DOCTORS OF THE WORLD - Annual report 2011

ANNUAL REPORT

DOCTORS OF THE WORLD

DOCTORS OF THE WORLD ANNUAL REPORT 2011

contents » 05

A word from our chairman

» 08

Campaign 2011

» 10

2011 in figures

» 12

octors of the World D financial management principles

» 14

Government and institutional funding

» 16

International programmes

18

Map of international programmes

20

Sub-Saharan Africa

28

Latin America

36 Asia 44 Europe

50

North Africa and Middle East

» 58

Programmes in France

» 72

Our regional delegations

» 78

The international network

» 86

Key events

» 92

Cross-cutting projects

» 100

The Board of Directors

» 102

Our thanks to

» 104

Glossary

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“We make a stand, to challenge the status quo, but also to create something new. By defining existing injustices, and showing what it would take to build a better world, we create firm foundations for a successful struggle. To resist is to create.”

Lucie and Raymond Aubrac

Ethiopia © DR/MdM

DOCTORS OF THE WORLD ANNUAL REPORT 2011

A word from our Chairman 2011: A year of outrage The impact of the economic crisis on the poorest people As the crisis spreads it affects an increasing number of people. Those worst hit are those who were already vulnerable, and it is these people we support on a daily basis with our projects. The best example this year is Doctors of the World’s Greek team, reaching out to an ever-growing

number of those living on the margins of society. Globally, the reduction in private and public finances places the last decade’s progress, in relation to access to antiretroviral treatment under the auspices of the Global Fund, in serious jeopardy.

This has already caused an interruption in treatment for some patients, for example in Democratic Republic of Congo, where we continue to work.

humanitarian aid makes to the war economy, the work has been suspended.

However, we are still present in the country, thanks to a new programme for vulnerable displaced people and the urban population in Bossaso, Puntland.

This programme aims to improve access to sexual and reproductive health services. This area is currently deemed safe to work in.

A more dangerous environment for aid workers

Standing up for freedom and social justice

© David Delaporte

2011 began with the death of two French aid workers, who were killed during a military operation launched against their kidnappers, following their abduction in the heart of Naimey, Niger. The same year ended with the assassination of two colleagues working for MSF in Mogadishu.

These new threats to humanitarian aid have forced us to adapt. For example, our projects in the Sahel region have been regrouped to focus on the least exposed zones, and our movements are limited.

» Dr OLIVIER BERNARD CHAIR, DOCTORS OF THE WORLD FRANCE

The Arab spring, seeds of change in Burma and the social uprisings in Spain and elsewhere serve to remind us of our legitimate aspiration to have a say in decisions that affect us all. By endorsing community-based approaches and working with local partners, MdM is drawing up a more balanced delivery model for aid.

The organisation benefits from its roots in civil society for its defence of access to care. With France assuming the presidency of G20 in 2011, MdM called on the leaders to make a clear commitment In Merka, Somalia, as a result of barriers to access to care for the most vulnerable, to entering the country and our legitimate rolling out a campaign entitled Health is concerns about the contribution that not a luxury!

6 “Abroad”: international programmes

Libya, partnerships with local African organisations caring for refugees fleeing the war in Libya confirmed the effectiveness of working Crisis and conflicts: more aid with local actors in an emergency context. workers on the ground Unable to bring care to those in need inside On 14 January 2010, an earthquake devas- Syria, our teams were forced to set up at the tated Port au Prince and the surrounding borders, in Jordan and Lebanon, to care for area. At the end of that same year, cholera those fleeing the country. broke out in the country. Thanks to our longterm presence in Haiti, we were able to res- We must not forget that the confusion pond effectively to both disasters. between humanitarian aid and military action remains a problem. The reform of the In 2011, almost 4,000 medical consultations United Nations humanitarian system contiwere performed each week across the five nues with European Union involvement intervention zones. Cholera prevention and since the Lisbon Treaty came into force. It treatment helped reduce the effects of the calls into question the principle of neutraepidemic. All funds collected in 2010 and lity inscribed in the “European humanitarian 2011, following the earthquake, were used consensus” and, as such, somehow makes to carry out projects in the country. In future the subordination of humanitarian workers years MdM will continue its work there, par- to state control more official. Within this ticularly in rural areas. context, the financial independence of the organisation is more important than ever as This year we launched a number of emer- a means of resisting this influence. gency responses. Following a period of drought and the major food crisis in the Harm reduction: Horn of Africa, MdM worked in Kenya, Ethio- moving in the right direction pia and Somalia to improve access to care Afghanistan, Burma, Georgia, Tanzania, and, for people living on the outskirts of refugee soon, Kenya. So many countries, so many camps. In Cote d’Ivoire, in a bid to lessen projects where Doctors of the World teams the impact of the political crisis on maternal have developed and transferred their harm and child mortality, MdM decided to support reduction expertise, particularly relating to emergency obstetrics and sexual and repro- drug use. ductive health in Abidjan and the forgotten regions of San Pedro and Sassandra in the The fight against HIV and hepatitis B and C transmission in vulnerable groups has helsouth west of the country. ped to improve the health of people, both Our teams responded to the devastating tsu- individually and across vulnerable communinami in Japan and, in 2012, will continue to ties. At the same time, we advocate at local offer psychosocial support to some of those and international levels, sharing the impact affected. At the border between Tunisia and of our work with the aim of influencing public

policy. Existing policies often favour a repressive approach, to the detriment of those based on public health.

Sexual and reproductive health: evidence-based advocacy The opening of a maternal health programme in Laos, solid advances in our advocacy work in Uruguay, the continuation of projects in the Sahel region, Haiti, Liberia, Guatemala, Mexico and Nepal are several examples of our strong, lasting commitment to this issue, in relation to both healthcare delivery and health system development.

MdM also campaigns for universal access to sexual and reproductive healthcare services in line with international and regional human rights commitments, in particular those relating to women and their right to access good quality sexual and reproductive services.

Bearing witness to the impact of immigration policies on health The projects we run in Europe and at its perimeter, in Algeria, Turkey or Mali, allow us to work closely with migrants. In addition to the medical and psychological care we offer, we are committed to bearing witness to inhumane European policies that stigmatise and marginalise individuals.

In order to achieve this, the organisation shares information between programmes, ensuring that local partners are involved throughout the process.

International adoption: upholding children’s rights Doctors of the World continues to be a major

DOCTORS OF THE WORLD ANNUAL REPORT 2011

player in the international adoption arena. In making the adoption of children with special needs (older children, siblings, children with medical conditions, or disabilities) one of its priorities, the organisation puts its medical expertise to the service of children’s rights, and continues to view this element of our work as a key expression of our child protection work.

Essential increase in our outreach activities

Travel to where people live (or survive), to reach out to those experiencing homelessness, to sex workers, migrants, drug users, Roma people etc… has become a necessity because people who are already weakened by their social, economic, or mental health situation find themselves distanced from health services. The use of peer educators or health mediators, who “At home” in France and in Europe come from within the communities (Roma, sex workers), illustrates, on a daily basis, For many years we have focused on expo- the effectiveness of a community-based sing a double phenomenon in France. On approach and the importance of integrating one hand there is a progressive erosion this approach to encourage positive of the public healthcare system, which no behavioural change in prevention and care. longer has the capacity to care for the most vulnerable. On the other, the use of the Over and above our existing outreach work medical profession for migration control. we have developed new mobile healthcare We aim to reassert the opposite policy; the activities in rural and prison settings. dominance of public health over repression.

Ensuring unconditional access to care in France remains a priority

A campaign to highlight the degradation of our health system

European presence Doctors of the World also works in 10 European countries. Whilst the situation in Greece is well known, our findings in Spain, Portugal and Belgium are equally worrying. The fundamental right to access care is still not always open to all. In spite of well-developed social welfare systems, health inequalities for people living in Europe remain a reality. This will be condemned in a speech in Brussels in April 2012 on World Health Day.

Keeping our promises and expanding our organisation On December 16th 2011, the MdM draft budget was approved by the Board. The budget was put together in a time of economic crisis, thanks to the diligence and support of all involved, and taking into consideration the commitments made at the 2011 Annual General Meeting.

As a medical organisation, with over 2,000 volunteers in France and 1,200 members, The organisation has chosen to maintain its Despite the numerous safeguards put in MdM this year, once again, took the opporHealthcare and Advice Clinics in 21 French place, our teams are finding it harder and tunity to reaffirm its belief that the involvetowns. These clinics also enable us to docu- harder to ensure continuity of care for the ment of volunteers is a crucial guarantee of ment the rise in poverty and widening health most destitute, who suffer most from oppres- its independence, the quality of its work, and inequalities. The findings are very worrying: sive policies that make them less visible and the power of its testimony.

85% of new patients have no medical cover; even further removed from prevention and almost a quarter of them come for care at care activities. a late stage in their illness, either because they face difficulties in accessing State Me- In the context of the 2012 presidential and dical Aid, or because they cannot pay the parliamentary elections, MdM decided to 30 euros required to obtain it, or, they don’t challenge the candidates on the quality of the dare visit a healthcare centre for fear of ar- healthcare system and public health policies rest. Of pregnant women who come for the by conducting a massive awareness-raising first time, 68% are not receiving care. campaign in Paris and regionally.

8

Campaign 2011 Health is not a luxury!

Health may be priceless, but it has a cost. This cost is becoming increasingly unaffordable for the most vulnerable in both socalled rich countries and low-income countries.

For millions of people across the world, the requirement to pay for healthcare constitutes an unsurmountable financial obstacle and is a major cause of impoverishment.

Every year more than 100 million people fall into poverty because of healthcare costs (WHO figures). This is particularly acute in low income countries. In subSaharan Africa less than 10% of the population has health coverage. Universal health coverage is also a challenge in northern countries. In France, reforms of health insurance undertaken in recent years (e.g. co-payments, removal of some medicines from the list of refundable drugs, attacks on State Medical Aid, the AME, which is no longer free of charge) have only increased the financial difficulties that disadvantaged groups face in trying to access healthcare.

Limousines as ambulances In light of worsening health inequalities, Doctors of the World launched the Health is not a luxury! campaign in 2011 to reassert that health is not, and must not be, a luxury product.

protected objects. All the symbols of luxury and exclusivity are used to create this provocative image which nonetheless resembles the reality for the poorest populations trying to access healthcare.

A simple message for the G20 chaired by France in 2011 Arriving in limousines turned into ambulances, MdM doctors revealed a banner in the Place de la Bourse in Deauville on the opening day of the G8.

Our doctors also carried, one letter after another, a simple message to the G20 leaders during the meeting in Cannes between 3 and 4 November: Health is not a luxury!

Although the promotion of a base of universal social protection was on the agenda of the G20 meeting, chaired by France, it was important for MdM that the issue of access Limousine-ambulances to transport stretchers to healthcare for all figured in the debate and and doctors, display cabinets to show me- that firm commitments were made to facilidicines, stethoscopes, vaccines and Gold tate access to essential healthcare. medical records, transformed into precious,

DOCTORS OF THE WORLD ANNUAL REPORT 2011

© Benoit Guénot

© Benoit Guénot

»

© Benoit Guénot

Gold health cards, limousine ambulance, health is not a luxury for the most vulnerable.

» © DR/MdM

MdM wanted to send a powerful message to G8 members.

9

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2011

in figures INTERNATIONAL NETWORK

HUMAN RESOURCES*

IN FRANCE

151

3,865

29,466 service users seen in 21

international programmes in 64 countries

190 national projects in 13 countries

13

BREAKDOWN

1,465 actors on

international projects

member associations

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

MdM actors

Healthcare and Advice Clinics

40,627 medical

consultations

4,112 dental

consultations

» 1,290 national employees » 45 volunteers

19,500 social

» 65 expatriate employees » 65 headquarters employees

101 programmes in 29 towns

2,090 actors on our

programmes in France

» 2,000 volunteers » 80 employees in the field » 10 headquarters employees 310 actors supporting operations

» 200 voluntary programme managers

» 110

headquarters employees

* Figures at 31 December 2011

consultations

DOCTORS OF THE WORLD ANNUAL REPORT 2011

MDM FRANCE BUDGET €64 M

North Africa and Middle East

Europe

Asia

GEOGRAPHICAL BREAKDOWN OF PROGRAMMES

(people who could have recourse to services delivered by MdM)

1,500,000

beneficiaries (people who benefited from one or more services provided by MdM)

Europe

Asia

Africa

65 programmes 44 countries

Latin America

1,000,000 medical consultations

Miscellaneous projects

26 Africa.................................. in 17 countries 10 Latin America........................ in 6 countries 14 Asia.................................... in 10 countries 5 Europe.................................. in 5 countries 9 North Africa & Middle East..... in 7 countries North Africa and Middle East

6,800,000 target population

Latin America

INTERNATIONAL PROGRAMMES

Africa

MDM INTERNATIONAL NETWORK BUDGET €113 M

GEOGRAPHICAL BREAKDOWN OF INTERNATIONAL PROGRAMME EXPENSES

41% Africa 21% Latin America 22% Asia 3% Europe 10% North Africa and Middle East 3% Miscellaneous projects (Adoption, Opéra-

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

11

12

Primary healthcare in Mayotte Š MdM

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Doctors of the World's financial management principles RIGOROUS MANAGEMENT AND FINANCIAL TRANSPARENCY MdM is approved by the ComitĂŠ de la charte (the Charter Committee on Donating with Confidence) and is particularly committed to following the charter's principles, including rigorous management and financial transparency.

MDM FRANCE INCOME AND EXPENDITURE EXPENDITURE

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 an auditor, Deloitte.

Detailed audits are carried out by French, European and international institutional donors (such as 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 our work.

FINANCIAL SCOPE The financial results of MdM France include the other organisations in the Doctors of the World network where MdM France has some financial oversight: MdM Germany, MdM Japan, MdM Netherlands, MdM Sweden and MdM United Kingdom.

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

78.5% social programmes 15.5% fundraising costs 6% operating costs

INCOME 63% public generosity 29% public institutional grants 7% private grants and other private funds 1% other

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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 is 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, particularly UNHCR and WFP). In 2010, a recordbreaking year with the emergencies in Haiti and Pakistan, ECHO allocated nearly 1.1 billion euros to humanitarian projects, with around half going to NGOs.

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, civilianmilitary relationships).

• 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 • DG DevCo is charged with implemen- policy and other major issues in Northting, via EuropeAid, the aid mechanisms South relations.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

PROGRAMME AGREEMENTS BETWEEN AFD AND MDM

• The Council of Europe (COE) brings together 46 European states. MdM’s international network has consultative status with the COE and is part of OING Service, a liaison group for NGOs with this status.

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 UNITED NATIONS (UN) malaria. Since 2002, the Global Fund has committed around 23 billion dollars in • The Economic and Social Council 150 countries to support large-scale pre(ECOSOC) is the main co-ordinating body vention, treatment and care programmes for the economic and social activities of tackling the three diseases. the UN and its specialist bodies and institutions. MdM’s international network has FRENCH DEVELOPMENT special consultative status which means AGENCY (AFD) that it can carry out lobbying activities, especially in relation to the Human Rights The French Development Agency (AFD in Commission. It has observer status in this its French acronym) is one of the French governmental bodies involved in giving subsidiary body of ECOSOC. official development assistance for poor • MdM’s international network has countries. Its aim is to finance development representation at the High Commission for programmes.

Refugees (UNHCR), the World Health Organization (WHO) and UN Office for the Co- As part of the general reform of public poordination of Humanitarian Affairs (OCHA). licy (RGPP), AFD has been charged with a new responsibility since 2009: funding • MdM is a member of the Internatio- NGOs. This has led to the creation of the nal Council of Voluntary Organisa- NGO Partnership Division, which steers tions (ICVA), a network of NGOs involved the partnership with NGOs and monitors in human rights, which concentrates on initiatives run by NGOs. humanitarian issues. ICVA brings together more than 80 international NGOs.The THE CRISIS CENTRE (CDC) Council relates to the UN authorities by tackling different themes, such as the The Foreign Affairs Ministry's Crisis relationship between humanitarian wor- Centre manages French public funds for kers and the military, or the protection of humanitarian emergencies (Fonds humanitaire d’urgence – FUH). civilians during armed conflicts.

Doctors of the World runs programmes working on mother and child health, family planning, tackling STIs, HIV and malaria, and is committed to structured development and strengthening its activities in relation to reproductive health and reducing health risks. MdM has been working on harm reduction programmes since 1992, giving the organisation considerable expertise on this issue, both at home and abroad.

Following the programme agreement on gender-related violence (2007/2010), MdM and the French Development Agency (AFD in its French acronym) signed two new programme agreements in 2010, with funding of four million euros from AFD. In the first phase, this involves a four year partnership (2010-2014). One relates to reproductive health, while the other concerns harm reduction. These agreements aim to strengthen the work on these issues within MdM, by developing cross-cutting approaches while providing a part of the funding for around 12 projects.

Thanks to this support, MdM was able to launch the harm reduction projects in Georgia and Tanzania and the reproductive health programmes in Mexico, Guatemala and Laos.

In line with international commitments on the harmonisation of aid and AFD’s strategic direction, harmonised sectoral approaches are a priority for strengthening health systems.

For MdM, the co-operation with AFD on the cross-cutting programmes on reproductive health and harm reduction allows us to strengthen existing programmes and to raise MdM's profile internationally, thus bringing further long-term financial and institutional support that we need for our programmes.

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Awareness-raising session - Laos © Lâm Duc Hiên

DOCTORS OF THE WORLD ANNUAL REPORT 2011

International programmes contents » 18

Map

» 20

Sub-Saharan Africa

» 28

Latin America

» 36

Asia

» 44

Europe

» 50

North Africa and Middle-East

17

18

MAP OF INTERNATIONAL PROGRAMMES Tunisia Algeria Mexico

Mali Niger Chad

Haiti Guatemala

Burkina Faso Guinea

Nicaragua

Liberia C么te d'Ivoire Colombia

LONG TERM PROGRAMME Uruguay

EMERGENCY PROGRAMME EMERGENCY AND LONG-TERM PROGRAMME

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Russia

Serbia Romania Bulgaria Moldova

Turkey

Georgia

Afghanistan Japan

Syria Palestinian Territories Nepal Egypt

Burma Pakistan

Vietnam India

Yemen Sudan

Ethiopia Somalia Kenya Rwanda Dem. Rep. of Congo Tanzania

Angola Zimbabwe

Madagascar

Indonesia

Laos

20

programmes NIGER In IllĂŠla district, Doctors of the World is working to improve access to family planning and to raise awareness of problems associated with the high birth rate.

Š Martin Courcier

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Sub-Saharan Africa

Tanzania © Agnès Varraine Leca

22

“ ZIMBABWE Elton Mechanic, 19 years old

© Lahcène Abib

My name is Elton and I am HIV positive. My parents died of Aids. I first encountered Doctors of the World when I was in the 5th year of high school in Chipinge. They paid my school fees and for school equipment so that I could complete my secondary education. Through Doctors of the World, I met other HIV positive orphans.”

Mali

2

Niger

1 1 1

Chad Sudan

Burkina Faso Guinea

Liberia 1

1

Ethiopia

Côte d'Ivoire

Somalia

2

Sahel Kenya Rwanda Dem. Rep. of Congo

4

Tanzania

Angola

Zimbabwe

Madagascar

3

1

EMERGENCY PROGRAMME

LONG-TERM PROGRAMME

LONG-TERM AND EMERGENCY PROGRAMME

Detailed information sheets on the various programmes implemented in Africa can be found on the interactive CD attached to this report.

» ANGOLA » BURKINA FASO » CHAD » CÔTE D’IVOIRE » DRC » ETHIOPIA

» GUINEA » KENYA » LIBERIA » MADAGASCAR » MALI » NIGER

» RWANDA » SAHEL » SOMALIA » SUDAN » TANZANIA » ZIMBABWE

24

Ethiopia Š Ewelina Gasiorowska

DOCTORS OF THE WORLD ANNUAL REPORT 2011

KEY EVENTS IN SUB-SAHARAN AFRICA

Working in the context of crises and conflicts

2011 in Africa has been defined by a worsening in the security situation in many countries, notably in Cote d’Ivoire and the Horn of Africa. MdM has managed to adapt to this situation, developing its activities in areas where we are able to guarantee access to the population and assure the security of the programmes.

Managing the emergency and its aftermath in Cote d’Ivoire MdM has been working in Cote d’Ivoire since 1986 and at the end of April 2011 launched a new emergency response following the serious outbreaks of violence that occurred during the post-electoral crisis. In Abidjan, the emergency team supported 23 primary healthcare centres, one teaching hospital and a psychiatric hospital, as well as sending more than three tonnes of medical equipment. Particular efforts were directed to the enclosed district of Yopougon. Although the crisis has passed, there remain significant needs: the hospitals and health centres are desperately short of resources and sexual violence against women requires a particular type of care, both medical and psychological.

capacity for dealing with obstetric emergencies and mother and baby healthcare in 13 healthcare centres and three reference hospitals.

Response to the emergency in the Horn of Africa in a challenging situation The Horn of Africa is experiencing a period of unprecedented drought, against a backdrop of chronic political instability, particularly in Somalia. Thousands of refugees are pouring into already over-crowded camps in Ethiopia and Kenya. MdM’s activities in these countries aim to guarantee access to healthcare for these peoples but also for the host populations, affected by the massive influx of refugees.

In the east of Kenya, in Dadaab district, MdM, in partnership with Women and Health Alliance Finally, amongst the population in the west of the (WAHA), is dealing primarily with pregnant country, an exploratory project revealed an acute women and children under five years old, thelack of access to healthcare. As a result, MdM groups most affected by the crisis. Together, set up a programme to help reduce maternal we are supporting the district hospital and 10 and infant mortality in the San Pedro and Sas- healthcare centres. The main activities include sandra departments. The objective is to improve refurbishment of the centres, provision of medical

MdM is working in the Horn of Africa to ensure that displaced peoples and local populations have access to healthcare.

equipment and medicines and training of medical staff and community health workers.

The security problems in Somalia and the legitimate concerns over humanitarian aid contributing to the war economy have compelled MdM to close down its programme in Merka and move the activity elsewhere. As a result, an enhanced programme of sexual and reproductive healthcare has been set up with the local authorities and local associations in Bossaso, in Puntland. MdM’s role is to ensure the provision of medicines, vaccines and equipment and to train the local personnel to guarantee the transfer of skills. Thus MdM fosters the consolidation of local skills so that the community is equipped to respond to whatever crises may occur.

Since 2008, MdM has been present in the Djebel Marra area of Sudan, managing medical clinics delivering primary and reproductive healthcare as well as nutritional monitoring. In February 2011, MdM was notified of the SouthDarfur government’s decision to expel it from the region. All activities were abruptly curtailed.

In Ethiopia, programmes in the Somali region were also suspended because of serious administrative issues and fears for the security of teams when deployed outside the town of Kebri Dehar. We anticipate that operations will be redeployed to other regions.

26

67% of women using intravenous drugs are HIV positive

» TANZANIA

© Chien-Chi Chang / Magnum

Fighting against the Aids epidemic

An outreach team goes out to the users to ensure that they receive sterile syringes and to explain the services provided by the centre.

In Tanzania’s major towns, intravenous drug use is constantly increasing, putting almost 25,000 users at risk of Aids and hepatitis. MdM has launched a harm reduction programme to address this issue.

MdM has been in Tanzania for 18 years and has contributed to the implementation of HIV/Aids treatment and prevention measures. Whilst for the last few years, the epidemic appears to have stabilised, affecting 6.5% of the general population, certain groups remain especially at risk and vulnerable: people who use drugs, sex workers and gay men.

provides basic hygiene care, HIV screening and access to treatment. Every day, a mobile team goes out to see the users where they live. Women drug users, particularly those working in prostitution, are badly affected by the Aids epidemic: 67% of them are HIV positive. So, for one afternoon a week, MdM provides them with exclusive access to the healthcare centre, to allow them to receive care and be given psychological support away from male pressures.

So, in 2010, MdM launched a programme to reduce risks associated with drug use in the most deprived areas of Dar es-Salaam. Working in par- Beyond the project, MdM is campaigning for this tnership with two local NGOs, the centre deals approach to be adopted elsewhere. In December with over 50 people a day: it distributes needles, 2011, at the ICASA African regional conference on

HIV/Aids, the NGO launched its campaign, notably organising a satellite symposium devoted to harm reduction on the African continent.

We are pursuing this approach with high risk groups, but remain focussed on prevention and access to antiretrovirals for the greatest numbers possible. Especially as, on a similar project in the Democratic Republic of Congo, the deterioration in funding for treatments has made it difficult to obtain them. Therefore, MdM is carrying out an important role in campaigning to raise international funds which are essential for the eventual handover to local stakeholders.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» SAHEL

Removing obstacles to healthcare For several years Doctors of the World has been working alongside its partners to remove financial barriers to care in Burkina Faso, Mali and Niger.

For this reason, the regional project developed

by MdM, aims to remove these difficulties by supporting institutional and civil society partnerships which are striving to improve access to healthcare. Thus, remote facilities have been refurbished, referral systems are more robust, an economic study has been completed and procedures for eliminating user fees are in place. So many activities, run in parallel with sexual health, reproductive and nutrition programmes, are accompanied by advocacy with the authorities.

Sensitive to the issues surrounding migration, in Mali, MdM is also developing a programme Among the many obstacles that stand in the which aims to strengthen the capabilities of three way of the Sahel populations having access partner associations (AME, Aracem, Cahba) who to healthcare are their distance from healthcare are supporting people facing a forced return. centres and the fact that they have to pay for Faced with the ever-changing security situation medical services. National user fee exemption in this region, MdM, by adapting its approach, policies, which have become more common in has been able to assure the continuity of a rich sub-Saharan Africa over the past five years, are and varied range of projects. So, activities have worthy of support and are one of the responses been relocated to less exposed areas and some which aim to move towards universal access to deployments were restricted. a basic package of essential healthcare services.

In 2012, MdM plans to take action to deal with the nutritional crisis that is looming, owing to low rainfall and an increase in prices which has been aggravated by political instability.

A nutritional crisis is expected in 2012 in the Sahel region. © Isabelle Eshraghi

» DRC

Transfer of the programme on access to healthcare to local authorities Since 2006, MdM has been developing a partnership with the local health authorities to rebuild the health system in Tanganyika province. The project succeeded in, not only improving access to primary healthcare for the general population of Tanganyika, but also in improving the quality of provision. Having managed to hand over responsibility to the appropriate authorities in the district, the programme was closed in August 2011.

» ANGOLA Launch of a project for women and children Despite the country’s wealth from oil and diamonds, the health indicators in Angola are amongst the worst on the African continent.

Therefore, in 2011, MdM launched a programme for women and children in the north east of the country, in Kwanza Norte, and is raising awareness amongst the civil authorities of the difficulties of access to healthcare for the poorest in society.

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programmes COLOMBIA Since 2003, MdM has been supporting rural, indigenous and Afro-Colombian populations who have been isolated by the armed conflict in the NariĂąo, Guaviare and Atrato regions.

Š Andrea Lamount

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Latin America

Guatemala © Lâm Duc Hiên

30

“ HAITI Dominique 20 years old

© Lahcène Abib

I came to Parc-Cheval camp, where I now live with my family, a month after the earthquake. I have come because I have stomach ache. I have already been to the MdM clinic twice. Before MdM offered free consultations, I never went to see the doctor because I have not got any money.”

1

Mexico

Haiti

1

2

Guatemala 1

Nicaragua

3

Colombia

EMERGENCY PROGRAMME

LONG-TERM PROGRAMME

EMERGENCY AND LONG-TERM PROGRAMME Uruguay

Detailed information sheets on the various programmes implemented in Latin America can be found on the interactive CD attached to this report.

» COLOMBIA » GUATEMALA » HAITI

1

» MEXICO » NICARAGUA » URUGUAY

32 KEY EVENTS IN LATIN AMERICA

© Rémi Courgeon

» HAITI

An emergency project in constant evolution

Several months after the earthquake, which devastated Haiti on 12 January 2010, a cholera epidemic broke out, killing almost 7,000 people. Present in the country since 1989, MdM continues its work under challenging circumstances.

Reconstruction is barely underway, and yet funding from the international community is declining.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

30,000 cholera patients treated

two dollars a day, the earthquake then the cholera epidemic have at times been presented as an opportunity to rebuild the country on a healthier footing.

Now, unfortunately, the interim arrangements put in place to respond to these emergencies have become permanent and the country is more dependent than ever upon aid and international donors. At the New York conference, held after the earthquake, 10 billion dollars were pledged for the reconstruction of the country—only a few hundred million have been unlocked and, in light of the political instability, funds are drying up.

In October 2010, just 10 months after the earthquake of 12 January 2010, which cost the lives of 230,000 people, Haiti was struck by a cholera epidemic. Recorded initially in the Artibonite region, the epidemic quickly spread throughout the entire country, affecting more than half a million Haitians. By the end of November 2011, over 6,900 deaths had been recorded.

Whilst a slowdown in the epidemic has been observed, new outbreaks do, nonetheless, occur.

Although treatment in the capital is assured, thanks to the presence of many key players, healthcare centres in rural zones are few and far between and here the number of cholera related deaths remains high.

Teams from Doctors of the World intervened without delay to deal with the epidemic, setting up units and cholera treatment centres, as well as oral rehydration points: in this way, 30,000 cholera sufferers have been cared for

by MdM since the outbreak of the epidemic.

These medical activities have been reinforced by a prevention programme to raise awareness amongst the communities, to whom protective and hygiene kits have also been distributed.

Doctors of the World is committed to supporting the implementation of national health policies, and to campaigning for free healthcare for the most vulnerable, especially pregnant women and children under five years old. This advocacy now seems to be finding some favour with the Haitian Ministry of Health (MSPP), which, with WHO’s support, is launching the Healthy Mother and Baby project to provide free obstetric and infant care in 60 hospitals. Doctors As well as management of these emergencies, of the World supports this step towards a fair Doctors of the World is committed to a policy health system, which aims to guarantee access of access to healthcare for all. In this country, to healthcare for all, well beyond the immediate where 80% of the population lives on less than emergency.

34

26%

of maternal deaths are due to medical complications arising from abortions carried out in unsafe conditions.

MdM is supporting the actions of several LatinAmerican civil society organisations that are campaigning for access to legal, medical termination of pregnancy

» URUGUAY Focus on sexual and reproductive health More than half a million women in the world die each year during pregnancy or childbirth. A significant number of these deaths are due to complications associated with abortions carried out in unsafe conditions. This subject is the focus of MdM’s activities in Latin America.

MdM supports civil society organisations, that are campaigning for the decriminalisation of abortion in Latin America, and particularly in Uruguay, where 26% of maternal deaths are due to medical complications linked to abortions carried out in unsafe conditions.

such a high price that they are not accessible to the most needy.

Sexual and reproductive health is one of Doctors of the World’s priorities in Latin America, where 35% of all the illegal abortions in the world take place.

In this context, MdM is supporting the Initiativas Sanitarias (IS) organisation to set up sexual and reproductive healthcare services in six departments of the country and the Mujer Y Salud (MYSU) organisation in Uruguay is lobbying for free access to information on contraception, pregnancy prevention and safe and legal abortion.

In Uruguay, since 2001, campaigns by civil society have had a significant impact in changing the legislative provisions governing abortions.

In 2008, a proposal for legislation legalising abortions was adopted by parliament but the president has vetoed it. This is a paradox since another law, putting in place pre- and post-abortion follow-up, has been passed and drugs used in medical abortions are freely available, albeit at

In September 2011, with the support of MdM, a workshop was organised in Montevideo, bringing together civil society organisations from five Latin American countries (Guatemala, Nicaragua, Mexico, Peru and Uruguay). The objective of this workshop was to facilitate an exchange of knowledge and practices, which would support initiatives aimed at changing attitudes and medical practices in these different countries.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» COLOMBIA

Closure of the programme in Atrato Since 2003, MdM has been present in the Atrato region, working with rural, indigenous and Afro-Colombian populations, providing mobile healthcare clinics to enable populations isolated by the armed conflict to access healthcare. Given the relative political and military stability in this area, and in accordance

© Andrea Lamount

with our commitment to prioritise activities clo- we are withdrawing from and is still lobbying ser to conflicts, the organisation has taken the for better mainstream healthcare for the popudecision to withdraw from this area. lations. In reality, there are still very few public health services and they are generally inaccesIn the Méta, Guaviare and Nariňo regions, the sible to many confined sectors of the population, programmes have been maintained or enhanced. as illustrated by a travelling exhibition organised MdM continues to monitor the situation in areas by MdM on the ground.

In 2011, we strengthened our work on prevention, health education and training community-based workers

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programmes AFGHANISTAN Since 2006, MdM has been leading an ambitious programme of comprehensive healthcare for people who use drugs in Kabul, as well as ensuring the promotion of harm reduction activities on a national scale.

Š Sandra Calligaro

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Asia

Laos © Lâm Duc Hiên

38

“

BURMA Anne Lancelot General Coordinator

© MDM

We have developed a mother and child healthcare programme in the delta region. The teams travel by boat, sometimes for 10—12 hours at a time, to reach the most distant villages, where they train community health workers and midwives to provide these populations with better access to healthcare.”

Russia

1

Afghanistan

Georgia Japan

Nepal

Burma

Laos India

Vietnam

Pakistan

EMERGENCY PROGRAMME Indonesia

LONG-TERM PROGRAMME EMERGENCY AND LONGTERM PROGRAMME

See the interactive CD attached to this report for full details of the different programmes in Asia

» AFGHANISTAN » BURMA » GEORGIA » INDIA

» INDONESIA » LAOS » NEPAL » PAKISTAN

» RUSSIA (GREAT-NORTH)

» VIETNAM

40

Primary healthcare in Pakistan Š Kris Pannecoucke

DOCTORS OF THE WORLD ANNUAL REPORT 2011

KEY EVENTS IN ASIA

Diversity of partnerships:

a wealth of tailored support mechanisms In the majority of its programmes in Asia, MdM develops partnerships with civil society in many different guises. So, MdM works in co-operation with local NGOs that are already present in the countries or that were originally created under our direction and have become autonomous.

Alternatively, we tap into a network of local organisations, which are operating throughout the country. This diversity enables us to enrich and consolidate our partnership experience.

In Russia, MdM supports the Russian NGO Community Health Partnership (CHP), which has taken over and now manages the programme that works with the autonomous populations of Yamalo-Nenets, Yakutsk and Koriakie.

These populations are exposed to health risks associated with their socio-economic situation. It strengthens the network of doctors and community healthcare workers so that the populations are guaranteed access to primary healthcare and to treatment for tuberculosis, as well as access to support for alcohol dependency. From now on, CHP will be autonomous for the whole project, with MdM continuing to work in partnership on the prevention of alcohol dependency. But MdM’s primarily role is to strengthen the NGO’s project management and research capabilities and the management of institutional funding.

In Pakistan, MdM and the MCWAK organisation strengthen their co-operation through an exchange of information on practices and experiences.

any obstetric care. In response to this situation, MdM is supporting the local NGO Maternity and Child Welfare Association of Khanpur (MCWAK), to offer treatment to women living in rural areas on the shores of the Indus in southern Punjab.

The recruitment of female community health workers, helps to raise awareness amongst women of basic healthcare. Elsewhere, the two NGOs enhance the quality of their collaboration through policy. Beyond the project, the partnership that sharing their practices and experiences. has been established intends to foster an exchange of practices and co-operation in case of In India, MdM supports a programme of emergencies linked to natural disasters. access to primary healthcare led by the Voluntary Health Association of India (VHAI) local In Mongolia, between 2005 and 2009, MdM network, in remote forest areas of Orissa state. led a programme to improve the quality of The isolated populations of this region have a care and prevention related to alcoholism. level of maternal and infant mortality which is Following a request from our partners, Mongol much higher than the national average. The trai- Urkh and Nomt Otoch, who have taken over the ning of medical personnel, health education ses- programme, in 2011 MdM set up training sesIn Pakistan, the 2010 floods affected over sions in the communities, medical consultations sions for doctors specialising in alcoholism, psy18 million people and the damage caused a and the restoration of the main clinic are the chiatrists and psychologists on support during reduction in access to healthcare for the popu- primary focuses of the programme. Advocacy withdrawal, on cognitive behavioural therapy lations living in the flood zones. In particular, the at local and national levels complete MdM’s and early recognition of the problem. Since the destruction of infrastructure makes it impossible activities, which aim to draw attention to these closure of the programme, MdM continues to for pregnant women to get around and reach tribal populations long neglected by state health maintain links with key local partners.

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» BURMA

Encouraging signs of an opening up of the country Since the general elections in November 2010, the country has shown signs of opening up, particularly with the liberation of Aung San Suu Kyi. The emergence of a civil society is accompanied by the creation of NGOs, with which Doctors of the World hopes to work in the future.

The country is in the throes of an Aids epidemic which affects the most exposed groups in society (sex workers, drug users and gay men) and the national response remains woefully inadequate with only a quarter of those needing antiretrovirals having access to treatment. Therefore, MdM is working on a programme of harm reduction in the states of Kachin and Rangoon with these at-risk populations. They are given medical, psychological and social help in four clinics. In addition, mobile teams go out to see them.

In parallel, MdM is working in Pyapon, where living conditions remain difficult after hurricane Nargis devastated the banks of the Irrawaddy

1,218

people benefiting from antiretroviral treatment

river in May 2008. Focusing the project on maternal and child health, MdM is training community health workers and endeavouring to rebuild village committees and to involve them in prevention activities. MdM plans to transfer the community healthcare programme to MdM Netherlands in 2012. Furthermore, owing to the resumption of fighting between the Burmese army and the KIA independence movement, MdM is planning to work alongside local partners to facilitate access to healthcare for displaced people.

» VIETNAM Transferring our HIV/Aids programme MdM has developed a programme of prevention and treatment of patients affected

by HIV/Aids in four health centres in Hanoi and Hô Chi Minh-City. The programme targeted people who use drugs, sex workers and gay men, providing free and anonymous

screening, distributing condoms and syringes and provision of antiretroviral treatment.

Some 4,000 people have benefited from this treatment. The second arm of the programme focused on prevention and support for people, through the training of peer educators.

The authorities have taken over the running of Tay Ho and An Hoa, two of the pilot sites, whilst the other two are now managed by an international NGO.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

In March 2011, MdM Japan mobilised to provide assistance to those affected by the tsunami

» JAPAN Working with earthquake survivors On 11 March 2011, an earthquake struck the north-east coast of Japan, triggering a tsunami which caused almost 15,800 deaths and 4,000 people to disappear. Established in the country since 1995, MdM Japan set up programmes in the affected areas, with logistical support from MdM France. As well as providing an experienced logistician on natural disasters, the emergency desk at MdM France undertook the provision of radiation protection equipment, which quickly became impossible to obtain in Japan following the nuclear emergency. Organisational support was given to help the Japanese teams to facilitate rapid implementation of the medical activities and psychological care in the town of Otsuchi, in the north-east of the country.

© Éric Rechsteiner

» PHILIPPINES

Prevention of environmental risks affecting vulnerable populations At the end of 2011, an exploratory mission, which MdM hopes to develop in the future, on the subject of health and environment, was carried out in Manilla. The evaluation team focused on issues around recycling electronic waste products in the shantytowns of Manilla.

The intervention strategy emphasises reducing exposure, the promotion of protection and prevention measures for populations exposed to a combination of health, social and environmental risk factors. A programme is under consideration for 2012.

Within three to five years, reduce health and environmental risks associated with recycling of waste

44

programmes MOLDOVA In Moldova, many women, who are victims of trafficking can be found in protection centres.

One of these women, a cook by trade and mother of three children including this baby, has fled her village in the south of the country.

© Lâm Duc Hiên

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Europe

Serbia © Benoit Guénot

46

“

MOLDOVA Laura Pasquero Coordinator

© Lâm Duc Hiên

Many victims of trafficking come from the north of the country. This phenomenon is known but difficult to control as it is complex, ever changing and underground. Fear of reprisals and shame, mean that many victims conceal their story or do not return to Moldova.”

Russia

Moldova

Romania

Serbia

Bulgaria

LONG-TERM PROGRAMME

Details of all the different programmes in Europe are on the CD attached to this report.

» BULGARIA » MOLDOVA » ROMANIA

» RUSSIA (MOSCOW)

» SERBIA

48 KEY EVENTS IN EUROPE

Harm reduction, an approach that respects drug users For many years, MdM has been working with people who use psychoactive substances. The significant discrimination to which they are subjected, along with their habits and often precarious living conditions place them in a particularly vulnerable position. Favouring a holistic approach to the health of users, since 1989, MdM has been developing programmes to reduce the risks linked with the use of psychoactive substances by bringing a strictly non-judgmental, medical, psychosocial and community response.

 RUSSIA Since 1995, MdM has been working on the problem of alcoholism in the far north.

We are now drawing upon our experience of a particularly successful programme in Yakutsk in 2008, to develop a programme of harm reduction in Moscow.

The focus is on the prevention of foetal alcohol syndrome.

Launch of a programme to reduce alcohol-related risks in Moscow According to a global study carried out

by WHO and published in 2011, Russia is amongst the 10 most at-risk countries in the world, with around 400,000 deaths per year due to the consumption of alcohol. A serious public health problem, this excessive consumption also affects young and pregnant women. In view of the specific risks run by the latter, and the success of the project in Yakutsk, notably amongst women with excessive alcohol consumption, in 2011 MdM launched a programme of harm reduction focused on the prevention of foetal alcohol syndrome.

The objective is to train community health workers, based in healthcare facilities used by women in difficult circumstances, in innovative techniques of prevention and care. Against this background, the health authorities and several NGOs came together to share good practice and improve processes for identification and treatment of women of child-bearing age who consume alcohol.

At the same time, local policy makers have been made aware of these new practices and lobbying of the Russian ministry of health aims to demonstrate the importance of care for pregnant women from a public health perspective.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» SERBIA

A successful withdrawal In 2009, and for the first time in Serbia, a methadone delivery unit, integrated within a primary healthcare centre, opened its doors in Belgrade. Since then, the unit has been giving drug users access to comprehensive healthcare.

Although Serbia has approximately 25,000 drug users, methadone substitution treatment was initially provided exclusively by psychiatric units in Serbian hospitals, which offered no additional support.

For three years, MdM negotiated with the local authorities to obtain a change in Serbian law to allow storage and delivery of methadone within primary healthcare centres. Thus in 2009, the first substitution treatment centre was able to open, within the Savski Venac health centre, the biggest in Belgrade, and to register as a pilot project, allowing other similar units to open in Serbia, with the help of finance from the Global Fund.

MdM worked closely with the healthcare workers in the centre to train them to provide holistic care without judging the drug users, who are highly stigmatised in Serbia.

MdM withdrew from the project in December 2011, leaving a fully autonomous team of nine people, to train other teams and receive patients, who are now covered by social security throughout their substitution treatment. All these developments provide a continuity to this project, which is further strengthened by a link between the methadone centre and the local NGO Espace Independence. A visit by MdM is planned in 2012.

Methadone centre in Belgrade

© Benoit Guénot

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programmes TUNISIAN – LIBYAN BORDER Following the conflict in Libya, MdM supported the Malian Association of Deportees, which provides psychological support for foreigners fleeing the country.

© Djawad Guerroudj

DOCTORS OF THE WORLD ANNUAL REPORT 2011

North Africa and Middle East

Palestinian territories Š MdM

52

“

YEMEN Ahmed Villager

© Jean-Baptiste Lopez

This is the Bani Eid zone, in the Toor district, of Hajjah governorate.

Everything has been abandoned, there are no plans for this area, no electricity, no telephone or drinking water, no tarmacked roads: nothing.

We have nothing. We are cut off from the world. People have many health problems, there are lots of illnesses like cholera. Children suffer from vomiting, fever and malaria. One child in 10 dies at birth. We go to the unit in Bani Eid, it’s 2km over there. The unit did not have much before. There weren’t these medicines, there were no medical examinations, no doctors... Nothing. The unit only did vaccinations.”

Turkey

Tunisia & Egypt (Libyan crisis)

1

Syria

Palestinian territories

Egypt Algeria

EMERGENCY PROGRAMME Yémen

LONG-TERM PROGRAMME

EMERGENCY AND LONG-TERM PROGRAMME

The details of all the programmes in the Middle East and North Africa are on the CD attached to this report.

» ALGERIA » EGYPT » LIBYA » SYRIA

» PALESTINIAN TERRITORIES » TURKEY » YEMEN

54

Demonstration during the Arab spring - Egypt Š Benoit GuÊnot

DOCTORS OF THE WORLD ANNUAL REPORT 2011

KEY EVENTS IN NORTH AFRICA AND THE MIDDLE EAST

The Arab spring

MdM supports its partners The Arab revolutions caused major upheavals in the Middle East and North Africa.

The instability and climate of violence in Libya and Syria led MdM to prioritise emergency projects at the borders dealing with people fleeing from the conflicts.

Furthermore, the organisation is reinforcing its programmes in other countries within the region.

To respond to the needs of people fleeing from Libya, MdM been involved with the Choucha camp on the Tunisian border and at Salloum on the Egyptian border. Over several weeks, in the Choucha transit camp, MdM and the Malian Association of deportees (AME), with whom MdM already works in Mali, provided psychological support to sub-Saharan migrants fleeing the conflict. In Salloum, MdM supported the Egyptian authorities in setting up a health station for foreign workers, who were stuck at the border, often in a state of shock and exhaustion. MdM and Aracem, a partner in Mali, working with migrants, jointly set up psychosocial activities.

In the absence of permission to work in Syria, MdM has been forced to shut down its programme with the Red-Crescent in Alep, which provided logistics and medical support to eight healthcare centres. Because of the crisis, and because we were unable to gain access to the country, MdM, working with volunteer local doctors, chose to set up medical and psychosocial aid for refugees and injured Syrians taking refuge in a transit camp on the Jordanian border. MdM also provides medical supplies direct to Syrian doctors’ associations.

Present in Yemen since 2007, MdM has continued its activities in Saada governorate, to ensure continuity of access to healthcare for In Egypt, MdM assisted in caring for the populations affected by the 2009 conflict which wounded by providing medicines, as well as led to the displacement of 250,000 people. continuing its activities with Cairo street children, The organisation is supporting eight healthcare alongside six local partner NGOs. Aside from centres to overcome, in particular, the difficulmedical treatment for the conditions affecting ties of procurement of medicines and to restore this especially vulnerable part of the population, the damaged infrastructures to a basic working MdM also provided psychological support to level. Four mobile clinics provide primary and these children during the revolution. ante-natal healthcare to populations who are

far from medical centres. In 2012, MdM will gradually shift the focus to reproductive health, whilst continuing to support cases of severe malnutrition.

769

people benefited from treatment, discussion groups or individual interviews in the refugee camps of Choucha and the border zone of Salloum

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» TURKEY

Lobbying for better care for migrants Almost inevitably on the route for all potential immigrants into Europe, Turkey does not guarantee access to healthcare for these groups. MdM is lobbying for better care for migrants.

For the last two years, a project developed in Istanbul with the Turkish Tohav organisation, has targeted migrants who are undermined by the political-judicial system which removes any possibility of regularising their situation or of gaining access to care or suitable support.

projects in the Kumkapi area. Tohav and MdM work together to strengthen Turkish civil society and campaign for human rights, including the right to health for migrants both locally and Europe-wide. This advocacy, based on experience in the field, demonstrates the consequences for health of current migration policies.

A combined aid effort comprising listening, care, social support and referrals to specific services, is offered in a centre or through mobile outreach

» PALESTINIAN TERRITORIES Improving the mental health of isolated populations Palestinian villages in the north of the West Bank are regularly targeted by Israeli army operations. Isolation and the blockades imposed on the people by military checkpoints severely limit their access to healthcare, especially in emergency situations, and seriously affect their mental health. MdM is assisting with an improvement in psychosocial services

More than 2,000 people made aware of issues around mental health

in nine villages, by strengthening mental health services within healthcare facilities and training healthcare professionals to deal with emergencies.

Furthermore, MdM has launched an innovative psychosocial approach, entrusting children, who live in the villages around Nablus, with cameras so that they can bear witness to

their living conditions. The fruits of their labour led to the creation of an exhibition entitled Palestine, through my eyes, inaugurated in June in Ramallah.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

A drop-in centre in Gaza © Pauline Beugnies

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Lotus Bus - Paris Š Diane Grimonet

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Programmes in France contents » 61

Map

» 62

Programmes in France

» 64

Observatory on access to healthcare

» 65

Migrants

» 66

Roma

» 67

Harm reduction

» 68

Sex workers

» 69

Health and housing

» 70

HIV-hepatitis-STI-tuberculosis prevention

» 71

Buddying hospitalised children

59

60

“ ILE-DE-FRANCE Jeanine Rochefort Head of the Saint-Denis clinic

Roma camp in the parisian region © Steven Wassenaar

Tuberculosis is a disease of poverty, linked to poor housing.

We can all be carriers of the tubercle bacillus, but in conditions of normal hygiene and healthy accommodation it will stay dormant. When we are exposed to difficult living conditions, under-nutrition or unhealthy housing, the disease can develop.”

Colombes

-

Saint-Denis

62

Programmes in France Can we still claim that the French health system is the best in the world, given that it increasingly fails to meet the needs of the most vulnerable?

Although access to healthcare is recognised as a universal right, not everyone has access in reality, even in France, where the standard of medical care is one of the best in the world.

These days the process of accessing treatment and preventive care increasingly resembles an obstacle course for anyone with limited financial means—whether or not one they are French !

In fact, demand for MdM’s health centres is far from dropping off and our outreach teams are increasingly working with people who do not attend health facilities and whose fundamental needs— such as a place to sleep and access to food and water—are not met. These people have more and more difficulty in accessing the healthcare system, or they do not manage to realise their right to health coverage without help, despite the fact that anti-exclusion measures are supposed to protect these groups.

consultations in our clinics, still don’t have access to vaccination, nor to health insurance, at a time when potentially lethal epidemics, such as measles and tuberculosis, are returning to mainland France and Europe.

The global economic crisis is certainly contributing to widening health inequalities, with the growth in unemployment, insecure employment and heavy debt. Above all, however, it is the threats to our welfare-based health system, along with the impact of security policies on health, that are leading to a deterioration in access to healthcare for vulnerable groups. In fact, we are witnessing falling health insurance reimbursements, an increase in co-payments and, therefore, in patient costs. In addition, six per cent of insurees, equivalent to four million people, have no top-up As a result, around a quarter of patients atten- health insurance and we are seeing paradoxical ding our Healthcare and Advice Clinics have situations where patients find themselves “too delayed seeking medical advice, an increase poor” to pay for top-up insurance but “too rich” on previous years (from 11% in 2007 to 24% in to be entitled to the complementary universal 2010). Many children, who account for 12% of health insurance (CMU-C).

DOCTORS OF THE WORLD ANNUAL REPORT 2011

© Élisabeth Rull

Public health and deprivation: policies which harm health

These elements, among others, explain why 30% of the French population said that they delayed, or even abandoned, seeking healthcare for financial reasons.

In addition, we have to consider the government’s actions, which are often more focused on security than social issues, particularly towards marginalised populations such as sex workers, people who use drugs, rough sleepers and migrants (irrespective of whether they are European citizens or not). The reintroduction in 2003 of the offence of passive soliciting, as part of the Internal Security Law, has pushed sex workers further into the shadows, leaving them more exposed to violence and high-risk practices. In these conditions, HIV prevention programmes are rendered less effective, a point reiterated by the National Aids Council. Moreover, there is still no adequate response to the hepatitis C epidemic which affects around 60% of people who inject drugs, despite INSERM’s recommendation to implement innovative

measures, such as supervised injection rooms, which have shown their worth in other countries.

The increase in evictions from homes without any alternative proposals for re-housing, along with the threats to measures such as State Medical Aid and medical visas for seriously ill migrants, are manifestations of the government’s deliberate desire to dissuade migrants from staying in France. These measures lead to worsening living conditions and deteriorating access to healthcare for patients of overseas origin. These short-term and medium-term threats to health reflect the tension between a security-driven approach and protecting public health.

Consultation at MdM’s Lyon Healthcare and Advice Clinic

64

Observatory on access to healthcare » PROGRAMMES IN FRANCE

Doctors of the World’s Observatory on Access to Healthcare in France was created in 2000, following new antiexclusion legislation which had come into force on 29 July 1998 (with the establishment of healthcare access offices in hospitals, the introduction of Universal Health Insurance, the renewal of State Medical Aid), to monitor the impact of these measures and to highlight potential gaps for groups which remain excluded. This is an essential tool to help us understand the populations seen by Doctors of the World teams and enables us to show the links between their living conditions, rights and health problems. It also enables us to identify discriminatory practices and to see where the arrangements are not working well—as well as to highlight positive experiences.

»

21 Healthcare and Advice Clinics saw

29,466

service users,

»

in the course of 63,799 appointments They carried out

44,739

medical consultations,

(including dental care).

This included:

» 40,627

medical consultations for 22,081 service users

»4 ,112

dental consultations for 1,771 service users

Bearing witness to obstacles to healthcare for vulnerable groups The Observatory helps us to develop our understanding of vulnerable groups, which are often excluded from official public health statistics: the data include a significant number of homeless people and undocumented migrants.

It enables us to develop, and make the case for, proposals from the perspective of our work on the ground. Doctors of the World can then lobby or inform political decision-makers and health professionals to improve access to prevention and to care for vulnerable groups.

It also enables the teams working on the ground to have access to indicators, with a

view to enabling them to monitor and assess how their work changes over time.

An annual report is published each year to mark the International Day for the Eradication of Poverty. This report is based on medical and social data collected in the 21 Healthcare and Advice Clinics and outreach projects. It also draws on testimonies from service users, observations about the current arrangements for access to healthcare and problems which exist, programme activity reports, monitoring of legislative and regulatory developments relating to access to healthcare, and comparisons with other studies or reports in relation to health and deprivation.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Migrants

(vulnerable migrants and asylum seekers) » PROGRAMMES IN FRANCE

Legislation on immigration has led to further deterioration in the situation of foreign nationals in France. This has included removal of the right to regularisation after 10 years, threats to the right to a visa for medical reasons for seriously ill foreign nationals and increasing numbers of deportations, particularly for the Roma population. In addition, access to free hospital care remains a priority. Many healthcare access offices, however, still do not accept all patients, and the conditions for access to State Medical Aid, including a fee of 30 euros since 1 March 2011, limit access to care for a particularly vulnerable population. In this context, organisations working to defend migrants’ rights have come together and are working hard to fend off these attacks.

Supporting vulnerable migrants MOST COMMON NATIONALITIES

»R omanian, Algerian, Moroccan and Bulgarian COMMON REASONS FOR MEDICAL CONSULTATIONS

» Acute respiratory infections, uncomplicated hypertension, noninsulin dependent diabetes, acute bronchitis, dental problems, back problems, depression…

NUMBER OF PROGRAMMES

» All programmes VOLUNTEERS

» 1,965

FUNDING

» Regional public health agencies, district and regional councils, town councils…

» ACTIVITIES In 2011, MdM helped vulnerable migrants visiting our Healthcare and Advice Clinics to access their rights: • 93% of new service users are foreign nationals; • among the foreign nationals aged over 18 who should have a visa or residency permit, 77% do not have one; • 27% of first-time service users in the Healthcare and Advice Clinics are seeking, or have sought, asylum (including pending applications, applications which have not yet been submitted and refused claims); • 87% of migrants did not have effective access to health coverage when they came to the clinic for the first time. Of these, 90% should, theoretically, benefit from access to State Medical Aid, although this is not the case in practice.

» OUTLOOK We are continuing to develop prevention and screening programmes (rapid diagnostic tests for HIV, hepatitis and tuberculosis) in our programmes.

PARTNERS

At this time, when access to State Medical Aid is no longer free, and where the right to a visa on medical grounds for seriously ill foreigners living in France is under threat, MdM continues to work with other organisations to bear witness to any impact that these measures have on health.

1. The 2011 finance law introduces a fee of 30 euros for registration on the State Medical Aid scheme.

• In clinics: medical, prevention and social consultations, as well as referral to mainstream health and social services.

• Outreach activities relating to prevention, health promotion and harm reduction.

• Lobbying for the implementation of appropriate health services: healthcare access offices (PASS), nursing beds in shelters etc.

• Collecting medical and social data, as well as personal case studies concerning this population’s living conditions and problems with access to healthcare, preventive services and other rights.

» CIMADE, GISTI, LDH, CFDA, COMEDE, ODSE (Observatory on migrants’ right to health),the MOM collective, local and regional voluntary sector co-ordination bodies…

» RANGE OF SERVICES

66

Roma

» PROGRAMMES IN FRANCE

Since the Grenoble speech, there has been growing pressure on the Roma population. Evictions are particularly harmful because they push people further away from health services and voluntary sector support, breaking continuity of care and making it impossible to introduce effective measures to prevent epidemics. In Marseille, very many Roma have been evicted from where they live. This has often been accompanied by police harassment, preventing the population from settling. In this context, the Roma programme in Marseille plans to make a referral to the Defenseur des Droits, condemning the widespread violation of the fundamental rights of the city’s Roma population.

Working with Roma to improve health BENEFICIARIES

» more than 3,500 individuals NUMBER OF VOLUNTEERS

» 131

» ACTIVITIES

NUMBER OF PROGRAMMES

In 2011, MdM and other organisations carried out a health mediation action-research project with the aim of improving access to healthcare for women and young children, and improving the service they receive in health facilities in four areas: Lille (Areas), Fréjus (Sichem), Nantes (MdM), Seine-Saint-Denis (CAM), stopped in October 2011, and taken up by Val-d’Oise in November 2011 (Asav).

» 12

FUNDING:

» Regional public health agencies, district councils, regional councils, town councils…

PARTNERS

» Romeurope, support committees, shelters, mother and child health protection services, Comité d’aide médicale…

The organisation also carried out vaccination campaigns, particularly against measles, in Seine-Saint-Denis and Marseille.

» OUTLOOK In partnership with other organisations, MdM is continuing to lobby the public authorities for a better standard of living for the Roma population. The results of the action-research project, expected in September 2012, will enable us to evaluate the relevance of the mediation work and encourage the recognition of this profession.

» RANGE OF SERVICES • Medical follow-up: primary healthcare and helping people to access mainstream health services.

• Sanitation: lobbying councils for improved hygiene conditions in settlements (e.g. refuse collection, access to water).

• Maternity care: Prevention of abortions, ante-natal monitoring, information on contraception, child immunisation, accompaniment to mother and child health protection services and family planning.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Harm reduction » PROGRAMMES IN FRANCE

Through our work at festivals, we have developed a system of drug analysis using thin layer chromatography for use in the urban setting, with our CAARUD partners. In line with the June 2010 recommendations of the INSERM expert review on harm reduction among drug users, and despite the lack of favourable response from the government, MdM set up a project in July 2010 on educating users about the risks associated with injection (ERLI) to tackle the hepatitis C epidemic in drug users. An action-research project, in partnership with AIDES and INSERM Marseille, supported by the national HIV and hepatitis research agency, will enable us to evaluate this new tool.

Reducing the risks of drug use TYPES OF DRUGS

» Alcohol, cannabis, ecstasy, cocaine, LSD and other hallucinogens, amphetamines, heroin, anaesthetic substances etc.

HEALTH PROBLEMS

» Hepatitis C, HIV, psychiatric breakdowns, anxiety crises, dependency, various somatic problems, headaches, vomiting, feeling ill BENEFICIARIES

» More than 16,000 user contacts at raves/festivals and more than 220 people seen in squats in Marseille and Paris VOLUNTEERS

» 117

FUNDING

» Ministry of Health, regional public health agencies, regional councils, INTERREG (Europe)…

PARTNERS

» ANRS, INSERM, Techno Plus, AIDES, Act Up, Espace Indépendance, Sida Paroles, Bizia, Gaïa Paris, Bus 31/32, AFR… LOCATION OF HARM REDUCTION PROGRAMMES

» 5 Rave programmes: Bayonne, Mediterranean (based in Marseille and Nice), Montpellier, Nantes, and Toulouse; 2 harm reduction programmes in Marseille and Paris squats; 1 drug analysis programme; 1 project on education of risks associated with injection (ERLI)

» ACTIVITIES Since 1997 MdM has been running prevention and harm reduction activities at festivals/raves and in the urban context: • at techno festivals, free parties and in cross-border clubs; • in squats, during parties but also, more importantly, on an everyday basis. Like the Parisian programme, the team in Marseille has been working in squats in 2011, introducing a self-help approach into the programme; • with people who use intravenous drugs, by developing the project on education of risks associated with injection (ERLI); • drug analysis with thin layer chromatography. In 2011, 374 samples were collected and analysed.

The remaining syringe exchange programme run by MdM, in Lyon, handed over its work in July 2011.

» OUTLOOK • Evaluation of the ERLI programme.

• Consolidation and strengthening of the current arrangements in squats.

• Continuation of the current arrangements at raves//festivals in partnership with with user groups with a view to handing over services.

• Promoting thin layer chromatography and the recognition of drug analysis as a harm reduction tool.

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Sex workers » PROGRAMMES IN FRANCE

Eight years after the Internal Security Law came into force, all organisations working with sex workers report that the law is ineffective against prostitution rings and pimps. For sex worker, access to healthcare and to other rights is increasingly restricted, despite the fact that they are particularly exposed to sexually transmitted infections. Victims of violence and abusive arrests, sex workers often have to hide. This makes them less visible and more vulnerable, and further distances them from health and social services—making the work of support organisations more difficult.

On 6 December 2011, the National Assembly passed a resolution aiming to reinforce this abolitionist approach in France with a proposal to penalise clients, leading to fears that the law may yet make the situation even worse.

BENEFICIARIES

» More than 1,300 VOLUNTEERS

Providing support and facilitating access to healthcare for sex workers

» 103

» ACTIVITIES

COMMON CONDITIONS

• Organisation of night and day outreach sessions in places where prostitution takes place, clinic sessions and health workshops, in order to provide prevention materials, to provide information on the risks of sexually transmitted infections, HIV and hepatitis and to offer a listening service.

• Development of more individualised support, with physical accompaniment to mainstream health services.

» Gynaecological problems, illnesses linked to living on the streets, psychological problems linked to stress, isolation or abuse, drug dependency…

FUNDING

» Regional public health agencies, district councils, regional councils, town councils, Sidaction…

PARTNERS

» AIDES, Arcat, CDAG, CIMADE, Droits d’urgence…

1. LSI : Law n° 2003-239 of 18 March 2003 on internal security

» OUTLOOK The LSI1 has resulted in a shift in the places where prostitution takes place. An ‘indoor project’ has been set up in Nantes, with a particular focus on hostess bars. Finally, with the aim of awareness-raising and offering better access to HIV testing, the teams are considering the possible use of rapid HIV tests, which will enable us to increase early uptake of screening.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Health and housing » PROGRAMMES IN FRANCE

Four years after adoption of the DALO law realising the legally binding right to housing, there are still more than 3.6 million people who have no, or very poor, accommodation in France. This includes 133,000 people who are homeless.

Five million people are in extremely vulnerable situations. Despite the increase in emergency housing places, there is still inadequate provision to meet the needs and the conditions (separation of families or couples, restricted hours, prohibition of pets etc.) and the state of the accommodation (run down premises, overcrowding…) put people off accessing this provision.

NUMBER OF PROGRAMMES

» 23

Taking the health impact of poor housing into account

NUMBER OF VOLUNTEERS

» 326

MOST COMMON HEALTH PROBLEMS

» Back problems, gum and teeth problems, gastric problems, viral hepatitis, respiratory infection, asthma, parasites/candidosis, skin infections, anxiety-stress, somatic problems, depressive syndrome, hypertension, diabetes…

CONTACTS WITH HOMELESS AND POORLY HOUSED PEOPLE

» more than 20,000 »2 6% of service users attending our clinics are sleeping rough, in voluntary sector accommodation or in emergency housing (on a day to day basis or for a two week period). »14% are minors »4 6% live in insecure accommodation

» ACTIVITIES Through our work, MdM highlights the harmful consequences of homelessness or poor housing on health.

» OUTLOOK • To continue our healthcare, prevention and accompaniment activities.

• To support the introduction of public sector outreach activities (‘nursing bed’ facilities, mobile healthcare access teams etc…) that meet the specific needs of homeless people.

• To further study the impact of poor housing on the health of occupants.

• To continue to promote access to suitable accommodation and housing.

FUNDING

» ARS, regional councils, district councils, town councils…

PARTNERS

» Abbé Pierre Foundation, Secours catholique, Emmaüs, Red Cross, Restos du coeur, Samu social, DAL, local organisations (La Péniche, Les Amis de la rue, Le Fournil, GAF, Enfants du Monde Droits de l’homme…), homeless people support groups, Mother and Child Protection Services

HEALTH AND HOUSING PROGRAMME LOCATIONS

» Angoulême, Ajaccio, Bordeaux, Calais/Dunkirk, Cayenne, Grenoble, Le Havre, Lyon, Marseille, Metz, Montpellier, Nancy, Nantes, Nice, Paris and its suburbs, Poitiers, Reunion (Saint-Denis), Strasbourg, Toulouse, Valenciennes.

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Prevention project

HIV-Hepatitis-STIs-Tuberculosis » PROGRAMMES IN FRANCE

Legislation introduced on 17 November 2010 set out new conditions for rapid diagnostic tests, expanding access to HIV testing for groups with low uptake. These tests can now be carried out by non-medical personnel who work in prevention services and organisations. Although MdM has been offering these tests in our clinic in Cayenne since December 2009, their official authorisation enables us to extend their use to other healthcare and advice clinics and to our outreach activities.

BENEFICIARIES

» The 24,200 service users attending the pilot programmes HEALTH PROBLEMS

» HIV/AIDS, hepatitis B and C, sexually transmitted infections, tuberculosis FUNDING

» Ministry of Health

PILOT PROJECT LOCATIONS

» Healthcare and Advice Clinics: Bordeaux, Cayenne, Lyon, Marseille, Nice, Paris, Pau, Rouen, Saint-Denis, Toulouse » Sex worker programmes: Lotus Bus Paris, Funambus Nantes » Homeless programmes: Metz, Lyon » Projects working with drug users: Education of risks associated with injection (ERLI) programme, Paris and Colombes

Tackling HIV, hepatitis and tuberculosis » ACTIVITIES • Strengthening prevention: supplying programmes with prevention materials (flyers, condoms etc.), individual interviews and group sessions. The ERLI programme provides individuals with theoretical and practical education on injection during a pre-determined number of sessions, during which the person uses the product she or he takes regularly following a defined protocol.

• Improving access to screening: encouraging service users to go for testing, partnerships with free, anonymous testing services and local laboratories. In 2011, following the example of the clinic in Cayenne, Nice and Strasbourg introduced screening programmes using rapid testing methods. The team in Cayenne also introduced an outreach programme which provides rapid HIV testing in deprived areas of the city.

• Facilitating access to healthcare: partnership with mainstream health services, physically accompanying service users.

• Collecting testimonies of case studies in relation to these diseases.

» OUTLOOK • Continue to introduce rapid HIV testing in mainland France, implement a hepatitis C screening programme using rapid tests.

• Improve tuberculosis screening.

• Consolidate our partnerships with the free, anonymous testing centres.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Buddying

children in hospitals » PROGRAMMES IN FRANCE

Many children, often from disadvantaged backgrounds, from France and elsewhere in the world, are admitted to hospitals in and around Paris for conditions that cannot be treated closer to home. The Buddying Programme volunteers aim to ease the difficulties caused by the separation and to help the child to deal with the suffering. The importance of the volunteers’ presence is recognised. Increasingly, our volunteers support children who do have their parents by their sides, but who have to deal with numerous problems.

Supporting sick and isolated children NUMBER OF CHILDREN BUDDIED IN 2011

» 169 » In the Parisian region: 136 » In French Guiana: 33 NUMBER OF VOLUNTEERS

» 109 » In the Parisian region: 95 » In French Guiana: 14

PARTNERS IN ÎLE-DE-FRANCE

» Paris hospitals: Necker Sick Children’s Hospital, Armand-Trousseau Hospitals, Robert-Debré Hospital, Saint-Louis Hospital, Édouard-Rist medical and educational clinic, Institut Curie CENTRES IN THE PARISIAN REGION

» Centre des Côtes - Les Loges-enJosas, Margency Children’s Hospital, the French Red Cross, Bullion paediatric and rehabilitation hospital, Paul-Parquet Foundation-Neuilly-sur-Seine, Montreuil medical centre for young children,Villierssur-Marne rehabilitation centre, SaintMaurice rehabilitation centre IN FRENCH GUIANA

» Andrée-Rosemon hospital, Cayenne SUPPORT

» Vivendi, Air France Foundation, Air France, Air Austral, Air Caraïbe PROGRAMME LOCATIONS

» Paris and the Parisian region, French Guiana

» ACTIVITIES To help children to deal with the solitude and suffering more easily, the buddying must be set up as quickly as possible. Buddying involves three types of activity: • prevention: the programme aims to minimise psychological problems caused by unfulfilled emotional needs and the abrupt separation from parents; • support: the children are supported throughout their hospital stay; • maintaining links: helping to maintain links, sometimes damaged, between children and parents and also with health and social services.

To be able to do this, our volunteers visit the children three times a week, including once at the weekend, and sometimes organise outings if the child is well enough. Sometimes volunteers accompany children to their homes.

In around 20% of cases, volunteers accompany the child to the end of his or her life.

» OUTLOOK • Opening a branch in Saint-Laurent-du-Maroni, in Franck-Joly hospital.

• Setting up an agreement with child social services.

• Working to apply the Declaration on the Rights of the Child and the European Charter for Children in Hospital.

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Homeless programme - Nice Š Virginie de Galzain

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Our regional delegations Heavily called upon in 2011, Doctors of the World’s 13 regional delegations played their part in bringing people together to work on strategic and activist regional projects. In a tense political context, we need to be able to rely on our people on the ground and their values. That is why the delegations have concentred their efforts on boosting, and mobilising, MdM membership.

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Mobilising our members in the regions The regional delegations were tenacious and persistent in their advocacy work. As well as raising awareness among the general public and politicians, this work included educating health professionals about difficulties with access to healthcare and developing other activities within local networks, while also remaining alert to international issues.

Motivating volunteers in the regions While volunteer recruitment has traditionally relied on word-of-mouth and, unavoidably, co-option, new methods are being developed.

Appeals for volunteers are disseminated through local media (newspaper adverts, radio broadcasts), by specialist organisations such as France Benevolat, and through open days or welcome evenings for new recruits.

Regional training programmes have been defined in response to needs expressed by volunteers. In the Rhone-Alps region the process is well underway and in Ile-de-France monthly information meetings about Doctors of the World, along with meetings on particular themes every two months, have proved successful.

Similarly, in Aquitaine, Languedoc-Roussillon, Alsace and Midi-Pyrenees diverse themes— such as Roma, the toughening of immigration

laws, volunteering, analyses of practices, support relationships and bearing witness—have been explored. With an analytical approach, seminars and discussions on regional plans have taken place along with workshops more closely linked to particular activities (Roma, healthcare and advice clinics etc.).

Communication Doctors of the World teams worked hard to raise the organisation’s profile, particularly through exhibitions such as Exile, Exit? and Women, the aftermath of violence which were shown in Nice, Perpignan, Toulouse, Villeurbanne, Grenoble, Nancy and Bordeaux. The organisation had stands at different forums (e.g. health forum, volunteering forum) and voluntary sector days (Solidarity days, World Aids Day, Association day) across the country.

Doctors of the World’s involvement in cultural

events or street events, such as Musiques Métisses in Angoulême, the Gironde International Human Rights Festival (Bordeaux) and Macadam & Co (Rouen) helped to raise awareness amongst the general public or to raise funds.

A key feature was the introduction of a new type of action to mobilise citizens and activities with the organisation of the Health is not a luxury! flashmob in Lyon, Paris and during the G20 meeting in Nice. Monthly demonstrations about the housing situation were also organised in Toulouse.

Raising professional awareness From the general public to specialist audiences, the regional delegations expanded their awarenessraising activities by organising conferences and debates in the Rhone-Alps (Democracy and subjectivity: monitoring and caring; When exile brings the risk of violence), in Ile-de-France (on the healthcare access office), in Lorraine (Violence against women: from observations to responses; Haiti, one year on), or in the Loire (screening and conference on Roma).

Young people and students (future humanitarian, health or social professionals) are particularly receptive to discussions on the issues raised by Doctors of the World. That is why we are doing more presentations in professional educational establishments in the regions where we work.

We also now offer more internships and have trained many people through the university

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Highlighting the problems that vulnerable groups have in accessing healthcare, in order to influence policies, is particularly relevant and appropriate at the regional level. diploma on health and deprivation organised in Bordeaux, Grenoble, Montpellier, Paris and Strasbourg.

Local advocacy Highlighting the problems that vulnerable groups have in accessing healthcare, in order to influence policies, is particularly relevant and appropriate at the regional level. The primary concern of our delegations is how easy it is to access health services through healthcare access offices or by obtaining universal health insurance or State Medical Aid. Health problems linked to poor housing were a particular area of concern, especially in the Rhone-Alps and Loire regions. Advocacy focused on the health impact of security policies.

Some delegations carried out public surveys which enabled them to refine their arguments and advocacy approach. The Ile-de-France delegation, for example, examined the healthcare access offices in the region (but outside Paris) and the practices of primary healthcare insurance offices. The Normandy delegation was involved in two surveys organised by the central administration of the health and social affairs ministries. The first survey concerned social and health needs of sex workers, the second covered poverty trends and emerging issues.

health needs assessments have been carried “At home and abroad” out in areas where Doctors of the World is not The international dimension of Doctors of the currently working. Namely, on the situation of the World’s remit mainly manifests regionally through Roma population in Mulhouse, on poverty in the partnerships with local authorities. We are keen Bruche valley, on the healthcare access office in to find other ways to embed our international work in the regions.

Epinal and on Tunisian migrants in Valence.

A Street, Hospital, Prison action-research project is underway in Marseille to try to prevent the imprisonment of homeless people with mental health problems. In Strasbourg, another actionresearch project is examining the prevalence of diabetes, hypertension and obesity in disadvantaged groups. In Nantes, a study is being carried out in hostess bars.

Linking into networks Doctors of the World is represented locally and we foster constructive local collaboration through our heavy involvement in voluntary sector collectives (Roma solidarity groups, housing, anti-exclusion), steering committees (healthcare access offices, regional programmes on access to prevention and treatment), working groups and other institutional bodies (regional health conferences, local conferences) or coordination mechanisms (COREVIH).

Several options have been started. A needs assessment was carried out in Palestine by the Rhone-Alps delegation. Other regionallymanaged international programmes in the MidiPyrénées delegation (project in India) and the Indian Ocean delegation (programme in prisons in Madagascar) are coming to an end.

Beyond operational implementation, this also means exploring the links between our work “at home” and “abroad”. This led us to consider migration journeys more closely. A needs assessment took place in Ghardimaou in Tunisia, the home town of men based in the gourbi in Etang de Berre in France. In Normandy, this led to meetings on care and psychological follow-up for Malian and Algerian migrants living in Le Havre.

Regionalisation at work

The regional delegations, having been reinRegional delegations have also initiated, or forced and recognised by the organisation, taken part in, the formation of voluntary sector continue to pursue their regional plans and collectives on issues of particular concern. In also play a role in monitoring and activism. The Regional development Montpellier, for example, the delegation sup- regional set-up provides a mechanism for our With a view to responding to unmet needs or ports the Health and Deprivation collective and volunteers to bear witness and to continue to to supporting the calls of local stakeholders, the Roma collective. advocate for access to healthcare.

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Directory of regional delegations » Alsace

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

» PACA

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

»

» Aquitaine

» Lorraine

» Loire

2 rue Charleroix-de-Villiers 33300 BORDEAUX T: 05 56 79 13 82 F: 05 56 52 77 69 aquitaine@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

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

» Corsica

» Midi-Pyrenees

» Poitou-Charentes

22 rue du Dr-Del-Pellegrino 20090 AJACCIO T: 04 95 10 25 49 F: 04 95 10 25 49 corse@medecinsdumonde.net

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

22 allée du Champs-Brun 16000 ANGOULÊME T: 05 45 65 07 47 F: 05 45 61 18 85 poitou-charentes@medecinsdumonde.net

» Franche-Comté

» Normandy

» Rhone-Alps

10 rue Champrond 25 000 BESANCON T: 03 81 51 26 47 caso.besancon@medecinsdumonde.net

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

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

» Île-de-France

» Indian Ocean

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

250 bis rue du Général-Rolland Bât K- SHLMR Bouvet BP 964 - 97479 SAINT-DENIS Cedex T: 02 62 21 71 66 F 02 62 41 19 46 ocean-indien@medecinsdumonde.net

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

The detailed activities of each regional delegation are included in the interactive CD attached to this report.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Programme supporting sex workers - Rouen Š Elisabeth Rull

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Surgical care - Haiti Š Girorgos Moutafis

DOCTORS OF THE WORLD ANNUAL REPORT 2011

The international network 2011: The network took action in Haiti, Japan and Greece The international network is made up of 13 organisations:* Argentina, Belgium, Canada, France, Germany, Greece, Japan, Netherlands, Portugal, Spain, Sweden, Switzerland and United Kingdom.

During the year, two network members were hugely affected in their own countries:

• MdM Japan responded to the 11 March 2011 earthquake, immediately sending teams to the affected areas. The team continues to provide The international network management team (DRI long-term support to the poorest of those affected. in its French acronym) is responsible for its coordination and development, with guidance from • MdM Greece sees the consequences of the the two largest organisations in the network, MdM financial crisis in their country on a daily basis.

France and MdM Spain, and the network dele- The number of Greek patients who no longer gates, Dr Françoise Sivignon and Dr Hervé Ber- have access to healthcare continues to rise. tevas. DRI supports the development of network members according to their needs and means.

Raising funds remains a constant struggle. To further our reach, and to access new internatioIn 2011, the work in Haiti continued. When the nal funds, MdM opened an office in New York in teams were faced with the cholera epidemic, January 2012. smooth coordination on the ground enabled a swift and efficient response.

»d ri@medecinsdumonde.net + 33 1 44 92 14 80 www.mdm-international.org All network members’ pledge to respect MdM’s core values and founding principles.

* MdM Italy is currently inactive.

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Germ

Netherl Belgiu

MAP OF INTERNATIONAL PROGRAMMES

United Kingdom

Spain

Tunisia

Algeria Mexico

Dominican Republic Haiti

Mauritania Chad Senegal Guinea-Bissau Guinea French Guiana

Colombia

Benin São Tomé and Príncipe

Ecuador

Brazil

Bolivia

Argentina

INTERNATIONAL PROGRAMMES

NATIONAL PROGRAMMES

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Sweden Russia

many

lands um Serbia Bulgaria Romania Moldova Switzerland Turkey

Georgia Japan

Greece

Lebanon

Syria Palestinian territories

Egypt

Burma

India Yemen Cambodia

Ethiopia Uganda Somalia Kenya Indonesia Dem. Rep. of Congo Tanzania

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Overview of programmes run by international network members In 2011, the MdM network as a whole implemented 342 programmes in 76 countries: 151 international programmes in 64 countries and 190 national projects in 13 countries. Doctors of the World network members work to re-establish, or often simply facilitate, access to care for the most vulnerable.

In Haiti, the work continues with a large scale international network presence Faced with the massive needs in Haiti, six international MdM teams are still working to support the population. The large staff numbers mean that we are able to cover several sites including Portau-Prince, Gonaïves, Léogâne, Grand’Anse and Nippes.

the network. Notably, the teams were equipped with radioprotection equipment.

Backed by its history and expertise—MdM Japan was created after the Kobe earthquake— teams responded in the affected regions in the north of Japan, in the areas surrounding Otsuchi.

Since the quake, specialists (psychiatrists, nurses, and physiotherapists) have been providing care to people living in shelters and tempoIn 2011, the cholera epidemic hit the population at rary housing. Since the beginning of April 2011, a time when they were already very weak. Doctors teams have conducted medical and psychiatric of the World teams worked together to tackle the consultations and rolled out relaxation and study epidemic. Human resources and money, both dif- sessions at the town’s high school. In July, Docficult to secure, were shared in order to ensure the tors of the World opened a consultation room best response possible. for people suffering from post-traumatic stress disorder, where, working closely with the authoEarthquake in Japan : rities, psychiatrists and nurses share patient care. our teams on the ground Since the end of December, three-day relaxation sessions take place twice a month, at the The earthquake that hit Japan on 11 March 2011 request of the residents. affected the whole country. The nuclear catastrophe that followed forced Doctors of the World These activities are possible thanks to the comto confront risks never before experienced by mitment of our Japanese volunteers.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

A year on from the disaster, whilst the long-term consequences of radiation on health are difficult to assess, the ongoing needs are still great.

MdM Japan will continue to have a presence in the affected areas for several years.

The Greek crisis : demand for medical consultations rises Plans to save Greece are front page news, with billions of euros promised to avoid bankruptcy and a succession of austerity plans put forward to reduce the deficit. But these plans, aimed at saving the financial system, do not take into account the real human consequences, particularly for the most destitute. The poorest people stop accessing care, or turn to organisations like MdM, which had previously cared predominately for migrants, including asylum seekers. Visits from Greek citizens to MdM polyclinics have doubled this year: including pregnant women who have not received any care during their pregnancy, sick children and/or children who have not been vaccinated, retired people with no income, or public workers who have had their salaries cut.

MdM Greece reaches out to vulnerable people through its clinics and outreach teams.

International projects in 64 countries Africa represents almost half of our projects, with 68 programmes in 24 countries. Due to the political and security situation, MdM was forced

to leave Sudan and continues to work under extreme pressure in the Sahel region.

difficulties, with limited, if any, rights. As a consequence, all our country teams work to make sure that all fundamental human rights that enshrine In 2011, Doctors of the World started its first access to care are respected, while ensuring harm reduction programme on the African conti- that the international convention on the rights of nent, in Tanzania, working with drug users. the child, and rules relating to access to care for pregnant women, are upheld.

During the revolutions in Tunisia and Libya, teams were sent to the countries’ borders.

Other programmes work with people experiencing homelessness, who suffer a rapid deterioIn the other regions, Doctors of the World’s work ration in their health as a result of sleeping on is divided as follows: the streets. Mobile outreach is also carried out in most of the countries, sometimes with a specific • Latin America—37 programmes in 14 focus on homeless people suffering from mental countries; health problems.

• Asia—22 programmes in 13 countries; • Middle East—17 programmes in eight Roma communities experience discrimination, countries; both in their own country and in the countries • Europe—seven programmes in five countries. to which they travel. That is why MdM teams in France and in Greece reach out to families, National programmes in travelling to where they live (often in insanitary 13 network member countries camps), or welcome them to centres (in Germany and Belgium) to facilitate their access to In the countries where the international network vaccinations and care. Particular attention is paid members are present (Argentina, Belgium, Ca- to expectant mothers and children. nada, France, Germany, Greece, Japan, Netherlands, Portugal, Spain, Sweden, Switzerland and Sex workers, male and female, often migrants, UK), 190 national programmes are run on a daily are faced with multiple risks (violence from clients, basis. These programmes, run predominately by harassment by police, exploitation, sexually volunteers, care for those people who, without transmitted infections from clients who insist on help, could not access healthcare services. unprotected sex), coupled with the stigma that surrounds them. Thanks to its mobile clinics, In the majority of countries, foreign nationals MdM is able to work on the streets, but also in without residency permits live in the greatest the clubs, massage parlours etc. in order to help

84 sex workers to reduce risks that are inherent in their activity.

People who use drugs often struggle to protect their health because they are forced to hide their use for fear of prosecution. MdM operates a low threshold access policy for users, providing them with sterile injection equipment, materials for other consumption methods, information on products and ways of reducing the risks related to drug use.

A portfolio of other programmes are carried out by the teams (prevention of genital mutilation, child lead poisoning, support for the elderly and medical and social support in deprived areas…).

THE INTERNATIONAL NETWORK MEMBERS » Médicos del Mundo Argentina Chair: Mr Gonzalo Basile www.mdm.org.ar

» Médecins du Monde Belgium Chair: Professor Michel Degueldre www.medecinsdumonde.be

» Médecins du Monde Canada The work carried out by MdM teams at home and abroad shares common themes, namely, access to care for all, prevention and care for those affected by HIV/Aids, hepatitis and tuberculosis, the reduction of health inequalities and the right to access care, irrespective of immigration status.

Chair: Dr Nicolas Bergeron www.medecinsdumonde.ca

» Médecins du Monde France Chair: Dr Olivier Bernard www.medecinsdumonde.org

» Aerzte der Welt Germany In 2011, the European members decided to join forces within the framework of a European project. This will start in 2012 and aims to challenge the European Union leaders and member states on the question of access to care for the vulnerable people that MdM teams care for on a daily basis.

Chair: Professor Jochen Zenker www.aerztederwelt.org

» Medicos do Mundo Portugal Chair: Dr Abílio Antunes www.medicosdomundo.pt

» Medicos del Mundo Spain Chair: Dr Alvaro Gonzalez www.medicosdelmundo.org

» Läkare i Världen Sweden Chair: Ms Kristina Andersson www.lakareivarlden.org

» Médecins du Monde Switzerland Chair: Professor Nago Humbert www.medecinsdumonde.ch

» Doctors of the World UK Chair: Ms Janice Hughes www.doctorsoftheworld.org.uk

» Doctors of the World Greece Chair: Dr Nikitas Kanakis www.mdmgreece.gr

» Doctors of the World Japan For more information on the international network member programmes: www.mdm-international.org

Chair: M. Gaël Austin www.mdm.or.jp

» Dokters van de Wereld Netherlands Chair: Dr Remco Van de Pas www.doktersvandewereld.org

Find detailed information on specific international members in the interactive CD attached to this report

DOCTORS MÉDECINS OF THE DU MONDE WORLD RAPPORT ANNUAL REPORT MORAL 2011

Earthquake in Japan, Otsuchi © Nao Kuroyanagi

© Lahcène Abib

© Elisabeth Rull

1 December

© Eric Rechsteiner

crises & conflicts

© Chien-Chi Chang/Magnum

© Christina Modolo

© Isabelle Eshraghi

7 April

© MdM

© Benoit Guénot

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ACCESS TO CARE

DOCTORS OF THE WORLD ANNUAL REPORT 2011

KEY EVENTS 2011 was a busy year for Doctors of the World, from responding to emergencies to fighting for better access to care for the most vulnerable. The year was marked by a continued commitment to projects developed at home and abroad, and will be remembered as an important year for lobbying political decision makers.

Overview of key events in 2011.

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Quarter 1

January / February / March EMERGENCY 11 March 2011: Japan Following the earthquake and tsunami that struck Japan on 11 March 2011, Doctors of the World immediately sprung into action to help the victims. Since April 2011, Doctors of the World Japan has been running a primary health and psychological support programme in Otsuchi, located in the North-East of the country.

February-March 2011: The Arab spring The wave of protest that swept away the Ben Ali regime in Tunisia spread to other countries across the region. These youthled movements were harshly repressed by autocratic governments. MdM has a presence in the transit camps set up at the Tunisian-Libyan and Egyptian borders to care for people fleeing Libya.

© Nao Kuroyanagi

FRANCE 1 March: State Medical Aid 1 February: Mayotte The 101st French department does not A 30 euro yearly charge is introduced for provide either Universal Health Insurance adults to obtain State Medical Aid, the or State Medical Aid. Doctors of the World means by which access to care is given raises awareness concerning the medical to the poorest undocumented migrants. consequences of the migration policies implemented on the island.

Doctors of the World is working in partnership with other healthcare professioThe documentary entitled Mayotte, nals to campaign against this new charge. voices of undocumented migrants, In order to document its impact on the Renaud Eletufe, can be viewed on the most vulnerable, MdM introduces new Doctors of the World website in the monitoring tools in its clinics. publications section.

INTERNATIONAL 12 January: Haiti, one year on After a year, the long awaited reconstruction has still not begun, leaving Haitians in a precarious situation. Doctors of the World teams ensure that the population has access to primary care and carries out prevention and care activities to fight cholera. © Lahcène Abib

18 March: Internal Security Law On 18 March 2003, the Internal Security Law reintroduced the offence of passive soliciting, which had been decriminalised since 1994. On 18 March 2011, the anniversary of this change in the law, the organisation publishes the results of a survey of sex workers that confirms the harmful effects of this law on their health and safety.

Collected case studies are accompanied by photographs by Diane Grimonet, taken for the first time in the Lotus Bus (a project that supports sex workers in Paris).

Humanitarian Review n° 27 Haiti: emerging from aid dependence?

December 2010, Downloadable from the site humanitaire.revues.org

DOCTORS OF THE WORLD ANNUAL REPORT 2011

April / May / June

Quarter 2

7 April : World Health Day HEALTH IS NOT A LUXURY! Each year, more than 100 million people fall into poverty because of the high cost of healthcare. Faced with deepening health inequalities, MdM held an event at the Palais Royal in the centre of Paris, to reaffirm that health is not, and should not be, a luxury item!

Limousine-ambulances to transport stretchers and doctors, armoured glass to show off medicines, stethoscopes, vaccines and “Gold” health cards are displayed as luxury objects… A strong visual and symbolic backdrop. © Benoit Guénot

26 May: G8 And if they saved lives after having saved the banks?

At the Deauville summit, Doctors of the World reminds the G8 countries of their promises, in particular those on free access to care for the most vulnerable, and demands firm, quantifiable commitments. Free access to care must be financed in 2011.

The video entitled G8, and if they saved lives after having saved the banks? is available on the Doctors of World site in the Campaigns section.

22 June: Migrants/Calais Doctors of the World challenges Dominique Baudis, recently appointed Defenseur des Droits, and requests an inquiry into police treatment of migrants in the Calais region.

MdM collected testimonies from migrants documenting the police force’s behaviour, which appears to contradict their code of ethics (strategy of physically and mentally exhausting people, forcing them to leave Calais…).

The report entitled Migrant’s living conditions is available on medecinsdumonde. org, in the publications section.

© Benoit Guénot

To find the video North Coast: closest to migrants visit medecinsdumonde.org, in the publications section..

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Quarter 3

July/August/September 26 July PARIAHS: ROMA IN FRANCE In Grenoble, on 30 July 2010, Nicolas Sarkozy announced a policy of systematic expulsion of Roma people, labelling them as a threat to security. One year on, MdM teams working in Marseilles, Bordeaux, Lyon and in Ile-de-France document an even more serious situation: multiple expulsions and a degradation in living conditions. The Roma community is living in a climate of fear, fuelled by repeated intimidation, irregular administrative procedures to send them back to the border and unjustified police custody—a situation that generates chronic medical pro-

blems, including the interruption of care regimes and exclusion from the health system.

Against this backdrop, Doctors of the World published the results of the first survey carried out into vaccine coverage in France for adults and children from the community. At the same time, a photographic exhibition by Alain Keler, entitled Roma: Europe’s Pariahs, was shown at the Comptoir Général, in Paris, from 22 July to 7 August. Photographs taken between 1999 and 2010 illustrate the history, the journey and the Roma’s struggle, in France and in Eastern Europe.

© Steven Wassenaar

26 September G20: POSITIVE IMPACT OF USER FEE EXEMPTION IN NIGER Doctors of the World challenges the G20 leaders, as part of the Health is not a luxury! campaign. On the basis of the report, explaining the positive effects of abolishing user fees in Niger, MdM is able to show that the introduction of policies eliminating user fees for all or part of the population improves access to care as well as producing important savings in terms of disease prevention. The objective is to ensure the inclusion of a simple commitment in the final G20 declaration: health is not a luxury, medical coverage must be put in place to protect the poorest people.

© Isabelle Eshraghi

DOCTORS OF THE WORLD ANNUAL REPORT 2011

17 October HEALTH CRASH On World Poverty Day, Doctors of the World publishes its annual barometer charting access to care for the most disadvantaged groups in France. These groups have been dealt a double political blow: the dismantling of the welfare-based health system on the one hand, and the negative health consequences of security policies on the other. At a time when the debate on the welfare-based health system is on the agenda as part of the 2012 presidential campaign, Doctors of the World warns about the risks of a healthcare and humanitarian crisis in France and lobbies future candidates. © Benoit Guénot

1 December WORLD AIDS DAY Focus on French Guyana The French department worst hit by HIV shows severe delays in testing, with people often only being diagnosed once Aids has developed, numerous patients “lost” during the course of treatment, and late presentation for care and treatment.

According to WHO guidelines, a 1.3% HIV prevalence amongst women who gave birth in Saint-Laurent-du-Maroni means that the department is suffering from a general epidemic. This emergency requires a more incisive testing policy. As early as 2010 Doctors of the World set up a rapid testing service at a care centre in Cayenne that produces results in a matter of minutes. © Agnès Varraine Leca MdM teams also travel to the most deprived areas of Cayenne Spotlight on Tanzania to offer medical and social consultations and testing.

Despite a reduction in the HIV/Aids epidemic, which today affects 6.5% of the Tanzanian population, drug users, who are See the website for a press release, with an interview featuring growing in numbers in Dar es-Salaam, show alarmingly high Amandine Marchand, Cayenne project co-ordinator, or a full prevalence. They suffer from a strikingly high level of stigma and press pack. have no access to care. Against this backdrop, MdM is setting up a harm reduction project to support people who inject drugs, in collaboration with Tanzanian institutions and civil society.

Quarter 4

October / November / December

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See the documentary Bongo Fever on the Doctors of the World France website.

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Opération Sourire - Madagascar © Catherine Henriette

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Cross-cutting projects A broad analysis of technical or medical themes, that have been identified as priorities by MdM, enables teams on the ground to improve the relevance and quality of their projects. In parallel, advocacy work carried out to promote these themes aims to reinforce the organisation’s influence on political decision makers.

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» SEXUAL AND REPRODUCTIVE HEALTH

respect for the right to health and promotion of universal access to services

Doctors of the World has developed 20 projects that address the theme of sexual and reproductive health. Each project responds to the specific needs identified in different contexts: improving access to family planning in Niger, prevention and care for obstetric fistulas in Chad, improving access to maternal healthcare and removing user fees in Laos, prevention and care for unwanted pregnancies in Uruguay etc.

CO-ORDINATION

» Headquarters: S. Simon, M. Lussier » Board: C. Giboin SOURCE OF FUNDING

»F rench Development Agency funds the cross-cutting sexual health programme »B udget : 2.7 million euros for 2010-2012

Moreover, MdM aims to improve access to healthcare for local communities as well as the quality of care provided.

Within this overarching theme, MdM is also able to identity and care for victims of gender-based violence and work on its prevention. 2011 saw two fruitful workshops. One, in May, focused on the practices and experiences of team members working on sexual and reproductive health projects, reinforcing the coherence of the different projects.

The other, which took place in Montevideo (Uruguay) in September, enabled representatives from Nicaragua, Peru, Guatemala, Mexico and Uruguay to discuss concerns around access to safe and legal abortion in Latin America and share advocacy strategies.

At the end of 2011, MdM also strengthened the communications on its work in the sexual and reproductive health arena by compiling a document which will be shared in 2012. During the Dakar International Conference last December, MdM presented a well-received paper highlighting the inclusion of religious leaders in its family planning work in Niger. Lastly, an agreed common advocacy stance centred on two focal points: on the one hand, a call for the lifting of financial barriers that hamper access to quality healthcare, in particular sexual and reproductive healthcare services, and on the other hand, the reinforcement of access to safe and legal termination of pregnancy.

» DATA COLLECTION

to monitor programmes

A tool called Monitool has been developed by Doctors of the World and has been available since the beginning of the year to all teams. The tool, developed in a basic excel format, enables improved data collection across the organisation. It defines the indicators and records the right data in order to calculate indicators and analyse the results using tables and graphs. It is already being used in more than 25 programmes.

CO-ORDINATION

»H eadquarters: O. Cheminat, S. Gumucio

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Sexual and reproductive health programme - Laos © Lâm Duc Hiên

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» HARM REDUCTION

amongst stigmatised groups

Since 1989, Doctors of the World has worked on harm reduction programmes, gaining valuable expertise both in France and internationally. Working with people who use drugs, sex workers, men who have sex with men, girls living on the streets, and prisoners, MdM runs prevention projects to both reduce the risks associated with substance abuse on one hand and encourage safe sexual practices on the other, through a holistic response addressing medical, psychosocial and community aspects.

CO-ORDINATION

» H eadquarters: Dr N. Luhmann, M. Lussier » Board : O. Maguet FUNDING

»Cross cutting harm reduction programme financed by the French Development Agency COUNTRIES

»T anzania, Georgia, Democratic Republic of Congo (Kinshasa) CLOSED IN 2011

» Vietnam and Serbia

The key objectives for 2011 included developing the projects and achieving a higher profile with a more integrated approach to harm reduction work. This was demonstrated by the interventions and coverage achieved. Two new syringe exchange programmes opened. One in Dar es-Salaam (Tanzania), the first of this kind in East Africa, and the other in Georgia, in partnership with the New Vector organisation, which has been working in this field since 2006. In April 2011, during a week-long workshop in Broumana, Lebanon, the use of a multidisciplinary framework based on 12 key areas was reaffirmed.

In December 2011, MdM played an important role in the regional African ICASA conference on HIV/Aids, organising a satellite symposium dedicated to harm reduction in Africa and presenting as part of the scientific programme.

Four key priorities were identified to shape our advocacy in this area: • reform of laws and national regulations, as well as international policies, that lead to criminalisation, repression or control, or that punish the practices and lifestyles of affected populations in favour of approaches based on public health and human rights; • lobbying for access to testing and treatment for viral hepatitis; • development of harm reduction practices worldwide ; • promotion of harm reduction practices in Africa, where care for high-risk populations is almost non-existent.

» ADVOCACY This year our advocacy work focused on two main areas. Doctors of the World continued to call for primary care to be more financially accessible. In several countries, such as Haiti, Burkina Faso, Niger, Laos, or the Cote d’Ivoire, MdM supported the setting up of, or consolidation of, action plans aiming to reduce the financial obstacles faced by the most vulnerable people.

At the same time, several lobbying campaigns and public events took place during the G20 and G8 summits promoting social security, specifically medical coverage, in developing countries. The G20 summit, which was held in Cannes in November 2011, was also the opportunity to raise awareness of the Health is not a luxury! campaign: www.lasantenestpasunluxe.org.

CO-ORDINATION

» Headquarters: N. Guihard

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» SOCIO-CULTURAL DETERMINANTS and access to care (DSC-AS)

How people act and feel about their health comes from a mix of norms, values, perceptions, knowledge and practices that influence how care is provided or or how people seek care, and how they view access to care. Field workers are faced on a daily basis with programme beneficiaries who act in different ways and have a multitude of differing perceptions in France and abroad. Faced with this, a cross-cutting project on socio-cultural determinants and access to care was set up to enable field workers to better understand the issues and in turn improve the relevance and efficacy of projects.

CO-ORDINATION

» Headquarters : M. Bouchon, S. Gumucio Board Members : M.-L. DeneffeDobrzynski, M.-A. Vincent, D. Maraval FUNDING

» French Development Agency, MdM BUDGET

» Year 1 (07/2008-08/2009) : 100,000 euros » Year 2 (09/2009-08/2010) : 188,640 euros » Year 3 (09/2010-08/2011) : 211,360 euros

Raising awareness was the key objective for MdM in 2011. In November, a workshop brought together 50 local partners and field workers to discuss best practice in professional ethics and socio-cultural negotiation, resulting in several publications that can be found at: www.medecinsdumonde.org.

The organisation also revised the reference manual Socio-cultural determinants and access to care for publication and uploading on the website, developing a new practical guide entitled Working with communities, which took up the issues highlighted at the 2010 workshop in Nepal on the theme of Community and participation and produced films to raise awareness and train humanitarian workers on the ways in which socio-cultural determinants affect access to care.

» QUALITY OF MEDICINES

2011 continued the work that began last year: ensuring secure supplies and new audits (Nairobi, and Yemen), follow up of the recommendations which emerged from the pharmaceutical audits in Haiti, Colombia, DRC, Palestine and the Netherlands, improvements in storage conditions, training teams in stock management, and more pharmacists being sent to the field, particularly on emergency programmes.

In 2011, new opportunities opened up with the pilot project entitled Quality Medicine for All (QUAMED). This practical and research-based project is co-ordinated by the Anvers Institute of Tropical Medicine. Its overall objective is to improve universal access to quality medicines through the formation of a North-South network involving operational and academic professionals.

Joining this network, and pooling our resources with other network members, should allow us to expand our activities to evaluate and audit the quality of medicines and thus improve the quality of pharmaceutical supplies in the countries where we work.

CO-ORDINATION

» Headquarters: V. Solbès

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Adoption

Doctors of the World is the only medical, humanitarian organisation in France to have integrated an international adoption programme into its founding statutes and to have set up an international adoption agency. The status of Approved Adoption Agency (AAA) was granted in 1988. Our objective as an AAA is consistent with our overall mission to stand up for those who are most vulnerable, namely children, who are often the first to be affected by crisis or conflicts, as well as their fundamental rights to a family, healthcare and an education.

Putting children first CO-ORDINATION

»H eadquarters: Dr G. André-Trévennec (paediatrician) »D irector: P. Salignon MEMBERS OF THE ADOPTION COMMITTEE REPRESENTING THE BOARD

»D r O. Bernard (paediatrician), Dr L. Jarrige (anaesthetist)

In 2011, MdM’s adoption programme is still the only one integrated into a French medical NGO. The priority is to find families for children who cannot be adopted in their country of origin. MdM accompanies and prepares the candidates for complex adoptions: adoption of multiple siblings, children over six years old and adoption of children with medical conditions.

» ACTIVITIES

» €445,000 (in 2011, provisional)

MdM has supported the adoption of more than 3,800 children since 1990. In 2011, 131 children arrived in France and were adopted by 119 families.

40.5% of the adoptions were complex (some of the children adopted were both older and with siblings): • 22 children (16.7%) were siblings from Colombia, Brazil and Bulgaria; • 29 children (22.1%) were older than six, of whom 11 were adopted with siblings; • 14 children (10.6%) had medical conditions, coming from China, Vietnam and Bulgaria.

MdM supports the children and their families for at least two years, as and when needed. In 2011, MdM carried out 863 post-adoption home visits.

COUNTRIES

» ORGANISATION AND HUMAN RESOURCES

FUNDING

» Mainly adopting families, Ministry of Foreign and European Affairs – International Adoption Service, MdM and private donors BUDGET

» Albania, Brazil, Bulgaria, China, Columbia, Cote d’Ivoire, Haiti, Madagascar, Philippines, Vietnam » Non-operational country since April 2010: Russia; since September 2011: Ukraine STAFF

» 220, of whom 98% are volunteers, working for the adoption team, at headquarters and at 15 regional offices

MdM holds an adoption licence in 82 French departments. The programme is managed by the head office but also central to the work are 15 adoption hubs, based in the regional offices, each one managing several departments. The adoption programme benefits from a highly qualified volunteer workforce: 17% doctors, including paediatricians and child psychologists, 31% psychologists, 23% paramedics and social workers, 8% teachers and other professionals, including lawyers.

» OUTLOOK The focus will continue to be on complex adoptions: adoption of children who are older than six years old, groups of siblings and those with medical conditions.

The programme is also continuing its risk prevention policy development, by, for example, ensuring families about to adopt are well-prepared, ongoing training of volunteers (220 people took part in the 2011 training sessions) and financial transparency.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Opération Sourire Since the first mission in 1989 in Cambodia, Operation Sourire has continued to grow. Today, teams from five network offices (Germany, France, Japan, the Netherlands and the UK) carry out reparatory surgery in Asia and Africa.

CO-ORDINATION

» Head of Programme: Dr F. Foussadier » Headquarters: L. Ilié FUNDING

» L’Oréal Foundation BUDGET

» €450,759 COUNTRIES

» Benin, Cambodia, Chad, Madagascar, Mali, Mongolia, Niger, Rwanda

Give back a smile to those disfigured by illness or malnutrition » ACTIVITIES The programme is guided by two key objectives : • surgical care, working in close collaboration with local partners ; • training for local staff, mainly through shadowing.

During 2011, MdM France teams carried out 11 projects in Benin, Cambodia, Chad, Madagascar and Mongolia, operating on 395 patients suffering from cleft lips or scarring from burns.

Germany, Japan, UK and the Netherlands deployed their own teams, or worked jointly. In total, 412 people underwent operations.

» OUTLOOK In 2012, the international growth of Operation Sourire will continue. MdM France hopes to roll out 14 missions and support the rest of the network in their development.

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Doctors of the World management at 31 December 2011

Madagascar © Bruno Fert

» General Director, Humanitarian Action: Pierre Salignon until August » General Director, Management: François Dupré until August » General Director: Pierre Salignon since September » International Operations Director: Dr Gilbert Potier » French Programmes Director: Dr Jean-François Corty » Finance and Information Systems Director: Thierry Barthélemy » Human Resources Director: Anne-Claire Deneuvy » Administration and Legal Director: François Rubio » Communication and Development Director: Juliette Chevalier » Adoption Director: Dr Geneviève André-Trévennec » General Secretary of the International Network: Jean Saslawsky

DOCTORS OF THE WORLD ANNUAL REPORT 2011

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: the vicechairs, the treasurer, 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 5 June 2011, Doctors of the World members elected the Board:

»C hairman

Dr Olivier Bernard Paediatrician, hospital doctor

»V ice-chairs

Dr Frédéric Jacquet Public health inspector

Dr Christophe Adam

»D eputy treasurer Dr Luc Jarrige Hospital doctor

» International network delegate Dr Françoise Sivignon Radiologist

Other board members:

General Practitioner

»G eneral secretary

Dr Patrick Beauverie Hospital pharmacist

»D eputy general secretary Claire Boulanger Consultant

»T reasurer

Dr Thierry Brigaud Prevention doctor

»D r

Substitute board members : »M argarita

Gonzalez

Nurse »O livier

Maguet

Consultant »G érard

Pascal

Surgeon

Patrick David

Anaesthetist, intensive care doctor »D r Armelle Desplanques-Leperre

Doctor »C atherine

Giboin

Consultant »M aria

Melchior

Epidemiologist

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Our thanks to OUR PRIVATE PARTNERS Foundations and businesses

Norwegian Church Aid, Air France Foundation, American Express Japan, Association Ouest France Solidarité, Aviation Club de France, Bärchen, Bred, CIC, Chaîne du bonheur, Crédit mutuel, Crédit coopératif, Fellissimo Japan, Annenberg Foundation, Clinton Foundation, Drosos Foundation, Fondation de France, Bill & Melinda Gates Foundation, L’Occitane Foundation, L’Oréal Foundation, Marcel Lepoutre Foundation, Maria Stroot Foundation, McCall MacBain Foundation, Mitsui Japan, Optic 2000 Foundation, Peugeot Foundation, Renovabis Foundation, Roi Baudouin Foundation, Stern Stunden Foundation, Fubon Cultural & Educational Foundation, PPR Foundation for dignity and women’s rights, Imerys Ceramics France, l’Acoustics SA, Ivoire, Les Éditions Maréchal, L’Oréal SA, Matmut Assurances, Mr and Mrs Peters, Oh ! Éditions, Orepa Prévoyance, Rotary Club La Réunion, Sanofi Aventis France, Société générale, Solidarpresse, Vinci, Vivendi.

INSTITUTIONAL PARTNERS Multilateral organisations European Union (DG Echo, DG DevCO/ EuropeAid), United Nations agencies (UNDP, UNFPA, HCR, Unicef, OCHA, UNAIDS, UNODC, WFP, WHO, CHF, ERF, Cerf), Global

Fund against Aids, tuberculosis and malaria, World Bank, 3 Diseases Fund (3DF).

Bilateral organisations • In Europe : German official development assistance (AAH – urgence), UK official development assistance: Department for International Development (DFID), Spanish official development assistance (AECID, Junta de Andalucia), Monaco official development assistance (DCI), Dutch official development assistance (MFS and through the NGOs Cordaid and Novib), Norwegian official development assistance, Swiss official development assistance (DDC), Danish official development assistance.

• In France : Agence française de développement (AFD), Centre de crise du ministère des Affaires étrangères et européennes (CDC), French embassies (via SCAC and FSD).

• Others : American development assistance: USAID via the NGO PACT, PSI, Canadian International Development Agency (CIDA), Japanese official development assistance (JICA).

• French local authorities: Rhône-Alps region, Safer de l’Île-de-France, Reunion District Council, Val-d’Oise District Council, Alsace Regional Council, PACA Regional Council, Nord-Pas-de-Calais Regional Council, Aurillac

Basin Council and Greater Angoulême Council.

• Town councils: Paris, Grenoble, Rhinau, Le Cannet, Rehon, Dreux, Fontenay-sous-Bois, Montpellier, Guillestre, Haironville, Joigny, Rouen, Senches, Tournus, Dreux, Montpezat de Quercy, Saint-Aubin, Saint-Étienne…

For our regionally-managed international projects: District councils: Bouches-du-Rhône, Alpesde-Haute-Provence, Gironde, Charente-Maritime, Vosges, Doubs, Reunion, Midi-Pyrénées, PACA ; Regional councils: Provence-AlpesCôte d’Azur and Rhône-Alps ; présidence des régions, Guadeloupe prefecture.

For our programmes in France Agence nationale de recherche sur le Sida (ANRS), regional public health groups (GRSP) and regional health agencies (ARS), 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 (Acsé), Direction générale de la Santé (DGS), Direction générale de la cohésion sociale

DOCTORS OF THE WORLD ANNUAL REPORT 2011

(DGCS), Institut national de la santé et de la recherche médicale (Inserm), prefectures, healthcare access offices (PASS), the territorial army, Direction de l’Action sociale, de l’Enfance et de la Santé (DASES), Mission interministérielle de lutte contre la drogue et la toxicomanie (MILDT), Département Santé et Société (DSS), regional health insurance fund unions (URCAM), hospitals, Guiana social security fund (CGSS), Mutualité sociale agricole (MSA), Observatoire français des drogues et des toxicomanies (OFDT).

OUR PARTNER ASSOCIATIONS

Aides, ALC Nice, Amnesty International, ANEF, Association de communication et d’action pour l’accès aux traitements, Association des régions de France, Association française de réduction des risques, Association des familles victimes du saturnisme, Association d’autosupport et de réduction des risques des usagers de drogues, Association des gens du voyage, Santé sans frontières, Association des inadaptés des PO, Association des médecins du Pays de Retz, Association Cercle central, Association Gérer son stress, Association médicale Pascal, Association Partage et Fraternité, Association Régul 31, Association Rencontre avec des hommes remarquables, Association Une foulée pour la vie, Association

Le Foyer, Association Setton, Association Sanatatea, Association Sida paroles, Association Gaïa Paris, ATD Quart-Monde, Avenir et Coopération, Banque humanitaire, Bus 31/32, Centre de planification des Pays de la Loire, Coordination française pour le droit d’asile (CFDA), Collectif Alsace d’associations intervenant auprès des personnes se prostituant, Collectif interassociatif sur la santé (CISS), Collectif Romeurope, Collectif Migrants outre-mer (MOM), Collectif Alerte, Collectif de soutien aux victimes de Bam, Comité des amis d’Emmaüs, Communauté mariste, Congrégation des sœurs augustines, Cordaid, the Red Cross, CSF, Coordination française pour le droit d’asile, Coordination nationale des réseaux (CNR), Cyclamed, Droit au logement, D’une rive à l’autre, DHL Liens, Emmaüs, Entraide majolane, Équipe mobile Rimbaud, 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), Foyer Sonacotra, Foyer St-Benoît, Gisti, International Harm Reduction Association (IHRA), Ordre de Malte, La Case, les Amis du bus des femmes, Les Mondes solidaires, Les Restos du cœur, le Stade rennais FC, Brittany football league (and the Brittany clubs),

Ligue des droits de l’homme, Max Havelaar, Novib, Observatoire du droit à la santé des étrangers (ODSE), Observatoire international des prisons (OIP), Pact, Passerelle la Santé sans frontières, Pharmacie humanitaire internationale (PHI), Plateforme contre la traite des êtres humains, Secours catholique, Sidaction, Sid’espoir, Solidarité Sida, SOS Drogue international (SOS DI), SOS Femmes, Rasko, Techno Plus, Uniopss, Veille sociale, Vialtis, Tourism for Development (TFD), AS Kiwanis Club, Addocuiation, Les Jardins du livre, Association école de Karaté traditionnel, Rotary Club Saint-Nazaire Atlantique, Association Notre-Dame des Aides.

AND ALL OUR OTHER PARTNERS WHO HAVE SUPPORTED OUR WORK AT HOME AND ABROAD DURING 2011, PARTICULARLY THOSE WHO HAVE SUPPORTED US WITH A LEGACY OR LIFE INSURANCE POLICY AND OUR OTHER INDIVIDUAL DONORS.

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Glossary A ACF : Action Contre la Faim (Action against Hunger) AFD : Agence française de développement (French Development Agency) AFR : Association française pour la réduction des risques (French Harm Reduction Association) AFR : Association française pour la réduction des risques (French Harm Reduction Association) AIDS: Acquired Immune Deficiency Syndrome AME: Aide médicale de l’État (State Medical Aid) AME: Association malienne des expulsés (Malian Association for Deportees) ANRS: Agence nationale de recherche sur le sida et les hépatites virales (French National AIDS and Viral Hepatitis Research Agency) ARACEM: Association des refoulés d’Afrique centrale au Mali (Association for Central African Deportees in Mali) ARCAT: Association pour la recherche et la communication pour l’accès aux traitements (Association for Research and Communication on Access to Treatment) AP-HP: Assistance publique-Hôpitaux de Paris (Paris hospitals social services) ARS: Agence régionale de santé (Regional Health Agency) ARV: Antiretrovirals ASE: Aide sociale à l’enfance (Child social services)

C CAARUD: Centre d’accueil et d’accompagnement à la réduction des risques pour les usagers de drogues (Harm reduction centre for drug users) CABHA: Amadou Hampâté Bâ Centre CAPS: Comité d’action et de promotions sociales (Committee of social promotion and action) CDAG : Centre de dépistage anonyme et gratuit (Free and anonymous screening centre)

CDC: Center for Disease Control CFDA : Coordination française pour le droit d’asile (French Co-ordinating body on the Right to Asylum) CHP : Community Health Partnership CIDA: Canadian International Development Agency CIMADE: Comité inter-mouvement auprès des évacués - service œcuménique d’entraide (Ecumenical Mutual Aid Service) CMA: Commonwealth Medical Association CMU: Couverture maladie universelle (Universal Health Insurance) CMU-C: Couverture maladie universelle complémentaire (Complementary Universal Health Insurance) COE: Council of Europe COMEDE: Comité médical pour les exilés (Medical Committee for Exiles) CONCORD: Confédération européenne des ONG d’urgence et de développement (European Federation of Emergency and Development NGOs) COREVIH: Comité de coordination de lutte contre l’infection due au VIH (Co-ordination Committee for Action Against HIV) CPAM: Caisse primaire d’assurance maladie (Local Health Insurance Office) CREDOC: Centre de recherche pour l’étude et l’observation des conditions de vie (Centre for Research for Study and Observation of Living Conditions) CREN: Centre de récupération et d’éducation nutritionnelle (Nutritional Recovery and Education Centre) CRIPS: Centres régionaux d’information et de prévention du sida (Regional Centre for Prevention and Information on Aids) CRSA: Conférences régionales de la santé et de l’autonomie (Regional Conferences on Health and Independence)

D DDVLAT: Dispositif départemental de vaccination et de lutte anti-tuberculeuse (District Action Plan for Vaccination and Tackling Tuberculosis)

Dev-co: Programme of International Development Aid DGS: Direction générale de la Santé (French Ministry of Health) DoW: Doctors of the World (Médecins du Monde) DPO: Division du partenariat avec les ONG (NGO Partnership Division) DRDFE: Délégation régionale aux droits des femmes et à l’égalité (Regional Delegation for Women’s Rights and Equality) DRC: Democratic Republic of Congo DREES: Direction de la recherche, des études, de l’évaluation et des statistiques (Department for Research, Evaluation and Statistics) DRR: Disaster risk reduction DUA: Dar ul-Aman

E ECHO: European Commission Humanitarian Office ECOSOC: Economic and Social Council ERLI : Éducation aux risques liés à l’injection (Education on risks associated with injection) EU: European Union

F FUH: Fond humanitaire d’urgence (Humanitarian Emergency Fund) FAO: Food and Agriculture Organization FTE: Full-time equivalent

G GISTI: Groupe d’information et de soutien des immigrés (Immigrant support and information group)

DOCTORS OF THE WORLD ANNUAL REPORT 2011

H

L

T

HBV: Hepatitis B virus HCV: Hepatitis C virus HDI: Human Development Index (statistical index, from 0 to 1, created by the UN Development Program to evaluate the level of human development of 187 countries in the world. The HDI is based on three key criteria: life expectancy, educational level and standard of living.)

HIV: Human Immunodeficiency Virus

LDH: Ligue des droits de l’homme (Human Rights League)

TB: Tuberculosis TLC: Thin Layer Chromatography

M

U

MCWAK: Maternity and Child Welfare Association Khampur MDGs: Millenium Development Goals MdM: Médecins du Monde (Doctors of the World) MSF: Médecins sans frontières (Doctors without Borders)

UMAPP: Unité mobile d’action psychiatrique pour les personnes précarisées (Mobile psychiatric outreach unit for vulnerable people) UMAS: Unité mobile d’accès aux soins (Mobile Healthcare Access Unit) UN: United Nations UNAIDS: United Nations Programme on HIV/AIDS UNDP: United Nations Development Programme UNFPA: United Nations Population Fund UNHCR: United Nations High Commissioner for Refugees Unicef: UN Fund for Children

I ICASA: International conference on AIDS and STIs in Africa ICRC: International Committee for the Red Cross ICVA : International Council of Voluntary Agencies IFSI: Institut de formation en soins infirmiers (Nurse Training Institute) IMT: Institut de médecine tropicale (Tropical Medicine Institute) IND: International Network Department INSERM: Institut national de la santé et de la recherche médicale (National Institute for Health and Medical Research) INTERREG: European Cross-Border Co-operation IREPS: Instance régionale d’éducation et de promotion de la santé (Regional Authority on Health Education and Promotion) IRTS : Institut régional du travail social (Regional Social Work Institute) ISPED: Institut de santé publique d’épidémiologie et de développement (Institute of Public Health, Epidemiology and Development) ISL: Internal Security Law IUT: Institut universitaire de technologie (University Technology Institute) IVDU: Intravenous drug users

J JKSMS: Jan Kala Sahitya Manch Sanstha

K KAD: Kindianaise d’assistance aux détenus (Kindianese Support for Detainees) KIA: Kachin independence army KAP: Knowledge, Attitudes and Practices

N

NC: Not classified NGO: Non-governmental organisation

O

OCHA: UN Office for Humanitarian Affairs ODSE: Observatoire du droit à la santé des étrangers (Observatory on Right to Health for Migrants) OHRA : Organisation for Harm Reduction in Afghanistan

V VOICE: Collective of European NGOs VHAI : Voluntary Health Association of India

P

W

PACA : Provence-Alpes-Côte d’Azur PAF: Police aux frontières (Border police) PRAPS: Programme régional d’accès à la prévention et aux soins (Regional Programme for Access to Prevention and Healthcare)

WAHA: Women and Health Alliance WFP: World Food Programme WHO: World Health Organization

Q

X

QUAMED: Quality medicine for all

XBT: Drug analysis

S S2AP: Service d’analyse, d’appui et de plaidoyer (Analysis, Support and Advocacy Department) SAI: Service adoption international (International adoption service) SCD: Socio-cultural determinants SIAO: Service intégré d’accueil et d’orientation (Integrated Reception and Advice Service) SRH: Sexual and reproductive health STI: Sexually transmitted infection

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EDITOR-IN-CHIEF DR OLIVIER BERNARD COORDINATION HÉLÈNE VALLS EDITORIAL COMMITTEE ISABELLE BIOH-JOHNSON KASIA BONKOWSKA JULIETTE CHEVALIER NOLWENN ROUSSIER

EDITORS NOLWENN ROUSSIER SANDRA RUDE AUDREY THURIN HÉLÈNE VALLS EDITORIAL SECRETARY THÉRÈSE BENOIT

MAPS JULIEN BOUSAC VINCENT GIAVELLI GRAPHIC DESIGN & PICTURE EDITOR AURORE VOET PRODUCTION OF THE CD FILES ISABELLE MARTIJA-OCHOA

PRODUCTION E-GRAPHICS\FRANCE TRANSLATION KAREN MCCOLL ELINOR MIDDLETON GILL COCKIN ANGELINE DAVIES THANKS TO EVERYONE WHO HELPED WITH THE 2011 EDITION

DOCTORS OF THE WORLD ANNUAL REPORT 2011

107

WE ARE ALL DOCTORS OF THE WORLD

Médecins du Monde 62, rue Marcadet 75 018 Paris www.medecinsdumonde.org Tel. +33 (0)1 44 92 15 15 Fax. +33 (0)1 44 92 99 99 © Chien-Chi Chang/Magnum

© Isabelle Eshraghi

© Éric Rechsteiner

© Lâm Duc Hiên

© Sophie Brändström

© Lahcène Abib

© Lâm Duc Hiên

© Julien De Weck

© Katrijn Van Giel

© Andréa Lamount

International Programmes » AFRICA

DOCTORS OF THE WORLD

Angola

Sexual and reproductive health in rural areas

ANNUAL REPORT 2011

Since the end of the civil war in 2002, the process of reconstruction is accelerating in Angola, thanks, in large part, to oil revenues. But not everyone benefits from this wealth. In rural areas, access to healthcare remains difficult and little effort is spent on training medical personnel. By contrast, in the areas where people who benefit from oil revenue are concentrated, modern facilities are built and foreign doctors are recruited.

» Kwanza Norte

LIFE EXPECTANCY 51.1 YRS HDI 0.486; RANK 148

» ACTIVITIES

POPULATION

Since summer 2011, MdM Spain and MdM France have been working on a joint project in Kwanza Norte province, aiming to reduce maternal and infant mortality, which is the highest in Southern Africa. To refine the strategy, a series of anthropological and health surveys were conducted throughout the year.

PERSONNEL

» RESULTS

Source: UNDP 2011

»T arget: 56,057 »N ational: 2 » I nternational: 2

Drawing on the results of the surveys, a training programme for nursing staff in the province has been devised, in co-operation with the health authorities, and will be launched in 2012.

CO-ORDINATORS

»P rogramme: Luc Jarrige, Diana Sistiva »F ield: Begonia Ruiz »H eadquarters: Stéphanie Derozier FUNDING

»E uropeAid, MdM BUDGET

»2 011: € 47,338

» OUTLOOK Increased mobilisation of community stakeholders (young people, traditional midwives, leaders) will allow the populations to be involved in the organisation and decision-making regarding health issues. A campaign for greater investment to support healthcare facilities will also be developed.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Burkina Faso Treating child malnutrition

ANNUAL REPORT 2011

The health situation in Burkina Faso is amongst the most fragile in West Africa. Owing to poor economic growth and a lack of political will to create an effective healthcare system, the living conditions of the inhabitants are not improving. 45% of Burkinabes live below the poverty line. MdM is working to provide healthcare for the most vulnerable (children under five years old and pregnant women) and to prevent childhood malnutrition.

» Diébougou, in the south-west region

LIFE EXPECTANCY 55.4 YRS HDI 0.33; RANK 181 Source: UNDP 2011

POPULATION

»B eneficiary: 2,149 »T arget: children under five PERSONNEL

»N ational: partner organisation CO-ORDINATORS

»P rogramme: Philippe de Botton »M onitoring: PACA regional delegation, Isabelle Malaval FUNDING

»S CAC, private donors, MdM BUDGET

»2 011: €22,508

» ACTIVITIES MdM provides access to healthcare for malnourished children who may, or may not, be accommodated in the Centre for Recuperation and Nutrition Education (CREN), and is strengthening and consolidating its activity.

Nurses from the provincial hospital, the CMA, work three shifts a week to guarantee better medical and nutritional monitoring for the children. This action aims to strengthen the partnership between CREN and the CMA. Every Saturday, children who are not being cared for in these centres, who come from the surrounding villages and from Diébougou, have access to healthcare. In 2011, the programme screened for malnutrition, raised awareness and provided treatment for cases of chronic malnutrition in and around the villages of Bamako and Loto.

In addition, MdM finances medical and resuscitation equipment in the CREN and the CMA.

» RESULTS 26 children, suffering from acute or chronic malnutrition, cared for and given medical treatment in the CREN. 1,590 children (five times more than in 2010) had medical consultations, coupled with nutritional advice and distribution of supplementary flour. 533 children (three times more than in 2010) diagnosed and treated in the villages.

» OUTLOOK MdM began to withdraw at the end of 2011 but continues to strengthen its partnership with the district hospital.

The focus is on the systematic referral of children suffering from severe malnutrition, who are sent to the CREN. Alongside this, MdM continues its screening and nutritional education work in the villages, where the number of children affected by malnutrition seems to be increasing. MdM is also working with the diocese to set up a unit producing Misola flour in the town of Dissin in order to prevent and treat cases of chronic malnutrition linked to food insecurity. This is an industry which allows communities of women to have an income generating activity.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Burkina Faso Access to dental healthcare

ANNUAL REPORT 2011

The health situation in Burkina Faso is amongst the most fragile in West Africa. Owing to poor economic growth and a lack of political will to create an effective healthcare system, the living conditions of the inhabitants are not improving. 45% of Burkinabes live below the poverty line. Against this backdrop, MdM is attempting to remedy the shortcomings in oral health.

» Diébougou, region in the south west

LIFE EXPECTANCY 55.4 YRS HDI 0.33; RANK 181 Source : UNDP 2011

POPULATION

»B eneficiary: 1,182 »T arget: population of Diébougou province PERSONNEL

»N ational : partner organisation CO-ORDINATORS

»P rogramme: Philippe de Botton » Field: Severin Dabire » Monitoring: PACA Regional Delegation, Isabelle Malaval FUNDING

» MdM, SCAC BUDGET

»2 011: included in the Burkina Faso nutrition budget

» ACTIVITIES The dentist surgery, set up by MdM in 2006, continues to operate and is open five days a week. There was a significant increase in attendance in 2011 compared with 2010 (920 extra patients, meaning an increase of 30%).

Almost 80 patients are treated every month, of which 85% are new. The main activity is still extractions, which account for over 50% of procedures. Two monthly trips with a mobile unit bring dental healthcare to people living far away from the surgery. 262 patients, nearly all new, have been able to be treated in this way: here too, extractions continue to increase. This phenomenon can be explained, in part, by the reduction in the cost of treatment, which is 88% financed by MdM. This subsidy was 70% in 2010 and 35% in 2009. In addition, MdM is setting up a project to provide dentures and is building a denture laboratory, which we are supporting with two technical training programmes.

» RESULTS 1,182 consultations: extractions account for over 64% of all cases.

» OUTLOOK MdM began its withdrawal in December 2011, but will continue to supervise the project in 2012, to ensure its medical and financial sustainability. At the beginning of 2012, the dentist’s chair will be replaced during the maintenance team’s annual visit. The work of the surgery and the mobile unit will be strengthened with the arrival of a second practitioner, who has completed his training thanks to the support and finance provided by MdM since the beginning of the project. The denture programme will be further developed with the provision of training, in France, for two dental nurses.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Reduction in maternal and neonatal mortality, and mortality linked to obstetric fistulas

With 1,200 maternal deaths for every 100,000 births, Chad remains very backward in terms of access to healthcare for mothers and newborn babies. Against this backdrop, MdM is stepping up its presence and trying to overcome the shortcomings in the health system in the Kanem region, where there are only three doctors and three midwives for around 300,000 inhabitants.

Chad LIFE EXPECTANCY 49.6 YRS HDI 0.328; RANK 183 Source: UNDP 2011

POPULATION

»B eneficiary: 5,924 »T arget: 37,193 PERSONNEL

»N ational: 46 » I nternational: 5 CO-ORDINATORS

»P rogramme: Éric Peterman »F ield: Alexandra Panis »H Q: Bertrand Bréqueville FUNDING

»S DC (Swiss development assistance), Unicef, UNFPA, WHO, MdM BUDGET

»2 011: €831,751

ANNUAL REPORT 2011

» Kanem region, Mao and Mondo health districts

» ACTIVITIES The programme is supporting around 15 healthcare centres as well as the maternity unit and operating theatre of the hospital in Mao, the regional capital. MdM offers antenatal and postnatal consultations, provides additional training in maternal health and deploys an ambulance service, which means that obstetric emergencies can be referred from the healthcare centres to the hospital. Medicines are also provided for the hospital.

To raise awareness, of the importance of maternal and neo-natal healthcare, MdM conducts information sessions in the villages, based in the healthcare centres.

Finally, MdM trains and trains and supports Chadian doctors in the surgical treatment of obstetric fistulas. The women who have had operations, are given psychological and social counselling.

» RESULTS The awareness raising sessions are bearing fruit: 350 women a month come to a health centre for their third antenatal consultation.

» OUTLOOK In 2012, MdM plans to put greater emphasis on prevention measures. That will include greater involvement of community leaders at awareness-raising sessions and the establishment of a community referral system for obstetric emergencies between villages and the healthcare centres.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Côte d’Ivoire Access to healthcare in a post-conflict situation

ANNUAL REPORT 2011

At the time of the presidential election at the end of November 2010, Alassane Ouattara was declared the winner by the Independent Electoral Commission but the Constitutional Council declared the outgoing president Laurent Gbagbo the winner. This confusion triggered another period of difficulties which paralysed the economy and plunged Côte d’Ivoire’s population into a new crisis. MdM, having worked in Côte d’Ivoire between 1987 and 2007, decided to support the healthcare centres in Abidjan, which were affected by the conflict and to uphold the new policy of free healthcare agreed upon by Alassane Ouattara. » Abidjan

LIFE EXPECTANCY 55.4 YRS HDI 0.43; RANK 170 Source: UNDP 2011

POPULATION

»B eneficiary: 200,936 »T arget: 1,229,000 PERSONNEL

»N ational: 14 » I nternational: 5 CO-ORDINATORS

»P rogramme: Luc Jarrige »F ield: Christophe Gargot »M onitoring: Morgane Aveline FUNDING

»E CHO, Chaîne du Bonheur, MdM BUDGET

»2 011: €759,524

» ACTIVITIES Having worked in close co-operation with the local authorities to identify the needs, MdM has, for four months been supporting 21 public and community healthcare centres and five maternity clinics in the most vulnerable areas of Abidjan. MdM financed restoration work on these facilities, provided medicines and equipment and provided remuneration for medical personnel. Alongside this activity, MdM developed a programme to manage the screening and referral of victims of sexual or physical violence, of people suffering from mental problems or people with HIV/Aids or tuberculosis.

» RESULTS 113,007 people have benefited from a medical consultation during the project.

» OUTLOOK Once the acute crisis had passed in Abidjan, MdM decided to focus its attention on rural areas, which, as well as being affected by the crisis, are deficient in healthcare provision.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Côte d’Ivoire Improvement in access to healthcare for mothers and babies

ANNUAL REPORT 2011

The successive political and military crises in Côte d’Ivoire have had a major impact on the health of the population and on the healthcare system as a whole. Although the Abidjan region, which has 60% of health resources may have been spared, that is not the case in other regions such as Bas-Sassandra. Following a four month emergency programme in Abidjan, MdM is continuing its efforts, supporting the policy of free healthcare advocated

by President Ouattara, and targeting the most vulnerable. » Bas-Sassandra

LIFE EXPECTANCY 55.4 YRS HDI 0.43; RANK 170 Source: UNDP 2011

POPULATION

»B eneficiary: 25,014 »T arget: 391,211 PERSONNEL

»N ational: 14 » I nternational: 6 RESPONSABLES

» ACTIVITIES MdM is supporting 13 rural maternity units through a programme of renovation of premises and provision of medicines and essential equipment. The programme also offers targeted training in the care for and detection of women with at-risk pregnancies and victims of violence. At the same time, health education sessions are organised.

To ensure continuity of maternal and child healthcare, the project aims to improve provision of care for obstetric emergencies in three hospitals. MdM has established protocols, provided medicines and equipment and is training the personnel.

»P rogramme: Sophie Rhodes »F ield: Pascale Blanchetière »M onitoring: Morgane Aveline

» RESULTS

FUNDING

» OUTLOOK

»E CHO, Chaîne du Bonheur, MdM BUDGET

»2 011: €289,613

19,119 consultations took place.

MdM’s project continues until June 2012, at which time MdM Switzerland will take over the project, supporting three or four health centres. The aim is to continue to provide free care for pregnant women and children under five years old, all the while lobbying for the continuity of targeted free health provision.

International Programmes » AFRICA

DRC Treating and protecting girls living on the streets and their babies

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Democratic Republic of Congo Despite the gradual return to peace in most of the country, 2011 was marked by electoral political unrest and the relegation of the country to lowest ranking in the world’s human development index. MdM is supporting the health authorities and civil society partners in the provision of access to healthcare for the most vulnerable, in the fight against major endemic diseases and epidemics and violence against women.

» Kinshasa

LIFE EXPECTANCY 48.4 YRS HDI 0.286; RANK 187 Source: UNDP 2011

POPULATION

»B eneficiary: 2,564 »T arget: 20,341 PERSONNEL

»N ational: 23 » I nternational: 4 CO-ORDINATORS

»P rogramme: Didier Cannet »F ield: Pascale Barnich-Mungwa »H eadquarters: Céline Beaudic FUNDING

»A FD, EuropeAid, Fubon Foundation, Annenberg Foundation, MdM

» ACTIVITIES In partnership with the Congolese organisation AED, and in conjunction with an extensive network of institutional and civil society stakeholders, the project aims to promote the health of children living on the streets, in particular girls and their babies. The programme informs them of their rights, like contraception for minors or child protection. Education sessions on health are also offered, to try and reduce the sexual risks to which the children and adolescents are exposed. Alongside this, adolescents are offered workshops on self-esteem.

Basic healthcare consultations allow patients to be directed to appropriate healthcare facilities, in particular for HIV/Aids screening and treatment. Finally a semi-open clinic is specifically for girls and young women living on the streets. Here they receive medical treatment and information on reproductive health, they are listened to and supported in cases of sexual violence.

» RESULTS 15,319 consultations have taken place, of which 57% were for girls and 30% for children under five years old.

1,919 reproductive health consultations, of which 1,217 were pregnancy monitoring.

245 girls have started to use contraceptives.

BUDGET

»2 011: €751,136

» OUTLOOK MdM will strengthen the prevention arm of the programme, notably with regard to sexually transmitted infections and hepatitis. Psychological and social counselling of patients living with HIV will be further developed. Young girls will be increasingly involved with the project, in particular through self-help groups and peer education.

Interviews with young girls

“When I come to the BBS centre (reception centre), I rest, I have a wash and receive free treatment.”

“At the BBS centre, teachers replace our parents.”

“At the BBS centre, we receive affection that we can never have on the streets.”

International Programmes » AFRICA

DRC The fight against HIV/Aids

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Democratic Republic of Congo Despite the gradual return to peace in most of the country, 2011 was marked by electoral political unrest and the relegation of the country to lowest ranking in the world’s human development index. MdM is supporting the health authorities and civil society partners in the provision of access to healthcare for the most vulnerable, in the fight against major endemic diseases and epidemics and violence against women.

» Nord-Kivu province (health zones of Goma and Karisimbi)

LIFE EXPECTANCY 48.4 YRS HDI 0.286; RANK 187 Source: UNDP 2011

POPULATION

»B eneficiary: 5,756 »T arget: 20,000 PERSONNEL

»N ational: 26 » I nternational: 3 CO-ORDINATORS

» Programme: Almouner Talibo, Frédéric Jacquet »F ield: Pascale Barnich-Mungwa »H eadquarters: Céline Beaudic FUNDING

»G lobal funds (UNDP and Cordaid), WFP, MdM BUDGET

»2 011: €492,351

» ACTIVITIES Launched in 2003, the programme aims to ensure prevention of and treatment for sexually transmitted infections and HIV/Aids. MdM has teamed up with local stakeholders, health authorities and national organisations to support this project in Goma and Karisimbi. The arrangement comprises three services dedicated to sexually transmissible infections, an anonymous and free screening centre, an HIV/Aids treatment service, two centres working on reduction of mother to child transmission, as well as a provincial centre for blood transfusions. Twelve local organisations are also supported in their awareness-raising activities.

In 2011, MdM hoped to gradually hand over to local stakeholders but the freezing of payments from the Global Fund in DRC seriously undermined this plan.

» RESULTS 5,756 patients treated, of which 1,496 received antiretroviral treatment.

3,395 new screenings carried out (HIV found in 13% of cases).

» OUTLOOK Local stakeholders involved in the fight against HIV have acquired enough experience to be able to take over the project. MdM provides technical and financial support to ensure the sustainability of the activity. However, the drastic reduction in funding for programmes against HIV risks seriously undermining the project.

The case of an HIV patient treated in a centre that is supported by MdM. In the absence of funding, the coverage of antiretrovirals in DRC is very low, one of the lowest in the world. It is estimated that only 14% of the needs are met.

“I can no longer obtain antiretrovirals, everything is blocked, I am becoming weaker and weaker because I cannot get medicines... I am already facing death.”

International Programmes » AFRICA

DRC Combat sexual violence through the development of a community mental health programme

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Democratic Republic of Congo Despite the gradual return to peace in most of the country, 2011 was marked by electoral political unrest and the relegation of the country to lowest ranking in the world’s human development index. MdM is supporting the health authorities and civil society partners in the provision of access to healthcare for the most vulnerable, in the fight against major endemic diseases and epidemics and violence against women.

» Nord-Kivu province

» ACTIVITIES LIFE EXPECTANCY 48.4 YRS HDI 0.286; RANK 187 Source: UNDP 2011

POPULATION

» Beneficiary: 3,620 » Target: 14,400 PERSONNEL

» National: 14 » International: 3 CO-ORDINATORS

» Programme: Christian Laval » Field: Pascale Barnich-Mungwa » Headquarters: Céline Beaudic FUNDING

» AFD, MdM BUDGET

MdM’s objective is to develop the skills of psychosocial counsellors and community workers who support victims of sexual violence. A resource centre dealing with the issue of sexual violence has been created to promote the exchange and sharing of experiences by the counsellors. MdM also provides technical and financial support to 10 Congolese organisations that are developing community mental health projects to combat sexual violence in Goma and in the rural areas of the province. Thus, these organisations provide awareness-raising activities and psychosocial care for women who are victims of violence. They support them during their reintegration into society and their families.

» RESULTS 3,620 women victims of sexual violence supported by 83 psychosocial counsellors, trained in assisting victims.

» OUTLOOK A second group of community workers will be trained in assisting victims and the embedding of activities in Congolese civil society will continue, thanks to the partnership with local organisations involved in combatting sexual violence.

» 2011: €351,062

Annie, psychosocial counsellor

“I learned a lot during my training courses, which enabled me to share my knowledge within my organisation and my community. I also try to apply what I have learned on a day-to-day basis. This helps me personally on every level and has changed my life for the better. I have changed how I look at others and I am better able to interact with victims who need psychological support.”

International Programmes » AFRICA

DRC Strengthening the district health system and tackling epidemics

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Democratic Republic of Congo Despite the gradual return to peace in most of the country, 2011 was marked by electoral political unrest and the relegation of the country to lowest ranking in the world’s human development index. MdM is supporting the health authorities and civil society partners in the provision of access to healthcare for the most vulnerable, in the fight against major endemic diseases and epidemics and violence against women.

» Katanga province, Tanganyika district

LIFE EXPECTANCY 48.4 YRS HDI 0.286; RANK 187 Source: UNDP 2011

INTERNATIONAL DELEGATION

»M dM Belgium POPULATION

»B eneficiary: 140,643 »T arget: 209,846 PERSONNEL

»N ational: 33 » I nternational: 5 CO-ORDINATORS

»P rogramme: Xavier Joubert » Field: Pascale Barnich-Mungwa »H eadquarters: Céline Beaudic FUNDING

» ACTIVITIES From 2006 to 2011 this programme supported the health authorities in the rebuilding and strengthening of Tanganyika district health system, as well as in the fight against epidemics. The partnership promoted access to healthcare and was able to bring about an improvement in the quality of care available to the general population of the region. MdM worked alongside the health authorities in various health centres and assisted with the training of personnel in healthcare facilities. These facilities were renovated and provided with medicines and with rehydration equipment to enable them to deal with cholera victims. Epidemiological monitoring and vaccination campaigns were carried out—in particular against polio and measles. The communities benefited from health education programmes.

» RESULTS 119,143 cases of malaria treated and 140,643 children under one year old (0 – 11 months old) vaccinated against polio.

» OUTLOOK

»E uropAid, MFS (Netherlands), American Express Japan, UNDP, MdM

The partnership, which has been running for over five years has allowed responsibility to be transferred to competent authorities in the district. Thus, MdM closed its project in August 2011.

BUDGET

From emergency to reconstruction, MdM’s experience in Tanganyika, where it has been working for the past 10 years, has been the subject of a capitalisation study.

»2 011: €1,167,337

International Programmes » AFRICA

DOCTORS OF THE WORLD

Ethiopia Improving healthcare provision for people in isolated regions

ANNUAL REPORT 2011

In 2011, a nutritional crisis came on top of the ongoing conflict in the Ogaden region, of south-east Ethiopia. Humanitarian organisations, confronted with various problems (insecurity and red tape) around access to the Kebri Dehar area, were unable to carry out their work.

Faced with this situation, and despite the scale of need, MdM decided to end its activities in the Somali region in June.

» Kebri Dehar district

LIFE EXPECTANCY 59.3 YRS HDI 0.363; RANK 174 Source: UNDP 2011

POPULATION

»B eneficiary: 21,613 »T arget: 75,354 PERSONNEL

»N ational: 10 » I nternational: 1 CO-ORDINATORS

»P rogramme: Pierre Beze Beyrie »F ield: Claire Martel »H eadquarters: Bertrand Bréqueville FUNDING

»A FD, MdM BUDGET

»2 011: €210,241

» ACTIVITIES For the first few months of the year, MdM continued to support the hospital in Kebri Dehar by training midwives and completing the construction of a new maternity unit. Owing to serious administrative constraints and to insecurity when travelling outside the town of Kebri Dehar, MdM was unable to provide a satisfactory level of support to the health posts in rural areas. However, we were able to come to the aid of three healthcare centres (of which one has been newly built) in Kebri Dehar. Here, we provided medicines and equipment and also contributed to the training of staff.

» RESULTS The three healthcare centres in Kebri Dehar provide women and children who are unable to obtain hospital treatment, with basic healthcare.

» OUTLOOK After ending the programme in the Somali region, MdM is looking into redeploying its operations to other regions of Ethiopia. An exploratory project is planned in the Benishangul-Gumuz region, in the west of central Ethiopia.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Medical support for detainees

In Guinea, the new Alpha Condé political regime faces huge challenges with limited resources.

The social and economic situation is very precarious. In this context, the fate of prison populations is especially worrying. Working alongside its local partner, MdM is struggling against malnutrition in Kindia prison and is working towards the improvement of prison conditions.

Guinea

ANNUAL REPORT 2011

» Kindia

LIFE EXPECTANCY 54.1 YRS HDI 0.34; RANK 178 Source: UNDP 2011

POPULATION

» Beneficiary: 1,004 »T arget: 1,500 PERSONNEL

» ACTIVITIES MdM is supporting the organisation Kindian Assistance to Detainees (KAD) in its work to improve conditions of detention for prison populations in Kindia’s central prison. The programme revolves round several central themes: the environment (hygiene and sanitation, development, rehabilitation and maintenance of the facility), health (medical consultations, supplies for the pharmacy, nutritional support for the malnourished) and reintegration (education, literacy, income generating activities). MdM provides technical, moral and financial support to KAD

»N ational: local organisation

» RESULTS

CO-ORDINATORS

In 2011, 1,004 prisoners had medical consultations at the infirmary, 324 treatments were administered and 82 prisoners suffering from malnutrition were cared for by KAD in partnership with ICRC.

»P rogramme: Philippe Orcier » Field: Cellou Baldé » Monitoring: Rhône-Alps Regional Delegation FUNDING

»M dM

BUDGET

» 2011: €17,825

» OUTLOOK If the situation allows, MdM intends to further support the development of revenue generating activities. The focus will also be on raising funds from new donors so that eventually KAD can become autonomous.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Kenya Improving access to mother and child healthcare for local and refugee populations affected by drought LIFE EXPECTANCY 57.1 YRS HDI 0.509; RANK 143 Source: UNDP 2011

POPULATION

»B eneficiary: 7,152 »T arget: 68,000 PERSONNEL

The most serious drought in 60 years has arisen in the Horn of Africa, causing a major food crisis. In the north of Kenya, near the Somalian and Ethiopian borders, the Dadaab area is host to the biggest refugee camps in the world. The people here are especially vulnerable.

MdM has been working in the region for over 20 years and has set up a programme to meet the needs of the most vulnerable people.

» Dadaab district

» ACTIVITIES In partnership with the NGO Women and Health Alliance International (WAHA), MdM is supporting the district hospital in Dadaab, which treats both Kenyan people and refugees from the camps. MdM is working on refurbishing the hospital and on building other facilities (in particular, creation of a blood bank). We supply medicines and equipment and organise training sessions for the hospital personnel. Furthermore, the programme offers health awareness sessions.

» I nternational: 4

The support of nine outlying health centres is currently suspended for security reasons.

CO-ORDINATORS

» RESULTS

»P rogramme: Bernard Juan »F ield: Philippe Durand »H eadquarters: Ewelina Gasiorowska FUNDING

»S tern Stunden (Germany), Roi Baudouin Foundation (Belgium), Maria Stroot Foundation (Netherlands) BUDGET

»2 011: €349,322

ANNUAL REPORT 2011

7,049 consultations, 68 deliveries and 35 caesareans. Rehabilitation of a 60-bed hospital. Provision of 10 ambulances for the community.

» OUTLOOK MdM will continue working on the rehabilitation of the hospital until June 2012. Our partner organisation WAHA will continue with the project for the following two years.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Liberia Improving access to healthcare

ANNUAL REPORT 2011

Despite worrying health indicators (990 maternal deaths for every 100,000 births), the healthcare system in Liberia is steadily developing. The country is in the process of political stabilisation and has received the support of the international community, which augurs well for the future development of the country. Within this context, MdM is continuing its work in Bong county, with a focus on training and the transfer of skills.

» Bong County

LIFE EXPECTANCY 56.8 YRS HDI 0.329; RANK 182 Source: UNDP 2011

POPULATION

»B eneficiary: 119,642 »T arget: 333,000 PERSONNEL

» National: 53 » I nternational: 9 CO-ORDINATORS

»P rogramme: Patrick Hirtz »F ield: Brian Donaldson »H eadquarters: Bertrand Bréqueville FUNDING

»E CHO, EuropAid, AFD, McCall MacBain Foundation, MdM

» ACTIVITIES MdM, with its partners, supports 16 healthcare centres, amongst which is the CB Dunbar hospital in Gbarnga, the capital of the county. This support comprises the provision of a minimum level of services in sexual and reproductive health, in maternal and neonatal health as well as in mental health and primary healthcare. Community health initiatives have also been set up in the surrounding villages.

Open since 2011, the CB Dunbar hospital, with 55 beds, aims to become the hospital to which all obstetric and neonatal emergencies in the county are referred. It has specific support from MdM, both in terms of logistics and human resources.

In addition, MdM is working on strengthening the capacity of the core team in the Bong health district, and is responsible for supervising and co-ordinating activities.

Finally, MdM continues to train nurses and midwives, to ensure the sustainability of the project, which, in time, will be managed by local medical actors.

BUDGET

»2 011: €2,070,162

» RESULTS 1,022 children born at CB Dunbar Hospital, 356 caesareans, 93,758 curative consultations.

» OUTLOOK From 2012 onwards, MdM will start to reduce its involvement in the running of healthcare centres, whilst continuing to strengthen the capacity of the core team in the Bong health district (providing supervision, co-ordination, managing medicines etc). MdM should hand over its activities to the health authorities by the end of 2013.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Madagascar Paediatric cardiac surgery

ANNUAL REPORT 2011

The political and economic situation in Madagascar remains very precarious. International sanctions against the current government further weaken public policies. MdM’s activities are focussed on the most vulnerable: victims of natural disasters and political violence, prisoners and children awaiting surgery.

» Antananarivo

LIFE EXPECTANCY 66.7 YRS HDI 0.48; RANK 151 Source: UNDP 2011

POPULATION

»B eneficiary: 560 PERSONNEL

» ACTIVITIES This programme provides medical treatment for Madagascan children with heart defects and is often their only hope of survival. More than 80% of operations carried out in this specialism have been under the auspices of this project, which was launched in 1996 and encompasses the whole chain of cardiac surgery events, from screening to patient monitoring.

CO-ORDINATORS

Every year, the paediatric-cardiac team from Reunion, made up of cardiologists, cardiac surgeons, anaesthetists and intensive care practitioners, carry out two one-week missions in Madagascar. Closed heart operations are performed in collaboration with the Madagascan medical team. The ultimate objective is to create a Madagascan surgical team which is able to carry out these operations. This is why surgeons and cardiologists are trained in Reunion.

FUNDING

Children who need open heart surgery, on the other hand, are treated either in Reunion or in mainland France by several partners: La Ribambelle, La Chaîne de l’espoir and Mécénat Chirurgie Cardiaque.

»N ational: 15 » I nternational: 1 »P rogramme: Christophe Ottenwaelder »F ield: Catherine Courtin »H eadquarters: Stéphanie Derozier

» Monaco Principality, MdM BUDGET

» 2011: €66,967

» RESULTS 560 children have had medical consultations, 29 children have had open heart surgery and 20 children have had closed heart surgery. Two surgeons and one cardiologist have been trained to perform closed heart operations.

» OUTLOOK MdM plans to strengthen the capacity of Madagascan healthcare professionals by offering training in new skills.

MdM also seeks to guarantee access to cardiac care and surgery for the most vulnerable. A training course will be completed in 2012 by four people from the hospital’s intensive care unit so that a complete team can be established that is able to perform closed heart surgery.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Reduce health risks following natural disasters

The political and economic situation in Madagascar remains very precarious. International sanctions against the current government further weaken public policies. MdM’s activities are focussed on the most vulnerable: victims of natural disasters and political violence, prisoners and children awaiting surgery.

Madagascar

ANNUAL REPORT 2011

» The Sava region, in Sambava, Antalaha, Vohemar and Andapa districts

LIFE EXPECTANCY 66.7 YRS HDI 0.48; RANK 151 Source: UNDP 2011

POPULATION

» Beneficiary: 115,962 »T arget: 514,373 PERSONNEL

»N ational: 32 » I nternational: 2

» ACTIVITIES Having come to the aid of hurricane and flood victims on a dozen occasions, since 2008, MdM has been working on a programme of disaster risk reduction (DRC) to prepare communities for the effects of these tropical storms.

The pilot project, which was initially in Maroantsetra has been duplicated in the Sava region and comprises three prongs: support for the healthcare system (strengthening the community-based system, epidemiological monitoring, improving communications), support for victims of natural disasters (training rescue workers and an emergency medical team, developing a contingency plan, provision of equipment) and engaging the community with disaster risk reduction (participative analysis of the vulnerabilities, raising awareness through a traditional song competition, community micro-projects).

CO-ORDINATORS

»P rogramme: Emmanuelle Rachou, Dominique Coyez »F ield: Catherine Courtin »H eadquarters: Stéphanie Derozier

Following hurricane Bingiza, MdM stepped in, supporting the emergency teams (evaluating needs, providing medicines) in the Maroantsetra district in the north of the island but also strengthening the epidemiological monitoring system in the 15 communities in the south-east of the island, which were most affected by flooding.

FUNDING

» RESULTS

BUDGET

47 traditional medical practitioners were trained, 159 Red Cross rescue workers were trained in caring for injured people, six village health committees were revitalised, 16 awareness-building programmes were broadcast on the radio.

»E CHO/DipEcho, MdM »2 011: €755,282

» OUTLOOK In 2012, MdM will be part of a movement to develop capacity and transfer skills to local stakeholders. Their capitalisation work and lobbying of authorities, donors and partners will also continue.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Madagascar Medical care for prisoners

ANNUAL REPORT 2011

The political and economic situation in Madagascar remains very precarious. International sanctions against the current government further weaken public policies. MdM’s activities are focussed on the most vulnerable: victims of natural disasters and political violence, prisoners and children awaiting surgery.

» Boeny, Sofia Diana, Sava, Vakinankaratra, Analanjirofo and Menabe regions

LIFE EXPECTANCY 66.7 YRS HDI 0.48; RANK 151 Source : UNDP 2011

POPULATION

»B eneficiary: 6, 215 »T arget: 13,000 PERSONNEL

» National: 32 » I nternational: 2 CO-ORDINATORS

»P rogramme: Pascale Luciani Lehoucq »F ield: Catherine Courtin »H eadquarters: Stéphanie Derozier

» ACTIVITIES In partnership with other stakeholders in the prison environment, including the ICRC, MdM is pressing the Ministry of Justice to humanise detention conditions in Madagascar.

With the aim of improving conditions for prisoners in 24 prisons, MdM is working specifically on health issues: renovation of infirmaries, supplying medicines and equipment, mentoring for nurses, treating severe malnutrition and improving hygiene. In addition, MdM is lobbying for an improvement in prison conditions with regard, in particular, to prison overcrowding, hygiene and human rights.

Furthermore, MdM is supporting local organisations with the implementation of micro-projects to assist with the re-socialisation of prisoners.

FUNDING

By capitalising on the work carried out in these establishments, MdM has developed many tools, such as, for example, training modules, which have become the reference standard at national level.

BUDGET

» RESULTS

»E uropAid, AFD, MdM »2 011: €401,393

In 2011, MdM worked with 5,600 inmates in 24 institutions.

» OUTLOOK MdM’s withdrawal is planned for December 2012. The current withdrawal phase should allow Madagascan stakeholders to take over the whole operation and to take further action in the best possible conditions.

International Programmes » AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Mali Improving access to healthcare for migrant populations under conditions of forced return

Mali is a country of departure, of transit but also of forced return for many Africans wishing to emigrate and trying to get to Europe, via the Algerian or Mauritanian borders, then through Morocco or Libya. The MdM project aims to strengthen the capacity of three partner organisations (AME, ARACEM, CAHBA), to support people in situations of forced return to Mali.

» Bamako

» ACTIVITIES LIFE EXPECTANCY 51.4 YRS HDI 0.359; RANK 175 Source: UNDP 2011

INTERNATIONAL DELEGATIONS

» MdM Belgium, MdM Spain POPULATION

» Beneficiary: 1,241 » Target: 3,000 PERSONNEL

» National: 9 » International: 1 CO-ORDINATORS

»P rogramme: Brigitte Maître, Marie-Élisabeth Hochet » Field: Éric Mondadjanani » Headquarters: Isabelle Bruand

MdM is training all those involved from the three partner organisations to ensure provision of a reception, listening and counselling service for migrants finding themselves in a situation of forced return and for their families. Also, MdM is helping to set up a referral network of national professionals whose expertise in support for migrants is also strengthened. And, finally, this transfer of skills comes with raising awareness and providing information on migration in general and on the traumatic consequences of a forced return, to help combat the discrimination that is often suffered by migrants. For this, a doctor and a psychologist are provided for organisations to provide physical and psychological care for the migrants.

» RESULTS 1,241 migrants treated by the partner organisations.

» OUTLOOK Migration is a priority issue for MdM, and we are seeking to build bridges between projects on migrants, in France and internationally. In 2012, the focus will be on strengthening lobbying, based on data collected throughout the project and through the network of local partners.

FUNDING

» MdM

BUDGET

» 2011: €231,675

Touré Moussa, 27 years old

“I told my parents about my expulsion and they were not at all happy with me because they thought I had committed a serious crime. That is why I stayed in Bamako to look for work. I am really ashamed to return empty handed.”

International Programmes » AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Mali Comprehensive care for women with obstetric fistulas

Mali is one of the poorest countries in Africa, with a mainly rural population. Women generally marry young, have closely spaced pregnancies and give birth at home. Obstetric fistulas, induced by long labour with no medical intervention, cause chronic incontinence and the marginalisation of the women who are sufferers.

» Mopti region

LIFE EXPECTANCY 51.4 YRS HDI 0.359; RANK 175 Source: UNDP 2011

INTERNATIONAL DELEGATION

» MdM Belgium, MdM Spain POPULATION

» Beneficiary: 180 »T arget: 1,079 PERSONNEL

» ACTIVITIES There are three elements to MdMs activities: surgery on obstetric fistulas, psychological counselling for the women coupled with help with reintegration into the family and the community and finally, awareness raising and prevention work with communities. Surgical operations are performed by Malian surgeons from the Sominé Dolo Hospital in Mopti, which is supported by MdM. Regular missions by specialist surgeons provide continuous training for the hospital surgeons and allow the treatment of complex cases of fistulas. Patients receive regular counselling. Awareness-raising sessions and the promotion of deliveries in health centres throughout the Mopti area are delivered to community leaders and health workers.

»N ational : 4

» RESULTS

CO-ORDINATORS

136 patients have had operations, 867 counselling sessions have been provided and awareness raising sessions have been organised in 216 villages.

»P rogramme: Brigitte Maître, Marie-Élisabeth Hochet »F ield: Françoise Marquis »H eadquarters: Isabelle Bruand FUNDING

»A EN (Norwegian Church Aid), MdM

» OUTLOOK MdM has been working in the field of obstetric fistulas in Mopti since 1993. The hospital surgeons who have now been trained by the organisation, will be able to continue the programme after MdM’s withdrawal which is planned for 2013. A local organisation will gradually take over the counselling activities.

BUDGET

»2 011: €131,585

Adiarra Diallo, 26 years old

“When I returned to my village, I noticed that I had become incontinent and I had lost the use of my feet. Six months later, my husband came to tell me that my ailment could be treated in Mopti. It was a huge relief to hear this. We immediately returned to Mopti, but I didn’t believe that I could be cured.”

International Programmes » AFRICA

DOCTORS OF THE WORLD

Strengthening care for malnutrition and family planning

Niger has one of the highest birth rates in the world (7.75 children/woman). Large families, closely spaced pregnancies and teenage pregnancies have negative consequences for the health of women and children. MdM is supporting the Illela district health development plan to improve mother and child health services.

Niger

ANNUAL REPORT 2011

» Illéla district in Tahoua region

LIFE EXPECTANCY 54.7 YRS HDI 0.295; RANK 186 Source: UNDP 2011

POPULATION

» Beneficiary: 27,826 » Target: 92,207 PERSONNEL

» National: 37 » I nternational: 2 CO-ORDINATORS

» Programme: Joël Le Corre »F ield: Mamoudou Barro »H eadquarters: Isabelle Bruand FUNDING

» ECHO, AFD, MdM BUDGET

» ACTIVITIES In 2011, MdM steps up its activities in 17 health centres and in the Intensive Nutritional Recovery Centre by providing health workers and also training for new health workers. Family planning services were made more accessible and awareness was raised amongst the population thanks to the involvement of religious leaders through sermons, radio broadcasts and poster campaigns. MdM also improved the management of stocks of nutritional products and contraceptives in the health centres and is improving the standard of amenities. Finally, advocacy work, aimed at gaining acceptance for the view that the spacing out of births can contribute to the prevention of malnutrition, continues with the local national authorities and the international community.

» RESULTS The use of contraceptives increased from 14% in 2010 to 29% in 2011.

» OUTLOOK MdM is continuing its work in 2012, with the focus on nutritional aspects, in order to respond to the nutritional crisis affecting the region and Illéla district in particular.

»2 011: €481,094

A woman from Illéla, beneficiary of the project

“I had three pregnancies close together. Two of my children suffered from malnutrition. That is why I chose to use a method of contraception that would allow my child to be well breastfed and not suffer from malnutrition.”

International Programmes » AFRICA

DOCTORS OF THE WORLD

Rwanda Psychological support for genocide survivors

ANNUAL REPORT 2011

In the aftermath of the genocide perpetrated in 1994, the Rwandan people are trying to rebuild their society from a social, judicial and economic perspective. The judicial process, based on popular participation, ended in 2010 and was extremely difficult for genocide survivors who had to relive many traumas. MdM supports the Rwandan organisation Ibuka in providing psychological care for survivors.

» Kigali, and sites in Rutonde, Nyagasambu, Shogwe, Cyeza, Busasamana, Shyorongi and Murambi

LIFE EXPECTANCY 55.4 YRS HDI 0.429; RANK 166 Source: UNDP 2011

POPULATION

»B eneficiary: 765 » Target: 66,647 PERSONNEL

»N ational: Local organisation » I nternational: 1 CO-ORDINATORS

»P rogramme: Gilles Foucault, Frédéric Jacquet »F ield: Amélie Schafer »H eadquarters: Céline Beaudic FUNDING

»M dM

» ACTIVITIES The psychological and social reintegration of survivors, suffering trauma associated with the genocide, is at the heart of MdM’s project. Support for these people is based on group therapy, which allows them to overcome their traumas and build up a support network. In 2011, the project extended to include other mental health workers already working with survivors. The system set up by MdM was replicated by Ibuka’s professionals.

Previously trained, they take their turn in enhancing the skills of the mental health practitioners of partner organisations through training, sharing best practice and capitalising on experience.

» RESULTS 27 therapy groups organised for 765 beneficiaries.

48 practitioners, including 12 psychologists, trained in the methodology of the scheme.

» OUTLOOK We will explore ways of ensuring the sustainability of the project by finding other mental health stakeholders to take it on and through recognition by institutions. Ibuka helps to increase the professionalism of those involved.

BUDGET

» 2011: €111,762

A member of a therapy group

“Now I can express myself freely and openly about my suffering and my feelings, because I am listened to and understood.”

Josée, a psychologist from Ibuka

“You only have to remember how we started this project five years ago! We were scared of organising groups, we had no training and were badly organised. Today the situation has radically changed.”

International Programmes » AFRICA

DOCTORS OF THE WORLD

Sahel Improving access to primary healthcare

ANNUAL REPORT 2011

Niger, Mali, Burkina Faso

The health indicators of these three countries are showing very little improvement and the chances of achieving the Millennium Development Goals (MDGs) for health in 2015 remain extremely poor. Inadequate access to primary healthcare, in particular arising from user fees, is a key cause. The project aims to lift financial obstacles to access to healthcare by supporting institutional and civil society partners in a sub-regional context.

» Keïta (Niger), Koro (Mali) and Djibo (Burkina Faso) districts NIGER LIFE EXPECTANCY 54.4 YRS HDI 0.295; RANK 186 MALI LIFE EXPECTANCY 51.4 YRS HDI 0.359; RANK 175 BURKINA FASO LIFE EXPECTANCY 55.4 YRS HDI 0.331; RANK 181 Source: UNDP 2011

POPULATION

» Beneficiary: 17,038 »T arget: 377,928 PERSONNEL

»N ational: 71 » I nternational: 7 CO-ORDINATORS

»P rogramme: Joël Le Corre, Thierry Comte »F ield: Olivier Evreux »H Q: Isabelle Bruand FUNDING

»E uropAid, AFD, MdM BUDGET

»2 011: €1,348,657

» ACTIVITIES The improvement in access to healthcare involves the renovation of outlying healthcare facilities, the upgrading of equipment, advanced preventive and curative activities and the strengthening of referral and evacuation procedures. Support for community organisations and local authorities is given through the establishment of sustainable and fair arrangements for the removal of user fees to access to healthcare, as well as an economic study which will allow us to consider the possibilities of scaling up the operation.

These activities also comprise measures to improve the quality of services, particularly in the fields of sexual and reproductive healthcare, malaria and malnutrition and to strengthen the management of healthcare facilities. At the same time, the health authorities are lobbied to encourage the removal of user fees which hinder access to healthcare.

» RESULTS In Djibo district, the town halls have pledged to make deliveries and Caesarians free of charge, by supplementing the state subsidy.

» OUTLOOK The sharing of experience in the three countries, as well as support for decentralisation policies, will help strengthen existing arrangements in favour of improved access to healthcare. However, the extremely poor security context in the Sahel, remains a major concern for the continued implementation of the project.

International Programmes » AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Somalia - Puntland Improving access to mother and child healthcare for refugees and the most vulnerable urban populations POPULATION

»B eneficiary: 12,113 »T arget: 50,000 PERSONNEL

»N ational: 10 » I nternational: 4 CO-ORDINATORS

»P rogramme: Bernard Juan »F ield: Philippe Durand »H Q: Ewelina Gasiorowska FUNDING

»A AHH (Germany), Stern Stunden (Germany), MdM BUDGET

»2 011: €277,375

Located in the north-east of Somalia, Puntland enjoys relative stability. The region hosts regular influxes of refugees, fleeing the combat zones of central and southern Somalia, and the drought, which, in 2011, caused a major food crisis in the Horn of Africa. Already present in the Merka region of Somalia from 2007 to 2100, MdM continues to work with the most vulnerable populations. However, we do have to take account of the inherent security risks in this region and continually adapt to the situation. » Bossaso

» ACTIVITIES MdM supports four mother and child healthcare centres, with the aim of reducing the rate of mother and baby mortality by offering access to good quality and free primary healthcare. MdM provides medicines, vaccines and medical equipment, trains health personnel and supports awareness-raising activities amongst the most vulnerable populations. MdM works on this project in close co-operation with the local authorities, the Minister of Health and in partnership with the local NGO, Integrated Services for Displaced People (ISDP).

» RESULTS Between July and November: 3,981 consultations carried out, 2,179 ante-natal consultations conducted.

» OUTLOOK The project is intended to continue until December 2012.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Sudan Access to primary healthcare

ANNUAL REPORT 2011

In 2011, the Jebel Marra region was the scene of fierce fighting between the Sudanese army and rebels from the Sudanese Liberation Army (SLA). Once again, this year, the civilian populations have had extremely limited access to healthcare, in particular, those hundreds of thousands forced to flee the fighting. Unfortunately, MdM, which was the only remaining NGO working in the east of Jebel Marra, was expelled by the Sudanese authorities in March 2011. » East Jebel Mara and Mallam

LIFE EXPECTANCY 61.5 YRS HDI 0.408; RANK 169 Source: UNDP 2011

POPULATION

» Beneficiary: 7,000 » Target: 252,983 PERSONNEL

»N ational: 145 » I nternational: 3 CO-ORDINATORS

»P rogramme: Jérôme Larché »F ield: Michael Sidman »H Q: Morgane Aveline FUNDING

»E CHO, UN-CHF, MdM BUDGET

»2 011: €392,363

» ACTIVITIES Three medical clinics, dispensing primary healthcare were still operational at the time that MdM was expelled, even though they had been forced periodically to suspend activities because of the fighting. A new clinic was in the process of being opened. The system of referring serious medical cases to the Nyala and El-Fasher hospitals was still operational before MdM’s expulsion. This part of the programme was also suspended with MdM’s departure. As a result, over 150,000 already very vulnerable people lost access to basic healthcare.

» RESULTS Before the expulsion of MdM, 5,000 people per month benefited from primary healthcare.

» OUTLOOK Today there are no humanitarian organisations in this region and the civilian population have no guarantee of being able to access healthcare.

International Programmes » AFRICA

DOCTORS OF THE WORLD

Tanzania Harm reduction amongst drug users

ANNUAL REPORT 2011

A study carried out by Doctors of the World in Dar es-Salaam revealed an alarming prevalence of HIV amongst drug users whilst the epidemic begins to decline in the general population. Over 67% of female intravenous drug users are HIV positive. Whilst access to treatment is limited for these highly stigmatised people, MdM is launching the first syringe exchange programme in Africa.

» Dar es-Salaam, Temeke municipality

LIFE EXPECTANCY 58.2 YRS HDI 0.466; RANK 152 Source: UNDP 2011

POPULATION

»B eneficiary: 600 PERSONNEL

»N ational: 19 » I nternational: 2 CO-ORDINATORS

»P rogramme: Fatima Asouab »F ield: Sandrine Pont » HQ: Stéphanie Derozier FUNDING

»A FD, Paris City Council, Porticus (Netherlands), MdM BUDGET

» 2011: €442,790

» ACTIVITIES MdM teams have been working throughout the year to promote the concept of harm reduction to policy makers and national partners. Open days allowed them to raise awareness in the community and to engage the support of many volunteers. A drop-in centre serves as a place for listening and offers people who use drugs information on prevention, screening for infectious diseases, new syringes and basic first aid. Referral to healthcare facilities is organised for those whose state of health warrants it. Once a week there is a session, specially aimed at women drug users, who are at high risk of HIV transmission. MdM goes out to at-risk groups with a mobile unit, to carry out harm reduction activities through prevention, information on the work of the centre and the distribution of sterile needles. The programme has also enabled those people who are stigmatised and often brutalised to regain an identity by giving them the opportunity to participate in audiovisual training activities. Over and above prevention, the aim is to give them a voice and to rebuild their self-esteem.

» RESULTS Over 600 drug users have been able to obtain sterile kits on a regular basis, to access screening, healthcare and treatment for HIV. More than 30 users each month have benefited from referral to healthcare facilities. Over 17,000 needles have been distributed.

» OUTLOOK MdM hopes to strengthen the capacity of national and regional stakeholders in the area of harm reduction and to share good practice through a national resource and training centre.

Dimsas Mwendapole, who took part in the audiovisual training

“Now, I am somebody. Since I took part in this video project, people in my district respect me and I hope that the rest of the world will do the same when they see my films, my testimonies and my stories.”

International Programmes » AFRICA

DOCTORS OF THE WORLD

Zimbabwe Treating HIV/Aids and mother and child health

ANNUAL REPORT 2011

Following the collapse of the health system over the past few years, and the acute shortage of nursing staff, Zimbabwe has a very high mortality rate, exacerbated by the prevalence of HIV/Aids. These issues are of particular relevance in the poor and remote Chipinge district, which has also been struck by a cholera epidemic. MdM is the only healthcare NGO working in the region.

» Manicaland province, Chipinge district

LIFE EXPECTANCY 50 YRS HDI 0.376; RANK 173 Source: UNDP 2011

POPULATION

» Beneficiary: 38,000 »T arget: 350,000 PERSONNEL

»N ational: 31 » I nternational: 4 CO-ORDINATORS

» Programme: Vincent Fauchere, Simona Zompi »F ield: Joël Weiler »H Q: Stéphanie Derozier FUNDING

»E uropeAid, ECHO, UNERF, MFS (Netherlands), Île-de-France Regional Council, MdM BUDGET

»2 011: €992,893

» ACTIVITIES MdM is helping to improve primary healthcare and providing support for people affected by HIV in Chipinge district. This work is specifically aimed at pregnant women and children to reduce the risk of transmission of the virus from mother to child. Thus, MdM is supporting three hospitals and 48 healthcare facilities in the district.

At a community level, MdM has set up home visits, created nutritional gardens for people living with HIV and is conducting awareness-raising activities with young people. Orphans and the most vulnerable children are cared for by ‘grandmothers of the heart’. These actions allow people who are carrying the virus to be less stigmatised.

The programme also increases screening and improves the monitoring of patients’ treatment.

During the cholera epidemic in Chipinge district, MdM helped the authorities and health services to deal with the epidemic. MdM has also provided training for many healthcare workers and community health agents.

» RESULTS 375 healthcare workers trained, 6,949 pregnant women tested, 122 children on antiretroviral treatment and 725 cases of cholera treated.

» OUTLOOK During the course of 2011, MdM began planning for the handover of its activities to all of its partners, in anticipation of the closure of its programme in 2012.

International programmes » ASIA

DOCTORS OF THE WORLD

Afghanistan

Harm reduction among people who use drugs

ANNUAL REPORT 2011

For 20 years, Afghanistan has held world records for production of opium and opiates (90% of worldwide production). Now, it holds records for domestic consumption, with 1.5 million drug users identified in 2009 (8% of the adult population). Among these, the number of heroin users is increasing exponentially, which constitutes a major mode of transmission for HIV/Aids and hepatitis.

» Kabul

LIFE EXPECTANCY 48.7 YRS HDI 0.398; RANK 172 Source: UNDP 2011

POPULATION

» Beneficiary: 1,000 » Target: 150,000 PERSONNEL

»N ational: 44 » International: 3 CO-ORDINATORS

»P rogramme: Olivier Maguet, Guy Caussé »F ield: Olivier Vandecasteele »H eadquarters: Valérie Brunel FUNDING

»W orld Bank, Global Fund, Sidaction, UNAIDS, MdM BUDGET

» 2011: €786,337

» ACTIVITIES Since 2006, MdM has been leading an ambitious programme of harm reduction in Afghanistan. It focuses on two aspects: on the one hand, support for drug users, and on the other hand, the promotion of harm reduction at a national level. The former includes prevention and access to primary healthcare and treatment, as well as psychological and social support. The latter focuses on training local stakeholders, who are engaged with the struggle against HIV/Aids.

Over 1,000 drug users have had regular medical care in a drop-in centre. The country’s first antiretrovirals were prescribed in May 2009 and the first self-help group of people living with HIV/Aids, was set up shortly after. The first methadone substitution treatment was delivered in 2010, in partnership with the health authorities, and the first Afghan drug users self-help group was established.

The creation of the Organisation for Harm Reduction in Afghanistan (OHRA), last summer, marks the beginning of MdM’s withdrawal from harm reduction activities in Afghanistan.

» RESULTS 26,739 contacts with drug users in the field and in the reception centre, 68 patients on methadone, 176 people trained in harm reduction.

» OUTLOOK MdM is beginning a gradual withdrawal from the harm reduction programme, as prevention and primary healthcare activities are taken over by the national OHRA organisation. In order to guarantee the sustainability of harm reduction activities, in the long term, the programme will be entrusted to stakeholders in Afghan civil society.

International programmes » ASIA

DOCTORS OF THE WORLD

Burma/Myanmar Prevention and treatment of STIs and HIV/Aids

ANNUAL REPORT 2011

A year after the release of Aung San Suu Kyi and the elections, observers remain divided on the significance of recent events in Burma. Owing to restrictive economic policies and under-investment in health and education, poverty continues to grow. The Aids epidemic affects the most vulnerable populations and the national response remains completely inadequate: only one in four people needing antiretrovirals actually receive treatment.

» Kachin state (Myitkyina and Mogaung) and Rangoon

LIFE EXPECTANCY 65.2 YRS HDI 0.483; RANK 149 Source : UNDP 2011

POPULATION

» Beneficiary: 11,068 » Target: 41,000 PERSONNEL

»N ational: 143 » International: 5 CO-ORDINATORS

»P rogramme: Françoise Sivignon, Philippe Batel »F ield: Anne Lancelot »H eadquarters: Valérie Pardessus

» ACTIVITIES MdM is working with the most at-risk populations — sex workers, gay men and drug users — in the state of Kachin and in Rangoon. These populations are supported medically, psychologically and socially in four clinics, but also through outreach work in the field. This support includes diagnosis and treatment of sexually transmitted infections, anonymous and free screening, antiretroviral therapy, general medical consultations, diagnosis and treatment of the major opportunistic infections (including tuberculosis), screening for hepatitis and vaccination against hepatitis B. The centres also offer education sessions on health and nutrition, entertainment, social activities, activities to build self-esteem, legal advice, weekly support groups as well as training for volunteer educators.

Thus many links have been forged with key players in civil society, through information sessions on HIV/Aids and by promoting activities in communities, universities, police stations and prisons.

» RESULTS

FUNDING

1,218 people on antiretrovirals, 93 patients on methadone.

1, 255,000 condoms and 1,355,000 syringes distributed.

BUDGET

» OUTLOOK

»G lobal Fund, 3 Diseases Fund, WFP, USAID-PSI, MdM » 2011: €1,670,930

The methadone substitution programme took a decisive turn by offering users the opportunity to start the treatment as an outpatient at the hospital instead of in a closed drug addiction centre. In 2012, the substitution programme is expected to be gradually integrated into the healthcare system and the local NGOs will see their role enhanced.

International programmes » ASIA

DOCTORS OF THE WORLD

Burma/Myanmar Strengthen community health systems

ANNUAL REPORT 2011

The coastline of the Irrawaddy delta was badly affected by Hurricane Nargis in May 2008.

Almost four years later, reconstruction is far from complete. Some villages have not returned to the living conditions that they had before the hurricane. Fishing boats are missing, paddy fields are still damaged and herds have not been restored. MdM remains the only international medical organisation in the township of Pyapon, an area which was very badly damaged.

» Pyapon township

LIFE EXPECTANCY 65.2 YRS HDI 0.483; RANK 149 Source : UNDP 2011

POPULATION

» Beneficiary: 71,309 » Target: 208, 461 PERSONNEL

»N ational: 37 » International: 3

» ACTIVITIES MdM is working in 137 villages that have no healthcare infrastructure to train community health workers and auxilliary midwives, to supervise village health committees and to mobilise for prevention activities and health education sessions with the villagers.

The project focuses on maternal and child health. A fund, managed by the village health committees, has been set up in the 25 most remote villages, so that the most isolated populations can reach the hospitals in case of obstetric emergencies and illness in children under five years old.

CO-ORDINATORS

The programme is part of the national health policy. Thus, in partnership with the Ministry of Health and other humanitarian organisations (NGO and United Nations), MdM is actively participating in strengthening the healthcare system in the delta region, following the hurricane.

FUNDING

» RESULTS

» Programme: Françoise Sivignon »F ield: Anne Lancelot »H eadquarters: Valérie Pardessus »E uropAid, UNFPA, JIMNCH, MdM BUDGET

110 active community healthcare agents, 47 auxiliary midwives trained, 126 patients referred, thanks to village funds.

» 2011: €325,999

» OUTLOOK On 1 May 2012, the project will be handed over to MdM Netherlands, which will continue the work.

International programmes » ASIA

DOCTORS OF THE WORLD

Georgia Harm reduction programme among people who use drugs

ANNUAL REPORT 2011

In Georgia, where drug use is punishable more than anywhere else in the world, MdM has decided to set up a programme of harm reduction among intravenous drug users. 70% of drug users are infected with hepatitis C, and it is reaching epidemic levels in the general adult population, with almost 7% infected.

» Tbilisi

LIFE EXPECTANCY 73.7 YRS HDI 0.733; RANK 75 Source: UNDP 2011

POPULATION

» Beneficiary: 650 » Target: 27,000 PERSONNEL

» National: 4 » International: 2 CO-ORDINATORS

» Programme: Élisabeth Avril » Field: Véronique Miollany »H eadquarters: Anne Landaës FUNDING

»A FD, MdM BUDGET

» 2011: €258,589

» ACTIVITIES MdM is supporting the Georgian ‘New Vector’ organisation with the establishment of an innovative drop-in centre, which offers dental care to a population that is subject to discrimination. This service attracts many users who can thereby access a wide range of harm reduction services: sterile equipment, prevention, screening as well as psychological and social support.

As part of its co-operation with other key players in harm reduction, MdM also organises training and is lobbying for the decriminalisation of harm reduction practices (eg needle exchange) and for better access to diagnosis and treatment of hepatitis C.

» RESULTS 650 users have used the reception centre in Tbilisi, 42,573 syringes have been distributed, 417 dental consultations have been carried out.

» OUTLOOK In 2012, MdM will continue to strengthen the technical and organisational capabilities of New Vector and to consolidate 2011’s activities. Particular attention is given to supporting users and to integrating female users into the programme.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

India Mother and child health in 11 Jaipur shantytowns

Though India is acknowledged as an economic power, a major sector of society remains excluded from the development process. In the slums of Jaipur, one child in 12 dies before the age of five. Since 2007, an MdM delegation from Midi-Pyrenees, has been working with the most disadvantaged populations to improve their access to healthcare, focusing particular attention on the health of mothers and children.

» Jaipur, Rajasthan

LIFE EXPECTANCY 65.4 YRS HDI 0.547; RANK 134 Source: UNDP 2011

» ACTIVITIES MdM Midi-Pyrenees, in collaboration with its Indian partner JKSMS, is continuing its training programme. Thus in 2011, 40 community health volunteers, who live in the slums, were trained. Over half the activities that were originally set up by the social workers of JKSMS are now run by community health workers.

POPULATION

» Beneficiary: 3,000 » Target: 5,000 PERSONNEL

»N ational: local partner » International: 1 CO-ORDINATOR

»P rogramme: Isabelle Hainzelin, Maya Laporte »F ield: Willy Bergogné »H eadquarters : Tom Wingefeld Midi-Pyrenees regional delegation FUNDING

»M dM, Midi-Pyrenees regional council, Une foulée pour la Vie, Solidarité en pays de Save, Arvel Voyage, business school events

Alongside this, the programme team is still present in the slums, almost on a daily basis, and continues to develop links with the health authorities in Jaipur. In particular, they use interactive theatre to raise awareness and therefore improve access to healthcare for the population.

» RESULTS In 2011, 76% of pregnant women had three antenatal consultations, whereas that figure was only 25% at the beginning of the project in 2007.

» OUTLOOK So that its activities in the communities can be handed over for the long term to civil society, MdM will continue to develop its partnership with the Indian organisation JKSMS. Moreover, MdM is trying to persuade the authorities in Jaipur to take on all or part of the programme.

BUDGET

» 2011: €26,510

Testimony Aalia, trained as a community health worker

“It is the first time that they have given us the chance to improve things in the shantytowns. So I volunteered to be trained as a community health worker. This allows me to persuade other women to look after their health and that of their families. I have seen too many women crying over the loss of a child, and I don’t want it to happen anymore.”

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

India Access to primary healthcare

The Indian economy continues to grow at a significant rate but this growth is far from benefiting everyone. Whilst the state of Orissa has seen considerable development over the past 30 years, a significant gap has opened up between the rich coastal area and the inland forests, which are largely inhabited by tribal peoples and ‘untouchables.’ In this region, mother and child mortality are well above the national average.

» Orissa state, Kalahandi district LIFE EXPECTANCY 65.4 YRS HDI 0.547; RANK 134 Source: UNDP 2011

POPULATION

» Beneficiary: 20,223 PERSONNEL

»N ational: local partner » International: 1 CO-ORDINATORS

»P rogramme: Pierre Micheletti »F ield: Willy Bergogné »H eadquarters: Valérie Pardessus FUNDING

» MdM

BUDGET

» 2011: €85,586

» ACTIVITIES MdM and Voluntary Health Association of India (VHAI) are developing a programme of access to primary healthcare in six healthcare units. The objective is to contribute to an improvement in the population’s health and to re-establish and promote the provision of healthcare.

The main activities can be broken down as follows: the training of medical personnel, health education sessions in the communities—mainly on sexual and reproductive health—medical consultations, renovation of the main clinic and lobbying at district and state level to raise awareness among the public authorities of the living conditions of tribal populations and untouchables.

The partnership with VHAI is also one of the key elements of the programme. This is based on a three pronged approach: the establishment of a joint project in Orissa, mechanisms for the exchange of information and, finally, the sharing of expertise and training.

» RESULTS 48 trained health volunteers.

2,652 people have taken part in health education sessions.

» OUTLOOK The programme’s activities will continue and the partnership with VHAI will be further developed. This partnership intends to try out new practices in humanitarian operations and thus will prepare MdM for the challenges that Western models of aid currently face.

International programmes » ASIA

DOCTORS OF THE WORLD

Indonesia Improving access to reproductive healthcare

ANNUAL REPORT 2011

The highlands of western Papua are one of the most isolated regions of Indonesia and the world, resulting in very limited access to healthcare for the population. In this region, the prevalence of Aids is at 2.4% and is the highest in the country. Against this background, MdM is implementing a programme of sexual and reproductive health and is supporting access to diagnosis and treatment for people living with HIV/Aids.

» Western Papua

LIFE EXPECTANCY 69.4 YRS HDI 0.617; RANK 124 Source: UNDP 2011

INTERNATIONAL DELEGATION

»M dM Netherlands POPULATION

» Beneficiary: 4,189 » Target: 60,000

» ACTIVITIES MdM wishes to perpetuate the programme by strengthening the capacity of its local partners: the district health office, students club and the organisation Primari. With these partners, MdM organises information sessions in the communities on sexual and reproductive health and distributes educational material, focusing on HIV/Aids.

MdM also provides logistical support for two screening centres, organises training for health personnel, community health agents, peer educators and lobbies for access to healthcare.

» RESULTS

PERSONNEL

111 community health workers trained in sexual and reproductive healthcare.

4,000 participants in awareness sessions.

CO-ORDINATORS

» OUTLOOK

»N ational: 17 » International: 2 »P rogramme: Patricia GaillardOlokose, Remco Van de Pas »F ield: Mauro Weber Rosito »H eadquarters: Valérie Pardessus FUNDING

» CORDAID, MdM BUDGET

» 2011: €199,504

MdM’s withdrawal is planned for May 2012. The programme will be continued by the community organisation whose educators were trained by MdM. In April, a workshop will bring together partners and the authorities in order to share good practice and the lessons learned over the five years of the programme.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Laos Pilot programme for safe motherhood

With 4.1% of public expenditure devoted to health, the health situation in Laos People’s Democratic Republic is extremely worrying, especially in the area of perinatal care.

The maternal death toll remains one of the highest in South East Asia. In the districts concerned, over 90% of women give birth at home without medical assistance.

» Champassak province, Soukhouma and Mounlapamok districts

LIFE EXPECTANCY 67.5 YRS HDI 0.524; RANK 138 Source: UNDP 2011

POPULATION

» Beneficiary: 21,280 » Target: 101,354 PERSONNEL

»N ational: 17 » International: 3 CO-ORDINATORS

» Programme: Stéphane Saint Léger »F ield: Isabelle Decout »H Q: Valérie Pardessus

» ACTIVITIES MdM is working in Champassak province in the south of Laos, in Soukhouma and Mounlapamok districts. The programme aims to reduce maternal and infant mortality linked to pregnancy and childbirth and mortality in children under five years old. MdM has renovated health centres and is training midwives (in pregnancy, delivery, neonatal care, spacing of births) and volunteers in the villages, to promote maternal healthcare.

MdM is also actively involved with focus groups on the new national strategy for maternal and child healthcare, which includes, among others, the implementation of a system of free healthcare throughout the country. Despite being launched in autumn 2010, the programme only really got underway after signing the agreement with the Laotian government in May 2011.

» RESULTS

FUNDING

Eight community midwives trained over 10 months. 144 promoters of maternal and child health trained in the villages.

BUDGET

» OUTLOOK

» AFD, MdM » 2011: €339,980

Current activities are consolidated. At the district and provincial level, MdM is lobbying for the removal of user fees.

Testimony obtained in a village in Mounlapamok district, during the evaluation process

“I never went to the health centre to have my pregnancy monitored, I didn’t know it was important. I gave birth just with my husband, as with my first children. I was afraid that giving birth in the health centre would be too expensive. One woman died during childbirth in another village.”

International programmes » ASIA

DOCTORS OF THE WORLD

Nepal Combined programme of reproductive health and microfinance

ANNUAL REPORT 2011

Despite the progress that has been made, use of sexual and reproductive health services in the mountainous regions of Nepal remains insufficient. In Sindhupalchok district, only five per cent of deliveries take place in healthcare centres, which are inaccessible and lacking in qualified personnel and equipment. MdM is working both in health centres and in the communities to increase accessibility and improve the quality of healthcare.

» Sindhupalchok district LIFE EXPECTANCY 68.8 YRS HDI 0.458; RANK 157 Source: UNDP 2011

POPULATION

» Beneficiary: 5,500 » Target: 14,500 PERSONNEL

»N ational: 14 » International: 1 CO-ORDINATORS

»P rogramme: Patrick Baguet »F ield: Karen Van der Veken »H eadquarters: Valérie Brunel FUNDING

»S anofi, American Express Japan, MdM BUDGET

» 2011: €287,693

» ACTIVITIES MdM is working with women of childbearing age in microfinance centres in 10 cantons. The women meet regularly to discuss reproductive and sexual health before then participating in training sessions on saving and credit matters. In particular, they learn how to access funds in case of obstetric emergency. The aim of these meetings amongst very disadvantaged women is to improve their access to quality healthcare, particularly during pregnancy.

MdM provides support to 10 healthcare centres, supplying medicines and medical equipment, and training healthcare personnel. The referral system and emergency obstetric healthcare are reinforced. This programme encourages community involvement and sustainable access to reproductive healthcare.

» RESULTS 66 health professionals trained in reproductive healthcare, 3, 580 women advised, 9,813 homes with access to obstetric emergency funding.

» OUTLOOK In 2012, the emphasis will be on the improving the reception and quality of care in the health centres involved, with a view to encouraging women to attend them routinely.

Testimony Member of the Melamchi cooperative

“One individual cannot do anything. In small groups it is difficult to save and take out a loan to invest and generate income. In a cooperative the opportunities are far greater.”

International programmes » ASIA

DOCTORS OF THE WORLD

Pakistan Support for women affected by violence

ANNUAL REPORT 2011

In Pakistan, women are often victims of violence with complete impunity. In 2009, 8,548 cases were officially recorded, including 1,988 murders and honour killings. These figures, which are significantly lower than the reality, reflect a lack of recognition and support for women affected by violence. Those who flee are stigmatised and have little recourse to justice. The Dar ul-Amans (peace houses) of the Punjabi Department of Social Affairs, are the only institutions offering protection and medical, legal and psycho-social services. » Punjab province, 34 districts

LIFE EXPECTANCY 65.4 YRS HDI 0.5; RANK 145 Source: UNDP 2011

POPULATION

» Beneficiary: 13,487 » Target: 15,000 PERSONNEL

»N ational: 41 » International: 3 CO-ORDINATORS

»P rogramme: Barbara Ten Kate Swarthout, Arianne de Jong »F ield : Cristina Thevenot »H eadquarters: Valérie Brunel FUNDING

»E uropAid, PPR Foundation, Norwegian embassy, Danish embassy BUDGET

» 2011: €607,881

» ACTIVITIES MdM’s activities ultimately support the Department of Social Affairs’ programme, which aims to sustain the medical, psychological and legal services offered to residents. MdM is working towards improving the skills of the employees in the 34 Dar ul-Amans (DUA) and in the Department of Social affairs in terms of protection, setting up a network, management and monitoring, through training and development of action plans. Furthermore, MdM supports and leads Mumkin, a platform for local NGOs involved with the rights of women in Punjab, to improve co-ordination and work together towards an effective advocacy for the ratification of a law criminalising domestic violence.

» RESULTS In 2011, 10,682 women and 2,805 children stayed in the DUAs in Punjab for several days, weeks or months.

» OUTLOOK MdM’s withdrawal, planned for 2013, is gradually beginning so that the Department of Social affairs can, over time, take on the supervision of the DUAs. Capacity building continues until the end of the project. MdM also continues to be an active member of Mumkin.

International programmes » ASIA

DOCTORS OF THE WORLD

Pakistan Support for the organisation MCWAK to provide emergency obstetric care

ANNUAL REPORT 2011

The floods of 2010 affected over 18 million people. In many cases, the destruction of the infrastructure and road network prevents pregnant women from reaching obstetric care. In order to participate in post-crisis management, MdM signed a partnership agreement with Maternity and Child Association Khanpur (MCWAK), to provide healthcare to women in the rural areas along the Indus in southern Punjab.

» Punjab province, Rahim Yar-Khan district

» ACTIVITIES LIFE EXPECTANCY 65.4 YRS HDI 0.5; RANK 145 Source: UNDP 2011

POPULATION

» Beneficiary: 24,500 » Target: 64,302 CO-ORDINATORS

»P rogramme: Marc Tyrant »F ield: Angelina Robinson »H eadquarters: Valérie Brunel FUNDING

» MdM

BUDGET

» 2011: €99,000

MCWAK has equipped health centres in Abadpur and Chachran and employed qualified staff who are able to provide emergency obstetric care. The health centres have an outpatient department, equipped with an ultrasound machine, and an ambulance for referral of high risk pregnancies. The recruitment of female community health workers, allows women to be informed about basic healthcare, family planning as well as prevention, hygiene and health education.

» RESULTS 4,900 mother and child consultations, 200 assisted deliveries in health centres.

» OUTLOOK To reinforce results and ensure the sustainability of the service, the partnership between MdM and MCWAK is extended for 2012. This agreement will also support the partner organisation in its active search for funding. MdM and MCWAK are working to strengthen their ties with the Ministry of Health.

International programmes » ASIA

DOCTORS OF THE WORLD

Pakistan Medical assistance for victims of crises

ANNUAL REPORT 2011

Populations living in the border regions of Afghanistan are badly affected by the military operations aimed at eradicating insurgents. Since 2009, these operations have caused population movements of several million people. In order to meet their needs and also those of the host populations, MdM is running a programme of access to primary healthcare.

» Khyber Pakhtunkhwa province (Kohat, Hangu and Dera Ismail Khan districts)

LIFE EXPECTANCY 65.4 YRS HDI 0.5; RANK 145 Source: UNDP 2011

POPULATION

» Beneficiary: 104,985 » Target: 150,000 PERSONNEL

»N ational: 116 » International: 4 CO-ORDINATORS

»P rogramme: Marc Tyrant »F ield: Angelina Robinson »H eadquarters: Valérie Brunel FUNDING

» ECHO, WHO, Ouest France Solidarité, MdM BUDGET

» 2011: €1,048,344

» ACTIVITIES The displaced populations have access to medical treatment, thanks to the setting up of mobile clinics and MdM’s support for healthcare facilities. MdM’s activities comprise primary healthcare consultations, antenatal consultations, deliveries, family planning, referrals to hospital, health education and treatment of acute cases of severe malnutrition. The organisation also conducts epidemiological monitoring and establishes action plans to enable a rapid and efficient response in case of an epidemic. In this respect, a diarrhoea treatment centre permits the treatment of severe cases.

» RESULTS 98,241 curative consultations, 3,045 antenatal consultations, 3,699 vaccinations.

» OUTLOOK The ongoing conflict, and its consequences for the population, justify the continuation of medical care activities, focusing on the areas close to military operations. Therefore, in 2012, the teams are repositioning, closer to the displaced populations.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Russian Federation Support for Community Health Partnership

The autonomous populations of the Far North face many health risks owing to their social and economic situation. MdM is supporting Community Health Partnership, a Russian NGO, to strengthen its network of doctors and community health workers and to promote access to primary healthcare. In conjunction with this, the two organisations carry out activities to reduce harm associated with the consumption of alcohol and the prevention of tuberculosis in remote populations. » Yamalo-Nénétsie, Yakoutie and Koriakie autonomous districts

LIFE EXPECTANCY 68.8 YRS HDI 0.755; RANK 66 Source: UNDP 2011

POPULATION

» Beneficiary: 157 PERSONNEL

»N ational: partner organisation » International: 1 CO-ORDINATORS

»P rogramme: Armelle Desplanques-Leperre »F ield: Julia Krikorian »H eadquarters: Anne Landaës FUNDING

» MdM

BUDGET

» 2011: €174,163

» ACTIVITIES The partnership between MdM and the Russian NGO, Community Health Partnership (CHP), is further developing around training and advocacy. The programme is primarily designed to train and mobilise partner doctors and community healthcare agents and psychologists, who offer innovative methods for reducing harm associated with alcohol abuse.

» RESULTS 6 trainers, 12 community healthcare agents, 19 peer educators and 20 professionals trained in 2011.

» OUTLOOK CHP now manages the project independently as regards access to healthcare for the nomadic populations of the Far North and the prevention of tuberculosis. In 2012, MdM’s involvement will be limited to supporting activities to prevent alcoholism.

International programmes » ASIA

DOCTORS OF THE WORLD

Vietnam Prevention and support for at-risk people, living with HIV

ANNUAL REPORT 2011

HIV/Aids appeared in Vietnam at the beginning of the 1990s. While it remains confined to a marginalised and stigmatised sector of society, (drug users, sex workers and gay men), the risk of it spreading to the general population remains high. With a prevalence of 0.5% nationally (275,000 cases) and 10,000 people dying of it every year, HIV/Aids is a public health priority.

» Hanoi and Hô Chi Minh City

LIFE EXPECTANCY 75.2 YRS HDI 0.593; RANK 128 Source: UNDP 2011

POPULATION

» Beneficiary: 10,000 » Target: 115,000

» ACTIVITIES The programme has been developed in partnership with four health services in Hanoi and Hô Chi Minh-City. It aims to prevent the risk of transmission of HIV and hepatitis B and C through peer educators who inform, raise awareness, distribute condoms and syringes and offer confidential and free screening. Medical care is assured by a mixed team of medical personnel and people who are HIV positive who accompany patients during treatment.

PERSONNEL

The local authorities have taken over the two pilot schemes (in Tay Ho and An Hoa); the two other sites have been transferred to an international NGO. Support for patients continues to be provided.

CO-ORDINATORS

» RESULTS

»N ational : 66 » International : 2 »P rogramme: Karine Lacombe, Maud Lemoine »F ield: Antonino Faibene »H eadquarters: Valérie Brunel FUNDING

» USAID, MdM BUDGET

» 2011: €1,017, 740

6,000 people tested and 4,000 people on antiretroviral treatment.

» OUTLOOK MdM withdrew from Vietnam on 31 December 2011.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Colombia Access to healthcare for the Embera and AfroColombian populations affected by the armed conflict LIFE EXPECTANCY 73.7 YRS HDI 0.710; RANK 87 Source UNDP 2011

POPULATION

»B eneficiary: 4,948 »T arget: 8,000 PERSONNEL

»N ational: 8 » I nternational: 4 CO-ORDINATORS

»P rogramme: Christian Raggioli, Karina Morales »F ield: Vicente Gavidia »H eadquarters: Valérie Léon FUNDING

» AECID, MdM BUDGET

»2 011: €230,801

ANNUAL REPORT 2011

Since 2003, MdM has been supporting rural indigenous and Afro-Colombian populations, isolated because of the armed conflict. The objective is to improve their access to healthcare and to lobby for an improvement in the national healthcare system. MdM’s presence is concentrated in areas of intensified conflict, where there are clashes between illegal groups, campaigns to eradicate coca and operations of the armed forces.

» Atrato

» ACTIVITIES By training community volunteers, MdM has supported outreach activities, the fight against malnutrition and activities to monitor pregnant women and young children. Medical consultations have been conducted in communities which are isolated because of their geographical situation or because of the armed conflict. In 2011, the prevention and health education approach and the training of community stakeholders has been strengthened, in preparation for MdM’s withdrawal from the region.

» RESULTS 12 mobile clinics and 10 sessions to promote health and prevention were completed in six communities.

» OUTLOOK MdM withdrew from the Atrato region in June 2011. A travelling photographic exhibition in Colombia testifies to the lack of access to healthcare by remote populations caught up in armed conflict, such as the Embera people, that MdM has supported since 2004.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Colombia Access to healthcare for rural and indigenous populations, isolated by the armed conflict LIFE EXPECTANCY 73.7 YRS HDI 0.710; RANK 87 Source: UNDP 2011

POPULATION

ANNUAL REPORT 2011

Since 2003, MdM has been supporting rural indigenous and Afro-Colombian populations, isolated because of the armed conflict. The objective is to improve their access to healthcare and to lobby for an improvement in the national healthcare system. MdM’s presence is concentrated in areas of intensified conflict, where there are clashes between illegal groups, campaigns to eradicate coca and operations of the armed forces.

» Meta, Guaviare

» ACTIVITIES In partnership with the public health services, MdM deploys outreach teams, which offer medical and psychological consultations in the communities most affected by the conflict. Particular attention is devoted to women of childbearing age, to children under five years old and to victims of violence and their families. Furthermore, the programme aims to increase the active involvement of the communities and their leaders through training in psychological first aid and sexual and reproductive health.

» Beneficiary: 14, 300 » Target: 17,400

» RESULTS

PERSONNEL

56 mobile clinics established, of which 17 are in collaboration with the health authorities. 14,300 people have benefited from the service.

CO-ORDINATORS

» OUTLOOK

» National: 21 » International: 5 »P rogramme: Karina Morales, Antonio Berlanga » Field: Blanca Arevalo » Headquarters: Valérie Léon FUNDING

» DG ECHO, CIDA, MdM BUDGET

»2 011: €772, 918

MdM can only withdraw from certain areas if security conditions improve and the health authorities take over, or strengthen, the activities. In line with the strategy of supporting populations worst affected by the conflict, MdM will intensify its activities in towns in the south of Meta department and the north of Guaviare.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Colombia Access to healthcare for rural and indigenous populations, isolated by the armed conflict LIFE EXPECTANCY 73.7 YRS HDI 0.710; RANK 87 Source: UNDP 2011

POPULATION

»B eneficiary: 3,900 »T arget: 5,000

ANNUAL REPORT 2011

Since 2003, MdM has been supporting rural indigenous and Afro-Colombian populations, isolated because of the armed conflict. The objective is to improve their access to healthcare and to lobby for an improvement in the national healthcare system. MdM’s presence is concentrated in areas of intensified conflict, where there are clashes between illegal groups, campaigns to eradicate coca and operations of the armed forces.

» Nariño

» ACTIVITIES In close co-operation with the healthcare centre managed by the indigenous organisation Unipa, MdM deploys mobile clinics, within the Awas indigenous territories. The medical teams dispense treatment, focussing on the monitoring of pregnant women and children, vaccinations, nutritional monitoring, family planning and the diagnosis of cases of malaria and tuberculosis. MdM’s work also includes prevention activities, training and promotion of healthcare among community leaders and indigenous health promotion practitioners.

» RESULTS

PERSONNEL

23 mobile clinics established in collaboration with the indigenous organisation Unipa, providing care for 3,900 people.

CO-ORDINATORS

» OUTLOOK

»N ational: 10 » I nternational: 5 »P rogramme: Karina Morales, Antonio Berlanga »F ield: Blanca Arevalo »H eadquarters: Valérie Léon FUNDING

»D G ECHO, CIDA, MdM BUDGET

»2 011: €293,033

In 2012, MdM will continue to support Unipa in its lobbying activities in favour of a healthcare system which is culturally appropriate to the Awa people.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Guatemala Sexual and reproductive healthcare for women working in export industries LIFE EXPECTANCY 71.2 YRS HDI 0.574; RANK 131 Source: UNDP 2011

POPULATION

» Beneficiary: 1,042 » Target: 4,000 PERSONNEL

» National: 8 » International: 2 CO-ORDINATORS

»P rogramme: Anne Gilberteau, Sylvie Bianchi »G eneral Coordinator: Andrea Scheltdorf »H eadquarters: Ernesto Herrera FUNDING

»A FD, MdM BUDGET

»2 011: €171,450

ANNUAL REPORT 2011

There are many export companies in Guatemala. Their workforce is mainly female—women who are vulnerable, badly paid and often deprived of any rights.

Since 2006, MdM has been running a programme which aims to promote respect for workers rights in these industries and, in particular, their right of access to healthcare.

» Escuintla and Suchitepéquez departments

» ACTIVITIES Sexual and reproductive health consultations are offered to workers in export companies. Health promoters are recruited from their number and trained to improve their knowledge of health issues, workers rights and human rights. In addition, the team is raising awareness, among various administrative bodies, of the state of health of female workers.

» RESULTS 1,042 medical consultations completed.

» OUTLOOK MdM hopes to consolidate its activities in the Escuintla region and extend them to Suchitepéquez department.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Haiti Improving access to healthcare

Following the earthquake in January 2010, Doctors of the World set up around 10 semi-permanent clinics in Port-au-Prince to improve access to healthcare for the most vulnerable.

Given the slow pace of reconstruction and the local authorities’ limited resources, MdM continues to support the health authorities to facilitate the transition between MdM supported clinics and public health centres.

» West Department, Port-au-Prince, Delmas and Carrefour communes

LIFE EXPECTANCY 62.1 YRS HDI 0.454; RANK 158 Source: UNDP 2011

POPULATION

» Beneficiary: 92,135 » Target: 285,000 PERSONNEL

» National: 108 » International: 5 CO-ORDINATORS

»P rogramme: Anne Urtubia, Sophie Lasserre »G eneral Coordinator: Alain Le Garnec »H eadquarters: Stéphane Berdoulet FUNDING

»D G ECHO, Unicef BUDGET

»2 011: €2,493,034

» ACTIVITIES Six temporary MdM clinics and two health centres should be gradually handed over to the Haitian health system.

The clinics guarantee free access to primary healthcare and reproductive healthcare. Psychosocial care is also provided there (discussion groups, personalised listening sessions and psychological counselling ), as well as screening and referral of victims of sexual violence.

» RESULTS 81,057 free curative consultations completed.

» OUTLOOK The return, in 2012, of the two healthcare centres supported by MdM, into the hands of the health authorities, will allow the organisation to withdraw. Support for the personnel of the Ministry of Health will continue to enable the eventual transfer of activities.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Haiti Response to the cholera epidemic

Cholera disappeared from Haiti a century ago but reappeared in November 2010. The situation was swiftly brought under control in Port-au-Prince, but not in some rural and isolated areas, such as Grand’Anse department which has the highest mortality rate. In this situation, MdM, as the only medical NGO in the department, continues to support the local health authorities to deal with cases of cholera.

» Grand’Anse department

LIFE EXPECTANCY 62.1 YRS HDI 0.454; RANK 158 Source: UNDP 2011

INTERNATIONAL DELEGATIONS

»C anada, Belgium, Spain, Switzerland, Argentina POPULATION

»B eneficiary: 58,804 »T arget: 425,878 PERSONNEL

»N ational : 115 » I nternational: 3 CO-ORDINATORS

»P rogramme: Anne Urtubia, Sophie Lasserre »G eneral Coordinator: Alain Le Garnec »H eadquarters: Stéphane Berdoulet FUNDING

»D G ECHO BUDGET

»2 011: €1,612,142

» ACTIVITIES MdM provides medical care for the sick in two centres and three cholera treatment units. MdM teams support the Ministry of Health’s operations in cases of emergency or peaks in the epidemic, with a mobile team working throughout the department. The programme’s teams provide medicines, equipment, train health personnel in epidemic management and organise awareness-raising sessions in the general population. The programme also guarantees a better response to emergencies, as part of the protocol implemented by the health management services in Grand’Anse. Finally, activities are co-ordinated with water and sanitation authorities.

» RESULTS 13,020 cases of cholera treated.

» OUTLOOK With cholera becoming endemic, MdM will gradually withdraw and will no longer directly handle cholera cases, which are declining in number. However, MdM continues to support local authorities so that they are better prepared to respond to emergency epidemic situations.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Haiti Reducing mother and infant mortality

Haiti has the worst indicators for maternal and child health of the entire American continent.

80% of the population lives on less than two dollars a day and cannot access healthcare because of the cost. The consequences are dramatic, with one woman in 37 of childbearing age at risk of dying from complications linked to pregnancy. MdM has been in the mainly rural area of Grand’Anse since 1989 and continues its work to promote access to healthcare for pregnant women and children under five years old. » Grand’Anse department

LIFE EXPECTANCY 62.1 YRS HDI 0.454; RANK 158 Source: UNDP 2011

POPULATION

» Beneficiary: 98,582 » Target: 110,043 PERSONNEL

» National: 52 » International: 7 CO-ORDINATORS

» Programme: Anne Urtubia, Sophie Lasserre »G eneral Co-ordinator: Alain Le Garnec »H eadquarters: Stéphane Berdoulet

» ACTIVITIES Six health centres and five maternity units are supplied and maintained in order to guarantee free healthcare for children under five years old and pregnant women.

One prong of the programme deals with tackling malnutrition. The most severe cases, identified by the communities and the institutions, are treated. Referrals of cases requiring hospitalisation takes place, in the nutrition stabilisation unit, which was opened in 2009 within the Jérémie regional hospital.

Finally MdM supports the Grand’Anse health authorities, helping them to improve emergency responses, especially in case of epidemics and natural disasters.

» RESULTS 82,916 children screened for malnutrition.

FUNDING

» OUTLOOK

BUDGET

As the only medical NGO working in Grand’Anse department, MdM is continuing its work in 2012. That is, promoting access to healthcare for pregnant women and children under five years old and improving relations between the people and health centres.

» DG ECHO, Unicef, AFD »2 011: €1,612,142

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Sexual and reproductive health for migrant women, domestic employees and sex workers

Every year, Mexico receives around 40,000 Central American migrants, who come in through Chiapas, particularly through the town of Tapachula. The Mexican health system struggles to give adequate and non-discriminatory consideration to the problems of this population.

Against this backdrop, MdM is helping to improve access to healthcare, social and psychological services for migrant women.

Mexico

LIFE EXPECTANCY 77 YRS HDI 0.770; RANK 57 Source: UNDP 2011

POPULATION

» Beneficiary: 1,571 » Target: 4,100 PERSONNEL

ANNUAL REPORT 2011

» Tapachula and Huixtla, Chiapas state

» ACTIVITIES Since January 2011, MdM has set up awareness campaigns among migrant women on the subjects of sexual and reproductive health, violence, addiction and self-esteem. These women are directed to health centres for prevention and treatment. The most vulnerable are physically accompanied to the centres.

In addition, MdM is training healthcare workers to be more aware of the problems faced by this marginalised population.

» RESULTS

» National: 8 » International: 1

1,571 women have taken part in at least one of MdM’s activities: awareness raising, training, accompaniment.

CO-ORDINATORS

» OUTLOOK

»P rogramme: Frédérique Carrié »G eneral co-ordinator: Romain Lejeune »H eadquarters: Ernesto Herrera FUNDING

»A FD, MdM BUDGET

» 2011: €165,024

MdM hopes to develop a programme to reduce the risk of HIV/Aids infection amongst sex workers and to further strengthen its activities with the administrative and health authorities in Chiapas so that the problems of migration will be better addressed by health policies.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Nicaragua Sexual and reproductive health

ANNUAL REPORT 2011

RAAN is one of the poorest regions of Nicargua, characterised by a shortage of social infrastructure and weak government institutions. The health indicators are amongst the worst in the country, particularly with regard to women’s health. MdM is contributing towards an improvement in access to sexual and reproductive healthcare as part of the struggle against this poverty.

» Puerto Cabezas, North Atlantic Autonomous Region (RAAN in its Spanish acronym)

LIFE EXPECTANCY 74 YRS HDI 0.589; RANK 129 Source: UNDP 2011

POPULATION

» Target: 16,738 PERSONNEL

» National: 8 » International: 1

» ACTIVITIES MdM is running an awareness campaign on the subject of sexual and reproductive healthcare amongst women, adolescents and health professionals in 27 rural areas of the Puerto Cabezas district. Education sessions on the prevention of violence are organised for the men in various areas of Puerto Cabezas. In order to improve the standard of care, MdM supplies the healthcare units with equipment and medicines.

» RESULTS Working with the Ministry of Education, a sex education project has been developed with teachers.

CO-ORDINATORS

»P rogramme: Margarita González, Robert Chaluleau »G eneral co-ordinator: Mélanie Quetier »H eadquarters: Ernesto Herrera FUNDING

»A ACID (Agencia Andaluza de Cooperacion Internacional al Desarrollo), MdM BUDGET

»2 011: €124,044

» OUTLOOK The project will continue through training and awareness-raising activities.

International Programmes » LATIN AMERICA

DOCTORS OF THE WORLD

Uruguay Promoting sexual and reproductive health

LIFE EXPECTANCY 77 YRS HDI 0.783; RANK 48 Source: UNDP 2011

POPULATION

»B eneficiary: partner organisations

ANNUAL REPORT 2011

Clandestine abortions cause obstetric complications and the death of many women in Uruguay.

However, since 2008, by law, women who have terminated their pregnancies are supposed to be given support so that these risks are limited. In Uruguay and all of Latin America, civil society is campaigning for the decriminalisation of abortion. MdM is supporting the organisations MYSU and IS, promoting the exchange of experiences and supporting advocacy in favour of the right to safe and legal termination of pregnancy.

» ACTIVITIES MdM supports the actions of the Uruguayan organisation MYSU (association of activists for women’s rights) and IS (association of health professionals). These NGOs are working together to set up sexual and reproductive health services in six departments and to promote access to safe and legal abortion. Also, by facilitating a regional platform, MdM is supporting the activities of civil society stakeholders who are engaged in the defence and promotion of sexual and reproductive rights in Latin America.

PERSONNEL

»N ational: 2 » International: 1 CO-ORDINATORS

»P rogramme: Jean Guerrini, Camilla Giugliani »G eneral co-ordinator: Carine Thibault »H eadquarters: Valérie Léon FUNDING

»A FD, MdM BUDGET

» 2011: €186,698

» RESULTS In September, with the support of MdM, a workshop was organised in Montevideo, where civil society organisations from five countries of the continent (Guatemala, Nicaragua, Mexico, Peru and Uruguay) came together. The objective was to stimulate an exchange of knowledge and practices which would encourage initiatives aimed at changing attitudes and medical practices in these countries.

» OUTLOOK The project will adapt to the changing framework, with the bill to decriminalise abortion in Uruguay currently under debate in Parliament. The regional dimension will continue, in particular through a new workshop to exchange information on practices.

International Programmes » EUROPE

DOCTORS OF THE WORLD

Bulgaria Access to healthcare for the Roma community of Sliven

ANNUAL REPORT 2011

In a difficult economic context, affected by underlying corruption, the Bulgarian Roma community (3% of the population) is subjected to increasing discrimination. Health figures for this minority are catastrophic compared with those for the general population. The district of Sliven, where the Roma constitute a quarter of the population, has the highest infant mortality rate in the country.

» Sliven, Nadezhda quarter

LIFE EXPECTANCY 73.4 YRS HDI 0.771; RANK 55 Source: UNDP 2011

POPULATION

» Beneficiary: 2,400 » Target: 12,000 PERSONNEL

» ACTIVITIES In 2011, MdM continued its training and awareness-raising on health issues with our partners and with programme beneficiaries. A series of six health education sessions were organised on the themes of family planning, hygiene and pre- and postnatal care. Social workers carry out home visits and organise information meetings on hygiene, nutrition or vaccination in schools and cafes or after church services.

» RESULTS

» National: 8

200 people were trained, 2,000 homes were visited, 2,400 people reached by awareness-raising campaigns.

CO-ORDINATORS

» OUTLOOK

»P rogramme: Margarita Salteri, Patrick Contois »H eadquarters: Anne Landaës FUNDING

»R enovabis foundation, MdM BUDGET

» 2011: €67,268

In 2012, MdM intends to open a hygiene unit in Nadezhda in order to facilitate care for pregnant women within the actual hospitals. At the same time, MdM will look at access to healthcare for the Roma population of Nadezhda to support their integration into mainstream health services.

International Programmes » EUROPE

DOCTORS OF THE WORLD

Moldova Preventing human trafficking and helping victims

ANNUAL REPORT 2011

In Moldova the number of victims of human trafficking is estimated at 60,000 people, making it one of the countries most affected by this problem. Only a very small minority of these victims are identified and taken care of. These victims suffer from many different physical and mental health problems, and encounter difficulties with reintegration. MdM has raised awareness of this problem among a large network of professionals and offers support for victims in the north of the country. » Balti

LIFE EXPECTANCY 69.3 YRS HDI 0.649; RANK 111 Source: UNDP 2011

» ACTIVITIES MdM leads awareness-raising sessions on the problem of human trafficking in schools, targeting young, essentially vulnerable, people, and organises media campaigns. We have also created a network of people responsible for identifying victims of human trafficking and have provided training for them.

POPULATION

» Beneficiary: 1,479 PERSONNEL

» National: 13 » International: 1 CO-ORDINATORS

» Programme: Françoise Parrot » Field: Antoaneta Popescu »H eadquarters: Anne Landaës FUNDING

» EuropAid, MdM BUDGET

» 2011: €199,165

Looking after these victims involves a medical side, but also a psychological and social one, supported by a network of partners and two outreach teams.

All of MdM’s activities take place under the umbrella of the national reference system for victims of human trafficking.

» RESULTS 1,140 young people were made aware of the phenomenon of human trafficking and of high-risk migration.

400 professionals were trained in identifying and supporting victims.

» OUTLOOK In 2012 MdM is preparing to withdraw by supporting the reintegration of these victims into the mainstream health system and ensuring they are cared for by local services.

International Programmes » EUROPE

DOCTORS OF THE WORLD

Romania Protecting children and supporting the organisation COPII

ANNUAL REPORT 2011

Despite joining the European Union and the structural reforms of the 1990s, Romania does not seem to be able to overcome its political instability and economic difficulties. The situation hinders the government’s work on child protection. Doctors of the World’s PACA regional delegation supports the work of the COPII organisation and Romanian civil society in tackling abuse and abandonment of children.

» Satu Mare jadet

LIFE EXPECTANCY 74 YRS HDI 0.682; RANK 50 Source: UNDP 2011

PARTNER

» COPII organisation CO-ORDINATORS

» Programme: Hélène Picon » Field: M. Veres, COPII coordinator »H eadquarters: PACA regional delegation, Isabelle Malaval FUNDING

»M dM

BUDGET

» 2011: €4,855

» ACTIVITIES Prevention activities, aimed at mothers who are in a vulnerable socio-economical situation and/or showing signs of at-risk pregnancies, were carried out. At the same time, MdM supports the mobilisation of key local stakeholders to improve care and to provide a link for the COPII organisation with the network of MdM’s sister organisations in Poland, Bosnia, Russia and Bulgaria.

» OUTLOOK In 2012, MdM will help COPII study, analyse and implement a community-based project in an area of Satu Mare and in a rural village. The aim is to improve access to healthcare for women and children who are excluded.

International Programmes » EUROPE

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Russian Federation Prevention of foetal alcohol syndrome

The risks associated with the consumption of alcohol are poorly understood by Russian women of reproductive age. This problem is even more worrying given that 50% of pregnancies are unplanned. MdM and a network of governmental and non-governmental actors have rallied together to promote the training of gynaecologists in assisting women in the planning of their pregnancies and in harm reduction linked to alcohol consumption during pregnancy.

» Moscow, Saint Petersburg, Nijny Novgorod, Arkhangelsk, Narian Mar, Yakutsk, Samara-Tolyatti, Irkoutsk

LIFE EXPECTANCY 68.8 YRS HDI 0.755; RANK 66 Source: UNDP 2011

» ACTIVITIES The project aims to mobilise our Russian partners to promote the prevention of foetal alcohol syndrome around common goals: lobbying the federal health authority, forming practical guidelines for doctors, particularly gynaecologists, and the dissemination of practical tools by training educators in the eight regions of Russia involved.

POPULATION

» Beneficiary: 53

» RESULTS

PERSONNEL

30 health professionals and people from the social sector were trained in early identification methods, rapid intervention and motivational interviewing.

CO-ORDINATORS

» OUTLOOK

» National: 4 » International: 1 » Programme: Pierre Guibé, Armelle Desplanques-Leperre » Field: Julia Krikorian » Headquarters: Anne Landaës FUNDING

» MdM

BUDGET

» 2011: €75,629

In 2012, MdM will continue to support the Moscow partners in the pursuit of advocacy, and carry on supporting the training of health professionals and social workers in the Samara-Tolyatti region in partnership with a NGO helping women living in poverty, and with the local health authorities.

International Programmes » EUROPE

DOCTORS OF THE WORLD

Serbia Access to substitution treatment

ANNUAL REPORT 2011

After three years of negotiations with local authorities, the Savski Venac substitution treatment centre, supported by MdM, opened its doors in Belgrade in October 2009. This pilot project, the first to be attached to a centre for primary healthcare, has allowed better access for drug users to treatment and appropriate services.

» Belgrade

LIFE EXPECTANCY 74.5 YRS HDI 0.766; RANK 59 Source: UNDP 2011

POPULATION

» Beneficiary: 169 » Target: 5,000 PERSONNEL

» National: 2 » International: 1 CO-ORDINATORS

» Programme: Patrick Gassmann » Field: Ingo Stockel »H eadquarters: Anne Landaës FUNDING

»M dM

» ACTIVITIES The Savski Venac methadone centre is the biggest centre of its type in Serbia by number of patients (169 by the end of December 2011). It reports a 96% retention rate, which bears witness to the satisfaction of service users. This facilitates a clear demonstration of the effectiveness of harm reduction when applied to drug users at the primary care level. Harm-reduction offers a non-judgmental approach, breaking with the heavy discrimination which drug users experience in Serbia, as well as involving the medical and psycho-social services. The model is now recognised by the Serbian Ministry of Health.

» RESULTS The methadone centre now has a completely autonomous team of nine people capable of dealing with patients and training other teams in Serbia.

» OUTLOOK MdM will withdraw from the centre in January 2012. It is by now completely integrated and autonomous within Savski Venac primary healthcare centre. The intention is now to replicate this model throughout Serbia.

BUDGET

» 2011: €132,445

In 2012 MdM plans to lobby for new methadone centres to be opened at the primary care level.

International Programmes » NORTH AFRICA AND MIDDLE EAST

Algeria

Promoting rights and access to healthcare for migrants

DOCTORS OF THE WORLD ANNUAL REPORT 2011

With the closing of the northern borders, Algeria has become a ‘blocked’ area, and no longer a transit zone for sub-Saharan migrants, who today number around ten thousand in the country. Refugee status has been granted to only around a hundred migrants, leaving the great majority in an illegal and vulnerable situation. There are many obstacles blocking their access to healthcare, and civil society struggles to deal with this issue.

» Wilaya Algiers

LIFE EXPECTANCY 73.1 YRS HDI 0.698; RANK 96 Source: UNDP 2011

POPULATION

» Beneficiary: 145 » Target: 5,000 PERSONNEL

»N ational: 1 » International: 1 CO-ORDINATORS

»P rogramme: Philippe Gabrié »F ield: Camille Leprince »H eadquarters: Isabelle Bruand FUNDING

» EuropAid, MdM

» ACTIVITIES MdM is involved in raising awareness among stakeholders working in the field of health or law, making them aware of the specific needs of migrants. At the same time, MdM has begun to set up a network of health workers who take on a mediation role in established healthcare services by welcoming and providing medical care for migrants. In addition, a mapping of the location of migrants within Algiers, as well as a census of health services which could accept them, is underway. In this way, MdM is able to improve its understanding of the needs of the target population, so as to be able to respond appropriately.

» RESULTS 145 health workers have been made aware of the plight and specific needs of migrants, including migrant rights.

» OUTLOOK In 2012 MdM hopes to strengthen its network of organisations working with migrants, to map out healthcare facilities which could accept migrants to be able to help this population access these health centres.

BUDGET

» 2011: €101,507

Testimony

“A medical student was made aware of a migrant found to be in an alarming condition. He went to her bedside and found that the person was suffering from an ectopic pregnancy and should be hospitalised. He drove her to the hospital where he had just completed an internship. He is subsequently interrogated by an agent of the police who threatens him saying that such actions will damage his career.”

International Programmes » NORTH AFRICA AND MIDDLE EAST

Algeria

Health education

DOCTORS OF THE WORLD ANNUAL REPORT 2011

In Algeria, the public health sector is in crisis: structural reforms have effectively resulted in gradual privatisation. Consequently, through lack of funds, the population has less and less access to healthcare and faces difficulties in following treatment regimes for chronic diseases. Health education, prevention and service user support services are very poorly developed.

» Constantine

LIFE EXPECTANCY 73.1 YRS HDI 0.698; RANK 96 Source: UNDP 2011

POPULATION

» Beneficiary: 200 » Target: 3,000 PERSONNEL

»N ational: local partner CO-ORDINATORS

»P rogramme: Robert Allemand »H eadquarters: Rhone-Alps regional delegation

LONG TERME » ACTIVITIES MdM supports the organisation Cirta Oxygène to implement a programme promoting primary healthcare and community-based care.

This programme consists of promoting health education for patients suffering from chronic diseases by developing non-medical activities and practices (therapeutic education for patients). In addition, the two organisations are working towards increasing recognition of these practices by the authorities and other health actors in the country.

» RESULTS Around 200 people participated in different activities with Cirta Oxygène: individual medical consultations, diet and physical activity workshops, group awareness-raising sessions on specific themes, individual interviews, training in self-management practices and awareness-raising campaigns.

FUNDING

» MdM

BUDGET

» 2011: €9,216

» OUTLOOK Cirta Oxygène hopes to develop its training activities around the theme of ‘therapeutic patient education’, and establish its activities within a sustainable, institutional approach, which will enable MdM to withdraw in due course.

International Programmes » NORTH AFRICA AND MIDDLE EAST

Egypt Improving access to healthcare for street children in Cairo

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Egypt has an extremely high population density. Eighty million inhabitants are concentrated into 6% of a country that extends to one million square kilometres. In Cairo, a vast city of around 20 million inhabitants, street children make up a particularly vulnerable part of the population and are often victims of violence. Solutions offered by the government, as well as civil society, remain inadequate.

» Greater Cairo

LIFE EXPECTANCY 73.2 YRS HDI 0.644; RANK 113 Source: UNDP 2011

POPULATION

» Beneficiary: 3,600 » Target: 25,000 PERSONNEL

» National: 10 » International: 1 CO-ORDINATORS

»P rogramme: Raul Heimann »F ield: Marika Macco »H eadquarters: Isabelle Bruand FUNDING

» Drosos foundation, MdM BUDGET

» 2011: €216, 294

» ACTIVITIES In 2011 MdM carried out information, education and communication activities with social workers and the NGO partners of the project. Teams of social workers benefited from monthly training sessions on 12 different health themes, linked to conditions which commonly affect street children. The MdM team produced two manuals concerning reproductive health and sexual violence. In order to lobby for better care for these children, three important meetings, bringing together carers from the public health system and the partner NGOs, were held. A working group was set up with a view to encouraging the development of an explicit policy statement from public authorities and civil society to protect street children. Contact between health centres and the NGO partners has been improved to ensure the sustainability of these activities.

» RESULTS 476 information, education and communication (IEC) sessions organised, 2,800 children participated, 83 psychological debriefings during the revolution.

» OUTLOOK The street children programme will end in April 2012. Finance is being sought for a new programme in Cairo looking at improving access to mental healthcare.

Testimony Ahmed, 13 years old, on the IEC ‘theatre’ event

“I liked it because now I know some things. I learnt that smoking is bad for your health, and that it can bring on serious illnesses like cancer.”

International Programmes » NORTH AFRICA AND MIDDLE EAST

Libya Emergency medical aid and social support to victims of the Libyan crisis

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Following the Tunisian and Egyptian revolutions, the Libyan revolt started on 17 February 2011, known as ‘the day of anger’, and ended with the death of Colonel Gaddafi on 20 October 2011. The fighting drove many Libyans to flee, along with many foreign workers who are often stigmatised and have sometimes been subjected to retaliatory violence. MdM decided to provide emergency medical and social aid to the Libyan population and the foreign workers fleeing the Libyan crisis in the Egyptian and Tunisian border areas. » Ras el-Jdir (Tunisia) and Salloum (Egypt) border areas

LIFE EXPECTANCY 74.8 YRS HDI 0.760; RANK 64 Source: UNDP 2011

POPULATION

» Beneficiary: 5,769 » Target: 20,000 PERSONNEL

» National: 13 » International: 2 CO-ORDINATORS

»P rogramme: Djawad Guerroudj »F ield: Tamara Hallaq, Rafik Bedoui »H eadquarters: Morgane Aveline FUNDING

» ACTIVITIES In Egypt, MdM provided free medical consultations at the Salloum border post. MdM’s outreach work among the different communities present at the border made it possible to identify the more severe medical problems.

At the same time the programme has also brought psychological and social support. Lastly, MdM supported WFP’s nutritional programme.

In Tunisia, MdM set up in Choucha camp (situated near the Ras el-Jdir border post), in order to bring psychological support to the people fleeing the combat. Intermediaries between the Tunisian authorities and humanitarian workers, MdM facilitated the dissemination of information within the migrant communities, and made sure that the most serious health cases were enrolled on the lists of priority departures.

This programme was carried out in partnership with the Malian Association for Deportees and the Association for Central African deportees in Mali, with whom MdM has already worked in Mali.

» Paris City Council, MdM

» RESULTS

BUDGET

397 people participated in discussion groups in the refugee camp of Choucha over the course of the three-week programme.

» 2011: €50,105

» OUTLOOK MdM closed its programme in June 2011, but continues to monitor the situation of the refugees still in the camps, particularly in Tunisia.

International Programmes » NORTH AFRICA AND MIDDLE EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Palestinian Territories Emergency response and training civilians in first aid

In 2008, an Israeli military operation struck the Gaza strip, which was quickly overwhelmed by emergencies. The difficulty in managing the influx of wounded made it clear that the emergency planning adopted by the Ministry of Health in the Gaza strip was neither sufficiently operational nor adapted to the needs of the different health services. In this context of chronic crisis, MdM looks to improve access for the population to quality healthcare in cases of emergency by supporting local health actors. » Gaza strip

LIFE EXPECTANCY 72.8 YRS HDI 0.641; RANK 114 Source: UNDP 2011

INTERNATIONAL DELEGATION

» MdM Spain POPULATION

» Beneficiary: 4,753 » Target: 534,998 PERSONNEL

» National: 21 » International: 3 CO-ORDINATORS

» Programme: Julien Bousac, Anne Kamel » Field: Stéphane Vinhas »H eadquarters: Nathalie Godard FUNDING

» ECHO, MdM BUDGET

» 2011: €761,797

» ACTIVITIES MdM works at improving the capacity of health workers to respond in an effective and co-ordinated manner in the event of an emergency, and by following pre-established protocols and mechanisms. MdM supports the Ministry of Health’s emergency preparation plan, by training health professionals in the 11 clinics that have an emergency room. In addition, MdM organises training cycles in first aid for women and leaders of the communities in community centres and clinics. These activities reinforce the emergency preparation plan developed by MdM Spain in hospitals.

» RESULTS 73 health professionals were trained, 2,700 women and 495 community leaders were trained in aspects of first aid.

» OUTLOOK In 2012, MdM hopes to continue its activities with health services and the population of the Gaza strip. At the same time, we are also looking to develop programmes to promote mother and infant health for women and children.

International Programmes » NORTH AFRICA AND MIDDLE EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Palestinian Territories Mental health and emergency response among the most vulnerable communities LIFE EXPECTANCY 72.8 YRS HDI 0.641; RANK 114 Source: UNDP 2011

INTERNATIONAL DELEGATIONS

» MdM Spain, MdM Switzerland

The Palestinian villages in the north West Bank are regularly the target of Israeli army operations and of settler violence. Isolated and blockaded by military roadblocks, these populations have difficulties accessing healthcare, particularly in case of emergencies. This situation also affects their psychological health. MdM is supporting mental health services in established health services and is helping to improve the population’s capacity to deal with emergencies.

» West Bank, Nablus and Salfit governorates

» ACTIVITIES MdM is helping to improve psychosocial services within nine villages targeted by the project. We train professionals in the mental health community centres in Nablus and Salfit, along with social workers and teachers in 12 primary schools. The project has enabled the creation of a referral system between the different structures, and the provision of technical support for trained personnel. At the same time, MdM organised raising-awareness sessions about mental health issues, with a view to reducing the stigmatisation of people suffering from psychological problems.

POPULATION

» Beneficiary: 5,025 » Target: 11,565 PERSONNEL

» National: 17 » International: 4 CO-ORDINATORS

» Programme: Julien Bousac, Anne Kamel » Field: Stéphane Vinhas »H eadquarters: Nathalie Godard

Among other things, MdM provides training in first aid for representatives of the communities that are most affected by the conflict, and provides more advanced training for medical personnel in 10 primary healthcare centres. MdM also facilitates the training of community emergency committees for managing crises and provides emergency kits.

» RESULTS

FUNDING

21 health professionals, 16 social workers and 34 teachers were trained.

2,324 people were made aware of the problems of mental health.

24 first aid kits were distributed.

BUDGET

» OUTLOOK

» ECHO, MdM » 2011: €592,844

Following needs assessment carried out in January 2012, MdM plans to pursue the same broad programme themes after June 2012. At the same time, MdM hopes to support vulnerable populations in the north Jordan valley, particularly the Bedouin communities, who find access to healthcare difficult due to the strong Israeli military presence.

International Programmes » NORTH AFRICA AND MIDDLE EAST

Syria Access to basic healthcare

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Alep governorate is the most densely populated and one of the poorest in Syria. Unequal access to healthcare is one of the inequalities facing the population, the private system being the principal alternative to the public healthcare system. MdM supports the Syrian Red Crescent in improving the provision of healthcare.

» Alep governorate

LIFE EXPECTANCY 75.9 YRS HDI 0.632; RANK 119 Source: UNDP 2011

POPULATION

» Beneficiary: 69,759 » Target: 126,000 PERSONNEL

» National: 5 » International: 1 CO-ORDINATORS

» Programme: Marie-Ange Silicani, Fyras Mawazini » Field: Guela Sekhniachvili »H eadquarters: Ernesto Herrera FUNDING

» Drosos foundation, MdM BUDGET

» 2011: €254,098

» ACTIVITIES Eight healthcare centres, managed by volunteers from the Red Crescent, received medicines and medical equipment. A training plan was established for personnel and support was given in terms of organisation and service management. A health education element was also developed, targeting, in particular, women and schoolchildren.

» RESULTS 49,833 medical consultations were carried out.

» OUTLOOK The end of the programme, scheduled for December 2011, had to be brought forward due to the worsening political situation in the country.

International Programmes » NORTH AFRICA AND MIDDLE EAST

Turkey

Respect for human rights and access to healthcare for migrants

DOCTORS OF THE WORLD ANNUAL REPORT 2011

Due to its geographic position, commercial influence and its proximity to the Greek coast, Turkey attracts migrants coming from North Africa, sub-Saharan Africa, the Middle East and Asia. The project, developed together with the Turkish organisation Tohav, is aimed at people disadvantaged by a political and legal system that steers them away from any possibility of regularisation, access to healthcare or treatment adapted to their specific needs.

» Istanbul

LIFE EXPECTANCY 74 YRS HDI 0.7; RANK 92 Source: UNDP 2011

POPULATION

» Beneficiary: 3,811 PERSONNEL

» National: local partner CO-ORDINATORS

» Programme: Bernard Granjon » Headquarters: Isabelle Malaval, PACA regional delegation

» ACTIVITIES MdM provides medical and social aid to undocumented migrant populations living in Istanbul, in the Kumkapi neighbourhood. The service provided combines listening, healthcare, social assistance and referral towards specific services through a combination of provision of care in fixed locations and outreach activities in the areas where migrants live.

In addition, advocacy work, based on field experience and case studies, calls for this these migrants’ rights to be respected, at both the local and European levels. MdM carried out an important study on access to healthcare conditions for migrants and gathered testimonies on living conditions in Kumkapi and their experience during migration.

FUNDING

MdM and Tohav are involved in reinforcing Turkish civil society and promoting human rights, including the right to health, for migrant populations.

BUDGET

» RESULTS

» Bouches-du-Rhône district council, MdM » 2011: €49,846

3,811 consultations carried out.

» OUTLOOK MdM will use advocacy as a tool for change, both on an operational level (modification of current Turkish legislation and encouraging respect for rights) and on a political level. We will present objective arguments on the human consequences and health impact of European immigration and asylum policies that condemn migrants to live clandestinely in great insecurity. Communication events have been organised to bring this advocacy to Turkey and EU countries. In March 2012, in Paris, a seminar will take place on the health consequences of migration journeys.

International Programmes » NORTH AFRICA AND MIDDLE EAST

Yemen Primary healthcare for populations affected by the conflict

DOCTORS OF THE WORLD ANNUAL REPORT 2011

The armed conflict in 2009 between the Houthi rebels and the government has resulted in more than 250,000 displaced people. Gathered in camps, these refugees live in a vulnerable position and remain a long way from healthcare facilities. These refugees have suffered the consequences of the war: destruction of infrastructure, the fleeing of health personnel and difficulty in obtaining medicines. MdM, already in Saada governorate since 2007, continues to support health facilities, enabling continuous access to healthcare for these people. » Saada governorate, Haydan, Safra and Sahar districts

LIFE EXPECTANCY 65.5 YRS HDI 0.46; RANK 154 Source: UNDP 2011

POPULATION

» Beneficiary: 75,063 » Target: 101,118 PERSONNEL

» National: 37 » International: 3 CO-ORDINATOR

» Programme: Françoise Jeanson, Claire Haduong » Field: Michael Pollo »H eadquarters: Nathalie Godard FUNDING

» ECHO, MdM BUDGET

» 2011: €933,399

» ACTIVITIES In three areas of Saada governorate, MdM’s activities aim to re-establish access to healthcare for the population.

The organisation brings assistance to eight health centres— providing medicine, some light renovations, surveillance for epidemics— and has set up four mobile clinics that provide direct care (primary healthcare consultations and antenatal checkups). Children under five years old benefit from malnutrition screening, those suffering from acute malnutrition problems are then cared for and benefit from outpatient treatment (given appropriate nutrition rations).

» RESULTS 4,546 antenatal consultations, 63,688 curative consultations, 13,243 children benefited from nutritional screening.

» OUTLOOK MdM hopes to pursue its activities, further strengthening its support for healthcare centres. However, the general instability present in the country and the significant obstacles which exist makes the continuity of these activities uncertain.

» INTERNATIONAL NETWORK

Argentina CONTACT DETAILS

»M édicos del Mundo Argentina Alberti 48 - Ville Vs. As. Tel/Fax : (00 54 11) 4954 0080 www.mdm.org.ar medicosdelmundo@mdm. org.ar CONTACT

»C hair: Gonzalo Basile medicosdelmundo@mdm. org.ar BOARD OF DIRECTORS

»C hair: G. Basile Vice-chairs : J. Meritano, M. Gorban General Secretary: C. Tcholakian Treasurer: A. Dones Other Board Members: Ana C. Cafaro, D. Cordoba, M. Belardo, N. Lucatelli, Raúl Cimbaro, J. Radesca, C. Karaguezian Registered as a non-profit organisation under Argentinian law in November 1998

ACKNOWLEDGEMENTS

»U nion of South American Nations

(UNASUR), National Institute against Discrimination, Xenophobia and Racism (Inadi – Argentina), The Pan American Health Organisation, National Secretariat for Childhood, Adolescence and Family from the Argentinian Social Development Ministry, National Department of Mental Health and Addiction (Argentina), Buenos Aires City Government (Argentina), Credicoop Bank Argentina, Argentinian National Bank, Civil Society Consultative Council (Argentina) MAC Aids Argentina, Bambini Foundation, Navarrese Viole Foundation, HSBC, OTC AECID Argentina, OTC Aecid Haití, OTC Aecid República Dominicana, Buenos Aires Alliance Française, L´Oréal

» NATIONAL PROJECTS MdM Argentina has two strategic priorities in Latin America: Caring for the marginalised urban population For example: - Primary care programme with a focus on mental health and addiction for those (adults and children) living on the streets of Buenos Aires.

- Migration and health programme promoting intercultural health in Buenos Aires and Córdoba amongst migrants from Bolivia, Peru, Paraguay and the Dominican Republic.

- Health promotion programme in partnership with civil society organisations from the Buenos Aires province.

Supporting the rural population, who are mainly indigenous - Comprehensive health promotion strategy and community wide epidemic prevention activities to tackle chagas disease and the dengue fever epidemic.

- Strengthening inter-cultural primary healthcare activities amongst indigenous women.

» INTERNATIONAL PROJECTS MdM Argentina’s international projects are concentrated in Central and South America: In Peru, MdM Argentina has put in place a nutritional programme to ensure food sovereignty and food security, as well as access to care for women, in a bid to combat gender-related violence in farming and fishing communities.

In Paraguay, MdM Argentina has set up a project to improve primary healthcare in family healthcare and intercultural exchange centres in indigenous communities in San Pedro department.

In Haiti, MdM Argentina continues to provide community healthcare programmes in Léogane, Western province, working with farming and fishing communities in PetitRivière, an area that is belatedly beginning the process of reconstruction, and also in other rural communities. In

DOCTORS OF THE WORLD ANNUAL REPORT 2011

both cases, the organisation has strengthened the primary health system and local healthcare provision, with a strong health promotion and epidemic surveillance component to fight cholera and other endemic diseases, and the development of community-based disaster risk reduction strategies.

In Bolivia, MdM Argentina continues to share knowledge, technical assistance and training in collaboration with the Bolivian Ministry for Health and Sports.

In Dominican Republic, MdM Argentina began a community health and cholera prevention project at the end of 2011.

» COMMUNICATION AND EVENTS Among other things, MdM Argentina: • again participated in the National Social Forum on Health and the Environment in Argentina; • participated, as part of the National Congress, in the seminar entitled Social security and health in the political agenda of the 2011 presidential campaign. More than 15 political parties and their national representatives participated in the debate. Doctors of the World was in charge of opening and closing the seminar; • was chosen to take part in the civil society consultation during a meeting between governments from the Americas and the Pan American Health Organisation in San José in Costa Rica, on the theme of social determinants and their impact on health, and was invited to the Rio de Janeiro international conference on social determinants and their effect on health as a civil society representative from the Southern Cone; • participated in the Mercosur social summits, arranging the participation of the International Commission on Health of Southern Cone civil society organisations both in Paraguay and Brazil.

» INTERNATIONAL NETWORK

Belgium 1/2 CONTACT DETAILS

» Médecins du Monde Belgium Rue de l’Éclipse, 6 1000 Brussels Belgium Tel + 32 (0)2 648 69 99 Fax + 32 (0)2 648 26 96 www.medecinsdumonde.be CONTACT

» info@medecinsdumonde.be

» NATIONAL PROJECTS Brussels: - Healthcare and Advice Clinic • In 2011, increase in new clients (asylum seekers and people from new European member states).

• Consultations with the objective of referral to mainstream services.

2,053 social consultations, 2,510 medical consultations and 354 psychological consultations.

BOARD OF DIRECTORS

»C hair: M. Degueldre Vice-chair: E. Struys Secretary: P. Deltour Other Board Members: D. Van Osta, P. Viart, E. Gatera, S. Braekeveldt, J. Bourgaux STAFF

»D irector: P. Verbeeren Medical Director: E. Hesse Belgium Desk: S. Heymans Congo / Haiti Desk: F. Fille Mali Desk: E. Richard Nutrition Expert: C. Lucet HR Manager: A. Saunders HR Assistant: M. Reuss Secretary: A. Al Badaoui Marketing Manager: D. Baise Communications Managers: C. Eeckhout and S. Tisson Finance Manager: C. Socquet Internal Auditor: J. Quenum Grant Manager: M. Hamonet Accountant: A. Pierson »1 8 staff members in Belgium; 280 permanent volunteers in Belgium; 19 expatriates; 241 national staff on international projects; 30 volunteers left for the field Incorporated as an association under Belgian law May 1999

- Emergency winter homelessness plan In total, 3,730 consultations with the involvement of more than 200 volunteers. Three consultation sites in 2011.

- Specialist consultations MdM provides secondary care to vulnerable people with the support of 320 specialists (e.g. gynaecologists, physiotherapists) and 213 dentists.

- Counselling for isolated women (Talk to her) 5 volunteer counsellors. More than 100 contacts with vulnerable women.

- SOS Welcome 711 consultations with 40 volunteers.

Antwerp: - Healthcare and Advice Centre: Access to care is becoming more difficult for irregular migrants due to the tightening of conditions for access to urgent medical assistance.

- Winter plan: Development of a new project in partnership with other organisations in three places (a day centre and two night shelters).

» INTERNATIONAL PROJECTS Mali: Since 2001, MdM has intervened in the country on several levels: - Support of vulnerable children in Bamako: 1,510 medical

DOCTORS OF THE WORLD ANNUAL REPORT 2011

consultations, 193 people received ongoing psychological support. The project also has an advocacy component.

- Primary healthcare in the north of Mali (Kidal): 13 health centres.

- Emergency healthcare support in eastern Mali through the deployment of five outreach teams.

- Support to the Youwarou region, an area flooded for seven months a year, and the Kidal region.

Democratic Republic of Congo: Support for 45 health centres and three hospitals of western Kasai: construction of four maternity units and two health centres, drugs, medical supplies, supervision of health centres and hospitals, health training, intervention in seven areas of health, campaigns on measles vaccination.

Haiti: - Re-launch and strengthening of the maternity ward in Petit-Goâve, now open 24 hours a day, serving a population of 300,000. 1,800 deliveries and 200 caesarean sections in 2011.

- Fight against cholera in Nippes region: one cholera treatment centre, three treatment units, 15 oral rehydration units and 151 members of health staff trained. 3,300 people treated directly.

- Belgian doctors trained six interns in obstetric surgery: 50 in ultrasound and 24 in vaginal surgery.

» COMMUNICATION AND EVENTS - Exhibition Talk to her in September in Brussels and in October in Antwerp.

- Under the leadership of Doctors of the World, organisations and health professionals throughout Europe signed the European declaration for non-discriminatory access to healthcare.

- MdM is at the forefront of the SOS Welcome consortium bringing together eight NGOs to tackle the crisis of

» INTERNATIONAL NETWORK

Belgium 2/2 ACKNOWLEDGEMENTS

» F DGD, ECHO, WBI, SPP Intégration

Sociale, INAMI, Consortium 12-12, the national lottery, Peterbroeck Foundation, Delacroix support funds, P&V, Umicore, AGEAS, ING, Lhoist, L. Bégault, PSF, Euro RSCG, Nif Trust, King Baudouin Foundation

support for asylum seekers. It includes day care for those on the streets and night shelters for the most vulnerable.

» KEY EVENTS 2011 2011 was marked by the hard work and dedication of volunteers across the Winter Plan, specialist programmes, SOS Welcome and international emergencies (e.g. Mali, Horn of Africa) and the development of Belgian projects.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD

Canada 1/2 CONTACT DETAILS

»M édecins du Monde Canada 338, rue Sherbrooke-Est Montréal, QC, H2X 1E6 Canada Tel : + 514 281 8998 Fax: + 514 281 3011 info@medecinsdumonde.ca www@medecinsdumonde.ca CONTACTS

» info@medecinsdumonde.ca BOARD OF DIRECTORS

»C hair: N. Bergeron Vice-chair: C. Galand Treasurer: F. Scarborough Secretary: H. Duong Officer (no voting rights): A. Bertrand Other Members: Z. Brabant, V. Morel, Luc Rocheleau, M.E. Goyer, S.-R. Hypollite, M.-R. B. Lajoie STAFF

»D irector: A. Bertrand Bookkeeper : M. Duong Banh Logistics Assistant: E. Déry International Operations Assistant: I. Francœur Director International Operations: A. Houle Bookkeeper: V. Trung Huynh Project Manager: I. Mas Special International Projects Manager: B. Mille Communications and Fundraising: S. Djelidi Researcher: M. Fabre Finance Director: Y. Messier Database and Reception: R. Rajaonarison

» NATIONAL PROJECTS Montreal project Since 1999, Doctors of the World Canada has been working to improve the health of people who are marginalised and excluded from care in Montreal. Throughout the year, two outreach nurses work with excluded people delivering care and carrying out prevention and health promotion activities.

In 2010-2011, MdM Canada provided care to more than 1,000 vulnerable people.

Volunteer doctors also carried out approximately 205 medical consultations. 100 volunteers accessed individual psychological support service and 30 working groups receive group support on a monthly basis.

ANNUAL REPORT 2011

- Reproductive health programme.

In the Dominican Republic, the project aims to improve access to primary care for inhabitants of San Luis and surrounding sugarcane villages and supports implementation of a prevention of mother-to-child transmission of HIV/Aids programme.

In Nicaragua, 2010-2011 saw the end of the project to improve sexual and reproductive health, which had run for three years in partnership with the Casira Foundation, a very active local organisation working to defend women’s rights.

Migrants project Doctors of the World Canada offers medical care to vulnerable migrants. A first for Québec: a primary care clinic offering care for vulnerable irregular migrants without medical cover.

In three years, MdM Canada gave medical care to 16,240 women and their children, offered psychosocial support and a temporary safe haven to 13,380 women and their children. 70 community leaders trained by Doctors of the World have meant that 11,130 women and girls benefited from sexual health promotion activities focused on HIV, STIs, violence against women and girls, women’s rights, and child protection.

Doctors and non-medical volunteers welcome and care for migrants without medical cover and refer them to specialist services when needed.

In Colombia, in Meta region, MdM Canada, in partnership with MdM France, is working to ensure access to primary care for the conflict affected population.

» INTERNATIONAL PROJECTS

14th Doctors of the World Gala The gala was held on 30 March 2011. Almost 300 people attended and the donations (just over 105,000 Canadian dollars) went towards supporting MdM Canada’s projects.

In Haiti, In Haiti, four projects are up and running in CitéSoleil, Port-au-Prince: - Emergency intervention following the 12 January 2010 earthquake: more than 38,841 consultations thanks to mobile clinics.

- Cholera emergency response: 19 mobile clinics and 19 rehydration posts.

- HIV/Aids prevention of mother-to-child transmission programme.

» COMMUNICATION AND EVENTS

Sexperts For several years now, Doctors of the World has had a partnership with Sexperts: a group of young medical students from Montreal University and McGill University that holds awareness-raising and prevention sessions in

» INTERNATIONAL NETWORK

Canada 2/2 STAFF

»L ocal Projects Project Montreal Coordinator and Project Manager: L. Jean Administrative Assistant: M. Dotia Outreach Nurses: P. Boudreault, S. Beauchamp Group Psychologist : P. Létourneau Incorporated as a not for profit organisation under part III of the Quebec company law in May 1996

ACKNOWLEDGEMENTS

» Canada International Development

Agency (CIDA), United Nations Population Fund, Quebec Ministry for International Development, Unicef, Les Oeuvres du Cardinal Léger, Martin Duquette pharmacies, AstraZeneca Canada Inc., Familiprix, J. Armand Bombardier Foundation, Montreal Region Offices for Health and Social Services, Human Resources and Skills Development Canada (Sipli programme).

schools focused on HIV/Aids and other sexually transmitted infections, and fights for respectful and risk-free sexual practices.

Youth Wing Doctors of the World’s youth wing is involved in projects to promote Doctors of the World’s values to the under 30s, to stimulate engagement in international development and promote activism in young Canadians from 12 to 30 years old.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD

Germany CONTACT DETAILS

»A erzte der Welt e.V Doctors of the World Germany Augustenstr. 62 80333 Munich Germany Tel: + 49 89 45 23 081 - 0 Fax: + 49 89 45 23 081 - 22 www.aerztederwelt.org info@aerztederwelt.org BOARD OF DIRECTORS

»C hair: H.-Jochen Zenker Vice-Chair: P. Rosenstiel Honorary Chair: W. Schilli Treasurer: K. Wieners Other Board Members: M. Heinzlmann, B. Stambul, K. Schwenzer-Zimmerer, H. Schneider, N. Schmidt, G. Lauer, P. Schwick STAFF

»D irector: A. Schultz CFO: M. Gemeiner Fundraising, international projects : K. Radmüller Fundraising: G. Jüttner International Projects: N. Petersen : Networks, institutions and organisations: M. Pietzsch Director of Communication: U. Zurmühl Communication and Events: D. Perrot Project Co-ordination Germany: S. Schmitt, M. Chenevas MedMobil Stuttgart: I. Scherrenbacher open.med Munich: S. Bruins Database Assistant: R. Schwayer Association established under German law on 19 March 1999

ACKNOWLEDGEMENTS

» S ternstunden Foundation, German

Ministry of Foreign Affairs, Renovabis Foundation, L’Oréal Foundation, Daimler AG

» NATIONAL PROJECTS - Munich open.med clinic: In 2011, 1,070 medico– social consultations for 817 patients without medical cover or without a residency permit. A new session for pregnant women has been set up. The year has seen a further increase in patients from Eastern Europe, notably Bulgaria and Romania.

- Mobile team, MedMobil Stuttgart: More than 1,200 contacts with 439 vulnerable people were made in 2011.

More than 80% of those approached by the team should, in theory, have access to mainstream care, but are excluded for a number of reasons including financial.

» INTERNATIONAL PROJECTS - Two Opération Sourire missions carried out in Cambodia (Kampong Cham, O Reang Ov and Phnom-Penh).

- Burma: within the framework of a new long-term ophthalmology project, work has begun in the Rakhine region. Three doctors and a nurse worked alongside two Burmese ophthalmologists to carry out 60 operations, notably cataracts.

» COMMUNICATION AND EVENTS - Violence against women campaign: The Women, the aftermath of violence exhibition attracted 10,000 visitors during the four week Tollwood festival in Munich.

The exhibition was opened by women’s rights activist Fadumo Korn.

- Anniversary: Five years of delivering care to people without medical insurance or residency papers in Munich, in collaboration with the NGO Malteser. A number of political and civil service representatives were invited to discuss access to care for undocumented migrants and those without medical insurance and the responsibility of local public institutions in this area.

- The end of the campaign entitled European declaration for non-discriminatory access to healthcare in collaboration with the Huma network and the support of the

ANNUAL REPORT 2011

German Medical Council.

- Co-organisation of the 13th Congress on Theory and Practice of Humanitarian Aid in Berlin, with a number of participants from the MdM network and MSF Germany, the German Red Cross, Berlin Chamber of Physicians, The Charité Hospitial.

- Siemens donated eight ultrasound machines to Doctors of the World projects: Ukraine, Cambodia, Tunisia, France (Marseille), Germany (Munich), Greece, UK (London).

» FINANCIAL SUPPORT FOR MDM FRANCE PROGRAMMES

- Kenya: Access to care, and support for Dadaab hospital.

- Somalia: Access to care for displaced people and local people from Bossaso.

- Ukraine: Primary care, notably for migrants en route to Europe.

- Haiti: Primary care and mother and child care (Grand’Anse).

- Bulgaria: Primary care.

» HUMAN RESOURCES SUPPORT - Cambodia: 16 volunteers (surgeons, anaesthetists, paediatricians, nurse, operating theatre assistant).

- Myanmar: two ophthalmologists and a nurse.

» INTERNATIONAL NETWORK

Greece CONTACT DETAILS

»D octors of the World Greece Sapfous Street, 12, 10553 Athens, Greece Tel : + 210 32 13 150 Fax: + 210 32 13 850 info@mdmgreece.gr www.mdmgreece.gr BOARD OF DIRECTORS

»C hair: Nikitas Kanakis, Vice-chair A: Antonios Androutsos A. Vice-chair B: Spyros Kloudas General Secretary: Eleutheria Mouloudaki Secretary: Elena Mavropoulou Treasurer: Christos Skolarikos PR: Ioannis Giannakopoulos Members: Christos Agelidis, Ioannis Mouzalas ACKNOWLEDGEMENTS

» Vodafone, NovoNordisk

» NATIONAL PROJECTS - Four open polyclinics in operation in Athens (since 1997), Thessaloniki (since 2001), Chania (since 2007), and Piraeus-Perama (2009). Teams of volunteer doctors, nurses, social workers and psychologists provide primary care and medicines, and psychological care for those people who are excluded from the public health system.

- Shelter for asylum seekers: the centre supported over 354 people. The main objective is to facilitate the inclusion and integration of asylum seekers into Greek society, by giving them accommodation, food, psychological support and medical care.

- Mobile medical units. MdM set up six units to provide primary care to those with limited access to medical services. These projects include: • LITO: a child healthcare and dental unit that travels to remote regions (with a focus on villages and isolated islands).

• Iris: an ophthalmic unit caring for elderly patients and children.

• Roma: this unit provides, on a weekly basis, medical, pharmaceutical, and psychosocial support, including essential vaccines, to Roma people living in camps in the outskirts of Athens, Thessaloniki and Chania.

• Streets of Athens—harm reduction programme: the unit offers psychological support, primary healthcare and HIV, hepatitis B and C testing for drug users through weekly consultations. The programme provides new syringes to drug users and collects used syringes.

• There is also a mobile medical unit working in Western Greece, in Patras and Igoumenitsa: the unit seeks to improve primary healthcare and identifies vulnerable people (including asylum seekers) who require international protection. The unit provides medical, psychological and legal support.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» INTERNATIONAL PROJECTS Algeria Provision of medicines, materials and improvement of pharmaceutical systems management in the Sahrawi refugee camps (Tindouf, Algeria).

Uganda Support for medical centres in Monte and Gulu villages.

Tanzania Project aimed at early detection and treatment of diabetes in the rural Ifakara region.

» COMMUNICATION AND EVENTS • In November 2011, MdM Greece launched a nutrition campaign to support Greek nationals who face serious financial problems. In two months, food packs were distributed to 885 families.

• On 20 December, MdM Greece organised an open air event, where a Christmas tree was made from long life milk, as part of the nutrition campaign.

• During the Christmas holidays, Mega TV, one of the most popular private TV companies, organised an SMS campaign for MdM Greece’s polyclinics.

• MdM Greece held a number of press conferences, and participated in several events and festivals. For example, MdM gave a press conference on the theme Athens, a city in humanitarian crisis 2011-2012. As part of the nutrition campaign, MdM participated in the Athens Micropolis festival etc. MdM Greece was interviewed by many international media (newspapers, TV stations, radio) from most of the other European countries.

• On 30 May the Veteran Basketball Players’ Association and the employees of the Hellenic Postbank basketball team held a match to raise funds for the organisation.

• On 4 January, MdM Greece hosted a ‘love convoy’ to visit remote villages in northern Greece and provide medical care to inhabitants, in partnership with 4 x 4 vehicle clubs.

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD

Japan 1/2 CONTACT DETAILS

» Doctors of the World Japan Azabu Zenba Bldg 2F 2-6-10 Higashi-Azabu Minato-ku, Tokyo 106-0044 Japan Tel: + 81 3 3585 6436 Fax: + 81 3 3560 8073 http://www.mdm.or.jp CONTACTS

» info@mdm.or.jp BOARD OF DIRECTORS

» Chair: G. Austin Other members: A. Bourdé, P. David, F. Foussadier, M. Harada, H. Isomura, A. Kiuchi, N. Oura, N. Yamada, S. Terashima, S. Yoza STAFF

»D irector: N. Kuroyanagi S. Abe, T. Kase, H. Kataoka, S. Kumazawa, A. Nakamura, T. Sato, M. Seki, K. Tamate

» NATIONAL PROJECTS

ANNUAL REPORT 2011

» COMMUNICATION AND EVENTS

Project Tokyo Advocacy Project Tokyo’s work continues for the second year, giving In early 2011, MdM Japan participated in two major care to homeless people with mental health problems. In advocacy events: Global Forum on Human Resources 2011, the team made contact with more than 6,500 ho- for Health in Bangkok in January, and the World Social meless people during weekly night outreach activities, or- Forum in Dakar, in February. Advocacy activities related ganised by MdM teams and partner organisations. At the to the vulnerable people supported by Project Tokyo end of 2011, about 70 beneficiaries are receiving regular constituted another important platform this year. care from MdM psychosocial teams, three to four people also benefited from temporary shelter funded by MdM and Communication managed by our partner, Bethel no Ie. To better respond - With a few rare exceptions, the press coverage received to the psychological impact on volunteers working on the by the organisation centred on the psychological supproject, a component to support volunteers was added port offered to the victims of the tsunami in Otsuchi. The at the end of the year in partnership with a group of visibility of the project was even greater thanks to ADK, psychologists.

MdM’s partner communications agency and designer of the web site dedicated to the Otsuchi Nikokoro project, Nicocoro project which was able to negotiate free advertising space in Immediately after the 11 March tsunami, and in collabo- print media. ration with the international network office and the MdM France emergency desk, MdM Japan studied the possibili- - After two unsuccessful attempts, MdM was selected by ties of an emergency programme in the disaster area. Finally, the consortium of advertisers, AC Japan, as the benefia volunteer team of psychiatrists and nurses was deployed ciary for the next two years (June 2012-June 2014) of a in the city of Otsuchi in Iwate prefecture. Initially focused free advertising campaign in Japan. This news, received on visiting temporary shelters, the project has adapted to in October, is an opportunity for MdM to develop its rechanging needs e.g. now visiting families rehoused in tem- putation among the Japanese general public. It is also porary prefabricated housing, teacher training. recognition of the quality of the work done so far in Japan.

» INTERNATIONAL PROJECTS The Opération Sourire programme was affected by the 11 March disaster. The project planned for Cambodia in May-June was cancelled and an exploratory mission was postponed to the following year. Finally, two missions were held in Bangladesh (February and November) and a team of Japanese medical volunteers joined French colleagues in Madagascar in August.

- MdM gave lectures to young Japanese people both in primary schools (Yamaguchi), high schools, (Hakusan, Suiran, Mita) and universities (ICU, Keio).

» FINANCIAL SUPPORT TO

MDM FRANCE PROGRAMMES

- Haiti: Earthquake emergency - Nepal: Maternal-child health - Sahel: Primary healthcare - DRC: Primary healthcare - Niger: Primary healthcare

» INTERNATIONAL NETWORK

Japan 2/2 - Horn of Africa: Emergency - Angola: Maternal-child health - Madagascar: Heart surgery

» HUMAN RESOURCES SUPPORT TO MDM FRANCE PROGRAMMES

Opération Sourire Madagascar: 2 volunteers went to the field.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» INTERNATIONAL NETWORK

Netherlands 1/2 CONTACT DETAILS

» Dokters van de Wereld Nieuwe Herengracht 20 1018 DP Amsterdam Netherlands Tel: + 31 20 465 2866 Fax: + 31 20 463 1775 info@doktersvandewereld.org www.doktersvandewereld.org CONTACTS

» info@doktersvandewereld.org BOARD OF DIRECTORS

» Chair: R. van de Pas Secretary: M. Diaz Treasurer: J. v. Duin Other Board Members: H. Peters, B. Juan F. Sivignon Registered as a charity under Dutch law on 28 April 1997

STAFF

»D irector: M. Koppe R. Arts, A. Bovend’eerdt, N. Van Egmond, I. Fikkert, A. De Jong, B. Jurg, I. Kalmykova, W. Krabbenborg, M. Kroesen, M. Van Midde, K. Rinsma, A.M Scholten, M. Van Welie, S. Zwaan »E mployees who left during the year: J. Van Beers, S. Godschalk, N.L Pique, E. Van Puffelen, P. Schermers, M. Sellmeijer, I. Simpson, S. Voogd, L. Voorend ACKNOWLEDGEMENTS

» Ministry of Foreign Affairs (Matra,

MFS), Innovatiefonds Zorgverzekeraars, Maria Stroot Foundation, Aids Fund/ SBL, Cordaid, Commissie PIN, Skan Foundation, Stichting RC Maagdenhuis, NutsOhra Foundation, Stichting Janivo, Kerk in Actie, RCOAK, CCI IT Group, Hampshire Inn Amsterdam, Senshake, all the free media coverage and volunteers, interns and thousands of individual donors.

» NATIONAL PROJECTS MdM Netherlands (Dokters van de Wereld) continues to develop projects for the most vulnerable people in the Netherlands.

- Roma population: advice for stateless Roma people (project ended 31 March 2011).

- Programme for undocumented migrants Improving access to care for undocumented migrants in Amsterdam, the Hague and Rotterdam.

1. Registering undocumented migrants with general practitioners.

2. Information, mediation and prevention activities for undocumented migrants.

Specifically: - 1,367 consultations were provided, offering facilitation and information on the Dutch care system and the right to health (by telephone or face to face).

- Patients reported 104 problems with accessing care; MdM Netherlands worked successfully to negotiate with doctors. In 70% of cases, the patients were able to access care.

- 78 patients who needed to consult a general practitioner were successfully supported to obtain regular consultation with a doctor.

- MdM Netherlands met 2,679 migrants in churches, giving them information on the right to health and the Dutch healthcare system.

- 530 migrants attended information sessions on cardiovascular disease.

» INTERNATIONAL PROJECTS MdM Netherlands continues its international projects in Indonesia and Serbia.

In Aceh - Bener Meriah, the programme aims to improve access to care for mothers and their children. In Serbia, the programme, in partnership with the NGO local Veza,

DOCTORS OF THE WORLD ANNUAL REPORT 2011

is centred on the prevention of HIV/Aids among drug users (end of project 31 December 2011).

MdM Netherlands also started an Opération Sourire mission in Bangladesh in partnership with the university hospitals in the Netherlands and a hospital in Bangladesh.

» COMMUNICATION AND ACTION - Articles and videos related to undocumented migrants.

- Opération Sourire in the media and free advertising campaigns.

- Increased exposure on the internet (FaceBook/website/ internet/YouTube).

- Events to raise funds for Opération Sourire: Haaksbergenloop, Medisch Spectrum charity dinner, Dam-totdamloop race.

» FINANCIAL SUPPORT TO

MDM FRANCE PROGRAMMES

- Burma: Maternal-child health - Colombia: Primary healthcare - DRC: HIV/Aids - Haiti: post-emergency - Indonesia (Western New Guinea): HIV/Aids and primary healthcare - Indonesia: Maternal-child health - Côte d’Ivoire: Emergency - Kenya: Emergency - Liberia: Maternal-child health - Pakistan: Shelters for women - Opération Sourire - Zimbabwe: HIV/Aids

» INTERNATIONAL NETWORK

Netherlands 2/2 » HUMAN RESOURCES SUPPORT FOR MDM FRANCE PROGRAMMES

Seven international staff members working on the following projects: - Liberia: Medical referent, Nurse - Ethiopia: Nurse - Indonesia, Jakarta: General coordinator - Colombia, Meta: Administrator logistician - Myanmar, Pyapon site: Coordinator - Pakistan, Lahore: Programme coordinator

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» INTERNATIONAL NETWORK

Portugal CONTACT DETAILS

»M edicos do Mundo (MdM) Av. de Ceuta (Sul), Lote 4, Loja 1 1300-125 Lisbon Tel : + 351 213 619 520 / + 351 213 619 521 Fax: + 351 213 619 529 mdmp-lisboa@medicosdo mundo.pt www.medicosdomundo.pt CONTACTS

»D irector General : Carla Paiva International Programmes Director : João Blasques BOARD OF DIRECTORS

» Chair: Abílio Antunes Vices-chairs: António Andrade, Paulo Castro Seixas Treasurer: Cátia Palma Member : Catarina Vaz Velho Member: Fernanda Luís STAFF

» International Project Coordinator: Maria Sacchetti, International Projects Desk: Andreia Oliveira National Projects Coordinator: Carla Fernandes Communication, Marketing, Fundraising: Rosa Pereira, Communication, Marketing, Fundraising Consultants: António Neiva, Paulo Silva Administrative Coordinator : Patricia Serra Administrative Assistant: Ana Freitas Donor relations co-ordinator: Mónica Tavares Fundraising Administrative Assistant: Djamel Mameri Coordinator: Florbela Cordeiro HUMAN RESOURCES

» 200 active volunteers during 2011

DOCTORS OF THE WORLD ANNUAL REPORT 2011

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» NATIONAL PROJECTS Saúde Móvel (mobile health) project. Objective: reduce the spread of HIV and opportunistic infections. Teams conduct outreach sessions on the streets at night to offer medical support and referral to social care, or simply accompany people to night shelters. During 2011, 1,657 people benefited from the service.

Viver Saudável (Live healthy) in Lisbon. Objective: accompany, in their access to care, 250 elderly people (men and women over 65) living in Picheleira and its surrounding area over four years.

HIV/Aids prevention project in Alentejo. Objective: reduce the rate of infection among youths aged between 11 and 18 years by highlighting high-risk sexual practices.

Health without papers project (on a national scale, Porto, Lisbon and Évora). Objective: allow patients to consult healthcare professionals without presenting their official identity documents, which is currently a condition for guaranteed access to health services, psychosocial support, and referral to community groups working with undocumented migrants. In 2011, the team conducted 1,418 primary care consultations and 1,998 psychosocial interviews.

» INTERNATIONAL PROJECTS Timor-Leste. Comunidade Saudável project (community health). Objective: Priority given to the roll out of the Ministry of Health integrated community health service, which seeks to guarantee quality care, in particular sexual and reproductive care, within communities, particularly in the most isolated areas.

Guinea-Bissau. Protège a tua Vida/Tadja bu Bida project (Protect your Life). This project covers four regions: Bissau (Independent sector), Bubaque, Bafatá and Gabú, and aims to reduce HIV/Aids and STIs in Guinea-Bissau.

In 2011, 1,276 tests were performed in the five voluntary

testing and advice centres, 2,139 pregnant women were tested, 267,638 condoms and 18,784 leaflets distributed.

» OTHER INTERNATIONAL PROJECTS São Tomé and Príncipe: HIV/Aids (prevention, advice and voluntary testing) and sexual and reproductive health.

Angola : Primary healthcare.

Guinea-Bissau: HIV/Aids (prevention, advice and voluntary testing), water purification and cholera prevention.

Timor-Leste: Sexual and reproductive health.

Mozambique: HIV/Aids (prevention, advice and voluntary testing) and malaria.

» COMMUNICATION AND EVENTS MdM Portugal carried out campaigns through the website on several world days, such as Tuberculosis, Health and World AIDS Day. During 2011, some of MdM Portugal’s work was featured on television channels like RTP, notably on the theme of health and immigration.

» INTERNATIONAL NETWORK

Portugal ACKNOWLEDGEMENTS

» National project funders Câmara Municipal de Lisboa, Coordenação Nacional para a Infecção VIH/ sida, Delta, Direcção Geral de Saúde, EDP, Fundação Eugénio Almeida, ISS – Instituto de Segurança Social » Partners Agrupamento de Escolas das Olaias, Associação Crescer na Maior, Associação de Basquetebol do Alentejo, Associação de Futebol de Évora, Associação de Municípios do Distrito de Évora, Associação Lágrima Humana, Associação Nacional de Farmácias, Associação Portuguesa de Pais e Amigos do Cidadão Deficiente Mental, Cais, Câmara Municipal de Lisboa, Câmara Municipal de Matosinhos, Câmara Municipal de Redondo, Casa da Juventude de S. Mamede Infesta, Centro de Acolhimento VITAE, Centro Padre Alves Correia – CEPAC, Cidade Afável, Ciências e Letras – Formação Especializada, Lda., Clube de Rugby de Évora, Clube Desportivo de Beja, Clube Vitória de Lisboa, Comissão Social da Freguesia do Beato, Complexo Desportivo Municipal do Casal Vistoso, Confederação Portuguesa de Associações de Treinadores, Ditirambus, Escola 2,3 das Olaias, Escola Superior de Saúde do Alcoitão, Espaço T, Exército de Salvação, Grupo Desportivo e Recreativo Canaviais, HelpPhone, Hospital Magalhães Lemos, Instituto de Higiene e Medicina Tropical, Instituto de Segurança Social, Instituto Politécnico de Setúbal – Escola Superior de Enfermagem, Instituto Superior de Psicologia Aplicada, Junta de Freguesia de São João, Junta de Freguesia do Alto Pina, Junta de Freguesia do Beato, Juventude Sport Clube, Matosinhos Habit, Núcleo de Andebol de Redondo, Organização Internacional para as Migrações, Paróquia do Espírito Santo, Programa Escolhas, Programa K’Cidade, Projecto Há Escolhas no Bairro – Associação Mediar, Programa Escolhas, PSP – 12ª Esquadra, Rede Institucional de Apoio aos Sem-Abrigo da cidade do Porto, Rede Social de Lisboa, Redondense Futebol Clube, Santa Casa da Misericórdia de Lisboa, Serviço Jesuita aos Refugiados, Sport Lisboa e Évora, Universidade de Évora

DOCTORS OF THE WORLD ANNUAL REPORT 2011

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» INTERNATIONAL NETWORK

Spain 1/2 CONTACT DETAILS

» Médicos del Mundo España Conde de Vilches 15 28028 Madrid Tel : + 91 543 60 33 Fax : + 91 543 79 23 informacion@medicosdel mundo.org www.medicosdelmundo.org CONTACT

» Organisational Development Director: Ricardo Schleissner BOARD OF DIRECTORS

»C hair: Álvaro González Vice-chair with responsibility for social inclusion: Felipe Noya 2nd Vice-chair with responsibility for international development: José Luis Engel General Secretary: Pilar García Rotellar Treasurer: Ave María Aburto Board Member in charge of Communications: Daniel López Arteche Board Member in charge of Equality: María Yolanda Rodríguez Board Member in charge of External Social Mobilisation: María Florentina Martín Board Member in charge of Internal Social Mobilisation: Sagrario Martín Board Member in charge if International Network Liaison: Hervé Bertevas

Doctors of the World Spain has headquarters (in autonomous communities) and representative offices in 20 Spanish towns that carry out around 100 social inclusion and social engagement projects. The organisation also rolls out international development programmes in around 20 countries.

» NATIONAL PROJECTS The national projects developed by Doctors of the World Spain aim to enable access to healthcare for all people living in the country, regardless of status, with a particular focus on the social determinants of health, factors that can impede the full realisation of rights. Over and above medical care, psychological care and social services are offered to those facing obstacles in accessing the public health system. In 2011, Doctors of the World Spain began collecting data and case studies to document violations of the universal right to health experienced by people who visit its various projects.

Social Inclusion Training on HIV/Aids for vulnerable people was a key objective for 2011. The strategy, which uses peer education and focuses on groups susceptible to high-risk behaviours, turned out to be a great success in terms of prevention. The behaviour of sex workers, homeless people and/or drug users are among the key determinants of their state of health.

Peer educators share advice, information about prevention of illnesses associated with drug use, self-administration of hormones etc. The aim is to modify behaviours which involve health risks. 137 people successfully completed the course.

Development Education In a bid to ensure consistent messaging, Doctors of the World Spain has launched an initiative to bring together

DOCTORS OF THE WORLD ANNUAL REPORT 2011

the different strands of development education that exist across the organisation.

The Kushiriki por la Salud (Kushiriki for Health) project is worth highlighting. This project brought together children to discuss social barriers and consider the difficulties in accessing care experienced by migrant groups.

» INTERNATIONAL PROJECTS Sexual and reproductive health Sexual and reproductive health, along with mental health and psycho-social support in emergencies (such as in the Palestinian Territories) or responding to epidemics (as in Haiti), made up the bulk of Doctors of the World Spain’s work in 2011.

One example is the Convention implemented by Doctors of the World Spain in Salvador, Honduras, Guatemala and Nicaragua to improve the respect of the right to health for vulnerable people, more specifically for teenagers, women, sex workers and migrants. This Convention enabled the construction of a maternity unit and a mother and baby clinic as well as the reconstruction and kitting out of a clinical laboratory, serving a population of over 11,000.

Horn of Africa Emergency Drought, an increase in food prices, and other factors worsened the situation in the Horn of Africa, not only in Somalia (a country also devastated by an enduring armed conflict), but also in neighbouring countries like Kenya and Ethiopia, and further increased the numbers of displaced people who are unable to meet their basic needs.

In partnership with other network members, Doctors of the World Spain set up a humanitarian response project

» INTERNATIONAL NETWORK

Spain 2/2 to care for Somali refugees and local people affected by the crisis, with a focus on improving primary and secondary healthcare in the Dollo Ado and Filtu regions (Ethiopia), in particular for breastfeeding mothers, pregnant women and children under five.

» COMMUNICATION AND EVENTS Homeless service users worked on the creation, development and execution of a photography exhibition entitled City of all, home to few? that offers a firsthand account of living on the streets, with the aim of raising awareness about the plight of vulnerable homeless people. The exhibition, supported by the Ministry of Health, Social Services and Equality, was presented in Valencia, Palma de Mallorca, Seville, Bilbao, Madrid, Orense and Pamplona.

» FUNDING During 2011, Doctors of the World Spain contributed towards Doctors of the World France’s project in Nicaragua: improvement of sexual and reproductive health in Puertos Cabezas, the North Atlantic Autonomous Region.

The total project budget is 510,000 euros. Doctors of the World Spain was able to obtain a donation of 300,000 euros through the Andalusian international development cooperation agency (Government of Andalusia).

Doctors of the World Spain also donated 150,000 euros, used to finance projects in Sudan.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» INTERNATIONAL NETWORK

Sweden CONTACT DETAILS

»D octors of the World Sweden Läkare i världen Sverige Box 39006SE-100 54 Stockholm Sweden Tel: + 46 8 664 66 87 Fax: + 46 8 663 66 86 www.lakareivarlden.org info@lakareivarlden.org BOARD OF DIRECTORS

»C hair: K. Meseret Andersson Vice-chair: A. Hedeborg Treasurer: K. Fransson Other board members : H. Andersson, S. Andersson, D. Berlin, Anita Dorazio, S. Eriksson, I. Gasser, Deputies : B. Atmer, A. Björkman, M. Gillgren, K. Johnsson »M dM Sweden also has a network of more than 140 volunteers who work primarily on national projects

» NATIONAL PROJECTS Stockholm medical and social care centre In 2011, MdM Sweden continued its activities at the clinic for undocumented migrants created in the capital in 1995.

During the year the MdM centre saw 494 people, of whom half were from Asia, and in particular Mongolia (a third), which mirrored previous years’ figures. The centre also saw people from America, Oceania, Middle East, sub-Saharan Africa and Europe (including the European Union).

- A monthly HIV testing service has been in operation with Noaks Ark, an HIV prevention specialist. Thanks to MdM’s network, those who test positive are able to access free treatment.

- Between 2010 and 2011, the number of patients accessing the centre climbed from 721 to 843.

DOCTORS OF THE WORLD ANNUAL REPORT 2011

as nationals. In order to come into force it must now be presented to Parliament. MdM Sweden lobbies hard to ensure that access to care for undocumented migrants remains a key theme in political debate.

Concert A concert was held by Japan Charity Art at the Gothenburg Opera. All the income was channeled to the victims of the Japanese earthquake. The 10,000 euros collected, through donations and sale of 274 tickets, helped a primary care programme to be set up in Otsuchi, coordinated by MdM Japan.

Fundraising The patients coming to the clinic who need medicines cannot afford to buy them. In response to this need, MdM Sweden increased its capacity and can now take unused medicines that the doctors can, in turn, give free to patients.

STAFF

»D irector: L. Gamble Interim Director: C. Lidén Registered as a charitable organisation under Swedish law in October 1991

ACKNOWLEDGEMENTS

» Hatem & Sjunghamn Juristbyrå AB,

Right to Health Initiative, Advertising Agency RBK, Swedish Red Cross, Noaks Ark, Stockholms Stadsmission and Unilabs

Social support is offered by the MdM volunteer team who give legal advice on human rights and Swedish law, in particular in relation to migration. The team can also work as intermediaries in dealing with the authorities if required.

» COMMUNICATION / EVENTS Education and Information A project to raise awareness of maternal mortality was launched thanks to a grant from the development authorities. The programme, which will run for two years, will include several conferences and publications tailored to healthcare professionals working in Stockholm.

» KEY EVENTS IN 2011 Survey The report initiated last year by the Swedish Ministry of Social Affairs was presented. It contains a legal proposal giving undocumented migrants the same access to care

Homeless or poorly housed EU citizens MdM Sweden continues to work with Stockholm City Mission, a Christian charity. The centre, Crossroads, offers poor EU citizens healthcare, advice on finding work and accommodation.

» INTERNATIONAL NETWORK

Switzerland CONTACT DETAILS

» Médecins du Monde Suisse Rue du Château-19 2000 Neuchâtel Tel : + 41 (0)32 725 36 16 Fax: + 41 (0)32 721 34 80 Rue des Savoises 15 1205 Geneva Tel : + 41 (0)22 328 02 10 www.medecinsdumonde.ch administration@medecins dumonde.ch CONTACT

» pascale.giron@medecins dumonde.ch BOARD OF DIRECTORS

»C hair: N. Humbert Vice-chair: X. Onrubia, D. Schmid General Secretary: T. Tschoumy Treasurer: M. Machenbaum Other board members: V. Kernen, C. Persoz, B. Borel, V. Pini, A. Lironi, F. Bollmann STAFF

»P . Giron-Lanctuit, M.-C. Wittwer Perrin, K. Almeida, replaced by C. Marcos, then A. Oriti, M. Crettenand, L. Rossi, replaced by E. Placella, C. Gobet, replaced by L. Terrettaz, E. Roulin and M. Koegler (interns) Organisation established under Swiss law in April 1994

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» NATIONAL PROJECTS Health and Migration Network: facilitating access to healthcare and promote health for vulnerable migrants in Neuchâtel. A place to welcome, listen to and advise those seeking care. In 2011, the focus was on the development and consolidation of the medical and social support network that has been established.

Night Sessions: to provide a low-threshold service for female sex workers in Lausanne. The project restarted at the beginning of 2011 after a year of closure. It aims to improve access to the healthcare system and promote health. A nurse is on hand to answer sex worker’s questions.

» INTERNATIONAL PROJECTS

Benin: supporting sickle cell anaemia treatment in Abomey district hospital. MdM Switzerland continues to work in the unit that was opened in November 2010, which offers gynaecological consultations, child and family support and specialist medical care.

Cameroon: Project to improve child health – Koupa Kagnam Commune. MdM Switzerland was invited to conduct an exploratory mission by the Neuchâtel organisation REA Cameroon.

Côte d’Ivoire: Reducing the impact of the crisis on obstetric emergency care and mother and child care in the Bas-Sassandra region. Following the post-election crisis in 2011, the existing health facilities were unable to respond to the needs of the local population. Already on the ground, MdM France called on MdM Switzerland to take over this project during 2012.

Haiti : - Rebuilding post-earthquake primary care provision and nutritional care following the January 2010 earthquake in Grand-Goâve and Petit-Goâve. The health and nutrition programme has developed in line with needs and now provides a range of prevention and care services (general » COMMUNICATION AND EVENTS medical consultations, reproductive health consultations, - Roll out of the campaign Health is not a luxury! To highlight vaccination, nutritional screening, ongoing care for women the inequalities in the current health system, the team spent the day in Geneva in a limousine transformed into and children etc..)

- Cholera epidemic response. During June 2011, the an ambulance. cholera treatment centre in Grand-Goâve closed. Howe- - Organisation of the Doctors of the World festival in October, ver, four cholera treatment units enabled teams to res- including a documentary on MdM Switzerland’s work pond to the epidemic peaks. In addition, three rehy- and the importance of volunteering. dration posts were opened in June and passed on to - Participation in the first regional International Development Day, organised by the Neuchâtel Federation for community management.

Palestinian territories: strengthening the child psy- Development and Cooperation, highlighting what happens chiatry reference centre in Hebron district. MdM Switzer- to donations. land continued to support the Palestinian Health Ministry’s first community mental health centre for children and adolescents, and organised intensive training in order to build capacity among the centre’s personnel. Since April 2010, the centre has seen more than 600 patients, mostly between the ages of six and 12 years.

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD

United Kingdom 1/2 CONTACT DETAILS

»D octors of the World UK 6th Floor One Canada Square London E14 5AA United Kingdom Tel : +44 20 7515 7534 Fax : +44 20 7515 7560 info@doctorsoftheworld. org.uk www.doctorsoftheworld. org.uk CONTACT

»D irector: Catherine Giboin Cgiboin@doctorsoftheworld. org.uk BOARD OF DIRECTORS

»J . Hughes, R. Rogers, R. Lion, Lord Rogers of Riverside, A. Cavey, B. Gazzard STAFF

» C. Giboin, C. Allum, F. Qureshi, K. Harris, T. Pastena, M. Ernest Registered as a charity on 13 January1998

ACKNOWLEDGEMENTS

» Argus Media, AstraZeneca, Atos Healthcare, Barrow Cadbury Trust, Beatrice Laing Trust, Boots in Bethnal Green, City Bridge Trust, Comic Relief, Coutts Charitable Trust, Department of Health, Doctors.net, French Huguenot Charitable Trust, Jeune Chambre de Commerce Francobritannique, John Young Charitable Settlement, Leagas Delaney, London Catalyst, McKinsey, Mercers Company, NatWest CommunityForce, Souter Charitable Trust, Trust for London, Tudor Trust, and all our other donors without whom we couldn’t work at home or abroad

» NATIONAL PROJECT

ANNUAL REPORT 2011

The Prime Minister replied that their needs would be covered, drawing attention to the fact that the healthcare budget had been ring fenced. Whilst he gave no commitments, his position was encouraging and MdM UK continues to play an active lobbying role in the reforms process.

-As part of Small Charity Week, MdM UK hosted the - In 2011, Project:London expanded the sexual health Health is not a luxury! campaign stand. Visitors were component to include testing and referral for HIV and urged to sign a petition that was also launched online, to STIs. The service is run in partnership with the team be presented to the British government. It called for the from Tower Hamlets Contraception & Sexual Health-HIV rights of vulnerable migrants to be upheld, regardless of team. their ability to pay for treatment. This debate will only take - A team of 183 volunteers. place in the House of Commons if 100,000 signatures are - Training for healthcare professionals, administration collected. The petition will be online until September 2012. staff and local organisations aims to improve their knowledge of the rules pertaining to access to care and, in Events turn, improve the service offered to the most vulnerable. - 6th annual London to Paris bike ride. Almost 70 cyclists - Member of MdM’s European advocacy network. from the UK, France and Belgium joined the ride and raised over £80,000 for Doctors of the World.

- £11,000 was raised by 27 people running in the Royal » INTERNATIONAL PROJECTS Parks Foundation Half Marathon for Doctors of the World.

- Exploratory mission for an orthopaedic surgery project - A new race series, known as the Santa Run, saw 50 in Bangladesh. runners in London and Manchester. £5,000 was raised.

- Two exploratory missions for a risk reduction project in - MdM UK also secured places in the London Virgin Active Bangladesh.

Triathlon, 10 people took part and raised almost £6,000.

- In July, a Haitian surgeon received training at the John Radcliffe Hospital, arranged by a British colleague he met in Haiti following the earthquake. They jointly appeared » FINANCIAL SUPPORT FOR MDM FRANCE PROGRAMMES on the BBC Radio 4 flagship Today programme.

- Somalia: medical care in Merka. » COMMUNICATION AND EVENTS - Haiti: post-earthquake project.

Communication - British donors supported the MdM project in Tanzania - In April, MdM UK was invited to meet the Prime Minister through the Big Give initiative, organised by Argus Media. at 10 Downing Street, to discuss health service reforms. The money raised will go towards the harm reduction MdM UK highlighted the need to ensure access to health programme aimed at reducing HIV/Aids transmission in services regardless of status, in particular for vulnerable Dar es-Salaam. migrants, sex workers and homeless people.

Project:London aims to improve access to care for vulnerable people. The clinic offers medical care and advice three days a week and the first Saturday of the month. Outreach activities are also conducted in partnership with sexual health clinics and local partners.

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD

United Kingdom 2/2 » HUMAN RESOURCES SUPPORT Medical staff 2011 - Medical Assessor in Palestine, two months from February 2011.

- Medical Assessor in Ethiopia, one month from August 2011.

Non-medical staff 2011 - Vietnam Project Coordinator, eight months from May 2011.

ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

Alsace

Strasbourg

TEAM

» 130 volunteers » 3 employees » 77 members

» PROGRAMMES - Healthcare and Advice Clinic in Strasbourg - Homelessness project in Strasbourg - Roma project in Strasbourg - Adoption programme in Strasbourg

» RESULTS 2011 1/ Health promotion - Introduction of rapid diagnostic tests for HIV with support from the ARS and funding from the Ministry of Health - Health education project working with the Roma population - Implementation of an study to evaluate the prevalence of diabetes, hypertension and obesity among disadvantaged groups 2/ Helping disadvantaged groups to access healthcare - Recruitment of specific volunteers to accompany service users to services - Two training days on MdM’s work for 15 volunteers - Specific training with partner organisations 3/ Regional activities - Needs assessment on the health needs of the Roma population in Mulhouse - Study on poverty and access to healthcare in the Bruche valley - Co-operation projects between the adoption programmes in the Grand Est region - Organisation of an inter-university diploma in Health and Deprivation, with the medical faculty at Strasbourg and Nancy universities and Besançon university 4/ Communication, advocacy and lobbying - Representing MdM at the Council of Europe

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

Aquitaine

Bordeaux, Bayonne, Pau TEAM

»1 50 volunteers »6 employees » 126 members

» PROGRAMMES - Healthcare and Advice Clinic in Bordeaux - Healthcare and Advice Clinic in Pau - Squat and migrants programme in Bordeaux - Roma programme in Bordeaux - Rave project in Bayonne - Adoption programme in Bordeaux

» RESULTS 2011 1/ Communication and events - Participation in the International Human Rights Film Festival in Gironde - Exhibition Women, in the aftermath of violence at Bordeaux teaching hospital - Participation in the travelling exhibition of travel photographers, with an exhibition of Maxime Couturier’s photographs in Espace 29 and by organising meetings and discussions around the testimonies - Following the eviction of Roma from squats in Bordeaux, several articles were published in the press and some interviews televised - Interviews in the press and reportage on France 3 for the International Day for the Eradication of Poverty, on 17 October, concerning pregnant women on the streets and conditions in a Roma squat - Open day to recruit new volunteers 2/ Partnerships - Continuing with the university diploma Health, Deprivation, Solidarity at Bordeaux-2 university - Ongoing teaching on humanitarian medicine and health and deprivation in the third cycle of the general medicine curriculum - Presentations on humanitarian medicine at Bordeaux and Agen universities - Welcoming trainees, including student nurses, medical

DOCTORS OF THE WORLD ANNUAL REPORT 2011

students as part of the optional Health and Deprivation module, general medicine interns, and IUT, IRTS and University students - Initial contact with ISPED to develop a partnership on research themes to develop regional and local evidence for advocacy, and to inform our programme development 3/ Programmes underway - Review on the regorganisation of the Healthcare and Advice Clinic from a patient’s perspective - Meetings to review and discuss the development of a regional plan (planned for 2012) 4/ Programmes under consideration - Introduction of rapid diagnostic tests in Aquitaine programmes (horizontal objectives) in partnership with AIDES and Bizia - Development of more horizontal (cross-cutting) activities 5/ Mobilising members - Volunteer training on Analysis of Practices - Two days of workshops and exchanges between stakeholders in the Healthcare and Advice Clinic - Launch of review committees on reception and care, and proposals for activities and programme organisation - Volunteer training on support relationships in partnership with IREPS

» REGIONAL DELEGATIONS

Corsica Ajaccio

TEAM

» 20 volunteers » 26 members

» PROGRAMMES - Healthcare and Advice Clinic - Homelessness project - Joint working with other organisations

» RESULTS 2011 1/ Strengthening programmes - Continuing to provide medical consultations in the clinic and at the Stella Maris day centre - Successfully getting a shelter for homeless people set up - Monitoring and communication on issues relating to deprivation 2/ Mobilising members and volunteers - Formation of a new regional Board - Information meetings/ interviews with volunteers about the future of the Corsican delegation and the regional plan 3/ Outlook - Lobbying about the Healthcare Access Office (Pass) - Implementation of a volunteer recruitment campaign - Organisation of an event: hosting an exhibition - Monitoring the needs of vulnerable groups in Corsica

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

Franche-Comté Besançon

» PROGRAMMES - Healthcare and Advice Clinic in Besançon

» RESULTS 2011 TEAM

»1 0 volunteers »1 5 members

- Moving the Healthcare and Advice Clinic into the premises of the town’s social services - Increase in the number of services users seen in the Clinic - Evaluation and review of activities at the regional delegation

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

Île-de-France

Paris, Saint-Denis TEAM

» 400 volunteers » 21 employees » 369 members

» PROGRAMMES - Healthcare and Advice Clinic in Paris - Healthcare and Advice Clinic in Saint-Denis - Lotus Bus programme in Paris - Homelessness project in Paris - Drug analysis programme in Paris - ERLI programme in Paris and Colombes - Roma programme in Saint-Denis - Health and Housing programme in Saint-Denis - Buddying programme across Île-de-France - Rave and squat project across Île-de-France

» RESULTS 2011 1/ Access to healthcare and to rights - Internal evaluation of the Lotus Bus programme - Four month exploratory mission to assess the needs of the Roma population across Île-de-France - Health monitoring programme working with Tunisian migrants between May and July - Health monitoring programme with people evicted from a squat in Montreuil between September and November - Introduction of a survey of local health insurance office practices. Meetings with the Paris local health insurance offices - Completion of a survey on the Île-de-France healthcare access office from January to May 2011. Results published in September 2011 2/ Health promotion for the most vulnerable - Participation in the regional health and autonomy conference in Île-de-France and in the regional conferences - Participation in the steering committee in the ARS’ Regional Prevention Plan - Participation in the PRAPS steering committee - Participation in the PRAPS working group on the healthcare access office - Representation at the Town Hall (11th arrondissement) in

DOCTORS OF THE WORLD ANNUAL REPORT 2011

some COREVIH Est enquiries (women, migrants, deprivation and addiction) - Participation in the Healthcare access office collective in Paris - Participation in the Ministry of Health working group on perinatal health and deprivation 3/ Raising awareness of health and deprivation - Co-ordination of the Health, Deprivation and Solidarity university diploma in René-Descartes - Paris-V University - Co-organisation of the 2011 national Healthcare Access Office Conference - Presentations in the nursing training institute, social work schools and at CRIPS - Presentation at Louis-le-Grand high school - Presentations at Val-d’Oise district council - Presentation for Migrants’ Day in Avicenne hospital 4/ Communication - Involvement in the Alain Keler exhibition, Roma, Pariahs in Europe, co-organised by MdM at Comptoir général in Paris - Presentation of MdM to the town youth council at Mureaux town hall - Presentation of MdM to Fontainebleau IUT - Participation in Solidarity Days organised by the town council in the 11th arrondissement - Press conference for the publication of the 2010 report from MdM’s Observatory on Access to Healthcare in France 5/ Mobilising members and volunteers - Introduction of a monthly welcome meeting for volunteers - Introduction of bi-monthly training sessions for volunteers - Organisation of the Journées Mission France workshops in Paris

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD

Languedoc-Roussillon Montpellier

TEAM

» 18 volunteers » 3 employees » 101 members

» PROGRAMMES - Healthcare and Advice Clinic (medical, social and dental sessions) and two outreach projects for homeless people and the Roma population in Montpellier - Health promotion project with street sex workers in Montpellier - Harm reduction programme in festivals and raves (crossregional) - Adoption programme in Montpellier

» RESULTS 2011 1/ Training and awareness raising activities on health and deprivation - Development of the university diploma Health, Deprivation and Welfare - Involvement on the university diploma Public health practices in developing countries - Welcoming nurse interns, medical students, general medicine interns, IUT, IRTS and university students - Presentation to 70 interns in medicine on the theme of health and deprivation 2/ Partnership to improve access to healthcare and to rights - Consolidation of groups and themes for advocacy (State Medical Aid, healthcare access office, residency) - Supporting the Health and Deprivation collection - Supporting the Roma collective - Ongoing training for the Rave programme - Member of the SIAO monitoring commission and the SIAO health sub-group - Member of the ARS regional conference 3/ Events - On 17 October, International Day for the Eradication of

ANNUAL REPORT 2011

Poverty: press conference for the publication of the national Observatory on Access to Healthcare report - Participation in the Antigone des associations event in Montpellier - Exile, Exit? exhibition at the Visa pour l’image festival in Perpignan 4/ Outlook Improving programme quality: - Ongoing evalution - Supporting the teams - Strengthening user involvement - Capitalisation Exploration of new areas of intervention: - Review of situation in other districts - Study of access to healthcare and migrant rights - Study on mental health problems for vulnerable groups - Developing links with international programmes, organising conferences, training for new target groups

» REGIONAL DELEGATIONS

Lorraine Nancy, Metz

TEAM » 70 volunteers » 2 employees » 60 members

» PROGRAMMES - Healthcare and Advice Clinic in Nancy - Outreach project in Nancy - Outreach project in Metz - Adoption in Nancy and Metz

» RESULTS 2011 1/ Monitoring the needs in terms of access to healthcare in Lorraine - Responding to a request from the Association Accueil Écoute in Épinal and supporting this organisation in its advocacy to improve the healthcare access office 2/ Building projects and new activities - Introduction of the rapid diagnostic texts in the Metz outreach projects - Terminating the Roma project in Nancy, following the dismantling of the Laneauveville camp in July 3/ Advocacy at the regional level - Participation in the review of the Lorraine healthcare access offices by the Regional Health Agency - Advocacy for the opening of a dental care access office in Nancy, in conjunction with the Espace lionnois and the teaching hospital dental department 4/ Partnership and external communication - Women, in the aftermath of violence exhibition in partnership with Nancy town council from 10 to 25 November - Violence against women: from fact-finding to responses round table - Conference on the theme of Haiti, one year on with Olivier Bernard in Metz.

- On 17 October, International Day for the Eradication of Poverty: participation in a voluntary sector collective with ATD Quart Monde and a press conference and round table

DOCTORS OF THE WORLD ANNUAL REPORT 2011

in the form of a ‘speed dating’ event at Poincaré high school - Participation in the creation and set-up of a collective of organisations working with vulnerable groups in Nancy - World AIDS Day, 1 December in Metz 5/ Raising awareness of health and deprivation - Collaboration with the Alsace delegation on introduction of an inter-university diploma in Nancy and Strasbourg on health and deprivation

» REGIONAL DELEGATIONS

Midi-Pyrenees Toulouse, Albi TEAM

» 140 volunteers » 3 employees » 87 members

» PROGRAMMES - Healthcare and Advice Clinic in Toulouse - Street outreach project in Toulouse - Harm reduction programme in Toulouse - Welcome project in shelters in Toulouse - HIV, STI and hepatitis prevention programme in Toulouse - Child lead poisoning prevention project in Toulouse - Project working with the Chechen population in Albi - Adoption programme in Toulouse - Mother and child health project (regionally-managed) in 11 shantytowns in Jaipur, India

» RESULTS 2011 1/ Representation and voluntary sector action - Participation in the Roma Solidarity collective - Regular visits to a camp of Romanians and joint work with the Mother and Child Protection service and HauteGaronne vaccination and tuberculosis service (DDVLAT) - Work on the theme of health and housing as part of the joint voluntary sector collective. Participation in the organisation in the collective’s 25th anniversary flashmob in Place Wilson every second Thursday of the month at the Place du Capitole - Involvement in the steering committee for the organisation of a seminar Social suffering, Psychological Suffering in partnership with Marchant hospital, and participation in the seminar - Participation in CRSA inquiries (medico-social accompaniments, users’ rights) 2/ Communication and awareness raising - Cross events (Foulée pour la vie, Solidarité en pays de Save) in aid of MdM - Organisation of the photographic exhibition Exile, Exit? from 10 to 20 September. Organising a meeting with Martin Agossou and Olivier Jobard - Touring the photographic exhibition on India in Bonnefoy cultural space, Folles Saisons restaurant, Femmes dans

DOCTORS OF THE WORLD ANNUAL REPORT 2011

la tourmente exhibition (HIV/Burkina Faso) in the Communauté municipale de santé - Participation in the Dignity, human rights and poverty conference organised by Amnesty International - Participation, with ATD Quart Monde, in an event for the International Day for the Eradication of Poverty, on 17 October, with a press conference at MdM - Organisation of a conference on Innovative approaches to improving health in shantytowns in Jaipur, India - Presentation on humanitarian health in nurse training institutions (Albi, Marchant in Toulouse), healthcare assistance school (Toulouse Red Cross), ESF school (Institut Limayrac), Aragon high school(Muret) ; welcoming nurse training institute students (Toulouse Red Cross); presentation on prevention to Midi-Pyrénées ANPAA 3/ Mobilising members and volunteers - Working meetings on bearing witness with the Healthcare and Advice Clinic volunteers - Information and training meetings for volunteers on various themes (Roma, Toughening of laws affecting foreign nationals, Volunteering) - Meeting to bear witness (Palestinian Territories) - Regionalisation meetings and workshop 4/ International programme - Withdrawal from the mother and child health programme in 11 shantytowns in Jaipur 5/ Strategic axes - Strengthening programmes and partnerships with poor European migrant populations - Advocacy and awareness raising among the regional population by organising exhibitions - Working in partnership on the issue of housing, with advocacy and lobbying of the institutions and political decision-makers

» REGIONAL DELEGATIONS

Normandy Rouen, Le Havre TEAM

» 91 volunteers » 2 employees » 54 members

» PROGRAMMES - Healthcare and Advice Clinic in Rouen - Sex workers project in Rouen - Travellers project in Rouen - Outreach programme in Le Havre - Winter programme in Le Havre - Certificates for asylum seekers project in Le Havre - Psychological support for migrant women and children in Le Havre - Adoption programme in Le Havre

» RESULTS 2011 1/ Activities - Survey carried out, at the request of the DRDFE, on the social and health needs of sex workers - Participation in a survey with CREDOC, at the request of the Ministry for Social Inclusion’s anti-exclusion unit, which aims to understand changing trends in poverty and identify emerging issues - Launch of an information and vaccination campaign for travellers, in association with the ARS prevention services - Participation in the district consultation of travellers (which was reopened in 2011) - Fundraising for the replacement of the mobile unit - New plan: closer collaboration between MdM and the organisation Soins pour tous (Healthcare for all) 2/ Communication and awareness-raising - Participation in the Macadam & Co street event - Participation in a cafe debate with Elbeuf Human Rights League - Participation in the UMAPP steering committee - Participation in the Actions santé group in the social development department in Saint-Etienne du Rouvray - Participation in the carrefour des solidarités

DOCTORS OF THE WORLD ANNUAL REPORT 2011

3/ Healthcare access office lobbying - For creation of a dental care access office: meeting with the General Director of the dental department in Saint-Julien hospital (Petit-Quevilly) - Monitoring the development of the healthcare access offices: meeting with health manager at the Rouen teaching hospital mobile social support unit - Participation in the Normandy healthcare access offices co-ordination body 4/ Mobilising members and volunteers - Recruitment: joining France Bénévolat to take advantage of services offered - Organisation of a regional day with the presentation of the delegation’s regional plan

» REGIONAL DELEGATIONS

Indian Ocean Saint-Denis, Saint-Pierre, Madagascar TEAM

» 50 volunteers » 3 employees » 38 members

» PROGRAMMES - Homelessness programme in Saint-Denis - France programme in Saint-Pierre - Access to healthcare for excluded groups programme in Mayotte - Disaster risk reduction programme in Madagascar - Programme supporting prisoners in Madagascar - Paediatric surgery programme - Long-term paediatric cardiac surgery - Emergency programme (Indian Ocean)

» RESULTS 2011 1/ Communications and events - Meetings and seminar on the regionalisation project - Hosting and meeting with the Madagascar team (general co-ordinator and disaster risk reduction project) - Participation in the 20th anniversary of MdM Madagascar 2/ Programmes - Exploratory patrols to evaluate the needs of sex workers in southern Reunion (Belles de nuit programme) - Extension of the prisons programme in Madagascar to Antsirabe-Morondave and gradual withdrawal from the other areas, with complete withdrawal envisaged in 2012, along with gradual handover to civil society - Preparation of an exploratory post-cyclone (Bingiza) mission in Atsimo-Atsinanana region in the south east

DOCTORS OF THE WORLD ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD

PACA (Provence-Alpes-Cote d’Azur) Marseille, Nice, Aix-enProvence TEAM

» 220 volunteers » 11 employees » 155 members

» PROGRAMMES - Healthcare and Advice Clinic in Aix-en-Provence - Healthcare and Advice Clinic in Nice - Healthcare and Advice Clinic in Marseille - Gourbi project with undocumented seasonal farm workers in Berre-l’Étang - Roma programme in Marseille - Homelessness programme in Marseille - Homelessness programme in Nice - Mediterranean harm reduction project - Adoption programme in Marseille and in Nice - Burkina Faso regionally-managed project – Diébougou: access to dental and nutritional care - Romania regionally-managed project – Satu Mare supporting the local organisation COPII which works with children - Turkey regionally-managed project: migrants project in Istanbul

» RESULTS 2011 1/ Exploratory missions - A ‘Street, Hospital, Prison’ evaluation on avoiding imprisonment for homeless people with mental health problems in Marseille - Exploratory mission to Berre-Ghardimaou in Tunisia, in the home town of almost all the men in the Gourbi 2/ Events and communication - Exile, Exit ? exhibition in Nice in December 2011 - Concert in Nice - Article on access to healthcare for vulnerable groups in the spring issue of Le Mutualiste’s dossier on access to healthcare, inequalities as an obstacle - G20 at Cannes, Health is not a luxury! flashmob - Notaires conference in Cannes

ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

Loire Angers, Nantes TEAM

» 90 volunteers » 4 employees » 83 members

» PROGRAMMES - Healthcare and Advice Clinic in Angers - Healthcare and Advice Clinic in Nantes - Sex workers’ project in Nantes - Deprivation project in Nantes - Programme with Roma in Nantes - Adoption programme in Nantes

» RESULTS 2011 1/ Communications and awareness-raising - Organisation, with Gynécologie sans frontières, of a conference with Martin Olivera on Roma at the medical school and a debate evening and screening of the film Le Bateau en carton - Evening event at Cinématographe of the documentary film by Estelle Robin You, Funambus volunteer and producer. The film, Amours Propres, featured the programme working with sex workers - Presentations in nursing and osteopathy schools, to social work students and practising social workers. Themes include deprivation, health of Roma, health mediation and the situation of sex workers - Stand at the volunteering forum - Organisation of a press conference for the publication of the report by the Observatory on Access to Healthcare in France - Participation in awareness-raising and screening activities for World Hepatitis Day, World Aids Day and Gay Pride 2/ Domestic programmes - Internal evaluation of the sex workers project and preparation of a new five-year project plan - Needs assessment in hostess bars currently underway - Setting-up of a Nantes health mediation project as part of a research-action project run by the Romeurope national collective and the Ministry of Health - End of the harm reduction activities in festivals, with

DOCTORS OF THE WORLD ANNUAL REPORT 2011

gradual handover to Techno+ and to the district’s Drop-In and Support Centres for drug users.

3/ Advocacy - For the integration of inter-cultural treatment for psychological problems and trauma for migrants into mainstream services - For the development of interpreting services in health services, and healthier conditions in places where people live - To warn of the health impact of security policies on people and of the difficulties which sex workers face - Creation of a monitoring committee on the right to medical visas for seriously ill foreigners, in collaboration with AIDES and CIMADE

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD

Poitou-Charentes Angoulême, Poitiers TEAM

» 50 volunteers » 1 employees » 55 members

» PROGRAMMES - Travellers’ programme in Angoulême - Listening health bus in Angoulême - Street outreach programme in Poitiers - Sex workers programme in Poitiers - Mother and child migrants project in Poitiers - Winter patrols in Angoulême

» RESULTS 2011 1/ Programme news - New activities promoting contraception and obesity prevention among travellers in Angoulême - Review of the sex workers programme in Poitiers - Establishment of a monitoring committee for seriously ill foreigners in Angoulême 2/ Communication and awareness raising - Participation in International Day for the Eradication of Poverty activities on 17 October - Participation in the Festival Musiques métisses, in Angoulême - Involvement in the health forum on harm reduction and contraception - Radio interview during the programme Tapis rouge on Radio Diffusion Charentaise on MdM’s work in the PoitouCharentes region - Organisation of a theatre play in aid of Doctors of the World - Presentations in primary, middle and high schools 3/ Advocacy - For an effective healthcare access office in Angoulême 4/ Mobilising members and volunteers - Working meetings about the regional project - Mobilising the teams to participate in national events

ANNUAL REPORT 2011

» REGIONAL DELEGATIONS

Rhone-Alps Lyon, Grenoble, Saint-Étienne

TEAM

» 220 volunteers » 8 employees » 172 members

» PROGRAMMES - Healthcare and Advice Clinic in Lyon - Healthcare and Advice Clinic in Grenoble - Bus outreach in Lyon - Squat and shantytown outreach in Lyon - ‘Street Patrol’ programme in Grenoble - Adoption programmes in Grenoble, Lyon and SaintÉtienne - Regionally-managed international programme in Algeria - Regionally-managed international programme in Guinea

» RESULTS 2011 1/ Voluntary sector cooperation and partnerships - Partnership with Bioforce in Lyon for the introduction of dry toilets in squats/shantytowns - Operational and policy collaboration with voluntary sector collectives (Roma, health collectives etc.)

- Participation in institutional networks (steering committee for the healthcare access office, shantytown protocol, social street-hospital network, Lyonnaise Council for the respect of rights, Regional Health and Autonomy Council, town health workshops etc.) in Grenoble and Lyon - Participation in several press conferences and collective events by the Alerte Isère collective, to which MdM belongs, particularly in relation to housing.

2/ Programme news - Inauguration of the new MdM bus in partnership with Caisse d’épargne and the town hall of the 1st arrondissement - Handover of the bus harm reduction activities to the harm reduction organisation Ruptures - Needs assessment with Tunisian migrants in Valence - Exploratory mission in the Palestinian Territories

DOCTORS OF THE WORLD ANNUAL REPORT 2011

3/ Communication and awareness raising - Democracy and subjectivity: monitoring and caring conference at the political sciences institute in Grenoble - When exile leads to violence conference in Villeurbanne - Participation in the Five Continents Congress in Lyon on Humanitarian workers in globalisation - Exile, exit? exhibition in Villeurbanne and Grenoble - Health is not a luxury! flashmob and press conference in Lyon - Participation in the Économie solidaire forum - Interviews in various media: print, radio and television - Strengthening involvement in humanitarian training on the theme of health and deprivation (medical faculty, nursing school, midwifery school etc.)

- Introduction of an optional module on humanitarian medicine at Grenoble medical school; co-ordination of the university diploma Santé, solidarité, précarité in Grenoble 4/ Mobilising members and volunteers - Survey of volunteers and membership in Rhone-Alps with Grenoble IEP students - Roma evening event in Lyon - Working meetings on the regional plan - Collaboration with students from the Communication and Humanitarian Work masters in Lyon for production of the regional internal journal - Treasurers meeting in Lyon - Inter-university diploma meeting in Lyon - Evening on the right to medical visas for seriously ill foreigners in Grenoble - Training for new volunteers

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Médecins du Monde 62, rue Marcadet 75 018 Paris www.medecinsdumonde.org Tel. +33 (0)1 44 92 15 15 Fax. +33 (0)1 44 92 99 99 © Chien-Chi Chang/Magnum

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