MÊdecins Sans Frontières Australia Annual Report 2008
Contents Médecins Sans Frontières – Charter
2
Message from the President
3
2008 – Year in Review
5
Map – Médecins Sans Frontières projects funded by Australian donors
7
Médecins Sans Frontières Australia International Field Staff in 2008
8
Médecins Sans Frontières projects funded by Australian donors
11
Summary Activity Charts
22
Médecins Sans Frontières Australia Financial Statements
23
Cover: A Médecins Sans Frontières medical team, including Australian midwife Sonia Girle (right) carries out home visits twice a week to the homes of Afghan women in Zahedan, Iran. Since May 2008, the Médecins Sans Frontières medical team has followed up more than 400 mothers in their homes. Between 60 and 80 pregnant women have also been referred to maternity facilities. Photo: Valérie Babize/MSF
Médecins Sans Frontières – Charter Médecins Sans Frontières (MSF) is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principles:
Médecins Sans Frontières offers assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict, without discrimination and irrespective of race, religion, creed or political affiliation.
Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and demands full and unhindered freedom in the exercise of its functions.
Médecins Sans Frontières’ volunteers undertake to respect their professional code of ethics and to maintain complete independence from all political, economic and religious powers.
As volunteers, members are aware of the risks and dangers of the mission they undertake, and have no right to compensation for themselves or their beneficiaries other than that which Médecins Sans Frontières is able to afford them.
2
Message from the President As we write this message, four of our colleagues have just been released unharmed after being kidnapped in Darfur, Sudan. It seems each year we face similar ongoing challenges of securing access to provide medicalhumanitarian aid to the most vulnerable populations and threats to our staff. Médecins Sans Frontières has made a commitment to assist those in conflict situations, victims of natural disasters and populations marginalised and in distress. We do this as an independent medical-humanitarian organisation and don’t shy away from speaking out as witnesses to the suffering and plight of populations when needed.
attack in the southern port town of Kismayo. However, we have continued our medical assistance, with national staff members keeping the programs running. In 2008, we continued to work in nine regions in the country, providing primary healthcare, malnutrition treatment, medical assistance and support to displaced people, surgery, and water and relief supply distributions in an attempt to meet some of the massive needs of the Somali population. As in Somalia, the security situation in Iraq is acute, severe, unstable and complex meaning that the provision of medical aid is an enormous challenge. In 2008, Médecins Sans Frontières ran surgical programs in Amman, Jordan, for war-wounded patients referred by Iraqi medical colleagues, and in Iraqi Kurdistan for burn victims.
In 2008, a strong focus of our work remained in conflict zones, including Pakistan, where fighting has recently intensified, Democratic Republic of Congo (DRC), and Sri Lanka. In addition, we provided medical assistance to affected populations of Somalia, Iraq and Afghanistan. In DRC, renewed fighting in North Kivu has caused massive displacement in the region. A ceasefire agreement signed in January 2008 was not respected, and by the end of August large-scale fighting had broken out again in the region. Médecins Sans Frontières has been running projects throughout North and South Kivu provinces, providing emergency medical assistance, primary and secondary healthcare, water and sanitation assistance, distribution of essential items such as shelter materials and blankets, as well as responding to cholera and measles outbreaks. A particular challenge we have met head-on in DRC is providing help to victims of rape. Two reports on the medical-humanitarian situation in DRC were released in 2008-09: Condition: Critical, highlighting the civilian consequences of war; and a special report, Shattered Lives, highlighting the suffering and impact of rape on the women of DRC, as well as in many other countries in which our teams work.
Sudan continued to be wracked by two major humanitarian emergencies in 2008 – the crisis in Darfur and the consequences of decades of civil war in the south. Throughout 2008, our 1,500 field staff in South Sudan provided medical services in a region where, in addition to the ongoing violent attacks, malnutrition is prevalent; maternal mortality rates remain among the highest in the world; tuberculosis and kala azar are ongoing problems; while large-scale outbreaks of meningitis, measles, cholera and malaria are relentless. Further south, Zimbabwe’s disrupted healthcare system was further strained by a massive cholera epidemic. Médecins Sans Frontières medical teams set up cholera treatment centres and units, helped chlorinate water sources, disinfected homes, and sent teams throughout the countryside to treat outbreaks in rural areas. Between August, when the outbreak was first confirmed, and the end of December 2008, we treated more than 15,000 cases of suspected cholera. On 2 May 2008, Cyclone Nargis swept through Myanmar, displacing hundreds of thousands of people. Within 48 hours,
In Somalia, the local population experienced some of the worst violence in over a decade in 2008, with people in the central and southern parts of the country living under increasingly deteriorating humanitarian conditions. In early 2008, Médecins Sans Frontières was forced to withdraw its international staff members after three colleagues were killed in a roadside bomb
Médecins Sans Frontières teams were able to assess the scale of the disaster and provide immediate medical assistance to the population in Yangon and the heavily affected Irrawaddy Delta. Our access to this region was initially hampered by governmental authorities and fortunately our national staff
3
Message from the President were able to start distribution of aid and supplies. After six months, our teams had carried out nearly 90,000 medical consultations to people affected by the cyclone.
continued
Melbourne. Our networks of Association members around the different major cities are active. We welcome Association member feedback and input on a range of issues, particularly as the movement is looking at international governance.
Away from the conflict zones, we have worked consistently, although less visibly, in treating childhood malnutrition. Médecins Sans Frontières has been advancing the use of high energy ready-to-use foods that can treat severely malnourished children outside the settings of hospitals and clinics. The road to recovery for these children is hastened not only by the nutritional support but by the psychological impact of being able to remain at home with their mothers and families. We have remained strong advocates on ready-to-use foods, highlighting their potential to governments, international agencies and via medical journals, such as The Lancet.
Finally, we would like to thank our Executive Director, Philippe Couturier, and all the staff in the Sydney office for their hard work in 2008. Once again, our income and activity has increased from 2007 and we have successfully bedded down the international remuneration project into our core activities. The office has successfully met the logistical challenges of bringing a major event like Refugee Camp in Your City to several cities. The Médecins Sans Frontières Australia Project Unit has again been very active assisting the field with high quality and technical medical advice on women’s and children’s health both via the office in Sydney and through numerous field visits. There is scope for Médecins Sans Frontières Australia to assume a greater role in evaluating field work for the benefit of the international movement and conducting exploratory missions in the region. In 2008, Australian and New Zealand field workers filled 151 medical, logistic and administrative positions in the field in many different countries. Around the movement our workers are seen as highly qualified and are held in high regard. Our ongoing support to populations in distress, in both conflict and non-conflict settings, relies on the generosity of all our supporters. We sincerely thank all our pro bono donors, financial donors and office volunteers.
Médecins Sans Frontières’ medical action in the field is carried out through a combination of international and national staff. I would like to applaud the efforts of all our international staff and particularly note the tireless effort and dedication of the national staff, often working in difficult, remote, and insecure environments. In 2008, Médecins Sans Frontières Australia brought an exhibition, Refugee Camp in Your City to the cities of Brisbane, Sydney and Canberra. This unique public awareness event allows members of the public to experience what life is like in a refugee camp, learn how cholera, measles epidemics and malnutrition are managed, while being guided by experienced field workers. I would like to sincerely thank all those in the office who were a part of this event as well as all the volunteers who contributed to its success. In 2009, Refugee Camp in Your City will also visit Melbourne and Adelaide.
Dr Nicholas Wood Outgoing President, Médecins Sans Frontières Australia (President from 12 May 2007 – 7 December 2008)
In 2008, the Board of Médecins Sans Frontières Australia said goodbye to two of its experienced members after many years on the board: Dr Rowan Gillies, past Médecins Sans Frontières International President; and Dr Mike Toole, both of whom have made significant contributions to Médecins Sans Frontières Australia and the international movement. The Board has striven to keep all its Association members informed and held a very successful Open Board Meeting in December in
Dr Matthew Reid Incoming President, Médecins Sans Frontières Australia (Elected President on 7 December 2008)
4
2008 – Year in Review Humanitarian and operational dilemmas represent the core components of our work in delivering medical-humanitarian assistance to populations in need.
more responsibilities at field and coordination level. In 2008, 28 field workers took on a coordination role, including Head of Mission and Medical Coordinator roles.
Last year was no exception, and as mentioned by Nicholas Wood and Matthew Reid in their Message from the President, 2008 has delivered a raft of challenges in many of our field operations.
From the medical side, the Project Unit has further developed its direct medico-operational field support with regard to general paediatrics, women’s health and paediatric-HIV/AIDS/ tuberculosis dossiers. As part of the Paris Medical Department, the three members of the Project Unit have provided direct technical and medical support to no less than 18 field projects in 2008, including projects in Iran, South Sudan, Central African Republic, Democratic Republic of Congo, Darfur, Sri Lanka, Yemen, Palestinian Territories, Cambodia, China, Burkina Faso, Kenya, Uganda, Malawi and Thailand. Beyond the normal course of the Project Unit’s medical activities, they also responded with medical personnel to emergencies including the Sichuan earthquake in China and the conflict on Mindanao Island in the Philippines.
Despite these challenges and as part of our current strategic plan, the Australian section has continued to support Médecins Sans Frontières field operations through a significant increase in financial support. We are also contributing to the quality of Médecins Sans Frontières field projects with our field human resources and medical support. Identifying and deploying the appropriate field workers and further developing our medical support through the Project Unit, constitute without doubt the cornerstone of our section’s contribution. These two activities represent the key elements of the quality of our field operations.
Furthermore, and as an integral part of our social mission, the communication department has been very active in raising awareness of the plight of the populations we assist by utilising all possible media opportunities and by carrying out a large number of public events throughout the year. Communication is solely rooted in our field operations and is therefore an important part of our raison d’être.
It goes without saying that I could not start this year in review without paying tribute to all the medical doctors, nurses, midwives and non-medical dedicated field workers who have made our medical and humanitarian ambitions a reality. Last year, more than 150 Australians and New Zealanders, along with hundreds of international and thousands of national field staff, have given their best in responding to the medical and humanitarian needs of millions of people. Whether they have been trapped in the middle of ongoing violent armed conflict, or have not been able to access medical structures and care during an epidemic outbreak (such as the cholera outbreak in Zimbabwe), or were in need of HIV/AIDS drugs or tuberculosis treatments – in all of these cases, people deserved attention and care.
Last year approximately 1,000 articles and reports produced by the Australian and New Zealand media (newspapers, radio, online and television) covered the humanitarian and operational dilemmas that we have sought to bring to light. In 2008 a new public website was launched with the objective to provide better access to information for our supporters and those in the community who are interested in learning more about the work of Médecins Sans Frontières.
The skill and dedication of our international and national field staff is crucial while responding to these medical emergencies. Year after year, we see a clear increase in the number of departures of qualified and dedicated Australian and New Zealanders. There has also been a significant increase in their length of commitment and in their willingness to take on
As part of our objective to strengthen our link with the civil society and raise awareness of the plight of the population we assist, the Refugee Camp in Your City exhibition was a real success in 2008. More than 8,900 visitors gathered at South Bank in Brisbane, Olympic Park in Western Sydney, Martin
5
2008 – Year in Review Place in Sydney and Glebe Park in Canberra to experience life as a refugee or internally displaced person. The tours were facilitated by experienced field workers who have worked in such contexts with Médecins Sans Frontières.
continued
Face fundraising, direct response television campaigns and other programs continued to drive growth in this area. Many donors also found direct mail a convenient way to donate, with over AUD$7.3 million of income for our medicalhumanitarian projects generated through this program. Both
Presenting and defending Médecins Sans Frontières humanitarian principles in different platforms, and engaging in a dialogue with different actors involved with humanitarian issues is also part of our communication activity. With the support of Laurence Binet, a member of the Médecins Sans Frontières France Foundation, we have been able to identify these actors more precisely and in the last 12 months, we have increased our participation in these forums. For example, members of our Board of Directors and the Executive Team represented the organisation’s position at events including the Australian Red Cross seminar on International Humanitarian Law and the Impact on Humanitarian Work in the Field, hosted by the Australian Council for International Development; the Australian Defence Force Command and Staff College international emergency stabilisation operations (STABOPS) training; and a workshop at the Australian National University on Humanitarianism in the Age of Terror.
long-term supporters and people making their first donation also contributed to a growing source of online revenue which in 2008 totalled over AUD$1.7million. The redevelopment of the website in late 2008 is expected to continue to assist long term online revenue growth. Support from various trusts and foundations, corporations, including sponsorship of Refugee Camp in Your City, and individuals whose generosity continued to surprise us all, was also very much appreciated. Médecins Sans Frontières Australia would also like to acknowledge those kind-hearted people who, having made provision for our work in their will, contributed to our ability to provide medical-humanitarian assistance in some of the most difficult circumstances imaginable. To conclude this brief overview of 2008, I would like to thank all the office volunteers and staff members of the Sydney office for their hard work and amazing commitment and contribution toward the populations in need, to whom day after day we try to provide the best and most appropriate medical and humanitarian response under the very basic principle of humanity.
In forums such as these, we have found there is an increasing need to represent clearly our humanitarian principles of independence, neutrality and impartiality. This is made even more important in this era of growing coordination between civil and military organisations in response to humanitarian disasters, which continues to be a major concern for Médecins Sans Frontières.
Philippe Couturier Executive Director
2008 was another successful year for Médecins Sans Frontières Australia’s Fundraising Department. In total, the Australian community generously donated over AUD$40.3 million to our medical-humanitarian mission. This represents an increase of 13.4% on the AUD$34.9 million donated to Médecins Sans Frontières Australia in 2007. Field Partners, who contribute on a monthly basis, usually directly from a credit card or bank account, were once again our most significant source of funding. Over AUD$25.1 million was donated by nearly 77,000 Field Partners. Our Face to
6
Médecins Sans Frontières field projects are run by five operational centres (France, Switzerland, Spain, Holland and Belgium). The Australian section is an offical partner of the French operational centre, and Australian donors fund projects run by both the French and the Swiss operational centres. When needed, Médecins Sans Frontières Australia also provides human resources and medical support to all operational centres’ projects.
MEDECINS SANS FRONTIERES PROJECTS FUNDED BY AUSTRALIAN DONORS 75
74 66
11 17
Country 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.
A$ MSF France
Burkina Faso Cambodia Cameroon Central African Republic Chad China Darfur Democratic Republic of Congo Iraq Kenya Kyrgyzstan Laos Malawi Myanmar Niger Nigeria Palestinian Territories Somalia South Sudan Sri Lanka Swaziland Thailand Uganda Yemen
A$ MSF Switzerland 14
700,000 2,000,000
15 1,700,000
639,000 500,000 1,000,000 1,400,000 700,000 500,000 1,300,000
2,615,000
200,000 250,000
1,300,000 226,574 150,000
1,000,000 500,000 300,000 1,100,000 2,000,000 1,300,000 1,387,000
5
1 2
16
24
7 4
3 9
200,000 450,000
1,300,000 700,000 500,000
6
9
8
19 23 10 18 13
21
20
12 22 2
International Field Staff in 2008 Médecins Sans Frontiéres Australia Cambodia Chad
China
Djibouti
Stephanie Johnston
pharmacist
Ruth McKeown
medical doctor
Janet Coleman
nurse-midwife
Anthony Flynn
nurse
Kaheba Clement Honda
nurse
Euan Beamont
field coordinator
Sarah Jantos
nurse-theatre
Sue Mitchell
psychologist
Devi Lalloo
nurse
Democratic Republic of Congo Ethiopia
Australian medical doctor Ruth McKeown examines a patient in the Kampong Cham Provincial Referral Hospital, Kampong Cham, Cambodia. Médecins Sans Frontières provides medical care to people affected by HIV/AIDS and tuberculosis in this project. Photo: MSF
medical coordinator head of mission
Brett Adamson
nurse
Alana Baker
nurse
Matthew Ball
medical doctor
Christopher Clapp
logistician
Rachal Davis
medical scientist
Gail de Lucia
nurse
Anthony Flynn
nurse
Anne Kleinitz
medical doctor
Victoria Mowat
nurse
Carol Petrie
nurse
Will Robertson
head of mission
Natalia Rojas
field coordinator
Jayne Sheppard
nurse
Sally Stevenson
head of mission
Judy Stewart
medical doctor
Barry Suckling
medical doctor
Laurence Walker
medical doctor
Richard Wesley
logistician
Armenia
Brent Skippen
medical doctor
Scott Brown
medical doctor
Bangladesh
Penelope Summons
nurse-midwife
Ruth Dabell
nurse
Emily Gill
medical doctor
Cath Deacon
field coordinator
Shella Hall
field coordinator
Alistair McKeown
nurse
Anousha Victoire
medical doctor
Ruth McKeown
medical doctor
Eline Whist
medical doctor
June Mitchell
nurse
Maria Cartwright
field coordinator
Lainie Grummitt
field admin
Burkina Faso
Cambodia
Georgia
Shella Hall Anne Taylor
Haiti
8
Elise Page
nurse
Lesli Bell
logistics coordinator
International Field Staff in 2008 MĂŠdecins Sans FrontiĂŠres Australia Iran
Iraq
Jordan Kenya
Niger
continued
Rebecca Atkinson
logistics administrator
Nikki Blackwell
medical coordinator
Emmanuel Lavieuville
head of mission
Sonia Girle
nurse-midwife
Helen Cleary
nurse-theatre
Nigeria
Marianne Gale
medical doctor
Nikki Blackwell
anaesthetist
Rachal Davis
medical scientist
John Parker
medical coordinator
Trudi Davis
medical doctor
Sushila Desai
admin-fincoordinator
Anna Dicker
nurse
Sarah Jantos
nurse
James Lynch
logistician
Naomi McLean
field admin
Tonia Marquardt
field coordinator
Nikki Blackwell
anaesthetist
Rachel Marsden
nurse-theatre
Paras Valeh
medical doctor
Claire Mutton
nurse
Helen Boland
medical doctor
Carol Petrie
nurse
Helen Cleary
nurse-theatre
Janthi Price
field coordinator
Jacinta Gibson
logistician
Alan Scott
surgeon
Rosemary Hay
medical doctor
Nicole Trim
nurse
Paul Kwa
medical doctor
Sue Wainwright
midwife
Julianne Millar
medical doctor
Susan Kelsall
nurse-midwife
Catherine Moody
field coordinator
Pakistan
Sue Petrie
psychologist
Gregory Pead
deputy head of mission
Michael Rowell
financial coordinator
Elizabeth Scott
medical doctor
Michael Seawright
field coordinator
Susanne Weress
pharmacist
David Walkley
logistician
Laos
Sean Healy
head of mission
Shelley Wright
nurse
Lesotho
Linda Pearson
nurse
Palestinian
Liberia
Debra-Lee Holman
field coordinator
Territories
Malcolm Hugo
psychologist
Melanie Pountney
medical doctor
Kathleen Leach
psychologist
Karin Rautenbacher
medical scientist
Brian Moller
field coordinator
Richard Smith
medical doctor
Rosemary Stone
psychologist
Paras Valeh
epidemiologist
Colin Watson
nurse
Malawi
Rupa Kanapathipillai
medical doctor
Mozambique
Damien Brown
medical doctor
Myanmar
Nepal
Papua New Guinea Kara Blackburn
midwife
Lesli Bell
logistician
Catherine Georgeson
nurse-midwife
Van Tung Bui
anaesthetist
Ellie Kamara
admin-fincoordinator
Damien Moloney
logistician
Barbara Telfer
epidemiologist
Matthew Cleary
field coordinator
Jason Andean
logistician
Jane Connell
midwife
Scott Brown
medical doctor
Lisa Errol
nurse-midwife
Kate Hardie
medical doctor
Catherine Moody
field coordinator
Amber Hargans
nurse
Carol Petrie
nurse
Kamalini Lokuge
medical doctor
Helle Poulsen-Dobbyns
field coordinator
Devika Tharumaratnam
medical doctor
Amy Radford
nurse-midwife
Roslyn Brooks
medical doctor
Nicole Trim
med team leader
Somalia
9
International Field Staff in 2008 MĂŠdecins Sans FrontiĂŠres Australia Somalia
Sue Wainwright
Sudan
midwife
continued
Robin Sands
field coordinator
Shelagh Woods
head of mission
Susan Thomas
field coordinator
Peter Zelas
surgeon
Nicole Trim
nurse
South Africa
Helen Cox
epidemiologist
Raewyn Turner
nurse-theatre
Sri Lanka
Alana Baker
nurse-theatre
Richard Urmonas
logistician
Sudan
Ramona Vlaar
nurse
Marianne Gale
medical doctor
Kate Hardie
medical doctor
Eu-gin Lim
anaesthetist
Jane Lynch
logistics coordinator
Ronald Pereira
anaesthetist
Turkmenistan
Russell Townsend
anaesthetist
Uganda
Kwaku Agyemang-Baah
nurse
Shelagh Woods
field coordinator
Euan Beamont
logistics coordinator
Abdul Aleem
anaesthetist
Deanna Beaumont
logistician
Matthew Apostola
logistician
Judy Coram
nurse
Damien Brown
medical doctor
Malcolm Hugo
psychologist
Norma Corstorphan
nurse
Stephanie Johnston
pharmacist
Vanessa Cramond
nurse
Jayne Martin
nurse
Rachal Davis
medical scientist
Jonathan Ng
medical doctor
Ruth Eagles
medical doctor
Kylie Travers
nurse
Hannah Eaton
logistician
Kelly Wilcox
nurse
Thailand
Mohamad-Ali Trad
medical doctor
Simon Janes
medical coordinator
Thomas Wong
pharmacist
Kevin Baker
anaesthetist
nurse-midwife
Helen Cleary
nurse
medical doctor
Ruth Eagles
medical doctor
Deborah Heng
medical doctor
Matthew Merrington
logistics administrator
Donna Hindmarsh
nurse-midwife
Katrina Penney
nurse-midwife
Abioseh Kamara
logistician
Katrina Swanson
nurse
Anne Kleinitz
medical doctor
Shelley Wright
nurse
James Knox
medical doctor
Ahmose Abrahim
logistician
Paul Kwa
medical doctor
Vanessa Cramond
medical coordinator
Robyn Lea
nurse
Carolyn Merry
deputy head of mission
Jayne Martin
nurse
Sarah Fountain
med team leader
Julie Gawthorne
nurse
Fiona Gillett Hamish Graham
Mark Meredith
logistician
Matthew Merrington
logistics administrator
Damien Moloney
logistician
Catherine Moody
head of mission
Allison Moore
medical doctor
Uma Naguleswaran
medical doctor
Natalia Rojas
med team leader
Stratos Roussos
medical doctor
Yemen
Zimbabwe
10
Projects funded by Australian donors Médecins Sans Frontières’ field projects are run by five operational centres (France, Switzerland, Spain, Holland and Belgium). The Australian section is an official partner of the French operational centre, and Australian donors assist in the funding of projects run by both the French and the Swiss operational centres. When needed, Médecins Sans Frontières Australia also provides human resources and medical support to all operational centres’ projects. Listed below are all the French and Swiss projects which are supported by donations received by Médecins Sans Frontières Australia. If you would like to read more about our projects across all operational centres, please refer to the 2007 International Activity Report. The 2008 International Activity Report will soon be available online at www.msf.org.au children admitted to our nutrition programs are infected during the peak of the malaria season. In 2008, for the duration of the annual malaria peak, we provided malaria therapy to children in our programs, as well as to the general population attending local health facilities. In 10 weeks, a total of 10,794 children
BURKINA FASO Nutrition, malaria Total Field Staff: 248 Funding: A$700,000 (10% of total project costs) Project locations: Yako, Titao
were treated.
As one of the poorest countries in the world, Burkina Faso’s high levels of infant malnutrition continue to remain problematic in terms of detection and treatment. In 2008, Médecins Sans Frontières continued treating malnourished children in Yako and Titao, in the semi-arid region in the country’s north. Together with community health workers who help spread the word about the treatment program to mothers in villages, our teams conducted nutritional screening and follow-up care of children under five at 17 centres across the two provinces.
CAMBODIA HIV/AIDS, tuberculosis Total Field Staff: 245 Funding: A$2,000,000 (51% of total project costs) Project locations: Kompong Cham, Phnom Phen Improved health facilities and a government commitment to fight HIV/AIDS have ensured the progress in the scale-up of antiretroviral treatment programs in Cambodia. Because of this improved situation, Médecins Sans Frontières has begun handing over some of our HIV/AIDS projects. Some 8,000 patients received antiretroviral treatment from Médecins Sans Frontières, representing 30 percent of all those on treatment nationwide. Counselling, treatment of opportunistic infections and information on HIV/AIDS was also provided.
The use of ready-to-use therapeutic food has meant that 80 percent of children in the nutritional program in Burkina Faso can be treated at home. Only the complicated cases need to be admitted to hospital. In 2008, there were 7,130 children treated for acute malnutrition in the Titao region, and 9,365 were treated in Yako. In the hospitalisation centres, Médecins Sans Frontières is also offering testing and treatment for HIV and tuberculosis. In 2008, 19 children started on antiretroviral treatment, and 67 were tested positive for HIV. There were 44 children who were diagnosed with tuberculosis and who were placed on treatment; among these, 15 patients were co-infected with HIV.
Kompong Cham, northwest of Phnom Penh, is one of the most populated provinces in Cambodia. We have been working here since 2003 offering comprehensive HIV/AIDS care. During 2008, our HIV/AIDS program was handed over to the Ministry of Health, allowing us to now focus on treating patients coinfected with HIV and tuberculosis. Seventy percent of HIV patients currently in the hospital ward in Kompong Cham also suffer from tuberculosis.
There is a high prevalence of malaria among the general population in Burkina Faso, and more than 80 percent of the 11
Projects funded by Australian donors
continued
In Phnom Penh, our medical teams are working in the Khmer Soviet Friendship Hospital, one of the largest public hospitals in the city. In 2008, we provided HIV/AIDS care to 42 inmates from three of the city’s main prisons as well as medical follow-up for HIV patients co-infected with drug-resistant tuberculosis.
CENTRAL AFRICAN REPUBLIC
CAMEROON
Since 1997, Médecins Sans Frontières has worked in the Central African Republic, providing primary and secondary healthcare to those affected by ongoing violence. Conflict has resulted in massive displacement of the population, as many villages are looted or burned, forcing their inhabitants to flee. Often living in unstable makeshift shelters without access to healthcare, food or clean water, displaced populations are particularly susceptible to malaria, respiratory infections and diarrhoeal diseases.
Primary healthcare, nutrition Total Field Staff: 557 Funding: A$639,000 (10% of total project costs) Project locations: Paoua, Bocaranga
Primary healthcare, nutrition, Buruli ulcer, HIV/AIDS Total Field Staff: 90 Funding: A$1,700,000 (27% of total project costs) Project locations: Akonolinga, Batouri, Kousseri In Cameroon, Médecins Sans Frontières primarily responds to humanitarian needs related to neglected diseases, including Buruli Ulcer, as well as providing assistance to the influx of refugees from surrounding countries.
Since December 2007, groups of armed bandits have been mounting violent raids in the northwest region of Central African Republic. In February 2008, we opened a nutrition program in Bocaranga, a zone in the province of OuhamPendé which experiences heavy banditry. The program was launched to provide care to children suffering from severe acute malnutrition, a problem which has particularly affected the displaced people in Bocaranga and other towns in the region. One hundred children were admitted into the program during its first month of activity.
Since 2002, we have provided treatment for people suffering from Buruli ulcer, a debilitating and painful disease that carries a high level of morbidity, stigma and social exclusion. Between 100 and 120 patients are currently treated each year at the Akonolinga Hospital, Centre Province. Currently, operational research and monitoring is also underway to investigate necessary improvements in diagnostics, dressings, surgery and antibiotic treatment.
Families also took refuge in larger surrounding villages, but insecure conditions along the roads prevented us from reaching them. In March 2008, the mother of a young patient was shot dead in a Médecins Sans Frontières ambulance in the northeast of the country. As a result, we temporarily suspended all mobile activities outside the main towns in the region.
In 2008, our teams provided assistance to 80,000 refugees in the Batouri District in eastern Cameroon, who have escaped the violence and instability in neighbouring Central African Republic. Five mobile clinics provided nutritional and medical care, and further support was given to referral centres for treating people suffering malnutrition, tuberculosis and Konzo (a little known upper motor neurone disease which causes irreversible paralysis of the legs in children and women).
In 2008, our medical teams also ran a healthcare project at a hospital in Paoua and maintained health posts along the outskirts of the province.
In February, tens of thousands of Chadians sought refuge in Cameroon, in the border town of Kousseri. Our teams supported the emergency ward of Kousseri General Hospital, where more than 80 wounded were admitted in the first week, as well as distributing relief items and setting up water and sanitation facilities for the refugees. 12
Projects funded by Australian donors
continued
intermittent due to security risks. On June 19 2008 a group of armed men attacked and robbed the Médecins Sans Frontières team. As a result the team was temporarily evacuated to a more secure location in the township of Abéché.
CHAD Nutrition, paediatrics, primary healthcare, reproductive healthcare, surgery, nutrition, obstetric care, vesico-vaginal fistula Total Field Staff: 1,437
In southwest Chad, Médecins Sans Frontières also assisted thousands of refugees who have fled violence in Central African Republic. In the hospital in Goré, teams continue to provide emergency medical and surgical care for both the
Funding: A$3,115,000 (21% of total project costs) Projects funded by Australian donors: Adré, Guereda, Abéché, Goré
refugees and Chadian residents of the town. In January and June 2008, Médecins Sans Frontières undertook two surgical interventions in Chad for vesico-vaginal fistula (VVF) at the regional hospital in Abéché. Some 250 women were operated on in the hospital in 2008.
CHINA HIV/AIDS, emergency care, mental health Total Field Staff: 43
The prevalence of VVF is particularly high in eastern Chad, with two to five new cases per 1,000 births. The prevalence of VVF is linked to the lack of medical care during pregnancy and childbirth, and to taboos surrounding the female body. We also ran a major training component at the hospital to ensure that ongoing treatment is available to those women affected. Through such training, and awareness advocacy, we aim to work against the social stigma of VVF, providing treatment to reduce the prevalence and consequences of obstetric fistula.
Funding: A$1,000,000 (32% of total project costs) Project location: Nanning In 2008, HIV/AIDS became the top fatal infectious disease in China for the first time, with 44,839 new cases reported in the first nine months of 2008, according to the Ministry of Health. Although the Chinese government provides free antiretroviral treatment through its national program, many people still have limited access as HIV testing and the management of opportunistic infections are not free. Therefore, people can die from HIV-related illness before being able to access the free antiretroviral treatment. Moreover, stigma against the disease prevents people from visiting national facilities to get tested and receive earlier treatment.
Ethnic clashes and an additional influx of refugees from western Darfur in neighbouring Sudan provided several challenges for our teams in providing primary healthcare in the district area of Guereda. Nearly 5,000 outpatients a month were treated in four health centres in the district.
In collaboration with the Guangxi Public Health Bureau and Guangxi Centre for Disease Prevention and Control, we have been providing free and confidential treatment for HIV/AIDS patients in Nanning since December 2003. This comprehensive program provides voluntary counselling and testing, diagnosis, management of opportunistic infections, antiretroviral treatment and outreach activities in some communities. In 2008, 3,035 people received free counselling and testing and at the end of 2008, there were 1,550 patients enrolled in the program.
While Médecins Sans Frontières teams have been reduced in eastern Chad due to the unpredictable security situation, we continued to work in the region, including in Adré, providing mother and infant care, pre and postnatal consultations, preventive consultations for children, care for medical and psychosocial consequences of sexual violence, as well as water and sanitation. Our teams also performed emergency surgery at the hospital in Adré and responded to other medical and humanitarian emergencies as they arose.
Médecins Sans Frontières also responded to the devastating earthquake that hit Sichuan province in May 2008, leaving more than 80,000 people dead, 370,000 people injured and
Médecins Sans Frontières teams also worked in Dogdoré, a village home to 30,000 displaced people in the east of Chad. Unfortunately the presence of the international field staff is 13
Projects funded by Australian donors more than 10 million people homeless. In collaboration with the Sichuan Red Cross, we donated 4,310 family-size winter tents for more than 25,000 affected people and 300kg of medical equipment and drugs to Mianzhu City, approximately 60km east of the earthquake’s epicentre.
continued
month in Rutshuru. Cholera is endemic in North Kivu and our teams treated 1,480 cases of cholera in the area between Goma and Saké between January and September 2008. In October, we brought attention to the situation in Democratic Republic of Congo by issuing a press release calling strongly for the United Nations and other non-government organisations to provide adequate humanitarian assistance to the population. We also created a multi-media project www.conditional-critical. org to raise awareness of the situation in the country.
From June 2008, a team of our psychologists offered mental healthcare in Mianzhu city and by September, 290 consultations had been conducted. Our teams also provided training and supervision to Chinese counsellors.
DEMOCRATIC REPUBLIC OF CONGO
IRAQ Emergency care, burns unit Total Field Staff: 249
Cholera, measles, nutrition, water, primary healthcare, sexual violence, gynaecological care, sleeping sickness Total Field Staff: 2701
Funding: A$250,000 (5% of total project costs) Project locations: Ninewa, Kurdistan Médecins Sans Frontières pulled out of Iraq in 2004 when our presence in the conflict zone could no longer be considered secure. In 2006, we opened a project offering reconstructive maxillofacial, plastic and orthopaedic surgery in the Red Crescent Hospital in Amman, Jordan, to assist the Iraqi war wounded. To date, this program has treated more than 600 patients in need of very complex care that is almost impossible to provide in Iraq.
Funding: A$900,000 (6% of total project costs) Project locations: North Kivu, Aru Violence reached its highest levels in years in the North Kivu region of Democratic Republic of Congo in 2008. Hundreds of thousands of people were forced to flee their homes when full-scale war resumed at the end of August and many are still living in fear, without the means to meet their most basic needs.
In July 2007, Médecins Sans Frontières opened a project in Suleymaniyah, in Kurdistan, northern Iraq, to provide care to people with war-related injuries, as well as burns victims. In 2008, the plastic surgery, trauma and orthopaedic activities of the Suleymaniyah project were ceased due to reduced needs and the project now concentrates only on burn victims. Each month, the hospital admits an average of 100 patients with severe burns.
Some of the people who fled have reached relatively established camps, while others have gathered in isolated pockets of calm or with host families. Some people hid in the bush, trapped between armed groups. In North Kivu, Médecins Sans Frontières teams provided primary and secondary healthcare in and around Rutshuru, Nyanzale, Kayna, Kanyabayonga, Kitchanga, Mweso and Masisi. Rutshuru is one of the largest projects, providing secondary healthcare, including surgical, medical, paediatric and specialised care to victims of sexual violence. Between January and September 2008, our teams performed 2,777 surgical interventions and 7,359 emergency room consultations.
In the Ninewa governorate, also in northern Iraq, our teams have supported both the Mosul General Hospital Emergency Unit and Tal Afar Hospital since 2007, providing access to quality emergency and secondary level healthcare to the population. This includes ongoing assistance through training and providing medical supplies.
We also provided medical care and psychological support to victims of sexual violence. Between January and June, an average of 87 victims of sexual violence were treated each 14
Projects funded by Australian donors
continued
KENYA
February, our staff in Mathare received 25 wounded people,
HIV/AIDS, tuberculosis, emergency care Total Field Staff: 249
the majority of whom had been beaten or cut with machetes.
KYRGYZSTAN
Funding: A$1,300,000 (15% of total project costs) Project locations: Mathare, Homa Bay
Tuberculosis Total Field Staff: 46
Despite some positive progress in recent years, HIV/AIDS continues to have a devastating impact on every sector of Kenyan society. While around 5.9 percent of adults are thought to be infected, this can be as high as 35 percent in some rural areas where Médecins Sans Frontières works, such as Homa Bay. The Homa Bay program had 10,170 patients on antiretroviral treatment in 2008, of which 1,053 were children.
Funding: A$200,000 (11% of total project costs) Project location: Bishkek A country of political instability, Kyrgyzstan currently faces issues surrounding the healthcare system, particularly in reference to tuberculosis (TB). Although positive progress in these areas has been made by Médecins Sans Frontières and other local and international partners, such as the International Committee of the Red Cross, there remains a high TB prevalence in the Kyrgyz penitentiary system.
Growing resistance to first line tuberculosis (TB) treatment is another challenge and we have been treating people infected with multi-drug resistant TB since May 2006. We remain the only provider of free treatment for multi-drug resistant TB in Kenya and in 2008, five new patients started treatment in Homa Bay.
Since 2005, our teams have been working with local authorities who are committed to improving this situation. The high prevalence of drug-resistant TB amongst prisoners has emphasised the urgent need of adequate case management, including early detection, correct separation of patients according to resistance patterns, and administration of adequate treatment.
Following the disputed Kenyan election on 27 December 2007, more than 250,000 people were estimated to have fled subsequent violence. Around 300 were people killed after the violence erupted, mainly in the slums around Nairobi and in the Western Nyanza and Rift Valley Provinces. Due to the insecurity, the HIV/AIDS and TB projects run by our medical teams in Nairobi, including in the Mathare and Kibera slums, were temporarily closed for a few days in early January 2008.
In order to successfully provide treatment to inmates infected with TB, we have established programs for detection and treatment of around 20,000 male and female inmates throughout the Kyrgyz penitentiary system. In successfully implementing a TB management strategy, our objective is to reduce morbidity, mortality and transmission of regular and drug-resistant TB within the Kyrgyz penitentiary system.
In Kibera, where we support four health facilities, nearly 20 percent of patients receiving HIV care missed appointments in January because of the violence. In Mathare, the figure was around 10 percent. There was also a drop in the number of new patients enrolling in our treatment programs during this time. The program picked up again when the violence had subsided and at the end of 2008, 2,058 patients in the Mathare program were on antiretroviral treatment. Of the active patients, 84 percent were adults and 16 percent were children.
LAOS HIV/AIDS Total Field Staff: 36 Funding: A$450,000 (55% of total project costs) Project location: Savannakhet
Between 1 and 31 January, staff in Kibera also performed more than 11,500 consultations, of which 86 were intentional physical traumas related to the post-election violence. On 21 and 22
Since 2001, Médecins Sans Frontières’ activities in Laos have been focused on the treatment and care of people living 15
Projects funded by Australian donors
continued
had been initiated on antiretroviral treatment, 12,000 of whom still were being followed in our program in December.
with HIV/AIDS. We began our treatment and care project at Savannakhet Hospital in 2001. Savannakhet province is one of the most exposed in the country to HIV/AIDS, due to significant cross-border traffic with Thailand and Vietnam and the presence of a growing sex industry.
In 2008 we also started implementing integrated prevention of mother to child transmission programs in the health centres. By the end of 2008 we had started this activity in 5 of the 10 health centres and 1,035 women had received antiretroviral drugs to reduce the chance of transmitting the virus to the unborn child.
In 2006, the Lao government adopted a policy committing itself to universal treatment and care of people living with HIV, and since then we have been committed to supporting the government’s efforts in treatment and care. Since the program opened in 2001, our teams have provided 7,384 counselling and testing sessions and 822 patients have received antiretroviral treatment. Following the success of the project at the Savannakhet Hospital, we handed over the project on 31 December 2008.
* World Health Organisation, 2005
MYANMAR Primary healthcare, tuberculosis, HIV/AIDS, cyclone emergency Total Field Staff: 778
Médecins Sans Frontières will continue to work with the Centre for HIV/AIDS/STI in Laos supervising the program and providing support as required.
Funding: A$226,574 (2% of total project costs) Project locations: Kayah, Irrawaddy Delta Médecins Sans Frontières has been active in providing healthcare to the population in Kayah State who have very little access to health services, many of which have been disrupted due to conflict. In 2008, we ran two clinics in the region, providing primary healthcare and tuberculosis treatment. Due to low population figures and limited access to areas out of government control we had a very minimal impact in Kayah. The decision was made to close the project within the first months of 2009.
MALAWI HIV/AIDS, tuberculosis Total Field Staff: 652 Funding: A$1,300,000 (19% of total project costs) Project location: Chiradzulu HIV/AIDS is one of the most acute health concerns in Malawi. Despite intensive efforts by the authorities and international bodies, more than 170,000* people living with HIV in Malawi are still in urgent need of antiretroviral treatment.
In May 2008, Cyclone Nargis hit Myanmar’s Irrawaddy Delta with massive force leaving around 140,000 people missing or dead. We began our emergency intervention within 48 hours of the cyclone hitting Yangon, and between May and October our teams assisted more than 550,000 people by providing medical care and distributing essential non-food items including water and food.
Médecins Sans Frontières supports the Chiradzulu Hospital in southern rural Malawi, by providing care to HIV/AIDS and tuberculosis patients. In order to offer treatment close to patients’ home villages, we decentralise HIV care to 10 health centres in the district, allowing patients to save money and valuable time travelling to hospitals. Due to lack of medical personnel, nurses are given expanded responsibility to perform duties formerly carried out by medical doctors or clinical officers. With the appropriate training this achieves very good results.
In October, the majority of the emergency needs of the population were met, so we handed over our activities to the many other non-government organisations in the region. We continue however to run a mental health program in the heavily affected southern township of Bogaley.
By the end of 2008 around 29,000 patients had been enrolled in our program since its inception in 2001 and 17,700 patients 16
Projects funded by Australian donors Médecins Sans Frontières has worked in Myanmar since 1992 and it is one of the few international non-government organisations working in the country.
continued
NIGERIA Nutrition, obstetric care, vesico-vaginal fistula, measles, meningitis Total Field Staff: 319
NIGER
Funding: A$700,000 (8% of total project costs) Project locations: Jahun, Katsina, Yobe, Port Harcourt, Jos
Paediatrics, nutrition, meningitis, measles, Total Field Staff: 1,537
In 2008, several emergency interventions for cases of malnutrition, measles and meningitis took place in Nigeria. In June, a vaccination campaign began in Katsina State where our teams vaccinated approximately 130,000 people against meningitis.
Funding: A$1,450,000 (9% of total project costs) Project locations: Maradi, Zinder, Tahoua, Magaria Acute child malnutrition is a serious medical issue in Niger, despite increased national and international attention since the massive nutritional crisis of 2005. An annual ‘hunger gap’ exists between April and September, when family food stocks run out and hundreds of thousands of children have little access to food or the nutrients they need for healthy development.
Another campaign against measles began in the state of Yobe, in northeast Nigeria. In collaboration with the Ministry of Health, vaccination teams travelled to over 300 sites, and more than 237,000 people were vaccinated between 4 and 29 June. Additionally, the vaccination teams took the opportunity to check the nutritional condition of children under five. Out of a total of 119,000 screened, almost 900 children required medical and nutritional care.
In July 2008, the French section of Médecins Sans Frontières was informed of a decree issued by the Minister of Interior of Niger, suspending our authorisation to work in Niger. We were not informed of the reasons justifying this decision. At the time of the suspension, our medical teams were treating more than 3,400 children, including 233 who were hospitalised in nutritional centres. Additionally, more than 70,000 children were receiving a monthly nutritional supplement. As a result of the suspension, by October, all of the French section’s medical programs were forced ceased.
In Jahun, northern Nigeria, a program for vesico-vaginal fistula (VVF) and obstetrics began in 2008. Currently, our teams treat approximately 20 cases of VVF a month, as well as assisting with deliveries, including caesarean sections and postnatal care. We have also been working in the trauma centre at Teme Hospital in Port Harcourt since 2005, providing free emergency medical services. Port Harcourt is located in the heart of Nigeria’s densely populated, oil-rich Niger Delta region, where the struggle to gain power and control natural resources has sparked sporadic and deadly outbreaks of violence among a fragmented network of armed groups. In 2008 our medical teams continued to treat victims of violence and provided medical and psychological care to victims of sexual violence.
Another nutrition project in Magaria, also in the Zinder region run by the Swiss section, was able to continue treating children with acute malnutrition and related diseases in collaboration with local partners. Between January and April, over 42,000 children between the ages of six months and 15 years were also vaccinated for measles within a 15-kilometre radius of Magaria. Our mobile teams travelled to outlying villages in this rural area to improve the vaccination coverage rate and allow timely detection and treatment of people with the disease.
In December, following the post electoral riots in Jos, Plateau State, where 300 people were reportedly killed and many injured, we conducted an exploratory assessment and provided medical drugs and dressing material to local hospitals.
In collaboration with health authorities in Niger, we also vaccinated more than 700,000 children against measles in 2008 and our teams were also involved in responding to meningitis and cholera epidemics. 17
Projects funded by Australian donors
continued
PALESTINIAN TERRITORIES
SOMALIA
Post-operative care, mental health, emergency care Total Field Staff: 119
Primary healthcare, obstetrics, tuberculosis, kala azar, nutrition, emergency care Total Field Staff: 1,452 (supported by an additional 104 field staff based in Nairobi, Kenya)
Funding: A$500,000 (11% of total project costs) Project location: Gaza
Funding: A$1,000,000 (10% of total project costs) Project locations: Dinsor, Belet Weyne
Médecins Sans Frontières’ medical activities in the Gaza Strip were hindered again by embargoes in January and April 2008; particularly due to the lack of fuel. With diesel and gasoline being unavailable on the market, our teams had to limit their visits to only the most severely ill patients, who make up only one-fifth of the patient population of our post-operative care programs. Medical personnel were having trouble getting around – up to 40 percent of staff were absent in some hospitals. Patients were faced with the same difficulties. Ambulances had to limit their interventions to emergency situations.
Somalia has long been a violent and complex country to work in. Yet in the past year, the landscape has changed beyond recognition. Kidnappings, attacks and killings of aid workers are now commonplace. Médecins Sans Frontières experienced this firsthand when three field staff were killed in Kismayo in January 2008, and another staff member was killed in Balcad in March. These incidents have forced us to re-examine our operations in Somalia. As aid workers are increasingly being seen as legitimate targets in the conflict, we suspended all international field staff presence in all of our projects around the country in January. International field staff partially returned to selected locations in March.
Due to intra-Palestinian violence in early 2008, we had to temporarily close our clinics, but we were still able to donate medical items and essential drugs to other health facilities in Gaza. When the situation slightly abated, we reopened our clinics, and post-operative care resumed in Gaza and Khan Younis Hospital. Our mobile medical teams also resumed their home visits to patients who could not travel, and our teams distributed large quantities of medical supplies and medicines to hospitals that required assistance.
In 2008, Australian donors helped fund two projects in Somalia – one in Dinsor in the Bay region, and one in Belet Weyne in the Hiraan region. In Dinsor our teams run a 65-bed inpatient department, which serves the district’s entire population of approximately 110,000 people. Here we provide trauma care; life-saving surgical activities including caesarean sections; treatment for tuberculosis and kala azar; and therapeutic feeding for severely malnourished children. In 2008, we admitted 1,856 people to the inpatient department. The outpatient department provides treatment for respiratory tract infections, hypertension, diabetes, skin diseases, sexually transmitted diseases, urinary tract infections, diarrhoea, and malaria. Almost 2,500 antenatal care consultations were provided in the outpatient department throughout the year and 509 deliveries were assisted.
Our teams also continued to provide psychological care to victims of the conflict. The program included follow-up consultations, pain management, antibiotic supply and physiotherapy. In late March 2008, Médecins Sans Frontières also began a paediatric program in the north of Gaza. A team is providing follow-up care for children discharged from the paediatric ward of the Kamal Edwan Hospital. In late December, aerial attacks began on the Gaza Strip estimated to have killed 300 people and wounded over a thousand more, including civilians. Our teams donated medical supplies including bandages, disinfectants and antibiotics to local hospitals.
Médecins Sans Frontières also runs a project within the regional 99-bed hospital in Belet Weyne offering free, secondary level 18
Projects funded by Australian donors healthcare to the 280,000 inhabitants of the region. Our teams provide emergency and elective surgery, trauma care, paediatric care, treatment of severe malnutrition, and are also prepared to respond to medical emergencies in the region as they arise. In 2008, there were 2,399 people admitted to the hospital. Over 1,000 emergency and elective surgeries were performed, including 383 of which were for victims of violence.
continued
their homes due to the floods in Jaffna. Our medical teams also conducted mobile clinics in the affected areas to treat people injured during the floods.
SUDAN Nutrition, primary healthcare, obstetrics/ gynaecological care, cholera, meningitis Total Field Staff: 1727
SRI LANKA
Funding: A$1,900,000 (10% of total project costs) Project locations: Zalingei, Niertiti, Aweil
Obstetric/gynaecological care, emergency care Total Field Staff: 43
In 2008, Médecins Sans Frontières opened an obstetric care program unit at the Aweil Civil Hospital in Northern Bahr-elGhazal State in South Sudan after maternal and infant mortalities reached alarming levels. Each week on average 30 women come to the hospital to give birth, and five of those will have a caesarean. On average 35 children are also admitted, treated and cared for in the paediatric ward each week, and our teams treat common but deadly illnesses such as respiratory infections, malaria, diarrhoea and severe acute malnutrition. Our teams also responded to several emergencies in the region including cholera outbreaks after floods in and around Aweil in August and October. We supported the Ministry of Health’s cholera treatment centres with medical supplies and equipment and treated 6,298 patients.
Funding: A$300,000 (28% of total project costs) Project location: Point Pedro Médecins Sans Frontières returned to Sri Lanka in December 2006 after the breakdown of the ceasefire agreement between the Sri Lankan government and the Liberation Tamil Tigers of Eelam (LTTE) movement in the northeast of the country. We are the only international humanitarian organisation based in Point Pedro, in the east of the Jaffna Peninsula, serving a population of 100,000. The Point Pedro Hospital has a shortage of medical specialists and transfers to the closest referral hospital in Jaffna are difficult and dangerous. In 2008, together with Ministry of Health staff, we conducted a total of 1,321 surgical procedures, 689 deliveries and 1,806 emergency admissions. In addition to the surgical activities, we regularly donate medicines and medical equipment to the Point Pedro Hospital in order to maintain specialised medical activities.
We worked in three departments of Zalingei Hospital in West Darfur, supporting paediatric surgery and the emergency room. Between January and September 2008, the paediatrics department had 1,468 admissions, mainly for respiratory diseases. Our teams also worked in two camps for displaced people around Zalingei, providing nutritional care and transferring patients with medical complications to the reference hospital. From the beginning of the year up until July 2008, around 1,200 malnourished children had been admitted to the nutritional program. Between February and September, teams provided approximately 10,950 mother and child consultations, predominantly to children under five years at nearby Hassa Hissa camp.
In September 2008, the Sri Lankan government ordered all foreign aid organisations (with the exception of the International Committee of the Red Cross) to leave the areas under LTTE control in the Vanni region. With humanitarian aid greatly diminished by these restrictions, and increased fighting between the parties, the situation for the 300,000 civilians in the Vanni region continued to deteriorate. In November, cyclone Nisha hit northern Sri Lanka, causing heavy rains and flooding that affected tens of thousands of people living in the north including the Jaffna Peninsula. We distributed food and shelter for 300 people in Point Pedro and for 500 people in Katkovilam who were forced to leave
In response to malnutrition affecting children during the May to October hunger gap, our teams distributed supplementary 19
Projects funded by Australian donors food to thousands of children aged between six and 36 months in and around Zalingei. Around 11,000 children received four weekly rations in May and June, but due to government restrictions this program was interrupted and had not resumed by the end of 2008.
continued
The prevalence of HIV/AIDS in Swaziland’s adult population is 26 percent, also the highest rate in the world, and the rate of HIV/TB co-infection is over 80 percent. Médecins Sans Frontières is working in the Nhlangano health centre, providing care for TB and HIV/AIDS patients. We are also working in six community clinics set up in the most remote parts of the country in order to care for patients living in rural areas. During the first nine months of 2008, some 1,850 new patients were started on antiretroviral treatment in the region, while 1,500 started on TB treatment including 36 patients who were suffering from drug-resistant TB.
In Niertiti, also in West Darfur, which has a total population of approximately 33,000 including around 20,000 displaced people, we provide outpatient and inpatient care in a health clinic. From January to September 2008, our teams performed an average of 6,000 consultations (including 400 hospital admissions per month, of which 39 percent were children aged under five years). Diarrhoea, respiratory infections and malnutrition were the main causes of hospitalisation. In the therapeutic feeding centre in Niertiti Hospital, 986 malnourished children were hospitalised for medical complications. In February 2008, following a meningitis outbreak, 35 patients were admitted to the clinic. In response, we launched a mass vaccination campaign, vaccinating over 28,000 people aged between two and 30 years of age in five days.
THAILAND Primary healthcare, tuberculosis, food, water Total Field Staff: 225 Funding: A$2,000,000 (52% of total project costs) Project locations: Petchabun, Mae Sot An estimated 800 ethnic Lao Hmong refugees were forcibly returned to Laos by the Thai government in June. The Thai authorities also stated publicly that they intended to proceed with further repatriations to Laos from among the remaining 6,700 refugees in the Huai Nam Khao camp in northern Thailand’s Petchabun province. Médecins Sans Frontières called once again on the governments of Thailand and Laos to immediately stop all forced repatriations of the Hmong refugees. We also appealed for both governments to facilitate the access of independent monitors to all forced returnees in Laos and those believed to be held in detention centres in Thailand, in order that adequate medical and humanitarian assistance is provided to them.
SWAZILAND HIV/AIDS, tuberculosis Total Field Staff: 225 Funding: A$1,100,00 (43% of total project costs) Project location: Nhlangano The small kingdom of Swaziland in southern Africa has a population of just one million people, where the average life expectancy is only 32 years. It also has the highest rate of infection of tuberculosis (TB) in the world. Twelve out of every 1000 people contract this contagious disease each year. Working within the Swazi public health structure, Médecins Sans Frontières is treating those suffering from TB, with a particular emphasis on extensively drug resistant TB, a strain of the disease that has begun to spread.
Since July 2005, we have assisted the Hmong refugees in Huai Nam Khao camp by providing medical and psychological care, food, water and relief supplies to nearly 8,000 refugees. Since we started to provide tuberculosis (TB) treatment in mid 2006, 26 patients have been registered and 22 have successfully completed their treatment. We provided food rations composed of rice, soybeans, dried fish, salt, sugar, and oil; and since we initiated this monthly food-ration distribution,
The detection and treatment of drug-resistant tuberculosis was our priority in Swaziland in 2008. Throughout the year, some 12,000 new cases of TB were detected, 200 of which were identified as being of the drug-resistant strain. 20
Projects funded by Australian donors the level of malnutrition has dropped significantly. Our teams also provide essential non-food items such as soap, plastic sheeting and cooking pots, as well as water and sanitation services.
continued
to contain the outbreak. Our logistical team also started the construction of a permanent health centre in the camp. In Ishasha, the main entry point from Democratic Republic of Congo, a team provided medical consultations, organised water supplies, and improved sanitation conditions for over 10,000 refugees who arrived in early December. The refugees were later transferred to the nearby Niakivale transit camps.
In Mae Sot, on the Thai-Burmese border, Médecins Sans Frontières continues treating TB among unregistered migrant workers and refugees from Myanmar. The project also offers counselling and health education. In 2008, 320 patients were registered in the TB project in Mae Sot.
YEMEN Primary healthcare, maternity, emergency care Total Field Staff: 44
UGANDA HIV/AIDS, tuberculosis, cholera, primary healthcare, water Total Field Staff: 858
Funding: A$1,387,000 (26% of total project costs) Project locations: Haydan, Al Tahl, Razeh North Yemen has been in the grip of a conflict between governmental troops and the Al Houthi rebel movement since 2004. Médecins Sans Frontières began working in Saada governorate in September 2007, at Haydan hospital. Two other projects were also later opened, the Razeh rural hospital in December 2007 and Al Tahl rural hospital in April 2008.
Funding: A$1,300,000 (30% of total project costs) Project locations: Arua, Niakivale, Ishasha Between January and April 2008, Médecins Sans Frontières treated 845 patients during a cholera outbreak in Arua district. At the height of the outbreak, up to 40 patients were admitted each day to the cholera treatment centre in the Oli neighbourhood of Arua town. Our teams also worked to expand access to safe drinking water in three of the sub-counties where the highest number of cholera cases was recorded.
We work in partnership with Ministry of Health staff in providing inpatient and outpatient services, antenatal and maternity care, and assisting in the emergency rooms. In 2008, activities at the Haydan hospital expanded to cover surgery.
We have also been providing HIV/AIDS care in Arua since 2001. The program includes treatment for TB/HIV co-infection; nutritional support for malnourished adults and children living with HIV/AIDS; and prenatal care and prevention of the transmission of HIV from pregnant women to their unborn children.
On several occasions in June, international field staff had to temporarily evacuate from the projects in north Yemen as fighting resumed, although activities were sustained by national field staff. Between May and June, only 56 injured people (including 36 civilians) were treated in hospitals supported by Médecins Sans Frontières. This is because civilians cannot always get to a hospital, either due to the danger of travelling through the fighting, or because they fear being arrested for supporting the rebellion.
According to the United Nations High Commissioner for Refugees, close to 26,000 Congolese refugees crossed the border into Uganda between August 2007 and December 2008. In the Niakivale transit camp, our teams provided medical consultations to thousands of refugees, and set up a 24-bed cholera treatment centre after an outbreak occurred in the camp. We supplied 130 cubic metres of water per day for the refugee population and carried out community awareness activities about the importance of hygiene practices 21
Summary Activity Charts 2008 Highlights • • • • •
In 2008, there were 152 field positions filled by Australians and New Zealanders in more than 35 countries. Thirty eight percent of these were Field Staff on their first mission. Funding spent on social mission increased from $25.4 million in 2007 to $31.7 million in 2008. Income from fundraising for the year ended 2008 increased to $40.3 million from $34.9 million in 2007. At the same time, the total cost of fundraising decreased from 21% in 2007 to 17% in 2008. The number of people supporting the work of Médecins Sans Frontières Australia grew from 94,700 to 104,600.
2008 Income Field Partners (57.7%) Bequests (1.2%) Other private donations (33.6%) Income from other MSF sections (5.5%) Other income (1.4%)
Project Funds by Region
Gifts in kind (0.6%)
Africa (64%)
Field Human Resources by type
Middle East (12%) Asia (24%)
Medical (32%) Paramedical (51%) Non medical support staff (17%)
Summary Financial Results
Donation Income Total Income Social Mission Costs Total Costs Surplus/(deficit) Reserves 22
$m 2008
$m 2007
$40.3 $43.5 $31.7 $40.5 $2.9 $5.8
$34.9 $36.4 $25.4 $34.3 $2.1 $2.9
MÊdecins Sans Frontières Australia ABN 74 068 758 654
Financial Report for the Financial Year ended 31 December 2008