Year In Focus 2009 by Médecins Sans Frontières (MSF) Australia

ÂŠ Jaume Codina

Year in Focus

2009

January

2009

GAZA

A challenging conflict

The first weeks of 2009 were dominated by the escalation of violence in the Gaza Strip. The Médecins Sans Frontières team in Gaza, composed of nearly 70 Palestinian field workers and three international field workers (including Australian nurse Colin Watson), was severely restricted in its ability to provide medical assistance to the wounded over the course of the 23 day conflict. Our teams were unable to run projects to full capacity due to the security situation and intensity of the violence. The insecurity also prevented many wounded people from reaching hospitals and clinics. In order to access the population, our Palestinian medical teams including doctors, nurses and physiotherapists, took medical supplies into their own neighbourhoods and provided care to patients. The teams treated 270 people in this way in two weeks. Within three weeks of the ceasefire, 153 patients were admitted in our post-operative care programs, and our medical activities in clinics and the Khan Younis Hospital rose by 40 percent. We expanded our surgical and postoperative services and continued to offer medical and psychological support through a team of psychologists and social workers. To assist with the additional influx of patients, we also set up two inflatable tents to provide space for two additional operating theatres and a postoperative care unit. © Bruno Stevens/Cosmos

More information: Watch Colin Watson’s interview with ABC’s 7.30 Report Médecins Sans Frontières has worked in the Palestinian Territories since 1988

February 2009

ZIMBABWE

Beyond Cholera - Zimbabwe’s worsening crisis

Early 2009 saw the continuation of the cholera epidemic in Zimbabwe, with 4,000 new cases treated in Médecins Sans Frontières supported health facilities in the first week of February alone. Between August 2008 when the outbreak began, to February 2009, our teams treated more than 45,000 cholera patients (approximately three quarters of all cholera cases at the time). From early February, the focus of the outbreak shifted from the cities to rural areas, where access to healthcare was particularly limited. The unprecedented cholera epidemic, which claimed thousands of lives, was a

symptom of a multifaceted humanitarian crisis affecting Zimbabwe. The political crisis and resultant economic collapse led to the implosion of the healthcare system and basic infrastructure, resulting in political violence, hyperinflation, more displacement and refugees, food insecurity and a lack of access to HIV/AIDS treatment and healthcare more generally. Although Médecins Sans Frontières was able to respond to the cholera outbreak on a massive scale, humanitarian organisations continue to face significant restrictions in Zimbabwe. In August 2009, Rian van de Braak, Médecins Sans Frontières’ Head of

Mission in Zimbabwe, noted, “The population still does not have adequate access to healthcare, people continue to die of AIDS in outrageously high numbers and the next cholera outbreak is at the doorsteps.” More information: Read our online report

Médecins Sans Frontières has worked in Zimbabwe since 2000

March

2009

MATERNAL MORTALITY One woman every minute Every minute a woman somewhere in the world dies from a pregnancy-related complication. Of the 500,000 maternal deaths each year, more than 99 percent occur in the developing world. This year we marked International Women’s Day on 8 March in Australia and New Zealand by drawing attention to these preventable deaths, mostly caused by haemorrhage, infection, obstructed labour, hypertensive disorders or unsafe abortion. Maternal mortality is one of the most critical issues facing women around the globe and it forms a

key part of our activities across programs in over 20 countries. “The role of Médecins Sans Frontières is to provide access to skilled staff, drugs and equipment, as well as to work with government health systems to improve maternal health outcomes,” said Bronwyn Hale, Women’s Health Advisor from Médecins Sans Frontières Australia’s Project Unit. To mark International Women’s Day, Médecins Sans Frontières Australia hosted a series of lectures across universities in Australia and New Zealand,

and called for recognition of the concerning lack of progress being made in reducing the rate of maternal deaths around the world. More information: Read Bronwyn Hale’s editorial in The Age online

April

2009 WEST AFRICA

Massive meningitis vaccination campaign in Nigeria, Niger and Chad Several countries in West Africa (Nigeria, Niger and Chad) faced a deadly epidemic in April when more than 65,000 people were infected with meningitis. In what was our largest ever vaccination campaign, hundreds of Médecins Sans Frontières field workers were mobilised, and in cooperation with the Ministries of Health, vaccinated 7.5 million people over four months. The epidemic was one of the largest in a region known as the “meningitis belt.” Nigeria was the most heavily affected by the outbreak, with 57,795 cases recorded, along with 1,795 deaths. By the end of the epidemic 2,132 people had died across the region. On average, meningitis kills half of all infected people if not treated; and one in ten if treatment is provided. The number of deaths remained relatively low during this epidemic, due in part to good case management and the rapid launch of the massive vaccination campaign. Our large-scale mobilisation involved 200 international staff, including doctors, nurses and logisticians, as well as 7,500 national field staff.

More information: Read our online summary of the vaccination campaign

May

2009

KENYA

Somali refugees imperilled in overcrowded camps

Each month, an estimated 5,000 people arrive in the Kenyan border town of Dadaab, fleeing the continuing war in neighbouring Somalia. More than 270,000 refugees live in Dadaab’s three camps – Dagahaley, Ifo and Hagadera - making the town the world’s largest refugee site according to the United Nations. In May 2009, Médecins Sans Frontières drew the international community’s attention to the dire situation in the severely overcrowded camps, where refugees faced alarming shortages of food, water and adequate

shelter. We called upon the United Nations High Commissioner for Refugees, international donors and the Kenyan government to urgently address the lack of assistance and protection provided to arriving refugees and the dismal living conditions in the camps. “The situation is simply scandalous” said Joke Van Peteghem at the time, Médecins Sans Frontières Head of Mission in Kenya. “These refugees have risked everything to escape the fighting in Somalia. Now some are

telling us they would rather take their chances in Mogadishu than die slowly here.” More information: Hear Damien Moloney, a logistician from Victoria, talk about his experiences working in Dadaab. Médecins Sans Frontières has worked in Kenya since 1987

June

2009 SRI LANKA Treating the wounded

This year the 26-year civil war in Sri Lanka came to an end, with the Sri Lankan government claiming victory over the Liberation Tigers of Tamil Eelam. During the final stages of fighting, tens of thousands of civilians were trapped for months in a war zone reduced to a narrow strip of jungle and beach, with no aid and limited medical care after humanitarian aid agencies, including Médecins Sans Frontières, were made to leave the area. In Vavuniya hospital, located just beyond the exclusion zone, our teams worked alongside Ministry of Health staff, treating thousands of people who had managed to escape the warzone. From February to the end of June, almost 4000 war wounded had major surgical interventions in this hospital. In June, Australian nurse Lauren Cooney reported from the situation in Sri Lanka, “We were working at the site where people were first arriving into the Vavuniya area, so we were working sixteen hours a day, seeing about 150 to 200 patients during that time.” Thirty kilometres south of Vavuniya, our inflatable field hospital was the closest referral hospital for the more than 200,000 displaced people living in Manik Farm, the largest government-run displacement camp. From June to November, our teams treated over 500 trauma cases related to the conflict, with over 200 of them requiring surgery. More information: Listen to Lauren Cooney’s report Médecins Sans Frontières has worked in Sri Lanka since 2007

July

2009

SOMALIA

Population flees as violence escalates

In July, Médecins Sans Frontières was forced to close a paediatric hospital and three health clinics in the north of Somalia’s capital Mogadishu, following continuous shelling, explosions and open combat among various armed groups in the area. Along with the rest of the population, our staff had to flee to safeguard their own lives and those of their families. Our teams were performing an average of 2,500 outpatient consultations per week and treating nearly 400 malnourished children when they were forced to cease operations.

The deteriorating security situation in Somalia has made working in the country increasingly difficult for our teams. In April, two of our international field workers were kidnapped (and later released) in Huddur, in the Bakool region. On 18 June, one of our employees died in an explosion along with 30 other people. Also in June, one of our vehicles was attacked in North Galcayo, resulting in the death of the mother of a patient. “Despite all that has happened, we want to continue working in the country. The needs are huge and the main victims of this conflict are civilians,” said Benoit Leduc, head of operations for Médecins Sans Frontières in Somalia.

More information: Read more about our work in Somalia

Médecins Sans Frontières has worked in Somalia since 1991

August

2009

YEMEN

The sixth war in five years in Yemen’s northern Saada Governorate , and the most intense so far, escalated sharply in August as Yemeni Army forces began carrying out air strikes and artillery assaults against AlHouti rebels. Civilians and nonmilitary targets such as hospitals were heavily affected by the fighting - hundreds of thousands of people were displaced and humanitarian assistance came to a virtual halt. Since 2007 Médecins Sans Frontières had been working in collaboration with the Ministry of Health in two hospitals – in Al Tahl and Razeh, in the Saada Governorate –, providing medical and surgical care free of charge. Due to security concerns

Conflict intensifies with ‘Sixth War’ however, work ceased in Al Tahl in late September 2009. We were also then forced to suspend our activities at Razeh hospital after the facility was hit by rocket fire on 15 October. The hospital was the last functioning health facility outside the town of Saada. In the two months preceding the suspension of the projects, Médecins Sans Frontières and Yemeni Ministry of Health medical teams had carried out some 2,000 emergency consultations, and performed 195 surgical interventions, of which 70% involved war wounds. From mid August, Médecins Sans Frontières also intervened in Mandabah, north of the

Saada Governorate, providing healthcare services and access to clean drinking water to the thousands of displaced people in this region. In mid November, we were able to establish a hospital in the town to serve both residents and internally displaced persons who fled north to escape the conflict. More information: Read more about our work in Yemen Médecins Sans Frontières has worked in Yemen since 2007

September 2009 ASIA-PACIFIC

Natural disasters strike Asia-Pacific region

In the last week of September, a fierce trio of natural disasters - Typhoon Ketsana, the Sumatran earthquake and the South Pacific tsunami - displaced hundreds of thousands of people, wounded thousands more and claimed hundreds of lives. Médecins Sans Frontières provided emergency assistance to the populations devastated by these events in Indonesia, Samoa and the Philippines. Médecins Sans Frontières Australia was able to assist the organisation’s rapid assessment of the situation in Samoa by sending a team of three people including a nurse, psychologist and logistics/water and sanitation specialist. Our teams already working on other projects in the Philippines were able to start providing medical consultations within days in Rizal province and were reinforced by more international field staff thereafter and more than 22 tonnes of relief materials. In Indonesia, emergency teams were mobilised and almost 50 staff, including doctors, kidney specialists, surgeons, nurses, psychologists and logisticians, were on the ground within a week. Our mobile clinics provided critically needed primary healthcare for many people who were forced to live out in the open.

More information: Read more about how we responded to the regional emergencies

REFUGEE CAMP IN YOUR CITY Refugee Camp in Your City, Médecins Sans Frontières’ replica refugee camp event, kicked off its second Australian tour in Adelaide in September, and continued on to Melbourne in October. Opening for 17 days combined in the two cities, over 7,500 people experienced the tour, guided by our returned field workers, who shared their experiences of working with us in refugee camps around the world. Visit refugeecamp.msf.org.au for more.

October

2009

AFGHANISTAN In October Médecins Sans Frontières began working again in Afghanistan after a five year absence following the brutal killing of five of our staff in 2004. Our teams are now working in Ahmed Shah Baba hospital on the eastern side of Kabul as well as in Lashkargah, the capital of Helmand province, in the very heart of the conflict.

One year after violence erupted in Haut-Uélé district, in northern Democratic Republic of Congo (DRC), attacks and clashes expanded to new areas, forcing hundreds of thousands of people to flee. In October, Médecins Sans Frontières called attention to the urgent needs of the civilian population of Haut-Uélé and Bas-Uélé, who are caught up in a dramatic cycle of violence. Hundreds of thousands of people have been displaced and ongoing attacks continue to send thousands fleeing to seek shelter and greater security in towns.

Violence expands in northern Congo

“The local population is the target of violence: murder, kidnapping and sexual abuse,” says Luis Encinas, operations coordinator in Central Africa. “We are talking about tactics of violence aimed at instilling fear in the people. Médecins Sans Frontières provides surgical, nutritional, psychological and basic medical care to thousands of displaced people affected by the extreme violence. In 2009, violence also continued to affect other regions in DRC, particularly in the eastern part of the country. Earlier this

year, Sydney Morning Herald journalist Jonathon Pearlman and photojournalist Kate Geraghty travelled to North Kivu to document some of the tragic stories emerging from the conflict. More information: View Kate Geraghty’s photography Médecins Sans Frontières has worked in Democratic Republic of Congo since 1987

November 2009 MALNUTRITION

Governments spending ‘peanuts’ on childhood malnutrition

An estimated 3.5 to 5 million children die each year from malnutrition-related causes – this means there is one death every six seconds. Yet childhood malnutrition is a condition that is easy to prevent with the right mix of nutritious foods and is effectively treated with therapeutic products available today. In November, Médecins Sans Frontières released a report in advance of the World Food Summit in Rome that provided an in-depth analysis of funding trends in the field of childhood malnutrition and food aid. Despite the vast numbers of preventable deaths worldwide, the combined contribution of the world’s wealthy nations to combat malnutrition remained flat from 2000 to 2007. International assistance amounted to $350 million annually out of the $11.2 billion that the World Bank estimates is required to adequately combat malnutrition in 36 countries that have a high prevalence of the condition. The Médecins Sans Frontières report found that of the billions of dollars currently being spent on food aid and food security generally, less than two percent is spent on food that includes the nutrients required to prevent childhood malnutrition. In 2008, we treated more than 300,000 malnourished children in 22 countries, mainly with nutrient dense readyto-use food, a peanut and milk paste which is rich in protein, vitamins and minerals. While more expensive than foods currently provided by the food aid system, ready-to-use foods actually work to prevent and cure severe malnutrition and can be used on a very large scale. More information: Read “Malnutrition: How much is being spent?”

December 2009

HIV/AIDS

Despite significant progress, the HIV/AIDS emergency in the developing world is far from over. There is a dire need for newer medications, funding is stagnating and the prospect of universal access to treatment may be waning. An estimated six million people living with HIV/ AIDS in the developing world are in urgent clinical need of antiretroviral (ARV) therapy. The lack of increases in funding comes at a time when Médecins Sans Frontières medical teams— providing ARV therapy to 140,000 patients in 30 countries—are witnessing an urgent need for an increase in funding. There is a need to scale up access to

Funding crisis threatens progress treatment, to provide patients with the more robust and bettertolerated treatments that are widely available in wealthy countries, and to provide better adapted paediatric formulations. In December thousands of Australians helped us push for the creation of a patent pool for HIV/AIDS medications. More than 35,000 letters and emails were sent to pharmaceutical companies asking them to put their patents into a pool, which would allow generic manufacturers to produce more affordable medicines while compensating the original producers.

On 15 December, UNITAID, the international health financing agency, announced that the patent pool will go ahead and formal negotiations with pharmaceutical companies will begin. More information: Visit our Act Now for Access campaign