@medecinsdumonde.net

» Île-de-France

» Normandy

» Rhône-Alps / Auvergne /

62 bis, avenue Parmentier 75011 PARIS T: 01 48 06 63 95 F: 01 48 06 68 54 ile-de-france@medecinsdumonde.net

5, rue Elbeuf 76000 ROUEN T: 02 35 72 56 66 F: 02 35 73 05 64 normandie@medecinsdumonde.net

» Indian Ocean

Languedoc-Roussillon 18, rue Henri-Dunant 34090 MONTPELLIER T: 04 99 23 27 17 F: 04 99 23 27 18 languedoc-roussillon@medecinsdumonde.net

126, rue Roland-Garros 97400 SAINT-DENIS T: 02 62 21 71 66 F: 02 62 41 19 46 ocean-indien@medecinsdumonde.net

Burgundy

13, rue Sainte-Catherine 69001 LYON T: 04 78 29 59 14 F: 04 26 84 78 08 rhone-alpes@medecinsdumonde.net

Lyon © Jérôme Sessini/Magnum photos/MdM

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adoption

With the help of health professionals, Doctors of the World is able to support the adoption of the growing number of children with specific needs within the larger international pool of children for adoption. As an Approved Adoption Agency since 1988, Doctors of the World focuses on adoption for children whose rights cannot be secured in their country of origin. Through the adoption programme MdM defends the fundamental rights of the child: the right to grow up in a family, and to have access to healthcare and an education.

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Adoption programme : responding to the needs of children As the only French medical NGO with authorised adoption status, Doctors of the World has the capacity to support not only ‘straightforward’ but also ‘complex’ adoptions of children with specific needs.

The very sharp decline in numbers of internationally adoptable children, coupled with the significant increase in children with specific needs (children with medical conditions, siblings and older children), demonstrate the need for our expertise.

The needs of the child are paramount in MdM adoption procedures.

» Supporting families

The programme is run by professionals from start to finish and the constant support offered to candidates is essential to its success. In order to reduce the risk of failure MdM considers it essential that families are supported throughout the adoption process, both pre- and post-adoption. Over 200 professionals prepare candidates for MdM’s ethical framework means that the needs these complex adoptions. Of these 18% are of the child are overarching and finding a family doctors and 33% psychologists. The team also that suits their needs is central to the process. includes paramedics, social workers, lawyers MdM assesses each application with great care, and volunteers from many other professions. including the candidates capacity to adequately Together they help in the construction or recons- care for children with specific needs. truction of the lives of these children who, more That is why it is so important to invest in training often than not, have had their rights violated in for the teams. Every year at least 10,000 euros are invested in this training and the development of their country of origin. educational tools to prepare couples for adoption.

» adoption in 2014

» Milestones

• Active in all districts in mainland France. • 77 children were adopted by 67 families and there have been 4,079 adoptions since 1988. • 91% of adopted children had specific needs (compared to 76.5% in 2013, 40.5% in 2011 and 32% in 2010). • Children came from Albania, Brazil, Bulgaria, China, Côte d’Ivoire, Haiti, Madagascar, Philippines and Vietnam.

Doctors of the World is cited as an example in the arena of authorised adoption agencies, recognised for its expertise and the quality of its support and follow up. Notably, Doctors of the World presented at the National School for the Judiciary. Paediatrician Geneviève André-Trévennec also published an article ‘How does Doctors of the World’s adoption programme support families?’ in Issue 31 of the journal Neuro-Psy, issue 31.

co-ordination

» Head of programme: Dr G. André-Trévennec (paediatrician) » Executive director: O. Lebel members of the adoption committee representing the board

» Dr T. Brigaud (prevention doctor), Dr L. Jarrige (anaesthetist)

funding

» Mainly adopting families, Ministry of Foreign and European Affairs grants (International adoption service), MdM and private donors BUDGET

» €491,000

MdM’s adoption programme continues to contribute to ministerial working groups and scientific research as the organisation shares its expertise with the public sector. Doctors of the World is now a major player in the new vision of child protection in international adoption, and could also become one on domestic adoption.

countries

» Albania, Armenia, Brazil, Bulgaria, China, Colombia, Côte d’Ivoire, Haiti, Madagascar, Philippines, Vietnam

staff

» 190 people, of whom 98% are volunteers, working on the adoption programme, spread between headquarters and 14 regional offices

» Non-operational countries: Ukraine since 2014, Russia since April 2010 and Colombia since July 2013

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MdM Greece ÂŠ Giorgos Moutafis

international network The Doctors of the World international network is made up of 15 associations1 who have signed the same charter and who are working towards common objectives of providing care and bearing witness. The role of the International Network Department is to coordinate and develop MdMâ&#x20AC;&#x2122;s international network. It supports the different network members in their own institutional development, depending on their needs and their resources. In addition, the 11 Doctors of the World network members in Europe carry out joint advocacy and lobbying of EU institutions and the Council of Europe.

1. Argentina, Belgium, Canada, France, Germany, Greece, Japan, Luxembourg, Netherlands, Portugal, Spain, Sweden, Switzerland, United Kingdom, United States.

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map of

international network programmes

Canada

» the associations » Doctors of the World Argentina Chair: Mr Gonzalo Basile www.mdm.org.ar

United States

» Doctors of the World Belgium Chair: Professor Michel Roland www.medecinsdumonde.be

» Doctors of the World Canada Chair: Dr Nicolas Bergeron www.medecinsdumonde.ca

» Doctors of the World France Chair: Dr Thierry Brigaud www.medecinsdumonde.org

Guatemala

» Doctors of the World Germany

Honduras Salvador Nicaragua

Chair: Professor Jochen Zenker www.aerztederwelt.org

» Doctors of the World Spain

» Doctors of the World Japan

» Doctors of the World Sweden

Chair: Mr Gaël Austin www.mdm.or.jp

» Doctors of the World Luxembourg Chair: Dr Jean Bottu www.medecinsdumonde.lu

Chair: Dr Sagrario Martin www.medicosdelmundo.org Chair: Dr Hannes Olauson www.lakareivarlden.org

Peru Bolivia Paraguay

Chair: Dr Bernard Borel www.medecinsdumonde.ch

» Doctors of the World UK

» Doctors of the World Portugal

» Doctors of the World USA

Chair: Dr Abílio Antunes www.medicosdomundo.pt

Ecuador

» Doctors of the World Switzerland

» Doctors of the World Netherlands Chair: Mr Paul Meijs www.doktersvandewereld.org

Venezuela Colombia

» Doctors of the World Greece Chair: Dr Liana Maili www.mdmgreece.gr

Haiti Dominican Republic

Mexico

Chair: Ms Janice Hughes www.doctorsoftheworld.org.uk

Chair: Professor Ron Waldman www.doctorsoftheworld.org

Uruguay Argentina

Russia Sweden

United Kingdom

Netherlands Belgium Luxembourg Germany Moldova Switz. Romania Bosnia Bulgaria Georgia

France Spain Portugal Morocco Algeria

Mauritania

Mali

Senegal Burkina GuineaFaso Bissau Guinea Sierra Leone Liberia

Togo

Turkey Greece Syria Lebanon Tunisia Palestine Iraq Jordan

Niger

Egypt

Mongolia

Japan

Pakistan

Nepal India

Burma Bangladesh

Chad

Cambodia

Benin

Philippines

Ethiopia

CAR Cameroon

C么te d'Ivoire Sao Tome and Principe

Laos

Uganda Somalia Kenya DRC Burundi Tanzania

Angola

East Timor

PapuaNew-Guinea

Mozambique Madagascar

International programmes National programmes

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Overview of programmes run by international network members In 2014, Doctors of the World’s international network mobilised as one to fight the Ebola epidemic, help Syrian populations, confirm women’s right to choose freely what to do with their bodies and continue its European project on access to healthcare.

A strong response to the Ebola crisis The Doctors of the World network faced a major humanitarian crisis with the Ebola epidemic in West Africa. Due to our long-term presence in Liberia and Sierra Leone, the organisation was able to act quickly on the ground by training health professionals and providing information to communities. The teams of MdM France and MdM Spain, backed by MdM UK, tackled urgent needs in a high-risk environment by providing healthcare centres, through multidisciplinary teams working with local communities and by sending protection equipment. MdM teams also prepared and strengthened health services in neighbouring countries, such as in Côte d’Ivoire, Mali and the Democratic Republic of Congo. In December, Doctors of the World USA organised a petition which led Ebola fighters to be recognised as Time magazine’s 2014 ‘Person of the Year’.

Supporting Syrian refugees and displaced persons For the third consecutive year the Doctors of the World’s network supported millions of refugees fleeing the Syrian conflict. Most of our help was provided at Syria’s borders with Lebanon, Jordan and Turkey. Doctors of the World also supports the activities of doctors in Syria by sending them

supplies and training material for emergency care in a context of weakened health services. Keeping regular contacts with the organisation of Syrian doctors, which receives international support, helped us to tailor our aid to the needs of a population who has suffered more than three years of conflict. The Syrian conflict also affects Europe where tens of thousands of victims seek asylum. Doctors of the World calls on European governments to grant Syrian refugees asylum. Many of them, experiencing great difficulties, visit our clinics, mainly in Germany, France, Belgium and the United Kingdom.

Campaign for women’s right to decide whether and when they want a child Every year 250,000 women die from complications related to pregnancy and another 50,000 die from unsafe abortions. Most of these women are from poor countries where health services are inadequate and where abortion is illegal or inaccessible. In response to this intolerable situation, the Doctors of the World network ran an advocacy campaign during the global Cairo+20 summit. Before the summit street manifestations were carried out in Paris, London, Amsterdam and New York to raise awareness about women’s right to

choose freely. The campaign, called Names not Numbers, demonstrated that behind the statistics there are women and that each of them has a life, a story, a freedom of choice which was trampled. We heard UN Secretary-General Ban Ki-moon highlight the risks of illegal abortion in his remarks at the opening of the United Nations General Assembly Special Session: ‘We must confront the fact that some 800 women still die each day from causes related to pregnancy or childbirth. An estimated 8.7 million young women in developing countries resort to unsafe abortions every year. They urgently need our protection.’ Sexual and reproductive health is one of the priorities of Doctors of the World’s international network.

The international network’s European project Since 2004 Doctors of the World’s international network has been working on a joint project which was started in order to protect seriously ill migrants unable to access healthcare in their country of origin. In addition, the project also carries out routine and specific surveys to bear witness to barriers to access healthcare and to the health conditions suffered by those who visit our national programmes on a daily basis. We call this project the international network’s Observatory on access to healthcare. Our reports are published in collaboration with Dr Pierre Chauvin, who founded, as part of the French National Institute for Health and Medical Research (Inserm), the department of social epidemiology. Since 2011 MdM’s European project has been gaining influence. This is the result of a strategy which is rooted in our activities on the ground and of our pragmatic and non-ideological approach in dealing with European institutions’ political and administrative leaders. The objectives of the European project are:

1. Effective access to appropriate prevention and care for all vulnerable groups (and which prioritises pregnant women and children) within public health services which are based on the principles of solidarity, equality and fairness (as opposed to a profit motive).

•S ub-Saharan Africa: 72 programmes in 26 countries •A mericas: 47 programmes in 14 countries •A sia: 25 programmes in 12 countries •M iddle east and North Africa: 26 programmes in 10 countries •E urope: Five programmes in five countries

2. A more coherent European policy on infectious diseases (measles, HIV, hepatitis, tubercu- Doctors of the World runs 180 national prolosis) and a focus on immunisation. grammes in 15 countries, broken down as follows: •A mericas: 11 programmes in three countries 3. Protection of seriously ill migrants, since retur- • E urope: 166 programmes in 11 countries ning them back to their country of origin where (including the cross-cutting European advothey have no real access to the care they need cacy project run by the International Network will result in the dealth penalty. Department) •A sia: Three programmes in one country 2014 was marked by significant progress: the organisation is now recognised, and at Year on year the cohesion and coherence of the times sought after, as a player in health policy network is being strengthened. This is made posin Europe. The European Parliament and sible by the frequent exchanges on the ground— Commission acknowledged the negative impact during workshops or during joint advocacy of the crisis and of austerity on health systems. campaigns— between the various actors of the They now take (undocumented) migrants into network members. In 2014 during the network account in a more systematic manner when annual meeting held in Madrid, the organisation drafting guidelines — however, these guidelines started a discussion to define a shared vision, misremain non-prescriptive. Finally, we participated sion statement and common values. Following up in the drafting and dissemination of the Granada on this, the network members will spend a few Declaration which influenced, and will continue months in 2015 to develop a common strategic to influence, the EU Council’s policies. plan, in order to increase the impact of our actions. In order to strengthen our advocacy we are developing a new system of data collection for all outreach For more information on the programmes of the programmes. We are also streamlining data collec- members of MdM’s international network: tion by developing a computerised patient record ww.mdm-international.org system, which should be piloted in 2015. » dri@medecinsdumonde.net + 33 1 44 92 14 80 In total the 14,177 people involved in Doctors of the World’s international network run 355 programmes in 82 countries. The international network operates 175 international programmes in 67 countries, broken down as follows:

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funding

Doctors of the World is only able to develop its programmes in France and overseas because of the support of international institutions and, especially, individual donors, who ensure the financial independence of our association.

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2014 in figures international network

human resources*

iN FRANCE

175

4,000

20 healthcare, advice and

international programmes in 64 countries

180 national projects in 14 countries

breakdown

1,570 people working

on our international programmes

network members

Argentina Belgium Canada France Germany Greece Japan Luxembourg Netherlands Portugal Spain Sweden Switzerland United Kingdom United States

MdM personnel

» 1,390 national employees » 20 international solidarity volunteers

» 90 expatriate employees » 70 headquarters employees 2,120 people working on our

programmes in France

» 2,000 volunteers » 105 employees in the field » 15 headquarters employees 310 people supporting

referral centres

1 paediatric care centres

49 outreach programmes rogrammes with vulnerable » 34 pgroups such as migrants,

homeless people and asylum seekers...

programmes with people » 7 who use drugs programmes with sex » 5 workers programme on access to » 1 healthcare and rights in rural areas

programme buddying » 1 children in hospitals pilot programme with »1 prisoners

1 national cross-cutting

programme on prevention of HIV, STIs, hepatitis and tuberculosis

operations

» 200 voluntary programme managers

» 110

headquarters employees

* Figures as of 31 December 2014

71 programmes in 33 towns

MDM FRANCE BUDGET €77.9 M MDM international network BUDGET €135 M

international PROGRAMMES

geographical breakdown of programmes

28 Africa................................. 13 North Africa and Middle east.................. 8 Latin America and Caribbean................... 17 Eurasia...............................

Miscellaneous projects

Eurasia

Latin America/ Caribbean

North Africa/Middle east

Eurasia

Latin American/Caribbean

North Africa/Middle east

Africa

of our programmes

Africa

» 66 programmes » 40 countries

4,100,000 beneficiaries

geographical breakdown of international programme expenditure

in 14 countries in 9 countries in 5 countries in 12 countries

40% Africa 31% North Africa and Middle east 8% Latin America and Caribbean 18% Asia 3% Miscellaneous projects (Opération Sourire, needs

assessments, regionally-managed international programmes and cross-cutting projects)

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MdM’s financial management principles Rigorous management and financial transparency MdM is approved by the Comité de la charte (Charter Committee on Donating with Confidence) and is particularly committed to following the charter’s principles, including rigorous management and financial transparency.

Controls by external organisations MdM is subjected to control by the Cour des Comptes (French public finance court) and the organisation’s accounts are certified by the auditor, Deloitte. Detailed audits are carried out by French, European and international institutional donors (such as the French Development Agency and ECHO, the European Commission’s humanitarian agency) or the United Nations.

THE DONORS’ COMMITTEE MdM depends on an independent donors’ committee, which regularly analyses and examines the organisation’s work.

FINANCIAL SCOPE The financial results of MdM France include financial transactions with some other organisations in the Doctors of the World network: MdM Belgium, MdM Canada, MdM Germany, MdM Japan, MdM Netherlands, MdM Spain, MdM Sweden, MdM United Kingdom, MdM United States.

MdM FRANCE INCOME AND EXPENDITURE EXPENDITURE 81% social programmes 13% fundraising costs 6% operating costs

INCOME 52% public generosity 42% public institutional grants 4% private grants and other private funds 2% other

Our detailed financial report is available from our website: www.medecinsdumonde.org

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Government and institutional funding Links with international institutions are essential for NGOs working in the humanitarian field. As well as being important donors, these institutions are important policymakers. Doctors of the World is developing partnerships with some institutions, enabling us to influence international policymaking. Doctors of the World is involved in different groups which facilitate access to international decisionmaking authorities.

EUROPEAN UNION (EU) The two key European institutions concerned with solidarity are the European Commission’s Humanitarian Aid Office (DG ECHO) and the international development programmes (DG DEVCo), whose funding is provided by the mechanisms of EuropeAid (AIDCo). • ECHO’s mandate to provide aid and emergency relief to populations affected by natural disasters or conflict outside the EU. ECHO works in partnership with around 180 organisations (European NGOs, the Red Cross network and specialist UN Agencies). In 2013, ECHO allocated nearly 1.35 billion euros funding to humanitarian projects, with around half going to NGOs. • DG DevCo is charged with implementing, via EuropeAid, the aid mechanisms of the European Commission, a major donor for international development. • For several years MdM has been particularly active in Brussels-based VOICE,

the interface between NGOs and EU institutions (European Commission, DG ECHO, the European Parliament, Member States). VOICE brings together 80 European NGOs, including the largest and most influential. MdM France, representing the MdM network, is involved in various VOICE working groups (FPA Watch Group, European budget monitoring, European Consensus on humanitarian aid monitoring). • MdM relates to EuropeAid via CONCORD (European Confederation of Relief and Development NGOs) through the French NGO collective, Coordination SUD, which lobbies EU institutions and participates in the development of common positions on European development policy and other major issues in NorthSouth relations. • The Council of Europe (COE) brings together 46 European states. MdM’s international network has consultative status and is part of OING Service, a liaison group for NGOs with this status.

UNITED NATIONS (UN) • The Economic and Social Council (ECOSOC) is the main coordinating body for the economic and social activities of the UN and its specialist bodies and institutions. MdM’s international network has special consultative status which means that it can carry out lobbying activities, especially in relation to the Human Rights Commission. It has observer status in this subsidiary body of ECOSOC. • MdM’s international network has representation at the High Commission for Refugees (UNHCR), the World Health Organization (WHO) and UN Office for the Coordination of Humanitarian Affairs (OCHA). • MdM is a member of the International Council of Voluntary Organisations (ICVA), a network of NGOs that concentrates on humanitarian issues in relation to refugees. ICVA brings together more than 80 international NGOs. The Council relates to the UN authorities by tackling different themes, such as the relationship between humanitarian workers and the military, or the protection of civilians during armed conflicts.

the global fund The Global Fund against Aids, Tuberculosis and Malaria is an international multilateral donor created in 2002 and which gives grants to tackle HIV/Aids, TB and malaria. Since 2002, the Global

Fund has provided HIV treatment to 4.2 million people, TB treatment to 9.7 million people and 310 million insecticide-treated bed nets to prevent malaria in 150 countries, to support large scale prevention, treatment and care programmes for these three diseases.

FRENCH DEVELOPMENT AGENCY (AFD) The French Development Agency (AFD in its French acronym) is one of the French governmental bodies involved in giving official development assistance for poor countries. Its aim is to finance development programmes. As part of the general reform of public policy, AFD has been charged with a new responsibility since 2009: funding NGOs. This has led to the creation of the NGO Partnership Division, which steers the partnership with NGOs and monitors initiatives run by NGOs.

the crisis centre (CDC) The Foreign Affairs Ministry’s Crisis Centre manages French public funds for humanitarian emergencies (Fonds humanitaire d’urgence – FUH).

PROGRAMME agreementS between AFD and MdM Following the programme agreement on gender-related violence (2007-2010), the French Development Agency (AFD) supported MdM between 2010 and 2014 with two agreements, one on sexual and reproductive health and the other on harm reduction, with a total AFD contribution of €8M. In four years, these agreements have enabled new projects addressing these issues to be launched and existing projects to be strengthened, as well as raising MdM’s profile on these issues. Today MdM is, therefore, an internationally recognised authority on the harm reduction (particularly in relation to access to treatment for hepatitis C) and sexual and reproductive health (mainly on the challenges of sexual and reproductive rights). In line with the sexual and reproductive health programme, in 2014 AFD awarded funding for three more years for a programme to promote the ‘right to choose’, in order to reduce morbidity and mortality linked to unwanted pregnancies. AFD is contributing €2.5M to this new €6M programme. This agreement aims to strengthen MdM’s work on unwanted pregnancies by developing a crosscutting approach. Projects in Burkina Faso, DRC, Palestine and Peru will be supported as part of this programme. From 2015 AFD will also support a programme on advocacy and improving prevention and treatment for hepatits C.

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Doctors of the World management on 31 December 2014

» General Director: Olivier Lebel » International Operations Director: Dr Gilbert Potier » French Programmes Director: Dr Jean-François Corty »F inance and Information Systems Director: Thierry Barthélemy until November, Catherine Desessard since December

» Human Resources Director: Anne-Claire Deneuvy » Administration and Legal Director: François Rubio »C ommunication and Development Director: Luc Evrard » Adoption Director: Dr Geneviève André-Trévennec » General Secretary of the International Network: Jean Saslawsky

the board of directors The General Assembly elects 12 members of the Board for three years, along with three substitute board members. The Board, in turn, elects the Chair and the Bureau for one year: the vice-chairs, the deputy treasurer, the general secretary and the deputy general secretary. As the executive body of the organisation, the Board meets every month and takes decisions on the management of the organisation. At the General Assembly on 24 May 2014, Doctors of the World members elected the Board:

»C hair

Dr Thierry Brigaud Prevention doctor

» Vice-chairs

Dr Françoise Sivignon Radiologist

Dr Luc Jarrige Hospital doctor

» General secretary

Margarita Gonzalez Nurse

» Deputy general secretary Gérard Pascal Surgeon

» Treasurer

Christophe Adam General practitioner

» Deputy treasurer Olivier Maguet Consultant

» Philippe

de Botton

Endocrinologist

» Delegate for the Associative Project Dr Frédéric Jacquet Public health inspector

Other board members: » Dr

Substitute board members:

» Marie-Laure

Ferrari

Therapist » Dr

Serge Lipski

Radiologist

Patrick Beauverie

Hospital pharmacist » Andrea

Brezovsek

Nurse » Ariane

Junca

Anaesthetist » Christian

Laval

Sociologist

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our thanks to OUR PRIVATE PARTNERS Foundations and businesses

American Express Japan, Fellissimo Japan, Annenberg Foundation, Drosos Foundation, Ichiyoshi Shoken Japan, McCall MacBain Foundation, Open Society Foundation, Sternstunden Foundation, Fubon Cultural & Educational Foundation, Elton John Foundation, Fondation Niarchos, Association Ouest France Solidarité, Bärchen, Bred, CIC, Crédit coopératif, Crédit mutuel, L’Oréal Foundation, Optic 2000 Foundation, Veolia Environment Foundation, Sanofi Espoir Foundation, Imerys Ceramics France, Acoustics SA, Ivoire, Vinci, The Tolkien Trust, Orange Foundation, Fondation de France, Bilendi (ex-Maximiles), A2Presse – Solidaripresse, FM Global Foundation, Mobiloroma Foneloop, Arkea, Société Générale, Renault, SNCF, BETC, APS, KA Constructions.

INSTITUTIONAL PARTNERS Multilateral organisations European Union (DG ECHO, DG DevCO/ EuropeAid), United Nations agencies (UNDP, UNFPA, HCR, Unicef, OCHA, WFP, WHO), Global Fund to fight Aids, tuberculosis and malaria, World Bank, 3 Diseases Fund (3DF). Bilateral organisations • In Europe: German official development assistance (AAAH – urgence), German Ministry for economic aid (BMZ), UK

official development assistance (DFID), Monaco official development assistance (DCI), Norwegian official development assistance, Swiss official development assistance (SDC), Danish official development assistance (Danida). • In France: Agence française de développement (AFD), Centre de crise du ministère des Affaires étrangères (CDC), French embassies, France Expertise Internationale (FEI) • Other: American official development assistance (USAID), Canadian official development assistance (MAECD), Japanese embassy. • French local authorities: Rhône- Alpes region, Safer de l’Île-de-France, Réunion district council, Val-d’Oise district council, Haute-Garonne district council, Alsace regional council, PACA regional council, Nord-Pas-de-Calais regional council, Aurillac basin council, Greater Angoulême council. • Town councils: Aubiac, Octeville-surMer, Mably, Chenôve, Saint-Genis-dePouilly, La Rochelle, Guillestre, Saint-Alban Leysse, Moelan-sur-Mer, Gissey-sousFlavigny, Betton, Givet, Migné-Auxances, Fessenheim, Pau, Bischoffsheim, Cormellesle-Royal, Saint-Germain-les-Arpajon, Saint-Martin-d’Uriage, Elbeuf-en-Bray, Charny, Champgeneteux, Neuilly-surMarne, La-Celle-sur-Nièvre, Le Boulou, Saint-Cormier-des-Landes, Nouzonville,

Bullecourt, Parempuyre, Rarecourt, Vagney, Heimsbrunn, Vendays-Montalivet, SaintGeorges-les-Landes, Confort, Neure, Saint-Mars-La-Brière, Descartes, Bazelat, Grenay, Le Mesnil-Amelot, Saint-Laurent-desVignes, Saint-Cannat, Montigny-en-Gohelle, Castelalneau-de-Mandailles, Rougemont, Ally, Obersaasheim, L’Hôpital, Biarotte, Rainneville, Guitrancourt, Begaar, Jarnac, Laduz, Ostwald, Lespinasse, Fegersheim, Amneville, Keskatel, Auboue, Gilhoc-sur-Ormeze, Paris, Hagondage, Leers, Nevers, Annemasse For our regionally-managed international projects District councils: Bouches-du-Rhône, Isère; Regional councils: ProvenceAlpes-Côte d’Azur and RhôneAlpes; présidence des régions. For our programmes in France Agence nationale de recherche sur le Sida (ANRS), regional health agencies (ARS), district councils, regional councils, town councils, Caisse nationale d’assurance maladie (CNAM), family allowance funds (CAF), regional health insurance funds (CMR), local health insurance offices (CPAM), regional health insurance offices (CRAM), local social services (CCAS), free anonymous screening centres (CDAG), district councils, regional councils, town councils, Agence nationale pour la cohésion sociale et l’égalité des chances

(ACSE), direction générale de la Santé (DGS), direction générale de la Cohésion sociale (DGCS), regional youth and social cohesion offices (DRJCS), district offices for social cohesion (DDCS), Institut national de la santé et de la recherche médicale (INSERM), Local healthcare access offices (PASS), territorial army, Direction de l’action sociale, de l’enfance et de la santé (DASES), Paris observatory for gender inequality, Mission interministérielle de lutte contre les drogues et les conduites addictives (MILDECA), Département santé et société (DSS), regional unions of health insurance offices (URCAM), hospitals, Guiana social security fund (CGSS), Mutualité sociale agricole (MSA), Observatoire français des drogues et des toxicomanies (OFDT).

OUR PARTNER ASSOCIATIONS Act up-Paris, Aides, Amnesty International, Association française de réduction des risques (AFR), Association des familles victimes du saturnisme (AFVS), Association d’autosupport et de réduction des risques des usagers de drogues (ASUD), Setton association, Association Sida Paroles, Association Gaïa Paris, ATD Quart-Monde, Bus 31/32, Primo Levi centre, Collectif des associations unies pour une nouvelle politique du logement, Cimade, Collectif interassociatif sur la santé (Ciss), Romeurope collective, Migrants outre-mer (MOM) collective, Alerte collective, Comede, Coordination française

pour le droit d’asile (CFDA), Droit au logement (DAL), Emmaüs, Fondation Abbé Pierre (FAP), Fédération des associations pour la promotion et l’insertion par le logement (FAPIL), Fédération internationale des ligues des droits de l’homme (FIDH), Fédération nationale des associations d’accueil et de réinsertion sociale (FNARS), Groupe d’information et de soutien des immigrés (GISTI), International Harm Reduction Association (IHRA), Ordre de Malte, La Case, Amis du bus des femmes, Restos du cœur, Roses d’Acier, Ligue des droits de l’homme (LDH), Observatoire du droit à la santé des étrangers (ODSE), Observatoire international des prisons (OIP), Pharmacie humanitaire internationale (PHI), Plateforme contre la traite des êtres humains, Secours catholique, Solidarité Sida, Sidaction, SOS Drogue international (SOS DI), Strass (sex workers’ union) Techno Plus, UNIOPSS…

EUROPEAN PARTNER ASSOCIATIONS Health professionals European Public Health Alliance (EPHA), European Public Health Association (EUPHA), Comité permanent des médecins européens (CPME), Andalusian School of Public Health, Adapting European Health Services to Diversity (ADAPT), WHO Europe, Fédération européenne des médecins salariés (FEMS), Association européenne des médecins des hôpitaux (AEMH), Union européenne des médecins spécialistes (UEMS), Conseil européen des

Ordres de médecins (CEOM), European Nurses Federation (EFN), European Board and College of Obstetrics and Gynaecology (EBCOG), Eurohealthnet, European TB coalition, Global Health Advocates. Other partners Platform for International Cooperation on Undocumented Migrants (PICUM), AIRE, CORRELATION, Human Rights Watch, European Patient Forum (EPF), European Anti-Poverty Network (EAPN), Fédération européenne des associations nationales travaillant avec les sans-abris (FEANTSA), European AIDS Treatment Group (EATG), Association européenne des Droits de l’Homme (AEDH), ATD Quart Monde, European Network against Racism (ENAR), Confédération des organisations familiales de l’Union européenne (COFACE), International Lesbian Gay Association (ILGA), European Policy Center (EPC), TransAtlantic Consumer Dialogue (TACD), Health Action International (HAI), Social Platform, Eurochild.

AND ALL OUR OTHER PARTNERS WHO HAVE SUPPORTED OUR WORK AT HOME AND ABROAD DURING 2013, PARTICULARLY THOSE WHO HAVE SUPPORTED US WITH A LEGACY OR LIFE INSURANCE POLICY AND OUR OTHER INDIVIDUAL DONORS.

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Glossary A

CFDA: Coordination française pour le droit d’asile (French Co-ordinating body for the Right to Asylum)

AFD: Agence française de développement (French

CHU: Centre hospitalier universitaire (University

DALO: Droit au logement opposable (Right to housing)

Development Agency)

Hospital)

DFID: Department for International Development

AFR: Association française pour la réduction des

CIMADE: Comité inter-mouvement auprès des éva-

DPO: Division du partenariat avec les ONG (NGO

risques liés à l’usage de drogues

cués - service œcuménique d’entraide (Ecumenical

Partnership Division)

AIDCo: EuropeAid Cooperation Office

Mutual Aid Service)

DRC: Democratic Republic of Congo

AIDS: Acquired immune deficiency syndrome

CLACAI: Consorcio Latinoamericano Contra el

AIDES: Association de lutte contre le VIH/sida et les

Aborto Inseguro (Latin American consortium against

hépatites (Association fighting against HIV/Aids and

high-risk abortion)

hepatitis)

CMP: Centre médico-psychologique (Medico-psy-

ECHO: European Commission Humanitarian Office

AME: Aide médicale de l’État (State Medical Aid)

chological centre)

(DG ECHO: Directorate-General ECHO, Dipecho:

ANRS: Agence nationale de recherche sur le sida et

CMU: Couverture maladie universelle (Universal

Disaster Preparedness ECHO)

les hépatites virales (French National Aids and Viral

Health Insurance)

ECOSOC: Economic and Social Council

Hepatitis Research Agency)

CMUc: Couverture maladie universelle complémen-

ERLI: Éducation aux risques liés à l’injection (Educa-

ARCAT: Association pour la recherche et la com-

taire (Complementary Universal Health Insurance)

tion on risks associated with injection)

munication pour l’accès aux traitements (Regional

COE: Council of Europe

Association for the Study and Social Action among

CONCORD: Confédération européenne des ONG

Travellers)

d’urgence et de développement (European Federa-

ARS: Agence régionale de santé (Regional Health

tion of Emergency and Development NGOs)

FPA Watch Group: Framework Partnership Agreement

Agency)

CPAM: Caisse primaire d’assurance maladie (Local

FUH: Fonds humanitaire d’urgence (Humanitarian

ARV: Antiretrovirals

Health Insurance Office)

Emergency Fund)

nutritionnelle (infantile) ((Infant) Nutritional Recovery and Education Centre)

CAARUD: Centre d’accueil et d’accompagnement

CRENAS: Centre de récupération nutritionnelle

GAF: Groupe Amitié Fraternité (Friendship and Frater-

à la réduction des risques pour les usagers de dro-

ambulatoire pour la malnutrition sévère (Outpatient

nity Group)

gues (Harm Reduction Centre for Drug Users)

centre for nutritional recovery for severe malnutrition)

CDAG: Centre de dépistage anonyme et gratuit

CSAPA: Centre de soins, d’accompagnement et de

(Free and anonymous screening centres)

prévention en addictologie (Addiction Care, Support

HCV: Hepatitis C virus

CDC: Centre de crise (Crisis centre)

and Prevention Centre)

HDI: Human Development Index, (statistical indice

CREN(I): Centre de récupération et d’éducation

development in 187 countries. The HDI is based on life

expectancy, level of education and standard of living)

NGO: Non-governmental organisation

UE: Union européenne

between 0 and 1, created by UNDP to rank human

HIV: Human immunodeficiency virus

UK: United Kingdom

UN: United Nations

OAA: Official Adoption Agency

Unicef: United Nations Children’s Fund

UNDP: United Nations Development Programme

ICVA: International Council of Voluntary Agencies

OCHA: UN Office for the Coordination of Humanita-

UNHCR: United Nations High Commissioner for

INGO: International non-governmental organisation

rian Affairs

Refugees

INSERM: Institut national de la santé et de la

ODSE: Observatoire du droit à la santé des étrangers

recherche médicale (National Health and Medical

(Observatory on Right to Health for Migrants)

Research Institute) IUT: Institut universitaire de technologie (University Technology Institute)

V Voice: Coalition of European NGOs

PASS: Permanence d’accès aux soins de santé

(Healthcare Access Office)

WFP: World Food Program

KPK: Khyber Pakhtunkhwa, province in Pakistan

PHI: Pharmacie humanitaire internationale (Interna-

WHO: World Health Organization

PACA: Provence-Alpes-Côte d’Azur

tional Humanitarian Pharmacy)

PMI: Protection maternelle et infantile (Mother and Child Protection)

LSD: Lysergic acid diethylamide LSI: Loi pour la sécurité intérieure (Interior Security Law)

S STI: Sexually transmitted infection SRH: Sexual and reproductive health

MdM: Médecins du Monde (Doctors of the World) MIR: Mission internationale régionale (Regionallymanaged international programme) MOM: Migrants d’outre-mer (Overseas migrants)

T TLC: Thin layer chromatography TROD: Tests rapides d’orientation diagnostique (Rapid diagnostic screening tests)

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editor-in-chief Dr thierry Brigaud Coordination Thomas flamerion editorial committee luc evrard StĂŠphanie Derozier Emmanuelle Pons Hugo Tiffou editor Thomas flamerion editorial assistant pauline de smet maps Antoine Levesque

graphic design and picture editor Aurore Voet Production E-Graphics\France translation gill cockin Claire loussouarn Karen mccoll elinor middleton alison watson thanks to everyone who helped with the 2014 edition

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ÂŠ Corentin Fohlen

doctors of the world 62, rue Marcadet 75018 Paris Tel. +33 (0) 1 44 92 15 15 Fax. + 33 (0) 1 44 92 99 99 www.medecinsdumonde.org

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