Annual report 2012 by Médecins du Monde

DOCTORS OF THE WORLD

ANNUAL REPORT

2012

DOCTORS OF THE WORLD ANNUAL REPORT 2012

contents » 05

A word from our chair

» 10

2012 campaigns

» 12

2012 figures

» 14

Financial transparency

» 16

Public and institutional funding

» 18

International programmes

Emergency and long term programmes

22 Map

Sub-Saharan Africa

Latin America

40 Asia 48 Europe

North Africa and Middle East

» 62

Programmes in France

» 80

Regional delegations

» 86

The international network

» 92

Agenda

» 98

Cross-cutting projects

» 108

The Board of Directors

» 110

Our thanks to

» 112

Glossary

Jordan © Agnès Varraine Leca

DOCTORS OF THE WORLD ANNUAL REPORT 2012

A word from our Chair 2012 was a difficult year, but can also be seen as one of transition: ongoing Arab revolutions, worsening violence in Syria, northern Malian towns taken by Islamic insurgents, and elections in France, amongst other key events. Adapting to the world as it changed, Doctors of the World continued to develop projects in France and abroad, working side by side with the most vulnerable.

Humanitarian action in a constant state of flux

» Dr Thierry Brigaud chair of doctors of the world France

army set up a military hospital in a camp this summer, we restated our position In response to the Syrian crisis, syste- that blurring the lines between humanitamatic human rights abuses, flouting of rian and military action is dangerous. international humanitarian law and the targeting of healthcare workers, MdM In Syria, as soon as the security situaset up a range of programmes. tion allowed, the MdM emergency team crossed the border to help set up a camp In partnership with organizations caring for 5,000 displaced people living under for Syrians at the Turkish border, we set canvas. And, whenever possible, when up a post-operative centre that can care groups of doctors are known to us we use for up to 100 wounded. them to get medical equipment, products and medicines in to the country. In Lebanon, in partnership with Amel, the local organization, in the Bekaa Valley, In the north of Mali, the capture of sevedoctors are caring for refugees. In Kha ral villages by insurgents and a coup in village, close to the Syrian border, we are Bamako at the beginning of the year has running medical sessions in a clinic, ena- forced MdM to rethink its strategy. We bling us to treat those fleeing the fighting. took the risk of continuing our long-term programmes alongside our emergency In Jordan, MdM teams are working in response. In practice, this means we are several refugee camps. When the French caring for Malian refugees crossing the

Burkina Faso border in the Djibo region and supporting Malian migrant organisations that look after displaced people. Our emergency teams also conducted an exploratory mission in the Mopti region. We remain committed to constantly improving our work to ensure we are able to respond to crisis and conflicts, whilst remaining true to our principles and area of expertise.

A campaign to denounce health inequalities A participative process of reflection, involving those involved in our work in France, delivered a number of recommendations in the French electoral year of 2012. This co-authored document spans a range of issues and campaigns and has become a key point of reference. The awareness-raising campaign, Vote Health!, took the advocacy messages across the country.

ther two areas worth highlighting. In addition, 4,000 more beds were promised for asylum seekers and 4,000 more beds for emergency accommodation. But more progress is needed: • March 2013 marked 10 years since the Internal Security Law was passed; 10 years of its damaging effects on the health of sex workers. This provides the perfect opportunity to call for the abolition of passive soliciting as a criminal offence and the decriminalisation of prostitution. • The right to health for foreign nationals remains an issue. Leave to remain for foreigners with health problems was tightened up by the law passed on 16 June 2011. MdM has called for the return to the previous 1998 law. We await a political response. • A number of public and voluntary sector health organisations, including MdM, are calling for the merging of State Medical Aid and Universal Health Insurance. This still does not seem to be on the Government’s agenda. • And, finally, making modules on healthcare for vulnerable people compulsory for medical students throughout their training is more pertinent than ever and we will continue to call for such a change in syllabus.

Since France’s political transition in June 2012, there have been positive signs. In July, the 30 euro charge for State Medical Aid (AME in its French acronym) was abolished. On 11 December at the end of the Conference against poverty and social exclusion at which MdM was a key participant, the Prime Minister announced he was raising the Denouncing discrimination threshold of the Universal Health Insurance to against Roma groups include 500,000 potential new beneficiaries. Despite criticism, MdM teams have continued their work with Roma communities. Improvements to healthcare access centres This has included needs assessments, follow (known as PASS in the French acronym), and up, prevention activities, care, advice, setting more support to help people access their up networks and local advocacy. The unwarights, notably to accommodation, are ano- vering commitment of our staff and volunteers

is our best weapon against the increasing wave of abuse this community has suffered in the past five years. Whilst there is a real variation in what our teams see from one town to another, we have seen a blanket deterioration in Roma living conditions. Facing more stigma than ever before, more and more families are forced to move repeatedly. We must continue to advocate at the highest level, so that this population, too often victims of discrimination, can see their health determinants improve and their voices heard, ensuring that they are fully involved in lobbying for their cause.

Denouncing inequality in access to care and rights With 21 healthcare and advice clinics in France and 65 outreach programmes, Doctors of the World is scaling up the “go to” nature of its work. Our presence in squats, with sex workers, travellers and homeless people, is testament to MdM’s vitality. Once again this October, we presented the data gathered from our healthcare clinics in our observatory report on access to care for the most vulnerable. These significant figures confirm a deterioration of health indicators for patients seen in our centres. This worrying evidence points to a need for more advocacy, more political lobbying, more work to be done in our regional centres and brought to a national level. In November 2012, MdM reminded the Prime Minister of the need to make emergency

DOCTORS OF THE WORLD ANNUAL REPORT 2012

accommodation unconditional and available throughout the year, whilst underlining that emergency accommodation alone is not enough, without additional measures in place to meet the needs of the most vulnerable. In Calais, where we spoke out against police harassment, ‘prefabricated’ shelters, built by MdM with the agreement of the council, have improved the living conditions of the migrants. Our teams continue to guarantee access to care for the men and women in transit and speak out against the inhumane living conditions to which they are subjected. As for our harm reduction activities, in April 2012, MdM and Gaia announced their plans to open up a drug consumption room in Paris, a space where advice about the risks associated with injection can be given in real life situations. A number of meetings with MPs and political decision makers allowed us to validate this decision, and it will roll out in 2013. And, finally, our buddying project for children in hospital continues with a joint commitment to closer collaboration between the Ile-de-France delegation and head office. Some 167 children benefited from buddying and 17,000 hours of volunteering time were recorded in 2012. Analysis of the data, collected with the support of Mission France’s management team, has enabled us to identify a new area of social vulnerability experienced by some parents.

Refreshing our way of working Humanitarian action here and abroad means learning from the medico-social

approach that we know well in France, alongside tools like our community health expertise, and taking the risk of supporting social change at an international level. On the ground, doing humanitarian action differently means questioning our way of working. Planning projects by giving greater space and power to future ‘beneficiaries’ means a change in focus. To innovate, then, is to explore a model that does not only measure solidarity in figures. Whilst not always easy, examining the way we work in partnership is necessary, and moreover, it makes sense. There are encouraging signs; partnerships are in place on several projects. In the KPK region of Pakistan, the organisation is improving access to care for people exposed to internal conflict in partnership with a team borne from civil society. In spite of a worsening security situation, a hospital has been rebuilt and opened in Kenya, in partnership with the local organisation, WAHA. In the Puntland region of Somalia, MdM teams are running 10 centres with the support of a local organisation. In Palestine, especially in Gaza where armed conflict and bombs reared their heads once again, the measures put in place by the teams on the ground in 2008, to use health centres in the outskirts following Operation Cast Lead, worked this time too.

as the follow up, and psychological care to better support children with their wellbeing and social integration, are now key to the programme.

Our key areas of advocacy Sexual and reproductive health Women’s rights evolve, sometimes moving forwards (legalisation of abortions in Uruguay 2012) and sometimes backwards, with international agreements that established progress for women 20 years ago being called in to question. Doctors of the World endorsed two key positioning documents on sexual and reproductive health, the first on abortion and the second on the importance of good quality free care for pregnant women and children. In 2013, a reference framework will enable a quality assessment, already underway, on our programmes. Some programmes are ongoing (Uruguay, Mexico, Côte d’Ivoire, Laos, Haiti), others are just beginning (Chechnya, Peru) or are planned (Ethiopia, Gaza).

Reducing the harm caused by drug use

As for our harm reduction projects abroad, our flagship Afghanistan project is gradually being handed over to local partners, while our programmes grow in East Africa. On meeting Tanzanian politicians, I found that harm Finally, Operation Sourire’s strategic direc- reduction is an issue that resonates within tion, as outlined at the annual meeting in De- the Tanzanian parliament. These elected officember 2012, confirms the need to continue cials know better than us the reality of the HIV our surgical interventions. The preparation, epidemic and want to support new avenues pre-op consultation and selection, as well of work to stem the disease. MdM’s partici-

pation at the Washington Aids conference Governance enabled us to work on key harm reduction In June 2012, the General Assembly advocacy messages, in particular on treat- approved a change of President, with a ment for those suffering from hepatitis C. desire to continue the projects and direction initiated by Olivier Bernard.

The right to health for migrants Ten years after the closure of Sangatte, our fight for the recognition of migrants’ human rights in France remains topical. The network-wide European project gives a structure and wider scope for lobbying on the day-to-day reality for migrants here in Europe, where they are increasingly excluded due to the economic crisis, affected by both xenophobia and isolation. We must also be active on this issue outside European borders.

Doctors of the World’s regional foundations also continue to develop. Projects, run by those involved at the regional level, have been formalised and a regional policy framework has been put in place to ensure a clear strategic direction. By focusing on supporting existing projects and encouraging reflection on new ones, the regional delegations will continue to grow and gain greater legitimacy.

At the heart of our organisation, our changing practices are influencing how we work together. The autumn seminars As the only French medical NGO with were an opportunity to validate these authorised adoption status (OAA), policy choices, to enshrine social change granted in 1988, Doctors of the World is in our projects’ terms of reference. The a key player in international adoption. The role of the Programme Heads in our orgaorganisation is working in 12 countries nisation’s work was reaffirmed. Change and is bound by the principles of the must be embraced, and above all we Hague Convention. must welcome new activists, who will be tomorrow’s leaders. Motivated by the protection of vulnerable children and the defence of the rights At Doctors of the World, there is room of the child, Doctors of the World has for creativity, activism and new visions. made its priority complex adoptions of By daring to trust and daring to accept older children, siblings and children with difference, we continue to build and serious medical conditions. strengthen the ties of solidarity.

International adoption: adapt and do not give up

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Côte d’Ivoire © Sébastien Duijndam

Campaigns 2012 2012 was an eventful year; with presidential and legislative elections in France, the Olympic Games in London and a background of continuing economic crisis. Capitalising on topics making the news, Doctors of World led three campaigns to remind the general public that access to care for all remains a priority, at any time and in any place. Âť

Busts of a sick Marianne attract the attention of passers by

On the ground, the MdM road show went on a Tour de France to spread the word in 15 major cities. Several thousand voters were able to meet the team and find out more about the issues as part of this travelling exhibition and 30,000 of them slipped a Vote Health! ballot paper into the MdM urn. On the web, more than 100,000 people followed the campaign on the votezsante.org site. The organisation welcomes the abolition of the 30 euros charge for access to State Medical Aid (AME), a change that we had been calling ÂŠ BenoĂŽt Guenot for. However, MdM continues to advocate opportunity for MdM to alert the public and for the merger of AME and Universal Health politicians to this alarming situation. Coverage (CMU in its French acronym), and Among the patients seen by Doctors of the In the run up to the presidential and parlia- for the threshold for the CMU to be raised to World in 2011, a quarter presented late; mentary elections, we ran our Vote Health! the poverty line. The campaign was also an more than half of the pregnant women campaign. Images of a sick Marianne were opportunity to denounce repressive policies should have received ante-natal care ear- disseminated in the press, on posters and against migrants: policies that make people lier, and two-thirds of the children under busts displayed as part of an exhibition, to sick must be stopped. six years old were not up to date with their highlight that fact that health is a right gua- Check out the campaign at vaccinations. The 2012 elections were an ranteed by the state. http://votezsante.org

Vote Health!

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Olympic Games: The other side of the medal In July, athletes from around the world went to London in the hope of winning an Olympic medal. Doctors of the World used this opportunity to highlight the fact that from across the channel, every day, migrants try to reach the British capital in the hope of a better life. A few days before the opening ceremony, MdM screened a web-based documentary The Other Side of the Medal, revealing the determination of these ‘reluctant athletes’ faced with difficult migration journeys. Watch the web-documentary: http://webdoc.medecinsdumonde.org/#/home Every night, dozens of migrants try to make the crossing to England

» © DR/MdM

The economic crisis… Imagine what it’s like for them

Made up of snapshots taken by its teams, on 10 December Doctors of the World launched a campaign that explores the question ‘We face economic crisis... Imagine what it is like for them.’ ‘Them’ being the excluded people MdM supports in France and around the world, and whose number is increasing with the crisis. First and foremost, a message of empathy for all those whose life is more difficult and future is more uncertain, this campaign reminds us that, far from being obsolete, solidarity is one value which is needed more than ever. See the campaign at: http://tousmedecinsdumonde.org

Solidarity is essential for the most vulnerable, the first to suffer because of the economic crisis

2012

in figures INTERNATIONAL NETWORK

HUMAN RESOURCES*

iN FRANCE

147

3,642

20 Healthcare and advice clinics » 30,560 service users seen » 44,888 medical

international programmes in 65 countries

165 national programmes in 14 countries

BREAKDOWN

1,240 actors on

consultations

our international programmes

network members

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

MdM actors

» 1,063 national employees » 40 volunteers » 70 expatriate employees » 67 headquarters employees

1 paediatric care centre in Mayotte

» 1,877 service users

under 18 seen

» 3,166 medical

consultations

2,097 actors on our

programmes in France

» 2,000 volunteers » 84 employees in the field » 13 headquarters employees 305 actors supporting

63 outreach programmes 5 9

on access to healthcare and other rights

programmes with sex workers harm reduction programmes

operations

» 200 voluntary programme managers

» 105

headquarters employees

* Figures as of 31 December 2012

98 programmes in 30 towns

DOCTORS OF THE WORLD ANNUAL REPORT 2012

MDM FRANCE BUDGET €64.7 M

North Africa and Middle East

Europe

GEOGRAPHICAL BREAKDOWN OF programmes

1,730,315 beneficiaries

1,212,088 medical consultations

Europe

Asia

Latin America

Africa

67 programmes 46 countries

Miscellaneous projects

26 Africa................................. in 15 countries 10 Latin America..................... in 7 countries 17 Asia.................................... in 12 countries 5 Europe............................... in 4 countries 9 North Africa & Middle East.. in 8 countries

of our programmes

North Africa & Middle East

eople targeted p by our programmes

Asia

5,626,354

Latin America

INTERNATIONAL PROGRAMMES

Africa

MDM international NETWORK €113 M

GEOGRAPHICAL BREAKDOWN OF INTERNATIONAL PROGRAMME EXPENDITURE

46% Africa 15% Latin America 19% Asia 4% Europe 13% North Africa and Middle East 3% Miscellaneous projects (Opération Sourire, needs assessments, regionally-managed international programmes and cross-cutting projects)

Chad © Raphaël Blasselle

DOCTORS OF THE WORLD ANNUAL REPORT 2012

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

mdm france INCOME AND EXPENDITURE EXPENDITURE

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

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

FINANCIAL SCOPE The financial results of MdM France include financial transactions with some other organisations in the Doctors of the World network: MdM Belgium, MdM Germany, MdM Japan, MdM Netherlands, MdM Spain, MdM Sweden, MdM United Kingdom, MdM United States. Our detailed financial report is available from our website: www.medecinsdumonde.org

78.5% social programmes 15.3% fundraising costs 6.2% operating costs

INCOME 61% public generosity 31% public institutional grants 7% private grants and other private funds 1% other

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 2011, ECHO allocated nearly 1.2 billion euros to funding to humanitarian projects, with around half going to NGOs.

• For several years, MdM has been particularly active in Brussels-based VOICE, the interface between NGOs and EU institutions (European Commission, DG ECHO, the European Parliament, Member States). VOICE brings together 80 European NGOs, including the largest and most influential. MdM France, representing the MdM network, is involved in various VOICE working groups (FPA Watch Group, European budget monitoring, European Consensus on humanitarian aid monitoring).

• MdM relates to EuropeAid via CONCORD (European Confederation of Relief and Development NGOs) through the French NGO collective, Coordination SUD, which lobbies EU institutions and participates in the development of common posi• DG DevCo is charged with imple- tions on European development policy and menting, via EuropeAid, the aid me- other major issues in North-South relations. chanisms of the European Commission, a major donor for international development.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

PROGRAMME agreementS between AFD and MdM • 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.

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 proviUNITED NATIONS (UN) ded HIV treatment to 4.2 million people, • The Economic and Social Council TB treatment to 9.7 million people and (ECOSOC) is the main coordinating body 310 insected-treated bed nets to prevent for the economic and social activities of malaria in 150 countries, to support large the UN and its specialist bodies and ins- scale prevention, treatment and care protitutions. MdM’s international network has grammes for these three diseases. special consultative status which means that it can carry out lobbying activities, FRENCH DEVELOPMENT especially in relation to the Human Rights AGENCY (AFD) Commission. It has observer status in this The French Development Agency (AFD in its French acronym) is one of the French subsidiary body of ECOSOC. • MdM’s international network has governmental bodies involved in giving representation at the High Commission official development assistance for poor for Refugees (UNHCR), the World Health countries. Its aim is to finance developOrganization (WHO) and UN Office for ment programmes. the Coordination of Humanitarian Affairs As part of the general reform of public (OCHA). • MdM is a member of the Interna- policy, AFD has been charged with a new tional Council of Voluntary Orga- responsibility since 2009: funding NGOs. nisations (ICVA), a network of NGOs This has led to the creation of the NGO involved in human rights, which concen- Partnership Division, which steers the partrates on humanitarian issues in relation tnership with NGOs and monitors initiatives to refugees. ICVA brings together more run by NGOs. than 80 international NGOs.The Council relates to the UN authorities by tackling the crisis centre (CDC) different themes, such as the relationship The Foreign Affairs Ministry’s Crisis between humanitarian workers and the Centre manages French public funds for military, or the protection of civilians du- humanitarian emergencies (Fonds humanitaire d’urgence – FUH). ring armed conflicts.

Doctors of the World runs programmes working on mother and child health, family planning, tackling STIs, HIV and malaria, and is committed to structured development and strengthening its activities in relation to reproductive health and reducing risks associated with drug use and sexual practices. MdM has been working on harm reduction programmes since 1992, giving the organisation considerable expertise on this issue, both at home and abroad. Following the programme agreement on gender-related violence (2007/2010), MdM and the French Development Agency (AFD in its French acronym) signed two new 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 eight million euros. These agreements aim to strengthen the work on these issues within MdM, by developing cross-cutting approaches while providing a part of the funding for around 12 projects. Thanks to this support, MdM 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 co-operation with AFD on the cross-cutting programmes on reproductive health and harm reduction allows us to strengthen existing programmes and to raise MdM’s profile internationally, thus bringing further long-term financial and institutional support that we need for our programmes.

Harm reduction - Tanzania ÂŠ William Daniels/Panos Pictures

DOCTORS OF THE WORLD ANNUAL REPORT 2012

International programmes contents » 20

Emergency and long-term programmes

» 22

Map of programmes

» 24

Sub-saharan Africa

» 32

Latin America

» 40

Asia

» 48

Europe

» 54

North Africa and Middle-East

Emergency and long-term programmes Whether in the context of conflicts, crises or stable, developing areas, Doctors of the World is committed to improving access to healthcare for populations in general and for the most vulnerable in society. Thus, our programmes target over 5.6 million people and 1.7 million benefit directly. In 2012, MdM worked on 67 programmes in 46 countries.

Over and above the four areas of primary focus (sexual and reproductive health, harm reduction, migrants’ health and crises and conflicts), Doctors of the World has continued to develop programmes encompassing many areas such as surgery, nutrition, the struggle against epidemics (cholera, measles), mental health, gender based violence, primary health care, the struggle against HIV... This year, MdM has responded to humanitarian emergencies, notably in the face of the crisis in Syria, but has also continued to pursue its more long-term activities. These fall into various contexts and themes: from programmes providing humanitarian aid, such as those in Pakistan, in KPK, where MdM runs mobile clinics, to programmes aimed at achieving social change or the integration of new models of care, like the harm reduction project in Tanzania.

of the organisation’s activities in 2012. Beyond this, it is really a question of supporting our partners to help them to bring about change in their own countries. Doctors of the World supports Mujer y Salud and Iniciativas Sanitarias in Uruguay, which are campaigning for the right of women to have control over their own bodies. We highlight and support the local health authorities in Niger to bring evidence to European institutions regarding financial barriers to access to healthcare. We also assist with the emergence and development of a Burmese civil society by supporting the creation of local organisations from within the programme’s beneficiaries.

Increased co-operation within the network

MdM has also strengthened co-operation between the organisations in the network. Thus in Laos, MdM Japan is integrating work on access to healthcare for children under five Partnership at the heart of our work years old into MdM France’s programme, which The planning and joint implementation of pro- targets pregnant women and women of childjects with local partners remained a core feature bearing age. In Mali, MdM France’s emergency

DOCTORS OF THE WORLD ANNUAL REPORT 2012

desk teams supported MdM Belgium in the implementation of emergency programmes in the north of Mali and the logistics department of the French organisation provided supplies of medicines and medical equipment. In Palestine, alongside MdM Switzerland, the association has set up a joint mental health programme in Nablus, which will be launched in 2013.

combination of them, in an integrated structure with procedures and a wealth of experience, focussed on the speed, quality and security of the action. The role of the URR unit is both to respond to emergency situations and to support and strengthen MdM’s long-term teams.

In 2012, the URR unit was kept busy by the Syrian crisis, both at its external borders and A sustained process of reflection within Syria. This included coming to the aid of This year, geopolitical groups (one per conti- refugee populations and displaced people, as nent) continued their analysis, reflection and well as supporting Syrian medical colleagues, monitoring of needs and programmes. Chal- or supplying field hospitals or medical centres. lenged by events, by partners or teams on the ground, these groups are a forum for pre- Departmental co-operation liminary discussions on exploratory missions. 2012 was an important year for co-operation Whilst several needs assessments were car- between long-term programmes and Docried out in Moldova (alcohol), in Ethiopia tors of the World’s emergency response unit. (female genital mutilation), in Vietnam (harm Indeed, throughout the year, the MdM teams reduction) by the end of 2012, most of them tried to respond jointly to various emergency will be conducted during the first half of 2013: situations or crises that affected on-going in Bolivia, China, Côte d’Ivoire, Madagascar, projects. This manifested itself partly in an exchange of expertise and a strengthening of Uganda, Sri Lanka and Yemen. the teams when necessary (the support of an The emergency and rapid response member of the URR team in Niger with the unit (URR in its French acronym) organisation of a nutritional response, sending The emergency and rapid response unit (made a roving logistician to Goma, in the Democraup of a dedicated team at headquarters and tic Republic of Congo, and to Yemen). But the roving team which can be mobilised at a also, through various training initiatives, aimed moment’s notice to leave for the field) allows at improving our response and our practices, Doctors of the World to establish a presence either in terms of project planning or detection quickly (in a maximum of 48 hours) and res- and our first response to an emergency, as in pond to an emergency anywhere in the world. the Sahel in May 2012. In addition to the personnel, the URR unit holds pre-positioned medical and non-medical The importance of effective cooperation stocks, which are ready to be deployed quickly. between emergency and long term also relies Much more than the sum of the skills, it is the on the participation of various departments at

headquarters, such as the Analysis, Technical Support and Advocacy Unit (S2AP in its French acronym) for capitalisation work on cholera in Haiti. This team work involving different departments allows us both to capitalise on experience and continuously improve the quality of projects. Similarly, the support provided by the logistics department, allows us to reach intervention zones rapidly with medicines and equipment so that we can assist the populations as soon as possible. This combination of these qualitative factors allows Doctors of the World to continue to intervene in countries in crisis, even when the deteriorating security situation causes a reduction in active partners. Thus in Syria, in Mali or even in Somalia, Doctors of the World continues to provide aid and support to the most vulnerable populations, either directly with its own teams or via support for health services or for different civil society partners. The ability to adapt our methods and activities, according to the sensitivity of the situation in any given area, allows Doctors of the World to maintain or strengthen its activities.

INTERNATIONAL PROGRAMMES

Algeria Mexico

Mali Niger Chad

Haiti Guatemala

Burkina Faso Guinea

Nicaragua

Liberia C么te d'Ivoire Colombia

Peru

Uruguay

LONG-TERM PROGRAMME

EMERGENCY PROGRAMME

DOCTORS OF THE WORLD Russia

Romania Bulgaria Moldova

Turkey

Lebanon

Georgia

Afghanistan

Syria Palestine

Jordan

Nepal Egypt

Burma Pakistan

India

Yemen

Sri Lanka Somalia Kenya Rwanda Dem. Rep. of Congo Tanzania

Angola Zimbabwe

Madagascar

Indonesia

Laos

Philippines

ANNUAL REPORT 2012

programmes chad In Chad, more than one woman in 100 dies in childbirth. So MdM endeavours to improve access to healthcare in order to improve maternal health.

ÂŠ RaphaĂŤl Blasselle

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Sub-Saharan Africa

Liberia © DR/MdM

“

mali Sanata Coulibaly 18 years old

My family gave me away in marriage when I was 11 years old. I fell pregnant at 13 and it was horrible. My baby died and I was very ill. One day, when listening to the radio, I learned that the urine that had been flowing ever since was an illness that could be treated in Sominé Dolo de Mopti hospital. Doctors of the World and the hospital treated me. Now I am cured.”

DOCTORS OF THE WORLD ANNUAL REPORT 2012

2 1 1 1

Mali Niger Chad

Burkina Faso Guinea

Liberia 1

Côte d'Ivoire

Somalia

Sahel Kenya Rwanda Dem. rep. of Congo

Tanzania

Angola

Zimbabwe

Madagascar

EMERGENCY PROGRAMME

LONG-TERM PROGRAMME

Detailed information sheets for the various programmes in sub-Saharan Africa are in the attached interactive CD

» Angola » Burkina Faso » chad » côte d’ivoire » DRC » GuinEA

» Kenya » Liberia » Madagascar » Mali » Niger » Rwanda

» Sahel » SomaliA » TanzaniA » Zimbabwe

Côte d’Ivoire © Sébastien Duijndam

DOCTORS OF THE WORLD ANNUAL REPORT 2012

KEY EVENTS IN SUB-SAHARAN AFRICA

Emphasis on sexual and reproductive health A major part of Doctors of the World’s work in Africa concerns sexual and reproductive health. Globally, over 300,000 women die every year during pregnancy or childbirth, with 56% of these in sub-Saharan Africa. MdM focuses on the provision of care and advocacy. MdM is striving to establish a continuum of care on its programmes. This includes informing women on the availability of healthcare services and on their rights regarding reproductive and sexual health. It also means offering quality care from the young girls’ adolescence right through to care for mothers, from family planning and ante-natal care to childbirth. This development requires a three-pronged approach.

The second axis upon which MdM is working is the removal of financial barriers. In Sahel, advocacy is bearing fruit with the example of the Djibo district in Burkina Faso, where local councils contribute to making deliveries and caesareans free of charge by topping up the state subsidies. In Niger, a pilot project of financial support for referrals has become permanent, thanks to the commitment of local councils, who contribute to a common fund for referrals from Removing geographical barriers, which are their own budgets. In Cote d’Ivoire, the governoften an obstacle to access to healthcare. ment introduced free healthcare for women and In Chad, horse drawn carts have been given to children under five years old, however the funds remote villages, to enable women to reach the were insufficient. MdM is supporting the state healthcare centre or hospital in case of obstetric so that free healthcare can be provided and that emergency but also to attend ante-natal clinics there is a continuity of care. or bring their children for medical consultations. In Liberia, maternity waiting homes have been Finally MdM highlights the importance of created so that women living in areas distant taking socio-cultural factors into account. from healthcare centres can stay for several In Niger, for example, the imams and all the comweeks until their pregnancy reaches full term and munity stakeholders are made aware of family then go to the clinic, where they can give birth planning, in order to break down a negative image and allow women to access it with the assisted by skilled health workers.

agreement of their families and the religious leaders. Also in Niger, at Illéla, a noteworthy MdM initiative has been the setting up of the ‘school for husbands’ that aims to reach women through their husbands. The men involved in the project, who are chosen by health workers and village leaders, are tasked with educating their peers in order to promote a change in behaviour amongst husbands.

Geographical, financial and cultural barriers are obstacles to access to healthcare

In order to assure a high quality of healthcare, MdM restores and materially supports healthcare structures. In Kenya, for example, on 17 July, after significant renovation work and the creation of a maternity unit, Dadaab hospital was inaugurated. Furthermore, MdM trains personnel in Angola, Somalia, Chad and Mali, where surgical teams strengthen the skills of local surgeons in the treatment of obstetric fistulas.

Despite having left Zimbabwe, MdM remains vigilant and is ready to intervene in case of crisis

169 The number of HIVpositive children put on antiretrovirals in 2012

» zimbabwe A programme integrated into the health system In June 2012, MdM withdrew from its access to healthcare project in Zimbabwe having worked there since 2004. Throughout the years, MdM contributed to lowering maternal health risks, assuring the monitoring of and response to epidemics and guaranteeing the treatment of people affected by HIV. Targeting pregnant women and children in particular, the action focused on three hospitals and 48 healthcare centres in Chipinge district of Manicaland province. In particular, MdM played an important role in making healthcare accessible to people who are HIV-positive. Thus, MdM led the decentralisation of screening services and the treatment of people who are HIV-positive (antiretroviral treatments and, in particular, prevention and treatment of opportunistic infections) and the prevention of mother to child transmission (PMTCT), from the provincial hospital to the district

hospital, right to health centres which are closest to the communities. Many community activities were used to provide information and raise public awareness. A wide network of community health workers was created to ensure that patients had follow-up visits at home and to establish a link with healthcare structures. Support groups have also emerged amongst patients with MdM’s backing. Following a handover period of over a year, the Ministry of Health and the Greater Hope organisation took over.

» EthiopiA The struggle against female genital mutilation

In June 2012, MdM conducted a factfinding mission in Ethiopia on the issue of female genital mutilation (FGM) in Afar region. According to a survey carried out in 2005, 92% of Afar women were subjected to genital mutilation, which appears to be an important determinant of mortality and maternal morbidity. In partnership with Ethiopian organisations, MdM hopes to launch a project in 2013 that will implement awareness campaigns, train health workers in the care for FMG and facilitate a community dialogue with the aim of putting a stop to the mutilations.

DOCTORS OF THE WORLD

» mali

ANNUAL REPORT 2012

Support and aid for victims of conflict

MdM is the only NGO present in the thick of the conflict

For Malians, the beginning of 2012 was marked by attacks by the MNLA in Gao, Timbuktu and Kidal in the north, and by the coup on 22 March, followed by the seizure of power in the north by various jihadi groups who drove back the MNLA. © Myriam Pomarel/MdM

The conflicts and the north/south partition of the country resulted in significant population displacement towards neighbouring countries. On 16 January 2013, OCHA estimated that there were 157,900 refugees and 228,920 displaced people.

was provided to MdM Belgium’s emergency desk to assist in its response to the conflict. Already present in Kidal and Menaka, working on access to healthcare programmes, the Belgian NGO remained in the thick of the conflict, in order to alleviate the problem of the indigenous personnel fleeing the local healthcare centres and Doctors of the World led two different actions. to assure the continuity of access to healthcare Firstly, medical, logistics and personnel support for the local population. Then MdM intervened in

» Madagascar After eight years of involvement in the Madagascan prison environment, at the end of December 2012, Doctors of the World withdrew from its programme for the humanisation of prison conditions, handing over to institutional and civil society partners. The objective being to

Burkina Faso, in refugee camps in Mentao and Damba, on the border with Mali. Three health centres were created to deliver primary healthcare but also to work on sexual and reproductive health, HIV prevention and malnutrition. Finally, at the end of 2012, in the Mopti and Tenenkou regions, an exploratory mission was undertaken to support the health system from early 2013, in relation to primary healthcare and malnutrition.

Humanising prison conditions

improve prisoners’ rights to health, MdM was directly involved in health issues such as the renovation of infirmaries, the supply of medicines and equipment, mentoring nurses, management of severe malnutrition and improvement of hygiene. In parallel, advocacy was conducted, with the

aim of obtaining a sustainable improvement in prison conditions with regard to overpopulation, hygiene and human rights. For eight years, MdM was involved in improving living conditions of 24 prisons, thus affecting a third of all the country’s detainees.

programmes MexiCO Doctors of the World offers awareness sessions for migrants, women domestic employees and sex workers, so that they are aware of their rights and have access to healthcare.

ÂŠ Michel Redondo

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Latin America

Haiti © Lahcène Abib

“

HAITI Pierre-Jérôme 61 years old

MdM has saved lives, not only by providing medical care, but also by raising awareness. People used to think of cholera as a mystical phenomenon, a curse. By way of vengeance, when the epidemic broke out in the town, over a dozen people were lynched. This phenomenon disappeared when MdM conducted awareness sessions within the community.”

Mexico

Haiti

Guatemala 1

Nicaragua

2 Colombia

Peru

LONG-TERM PROGRAMME

Uruguay

Detailed information sheets for the various programmes in Latin America are in the attached interactive CD

» Colombia » Guatemala » Haiti » Mexico

» Nicaragua » Peru » URUGUAY

Mexico ÂŠ Michel Redondo

DOCTORS OF THE WORLD ANNUAL REPORT 2012

KEY EVENTS IN LATIN AMERICA

» Guatemala / MexiCO

Access to healthcare for women workers

In Guatemala and Mexico, certain categories of women workers have difficulty in exercising their right to health. In both these countries, MdM educates women on health issues, informs them of their rights and enables them to access healthcare. Alongside local partner organisations, MdM also lobbies employers and government institutions to re-establish the rights of women workers.

In Escuintla district in Guatemala, women working in export companies, particularly in textile companies, and on farms live in poor conditions. As well as the difficult work which can affect their health, they have limited access to healthcare. A survey carried out by MdM teams showed that, despite having social security deductions on their wages, almost half of these workers were not registered with the social security system so could not access healthcare, particularly with regards to sexual and reproductive health. We estimate, for example, that over half of these women have no ante-natal care during pregnancy. Against this backdrop, MdM educates the women to have a positive outlook

on health issues and informs them of their rights as workers. Health promoters are recruited and trained to spread the word. Medical consultations are also organised in the workplace and in MdM premises on Sundays. Finally, work is underway to co-ordinate efforts to enforce the rights of women, particularly their right to access to health, in conjunction with the companies themselves and with public institutions. Every year, Mexico receives around 40,000 central American migrants (from Guatemala, Honduras, Nicaragua and El Salvador) who move on after a while or who stay in Chiapas, particularly in Tapachula and Huixtla. Many

Every year, Mexico receives around 40,000 central American migrants

migrant women become domestic workers, but, usually in the absence of any contract of employment and being subjected to discrimination, they are unable to access healthcare. It is the same for sex workers, for whom there is no prevention or harm reduction activity. The Mexican health system’s response to these groups is barely adequate. MdM alerts women to health issues, notably through awareness campaigns on questions of sexual and reproductive health, violence and addiction, and on self-esteem. The organisation supports them to enable them to access health centres. A network of local stakeholders, whose aim is to support women’s rights has been strengthened. The project also relies on the involvement of the local authorities, the ministry of health and the local health bodies, as well as civil society working with partner NGOs.

38 After several years of supporting local organisations, MdM welcomes the adoption of the law on termination of pregnancy, whist remaining vigilant over its implementation.

» Haiti

» Uruguay

Prevention and management of unwanted pregnancies Against a regional backdrop noted for its lack of recognition of sexual and reproductive rights, Uruguay has distinguished itself this year by the passage of a law in favour of the partial decriminalisation of abortion. Despite this major step forward, there remain many obstacles and barriers. Since 2010, in partnership with Iniciativas Sanitarias (IS) and Mujer y Salud in Uruguay, Doctors of the World has been running a programme intended to improve access to health services, with regard, in particular, to caring for women finding themselves with unwanted pre-

gnancies. Thus, there has been awareness-raising for social organisations on the matter, and a coalition for ‘the right to decide’ has been established with the largest union in the country and sexual and reproductive health teams in three departments have been trained on the framework of the law on abortion. MdM will continue to support its partners to assist with the implementation of the law, to identify and analyse obstacles and barriers to sexual and reproductive health services, including, in the light of the new law, access to abortion services.

Over 40, 000 children from six months to four years old were screened for acute malnutrition

From post-emergency to long-term actions 2012 was a pivotal year for Doctors of the World in Haiti, falling between the end of post-emergency intervention and ensuring the continuity of long-tem programmes. In Port au Prince, the remaining primary healthcare activities that were set up following the earthquake, have been handed over to the Minister of Health. The last of the 10 clinics, built by MdM on the outskirts of the city, is now permanent and the authorities have appointed staff. In

Grand’Anse, the two cholera treatment centres were taken over by the health authorities during the first part of the year but MdM teams stayed on in a supporting role to deliver training and to assist with care in case of a peak in the epidemic. The long term primary healthcare and sexual and reproductive health programmes are continuing in five health centres and in 2013 an exploratory mission in Port au Prince will look into a new sexual and reproductive health project. © Lahcène Abib

DOCTORS OF THE WORLD ANNUAL REPORT 2012

» COLOMBIA

A fruitful partnership with the indigenous organisation, Unipa, has set up mobile clinics

Populations still affected by the conflict

The possibility of a peace accord in Colombia conceals a situation which remains worrying for the groups with whom MdM is working, who are affected by the conflict. Despite positive political progress including peace talks with the FARC, the population continues to suffer from a on-going conflict and from the policy to eradicate cocaine, which deprives them of a source of income and contaminates their food crops. In Nariño, Meta and Guaviare districts, MdM continues to provide access to healthcare for indigenous and mixed race communities, in areas which are very diffi-

cult for the government and other NGOs to reach. By organising mobile clinics, MdM dispenses primary healthcare and psychosocial care. In 2012, thanks to successful lobbying, the health authorities recruited nurses for two health centres in isolated areas and, increasingly, they accompany MdM teams who go out into the communities.

» PEru Opening a programme for women Sexual and reproductive health is a priority for MdM in Latin America. In September 2012 a team of two people arrived in Peru to prepare for the launch of a new programme on this subject. The objective is to improve access to, and the quality of, prevention services and medical treatment for women of childbearing age living in Villa El Salvador on the outskirts of Lima, who find themselves with unwanted pregnancies.

programmes

LAOS MdM is running a programme in the south of Laos, aimed at reducing the mother and child mortality rate, which is one of the highest in South East Asia.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Asia

Burma © William Daniels/Panos Pictures

“

The first time I benefited from the programme was when I gave birth to my second baby: I received 1,000 rupees, my children had free vaccinations and received post-natal care. Now I work for JKSMS with Bhanwar (the programme’s social worker). I help other poor people. I take them to hospital to receive free treatment. ”

india Laxmi, 25 years old Community health worker

Russia

Afghanistan

Georgia

Nepal

Burma

Laos

Philippines

India Pakistan

3 Sri Lanka

Indonesia

LONG-TERM PROGRAMME

Detailed information sheets for the various programmes in Asia are in the attached interactive CD

» Afghanistan » Burma » Georgia » India

» INDONesia » LAOS » Nepal » Pakistan

» PHILIPPINES » RUSSIa (Great North)

» sri lanka

Harm reduction - Afghanistan ÂŠ Robin Hammond/Panos Pictures

DOCTORS OF THE WORLD ANNUAL REPORT 2012

KEY EVENTS IN ASIa

Reducing harm

without judging behaviour Harm reduction at Doctors of the World aims to be pragmatic, focussing on the individual and their needs. It is firmly rooted in a non-judgemental approach to the people it encounters and to their practices. It focuses on 12 areas, ranging from information and prevention, to socioeconomic reintegration, through diagnosis, the treatment of sexually transmitted infections, HIV, hepatitis and substitution treatment. In Afghanistan after a six-year programme, which enabled the establishment of a dropin centre, of healthcare and of outreach activities, Doctors of the World is gradually handing over the baton to local stakeholders, with the intention of withdrawing from these activities in the course of 2013. People who use drugs have access to a range of services such as provision of injecting materials, screening for HIV and hepatitis, individual and group counselling, primary healthcare, management of addiction and social support. Furthermore, the resources and training centre established by MdM mean that since 2008, over 500 Afghan professionals (NGOs, community representatives, judicial and health agencies) have been trained in good practice for harm reduction.

In Georgia, the prevalence of hepatitis C is one of the highest in the world. Of an estimated 40,000 people who use intravenous drugs, between 70% and 90% have contracted hepatitis C. As well as many harm reduction activities carried out in the healthcare and advice centre managed by the Georgian organisation New Vector, and supported by MdM, a study on liver fibrosis was conducted in 2012 and will help reinforce advocacy on access to treatment for hepatitis C.

Vietnam is experiencing the same problems as Georgia. It is one of the countries in the world most affected by the hepatitis C epidemic. MdM conducted a preliminary exploratory mission at the end of 2012, to identify a new project whose aim would also be to strengthen advocacy for access to screening and treatment It was MdMâ&#x20AC;&#x2122;s work that first enabled the pres- of hepatitis C. cription of antiretrovirals to people who use drugs in April 2009 as well as the first methadone subs- In Burma, MdM is working with people who titution treatment. At the beginning of 2013, the use drugs in four clinics in the Kachin area Afghan government announced an expansion of and with sex workers and gay men in Yanaccess to substitution treatment to 850 patients. gon. Medical, psychological, social and judicial

care is provided by a team of health professionals and peer educators. At the end of 2012, 1,320 people were on antiretrovirals and 300 people who use drugs were on methadone. In total around 20,000 people benefited from MdMâ&#x20AC;&#x2122;s activities.

In Georgia, of an estimated

40,000 people who use drugs, 70 to 90% have contracted hepatitis C

» LAOS / Nepal

Reducing maternal mortality

The cost and difficulty of access to healthcare are obstacles for women

In both Nepal and Laos, women have very little access to sexual and reproductive healthcare services. MdM is working both to improve provision of care and to increase demand. The intention is to minimise any barriers preventing access to healthcare.

In the first instance, Doctors of the World is working on the provision of healthcare by renovating and equipping healthcare centres, training personnel and community stakeholders. Thus, in Laos, 10 community midwives and 144 village-based health promoters have been trained on maternal health issues.

» in dia

Programme handover

Secondly, MdM is focusing on women’s health education and the establishment of financial solutions. In Nepal, by being involved in microfinance activities, women improve their financial independence through improved management of household budgets, forward planning for health expenditure and access to emergency obstetric funds.

Since 2007, Doctors of the World has been working with the most disadvantaged populations in the shantytowns of Jaipur, to improve their access to healthcare with a particular emphasis on mother and child health. In 2012, MdM strengthened its par-

In Laos, MdM subscribes to the national policy of free healthcare by distributing healthcheques, which provide pregnant women with free access to ante-natal and post-natal consultations, professional medical-assisted labour, treatment for pregnancy-related complications and transport to enable them to reach healthcare centres.

tnership with the Indian JKSMS organisation, with the intention of handing over its activities. MdM will continue to provide support in 2013 as well as its advocacy in order to convince the Jaipur authorities to take on all or part of the programme.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

In the KPK region of Pakistan, the level of malnutrition (17%) is alarming.

90,000

consultations were carried out in Pakistan by MdM teams

» burma / Pakistan

Access to healthcare for displaced people In Burma and in Pakistan, internal conflicts have caused the displacement of thousands of people. Far from home, they have limited access to healthcare. In a difficult security environment, MdM provides primary healthcare.

On the Afghan border, at the outer limits of the tribal areas of north Pakistan, MdM is working in isolated areas where displaced people have found refuge with family members or relatives. The organisation’s strategy is to follow the conflict and population displacements, working in an environment of unstable security. A lengthy process of information provision and gaining acceptance is needed with leaders and communities before any medical activity can commence. Mobile clinics are set up to support health facilities and offer primary healthcare

consultations, as well as ante-natal consultations, nutritional rehabilitation, vaccination sessions etc. In 2012, 90,000 consultations were carried out by MdM teams. After 17 years of ceasefire, the conflict between the KIA and the Burmese government restarted in June 2011 in Kachin. Fierce fighting throughout 2012 caused the displacement of over 100,000 people, who found themselves in makeshift camps. MdM does not have access to these camps so supports two local organisations who run health centres in six camps close to the Chinese border. MdM provides medicines, equipment, renovates the centres, trains the staff and oversees the emergency referral of patients to hospitals.

programmes BULGARIa Nadezhda is one of Europe’s largest Roma ghettos. Hygiene conditions there are catastrophic and health indicators are alarming, particularly for women and children.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Europe

Chechnya © DR/MdM

“

Bulgaria Atanas Dimitrov Coordinator

Very often Roma living in Nadezhda suffer discrimination at the hands of the emergency services of the Sliven regional hospital. When they call the emergency number 112 and ask for an ambulance, the phone operator claims that there isn’t one available to come to Nadezhda. In reality, ambulances do not go to this area or only after several calls. Sometimes the ambulance arrives with a police escort.”

Russia

Romania

Moldova

Bulgaria

LONG-TERM PROGRAMME

Detailed information sheets for the various programmes in Europe are in the attached interactive CD

» Bulgaria » MoldOVA

» RomaniA » RussiA (Samara and chechnya)

52 key events in Europe

700 young people were alerted to the risks of trafficking

» Moldova

Handover of the project fighting trafficking Human trafficking in Moldova is a complex phenomenon surrounded by fear and shame. For nine years, MdM has worked to raise public awareness and to improve care for victims. In 2012, the baton was passed to local partners. © Lâm Duc Hiên

Moldova is one of the poorest countries in Europe and the one most affected by human trafficking. Poverty, corruption, domestic violence and unemployment are all factors contributing to the departure of many Moldovans for other countries. An estimated quarter of the population works abroad, of whom at least 60,000 end up exploited in networks dealing in prostitution, forced labour, begging or organ trafficking.

60,000 Moldovans find themselves exploited in prostitution networks and forced labour...

In 2003, in the Balti region of northern Moldova, MdM launched a programme to combat this phenomenon and to support victims. In 2012, MdM handed over to local professionals, focusing on two major aspects of the problem: prevention and support for victims. This support is MdM has assisted over 300 victims and their families with two mobile teams, each comprising medical, psychological, judicial and social. a social worker and a psychologist, who went Throughout the programme, by means of training out to meet families and identify victims. Over and support for a national reference system (NRS), 10,000 people have taken part in awareness sesWhen the victims return after having escaped or MdM has improved the ability of local professio- sions run by MdM, their partners and Moldovan negotiated their release, they often suffer serious nals to identify, record and support victims. Fol- volunteers. emotional distress, rejection by their families and lowing a national workshop on NRS, a guide for economic difficulties. For fear of reprisals, they the identification of victims and potential victims MdM has served as a bridge between the exisdare not lodge a complaint and make themselves was published and 4,000 copies were distributed ting system and the victims, as well as supporknown. They do not know their rights and so do to all social workers in Moldova. Victims’ access ting and energising the policy introduced by the not turn to institutions or aid organisations. to multi-disciplinary support was also improved. government through its support for NRS.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

» Romania

» CHECHNYA

Building a project together

Focus on mother and child health

Following the closure of the programme in 2012, MdM stayed to support COPII, its Romanian partner, in developing a project to provide access to healthcare and to rights for extremely vulnerable populations in four municipalities. This project will be launched in 2013 for two years.

Despite attempts at reconstruction, the Chechen health system remains under-developed in rural areas. MdM has launched a sexual and reproductive health programme in the south-east of Chechnya.

» BULGARIA Improve the health of Roma

Between 2008 and 2010, the reconstruction or refurbishment of health facilities was a Chechen government priority. Nevertheless, access to healthcare is not guaranteed because the medical facilities are either insufficient or misused by personnel who do not always have all the necessary skills and are understaffed in all specialist areas. As for medicines, they are available in Grozny but not in rural areas. Against this background, MdM set up in the Vedeno region with the objective of improving mother and child health. The focus is on three particular issues.

Firstly, the training of gynaecologists and midwives, to international standards, in ante-natal and post-natal care, as well as formalising and communicating protocols for care. Then, the establishment of a mobile team of gynaecologists in primary healthcare centres. Finally, strengthening the knowledge and skills of women and their in-laws in matters of sexual and reproductive health. In 2013, MdM hopes to further develop the role of community midwives as mediators for the health education of their fellow citizens.

In Sliven, MdM is working with Roma people of Nadezhda, the poorest people in the country and victims of discrimination. Since 2009, health education sessions have been organised to raise awareness in the communities, of various issues such as hygiene, family planning, ante-natal and post-natal care. At the end of 2012, the municipality provided premises for this activity. Once the premises have been renovated, in 2013, they will serve as a hygiene unit so that pregnant women and young mothers can go for a shower and have a place where they can get personalised advice.

Heath centre in Vedeno district

programmes YEmen Following the armed conflict of 2009, which resulted in over 250,000 displaced people, MdM enabled the people of Saada region to have access to healthcare.

ÂŠ DR/MdM

DOCTORS OF THE WORLD ANNUAL REPORT 2012

North Africa and Middle East

Syrian crisis © Agnès Varraine Leca

“

SyriA Leïla 25 years old, first aid worker

I used to work in Dar al-Shifa hospital, which was bombed a week ago. Government forces use ambulances to attack field hospitals. They also pick up rebels who have been injured in combat to finish them off [...] Three nurses were arrested because they were carrying first aid kits. Their partially burned bodies were returned to their families seven days later.”

Turkey

Syria Lebanon (Syrian crisis) Palestine Jordan (Syrian crisis)

Egypt Algeria

Yemen

EMERGENCY PROGRAMME

LONG-TERM PROGRAMME

Detailed information sheets for the various programmes in North Africa and the Middle East are in the attached interactive CD

» Algeria » egypt » PALESTINE

» SYRIa

(Jordan, Lebanon)

» TURkey » YeMEN

Syrian border ÂŠ AgnĂ¨s Varraine Leca

DOCTORS OF THE WORLD ANNUAL REPORT 2012

KEY EVENTS IN NORTH AFRICA AND THE MIDDLE EAST

Providing care in Syria and on the

borders, bearing witness to suffering After two years of war, 70,000 dead, according to the Syrian Observatory for human rights, the Syrian conflict is of a rare violence and shows no sign of abating. In February, Doctors of the World took action to support the growing number of refugees on the Lebanese, Jordanian and Turkish borders, before acting directly in Syria. Deraa was the first town to be involved in the uprising and the first to suffer severe repression, causing many civilians to flee to Jordan. Therefore from the outset, MdM supported the Jordanian authorities in the transit camps, treating the injured and referring the most serious cases and women on the point of giving birth to nearby hospitals. In order to deal with the regular influx of refugees, new camps were created in and around the town of Ramtha. During the summer, MdM renovated a building donated by the municipality, to open it as a health centre in Ramtha. Over 100 consultations per day take place there. In addition to primary healthcare, psychiatrists, psychologists and social workers provide psychological support. Many refugees are traumatised by what they have seen and lived through, both before and during their escape.

In order to assist refugees at the borders, MdM is also operating in Lebanon, supporting its longtime partner, Amel, at El Ein in Bekaa region and at Kha in a health centre run by a priest. MdM has also provided first-aid training in five villages in Bekaa region via the organisation Salam. In June, the Union of Syrian Medical Aid Organisations (known by the acronym UOSSM) requested support with training and supervision for a post-operative and rehabilitation centre that it opened on the northern border of Syria. So a rehabilitation specialist, two physiotherapists and a nurse went to the centre, taking with them equipment and medicines.

other Syrian medical partners, MdM transports medicines and surgical equipment. And lastly, primary healthcare and surgical kits as well as vehicles, are positioned in Jordan and Lebanon, poised to respond rapidly if the borders are opened.

As time goes on the needs have become more and more acute in northern Syria. In September, MdM arrived at Qah camp, which is inhabited by 80% women and children. In October a health centre was opened and water treatment, distribution of blankets and tarpaulins for the winter were put in place. By the end of December, the camp had 4,300 inhabitants. In response to requests by pregnant women, MdM set up a rest centre, For the first time in a war situation, teams where women could go after giving birth. In 2013, on the ground witnessed medical staff it will become a mother and child healthcare being abducted, tortured, killed and hos- centre, providing ante-natal and post-natal care. pitals bombed... In July, MdM launched an At the same time, MdM opened a primary heal- appeal to alert the general public and govern- In 2013 activities will be stepped up in Lebathcare centre in Zaatari camp, where two doc- ments to the intolerable situation of health non, Jordan and Syria because the conflict tors carry out over 200 consultations a day, as professionals in Syria. Thus, the second line of is ongoing. After two years, there is no slowing well as one in King Abdullah Park camp, suppor- action has been to support Syrian organisations down in population movements and access to ting the Jordanian ministry of health. inside the country. Working with UOSSM and healthcare is more difficult than ever.

» algeria / TURkey

Access to healthcare and to rights for migrants The theme of access to healthcare for migrants is one of Doctors of the World’s four main priorities. Programmes are conducted both in France and abroad with an approach tailored to each different situation. In Algeria, the emphasis is on raising awareness, health education and on rights, whereas in Turkey the activity of a healthcare centre which treats large numbers of migrants, supports advocacy for access to healthcare.

In Algeria, MdM raises the awareness of health professionals to the specific needs of migrants and their right to health. A network has been established of healthcare providers, working in a mediating role in various health facilities to advise and provide treatment to migrants. In fact, even if free access to healthcare is tech-

nically guaranteed, for sub-Saharan migrants, especially undocumented migrants, the reality is very different, because they face hostility from health workers, denial of treatment, or are reported to the police who then arrest them. MdM and its Algerian partners are working to raise awareness of the need for migrants to access healthcare and, where necessary, accompany them to healthcare facilities. Health mediators are chosen from amongst the migrants to promote health education and make referrals. With its partners and migrant support organisations, MdM aims to create a network around the issue of access to healthcare for migrants, to improve quality of care and to add weight to its advocacy activity.

services, were collected during the year. This work feeds into lobbying of local and international authorities for the improvement of medical treatment of poor migrants in Turkey. 3,000 consultations were carried out in 2012 and the project will continue in 2013.

In Turkey, MdM supports a medico-social centre in the Kumkapi area of Istanbul, which is managed by its partner TOHAV. This centre is open to anyone who is excluded from public health facilities, most of whom are undocumented migrants, asylum seekers and refugees. Those working in this centre provide primary healthcare and support and guidance for patients so that they are referred to appropriate hospitals, accompanying them when needed. It is also a place for rest, for listening, for information and education. Patient testimonials, as well as expertise provided by the team, on conditions of access to healthcare for poor migrants in Turkish health

MdM closed its programme in Saada in July because of the difficult political situation and insecurity. Since 2010 a programme of primary healthcare, with a nutritional component and a reproductive and sexual health component, focused on host populations and displaced people fleeing the conflict. MdM supported six health centres, organised four mobile clinics, trained staff and organised education sessions on health and vaccination. In 2013, the organisation will conduct an exploratory mission to launch a new project.

» YEmen

Closure of the project in Saada

DOCTORS OF THE WORLD ANNUAL REPORT 2012

» PALESTINe

Training to manage emergencies Present in the Gaza strip since 2002, and rooms have been set up—with equipment having witnessed how hospital emergency and staff training—in health centres, allowing services are overwhelmed, particularly in patients to be treated and, where appropriate, times of crisis, MdM has helped improve to be referred on. emergency care, in health centres and at This facility, which is now a permanent fixture, community level. To this end, volunteers from made an important contribution to the treatthe Palestinian community have been trained in ment of the injured during Israel’s last military first aid and patient referral. Eleven emergency action on the Gaza strip in November 2012.

During this period, 2,200 consultations and treatments were delivered, 80% of which could be completed here, without the need for transfer to a hospital.

MdM has trained 3,500 volunteers in first aid

Migrants project, on the Channel coast ÂŠ Sarah Alcalay

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Programmes in France contents » 65

Map

» 66

Programmes in France

» 68

Observatory on access to healthcare

» 69

Migrants

» 70

Roma

» 73

Harm reduction

» 74

Prostitution

» 77

Health and housing

» 78

Prevention HIV-hepatitis-STI-tuberculosis

» 79

Buddying of children in hospital

“

toulouse Julien Volunteer

We go on outreach patrols all year round, but from March onwards we’re the only ones. Homeless people prefer the cold to the heat, because they can combat cold with blankets, but can’t do anything against the heat. In summer, we give them water and soup because some don’t eat when the soup kitchens are closed.”

Dunkirk

Colombes

HEALTHCARE AND ADVICE CLINIC

La Plaine-Saint-Denis

Saint-Eloy-les-Mines

OUTREACH PROJECTS

SEX WORKERS BUDDYING CHILDREN IN HOSPITAL HARM REDUCTION

PAEDIATRIC CLINICS

Programmes in France A progressive chipping away at certain social protection measures, accentuated by the current global economic crisis and policies which, at best, do not meet the needs of vulnerable groups, is resulting in growing social and geographical inequalities in health. In 2012, it seems to have become increasingly difficult for anyone with limited financial resources to benefit from healthcare, French nationals and migrants alike.

On a daily basis Doctors of the World France teams witness the damaging effects of the chipping away at social protection measures on people’s health and the challenges that this presents for public health. In fact, Doctors of the World’s 21 Healthcare and Advice Clinics (CASO in the French acronym) are far from empty. Quite the contrary; for the last few years there has been more and more work. Our clinics recorded an increase of 8% in their workload between 2010 and 2011, and of 17% since 2004. Our service users face particularly difficult living conditions: 99% of them live below the poverty line and most experience serious housing problems (nearly half live in insecure accommodation and a quarter are staying in public or voluntary sector accommodation facilities or are homeless). For many reasons (e.g., poor awareness of their rights, administrative complexity, language barriers, residency criteria or financial problems) these vulnerable groups find it increasingly difficult to access healthcare. As a result, according to the doctors in our clinics, more than a third of service users delay seeking healthcare even though four in ten consultations require long-term treatment (for at least six months) and more than

one in 10 service users present with a potentially serious condition (e.g., hypertension, diabetes, asthma, epilepsy, cancer or psychosis).1 Given the constant increase in the portion of fees not covered by health insurance (e.g., franchises médicales,2 removal of certain medicines from the list of reimbursed drugs, increase in hospital in-patient costs) it is increasingly important for the most vulnerable to be able to access top-up insurance. In 2012, migrants represented the vast majority of service users seen in Doctors of the World clinics. This population continues to face oppressive policies, aimed at dissuading those without residency permits from staying in France, which put them in danger and further stigmatise some groups. Migrants in transit on the Channel coastline, undocumented migrants in Mayotte or sex workers, another marginalised group, are subject to a lot of pressure. This climate sees their living conditions deteriorate and further distances them from the health system (often leading to gaps in treatment and/or people giving up on seeking healthcare). At the same time, these problems hinder efforts on prevention, harm reduction and to help these groups access access healthcare and other rights. In the context of political change, voluntary sector organisations saw some positive changes in

1. Doctors of the World (2012). Observatory on access to healthcare — Report of Mission France 2011.

2. Deductions from the amount reimbursed for certain medications and procedures.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Doctors of the World is watching carefully to make sure that commitments made during the last election campaign are upheld

The majority of service users seen by MdM have serious housing problems

ÂŠ Christina Modolo

2012, suggesting a different approach towards deprivation and a political will to reintroduce dialogue and consultation. The charge for access to State Medical Aid was removed, along with some temporary measures for Romanian and Bulgarian citizens. Doctors of the World remains concerned, however, about the pressures put on the Roma minority last summer and the obstacles which continue to hinder this group from improving their living conditions. Doctors of the World continues to watch carefully to ensure commitments are being upheld. Particularly strong measures are needed to respond to the economic crisis and its consequences for the most vulnerable groups. In addition, the right

of seriously ill foreigners to obtain a visa must be respected, the offence of passive soliciting must be repealed urgently and effective responses, such as authorisation for the opening of drug consumption rooms, are needed to tackle the hepatitis C epidemic among people who use intravenous drugs. The national conference on tackling poverty and exclusion, in December 2012, resulted in a fiveyear plan that will contribute to an improvement in the financial accessibility of healthcare and in measures to facilitate access to care, such as the Healthcare Access Offices. We would like to see, however, concrete steps towards the merger of the State Medical Aid scheme with

the Universal Health Coverage scheme and a clear policy on helping people towards longterm housing solutions. As a health and social organisation, Doctors of the World will follow the implementation of measures which are announced, and will highlight the importance of continuing the consultation with public and voluntary sector organisations which was carried out throughout this conference. Public health principles and respect of fundamental rights must form the fundamental basis for public policies to enable the best possible access to healthcare for all.

Observatory on access to healthcare » PROGRAMMES IN France

Doctors of the World’s Observatory on Access to Healthcare in France was created in 2000 to bear witness to diffficulties in accessing mainstream health services experienced by our service users. The Observatory is a tool to help develop understanding of the vulnerable groups (who are often ignored by 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 vulerable and excluded groups.

20 Healthcare and

Bearing witness to obstacles to healthcare for vulnerable and/or excluded groups

Advice Clinics saw a total of

30,560 service users,

in the course of 63,212 appointments

44,888

medical consultations were carried out » 3,855 dental consultations

» 18,000 social consultations

The average age of service users is 33 years

»1 2.3%

are under 18 years old

» 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. Every year, the Observatory produces a report, published on the 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 the legislation in 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 the advocacy activities based on objective data collected on the ground.

»9 4.1%

are of foreign origin

»9 6.3% live below the poverty line

FUNDING

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

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Migrants

(vulnerable migrants and asylum seekers) » PROGRAMMES IN France

Access to health insurance for vulnerable migrants remains difficult, as a result of various administative 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 euro fee to join the State Medical Aid scheme, many Healthcare Access Offices (PASS) still do not see patients, and migrants who do not have a social security number face real problems accessing healthcare.

By the side of vulnerable migrants » 94% of first-time service users in the clinics are foreign nationals.

» activities

» Romania, Algeria, Morocco, Tunisia, Cameroon…

• In clinics: medical, prevention and social consultations, as well as 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 2012, MdM spoke out about the poor living conditions of migrants, from Calais (where the Défenseur des droits1 denounced police harassement of migrants) to Mayotte (where access to healthcare is not in place for foreign minors).

common reasons for medical consultations

» outlook

» 27% of first-time service users in the clinics have sought, or are in the course of seeking, asylum » 88% of migrants did not have effective access to health coverage when they came to the clinic for the first time. most common nationalities

» Acute respiratory infections, abdominal pain, dental problems, back problems, skin infections, hypertension, type 2 diabetes, sleep disturbance, fatigue/ weakness, anxiety/nervousness/stress, etc. number of programmes

» All programmes

number of volunteers

» 1,971

We are continuing to develop prevention and screening programmes (rapid diagnostic tests for HIV, hepatitis and tuberculosis) in our programmes. The abolition on 1 January 2013 of the offence of solidarity is a positive sign for organisations working for migrants’ rights. At a time when the economic crisis is revealing hostile behaviour towards migrants, and when access to healthcare for vulnerable and poor migrants is under threat, as evidenced by the backward steps in relation to visas for seriously ill foreigners, MdM continues to work, with our partners, to bear witness to the conditions these group live in and to lobby for effective access to healthcare.

Partners

» Observatory on Migrant Right to Health (ODSE in its French acronym) member organisations, MOM Collective, local and regional voluntary sector co-ordination bodies

1. Opinion 2011-113 of 12 November 2012

FUNDING

» MdM’s own funds, regional public health agencies, along with district, regional and town councils.

Roma

» PROGRAMMES IN France

2012 was a year notable for evictions from Roma camps and high social tension, sometimes accompanied by violence. Living conditions in Roma settlements are extremely insecure and harmful to health—a worrying situation, especially when there are conditions with potential for epidemics (e.g., tuberculosis). It is still difficult for Roma to join the State Medical Aid insurance scheme, and this group faces many obstacles and has great difficulty realising their rights. The circular issued on 26 August 2012, on advance evictions, had been an encouraging sign to improve expulsion conditions. In reality, implementation is patchy across the country and evictions of settlements, particularly in the PACA and Ile-de-France regions, continue, reinforcing the deprivation and preventing the population from settling.

Working with Roma to improve health BENEFICIARIES

» nearly 3, 900 individuals NUMBER OF VOLUNTEERS

» 148

NUMBER OF PROGRAMMES

»9

FUNDING

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

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

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

» activities • Medical follow-up: primary healthcare and helping people to access mainstream health services. • Sanitation: lobbying councils for improved hygiene conditions in settlements (e.g., refuse collection, access to water). • Maternity care: Prevention of abortions, ante-natal monitoring, information on contraception, child immunisation, accompaniment to mother and child health protection services and family planning. • Vaccination campaigns, particularly for measles (Seine-Saint-Denis, Marseille). In 2012, MdM and other organisations continued and completed an action-research project on health mediation which was launched in 2011 with the aim of facilitating access for women and young children to health services and to improve how services welcome them in four locations: Lille (Areas), Fréjus (Sichem), Nantes (MdM) and Val-d’Oise (Asav). The results of this experiment demonstrate the relevance of health mediation as a tool and recommend that the profession of health mediator be recognised as a health profession in order to improve access to healthcare for these groups. By recognising the pertinence of health mediation to address social inequalities, the multi-year plan against poverty and for social inclusion confirms this operational choice.

» outlook MdM continues to work closely with other organisations to lobby the authorities to improve the living conditions on settlements where Roma are living. We are also working hard to ensure that there are no more advance evictions without suitable long-term alternatives.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

ÂŠ Christina Modolo

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Harm reduction » PROGRAMMES IN France

In 2012, the new government took on the subject of drug consumption rooms. An analysis on the feasibility of such an approach was carried out in several towns, including Bordeaux, Marseille and Paris. This suggested there was an opportunity for Gaia and MdM to open an experimental room in Paris. In addition, the action-research project on the accompaniment and education for users on the risks associated with injection (AERLI), in partnership with Aides and INSERM Marseille, supported by the national HIV and hepatitis research agency, continued with the inclusion of the final users in December 2012. MdM is also committed 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. Health problems

» Hepatitis C, H IV, psychiatric breakdowns, anxiety crises, bad trips, dependency, various somatic problems, vomiting, feeling ill beneficiaries

» More than 13,000 contacts at raves/ festivals and more than 220 people seen in squats in Marseille and Paris NUMBER OF VOLUNTEERS

» 121

FUNDING

» MdM’s own funds, Ministry of Health, regional health agencies, regional councils, INTERREG (Europe), MILDT… Partners

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

» activities Since 1997 MdM has been running prevention and harm reduction activities at festivals/raves and in the urban context: • at techno festivals, free parties and in cross-border clubs ; • in squats, during parties but also, more importantly, on an everyday basis ; • 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; • research on Skenan (a morphine-based medicine) was started in 2012, results are expected in 2013.

» outlook • Continuation of the current arrangements at raves//festivals with a view to handing over services. • Consolidation and strengthening of the current arrangements in squats. • Continuation of the action research project on AERLI and analysis of the first results. • Analysis of the findings of the research on Skenan and promoting thin layer chromotographic analysis as a harm reduction tool. • Supporting the set up of a drug consumption room and education in Paris. location of programmes

» Four rave programmes : Bayonne, Mediterranean, Montpellier and Toulouse ; Three programmes in squats in Bayonne, Marseille and Paris ; Five drug analysis programmes (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.

Sex workers » 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. Access to healthcare and other rights is increasingly difficult for this group. Often victims of violence or abusive arrests, these persons are often obliged to hide themselves, making it more difficult for support organisations to reach them and distancing them from the prevention services they had been using.

Beneficiar ies

» More than 1,450 number of volunteers

» 117

COMMON CONDITIONS

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

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

» AIDES, Arcat, CDAG, CIMADE, Droits d’urgence… Location of programmes

» Montpellier, Nantes, Paris, Poitiers, Rouen

Providing support and facilitating access to healthcare for sex workers » activities • Organisation of night and day outreach sessions in places where prostitution takes place, clinic sessions and health workshops, in order to provide prevention materials, to provide information on the risks of sexually transmitted infections, HIV and hepatitis and to offer a listening service. • Development of more individualised support. • Physical accompaniment to mainstream health services. • The Lotus Bus team carryied 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.

» outlook With the aim of raising awareness and offering better access to HIV screening, the teams are considering the possible use of rapid testing kits. In addtion, MdM would like to develop its activities with peer educators, who have a different approach, experience and specific skills and who can also can reach people that our teams have not yet been able to reach. In December 2011, then presidential candidate François Hollande promised to abolish the offence of soliciting. This proposal will be debated in the Senate at the end of March 2013, in the absence of a plan for a more general law on prostitution. MdM will be watching carefully.

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

DOCTORS OF THE WORLD ANNUAL REPORT 2012

ÂŠ Bruno Fert

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Health and housing » PROGRAMMES IN France

Five years after adoption of the DALO law, realising the legally binding right to housing, there are still more than 3.6 million people who have no, or very poor, accommodation in France. This includes 133,000 people who are homeless. Five million people are in extremely vulnerable situations in relation to housing.1 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 PROGRAMMES

» 19

NUMBER OF VOLUNTEERs

Taking the health impact of poor housing into account

» 363

» activities

MOST COMMON HEALTH PROBLEMS

• Providing healthcare, prevention and accompaniment. • Support for the implementation of appropriate public sector outreach teams (e.g., healthcare access outreach teams, EMPP). • Development of a study on the impact of unhealthy housing on health. • Promotion of appropriate housing and accommodation solutions (e.g., ‘nursing bed’ facilities, LAM).

» respiratory infections, hypertension, gum and teeth problems, gastric function problems, skin infections, depression, depressive/anxiety/nervous syndromes, back problems, asthma, etc. CONTACTS WITH HOMELESS and poorly housed PEOPLE

» nearly 14,000 »2 6.5% of service users in our clinics are sleeping rough, in voluntary sector accommodation or in emergency housing (on a day to day basis or for a two week period) » 13% of minors are homeless or in emergency housing (on a day to day basis or for a two week period) »4 3.5% live in insecure accommodation funding

Through its work, MdM is able to speak out about the harmful consequences of homelessness or poor housing on health.

» outlook MdM will continue this work in 2013 and will follow the implementation and progress in measures announced in the five-year plan against poverty and exclusion. .1. 2013 report on the state of housing in France by the Abbé Pierre Foundation, February 2013 and the INSEE 2006 census which counted 133,000 sleeping rough; DREES, 2008 survey of social services; administrative sources.

» 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…

location of programmes

» Angoulême, Ajaccio, Bordeaux, La Plaine-Saint-Denis, Cayenne, Grenoble, Le Havre, Lyon, Marseille, Metz, Montpellier, Nancy, Nantes, Nice, Poitiers, Reunion (Saint-Denis), Strasbourg, Toulouse, Valenciennes.

Prevention project

HIV-Hepatitis-STIs-Tuberculosis » PROGRAMMES IN France

Legislation introduced on 17 November 2010 which set out new conditions for rapid diagnostic tests (TROD) for HIV has expanded, among other things, the pool of people approved to carry out these tests. MdM was ahead of the legal authorisation to use these tests, by introducing TROD in Cayenne on 1 December 2009. Since then, the screening plan has been extended to six other MdM programmes. In 2012, to tackle the public health emergency that is the hepatitis C epidemic, and in advance of any legal authorisation, the harm reduction programme in Bayonne offered drug users hepatitis C screening with rapid tests, as part of an overall screening strategy.

Tackling HIV, STIs, hepatitis and tuberculosis Beneficiaries

» The 33,103 service users attending the pilot programmes HEALTH PROBLEMS

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

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

pilot project locations

» Healthcare and Advice Clinics : Bordeaux, Cayenne, Lyon, Marseille, Nantes, Nice, Paris, Rouen, Saint-Denis, Strasbourg, Toulouse » Sex worker programmes: Lotus Bus Paris, Nantes

» 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. • Facilitating access to care: partnership with mainstream health services, physically accompanying service users. • Collecting testimonies of case studies in relation to these diseases. In 2012, MdM launched some new initiatives: • Following the example of the clinics in Cayenne, Nice and Strasbourg, the Healthcare and Advice Clinics in Bordeaux and Nantes introduced rapid HIV testing. • The programme in Metz offers rapid HIV testing in accommodation shelters. • One programme with people who use drugs, the Rave mission in Bayonne, offers HIV and hepatitis C rapid tests for drug users in the premises of the harm reduction facilities run by the organisation Bizia.

» Homeless programmes : Metz, Lyon

» outlook

» Projects working with drug users: Education of risks associated with injection (ERLI) programme, Paris and Colombes, Bayonne rave programme

• Continue to introduce rapid HIV and hepatitis C testing in mainland France, as part of a wider screening strategy and to develop access to screening in appropriate and innovative ways. • Do more work on screening for other sexually transmitted infections. • Strengthen our partnerships with the free, anonymous testing centres.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Buddying

children in hospitals » PROGRAMMES IN France

Many children, often from disadvantaged backgrounds, from France and elsewhere in the world, are admitted to hospitals in and around Paris for conditions that cannot be treated closer to home. The Buddying programme volunteers aim to ease the difficulties caused by the separation and to help the child to deal with the suffering, thus greatly improving the quality of care. Increasingly, our volunteers 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 2012

» 166 » In the Parisian region: 133 » In French Guiana: 33 NUMBER OF VOLUNTEERS

» 94 » In the Parisian region: 82 » In French Guiana: 12

Partners in Ile-de-France

» Paris hospitals: Necker Sick Children’s Hospital, Armand-Trousseau Hospitals, Robert-Debré Hospital, Saint-Louis Hospital, Édouard-Rist medical and educational clinic, Institut Curie Centres in the parisian region

» Centre des Côtes - Les Loges-enJosas, Margency Red Cross Children’s Hospital, Bullion paediatric and rehabilitation hospital, Paul-Parquet Foundation-Neuilly-sur-Seine, Montreuil medical centre for young children, Villiers-sur-Marne rehabilitation centre, Saint-Maurice rehabilitation centre in french guiana

» Andrée-Rosemon hospital, Cayenne funding

» MdM’s own funds, Air France foundation, Air France, Air Austral and Air Caraïbe

» 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 • Opening a branch in Saint-Laurent-du-Maroni, in Franck-Joly hospital and in Saint-Denis in Reunion. • Setting up an agreement with child social services. • Working to apply the Declaration on the Rights of the Child and the European Charter for Children in Hospital.

Clinic - Toulouse © Benoît Guenot

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Regional delegations Given a legitimate mandate by the Board of Directors to pursue national strategies at the local level, the regional bodies responded by lobbying the authorities while carrying on with their day-to-day work. That is, to ensure effective implementation of programmes in their area, to mobilise members, strengthen partnerships, develop strategy and continue advocacy activities.

Mobilising our members in the regions 2012 was a busy year politically, and several campaigns were carried out: one for the general public, around the presidential and parliamentary elections; and an internal campaign for the regional elections in early 2013. Between March and June, the Vote Health roadshow visited 14 towns. This presented the opportunity to speak about our local programmes, while also raising awareness of MdM’s recommendations for long-term health policy. Our teams engaged with professionals and decision-makers, but also with the general public whether through direct contact on the streets, by organising conferences and debates or by writing letters asking for meetings with candidates. In this way, the regional delegations managed to get clear position statements from local politicians on some of Doctors of the World’s advocacy themes. These campaigns were an opportunity to get media coverage. We also organised a number of press conferences, for example, to highlight Roma evictions, for the International Day for the Eradication of Poverty, or to air criticisms of the Internal Security Law…

Our advocacy work goes much further than these events. In relation to violence against women, the exhibition, Women, the Aftermath of Violence, was shown in Le Havre and Toulouse. On the subject of migrants, a film screening and debate was held in Lille. On poverty and deprivation, a conference was organised in Ajaccio. In relation to housing, a conference was held in Lyon and flashmobs organised in Toulouse. Finally, the Nantes team lobbied for the recognition of health mediator as a health profession. In the run up to the 2013 regional elections within Doctors of the World, the regional bodies organised the succession: encouraging new members to join (thereby increasing the number of people eligible to vote), identifying possible candidates and supporting them through the process.

lation in Mulhouse; a study on the deployment of MdM teams in rural Aquitaine; establishment of a mediation, prevention and health education programme among vulnerable groups in the Bruche valley; an investigation on the avoidance of incarceration for homeless people with psychosis in Marseille; studying the possibility of opening a programme in Avignon in the Vaucluse; a needs assessment in the detention area in Nice). These assessments, which are linked to the organisation’s advocacy for better access to healthcare for the most vulnerable, enable us to monitor health needs.

None of these initiatives will lead anywhere unless we work closely with a network of partners. That is why the Regional Representatives organised informal meetings with voluntary and public sector parInnovation and partnerships tners. In some regions this resulted in closer links The capacity for reflection within regional dele- on skills (with training centres and universities on gations has resulted in some innovative initia- communication, training and evaluation) and on tives. These include surveys (on the revalence operational questions. In Marseille, for example, a of diabetes, hypertension and obesity in deprived partnership was developed with Nouvelle Aube, a groups in Strasbourg, on Local Health Insurance self-help organisation working with young people Offices in Ile-de-France), needs assessments (a in squats. In Rouen, Soins pour tous, which works study on the health needs of the Roma popu- with homeless people became a partner.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

The involvement of volunteers is a priority for the regional delegations, and, as such, is increasingly being systematically encouraged

Motivating and supporting volunteers Our regional delegations have shown that they can motivate their volunteers. Beyond providing healthcare, volunteers are called upon to raise awareness among young people (in schools, training centres, and in medical, nursing and social work schools), to bear witness by taking part in communication events (exhibitions, conferences etc.), to feed into our policy decisions (by participating in national seminars on particular topics, regional away days, team meetings etc.), to convey policy messages or to lobby local officials and to welcome new volunteers into the team. This degree of involvement and activism should be recognised and supported. The involvement of volunteers is a priority for regional delegations, and, as such, is increasingly being systematically encouraged. Recruitment of new volunteers (organisation of open days or information evenings) is one of the first priorities, but is not the only one. It also means welcoming new volunteers and supporting them throughout their involvement with the organisation. This can be achieved through the development of a delegation welcome pack, regular information and induction meetings, topic-specific training, seminars and workshops, encouraging membership of the organisation and so on. Paying attention in this way helps ensure the quality of our work and the relevance of our position statements. A new generation of activists is gradually joining, and sometimes shaking up, our teams. And regional delegations need to nurture this type of diversity to really fulfil their role in the organisation.

On international issues, the regional offices sought to step up their work. Most of the regionally-managed international projects (MIR in the French acronym) have successfully been handed over to local partners, as in Algeria and India. In other cases, these programmes provided support or a new impetus to local partners—as in Guinea, with the coordinator’s visit to France, or in Romania with the development of a new project working with vulnerable groups and Roma. New programmes have started in Sri Lanka (an outreach programme on access to healthcare in the north) and in Tunisia (with an extension of the Gourbi programme and a needs assessment in Kasserine region). The European dimension has also inspired regional delegations that want to work across borders. For example, Aquitaine is working with Doctors of the World Spain on harm reduction. Similarly, the Nord-Pas-de-Calais region and Doctors of the World Belgium working on migration journeys. Another example is the building of bridges with Eastern European countries where many of our service users come from. Pooling resources Although still in the planning, these initiatives To help some programmes to be less isolated, nearby delegations have agreed to provide supshould take shape throughout 2013.

port and integrate them into their own regional activities. The Healthcare and Advice Clinic in Besançon has now joined the Alsace regional delegation (December 2012). The Rhône-Alps delegation now has programmes in the Auvergne (adoption, university diploma and a rural health programme). In addition, the delegations increasingly share skills and encourage joint meetings and training sessions in the regions (always combined with a tour of the premises and a presentation on projects). In the East of the country, for example, Nancy and Strasbourg are putting together an inter-university diploma on health and deprivation. The adoption teams from Metz, Nancy and Strasbourg met with the adoption team at Nancy university hospital.

Regional development Most regional delegations presented a regional plan to the decision-making bodies within our organisation. With a unifying aim, these plans prioritise innovation, better support for volunteers within MdM and strengthening advocacy. To realise these plans, we tried setting up joint regional committees with three delegations (Aquitaine, Normandy, Rhone-Alps). These committes aim to define the political and operational goals and allocate resources. Following the positive results of this trial, each delegation is invited to conduct the same exercise which is somewhat cumbersome but which ensures a shared vision of regional strategies. The regionalisation process has affirmed the importance of regional delegations, who have a key role to play in MdM. As the link between headquarters and the work on the ground, they have becomemore autonomous in implementing their plans and a healthy involvement of volunteers.

Directory of regional delegations » Alsace / Franche-Comté

» Lorraine

» Loire

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

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

» Aquitaine

» Midi-Pyrenees

» Poitou-Charentes

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-pyrénees@medecinsdumonde.net

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

» Corse

» Normandy

» Rhone-Alps / Auvergne /Bur-

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

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

» Île-de-France

» Indian ocean

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

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

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

gundy

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

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

Find the detailed sheet for each regional delegation in the interactive CD attached to this report

DOCTORS OF THE WORLD ANNUAL REPORT 2012

International network The international network is made up of 14 organisations: Argentina, Belgium, Canada, France, Germany, Greece, Japan, Netherlands, Spain, Portugal, Sweden, Switzerland, United Kingdom and United States.

for the most vulnerable. With a common charter, name and logo, the 14 organisations aim to offer care and engage in advocacy, mobilising healthcare professionals in their respective countries. The international network management team (its French acronym is DRI) is resIn 2012, the combined MdM international ponsible for its coordination and developnetwork delivered 312 programmes in 79 ment, with guidance from the two largest countries: 147 international programmes organisations in the network, MdM in 65 countries and 165 national pro- France and MdM Spain. The team supgrammes in 14 countries. The internatio- ports the development of network memnal network members seek to re-establish, bers according to their needs and means. or often simply to enable, access to care In addition, the 10 European members

are now united in their lobbying activities aimed at influencing decision-makers responsible for health policy at a European Union level. The network is working more closely than ever before on joint communications in their respective countries, taking advantage in particular of the growing use of social media.

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

» international network members » Doctors of the World Argentina

» Doctors of the World Greece

» Doctors of the World Belgium

» Doctors of the World Japan

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

Chair: Prof. Michel Degueldre www.medecinsdumonde.be

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

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

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

Chair: Dr Nikitas Kanakis www.mdmgreece.gr Chair: Mr Gaël Austin www.mdm.or.jp

» Doctors of the World Netherlands Chair: Dr Remco Van de Pas www.doktersvandewereld.org

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

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

» Doctors of the World Sweden Chair: Mme Kristina Meseret Andersson www.lakareivarlden.org

»D octors of the World Switzerland Chair: Professor Nago Humbert www.medecinsdumonde.ch

» Doctors of the World UK

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

» Doctors of the World US

Chair: Ms Abby Stoddard www.doctorsoftheworld.org

Find the detailed information sheet for each member of the international network in the attached CD.

Germa Netherlan Belgium

United Kingdom

MAP OF programmes across the international network

Canada France Spai n United States of America

Portugal

Tunisia Algeria Mexico

Haiti El Salvador

Mali Niger Mauritania Chad Senegal Burkina Faso Guinea-Bissau Guinea Sierra Leone Côte d’Ivoire French Guiana (Fr) Liberia Benin

Dominican Republic

Honduras

Guatemala Nicaragua

Colombia

São Tomé & Principe

Ecuador

Peru

Bolivia Paraguay

Uruguay Argentina

INTERNATIONAL PROGRAMMES

NATIONAL PROGRAMMES

Togo

DOCTORS OF THE WORLD

Sweden

ANNUAL REPORT 2012

Russia

any nds

Bulgaria Romania Moldova

Mongolia

Switzerland Turkey

Georgia Japan

Greece

Lebanon

Syria

Afghanistan

Palestine Jordan Nepal Bangladesh

Egypt

Pakistan

India

Yemen

Laos

Burma

Philippines

Cambodia Somalia Sri Lanka

Ethiopia Uganda Kenya Rwanda

Indonesia

Dem. Rep. of Congo Tanzania Mozambique Mayotte (Fr.)

Angola

Madagascar Reunion (Fr.)

Zimbabwe

Timor Leste

Overview of programmes run by international network members

Doctors of the World members were busy across the network, working together on emergency responses in Mali and Syria and responding to the fallout from the European economic crisis. The network continues to grow, and we welcome a new member, MdM US.

Social and economic crisis in Europe 2012 was characterised by a worsening of the social and economic crisis. Austerity measures taken to combat the situation impacted on both social protection schemes and healthcare services. Meanwhile, an increase in unemployment and poverty across Europe has given rise to more hate speech, stigmatising migrants. An increase in xenophobic incidents has been seen in Greece and other European countries. An increase in migration within Europe is another growing phenomenon which is a consequence of poverty. Those EU citizens living in poverty with no social protection, who have medical needs, are treated in the same way as undocumented migrants from outside the EU. At the same time, those who already suffered multiple deprivation before the crisis, such as undocumented migrants, asylum seekers, people who use drugs, sex workers, EU citizens living in poverty, and the homeless, have seen a reduction in, or the removal of, the social safety nets

and networks that were previously offering them basic protection. NGOs and healthcare workers offer care and support, but the responsibility to ensure that the most vulnerable people are protected is that of the respective governments; some of which are simply no longer providing this support. Patients suffering multiple deprivation should be receiving more support in these times of xenophobia and economic crisis, not less. Our 2012 report on access to care in Europe found that more than 80% of service users were unable to access care without paying full price. 59% of pregnant women had no access to ante-natal care. 40% of patients who shared stories of violence at our clinics had lived in a war-torn country and a fifth had been attacked, imprisoned or tortured for their beliefs. A fifth had suffered violence at the hands of police or the armed forces. 49% were in temporary or unsafe accommodation and 26% said they were in a bad or very bad state of health.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

However, healthcare represents only 1.6% of the reasons given for migration by service users, which counters the idea that the welfare state is a major pull factor for migrants. Patients seen on a daily basis by MdM programmes—be they locals or migrants, children or older people, pregnant women or those suffering from chronic conditions—continue to be in a worse state of health than the general population. Several network members have seen a drastic reduction in institutional or private grants. This has meant we need to seek more diverse sources of income in order to continue offering vital services in difficult economic times. To show solidarity with our Greek colleagues, the annual international network meeting was held in Athens in May 2012. It was a great opportunity to share the work of these colleagues, who have been overwhelmed with need since the beginning of the crisis in Greece, and to brief both international and Greek journalists. We also spoke at the University of Athens’s medical school.

up and running in no time. Just a few weeks after the arrival of the new Director, the team launched their first project in response to the victims of Hurricane Sandy, which hit the American coast at the end of 2012. Clinics were set up in Rockaways, near to JFK airport. This area housed people who were vulnerable even before the hurricane hit, so this will be a long-term project and the team will remain in place in 2013. The launch of Doctors of the World US is an important step for our international network. Alongside Argentina and Canada, the office is the third in the Americas. For more information: www.doctorsoftheworld.org

Pooling resources on emergency missions

Moreover, network-wide communication on the largest crises (through websites, conferences, and press releases) mean that both human and financial resources are internationally sourced. For example, in 2012, several international members supported our work in Syria by seeking institutional and private funding in their respective countries. Our teams in the field are now entirely international, and as such, have the necessary means to deliver care programmes in complex environments. At the international level, Doctors of the World network programmes break down as follows: • Africa: 66 programmes in 25 countries; •L atin America: 34 programmes in 13 countries; • Asia: 24 programmes in 13 countries; •N orth Africa and Middle East: 17 programmes in nine countries; •E urope: (outside the European Union): six programmes in five countries.

In 2012, we continued our efforts to pool resources on our emergency missions. Security risks in some places (e.g., the Sahel, Syria), as well as the cost of intervention in some of the most remote areas, has meant that collaboration across The launch of Doctors of the World in the international network has been indispensable. the United States Regular workshops are held to ensure a coor- For more information on the work of the interDuring 2012, Doctors of the World opened a new dinated approach to security measures. These national network: office in the US. The New York office will contri- bring together the relevant departments and field www.mdm-international.org bute to the diversification of resources, link up workers on high-risk programmes. Experienced with institutions and partners in the US, bring in security staff outline network-wide protocols that new skills and set up projects. With a great team are then adapted according to the situation of and an active Board, Doctors of the World was the country in question.

World Health Day

Fight against HIV/Aids

Deprivation

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Key events Deepening poverty, intensifying conflicts, worsening health indicators for the most vulnerable: so many areas in need of Doctors of the Worldâ&#x20AC;&#x2122;s intervention. A round-up of important dates in 2012.

Quarter 1

January / February / March Haiti, two years on 12 January Twenty-four months after the earthquake that devastated Haiti, Doctors of the World published a multimedia experience on the internet entitled Haiti Two Years On: an unfinished portrait, created by artist Rémi Courgeon. Since the earthquake struck on 12 January 2010, the country has been undergoing a process of reconstruction. MdM continues to provide primary care, sexual and reproductive health education and support for women who are victims of violence, as well as fighting the spread of cholera. Experience the web-documentary here: www.medecinsdumonde.org/Haiti-2-ans-apres

Mayotte 29 March More than seven per cent of children under five seen by Doctors of the World in Mayotte suffer from acute malnutrition. This statistic comes from a study of 422 children coming to the Koungou pediatric clinic, which was opened in 2009. This finding is unacceptable for the 101st French department, which benefits neither from the AME, nor CMU protection, and where a repressive immigration policy impedes access to care for children. During the human rights commissioner’s visit in November, MdM called for measures to be put in place to ensure effective access to care for all children in Mayotte.

Emergency accommodation 28 March MdM’s survey conducted amongst people who called the emergency line in France (115), found that 58% had been refused. This is just one of the shocking statistics published in MdM’s annual emergency accommodation survey, conducted this winter. The organisation criticises the ‘thermometer-guided’ management of emergency accommodation and recommends setting up accommodation that is open all year round, adapted for those who need it. Download the report at: www.medecinsdumonde.org/Presse/Communiques-de-presse/ France/Fin-du-plan-grand-froid © DR/MdM

DOCTORS OF THE WORLD ANNUAL REPORT 2012

World Health Day 7 April In February, MdM launched its Vote Health! campaign, sending a roadshow across the country to meet the public and politicians. On World Health Day activists stormed the Place du Palais Royal dressed up as sick Mariannes (the symbol of the French nation), to pass on the Vote Health! message. At the same time, a cyber-protest brought together 5,500 internet users at the Place de la Bastille: their avatars paraded across the site votezsante.org, brandishing placards sharing our messages. Check out campaign visuals and find more information on our proposals at: MdM sur www.votezsante.org

Quarter 2

April / May / June

Niger April A national survey shows that five million people suffer from food insecurity. In Niger, Doctors of the World stepped up its malnutrition prevention programmes in the local health centre in Tahoua and made sure that pregnant women and children under five are given priority medical and nutritional care.

Hepatitis 22 May SOS Hépatitis and MdM organise a protest day against hepatitis B and C. Both organisations offer rapid testing for HIV and hepatitis at the Plaine-Saint-Denis MdM healthcare centre. In France, some 500,000 people carry the hepatitis virus. But while rapid testing is available for HIV,

it is not for hepatitis. MdM calls for permission to carry out both tests to ensure that those affected receive treatment earlier and avoid risky complications. See the video here: www.medecinsdumonde.org/Presse/Communiques-depresse/France/22-mai-Journee-sauvagede-lutte-contre-les-hepatites-virales

European financial crisis 24 May The Presidents and Directors of the 14 international network organisations meet in Athens 24-25 May to denounce the austerity measures that adversely affect

European healthcare systems. Against the backdrop of the crisis, MdM calls for equal access to care for everyone in the European Union. It also calls for an end to the expulsion of seriously ill migrants if care is not available in their country of origin.

Quarter 3

July/ August/ September Olympic Games 5 July In the run up to the Olympic Games opening ceremony in London, MdM aired a web-documentary entitled 2012: The Other Side of the Medal to highlight the tough living conditions and lack of access to care experienced by migrants in the Nord-Pas-de-Calais. Made up of © Sandra Calligaro interviews, it shares the determination of Watch the web-documentary: these ‘reluctant athletes’ who try every http://webdoc.medecinsdumonde.org/#/ day to reach London. home Syria 31 July In Syria and the refugee camps in neighbouring Jordan and Lebanon, 18 months into the brutal conflict, fundamental human rights are being breached daily: women and children injured or killed, doctors tortured, hospitals targeted, and deliberate blocking of medical aid access

HIV 22 to 27 July Fight HIV and hepatitis, not drug users! This was the message brought by Doctors of the World to the 19th International Aids Conference held in Washington. With recognised expertise in the area of prevention, MdM calls for the use of a proven community-based response. MdM also highlighted the importance of the fight against hepatitis C, crippling for people living with HIV, and for more harm reduction programmes in Africa.

to areas under attack. Faced with this dramatic situation, Doctors of the World speaks out and launches an Mali appeal to remind all parties that internatio- 11 September nal laws exist and must be respected. You can find the full text here: http://appelsyrie.medecinsdumonde.org

In the north of the country, the violence associated with the armed conflict, accentuated by the coup on 22 March, has resulted in close to 400,000 displaced people. At the border with Burkina Faso, Doctors of the World opened health centres in two Malian refugee camps, holding around 15,000 people. In spite of political tensions, MdM continues its medical activities and scales up its response to the food crisis in the Sahel.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

October/ November/ December

Quarter 4

International Day for the Eradication of Poverty 17 October Against the backdrop of the International Day for the Eradication of Poverty, Doctors of the World publishes its annual observatory on access to healthcare in France report. This yearly benchmark underlines the deterioration of access to care for the most vulnerable: 98% of the service users seen by MdM teams live below the poverty line, 38% accessed care too late, and more than 20% had given up on seeking care in the past 12 months. MdM calls on the government to put special measures in place to protect the poorest. Download the report here: http://17octobre.medecinsdumonde.org © Elisabeth Rull

Fight against HIV 1 December

On World Aids Day, MdM publishes a web-documentary entitled Nothing Will Be Done Without Us. ‘Us’ refers to the peer workers who share prevention messages within their own communities (sex workers, people who use drugs etc.) This community-based, medical and social approach to harm reduction is now internationally recognised as the most effective method of preventing transmission. To find out more: http://riensansnous. medecinsdumonde.org

Violence 17 December On the International Day to End Violence Against Sex Workers, MdM publishes the results of the survey carried out on the Lotus Bus (a project that supports Chinese migrant sex workers). The results showed that 86% of them had experienced at least one form of violence. MdM calls for the repeal of the passive

soliciting law and rejects all future plans for criminalisation of clients that could further increase the vulnerability of sex workers and lead to an even greater infringement of their rights. Read the results of the survey: www.medecinsdumonde.org/ Presse/Prostitution-et-violences

Human Rights 10 December Twenty-one months since the Syrian revolution began, the violence against civilians continues with the death toll reaching over 40,000, and more than one million displaced people (according to the UN). Working in the refugee camps in Jordan and Lebanon, and since October in Qah camp in the north-west of Syria, MdM provides care and medical equipment to thousands of Syrians displaced by the conflict. On International Human Rights Day, the appeal launched in July is more relevant than ever. Find the press pack here: http://www.medecinsdumonde.org/ Presse/Dossiers-de-presse/A-l-International/Soigner-en-Syrie-et-aux-frontierestemoigner-des-souffrances

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Cross-cutting projects A broad analysis of technical or medical themes identified as priorities by MdM, enables teams on the ground to improve the relevance and quality of projects. In parallel, advocacy work aims to reinforce the organisationâ&#x20AC;&#x2122;s lobbying influence on political decision-makers.

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» Sexual and

reproductive health promotion of the right to health and universal access

to services

A rights-based approach to public health Doctors of the World has developed 20 projects that address the theme of sexual and reproductive health. Each project responds to the specific needs identified in different contexts: improving access to family planning in Niger, prevention of, and care for, obstetric fistulas in Chad, improving access to maternal healthcare, prevention of, and care for, unwanted pregnancies in Uruguay, etc. Moreover, MdM aims to improve access to healthcare for local communities as well as the quality of care provided. This involves facilitating the relationship between the community and healthcare services and increasing awareness regarding access to sexual and reproductive healthcare. Within this overarching theme, MdM is also able to identify and care for victims of gender-based violence and work on its prevention. Having agreed on a policy position, the organisation is finalising a sexual and reproductive health reference framework with a key aim of supporting the teams on the ground to implement their projects. Two key areas of work Over and above a purely health perspective, MdM is focusing its lobbying activities on two key priorities: • In low-income countries, the cost of care is a big obstacle to access, in particular for the most vulnerable families. Anxious to support healthcare systems that are functional and accessible to all, MdM advocates the adoption of public policy establishing free access to primary care. There is a particular focus on exempting pregnant women and children under five from user fees. In March 2012, a workshop in Paris brought together teams from 10 different projects and led to the adoption of an official position on financial accessibility of care. Lobbying activities have started in several areas, notably Niger, Burkina Faso and Côte d’Ivoire. Finally, general advocacy on universal health coverage was ongoing throughout 2012 and will continue in 2013, culminating in the adoption of this principle as one of our key post-2015 development objectives. • MdM actively supports the right of women to decide whether to have children or not. All women should be able to use contraception to avoid unwanted pregnancies and have access to safe and legal abortion, where appropriate. 97% of women in Latin America live in countries with highly restrictive abortion laws. A call for Access to Safe and Legal Abortion was developed by MdM and its partners. It links up different groups (MdM, civil society, health professionals) from seven countries in Latin America and the Caribbean. A first workshop was held in Uruguay and a second in Mexico City to exchange ideas and share advocacy strategies.

funding

» SRH project, funded by the French Development Agency and other funders.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

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Afghanistan ÂŠ Robin Hammond/Panos Pictures

DOCTORS OF THE WORLD ANNUAL REPORT 2012

» Harm reduction

focused on supporting stigmatised populations

A medical and political approach based on public health and human rights Since 1989, Doctors of the World has been working on harm reduction programmes in France and abroad. In collaboration with people who use drugs, sex workers, and men who have sex with men, MdM is implementing projects to reduce the risks related to the use of psychoactive substances and risky sexual practices, by providing a holistic response encompassing medical, psychosocial and community care.

Two key areas of work • Promoting the concept and practices of harm reduction in Africa, where support for populations at risk is almost non-existent. Fewer than one per cent of drug users in Africa have access to a support programme. To continue to influence health policy in this area, particularly in East Africa, MdM opened a second programme in Kenya. We also continued to strengthen our flagship project in Tanzania. It now offers a range of training courses for various workers in the sector (institutions, local NGOs and health professionals...) and the needle exchange component, which has seen positive results, has been extended. • Advocacy for access to screening, diagnostic tools and treatment for hepatitis C. There are 180 million hepatitis C carriers and 70% of new infections are amongst intravenous drug users. Access to affordable treatments is crucial. In this area, MdM’s advocacy focuses on three strategies: mobilising civil society workers, supporting the production of generic medicines and proposing an appropriate treatment model. In April, a French coalition was formed to tackle the theme of access to hepatitis treatment (ANRS, Aides, Sidaction, Act Up, MSF, CHV, etc.). Then, an international coalition (HepCoalition, www.hepcoalition.org), made up of a range of self help groups and NGOs, was created at the international conference on Aids in Washington in July 2012. This aims to coordinate actions targeting the pharmaceutical companies, political leaders, donors and UN agencies. In Georgia, a survey was conducted amongst 217 intravenous drug users. Initial results show that 83% were infected with chronic hepatitis C. Among these, nearly 25% were suffering from severe liver fibrosis and required immediate treatment.

FUNDING

»H arm reduction programme funded by the French Development Agency and other funders.

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» Socio-cultural determinants and access to care (DSC-AS project)

Far from being universal, access to care for our beneficiaries depends hugely on the cultural norms, values and the knowledge base of each community. Taking this into account, the working group, supported by the AFD for three years (2008-2011), considered the influence socio-cultural determinants have on access to care, with the aim of improving programme quality. Questioning concepts, discussing issues, and taking into account experiences in the field: since its inception, the working group makes the link between the scientific and operational approach through the implementation and compilation of field studies, training and a number of publications. In 2012, with the benefit of experience, the group continued its activities, producing two new methodological guides (Working with Communities and Socio-cultural Determinants of Access to Care), and delivered programme support by setting up qualitative studies. Also, to enable exchange and information gathering, the group now has a mini-site, linked to the main MdM website: dsc.medecinsdumonde.org.

‟To destroy prejudice, (...) we do not open the eyes of others to reason; we must open our own eyes to the reason of others.” Alain Finkielkraut, commenting on Lévi-Strauss, La Défaite de la pensée, Folio, 1987.

» Geopolitical analysis

and security

In recent years, the international situation has changed, generating tensions and new conflicts. Moderate thinking is becoming rarer and the humanitarian space has been reduced. The principle of not shooting at ambulances, far from being respected by all, is no longer a given, and our humanitarian cause protects neither our staff nor our partners in the field. This is in addition to endemic crime in areas of growing poverty under unstable regimes. In 2012, Doctors of the World continued to strengthen its operational capacity for analysis and risk reduction in order to ensure the safety of its national and international teams on the ground, and is establishing these activities for the long term. Security assessment missions were carried out in the Yemen, Afghanistan, Pakistan and the Democratic Republic of Congo. MdM is also a member of the European Interagency Security Forum (EISF), a network of European NGOs. This network works to improve practices in the field and exchange information on volatile or particularly risky environments. In May 2012, Doctors of the World became a Member of the EISF Steering Committee.

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Adoption Doctors of the World is the only medical, humanitarian organisation in France to have an international adoption programme within its founding statutes and to have set up an international adoption agency. The status of Approved Adoption Agency (AAA) was granted in 1988. Our objective as an AAA is consistent with our overall mission: to stand up for those who are most vulnerable, namely children, who are often the first to be affected by crisis or conflicts, as well as promoting their fundamental rights to a family, healthcare and an education (UN Convention on the Rights of the Child, 20 November 1989).

Vulnerable children, our priority CO-ORDINATION

»H ead of Programme: Dr G. André-Trévennec (paediatrician) »D irector: P. Salignon Members of the adoption committee representing the board

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

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

» € 515,864 COUNTRIES

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

» 205 of whom 98% are volunteers, working for the adoption team at headquarters or in 15 regional offices

The very sharp decline in numbers of international adoptable children, coupled with the significant increase in children with specific needs (children with medical conditions, siblings and older children), demonstrate how much this service is needed. The priority is to find families for these children who have no one to care for them in their country of origin. The team prepares candidates for these complex adoptions and monitors the situation closely after the adoption, to reduce the risk of failure.

» Activities MdM has accompanied the transfer of 3,934 adopted children since 1990. In 2012, 96 children arrived in France and were adopted by 84 families. 67% of the adoptions were classified as complex (compared to 40.5% in 2011): • 22 children (22.7%) were adopted with their siblings from Colombia and Brazil; • 22 children (22.7%) were older than six years old, of which 10 were siblings, from Brazil and Bulgaria; • 39 children (40.2%) had medical needs, mainly from China. MdM keeps track of the adopted children and their families for at least two years, as and when necessary.

» Organisation and human resources • A consistent approach across France: MdM holds an adoption licence in 85 French departments. The programme is managed by the head office, but also central to the work are 15 adoption hubs, based in the regional offices, each one covering several districts. • Significant ongoing training : the changing profile of children available for adoption has made parenthood more challenging; as a result, the team have called on experts to carry out ongoing staff training. • A policy of openness, partnership and exchange: as an Approved Adoption Agency, we communicate with regional councils at regular meetings or at special meetings in cases of complex adoptions. The team also contributes to themed working groups, at the request of government departments and works in partnership with international structures (the Swiss Foundation of the International Social Service, for example), or experts from other host countries such as Canada or Belgium, in order to study and anticipate problems and be an ‘engine’ for constructive change.

106

Madagascar ÂŠ Virginie de Galzain

DOCTORS OF THE WORLD ANNUAL REPORT 2012

Opération Sourire Since the first operation performed in Cambodia in 1989, Operation Sourire has continued to grow. Today, teams from four network members (Germany, France, Japan and the Netherlands) perform reconstructive surgery in Africa and Asia. The overall objective of the mission is to restore smiles, in particular to those children suffering from congenital or acquired diseases. National medical staff are also trained and, beyond the surgery, vital work is done to facilitate the social reintegration of patients in to the heart of their community.

Give back a smile and help social reintegration CO-ORDINATION

» Head of Programme: Dr F. Foussadier » Headquarters: S. Poisson FUNDING

» L’Oréal Foundation Budget

» € 500,000 COUNTRIES

» Bangladesh, Burma, Burundi, Cambodia, Chad, Guinea-Bissau, Madagascar, Mongolia, Sierra Leone

» Activities This programme is inspired by the principle of solidarity with the most disadvantaged people: those suffering from disfigurement. Through this programme, Doctors of the World builds patients’ confidence and helps them rejoin their communities. • In 2012, the teams operated on 1,224 patients during 26 missions in nine countries. • MdM France completed 11 missions in four countries (Cambodia, Madagascar, Mongolia and Chad), caring for 361 patients mainly suffering from cleft palates and scarring from burns. MdM Germany, Japan and the Netherlands implemented their own missions in Cambodia, Bangladesh, Burundi, Burma, Sierra Leone and Guinea-Bissau. Thanks to them, 863 people benefited from surgical interventions. • The increase in the number of people operated on in 2012 (807 patients in 2011) is due to the missions carried out by MdM Netherlands, which conducted nearly 500 operations in 2012. These missions are particularly well planned and enjoy the support of the staff working in the Netherlands office. An exploratory mission is systematically conducted prior to the implementation of a programme; teams that operate benefit from supervision and coordination before, during and after the mission.

» Outlook In 2013, the Operation Sourire teams plan to carry out 29 missions, including four exploratory missions. MdM France plans to carry out 14 missions and to continue to support the development of new missions by other network members.

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Doctors of the World management at 31 December 2012

» General Director: Pierre Salignon » 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 : Juliette Chevalier until June, Luc Evrard since November

» Adoption Director : Dr Geneviève André-Trévennec » General Secretary of the International Network: Jean Saslawsky

DOCTORS OF THE WORLD ANNUAL REPORT 2012

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 2 June 2012, Doctors of the World members elected the Board:

»C hairman

Dr Thierry Brigaud Prevention doctor

»V ice-chairs

Dr Françoise Sivignon Radiologist

Dr Frédéric Jacquet Public health inspector

»G eneral secretary

Dr Patrick Beauverie Hospital pharmacist

»D eputy general secretary Maria Melchior Epidemiologist

»D eputy treasurer Dr Luc Jarrige Hospital doctor

Other board members : »P atrick »C laire

Christophe Adam General Practitioner

Boulanger

»M argarita

Gonzalez

Nurse »O livier

Maguet

Consultant »P hilippe

de Botton

Endocrinologist

Consultant »O livier

Bernard

Paediatrician, hospital doctor »G érard

Pascal

Surgeon »A ndrea

Nurse

»T reasurer

David

Anaesthetist, intensive care doctor

Substitute board members :

Brezovsek

109

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Our thanks to OUR PRIVATE PARTNERS

Foundations and businesses American Express Japan, Fellissimo Japan, Annenberg Foundation, Drosos Foundation, Ichiyoshi Shoken Japan, McCall MacBain Fondation, Mitsui Japan, Open Society Foundation, Renovabis Foundation, Stern Stunden Foundation, Fubon Cultural & Educational Foundation, Norwegian Church Aid, Air France, BVA, Association of Cake Designers in France, Air France Foundation, Association Ouest France Solidarité, French Aviation Club, Bärchen, Bred, CIC, Rhône-Alpes Islamic Council - Lyon mosque, Crédit agricole, Crédit mutuel, Crédit coopératif, Agnès B Foundation, L’Occitane Foundation, L’Oréal Foundation, Optic 2000 Foundation, Roi Baudouin Foundation, PPR foundation for dignity and women’s rights, PSA Peugeot Citroën Foundation, Veolia Environment Foundation , Sanofi Espoir Foundation, GCE Fidélisation, Imerys Ceramics France, l’Acoustics SA, Ivoire, Les Éditions Maréchal, Maximiles, Mobilorama, Scooter INSTITUTIONAL PARTNERS Multilateral organisations European Union (DG Echo, DG DevCO/ EuropeAid), United Nations agencies (UNDP, UNFPA, UNHCR, Unicef, OCHA,

UNAIDS, UNODC, WFP, WHO), Global Fund, World Bank, 3 Diseases Fund (3DF).

dage, Éguilles, Auray, Leers, Nevers, Rungis, Talange, Blanquefort, Annemasse.

Bilateral organisations • In Europe : German official development assistance (AAH – urgence), UK official development assistance: Department for International Development (DFID), Spanish official development assistance (AECID, Junta de Andalucia), Monaco official development assistance (DCI), Norwegian official development assistance, Swiss official development assistance (DDC), Danish official development assistance. • In France: Agence francaise de développement (AFD), Centre de crise du ministère des Affaires étrangères et européennes (CDC), French embassies (via SCAC and FSD). • Other: American development assistance: USAID via the NGO PSI, Canadian International Development Agency (CIDA), Japanese official development assistance (JICA). • French local authorities: Rhône-Alps region, Safer de l’Île-de-France, Reunion District Council, Val-d’Oise District Council, Alsace Regional Council, PACA Regional Council, Nord-Pas-de-Calais Regional Council, Aurillac Basin Council and Greater Angoulême Council. • Town councils: Paris, Ploufragan, Hagon-

For our regionally-managed international projects District councils: Bouches-du-Rhône, Alpesde-Haute-Provence, Gironde, Charente-Maritime, Vosges, Doubs, Reunion, Midi-Pyrénées, Paca; Regional councils: Provence-AlpesCôte d’Azur and Rhône-Alpes; présidence des régions, Guadeloupe prefecture. For our programmes in France Agence nationale de recherche sur le Sida (ANRS), regional health agencies (ARS), Caisse nationale d’assurance maladie (CNAM), family allowance funds (CAF), regional health insurance funds(CMR), local health insurance offices (CPAM), regional health insurance offices (CRAM), local social services (CCAS), free anonymous screening centres (CDAG), district councils, regional councils, town councils, Agence nationale pour la cohésion sociale et l’égalité des chances (ACSE), Ministry of Health (DGS), Ministry of Social Cohesion (DGCS), 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), Mission

DOCTORS OF THE WORLD ANNUAL REPORT 2012

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 ASSO CIATIO NS

Aides, ALC Nice, Amnesty International, Anef, Association de communication et d’action pour l’accès aux traitements, Association des régions de France, Association française de réduction des risques, Association des familles victimes du saturnisme, Association d’autosupport et de réduction des risques des usagers de drogues, Association des gens du voyage, Santé sans frontières, Association des inadaptés des PO, Association des médecins du Pays de Retz, Association Cercle central, Association Gérer son stress, Association médicale Pascal, Association Partage et Fraternité, Association Régul 31, Association Rencontre avec des hommes remarquables, Association Une foulée pour la vie, Association Le Foyer, Association Setton, Association Sanatatea, Association Sida paroles, Association Gaïa Paris, ATD Quart-Monde, Avenir et Coopération, Banque humanitaire, Bus 31/32, Pays de la Loire

planning centre, Coordination française pour le droit d’asile (CFDA), Collective of associations united for a new housing policy, Alsace Collective of organisations working with sex workers, Collectif interassociatif sur la santé (CISS), Romeurope collective, Migrants outre-mer (MOM) collective, Alerte collective, Collectif de Soutien aux Victimes de Bam, Comité des amis d’Emmaüs, Communauté mariste, Congrégation des sœurs augustines, Cordaid, the Red Cross, CSF, Coordination française pour le droit d’asile, Coordination nationale des réseaux (CNR), Cyclamed, Droit au logement, D’une rive à l’autre, DHL Liens, Emmaüs, Entraide majolane, Rimbaud mobile team, 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, Gisti, Harm Reduction International (HRI), Ordre de Malte, La Case, Les Amis du bus des femmes, Les Mondes solidaires, Les Restos du cœur, Le Stade rennais FC, Brittany football league (and the Brittany clubs), Ligue des droits de l’homme, Max Havelaar, Novib, Observatoire du droit à la santé des étrangers (ODSE), Observatoire international des prisons (OIP), Pact, Pas-

serelle la Santé sans frontières, Pharmacie Humanitaire Internationale (PHI), Plateforme contre la traite des êtres humains, Secours Catholique, Sidaction, Sid’espoir, Solidarité Sida, SOS Drogue international (SOS DI), SOS Femmes, Rasko, Techno Plus, UNIOPSS, Veille sociale, Vialtis, Tourism for Development (TFD), AS Kiwanis Club, Addocuiation, Les Jardins du livre, Association école de Karaté traditionnel, Saint-Nazaire Atlantique Rotary Club, Association Notre-Dame des Aides. AND ALL OUR OTHER PARTNERS WHO HAVE SUPPORTED OUR WORK AT HOME AND ABROAD DURING 2012, PARTICULARLY THOSE WHO HAVE SUPPORTED US WITH A LEGACY OR LIFE INSURANCE POLICY AND OUR OTHER INDIVIDUAL DONORS.

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Glossary A

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

CAARUD: Centre d’accueil et d’accompagnement à la réduction des risques pour les usagers de drogues (Harm reduction centre for drug users) CASO: Centre d’accueil, de soins et d’orientation (Healthcare and Advice Clinic) CCN: Conseil consultatif national au Congo (Congo National Consultative Council) CDAG: Centre de dépistage anonyme et gratuit (Free and anonymous screening centre) CEDCF: Community Development and Environment Conservation Forum CENHOSOA: Soavinandriana hospital CFDA: Coordination française pour le droit d’asile (French Co-ordinating body on the Right to Asylum) CHP: Community Health Partnership CHV: Collectif Hépatites virales (Viral Hepatitis Coalition)

ICRC: International Committee of the Red Cross CIMADE: Comité inter-mouvement auprès des évacués - service œcuménique d’entraide (Ecumenical Mutual Aid Service) CISS: Collectif interassociatif sur la Santé (Voluntary Sector Health Coalition) 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) COCA: Consultations d’orientation et de conseils en adoption (Adoption advice and orientation sessions) COE: Council of Europe COMEDE: Comité médical pour les exilés (Medical Committee for Exiles) CONCORD: Confédération européenne des ONG d’urgence et de développement (European Federation of Emergency and Development NGOs) COPIL: Comité de pilotage (Steering Committee) CORDAID: Catholic Organisation for Relief and Development Aid COREVIH : Comité de coordination de lutte contre l’infection due au VIH (Co-ordination Committee for Action Against HIV) CPAM: Caisse primaire d’assurance maladie (Local Health Insurance Office) CREN(I): Centre de récupération et d’éducation nutritionnelle (infantile) ((Infant) Nutritional Recovery and Education Centre) CRIPS: Centres régionaux d’information et de prévention du sida (Regional Centre for Prevention and Information on Aids) CSAPA: Centre de soins, d’accompagnement et de prévention en addictologie (Addiction Care, Support and Prevention Centre)

DDVLAT: Dispositif départemental de vaccination et de lutte anti-tuberculeuse (District Action Plan for Vaccination and Tackling Tuberculosis) DEEE: Déchets d’équipements électriques et électroniques (Electronic and Electric Equipment Waste) DEV-CO: International Development Aid Programme DFID: Department for International Development

DIU: Diplôme interuniversitaire (Joint University Degree) DPO: Division du partenariat avec les ONG (NGO Partnership Division) DREES: Direction de la recherche, des études, de l’évaluation et des statistiques (Department for Research, Evaluation and Statistics) DRR: Disaster Risk Reduction

ECHO: European Commission Humanitarian Office (DG ECHO: Directorate-General ECHO, DIPECHO: Disaster Preparedness ECHO) ECOSOC: United Nations Economic and Social Council EISF: European Interagency Security Forum EMPP: équipe Mobile Psychiatrie Précarité (Psychiatry 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

FARC: Colombian Armed Revolutionary Forces FAS: Foetal alcohol syndrome FED: Fonds européen de développement (European Development Fund) FGM: Female genital mutilation FIFDH: Festival du film et forum international sur les droits humains (International Human Rights Film Festival and Forum) FPA Watch Group: Framework Partnership Agreement FUH: Fond humanitaire d’urgence (Humanitarian Emergency Fund)

GISTI: Groupe d’information et de soutien des immigrés (Immigrant support and information group) GIZ: Deutsche Gesellschaft für Internationale Zusammenarbeit

HDI : Human Development Index (statistical index,

DOCTORS OF THE WORLD ANNUAL REPORT 2012

from 0 to 1, created by the UN Development Program to evaluate the level of human development of 187countries in the world. The HDI is based on three key criteria: life expectancy, educational level and standard of living.) HRI: Harm Reduction International

ICVA : International Council of Voluntary Agencies IFRASS: Institut de formation, recherche, animation sanitaire et sociale (Health and Social Training and Research Institute) IFSI: Institut de formation en soins infirmiers (Nurse Training Institute) INSEE: Institut national de la statistique et des études économiques (National Economic Statistics Institute) INSERM: Institut national de la santé et de la recherche médicale (National Health and Medical Research Institute) INTERREG: European Cross-Border Co-operation IREPS: Instance régionale d’éducation et de promotion de la santé (Regional Health Education and Promotion Authority) IRTS: Institut régional du travail social (Regional Social Work Institute) IS: Iniciativas Sanitarias ISDP : Integrated Services for Displaced People ISPED: Institut de santé publique, d’épidémiologie et de développement (Public Health, Epidemiology and Development Institute) IUT: Institut universitaire de technologie (University Technology 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

LDH: Ligue des droits de l’homme (Human Rights League) LSD: Lysergic acid diethylamide LSI: Loi pour la sécurité intérieure (Internal Security Law)

MCWAK: Maternity and Child Welfare Association

Khampur MDGs: Millenium Development Goals MdM: Médecins du Monde (Doctors of the World) MILDT: Mission interministérielle de lutte contre la drogue et la toxicomanie (Interministerial programme against drugs and addiction) MIR: Mission internationale régionale (Regionally managed international programme) MNLA: Mouvement national de libération de l’Azawad (National Azawad Liberation Movement) MSF: Médecins sans frontières (Doctors without Borders) MSPP: Ministère de la Santé publique et de la Population (Ministry of Public Health and Population) MYSU: Mujer y Salud (women and health)

Treatment in Africa SCAC: Service de coopération et d’action culturelle (Aid and cultural support department) SCD: Socio-cultural determinants SEDEC: Social and Economic Development Centre SIAO: Service intégré d’accueil et d’orientation (Integrated Reception and Advice Service) SOLIPAM: Solidarité Paris maman SRH: Sexual and reproductive health STRASS: Union of sex work STI: Sexually transmitted infection SUD: Solidarité Urgence Développement (Solidarity Emergency Development)

NGO: Non-governmental organisation NSR : National System of Referral

TLC : Thin layer chromatography TOHAV: Foundation for Society and Legal Studies in Turkey TROD: Rapid diagnostic tests and advice

OAA : Official Adoption Agency OCHA: UN Office for Humanitarian Affairs ODSE : Observatoire du droit à la santé des étrangers (Observatory on Right to Health for Migrants) INGO: International non-governmental organisation

PACA : Provence-Alpes-Côte d’Azur PASS: Permanence d’accès aux soins de santé (Healthcare access office) PPR : Fondation Pinault-Printemps-Redoute (PinaultPrintemps-Redoute Foundation) PRAH: Programme médico-social en soins spécialisés (Specialist healthcare and medico-social programme) PRAPS: Programme régional d’accès à la prévention et aux soins (Regional Programme for Access to Prevention and Healthcare) PTMCT: Prevention of Mother to Child Transmission

UN: United Nations UNDP: United Nations Development Programme UNFPA: United Nations Population Fund UNHCR: United Nations High Commissioner for Refugees UNICEF: United Nations Fund for Children UNIPA: Unidad Indígena del Pueblo Awá UNOPS: United Nations Office for Project Services UOSSM: Union des organisations de santé et de soins médicales (Union of health and medical care organisations) URR: Emergency and rapid response

VHAI: Voluntary Health Association of India HVC: Hepatitis C virus HIV: Human Immunodeficiency Virus VOICE: Coalition of European NGOs

DRC: Democratic Republic of Congo RdR: Harm reduction REEJER: Réseau des éducateurs des enfants et jeunes de la rue (Network of street children educators)

S2AP: Service d’analyse, d’appui et de plaidoyer (Analysis, Support and Advocacy Department) SAI: Service adoption international SAPTA: Support for Addictions Prevention and

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

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XBT: Drug analysis

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EDITOR-IN-CHIEF Dr thierry Brigaud Coordination Nolwenn roussier EDITORIAL COMMITTEE Isabelle Bioh-Johnson luc evrard

EDITORS Nolwenn Roussier morgan fiette

GRAPHIC DESIGN & PICTURE EDITOR Aurore Voet

EDITORIAL ASSISTANT Thérèse Benoit

PRODUCTION OF THE CD FILES isabelle martija-ochoa

MAPS Julien Bousac Vincent Giavelli

Production E-Graphics\France

TRANSLATION GILL COCKIN ANGELINE DAVIES KAREN MCCOLL ELINOR MIDDLETON THANKS TO EVERYONE WHO HELPED WITH THE 2012 EDITION

OF THE WORLD!

ALL DOCTORS

Tel. +33 1 44 92 15 15 Fax. +33 1 44 92 99 99