Annual report 2013 by Médecins du Monde

2013 doctors of the world

annual

report

DOCTORS OF THE WORLD ANNUAL REPORT 2013

contents » 04

A word from our chair

Priority themes

Advocacy and campaigns

» 22

International programmes

Emergency and long-term programmes

26 Map

North Africa and Middle-East

Sub-Saharan Africa

Latin America and the Caribbean

48 Asia 54 Europe 60 Opération Sourire

Programmes in France

Regional delegations

Adoption

The international network

96 Funding

» 104

Board of Directors

» 106

Our thanks to

» 108 Glossary

“He who despairs of the human condition is a coward, but he who has hope for it is a fool.” A. Camus

Philippines © Sébastien Duijndam

DOCTORS OF THE WORLD ANNUAL REPORT 2013

A word from our chair

» Dr Thierry Brigaud CHAIR, DOCTORS OF THE WORLD France

2013 was a year framed by two French military inventions, one in Mali and the other in the Central African Republic. A year characterised by a frightening and unrelenting deterioration in the humanitarian situation in Syria. A year also marked by the typhoon which hit the Visayas in the Philippines, reminding us that climate disasters could become a defining feature of this century. The year also saw the death of Nelson Mandela, who said: “What is done for us, without us, is against us”. As a tribute to him, his words must become the basis for our actions and guide our programmes for the health and rights of the poor, in France and in the world.

The long-term crisis: a new governance paradigm? With the Syrian crisis, international law is continually violated. Civilians are not protected. In nearly three years, the civil war has left a staggering legacy: 150,000 dead, three million refugees, three million internally displaced persons (IDPs). This underlines the inability of international bodies to resolve the conflict politically and enforce the law, even when a chemical arsenal is used. Should we cynically think that the emerging ‘grey’ areas, places where lawlessness becomes a mode of governance, will be accepted by democracies? What then is the role of non-governmental bodies from secular civil society? Are we part of the consolidation of these areas of lawlessness? Alternatively, is it by using our evidence and our advocacy on the subhuman situations we witness on a daily basis that we will be able to compel the international community to put an end to this situation? The list appears to be growing: Somalia, Afghanistan, Iraq, Syria, northern Mali, CAR, South Sudan, North Kivu, etc. In 2013, Doctors of the world - Médecins du Monde (MdM) decided to intervene heavily in these ‘grey’ areas. We have chosen to accept funds from various international institutional donors, which explains the growth of our budget to 84 million euros for 2014. This allows us to meet the humanitarian needs of these people in the midst of despair. But while it is right to engage with these populations, we also need to constantly examine

at the service of the French army in this way. MdM opted to maintain the projects where we were already present before the French The Syrian crisis military intervention, and MdM Belgium In Jordan, Turkey and Lebanon, we are maintained its projects in Gao and Kidal, in continuing to offer assistance to hundreds the north. Subsequently, in Mopti region, we of thousands of refugees who continue to ar- intervened to restart health centres that had rive in these countries. We are also carrying been temporarily abandoned. The security on our work inside Syria. In the north, we situation in the Sahel region is worrying for directly support displaced populations. In our teams, who continue their work in Mali, parallel, we provide support to networks that Burkina Faso and Niger. have developed inside Syria where people who offer help and medical care are suspec- CAR ted of being rebels. The danger is great for From July 2013, together with other humanitarian organisations, we denounced the our teams and our partners. In Lebanon, the decision to work in par- deteriorating living conditions for people in tnership with the association Amel is bearing the Central African Republic: a failed state, a fruit. We support Lebanese civil society that devastated health system and more alarming cares for Syrian refugees in an extremely fra- health indicators than in other countries at gile political context. The presence of more war. We decided to support clinics that were than one million Syrian refugees in Lebanon still active around Bangui. Our work is made more complicated by the chronic insecurity is a burden for the ‘country of cedars’. Whenever possible, we will continue to bear that forces teams to be very cautious. Once witness and continue to call for all parties to again, at the end of 2013, to prevent what respect international humanitarian law. The promised to be a ’genocide risk‘, France time will come, I hope, for peace and justice. took on the task of maintaining peace and protecting civilians. How can one believe Mali there can be a sustainable improvement if The French president authorised a military the French and African forces give themintervention in January 2013. It follows selves the role of police in a divided country, the already long list of so-called just wars: which is incredibly poor and with no functioRwanda, Bosnia, Libya.... NGOs, against ning judicial system? How can the country their wishes, risk being associated with be rebuilt if democracy is absent? the objectives of the armed forces fighting Here, as elsewhere, Doctors of the World against those designated by Paris as ‘ter- undertakes the difficult path of responrorists’. MdM has chosen not to place itself ding to people’s health needs, while the conditions of our presence, and carefully monitor our independence.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

supporting a process of social emancipation to promote the right to health. Otherwise, we risk being treated as occupants from the ‘globalised world’ distributing a few ‘crumbs of survival’ to those who have been left in abandoned regions.

of female drug users are HIV positive, 27% are co-infected with the hepatitis C virus (HCV). We are learning alongside the locally elected officials how to improve the right to health. New ways of working are emerging. Alliances are being set up to change the way people who use drugs are treated. Today, Humanitarianism closer this is working in Tanzania and tomorrow, to the people perhaps, elsewhere in Africa. Internationally, the desire to support social Harm reduction can only work if the benechange is underway. ficiaries gain autonomy and are empowered. As Z., a 26 year-old drug user and peer Partnerships in emergencies educator in Burma, tells us: ‘Here, I learned After Typhoon Haiyan hit the Philippines, about Aids and how to protect myself. I Doctors of the World quickly opened a pro- would have preferred to know all this begramme on devastated Leyte to respond to fore. I would not have shared syringes. But, the emergency and overcome the destruc- anyway. Today I can share what I have learnt tion of 90% of health facilities. Doctors of with my friends, at the centre or elsewhere. the World chose this island, in consultation Being an educator gives me a purpose in life, with the Philippine Ministry of Health, to gain other than trying to find drugs, which has access to the most remote and the most governed the last 10 years of my life.’ vulnerable people. Around 1,000 consultations per day were carried out. The choice to Migrant health support local authorities, and not do it alone In Istanbul, a symposium organised by our or instead of them, was facilitated by the Turkish partner enabled different actors inlong-term presence in Manila of a team who volved with the theme of migration to meet. were familiar with the Philippines and the way Participants came from the teams working in France and on international projects, the health system is organised. but also from other members of the MdM Harm reduction network and partner organisations. All were In Tanzania, in the Temeke district of Dar es able to take time to compare their respective Salaam, it is the municipalities, local officials approaches. and health teams that mobilise their energies The right to health for migrants during their to advance harm reduction. They unders- migration, as well as in their host country, tand the challenges they face only too well. In must coincide with the struggle to improve our needle exchange clinic at Temeke, 67% the health of the most vulnerable. Again, we

need not only to treat, but also to describe the intolerable situations we witness, and to focus on migrants from an overall perspective that makes the migration route a winning story for the country of origin, for migrants and for the host country.

Sexual and reproductive health When we closed the financial accessibility project in the Sahel region, the local mayors confirmed they wanted to continue the introduction of free care for the most vulnerable. Access to free care for childbirth, as is already the case in the Djibo dstrict, Burkina, is now supported by local elected officials. For 2014, we devised a campaign on the right of women to decide freely whether or not to have children. 50,000 women around the world die each year as a result of an illegal abortion with no medical care. We decided to express our indignation in a campaign that will allow us to prepare our advocacy work around the international conference Cairo+ 20 in New York, which plans to redefine international sexual and reproductive health policy. In the daily work of Opération Sourire, by buddying with children in hospital and through supporting families who adopt children, Doctors of the World teams share their humanity. Thus, Doctors of the World expresses solidarity in various ways.

Supporting social change in France As in previous years, our work on the ground, and the formidable support

network for Doctors of the World’s work, lends weight to our campaigning. The International Day for the Eradication of Poverty again provided the opportunity to denounce the increase in poverty in France. Our 20 Healthcare, Advice and Referral Clinics bear witness, as sentinel sites, as do our street outreach teams and our work in squats and slums. We cannot accept that the pregnant women we meet are not properly cared for in our country when they have high-risk pregnancies. We cannot look on in silence at the slow progress of exclusion with the most vulnerable being shut out in the cold, the ongoing marginalisation of the poorest, and, increasingly, women and children being unable to find accommodation. One year after the announcement of the plan against poverty and for social inclusion, and in spite of some advances identified in the recent Chérèque report, Doctors of the World still finds deficiencies in access to care for the poorest and reiterates its proposals. These are: raise the threshold for Universal Healthcare Coverage to the level of the poverty line in order to simplify access; make the Healthcare Access Offices (PASS) effective; develop outreach health services; create additional places in accommodation and emergency shelters for asylum seekers; make access to housing a priority; develop health and welfare mediation; launch innovative mental health and deprivation projects; open lower risk drug consumption rooms (as set out by the Interdepartmental Pro-

gramme for the fight against Drugs and Drug Dependency); abandon the bill to penalise people who use sex workers, which would negatively affect sex workers; and continue to question specific issues around deprivation in districts and overseas territories. The economic crisis should not be an excuse for withdrawal or abandonment of social diversity. Health for all, in every corner of the territory, without discrimination or stigmatisation, remains a requirement. New areas of need are emerging in rural areas, where ‘neorural’ poor are forced into the countryside, and also in our banlieues where the number of health professionals is declining.

a branch in Luxembourg, and we want to support them in this growth. Faced with the economic crisis, MdM Spain and MdM Greece have weathered the storm while increasing their advocacy for the most vulnerable. MdM Portugal is in trouble. But above all, the European network is structured around the European report on access to healthcare, triumphant this year, thanks to the European authorities’ decision to include in their texts our focus on advocacy for migrant rights within and outside Europe.

Governance

The Mission France away days in Sète were a great success, in terms of organisation, ambiance and content. We were invited to act as caregivers, lawyers, activists and as lobbyists all at the same time. By querying the place of ‘beneficiaries’ in our programmes, these days of reflection enabled the participants to step out of the asymmetric doctorpatient relationship to work towards a truly intersubjective relationship, where everyone becomes an actor in their own right.

Following the Annual General Meeting in 2013 Pierre Salignon confirmed his desire to step down. His career with us at a time of transition secured our organisation and its social mission. Olivier Lebel succeeded him and took over the role at the same time as the budget for 2014 was being drafted. With the new General Director we will work on the implementation of a strategic plan for 2015-2018. I want to thank them both, as well as Thierry Barthélemy, Chief Financial Officer, and Gilbert Potier, International Operations Director, who acted up during the four month transition period.

International Network

Associative project

The international network of Doctors of the World is changing. Joint applications for funding are important and have enabled MdM France to finance emergency projects. MdM Belgium is growing, having decided to open

At the September 2013 seminar, the Board decided to continue its reflections on the ‘new’ associative project started in 2011. This process enabled participants to take into account the progress made in recent

Act together Mission France away days 2013

DOCTORS OF THE WORLD ANNUAL REPORT 2013

France ÂŠ Constance Decorde

years: in regionalisation, guidelines for heads of project, reorganisation of international operations, thematic approaches, ensuring non-overlapping mandates and limits on term times. We are engaged in a lengthy participatory process to create link between the different stakeholders in our association and to share their joint ambition with partners and authorities. This will culminate, I hope, in a new

collective and political plan for Doctors of the World for years to come.

It is this ambitious project that has driven our association for over 30 years. It is our responsibility to write a new page each year. In conclusion Our collective dynamic, and the sense of Doctors of the World puts its faith in in- purpose in our projects, allow us to meet dependence and solidarity in a world in the future and start again, refreshed but turmoil. It must stay on course as a huma- militant as ever. nitarian organisation committed to the most vulnerable, caring for and accompanying them in their desire for social change.

Philippines © Lâm Duc Hiên

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Priority themes Doctors of the World is an organisation that supports social change. It acts in emergencies, but also creates long-term programmes. Over and above ensuring access to care for the most vulnerable, MdM has identified four priorities for its work in the field: crisis and conflicts, sexual and reproductive health, harm reduction, and migrants.

12 Crises and conflicts Where there is a conflict or natural disaster, Doctors of the World reacts quickly to send an emergency team and equipment to the field to meet immediate health needs. If teams working on long-term projects are present in the country, MdM calls on them to enhance its effectiveness and act faster. Sometimes MdM then remains on the ground long after media attention has faded, to work on reconstruction programmes.

Health and the environment The theme ’health and the environment‘ features alongside the four priorities identified by MdM in its intervention framework. It demonstrates MdM’s willingness to respond to the consequences of environmental degradation for the health of the most vulnerable. Currently, two programmes focus on these themes: decreasing the risks related to natural disasters in Madagascar and reducing environmental risks for informal recyclers of electronic waste in Manila, Philippines.

Sexual and reproductive health Sexual and reproductive health (SRH) covers various aspects of women’s and couples’ health: maternal and child health; prevention and management of unwanted pregnancies; the fight against sexually transmitted diseases; prevention of mother-to-child HIV transmission, etc. More than 25 MdM projects are centred on this theme and the organisation is keen to increase its focus in order

In 2013 the international emergencies group was created to improve the organisation’s emergency response. This group acts as a short cut, bringing together six people to make policy and operational decisions and work with the emergency desk team to launch the mission. It steps down once operations are stabilised. On a permanent basis, a group entitled ERUC brings members together to reflect on emergencies and crises. It meets regularly to discuss cross-cutting and very complex issues: forgotten crises in countries where the organisation is not present; new ways of working in emergencies with local partners and innovative projects (e.g., environmental health).

to give women control over their choices and access to quality sexual and reproductive health services. In this context, over the past four years MdM has been developing a cross-cutting programme to improve access and the quality of care available in its projects. This programme aims to promote the sexual and reproductive health rights of women, but also to enhance the organisation’s visibility and enable it to become a key player in this field. This year the main focus was on prevention and management of unwanted pregnancies (family planning and abortions), with, for example, the organisation of a workshop bringing together the 15 MdM projects focusing on this key theme, which is all too often sidelined.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Jordan © Clément Mahoudeau

Burma ÂŠ William Daniels/Panos Picture

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Harm reduction For many years, Doctors of the World has the involvement of beneficiaries, civil society worked with populations at risks including and the authorities, with social change as drug users and sex workers. Because they the ultimate goal. The priorities are to proare victims of stigma, marginalisation and mote harm reduction in Africa, where sercriminalisation, these people are exposed vices are virtually non-existent, and to further to numerous risks, including disease, vio- advocacy for access to diagnosis and treatlence and police harassment. To meet these ment of hepatitis C. challenges, since 1989 MdM has managed harm reduction programmes, related on the one hand, to the use of psychoactive substances, and, on the other, to sexual practices, providing medical, psychosocial and community responses. In this context, for the past four years MdM has been developing a cross-cutting programme to improve the quality and visibility of harm reduction projects and to strengthen

Socio-cultural determinants

Migrants For over 25 years MdM has been working with migrants in France, Europe and, most recently, in Africa and the Middle-East with the aim of assessing and testifying about the negative impact that European policies to limit immigration have on migrant health. To do this, Doctors of the World has developed various projects, primary healthcare centres and mobile teams that reach out to migrants where they are living and specific projects that take account of mental suffering and post-traumatic stress. The projects offer a place to rest, talk, the chance of a therapeutic break, medical care and welfare guidance. They also provide an opportunity for

Far from being universal, access to care for the beneficiaries of our programmes depends heavily on the norms, values, preconceptions and the level of knowledge within each community. Aware that illnesses are seen differently by different cultures and different societies, the socio-cultural determinants group considers the matter of socio-cultural determinants in access to care as an ethical concern, with a view to improving the quality of the programmes.

migrants to share their experiences and the obstacles faced, highlighting any breaches in care for chronic diseases, or negative impact on health of migrants during their personal, and therefore unique, journey.

Côte d’Ivoire © Sébastien Duijndam France © Boris Swartzman

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Advocacy and campaigns Once again, in 2013, the fight against discrimination and exclusion was more necessary than ever. Throughout the year, Doctors of the World rolled out awareness campaigns to remind people that access to healthcare for all is a priority. As an international humanitarian organisation, MdM continues to lobby for change. The campaign entitled Names not Numbers promoting the right of women to decide freely whether or not to have children, created in 2013, will facilitate our 2014 campaign on universal access to contraception and safe and legal abortion.

18 Crises and conflicts » Syria: the unending crisis Since the beginning of the Syrian revolution in March 2011, the conditions for survival in Syria continue to deteriorate. The crisis has morphed into civil war, and has already claimed more than 130,000 victims and left an estimated 6.5 million people displaced. Faced with the upsurge of violence that affects the population, medical personnel and health facilities, the Syrians have had no choice but to flee and find refuge in neighbouring countries, because in Syria itself,

today, “only bombs have access to the civilian population.” In April 2013, MdM called for the cessation of hostilities to bring relief to those in need, and to see access for international aid facilitated and improved. The objective is to treat civilians and the wounded without discrimination and to oppose unacceptable behaviour. Doctors of the World continues and strengthens its work to help Syrian refugees who need free access to healthcare whilst they are living far from home in insecure and destitute conditions.

In Greece, MdM launched the project Enough, aimed at promoting tolerance and fighting racist violence.

net diminish or even disappear entirely. Grèce © Giorgos Moutafis This situation, combined with rising unemployment and poverty » Vulnerable migrants: access in Europe, has given rise to stigmatising and to care in Europe at a time of xenophobic statements against migrants. crisis and rising xenophobia In Europe, access to healthcare for the poo- Economic crisis and lower levels of social rest is becoming extremely difficult. Faced protection too often lead to finger pointing with the austerity measures adopted by Eu- at the poorest groups, often already affected ropean governments, those in a precarious by social exclusion before the crisis. situation are seeing their social security safety MdM published a report on access to care

for the most vulnerable in Europe in April 2013, demanding the right to provide healthcare, in accordance with medical ethics, for all patients and the sick, regardless of their social status or ethnicity. It also calls for the maintenance of national public health systems — that, according to the principles of solidarity, equality and equity, should be accessible to anyone living in Europe, especially the poor — rather than systems that are based on profit.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

France Âť Doctors of the World, doctors for everyone Each year, throughout France, Doctors of the World volunteers care for more than 50,000 people in 30 cities. Last May, the organisation launched the Doctors of the World for everyone campaign, advocating for values of solidarity by shedding light on exclusion. The NGO exposes the current state of insecurity and exclusion in France and gives an overview of its outreach work with the most disadvantaged. The annual report on access to healthcare for the poorest in France, published on 17 October, International Day for the Eradication of Poverty, reveals how poverty and social and regional health inequalities continue to worsen. Solidarity, therefore, remains more vital than ever.

ÂŠ DR/MdM

20 » Sex workers: Stop the laws

In Paris, sex workers demonstrated in front of the national assembly against solicitation as an offence.

that make us sick! In March 2013, Doctors of the World campaigned to protect the health of sex workers with the slogan Stop the laws that make us sick! The Internal Security Law, established in 2003, made solicitation an offence. Since then, the living conditions of sex workers have deteriorated. Doctors of the World, therefore, calls for the immediate repeal of the public solicitation offence and rejects any proposed penalty for sex workers’ clients that leads to an increase in the number of sex workers working in more isolated places. Forcing prostitution underground increases risk in terms of health and personal safety. In November, on the eve of consideration of the bill to penalise customers, MdM sent MPs a DVD collecting the testimonies of sex workers to ensure that the voices of all those that the law would push further into the shadows were heard.

Harm reduction » Hepatitis C: Missing Chan A month before 28 July, World Hepatitis Day, MdM launched a petition (signed by over 4,000 people including Nobel Prize in Medicine winner, Françoise Barré-Sinoussi, www.hepcoalition.org) calling on Dr Margaret Chan, Director General of WHO to act urgently to improve universal access to prevention tools, diagnosis and treatment of hepatitis C (HCV). As a veritable viral time bomb, HCV has already caused over a million deaths since 2010, although the disease is curable. Today, more than 185 million people are infected with the virus, against which there is no preventive vaccine. But there are effective treat-

ments, and hepatitis C could be eradicated. Unfortunately, only a tiny proportion of those who know they carry the virus have access to treatment. The main obstacle is the exorbitant cost. On Valentine’s Day, MdM launched a campaign Have a heart, save my liver! calling on pharmaceutical giants Merck and Roche to drastically reduce the prices charged for pegylated interferon, the treatment against the virus. For over 20 years, MdM has been developing its approach to harm reduction with people who take drugs and sex workers. Last June, Doctors of the World presented its programmes at the International Harm Reduction Conference in Vilnius.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Mali © David Delaporte

Migrants » Travellers , a web-documentary exploring the life of migrants in Turkey, Algeria and Mali. Doctors of the World has worked with vulnerable people, including migrants, since 1986. Poverty, discrimination, violence and conflicts lead to displacement and make access to care difficult. In Turkey, Algeria

and Mali, many migrants try to reach Europe, not always successfully. Others, who reach Europe are sometimes expelled after several years of living and working, and are rejected by their community once they return home. Doctors of the World and its local partners, therefore, provide psychosocial support in Istanbul, Algiers and Bamako. Under its mandate ‘to provide care and to bear wit-

ness’, Doctors of the World gave a voice to these migrants it encountered during their migration journeys. The web documentary Travellers, funded by the European Commission, presents the reality on the ground and current issues of migration.

CAR © Sébastien Duijndam

DOCTORS OF THE WORLD ANNUAL REPORT 2013

International programmes contents » 24

Emergency and long-term programmes

» 26

Map

» 28

North Africa and Middle-East

» 34

Sub-Saharan Africa

» 42

Latin America and Caribbean

» 48

Asia

» 54

Europe

» 60

Opération Sourire

Emergency and long-term programmes In 2013, Doctors of the World focused on providing a proactive response in areas affected by conflict and disaster. In line with its commitment, the organisation continues to improve access to healthcare for the most vulnerable populations.

2013 has been a challenging year. When passing the provisional budget for the year, the board sent a strong message: the volume and relevance of international projects must increase. An operational reorganisation was required but the message got through, with Doctors of the World increasing its operational volume by almost 20% and conducting around 20 needs assessments in Latin America, Africa, Europe and Asia. The projects implemented focused on the organisation’s priority areas. Sexual and reproductive health (e.g., continuity of care (antenatal, postnatal and newborn), medical care in case of complications following incomplete abortions, access to contraception) was central to MdM’s activities in 2013. Specifically, in Peru, a programme was launched to reduce maternal mortality associated with unwanted pregnancies. Also, the organisation supported an innovative approach to harm reduction through pilot projects conducted amongst populations affected by the hepatitis C epidemic and, in particular, people who use intravenous drugs. The programme’s success in Tanzania was replicated in Kenya and, based on

this experience, MdM, is now lobbying for the development of harm reduction services throughout Africa. Migrants, or to be precise, the health consequences of anti-migratory policies, were highlighted by organising a conference on the subject in Istanbul, and the release of an online documentary on our programmes in Mali, Algeria and Turkey. Lastly, the mental health component of our work is expanding. In 2013 this was included right from the outset in the provision of care for people who are victims of violence, particularly in Syria, Jordan, Lebanon and Palestine.

Responding to humanitarian emergencies In 2013, a number of emergency situations required MdM’s intervention. In Mali, the organisation supported populations displaced as a result of the armed conflict, which broke out in the north of the country in 2012. In the Philippines, after typhoon Haiyan, we quickly sent a team to assess the needs on the ground before deciding upon action in partnership with the Philippine Ministry of Health. This fast and well-organised

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Logistics is a hidden, yet essential, aspect of the smooth running of our operations.

Building on MdM’s development work in a given country, our teams are able to organise an emergency response.

Colombia © Nadia Berg

response was achieved thanks to the International Emergency Unit (CUI in its French acronym), which was founded on 12 April 2013, to improve Doctors of the World’s responsiveness in emergency situations. The experience of the team managing emergency projects, which had been heavily deployed during the Syrian crisis in 2012, was also crucial for the smooth running of the operation. In Mali, as in the Philippines, MdM already had a presence on the ground, working on development projects for the long term. Naturally, a partnership was established between teams working for the long term and the emergency teams to organise the best possible response to these crises. Thus, emergency responses are organised as a result of the development work carried out by MdM. In this situation, the general co-ordination team of the country in question needs to be strengthened and operational pro-

Faso are conducted with the help of MdM Belgium and MdM Spain. In Laos, the partnership with MdM Japan continues. With an annual meeting focusing on sharing good practice and Partnership, the key to our projects evaluating actions, Opération Sourire continues Except in specific cases, the organisation works to lead the way with five participating delegations. with the health authorities of the country in which This type of partnership is present in other regions we are operating. In humanitarian emergencies, or continents: in the Middle East, for example, the health services and Ministry of Health are with shared projects with MdM Switzerland and generally preferred partners. In this way, an or- MdM Spain, and also with MdM Spain in Haiti. ganised, co-ordinated response can be put in In 2013 through its projects, Doctors of the World place when there is a crisis or disaster. Local reaffirmed its core values: to independently aspartners, associations and civil society are also sist the most vulnerable populations and to bear approached, especially in countries where there witness to barriers to access to healthcare and are long-term projects. Developing projects in access to rights. partnership is our preferred way of working. In addition, partnerships within the international network have enabled MdM to continue and strengthen its operations in a number of countries. In the Sahel region, operations in Mali and Burkina

cedures need to be harmonised, even though timescales for emergencies and development work are different.

map of international programmes

Mexico Guatemala Nicaragua

Haiti

Colombia

Long-term programme (one colour for each region)

Peru

Emergency programme

Uruguay

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Russia

Romania Bulgaria

Georgia Afghanistan

Turkey Syria

Lebanon Tunisia Palestine

Mali Guinea

Egypt

Niger

Burkina Faso

Nepal

Jordan

Algeria

Laos Pakistan

Chad

Burma India

CAR Liberia

Rwanda Kenya DRC Tanzania

C么te d'Ivoire

Philippines

Somalia

Angola Madagascar

Syria For three years Doctors of the World has been working with victims of the Syrian conflict, whilst denouncing violations of human rights and health.

ÂŠ Richard Delaume

DOCTORS OF THE WORLD ANNUAL REPORT 2013

our programmes in

North Africa Middle-East �� Countries in the region have experienced a turbulent year with varying degrees of violence. Syria is sinking even deeper into horror, Palestine is faced with violence from the settlers, and Egypt is struggling to recover from the Arab Spring. Doctors of the World, therefore, maintains its presence amongst the most vulnerable and is further developing psychosocial support.

FRANCE

RUSSIA

Black Sea

BULGARIA

ITALY

GEORGIA ALBANIA

ARMENIA

SPAIN GREECE

Turkey

CYPRUS

Mediterranean Sea

Lebanon

Tunisia

MOROCCO

Syria

ISRAEL

IRAQ

Palestine Jordan Algeria LIBYA

Egypt SAUDI ARABIA

MAURITANIA

Djibouti MALI NIGER ERITREA

CHAD

SUDAN

ETHIOPIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» Algeria » egypt » Jordan » Lebanon » Palestine » Syria » Tunisia » Turkey

key events

» syrian crisis Providing care in Syria, despite the violence For three years now, Syria has been in the midst of a destructive and deadly conflict, the outcome of which looks more uncertain by the day. On the ground, and despite growing security risks, Doctors of the World has strengthened and expanded its activities in response to the unprecedented humanitarian crisis which is affecting the whole country and also the region, especially Lebanon and Jordan.

For detailed fact sheets on the various programmes in North Africa and the Middle-East, see the interactive CD attached to this report

Syria Since the start of the conflict, Doctors of the World has supported the decreasing number of medical staff who have remained in Syria and who are short of everything. Relationships based on trust have gradually been established with several Syrian medical organisations which manage the hospitals and healthcare centres in Alep, Damas and Deraa regions. Today, it is Syrians (doctors, nurses, volunteers) who operate, treat and dispense medication to most of the sick and injured in Syria. Doctors of the World works with seven Syrian organisations, regularly providing them with medical equipment and medicines.

It is not only the bombs that kill in Syria today. Patients with renal failure have been unable to get to their dialysis sessions, patients with cancer or diabetes are dying at home through lack of treatment. It is also increasingly difficult to prevent and treat common infectious diseases or to deliver babies in good conditions. Immunisation coverage has plummeted, causing the reappearance of illnesses such as polio, which had disappeared from the country 10 years ago. Against this background, access to primary healthcare, support for pregnant women and vaccination of children are more essential than ever.

32 In the north of Idlib, near to the Turkish border, Doctors of the World has opened nine health centres which are there for displaced Syrians, living in makeshift camps. A centre for women and children has also been set up to support women throughout their pregnancy and after giving birth. At the borders The conflict is fuelling a massive exodus: over 2.5 million Syrians have fled their country to seek refuge, mostly in Lebanon, Jordan, Turkey and Iraq. Already vulnerable, these countries find it increasingly difficult to deal with this population influx and to provide an appropriate welcome for the refugees. As the crisis continues, the Syrian refugees’ money runs out and, therefore, their ability to obtain care from the health services, which often become financially inaccessible. Since the beginning of 2012, in order to guarantee access, not only for Syrian refugees but also for the most vulnerable amongst the local populations, Doctors of the World has opened three health centres in Jordan. In Lebanon we support five primary healthcare centres, which are managed by partners.

» Egypt

Over 200,000 primary healthcare consultations have been carried out in centres supported by MdM.

Reduced activity MdM carried out a number of activities in 2013 whilst waiting for government approval for the launch of a mental health programme for the most vulnerable: debriefing of partner NGO’s staff following violence and the

tense situation in the country; training Ministry of Health doctors and partners; drama activities with social workers and beneficiaries to fight against preconceptions of mental health.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» Algeria / Turkey

Spotlight on migration in 2013 The theme of access to healthcare for migrants is a top priority for Doctors of the World, which has chosen to make this a topic for discussion and advocacy.

Around 80 Palestinian health personnel will be trained in mental health.

In 2013, on two occasions, particular emphasis has been placed on the theme of access to healthcare and human rights for migrants. Firstly in the media, through a web documentary entitled Les Voyageurs (Travellers) which, through films and photographs, gives a voice to migrants in Algeria, Turkey and Mali. Then, at a conference in Istanbul on the health implications of migration journeys, where teams from Doctors of the World with an interest in this issue were gathered. The objective was to summarise the state of play, to share experiences and to generate proposals for undertakings for years to come. The ‘migrant’ programmes continued as normal. In Algeria, MdM raises awareness among health

professionals of the specific needs of migrants and of their right to health. A network of care providers, working in various healthcare facilities, has been created. They act as mediators, organising the reception and medical care of migrants. Health mediators are also enlisted from amongst the migrants to provide health education and make referrals. In Turkey, MdM supports a medico-social centre in Istanbul, in Kumkapi quarter, which is managed by Tohav, a partner organisation. This centre treats anyone who is unable to access public healthcare provision, the vast majority being undocumented migrants, asylum seekers and refugees.

» Palestine Mental health in the West Bank In West Bank, violent attacks by settlers on Palestinians continue to increase, creating a need for significant psychological support. As a result, in 2012, the Palestinian Ministry of Health incorporated mental health into its primary healthcare programme. MdM France and MdM Switzerland are supporting this initiative by developing a programme that aims to incorporate mental health provision in 25 medical centres in © MdM

Nablus, as well as working at community level to renovate the centres and train staff. MdM France was already working in this field and, in 2012, had set up a pilot project providing an emergency psychosocial response to victims of attacks by settlers, with a component devoted to building resilience. In view of the positive results and the growing need, the project was extended to 18 villages in the south of Nablus.

burkina faso In Djibo district, MdM is running two programmes: one on the treatment of child malnutrition, the other on assistance for refugees and asylum seekers.

ÂŠ MylĂ¨ne Zizzo

DOCTORS OF THE WORLD ANNUAL REPORT 2013

our programmes in

Sub-Saharan Africa �� With some 20 projects underway, Sub-Saharan Africa is the region with the most Doctors of the World programmes. From emergencies in Mali, Central African Republic and Somalia, to longterm projects – harm reduction in Tanzania and Kenya, sexual and reproductive health (SRH) in Cote d’Ivoire and Chad, and migrants in Mali – representing our four priority action areas.

ALGERIA

LIBYA

WESTERN SAHARA

EGYPT

MAURITANIA

Mali Niger

GAMBIA GUINEABISSAU

ERITREA

Chad

SENEGAL

SUDAN

Burkina Faso

Guinea

DJIIIBO BOU OU O UTI UT U BENIN

SIERRA LEONE

C么te d'Ivoire

NIGERIA TOGO

ETHIOPIA

Central African Republic

GHANA

Liberia

CAMEROON

Somalia EQUATORIAL GUINEA

UGANDA

Kenya

Rwanda

GABON

Democratic Republic of Congo

CONGO

BURUNDI

INDIAN OCEAN

Tanzania

ATLANTIC OCEAN

COMORES

Angola

MALAWI ZAMBIA

ZIMBABWE NAMIBIA

BOTSWANA

SWAZILAND

LESOTHO SOUTH AFRICA

MOZAMBIQUE

Madagascar

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» Angola » Burkina Faso » CAR » chad » Côte d’Ivoire » DRC » Guinea » Kenya » Liberia » Madagascar » Mali » Niger » Rwanda » SAHEL » Somalia » Tanzania For detailed fact sheets on the programmes in Sub-Saharan Africa, see the interactive CD attached to this report.

key events

» sahel

Free healthcare proves its worth

The health authorities have adopted new policies on access to healthcare.

After four years of activity, the regional programme in Sahel has come to an end. We are considering what to do next. On 31 October the Sahel regional programme, whose objective was to improve access to primary healthcare for women and children under five in Djibo district, Burkina Faso, Keita district in Niger and Koro district in Mali, came to an end. A closing event which brought together all those involved with the project (teams, authorities, donors, etc.) enabled us to take stock and present the good results obtained, particularly in Djibo, where completely free deliveries became available thanks to the heavy involvement of the communes.

MdM hopes the idea will catch on throughout the country. The rate of assisted births has grown from 56% at the start of the project to 68% a year later as a result of the programme and the new forms of support available. In the three districts the system for referral and health evacuation improved, thus reducing maternal and infant mortality. MdM hopes to continue to work in the three countries and continues to provide support in the three districts by supervising activities set up during the four years of the regional programme.

» car

Many people who have been wounded by arrows, machetes, grenades and heavy arms are treated in the health centres.

Emergency following the coup d’état The healthcare system in CAR is failing and the current crisis is weakening it further. The population urgently needs access to primary healthcare. © Sébastien Duijndam

Following the coup d’état of 24 March 2013, Doctors of the World, which had not been in the country for 10 years, sought to return to the Central African Republic to work with the most vulnerable populations. In August 2013, a short-term emergency project was set up with two local partners to support four primary health and sexual and reproductive health facilities in and around Bangui. MdM provided medicines

and equipment, and trained local staff. In addition, the organisation conducted health needs assessments, working closely with the Ministry of Health. This phase, comprising set-up, evaluation and support for partners, has enabled us to thoroughly analyse the security and humanitarian situation, to make ourselves known to the various stakeholders and to fit into an already existing coordination effort.

On 5 December, there was another attempted coup d’etat with an upsurge in violence throughout the country, resulting in a modification of the project in order to best meet the immediate needs of the population. Thus, the provision of healthcare was boosted in four assembly centres where several thousand people were gathered. At the same time we continued to lay the groundwork for a medium-term intervention.

» ANGOLA

Successful withdrawal Since 2010, MdM France and MdM Spain had been conducting a programme to reduce maternal and neonatal mortality. The two NGOs were involved in four districts of Kwanza Norte province, in partnership with the health autho-

rities to boost the healthcare provision and the skills of the local personnel. There was a great deal of training on family planning, pregnancy monitoring and treatment of HIV. Work was also carried out with community leaders, traditional

midwives and young people in schools so that they are involved in awareness-raising. At the end of December MdM withdrew, leaving the authorities better organised and trained and with an increase in medically assisted deliveries. Launch of a new programme is envisaged in 2014.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» mali

Between transfers and emergencies 2013 was a turning point for MdM’s programmes in Mali. Two of them, access to healthcare and human rights for migrants, and treatment of obstetric fistulas, came to an end, and an emergency programme was started due to the conflict.

Migrants For five years, Doctors of the World supported and trained four partner organisations to enable them to provide a welcome, a listening ear and medical guidance which was appropriate for migrants. In Mali, a country of departure, transit and forced returns, MdM raised awareness amongst the population of migration and its consequences, in order to tackle discrimination suffered by migrants. At the end of 2013, this programme was put on hold, but the organisation remains at the ready in case of mass deportations from Algeria.

Fistulas The programme for treatment of obstetric fistulas in the Mopti region is a long-standing one for Doctors of the World. Since 1993, the organisation has supported the regional hospital in Mopti, initially, through surgical interventions, then through comprehensive medical and psychosocial care. The transfer of medical skills to Mopti hospital is complete, a team of Malian surgeons has been trained to treat fistulas, even including complex cases. A psychosocial component has also been developed, incorporating psychological support and awareness-raising workshops. It is being taken over by Iamaneh, a local NGO. Training and an exchange of expertise with MdM are already underway. Emergency In response to the conflict which broke out in 2012, and to the major population movements of people fleeing the north, Doctors of the World decided to come to the aid of health centres in Mopti and Tenenkou district, as well as to support the targeted policy of free treatment that had been introduced by the government. MdM carried out several renovations and supplied the facilities with medicines, consumables and equipment, screened for and treated acute malnutrition in children under five years old, etc. The region is still affected despite the end of the conflict, so the organisation has stayed on in a support role and hopes to use 2014 to lobby for continuing free healthcare.

Almost 2,000 women had operations for fistulas and were supported during their reintegration. © David Delaporte

» tanzania

Harm reduction is established in Africa The first harm reduction programme in Africa led by MdM is running smoothly, thanks to the efforts of the authorities and local partners.

Harm reduction amongst people who use drugs is a new field of activity in Africa, one which the organisation would like to see widely promoted. MdM’s pilot programme in Dar es-Salaam, Tanzania, is a success from both socio-medical and political perspectives. In 2013, the Chair of Doctors of the World went to Tanzania, where he met the Tanzanian president; this meeting followed a visit by Tanzanian parliamentarians to France.

The authorities are very open to discussion and are supportive of harm reduction in their country. MdM has set up a centre where around 100 users attend every day to wash, rest, get informed, be screened or get vaccinated, obtain needles, see a nurse or a psychologist, or become involved in a revenue-generating activity. The centre is also a training venue for medical personnel working in health facilities, the police, community leaders and local NGOs. In addition, a mobile unit goes out to reach the most marginalised or women, who remain less visible. This year, TANPUD, a self-support group, was created to allow users to express themselves and to do advocacy. A partnership was established with the Mukikute organisation to incorporate harm reduction into its activities and to improve access to its services in the town of Dar es-Salaam.

4,200 drug users benefited from MdM’s services in 2013. © William Daniels/Panos Picture

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» kenya

Replicating the programme The harm reduction programme for people who use drugs in Nairobi is the little brother of the pilot programme in Tanzania. It was difficult to get the programme off the ground in 2013, because of the more challenging environment. A centre is open for users requiring various services (needles, social support...) but it is going to move, in the hope of reaching more people. A mobile outreach team goes out to meet the most isolated and is looking for areas in which to take action. In 2014, the programme is expected to expand, including the component dealing with lobbying the authorities.

» liberia

Ten years support instrumental in gaining recognition for the need for mental health and its incorporation into the system. Then we supported the training of medical personnel by creating a grant system whose recipients (around 50 in five years) committed to working for two years in the facilities in Bong county. The CB-Dunbar hospital was built and became the regional reference hospital for obstetric At the end of the second civil war in Liberia tal healthcare and training in 10, and then 16, and neo-natal care. Finally, two maternity waiting in 2003, MdM launched a programme for health facilities. In 2006, following the election homes were opened close to a health centre to access to healthcare in the north and north of Ellen Johnson Sirleaf to the presidency, MdM accommodate women about to give birth. east of Bong county. Initially aimed at former assisted the government in the establishment of In August 2013, all the activities were handed over to the Ministry of Health and in 2014, a new child soldiers, the project quickly expanded to a national policy on health. the whole population, offering primary health- During these 10 years, MdM has conducted programme will be launched in the shantytowns care, sexual and reproductive healthcare, men- four successful major projects. Firstly, we were of Monrovia.

After 10 years of activity in Liberia, one of MdM’s long-standing programmes came to an end. Activities undertaken in partnership with the government have been completely handed over and MdM leaves behind better trained personnel and a working hospital.

Guatemala Present in Guatemala since 1987, MdM has just completed an SRH programme with women working in export industries.

ÂŠ Michel Redondo

DOCTORS OF THE WORLD ANNUAL REPORT 2013

our programmes in

Latin America and the Caribbean �� For Doctors of the World’s programmes in the region, 2013 has meant a lot of change. Assessment of the regional strategy is underway, one programme was launched in Peru, and the one in Guatemala ended. One thing has not changed — that the programmes are mainly developed around sexual and reproductive health.

44 UNITED STATES

BAHAMAS CUBA

Mexico

DOMINICAN REPUBLIC

JAMAICA BELIZE

Haiti

Guatemala HONDURAS SALVADOR

ATLANTIC OCEAN

Nicaragua

COSTA RICA

VENEZUELA

PANAMA

GUYANA SURINAME

Colombia

ECUADOR

Peru BRAZIL

BOLIVIA

PACIFIC OCEAN

CHILE

PARAGUAY

Uruguay ARGENTINA

FRENCH GUIANA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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

For detailed fact sheets on the various programmes in Latin America and the Caribbean, see the interactive CD attached to this report.

» latin america

and the caribbean

The region acquires a joint programme Projects in Latin America focus on sexual and reproductive health and the fight against illegal abortions. MdM took the decision to strengthen its activity through a regional programme. © Michel Redondo

Following on from the Uruguay project (a partnership with other organisations to provide access to safe, legal abortions and to sexual and reproductive rights), Doctors of the World sought to develop a regional project in Latin America, where abortion is a major issue. The objective is to create momentum around the prevention of unwanted pregnancies. This project is made up of three components. Firstly, developing the expertise of staff — from MdM and from the health facilities that they support — in family planning, mana-

gement of abortions, and post-abortion care. Next, the development of health education for the populations, by creating appropriate training and communication resources. Finally, the implementation of regional advocacy based on national projects, in particular with Clacai, the Latin American network against unsafe abortions. We were able to formalise the project in 2013, meet with partners and clarify that our approach to support is to complement rather than replace. In 2014, workshops and training will take place.

» Haiti

Between support and project creation 2013 has been a year of transition, following on from post-earthquake programmes. In the course of working in clinics set up after the earthquake, the teams witnessed a significant number of unwanted pregnancies which often resulted in illegal abortions. Post-abortion complications could be responsible for a third of maternal mortality in Haiti. In Port-au-Prince an assessment is underway which, in 2014, will lead to a project on preven-

tion and awareness-raising, as well as advocacy for sexual and reproductive health (SRH). In Grande Anse, MdM has continued to support the local authorities as they take over primary healthcare, nutrition and SRH activities. With the cholera epidemic still active, the organisation remains on stand-by with an emergency mobile unit to assist the health authorities in their response to outbreaks of the disease.

» pEru

Prevention of unwanted pregnancies As part of its regional project, Doctors of the World launched a programme in Lima in early 2013 dealing with the issue of illegal and incomplete abortions.

In Peru abortion is illegal. Nonetheless, around 400,000 elective abortions are carried out every year. In the streets of Villa El Salvador in Lima, posters offer ‘immediate solutions to a late period’. Women can also obtain Misoprostol (the abortion pill) without prescription but also without information on dosage. There are many cases of incomplete abortions or complications. Thus, Doctors of the World has launched a programme for the prevention and management of

unwanted pregnancies. It supports Promsex, a local organisation, which is a telephone information line for women. It also trains health promoters in family planning and medical personnel in the management of incomplete abortions. MdM is also lobbying alongside Peruvian universities, medical colleges and pharmacists, to establish a protocol for dealing with incomplete abortions and for abortion to be legalised in cases of rape.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» mexico Rights for migrants In the far south of Mexico, MdM is working with migrant women, who have become domestic workers, sex workers or waitresses, to improve their access to health, social and psychological services. The project moved into its second phase in 2013, more focused on advocacy with the authorities and the police, to raise their awareness of the situation of migrant women and to improve access to healthcare through a more efficient referral network. MdM also hopes to extend its reach to a number of border towns.

» COLOMBIa Resurgence of violence

As well as providing medical care, MdM’s presence is reassuring and offers some protection for the population.

» Guatemala

Doctors of the World teams have to constantly adapt to the Colombian situation in order to provide continued support for victims of the conflict. Despite peace negotiations between FARC and the Colombian government, violence continues to increase and the security situation impacts upon Doctors of the World’s programme in Meta, Nariño and Guaviare provinces. Alongside their usual work, the teams are responding more often to ad hoc emergencies (e.g. respiratory epidemics...) They continue to work with populations who are isolated

or displaced as a result of the conflict, providing primary healthcare, sexual and reproductive healthcare and psychological support in cases of stress caused by the violence. At the end of 2013, a nutrition element was developed for the benefit of pregnant women and children, as well as community work to enhance the skills and resilience of the populations.

End of the SRH project

Since 2008, MdM has worked in the fincas (farms) in southern Guatemala for the right to sexual and reproductive health for women working there. Medical care and awareness sessions were offered, as well as training for health promoters, where required. At the end of 2013, the programme came to an end. MdM is considering a new project, more closely linked to the context of violence in the country. An exploratory mission will take place in 2014 to assess the needs of women who are victims of this violence.

indIA In Andra Pradesh, MdM supports a local NGO, Sitara, to care for the tribal populations affected by the Naxalite conflict.

ÂŠ Joan Coleman/MdM

DOCTORS OF THE WORLD ANNUAL REPORT 2013

our programmes in

Asia �� Doctors of the World is working in around 10 countries in Asia, with a strong presence in Burma and Pakistan. Programmes on harm reduction and access to healthcare for displaced people in these two countries continued to run as normal in 2013. In Burma, and also in Laos and Nepal, Doctors of the World is working towards the removal of user fees for access to sexual and reproductive health services. The year was marked by the emergency response following the hurricane in the Philippines, by the closure of two flagship programmes in Russia and Afghanistan, and by exploratory missions in Vietnam and Sri Lanka.

Russia

KAZAKHSTAN MONGOLIA

NORTH KOREA

UZBEKISTAN

Georgia

KYRGYZSTAN

ARMENIA

TURKMENISTAN

AZERBAÏJAN

SOUTH KOREA

TAJIKISTAN

JAPAN

CHINA

Afghanistan IRAQ

IRAN

Pakistan

BHUTAN

Nepal TAÏWAN

SAUDI ARABIA

PACIFIC OCEAN

U.A.E.

Burma

India

OMAN

Laos

BANGLADESH THAILAND YEMEN

INDIAN OCEAN

CAMBODIA VIETNAM

SRI LANKA MALAYSIA

Philippines

DOCTORS OF THE WORLD ANNUAL REPORT 2013

key events » Afghanistan » Burma » Georgia » India » Laos » Nepal » Pakistan » Philippines » Russia (the GREAT north)

For detailed fact sheets on the various programmes in Asia, see the interactive CD attached to this report.

» Georgia

Lobbying for access to treatment for HCV Georgia has repressive laws against the many people who use drugs in the capital. Access to harm reduction services and to treatment for hepatitis C (HCV) is very limited. In 2012, Doctors of the World conducted a study of hepatitis C in Tbilisi. This showed that 92% of drug users are affected by the hepatitis C virus and 24% of these suffer from severe liver fibrosis. In 2013, these results were disseminated through a number of local, European and international conferences on harm reduction. The

recent publication of the study in the scientific journal International Journal of Drug Policy will enable the results to be disseminated still further and will strengthen the organisation’s advocacy on access to treatment for this silent epidemic. The harm reduction programme in Georgia has been extended for three years to strengthen the local partner New Vector, in terms of technical, managerial and financial expertise, in preparation for the withdrawal of MdM.

» india Healthcare for the displaced In April 2013, MdM launched a programme of access to primary healthcare for displaced tribal populations in Andra Pradesh. Driven out of the state of Chhattisgarh by the Naxalite conflict, they are isolated in the forest, in a state that, contrary to national positive discrimination laws, does not recognise their citizenship.

Working with Sitara, a local NGO, MdM set up mobile clinics, training for community networks, awareness and health education sessions in 17 villages reaching 2,000 beneficiaries. MdM also lobbies the state of Andra Pradesh for the recognition of rights for these displaced populations.

Once the health facilities are returned to working order, MdM will close the project.

» Philippines A country affected by ecological disasters © Sébastien Duijndam

MdM Spain, made a base on the island of Leyte, targeting five priority areas. The objective was to support the communes and advanced health posts in isolated areas by carrying out emergency repairs (repairs to roofs, doors, windows), by providing equipment and medicines and by setting up psychological support for medical staff. Ultimately, five mobile clinics came to reinforce the health Emergency system, over 45 tonnes of equipment were sent On 8 November 2013, typhoon Haiyan, one of and cholera and malaria kits were provided in the the most powerful ever registered, struck the Phi- region in anticipation of an epidemic. lippines, causing enormous damage and several thousand deaths and displaced people. Doctors Health and the environment of the World was already in the country, working Since summer 2013, a project has been running on a long-term programme, so immediately mo- on the prevention of environmental harm among bilised its medical and logistical coordinators to informal recyclers in the conurbation of Manila. At assess the needs. In partnership with the Philip- each of the four sites where MdM is working, a pine Ministry of Health, MdM France, working with ‘core’ group of recyclers has been identified and

Thanks to the teams that had been in the Philippines for a year, the emergency response to the typhoon was swift and efficient.

» Vietnam Needs assessment

Two exploratory missions were carried out in Hanoi with the objective of developing an advocacy programme for access to treatment for hepatitis C for people who use intravenous drugs. In fact, within this group of people who have no access to screening or treatment —

is now responsible for all the activities on-site, liaising daily with MdM leaders and community workers. Given that each site has its own characteristics and differences, the rate of progress is not uniform. So, some groups requested equipment and organised a cleaning day in their district, to change locals’ perceptions of their activity. Others preferred to be trained on electronic waste and the risks of handling it. Eventually, all the activities will be run on the four sites, each one progressing at its own pace, and MdM is involving the beneficiaries, who need to take ownership of the project. The objective for 2014 is to gain legal recognition by the authorities for recyclers’ associations and the promotion of dedicated areas for dismantling electronic refuse so that toxic products are removed from the places where recyclers and their families live.

which is very expensive at between 9,000 and 20,000 dollars (6,500 to 14,500 euros) depending on the country — prevalence of the disease is as high as 97%.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» RussiA

GREAT NORTH

End of the programme After nearly 20 years working in the Russian Great North, MdM hands over its programme to the indigenous people. Initially focused on training community health workers amongst the nomads, the programme evolved towards preventing alcoholism and suicide in isolated villages. MdM assisted with the creation of the organisation Community Health Partnership, bringing together doctors and psychologists to extend the project to several regions and to enable the dissemination of training and the exchange of good practice.

» Afghanistan

Handover of a pilot programme In September, after seven years presence in Kabul working with people who use drugs, MdM handed over its activities to AFGA, its local partner, and to the Ministry of Health. This first harm reduction programme enabled the creation of a drop-in centre, mobile healthcare and outreach activities, where users have access to the full range of services (injecting equipment, screening, primary healthcare, social support, etc.). MdM’s action made possible the prescrip-

tion of the first antiretrovirals for drug users in April 2009, and of the first methadone substitution treatments. Over 500 Afghan professionals (NGOs, community representatives, judicial and health institutions) have also been trained in good practice in relation to harm reduction.

The harm reduction programme in Kabul became a model, which has since been replicated elsewhere, particularly in Africa.

» Sri Lanka Supporting Tamil women

In 2012, Doctors of the World launched a partnership with Caritas concerning mobile clinics providing primary healthcare and psychological support to women in northern Sri Lanka. This partnership ran throughout 2013 and responds to needs linked to post-trauma, in a predominantly militarised region (80%) where gender-based violence is common. It will be extended for six months in 2014. In parallel, MdM will set up a base with a view to a new project in the north and/or in the tea plantations in the centre of the country, where Tamil women have little access to health or to other rights. © Robin Hammond/Panos Picture

54 serbia Thanks to its expertise on the subject of migration, MdM could open a programme in Serbia, a country with an influx of migrants..

ÂŠ BenoĂŽt Guenot

DOCTORS OF THE WORLD ANNUAL REPORT 2013

our programmes in

Europe �� 2013 was a pivotal year for programmes in Europe. Deliberations took place so that projects could be redefined, given a new dynamism and also so that new projects could be set up in line with needs. Foundations were laid for more robust projects in years to come.

56 BELARUS

POLAND

UKRAINE

SLOVAKIA MOLDOVA HUNGARY

Russia Romania

CROATIA BOSNIAHERZEGOVINA

SERBIA

Black Sea

MONTENEGRO KOSOVO

Adriatic Sea

Bulgaria

GEORGIA

MACEDONIA ALBANIA

ARMENIA

GREECE

Aegean Sea

Mediterranean Sea

TURKEY

CYPRUS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

key events » Bulgaria » Romania » Russia

(chechnya)

» serbia

Migrants at the gates of Europe As part of its strategy of action and advocacy on the impact of migration policies on health, Doctors of the World is interested in European migration and is considering the development of a programme in Serbia.

For detailed fact sheets on the various programmes in Europe, see the interactive CD attached to this report.

Access to healthcare and to rights for migrants is one of Doctors of the World’s priorities. A study was carried out in 2013 on migration at gateways to Europe in four countries: Bulgaria, Poland, Romania and Serbia. The results showed an influx of migrants in Serbia, and that these migrants have particularly difficult living conditions. In 2013, there were 5,000 requests for asylum compared with 80 in 2008. Most of the migrants come from the Middle-East, Asia and North Africa, via Greece or Turkey. So an exploratory mission was carried out in September to assess the needs and the feasibility of a programme. A project on access to healthcare and advo-

cacy is under consideration, but the migrants are very difficult to reach because they are highly mobile, they cross the Hungarian border as soon as possible, and are subjected to police brutality and xenophobia from the host populations. The objective is to establish a partnership with a local organisation which provides legal assistance, and to add a medical and, possibly, logistics component (distribution of survival kits, building shelters, etc.). Local advocacy would be established for migrants to have the same access to healthcare as the Serbs, and European advocacy would focus on combating institutional violence associated with detention and readmission.

» Moldova

Tackling foetal alcohol syndrome

» bulgaria

Sexual and reproductive health in Sliven

In Moldova, excessive consumption of alcohol is a major concern, especially for women who are unaware of the risks and continue to drink during pregnancy. The identification of risky consumption and the procedures for management of alcohol dependency offered by the health services are very limited. Therefore, in 2013, MdM devised a programme for awareness and prevention of alcoholism in Nisperoni district, which should start, with the help of the communities, in 2014. Health professionals will be trained in the early identification of people at risk and in prompt intervention as part of the management of alcohol dependency. Reduction of foetal alcohol syndrome is specifically targeted.

The programme to improve the health of Roma has developed into a programme of sexual and reproductive health for at-risk populations in Sliven. Doctors of the World has been working in Sliven, in the Roma ghetto of Nadezhda, since 2004. This year there arose a need to ‘de-ethnicise’ the programme, since it is not only the Roma who do not have access to care, but the entire vulnerable population of Sliven (25,000 people). In addition to the assessment, a report on the population’s socio-cultural determinants was prepared. The project was re-worked to

better meet the needs of the beneficiaries. It will concentrate on sexual and reproductive health, focusing on combating the high incidence of unwanted pregnancies and responding to women’s demand for contraception. The council has provided premises, which MdM transformed into a family planning centre. In 2014, discussion groups and awareness raising will be arranged and a nurse

will join the team of mediators, who guide women towards practitioners funded by the local council, in order to get free healthcare. In Bulgaria, where the rates of maternal mortality and abortion are double the European average, MdM will spend the next three years campaigning, with the Bulgarian family planning organisation, for better access to sexual and reproductive healthcare.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

» Romania MdM called upon to intervene in Bucharest With a presence in Romania, working alongside COPII, for several years, MdM wants to expand its activities in the country.

Despite its membership of the European Union and the structural reforms carried out in the 1990s, Romania remains one of the poorest countries in Europe. In 2013, the French embassy in Romania requested that Doctors of the World conduct a health and social assessment in the Ferentari quarter of Bucharest. Close to being a ghetto, this quarter has seen the authorities give up, through lack of resources.

» CHECHNYA

The exploratory mission, conducted at the end of the year, identified a wide range of needs. The inhabitants of this area are in a survival situation, with significant difficulties in gaining access to healthcare. 80% of the inhabitants are not covered by medical insurance. The main issues identified in this quarter include: primary healthcare, sexual and reproductive health (pregnancy monitoring, family planning, etc.), harm reduction (HIV, hepatitis) and screening for tuberculosis. This assessment was shared with the Ministry of Health and the French embassy, who wish to demonstrate that with the will and the means, it is possible to reverse the trend in Ferentari, then to replicate the model if it is a success.

Mother and child health The project to improve mother and child health in Vedeno district, which began in July 2012, continued in 2013. Mobile teams of gynaecologists went out to see women in primary healthcare centres. 540 women received pregnancy monitoring and 554 deliveries took place. The local teams were trained, to enhance their skills in care and family planning. This brought about increased confidence on the part of the women, who are now less hesitant to go to the health centres. The project will come to an end in July 2014 after a period of evaluation and capitalisation of the experience.

Niger ÂŠ Catherine Henriette

DOCTORS OF THE WORLD ANNUAL REPORT 2013

our programmes

Opération Sourire �� Since the first operation, performed in 1989 in Cambodia, Opération Sourire has grown steadily. Today, Doctors of the World teams carry out plastic and reconstructive surgery assignments in Africa and Asia. The objective is to restore the smile of people, and particularly children, who are affected by congenital or acquired conditions, and to promote the training of national medical staff. As well as the surgery, it is about encouraging the social re-integration of people into their communities after surgery.

On every project, surgeons train local teams to consolidate their skills.

Restoring faces and encouraging social re-integration Opération Sourire is part of an approach that shows solidarity with the most deprived whose appearance has been changed. Through these actions, teams from four branches of Doctors of the World’s international network (France, Germany, Japan, Netherlands) are helping to rebuild patients’ confidence and to encourage their social re-integration.

In 2013, the teams operated on 1,075 patients during 20 missions in 10 countries. MdM France conducted nine missions in five countries: Benin, Cambodia, Madagascar, Mongolia, and Pakistan. The teams were able to treat 311 patients, suffering mainly from cleft lips and palates and burn injuries. MdM Germany, MdM Japan and MdM Netherlands set up their own surgical operations in Cambodia, Bangladesh, Burundi, Burma, Sierra Leone and Guinea-Bis-

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Missions are announced by local media, resulting in an influx of potential patients.

sau. Thanks to them, 764 people had surgical operations. For its part, MdM France took on a surgical project with women who were victims of acid attacks in Pakistan but had to defer two projects (Chad and Madagascar) owing to the extremely adverse environment, where the safety of the teams could not be guaranteed.

promote its unique approach to plastic and reconstructive sur» OUTLOOK AND CHALLENGES gery in the countries where it is In 2014, Opération Sourire teams plan to working. National staff training conduct 29 missions in the field, of which and evaluation of the missions © Catherine Henriette three will be needs assessments. (to assess the benefits of the The idea is always to favour missions in countries thorisations and partnership agreements, but also operations performed) will be core priorities. where MdM is already working on long-term pro- with the security and supervision of the teams. Finally, 2014 will be the 25th anniversary of Opéjects, with a local base. This helps not only with Doctors of the World also wishes to further ration Sourire. In this context there will be work logistics, recruitment, monitoring of patients, au- develop the quality of its programmes and to on awareness raising and communication.

» PAKISTAN MISSION After a break of six years, last September Doctors of the World resumed its Opération Sourire programme in Pakistan. The team operated on 17 women, all victims of acid attacks. Two local partners worked on recruitment and selection of patients: the Family Planning Association of Pakistan (FPAP), an organisation which helps women and children through the Charity Hospital network, and Acid Survivors Foundation (ASF), a not-for-profit organisa-

COORDINATORS

»H ead of programme Dr François Foussadier »H eadquarters : Sophie Poisson

countries

tion which supports acid victims in Pakistan. Self inflicted and criminal acid burns (vitriol or sulphuric acid) are relatively common in this part of the world and are responsible for extremely serious disfigurement of the women who are the victims. They are ‘crimes of honour’, which intend to mutilate a woman or a girl whose behaviour is considered to contravene the norms of the society in which she lives.

»B angladesh, Benin, Burma, Burundi, Cambodia, GuineaBissau, Madagascar, Mongolia, Pakistan, Sierra Leone

BUDGET

» € 592 558 partners

» L’Oréal Foundation

Paris © Véronique Burger/Phanie

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Programmes in France contents » 66

Programmes in France

» 68

Map

» 69

Observatory on access to healthcare

» 70

Shantytowns

» 72

Migrants

» 73

Harm reduction

» 74

Prostitution

» 76

Prevention HIV-hepatitis-STIs-tuberculosis

» 77

Buddying of children in hospital

» 78

Health and housing

Programmes in France In France, the impact of the economic crisis on health and access to healthcare particularly affects the most vulnerable groups. Social inequalities in health are exacerbated in a context where public responses are more concerned about security than social welfare, especially when relating to migrants, sex workers and people who use drugs. Those groups face increasing difficulties in accessing healthcare which leads to a worsening of their general health.

Streamlining access to care and rights Our Healthcare, Advice and Referral Clinics are constantly growing busier, with a worrying and relentless increase in the number of minors since 2008. Service users face financial problems and poor housing conditions, along with problems with their health and access to healthcare. 43% of them are late in accessing healthcare and 22% of them have given up trying to access any healthcare in the last 12 months. These two benchmarks, which have been increasing steadily for several years, demonstrate how health and access to healthcare are worsening for the most vulnerable groups. Since 2012, some political decisions have tried to address these problems, such as, for example, the abolition of the â&#x201A;Ź30 fee to join the State Medical Aid scheme. The Pluriannual Plan against Poverty and for the Promotion of Social Inclusion also demonstrates a political will to fight social and territorial inequalities in health by calling for social reforms in healthcare: raising the threshold of the complementary Universal Health Insurance (CMU-C), strengthening of Healthcare Access Offices (PASS in its french acronym), streamlining of residency assessment procedures. However, the real impact of these measures remains insufficient, while the issue of migrantsâ&#x20AC;&#x2122; health is still not being

tackled adequately. In general, there is a real need to streamline access to healthcare and rights. Reforms such as the merging of the State Medical Aid and the Universal Health Insurance, as well as the strengthening of Healthcare Access Offices and local facilities, must be seriously considered. Ensure sustainable housing As far as housing is concerned, the government has promised to increase the number of refugee centres (CADA) and to abolish ad hoc accommodation. These claims, however, still remain to be translated into concrete action in certain regions. Moreover, the right to housing and unconditional access to emergency accommodation are not fully upheld everywhere. Some women and children still sleep rough. It is time to abolish the seasonal management of housing and to provide enough facilities that are open all year round and which support access to long-term housing. The circular of 26 August 2012 was meant to ensure advance planning of evictions from shantytowns, and that support is provided to those affected. However, their destruction continues without the provision of housing alternatives. The right to remain for medical reasons for migrants residing on the French territory has

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The right to housing and unconditional access to emergency accommodation are not always fully upheld.

Each year, the number of minors who come to MdM clinics increases.

Paris © Véronique Burger/Phanie

been made ineffective by the 2011 Besson legislation. Seriously ill migrants can now be returned to their country of origin as long as the medical treatment exists there, even if there is limited access to that treatment in practice. As a consequence, migrants diagnosed with serious medical conditions are returned despite the fact that the conditions may be life-threatening in the short or medium-term. MdM asks, therefore, for the reinstatement of the 1998 legislation which protects seriously ill migrants. Preventing harm among drug users For over 20 years, Doctors of the World has been committed to reducing drug-related harm for people who use drugs and sex workers. The type of intervention is carefully tailored to those

two groups, with the aim of providing a healthcare service which is adapted to their specific needs, while advocating for an improvement intheir social and legal status. The political debate on drug use in France has been limited for years by repressive, rather than preventive, policies and has thus impaired the implementation of measures which would have prevented a hepatitis epidemic, particularly hepatitis C. However, effective measures to contain the hepatitis C epidemic among those who inject drugs can still be taken by, for example, supporting experimental initiatives such as the opening of low-risk drug consumption rooms. It is also urgent to legalise rapid hepatitis C testing without delay. In this time of political reform of refugee laws, the implementation of the Alur law on housing,

and the drafting of new legislation on sex work (which proposes to repeal the criminalisation of soliciting in the streets, but also to criminalise sex workers’ clients, a new measure which will make it more difficult for sex workers to access to care and rights), Doctors of the World calls for policymakers to respect the basic principles of public health and human rights. Sixteen years after the first law against social exclusion, we are still hoping that a medical and social policy which focuses on solidarity can be implemented effectively regardless of individuals’ administrative status.

UNITED KINGDOM

Dunkirk

Calais

Nord-Pasde-Calais

Rouen

BELGIUM

Valenciennes

GERMANY LUX.

Saint-Denis

Le Havre

Metz

Normandy Colombes Île-deFrance

Paris

Lorraine Nancy

Strasbourg

Alsace FrancheComté

Pays de la Loire Angers

Besançon

Nantes Healthcare, Advice and Referral Clinics

SWITZERLAND

Poitiers

Paediatric clinics

Rhônes-Alps, Burgundy, Auvergne

PoitouCharentes

Buddying for hospitalised children

Combrailles

Angoulême

Outreach actions on the streets, in shantytowns, with migrants, etc.

Lyon ITALY

Grenoble

Projects working with sex workers

Bordeaux

Projects working with people who use drugs

Aquitaine

MidiPyrénées

Bayonne

Languedoc-

ProvenceAlpesCôte d’Azur

Nice

Toulouse Pau Montpellier Aix-en-Provence Corsica Marseille

Saint-Denis Mayotte

Cayenne

Mamoudzou SURINA

Saint-Pierre BRAZIL

Ajaccio

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Observatory on access to healthcare » Programmes in France

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

20 Healthcare, Advice and Referral Clinics saw a total of 29,960 service users in the course of 63, 212 appointments

44,232

medical consultations were carried out

» 3,685

dental consultations

»1 4,000

social consultations

» T he

average age of service users is 33 years old

The centre for paediatric care in Mayotte saw

1,276 children

and carried out 2,060 medical consultations.

» 6 0.6% of children seen

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

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

are under three years old

»1 2.6%

are under 18 years old

»9 4.5% are of foreign origin »9 6%

live below the poverty line

funding

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

ÂŠ Steven Wassenaar

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Shantytowns » Programmes in France

2013 was a year which saw an increase in evictions from shantytowns being carried out without the provision of housing alternatives, or any prior social assessment, and sometimes accompanied by violent tensions. The poor living conditions are worrying because they expose populations to major health risks. Access to State Medical Aid remains difficult. The circular issued on 26 August 2012, which aimed to improve the conditions under which expulsions are carried out, remains ineffective on most of the French territory, despite close and repeated communication with the interministerial delegation for housing and access to housing (DIHAL in its French acronym).

Beneficiaries

» more than 6,000 people

Working with shantytown residents to improve their access to healthcare

Number of volunteers

» 173

funding

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

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

» activities • Health and social care: support to access rights, primary healthcare and referral to mainstream services. • Sanitation: lobbying local authorities for the improvement of sanitary conditions in shantytowns (waste collection, access to water, etc.) • Perinatal care: prevention of abortions, antenatal monitoring, information about contraception, child immunisation, and support to access mother and child health protection centres (PMI) and family planning centres. • Immunisation campaigns, especially against measles (Seine-Saint-Denis, Marseille).

Programme locations

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

In 2013, MdM and other organisations continued and finalised a health mediation project which started in 2011, with the aim of easing and improving access to mainstream health services for women and young children in the four following sites: Lille (Areas), Fréjus (Sichem), Nantes (MdM), Val-d’Oise (Asav). The outcomes of this experimental project demonstrated that this tool was useful and, as a result, it was recommended that the profession of mediator be recognised as an effective tool to improve access to healthcare for those populations. By recognising the relevance of health mediation to tackle social inequalities, the Pluriannual Plan against Poverty and for Social Inclusion confirms the validity of this measure.

» outlook Supporting a policy of shantytown reduction which does not infringe a person’s dignity and the application of the circular issued on 26 August 2012, MdM calls for better planning of expulsion procedures with provision of social and health assessments and sustainable housing alternatives. MdM advocates for the maintenance of shantytowns (access to water, waste collection) when they present no health risk and when no satisfactory sustainable housing alternatives are offered.

Migrants » Programmes in France

Access to health insurance for vulnerable migrants remains difficult, as a result of various administrative obstacles (e.g., excessive demands for documentary proof by Local Health Insurance Offices, new conditions for being able to access State Medical Aid, refusal to recognise proof of address). Despite the abolition of the €30 fee to join the State Medical Aid scheme, too many migrants face serious delays in access to healthcare (43%). It is important to streamline access to healthcare rights and to improve the service of Healthcare Access Offices (PASS) which remains inadequate.

Supporting vulnerable migrants » 94% of first-time service users in the clinics are foreign nationals. » 31% of first-time service users in the clinics have sought, or are in the course of seeking, asylum. » 87% of migrants did not have effective access to health coverage when they came to the clinic for the first time. » Nearly 3,000 contacts were made with migrants in transit on the Channel coast and more than 300 contacts were made with agricultural workers in Berre.

» activities • In MdM clinics: medical and social consultations, as well as prevention and referral to mainstream health and social services. • Outreach activities: nursing care, medical consultations, health promotion, prevention 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. • Throughout 2013, MdM spoke out about the poor living conditions of migrants, from Calais (where the Défenseur des droits1 denounced police harassment of migrants) to Mayotte (where access to healthcare is not in place for foreign minors).

most common nationalities

» Romania, Algeria, Morroco, Tunisia, Cameroon… Number of programmes

» All programmes

Number of volunteers

» 1,979

» outlook Following its participation in a national consultation about the conditions of asylum seekers at the end of 2013, MdM is lobbying for the implementation of its recommendations in the asylum law reform planned for 2014. MdM urges streamlining of access to healthcare and strengthening of healthcare services for both vulnerable migrants and asylum seekers.

Partners

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

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

1. Notice 2011-113 issued on 13 November 2012.

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Harm reduction » programmes in France

In September 2013, the interdepartmental programme against drugs and addiction made public its latest plan to fight drugs and drug dependency 2013-2017, in which the experimental introduction of low-risk drug consumption rooms was announced. However, the Conseil d’Etat expressed a negative opinion against this measure, asking for more legislative grounding by recommending the government clarify the basic principles of this service in legislation. This has the effect of delaying, by several months, the project, which is supported by Gaia Paris, MdM and Paris city council. In 2013, MdM also committed itself to continuing to develop drug analysis as a harm reduction tool within harm reduction centres (known as CAARUDS).

Reducing the risks of drug use Types of drugs

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

» Nearly 11,400 contacts in raves and 1,300 in squats in Bayonne, Marseille and Paris. 120 ERLI beneficiaries. 340 drugs analysed by the drug analysis programme.

» activities Since 1997, MdM has been running prevention and harm reduction activities at festivals/raves and in the urban context: • in free parties and cross-border clubs; • in squats; • with people who use intravenous drugs, by developing the project on education of risks associated with injection (ERLI); • by developing drug analysis with thin layer chromatography.

Number of volunteers

» 107

funding

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

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

Moreover, in 2013 the action-research project into the support and education of risks associated with injection (AERLI), in partnership with Aides and Marseille INSERM and supported by ANRS, was completed.

» outlook • Handover of harm reduction services at raves and festivals to the self help groups and CAARUD. • Consolidation and strengthening of the current arrangements in squats. • Publication of the findings of the action research project on AERLI in partnership with Aides, Marseille INSERM and ANRS. • Publication of the findings of the research on Skenan® (a morphine-based medicine) and promotion of the thin layer chromatographic analysis as a harm reduction tool. • Supporting the set up of a low-risk drug consumption room with educative purposes in Paris.

Programme locations

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

Prostitution » programmes in France

Ten years after the Internal Security Law came into force,1 all organisations working with sex workers are in agreement: the offence of passive soliciting heavily penalises sex workers and makes them more vulnerable. The first draft of a legal reform on prostitution, which aims to strengthen the fight against procurement of prostitution and sex trafficking, was passed in the French National Assembly. The reform plans to repeal the criminalisation of soliciting in the streets, but it also plans to criminalise customers, and this, in our view, will make it more difficult for sex workers to access their rights and healthcare.

Beneficiaries

» Around 2,000

Providing support and facilitating access to healthcare for sex workers

Number of volunteers

» 116

» activities

funding

• 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. • Recruitment of prevention facilitators (peer educators) who come from the field of prostitution and have appropriate skills and expertise. • Development of more individualised support. • Physical accompaniment to mainstream health services. • The Lotus Bus team carried out a survey of 86 Chinese women working in prostitution in Paris on the violence they experience. Three-quarters (75%) of them had been arrested for soliciting within the past 12 months.

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

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

» Montpellier, Nantes, Paris, Poitiers, Rouen

» outlook Two new surveys are currently in the pipeline and could produce outcomes in 2014: • one survey will collect data among paid sex workers, about their knowledge, expertise and practices in relation to HIV, hepatitis, and other STIs; • the second survey will collect data about the impact of the draft legislation on access to care and rights for sex workers. The bill examined by the Senate in 2014 could be enacted as early as 2015. In the meantime, all MdM’s programmes which work with paid sex workers and their partners in the field are lobbying, by the means of hearings, MPs and independent institutions, about the negative impact that some measures of the bill might have.

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

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Prevention Project

HIV-Hepatitis-STIs-Tuberculosis » programmes in France

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

Beneficiaries

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

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

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

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

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

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Buddying

children in hospitals » progammes in France

Many children, often from disadvantaged backgrounds, from France and elsewhere in the world, are admitted to hospitals in Paris, French Guiana, and Reunion for conditions that cannot be treated closer to home. The Buddying programme volunteers aim to ease the difficulties caused by separation and to help the child to deal with the suffering, thus greatly improving the quality of care. Increasingly, our volunteers also support children who do have their parents by their sides, but whose parents have to deal with numerous problems.

Supporting sick and isolated children Number of children buddied in 2013

» 145 » In the Parisian region: 115 » In French Guiana: 24 » In Reunion: 6 Number of volunteers

» 118 » In the Parisian region : 90 » In French Guiana 19 » In Reunion: 9

Partners in the Parisian region

» Centre des Côtes - Les Loges-enJosas, Margency Red Cross Children’s Hospital, Bullion paediatric and rehabilitation hospital, Paul-Parquet Foundation-Neuilly-sur-Seine, Montreuil medical centre for young children, Antony re-habilitation centre for very young children, Saint-Maurice re-habilitation centre, Gustave-Roussy Institute in Villejuif, Kremlin-Bicêtre hospital in Guiana

» Andrée-Rosemo hospital in Cayenne, Franck-Joly hospital of Saint-Laurent-duMaron, in West Guyana. in Reunion

» Félix-Guyon hospital in Saint-Denis in Reunion

» 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 activities; • maintaining links: helping to maintain links, sometimes damaged, between children and parents on one hand and with health and social services on the other hand. 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 • Working to apply the Declaration on the Rights of the Child and the European Charter for Children in Hospital. • Strengthening of our action in Guiana and Reunion with the objective of opening another branch of the SaintPierre mission, subject to ARS funding.

Partners in Île-de-France

» Hospitals in Paris: AP-HP Necker-sick children hopsital, AP-HP Armand-Trousseau hospital, AP-HP Robert-Debré hospital, AP-HP Saint-Louis hospital, Édouard-Rist medical and pedagogical clinic, Curie Institute. funding and support

» MdM’s own funds, Bouygues Foundation, Air France, Air Austral and Air Caraïbe.

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Health and housing » Programmes in France

Seven years after adoption of the DALO law, realising the legally binding right to housing, there are still more than 3.5 million people who have no, or very poor, accommodation in France.1 According to the National Institute of Statistics and Economics Studies (INSEE), 141,500 people are homeless in France and their number has doubled in 10 years.2 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, hotels…) put people off accessing this provision.

Number of volunteers

» 333

CONTACTS WITH HOMELESS and poorly housed PEOPLE

»n early 18,000 contacts for approximately 6,000 beneficiaries; »7 0% of service users in our clinics do not have stable accommodation; » 31% of service users in our clinics are sleeping rough or in voluntary sector accommodation for at least two weeks, or in emergency housing (for less than a two week period); »2 3.6% of minors are homeless or in emergency housing for less than two weeks; »6 9.5% live in insecure accommodation.

Taking the health impact of poor housing into account » activities • Providing healthcare, prevention and accompaniment in the streets and in squats via outreach actions (on board a vehicle or within partners’ facilities) and in the premises of MdM clinics. • Support for the implementation of appropriate public sector outreach teams (e.g., healthcare access outreach teams, psychiatric outreach teams). • Promotion of appropriate housing and accommodation solutions (e.g., ‘nursing bed’ facilities, medical shelter beds). • Participation in the joint collective of associations (CAU) on the three themes of prevention, accommodation, housing. Through its advocacy actions, MdM is able to speak out about the harmful consequences of homelessness or poor housing on health. MdM calls for a qualitative and quantitative improvement of emergency housing conditions and for political reforms which will ensure sustainable housing.

funding

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

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

» outlook MdM will continue this work in 2014 and will supervise the implementation and development of the measures announced in the five-year plan against poverty and exclusion, in collaboration with CAU.

1. 2013 Report on poor housing in France, Abbé Pierre Foundation, February 2013, and National Institute of Statistics and Economics Studies (INSEE), 2006 census reported a number of 133,000 homeless people; Directorate of Research, Studies, Evaluation and Statistics (DREES), 2008 survey on social establishments (ES); administrative sources. 2. Survey on homeless people in 2012,National Institute of Statistics and Economics Studies (INSEE), July 2013.

Bordeaux ÂŠ Constance Decorde

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Regional Delegations Regional delegations run local political action in coordination with, and on behalf of, MdMâ&#x20AC;&#x2122;s Board of Directors. They carry out coherent and ongoing actions before inscribing them within a strategic regional plan.

Mobilising our members in the regions 2013 first saw a high level of turnover in Supporting and valuing volunteers the regional colleges (boards), where new There has been particular focus on the work of members quickly adapted to the constant the 2,000 active volunteers of Doctors of the World’s regional delegations in France, particudemands and the need to take action. larly when it comes to putting a value on their Each member was offered tailored support (in- contribution. In each delegation, software for maduction training, accounting training) in line with naging volunteers and improving the calculation their increased responsibilities. Members of the of their working hours allows MdM to estimate recently formed college of Nord-Pas-de-Calais, more accurately their contribution, and therefore which with the newly opened delegation in Lille to highlight the value of MdM’s model. are expected to strengthen programmes with The need to communicate internally, and through more teams and support, have been particularly different media, prompted the creation of more responsive to take on such support. internal newsletters (La Cigogne et l’Horloge in AlTo this end, they are following the recommended sace/Franche-Comté, le Fil info in the Loire, Le Fil practices of recruitment and of volunteer deve- in Île de France, La Bazarette in the PACA region) lopment, as supported and strengthened in MdM in addition to Lettres et débats in Midi-Pyrénées regional training guidelines (implementation of and Raban in Rhône-Alpes. By organising denew rules, data collection, advocacy, violence bates, forums and other events, members really management, welfare rights…), and therefore nurture the philosophy and policies which provide they are complementing national provision. the organisation with momentum and dynamism.

Each regional delegation faces the multifaceted challenge of training and raising awareness among future generations and professionals about health and deprivation and how their actions towards that end will shape the future.

Developing regional actions In response to the increasing health needs of the most vulnerable and exposure of the teams to tense situations, there has been more reflection on the quality, ethics and meaning of our actions. As a result, seminars of reflection and exchanges of practices (internal to each programme, regional delegation and at a national level) have led to the restructuring of many programmes (such as the Healthcare, Advice and Referral Centres in Bordeaux, Lyon, Paris and Ajaccio; the shantytown project in Montpellier; the homeless programme in Reunion) and the extension of programme facilities (Bordeaux, Rouen, Grenoble, Ajaccio, Nice). With that consolidation, regional delegations are driven to explore new fields (needs assessments in rural areas of Lorraine and Languedoc-Roussillon) and the maintenance of relationships with international programmes (the Rhone-Alps delegation runs a new programme in Palestine; orga-

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ANNUAL ANNUAL REPORT REPORT 2013

nisation of a symposium on health and migration in Istanbul; projects in the pipeline in Aquitaine and Midi-Pyrenees).

Training, awareness raising and advocacy Each regional delegation faces the multifaceted challenge of educating and raising awareness among future generations and professionals about health and poor living conditions and how their actions towards that end will shape the future: presentations at nursing, midwifery and medical schools; coordination of university degrees (‘health and deprivation’, ‘access to healthcare’, ‘public health’) nursing internships, specialty and GP registrars, students in Master 2, etc. Through its presence in employment forums or during solidarity weeks, the organisation spreads the word about its actions, and the professional careers within Doctors of the World, to a wider audience. It is also through its presence in debates and/ or the organisation of conferences (health and social mediation in Bordeaux and Nantes; drug addiction, hepatitis, Aids (Hormone Replacement Therapy), poor living conditions and prevention; sex workers; ethics and humanitarian action) that regional delegations exercise their critical reflection and strengthen their advocacy work (Health Access Offices (PASS); shantytowns; within the Council of Europe; calling for the winter shelter arrangements to be respected). Regional delegations fully participate in the action of bearing witness and often carry out surveys about specific local issues (about health conditions of homeless people in Strasbourg; about paediatric Health Access Offices in Paris; or, access to contraception and abortion among MdM service users), communication events in festivals (such as Rencontres Inattendues in Marseille, ManifestO in Toulouse, Musiques Métisses in Angoulême…),

In Rouen, MdM outreach teams provide care and support to those sleeping rough.

photo exhibitions (MdM clinic in Lyon: words and ted this process (starting with Aquitaine, Languefaces, Women, the aftermath of violence in Mar- doc-Roussillon and the Loire, it is now Alsace/ seille) or MdM’s 25th anniversary in Nancy. Franche-Comté and Nord-Pas-de-Calais which are benefiting). 2013 was the time to set up new Towards autonomy? regional frameworks, while 2014 is a time when In more than half the delegations, joint commit- delegations will probably finalise the regionalitees have established and have made progress sation process by confirming their regional plan, in defining and grounding delegations’ political proposing a strategy and deciding a budget. and operative aspirations within regional policies and feeding these into the national budget. For some delegations, regional coordinators, intended to support the regional boards, valida-

Directory of regional delegations » Alsace / Franche-Comté

» Lorraine

» PACA

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

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

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

» Aquitaine

» Midi-Pyrénées

» Loire

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

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

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

» Corsica

» Nord-Pas-de-Calais

» Poitou-Charentes

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

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

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

» Île-de-France

» Normandy

» Rhone-Alps / Auvergne /

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

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

» Indian ocean

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

Burgundy

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

250 bis, rue du Général-Rolland SHLMR Bouvet – Bât K 97400 SAINT-DENIS T: 02 62 21 71 66 F: 02 62 41 19 46 ocean-indien@medecinsdumonde.net

You will find detailed fact sheets on the different regional offices in the CD attached to this report.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Migrants programme on the north coast © Jérôme Sessini/Magnum photos/MdM

ÂŠ Virginie Vican

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Adoption As an Approved Adoption Agency (AAA) since 1988, Doctors of the World focuses on adoption for children whose rights cannot be secured in their country of origin. Through the adoption mission MdM defends the fundamental rights of the child: the right to grow up in a family, and have access to healthcare and an education.

MdM considers it essential that families are supported throughout the adoption process, both pre- and post-adoption

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

The very sharp decline in numbers of internationally adoptable children, coupled with the significant increase in children with specific needs (children with medical conditions, siblings and older children), demonstrate the need for our expertise. Over 205 professionals prepare candidates for these complex adoptions. Of these, 17% are doctors and 33% psychologists. The team also includes paramedics, social workers, lawyers and volunteers from many other professions. Together they help in the construction or reconstruction of the lives of these children who, more

often than not, have had their rights violated in their country of origin.

» Support : the great strength of MdM’s adoption programme

The programme is run by professionals from start to finish and the constant support offered to candidates is essential to its success. The team prepares candidates for complex adoptions and monitors the situation closely after the adoption to reduce the risk of failure. MdM’s ethical framework means that the needs of the child and finding them a family that suits their needs is cen-

DOCTORS OF THE WORLD ANNUAL REPORT 2013

tral to the process. Avoiding mistakes is crucial. Mistakes can affect not only the child, but destroy a whole family. That is why it is so important to invest in training for the teams. Each year, no less than 10,000 euros are invested in this training, and educational tools are designed to prepare couples for adoption.

article on support for international adoptions was then published in the publication of the same name. 2013 was not only a year of recognition for MdM’s adoption team. It was also notable for its contributions to ministerial working groups and

scientific research as the organisation shared its expertise with the public sector. Doctors of the World is now a major player in the new vision of child protection in international adoption, and could also become one on a national scale.

» The 2013 adoption programme

• Active in all departments in mainland France. • 68 children were adopted by 59 families; there have been more than 4,000 adoptions since 1988. • 76.5% of children adopted had specific needs (40.5 % in 2011 and 32% in 2010). • Children came from Vietnam, China, the Philippines, Madagascar, Côte d’Ivoire, Haiti, Colombia, Brazil, Ukraine, Bulgaria and Albania.

» Milestones In 2013, Doctors of the World was repeatedly cited as an example in the world of authorised adoption agencies, recognised for its expertise and the quality of its support and follow up. Notably, Doctors of the World presented at the National School for the Judiciary and at the ‘Enfances et Psy’ (Childhood and Psychology) seminar. Paediatrician Geneviève André-Trévennec’s © Éric L’Helgouac’h/Jean-Baptiste Desveaux

CO-ORDINATION

funding

»H ead of programme: Dr G. André-Trévennec (paediatrician) »E xecutive Director: P. Salignon then O. Lebel

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

members of the adoption committee representing the board

BUDGET

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

» € 517,155

countries

» Albania, Brazil, Bulgaria, China, Columbia, Cote d’Ivoire, Haiti, Madagascar, Philippines, Ukraine, Vietnam » Non operational countries: Russia since April 2010 and Colombia since July 2013

STAFF

» 205 people, of whom 98% are volunteers, working on the adoption programme, spread between headquarters and 15 regional offices

Papua New Guinea ÂŠ MdM Germany

DOCTORS OF THE WORLD ANNUAL REPORT 2013

International network The Doctors of the World international network is made up of 14 associations1 who have signed the same charter and who are working towards common objectives of providing care and bearing witness. The role of the International Network Department is to coordinate and develop MdMâ&#x20AC;&#x2122;s international network. It supports the different network members in their own institutional development, depending on their needs and their resources. In addition, the 10 Doctors of the World network members in Europe carry out joint advocacy and lobbying of EU institutions.

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

MAP OF programmes OF THE INTERNATIONAL NETWORK Canada

» the associations

United States

» Doctors of the World Germany Chair: Professor Jochen Zenker www.aerztederwelt.org

» Doctors of the World Argentina

Mexico

Chair: Mr Gonzalo Basile www.mdm.org.ar

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

Guatemala Salvador Nicaragua

Honduras

Colombia

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

» Doctors of the World Spain Chair: Dr Alvaro Gonzalez www.medicosdelmundo.org

» Doctors of the World USA

Chair: Professor Ron Waldman www.doctorsoftheworld.org

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

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

» Doctors of the World Japan Chair: Mr Gaël Austin www.mdm.or.jp

Haiti Dominican Republic

Écuador

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

» Doctors of the World Portugal Chair: Dr Abílio Antunes www.medicosdomundo.pt

Peru Bolivia Paraguay

» Doctors of the World UK

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

» Doctors of the World Sweden Chair: Ms Hedda Iseline Gasser www.lakareivarlden.org

» Doctors of the World Switzerland Chair: Dr Bernard Borel www.medecinsdumonde.ch

Uruguay Argentina

DOCTORS THEWORLD WORLD DOCTORS OFOF THE

ANNUAL ANNUAL REPORT REPORT 2013

Russia Sweden

Netherlands Belgium Germany Switzerland France Romania Bulgaria Spain

United Kingdom

Portugal

Greece

Turkey

Lebanon Tunisia Palestine

Morocco Algeria

Mauritania

Georgia Syria Jordan

Egypt

Mali

Niger Senegal Chad Burkina GuineaFaso Bissau Guinea Benin CAR Sierra Somalia Leone Cameroon Uganda Togo Liberia Kenya Côte Rwanda d'Ivoire São Tomé Burundi and Príncipe DRC Tanzania Angola

Japan Afghanistan Pakistan

Nepal India

Burma Bangladesh

Laos Cambodia

Philippines

Indonesia Timor Leste

Mozambique Madagascar

International programmes Headquarters of a Doctors of the World association and national programmes

Detailed factsheets on all the international network members are available on the attached CD.

PapuaNew-Guinea

Overview of programmes run by international network members Doctors of the World members were busy across the network, working together on emergency responses in Syria and the Philippines and responding to the fallout from the European recession. The members also worked together on joint communication.

European mobilisation against the economic and social crisis

In the 10 European countries1 where we work, 2013 was characterised by the continuing social and economic crisis. Austerity measures have had a significant impact on social protection programmes, including those related to healthcare. We saw an increase in xenophobic behaviour and laws in Greece and in other European countries. Another effect of the increase in poverty is the rise in internal migration. Those EU citizens living in poverty or with no social protection, are treated in the same way as undocumented migrants from outside the EU when they have medical needs. Patients encountered daily in these 10 European countries — whether national citizens or migrants, children, elderly people, pregnant women or those who are chronically ill — continue to have generally poorer health than the population as a whole. While the general population faces increasing poverty, populist political parties take advantage of this situation, and place the blame on poor migrants, easy to target as scapegoats. At the same time, those who already suffered multiple deprivations before the crisis, such as undocumented migrants, asylum seekers, 1. Belgium, France, Germany, Greece, people who use drugs, sex workers, EU citizens Netherlands, Portugal, Spain, Sweliving in poverty and the homeless, have seen a den, Switzerland, United Kingdom

reduction in, or the removal of, the social safety nets and the social networks that offered them basic assistance. Health coverage has been reduced, leaving an ever-greater proportion of the costs to the responsibility of the patient, even if they have no financial resources. This injustice, which undermines the social base of solidarity in Europe, must be challenged. As health professionals, we are active at the European level. In accordance with the medical code of ethics, we unequivocally demand the right to provide healthcare to all patients regardless of administrative status, ethnic origin or financial resources. We call for the establishment of national health systems based on solidarity, equality and equity, open to all people living in the EU: these systems must be strengthened in times of crisis instead of being gradually dismantled. We ask for equitable access to all national immunisation programmes as well as paediatric care. We call for all pregnant women, in particular the most vulnerable, have access to ante and postnatal care. In 2013, we made the following demands of European institutions: • Although ‘healthcare provision is an issue of Member State competency’, the European Commission and European Parliament have an important role to play in encouraging members to protect their health systems and mechanisms

DOCTORS OF THE WORLD ANNUAL REPORT 2013

of social protection in times of crisis and to make them more accessible. • The European Union Agency for Fundamental Rights is a beacon of hope for many citizens in times of crisis: we call on Member States to fully implement the views expressed by this body. • The Council of Europe has an important role to play in the protection of fundamental rights in Europe. The European Committee of Social Rights gave a strong signal confirming that the right to healthcare described in the European Social Charter clearly applies to every person, regardless of their administrative situation.

Advocacy campaigns and networkwide communication

the week’ on social networks, chosen by international network communications teams. An international campaign, focusing on women’s health and their right to decide freely whether to have children or not, was developed during 2013. The campaign will be used to lobby at the international conference in Cairo + 20 and will be released in seven languages and 12 countries throughout 2014.

The Doctors of the World international network operates 147 programmes, broken down as follows: • Sub-Saharan Africa: 54 programmes in 26 countries. • Americas: 41 programmes in 13 countries. • Asia: 28 programmes in 14 countries. • Middle-east and North Africa: 26 programmes in eight countries. • Europe: three programmes in three countries.

Pooling of resources in emergencies In 2013, with the support of its main operational centres (Paris, Madrid and Brussels), the international network of Doctors of the World mobilised as one to respond to major humanitarian crises. Security risks in some countries (e.g., Syria, Mali) and the budgetary resources needed to intervene in isolated areas (e.g., Philippines) made a global response indispensable when faced with major crises. Through global communication (websites, social networking, press releases, etc.), we mobilise financial and human resources at an international level. In 2013, several network members contributed to support the intervention in Syria by sourcing private and public donations in their own countries (notably from Germany and the United Kingdom). Our field teams are now entirely international. As such, they have the necessary means to implement care programmes in complex situations.

The international Doctors of the World network now strives to speak with one voice despite the differences in culture or communication practices in individual countries. Our increased presence on social media networks allows us to get closer to the public in each country, carrying universal messages about our values and campaigns. Thus, in 2013, Doctors of the World launched several appeals highlighting the situation in Syria, these were disseminated in 14 international network countries (and often beyond). Now our common identity is stronger, campaigns with an international dimension have greater impact. A monthly teleconference and almost daily communication amongst network teams allows staff to pool their expertise. In total, the 12,800 people involved in DocEach week, since a September 2013 seminar, tors of the World’s international network run every Doctors of the World publishes a ‘photo of 316 programmes in 78 countries.

At the national level, Doctors of the World runs 169 programmes which are distributed as follows: • Americas: 12 programmes in three countries. • Europe: 154 programmes in 10 countries (including the cross-cutting European advocacy project). • Asia: three programmes in one country. In this way, the cohesion and coherence of the network continues to strengthen year after year through multiple exchanges between staff from different Doctors of the World network countries, whether it be in the field, at seminars or through joint advocacy activities.

For more information on MdM international network programmes: www.mdm-international.org

»d ri@medecinsdumonde.net + 33 1 44 92 14 80

CAR © Sébastien Duijndam

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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

2013 in figures INTERNATIONAL NETWORK

HUMAN RESOURCES*

IN FRANCE

147

3,799

20 healthcare, advice and

international programmes in 64 countries

169 national programmes in 14 countries

BREAKDOWN

1,386 people working on our international programmes

network members

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

MdM personnel

» 1,224 national employees » 14 international solidarity volunteers

» 87 expatriate employees » 61 headquarters employees 2,101 people working on our

programmes in France

» 2,000 volunteers » 87 employees in the field » 14 headquarters employees 312 people supporting

referral centres

1 paediatric

care centre

48 outreach programmes rogrammes with » 34 pvulnerable groups such as

migrants, homeless people and asylum seekers…

with people » 7 programmes who use drugs

with » 5 programmes sex workers on access to » 1 programme healthcare and rights in rural areas

buddying » 1 programme children in hospitals

1 national cross-cutting

programme on prevention of HIV, STIs, hepatitis and tuberculosis

operations

» 200 voluntary programme managers

» 112

headquarters employees

* Figures as of 31 December 2013

70 programmes in 32 towns *

* The change from 98 programmes in 2012 to 70 in 2013 does not reflect any reduction in our activities: we simplified the classification of programmes in 2013, grouping together some of the activities in a town into a single programme.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

MDM FRANCE BUDGET €67.1 M MDM international NETWORK BUDGET €114 M INTERNATIONAL PROGRAMMES » 60 programmes » 41 countries

11,700,000 p eople targeted by our programmes

2 ,800,000 beneficiaries

GEOGRAPHICAL BREAKDOWN OF programmes

22 Africa................................. in 15 countries 12 North Africa and Middle-East................. in 8 countries 8 Latin America and Caribbean.......................... in 7 countries 15 Asia.................................... in 9 countries 3 Europe............................... in 3 countries

Various projects

Europe

Asia

Latin America / Caribbean

North Africa / Middle-East

Africa

Europe

Asia

Latin American / Caribbean

North Africa / Middle-East

Africa

of our programmes

GEOGRAPHICAL BREAKDOWN OF INTERNATIONAL PROGRAMME EXPENDITURE

44% Africa 22% North Africa and Middle-East 11% Latin America and Caribbean 16% Asia 3% Europe 3% Miscellaneous projects (Opération Sourire,

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

100

Nepal © Stéphane Lehr

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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

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

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

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

MdM FRANCE INCOME AND EXPENDITURE EXPENDITURE 79% social programmes 15% fundraising costs 6% operating costs

INCOME 60.5% public generosity 34% public institutional grants 5% private grants and other private funds 0.5% other

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

101

102

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). In 2012, ECHO allocated nearly 1.2 billion euros to funding to humanitarian projects, with around half going to NGOs. • DG DevCo is charged with implementing, via EuropeAid, the aid mechanisms of the European Commission, a major donor for international development. • For several years, MdM has been particularly active in Brussels-based VOICE, the interface between NGOs and EU institutions (European Commis-

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

UNITED NATIONS (UN) • The Economic and Social Council (ECOSOC) is the main coordinating body for the economic and social activities of

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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

THE GLOBAL FUND The Global Fund against Aids, Tuberculosis and Malaria is an international multilateral donor created in 2002 and which gives grants to tackle HIV/Aids, TB and malaria. Since 2002, the Global Fund has provided HIV treatment to 4.2 million people, TB treatment to 9.7 million people and 310

million insecticide-treated bed nets to prevent malaria in 150 countries, to support large scale prevention, treatment and care programmes for these three diseases.

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

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

PROGRAMME agreementS between AFD and MdM 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 of its activities in relation to reproductive health and reducing risks associated with drug use and sexual practices. MdM has been working on harm reduction programmes since 1989, 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) signed two new two-year programme agreements in 2010. One of these agreements relates to reproductive health while the other concerns harm reduction. In 2012, two new programme agreements were signed as part of this four-year partnership (2010-2014) with a total contribution from AFD of €8M. These agreements aim to strengthen the work on these issues within MdM, by developing crosscutting approaches while providing a part of the funding for around 12 projects. Thanks to this support, MdM has been able to launch harm reduction projects in Georgia, Kenya and Tanzania and 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 cooperation 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.

104

Doctors of the World management on 31 December 2013

Philippines © Lâm Duc Hiên

» General Director: Olivier Lebel » 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 »C ommunication and Development Director: Luc Evrard » Adoption Director: Dr Geneviève André-Trévennec » General Secretary of the International Network: Jean Saslawsky

DOCTORS OF THE WORLD ANNUAL REPORT 2013

The Board of Directors The General Assembly elects 12 members of the Board for three years, along with three substitute board members. The Board, in turn, elects the Chair and the Bureau for one year: the vice-chairs, the deputy treasurer, the general secretary and the deputy general secretary. As the executive body of the organisation, the Board meets every month and takes decisions on the management of the organisation. At the General Assembly on 25 May 2013, Doctors of the World members elected the Board:

»C hair

Dr Thierry Brigaud Prevention doctor

»V ice-chairs

Dr Françoise Sivignon Radiologist

Dr Luc Jarrige Hospital doctor

»G eneral secretary

Dr Patrick Beauverie Hospital pharmacist

»D eputy general secretary Maria Melchior Epidemiologist

»T reasurer

Christophe Adam General practitioner

»D eputy treasurer Gérard Pascal Surgeon

David

Anaesthetist, intensive care doctor »A riane

»M argarita

Gonzalez

Nurse

Other board members: »P atrick

Substitute board members:

Junca

»P hilippe

de Botton

Endocrinologist »D r

Frédéric Jacquet

Public health inspector

Anaesthetist »C hristian

Laval

Sociologist »A ndrea

Brezovsek

Nurse »O livier

Maguet

Consultant

105

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Our thanks to OUR PRIVATE PARTNERS Foundations and businesses

American Express Japan, Fellissimo Japon, Annenberg Foundation, Drosos Foundation, Ichiyoshi Shoken Japan, McCall MacBain Foundation, Mitsui Japan, Open Society Foundation, Sternstunden Foundation, Fubon Cultural & Educational Foundation, Catapult, Elton John Foundation Norwegian Church Aid, Air France, BVA, Air France Foundation, Association Ouest France Solidarité, French Aviation Club, Bärchen, Bred, CIC, Crédit mutuel, Crédit coopératif, Bouygues Telecom Foundation, L’Occitane Foundation, Lille Foundation, L’Oréal Foundation, Optic 2000 Foundation, Veolia Environnement Foundation, Sanofi Espoir Foundation, GCE Fidélisation, Imerys Ceramics France, l’Acoustics SA, Ivoire, Les Éditions Maréchal, Vinci, the European Programme for Integration and Migration (EPIM), a joint initiative of the network of european foundations (NEF). INSTITUTIONAL PARTNERS Multilateral organisations European Union (DG Echo, DG DevCO/ EuropeAid), United Nations agencies (UNDP, UNFPA, HCR, Unicef, OCHA, UNAIDS, UNODC, WFP, WHO), Global Fund, 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), Monaco official development assistance (DCI), Norwegian official development assistance, Swiss official development assistance (DDC), Danish official development assistance (Danida). • In France: Agence française de développement (AFD), Centre de crise du ministère des Affaires étrangères (CDC), French embassies, France Expertise Internationale (FEI). • Other: American development assistance (USAID), Canadian International Development Agency (CIDA), Japanese official development assistance (JICA). • French local authorities: Rhône-Alpes region, Safer de l’Île-de-France, La Réunion district Council, Val-d’Oise District Council, Haute-Garonne District Council, Alsace Regional Council, PACA Regional Council, Nord-Pas-de-Calais Regional Council, Aurillac Basin Council and Greater Angoulême Council. • Town councils : Paris, Ploufragan, Hagondage, Eguilles, Auray, Leers, Nevers, Rungis, Talange, Blanquefort, Annemasse

For our regionally-managed international projects District councils: Bouches-du-Rhône, Alpesde-Haute-Provence, Gironde, CharenteMaritime, Vosges, Doubs, La Réunion. Regional councils: Midi-Pyrénées, ProvenceAlpes-Côte d’Azur and Rhône-Alpes; présidence des régions, Guadeloupe prefecture. For our programmes in France Agence nationale de recherche sur le Sida (ANRS), regional health agencies (ARS), district councils, regional councils, town councils, Caisse nationale d’assurance maladie (CNAM), family allowance funds (CAF), regional health insurance funds (CMR), local health insurance offices (CPAM), regional health insurance offices (CRAM), local social services (CCAS), free anonymous screening centres (CDAG), district councils, regional councils, town councils, Agence nationale pour la cohésion sociale et l’égalité des chances (ACSE), Ministry of Health (DGS), Ministry of Social Cohesion (DGCS), regional youth and social cohesion offices (DRJCS), district social cohesion departments (DDCS), Institut national de la santé et de la recherche médicale (INSERM), healthcare access offices (PASS), the territorial army, Direction de l’action sociale, de l’enfance et de la santé (DASES), Observatoire

DOCTORS OF THE WORLD ANNUAL REPORT 2013

de l’égalité femmes-hommes de la mairie de Paris, 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

Act up-Paris, AIDES, ALC Nice, Amnesty International, Anef, Arvel, Association de communication et d’action pour l’accès aux traitements, Association des régions de France, Association française de réduction des risques (AFR), Association des familles victimes du saturnisme (AFVS), Association d’autosupport et de réduction des risques des usagers de drogues (ASUD), 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, Primo Lévi centre, Pays de la Loire planning centre, Coordination française pour le droit d’asile (CFDA), Collective of associations united for a new housing policy, CIMADE, Alsace Collective of organisations working with sex workers, Collectif interassociatif sur la santé (CISS), Romeurope collective, Migrants outre-mer collective (MOM), Alerte collective, Collectif de soutien aux victimes de Bam, Comede, Comité des amis d’Emmaüs, Communauté mariste, Cordaid, the Red Cross, CSF, Coordination française pour le droit d’asile (CFDA), Coordination nationale des réseaux (CNR), Cyclamed, Dom’asile, Droit au logement (DAL), D’une rive à l’autre, DHL Liens, Emmaüs, Entraide majolane, Rimbaud mobile team, Abbé Pierre Foundation, 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 Saint-Benoît, Groupe d’information et de soutien des immigrés (GISTI), International Harm Reduction Association (IHRA), Ordre de Malte, La Case, les Amis du bus des femmes, les Mondes solidaires, les Restos du cœur, Ligue des droits de l’homme (LDH), Max Havelaar, Novib, Observatoire du droit à la santé des étrangers (ODSE), Obser-

vatoire 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, Sidaction, SOS Drogue international (SOS DI), SOS Femmes, Rasko, the sex workers’ union (STRASS) Techno Plus, UNIOPSS, Veille sociale, Vialtis, Tourism for Development (TFD), AS Kiwanis Club, Addocuiation, Les Jardins du livre, traditional karate school association, Saint-Nazaire Atlantique Rotary Club, Association Notre-Dame des Aides. At the European level: PICUM, EATG, ECDC, FRA, CPME… AND ALL OUR OTHER PARTNERS WHO HAVE SUPPORTED OUR WORK AT HOME AND ABROAD DURING 2013, PARTICULARLY THOSE WHO HAVE SUPPORTED US WITH A LEGACY OR LIFE INSURANCE POLICY AND OUR OTHER INDIVIDUAL DONORS.

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Glossary A

AC Japan: Advertising Council Japan ACABEF: Association centrafricaine du bien-être familial (Central African Association of Family Wellbeing) AERLI: Accompagnement et éducation aux risques liés à l’injection (Support and education on risks associated with injection) AED: Aide à l’enfance défavorisée (Support to disadvantaged children) AFD: Agence française de développement (French Development Agency) AFGA: Afghan Family Guidance Association AFR: Association française pour la réduction des risques liés à l’usage de drogues (French Harm Reducation Association) AIDCo: EuropeAid Cooperation Office AIDS: Acquired Immune Deficiency Syndrome AIDES: Association de lutte contre le VIH/sida et les hépatites (Association fighting against HIV/Aids and hepatitis) AME: Aide médicale de l’État (State Medical Aid) 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 Africal 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) AREAS: Association régionale d’étude et d’action sociale auprès des gens du voyage (Regional Association for the Study and Social Action among Travellers) ARS: Agence régionale de santé (Regional Health Agency) ARV: Antiretrovirals ASA: Accueil Santé Asile (Welcome Health Asylum) ASAV: Association pour l’accueil des voyageurs (Association for the Reception of Travellers) ASEM: Association de soutien et d’entraide aux migrants (Migrant Support and Self-Help Association) ASF: Acid Survivors Foundation AURA: Associations unies de Rhône-Alpes (RhoneAlps Associations United)

BEmOC: Basic Emergency Obstetric Care

CAARUD: Centre d’accueil et d’accompagnement à la réduction des risques pour les usagers de drogues (Harm Reduction Centre for Drug Users) CADA: Centre d’accueil de demandeurs d’asile (Reception Centre for Asylum Seekers) CAR: Central African Republic CAU: Collectif des associations unies (Collective of United Associations) CAUSS: Coordination des acteurs de l’urgence sanitaire et sociale (Coordination of emergency health and social services) CDAG: Centre de dépistage anonyme et gratuit (Free and anonymous screening centres) CDC: Centre de crise (Crisis centre) CEDCF: Community Development and Environment Conservation Forum CEMEA: Centre d’entraînement aux méthodes d’éducation active (Interactive Educational Techniques Training Centre) CENHOSOA: Soavinandriana hospital (Madagascar) CESVI: Cooperazione e sviluppo (Cooperation and development CFDA: Coordination française pour le droit d’asile (French Co-ordinating body for the Right to Asylum) CFTA: Cultural and Free Thought Association, Palestinian association CHP: Community Health Partnership CHR: Regional hospital CIMADE: Comité inter-mouvement auprès des évacués - service œcuménique d’entraide (Ecumenical Mutual Aid Service) CLACAI: Consorcio Latinoamericano Contra el Aborto Inseguro (Latin American Consortium against high-risk abortion) CLE: Collectif interassociatif de lutte contre l’exclusion (Voluntary Sector Coalition against Exclusion) CMF: Centre for Micro Finance CMU: Couverture maladie universelle (Universal Health Insurance) CMUc: Couverture maladie universelle complémentaire (Complementary Universal Health Insurance) COE: Council of Europe CONASAN: Coordination nationale catholique de santé (National Catholique Health Coordinating Body) CONCORD: Confédération européenne des ONG d’urgence et de développement (European Federation of Emergency and Development NGOs)

CPAM: Caisse primaire d’assurance maladie (Local Health Insurance Office) CPCT: Centre psychanalytique de consultation et traitement (Centre for Psychoanalysis) CPMI-NFED: Centre de prise en charge médicale intégrée du nourrisson et de la femme enceinte atteints de drépanocytose (Centre for integrated medical care for infants and pregnant women suffering from sickle cell anaemia) CREN(I): Centre de récupération et d’éducation nutritionnelle (infantile) ((Infant) Nutritional Recovery and Education Centre) CRENAS: Centre de récupération nutritionnelle ambulatoire pour la malnutrition sévère (Outpatient centre for nutritional recovery for severe malnutrition) CRIPS: Centres régionaux d’information et de prévention du sida (Regional Centres for Prevention and Information on Aids) CSAPA: Centre de soins, d’accompagnement et de prévention en addictologie (Addiction Care, Support and Prevention Centre) CSIKK: Centre de santé intégrée de Koupa (Koupa integrated health centre) CSPS: Centres de santé et de promotion sociale (Centres for Health and Social Promotion)

DALO: Droit au logement opposable (Right to housing) Dev-co: International Development Aid Programme DFID: UK Department for International Development DIHAL: Délégation interministérielle à l’hébergement et à l’accès au logement (Interministerial delegation on housing and access to accommodation) DoH: Department of Health DPO: Division du partenariat avec les ONG (NGO Partnership Division) DRC: Democratic Republic of Congo DRR: Disaster Risk Reduction DUA: Dar ul-Aman

ECHO: European Commission Humanitarian Office(DG ECHO: Directorate-General ECHO, Dipecho: Disaster Preparedness ECHO) ECOSOC: Economic and Social Council EMPP: équipe mobile psychiatrie précarité (Psychia-

DOCTORS OF THE WORLD ANNUAL REPORT 2013

tric Outreach Team) ERLI: Éducation aux risques liés à l’injection (Education on risks associated with injection) ESC: école supérieure de commerce (Business School) EU: European Union

Fed’LH: Fédération des étudiants havrais (Federation of Le Havre students) FPA Watch Group: Framework Partnership Agreement FPAP: Family Planning Association of Pakistan FRA: Agence de l’Union européenne pour les droits fondamentaux (EU Agency for Fundamental Rights) FUH: Fonds humanitaire d’urgence (Humanitarian Emergency Fund)

GMC: Groupe pour l’abolition des mutilations sexuelles (Group for the abolition of sexual mutiliation)

HCV: Hepatitis C virus HDI: Human development index (statistical indice between 0 and 1, created by UNDP to evaluate the level of human development in the 187 countries in the world. The HDI is based on three major criteria: life expectancy, level of education and standard of living) HIV: Human immunodeficiency virus HRT: Hormone Replacement Therapy

IAMANEH: International Association for Maternal and Neonatal Health (Malian NGO) ICMI: Integrated management of childhood illnesses ICVA: International Council of Voluntary Agencies IDPs: Internally Displaced People IFRASS: Institut de formation, recherche, animation sanitaire et sociale (Health and Social Training and Research Institute) IND: International Network Department INGO: International non-governmental organisation INSEE: Institut national de la statistique et des études économiques (National Economic Statistics Unit) INSERM: Institut national de la santé et de la recherche médicale (National Health and Medical Research Institute) ISDP: Integrated Services for Displaced People ISPED: Institut de santé publique, d’épidémiologie et de développement (Public Health, Epidemiology and Development Institute) IVDU: Intravenous drug users

JKSMS: Jan Kala Sahitya Manch Sanstha

KAD: Kindianaise d’assistance aux détenus (Kindianese Support for Detainees) KIA: Kachin independence army KPK: Khyber Pakhtunkhwa, province in Pakistan KenPUD: Kenya Network of People who Use Drugs

LADDH: Ligue algérienne pour la défense des droits de l’homme (Algerian human rights defence league) LSD: Lysergic acid diethylamide

MdM: Médecins du Monde (Doctors of the World) MILDT: Mission interministérielle de lutte contre la drogue et la toxicomanie (Cross-departmental programme against drugs and addiction) MOFA: German Ministry of Foreign Affairs MoH: Ministry of Health MSPP: Ministère de la Santé publique et de la Population (Ministry for Public Health and Population) MYSU: Mujer y Salud (Women and Health)

NAPE: Nouvelles approches sur la pauvreté et l’exclusion dans le Nord-Pas-De-Calais (New approaches to poverty and exclusion in Nord-PasDe-Calais) NASCOP: National Aids/STI Control Program NGO: Non-governmental organisation

OAA: Offical Adoption Agency OCHA: UN Office for the Coordination of Humanitarian Affairs ODSE: Observatoire du droit à la santé des étrangers (Observatory on Right to Health for Migrants) OVHA: Orissa Voluntary Health Association

PACA: Provence-Alpes-Côte d’Azur PASS: Permanence d’accès aux soins de santé (Healthcare Access Office) PCC: Palestinian Counseling Center PCI: Prise en charge de la malnutrition en interne (Inpatient treatment for malnutrition) PCMA: Prise en charge communautaire de la malnu-

trition (Community-based treatment for malnutrition) PHI: Pharmacie humanitaire internationale (International Humanitarian Pharmacy) PRAPS: Programme régional d’accès à la prévention et aux soins (Regional programme on access to prevention and care) PDSD: Plan du développement sanitaire du district (District health and development plan) PMTCT: Prevention of mother-to-child transmission

REEJER: Réseau des éducateurs des enfants et jeunes de la rue (Network of street children educators) RSM: Réseau Santé Migration (Health and Migration Network)

SOLIPAM: Solidarité Paris maman SRH: Sexual and reproductive health STI: Sexually transmitted infection STRASS: Syndicat du travail sexuel (Sex workers’ union)

TANPUD: Tanzanian network of people who use drugs TLC: Thin layer chromatography

UK : United Kingdom UN: United Nations UNADEV: Union nationale des aveugles et déficients visuels (National Union for the Blind and Partially Sighted) UNDP: United Nations Development Program UNFPA: United Nations Population Fund UNHCR: United Nations High Commissioner for Refugees Unicef: United Nations Children’s Fund UNIPA: Unidad Indígena del Pueblo Awá UNOPS: United Nations Office for Project Services

VHAI: Voluntary Health Association of India VOICE: Coalition of European NGOs

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

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EDITOR-IN-CHIEF Dr thierry Brigaud Coordination Nolwenn roussier EDITORIAL COMMITTEE luc evrard Stéphanie Derozier Emmanuelle Pons Hugo Tiffou

EDITORS Nolwenn Roussier Catherine Silva

GRAPHIC DESIGN & PICTURE EDITOR Aurore Voet

EDITORIAL ASSISTANT Thérèse Benoit

PRODUCTION OF factsheets isabelle martija-ochoa

MAPS Antoine Levesque

Production E-Graphics\France

TRANSLATION GILL COCKIN ANGELINE DAVIES CLAIRE LOUSSOUARN KAREN MCCOLL ELINOR MIDDLETON alison watson

THANKS TO EVERYONE WHO HELPED WITH THE 2013 EDITION

DOCTORS OF THE WORLD 62 rue Marcadet 75018 Paris Tel. + 33 1 44 92 15 15 Fax. + 33 1 44 92 99 99

www.medecinsdumonde.org

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Algeria

SPAIN

MOROCCO

Algiers TUNISIA

life expectancy Hdi 0.713 rank 93

73.4 yrs

Source: UNDP 2013

LIBYA POPULATION

Sexual and reproductive healthcare for sub-Saharan migrant women

»B eneficiaries: 5,000 » Target: 30,000 to 40,000

MALI NIGER

For a long time, Algeria has been a transit zone for migrants heading for Europe. Now, it is a destination country for people who are exhausted after their migratory journey, having arrived in North Africa. There are many tens of thousands of sub-Saharan migrants in Algeria, and amongst these, 9,000 to 10,000 are settled, more or less permanently (the average length of stay is three years), in the north of the country. » Algiers, Oran, Annaba

» background The programme, started in 2011, was launched first in Algiers. The successful mapping of the places where the migrants live, as well as a survey of healthcare facilities enabled the set up of measures to direct migrants towards the public health centres. Migrant peer educators recruited onto the programme facilitate regular contact with the target groups. Awareness-raising activities directed towards healthcare personnel in the chosen health centres were initiated to improve reception for the migrants.

» activities In 2013, MdM carried on these activities, facilitating access to healthcare for migrants, in particular access to sexual and reproductive healthcare for migrant women (monitoring pregnancies, mother and infant health, contraception, access to screening and treatment for conditions connected with STIs/HIV/Aids). Material support was regularly handed out to the most vulnerable migrants (hygiene kits, blankets, nappies), and psychological consultations were started. A discussion group for migrant women was set up. Legal advice was offered to migrants in partnership with lawyers in the Algerian league for the defence of human rights and a guide to migrants’ rights was produced.

funding

»E uropeAid, MdM

Budget

»2 013: €225,310

MdM was involved in the creation of a web documentary on the access to healthcare for migrants (http://lesvoyageurs.medecinsdumonde.org).

» results 1,214 migrants referred to, or accompanied to, healthcare centres. Awareness raised in 11 health centres in Algiers. 600 migrants benefited from health education meetings. 640 hygiene kits for women were distributed.

» outlook Over 2014-2015 MdM will work towards the implementation of similar work in Oran and Maghnia (on the border with Morocco), in partnership with the Association for Protection Against Aids, while maintaining the same level of activity in Algiers. At the same time, MdM hopes to set up a programme aimed at young Algerians who have tried and failed to migrate, and with the families of migrants who die at sea.

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Egypt

ISRAEL

LIBYA

Cairo/ Giza

life expectancy Hdi 0.662 rank 112

73.5 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 1,600 » Target: 2,500

Access to mental healthcare for high-risk groups

SUDAN

Political instability is ongoing since the revolution. This makes at-risk groups even more vulnerable (disabled children, women affected by violence, street children). MdM supports six Egyptian NGOs and the Ministry of Health to make it possible for different at-risk groups to have access to mental health services in their own communities and primary health centres in their areas.

» Cairo and Giza

» background

» results

MdM has been working in Egypt for eight years. After a project which improved access to healthcare for street children, in cooperation with the Ministry of Health and Egyptian NGOs, MdM continued these partnerships in 2013, supporting the integration of mental health at community level as well as at the primary healthcare level. Indeed, mental health services are today limited to hospitals in big cities, and therefore inaccessible to the majority of the population in the slums as well as rural areas.

15 doctors and 54 social workers were trained in mental health

» activities A manual for the management of street children’s health has been distributed to all the partners. In parallel, a website was set up for a group of health professionals specialising in the care of street children. Training and debriefing for the NGO partners’ staff was organised. The at-risk groups have been introduced to the use of theatre as a means to help them express themselves.

funding

» Drosos Foundation, MdM

Budget

» 2013: €127,995

» outlook Before being able to develop the whole project, MdM must obtain the authorisation of the Egyptian authorities.

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Jordan

LEBANON

SYRIA

King Abdullah Park / Ramtha PALESTINE

IRAQ

Zaatari

ISRAEL

life expectancy Hdi 0.7 rank 100

73.5 yrs

Source : UNDP 2013

POPULATION

»B eneficiaries: 89 ,528

Primary healthcare and psychosocial support for Syrian refugees

SAUDI ARABIA

Forced to flee the civil war that has ravaged their country since March 2011, more than 575,000 Syrians are now refugees within Jordan. Many have no income, are living in terrible conditions and are haunted by the violence that they have witnessed. Since the Jordanian health services are becoming increasingly over-stretched, Doctors of the World offers the Syrians and vulnerable Jordanians basic healthcare and free medicines, as well as psychological and social aid. » Ramtha and King Abdullah Park camp (Irbid governorate), Zaatari camp (Mafraq governorate)

» background MdM has been working with the Syrian refugees in Jordan since March 2012. First of all, the NGO supplies the medical posts in the main transit camps set up by the Jordanian authorities for Syrian refugees. Since the summer of 2012, a huge influx of refugees led to the opening of Zaatari camp, where MdM set up a healthcare centre, ensuring nearly 2,500 basic medical consultations per month. In July 2012, the association also opened a healthcare centre in Ramtha, a town situated only a few kilometres from the Syrian border, and a refuge for many Syrians since the beginning of the conflict.

» activities In April 2013, MdM opened a second healthcare centre in Zaatari, to meet more of the medical needs of the camp inhabitants (who now number 100,000). The organisation of the three health centres has been redesigned and streamlined allowing greater efficacy in patient care. The medical teams, comprising mainly Jordanians and Syrians, undergo continuous training, which guarantees quality healthcare. New medical services have been set up by MdM in these centres: monitoring of people suffering from chronic diseases, health education, vaccination, family planning, antenatal and postnatal care. A mental health component has also been added and developed. Psychologists are available in the health centres. General practitioners in the centres have been funding

» Sternstunden Foundation, regional council, MOFA, SDC, CDC, DFID, ECHO, Paris city council, Wallonie

Budget

trained to identify mental health problems. In Zaatari camp, a team of community-based representatives identify people who may be in need of psychological support.

» results 81,037 primary healthcare consultations carried out in the MdM healthcare centres. 573 people benefited from individual consultations with MdM psychologists.

» outlook MdM will make access to primary healthcare possible for more than 189,000 recipients, and this will include 42,000 consultations in sexual and reproductive health for women of childbearing age, by way of: –– essential medicines and vaccination services, psychosocial care and mental healthcare; –– continuous training and support for the local medical and non medical personnel (MdM and our partners); –– consolidating the capacity to respond to the health needs of the community (targeting Syrians and the most vulnerable Jordanians).

» 2013: €1,980 ,768

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Lebanon

SouthBeirut

El Qaa El Aïn

72.8 yrs

Source: UNDP 2013

Kamed El-Loz

Primary healthcare and psychological support

life expectancy Hdi 0.745 rank 72

SYRIA

POPULATION

»B eneficiaries: 20,272 » Target: 51,200

ISRAEL

At the end of 2013, more than 800,000 Syrians were registered as refugees in Lebanon. Increasingly, their limited financial resources force them to live in encampments, overcrowded apartments or buildings that are abandoned or under construction. Scattered amongst hundreds of Lebanese municipalities, often in the poorest regions of Lebanon, the Syrian refugees have difficulties accessing essential services. » North Bekaa (the villages of El-Qaa and El-Ain), west Bekaa (the village of Kamed el-Loz), south Beirut (Hay el-Sellom district)

» background Since May 2012, MdM has been working with Lebanese organisations to improve access to quality basic healthcare for Syrians and vulnerable Lebanese. In the particularly vulnerable region of Bekaa, MdM assists three healthcare centres, including two run by the association AMEL, a long time partner of MdM in Lebanon. The support of MdM makes it possible for vulnerable patients to receive free healthcare and medicines. MdM also organised training in first aid for Lebanese volunteers in five villages in Bekaa.

» activities From April 2013, MdM expanded its activities in Lebanon by supporting an additional healthcare centre belonging to AMEL in south Beirut, and then, in August 2013, a mobile clinic covering the encampments and villages around Kamed el-Loz in Bekaa. Since August 2013, MdM psychologists have been available in the healthcare centres to care for the psychosomatic suffering of service users, through individual consultations and therapy. For serious mental health problems, service users are referred to specialist services by the psychologists. A medico-social outreach team was set up to improve the collection of relevant medical data in the health centres supported by MdM. The team analyses this data in order to anticipate any epidemics and to be ready to intervene wherever necessary. funding

Sternstunden Foundation, regional council, MOFA, SDC, » CDC, DFID, ECHO, Paris city council, Wallonie

Budget

» results 63,934 consultations took place in the health centres supported by MdM. 282 people benefited from one or more consultations with a MdM psychologist.

» outlook In the two coming years, MdM will carry on giving support to the four healthcare centres and the mobile clinic. An additional health centre will be supported in 2014. A second medico-social outreach team will be established and will be able to be deployed quickly in case of medical emergency. Outreach workers will be available within the communities to identify people suffering from mental health problems and to direct them towards the psychologists.

» 2013: €1, 320, 854

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Palestine

life expectancy Hdi 0.67 rank 110

Nablus

73 yrs

Source: UNDP 2013

ISRAEL

Psycho-social support for communities exposed to conflict-related violence

EGYPT

POPULATION

JORDAN

»B eneficiaries: 6,000 » Target: 120,000

Netanyahu’s government has clearly reiterated its wish to expand the settlements after the re-election of the Knesset (Israeli Parliament) in 2013. In the West Bank, between January and August 2013, the United Nations Office for the Coordination of Humanitarian Affairs recorded 278 incidents of settler violence. In that time, 253 Palestinians were injured: 143 (including children) by the Israeli army¹ and 110 by settlers (four times as many as in 2012). » West Bank, Nablus governorate, 18 villages situated South of Nablus

» background

» results

Given the positive results of the pilot scheme set up in 2012, and the growing need, the project was extended in 2013 to 18 villages. Thus Doctors of the World brings psychological and social help to the victims of attacks from settlers and strengthens the communities’ resilience.

81 post-attack evaluations were carried out. 760 people were looked after including 15 support groups for women, 10 for men and six groups for children and adolescents. 157 cases were referred to protection organisations.

» activities

» outlook

Several mobile teams were set up to ensure post-attack evaluation and psychological first aid in the 72 hours after an attack. These teams are involved in discussion groups with women, men and children. At the same time, a network of community stakeholders charged with protecting the public was developed (jointly with other organisations). The victims of attacks were supported and referred to organisations that are able to offer legal assistance, or help to repair buildings and land damaged by the settlers, or even install a protective presence... Every case that was taken up has been documented and contributes to advocacy.

MdM’s intervention in these villages will extend to new areas affected by settler violence. MdM intends to consolidate its involvement with the biggest support groups. Finally, sticking to the principle that bearing witness and documentation of situations are essential in promoting respect for human rights, the activities in 2014 will include a much stronger approach to advocacy.

During clashes between Israeli settlers and the Palestinian population international Delegation

»M dM Switzerland

funding

» ECHO, CDC, MOFA, AFD, MdM

Budget

» 2013: €221, 747

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Palestine

life expectancy Hdi 0.67 rank 110

Nablus

73 yrs

Source: UNDP 2013

ISRAEL

Development and integration of mental healthcare into primary healthcare centres

EGYPT

POPULATION

JORDAN

»B eneficiaries: 5,000 »T arget: 300, 000

There are very considerable mental healthcare needs in the area. The Ministry of Health has confirmed that the integration of mental healthcare into primary healthcare centres is part of its 2012-14 strategy. Because of the overwhelming need, Doctors of the World France and Doctors of the World Switzerland support the political decision of the Ministry of Health, with a project spanning three years set up in Nablus governorate, in partnership with a civil society organisation, Palestinian Counseling Centre (PCC). » West Bank, central Nablus and 25 villages

» background

» results

MdM has been helping in Nablus governorate since 2002, and during the second intifada, set up a clinic to look after victims of the conflict. This clinic was handed over to the Ministry of Health in 2004. After that MdM turned its attention to strengthening the capabilities of the Ministry of Health in detecting and looking after people suffering from psychological difficulties by setting up medical and psychological centres. Since 2009 MdM has been concentrating on the integration of mental healthcare into primary healthcare.

In the first phase of the programme, the team signed almost all the agreements on working together, recruited necessary personnel and developed the training programmes. 25 primary healthcare centres were selected as partners.

» activities

» outlook Institutional monitoring and clinical supervision will begin. 80 healthcare professionals from the Ministry of Health will be trained. Local partners will be supported through advocacy.

The project started on 1 May 2013 with an evaluation of the refurbishment and improvements needed to integrate a paediatric department into the medical and psychological centre. 25 villages were selected, and the training was prepared for the 25 primary health centres.

international Delegation

»M dM Switzerland, Palestinian Counseling Center (PCC) and the Ministry of Health

funding

»E CHO, CDC, MOFA, AFD, MdM

Budget

» 2013: €221, 747

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Palestine

life expectancy Hdi 0.67 rank 110

73 yrs

Source UNDP 2013

ISRAEL POPULATION

Improving emergency health arrangements

Gaza

JORDAN

»B eneficiaries: 75 ,890 »T arget: 247,150

EGYPT

Despite a lower level of violence in 2013 than in the last few years, the humanitarian and political situation gets worse. The fall of the Muslim Brotherhood government in Egypt, Hamas’ main ally, has led to the closure of tunnels between Gaza and Egypt, through which 60% of food and commodities passed. In this situation, it is essential to support the emergency services in the healthcare centres in order to be closer to the communities in case of crisis. » Gaza, Deir el-Balah, El-Bureij, El-Nuseirat

» background

» results

MdM has been active in Palestine since 2002. As well as its work within the clinics, MdM also prepares people within the communities for emergency situations through methods of care and first aid. Following the Israeli military operation ‘Pillar of Defence’ in November 2012, and an evaluation of the methods already set in place, MdM redirected its efforts more specifically towards the buffer zones where numerous inhabitants are regular victims of incidents or firing by the Israeli or Egyptian armies.

From September to December 2013: –– 115 emergency cases reported by community volunteers; –– 22,276 emergency medical procedures carried out in the three clinics; –– 147 emergency cases referred to hospitals.

» activities Activities are concentrated on building capacity at different levels: training and supervision in first aid for 400 fisherfolk and farmers living and working in the buffer zones; training and supervision in emergency care (first aid, triage, haemorrhages and shock, trauma, sutures, burns, emergency evacuation) for 25 ambulance drivers and 50 health workers, doctors and nurses in three clinics. In addition, the MdM team is working on consolidating emergency plans in close collaboration with the health authorities. Stocks of emergency medicines and other clinical equipment were given out to the clinics, ambulances and community volunteers. Finally, a radio and SMS campaign was implemented to make the population aware of the existence of these emergency services in the three clinics.

funding

»E CHO, CDC, MOFA, AFD, MdM

Budget

» 2013: €487, 477

» outlook The expansion of the emergency preparedness project, the implementation of an exit strategy, and a new project in the buffer zones of Gaza will facilitate a coordinated humanitarian response by focusing on the vital needs of the victims of shooting incidents, and offering short- and medium-term solutions via a system referring patients to existing services.

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Palestine

LIFE EXPECTANCY HDI 0.67 ranK 110

73 YRs

Source UNDP 2013

ISRAEL POPULATION

Preparation of a sexual and reproductive health project

Gaza

»B eneficiaries: 81 JORDAN

EGYPT

In Gaza, use of sexual and reproductive healthcare services is very low, access to information is limited and there are many misconceptions about methods of contraception. According to the Population Reference Bureau, 12% of pregnancies were unwanted and 26% inconvenient for the female Palestinian population in 2006. Moreover, the threat of seeing an increase in unsafe abortions is very real, because access to abortion is highly restricted by law. » Gaza, Deir el-Balah, El-Bureij, El-Nuseirat

» BACKGROUND

» rEsults

Following a sexual and reproductive health evaluation in Gaza, which highlighted a great need in this area, a project was set up on this theme. The subject being new to MdM in the region, and sensitive in Gaza, it was agreed that it was better to work with a known Palestinian organisation (CFTA) to identify, define and create a reference project to be implemented jointly in 2014.

One partnership agreement and one reference project were approved. 50 personnel in women’s centres were trained in the prevention and control of infections. Nine discussion groups/information sessions were conducted jointly with CFTA.

» activitIEs

» OUTLOOK

MdM improved prevention and control of infections in two CFTA healthcare centres. In these centres, as well as those belonging to the Ministry of Health, MdM and CFTA organised discussion groups for women so that they could better understand their needs. Working sessions between the two organisations immediately led to the possibility of building a project together to tackle the issue of unwanted pregnancy.

In 2014, MdM is beginning the project for an initial two-year period, and hopes to improve the medical skills of the CFTA and the Ministry of Health regarding sexual and reproductive health. At the same time, the project aims to raise awareness on this subject in communities living in isolated areas.

FUNDING

» ECHO, CDC, MOFA, AFD, MdM

Budget

» 2013: €42,280

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Palestine

ISRAEL

life expectancy Hdi 0.67 ranK 110

73 yrs

Source: UNDP 2013

Bethlehem

Improving access to healthcare for young diabetics

POPULATION

JORDAN

»B eneficiaries: 60 » Target: 150

EGYPT

MdM set up a project looking at improving the care and support for young diabetics in Bethlehem. This is part of a partnership between the governorate of Bethlehem and Isère district council. Children and young adults with Type 1 diabetes make up a very vulnerable part of the West Bank population, especially regarding access to healthcare (problems with travel and access to the healthcare systems) as well as the stigma associated with the disease. » Bethlehem

» background

» outlook

The project, started in 2013 and lasting for a period of three years, was set up to improve the quality of care for diabetics provided by the organisation Diabetic Friends Society (DFS) and local healthcare providers. It also aims to raise awareness about diabetes amongst the public at large as well as medical personnel, and, lastly, to help build capacity and consolidate skills within DFS.

MdM hopes to develop a public awareness component to the project, and to carry on the training of health professionals, as well as keeping the summer camp (therapeutic education) going, all whilst expanding the skills and capacity of our partner DFS.

» activities A workshop provided jointly by a diabetologist from Grenoble University Hospital and some Palestinian trainers brought together healthcare professionals in contact with Type 1 diabetics in Bethlehem in March. A therapeutic summer camp enabled 25 children and young adolescents to benefit from courses in health education, discussions and sport and recreational activities.

funding

» Isère district council, General Consulate of France in Palestine, MdM

Budget

» 2013: €15,000

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Syria

TURKEY

LIFE EXPECTANCY HDI 0.648 ranK 116

Qah

76 YRs

Source UNDP 2013

LEBANON

Damascus IRAQ

Access to healthcare for the displaced population and support for Syrian doctors

POPULATION

»B eneficiaries: 87,344 JORDAN

SAUDI ARABIA

Since March 2011, the humanitarian situation in Syria has continued to deteriorate. Massacres, attacks, bombings have cost the lives of more than 100,000 people. Some 6.5 million Syrians have been displaced within the interior of the country. Aerial attacks on hospitals, violence against health professionals caring for the wounded, the use of medical facilities as places of torture and oppression, and supply problems have caused the collapse of the Syrian health system. » Deraa governorate, north Idlib, north-east Alep, south Damascus

» BACKGROUND From the very start of the violence in Syria, networks of doctors and volunteers were formed in an attempt to deal with emergency medical needs. Since April 2012, MdM has been supporting these networks by sending them essential medicines, medical equipment and surgical kits. Since July 2012, MdM has been supporting a post-operative care and rehabilitation centre on the Turkish-Syrian border that looks after the wounded. In October 2012, MdM opened a health centre in the displaced persons camp at Qah in northern Syria.

» activitIEs At the end of 2013, nine healthcare centres were offering free consultations, basic healthcare and essential medicines, as well as vaccinations. In March 2013, MdM opened a centre for women and children in the village of Qah, where they have access to sexual and reproductive healthcare services (antenatal, postnatal and obstetric care, family planning services...). Support for the post-operative and rehabilitation centre has continued, with capacity building for the personnel in matters of post-operative care and physiotherapy, as well as providing the centre with medicines, equipment and material. Thanks to its presence in the north of Syria, Lebanon and Jordan, MdM strengthens the relationships between professionals and increases the trust established between different networks of

FUNDING

» Sternstunden Foundation, regional council, MOFA, SDC, CDC, DFID, ECHO, Paris city council, Wallonie

Budget

Syrian doctors and volunteers. At the same time, MdM supplies medical facilities in the north of Syria, in Damascus and Deraa.

» rEsults 62,238 consultations in the MdM primary healthcare centres and 13,969 consultations in post-operative care and rehabilitation were carried out. 398 women and their newborns treated after childbirth.

» OUTLOOK In view of the growing medical needs in Syria, MdM will maintain and consolidate its different activities in the months to come. A new postoperative centre will be supported. MdM’s ability to quickly react to the requirements of its Syrian partners will be increased.

» 2013: €2,426 ,508

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Tunisia

Kasserine

LIFE EXPECTANCY HDI 0.712 ranK 94

74.7 YRs

Source: UNDP 2013

Needs assessment on physical access to healthcare in rural areas

POPULATION

ALGERIA

» Target: 40, 000 LIBYA

After the ‘Jasmine Revolution’, the country has found itself once again in a situation of instability. The significant delay in accessing healthcare for the people of the centre-west with health needs prompted this mission to assess the situation, jointly with Santé Sud.

» Kasserine

» background

» results

At the beginning of 2012, contact between Kasserine governorate (where the Jasmine Revolution was more intense than elsewhere in Tunisia) and the PACA region was established, giving rise to a partnership agreement. One of the major concerns of the Tunisians involved access to healthcare for people who, until now, had been far away from, or cut off from, the healthcare system. MdM and Santé Sud were asked to conduct an evaluation in close collaboration with a reference group of Kasserine healthcare professionals.

The evaluation led to the development of a programme to support accessible healthcare in Kasserine governorate, with a general objective to improve the health of the 40,000 inhabitants of two rural districts: El-Ayoun and Hassi el-Ferid.

» activities An assessment of the situation (2012-2013) was made during two missions to Tunisia, the first one involving three doctors together and the second involving one doctor and one nurse. A joint brainstorming workshop (NGO + Kasserine partners) was organised over three days in Marseille.

funding

» PACA regional council, MdM

Budget

» 2013: €20,000

» outlook The operational set up of the project is planned for February-March 2014 with the departure of the first support teams (doctors, nurses and midwives).

International programmes » NORTH AFRICA AND MIDDLE-EAST

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Turkey

RUSSIA BULG LG GARIA RIA

GE EORG RGIA

Istanbul

Access to healthcare and rights for the migrant population in Istanbul

CYPR CYP CYPR RUS RUS

life expectancy Hdi 0.722 rank 90

74.2 yrs

Source: UNDP 2013

SYRIA IRAQ

Due to its strategic geographic position, commercial influence and its proximity to the Greek coast, Turkey attracts migrants coming from the countries of the Maghreb, from sub-Saharan Africa, the Middle-East and Asia. The tightening up of European anti-migration politics and the current crisis in Greece has made Istanbul a kind of enforced long-term stopping point on the migrant route.

» Istanbul

» background Started in 2012, in partnership with the Tohav organisation (defence of human rights, working mainly with Turkish and Kurdish citizens), the project is now being developed in partnership with the Support and Mutual Aid for Migrants Organisation (ASEM), a Turkish-African organisation. The programme is intended for people put at a disadvantage by the political and legal system, which isolates them from all possibility of regularising their immigration status, access to healthcare and treatment adapted to their specific needs.

» activities Via its partner ASEM, MdM provides medical and social aid to undocumented migrant populations living in Kumkapi neighbourhood. The local services offer combined listening, healthcare, social and legal assistance and referral towards specialist Turkish facilities. Moreover, a prevention awareness campaign was started in an effort to reduce risks (STIs, deprivation and hygiene risks, nutrition...). Furthermore, our advocacy, based on field experience, calls for migrants’ rights to be respected, at both local and European levels. MdM carried out a major study on access to healthcare conditions for migrants and gathered case studies on migrants’ experiences in Kumkapi and on migration routes.

funding

»B ouches-du-Rhône general council, Verso Il Kurdistan Association and MdM

Budget

Finally, ASEM and MdM are working together to consolidate Turkish civil society and promoting human rights, including the right to health.

» results 1,483 medical consultations, 723 social and legal interviews and 384 medical referrals to Turkish healthcare facilities were carried out. Six monitoring missions and project supervision and partnership support took place over the course of the year.

» outlook The same service will be offered to the migrant population, whatever their legal and administrative position, in Istanbul in 2014. Specific attention will be paid to female migrants. MdM will use advocacy work as a tool for change — both on an operational level (modifying current legislation in Turkey, promoting the respect for rights) and at the policy level. A book on access to healthcare for foreigners in Turkey will be published, first in Istanbul, then in France.

» 2013: €100,000

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Angola

D.R.C.

LIFE EXPECTANCY HDI 0.508 ranK 148

Kwanza Norte

Source: UNDP 2013

ZAMBIA

Improving health and the right to health for women and young people

51.5 YRs

POPULATION

»B eneficiaries : 25,576 » Target: 254,800

NAMIBIA

Since the end of the civil war in 2002, the reconstruction process in Angola is accelerating thanks, in large part, to oil revenues. But not everyone benefits from this wealth, and the shortage of skilled staff remains a major problem. In rural areas, the problems in decentralising care to outlying areas and of ensuring that people, especially women and young people, can exercise their right to health are limiting access to care. » Kwanza Norte Province – Samba-Cajú District, Ambaca, Lucala and Cazengo

» background

» results

Launched in 2010, the project initially focused on enhancing the skills of health professionals and supporting the province’s health authorities in management of the health system. Then the team transferred its support to nearby health facilities in four districts. In parallel, various studies were carried out to reach greater understanding of community organisation and how various groups in society exercise their right to health.

346 health professionals trained in SRH. 100 students trained in awareness-raising techniques in relation to SRH. 5,000 people made aware of their rights regarding sexual and reproductive health. 11 civil society organisations trained to exercise the right to health.

» activities

Closed in December 2013, the project is expected to enter a new phase in 2014, based on the experience of these past three years of intervention by, in particular, strengthening the community-based approach, the relationship between the various stakeholders and the mechanisms for citizen consultation.

Activities have continued, to strengthen the existing health facilities, not only with a great deal of training of health professionals in care, referral and data collection, but also with day to day support and donation of equipment to healthcare facilities. In addition, activities promoting the right to health in the communities and especially amongst young people and women increase the demand for healthcare and encourage the exercise of the right to health. Work has been done with the various stakeholders and regional authorities to strengthen links between them and to raise awareness of the difficulty of accessing SRH services and of the need to find joint solutions.

international Delegation

»M dM Spain

funding

»E uropeAid, MdM

» outlook

Budget

» €48,249

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Burkina Faso

MALI

Djibo

NIGER

life expectancy Hdi 0.343 rank 183

55.9 yrs

Source: UNDP 2013

BENIN GHANA CÔTE D'IVOIRE

TOGO

POPULATION

»B eneficiaries: 934 » Target: 83, 975

Treating child malnutrition

The health district of Djibo is in the Sahel region, where there are recurrent problems with food availability. Statistics for hospital treatment for malnutrition as well as the figures for severe acute malnutrition (SAM) and global acute malnutrition (GAM) remain a concern. In 2011, the death rate there was over 18.95%. Furthermore, the medical staff were inadequately trained.

» Djibo, Sahel Region

» background The first phase of the programme, which started in 2013, involved the renovation and equipping of the residential centre for nutritional recuperation (CRENI), in addition to recruiting and training staff dedicated to the treatment of malnutrition. It also includes triage and treatment of emergencies and preventing infections in the hospital environment. The second phase concentrated on boosting free treatment in the health centres for cases of severe acute malnutrition with complications and promotion of CRENI in the community.

» activities During 2013, the main activities were as follows: –– renovation and equipping of CRENI in Djibo; –– purchase of medicines and therapeutic foods; –– donation of bedding and hygiene kits; –– payment of referral fees for children with severe acute malnutrition with complications to CRENI and of laboratory test fees; –– awareness raising in the communes of Arbinda, Djibo, Pobé Mengao and Tongomayel; –– training of 120 health workers in in-patient care for malnutrition, triage, assessment and emergency treatment, community based

international Delegation

»M dM Spain (work in consortium)

funding

» ECHO, Sternstunden Foundation, UNHCR, Annemasse city

care for malnutrition and integrated treatment for childhood illnesses; –– organisation of monthly meetings on referral and cross-referral of cases of severe acute malnutrition and advocacy workshops with administrative, community and religious authorities, women’s coordinators within the province, voluntary sector organisations and district agents.

» results 934 children with severe acute malnutrition with complications received free treatment at CRENI and 670 of them were stabilised.

» outlook In 2014, the paediatric unit should integrate Djibo CRENI and a new CRENI should open in Arbinda. The intention is to gradually transfer treatment for cases of severe acute malnutrition with complications to our partners and the local health authorities in the district.

Budget

»2 013: €563, 971

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Burkina Faso

MALI

Djibo

NIGER

life expectancy Hdi 0.343 rank 183

55.9 yrs

Source: UNDP 2013

BENIN GHANA CÔTE D'IVOIRE

TOGO

POPULATION

»B eneficiaries: 92, 504 »T arget: 444,220

Assistance for refugees and asylum seekers Since late January 2012, the conflicts between the Malian army and armed groups in the north of Mali have led to significant population movements both within the country and towards neighbouring countries. Soum province, in Burkina Faso, has seen a significant influx of refugees. MdM, which has been in the province since 2010, took over the provision of medical aid to refugees in Mentao and Damba, the province’s reception camps. » Djibo district, Sahel region

» background The emergency project on assistance for Malian refugees was launched in April 2012. In its initial phase, the project covered two refugee camps, Mentao and Damba, with a total of four healthcare centres, which were open 24 hours, seven days a week: three in Mentao and one in Damba. The Damba refugee camp was re-located to Mentao in March 2013. Its healthcare centre closed following the re-location. In the healthcare centres, the medical staff comprises doctors, state-registered nurses and midwives/birth attendants.

» activities MdM’s assistance for Malian refugees consisted of providing primary healthcare to refugee populations and to host populations in the surrounding villages. During 2013, the main activities were as follows: –– medical and nursing treatment; –– referrals/evacuations to secondary facilities via MdM ambulances; –– assisted deliveries; –– awareness raising and family planning; –– antenatal and postnatal consultations; –– prevention of mother-to-child transmission of HIV; –– treatment for sexually transmitted infections;

funding

»E CHO, Sternstunden Foundation, UNHCR, Annemasse city

Budget

»2 013: €896, 441

–– treatment for HIV/Aids in conjunction with the local health service; –– routine vaccination for children under one year old and pregnant women; –– outpatient care for the malnourished; –– organisation of awareness sessions on a variety of health matters.

» results 71,157 people seen in MdM health facilities. 220 assisted deliveries. 57 cases of moderate acute malnutrition brought under control and 48 cases of severe malnutrition treated.

» outlook Between January and June 2014, MdM will provide for the primary healthcare needs of 12,270 Malian refugees and 3,500 vulnerable local people living near to Mentao refugee camp. Following successful elections in Mali, a gradual return of refugees is expected towards the end of 2014 as long as the conflict between the armed groups and the Malian authorities is resolved.

International programmes » SUB-SAHARAN AFRICA

DOCTORS THEWORLD WORLD DOCTORS OFOF THE

ANNUAL ANNUAL REPORT REPORT 2013

Chad

LIBYA

life expectancy Hdi 0.34 rank 184

NIGER

Kanem

49.9 yrs

Source: UNDP 2013

SUDAN

Supporting health services and increasing community involvement

POPULATION

NIGERIA

CAMEROON

CAR

»B eneficiaries: 32,651 »T arget: 295,749

With an extremely high level of maternal mortality (1,100 maternal deaths for every 100,000 live births) and a low level of contraceptive use (4.8%), Chad is still very far behind regarding access to maternal and neonatal healthcare. In this context, Doctors of the World subscribes to the new health policy which calls for Chad to accelerate the reduction of maternal and neonatal mortality.

» Kanem region, Mao and Mondo districts

» background Doctors of the World has been in Kanem (the region to the north-west of N’Djamena) since 2009, where the organisation is currently managing a project in 15 areas and at the Mao regional hospital on reducing maternal and neonatal mortality, as well as reducing the incidence of obstetric fistulas.

–– renovating delivery suites in four health centres; –– medical, surgical and psychosocial care for women suffering from obstetric fistulas.

» results 574 deliveries took place in 2013, against 451 in 2012.

» activities

» outlook

Doctors of the World has continued its activities in the 15 areas under the jurisdiction of Mao and Mondo, including: –– raising awareness amongst village communities and young people in Mao’s schools and colleges, of sexual and reproductive health and of vaccination; –– training and enhancing the skills of medical and paramedical personnel on the minimum package of activities at health centre level and on the package of complementary activities at Mao regional hospital in addition to SRH and child health; –– implementing suitable methods of referral, based on community management (referrals using community carts); –– supporting management teams in Mao and Mondo districts in the organisation and planning of district health activities;

MdM’s outlook: –– assigning midwives to health centres; –– the introduction of a component on prevention of mother-to-child transmission of HIV; –– the launch of family planning activities; –– scaling up the component on referrals using community carts.

funding

»E uropeAid, SDC, UNICEF, UNFPA

Budget

»2 013: €853,284

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

CAR

SUDAN CHAD

LIFE EXPECTANCY HDI 0.352 ranK 180

CAMEROON

Central African Republic

Bangui

49.1 YRs

Source: UNDP 2013

POPULATION

Reducing morbidity and mortality in people affected by the crisis

CONGO

DEMOCRATIC REPUBLIC OF CONGO

»B eneficiaries: 148,547 » Target: 192,945

Since the coup d’état by Séléka forces in March 2013, there is now a security and humanitarian crisis as well as the political crisis. The health system, which was already very fragile, has completely collapsed. Populations who are terrorised by the violence flee their villages to take refuge in the bush. Doctors of the World is working to restore primary and secondary healthcare facilities, with a particular focus on sexual and reproductive health. » Bangui and surrounding area

» background Between 1996 and 2000, MdM worked in CAR on developing HIV/Aids prevention activities and opened the first centre for free, anonymous voluntary HIV testing in Bangui. This flagship centre for STIs and prescription of ARVs was handed over to the Ministry of Public Health and Population in 2000 and is still operational today. Following the coup d’état of 24 March 2013, MdM wanted to return to CAR to set up projects with the most vulnerable populations.

» activities After an exploratory mission conducted in July, the first phase of the project began with re-establishing MdM in the country, on the administrative, health and social levels. Throughout this phase, which ended at the end of the year, MdM inspected many healthcare facilities in Bangui and in the south-west of the country and met with stakeholders at all levels (public sector, voluntary sector, national and international). MdM also supported two national organisations: the Central African Association for family welfare (ACABEF in its French acronym), which dispenses sexual and reproductive healthcare, and the National Catholic Health co-ordination (CONASAN in its French acronym), which provides primary healthcare. This support took the form of donations of essential medicines,

FUNDING

»C DC, MdM

Budget

»2 013: €311,211

medical equipment, minor renovations, training of CONASAN staff and financing two posts for ACABEF.

» results 5,402 family planning consultations. 288 victims of violence treated. 785 cases of malaria treated. 399 children vaccinated. Between 15 and 30 December: –– 270 antenatal consultations in makeshift camps –– 34 deliveries in makeshift camps.

» outlook The project aims to support the various levels of the national health pyramid (community, primary, secondary), prioritising training, treatment for the most vulnerable and life-threatening emergencies. MdM also hopes to be able to react to potential emergencies (epidemics, population displacements, violent outbreaks...) in places where it is working.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Côte d’Ivoire

MALI

BURKINA FASO

life expectancy Hdi 0.432 rank 168

GUINEA

GHANA LIB LI LIB BE BERIA

San Pédro

56 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 78,000 » Target: 187, 000

Introducing targeted free healthcare After 10 years of instability, Côte d’Ivoire underwent a post-electoral crisis in 2011 which undermined the health system in the entire country. The lack of investment in infrastructure, personnel and medicines seriously damage the quality of healthcare available. The levels of maternal, neonatal and childhood mortality are alarming. MdM is working to strengthen the health system and to establish a policy of targeted free healthcare for pregnant women and children under five years old. » Bas-Sassandra district, Gboklé, Nawa and San Pédro districts

» background In September 2011, in partnership with the Ministry of Health, MdM launched its programme in 17 health facilities, with support for training health personnel and renovation of buildings. In September 2012, the project was extended to all 43 health centres in the affected areas, with increased support for the local health authorities to help them fulfil their supervision and management activities. The community-based approach was also developed to better engage the various communities in health activities.

» activities In 2013, the activities were focused on: –– training health professionals in emergency obstetric and neo-natal healthcare; –– treatment for childhood illnesses; –– collection and analysis of epidemiological data and medication management; –– provision of essential medication for pregnant women and children under five years old; –– support for outreach strategies to bring care closer to remote communities; –– repair of ambulances to enable the transport of women in labour funding

»E CHO, WHO

Budget

»2 013: €962,488

who have been referred; –– construction of water and sanitation infrastructure (wells, latrines, incinerators), with the involvement of the communities; –– support for planning, monitoring and evaluation activities in health centres with district management teams; –– advocacy to improve availability of free healthcare.

» results 15,000 assisted deliveries, 78,000 children under five years old seen and 43 health centres provided with medical equipment. Water and sanitary infrastructure provided in 24 health centres.

» outlook MdM will continue to support the region’s health authorities by including a new health district, making a total of 120 health facilities. In Abidjan, MdM hopes to work on a project with people who use drugs, to improve their access to health and in particular, to provide care for hepatitis sufferers.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

DRC

SUDAN

CAR

UGAN GANDA AN A NDA N DA CONGO

Democratic Republic of Congo

Goma

RW RW W.. BU UR. Burundi Bu TA AN NZANIA

ANGOLA

Z ZAMBIA A

life expectancy Hdi 0.304 rank 186

48.7 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 115,000 » Target: 1,000,000

Integrated programme tackling HIV/Aids The health system in DRC has been undermined by years of chronic insecurity and major institutional dysfunction. The rate of access to healthcare is well below Sub-Saharan averages and HIV remains a serious public health issue. These past few years, international resources have diminished, without being replaced by extra national resources, reducing any hope of slowing the epidemic. » Province of Nord-Kivu, Goma and Karisimbi health areas

» background

» results

This integrated programme for tackling HIV has been under development since 2003, in partnership with the health authorities and civil society stakeholders. After an initial phase of establishing a high quality system to tackle HIV (2003 – 2006), MdM extended this system (2007 – 2009). Today, the organisation is finalising its transfer to national stakeholders (2010 – 2015).

» activities

2,394 people have access to ARV treatment. 9,500 tests carried out.

» outlook Between now and the end of 2014, MdM expects to finalise the transfer of steering the programme to institutional stakeholders and Congolese civil society. The final year of the programme will enable the position of civil society to be consolidated within the running of the project.

The question of governance is essential for the smooth operation of the system for tackling HIV/Aids, and MdM has demonstrated that a collective, shared approach to health project management can provide an effective alternative. Thus, at the same time as continuing to support a system of prevention and care, the strengthening of civil society goes on. Ultimately it is aiming to promote civil society’s role within the bodies that steer programmes. Increased international and national resources are a key factor in the ability to reduce the incidence of HIV in DRC. MdM has worked hard to lobby for this in 2013, with the result that consideration of community level issues and the most at-risk populations has been included in the new national strategic plan for tackling HIV.

funding

» Fubon Foundation,Global Fund, AFD, Sternstunden Foundation, Japanese embassy, UNICEF, Maehol, UNDP, WFP, UNFPA, MdM

Budget

»2 013: €556,042

International programmes » sub-saharan SUB-SAHARAN africa AFRICA

DOCTORS THEWORLD WORLD DOCTORS OFOF THE

ANNUAL ANNUAL REPORT REPORT 2013

DRC

CAR

SUDAN UGAN GANDA AN A NDA N DA

CONGO

Democratic Republic of Congo

Kinshasa

ANGOLA

RW RW W.. BU UR. Burundi Bu TA AN NZANIA

Z ZAMBIA A

life expectancy Hdi 0.304 rank 186

48.7 yrs

Source UNDP 2013

POPULATION

»B eneficiaries: 5,000 » Target: 24,200

Promoting health for girls living on the streets According to the latest survey, conducted in 2009, over 20,000 children live on the streets of Kinshasa. Almost half of them are girls and their number has increased since the survey. A marginalised and vulnerable population, often living from prostitution and sometimes subjected to repeated rape, the young girls have significant needs both in terms of protection and reproductive healthcare. » Kinshasa

» background Since 1999, MdM has been striving to guarantee access to good quality medical-social services for children. Today MdM is targeting girls living on the streets and their new-born babies with an approach aimed at reducing harm associated with their unprotected sexual behaviour. After several years of supporting our partners on these matters, capitalisation and dissemination of good practice are key issues. The aim is to transfer operational and financial responsibility for this programme to Aid for Disadvantaged Children (AED) and Network of Street Children Educators (REEJER in its French acronym).

» activities With the support of MdM, the partner organisation, AED opened a new refuge for young girls who live in the streets and their children, which enabled a greater number of girls to be seen whilst also providing a degree of continuity in the activities run by AED. In 2013, some essential activities were handed over to partners, though MdM continues to provide significant support in sexual and reproductive health, especially in monitoring pregnancies, screening for and treatment of STIs, including HIV, and post-abortion care. A conference organised by MdM in Kinshasa on the theme Children living on the streets in DRC, an approach based on health promotion brought together Congolese stakeholders funding

» Fubon Foundation, Global Fund, AFD, Sternstunden Foundation, Japanese embassy, UNICEF, Maehol, UNDP, WFP, UNFPA, MdM

Budget

as well as a number of African stakeholders. MdM continues to work with organisations from Congolese civil society on lobbying for the legalisation of access to contraceptives for minors.

» results 1,955 reproductive health consultations, of which 124 were for antenatal monitoring. 161 girls started to use contraceptives.

» outlook In 2014, MdM will continue to support its operational partners in providing sexual and reproductive healthcare and involve the beneficiaries within the programme. The spread of ‘good practice’, supervision of care and training of personnel will gradually be taken over by REEJER, a Congolese organisation.

»2 013: €715,998

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

DRC

CAR CONGO

SUDAN UGAN GANDA AN A NDA N DA

Nord Kivu RW RW W.. BU UR. Burundi Bu

Democratic Republic of Congo

TA AN NZANIA

life expectancy Hdi 0.304 rank 186

48.7 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 4,105 ANGOLA

Z ZAMBIA A

Community mental health and tackling sexual violence For 20 years there has been one conflict after another in the east of DRC. North-Kivu is the worst affected province with over a million internally displaced people. This situation has caused the complete disintegration of social bonds between communities. Traditional methods of conflict resolution have, for some time, no longer been enough. The populations find it increasingly difficult to put back together their lives, which all too often are affected by this recurring violence. » North-Kivu Province

» background

» results

In 2007, during a socio-anthropological survey, MdM encountered members of Congolese civil society who, despite the extreme poverty in the province, spontaneously and often voluntarily help to support victims of gender-based violence. Working closely with these key players, MdM developed a programme aimed at improving this support and promoting mental health in the communities.

2,972 victims of sexual violence treated by trained psychosocial counsellors. 15 civil society organisations supported.

» activitIEs In line with results achieved in 2011 and 2012, the following activities were continued: strengthening the skills of psychosocial counsellors and community stakeholders who care for victims of violence; integration of mental health issues at the heart of communities through projects being implemented by partners and support for a network of civil society organisations, now formed into a collective. December 2013 marks the end of a project cycle, the issues around the creation of this collective are key. A true guarantee of ownership of the programme activities and objectives by local stakeholders, the fledgling associative project is on track to find an autonomous place in the landscape of combating violence in North-Kivu.

funding

» Fubon Foundation, Global Fund, AFD, Sternstunden Foundation, Japanese embassy, UNICEF, Maehol, UNDP, WFP, UNFPA, MdM

Budget

» outlook Buoyed by this community experience in psychosocial care, MdM hopes to devise a programme which focuses on the development of training for community and health stakeholders and on reinforcing links between these stakeholders, to enable mental health to be integrated with primary healthcare provision.

»2 013: €530,306

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Guinea

SENEGAL

MALI

GUINEABISSAU

life expectancy Hdi 0.355 rank 178

Kindia

54.5 yrs

Source: UNDP 2013

SIERRA LEONE

Health in prisons

POPULATION

»B eneficiaries: 235 prisoners LIBERIA

The government elections in September 2013, which had been postponed on numerous occasions, give some hope for a stabilisation of the political and economic situation. Nevertheless there continue to be sporadic outbursts of violence in various places, without the population feeling any improvement in the situation. Against this background, MdM’s support for the activities of the Kindianaise Assistance for Detainees (KAD) is essential to improve the conditions of prisoners. » Kindia

» background

» results

Since 2001, MdM has supported the KAD, a Guinean organisation, in its mission to support detainees in Kindia prison. The project aims to improve prison conditions: the environment (hygiene, renovation, repair), health (provision of medicines, medical consultations) and reintegration (education, revenue generating activities). Prison conditions in health terms and access to care are now better, even if there is still insufficient involvement of prison authorities.

Access to care for prisoners was provided, as was support with literacy through peer learning. 82 cases of mild malnutrition were treated.

» activities A slight improvement in the standard of prisoners’ food has allowed us to concentrate efforts on access to healthcare and maintenance of sanitation facilities. In partnership with Prisoners without Borders, training on prisoners’ rights was offered to prison management. Revenue-generating activities represent a challenge owing to the downturn in all economic activity throughout the country.

funding

»M dM

Budget

»2 013: €4,000

» outlook Advocacy led by KAD aims to make the prison authorities take on their responsibilities with regard to prisoners’ rights. Financial autonomy of KAD, through the development of revenue-generating activities is the priority for the coming year.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Kenya

SUDAN

ETHIOPIA SOMALIA

UGANDA

Nairobi

life expectancy Hdi 0.519 ranK 145

57:7 yrs

Source: UNDP 2013

POPULATION

Tackling HIV/Aids and hepatitis amongst people who use drugs

TANZANIA

»B eneficiaries: 400 »Target: 34,000

Kenya is one of the countries with the highest number of intravenous drug users. The prevalence of HIV within this population is very high and there is no comprehensive response to their needs. Infection with viral hepatitis is one of the main risks of this method of drug consumption. Users are heavily stigmatised both by the public and by health professionals, which leaves them even more marginalised. » Nairobi

» background As a result of a study of the situation and an exploratory mission conducted in Nairobi in November 2011, MdM, which has been working in Kenya for over 20 years, launched a harm reduction project with vulnerable populations in May 2013. This project aims to enhance the skills of Kenyan stakeholders and seeks to become a model project for the whole country. In the longer term, it aims to contribute to the development of a regional programme, specifically with Tanzania, to set up training and joint advocacy.

» activities During the initial phase of the project, MdM identified needs and priority areas for intervention. Then, the programme focused on recruitment of medical personnel and a psychosocial counsellor as well as recruitment and training of outreach workers and peer educators. Since July 2013, a permanent base has offered screening for infectious illnesses, vaccination sessions, distribution of sterile needles, guidance towards health facilities and psychosocial activities. The team provides awareness sessions on harm reduction. A mobile unit goes out to reach the most disadvantaged users. They are offered prevention equipment and health education materials. The permanent team work closely with local structures: the National AIDS/STI

funding

»A FD, MdM

Budget

»2 013: €226, 028

Control Program (NASCOP) and the national users’ network (KENPUD), to develop national policies, targeted communication materials etc.

» results 62 users/month, on average, visit the drop in centre. 11,000 syringes distributed (July – December 2013).

» outlook In 2014, the number of service users will be increased in a controlled way, mainly through extending mobile services and moving the drop-in centre to a more suitable place. Screening for hepatitis C will be rolled out in co-operation with partners. The capabilities of local facilities and advocacy will be strengthened.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Liberia

GUINEA SIERRA LEONE CÔTE D'IVOIRE

Gbarnga

life expectancy Hdi 0.388 rank 174

57.3 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 40,638 » Target: 333, 500

Reducing poverty and improving access to healthcare

Liberia has a very high rate of maternal and neonatal mortality owing to the shortage of qualified health personnel and the practice of home birth, which is widespread in rural areas. Since 2011, MdM has been working with the Bong county health authorities to improve the health of women and children through training of health personnel and the construction and support for health facilities. » Gbarnga, Bong County

» background

» results

Since 2011, MdM has been working in 10 health facilities in Bong, implementing a comprehensive package of care. The programme has renovated health centres, built a maternity hospital and a home to accommodate pregnant women who live far away from the facility. Training for healthcare personnel and community health workers was provided. Raising awareness amongst traditional midwives and support for the referral system have increased the number of deliveries in a medical setting.

94% children under one year old were vaccinated with Pentavalent. 77% obstetric emergencies were treated in healthcare facilities.

» activities A second home for pregnant women has been built with significant community involvement. The emergency contraceptive pill has been introduced in the area it covers. Healthcare personnel, trained in mental health provided consultations in the facilities, whilst also being supported by the programme. Supported by MdM, community health workers, traditional midwives and nursing staff attended health education sessions in the healthcare facilities and in the communities on use of the services and deliveries in a medical setting. As part of the programme closure, planned with the local and national health authorities, a gradual handing over of activities to the Bong health management team was organised through a series of joint supervisions. The programme came to an end in August 2013, after handover of activities to the Bong County health authorities and to national partner organisations. funding

» AFD, EuropeAid, McCall MacBain Foundation, MdM

Budget

»2 013: €1,745,700

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Madagascar

COMORES MOZAMBIQUE

Antananarivo

LIFE EXPECTANCY HDI 0.483 ranK 151

66.9 YRs

Source: UNDP 2013

POPULATION

»B eneficiaries: 636

Paediatric cardiac reconstructive surgery

The political and economic situation in Madagascar appears to have settled down with the presidential election at the end of the year, and the inauguration of the newly elected leader in January 2014. Donors are waiting for the formation of a new government before releasing funds to support the country. At the end of 2013, the public sector remained impoverished.

» Antananarivo

» background Since 1994, working in partnership with the Soavinandriana Hospital (Cenhosoa), MdM’s team from Reunion, made up of one cardiac surgeon, two anaesthetists and two or three cardiologists, has conducted a medical and surgical mission twice a year. The objective is to reduce the death rate of children under 16 years old who suffer from cardiac disease. This programme aims to empower the Cenhosoa team to take over responsibility for closed heart surgery.

» activities The 32nd and 33rd missions were carried out at Cenhosoa and comprised: –– paediatric cardiology consultations; –– closed heart operations with continued training, through mentoring, for the staff at Cenhosoa; –– a six-month training programme in Reunion to enhance the skills of the Cenhosoa staff in cardiac surgery (anaesthetics); –– open heart operations conducted by MdM and its partners in mainland France and Europe; –– the joint completion (with Cenhosoa) of the construction and equipping of a cardiac surgery unit right in Cenhosoa hospital. This comprises a cardiac surgery building with an operating theatre, a recovery room and two ultrasound consultation rooms. funding

» Monaco State, EuropeAid, ECHO, AFD, Niarchos Foundation, Care, MdM

Budget

» results 636 consultations completed. 22 children had closed heart surgery, of which 18 operations were carried out by the Malagasy team, under the supervision of the MdM team. 33 children had open heart surgery.

» outlook A one year training programme is planned with the faculty of medicine of Antananarivo, the faculty of Reunion and MdM all working together. Training is planned for five health professionals from Cenhosoa in Reunion and Marseille to enhance their skills. The operating theatre of the cardiac surgery unit at Cenhosoa should be up and running in April 2014.

»2 013: €120,986

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Madagascar

Sambava Antalaha MOZAMBIQUE

Maroantsetra

life expectancy Hdi 0.483 rank 151

66.9 yrs

Source: UNDP 2013

POPULATION

Disaster risk management

Vangaindrano

»B eneficiaries: 221,546 » Target: 941,505

» Sambava, Antalaha, Maroantsetra and Vangaindrano districts

» background

» results

Since 2008 MdM has run a disaster risk reduction programme (DRR) to prepare communities for the effects of tropical cyclones. The pilot project, conducted initially in Maroantsetra, was duplicated in the Sava region in 2010. Subsequently, through working with other partner organisations funded by DipEcho, the intervention area was extended to a town in Vangaindrano district in Atsimo-Atsianana region.

3,300 people sensitised. 33 emergency facilities completed. 18 contingency plans and rapid reaction matrices operational. Four districts provided with emergency teams and rescue plans.

» activities The third phase of the programme came to an end in December 2013. In the course of the project, three strands were developed: support for the health service (health monitoring at community level, epidemiological monitoring, improvement of the communication system), support for victims of natural disasters (training rescue workers and an emergency medical team, developing a contingency plan, donation of equipment) and creating momentum within the community for disaster risk reduction (DRR) (strengthening and consolidation of the disaster risk reduction committees, vulnerability analysis by stakeholders, raising awareness through a traditional singing competition, community micro projects). This final strand placed the emphasis on sustainability by: –– empowering the disaster risk management committees; –– strengthening links between the various healthcare stakeholders and the committees. funding

»M onaco Sate, EuropeAid, ECHO, AFD, Niarchos Foundation, Care, MdM

Budget

» outlook A proposal for a project in partnership with Care, in Vatomandry district, has been lodged with DipEcho. It seeks to implement health /DRR activities within a disaster risk management programme led by Care.

»2 013: €399,314

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Mali

ALGERIA

life expectancy Hdi 0.344 rank 182

MAURITANIA SENEGAL

Comprehensive care for women with obstetric fistulas

GUINEA

Mopti NIGER BURKINA FASO CÔTE D'IVOIRE

51.9 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 193 » Target: 342,006

Doctors of the World has worked in Mali for over 20 years and has developed a programme of comprehensive care for women with obstetric fistulas. The huge political crisis, which shook the country in 2012, and the deterioration of the security situation, made simple access to hospital for women in the Mopti region more difficult, let alone access to surgical treatment.

» Mopti, Mopti region

» background

» results

The project was launched in 1993. In 2010, the thousandth woman was treated at the Sominé Dolo hospital in Mopti, a partner of the programme. Treatment encompasses medical, surgical, psychological and social aspects. Another strand, on awareness and prevention, was added in 2008 to inform people about the causes of fistulas.

113 femmes had operations carried out by MdM in conjunction with Sominé Dolo hospital in Mopti. 100 fistulas were repaired, that is a success rate of 88.49%.

» activities MdM has continued to provide medical and surgical treatment for women and to work on raising awareness amongst the population at large, as to the causes of the illness and the opportunities available for treatment by MdM through Sévaré hospital. Women with fistulas have been given psychological support. A mass treatment session was organised in December 2013, so that a greater number of women could be reached, especially those coming from the northern regions, whose treatment had been disrupted by the crisis.

funding

»A EN, ECHO, WHO, Rungis city, Crolles city, MdM

Budget

» outlook After 20 years of involvement in this project, MdM stopped providing care in January 2014. The national NGO Iamaneh took over MdM’s activities. MdM, however, remains a resource organisation in the field of management of obstetric fistula.

»2 013: €143,057

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Mali

ALGERIA

life expectancy Hdi 0.344 rank 182

MAURITANIA

51.9 yrs

Source: UNDP 2013

SENEGAL

Bamako

Improving access to healthcare for migrant populations who are forced to return

GUINEA

NIGER BURKINA FASO

POPULATION

»B eneficiaries: 2,850

CÔTE D'IVOIRE

Mali has been in the throes of a social and political security crisis since the beginning of 2012. Doctors of the World has been in the country, working on development programmes, for over 20 years and towards the end of 2009 launched a programme to improve access to healthcare for migrants being forced to return. Since the beginning of the crisis in the north of the country, the internally displaced, arriving in great numbers in Bamako, have also benefited from the project. » Bamako

» background Since 2009, there has, in Bamako, been a programme of access to healthcare for migrant populations being forced to return. The main objective of this programme is to reduce the health and psychological consequences of expulsion, return and transit of migrants on their various routes between Africa and Europe.

» activities MdM continued to support the Malian Association for Deportees (AME in its French acronym), the Association for People Expelled from Central Africa to Mali (ARACEM in its French acronym) and the Forum for another Mali at the Amadou-Hampâté Bâ centre (Foram-Cahba) in providing reception, psychological and medical care through two community healthcare centres (CSCOM). It was the same for the Direh Ben de Gao organisation, which plays an important role in monitoring the movement of migrants and the flow over the border in case of mass arrivals. In 2012, the number of migrants in Bamako fell significantly and MdM provided assistance for internally displaced people who came to Bamako from the north. In December 2013 there was a workshop to devise a contingency plan in case of mass arrivals. All the stakeholders who could be involved in caring for migrants in case of mass deportations from Algeria were there.

international Delegation

»M dM Belgium

funding

» AEN, ECHO, WHO, Rungis city, Crolles city, MdM

In October 2013, training on ‘stress management’ was also provided for stakeholders in partner organisations.

» results Through the migrant project, the two community healthcare centres in Djélibougou and Faladjé, provided 111 medical consultations and supported 281 displaced persons.

» outlook The programme is entering its third phase. MdM’s partners have set up a monitoring committee. This is an extension of the migrant programme, which has allowed the development of an early warning system and a contingency plan in case of mass arrivals.

Budget

»2 013: €160,884

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Niger

LIBYA

ALGERIA

life expectancy Hdi 0.304 rank 186 Source: UNDP 2013

MALI

Improving access to health services and medico-nutritional care

BURKINA FASO

55.1 yrs

Illela / Tahoua NIGERIA

CHAD

POPULATION

»B eneficiaires: 220,626 » Target: 391,262

BENIN

Niger has one of the highest birth rates in the world (7.6 children/woman). Closely spaced pregnancies and teenage pregnancies have negative consequences for the health of women and their children. The country is also in the midst of a chronic nutritional crisis. Since 2011, MdM has been working on a programme to treat malnutrition and promote modern methods of family planning in Illéla district. » Illéla district, Tahoua region

» background MdM has had a presence in the Tahoua region of Niger since 2006, with a primary healthcare programme developed in Keita. A support programme in Illéla health district to improve access to health services for mothers and children operated between April 2011 and December 2013 and was financed by ECHO. The 2013 programme is the logical continuation of the research–action advocacy project which ran from 2007 to 2010.

» activities MdM is supporting the health development plan of Illéla district (PDSD) to improve access to health services for mothers and children. This programme consists of a nutrition component focused on medical and nutritional care for severely malnourished children and also includes the promotion of family planning. The principal activities in 2013 were: –– support for the routine activities in 22 outpatient therapeutic feeding centres for the severely malnourished (CRENAS in its French acronym) and for CRENI by providing health workers; –– strengthening capability through training and supervision; –– promotion of family planning;

funding

»A FD, WFP, ECHO, EuropeAid, UNFPA, Oxfam

Budget

»2 013: €975,460

–– raising awareness amongst the general public with the assistance of religious leaders by means of preaching caravans; –– radio broadcasts; –– establishment of ‘schools for husbands’ to promote family planning; –– establishment of a strategy regarding matrons (auxiliary midwives).

» results From 2012 to 2013: –– the treatment rate in CRENI rose from 78% to 89%; –– the drop-out rate fell from 6.9% to 1%; –– the mortality rate fell from 11% to 9%.

» outlook A continuation of support for medical nutritional care, with finance from ECHO, is planned for 2014. Support for reproductive health activities — especially promotion of family planning, through working with religious and community leaders, the ‘school for husbands’ and the matrons strategy — is expected to continue.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Niger

LIBYA

ALGERIA

life expectancy Hdi 0.304 rank 186 Source: UNDP 2013

MALI

Improving referral systems for medical evacuations

BURKINA FASO

55.1 yrs

Illela / Tahoua NIGERIA

CHAD

POPULATION

»B eneficiaries: 7,124 » Target: 2,925,555

BENIN

In 2005, the state of Niger decided to make healthcare free for vulnerable populations. However, this strategy only covers the cost of care and not the cost of referral. Since November 2013, MdM has been leading a two-year project supporting the involvement of local communities in Tahoua region in the referral and medical evacuation system for vulnerable populations, especially pregnant women and children. » Tahoua region, Keita and Illéla districts

» background

» results

MdM has had a presence in the Tahoua region of Niger since 2006, with a primary healthcare programme developed in Keita. A pilot project was launched in May 2009, in Keita district, where MdM developed an ‘extra cent’ referral strategy. MdM has repeated the experiment in Illéla district.

From 2012 to 2013, the number of evacuations rose from: –– 529 to 1,278 in Illéla district; –– 688 to 990 in Keita.

» activities The project was launched in November 2013. The initial activities were as follows: –– six information sessions with 475 local and regional elected officials (in Keita, Illéla, Bouza, Konni, Madoua districts) on the operation of the referral system and the system for referring medical evacuations; –– six training sessions with local and regional elected officials (in Keita, Illéla, Bouza, Konni, Madoua) on budgets and financial management of the fund for medical evacuations; –– workshops on setting up the referral system in the Madoua, Bouza and Konni departments; –– training and mobilisation of civil society organisations in advocacy for the referral system of medical evacuations in Tahoua region.

funding

»A FD, WFP, ECHO, EuropeAid, UNFPA, Oxfam

Budget

»2 013: €9,511

» outlook The involvement of partners from the very beginning of the project should allow ongoing and progressive transfer of the skills needed for the continuation of activities. This multi-partner approach also enables the project to continue and be consolidated at very little cost. It is also planned that the referral system will be extended to Bouza, Konni and Madoua districts. With the accent very much on advocacy, the authorities and partners should be encouraged to focus on improving access to healthcare for the population.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Rwanda

UGANDA

life expectancy Hdi 0.434 rank 167

D.R.C.

Kigali TANZANIA

Psychological support for survivors of the Tutsi genocide

BURUNDI

55.7 yrs

Source UNDP 2013

POPULATION

»B eneficiaries: 3,498 » Target: 472,396

Psychological suffering related to the genocide and its aftermath continue to be pervasive in Rwandan society. MdM has established a programme to help tackle the trauma of the genocide and to reinforce the skills of mental health professionals.

» Kigali town and 15 districts in the four provinces of Rwanda

» background

» results

The psychological support mechanism was established in 2005 within the framework of the partnership between MdM, Ibuka France and Ibuka Rwanda. The first phase provided psychological care for genocide survivors during and after the ‘gacaca’ people’s courts, and also training and supervision for Ibuka’s psychologists and trauma counsellors. From 2012, the second phase extended the experience to member organisations of the Ibuka collective, enhanced the skills of their psychologists and provided training for clinical supervisors.

32 psychologists received on-going training and monthly clinical supervisions. 10 psychologists were trained as supervisors.

» activities A mentoring system was implemented: Ibuka psychologists jointly facilitated therapeutic groups with their counterparts so that they could share their know-how and expertise in facilitating these groups. Furthermore, training with follow up supervision was given to the group’s psychologists and certified training was given to Ibuka psychologists trained in supervision since 2012.

funding

»M dM

Budget

»2 013: €127, 929

» outlook This experience, built up over the years, has paid special attention to the joint development of sustainable practice, which can be modelled and made available to people affected by trauma. MdM would like to support the creation of a Rwandan psychotherapist’s organisation which will be able to develop the momentum for a network and for advocacy in favour of care provision for post-genocide suffering.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Sahel

ALGERIA

MAURITANIA

Burkina Faso, Mali, Niger

Koro

Keita

(MALI)

GUINEA

(NIGER)

Djibo

(BURKINA FASO)

Improving access to primary healthcare

NIGERIA

life expectancy (yR) BF: 55.9 / M: 51.9 / N: 55.1 Hdi BF: 0.343 / M: 0.344 / N: 0.304 rank BF: 183 / M: 182 / N: 186 Source: UNDP 2013

POPULATION

»B eneficiaries: 334,175 » Target: 477,179

In November 2010, MdM established a regional project whose overall objective was to contribute to improving the state of health of populations in the districts of Keita in Niger, Koro in Mali and Djibo in Burkina Faso through improving geographical, physical and financial accessibility of basic healthcare. This project’s primary target was women of childbearing age and children under five years old. » Djibo (Burkina Faso), Koro (Mali) and Keita (Niger) districts

» background

» results

The objective of the programme, which ran from November 2010 to October 2013, was to improve access to primary healthcare for the populations in Djibo, Koro and Keita health districts. The project also aimed to improve the organisation of care and to encourage the health authorities to adopt new policies on access to care.

The referral system improved. The health authorities adopted new policies on access to care: free deliveries in Keita and free caesareans and deliveries in Djibo.

» activities The project activities were developed around the issues of sexual and reproductive health and tackling maternal mortality. The main lines of the work centred on improving access to care from both financial and geographical perspectives, improvement in the quality and organisation of services, and promotion of new health policies in favour of removing financial barriers to healthcare. Particular efforts have been devoted to the issue of referrals for medical evacuations, setting up systems involving local input, especially from the local councils, which should offer hope of a sustainable system.

funding

»E uropeAid, AFD

Budget

»2 013: €1,265,656

» outlook Consideration will be given to the best way forward with this programme. In addition, a concept note has been submitted to the European Union for Burkina Faso and Niger on the subject of SRH.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Somalia

DJIBOUTI

Bosaso ETHIOPIA

life expectancy Hdi NC rank NC

51.5 yrs

Source: UNDP 2013

POPULATION

Providing good quality mother and child health services

KENYA

»B eneficiaries: 200,000 » Target: 350,000

Puntland is faced with a massive influx of displaced people from the war zones of southern and central Somalia. This influx has recently increased owing to the drought in the Horn of Africa. Newly displaced people came to join the already overcrowded camps and created new ones, bringing the number to 33 in the town of Bosaso. Both the displaced people and the host populations have significant health needs. » Bosaso, Puntland region

» background MdM has been in Somalia since 2007. After the closure of the Merka project in 2011, exploratory missions were conducted in 2011 and 2012, which concluded that there was a lack of medical facilities capable of providing good quality services to displaced people (50,000 people) or to the local population in Bosaso. MdM is working in partnership with the Somalian NGO, Integrated Services for Displaced People (ISDP).

» activities MdM supports the maternity and surgical services at Bosaso General Hospital (BGH) and six mother and child health centres by providing medicines, equipment and medical supplies. The medical teams receive training. The Isino health centre provides a more comprehensive service for the general population and for women in particular, offering basic emergency obstetric and neo-natal care (BEmOC). A second health centre has been built and will offer the same services. A system has been set up for gynaecological and obstetric emergencies to be referred to BGH through the provision of an ambulance. In parallel, as part of the nutritional component, MdM delivers education sessions on nutritional health and distributes food rations to pregnant women, to breastfeeding women and to children under two years old. A system for referral of cases of severe acute malnutrition and a mecha-

funding

» Sternstunden Foundation, WFP, DFID

Budget

»2 013: €1,411,203

nism for screening and recording vulnerable and /or displaced people have been established.

» results 1,119 deliveries carried out. 377 caesareans. 12,752 antenatal consultations. 6,874 pregnant women vaccinated against tetanus. 30,835 children had nutritional screening.

» outlook Phase 3 of the project aims to build upon the activities conducted since 2011, by extending the range of services and their accessibility to a greater part of the population, and to prepare an exit strategy with handover to our partner ISDP.

International programmes » SUB-SAHARAN AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Tanzania

UGANDA KENYA

RWANDA BURUNDI

life expectancy Hdi 0.476 rank 152

58.9 yrs

Source: UNDP 2013

D.R.C.

Harm reduction amongst drug users

Dar es-Salaam

ZAMBIA

POPULATION

»B eneficiaries: 6,300 » Target: 12,000

MALAWI

In Tanzania (a real hot spot for heroin trafficking), injecting drug use is very widespread and, with that, the transmission of HIV (prevalence of 75.5% amongst injecting users) and hepatitis. Since 2010, MdM has been raising awareness of the health problems affecting people who use drugs and harm reduction at the national level. However, existing services remain limited, stigmatisation of drug users is still widespread and there are daily arrests by the police. » Dar es-Salaam

» background

» results

MdM has been working in Tanzania since 1992 and has helped to extend access to counselling and voluntary testing, prevention of motherto-child transmission and antiretroviral treatment. MdM launched harm reduction activities in 2010. The project targets people who use drugs and sex workers who are most affected by the HIV/Aids epidemic, and for whom no appropriate response is available in terms of prevention and care services.

4,200 drug users (and 2,000 sex workers) have used the services. 33 peer educators and over 3,000 stakeholders (of whom 1,630 are police officers) were trained and made aware of harm reduction. 37 women took part in revenue generating activities. 25,000 syringes and 18,000 condoms distributed every month.

» activities The reception centre offers preventive measures, screening for infectious diseases, sterile equipment, psychosocial activities and referral to health facilities. Education and communication tools are created by an editorial team made up of peers. The MdM bus still goes out to reach the most atrisk users. They are offered prevention material, but also screening, which also provides the opportunity to invite them to the centre. The resources and training centre has trained medical personnel working in partner healthcare facilities and interested NGOs not only in Tanzania but in other countries in Sub-Saharan Africa. Awareness has been raised amongst many stakeholders including politicians and members of governments. A national network of drug users (Tanpud), created in January 2013, is mobilised to educate peers, the general public and policy makers. Sources de financement

»A FD, Paris city council, Open Society Foundation, UNAIDS, UN-ILO, USAID, MdM

Budget

» outlook MdM and Mukikute, the Tanzanian NGO, will develop harm reduction activities throughout Dar es-Salaam, whilst still carrying out advocacy with other Tanzanian stakeholders on the question of mobilising funding. Civil society must also play its part by monitoring and promoting the rights of users, especially where the prevention of HIV and hepatitis are concerned.

»2 013: €639,444

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Colombia

PANAMA

VENEZUELA

Meta / Guaviare

Access to primary healthcare for rural populations affected by the armed conflict

Nariño ECUADOR

life expectancy Hdi 0.719 rank 91

73.9 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 18,000 »T arget: 50,000

PERU

Over the past five decades the civilian population in Colombia has suffered a serious humanitarian crisis (recruitment of boys and girls, kidnappings, forced disappearances, internal displacement, assassinations) due to the internal armed conflict. Colombia also suffers from natural disasters: floods, volcanic eruptions, drought, tsunamis and earthquakes.

» Meta, Guaviare and Nariño districts

» background

» results

MdM launched its activities in 1990 with projects working with the indigenous Apaporis population and street children in Bogata. In 2004, MdM turned its attention to mother and child health and primary healthcare including sexual and reproductive health, monitoring children’s growth and development, tropical diseases, general medicine and genderbased violence linked to the conflict, as well as psychosocial support.

24,000 medical consultations. 2,500 sexual and reproductive health consultations. 2,100 psychological consultations. 300 victims of violence supported. 120 health promoters trained.

» activities

» outlook

MdM deploys mobile clinics in Meta, Guaviare and Nariño departments, at the heart of communities badly affected by the conflict. In Nariño, territory of the indigenous Awas, MdM works closely with the health service which is managed by the local UNIPA organisation. In each of the three areas, MdM teams offer primary healthcare (vaccinations, nutritional monitoring, antenatal consultations, family planning, diagnosing cases of malaria and tuberculosis...); with particular attention to women of childbearing age, to children under five years old and to victims of violence and their families. MdM’s involvement also includes prevention activities and health promotion, strengthening local capacities through training community leaders and providing psychosocial support services. There is also active lobbying of decision-making bodies in Bogota to ensure that public policies are applied.

MdM will continue to support populations affected by the armed conflict. In the context of the current peace talks, the strategy of emergency intervention will shift to one of support for the public health system. However, this new approach is not likely to happen in the immediate future since the security situation still prevents people from having access to the state health service.

funding

»C IDA, ECHO, WHO, UNICEF, MdM

Budget

»2 013: €1,317,575

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Guatemala

BEL LIIZE MEXICO

Access to sexual and reproductive rights for women working in export industries

life expectancy Hdi 0.581 rank 133

71.4 yrs

Source: UNDP 2013

Escuintla

HONDURAS

SALVADOR

POPULATION

»B eneficiaries: 6,500 » Target: 7,500

Since 2006, MdM has been striving to promote respect for the rights of women working in the many export companies and farms in Guatemala. As well as the difficulties that the women have in asserting their health rights, there are serious taboos around the body and sexuality. Consequently, many women are unaware of their rights and are unable to access sexual and reproductive health services. » Escuintla district

» background

» results

MdM has been in Guatemala since 1987, originally working on primary healthcare projects, with a focus on training health promoters from internally displaced populations. Since 1993 MdM has supported refugees returning to their lands from Mexico. Since 2006, the organisation has supported access to sexual and reproductive healthcare for women working on fincas and in maquilas.

798 women had medical treatment in the women’s health centre at Escuintla. 1,895 medical consultations completed by MdM. 59 women trained and their knowledge of SRH enhanced. 495 women took part in SRH education sessions in their communities.

» activities

MdM is closing this project at the end of 2013 and hopes to continue promoting sexual and reproductive rights for the women of Escuintla. In 2014, an exploratory mission will be organised to assess the country’s strategic direction.

MdM organises medical consultations on sexual and reproductive health (SRH) in export and farm businesses. A medical service for workers is provided every Sunday in MdM’s premises. Health promoters are trained and supported to spread the word to their communities on health, employment law, and human rights. Awareness of the difficulties experienced by workers when trying to access healthcare has been raised amongst professionals in administrative bodies and women who suffer from violence are identified, supported and directed to suitable services.

funding

»A FD, MdM

Budget

»2 013: €210,996

» outlook

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Haiti

BAHAMAS

life expectancy Hdi 0.456 rank 161

CUBA

62.4 yrs

Source: UNDP 2013

Response to the cholera epidemic

Grande Anse

DOM. REP.

POPULATION

»B eneficiaries: 11,574 »T arget: 438,654

Grande Anse is amongst the areas worst affected by the cholera epidemic, with the second highest death rate in the entire country since the start of the epidemic. In 2013, there were 4,920 cases of cholera, compared to 3,060 in 2012. There are still significant capacity issues regarding management of the epidemic in health facilities. The district was badly affected by outbreaks during the 2013 hurricane season. » Grande Anse

» background

» results

Since the start of the epidemic in 2010, MdM has been dealing with cholera. The project undertaken in 2012, for developing health management and supporting the response to cholera, has helped to provide support for the department’s epidemiological monitoring service, to facilitate a rapid response and to reduce the risk of peaks when outbreaks occur. MdM teams came to the assistance of the Ministry of Health facilities in case of emergencies or epidemic peaks, via a mobile team working throughout the district.

9,676 educated about cholera. 4,920 patients hospitalised, of which 1,898 were treated directly by MdM.

» activities In 2013, MdM continued its work supporting the response to cholera and assisting local health actors to provide integrated and high quality treatment in health facilities. Throughout the department, epidemiological monitoring and care have been enhanced through on-going training of health personnel, the mobilisation of community networks and close coordination with health management. Supervision carried out by the mobile emergency team, deployment of medical personnel to support health facilities in case of peaks as well as logistics support to deliver supplies, enabled the speed and quality of care to improve and a limiting of infection risk on the sites.

funding

»A FD, OCHA, ECHO, UNICEF, WHO, MdM Spain, Caritas, French embassy, MdM

Budget

»2 013: €51,806

» outlook In 2014, MdM hopes to renew the action carried out in consortium with MdM Belgium and MdM Spain in 2013, based on three strengthened areas: a monitoring system to trigger early and systematic alerts (especially in isolated areas), a coordinated rapid response system with water and sanitation specialists, as well as an emergency team of carers and hygienists available for interventions in case of outbreaks.

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Haiti

BAHAMAS

life expectancy Hdi 0.456 ranK 161

CUBA

62.4 yrs

Source: UNDP 2013

Grande Anse

Reducing mother and infant mortality and morbidity

DOM. REP.

POPULATION

»B eneficiaries: 60,015 » Target: 142,601

Between 2005 and 2012, the infant mortality rate fell from 68 to 59 for every 1,000 live births and overall acute malnutrition amongst children under five years old fell from 9% to 5%. Nevertheless, the situation of the population in Haiti remains a concern: 47% of the population still has no access to healthcare, only 18% of women of childbearing age have access to modern methods of family planning and only 25% of deliveries are in a health facility. » Grande Anse

» background

» results

MdM has supported the health authorities of the extremely isolated Grand Anse district since 2006, in order to improve access to healthcare for the most vulnerable and, in particular, to guarantee free healthcare for pregnant women and children under five years old. This intervention has enabled the implementation of various measures in primary health, sexual and reproductive health and in nutrition, as well as emergency response to disasters affecting the district and the rest of the country.

48,611 general consultations for women and children under five years old completed. 25,318 children screened for acute malnutrition and, of these, 463 severe cases were treated. 673 deliveries in medical facilities.

» activities The activities concerned the whole continuum of care: establishing a network of community stakeholders to strengthen links with health facilities, on-going training of healthcare providers, support for the care of cholera patients, renovation of healthcare facilities, provision of equipment and materials etc. MdM has also worked on advocacy in favour of the adoption and implementation of free healthcare for pregnant women and children under five years old as part of the national health policy. Although this free access is featured in the plans announced by the Haitian government, the resources needed to achieve this are sadly lacking and rely heavily on financial support from outside.

international Delegation

» Belgium, Spain, Argentina, Switzerland, Canada

funding

»A FD, OCHA, ECHO, UNICEF, WHO, MdM Spain, Caritas, French embassy, MdM

» outlook In 2014, Doctors of the World plans to reinforce its work with Haitian civil society so that it can play an active role in the process of changing the health system and in lobbying the health authorities on access to healthcare. An exploratory mission on this is being considered for early 2014.

Budget

»2 013: €1,215,535

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Mexico

UNITED STATES

life expectancy HDI 0.775 ranK 61

77.1 YRs

Source: UNDP 2013

Huixtla / Tapachula

Access to sexual and reproductive health for migrant women

BELIZE

POPULATION

»B eneficiaries: 4,041

GUATEMALA

Every year, around 40,000 Central American migrants arrive in Mexico. Not all migrant women continue on the route to the north, with some staying for a while in the Soconusco region of Chiapas, especially in Tapachula and Huixtla. They are domestic workers or sex workers in bars, often in very precarious situations.

» Chiapas state, Soconusco, Tapachula and Huixtla region

» background

» results

MdM set up its first mission in Chiapas state in 1994. Between 1998 and 2000, MdM worked there on several projects with displaced people. From 2002 onwards, MdM developed training programmes aimed at health workers and has supported the community-based health system to improve access to care for indigenous populations. Since 2010, in partnership with the Fray Matias organisation, the association has developed a programme for improving access to sexual and reproductive healthcare for sex workers and domestic workers.

1,812 migrant women took part in awareness workshops and 3,344 had awareness raising and advice visits. 1,025 sex workers and 209 migrant women were directed to health centres. The local authorities were made aware of the issued faced.

» activities Since January 2011, MdM has run awareness campaigns in Soconusco region, for female migrant sex workers or domestic workers, on sexual and reproductive health, violence, addiction and self esteem. These women are referred to health centres for preventive and curative care. For the most vulnerable, physical accompaniment to these services is provided. Furthermore, MdM trains health professionals to raise awareness of the problems faced by this marginalised population, to respect their rights and especially to promote migrant women’s right to health.

funding

»A FD, MdM

Budget

»2 013: €231,367

» outlook MdM will further develop its training, supervision and advocacy with the administrative and health authorities of Chiapas, so that the rights of migrants are given better consideration in health policies.

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Nicaragua

HONDURAS

Puerto Cabezas

LIFE EXPECTANCY HDI 0.599 ranK 129

74.3 YRs

Source: UNDP 2013

POPULATION

Improving sexual and reproductive health

COSTA RICA

»B eneficiaries: 17,600 »T arget: 67,000

Puerto Cabezas is the capital of the North Atlantic Autonomous Region. It is one of the poorest and most vulnerable regions of Nicaragua, where the health indicators are amongst the worst in the country, particularly with regard to sexual and reproductive rights for women of all ages. The current project aims to improve sexual and reproductive health of people from 27 communities in Puerto Cabezas. » Puerto Cabezas, North Atlantic Autonomous Region (RAAN in its Spanish acronym)

» BACKGROUND

» rEsults

MdM has been working in this region of Nicaragua since 1987. The early projects were developed around primary healthcare, training of health promoters and capacity building. Then, between 2006 and 2010, the focus was domestic and sexual violence and, latterly, rights and sexual and reproductive health.

The following people received training: –– 58 traditional midwives and 25 community health leaders; –– 54 teenagers and young people in rural areas; –– 135 female health promoters; –– 15 nurses; –– 49 school counsellors; –– 30 young men from the Bilwi urban area; –– 108 community and religious leaders.

» activitIEs The main focuses of the project are training on sexual and reproductive rights, sex education, prevention of gender-related violence, tackling gender stereotypes through engaging with groups of men, etc. The training is aimed at teenagers, women and men who are district and community leaders, school counsellors, community health workers and health personnel in 27 communities.

funding

»J unta de Andalucía, MdM

Budget

»2 013: €110,478

» OUTLOOK Now that training is completed and the capacity of local partners enhanced, MdM has decided to withdraw from the project. Partner organisations will continue to provide training for groups of beneficiaries on sexual and reproductive rights.

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Peru

ECUADOR

COLOMBIA

BRAZIL

life expectancy Hdi 0.741 rank 77

74.2 yrs

Source: UNDP 2013

Lima

Reducing mortality and morbidity caused by unwanted pregnancies

POPULATION

BOLIVIA

»B eneficiaries: 31,500 »T arget: 126,000

Many women, especially the most vulnerable, are affected by unwanted pregnancies and illegal abortions. MdM supports the health authorities with the aim of improving access to prevention and management of unwanted pregnancies. Working alongside civil society, the association lobbies in favour of a protocol for therapeutic abortion, free distribution of emergency contraception and the legalisation of abortion in case of rape. » Villa El Salvador, outskirts of Lima

» background

» results

MdM began its activity in Peru at the end of the 1980s by tackling the major pandemics. Between 2006 and 2010 MdM ran a sexual and reproductive health project with teenagers in three districts of south Lima. Since 2013, MdM has developed a project on prevention and management of unwanted pregnancies in Villa El Salvador on the outskirts of Lima. This project facilitates women’s access to health services and to information, so that they can exercise their right to free choice in matters of reproduction.

130 health professionals trained in obstetric emergencies, including incomplete abortions. 75 community health workers trained in SRH. 2,500 women educated about prevention and treatment of unwanted pregnancies.

» activities Agreements have been signed with the Ministry of Health to strengthen the training of health personnel in the prevention and management of unwanted pregnancies, including the management of incomplete abortions, to improve training community workers in sexual and reproductive health and facilitate access to information on unwanted pregnancies in the district. MdM has also contributed to the supply of essential medical equipment in three health centres, to avoid the referral hospital being overwhelmed. Working with organisations from civil society, MdM participated in the drafting of an alternative report on ‘Cairo+20’, and conducted field research on the use of Misoprostol (a drug used for abortions) in the treatment of unwanted pregnancies.

funding

»M dM

Budget

»2 013: €170,084

» outlook MdM intends to support the work of health personnel in the management of incomplete abortions and post-abortion counselling. They will also support health promoters working in the field of SRH and civil society organisations striving for the legalisation of abortion following rape and for the adoption of national guidelines on therapeutic abortions. Furthermore, the association hopes to create a network of ‘safe’ pharmacies through training pharmacists in the correct use of Misoprostol and in good practice in case of complications.

International programmes » LATIN AMERICA AND CARIBBEAN

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Uruguay

ARGENTINA BRAZIL

life expectancy Hdi 0.792 rank 51

77.2 yrs

Source: UNDP 2013

POPULATION

Access to good quality sexual and reproductive health services, including abortions

Montevideo

»B eneficiaries: 96,547 »T arget: 359,100

In the context of a region notable for its lack of recognition of sexual and reproductive rights, Uruguay is distinguished by the recent passage of two laws providing for sexual and reproductive health services, including pregnancy termination, throughout the country. This progressive legal framework has just been put in place but is faced with difficulties both from political opposition and from health professionals. » The entire country

» background The programme started in 2010 by supporting the work of two partners: Iniciativas Sanitarias, an organisation of health professionals and Mujer y Salud en Uruguay (MYSU), a feminist organisation. Since 2012, pregnancy termination has been decriminalised: one of the tangible results of advocacy conducted by our partners. In 2013, the programme focused on maintaining our support for our partners by providing a telephone helpline.

» activities Enhancing the skills of health personnel: –– four workshops to raise awareness on pregnancy termination, –– three training days on pregnancy termination and two national meetings on sexual and reproductive health, –– monitoring and computerisation of data on the SRH service in the largest public hospital in Montevideo Informing and raising awareness in the population: –– two days of raising awareness on SRH. –– two leaflets aimed at women, explaining the practicalities of pregnancy termination.

funding

»M dM

Budget

»2 013: €256,541

Advocacy: –– three days of the coalition for sexual and reproductive rights, with over 167 public organisations, –– campaign against the referendum aimed at overturning the law allowing pregnancy termination, –– a study on the experiences of women with access to SRH services and pregnancy termination, –– production of a web documentary entitled Free to choose on clandestine abortions.

» results 100 health personnel trained. 152 health professionals trained in terminations. Six awareness raising kits on sexual and reproductive rights produced. 139,200 visits to MdM and partner websites.

» outlook Mujeres en el Horno, a telephone hotline will be launched to provide information and support to women. Awareness raising and training of personnel by our partner, Iniciativas Sanitarias, will be stepped up. MYSU will coordinate a platform of social organisations in a campaign for sexual and reproductive rights.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Afghanistan

UZBEKISTAN TURKMENISTAN

TAJIKISTAN

Kabul IRAN

Harm reduction amongst people who use drugs

life expectancy Hdi 0.374 rank 175

49.1 yrs

Source: UNDP 2013

POPULATION

PAKISTAN

»B eneficiaries: 95 »T arget: 120,000

Afghanistan, the world’s biggest producer of opium, has 1.5 million drug users in a population of 35 million. Drug use in general, and the use of opiates in particular, has increased exponentially over the last 10 years, both in the cities and in rural areas. Heroin injection, which affects around 120,000 people, is a major vehicle for the transmission of HIV/Aids and viral hepatitis.

» Kabul

» background Between April 2006 and September 2013, MdM has been running a harm reduction project in Kabul as part of the national fight against HIV/ Aids. On one hand, the projects offers drug users access to care and on the other hand it promotes harm reduction on a national level. The first antiretrovirals in the country were prescribed to drug users in April 2009 and the first opiate substitution treatment (methadone) was offered in partnership with the health authorities in 2010.

» activities In 2013, we handed over some of the project activities to a local association, Afghan Family Guidance Association (AFGA), particularly the drop-in center and the outreach team services. In parallel, MdM is strengthening AFGA’s staff capacity in terms of methadone prescription and distribution, as well as continuity of care to drug users. In February 2013, three years after the first methadone prescription in MdM’s centre, the Ministry of Health announced the extension of the subsitution treatment to 850 drug users throughout the whole of the country (350 in Kabul, of which 200 as part of the MdM project). Despite the Ministry of Health’s genuine intention to extend access to methadone treatment, the process keeps facing significant political resistance which means that only a limited number of drug users have access to treatment in practice.

funding

»G lobal Fund, World Bank, French embassy, MdM

Budget

» results 60 drug users are receiving substitution treatment.

» outlook MdM has successfully handed over the project activities to AFGA, as well as transferring the leftover methadone stock to the health authorities. It officially withdrew from the project in September 2013. The methadone distribution was taken over by another Afghan NGO, OTCD in November 2013, following a decision from the Ministry of Health. In 2014, Doctors of the World will keep one office and one employee in Kabul, in order to monitor how the current situation develops. MdM wants to maintain its presence in the country and plans an exploratory mission for the second half of the year.

» 2013: €176,779

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Burma

CHINA INDIA BANGLADESH

Kachin State LAOS

Prevention and care for displaced people

THAILAND

life expectancy Hdi 0.498 rank 149

65.7 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 11,000 »T arget: 70,000

In June 2011, at the same time as the government began a process of democratic transition, the civil war between the Burmese army and the Independent Army of Kachin resumed in the north of the country, after a 17-year cease fire. More than 90,000 people displaced by the conflict live in makeshift camps. MdM is setting up a programme to support primary healthcare for the most vulnerable populations. » Kachin State

» background

» outlook

MdM has been in the Kachin state since 1996 with a HIV project. In May 2013, as fighting decreased, MdM proposed to care for displaced people in the region, in partnership with the Italian NGO Cesvi, which specialises in water supplies and sanitation in refugee camps,

In 2014, the project will train health workers who work in health centres. These training activities will make the local actors more autonomous and will ensure the sustainability of the project once it is handed over in mid 2014. MdM will monitor this region via its involvement in the harm reduction project in Kachin state.

» activities MdM supports several health centres in the camps along the border between Burma and China, in partnership with local partners. MdM helps with drug supplies, the rehabilitation of health centres and the cost of healthcare and transport to hospitals in the region in emergency cases. When needed, MdM teams in collaboration with health staff, provide general, ante and postnatal consultations, as well as minor surgical operations.

» results 8,687 consultations carried out. 3.5 tonnes of drugs were sent to the health centres of seven IDP camps. 7 health centres refurbished.

funding

»E uropeAid, USAID, Global Fund, UNOPS, WFP, ECHO, UNFPA

Budget

» 2013: €132,234

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Burma

CHINA INDIA

life expectancy Hdi 0.498 rank 149

BANGLADESH

LAOS

Strengthening community health systems

Pyapon

THAILAND

65.7 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 265,718 »T arget: 313,642

The coastline of the Irrawaddy delta was badly affected by cyclone Nargis in May 2008. Approximately 140,000 people died and 450,000 houses and 630 health centres were destroyed. To this day, 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. » Payapon Township

» background

» results

Following cyclone Nargis in May 2008, MdM responded to the urgent situation in Payapon township. In 2009, primary healthcare activities were developed to strengthen the work done by community workers and village health committees. First covering 99 villages, the project extended in 2010 to 137, therefore reaching around 145,000 inhabitants. From March 2011, new activities were set up in order to strengthen access to ante- and postnatal care and to support births with qualified health professionals. The project was taken over by MdM Netherlands in May 2012 and handed back to MdM France in June 2013.

50 auxiliary midwifes and 50 community health workers trained. 60 fisherfolk trained in first aid. Implementation of a referral system which removes financial barriers to access to healthcare.

» activities MdM is working in 232 villages that have no healthcare facilities in order to train community health workers. MdM manages a network of community health workers, as well as of village health committees spread out all over Payapon. In collaboration with the local employees from the Ministry of Health, MdM monitors the health situation and develops training in health education, with a focus on maternal and child health.

funding

»E uropeAid, USAID, Global Fund, UNOPS, WFP, ECHO, UNFPA

Budget

» 2013: €454,514

» outlook In partnership with five other international health NGOs, each of them providing care in other townships, this project takes place as part of a wider support to the Ministry of Health in its policy of decentralisation. By providing technical and logistical support, the aim is to ensure each township is managing its own health system by 2016.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Burma

CHINA INDIA BANGLADESH

Kachin State LAOS

Yangon

Prevention and treatment of STIs and HIV/Aids

THAILAND

life expectancy Hdi 0.498 rank 149

65.7 yrs

Source: UNDP 2013

POPULATION

»B eneficiaries: 19,643 »T arget: 179,000

Despite the recent transition to democracy, Burma still faces important challenges. The government has under-invested in health, with disastrous consequences. Today, the country is currently experiencing one of the largest Aids epidemics in South-east Asia, with nearly a third of people who use drugs or sex workers infected with HIV. Almost 60,000 people who are in urgent need of antiretrovirals do not have access to treatment. » Kachin state and Yangon

» background MdM made its first contact in 1991. Following a few sporadic missions, Kachin state was identified as a zone which required intervention due to the fact that there were many intravenous drug users. The project started in 1996 with prevention activities. In 1998, a similar project was set up in Shan state and then closed in 2000, following the start of activities in Yangon with male and femaie sex workers. Over time, the project evolved towards providing comprehensive care for those suffering from HIV/Aids, providing prevention and treatment services.

» activities MdM is providing medical, psychological and social support to people who use drugs. The teams include health professionals and peer educators drawn from the affected communities. MdM also runs three clinics in Kachin State and another one in Yangon. The clinic services range from health education to provision of condoms or distribution of sterile syringes, as well as HIV and hepatitis testing and antiretroviral treatment. MdM also offers social activities (aimed, for example, at re-establishing self-esteem), provides legal advice, and even provides access to methadone substitution treatment.

funding

»E uropeAid, USAID, Global Fund, UNOPS, WFP, ECHO, UNFPA

Budget

MdM has succeeded in forging strong links, not only with community and civil society organisations, but also with the health authorities. Today, MdM is recognised as a major player in harm reduction in Burma.

» results 1,557 people on antiretrovirals. 680 drug users on methadone.

» outlook MdM must continue to contribute to advances in methadone substitution, to strengthen prevention and care for those suffering from hepatitis C, to support the development of local community players and involve drug users in prevention activities. MdM is involved with a national process aimed at strengthening the capacity of the Ministry of Health to provide antiretroviral treatment.

» 2013: €1,377,920

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Georgia

RUSSIA AZERBAÏJAN

Tbilisi

life expectancy Hdi 0.745 rank 72

73.9 yrs

Source: UNDP 2013

POPULATION

Harm reduction amongst people who use drugs

ARMENIA TURKEY

»B eneficiaries: 1,185 »T arget: 4,100

For many years, the population of Georgia has had a high prevalence of drug consumption. The country has around 45,000 intravenous drug users (IDUs), of whom around 27,000 are in Tbilisi. Between 70% and 90% of them could be infected with hepatitis C. In order to tackle the epidemic, MdM is working on a harm reduction programme.

» Tbilisi

» background

» results

MdM has been in Georgia since 2004. In 2007 and 2008, two exploratory missions provided MdM with a better understanding of the Georgian context and the evolution of drug use practices. MdM decided to set up a harm reduction project by supporting a local drug users’ association, New Vector. MdM also established a close partnership with the Georgian harm reduction network, and MdM is involved in training and advocacy activities.

1,678 users have benefited from MdM or New Vector services. 494,366 syringes distributed. 812 medical consultations. 1,232 dental consultations. 103 psychological consultations. In 2013, 60% of the total number of tested individuals were infected with hepatitis C.

» activities

» outlook

MdM has continued to support the association New Vector with the management of a drop-in centre which offers users a wide range of harm reduction services: sterile equipment, screening and medical and dental consultations. The teams also do outreach work to provide sterile equipment and to spread the word on prevention. The results of the hepatitis C survey carried out in October 2012 were published and are used to support the lobbying activities. As the project is entering a new phase, MdM has developed a strategy which aims to strengthen the partner’s expertise in technical knowledge, management and administration, in order to facilitate the handover in three years time.

In 2014, MdM will develop a strategy which aims to strengthen New Vector’s capacity. It will also continue to lobby for access to hepatitis C treatment and the decriminalisation of drug users.

funding

»A FD, MdM

Budget

» 2013: €375,633

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

India

CHINA

NEPAL

BHUTAN

Andrah Pradesh

life expectancy Hdi 0.554 rank 136

65.8 yrs

Source: UNDP 2013

BANGLADESH POPULATION

Improving access to primary healthcare for displaced tribal populations

»B eneficiaries: 2,104 »T arget: 2,104 SRI LANKA

The naxalite conflict takes place across several states in India and particularly affects the tribal populations of Chhattisgarh, who as a result seek refuge in the neighbouring state of Andhra Pradesh. When they cross the border, the displaced persons lose some of their rights, become victims of discrimination, do not speak the local language, and settle in very isolated camps where access to healthcare is really difficult. MdM contributes to improving access to healthcare for those displaced tribal populations by strengthening existing services. » Andhra Pradesh state, Khammam district

» background

» results

Following a needs assessment carried out at the end of 2012, MdM started in June 2013, with funding from ECHO, its first programme in Andhra Pradesh in partnership with Indian partner NGO, Sitara. MdM’s objectives are to strengthen the Indian partner’s capacity and autonomy. The agreed strategy is to lobby the health authorities to improve access to healthcare for the displaced tribal populations, who are particularly vulnerable.

123 mobile clinics organised. 2,016 consultations completed.

» activities Since the teams have been recruited and the base was opened in June, two mobile clinics visit 17 targeted villages twice a month in in order to provide primary healthcare to displaced tribal populations. MdM and Sitara teams also liaise with local health structures so that more serious conditions and pregnant women are appropriately referred to Indian mainstream health services. MdM and Sitara support the health authorities to provide better care to these IDPs and to understand their specific needs better. An anthropological study which was carried out at the beginning of the programme helped to better understand these populations and ensured that appropriate means of communication were used.

funding

»E CHO, MdM

Budget

» 2013: €162,155

» outlook Community health workers from within the target population joined the programme to raise awareness and to facilitate the referral of patients. In 2014, malaria will become the priority: prevention, awareness raising and care. Advocacy work and the development of relations with the authorities will help to improve access to healthcare and mainstream health services for displaced tribal populations.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

India

CHINA

NEPAL

BHUTAN

Jaïpur

life expectancy Hdi 0.554 rank 136

65.8 yrs

Source: UNDP 2013

BANGLADESH POPULATION

»B eneficiaries: 3,000 »T arget: 5,000

Mother and child health SRI LANKA

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. To tackle this problem, MdM set up a programme which aims to improve access to care for mothers and children in 11 slums of Jaipur.

» Jaipur, Rajasthan

» background

» results

Started in 2007, the mother and children health programme is supported by the Midi-Pyrénées delegation in partnership with JKSMS in 11 slums of Jaipur in Rajasthan. The main objectives are to improve access to care for mothers and children and to educate the population about health and basic practices to take care of one’s health.

In 2013, 76% of women benefited from three antenatal visits, compared with only 20% in 2007.

» activities MdM, in collaboration with its Indian partner JKSMS, finalised the training of 40 community health workers from the slums. As a result, in 2013, more than 90% of the programme activities, which were previously organised by social workers from JKSMS, are now run by community health workers. Beneficiaries now have ownership of the programme. Most of the slum inhabitants are informed about their rights, especially in relation to health. The slum population knows which mainstream health services they can go to and that they can ask the help of community health workers when they have health problems. They acknowledge the legitmacy and the role of community health workers as necessary health mediators, facilitating access to mainstream services.

funding

»E CHO, MdM

Budget

» 2013: €82,272

» outlook In order to finalise the handover of its activities to communities and civil society, MdM will continue to support its Indian partner JKSMS, in order to convince the Jaipur authorities to take over all or part of the programme.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

India

CHINA

NEPAL

BHUTAN

life expectancy Hdi 0.554 rank 136

65.8 yrs

Source: UNDP 2013

Orissa BANGLADESH

POPULATION

»B eneficiaries: 23,900 »T arget: 83,500

Access to primary healthcare SRI LANKA

MdM’s project in Orissa takes place at the borders of the ‘Indian red corridor’, territory under control of naxalites, an Indian Maoist rebel movement. The tribal populations in rural areas are particularly vulnerable and health indicators have worsened. The rates of infant and maternal mortality are well above the national average.

» Kalahandi District, Orissa State

» background

» results

Since 2011, MdM and the Voluntary Health Association of India (VHAI), a federation of health NGOs that are present in each Indian state, are working with the Orissa state government to develop a programme of access to primary healthcare in six public health facilities. The main objective is to contribute to an improvement in the rural population’s health and to re-establish and promote the provision of healthcare.

12,723 primary healthcare consultations.

» activities The project activities consist of training the medical staff, providing health promotion sessions (especially on sexual and reproductive health) to the communities, and medical consultations. The main community health centre was rehabilitated and MdM is lobbying the district and the State to raise awareness about the poor living conditions of tribal and marginal populations.

funding

»M dM

Budget

» 2013: €103,987

» outlook MdM’s work in Orissa has been extended for another year in order to anchor its advocacy work and to ensure the sustainability of the project activities. In 2014, VHAI handed over the operational management to its regional office, Orissa Voluntary Health Association (OVHA).

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Laos

CHINA VIETNAM BURMA

life expectancy Hdi 0.543 rank 138

67.8 yrs

Source: UNDP 2013

THAILAND

Pilot programme for safe motherhood

Champassak

POPULATION

»B eneficiaries: 41,950

CAMBODIA

Despite the significant increase in public expenditure devoted to healthcare (increasing from 4.1% to 9% of the total budget) the health situation in the People’s Democratic Republic of Laos is extremely worrying. The rate of maternal mortality remains one of the highest in South-east Asia, 405 out of 100,000 births. The Millennium Development Goals aim to reduce this rate to 185 out of 100,000. In the districts concerned, 80% of women give birth at home, mostly without medical assistance. » Champassak Province, Soukhouma, Mounlapamok, Khong and Champassak districts

» background The project started in April 2011 in two districts in the south of the country. MdM rehabilitated 10 health centres and two hospitals, trained community midwives, volunteers and health workers, and abolished user fees for pregnant women. The second phase of the project, in partnership with MdM Japan, started in October 2012. It includes two new hopsitals, providing support for urgent obstetric care and activities to prevent mother-to-child transmission of HIV/Aids.

» activities The programme aims to reduce the maternal and infant mortality rate during childbirth and for children under five years old. The project activities ensure that pregnant women benefit from pregnancy care of high standards and that births are attended by qualified medical staff. In collaboration with the Laos Red Cross, the project also ensures that those services are free to access (through the provision of health cheques) and that the lack of financial means is not a barrier to access quality care. Cheques are given out by volunteers in villages and cover anteand postnatal care, birth, and any pregnancy-related complications. It also includes non medical services such as transport to health centres to give birth or when any obstetric complication arises.

international delegation

»M dM Japan

funding

»A FD, MdM

At the beginning of 2013, the project activities were extended to children under five years old which meant that families could also benefit from access to free healthcare for their children.

» results Institutional birth rate: 22%, equivalent to 822 births in the health centres. 2,257 first antenatal consultations; 89% of these consultations were received by the means of the cheques which were given out. 910 postpartum consultations (within six weeks of delivery). 9,318 free consultations for children under five years old. 110 health educators, on average, at each of the six training courses organised.

» outlook The project, in partnership with the Ministry of Health, will develop training in urgent obstetric and neonatal care for the medical staff in hospitals. It will also strengthen health promotion to continue to educate about the importance of medical follow-up. Finally, it will consolidate the system for referrals to mainstream health services in terms of medical, administrative and financial aspects.

Budget

» 2013: €439,673

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Nepal

CHINA

Sindhupalchok

life expectancy Hdi 0.463 rank 157

69.1 yrs

Source: UNDP 2013

POPULATION

Improve access to, and use of, sexual and reproductive health services

»B eneficiaries: 28,000 »T arget: 58,000

INDIA BANGLADESH

In recent years, Nepal has made significant progress in the field of sexual and reproductive health: maternal mortality was reduced by almost 60% between 2001 and 2010, and infant mortality by almost two thirds. However, cost and difficult access to sexual and reproductive health services are a major obstacle for many of the women from the isolated communities of the mountainous regions. » 10 cantons of Sindhupalchok district

» background Since 2007, Doctors of the World has been working mainly with women of childbearing age in the remote communities of Sindhupalchok district. The objective is to increase the use of public sector sexual and reproductive health services and to reduce factors contributing to maternal and neonatal mortality. Women are helped to realise the importance of having access to health services and improve their financial independence through better management of the family budget, anticipation of expenditure on health and access to emergency obstetric funding.

» activities Doctors of the World’s project intends both to ensure that good quality health services are available at the community level (renovation and equipping of health facilities, training of health personnel, referrals) and to support women by improving their ability to access healthcare. The originality and sustainability of the project lies with the involvement of women in microfinance activities, and in education sessions on prevention and management of pregnancy, childbirth and postnatal care. MdM is working with two national organisations: CEDCF looks after operations and CMF provides technical support in terms of microfinance. MdM has also forged close links with Planet Finance, which shares its expertise in microfinance through training, evaluation and advice.

funding

» Sanofi Foundation, MdM

Budget

» 2013: €310,912

In 2013, MdM took part in the renovation of two additional health structures in the district and ensured the ongoing training of 33 health workers.

» results 4,600 women participated in health education and microfinance sessions. 85 women accessed the obstetric emergency fund. 400 women gave birth in 10 health centres supported by MdM.

» outlook The project will end in June 2014. A KAP (knowledge, attitudes and practices) survey will be carried out in April-May. MdM plans to continue its activities with women who live in the isolated villages of Sindhupalchok district.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Pakistan Medical assistance for victims of crisis

TAJIKISTAN

CHINA

life expectancy Hdi 0.515 rank 146

KPK AFGHANISTAN

65.7 yrs

Source: UNDP 2013

POPULATION

IRAN INDIA

»B eneficiaries: 135,000 »T arget: 300,000

Khyber Pakhtunkhwa Province (KPK) is a place of refuge for constant waves of people who are running away from the fighting between insurgents and the Pakistani Army or between rival groups within the tribal areas at the border with Afghanistan. In 2013, the number of displaced persons was estimated at 1.5 million in KPK. Healthcare services cannot cope with the rising needs. Malnutrition (17%), maternal mortality (380/100 000) and infant mortality (87/1 000) rates in the province are terribly alarming. » Khyber Pakhtunkhwa Province (KPK)

» background

» outlook

In 2009, following the massive population displacements from the Swat valley, MdM started a programme of access to primary healthcare for the most vulnerable, especially women and children, in two KPK districts. Since then, MdM has re-directed its teams and activities in seven other districts in the province to respond to additional needs of the IDPs in terms of access to healthcare, following recent conflicts in the tribal areas, flooding and cholera epiemic.

In 2014, MdM will continue to offer primary healthcare to the displaced populations in the KPK and will respond to possible emergencies.

» activities MdM medical teams support healthcare facilities in the districts by providing medical and sexual and reproductive health consultations, improving immunisation cover, screening children for malnutrition and dispensing health promotion sessions. MdM also trains heathcare staff, provides stocks of drugs and ready-to-use therapeutic foods and ensures patients are referred to mainstream health services when needed. In 2013, MdM repeated its work in Kohat district following a wave of incoming IDPs (80,000 people in total of which 40,000 are based in Kohat) and set up a base at Peshawar. MdM also provided support to new healthcare facilities, especially those which are isolated and closer to tribal areas (Tank and Thali).

funding

»D anish embassy, MOFA, ECHO

Budget

» 2013: €1,057,321

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Pakistan Support for women affected by domestic violence

TAJIKISTAN

CHINA

life expectancy Hdi 0.515 rank 146

AFGHANISTAN

65.7 yrs

Source: UNDP 2013

Punjab IRAN

POPULATION

»B eneficiaries: 20,000 INDIA

Assaults against women, particularly domestic violence remain a tragic reality in Pakistan. In 2011, 8,539 cases of gender-based violence were recorded in the whole country and 6,188 of these were in Punjab province alone. Despite the announcement of legislation in favour of women’s rights in March 2011, and the adoption by the Senate of a bill against domestic violence at the end of 2011, there is still no effective legal framework to protect women against such violence. » Punjab Province

» background

» results

Since 2004, MdM supports the Punjabi Department of Social Affairs by improving treatment of women — and their children — who left home as a result of domestic violence and who have found refuge in one of the 35 Dar ul-Aman of the province.

16,000 women seen in the Dar ul-Aman. 4,200 children seen in the Dar ul-Aman.

» activities Mid-2011, MdM handed over the project to the Punjab authorities and now focuses its activities on consolidating the skills of staff working in the Dar ul-Aman and the Department of Social Affairs. The aim is to ensure the long-term viability of the multidisciplinary services which are offered and the respect of the minimum standards and of the management tools which were developed. MdM is also a member of the Mumkin platform which brings together 21 Pakistani associations for the defence of women’s rights, and was an active player in the advocacy campaign which led to the adoption of a new national legislation against domestic violence which was voted by the Punjab Senate at the end of 2011.

funding

»D anish embassy, MOFA, ECHO

Budget

» 2013: €568,813

» outlook In 2014, MdM will continue to provide training to the Department of Social Affairs staff and strengthen protection activities within the programme. It will particularly strengthen staff expertise in order to systematise mechanisms of prevention, detection, declaration and follow up of cases of human rights violations in the Dar ul-Aman. A major evaluation is planned during the last year of the programme.

International programmes » ASIA

DOCTORS THEWORLD WORLD DOCTORS OFOF THE

ANNUAL ANNUAL REPORT REPORT 2013

Philippines

Manila

life expectancy Hdi 0.654 rank 114

69 yrs

Source: UNDP 2013

POPULATION

Reducing the health and environmental risks of recycling electronic waste

»B eneficiaries: 418 »T arget: 2,114 MALAYSIA

In the Philippines, 22% of the morbidity and 6% of the mortality are due, in part, to the informal recycling of electronic and electrical waste. In the short term, respiratory and skin problems arise, along with various wounds caused by the recycling. In the long term, these products provoke neurological and immunological problems, affect the reproductive system and cause different cancers.

» Metropolitan region of Manila, Manila, Malabon and Caloocan cities

» background In 2012, MdM’s health and environment group decided to set up a project which will address questions of reducing the risks for vulnerable populations exposed to toxic products. The project opened in July 2012 in Manila and MdM was registered with the authorities the following year. The project was developed in partnership with the Veolia foundation which supports the project financially and technically by providing technical expertise in toxic waste management.

» activities At the end of 2013 activities within recycling communities were launched in four poor urban areas of Manila: Bagong Silang, Camarin, Capulong and Longos. MdM community workers are rooted in the communities and identify with them what sort of difficulties they face (economic, access to healthcare), where they are vulnerable and which practices are risky. MdM promotes the training of recycling groups who have become strong partners in setting up the project. A series of training sessions for these groups was initiated in order to strengthen their organisational capabilities and capacity for representation. Some of the activities which are organised in partnership with the recycling groups include: education sessions about recycling related risks;

funding

» Veolia foundation, MdM

Budget

» 2013: €129,946

identifying risky practices and knowing how to protect oneself; provision of protective material; and ‘clean-up drives’, cleaning and sanitising activities, led by recycling groups, of the urban areas where communities live.

» results 41 persons who recycle trained about recycling risks. 60 persons who recycle involved in the formation of community organisations. 4 clean-up drives.

» outlook At the beginning of 2014, Annual General Meetings will be organised to establish the recycling organisations; these are necessary in order to obtain official recognition from the authorities. The project will need to develop its medical activities by training the staff of primary healthcare centres and community health workers in this specific topic and to improve access to healthcare for recyclers.

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Philippines Provide urgent medical care to those affected by typhoon Haiyan/Yolanda

life expectancy Hdi 0.654 rank 114

69 yrs

Source: UNDP 2013

Leyte

POPULATION

»B eneficiaries: 23,812 »T arget: 184,720 MALAYSIA

On 8 November, the Philippines was hit by an incredibly strong typhoon. The number of displaced persons is estimated at 3.4 million and that of those who were evacuated at 240,800. The entire health system was badly damaged, from baranguays to advanced health posts. Buildings were severely damaged and suffer from serious shortages of essential drugs and medical equipment.

» Carigara, Ipil, San Pablo, Albuera, Abuyog districts, Leyte island, Region V

» background MdM has been in Manila in the Philippines since July 2012 with a programme to reduce the health and environmental risks from recycling of electronic waste. Following typhoon Haiyan, and in direct coordination with the priorities established by the government and the Ministry of Health (MoH), MdM decided to work on Leyte to provide access to primary healthcare within local and displaced communities until February 2014.

» activities Five outreach medical teams cover the five districts of Leyte. They provide primary healthcare and sexual and reproductive health services. They also offer prevention services, such as nutritional screening for children under five years old and pregnant women, antenatal consultations and catch-up immunisation according to the Philippines national immunisation calendar (EPI). One of the MdM psychiatrists trained the NGO teams, as well as the medical and paramedical teams of the Philippines Department of Health, on provision of psychosocial support to the typhoon victims. MdM helped with the rehabilitation of mainstream health services on Leyte by doing basic repairs on the healthcare facilities, and by re-equipping the centres which lost most of their medical equipment.

international delegation

»M dM Spain

funding

» Maria Stroot Foundation, Sanofi Foundation, Cerf

Faced with the risk of sudden peaks in endemic diseases, such as malaria, or epidemics caused by poor living conditions on Leyte, MdM in collaboration with the Ministry of Health, pre-positioned supplies for emergency preparedness.

» results 2,168 consultations. 42 medical personnel (MdM and MoH) received mental health and psychosocial support training. 33 members of MdM and MoH staff seen in a psychosocial consultation. 32 patients seen in a psychosocial consultation. 30 health centres restocked with drugs and medical equipment. 20 health centres rehabilitated.

» outlook Once the emergency phase is finished and the health facilities are operational again, MdM will close the project and withdraw from Leyte.

Budget

» 2013: €651,754

International programmes » ASIA

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Russia (Great North)

Great North

life expectancy Hdi 0.788 rank 55

69.1 yrs

Source: UNDP 2013

POPULATION

Supporting the NGO Community Health Partnership

»B eneficiaries: 89 »T arget: 6,200

The autonomous populations of the Great 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, it carries out activities to prevent alcohol-related harm, suicide and tuberculosis in remote populations. » Nijni Novgorord, Arkhangelsk, Narian-Mar, Yakutsk

» background Following 15 years of MdM community health programmes among the indigenous populations of the Great North of Russia, the Russian doctors who participated in the project decided to set up an NGO, Community Health Partnership (CHP), in 2009. The aim was to continue to train community health workers and general practictioners in isolated regions in innovative methods for prevention of alcohol abuse (motivational interviews, TCC, brief interventions) while benefiting from the technical support of MdM (support in alcohol prevention training).

» activities Community Health Partnership is an organisation that trains health mediators from the indigenous communities of the Great North. In addition, it is working to educate and train professionals in foetal alcohol syndrome and in suicide prevention amongst young people. Activities are conducted in partnership with MdM, the Nenetsk organisation ISAV and the Lithuanian Youth Psychological Aid Centre (YPAC), which specialises in suicide prevention among young people. In collaboration with CHP, in November 2013 MdM started an advanced training programme for four doctors in the nenets autonomous district (Great North of Russia), which will allow them in turn to train their colleagues. Led by an MdM specialist in addictions, this training session tack-

funding

»F rench embassy

Budget

» 2013: €148,629

led prevention in foetal alcohol syndrome by teaching a method which is normally called ‘brief intervention’. In 2013, CHP organised a seminar in order to close its programme and to hand over the project tools to the chair of polar medecine in Arkhangelsk.

» outlook In 2014, those who participated to the training which took place in November 2013 will, in turn, train 12 medical consultants of the nenets autonomous district hospital and six staff members of the polar district polyclinic.

International programmes » EUROPE

DOCTORS THEWORLD WORLD DOCTORS OFOF THE

ANNUAL ANNUAL REPORT REPORT 2013

Bulgaria Improving insanitary conditions

ROMANIA

SERBIA

Sliven

73.6 yrs

Source: UNDP 2013

POPULATION

MACEDONIA GREECE

life expectancy Hdi 0.782 rank 57

TURKEY

»B eneficiaries: 2,200 »T arget: 10,000

Part of the European Union since 2007, Bulgaria shows disturbing sexual and reproductive health figures, particularly in relation to teenage and unwanted pregnancies. The town of Sliven is particularly affected by this phenomenon, where at-risk groups, particularly the Roma population, are vulnerable to problems relating to difficulties accessing contraception.

» Sliven, Nadejda quarter

» background

» results

Since 2004, Doctors of the World has been running a health promotion programme designed to improve the living conditions and health in the communities of Nadejda quarter in Sliven. Educational activities, carried out within the programme, are performed by a team of community mediators belonging to the four ethnic groups represented in Nadejda.

230 people participated in information sessions on pregnancy, family planning and hygiene. 17 discussion groups took place with community leaders in Nadejda around themes of immunisation and child marriage. 105 pregnant women used showers available in the new premises. 1,828 interviews were conducted by health mediators in the community.

» activities 2013 was a transitional year for the project. Awareness-raising activities are carried out by visiting the population in the Nadejda ghetto and through information, education and communication sessions in the MdM centre. A re-evaluation of the needs of this at-risk group was undertaken, an anthropological study on the barriers to healthcare access was carried out, and the overall strategy redefined. The programme is now centred on the promotion of sexual and reproductive health. Partner relationships have been developed around this new project. MdM refurbished new premises made available by Sliven town council.

funding

»M dM, French embassy

Budget

» 2013: €151,962

» outlook In 2014 MdM will start a new project to combat unwanted pregnancies, concentrating on providing information and free access to contraception for vulnerable people in collaboration with the town council and the Bulgarian Family Planning Association.

International programmes » EUROPE

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Romania

Satu Mare

UKRAINE MOLDOVA

HUNGARY

life expectancy Hdi 0.786 rank 56

74.2 yrs

Source: UNDP 2013

Access to healthcare and rights for people living in extreme deprivation

POPULATION

SERBIA KOSOVO

»B eneficiaries: 18,000 BULGARIA

Despite joining the European Union, and the reforms undertaken, Romania does not seem to be able to overcome its political instability and economic difficulties. Today the country is greatly affected by the financial crisis and it is estimated that a third of the population lives in severe material deprivation. Discrimination, absence of identity papers, poverty, the low level of education and difficult living conditions are obstacles to healthcare access and basic social services. » Satu Mare district

» background

» outlook

Doctors of the World’s PACA delegation has been working in the Satu Mare district (judet) for around 20 years through different programmes. Since 2006, PACA has been working in collaboration with the Romanian organisation COPII fighting against social exclusion. Initially focused on programmes to protect children (fighting abuse and abandomnent), today the project works with vulnerable populations.

MdM will now set up the operational side of the project. At the same time, the organisation hopes to contribute to advocacy on sexual and reproductive health, and to develop ties with the organisation, STEA, which works with people on the streets of Satu Mare in order to facilitate their access to healthcare and rights.

» activities Professional exchanges with COPII continued. Furthermore, MdM put COPII in touch with the Rainbow network, made up of MdM’s ‘sister’ organisations in Poland, Bosnia-Herzegovina, Russia, Bulgaria and Romania. Fundraising, both in Romania and the PACA region, has been initiated.

funding

» MdM

Budget

» 2 013: €65,000 for two years, of which €36,000 for the first year funding applications pending

International programmes » EUROPE

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Russia (Chechnya)

RUSSIA

Vedeno

life expectancy Hdi 0.788 rank 55

69.1 yrs

Source: UNDP 2013

GEORGIA

Improving the quality of, and access to, sexual and reproductive healthcare

AZERBAÏJAN ARMENIA

POPULATION

»B eneficiaries: 1,000 women »T arget: 7,382

After 15 years of conflict, the situation in Chechnya has been improving since 2007. But despite the apparent normalisation, the country is experiencing an Islamisation of politics and rebel movements are still active. Women suffer strong pressure to have several children whilst enduring an erosion of their rights. In February 2012, MdM identified a lack of ante- and postnatal healthcare in primary healthcare centres. The programme started in July 2012, for a duration of two years. » Vedeno district, Chechnya

» background

» results

In March 2009, having finished its previous programme in Chechnya carried out during the war, MdM made the decision to keep a representative in the State so as to monitor the development of the humanitarian and security situation and to identify the possibility of opening a new project. In July 2012, MdM started a new programme on sexual and reproductive health.

In 2013 the mobile teams supported by MdM carried out: –– 1,232 antenatal consultations and 179 postnatal consultations; –– 775 ultrasound scans; –– 190 smear tests for cervical cancer. 418 women benefited from gynaecological examinations.

» activities

MdM’s programme in Chechnya will end in July 2014. MdM will then identify new needs in the different republics of the North Caucasus, concentrating on sexual and reproductive health.

The goal of the programme’s activities is to reintegrate ante- and postnatal healthcare into primary healthcare centres in Vedeno district by: –– training professionals (midwives and gynaecologists) in international standards of ante- and postnatal care; –– finalising and publicising protocols for care through professionals in the sector; –– setting up a mobile outreach team of gynaecologists in the primary healthcare centres; –– strengthening the knowledge and skills of women and their in-laws on matters of sexual and reproductive health.

funding

»F rench embassy, MdM

Budget

» 2013: €240,747

» outlook

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Alsace FrancheComté

Strasbourg team

GERMANY

Budget

Besançon

» Programmes –– Healthcare, Advice and Referral Clinic in Besançon. –– Healthcare, Advice and Referral Clinic in Strasbourg. –– Homelessness project in Strasbourg. –– Roma project in Strasbourg. –– Haute Vallée de la Bruche project. –– Adoption programme in Strasbourg. –– University diploma Health, deprivation, and solidarity Strasbourg-Nancy.

» results 2013 Programmes –– As part of the screening week, organisation of rapid diagnostic tesing for HIV in the Adoma shelter in Strasbourg. –– Organisation of two training sessions on Welfare rights for migrants in partnership with Cimade. –– Completion of a survey Hygiene in the homeless population in Strasbourg. –– Organisation of a gathering of parents who have adopted a child between 1998 and 2002. –– Ongoing response to the obstacles emerging in a troubled context for international adoption: political instability for adoption in most countries where the adoption programme is operating.

»€ 271,597

Mobilising members –– Election of a new regional board. –– Organisation of three training sessions for volunteers in Strasbourg and Besançon. –– Organisation of a discussion/debate about the political challenges and the different options of development and partnership in terms of drug harm reduction in France. –– Launch of the delegation newsletter: La Cigogne et l’Horloge.

» outlook –– Strengthening the expertise of MdM players by providing training on specific themes. –– Appointment of a new regional coordinator in January 2014.

Alsace Franche-Comté Delegation

»T el: 03 88 14 01 00

SWITZERLAND

–– Organisation of seminars of ethical reflection on policies which address deprivation yesterday and today, in partnership with the European Centre on Teaching and Research of Ethics. –– Participation in the network of Besançon voluntary organisations. –– Presentations in the Health and migrations 2nd year module of Strasbourg faculty of medicine. –– Talks in various schools: annual job forum in Heinrich-Nessel secondary school in Haguenau, international solidarity week in HauteBruche city school and nursing and midwifery schools.

Communication and events –– Adoption in June 2013 of the report Equality of access to healthcare (report by Jean-Louis Lorrain, from the Senate Social Affairs commission) by the Parliamentary Assembly of the Council of Europe.

» 2 4, rue du Maréchal-Foch 67000 Strasbourg

»1 25 volunteers »3 employees »1 08 members

»a lsace@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Aquitaine

team

Bordeaux Bayonne

»1 80 volunteers »7 employees »1 25 members Budget

» €1,077,559.55 over 35 months SPAIN

» Programmes –– Healthcare, Advice and Referral Clinic in Bordeaux (medical consultations; Primary Healthcare Insurance Office (CPAM) services; rapid diagnostic testing; psychiatric, psychological and dental consultations; registration to health insurance; pregnant women action; teaching French as a foreign language; eye care at UNADEV; medical consultations at Relais du cœur). –– Roma programme in Bordeaux. –– Adoption programme in Bordeaux. –– Rave project in Bayonne. –– Healthcare and Advice Clinic in Pau. –– University degree Health, deprivation and solidarity at Bordeaux 2 University.

» results 2013 Programmes –– Organisation of a strategic joint commission to assess the progress of the regional project and plan 2014. –– Expansion and re-organisation of the Healthcare, Advice and Referral Clinic in Bordeaux. –– Creation of a coordinator position for the Roma programme. –– Organisation of a workshop across programmes (mental health, advocacy, specific themes/health promotion.) –– Planning of a needs assessment in Mali and Vietnam (budget planned for 2014).

Communication and events –– Participation in the International Human Rights Film Festival in Gironde. –– Colloquium about Social and health mediation: new practices and challenges at Bordeaux Segalen university. –– Training session for fundraisers in the delegation office. –– Symposium Vulnerability and prevention: current challenges and local responsibilities at Isped. –– Colloquium HRT and deprivation in Biarritz congress centre. –– Visit of two members from the donors’ committee. –– Shooting with France 5’s Les Maternelles about continuity of care for pregnant women living in poor conditions. –– Participation in Gironde deprivation and poverty conference. Advocacy and lobbying –– Teaching third cycle of general medicine about humanitarian medicine and health in situation of deprivation. –– Raising awareness among medical and social professionals about Doctors of the World’s values: field internship for nursing students, optional module Health and deprivation for medical students, interns in general medicine, midwifes, University Institute of Technology, students, universities. –– Mobilising delegation members. –– Election of a new regional board. –– Organisation of training sessions for MdM volunteers: Analysis of our practices, First aid, Social training. –– Exchanging medical practices. –– Continuing the healthcare and advice review committees.

acquitaine Delegation

» 2 2, rue Charlevoix-de-Villers 33300 Bordeaux

»T el: 05 56 79 13 82

Pau

»a quitaine@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Corsica

team

»1 0 volunteers »2 5 members

Ajaccio

» Programmes Healthcare, Advice and Referral Clinic in Ajaccio.

» results 2013 Programmes –– Participation in the drafting and in the follow up of the regional health project and the Regional Health Agency’s (ARS in the French acronym) Access to Prevention and Care Regional Programme (PRAPS). –– Participation in providing healthcare to migrants, with the ARS, and an anti-racist collective. –– Participation in the drafting of sustainable development plans for Corsica and the charter against social deprivation. –– Participation in the setting up of a sustainable shelter for homeless people (member of the shelter watchdog committee). –– Joint signature of an open letter adressed to Ajaccio council candidates about poor living conditions in the town. –– Participation in the town’s voluntary sector network –– Moving delegation premises and refurbishment of the clinic. –– Re-organisation of advice serivces in the clinic with the recruitment of new volunteers. –– Set up of psychiatric services: presence of a nurse from the psychiatry-deprivation outreach team.

»T el: 04 95 51 28 93

» €24,179

Communication and events –– Participation in the organisation of I Muvrini concert in Ajaccio, whose profits will be partly donated to MdM. –– Information stand about MdM held on the night of the concert. –– Participation in a RCF radio programme about poverty in Corsica. Mobilising members –– Election of a new regional board. –– Monthly meetings in the office. –– Volunteer party. ––

» outlook

–– Organise the clinic files: archiving, confidentiality. –– Setting up nursing care in the clinic.

corsica Delegation

» Bd Danielle-Casanova 20000 Ajaccio

Budget

»c orse@medecinsdumonde.net

» REGIONAL DELEGATIONS

Île-deFrance

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Colombes

Saint-Denis

Paris

team

»4 00 volunteers »2 3 employees »3 44 members Budget

1/2

» Programmes –– Lotus Bus programme in Paris. –– Homelessness project in Paris. –– Drug analysis programme in Paris. –– ERLI programme in Paris and Colombes. –– Shantytown programme in Saint-Denis. –– Roma programme in Saint-Denis. –– Health and Housing programme in Saint-Denis. –– Buddying programme across Île-de-France. –– Rave project across Île-de-France. –– Healthcare, Advice and Referral Clinics in Paris and Saint-Denis. –– University degree Health, deprivation and solidarity at Descartes university.

» results 2013 Programmes –– Re-evaluation and new organisation of the Paris clinic. –– Strengthening of the mediation actions in shantytowns. –– Lobbying actions in partnership with DAL (Right to Housing) and the Abbé Pierre foundation for the respect and re-establishment of winter housing arrangements. Communication and events –– Press conference on 16 October to launch the report of MdM’s Observatory to access healthcare. –– Participation in Solidarity Days organised by the town council in the 11th district.

» €2,081,302

–– Coordination of the module Healthcare pathways organised by Descartes university. –– Presentations in tranining centres (nursing schools, secondary schools, regional Aids information and prevention centres CRIPS) and other places of debates (social cafés). –– Participation in the French public health society congress (written communication presented with the Solipam newtork), in roundtable discussions, conferences (COREVIH-IDF-Est migrant commission, Bichat hospital, Antoine hospital- Béclère). –– Completion of a survey about pediatric PASS healthcare centres in Paris (AP-HP) hospitals. –– Completion of a quantitative and qualitative survey about access to contraception and abortion among MdM service users. –– Self-evaluation of an advocacy project for those seeking the right to remain on medical grounds. –– Drafting and proposition of a PASS healthcare centre project to SaintDenis health-city workshop and the ARS. Mobilising members –– Election of a new regional board. –– Organisation of a cycle of bi-monthly, thematic and technical training sessions for Île-de-France members (induction of new members; regulation procedures in terms of access to rights and care; data collection - observatory and advocacy; harmonisation of our programmes with the Ottawa Charter). –– Organisation of a cycle of bi-monthly presentation-information sessions about the programmes for the members and volunteers of Île-de-France.

» REGIONAL DELEGATIONS

Île-deFrance

DOCTORS THEWORLD WORLD DOCTORS OFOF THE

ANNUAL ANNUAL REPORT REPORT 2013

Colombes

Paris

»4 00 volunteers »2 3 employees »3 44 members » €2,081,302

2/2

–– Participate in the forthcoming local elections campaign. –– Consolidate the bi-monthly newsletter Fil. –– Continue to work on socio-culturals determinants. –– Organising an open annual information session to raise awareness about our actions with the aim of recruiting new volunteers.

» outlook –– Continuing our lobbying actions: for the acknowledgment of minors’ rights, against the use of bone age assessment practices to determine minority; for regulation to be respected and Primary healthcare offices practices to be harmonised for better access to health insurance; for regulation to be respected and PASS healthcare access offices to have good working practices; against evictions and for the respect of winter arrangements for those living in squats and shantytowns. –– Publication and distribution of the survey about paediatric PASS healthcare access offices. –– Continuing to reflect on how to advocate on behalf of those seeking the right to remain on medical grounds. –– Publication of the survey about access to contraception and abortion. –– Monitor the experimental PASS healthcare access office project set up by the ARS.

île-de-france Delegation

»T el: 01 48 06 63 95

team

Budget

–– Publication of the first edition of Fil in December (Île-de-France newsletter). –– Organisation of focus groups and one-to-one sessions to assess the impact of socio-cultural determinants on the clinics’ practices and how we can improve our practices once we better understand them. –– Creation of a working group for the care of isolated minor migrants and for the acknowledgement of their status as minors.

» 6 2 bis, avenue Parmentier 75011 Paris

Saint-Denis

» i le-de-france@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Indian Ocean

Mamoudzou MAYOTTE

Saint-Denis Antananarivo MADAGASCAR

–– Medical consultations in Saint-Denis and Saint-Pierre. –– Buddying programme in Saint-Denis, in collaboration with Île-de-France delegation. –– Comoro islands programme (paediatric care centre in Mayotte). –– Paediatric surgery programme in Madagascar.

» results 2013 Programmes –– Re-assessment of the targeted populations for Saint-Denis and Saint-Pierre clinics. –– Participation in Christmas for homeless people Day. –– Opening of a new branch for the buddying programme in Saint-Denis hospital (volunteer recruitment, psychologist, meeting with the partners in Mayotte, organisation of a monthly meeting between the psychologist coordinator and the volunteer buddies). –– Organisation of four specialised surgery missions in Madagascar. –– Professional visit of a logistics expert from MdM headquarters to support the set up of a surgery room in Cenhosoa hopsital in Madagascar. –– Skill transfer: intership of Madagascar professionals at Reunion University Hospital Centre. –– Participation in the annual gathering of Opération Sourire programme. Communication and events –– Press conference about MdM programmes in Indian Ocean (with the presence of MdM’s chair).

Budget

–– Participation in Mental Health Week –– Participation in Healthy city and mental health caravan in collaboration with Reunion mental health public centre (EPSMR). –– Participation in charity concert Sport Solidarity. Mobilising members –– Election of a new regional board. –– Training of volunteer buddies. –– Appointment of new programme coordinators in Saint-Denis and SaintPierre. –– Meeting between the regional board with the Mission France teams: re-evaluation of the programme.

» outlook –– Strengthening of the regional board (intermediary regional assembly). –– Entering volunteers’ working hours into Sphinx software and training at the headquarters. –– Organisation of Women, the aftermath of violence exhibition. –– Organisation of photographic reportage about the Mayotte programme. –– Setting up an international humanitarian pharmacy (PHI). –– Organisation of internal communication. –– Reflecting on whether to continue specialised surgery programmes in Madagascar. –– Needs assessment of undocumented migrants in Reunion

indian ocean Delegation

»T el: 02 62 21 71 66

»1 00 volunteers »3 employees »4 8 members »€ 210,980

» Programmes

» 2 50 bis, rue Général-Rolland SHLMR Bouvet – Bât K / 97400 Saint-Denis

REUNION

team

» océan-indien@medecinsdumonde.net

» REGIONAL DELEGATIONS

LanguedocRoussillon » Programmes –– Healthcare, Advice and Referral Clinic in Montpellier (medico-social and dental consultations, shantytown action, homeless action). –– Sex workers programme in Montpellier. –– Harm reduction programme in festivals and raves in Montpellier. –– Adoption programme in Montpellier. –– University diploma Health and deprivation.

» results 2013 Programmes –– Re-organisation of the shantytown action. –– Re-evaluation of the harm reduction programme with skill transfer to partner organisations, targeting of population living in squats and advice to famillies in Perpignan hospital. –– Training session about managing violence for volunteers. –– Review of practices for volunteers and employees’ practices (once a month). –– Evaluation of MdM expansion into rural areas. –– Set up of rapid diagnostic testing (HIV, Hepatitis B and C) for sex workers. –– Thesis research about young African sex workers and their knowledge about means of contraception. –– Re-direction of homeless project towards the most excluded (periphery, squat) in collaboration with the harm reduction programme. –– Continuing the adoption of children with specific medical conditions. Communication and events –– Participation in a theatre festival on sex work and social exclusion. –– Participation in a debate about sex work following the screening of the

DOCTORS OF THE WORLD ANNUAL REPORT 2013

team

Montpellier

Budget

» €259,954 SPAIN

film Elles, in Ganges. –– Participation in 17 October day in collaboration with other organisations and making of a film Two-speed Healthcare. –– Preparation and organisation of Mission France Away Days in Sète. –– Coordination of the university degree Public Health Practices. –– Recruitment and training of interns in general medicine, especially in the Clinic (Saspas, third cycle teaching). –– Raising awareness among medical and social professionals about MdM’s values (schools, secondary schools, nursing schools, universities, students in medicine). Mobilising members –– Election of a new regional board. –– Organisation of cycles of training sessions to reflect on our practices, violence management, harm reduction and access to health insurance. –– Participation in voluntary sector networks: Montpellier, Perpignan, Carcassonne. –– Visit of the Latin America geopolitical group. –– Setting up an induction programme for new volunteers. –– Strengthening the expertise of MdM actors (partner organisations, employees, volunteers).

» outlook –– Follow up and evaluation of the regional project. –– Expansion of MdM action to other towns (Perpignan). –– Recruitment of a new regional coordinator. –– Continuing to strengthen MdM actors’ skills.

languedoc-roussillon Delegation

» 1 8, rue Henri-Dunant 34090 Montpellier

»T el: 04 99 23 27 17

»1 05 volunteers »2 employees »1 03 members

» l anguedoc-roussillon@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Lorraine

LUX.

GERMANY

Metz

team

»7 5 volunteers »2 employees »6 2 members

Nancy

Budget

»€ 153,180

» Programmes –– Healthcare, Advice and Referral Clinic in Nancy. –– Outreach project in Nancy (dental consultations; medical services on Sundays on Cours Léopold; outreach to the Roma population of Maxéville; medical service at Shelter 32; medical services at the Salvation Army during the winter). –– Outreach project in Metz (medical services at the Abbé Pierre foundation charity shop and in Housing and Social Rehabilitation Centres (CHRS): in Trêves and Pont des grilles; prevention and health promotion action – rapid diagnostic testing for HIV and Hepatitis C; outreach in the winter with Abbé Pierre foundation ; one-off action in an asylum seekers’ camp). –– Adoption programme in Nancy and Metz. –– Inter-university degree Health, deprivation, solidarity, StrasbourgNancy.

–– Participation in various meetings: health and autonomy regional conference, territory conference. Mobilising members –– Election of a new regional board. –– Organisation of informal meetings to reflect on various themes.

» outlook –– Evaluation and update of the regional project and its actions. –– Raising awareness about becoming programme advisers. –– Raising awareness and re-energising all players about MdM policy. –– Focus on volunteer development: recruitment, support, training… –– Cooperation with the Alsace delegation.

» results 2013 Programmes –– Re-evaluation of the outreach project in Metz. –– Needs assessment in Longwy - Mont-Saint-Martin. Communication and events –– Participation in Lorraine medical week. –– Participation in national awareness-raising days in Metz and Nancy. –– Communication action for MdM’s 25th anniversary in Nancy (party, short films). –– Present wrapping stand for Christmas at Saint-Sébastien shopping centre.

lorraine Delegation

» 5 , rue de l’Armée-Patton 54000 Nancy

»T el: 03 83 27 87 84

» l orraine@medecinsdumonde.net

» REGIONAL DELEGATIONS

MidiPyrénées

DOCTORS OF THE WORLD ANNUAL REPORT 2013

team

»1 50 volunteers »3 employees »9 2 members

Toulouse

1/2

» Programmes –– Healthcare, Advice and Referral Clinic in Toulouse. –– Street/Homeless people programme in Toulouse. –– Harm reduction programme in Toulouse. –– Programme for European migrants living in poor conditions in Toulouse. –– Advice services in housing centres in Toulouse. –– HIV, STI and hepatitis prevention in Toulouse. –– Adoption programme in Toulouse.

» results 2013 Voluntary organisation actions –– Participation in the Roma Solidarity collective. –– Mobilising the voluntary sector collective about the question of healthhousing: participation in collective actions, press conferences. –– Participation in institutional networks: health and autonomy regional conference (users’ rights commission and advocacy and access to care commission), meetings with Toulouse town council, healthdeprivation network, access to rights and care CPAM 31 network, public health hospital project at Toulouse university hospital. Communication and events –– Events A stride for life and Solidarity in Save country organised in aid of MdM. –– Participation in Toulouse and health Day organised by Toulouse town council. –– Organisation of exhibitions: Supsended, inside a Roma community at ABC cinema and as part as the images festival ManifestO; Life in a Shantytown in Jaipur in Seysses media library and Women, the after-

Budget

»€ 285,502 SPAIN

math of violence in Folles saisons restaurant. –– Participation in the International Human Rights Film Festival (FIFDH) ; presentation with screening of the film: A neglected population; screening of the film Life in a shantytown in Jaipur in Seysses village hall. –– Organisation of boot sales. –– Organisation of an intercultural day with the participation of 12 Roma families. –– Organisation of a debate (at the Lighthouse in Tournefeuille) about drug regulation and its consequences. –– Open day at the delegation on the International Day for the Eradication of Poverty. –– Presentations about humanitarian health: nursing school foundation course in Aragon secondary school (Muret), nursery nurses, university degree Paediatric health ethics ; Rangueil nursing schools, visit of nursing students (Pamiers and Rodez) to the delegation. –– Workshop on solidarity in a leisure centre affiliated to a primary school. –– Presentation of MdM and its actions in the Midi-Pyrénées region to the donors recruiting team. –– Presentation of MdM adoption programme to district councils 31, 32, 81 and 82 in a day; organisation of a training day with adoption applicants.

» REGIONAL DELEGATIONS

MidiPyrénées

DOCTORS OF THE WORLD ANNUAL REPORT 2013

team

»1 50 volunteer »3 employees »9 2 members

Toulouse

»€ 285,502

2/2

Mobilising members –– Election of a new regional board (college). –– Visit of MdM partners centres in two half days. –– Information and training meetings for volunteers about: harm reduction, psychosis (with the participation of a medical and psychological centre CMP), going towards the other (with the participation of the social outreach team) and bearing witness (volunteers from the clinic). –– Publication of three issues of the internal newsletter Lettre et débats. International programme –– Evaluation, advocacy and capitalisation at the end of the mother and child health programme in India in 11 shantytowns in Jaipur and ongoing partnership with JKSMS by provision of technical and moral support.

SPAIN

» outlook –– Strengthening of our actions and our partnership with poor European migrant populations. –– Lobbying and raising awareness among the regional population by organising exhibitions (Suspended, inside a Roma community; Spring in a shantytown in Jaipur). –– Building a regional partnership to set up an international project to improve healthcare. –– Collaborative work about housing by advocating and lobbying institutions and policy makers. –– Developing the expertise of regional health players on the themes of health and deprivation.

Field internship –– Master 2 in geopolitics and international relations internship, humanitarian action and rights in Aix-en-Provence; 2nd and 3rd year students at Toulouse Red Cross social work school; awareness/professional retraining (logistics). –– Visit of Toulouse ESC students as part of 50 civil hours for collectivity (educational project which is part of 1st year students curriculum).

midi-pyrénées Delegation

» 5 , bd Bonrepos 31000 Toulouse

»T el: 05 61 63 78 78

Budget

» midi-pyrenees@medecinsdumonde.net

» REGIONAL DELEGATIONS

NordPas-de-Calais » Programmes –– Migrants programme in Calais, Dunkirk and Tatinghem. –– Healthcare, Advice and Referral Clinic in Valenciennes, which also provides care to Roma population. –– University diploma Health and deprivation at Lille 2 university.

» results 2013 Programmes –– Frequent media coverage of the coastal migrants programme. –– Re-evaluation of the coastal migrants programme to improve referral work towards PASS healthcare centres and set up of a health mediation team in Calais. –– Advocacy to improve the current system which links PASS healthcare centres and Dunkirk hospital centre (participation in pilot committee, improving current practices, raising awareness among health professionals). –– Reflect on migrants’ living conditions in partnership with local organisations and institutions. –– Supporting Valenciennes volunteer team and reflecting on the programme’s objectives. Communication and events –– To celebrate the opening of the new delegation: organisation of a public event in Lille, with screening of three short films about migration and deprivation; and communication with the press and the organisations and institutions network.

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Dunkirk BELGIUM

Calais

»T el: 09 72 38 88 14

»1 00 volunteers »3 employees »4 8 members Budget

Valenciennes

»€ 210,980

–– Raising awareness among volunteers about the role played by the delegation, how MdM works and its values. –– Presentation in nursing schools. Setting up a regional delegation –– Election of a new regional board and re-opening of a regional delegation. –– Recruitment of a regional coordinator. –– Training the new regional board members. –– Mobilising members, meetings with volunteers. –– Linking the regional delegation with the organisation and institutions network in Lille.

» outlook –– Plan a regional project with predefined regional priorities in order to identify new and innovative directions for action. –– Participation in the NAPE project (New ways to approach poverty and social exclusion in Nord-Pas-de-Calais). –– Participation in the creation of a migrants’ home project in collaboration with all stakeholders. –– Recruitment and training of volunteers. –– Reflecting on and re-evaluating Valenciennes programme. –– Meeting with MdM Belgium and MdM UK as part of the coastal migrants programme. –– Raising awareness among health professionals about deprivation (university degree Health and deprivation, participation in a re-assessment of interns training and the ongoing medical training for doctors).

nord-pas-de-calais Delegation

» 2 5, rue Henri-Kolb 59000 Lille

team

» nord-pas-de-calais@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Normandy

team

Le Havre Rouen

»8 4 volunteers in Rouen 19 in Le Havre »2 employees »6 0 members Budget

»€ 122,989

» Programmes –– Healthcare, Advice and Referral Clinic in Rouen. –– Sex workers project in Rouen. –– Travellers project in Rouen. –– Sex workers project in Rouen. –– Homelessness project in Rouen. –– Le Havre programme: psychological support consultations for asylum seekers and treatment of traumatism linked to FGM, in partnership with the group for the abolition of sexual mutiliation (GAMS), accountancy certificates for asylum seekers. –– Eye glasses services in partnership with Medico Lion’s Club. –– Adoption programme in Le Havre.

» results 2013 Programmes –– Training of a team qualified to provide HIV rapid diagnostic tests and introduction of rapid diagnostic testing to the MdM clinic in Rouen. –– Development of new premises for the MdM clinic with a wheelchair access. Communication and events –– Open day for the International Day for the Eradication of Poverty and to recruit new volunteers in Rouen. –– Participation in Macadam & Co, festival for and about homeless people: presentation about Prevention and testing with a proposition to introduce rapid diagnostic testing in Rouen. –– Participation in the voluntary sector forum in Rouen. –– Awareness campaign on World Aids Day in Rouen.

–– Presentations in schools, universities, nursing schools (Le Havre, Fécamp, Lisieux), medical and social care centres, CEMEA training centres (Active education centres) in Le Havre. –– Stand on Welcome Day organised by 15 student offices (BDE) and Le Havre Student Federation (Fed’LH) with the financial and logistical support of Le Havre town. –– Participation in Le Havre town HIV network board meeting (REVAH). –– Meetings with partners: deprivation-mental health outreach team, solidarity-social rehabilitation space in Le Havre. Mobilising members –– Election of a new regional board. –– Creation of a web site for MdM Normandy. –– Distribution of a bi-monthly newsletter. –– Annual volunteer day in Le Havre.

» outlook –– Expansion of MdM activities to Basse-Normandie. –– Creation of a regionally-managed international project. –– Develop advocacy activities (advice, referral, support to access). –– Creation of a day centre for sex workers in Rouen. –– Continuing to reflect on needs assessments of sex workers in Le Havre.

normandY Delegation

» 5 , rue d’Elbeuf 76100 Rouen

»T el: 02 35 72 56 66

» normandie@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Paca Provence-Alpes-

ITALY

Aix-en-Provence Nice

Côte d’Azur

Marseille

» Programmes –– Healthcare, Advice and Referral Clinics in Aix-en-Provence, Marseille and Nice. –– Homelessness programmes in Marseille and Nice. –– Berre-Ghardimaou programme. –– Shantytown programme in Marseille. –– Mediterranean harm reduction project. –– Adoption programmes in Marseille and in Nice. –– Burkina Faso regionally-managed project – Diébougou: access to dental and nutritional care. –– Regionally-managed international project in Romania – Satu Mare supporting COPII, a local organisation which works with children. –– Regionally-managed international project in Turkey: migrants project in Istanbul. –– Regionally-managed international project in Tunisia (improve access to healthcare for rural populations in Kasserine gouvernorat). –– Regionally-managed international project in Sri Lanka (diagnostic programme).

»€ 1,202,381

Mobilising members –– Election of a new regional board. –– Organisation of a day about working in an organisation in Nice.

Programmes –– Re-evaluation of homeless programmes in Marseille and Nice. –– Inauguration of the Nice clinic new premises by organising a conference about Humanitarian NGOs and their current challenges, the specific case of Doctors of the World. –– Conference in Marseille about Ethics and humanitarian action. –– Organisation of a workshop Health and migration in Istanbul (23 and 24 November): Which strategies should Doctors of the World adopt?  PACA Delegation

»T el: 04 95 04 59 60

Budget

Communication and events –– Organisation of the exhibition Women, the aftermath of violence at Gallife mansion, in Aix-en-Provence. –– Participation in Unexpected encounters festival, organised as part of the International Day for the Eradication of Poverty. –– Participation in the Provencal day on humanitarian health. –– Publication of the first issue of La Bazarette, quaterly internal newsletter for the PACA delegation. –– Organisation of the annual party for MdM donors.

» results 2013

» 4 , Avenue Rostand 13003 Marseille

team

»2 50 volunteers » 14 employees (13 FTE) » 168 members

» paca@medecinsdumonde.net

» REGIONAL DELEGATIONS

Loire

DOCTORS OF THE WORLD ANNUAL REPORT 2013

1/2

TEAM

Angers

Nantes

» Programmes –– Healthcare, Advice and Referral Clinics in Angers and Nantes. –– Programme for people charging for sexual services in Nantes. –– Needs assessment in a prison in Nantes. –– Health mediation programme with Roma migrants in Nantes. –– Mother and child health programme with Roma migrants in Nantes. –– Medical and social consultations in a shelter in Nantes. –– Adoption programme in Nantes.

» results 2013 Programmes –– Important development in transferring post-traumatic care and consultations to Nantes university hospital. –– End of needs assessment in hostess bars. –– Set up of a qualitative data collection within the sex workers programme (measuring the programme impact). –– Merging of the Roma and health mediation programmes. –– Participation in the new national health mediation programme (20132016), coordinated by ASAV and the Ministry of Health. –– Organisation of a picnic by the adoption programme team with the objective to create connections between families who have adopted or who are going to adopt. Communication and events • 1/ Fight against policies which make people ill and for access to healthcare for the most vulnerable groups: –– Active contribution to Nantes Romeurope collective, meetings with

»1 00 volunteers »6 employees »8 8 members Budget

»€ 412,948

the Chief Constable and the Défenseur des droits and the Régnier Chief Constable; –– Participation in the migrants collective in Angers: questioning the Chief Constable about the way migrants and isolated minors are received in Maine-et-Loire. –– Lobbying to denounce the health consequences on sex workers of the 10 year-old internal security legislation which criminalises street soliciting and of the recently draft law against sex work which criminalises sex customers: demonstrations in Paris, happening in Nantes, creation of a DVD to give voice to those who are directly affected. –– Participation in the workshop Mental health and social deprivation organising committee and facilitating the workshop Networking and transcultural clinics. –– Organisation of a press conference about Which political changes are possible for the most deprived? on MdM national advocacy day. –– Meetings with candidates for the March 2014 local elections and drafting of a local lobbying charter. –– Participation in an information and hepatitis screening day. • 2/ Distribution of our rationale and lobbying for the recognition of health mediation: –– Presentations to nursing, social work, and medicine students and partnership in setting up two continuous learning course options on four days about Roma migrants and travellers; –– Presentation during an evening debate about Advocacy for Roma populations in Poitiers; –– Organisation of a regional colloquium about health and social mediation

» REGIONAL DELEGATIONS

Loire

DOCTORS OF THE WORLD ANNUAL REPORT 2013

2/2

team

Angers

Nantes

New practices and challenges –– Presentation about health mediation at the national congress of the French Society for Public Health, during the regional voluntary sector meeting and ARS deprivation meetings. • 3/ Humanitarian aid, recruitment: –– Participation in the humanitarian and solidarity Tour de France stage; –– Stand at the volunteer forum in order to recruit new volunteers and to strengthen MdM’s visibility and brand awareness.

»€ 412,948

–– Develop or strengthen community-based approach in our programmes. –– Recruitment of a peer worker in the sex worker programme. –– Starting to work on the transfer of the sex worker programmes. –– Completing the transfer of post-traumatic care and consultations to Nantes university hospital and continuing to pursue this approach of transfer to other programmes. –– Improve the quality of our practices (training, tools, premises). –– Monitoring arising issues. –– 2014 local elections lobbying.

loire Delegation

»T el: 02 40 47 36 99

Budget

» outlook

Mobilising members –– Election of a new regional board. –– Planning new training sessions for all the volunteers to start in 2013: healthcare network, migrants journey, first aids, intranet. –– Two general meetings : psycho-traumatism, sex work. –– Internal communication with the reworking of Fil, the monthly regional newsletter. –– Annual discussion with the volunteers of the sex workers programme: outcomes, training, prospects and lobbying. –– Follow up of the training sessions organised by the sex workers programme (once a month).

» 3 3, rue Fouré 44000 Nantes

»1 00 volunteers »6 employees »8 8 members

» pays-de-la-loire@medecinsdumonde.net

» REGIONAL DELEGATIONS

DOCTORS OF THE WORLD ANNUAL REPORT 2013

PoitouCharentes » Programmes –– Winter and summer patrols in Angoulême. –– Travellers’ programme in Angoulême. –– Outreach programme (mobile medical consultations) in Angoulême. –– Health listening space in Angoulême. –– Street outreach programme in Angoulême and Poitiers. –– Sex workers programme in Poitiers. –– Mother and child migrants project in Poitiers. –– Migrant families project in Poitiers.

» results 2013 Programmes –– Meetings to plan the PASS healthcare centres lobbying in Angoulême. –– Participation in health and social emergency professionals Coordination (CAUSS) meetings in Angoulême. –– Participation in the Siao (115) meetings in Angoulême. –– Creation of working groups in Angoulême. –– Participation in the health local contract in Angoulême (Soyaux city). –– Participation in the monitoring committee for ill foreigners in Angoulême. –– Facilitating the monitoring committee for ill foreigners in Poitiers. –– Participation in Romeurope 86 meetings in Poitiers. –– Meetings with Toit du Monde (partner) in Poitiers.

team

Poitiers Angoulème

–– Supporting the Food Bank annual fundraising event in Angoulême. –– Participation and running (street and conference) of International Day for the Eradication of Poverty in Angoulême and Poitiers. –– Participation in Toit du Monde (partner) party in Poitiers. Mobilising members –– Election of a new regional board. –– Organisation of an induction training in Angoulême and volunteer training.

» outlook –– Updating the regional project and preparation of the regional joint commission. –– Continuing to provide induction training for new volunteers. –– Re-organisation and re-direction of Angoulême and Poitiers programmes. –– Setting up a convention in collaboration with CDAG for testing in Angoulême. –– Moving the delegation and Angoulême programme.

Poitou-charentes Delegation

»T el: 05 45 65 07 47

Budget

» €1,202,381

Communciation and events –– Participation in Angoulême health forum. –– Participation and stand at Festival musiques métisses in Angoulême. –– Supporting the fundraising event of Saujon (Angoulême) organisation for the Philippines.

» 2 2, allée du Champ-Brun 16000 Angoulême

»2 50 volunteers »1 4 employees (13 FTE) »1 68 members

» poitou-charentes@medecinsdumonde.net

» REGIONAL DELEGATIONS

Rhone-Alps Burgundy Auvergne

DOCTORS OF THE WORLD ANNUAL REPORT 2013

team

SWITZ.

Lyon

»2 50 volunteers »1 0 employees »2 13 members Budget

Combrailles Grenoble

ITALY

»€ 849,990

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» Programmes –– Healthcare, Advice and Referral Clinics in Grenoble and Lyon. –– Outreach project in Grenoble and Lyon. –– Squat and shantytown programme in Lyon. –– Rural programme in Les Combrailles. –– Regionally-managed international programme in Guinea. –– Regionally-managed international programme in Palestine. –– Adoption programmes in Clermont-Ferrand, Grenoble, Lyon and Saint-Étienne. –– University degree Health, solidarity and deprivation in partnership with the faculty of medicine and Grenoble city.

» results 2013 Election of a new regional board. Voluntary sector coordination, partnership, lobbying –– Lyon: participation in the creation of AURA (Rhône-Alpes organisations united) about poor housing. Participation in various reflexive discussions: encounters with various public sector actors (ARS, police headquarters, PASS healthcare centres, ASV…) and organisations (community clinics, Psychoanalytical consultations and treatment centres (CPCT), Cabiria, etc.) in the health field. Publication of an advocacy document Health and housing launched at the same time as the annual report. –– Grenoble: participation in several press conferences and collective actions organised by Alerte Isère collective (about housing). Observation of the police authority’s practices with asylum seekers in Grenoble (Cimade).

–– Advocacy relating to the PASS centres in Grenoble and Lyon. –– Auvergne: meetings with health stakeholders and establishing a network. Programme news –– Healthcare, advice and referral clinic in Lyon: increase in current service users in the clinic; improving service user reception; creation of an employee position in charge of regulation, social cohesion and referral. A week of closure in October to reflect on the working practices of the centre. Regional reflection on psychological and psychiatric care –– Bus programme in Lyon: continued shift in our targeted population ‘isolated individuals with addiction and mental health issues’ for that of ‘asylum seekers families from the Balkans’: regular patrols, communication and raising awareness actions in June 2013 about homeless asylum seekers. Set up of another service in a third location to reach this isolated population. –– Squat and shantytown programme in Lyon: several fires, of which one was lethal, and multiple evictions outside the winter. Setting up health mediation. –– Adoption: developing procedures to better prepare parents beforehand and to support families when the child has arrived; decrease in applications for adoption and in the number of children adopted each year. –– Grenoble: change of premises currently taking place, finalising the review of the outreach patrols project. –– Guinea: access to healthcare for prisoners provided by the operational partner (Kindianese support to prisoners), political instability has impeded some of the income-generating activities

» REGIONAL DELEGATIONS

Rhone-Alps Burgundy Auvergne

DOCTORS OF THE WORLD ANNUAL REPORT 2013

team

SWITZ.

Lyon

»2 50 volunteers »1 0 employees »2 13 members Budget

Combrailles Grenoble

ITALY

»€ 849,990

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–– Palestine: late set up due to governance changes in the partner organisation Diabetic Friends Society. Organisation of a training for health professionals caring for people with Type 1 diabetes in Bethlehem, in collaboration with a diabetologist from Grenoble university hospital and two Palestinian trainers. Therapeutic camp held in the summer for 30 children and their parents. Exhibitions, public talks and press conferences –– Presentations on International Solidarity Week in Meylan (38) about Syria, with the exhibition Palestine through my eyes. –– Raising awareness among the public about the issue of homelessness (temporary exhibition and camp occupation of the public space): The call of 19 June. –– Participation of the legacy department in Lyon solicitors congress. –– Press conference on International Day for the Eradication of Poverty. –– Participation in evening debates about the Roma/tzigane culture in collaboration with Anoukis theatre (01).

Mobilising our members –– Organisation of thematic evenings (Street outreach with Doctors of the World, MdM’s organisational model or how to continue our activities in time of crisis, Challenges face by French humanitarian aid challenge in the Syrian conflict, Balkans). –– Publication of a bi-annual regional newsletter, Raban, in partnership with master 2 Humanitarian aid and solidarity in Lyon 2 Communication Institute. –– Exhibition Lyon clinic: words and faces, photos by Cécile Creiche, in the delegation premises. –– Regular socialising events which allow volunteers and employees to meet and share their involvement in the organisation, within each programme or at the regional level. Twelfth-night pancake, season’s greetings, volunteer parties organised in Lyon and Grenoble. –– Increased participation of volunteers and associative managers (heads of mission, board members) in the training sessions offered by the headquarters (MdM Induction, volunteer management, prevention action, health mediation, etc.) and by other regional delegations.

Visits in schools –– Improving professionals’ practices by speaking about health and deprivation and humanitarian medecine as part of the curriculum: Grenoble faculty of medicine-pharmacy; Lyon-East faculty of medicine (humanitarian medicine option); nursing schools in the regions; intrauniversity degree Health, society and migration (access to healthcare module); hosting interns (faculty of medicine, nursing schools, public health, communication, third year internship); secondary schools and others (Political Studies Institute IEP, Lyon 2 Communication Institute).

rhône-alpes, bourgogne, auvergne Delegation

» 1 3, rue Sainte Catherine 69001 Lyon

»T el: 04 78 29 59 14

» rhone-alpes@medecinsdumonde.net

» INTERNATIONAL NETWORK

Argentina CONTACT DETAILS

Médicos del Mundo Argentina Alberti 48 – Buenos Aires

Tel./fax: (+ 54 11) 49540080 www.mdm.org.ar

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contact:

medicosdelmundo@mdm.org.ar

» NATIONAL PROJECTS

» INTERNATIONAL PROJECTS

Caring for marginalised people in urban areas: –– Primary healthcare programme focused on mental health and drug dependence, targeting people living in the streets of Buenos Aires and Rosario. –– Migration and Health Programme promoting an intercultural approach to health in Buenos Aires and Cordoba amongst migrants from Bolivia, Peru, Paraguay and the Dominican Republic. –– Childhood and public health programme with a focus on primary health and promotion of the rights of children and adolescents, with a harm reduction approach in relation to drug use in Buenos Aires city and province. –– Environmental health programme: influence of socio-environmental factors on life, education, and promotion and monitoring of environmental health in the towns and Buenos Aires and Cordoba provinces. –– Right to health and HIV/Aids prevention programme for prisoners incarcerated in the federal prison system and across Buenos Aires province. –– Social and environmental emergencies programme through risk management at a network and community level; planning for prevention, emergency preparedness and response to social environmental emergencies; implementation of rapid response health teams.

Peru: in Chincha and Pisco provinces, MdM Argentina works on the promotion of health for women living in rural areas and to combat gender-based violence in traditional agricultural and fishing communities.

Supporting the rural population, who are mainly indigenous -Fighting against chagas disease and tropical diseases such as dengue fever in Chaco, Formosa and Salta provinces.

Paraguay: programme to tackle gender-based violence and promote the health and rights of women in poor urban areas in Bañado Sur à Asunción. Also continuing to promote traditional medicine and intercultural health in the indigenous rural communities of Canindeyú region. Haiti: work focused on strengthening the local primary care network by community healthcare teams, tackling cholera and other epidemics, a network of community health agents, and the integrated management of socio-environmental emergencies and consolidation of local health systems with the construction of three community health posts in the rural communes of Léogâne, Fonds Parisien, Mirebalais, Lascahobas and Belladère. Bolivia: support and exchange of ideas with training of representatives of the communities and of social movements, in collaboration with AlamesBolivia. Dominican Republic: a project to combat cholera and a project addressing gender-based violence in rural communities and border provinces of Elias Pina, Independencia and Bahoruco. There is also work on the integrated management of risks, prevention and emergency preparedness and response in relation to socio-environmental emergencies in Enriquillo region.

» INTERNATIONAL NETWORK

Argentina contact details

Médicos del Mundo Argentina Alberti 48 – Buenos Aires

Tel./fax: (00 54 11) 49540080 www.mdm.org.ar

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contact:

medicosdelmundo@mdm.org.ar

» COMMUNICATION and events National coordination of a coalition of civil society organisations belonging to the National Forum on Health and the Environment. MdM also acts as Executive Coordinator of the World Social Forum on Health and Social Security and the Regional Council of the Latin American Social Medicine Association (ALAMES). Co-organisation, with the Social Health Forum, the World Social Forum for Health and Social Security and the Pan American Health Organisation/World Health Organisation (PAHO/WHO), of the second national seminar on Health and social security system on the political agenda: debate on universality, inclusivity, and interdependence of rights, which enjoyed the participation of all political parties, the government and experts during the Argentine National Congress. Promotion, organisation and participation in awareness-raising strategies to promote South-South cooperation, health and social security system reforms and the right to health in Argentina, Venezuela, Dominican Republic, Costa Rica, Uruguay, Brazil and Bolivia.

Training on humanitarian action and public health at the Institute for Advanced Studies in Public Health with Dr. Gabaldón from Venezuela. Behind the regional seminar Women’s Week in Buenos Aires in which representatives of public sector and civil society organisations discussed, over three days, the issues of safe abortion, gender-based violence and human trafficking. During the event the photographic exhibition entitled Testimonios (Testimony) was shown. It features portraits of women who have had clandestine and unsafe abortions. This exhibition on the topic of unsafe abortions was also shown at the National Congress by Argentine legislators. MdM acted as Coordinator for the International Health Committee of the Civil Society Advisory Council at the Mercosur Social Summits (Southern Common Market) held in Uruguay and Argentina in 2013. Participation and promotion of a new forum for citizen participation in UNASUR (Union of South American Nations) to encourage a process of dialogue, consultation and participation of South American civil society in regional integration and international cooperation.

Selected to be the Latin American civil society representative for PAHO/ WHO consultation on universal health coverage conducted in Antigua, Guatemala.

TEAM

»2 25 members »1 58 volunteers in headquarters and on national projects »1 3 employees working on national projects »8 headquarters employees »1 9 employees on international projects »2 volunteer on international projects »1 9 staff members working on international projects

acknowledgements

»U nion of South American Nations (UNASUR), Pan American Health Organization,

OCHA (UN Office of Coordination of Humanitarian Affairs), Australian Embassy in Peru and Paraguay (DAP-Australia), Dominican Office of UNFPA, Canadian Fund for Local Initiatives (Dominican Republic), United Nations Environment Programme (Dominican Republc), Ministry of Social Development (Argentina), Ministry of Health (Argentina), National Women’s Council (Argentina), Ministry of Culture (Argentina), National Institute against discrimination, xenophobia and racism (INADI - Argentina), MAC Aids (Argentina), Credicoop Bank (Argentina), Banco Galicia (Argentina), Mercosur civil society consultative council, Navarrese Viole Foundation (Argentina), OTC Aecid (Republican Dominican).

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Belgium CONTACT DETAILS

Médecins du Monde Belgique Rue Botanique 75 B-1210 Brussels

Tel. +32 (0)2 225 43 00 Fax: +32 (0)2 218 69 00 www.medecinsdumonde.be

contact:

info@medecinsdumonde.be

» NATIONAL PROJECTS Brussels Day and night (para)medical response teams in homeless shelters (SAMU Social), squats, occupations, on the streets and in winter shelters. About 6,000 consultations were carried out. Emphasis on continuity of care: screening, vaccination, prevention, referrals to external agencies or to our Healthcare, Advice and Referral Clinic. Several cases of tuberculosis were diagnosed and an increase in chronic diseases was noted. Medical response and mobile harm reduction teams in stations, and areas of high drug use and prostitution. Sexual and reproductive health promotion in the premises of voluntary sector organisations that support women. Healthcare Advice and Referral Clinic: Approximately 5,800 free social, medical and psychological consultations by appointment were carried out. The emphasis was on referral to medical centres and other sociomedical professionals. We have seen a growing number of cases where integration into mainstream services is refused. Specialist consultations: when we are unable to get a patient back into mainstream services, MdM refers them to a network of volunteer specialists for a range of treatments including dentistry (partnership with Dentists of the World). Approximately 600 such consultations.

Antwerp Day and night (para)medical teams offering care in homeless shelters: Around 1,500 consultations. Clinic: Consultations that are free and by appointment: Approximately 3,200 social, medical and psychological consultations. There is also advocacy for access to care for pregnant women and follow-up for diabetics without access to care. Health promotion groups: diabetes, STIs. La Louvière Medical consultations within relais santé: about 400 consultations.

» INTERNATIONAL PROJECTS New programme in Morocco (migrants and violence). Emergency programme in northern Mali. Roll out of governance programme in Tunisia.

» COMMUNICATION AND EVENTS Advocacy priorities were defined as access to healthcare, Universal Health Coverage, sexual and reproductive health and migrant health. Acquisition of a new property and relocation of premises. New board members.

With Her project: advice, support and gynaecological, family planning and paediatric care for extremely isolated women and children. Here there was a marked increase in the medical aspect of the project. About 1,000 client contacts. A survey on the health of Roma women was also carried out.

TEAM

»1 34 members »4 04 volunteers (HQ and national projects) »1 9 employees on national projects »2 0 employees at headquarters »2 3 expatriates on international projects »2 82 national staff on international projects

ACKNOWLEDGEMENTS

»D GD, ECHO, AFD, MAE AHI (CIDA), Unicef, WFP, IOM, Coop. Suisse, WBI, Inami,

SPP IS, FWB, Cocof, Région bruxelloise, FRB, AGEAS, P&V, Fondation Vieujant, Fondation Peterbroeck, Fonds Marie Delacroix, NIF, Pooled Fund, National Lottery, Carrefour.

» INTERNATIONAL NETWORK

Canada CONTACT DETAILS

Médecins du Monde Canada 338, rue Sherbrooke Est Montreal (Quebec), H2X 1E6

Tel.: 001 514-281-8998 Fax: 001 514-281-3011 www.medecinsdumonde.ca

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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info@medecinsdumonde.ca

» NATIONAL PROJECTS

» INTERNATIONAL PROJECTS

Set up in 1999, Projet Montréal has two key components: community healthcare that aims to improve the health conditions of people who are destitute, homeless, marginalised or excluded from healthcare, and psychological support for community workers who work with excluded people. The project also aims to improve the collaboration between the network of community organisations and public health institutions. Three outreach nurses supported by around 50 volunteer doctors — in partnership with street outreach workers and actors from several community organisations — administer care, carry out prevention and health promotion activities, and refer to the public network of health and social services for marginalised people. In 2013, almost 1,000 patients were reached by the network; 4,000 treatments were given by nurses, more than 200 medical consultations and 1,000 psychological support consultations were conducted in nearly 50 Montreal community organisations.

Haiti Since April 2012: strengthening of the health system to fight against cholera for the population of Cité Soleil, in the Port-au-Prince district. A plan for the elimination of cholera from the island of Hispaniola over 10 years (2012-2022) provides for a two-year emergency phase during which cholera will remain a major public health problem which must be addressed. At the same time, local capacity must also be strengthened. Under the eradication plan, the project is to support and reinforce Delmas municipal health office as well as public and mixed healthcare centres and community oral rehydration posts in Cité-Soleil municipality for prevention and support of patients with cholera. The plan also includes the setting up of a community early warning system and rapid response, with the deployment of emergency medical teams in the event of cholera outbreaks, particularly related to natural disasters.

In operation since September 2011, the migrant clinic, set up to care for undocumented migrants, enjoys the support and collaboration of many doctors and other professional volunteers. They welcome and treat migrants without access to healthcare and refer them to specialists if necessary. In 2012-2013, over 1,409 people benefited from the clinic’s services; 423 were able to see a doctor and the nurses provided 1,337 treatments.

Since September 2013, MdM Canada has been running a project to improve the coverage of primary healthcare services in the most vulnerable of areas of Cité Soleil. The project is supporting the Haitian Ministry of Health in the implementation of its 2012-2022 Master Plan. In line with community health policy, MdM Canada supports training, equipping and deployment of 30 multi-purpose community health workers to improve the health status of people living in Cité Soleil. The project aims to increase access to quality health promotion, preventive and curative health services. The project also strengthens the management of Chapi public institution in the area where it is being rolled out.

» INTERNATIONAL NETWORK

Canada CONTACT DETAILS

Médecins du Monde Canada 338, rue Sherbrooke Est Montreal (Quebec), H2X 1E6

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Tel.: 001 514-281-8998 Fax: 001 514-281-3011 www.medecinsdumonde.ca

contact:

info@medecinsdumonde.ca

Colombia Financial partnership with MdM France for the primary healthcare project for rural people affected by the Colombian armed conflict in four municipalities in Meta Department. Mali Financial partnership with MdM Belgium for the project on assistance to populations affected by the humanitarian crisis in North Mali through a medical and nutritional programme for people in Kidal and Gao regions.

TEAM

»5 0 members »2 55 volunteers (HQ and national projects) »8 employees on national projects »7 headquarters employees »6 volunteers on international projects »2 1 national employees on international projects

» COMMUNICATION and events The annual benefit gala was held in May 2013 featuring the opera singer, Marie-Josée Lord. The gala was attended by 250 participants and generated revenue of nearly $80,000 for projects. More than 15,000 individual donors supported local and international interventions.

ACKNOWLEDGEMENTS

»C anadian International Development Agency, Montreal Regional Health and Social

Services Agency, Quebec Ministry of International Relations, Canada Development and Human Resources, Secours Catholique / Caritas France, J.A. Bombardier Foundation, L’Œuvre Léger, Beati Foundation, Bell Canada, Green Shield Canada, La Fondation du Grand Montréal et le Canadien National.

» INTERNATIONAL NETWORK

Germany cONTACT DETAILS

Ärzte der Welt e.V. Leopoldstr. 236, 80807 Munich

Tel.: +49 (0) 89 45 23 081-0 www.aerztederwelt.org

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contact:

info@aerztederwelt.org

» NATIONAL PROJECTS Open.med clinic in Munich: Due to a sharp increase in the number of consultations in 2013 open.med extended its care to include longer opening hours. The majority of patients come from south-east Europe. MdM Germany notes that the number of service users without insurance is still on the increase. The benefits of a federal directive allowing people who are excluded back into the system are not yet in evidence. Mobile unit MedMobil Stuttgart: MdM Germany also saw an increase in its work with vulnerable people in Stuttgart with nearly 1,200 consultations conducted in 2013.

» INTERNATIONAL PROJECTS Cambodia: Opération Sourire continued its work with two missions carried out in Ou Reang Ov and Kampong Cham. At the same time as performing surgery, MdM is increasing the capacity of local medical staff with training sessions in ultrasound techniques. Burma: MdM Germany’s project aims to restore sight to people who are completely or partially blind (due to cataracts). Our ophthalmologists visited twice and also teach at the University of Yangon. Togo: MdM Germany is working with the National School of Midwives to improve access to obstetric care, especially in rural areas. In 2013, the first class began their training and the future midwives will be supplied with an obstetrics kit.

Papua New Guinea: MdM Germany’s goal is to improve immunisation rates for children, particularly in remote areas of the Pacific island state. In 2013, several training sessions were organised with local staff to improve the effectiveness of future vaccination campaigns. MdM Germany is also involved at a strategic, administrative and financial level in MdM international network projects in Burkina Faso, Ethiopia, Pakistan, Palestine, Somalia, Syria and Turkey.

» COMMUNICATION AND EVENTS 2013 saw a strong media resonance for common themes highlighted across the MdM network, including the humanitarian crisis in Syria and socio-economic situation in Greece and Typhoon Hayian in the Philippines. Faced with growing indifference towards the Syrian crisis, MdM signed up to the campaign STOPP. Schau hin! (Stop. Look!) The campaign involved a coalition of 35 non-governmental organisations. For an entire week, participating NGOs chose to focus their communications on a common message: that they refuse to accept the intolerable situation in Syria.

» INTERNATIONAL NETWORK

Germany coordonnées

Ärzte der Welt e.V. Leopoldstr. 236, 80807 Munich

Tel.: +49 (0) 89 45 23 081-0 www.aerztederwelt.org

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contact:

info@aerztederwelt.org

A highlight of our communications calendar in 2013 was the 7 Milliarden Andere (7 billion others) exhibition, organised in collaboration with photographer Yann Arthus-Bertrand and his Good Planet Foundation, which saw considerable success with nearly 30,000 visitors during the Tollwood cultural festival in Munich. 7 billion others presents a mosaic of humankind through 6,000 testimonies from around the world. Thanks to its presence in several countries, MdM was able to provide some operational support to the project.

TEAM

»6 8 members » 230 volunteers » 4 employees on national projects » 19 employees at headquarters » 32 international volunteers

ACKNOWLEDGEMENTS

»D aimler AG, L’Oréal foundation, Olympus Europa foundation, Sternstunden foundation, RFA Ministry of Foreign Affairs, Siemens AG, Munich City Council, Stuttgart City Council.

» INTERNATIONAL NETWORK

Greece contact details

Headquarters: Athens 12 Sapfous street 105 53 Athens

Tel.: +210 3213150 Fax: + 210 3213850 www.mdmgreece.gr

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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info@mdmgreece.gr

» national projects MdM Greece manages 17 national projects, of which eight began after 2010 in response to the growing needs caused by the social and economic crisis in Greece. In 2013, five polyclinics received 75,600 visits, 9,000 were reserved for children without health insurance. The psychosocial service supported 11,000 cases and more than 100 people were housed in the homeless shelter. We distributed 6,300 food parcels to families, accommodated more than 6,000 refugees on the island of Lesbos, assisted 75 victims of racist attacks, provided healthcare services to 14,700 people using mobile medical units, supported 200 homeless people and 2,047 drug users, and opened a shelter with the capacity to house 50 people per night. MdM Greece currently supports the following national programmes: –– Five polyclinics in Athens (since 1997), Thessaloniki (2001), Chania (2007), Perama (2009) and Patras (2012); –– An overnight accommodation centre for refugees and asylum seekers in Athens with space for 70 people; –– Three mobile units that offer medical services to people living in isolated and remote areas of Greece. Leto mobile unit offering dental care for children, Iris, the ophthalmological unit and a mobile unit providing general healthcare for women and children; –– A unique project on the islands of Lesbos and Chios offering medical interventions, detecting the most vulnerable cases, offering social assistance and legal support for people who may need international protection; –– Two projects for homeless people in Athens and Piraeus offer healthcare services and practical assistance, and psychosocial support based on an individual’s needs; –– Athens Street, a project aimed at harm reduction for drug users (IVDUs);

–– The Roma Project, which provides vaccinations and medical care for Roma children living in camps around Athens; –– A night shelter for homeless people in the centre of Athens; –– Message for life, a support programme the elderly; –– the Enough! project which aims to promote tolerance and fight against racist violence in Greece.

» international projects Uganda: Village Monte (August 2009). MdM’s objective is to improve, equip, expand and fully utilise the Monte medical centre. New material includes appropriate medical instruments that can perform diagnostic tests and support the majority of patients. Additionally, MdM embarked on the recruitment of centre staff. A permanent nurse and a doctor, as well as other medical volunteers from Greece, use their knowledge to provide pharmaceutical treatments and raise awareness of the importance of hygiene, prevention and health for programme beneficiaries.

» INTERNATIONAL NETWORK

Greece contact details

Headquarters: Athens 12 Sapfous street 105 53 Athens

Tel.: +210 3213150 Fax: + 210 3213850 http://mdmgreece.gr

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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info@mdmgreece.gr

» COMMUNICATION and events In 2014, MdM Greece will focus its advocacy on three themes: –– access to healthcare for children and pregnant women, in particular the promotion of actions that guarantee coverage for uninsured children; –– the protection of elderly and vulnerable pensioners who are living below the poverty line; –– the promotion of tolerance and the fight against racist violence in Greece.

TEAM

»1 ,300 members »6 00 headquarters and national project volunteers »4 6 employees on national projects »2 7 employees at headquarters

» INTERNATIONAL NETWORK

Japan contact details

Doctors of the World Japan Azabu Zenba Bldg 2F 2-6-10 Higashi-Azabu Minato-Ku, Tokyo 106-0044

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Tel.: +81 3 3585 6436 Fax: +81 3 3560 8073 www.mdm.or.jp

contact:

info@mdm.or.jp

» national projects

» international projects

Project Tokyo: addressing the needs of homeless people who suffer from mental health issues or have special needs in Ikebukuro, Tokyo. This helps these very vulnerable people to lead a more stable and safer life, and has helped a number of them to become more self-reliant and no longer to have a need for our services. The project has benefited 300 people, including 80 ongoing clients.

Opération Sourire – Bangladesh and Burma: in January the Japanese Opération Sourire team conducted its second exploratory mission to Burma, which will be followed by two missions in June and December. In Bangladesh, MdM Japan sent two teams to Dhaka, where, since the project began in 2009, a total of 10 missions have been carried out and 449 patients operated on.

Projects for the north east region affected by the earthquake - Nikokoro and Soso: the MdM team manages two projects in this region, one in Otsuchi, in Iwate Prefecture and the other in the area of Soso, in Fukushima Prefecture. Both projects aim to provide mental healthcare and to support the efforts of local stakeholders to implement a new mental healthcare system, as well as supporting residents as they rebuild their cities and their lives.

Paediatric project in Laos: In 2012, MdM Japan launched its first longterm international programme in Laos. Its paediatric project is an extension of the maternal care programme that MdM France has been running in this country since 2010. The project targets 15,000 children under five and their families in two districts of Champassak province. The activities are organised around three themes: strengthening the position of health professionals, increasing awareness amongst the population and supporting the policy of free healthcare set out by government.

MdM came to Otsuchi just after the disaster in March 2011. Over and above the care provided by volunteer doctors and nurses and its contributions to the city magazine, MdM fulfils its humanitarian mission on the basis of relationships built on mutual trust with local stakeholders and residents. Around Soso, which includes the evacuation zone established after the accident at the Fukushima Daiichi power station, MdM is working with a new local organisation, which aims to address the lack of psychiatric services in the region. Since 2012, MdM has been sending the same medical volunteers to this organisation in order to ensure the relationship can development smoothly.

Financial contribution to international projects MdM France: MdM Japan has provided financial support for international missions conducted by MdM France in nine countries and regions (Central African Republic, Côte d’Ivoire, Democratic Republic of Congo, Mali, Nepal, Niger, Philippines, Sahel and Syria).

» INTERNATIONAL NETWORK

Japan contact details

Doctors of the World Japan Azabu Zenba Bldg 2F 2-6-10 Higashi-Azabu Minato-Ku, Tokyo 106-0044

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Tel.: +81 3 3585 6436 Fax: +81 3 3560 8073 www.mdm.or.jp

contact:

info@mdm.or.jp

Human resources support for MdM France international projects: three volunteers participated in the MdM France Opération Sourire trip to Madagascar and Pakistan.

» COMMUNICATION and events Activism: MdM Japan’s campaigns are concentrated on topics related to national programmes. Before the end of year holidays, during which public services are suspended for a week, the Tokyo project team and other activists sent an official letter to the Ministry of Health and held a press conference to call for replacement services to be offered to ensure that care was available for those in need. Communication: MdM Japan was selected by AC Japan (Japanese Council of Advertising) to benefit from its advertising campaign during 2012-2013 and 2013-2014. During these periods, MdM was able to distribute adverts in four major media (TV, radio, newspapers and magazines) throughout the country at no cost. Exceptionally, the period of free distribution was extended to 2014-2015.

TEAM

»3 2 members » 52 headquarters and national project volunteers »3 employees on national projects »8 headquarters employees »2 volunteers on international projects »9 national staff on international projects

ACKNOWLEDGEMENTS

» A merican Express International, Inc., Ichiyoshi Securities C., Ltd., Venture Bank,

Inc., French embassy in Japan, Ministry of Foreign Affairs in Japan, L’Oréal Foundation, Chanel K.K., French Food Culture Center, White & Case LLP, Felissimo Corporation

» INTERNATIONAL NETWORK

Netherlands contact details

Dokters van de Wereld Nieuwe Herengracht 20 1018 DP Amsterdam

Tel.: +31 20 465 2866 Fax: +31 20 463 1775 www.doktersvandewereld.org

DOCTORS OF THE WORLD ANNUAL REPORT 2013

contact:

info@doktersvandewereld.org

» national projects

» international projects

Activities include awareness raising, mediation and prevention for undocumented migrants during consultations, with social aid in Amsterdam and The Hague, and by phone through the national helpline. Advocacy for access to healthcare for undocumented migrants. Registration of undocumented migrants with GPs. In figures: –– 1,522 consultations were carried out, providing mediation, counselling and information on the Dutch healthcare system and rights to health (by phone or face-to-face); –– 862 consultations were carried out by telephone; –– 182 problems in obtaining access to medical care were identified. When this happens, MdM Netherlands then mediates with health professionals. In over 84% of cases, access to healthcare is obtained. 127 service users who needed to see a GP were successfully supported in registering with a local doctor; –– Advocacy: MdM Netherlands convened a meeting of senior level experts to discuss public health and undocumented migrants in the Netherlands. MdM Netherlands participated in MdM’s international Observatory network, with the inclusion of 135 service user cases.

Opération Sourire. 433 operations were carried out on children and young adults. In total, five surgical missions were conducted in Bangladesh, Guinea-Bissau, Burundi and Sierra Leone, in partnership with university hospitals and Interplast Holland. 101 national and local medical staff attended surgical camps where training and group sessions took place.

TEAM

»6 9 members, 113 volunteers » 3 employees on national projects » 6 headquarters employees » 3 expatriate employees » 19 volunteers » 54 national employees

In mid-2013, MdM Netherlands transferred its international projects in Myanmar to MdM France. The mother and child health programme in Indonesia was completed at the end of May, when its activities were transferred to local partners. Financial support to international network programmes: Syria refugee camps; basic medical care in Colombia; Philippines emergencies; fistula programme in Chad; street children (girls) in the Democratic Republic of Congo; mother and child care in Mali.

» COMMUNICATION and events Featured in the media, with articles about undocumented migrants, Opération Sourire and a free advertising campaign. Increased online exposure and social media (Facebook/website/YouTube). Fundraising campaigns for Opération Sourire: Dam-tot-damloop half marathon, Dr. Love Party, poetry reading and running roughly six kilometres.

ACKNOWLEDGEMENTS

» I nnovatiefonds Zorgverzekeraars, Maria Stroot Foundation, Cordaid, Commission

PIN, Fondation Skan, Stichting RC Maagdenhuis, NutsOhra Foundation, Stichting Janivo, Kerk in Actie, Remonstranten, Hulp na Onderzoek, écht©goed doen, Kerry Stichting, National Lottery, L’Oréal via MdM France, the Joint Initiative for Maternal, Neonatal and Child Health (JIMNCH) via MdM France.

» INTERNATIONAL NETWORK

Portugal contact details

Médicos do Mundo Av. de Ceuta (Sul), Lote 4, Loja 1 1300-125 Lisbon

Tel.: +351 213 619 520 www.medicosdomundo.pt

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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mdmp-lisboa@medicosdomundo.pt

» national projects

» international projects

Porto UHSA – Santo António Residential Unit (in progress): provides healthcare to the people in this unit. Estilus (July 2010-June 2014): contributes to making activities to reduce risky behaviours more effective. Older people (July 2010-June 2014): to improve the autonomy and independence of this population. Mensanus (April 2009-March 2013): to improve the quality of life of people with mental health problems through social inclusion and the protection of their rights and dignity.

São Tomé and Príncipe Saber é Poder (Knowledge is power 1 March 2011 - 28 February 2014): contributed to the prevention of early pregnancies, especially among young people between 11 and 24 years old. Viver Positivo (Living positively, January 2011 - August 2013): to improve the quality of life of people living with HIV/Aids in São Tomé and Príncipe.

Évora Prevention for all (January 2013-December 2013): provide primary care and, at the same time, carry out prevention and early detection of illness among people over the age of 65 who live in the remote Alentejo hills. Lisbon Live in good health (2002 to May 2014): promotes physical activity amongst 25% of seniors living in the Bairro da Picheleira (district in Lisbon) and surroundings. Mobile health (since January 2010): contributes to the prevention of diseases, with particular attention to the most vulnerable populations. Like Me (January 2013-December 2015): contributes to the promotion of the mental health of young people. Farmédicos (January 2013-June 2014): greater equality of access to drug treatment.

Timor – Leste Healthy community (1 January 2010 to 31 August 2014): Reducing mortality and the rate of maternal and child morbidity by increasing access to health services within existing networks and at a community level in the districts of Lautem and Viqueque. Mozambique Tackling HIV/Aids (1 July 2011 to 30 June 2013): aiming to reduce the national incidence of HIV/Aids by focusing on prevention, treatment services and harm reduction efforts. Prevention and control of malaria (1 July 2011 to 30 June 2013): aiming to halve the mortality rate associated with malaria by 2015.

» INTERNATIONAL NETWORK

Portugal contact details

Medicos do Mundo Av. de Ceuta (Sul), Lote 4, Loja 1 1300-125 Lisbon

Tel.: +351 213 619 520 www.medicosdomundo.pt

DOCTORS OF THE WORLD ANNUAL REPORT 2013

2/2 contact : mdmp-lisboa@medicosdomundo.pt

» COMMUNICATION and events Call Us More campaign ‘The interest you take in us has never been more important. Pay more attention to homeless people and to elderly people at risk. Call Doctors of the World more. Call anyone who needs more of your attention. Call now 760 501 050 (0.60 € + VAT) and make a donation.’ IRS campaign Donate to MdM through your tax return. We need your help! Any contribution will make a difference. Events Amongst a number of events, we wanted to highlight the International Day of Older People. MdM hosted a series of events in Lisbon, Porto and Évora.

TEAM

»1 86 members »2 00 headquarters and national project volunteers » 13 employees on national projects »9 headquarters employees » 11 employees on international projects » 5 volunteers on international projects » 134 national staff on international projects

» INTERNATIONAL NETWORK

Spain CONTACT DETAILS

Médicos del Mundo España C/ Conde de Vilches 15, 28012 Madrid

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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Tel.: 915436033 Fax: 91 5437923 www.medicosdelmundo.org

contact:

informacion@medicosdelmundo.org

» national projects During 2013, projects focused on caring for vulnerable groups. One year after the adoption of Royal Decree 16/2012, hundreds of thousands of people living in Spain have been left without access to care. Faced with this situation, work focused on raising awareness of this violation of the right to health, and caring for those affected whilst lobbying authorities about the lack of protection and the exclusion of the most vulnerable groups. As part of the awareness-raising and educational development projects, MdM Spain continued to work on human trafficking for purposes of sexual exploitation by organising round tables and film series at universities. The organisation worked with students to develop positive attitudes and behaviour towards migrants. Materials on specific topics, such as teaching guides for classroom work, were also developed.

» international projects MdM Spain is active in 20 countries or territories, with 52 projects that reach more than four million people whose rights are denied. The organisation works in a network with 137 national organisations. The teams are made up of more than 500 people of different nationalities; three-fifths of them work in their country of origin. The priority themes are: access to public sector health services; sexual and reproductive health; gender-based violence and sexual violence against women, children and adolescents; health policies that include vulnerable populations and ensuring gender issues are taken into account in the design and development of health policy.

MdM Spain has humanitarian projects in Jordan and the Philippines. It is also important to highlight the work in the Dori refugee camp, Burkina Faso.

» COMMUNICATION and events

Advocacy The 23,000 signatures collected during the campaign Derecho a curar (Right to Treat), conducted in 2012, were submitted to the Ministry of Health. MdM Spain attended the meeting with parliamentary assistants from the Health Commission of the Congress of Deputies and presented its analysis of the impact of Royal Decree (RDL) 16/2012 in terms of exclusion from the health system. The organisation had a meeting with the State mediator to submit a report on the impact of the RDL on hundreds of people who come to seek advice and support from its services. Throughout the year, local groups liaised with, and participated in, meetings with autonomous community authorities to highlight multiple cases of particular concern. MdM Spain launched the Nadie desechado (No person rejected) campaign, to mobilise public opinion against the consequences of the health system reform, not only for the migrant population directly affected from the start, but also for other vulnerable groups. The Action for Global Health network launched a report in Spain entitled Who Pays for Health? Trends in Official Development Assistance for access to care, and hosted a conference in Madrid on 20 November 2013 entitled The new challenges for international cooperation and UHC (Universal Health Coverage) in the next global development agenda.

» INTERNATIONAL NETWORK

Spain contact details

Médicos del Mundo España C/ Conde de Vilches 15, 28012 Madrid

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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Tel.: 915436033 Fax: 91 5437923 www.medicosdelmundo.org

contact:

informacion@medicosdelmundo.org

Events The XVII Luis Valtueña International Photography Award: Niclas Hammaström from Sweden won this latest edition with his Aleppo series. The finalists were Dark Passage by Fabio Cuttica; La Casa de la Buena Vida by WaiHnin Tun and Silenciosa espera by Mingo Venero.

TEAM

»5 56 members »1 ,302 headquarters and national project volunteers »1 24 employees on national projects »7 5 headquarters employees »6 2 employees on international projects »5 2 volunteers on international projects »2 95 national staff on international projects

ACKNOWLEDGEMENTS

» S panish agency of international cooperation for development (Ministry of Foreign Affairs and Cooperation), UNHCR, town councils and autonomous communities, deputations, ECHO, foundations, Ministry of Health, Social Policy and Equality, Ministry of Labour and Social Affairs DGII, Unicef, European Union.

» INTERNATIONAL NETWORK

DOCTORS OF THE WORLD ANNUAL REPORT 2013

Sweden contact details

Läkare i Världen Sverige Box 39006 SE-100 54 Stockholm

Tel.: +46 2 222 567 87 Fax: +46 2 222 567 86 www.lakareivarlden.org

contact:

info@lakareivarlden.org

» national projects

» COMMUNICATION and events

Medical clinic in Stockholm. In 1995, MdM Sweden began running a clinic for undocumented migrants. Since January 2014, the clinic also cares for EU citizens and citizens from other countries. The clinic is open one night a week and provides primary healthcare without appointment.

MdM Sweden launched an information campaign for undocumented migrants and health personnel a month before the new law came into force. MdM Sweden is taking on the role of ‘watchdog’ for the new law and closely monitors how it is applied. Through monitoring records of service users referred to public health services, MdM Sweden revealed in a report that many undocumented migrants are denied access to subsidised care in spite of their entitlement under the new law. MdM Sweden launched a campaign for the creation of a ombudsman for health services for undocumented migrants. The campaign (www.vardombudsmannen.se) relies on crowdfunding (participatory finance) and will continue in 2014.

In 2013, Sweden made great strides in access to healthcare for undocumented migrants. A new law, in force since 1 July 2013, gives undocumented minors the same rights in terms of healthcare as children of the resident population, that is to say, the right and access to subsidised comprehensive healthcare, including dental care. Adults can receive care ‘that cannot be postponed’, including dental care. Antenatal monitoring for pregnant women, contraceptive counselling, healthcare related to abortions or infectious diseases and medical examinations are provided free and without any restrictions. The new law has changed the work of MdM in the clinic. We stopped offering medical treatment for undocumented migrants in the clinic when the law came in to force. Our work now focuses on sharing information with patients about their new rights.

MdM Sweden participated in several seminars and public awarenessraising meetings to warn about problems related to the implementation of the new law. The main seminar was held at the Swedish Forum for Human Rights in Stockholm on 15 November. MdM Sweden developed its activities on social networks during the year and has experienced a significant increase in its followers on Facebook and Twitter.

We received more than 300 patients in the clinic and conducted a total of 350 medical consultations during the year. Psychiatrists and psychologists also provide support to migrants every two weeks. MdM Sweden’s psychosocial team received 56 patients during the year for a total of 208 visits. MdM Sweden also provided legal aid for beneficiaries in collaboration with lawyers and other experts on immigration and asylum law. This consultation is provided once a week and can accommodate up to 20 clients.

TEAM

»1 00 members »5 5 headquarters and national projects volunteers »1 employee at headquarters

ACKNOWLEDGEMENTS

»W ebdesign Wof factory, Unilabs, lawyers Hatem & Sjunghamn, photographer Elisabeth Ohlson-Wallin, Swedish Red Cross.

» INTERNATIONAL NETWORK

Switzerland contact details

Médecins du Monde Suisse Rue du Château 19 2000 Neuchâtel (headquarters)

Tel. +41 32 725 36 16 www.medecinsdumonde.ch

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contact:

info@medecinsdumonde.ch

» national projects Health and Migration Network (HMN): the HMN project offers nurse consultations and social support to vulnerable people and migrants. 2013 saw the strengthening of public information activities for migrant communities with the recruitment of a part-time social worker in April, which resulted in a 44% increase in the number of consultations carried out at the HMN. Permanence santé (PS): the PS project aims to promote access to care for sex workers by providing a healthcare professional to add to the activities of the association Fleur de Pavé. The main objective for the year was to transfer the project to the Vaud health authorities. Several meetings and discussions took place, leading to the transfer at the end of December 2013 to the University Medical Polyclinic. Accueil santé asile (ASA): provides primary healthcare and health promotion advice to asylum seekers housed in centres in Neuchâtel canton. During the first nine months of the project, 486 consultations were carried out with 167 people; 75% of them had come for care, 20% for psychological issues and 5% for other reasons. The ASA project was planned for two years, with a view to transferring to public institutions.

» international projects Benin Since 2009, MdM has been supporting the national fight against sickle cell disease through the National Institute of SCD Infants and Pregnant Women (CPMI-NFED). Activities in 2013 were mainly dedicated to taking the necessary administrative steps towards re-registering MdM and reopening the MdM office, contact and partnership agreement negotiations with CPMI-NFED, formalising the establishment of a branch in Parakou and related objectives.

Cameroon MdM started its project to strengthen Koupa Kagnam Centre for Integrated Health in October 2013. Supporting the Centre represents a pilot project, along with a research project on the population’s use of health services that will identify community health needs, and assess the feasibility of a programme in the region to improve the health of the population. Haiti In early 2013, MdM completed the preliminary stages of the response to the cholera that followed the 2012 storms. More than one hundred children were cared for in a nutritional stabilisation unit and reconstruction of the Dufour dispensary resumed. A health promotion committee was established, trained, and led a participatory community needs assessment with over 50 people from the community. Comprehensive training for 14 community health workers started in late 2013. Palestine In 2013, MdM started the final phase of its mental health programme in the Halhul community mental health centre for children and adolescents, in Hebron district. Once this pilot programme is handed over to the local authorities, our main partner, the Palestinian Ministry of Health, has asked us to open a new centre in Nablus.

» INTERNATIONAL NETWORK

Switzerland contact details

Médecins du Monde Suisse Rue du Château 19 2000 Neuchâtel (headquarters)

Tel. +41 32 725 36 16 www.medecinsdumonde.ch

DOCTORS OF THE WORLD ANNUAL REPORT 2013

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contact:

info@medecinsdumonde.ch

» COMMUNICATION and events To mark its 20th anniversary, MdM Switzerland chose to meet new people and enjoy open discussions and celebration. A packed programme of activities was rolled out in 2013, all based on the desire to bring people together. To highlight its long-term presence and dedication to the places where it runs projects, Doctors of the World Switzerland, set up spaces for reflection, images, and music. The programme of celebrations was strengthened by the opening of a new ASA project in the Neuchâtel asylum seekers’ centres and launch of a campaign on one of the MdM’s major areas of concern: maternal and infant mortality.

TEAM

»1 46 members »6 0 volunteers (headquarters and national projects) »3 employees on national projects »9 headquarters employees »2 expatriates on international projects »7 volunteers on international projects »4 3 national staff on international projects

ACKNOWLEDGEMENTS

»A ssociation FestinG, Café la Semeuse, Centre hospitalier universitaire vaudois,

Chaîne du Bonheur, Chipset Design, Chloe Sa, Club 44 at la Chaux-de-Fonds, CoFRa foundation, Pully council, DDC, eCHo, epeR, entraide protestante suisse, État de Genève, Fondation des amitiés gréco-suisses, Fédération des coopératives Migros, Fédération Genevoise de Coopération, Fondation Jane Stale-erzinger, Fondation Optival, Fondation prévention et santé, Fonds Ciel bleu supported by the Symphasis charitable foundation, Pierre-William Henry (photographer), Neuchâtel hospital, Philippe KItSoS (barrister), Maud lanCtuIt, (graphic designer), Latitude 21, Fédération neuchâteloise de coopération au développement, Romandy lottery, Moser Graphic, promotor Stiftung, Proxylab analyses médicales SA, Rotaract Club neuchâtel, Unicef, La Chaux-de-Fonds council, Ville du locle, Visilab Sa

» INTERNATIONAL NETWORK

United Kingdom contact details

Doctors of the World UK 34th Floor, One Canada Square, London, E14 5AA

Tel. +44(0) 207 1675789 www.doctorsoftheworld.org.uk

DOCTORS OF THE WORLD ANNUAL REPORT 2013

contact:

info@doctorsoftheworld.org.uk

» national projects

» COMMUNICATION and events

The programme improves access for people who are excluded from basic medical care. Forty volunteer doctors, nurses and assistants provide information and basic short-term medical care as necessary to the most vulnerable people in the UK.

Highlights from 2013 include: –– the immigration bill: Interviews on major TV channels such as BBC News, Sky News, ITV Daybreak, and all BBC Radio stations; –– Medical care for migrants: Channel 4 and Al Jazeera filmed our clinic in London; –– Syria: appearances on BBC News, Sky News and BBC Radio stations; –– Government Communications Headquarters (GCHQ) spying scandal: international news coverage with primetime interviews on BBC and ITN news and frontpage of The Guardian newspaper.

In 2013, MdM: –– provided 1,044 consultations for service users of the clinic; –– provided social assistance to sex workers and migrant organisations; –– offered 25 training sessions to health professionals and community organisations, reaching more than 1,000 people; –– coordinated the voluntary sector response to government proposals to restrict access to healthcare for migrants; MdM UK was also active in the media and was invited to work with the Ministry of Health to soften the impact of these changes on the most vulnerable.

» international projects Emergency response for Syria, funded by the Department for International Development (DFID), helps reduce the immediate effects of the Syrian crisis on the physical and mental health of Syrians. The number of people fleeing Syria to join neighbouring countries has been increasing rapidly since the outbreak of the conflict, the vast majority travelling into Lebanon or Jordan. We operate in both countries, bringing basic medical care to vulnerable people in overcrowded camps and in our clinics, where our doctors provide basic medical care along with antenatal and postnatal care. Our teams also work with survivors of violence based on their sexual orientation. TEAM

»1 00 headquarters and national project volunteers »2 employees on national projects »9 headquarters employees

The Royal Parks Half Marathon, one of the most beautiful runs in the world through London’s parks, raised more than £16,000.The Santa Run in Greenwich Park (London) saw a record number of runners, with 120 taking on 5 or 10 km and raising more than £11,000. A gala was held for the first time, celebrating 15 years of MdM UK. The reception was hosted by French Ambassador Bernard Emie in his London home, assisted by Lord Rogers, a founding member of our Board of Trustees. 93 distinguished guests from the world of finance, entertainment, media and international development were present. From ticket sales, generous donations and a silent auction, more than £100,000 was raised for MdM UK.

ACKNOWLEDGEMENTS

»D FID, Comic Relief, UK Department of Health, City Bridge Trust, Souter Charitable Trust, Coutts, Sigrid Rausing Trust, London Catalyst/Samaritans, Barrow Cadbury, Anne Marie Pouliquen, Argus Media and our anonymous donors, without whom it would not be possible to run our projects.

» INTERNATIONAL NETWORK

United States contact details

Doctors of the World-USA, Inc. 137 Varick Street, 8th Floor New York City, NY 10013, USA

Tel.: +1.646.407.7586 www.doctorsoftheworld.org

contact:

info@doctorsoftheworld.org

» national projects

» COMMUNICATION and events

Doctors of the World USA free clinic in the Rockaways Doctors of the World first came to the Rockaways district on the outskirts of New York in November 2012, immediately after Hurricane Sandy had devastated the peninsula. It was obvious that this disaster had decimated the health infrastructure in the area. It gradually became clear that many residents had problems with access to healthcare long before the hurricane struck. The area was designated as a medical desert (Medically Underserved Area - MUA; and Health Professional Shortage Area - HPSA) by government authorities, which means that there were not enough health professionals available and/or willing to help the most disadvantaged. In early 2014, 40% of health services are still closed due to damage from Hurricane Sandy. The free Doctors of the World Rockaways clinic welcomed its first service users on 24 October 2013 and is currently open two days a week to provide preventive and primary healthcare to adults in the area who have no health insurance. The centre relies heavily on volunteer doctors and nurses and a small team of employees. The centre provides free electronic prescriptions which are valid in local pharmacies. It also prescribes free laboratory tests, reduced cost x-rays and makes referrals to local specialists on a sliding cost scale.

TEAM

»1 2 members »2 2 volunteers in headquarters and on national projects »4 employees on national projects »1 7employees in headquarters

DOCTORS OF THE WORLD ANNUAL REPORT 2013

March 2013: Fashion Cocktail for Rockaways centre. March-June 2013: three MdM programmes (Syria, Laos and Nepal) joined the Chime for Change campaign sponsored by Gucci and the Kering Foundation. A concert marked the end of the campaign. The total amount collected by MdM was $75,000. May-June 2013: partnership with Michel Cluizel. October 2013: Jacadi event to raise funds for MdM programmes that help women and children affected by the Syrian crisis. December 2013: Mauboussin cocktail event to benefit the free care Rockaways centre, sponsored by Air France and D’Artagnan. Communications also included regular emails and updates on social networks, as well as emergency appeals for the typhoon in the Philippines and other appeals, specifically, for the free care Rockaways centre. Finally, an email campaign was launched in early 2013 and was followed by another appeal for donations at the end of the year.

ACKNOWLEDGEMENTS

» J acadi Paris, Mauboussin, Michel Cluizel, Ms Salma Hayek-Pinault, Gucci and the Kering Foundation, TheLadders.com, Inc, Air France KLM, Sidley Austin, D’Artagnan