MÊdecins Sans Frontières Australia Annual Report 2010
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Contents
Part A Médecins Sans Frontières – Charter
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Message from the President
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2010 – Year in Review
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Map – Médecins Sans Frontières projects funded by Australian donors
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Médecins Sans Frontières Australia Australian and NZ field staff 2010
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Projects funded by Australian donors
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Summary Activity Charts
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Médecins Sans Frontières worldwide 2009: Extract from International Activity Report 2009
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Part B Médecins Sans Frontières Australia Financial Report
Cover photos clockwise from top: Democratic Republic of Congo, October 2010. © Stella Evangelidou /MSF Dadaab refugee camp, Kenya, March 2010. © Frédéric Baldini /MSF Pakistan floods, September 2010. © Seb Geo Haiti earthquake, January 2010. © Frederic Sautereau
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Médecins Sans Frontières Charter
Médecins Sans Frontières 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 honor 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.
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Message from the President Dr Nicholas Coatsworth
Dear Friends, At the beginning of 2010 I visited a tuberculosis treatment project in Cambodia where I found a French head of mission working with an Argentine medical coordinator, a Liberian doctor, a Spanish logistician and a Kiwi nurse (there is always a Kiwi nurse!), all working alongside a Cambodian team, some of whom were preparing to leave on their first field placement with Médecins Sans Frontières outside their home country. Seeing that group of people work together reminded me of the common purpose that delivering medical care can create amongst individuals from different cultures and circumstances. It showed me just what Médecins Sans Frontières had become – far from a Euro-centric, Western aid organisation, here was a team that was clearly ’without borders’, but whose purpose was the same as those who founded the organisation in 1971. As Médecins Sans Frontières approaches its 40th year in 2011, looking back on 2010 gives us pause to reflect on the challenges our teams faced in the field. These challenges were met with the same principles that have always united us: our impartiality, our independence, our neutrality and our fundamental respect for medical ethics in the treatment of our patients. The year was book-ended by two major emergencies in Haiti. On January 12 an earthquake flattened Port-au-Prince. Médecins Sans Frontières had worked with the Haitian people for nearly two decades and amongst the staggering number of victims were twelve Haitian Médecins Sans Frontières staff that had been working at the time of the earthquake. Of our three medical facilities that existed in the minutes before the earthquake, only one was operational immediately afterward. From that immediate post-earthquake phase through to the end of October our teams treated 360,000 patients. The response of Médecins Sans Frontières to the Haitian earthquake and cholera outbreak has been detailed in the excellent and reflective report Haiti One Year After, but it is worth highlighting several points. The Haiti earthquake showed two sides of humanitarianism in stark contrast. On the one hand was a world that saw the need for (and was prepared to deliver) a rapid and efficient response to a humanitarian disaster. But, on the other hand, there were very real questions raised about the effectiveness and coordination of the humanitarian response. In the days following the disaster, as the rescue crews were flown to
Port-au-Prince to an airport controlled by the US military, aircraft carrying supplies for Médecins Sans Frontières were denied permission to land. In what was later labelled as “the most powerful ‘tweet’ of 2010”, American journalist Ann Curry saw a tweet from our New York office, took up the cause and herself tweeted “@usairforce find a way to let Doctors without Borders planes land in Haiti: http://bit.ly/8hYZOKTHE most effective at this”. Within 24 hours Médecins Sans Frontières logistics was again able to supply teams that had been treating patients in the immediate post-quake phase. At the end of the year, Haiti suffered a second blow as a cholera outbreak spread throughout the country. Our teams – made up of 7,500 Haitian and 400 international staff – treated more than 110,000 patients for this preventable disease in cholera treatment centres across the country. A single death from cholera is unnecessary; in Haiti there were 3,600 deaths. Despite there being around 12,000 non-government organisations present, Médecins Sans Frontières was the major provider of care during the epidemic, and alongside doctors from neighbouring Cuba, treated more than half of all victims. The anger and fear generated by an epidemic of such a scale led to violence against some aid workers. There was a breakdown of trust between the Haitian people and the United Nations (UN) and its affiliated agencies, a breakdown that had the potential, and in some cases did, compromise patient access to life-saving treatment. The quality of care from Médecins Sans Frontières teams and recognition of
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Message from the President continued our independence from the UN allowed our medical staff to continue to treat cholera victims across the country. There is clear value to our patients in remaining an independent aid organisation, and the experience of our teams in Haiti once again reinforced our commitment to this position. Haiti also offered lessons for Médecins Sans Frontières as a global organisation. It has always been the character of the organisation to constantly question the relevance and efficacy of its action. Our Association of returned and active field workers acts as a check on our action and source of constant reflection. And it would be correct to say that our own response was far from perfect. Lessons have been learnt about interaction with other agencies in the field and about the provision of medical care in chaotic circumstances. Our experience has also sparked debate on longer-term integration into the health system in contexts like Haiti with ‘permanent’ humanitarian emergencies. Having returned to Afghanistan in late 2009 after a five year absence following the murder of five of our staff in Bagdhis province, Médecins Sans Frontières scaled up our response to the conflict there in 2010. Our teams support Boost Hospital in Lashkarhah in Helmand Province and Ahmed Shah Baba Hospital in eastern Kabul. In 2010, more than 1200 patients were treated each month in Boost Hospital. Through our complete financial independence and constant communication with all warring parties we have managed to carve out operational space in the most difficult of circumstances. Médecins Sans Frontières teams see first hand the difficult position Afghan patients find themselves in: accessing care from facilities affiliated with one side can make them a target for reprisals from the other. The very act of seeking medical attention can in fact put patients in a worse position. This situation contradicts international humanitarian law, which enshrines the provision of medical care independently of warring parties. But it also debases fundamental medical ethics. For these reasons we refuse to be co-opted as part of the counterinsurgency strategy of Western forces. To facilitate the work of our teams in the field, Médecins Sans Frontières Australia has maintained dialogue in 2010 with the Australian Defence Force and other civil-military forums where we continue to assert our independence from the military and other nongovernment organisations. 2010 also saw Médecins Sans Frontières undertake a unique intervention in northern Nigeria, treating children and
pregnant women suffering from unprecedented levels of lead poisoning as a result of small-scale gold extraction. Supported by an international network of toxicologists, our team delved into unknown territory, designing a treatment protocol that could not only address extremely high levels of poisoning, but also be rolled out on a large scale with limited resources and adapted to address what would be culturally acceptable for local communities. Of course, these examples are a fraction of the work done in 2010 by our doctors, nurses, administrators and logisticians, work that is undertaken in the most precarious of contexts. We continue to offer medical care to patients forgotten by the global community, in the Democratic Republic of Congo, the Caucasus and the Sahel region of Africa. Alongside our direct patient care we continue to advocate for improved access to essential medicines, to ensure that generic drugs are made available for patients living with HIV and to develop new research initiatives into neglected tropical diseases such as sleeping sickness and kala azar, and remain at the forefront of the fight against multi- and extremely- drug resistant tuberculosis. As a final word I would like to thank everyone who works with Médecins Sans Frontières Australia for their efforts over the past year. There were a record number of departures to the field in 2010. Staff in the Sydney office provided high level and valued support to the organisation’s operations. I constantly received messages of thanks from our colleagues in operations for the work of all our departments from Communications to Finance and Administration to Human Resources and Fundraising. That is of course testimony to the work of those individuals, but also to the work of our departing Executive Director, Philippe Couturier, who led Médecins Sans Frontières Australia to its position as a valued contributor within the international movement on so many levels. I wish Philippe well in 2011 and into the future. Thanks also to my colleagues on the Board for their work as volunteer representatives and directors of Médecins Sans Frontières Australia. Finally, thank you to our donors who have in 2010 made it possible for us to make an even greater contribution to the benefit of our patients. Sincerely, Dr Nicholas Coatsworth ustrralia President, Médecins Sans Frontières Australia
w w w.m sf. org. a u Paul McPhun
2010 Year in review 2010 was a remarkable year, not only for Médecins Sans Frontières Australia, but for the Médecins Sans Frontières movement as a whole. As already well elaborated in the President’s message, Haiti is for many reasons the country most will associate with natural disaster and humanitarian action in 2010. The earthquake that struck Haiti resulted in the largest scale medical humanitarian response Médecins Sans Frontières has ever launched, and this was possible only given the immense support we continue to receive from our Australian donors. This support has enabled multiple, complex and large scale emergency activities to be launched simultaneously in response to the massive needs generated in this horrific disaster. It also enabled us to scale up rapidly, where other organisations depended first on securing sufficient funds. As a result, this emergency response had a significant impact on all Médecins Sans Frontières offices around the world, where huge pressure was placed upon all departments to support the operational needs of this immense response. By contrast, the devastating floods in Pakistan garnered less media attention, and risks now slipping into the ‘forgotten crisis’ category as new events worldwide in 2011 emerge. It is worth remembering that over 20 million people (twice the population of Haiti) lost their homes and their livelihoods in this natural disaster, and the long term impact of this will also take many years to resolve. Médecins Sans Frontières has committed to continue its medical activities in recognition of the chronic ongoing needs of this highly vulnerable population, on top of our continuing programs for populations in conflict affected regions such as Balochistan and Khyber Pakhtunkhwa Province. 2010 was also a year of multiple outbreaks of infectious disease. Again Haiti and the failure of the international community at large to prevent cholera-related deaths drew the attention of the world as already highlighted. But it is also worth noting that across the organisation, while this was going on, many other Médecins Sans Frontières field staff were also managing large scale cholera emergencies, in Chad, South Sudan, Central African Republic, Democratic Republic of Congo, Nigeria, Papua New Guinea and more. Again, all offices of Médecins Sans Frontières around the world were called upon to support, with the provision of field staff, specialist medical support, communications support and fundraising efforts to enable our field teams to manage the scope of these outbreaks.
The greatest impact of these emergencies in addition to our regular planned programs surely fell on our Field Human Resources (HR) department. They rose to the challenge, filling 198 field placements with Australians and New Zealanders compared to 118 in 2009. Emergencies were not limited to large scale international disasters. Our Field HR team also played an integral role in supporting rapid assessments and emergency responses locally in the Asia-Pacific region. In addition to their regular focus on recruitment and placement, the team has also been active on an international level to further the quality and efficiency of HR management within the international organisation. They were and still are engaged in projects such as the End of Mission Survey, the National Staff Common Remuneration Project, the International Retention Benefits Scheme and the development of an International Human Resources Database/Management System. Our communications teams were no less active, as a significant demand for information fell to Médecins Sans Frontières, as a key and hugely relevant actor in emergencies worldwide. The relevance of Médecins Sans Frontières Australia in support of field communication needs has been undeniable this year. Our own Head of Communications travelled to Pakistan and assumed the role of Emergency Communications Officer on behalf of the organisation in response to the floods there. Our Press and Information Officer travelled to South Sudan to support Médecins Sans Frontières activities, and was called upon to relocate again to South Sudan for two months to support the organisation through Sudan’s unstable referendum process at the start of 2011. Our Communications Officer was also in the field in Kenya, producing material on paediatric tuberculosis and Prevention of Mother-to-Child Transmission of HIV. Of significant note and direct relevance to field operations, our communications and fundraising departments jointly developed a unique online visual presentation of a Haiti Cholera Treatment
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2010 Year in review continued Centre, a tool used for visibility and leverage where the international response to the emergency was seen to be lacking. On the home front, the communications department worked with the Project Unit - Médecins Sans Frontières Australia’s medical team - to launch the inaugural International Child Health Seminar and for the second year, organise a series of lectures for International Women’s Day, this time on the topic of sexual violence. Our regular publications to keep our donors and association members up to speed continued despite additional workloads, as did the regular input in support of all department activities. Although Médecins Sans Frontières Australia does not subscribe to fundraising appeals linked to international crises, the impact of the disasters in Haiti and Pakistan were nevertheless significant on the workload of our fundraising and administration teams. Every effort was made to ensure our supporters understood the needs we faced elsewhere, and secure their pledges as open and not earmarked donations. This was very successful, as was the planned activities of our fundraising department, which raised over $56 million in 2010, an increase of over $13 million on the previous year’s activities. The finance and administration departments also achieved a huge amount in 2010, ensuring administrative and IT support to all departments and our partners within the movement, updating internal policies and procedures, completing a remuneration review and deploying a new system of performance management. The Project Unit continued to prove invaluable in providing technical support in the fields of women’s health and paediatrics to field projects. The head of the Project Unit based in Sydney assumed the dual role of supervisor for all Project Unit activities as well as deputy medical director to the Operational Centre Paris (OCP). Members of the Project Unit conducted nine field visits in support of medical activities in Democratic Republic of Congo, Sudan, Congo Brazzaville, Kenya, Uganda, Laos and Central African Republic. Much input was given to improving medical guidelines, protocols, tools, and trainings.
missions were launched in Papua New Guinea and Indonesia in response to cholera outbreaks and a tsunami. In 2011 a new department will be formed under the direction of the emergency desk in Paris to assume an even greater responsibility for regional emergency management from the Sydney office. Last, but far from least, 2010 marked a significant turning point in the relationship between the Médecins Sans Frontières sections contributing to the OCP group. Following years of careful, slow and sometimes frustrating progress, the sections of Médecins Sans Frontières USA, Japan, France and Australia reached formal agreements on a new common governance structure, and a commitment to a shared social mission supported by all as equal partners. Although each section remains independently managed through its boards and executives, two new international group platforms will now ensure greater collaboration and participation in group decision making, and strategic development in support of OCP operational objectives. The outcome of this is to better utilise the capacities and experiences of all partners to enhance decision making, limit areas of duplication, and provide for great resource security to operations, whilst also enabling us as a group to start thinking in terms of longer commitments to operations over a period of years, instead of on annual cycles of support. As our own field interventions become ever more complex, and as Médecins Sans Frontières takes on longer term commitments in specialised hospitals, and to large cohorts of patients with complicated diseases such as HIV and tuberculosis, the OCP group will be better positioned to support these ambitions through a reliable and committed partnership. None of the impressive achievements in 2010 would have been possible without the outstanding support of our loyal donor community, and the impressive commitment of our office staff and volunteers and board of volunteers. I would like to take this opportunity to sincerely thank everyone for their extraordinary commitment to our patients overseas, and I very much look forward to reporting on the exciting plans and outcomes of 2011. Sincerely,
A lot of effort went into better management of Médecins Sans Frontières Australia’s regional emergency surveillance capacity. A regional mapping exercise was undertaken, baseline tools and resources introduced, and exploratory
Paul McPhun Executive Director, Médecins Sans Frontières Australia
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Médecins Sans Frontières projects funded by Australian donors
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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.
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Country 1. Burkina Faso 2. Cambodia 3. Cameroon 4. Central African Republic 5. Chad 6. Democratic Republic of Congo 7. Djibouti 8. Ethiopia 9. Haiti 10. Iran 11. Iraq 12. Kenya 13. Kyrgyzstan 14. Malawi 15. Mali 16. Mozambique 17. Myanmar 18. Niger 19. Occupied Palestinian Territory 20. Pakistan 21. Republic of Congo 22. Somalia 23. Sudan 24. Swaziland 25. Uganda 26. Yemen Other countries
A$ MSF France
A$ MSF Switzerland
1,360,000 700,000
74 66
900,000 480,000 690,000 2,990,000 400,000 421,902 2,560,000 1,680,000 2,300,000
1,300,000 680,000 500,000
9
10
18
5
26
23
7 8
4
3 21 9
6
25 12 22
14 16 1,200,000 600,000 800,000
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1,300,000 1,500,000 2,000,000
1,000,000 700,000
Note: An amount of A$200 was specifically directed to MSF Belgium to be donated for a project in Afghanistan.
300,000
20 17
15 2
3,368,500 900,000
900,000 1,601,500 640,000 1,900,000 50,000
11
19
1 300,000 800,000 200,000
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Australian and NZ field staff 2010 Afghanistan Raewyn Turner Armenia
OT nurse
Colombia
Stephanie Johnston
pharmacist
Democratic
Janthimala Price
field coordinator
Republic of
Melinda Staunton
counsellor
Congo
Peter Wigg
psychiatrist medical coordinator
Bangladesh Stewart Condon Robert Gardner
administration/
Katrina Harper
medical doctor
financial coordinator
Rachel Creek
logistician/administrator
Emily Berry
logistician/administrator
Jean-Paul Margot
logistician
Michael Rowell
administration/ financial coordinator
Ethiopia
Margie Barclay
nurse-midwife
Kaye Bentley
administration/
Burundi
Henri Stein
logistician
Cambodia
Gina Bark
field coordinator
Linda Pearson
field coordinator
Jennifer Gibson
logistician/administrator
Rolands Selis
nurse
Stella Smith
nurse
Colin Watson
nurse
Central African Republic
Chad
Georgia
Kaheba Clement Honda nurse
Judy Coram
psychologist
Suman Majumdar
medical doctor
Louise Johnston
nurse
Guinea
Devi Lalloo
nurse
Alan Scott
surgeon
Haiti
Ahmose Abrahim
logistician
Eline Whist
medical doctor
Sarah Andrews
medical doctor
Cassandra Arnold
medical doctor
Alana Baker
nurse
Sita Cacioppe
nurse
Margie Barclay
midwife
Mireia Coll Cuenca
nurse
Margaret Bell
midwife
Stephanie Johnston
pharmacist
Virginie Whiteway-Wilkinson China
financial coordinator
Rebecca Bennett
psychologist
nurse
Franck Boulay
logistician
Brian Willett
logistician
Sita Cacioppe
nurse
Matthew Apostola
logistician
Cath Deacon
medical doctor
Lee-Anne Cameron
administration/
Robert Delacour
nurse
financial coordinator
Matthew Everitt
logistics coordinator
Helle Poulsen-Dobbyns field coordinator
Nerida Greenaway
OT nurse
Kelly Wilcox
Rosemary Hay
medical doctor
field coordinator
Australian nurse-midwife Margaret Bell in Haiti, February 2010. Š Benoit Finck /MSF
Debra-Lee Holman
nurse
Malcolm Hugo
psychologist
Louise Johnston
nurse
Tracey Leslie
water/sanitation
Rachel Marsden
OT nurse
Damien Moloney
logistician
Michael O’Brien
nurse
Sneha Parghi
medical doctor
Katrina Penney
midwife
Stuart Perry
anaesthetist
Lesli Bell Powell
logistics coordinator
Amy Ruede
OT nurse
Arnold Santiago
logistics coordinator
Alexandra Serri
field coordinator
Robert A Simpson
medical doctor
Henri Stein
logistician
Mohamad-Ali Trad
medical doctor
Raewyn Turner
OT nurse
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Australian and NZ field staff 2010 continued Haiti
India
Paras Valeh
epidemiologist
David Walkley
logistician
Colin Watson
nurse
Sally Stevenson
head of mission
Devika Tharumaratnam medical doctor Indonesia
Kate Ferguson
logistics coordinator
Helle Poulsen-Dobbyns medical coordinator
Iraq Jordan
Sally Stevenson
head of mission
Anne Taylor
head of mission
Susan Petrie
psychologist
Susan Petrie
medical coordinator
Michael Rowell
administration/ financial coordinator
Kenya
Kyrgyzstan
Malawi
Prue Coakley
field administrator
Jennifer Gibson
field administrator
Jacinta Hurst
field coordinator
Janine Issa
midwife
Australian nurse Monica Burns in Malawi, May 2010. Š Nabila Kram
Nigeria
Haydar Alwash
surgeon
Don McCallum
logistician
Kevin Baker
anaesthetist
Catherine Moody
head of mission
Debra Blackmore
medical doctor
Rebecca Bennett
psychologist
Prue Coakley
field administrator
Erin Calabrese
nurse
Chris Daley
logistician
Malcolm Hugo
psychologist
Judith Forbes
anaesthetist
Jonathan Nichol
nurse
Jacinta Gibson
logistician
Toby Barton
logistician
Fiona Gillett
midwife
Roslyn Brooks
medical doctor
Aisleen Glasby
nurse
Monica Burns
nurse
Eileen Goersdorf
OT nurse
Heather Cook
field administrator
Alan Hughes
obstetrician/gynaecologist
Chris Daley
logistician
Nicole Hunter
field administrator
Chris Fletcher
nurse
Kamalini Kalahe-Lokuge epidemiologist
Rosemary Hay
medical doctor
Abi Kamara
logistician
Serene Hu
medical doctor
Janet Loughran
anaesthetist
Abi Kamara
logistician
Jenny Mackenzie
medical doctor
Ellen Kamara
administration/
Uma Naguleswaran
medical doctor
financial coordinator
Melinda Perrottet
logistician
nurse
Kelly Saunders
nurse
Natasha Martin
pharmacist
Alan Scott
surgeon
Lisa Mazlin
nurse
Sally Thomas
logistician
Henri Stein
logistician
Bill Wilson
logistician
Laura Margison
Pakistan
Lisa Trigger-Hay
medical doctor
Haydar Alwash
surgeon
Shelagh Woods
head of mission
Eugene Athan
epidemiologist
Sofie Yelavich
medical doctor
Michael Bala
medical doctor
Mongolia
Maria Cartwright
field coordinator
Toby Barton
logistician
Niger
Daniel Baschiera
logistician
Monica Burns
nurse
Warren Keen
logistician
Frederick Cutts
logistician
Christopher Lack
medical doctor
Fiona Gillett
midwife
Awras Majeed
medical doctor
Julianne Millar
medical doctor
Damien Moloney
logistician
Brian Moller
field coordinator
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Australian and NZ field staff 2010 continued Sudan
Australian nurse Sam Bartlett in South Sudan, November 2010. © Kate Geraghty/ Fairfax Media
Pakistan
Sam Bartlett
nurse
Terry Coffey
logistician
Janet Coleman
midwife
Anthony Flynn
field coordinator
Anthony Flynn
medical team leader
Lisa Gray
nurse
Alan Hughes
obstetrician/gynaecologist
Peter Labattaglia
surgeon
Robyn Lea
midwife
Lesley Ludkin
HR officer
Matthew Merrington
logistician
Wedyan Meshreky
pharmacist
Danielle Moss
field administrator
Wanda Tan
medical doctor
Alexander Wilson
paediatrician
Ruth Dabell
nurse
Uganda
Liz Bannister
medical doctor
logistics coordinator
Rebecca Caporn
nurse
Ruth Priestley
nurse
Will Robertson
head of mission
Lisa Searle
medical doctor
Mark Ward
logistician
Michael Seawright
field coordinator
Sofie Yelavich
medical doctor
Kevin Baker
anaesthetist
Hannah Jensen
psychologist
Julie Guy
medical doctor
Carol Nagy
medical coordinator
Carolyn Merry
head of mission
Kelly Wilcox
field coordinator
Joanne Sage
nurse
Lesli Bell Powell
Amy Ruede
OT nurse
Raewyn Turner
OT nurse
Peter Wigg
psychiatrist
Chris Daley
logistics coordinator
Kate Ferguson
logistician/administrator
Papua New Guinea
medical doctor
Swaziland
Yemen
Palestinian Territories
Philippa Boulle
Janet Loughran
anaesthetist
Clair Mills
field coordinator
Carol Nagy
medical coordinator
Penny O’Connor
medical coordinator
John Parker
medical coordinator
Karina Severin
medical doctor
Somalia
David Nash
field coordinator
Sri Lanka
Kevin Baker
anaesthetist
Jessica Cooper
OT nurse
Juliet Donald
psychologist
Kathleen Leach
psychologist
Jayne Martin
field coordinator
Susanne Weress
pharmacist
Zimbabwe
Michael Bala
medical doctor
Veronique De Clerck
medical coordinator
Cath Deacon
field coordinator
Andrew Dimitri
medical doctor
Australian logistician Toby Barton in Malawi, May 2010. © Nabila Kram
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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 2009 International Activity Report. The 2010 International Activity Report will soon be available online at www.msf.org.au.
BURKINA FASO Nutrition, malaria Total Field Staff: 251 Funding: A$1,360,000 (approx 25% of total project costs) Project locations: Titao, Yako Malnutrition is a chronic problem in Burkina Faso, but hits particularly hard in the period between the two annual harvests, known as the ‘hunger gap’. Since 2007 Médecins Sans Frontières has been treating malnutrition in children under the age of five in the northern districts of Yako and Titao. Our treatment programs are based in 16 local health centres, bringing care closer to more people’s homes. We expanded the hospital in Titao in 2010, building an extra structure that increased capacity from 80 to 150 beds. In 2010, more than 11,700 children received care for malnutrition. Since the project started in 2007, more than 50,000 children have
A TB consultation in a prison in Phnom Penh, Cambodia. Overcrowding, lack of ventilation and generally poor living conditions in prisons mean there tends to be a high risk of TB infection. In 2010, Médecins Sans Frontières extended its HIV and TB services in Phnom Penh prisons to provide comprehensive testing, counselling and treatment for both diseases. © Brigitte Breuillac/MSF
received care. 3000 HIV patients were transferred to the care of the health Malaria is very common in Burkina Faso and in 2010 we
authorities, and Médecins Sans Frontières shifted its focus
increased our efforts to combat the disease, offering testing
to tuberculosis (TB) care.
and treatment to every person at every centre where we were working. Between August and December, approximately
Cambodia is one of 22 countries listed by the World Health
74,300 people received treatment, including 780 children
Organization as having a high burden of TB. In Kampong
who had more serious forms of malaria.
Cham, the most populous province in the country, our teams worked to improve the diagnosis and care of people with TB
CAMBODIA
and drug-resistant TB (DR-TB). Staff established a chest clinic
HIV/AIDS, tuberculosis, response to epidemics Total Field Staff: 76
within the TB ward of Kampong Cham provincial hospital, and
Funding: A$700,000 (approx 32% of total project costs) Project locations: Kampong Cham, Phnom Penh
patients who had been admitted to hospital for other reasons.
began to actively seek patients with TB, and offer TB testing to
By the end of 2010, the number of TB patients had increased by In 2010, Médecins Sans Frontières completed the handover
25 per cent, and revealed a need for improved patient follow-up.
of its activities in the infectious disease department of the
Médecins Sans Frontières had carried out an assessment of
Khmer-Soviet Friendship Hospital in Phnom Penh. More than
facilities for TB care in four districts of Kampong Cham, and
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Projects funded by Australian donors continued had begun providing TB care in local health centres.
received care in 2010. Médecins Sans Frontières is conducting outreach activities from the pavilion so that people living
Overcrowding, lack of ventilation and generally poor living
further away can access care more easily. In 2010, the Ministry
conditions in prisons mean there tends to be a high risk of TB
of Health declared the pavilion a national reference point for
infection. Médecins Sans Frontières extended its HIV and TB
the treatment of Buruli ulcer.
services in Phnom Penh prisons to provide comprehensive testing, counselling and treatment for both diseases. Teams
CENTRAL AFRICAN REPUBLIC
also provided general healthcare.
Primary healthcare, emergency healthcare, surgery, obstetrics, paediatrics, HIV/AIDS, tuberculosis Total Field Staff: 253
In Phnom Penh men’s prison, more than 80 per cent of inmates agreed to be tested, and results showed 3 per cent prevalence of HIV in comparison with 0.6 per cent among the general
Funding: A$480,000 (approx 7% of total project costs) Project locations: Paoua, Mongoumba, Carnot, Bocaranga
population, and 3.9 per cent prevalence of TB in comparison with 0.7 per cent among the general population. Prevalence
The Central African Republic (CAR) has suffered armed conflict
was slightly lower in the city’s women’s and children’s prison,
between rebel groups and the government for the past five
at 2.7 per cent and 2 per cent, respectively.
years. People face enormous difficulties in accessing healthcare. Many live in extremely isolated regions, and travelling is
Our teams also assisted during cholera outbreaks across the
dangerous as banditry is widespread.
country in 2010. Staff provided technical support and cholera kits that were adapted for use in national treatment centres. In
Since 2006, Médecins Sans Frontières has been working in the
collaboration with other organisations, Médecins Sans Frontières
referral hospital in the town of Paoua in the northwest of the
helped to strengthen the surveillance system for communicable
country. Teams provide paediatric, surgical, maternal, emergency
diseases, especially cholera, dengue fever and measles. Staff
and outpatient care. More than 35,150 consultations were
are working with health programs at national and provincial
carried out in 2010, and more than 6900 patients were admitted
levels, investigating suspect cases and analysing the performance
to hospital. Staff held more than 7400 antenatal consultations,
and challenges of the care given. This should enable timely
and assisted more than 1500 births. Teams also cared for 320
identification of outbreaks and a more efficient response.
patients with HIV/AIDS, including patients coinfected with both TB and HIV. Staff worked in seven health centres in the surrounding
CAMEROON
area, carrying out nearly 4000 consultations every month.
Buruli ulcer Total Field Staff: 52
Médecins Sans Frontières also provided a paediatric service
Funding: A$900,000 (approx 45% of total project costs) Project locations: Akonolinga
in Bocaranga hospital, 100 kilometres west of Paoua. Teams admitted around 160 children to the hospital and held an average of 1000 consultations with children under five every
Buruli ulcer is an infection related to leprosy and TB, which can
month. During the seasonal peak of malaria, teams provided
cause painful wounds and physical deformations, and often
supplementary support to this zone’s health posts.
leads to social stigma for people with the disease. Early diagnosis and treatment are vital to prevent irreversible deformities, but
In November 2009, Médecins Sans Frontières launched an
treatment is complicated, expensive, and can take over a year,
emergency program along the Ubangi River to bring aid to the
involving antibiotics, skin transplants, special wound dressings
tens of thousands of Congolese (DRC) refugees in exile in the
and physiotherapy.
south of CAR and in the Republic of the Congo. In January 2010, the program was extended to provide medical care to
Since 2002, more than 1000 patients have been treated at
15,000 refugees who had settled in the south of CAR. Our teams
Médecins Sans Frontières’ program in Akonolinga, a town
brought primary and secondary healthcare to refugees and
in central Cameroon. Médecins Sans Frontières has set up a
residents of Mongoumba and the surrounding area. There
“Buruli pavilion” in the town’s hospital, where 120 patients
were an average of 5000 consultations per month. In February
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Projects funded by Australian donors continued 2010, 12,500 children aged six months to five years were
In Dogdoré, 30 kilometres from the border with Sudan, residents
vaccinated against measles. The presence of other organisations
live alongside a large number of displaced people. Médecins
providing healthcare in the area allowed us to close the project
Sans Frontières teams carried out more than 12,100 medical
in Mongoumba at the end of August 2010.
consultations and treated 430 patients in hospital during the first seven months of 2010. They provided 2460 antenatal
In 2010, Médecins Sans Frontières began a new HIV/AIDS
consultations, assisted more than 200 births and vaccinated
project in the south-eastern city of Carnot, where we had been
some 1060 children against measles. More than 400 people
running a nutritional program since 2009. The program aims
were admitted to the nutritional rehabilitation program.
to develop a sustainable strategy for providing HIV care in a context with very poor health infrastructure.
In July 2010, however, Médecins Sans Frontières was forced to close the program. Repeated security incidents made it
CHAD
impossible to maintain a team in Dogdoré. Before leaving,
Nutrition, obstetrics, vesico-vaginal fistula, response to epidemics Total Field Staff: 492
Médecins Sans Frontières donated drugs and medical supplies
Funding: A$1,990,000 (approx 7% of total project costs) Project locations: Abéché, Dogdoré, Hadjer Lamis, Moissala, N’Djamena
to the hospital to help ensure the continuation of medical care after the team’s departure. In the city of Abéché, Médecins Sans Frontières continued running Project Papillon (Project Butterfly), treating 144 women with obstetric fistula. We also supported the regional maternity
In 2010, the heaviest rains for 40 years destroyed crops, flooded
hospital, with the objective of improving obstetric care in order
wells and cut off entire villages in Chad. These floods followed a
to prevent new cases of fistula occurring. In 2010, our staff
long drought in 2009, which had already resulted in a significant
assisted with more than 3400 deliveries.
drop in farm production. Chadians faced a major food crisis and several outbreaks of disease, including cholera, meningitis,
In several health centres in Moissala, a district in southern Chad,
measles and malnutrition. One quarter of children under the
our staff trained community health workers to screen patients
age of five were suffering from acute malnutrition in the Sahel
for malaria and offer early treatment for uncomplicated cases.
region of western Chad in 2010.
People suffering from complicated malaria were referred to
A child is vaccinated against measles during an outbreak in N’Djamena, Chad. Médecins Sans Frontières teams vaccinated more than 290,000 children during the vaccination campaign. © Mathieu Bichet/MSF
Moissala hospital, where Médecins Sans Frontières runs a 50-bed malaria treatment unit. More than 20,000 patients were treated for malaria over five months. More than 1030 patients were hospitalised in the malaria treatment unit. During the first months of 2010, there was an outbreak of measles in the capital city, N’Djamena. More than 400 patients were hospitalised and more than 290,000 children were vaccinated. While responding to the measles outbreak, our staff observed high rates of acute malnutrition among children. This led to the opening of a nutrition program in N’Djamena in March. An emergency program was also opened in the western region of Hadjer Lamis. More than 1500 malnourished children were admitted to the inpatient therapeutic feeding centre set up by our team in Massakory, while more than 19,700 children benefited from a system of 35 ambulatory therapeutic feeding centres throughout the region. In September, our teams treated 858 cases of cholera during an outbreak in N’Djamena.
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Projects funded by Australian donors continued DEMOCRATIC REPUBLIC OF CONGO
range of care, including surgery, paediatrics, mental healthcare,
Primary healthcare, secondary healthcare, emergency healthcare, obstetrics, surgery, paediatrics, nutrition, sleeping sickness, response to epidemics Total Field Staff: more than 648
emergency healthcare and obstetrics. The area is also affected
Funding: A$3,670,000 (approx 17% of total project costs) Project locations: Katanga, Rutshuru, Nyanzale, Haut et Bas Uélé
Médecins Sans Frontières also has a team based in Katanga
by African Human Trypanosomiasis, or sleeping sickness. Our staff treated 829 patients for this deadly disease, which is transmitted to humans through the bite of the tsetse fly.
province in south-eastern DRC, which monitors and responds to emergencies in the province as they arise. In 2010, the team responded to cholera, measles and nutritional emergencies and
In the east of the Democratic Republic of the Congo (DRC),
also provided assistance to groups of internally displaced persons.
civilians have borne the brunt of more than a decade of violent conflict. Villages have been pillaged and destroyed, armed
DJIBOUTI
men have forced people to flee, and rape has been used as a
Nutrition, response to epidemics Total Field Staff: 131
tool of war. In 2010, thousands more people were displaced from their homes by violence. Throughout the country, decades of neglect of the health system have resulted in a rise in infant
Funding: A$500,000 (approx 14% of total project costs) Project locations: Djibouti City
and maternal mortality rates and, according to the World Health Organization, life expectancy is among the lowest in the world.
Drought, rising food prices and increased numbers of migrants passing through the country have had a profound impact on
Médecins Sans Frontières has been working in the referral
Djibouti. Levels of malnutrition exceeded emergency thresholds
hospital in Rutshuru in North Kivu since 2005. The hospital has
in a number of locations in 2010. Médecins Sans Frontières
grown from being a general referral hospital with a capacity of
has concentrated its efforts on reducing malnutrition among
120 beds, to a provincial hospital with over 300 beds. In 2010,
children in the slums of Djibouti City.
there were 5082 surgical interventions, 10,867 admissions in the emergency department and 4284 deliveries in the
In 2010, we provided medical care for malnourished children
hospital. There were also more than 3600 admissions to the
in the districts of Balbala, Hayableh, Arhiba and PK12. These
paediatric department and 67 admissions each month to the
districts are home mainly to migrants, asylum seekers and
intensive care unit.
Djiboutians who have moved to the city from rural areas.
Meanwhile, in the health centre in Nyanzale in North Kivu, we
In order to reach as many of the 200,000 inhabitants of the
provided treatment to 1372 survivors of sexual violence. There
slums as possible, teams travelled from door to door to identify
were more than 2000 admissions to the nutrition program and
acute malnutrition in children and to raise awareness about the
more than 35,000 consultations took place in the outpatient
condition. According to their level of malnutrition, children were
department. Each month, an average of 171 deliveries took place
referred to one of six Médecins Sans Frontières feeding centres
in the facility. Teams also vaccinated 2700 children against
that provide outpatient care, or to our 35-bed therapeutic
measles in response to an outbreak taking place throughout DRC.
feeding centre, where children suffering from malnutrition with complications receive 24-hour medical care. Almost 1030
In Haut-Uélé and Bas-Uélé in Orientale Province in the country’s
malnourished children were hospitalised in 2010 and more
north, insecurity means that many displaced people can only
than 3620 received outpatient care.
be reached by plane. By the end of October 2010, it was estimated that there were more than 264,000 displaced people in Haut-Uélé
Our teams also vaccinated young patients against measles and
and Bas-Uélé. Médecins Sans Frontières has been working in
provided medical follow-up. In 2010, almost 140 malnourished
the area for nearly ten years and the situation has deteriorated
children in the feeding centres tested positive for TB. Staff
significantly since 2008. In Dungu, Doruma and Dingila, Médecins
treated the children for both TB and malnutrition before referring
Sans Frontières is the only medical organisation providing a full
them to the national TB program.
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Projects funded by Australian donors continued homeless in Haiti, Médecins Sans Frontières mobilised the largest emergency response in the organisation’s 40-year history. Funding from Médecins Sans Frontières Australia contributed to the running of Saint Louis Hospital – the inflatable tent hospital that replaced the destroyed La Trinité hospital – which provided emergency medical care as well as more specialised trauma and orthopaedic surgical care. Sadly, 12 Haitian Médecins Sans Frontières staff members were killed in the earthquake. Thousands of Haitians, most of whom were directly affected by the disaster, mobilised along with hundreds of international staff to help Médecins Sans Frontières provide assistance. The existing group of 800 field staff in Port-au-Prince quickly expanded to 3400 A team travels to a remote village in the Gambella region of Ethiopia. Depending on the season, mobile teams travel by car or by boat to provide care to the most isolated populations, carrying out 6800 consultations between April and December 2010. © Guillaume Clatot / MSF
people working in 26 hospitals and four mobile clinics. From 12 January to 31 October, medical teams treated more than 358,000 people and performed more than 16,500 surgeries.
ETHIOPIA
The Médecins Sans Frontières obstetric and trauma hospitals
Primary healthcare, secondary healthcare, obstetrics Total Field Staff: 150
were destroyed. Only the Martissant emergency facility, in
Funding: A$400,000 (approx 19% of total project costs) Project locations: Gambella
overwhelmed. Within hours of the earthquake, more than
The Nuer population of the Gambella region, in the far west
At the centre in Pacot, which provided post-operative care,
of Ethiopia, has grown as people have crossed the border to
only one operating table was available for minor operations.
escape violence in southern Sudan. In May 2010 Médecins Sans
In and around the collapsed La Trinité hospital, surgery was
Frontières moved into a new health centre. Staff held close to
carried out in tents and, after a few days, in a converted
29,000 consultations, and 873 patients were hospitalised.
shipping container. Within approximately 48 hours, our
The main illnesses suffered by patients were respiratory tract
teams identified available rooms and a dressing station at
infections, diarrhoea and malaria. Maternity staff assisted an
the Ministry of Health’s Choscal hospital and managed to
average of 10 births per month. Depending on the season,
start surgical activities in two operating theatres there. By
mobile teams travelled by car or by boat to provide care to the
15 January, major surgery was also being provided in tents
most isolated populations, carrying out 6800 consultations
around Carrefour hospital. Our surgeons performed more
between April and December.
than 5700 major surgical procedures during the first three
south Port-au-Prince, was still operational, but it was quickly 400 critically injured patients had arrived at Martissant.
months, 150 of which involved amputations.
HAITI Primary healthcare, secondary healthcare, surgery, obstetrics, emergency healthcare, mental healthcare, response to epidemics Total Field Staff: 3104 (including earthquake
Emergency field hospitals were set up in all kinds of structures
response for all Médecins Sans Frontières sections) Funding: A$421,902 (approx 1% of total project costs) Project locations: Port-au-Prince
and post-operative care. More than 500 patients underwent
In the wake of the devastating earthquake of 12 January 2010,
Médecins Sans Frontières to help patients recover and adapt
which killed an estimated 222,000 people and left 1.5 million
to prosthetics. Mental healthcare was also provided.
– a dental clinic at Bicentenaire, a school in Carrefour, and semi-permanent buildings in Léogâne, west of Port-au-Prince. In Sarthe, we opened a centre for post-emergency surgery specialised orthopaedic or reconstructive surgery. Handicap International physiotherapists worked in collaboration with
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Projects funded by Australian donors continued Jacmel, a town on the south coast, was also badly hit by the
other health providers. Médecins Sans Frontières provided
earthquake, and our teams started supporting the 80-bed Saint
psychosocial or psychiatric support to more than 40,000
Michel hospital on 22 January. Staff carried out 662 surgical
people during the initial emergency phase.
operations and delivered 1443 babies over the course of the year. By the end of June, Médecins Sans Frontières had distributed As our emergency obstetric hospital had been destroyed,
more than 28,640 tents, approximately 2800 rolls of plastic
Médecins Sans Frontières started offering staff, drugs and
sheeting, and close to 85,000 relief supply kits (made up of
obstetrics expertise to support the Ministry of Health maternity
items such as cooking utensils, hygiene products and blankets)
hospital, Isaïe Jeanty, which had not been damaged by the
to people living near the epicentre of the earthquake.
earthquake. Isaïe Jeanty treats pregnant women with medical complications such as eclampsia and malaria, and provides
Much of Médecins Sans Frontières’ water and sanitation work
neonatal and postnatal services and a blood bank. In Léogâne,
focused on creating the appropriate hygiene conditions to
our staff set up a 120-bed field hospital, which was later replaced
carry out medical and surgical programs. Teams ensured the
with a more permanent container hospital. More than 15,000
supply of safe water, constructed or rehabilitated latrines, and
babies were delivered in Médecins Sans Frontières supported
set up the safe evacuation of waste at our 26 facilities.
facilities in 2010. In mid-October, suspected cases of cholera, a disease not When Médecins Sans Frontières’ La Trinité hospital was destroyed,
reported in the country for decades, emerged in the Artibonite
Haiti lost its only specialised treatment unit for severe burns.
region, western Haiti. Médecins Sans Frontières dispatched
Re-establishing this unit became a priority, especially given
teams to the town of Saint Marc and they immediately began
the dangerous living conditions. By late March, a new 30-bed
treating patients for severe dehydration from diarrhoea in the
burns unit had been set up under canvas within the nearby
Ministry of Health hospital.
Saint Louis hospital compound. The outbreak would eventually touch every province in the Psychiatric care was also organised at Saint Louis hospital for
country. From 22 October until the end of the year, our teams
patients who required mental health services and could be
treated more than 91,000 of the 171,300 people reported as
referred from other Médecins Sans Frontières programs or
having cholera nationwide. Specialised treatment centres were set up for pregnant women in Isaïe Jeanty hospital and in
A field worker speaks with a patient trapped under the collapsed La Trinité hospital in Port-au-Prince, Haiti. Following the earthquake, he was trapped under the building for four days before being rescued. © Ron Haviv/VII
Léogâne. Teams established over 4000 beds in 47 facilities around the country. More than 1000 tons of medical and logistical supplies were delivered, and more than 5500 staff dedicated to cholera treatment.
IRAN Primary healthcare, maternal and child healthcare Funding: A$2,560,000 (approx 62% of total project costs) Project locations: Zahedan One to two million undocumented Afghans are estimated to be living in Iran. People are continually crossing the border between the two countries, both voluntarily and under pressure from Iran’s policy of repatriation. Most of the Afghans living in Iran are longstanding residents. For more than a decade, Médecins Sans Frontières’ assistance in Iran has focused on medical support for vulnerable and
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Projects funded by Australian donors continued IRAQ Surgery, emergency healthcare, dialysis Total Field Staff: more than 76 Funding: A$1,980,000 (approx 20% of total project costs) Project locations: Kirkuk, Ninewa, Amman (Jordan) The seventh year of violence and political tension since the war began saw continuing pressure on the emergency capacity of the health system in Iraq. The needs are not only for trauma care following explosions but for a whole range of specialist services. Direct access to victims of the violence in the most densely populated areas remains limited for international and independent humanitarian organisations. Activities are still considerably restricted by the remaining threats to staff, but the response to pressing needs in the country developed in new directions in 2010. The ability to travel and work in some of the more stable parts of the country has increased Médecins Sans Frontières’ A child is assisted during a rehabilitation session in Zahedan, Iran. For more than a decade, Médecins Sans Frontières’ assistance in Iran has focused on medical support for vulnerable and minority groups. In 2010 staff held more than 6300 consultations per month in three clinics in Zahedan. © Marit Helgerud/MSF
capacity to support more complex areas of medicine and to raise standards of care. Although many health facilities are functioning, the quality of
minority groups. We have opened three clinics in Zahedan,
care has been affected by a shortage of specialised staff and
the provincial capital of Sistan-Baluchestan. In 2010 staff held
lack of training. According to the Iraqi health ministry, hundreds
more than 6300 consultations per month. Médecins Sans
of medical employees have been killed in the course of the
Frontières refers patients requiring specialist medical and
conflict and great numbers have fled the country.
surgical care to Ministry of Health structures, covering the costs of emergency care, specialist consultations, treatment
Iraq is short of nurses and of specialist doctors and there has
and hospitalisation. All referrals are followed up by a Médecins
been no upgrading of skills since the early 1990s. Iraq’s doctors
Sans Frontières doctor.
once provided some of the highest quality and best resourced services in the region, but now the quality of some medical
In a fourth clinic, our team focuses on maternal and paediatric
services is seriously impaired.
care. Our staff ensures that uncomplicated deliveries are performed at the national safe delivery centres, and high-risk
The pattern of remote support for Iraqi staff and for Ministry
births are referred to the city’s hospitals. A home visitor team,
of Health facilities still prevails, with Médecins Sans Frontières
which includes midwives, ensures postnatal care directly in
providing more general support to four hospitals in Kirkuk
patients’ homes.
and Ninewa by providing medical supplies and supporting emergency response and health education campaigns.
There is also a team responsible for identifying vulnerable people and ensuring that they get the care they need. Staff
Médecins Sans Frontières has carried out training in on-the-
make home visits in Zahedan to find returnees, identify their
spot triage, a process for determining the priority of patients’
needs, and offer training in basic hygiene and distribute relief
treatments based on the severity of their condition. As a result,
items such as food, cleaning materials, blankets and heaters.
a functioning triage system has now been implemented in all four emergency departments. In Kirkuk, Médecins Sans Frontières also supports the dialysis unit of the public hospital and started a renal treatment
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Projects funded by Australian donors continued program in June 2010 for patients with severe kidney failure. The target is to treat around 80 people who need the complex dialysis procedure. In the northern city of Hawijah, a Médecins Sans Frontières surgical team of Iraqi doctors in the general hospital performs around 300 operations a month. The reconstructive surgery program in the Jordanian capital of Amman, which was started in 2006, continued to receive Iraqi patients. In 2010, more than 300 people benefited from the orthopaedic, maxillofacial and plastic specialties. Treatment and follow-up are complex, requiring months of hospitalisation. The team carried out 19,000 individual physiotherapy sessions over the year.
KENYA HIV/AIDS, tuberculosis, sexual violence, primary healthcare, obstetrics, surgery, paediatrics, nutrition Total Field Staff: 368
In the Kenyan capital Nairobi, Médecins Sans Frontières provides HIV/AIDS and TB treatment in the slum area of Mathare. Here, 3170 people living with HIV/AIDS are receiving care at the Blue House clinic, with 2522 on antiretroviral treatment. © William Martin/MSF
Funding: A$3,100,000 (approx 21% of total project costs) Project locations: Homa Bay, Nairobi, Dadaab
refugees, there is little solace to be found on the Kenyan side of the border. Médecins Sans Frontières has taken charge of the healthcare needs of refugees living in Dagahaley camp,
There are 1.5 million people living with HIV/AIDS in Kenya,
part of a complex of refugee camps near Dadaab. There are
and Médecins Sans Frontières’ work in the country continues
300,000 people living in a space made for 90,000 in the Dadaab
with a strong focus on HIV care. In an effort to improve access
camps. With the camps already overcrowded, new arrivals have
to treatment, Médecins Sans Frontières has extended its
been forced to settle in makeshift shelters outside.
decentralised care program in Homa Bay, the district most affected by the epidemic. In collaboration with the Ministry of
Each week, there are 1400 to 1500 new arrivals from Somalia.
Health, our team ensured that treatment is available in eight
Médecins Sans Frontières has been working in the camp since
healthcare clinics across Homa Bay: 10,000 people living with
2009, running a 110-bed hospital and four health posts. In
HIV received care, of whom, 850 were children under 15 years old.
2010, an average of 10,000 general consultations were held and 600 patients were admitted to the hospital every month.
In the capital Nairobi, Médecins Sans Frontières provides
In addition to providing medical services in Dagahaley camp,
HIV/AIDS and TB treatment in the slum area of Mathare. Here,
our team also provided shelter material to 700 families and,
3170 people living with HIV/AIDS are receiving care at the Blue
with other organisations, ensured the supply of clean water
House clinic, with 2522 on antiretroviral treatment.
for the new arrivals.
In Mathare, the team also started operating a 24-hour on-call
KYRGYZSTAN
service for sexual and gender based violence. The clinic offers
Tuberculosis Total Field Staff: 34
post-exposure prophylaxis – medication that greatly reduces treat around 70 patients every month, many of whom are children.
Funding: A$200,000 (approx 10% of total project costs) Project locations: Bishkek
In eastern Kenya, near the Somali border, teams provided
Médecins Sans Frontières has been treating prisoners infected
healthcare where hundreds of thousands of Somali refugees
with TB in Kyrgyzstan since 2005. The incidence of the disease
live in camps around the town of Dadaab. For many Somali
in prisons has declined over the years: the number of patients
the risk of HIV infection – counselling and social support. Staff
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Projects funded by Australian donors continued MALAWI HIV/AIDS, response to epidemics Total Field Staff: 2283 Funding: A$3,368,500 (approx 30% of total project costs) Project locations: Chiradzulu In 2010, Malawi experienced its worst outbreak of measles since 1997: 105,000 cases and 251 deaths were reported. Between April and August, Médecins Sans Frontières teams helped authorities deal with the outbreak, conducting a vaccination campaign in nine districts for 3.3 million children aged between six months and 15 years. Our teams also supported the treatment of nearly 23,000 people for measles in 15 districts across the country, with a particular focus on the hard-hit southern region. The response to the emergency involved almost 1800 Médecins Sans Frontières staff. Colony 31 prison in Bishkek, Kyrgyzstan. Médecins Sans Frontières has been treating prisoners infected with TB in Kyrgyzstan since 2005. In 2010, our team treated 230 new TB patients. Around two-thirds of infectious TB patients in the penitentiary system have drug-resistant TB. © William Daniels / Panos pictures
Malawi has an ambitious HIV/AIDS treatment plan, but it continues to face a severe shortage of healthcare professionals. A lack of international donor commitments from governments
detected each year dropped from 700 to 350 between 2006
or the Global Fund to implement the treatment plan makes the
and 2010. This is mainly because of a reduction in the prison
fight against HIV a mammoth task. In 2009, more than 920,000
population. Around two-thirds of infectious TB patients in
people (11 per cent of people aged between 15 and 49 years)
the penitentiary system have drug-resistant TB (including all
were estimated to be infected with HIV, while the country had
forms of drug-resistant TB). The treatment program for drug-
an average of only two doctors per 100,000 inhabitants.
resistant TB is often very long and difficult. In 2010, our team treated 230 new TB patients.
By the end of 2010, more than 345,000 people had been enrolled in the national antiretroviral (ARV) treatment program,
Prisoners diagnosed with TB are referred to treatment facilities in three prisons in and around Bishkek, where staff work in collaboration with the Ministry of Health, the prison authorities and international organisations such as the International Committee of the Red Cross. One of the most important challenges is to assure uninterrupted treatment after release, as one-third of TB patients are released from prison before treatment is completed. Médecins Sans Frontières provides medical and social support to former prisoners with TB and is working to find ways to motivate them to complete their treatment. In 2010, 78 TB patients were released from prison, and 57 of them were still receiving treatment at the end of the year. Médecins Sans Frontières is advocating for a national TB control policy in the penal system.
Children line up to be vaccinated against measles during an outbreak in Lilongwe, Malawi. In 2010, Malawi experienced its worst outbreak of measles since 1997: 105,000 cases and 251 deaths were reported. Between April and August, Médecins Sans Frontières teams helped authorities deal with the outbreak, conducting a vaccination campaign in nine districts for 3.3 million children aged between six months and 15 years. © Nabila Kram
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Projects funded by Australian donors continued representing an estimated 63 per cent of patients requiring
We helped to increase the capacity of the paediatric department
ARV treatment.
in the district hospital of Koutiala. A team of Médecins Sans Frontières and Ministry of Health staff set up a paediatric
In 2003 Médecins Sans Frontières started providing ARV
intensive care unit, built wards to allow the hospitalisation of
treatment to people with HIV in Malawi and its programs
children with complicated malnutrition, offered staff training
soon evolved to include the prevention of mother-to-child
and assured a regular supply of drugs and medical material.
transmission, the detection of treatment failure, and the
More than 9900 children were admitted to the hospital in
provision of paediatric HIV care. Médecins Sans Frontières is
2010. More than 82 per cent of these children had malaria.
also assisting the Ministry of Health in instituting the provision of decentralised healthcare for HIV and TB from district-level
The Ministry of Health and Médecins Sans Frontières began
hospitals to community clinics and rural health posts.
a joint project in the district of Konseguela, also in Sikasso region, in March 2010. The project aims to find new approaches
In the district of Chiradzulu, our team supports HIV programs
to reducing mortality among children under five, and focuses
in 11 health centres, offering testing, holding consultations,
on simplifying and decentralising the treatment, early detection
supplying medicines, and providing dedicated TB treatment
and prevention of the main killer diseases – malaria, malnutrition,
services. By the end of 2010 more than 18,000 people living
pneumonia and diarrhoea.
with HIV in Chiradzulu were receiving ARV treatment, with some 650 new patients starting the program each month.
A clinic is held at the health centre in Konseguela, offering regular check-ups for children under two. These children
Despite having ambitious HIV treatment program guidelines
regularly receive ready-to-use food in an effort to compliment
in line with new World Health Organization recommendations,
their dietary intake in micronutrients, protein and calories to
implementation of these plans will be delayed or staged
prevent severe malnutrition. In December 2010, more than
according to available resources. Malawi did not receive
1250 children were enrolled in the program. Families with
much-needed money from the Global Fund’s most recent round
young children also receive mosquito nets. Almost 50 per cent
of funding, which ended in December 2010. These dwindling
of the 15,000 consultations held at the health centre in 2010
funding commitments point to a growing disconnect between
related to malaria.
the international community’s bold and ambitious visions for achieving global health goals, and its inability to fully support
Every month, a team visits all 17 villages in this district and
such recommendations.
carries out routine immunisations against TB, polio, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, Haemophilus
MALI
influenza type b (which can cause meningitis and pneumonia),
Paediatrics, nutrition, malaria, meningitis Total Field Staff: 305
measles and yellow fever.
Funding: A$900,000 (approx 11% of total project costs) Project locations: Konseguela, Koulikoro, Koutiala
In July 2010, trained staff in all of the villages began carrying out early screening for malaria, offering a rapid diagnostic test and treatment in order to reduce the development of severe
In the southern district of Koutiala in Sikasso region, near the
forms of the disease. Staff treated 9400 children under five
border with Burkina Faso, more than one in five children die
for non-complicated malaria in 2010.
before reaching the age of five. In July 2009, Médecins Sans Frontières started offering paediatric care, including treatment
A sharp decrease in child mortality has been reported by local
for malnutrition, to children under five in Koutiala town and
authorities and communities since Médecins Sans Frontières
in five of the 42 health areas in the district. In 2010, staff
began activities in Konseguela.
conducted 48,100 paediatric consultations, 33,300 of whom were diagnosed with malaria. A further 5360 children were
In December 2010, Médecins Sans Frontières participated in
treated for severe malnutrition.
the national preventive vaccination campaign against meningitis using a new vaccine that provides extended coverage against
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Projects funded by Australian donors continued the disease (over ten years) and stops transmission by eliminating
Sans Frontières also provides a buffer supply of HIV and TB
the carriage of the germ. With Ministry of Health staff, 85 teams
drugs to health facilities.
vaccinated more than 728,900 people aged between 1 and 29 years in three districts of the Koulikoro region.
MYANMAR
MOZAMBIQUE
HIV/AIDS, tuberculosis, primary healthcare Total Field Staff: 92
HIV/AIDS, tuberculosis Funding: A$1,200,000 (approx 30% of total project costs) Project locations: Maputo
Funding: A$600,000 (approx 22% of total project costs) Project locations: Dawei Low national and international investment in the health sector
Despite Mozambique’s recent economic growth many people
combined with tensions and low intensity conflicts limit access
in the country remain dependent on international aid. Of the
to healthcare in many areas of Myanmar. The country remains
1.6 million people living with HIV, about 430,000 are in urgent
largely isolated on the international stage and faces severe
need of life-extending antiretroviral (ARV) treatment. Along
restrictions from the international aid community. Despite the
with HIV, TB presents a serious public health concern, and up
return of the Global Fund, the country continues to suffer from
to 60 per cent of TB patients are also infected with HIV. For the
a chronic lack of resources to tackle diseases like HIV/AIDS, TB
majority of Mozambicans, access to healthcare remains very
and malaria.
limited and the frail healthcare system struggles with the high number of people infected with both HIV and TB.
More than 240,000 people are living with HIV in Myanmar, and an estimated 120,000 are in need of lifesaving antiretroviral
Over the past decade, Médecins Sans Frontières has established
(ARV) treatment. However, treatment is currently available to
standardised procedures for HIV care and treatment, paying
only 21,000 people.
special attention to treating HIV and TB co-infections. The comprehensive HIV/AIDS programs offer testing, pre- and
In Dawei district, in the south of Myanmar, Médecins Sans
post-test counselling, treatment and prevention of opportunistic
Frontières runs an HIV and TB clinic for a local population
infections that can occur as a result of a compromised immune
consisting mainly of migrant workers and fishermen. Staff also
system, psychological support, paediatric diagnosis and
conduct outreach activities in the surrounding district, going
treatment, and prevention of mother-to-child transmission.
out in the community to test people and see patients who may not be following their treatment regime. At the end of 2010,
Our teams support the Ministry of Health in providing integrated
there were 2126 enrolled in the HIV program, with 1836 patients
HIV/AIDS and TB care in five health centres in the health zone
receiving ARV treatment. There were also 421 patients registered
of Chamanculo in the capital Maputo. By the end of 2010,
in the TB treatment program. Médecins Sans Frontières also
there were 58,044 patients enrolled in the HIV treatment
provides primary healthcare to particularly vulnerable populations
program, with 12,132 receiving ARV treatment. Médecins Sans
in Thayetchaung and Palaw townships through a network
Frontières also supported the referral centre Alto Mae, where
of mobile clinics. The main morbidities are respiratory tract
more complicated patients were admitted.
infections and malaria.
To ensure that patients get care and treatment despite the
NIGER
country’s shortage of healthcare workers, Médecins Sans
Nutrition, paediatrics Total Field Staff: 782
Frontières is trying to develop programs such as task-shifting. Task-shifting trains nurses to independently assess patients, diagnose and treat opportunistic infections, and initiate and
Funding: A$800,000 (approx 13% of total project costs) Project locations: Zinder
monitor ARV treatment, thereby taking on some of the responsibilities of doctors.
Nutritional crises are a chronic problem in Niger, but a particularly poor harvest in 2009 made the 2010 crisis far worse. Global
Where the supply of HIV and TB drugs falls short, Médecins
acute malnutrition rates among children passed the emergency
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22
Projects funded by Australian donors continued threshold of 15 percent, with more than three percent of
An ambitious target was set: to reach more than 650,000
under-fives suffering from severe acute malnutrition.
children. Médecins Sans Frontières provided supplementary food rations to thousands of children aged six months to
The extent of the food crisis was recognised early, and the
three years, and results of a survey carried out in Zinder region
Ministry of Health, international organisations and national
during the second half of 2010 show that this strategy had a
associations treated 328,000 children for severe acute malnutrition.
significant impact on mortality rates.
Even when receiving good care in a high-quality nutrition
In Zinder region, Médecins Sans Frontières supported 19 health
program, between three and five per cent of patients suffering
centres in the departments of Mirriah and Magaria with feeding
severe acute malnutrition will die. For some years, Médecins
programs, providing extra staff and essential drugs to ensure
Sans Frontières’ nutrition projects in Niger have been implementing
free healthcare for children under five. A network of 250
a preventive approach. Children under two years of age who
community health workers was built up and dispatched across
are suffering moderate malnutrition or are at risk of malnutrition,
Magaria to screen children for signs of malnutrition and encourage
are given ready-to-use supplementary food before their condition
parents to seek treatment for their children. Médecins Sans
can deteriorate to the level of severe acute malnutrition.
Frontières managed two therapeutic feeding centres. More than 34,000 malnourished children received treatment for severe
In 2010, this innovative approach was taken up for the first time
and acute malnutrition in these centres. The supplementation
by the Niger government, the UN and their partner organisations.
program in Mirriah district reached more than 106,500 moderately malnourished children or children at risk of malnutrition. Our teams also provided technical support to BEFEN/ALIMA, a local association running 15 outpatient feeding centres and one therapeutic feeding centre in Mirriah department. In Zinder, Médecins Sans Frontières also treated more than 72,500 cases of malaria. Over a quarter of the children hospitalised for malnutrition were also suffering from malaria.
OCCUPIED PALESTINIAN TERRITORY Surgery, post-operative care, mental healthcare Total Field Staff: 119 Funding: A$900,000 (approx 16% of total project costs) Project locations: Gaza The conflict with Israel and the inter-Palestinian conflict within the Occupied Palestinian Territory continued to traumatise the population in 2010. Economic, social and political pressures are all making an already poor health situation far worse. The demand for psychological care is high, but capacity is limited because of a significant shortage of trained medical staff. It can be difficult for people in need of mental healthcare to find help. The team in Gaza provides psychological care as well A mother walks home carrying a supply of supplementary food in Niger. Nutritional crises are a chronic problem in Niger, but a particularly poor harvest in 2009 made the 2010 crisis far worse. As well as providing treatment for malnourished children, Médecins Sans Frontières also provided supplementary food rations to thousands of children aged six months to three years to prevent them becoming severely malnourished. © Anthony Bourasseau / MSF
as medical and social support to address the traumatic and violent consequences of the conflicts. Médecins Sans Frontières teams have been working in the Gaza Strip since 2000, adapting their activities according to the needs
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23
Projects funded by Australian donors continued The floods that hit Pakistan in 2010 affected around 14 million people. The waters swept down from the mountainous northeast into the heavily populated river valleys and plains, driving desperate people ahead of them. In a country already suffering gaps in healthcare provision the need for assistance grew enormously. Médecins Sans Frontières was the first international emergency organisation to respond to the disaster in many flood-hit areas. Along with local organisations, our teams were able to react immediately to meet the needs of people affected by the floods. As the disaster unfolded, we expanded operational activities, based on our independent assessment of people’s needs, following the path of the worst flooding from Balochistan, to Khyber Pakhtunkhwa, Punjab and finally Sindh. Funding from Médecins Sans Frontières Australia contributed to the flood response in Peshawar, Nowshera and Hangu in Khyber Pakhtunkhwa, as well as in Kot Addu in Punjab province. As the exceptional monsoon rains fell, rivers broke their banks, A patient is assisted at the post-operative care clinic in Gaza City, Occupied Palestinian Territory. In 2010, more than 180 surgical operations were performed and mental health staff held almost 3400 consultations. The rehabilitation team carried out more than 33,000 physiotherapy sessions. © Isabelle Merny / MSF
washing away bridges, roads, villages and livelihoods. Food
of the population. In 2010, despite having been partially lifted,
for the relief effort.
and safe water were in short supply. The risks of illness and contagion, and the sheer number of vulnerable people completely exposed to the elements were major challenges
the blockade was still affecting healthcare, restricting availability, provision for people with special needs, and the general quality
At the height of the flood response, more than 1600 Médecins
of care. One of the main objectives is to transfer expertise to
Sans Frontières staff were supporting hospitals, treating injuries
local Palestinian staff, who are unable to leave the territory for
and illnesses, running mobile clinics and distributing tents,
professional training. Médecins Sans Frontières is also filling
shelter materials, and washing and cooking kits. One of the
specific gaps in medical care, providing specialised surgery
most urgent needs was for safe drinking water and our teams
(reconstructive and orthopaedic) and rehabilitation for trauma
distributed up to 2.1 million litres a day. Set against the
patients, as well as medical and psychosocial assistance to help
requirements of so many uprooted people, even these figures
patients cope after experiencing trauma. In 2010, more than
were dwarfed by the scale of the disaster.
180 surgical operations were performed and mental health staff held almost 3400 consultations. The rehabilitation team
Overall in the emergency, Médecins Sans Frontières conducted
carried out more than 33,000 physiotherapy sessions.
over 100,000 consultations in five hospitals, seven mobile clinics and six diarrhoea treatment centres. Our teams conducted 434
PAKISTAN
complicated deliveries and 82 caesarean sections and treated
Primary healthcare, obstetrics, surgery, response to epidemics Total Field Staff: 1936 (including flood response
more than 8800 malnourished children.
from all Médecins Sans Frontières sections) Funding: A$1,601,500 (approx 18% of total project costs) Project locations: Peshawar, Hangu, Kurram, Nowshera, Punjab, Darband
before, during and after the floods, as it had for the last five
Fighting continued in the northern regions of the country years and our teams continued to provide emergency services for people affected by conflict. In Khyber Pakhtunkhwa and the Federally Administered Tribal Areas (FATA), the violence
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24
Projects funded by Australian donors continued shut down hospitals, access roads and the transport of medical
leishmaniasis, a parasitic disease transmitted by sand flies.
supplies. Even if emergency patients found their way to hospital,
The disease causes ulcer-like lesions and can lead to
the limitations of nursing care and low standards of equipment
severe disfigurement.
and hygiene did not ensure good quality services. More than one million people depended on Médecins Sans Frontières to
In May 2010, Médecins Sans Frontières closed its project in the
provide free emergency surgery.
town of Darband, where the team had been supporting the hospital to provide care to the population of the remote and
A new project covering emergency department services and
difficult to access Kala Dhaka valley.
emergency surgery was opened in Hangu district, close to the tribal areas, and treated around 1300 patients a month. The
REPUBLIC OF CONGO
team also supports maternity activities in the hospital.
Primary healthcare, emergency healthcare, surgery, obstetrics/gynaecology, paediatrics, response to epidemics
In Peshawar, our teams supported up to seven basic health units with medical personnel, drugs and medical supplies in order to provide primary healthcare to hundreds of thousands
Funding: A$640,000 (approx 7% of total project costs) Project locations: Bétou, Impfondo, Pointe-Noire
of internally displaced people who had fled to the area in 2008 and 2009 due to conflict. The project was closed in October
At the end of 2009, tens of thousands of people crossed the
2010 after the majority of people had returned home.
Ubangi River to the Republic of the Congo, seeking refuge from fighting in Equateur province of the Democratic Republic
In Kurram Agency, in FATA, Médecins Sans Frontières runs
of the Congo. The population of Likouala province, in the
paediatric outpatient departments in two villages and also
Republic of the Congo, doubled as a result. Médecins Sans
launched a program to treat people suffering from cutaneous
Frontières teams have been working along the river to improve the availability of healthcare in the area. When our team arrived in the town of Bétou, only the hospital and one of the three district health centres were functioning. The hospital had been built by Médecins Sans Frontières in 2003, and teams reorganised the emergency, outpatient, medical, paediatric and surgical departments and added gynaecological, obstetric, nutrition and laboratory services. Each month, 340 patients were admitted to the hospital and around 3000 consultations were held, mostly in relation to respiratory infections, malaria and diarrhoea. There are now six functional health centres in the district. To reach more remote settlements, mobile medical teams travel up and down the river by boat, providing general consultations and antenatal care, and treating severe malnutrition. These teams carried out an average of 10,000 consultations a month, with the most urgent cases being referred to Bétou hospital. Further south, in the town of Impfondo, Médecins Sans
In 2010, Médecins Sans Frontières opened a new project supporting emergency department services and emergency surgery was opened in Hangu district, Pakistan, and treated around 1300 patients a month in 2010. © Vali
Frontières started the year supporting the medical, emergency, maternity, surgical and paediatric wards in the general hospital. Teams also worked in health centres and operated
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25
Projects funded by Australian donors continued The health authorities and international agencies carried out a polio vaccination campaign, targeting around three million people. Médecins Sans Frontières lent logistical support for the vaccination of some 90,000 people living around Bétou.
SOMALIA Primary healthcare, secondary healthcare, emergency healthcare, obstetrics, nutrition, response to epidemics Total Field Staff: 362 Funding: A$3,200,000 (approx 38% of total project costs) Project locations: Mogadishu, Jamaame, Belet Weyne The security situation in Somalia deteriorated further in 2010 and while needs have grown, basic medical services continue to dwindle. Despite a number of incidents directly affecting our staff in recent years, Médecins Sans Frontières is still working Constructing a well in the Republic of Congo. At the end of 2009, tens of thousands of people crossed the Ubangi River to the Republic of the Congo, seeking refuge from fighting in Equateur province of the Democratic Republic of the Congo. Médecins Sans Frontières teams have been working along the river to improve the availability of healthcare in the area. © Roselouise Cadot / MSF
in the country. International staff are unable to stay for long periods in Somalia due to the security risks, so Médecins Sans Frontières’ projects
mobile clinics to the north and south of the town, carrying
depend heavily on the commitment of Somali staff, supported
out around 3600 consultations a month. In July, Médecins
by teams of specialist staff based in Nairobi who visit the
Sans Frontières moved its activities to the 20-bed hospital in
projects when possible.
Bolembé, 60 kilometres south of Impfondo, to be closer to the refugee population.
Fighting in Mogadishu was continuous in 2010, with major offensives in February and during Ramadan in August. It is
At the end of 2010, a polio epidemic broke out in the southeast
estimated that only 500,000 people remain in the capital. For
of the country, centred in the city of Pointe-Noire. In total, 542
these remaining residents, healthcare facilities are virtually
cases were recorded by the national health authorities, and
non-existent. There are two public hospitals, which provide
220 people died. The resurgence of the disease, the extremely
surgery only for war-related injuries. The few clinics that are
high mortality rate, and the fact that males aged 15 to 30 were
running charge fees for services that are of unreliable quality.
the most affected group were all cause for concern. Daynile hospital is nine kilometres northwest of Mogadishu. At the request of the Ministry of Health and the World Health
Médecins Sans Frontières provides free emergency surgery and
Organization, Médecins Sans Frontières began work in the
care for the war-wounded. The hospital has 59 beds and is
intensive care unit at a hospital in Pointe-Noire at the beginning
equipped with two operating theatres and an intensive care unit.
of December. The peak of the epidemic had already passed
Médecins Sans Frontières also provides financial support and
by the end of the year, but dozens of patients were still being
medical supplies. In 2010, more than 5500 patients were admitted
admitted every day. Medical teams treated the symptoms of
to the emergency department. Staff performed 1136 surgeries.
the disease (such as breathing difficulties and muscle spasms) and two outpatient physiotherapy centres were set up to help
In Jamaame in the south of the country, Médecins Sans Frontières
patients who had left hospital before their treatment was
supported the inpatient and outpatient departments of the 61
complete. The program will end in 2011 with the association
bed hospital and provided treatment for patients with malaria
Handicap International taking on the provision of physiotherapy
and malnutrition. They also conducted more than 5800 antenatal
and mobility aids to patients.
consultations and assisted in 127 deliveries.
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26
Projects funded by Australian donors continued In the town of Belet Weyne, not far from the Ethiopian border, our team runs a 120 bed hospital and provides comprehensive secondary level healthcare including an emergency room, surgery, an inpatient department, a maternity department and nutritional activities. In January, the area experienced significant insecurity and teams treated wounded patients suffering multiple fractures, abdominal and chest injuries. On 12 January, the hospital was hit by a mortar and two Médecins Sans Frontières staff members were injured. In 2010, staff assisted 483 deliveries, conducted 875 surgical interventions and carried out 14,102 consultations in the emergency room.
SUDAN Primary healthcare, obstetrics, paediatrics, nutrition, response to epidemics Total Field Staff: 553 Funding: A$1,550,000 (approx 4% of total project costs) Project locations: Aweil, Abyei/Agok, Al Gedaref Medical needs among the people of Sudan remain significant, with security and administrative constraints hampering efforts
Dr Nina Doench with the medical team during their ward rounds at the hospital in Agok, Abyei Special Area, Sudan. In Agok Médecins Sans Frontières teams provide primary and secondary healthcare, including reproductive healthcare and treatment for malnutrition. Between January and November 2010, staff carried out over 27,812 outpatient consultations and there were 668 deliveries in the maternity ward. © Kate Geraghty
to reach the most vulnerable. In the south, access to healthcare is particularly poor.
more than 37,000 antenatal consultations, assisted more than 3000 births, and treated some 2600 children for malnutrition.
A five-year-old peace agreement between the government in Khartoum and southern rebels has ended 22 years of brutal
Médecins Sans Frontières has been working in the transitional
civil war, but conflict persisted in south Sudan as economic
area of Abyei since 2006. Our teams provide primary healthcare
and political changes following the agreement have resulted
services through an outpatient clinic in Abyei town, offering
in violent struggles for power. Nonetheless, in anticipation
nutritional support for children under the age of five, as well
of the January 2011 referendum on secession, hundreds of
as maternity and paediatric services, and also respond to
thousands of people made the journey back to south Sudan,
emergencies. Médecins Sans Frontières was running five mobile
adding to the two million who had already returned since the
clinics in the northern part of Abyei up until July 2010, when
peace agreement was signed.
mobile clinic activities were suspended due to security concerns.
Médecins Sans Frontières has been working in the emergency,
In May 2008, following violent clashes in the transitional area
maternity and paediatric departments of Aweil Civil Hospital,
of Abyei, nearby Agok became a host town to thousands of
in Northern Bahr El Ghazal state, since 2008. Our team works
displaced people. Médecins Sans Frontières responded quickly
with the Ministry of Health to reduce maternal and paediatric
by setting up an emergency medical program caring for the
mortality, treat malnutrition and respond to emergencies.
wounded and displaced. There are 60 inpatient beds and the
Staff perform surgery, including caesarean sections, provide
medical teams provide primary and secondary healthcare,
gynaecological consultations including antenatal and postnatal
including reproductive healthcare and treatment for malnutrition.
care, as well as vaccinations. The hospital has an inpatient
Between January and November 2010, Médecins Sans Frontières
therapeutic feeding centre and an outpatient feeding program.
staff carried out over 27,812 outpatient consultations, 1450
More than 18,000 returnees moved to camps around the town
patients were admitted to the inpatient department and more
in 2010. Médecins Sans Frontières helped the hospital to cope
than 3164 pregnant women were seen in the antenatal clinic.
with increased demand for medical care and staff conducted
In the same period, there were 668 deliveries in the maternity
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27
Projects funded by Australian donors continued ward, 10,141 nutrition screenings and 2283 children were
The results of TB treatment, which is a notoriously long and
treated for severe malnutrition.
difficult process for the patient, also saw marked improvement.
In the east of the country, Médecins Sans Frontières launched
Managing DR-TB is a growing challenge. Médecins Sans Frontières
emergency nutrition programs in Al Gedaref state. Staff treated
supported the decentralisation of DR-TB care to the three main
more than 6000 malnourished children under the age of five.
health facilities in Shiselweni in an effort to improve patients’
Following the emergency response, we began an observation
access to treatment. A new DR-TB ward with a laboratory is
project with the Ministry of Health in order to formulate a
being built, and will be finished in June 2011.
quicker response if needed in the future. Swaziland is desperately short of doctors, and because of limited
SWAZILAND
resources, not enough nurses are being trained. For Médecins
HIV/AIDS, tuberculosis
Sans Frontières, the solution is to entrust more tasks and
Funding: A$2,000,000 (approx 25% of total project costs) Project locations: Shiselweni
responsibilities to other personnel by training nurses to prescribe medicine or treat cases of uncomplicated, nonresistant TB, for example.
Swaziland is facing a health emergency of immense proportions. According to the World Health Organization, HIV prevalence
In line with this idea, Médecins Sans Frontières has enlisted
is the highest in the world, at 25.9 percent among adults
the support of “expert patients”. These are people living with
aged 15 to 49, and there are more than 1250 cases of TB per
HIV/AIDS who carry out screening, advise and inform new
100,000 people. TB is the leading cause of mortality among
patients about treatment, and raise awareness of HIV in their
people living with HIV and, to make matters worse, cases of
communities. In 2010, 80 expert patients were working for
drug-resistant TB are increasing: 10 per cent of all TB cases
Médecins Sans Frontières in Swaziland.
diagnosed are resistant to TB medication. Life expectancy in the country has plummeted over the past two decades – from
UGANDA
an average of 60 years to 41 years.
HIV/AIDS, tuberculosis, nutrition Total Field Staff: 206
Swaziland is a rural country of many small, isolated villages.
Funding: A$1,000,000 (approx 15% of total project costs) Project locations: Arua
The cost of long and frequent journeys to health facilities is often prohibitive for patients, so Médecins Sans Frontières has developed a decentralised, community-based approach to
It is estimated that more than one million adults and children
care. People living in the community have been trained as HIV
are living with HIV/AIDS in Uganda. The prevalence rate among
counsellors and to test for the disease. The aim is to increase
adults is estimated to be 6.3 percent.
the overall number of people being tested, so that more people with HIV can begin treatment earlier. By decentralising care,
Médecins Sans Frontières has been working in Arua in the West Nile
Médecins Sans Frontières hopes that fewer patients default
region in north-western Uganda since 2002. The Arua Hospital
from their treatment and, in general, patients’ state of health
Aids Program offers treatment for people with HIV/AIDS and/or
will improve.
TB as well as interventions to prevent the transmission of HIV from mother to child. Staff also provide nutritional support for
Throughout 2010, our teams supported all 21 clinics in Shiselweni,
malnourished adults and children living with HIV. Of the more
the poorest and most remote region in the country. Each of
than 8000 patients currently registered at the hospital, almost
these clinics now provides fully integrated care for HIV/AIDS
5500 are receiving antiretroviral (ARV) treatment and 432 pregnant
and TB. Médecins Sans Frontières tested some 14,500 people
women were registered in the Prevention of Mother-to-Child
overall for HIV, tripling the number of tests given each month.
Transmission program. In 2010, 631 patients were treated for TB.
The number of people starting antiretroviral (ARV) treatment doubled. More than 2550 new TB patients began treatment,
Our teams also supported the Ministry of Health in decentralising
including over 100 patients infected with drug-resistant TB (DR-TB).
HIV care by providing support to a health centre in Oli, an
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Projects funded by Australian donors continued area from which more than half of the patients in at Arua
Médecins Sans Frontières provided medical care for 10,000
come from. By October 2010, more than 5000 patients were
internally displaced people living in four camps. The project
receiving ARV treatment there.
was closed in November once the majority of the displaced population had returned home.
Médecins Sans Frontières also runs a paediatric nutrition program in Arua. In the first ten months of the year, 435 patients were admitted to the program. Our team also expanded the intensive care area of the specialised HIV/nutrition paediatric unit used to treat severe cases.
YEMEN Primary healthcare, emergency healthcare, surgery, obstetrics, nutrition, response to epidemics Total Field Staff: 367 Funding: A$700,000 (approx 12% of total project costs) Project locations: Saada, Amran The sixth round of conflict in the northern governorate of Saada, between the Yemeni government and the al-Houthi armed group, was the most intense since the beginning of the war in 2004. A ceasefire was negotiated in February 2010, but sporadic clashes continued to occur throughout the rest of the year. After having had to suspend activities for several months due to the intense fighting, Médecins Sans Frontières resumed work in Al Talh hospital, just outside the town of Saada, in March, and in Razah hospital, near the Saudi border, in April. In total, our staff carried out more than 32,000 consultations. During a measles outbreak between April and June, Médecins Sans Frontières and Ministry of Health staff treated more than 1500 patients, 400 of whom were hospitalised, and carried out a vaccination campaign. In July, Médecins Sans Frontières opened a nutrition program in Al-Jamouri hospital, also in the town of Saada, and treated 820 severely malnourished children. Staff also supported the teaching hospital in Saada. Our teams provided water, relief items and medical care to people displaced by the conflict but still living within Saada. Thousands more moved to neighbouring governorates. In Amran, capital of Amran governorate, Médecins Sans Frontières supported three health structures. Staff provided emergency, postnatal and outpatient services at the Beit-el-Sultan health centre to help the facility cope with the increased number of people needing care. We also began assisting the emergency, surgery, maternity and reproductive health departments. In Mandabah, near the Saudi border,
28
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Summary Activity Charts 2010 Highlights • In 2010, there were 198 field positions filled by Australians and New Zealanders in 36 countries. Twenty eight percent of these were Field Staff on their first mission. • Funding spent on social mission increased 17% to $43.1 million in 2010 from $36.7 million in 2009. 7 million in 2009. • Income from fundraising for the year ended 2010 increased to $56.9 million in 2010 from $43.7 • At the same time, the total cost of fundraising decreased from 16% in 2009 to 14% in 2010. rew from 11 16,300 to 130,800. • The number of people supporting the work of Médecins Sans Frontières Australia grew 116,300
2010 income Field Partners (54.6%) Bequests (5.4%) Other private donations (33.6%) Income from other MSF sections (5.0%) Other income (1.2%) Gifts in kind (0.2%)
Project funds by region
Africa (68.9%)
Field human resources by type
Asia (10.6%) Middle East (19.2%) Americas (1.3%)
Medical (28.8%) Paramedical (43.4%) Non medical support staff (27.8%)
Summary Financial Results Donation Income Total Income Social Mission Costs Total Costs Surplus / (deficit) Reserves
$m 2010
$m 2009
56.9 60.6 43.1 53.3 7.3 14.0
43.7 46.8 36.7 45.9 0.9 6.7
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Médecins Sans Frontières worldwide 2009: Extract from International Activity Report 2009 The figures presented here describe Médecins Sans Frontières’ finances on a combined international level. The 2009 combined international figures have been set up in accordance with Médecins Sans Frontières international accounting standards that comply with most of the International Financial Reporting Standards. The figures have been jointly audited by the accounting firms of KPMG and Ernst & Young in accordance with international auditing standards. A copy of the full 2009 financial report may be obtained upon request. The figures presented here are for the 2009 calendar year. All amounts are in millions of Euros.
Income Private Public International Other Total Income
In M€
In %
572.4 77.9 15.1 665.4
86 12 2 100.0
In M€
In %
462.4 21.7 6.4 490.5 87.4 38.9 126.3 616.8 2.9 51.5
75 4 1 80 14 6 20 100
In M€
In %
433.3 68.5 36.6 538.4 2.5 475.5 -9.8 468.2 70.2 538.4
80 13 7 100 0 89 -2 87 13 100
No. of Staff
In %
1,239 1,459 2,046 4,744 2,015 20,447 22,462 874
26 31 43 100 9 91 100 18
How was the money spent? Operations* Témoignage / Awareness raising Other humanitarian activities Total social mission Fundraising Management, general & administration Other expenses Total expenditure Net exchange gains & losses (realised and unrealised) Surplus / deficit * Programmes & HQ programme support costs
Balance Sheet Cash & equivalents Other current assets Non-current assets Total assets – net Permanently restricted funds Unrestricted funds Other retained earnings Retained earnings and equities Current liabilities Total liabilities and retained earnings
HR statistics Medical pool Nurses and other paramedical pool Non-medical pool Total international departures (full year) International staff National staff Total field positions First time departures (full year)
30
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MÊdecins Sans Frontières Australia ABN 74 068 758 654
Financial Report for the Financial Year ended 31 December 2010
31
Médecins Sans Frontières Australia ABN 74 068 758 654 PO Box 847, Broadway NSW 2007, Australia Tel: +61 2 8570 2600 1300 136 061 Fax: +61 2 9552 6539 Email: office@sydney.msf.org www.msf.org.au © 2011 Médecins Sans Frontières Australia