MSF Canada Annual Report 2009 by Doctors Without Borders / Médecins Sans Frontières (MSF) Canada

Contents

General Director and President’s Message

Médecins Sans Frontières

MSF’s emergency aid: As urgently needed as ever

Recruitment: Post-tsunami slump

Fundraising: Income up in a recession year

Finance: Effects of the financial crisis marginal

Projects funded by Canadians

Canadians on mission

Estate gifts

Sans Frontières Society

Board of directors

Colophon

General Director and Presidentâ&#x20AC;&#x2122;s Message

We keenly felt our limitations as medical workers in 2009, as MĂŠdecins Sans FrontiĂ¨res (MSF) was witness to populations trapped in brutal situations in such places as the Gaza Strip, Sri Lanka and western Sudan. Yet our limitations were also matched by successes, such as our unparalleled ability to cross all front lines during the fighting in eastern Democratic Republic of Congo, and our response to disease outbreaks such as meningitis in the Sahel, and cholera outbreaks in Zimbabwe and Papua New Guinea. At the start of 2009, intense fighting between the Israeli forces and Hamas in the Gaza Strip left thousands of civilians trapped by violence, many of whom were wounded and without desperately needed surgical care. Due to the intensity of the bombing campaign and restrictions at the borders, MSF teams were not able to significantly assist in the evacuation of wounded or support the overwhelmed trauma centres in Gaza city. Meanwhile, the Sri Lankan government and the Liberation Tigers of Tamil Eelam (commonly known as the Tamil Tigers) launched their last battles. As the Sri Lankan government closed in on the Tamil Tigers, they also closed in on 250,000 civilians. Neither side protected the very people they were meant to be fighting for. The combination of indiscriminate shelling and forcible

entrapment was deadly for innocent people simply trying to survive. Again surgical teams were overwhelmed; but only with those who managed to escape the violence, because MSF was shut out of the areas where people were most in need of urgent medical attention. As this war raged on, we faced another showdown in Sudan. Caught in the middle of an International Criminal Court indictment of president Omar al-Bashir, Sudan expelled 13 non-governmental organizations from Darfur, among them two MSF teams, and thousands lost access to health care and other essential services. No matter what the geopolitical reasoning, the result was the same: the people, normally protected in conflicts, were used as commodities of war and became trapped or targeted as a result. With this, respect for aid and humanitarian intervention was further weakened. As both civilians and their life-saving aid became increasingly subject to indiscriminate abuse, we continued to do whatever we could to alleviate suffering and stand in solidarity with those who had been ravaged by years of war. The year was also marked by an increased need to respond to both epidemics and natural disasters. MSF doctors and nurses were busy trying to save as many people as they could in Zimbabwe, where an unprecedented cholera outbreak killed 3,000 people 3

and devastated tens of thousands of others. A country that once boasted being the bread-basket of southern Africa had degenerated into nothing more than a series of humanitarian crisis. As well, in response to a meningitis outbreak in the Sahel, we vaccinated more than 7 million people in our largest ever meningitis vaccination campaign, across Nigeria, Niger and CAR. Meanwhile, flooding in West Africa, an earthquake in Indonesia, and tropical storms in the Philippines also demanded relief action from MSF. Like every year before, the world remained a grim place for millions. For MSF, that was not a reason to give up, but a reason to keep trying. We could not and should not remain complacent in the face of others’ suffering. As we attempt to realize our moral duty to respond simply because we are all human beings, it is important to also realize that none of MSF’s work would have been possible without you, without your support, without your dedication to others simply because we are all human beings. Thank you.

Marilyn McHarg General Director MSF Canada

Joni Guptil President MSF Canada

The MSF Charter Médecins Sans Frontières (MSF) is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principles: • Médecins Sans Frontières offers assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict, without discrimination and irrespective of race, religion, creed or political affiliation. • Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and demands full and unhindered freedom in the exercise of its functions. • Médecins Sans Frontières’ volunteers promise to honour 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 missions 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.

Médecins Sans Frontières Medical aid & Advocacy Everyone has a right to life-saving medical care. That includes people living in war zones and conflict regions. However, in many of these areas across the world, hundreds of thousands of people are cut off from any form of health care. MSF finds that unacceptable. Our teams try to reach the most vulnerable and isolated victims of wars, conflict and natural disasters around the world. We are equipped to offer medical emergency aid quickly using specially trained staff, medication and water treatment equipment. In many areas where MSF works, even basic human rights are violated on a large scale. Refugees and internally displaced people are subjected to violence or denied emergency medical aid for political or other reasons. In these cases, giving medical assistance alone is not enough. We also appeal to those in power – including governments and international organizations – and speak out about the abuses we encounter in the course of our work. Independent, impartial, neutral MSF is completely independent of any political, religious or economic powers. We do not choose “sides” in a conflict; instead we focus on the victims of violence and crises. In order to uphold these principles in all circumstances, MSF’s projects are funded mainly by direct donations. Other important sources of income include contributions from the international MSF network and project subsidies received from institutional donors. Collaboration Where possible, MSF recruits staff from its project countries. National staff members act as the liaison between our international

field staff and local communities. Our national staff speak the local language and understands the customs and unique cultural practices carried out in a particular country or region. They bring their own skills as doctor, nurse, logistician, translator or other position to the team. Where necessary, international MSF teams train local staff members so they can continue the project independently if the international staff have to withdraw or temporarily evacuate for safety reasons. However, MSF strives to place international staff at all its project sites. The organization firmly believes that our field staff need to be in direct contact with the beneficiaries in order to guarantee and improve the quality of the assistance. International staff are often involved in speaking out on what they witness, something that, depending on the situation, can pose risks to locally recruited staff. How MSF started In 1971, Nigeria was embroiled in a bloody civil war. The Red Cross was in the area but its mandate did not allow it to offer assistance without the government’s permission. Two French doctors working for the Red Cross, Bernard Kouchner and Max Reclamier, could not reconcile themselves with this method of working. They maintained that all victims should get medical treatment, even, if necessary, in defiance of the government’s wishes. When they returned to France, together with a group of journalists they decided to create their own organization: Médecins Sans Frontières. MSF Canada was founded in 1991. Since then Canadians have taken on close to 2,200 field assignments with MSF in over 80 countries including Afghanistan, Angola, Bosnia, Cambodia, Colombia, Liberia, Rwanda, Sri Lanka, Sudan, and many others. In 1999 MSF was awarded the Nobel Peace Prize for its medical

efforts and its advocacy carried out on behalf of deprived people. In 2009, MSF worked in 64 countries. For a complete list, see the map on page 19 Sharing responsibilities Today, MSF is an affiliation of 19 country organizations, all of which are independent legal entities. Originally, five country organizations managed all the field projects, while the other 14 helped raise funds and recruit new field staff. As the movement grew, it was felt that this division of responsibility separated the majority of the MSF offices from its fieldwork. To change this, five groupings of national MSF organizations were created around the original five country organizations that managed projects. These groups are called Operational Centres. In each centre, a number of MSF country organizations share the responsibility of managing a portfolio of project countries. On Oct.1, 2006, MSF in Holland and MSF country organizations in Canada, Germany and the United Kingdom started the Operational Centre Amsterdam (MSF OCA). MSF OCA has no legal standing, but rather is an entity in which the four MSF organizations work together on a voluntary basis. At the end of 2009, MSF Canada managed projects in Colombia, Haiti, Nigeria, Papua New Guinea and Russia/North Caucasus. MSF Germany handled projects in the Central African Republic, Chad, Turkmenistan, Uzbekistan and Zimbabwe. MSF UK contributed to MSF OCA by providing medical expertise and implementation support for our tuberculosis projects. Our work in Bangladesh, the Democratic Republic of Congo, Ethiopia, India, Iraq, Myanmar, Nepal, southern Sudan, Pakistan, Somalia, Sri Lanka and Uganda is managed from Amsterdam.

An association Like all MSF country organizations, the Canadian branch of MSF is an association. Its members are current and former field workers and office staff as well as those who have served the organization in another way. As of Dec. 31 2009, the MSF Canada Association had 204 members. The MSF Canada Association Board is responsible for supervising MSF Canada and ensuring that agreed policies are implemented. The Board safeguards the identity of the organization and functions as a sounding board for the General Director and the rest of the Management Team. The General Assembly of Members is the highest body within the MSF Canada Association. It meets at least once a year. The members make decisions on identity issues, evaluate the Boardâ&#x20AC;&#x2122;s performance in the past year and approve the annual report and annual accounts.

MSF’s emergency aid: As urgently needed as ever MSF worked through a year of striking contrasts in 2009. In March, we had to close some of our projects in the Sudanese region Darfur, one of our largest, because the Sudanese government decided to expel MSF staff from the country. Six MSF colleagues were kidnapped and – fortunately – released unharmed. In 2009, MSF looked back at 38 years of medical emergency aid provision. In that time MSF has come a long way from being a small group of visionary doctors to becoming a recognized, experienced and successful provider of medical care for victims of conflict and disaster. Our conviction that everyone is entitled to life-saving medical care, and ambition to reach those in crisis areas who suffer most and have no access to care have remained unchanged. The world, however, has changed a great deal. Instead of a cold war, a new world order exists with tensions between the North and a developing and self-asserting South, between the West and radical Islam. New global powers such as India and China compete for influence with the traditional Western powers. These developments have affected the way in which humanitarian agencies can work. It is chilling to see that respect for humanitarian action and humanitarian workers has decreased to dangerously low levels. The number of security incidents involving staff has risen sharply over the past few years. Cynically enough, aid workers have become attractive targets for armed groups who want to put pressure on governments or influence public opinion.

In 2009, the MSF international movement faced the kidnapping of six workers in Chad, Darfur, Pakistan and Somalia. Thankfully, they were all released unharmed, but the effect of their capture on the organization’s ability to deliver medical assistance has been widely felt. MSF was forced to suspend its activities, if only temporarily, with the result that people in need paid dearly for these acts of senseless violence. Dangerous profession The job of a humanitarian aid worker has become one of the most dangerous in the world. Although, thankfully, there were no MSF fatalities due to targeted attacks or violence in 2009, there was certainly no improvement in the projects’ overall security. The courage of our staff from our project countries and of our international staff, and their determination to work under extremely difficult circumstances, is indeed remarkable. Rebel and criminal groups have demonstrated increasing disrespect for humanitarian action, but the trend is also visible among governments. More and more countries simply do not allow independent humanitarian agencies to serve people in conflict. In 2009, the starkest example was the Sudanese government’s expulsion of staff in some MSF projects and 12 other humanitarian agencies. Governments, including those of Sri Lanka and Ethiopia, did not allow MSF to speak publicly about the often terrible circumstances in these countries. These and other limitations presented serious moral and practical dilemmas. How long can we work in countries if our independence is not respected? If we compromise in this respect, we risk losing credibility in the eyes 7

of warring factions. This endangers our access to patients and the security of our teams. How do we find the people who are most in need of life-saving medical care if we cannot travel? The development of the state apparatus can of course be a positive trend, if the strength of the state is being used to provide health care to neglected people. Unfortunately, in many countries, that is not the case. The combination of insecurity and strong uncooperative state policies has led to a further narrowing of the “humanitarian space” in conflict areas. This is where victims can seek the assistance they need without fear of being attacked by warring parties. This “space” also enables aid organizations to do their work without being threatened or manipulated. The ability of aid agencies to do their work independently is further undermined by the Western agenda of state-building through military and diplomatic means and the development of infrastructure. For example in Afghanistan, diplomacy, defence forces and development aid organizations cooperate closely. This threatens the ability of aid organizations to work independently and turns medical facilities into political and military arenas.

We strive to bring medical care of the highest possible calibre to low-resource settings Urgent need Meanwhile, the need for independent humanitarian aid remains undiminished. People are suffering, not only in familiar crises areas such as in Myanmar or Democratic Republic of Congo, and in largely ignored countries such as Central African Republic and Papua New Guinea. It is clear that whether violence is caused by state oppression, rebel movements, or within families and communities themselves, medical assistance is still just as urgently needed as it was when MSF was established. 8

One response to teams’ limited access to certain areas is the greater involvement of staff from the project countries themselves. MSF traditionally employs international workers in its projects since they are considered as neutral outsiders in the conflict areas where we work. However, in places such as Somalia, Russia and Iraq, this perception has changed and international staff have unfortunately become a target. There, we have developed over the years the model of “remote management” in which our key locally hired staff, who are trusted by their society, take on the day-to-day responsibility for the projects. International staff visit from time to time. Although not our preferred model of practice, this allows MSF to continue delivering medical assistance to people in need. Capability As a responsible and value-driven organization we have the will and the capability to offer solutions in places where others cannot. We strive to bring medical care of the highest possible calibre to low-resource settings. Examples of this are the treatment of drug-resistant tuberculosis in Uzbekistan and HIV/ AIDS among the violent chaos of Congo. We continue to assist and lobby on behalf of people who have been isolated or neglected for many years, such as the Rohingyas in Bangladesh, the Adivasis of Chhattisgarh, India, or the forgotten refugees in Somaliland, Somalia. At a time when humanitarianism is under siege, we believe that there is a place for our organization, which has the tools, the courage and the resources to bring relief where it is needed most and where others will not or cannot go. We are fortunate to have a great number of donors who recognize and value our efforts. Despite the economic downturn, they entrusted us with a considerable amount of funding, most of it unrestricted, allowing MSF to respond there where it is most needed. Our proven capacity to respond and the continued support of many of donors reinforces our commitment to deal with the challenges brought about by conflict, natural disaster, urban violence and the effects of climate change.

This confidence should not be confused with brazenness or over ambition. Humanitarian assistance will not change the course of the political conflicts that have set the world against itself. Real and lasting solutions are in the end the responsibility of government. However, humanitarian aid is an indispensable condition for survival. We remain concerned and alert for the increasing dangers associated with providing humanitarian assistance. In the interest of those who depend on us, we will fight any attempt to manipulate aid or to compromise the independence of our assistance. Major interventions in Sri Lanka & Nigeria Throughout 2009, teams provided life-saving medical care, distributed relief items including blankets, personal hygiene items and cooking utensils and offered psychosocial care to hundreds of thousands of victims of armed conflict. Where necessary and possible, MSF did this on both sides of the frontlines. Major interventions were those in Sri Lanka and Nigeria; a milestone was the restart of our work in Afghanistan, five years after five of our colleagues were brutally murdered in Badghis province. As in 2008, MSF staff were refused access to the people trapped in the ever-shrinking rebel-held area of Sri Lanka. When they were allowed to leave after months of relentless battles, the exhausted people could seek refuge in Vavuniya, the nearest city where help was available. MSF staff received and treated thousands of the exhausted and often heavily wounded people at Omanthai checkpoint, the last stop before Vavuniya. In the general hospital there, our teams performed surgery on 4,000 war-wounded people and cared for more than 60 patients with spinal-cord injuries who needed rehabilitation. We also set up a feeding program for 26,000 malnourished children in the camps around Vavuniya.

Shutdowns in Sudan Sadly, our involvement in the battered Sudanese Darfur region was also curtailed in 2009. Government expulsion of aid workers forced more than half of MSFâ&#x20AC;&#x2122;s programs to close. Two more projects in Serif Umra and Kebkabiya in North Darfur, and activities in Tawila, also in North Darfur, were suspended. Shortly before we had to leave, meningitis broke out in Kalma Camp which, with 90,000 people, was one of the largest camps for displaced people in the world. One consequence of our expulsion was the closure of the only hospital for the 70,000 people in the Muhajariya region. In the Jebel Marra Mountains, the 3,000 people who relied on MSFâ&#x20AC;&#x2122;s health care every month were left without services. MSF nonetheless provided over 168,000 consultations, more than 28,000 antenatal consultations, admitted nearly 2,500 people to hospital and treated some 4,500 people for malaria throughout the year. Teams handed over projects in Golo and Killin to the Ministry of Health in October, and in the same month were able to restart activities in Tawila. At the end of the year, MSF started working in a remote area of North Darfur, Um Baru, providing medical support to five rural health centres that care for very isolated communities. As far as we know, no overwhelming disaster materialized in Darfur after MSF had to leave, but the toll of individual tragedies remains unknown. Return to Afghanistan Having left the country after the brutal killing of five staff in Badghis province in June 2004, MSF returned to Afghanistan in 2009. Increasing signals that the overall situation for Afghans was getting worse rather than better motivated the return. The people have been trapped for years in impoverished conditions, and many lack access to medical treatment. Public hospitals do not function well and private clinics are often prohibitively expensive. 9

In October 2009, MSF started supporting activities in a district hospital in the east of Kabul and in a hospital in the capital of Helmand province. The Ahmed Shah Baba hospital in the east of Kabul has 30 beds and one operating theatre. Mother and child health care became an important component of our work. Teams focused mainly on Afghan refugees who had returned from Pakistan, and displaced people from other parts of the country. In Helmand province, where the conflict was raging, a team started assisting the hospital of the provincial capital Lashkargah. The hospital has 150 beds and two operating theatres, and provided a broad range of services. MSF treated 22,000 patients in the two facilities in 2009. Recognizing the Rohingya Another manmade tragedy MSF responded to in 2009 was the persecution of the unrecognized Rohingya refugees in the makeshift Kutupalong camp in the south of Bangladesh. While their number, 20,000, was relatively small, their fate was heartbreaking. Having almost no civil rights in their native Myanmar, 200,000 of them have fled to neighbouring Bangladesh over the past three decades. There, most of them live illegally and try to survive on the fringes of Bangladeshi society. MSF set up basic health care, a feeding project and improved the hygiene and water supply. We spoke out on their behalf when local authorities forcibly removed thousands from parts of the camp. We also continued our involvement in Zimbabwe, where, in 2008, a huge outbreak of cholera coincided with the political and economic crisis. In June 2009, the outbreak was officially declared over. By that time, our teams had treated 65,000 patients and supported numerous treatment centres throughout the country. However, the chronic health crisis in Zimbabwe though is still HIV/AIDS. One in six adults is HIV-positive and almost 400 people die every day of AIDS-related causes. By the end of 2009 MSF had provided care for more than 52,000 people, 39,000 of whom were put on antiretroviral therapy. 10

Our life-saving efforts also continued in the battered east of Democratic Republic of Congo, where the dire situation deteriorated further. We treated more than 600,000 patients. MSF continued to highlight the fate of the people in the country via the international website www.condition-critical.org. Natural disasters Natural disasters were especially numerous in Asia in 2009. On May 25, the border area between India and Bangladesh was hit by cyclone Aila, killing some 200 people and rendering 500,000 homeless, according to the authorities. MSF assisted 75,000 people by distributing relief items, repairing water sources and providing basic healthcare services.. In September and October, four large storms hit the Philippines within a four-week period. Since MSF was already present in the country, we were able to react quickly and set up an emergency program. More than 4,300 consultations were carried out. MSF helped by distributing relief items, including plastic sheeting, hygiene and construction kits. Epidemics Our teams carried out several extensive vaccination campaigns in 2009. The largest was in northern Nigeria, where, in cooperation with state health facilities, 4.7 million people were vaccinated against meningitis between January and May. In the same period, the Ouaddai region in Chad faced a measles epidemic. MSF vaccinated 226,000 children aged between six months and nine years. Teams also carried out extensive vaccination campaigns against measles in Bangladesh, Democratic Republic of Congo and Ethiopia, Nigeria and Pakistan. Risk management As a prominent medical emergency organization, MSF faces a variety of potential risks. To mitigate them as much as possible, we have put a set of procedures and regulations in place related to all sectors of our work.

Ensuring the safety of our field teams To reach those who need our help most, we often work in unstable regions. Although we do our utmost to avoid unnecessary risks, a certain amount of risk is inevitable. The safety of our field staff is managed by our heads of mission under the direct responsibility of the operational managers. Each field mission has detailed safety regulations and plans in place that clearly outline strategies and specific measures and responsibilities. Before starting a new project, MSF conducts a thorough process of risk analysis. We ensure acceptance of our presence by negotiation with officials and other relevant actors and take appropriate security measures to protect our employees. Knowing that it is impossible to eliminate all risks, every staff member is thoroughly briefed. Each person then has to decide if he or she accepts the risks involved and accepts the assignment or declines it because the risks are unacceptable. MSF accepts each individual’s decision and makes it clear that his or her answer will not have a negative influence on any future cooperation. Starting in January 2009, MSF started to carry out annual security audits in high-risk missions such as those in Somalia, Pakistan and Iraq. In general, the findings were that security plans and measures are adequate, but that implementation of procedures and processes needs continuous attention and refinement. Too often, risk analysis and mitigation is the responsibility of a few key individuals, whereas it needs to be more of a collective effort by the international and national staff. To increase our knowledge of local developments and potential security threats, locally hired staff members were appointed as Deputy Heads of Mission in Pakistan, Somalia, Iraq, Chad and Colombia, among others. In Amsterdam, an additional field security advisor will be appointed to support the teams in the field in dealing with risk analysis and implementation of existing tools and systems.

If a serious security incident occurs, MSF forms a crisis team at headquarters as well as in the field. Its composition and organization depend on the incident’s nature, but potential members of the crisis team are pre-trained. Of course, MSF never knowingly exposes its teams to targeted violence. If we receive a specific and credible threat in a project, our policy is always to take it seriously to the extent we may withdraw the team concerned until the situation is clarified or the tension has decreased. On rare occasions, we have decided to adapt our activities in a mission or completely suspended them as a result of such information. Many security incidents have a significant psychological impact on the involved staff. In almost all cases, the concerned staff received psychosocial care from MSF’s Psychosocial Care Unit.

MSF intervenes until the authorities themselves are able to provide the necessary care again Tried and tested medical action Our medical action is carried out following detailed MSF clinical guidelines and protocols. These documents are the result of our experience in emergency medical work. Our guidelines are evidence-based and are regularly reviewed and updated. The pharmaceutical quality of the drugs we use is guaranteed by a stringent drug-quality assurance policy. Together with MSF’s international office in Geneva, we regularly audit manufacturers’ sites according to a risk assessment schedule. In early 2009, one such audit’s outcome resulted in a precautionary quarantine of a number of drugs. MSF’s protocol for product recall was immediately put into place. The affected products were put in quarantine, and alternative sources of quality-assured products were quickly found. 11

A girl is injected with meningitis vaccine at an MSF vaccination site in Gangara, near Aguie, Maradi Region, Niger. ÂŠ Olivier Asselin

Recruitment: Post-tsunami slump Statistically, recruitment numbers trended downwards in 2009. MSF Canada sent 157 Canadians on 217 assignments in 39 countries. The decline is particularly noticeable when compared to 2005, a year in which the tsunami and the earthquake in Kashmir resulted in record recruitment numbers. Similarly, the Haiti earthquake is expected to cause a peak in the number of people applying for and working in MSF projects in 2010. Bilingualism still an asset MSF Canada is an important supplier of French-speaking field workers to the MSF movement. MSF Canada recruits roughly half of its field workers from the province of Quebec, and a very large proportion of Canadian field workers do missions in Democratic Republic of Congo, Chad and Central African Republic. This need for French-speakers will definitely continue into 2010 and beyond, and is a trend seen in the wider international humanitarian community. The devastating earthquake in Haiti has necessitated a massive humanitarian response and it is anticipated that an acute nutritional crisis will hit Niger. Both of these countries require French-speakers and a bilingual country

like Canada is a strategically important recruitment ground for MSF as a result. Fewer first missions The gradual decline in first missions is attributable to the closure of projects in countries that accepted more staff on their first mission - notably Sierra Leone, Liberia and Ivory Coast. Conscious efforts to transfer more responsibility to national staff also resulted in fewer first missions. In terms of professions, it remains a challenge to attract generalist medical doctors (general practitioners and emergency physicians) for missions of six months or longer. However, those that do join MSF tend to go out to the field repeatedly. MSF has an ongoing need for medical specialists like general surgeons, anesthetists, obstetricians and pediatricians. At various information events across the country we have seen strong interest among medical students to do humanitarian work; but the numbers that eventually apply to MSF is proportionally small. Efforts are underway to understand this phenomenon and to help raise awareness among medical students that in order to do humanitarian work of a voluntary nature, they need to think about how they will manage debt loads after school while working in the field. With proper financial planning, it can be done. 13

Logisticians wanted Another challenge is to recruit what MSF call technical logisticians. These are critical people in the field who ensure that all non-medical aspects of running a medical program are taken care of. This includes rehabilitation of health facilities, maintenance of a vehicle fleet, set-up and operation of an effective communications system, timely procurement of medicines and proper storage of heat-sensitive articles like vaccines, set-up of generators and pumps to ensure electricity and water for operations to function. Typically the best candidates for this role are people with strong general technical skills â&#x20AC;&#x201C; Jacks or Jills of all trades â&#x20AC;&#x201C; that also have some degree of international experience and inter-cultural aptitude. Some of the organizationâ&#x20AC;&#x2122;s most successful technical Logisticians have been coordinators of tree-planting camps or people involved in the resource sectors in Canada or abroad. The challenge for MSF is how to attract such as diverse and dispersed group to humanitarian work. Management of field staff improved There were improvements and changes to structures and policies for field staff in 2009. The implementation of the pool management system was completed. In this system, staff with specific competencies is managed as a group. This improves the availability of specific staff at the right time for the right type of position in the field. It also allows the organization to do better career planning and talent-spotting and to address shortages of certain types of staff through more targeted recruitment and training. In 2010 this new system is expected to yield results including fewer vacancies and a reduced turnover in coordination positions.

Psychosocial support improved Fieldwork for MSF can have a considerable psychological impact. Specialists from our psychosocial care units work to limit the consequences of this burden. In 2009, many of these activities were expanded. Besides the regular briefings and debriefings of field staff, some preventive policies were introduced. Contacts with medical coordinators in the field and the operational managers in some MSF offices were intensified to discuss the general management of stress. Psychosocial specialists were hired to assist those going to operations managed by MSF Canada. An additional training program was drawn up for the external consultants employed in crisis interventions.

Fundraising: Income up in a recession year 90,000 individualS contributed to MSF Thanks to the generous support of our donors, MSF is able to maintain the financial and operational independence that allows us to provide urgent medical care to millions of people affected by conflict, malnutrition, natural disaster, disease and exclusion in more than 60 countries around the world. Recognizing the important role this support plays, we are committed to being transparent and accountable to our donors through updates and information on how we use donations. Programs 79.2% Program costs consist of direct expenses to our medical humanitarian mission to save lives and alleviate suffering. These costs relate to our operations on the frontlines, including the purchase and shipment of medicines and supplies, recruitment of our teams of international and local staff, and the running of our medical programs. They also include awareness-raising activities in Canada. Fundraising 16.7% These are the associated costs of raising and processing private donations that support our projects. MSF’s fundraising activities include engaging with donors in person, by mail, phone, email and street canvassing and reporting on our work through Dispatches, News from the Frontline, and our enewsletter. Administration 4.1% Other costs not related to programs or fundraising include general office expenditures, management and finance salaries, bank fees, professional fees and common office expenses.

Thank you! MSF relies on the generosity of individuals, foundations, corporations and organizations to carry out our medical humanitarian mission. In 2009, 75 per cent of MSF Canada’s revenue came from private Canadian donors, with the remaining 25 per cent coming from the Canadian International Development Agency, and grants from other MSF sections.

2009 revenue sources 8% MSF grants

<0.5% Other*

17% CIDA

75% Private donations

* includes interest, tax rebtes and Association membership dues

Close to 35,000 individuals supported MSF through the Partners Without Borders monthly giving program, providing 38 per cent of MSF’s revenue in 2009. When asked what motivates him to give in this way, Tony Morris, a doctor from Red Deer, Alberta, told us “I really feel like my support contributes to work that represents the difference between life and death, making people’s lives better.” 15

In 2009, many individuals and foundations funded considerable portions of MSF projects around the world. Their generous support has helped ensure MSF can have the greatest impact on the most challenging humanitarian crises. Hundreds of individuals and groups across the country organized fundraising events for MSF in 2009. MSF recognizes and thanks them for their dedication to our medical humanitarian mission. Alastair and Kieran Kreidié-Akazaki, ages 7 and 10, wanted to help MSF and did so by running a lemonade stand in their neighbourhood. Their goal, according to Alastair was to “raise a lot of money for Médecins Sans Frontières so that they can continue helping people around the world.” Kieran explained why they chose to support the organization: “MSF goes anywhere it’s needed. Its workers have the courage to care for victims of war, epidemics and natural disasters. They have the conviction to speak out on behalf of the oppressed. And most importantly, they never, ever give up.” MSF is thankful for the initiative and inspiration of individuals like Kieran and Alastair who are dedicated to relieving suffering around the world. In 2009, companies and workplaces large and small, demonstrated their solidarity with people in need with their financial commitments to the principles and work of MSF. Through the Beyond Miles program, Aeroplan and hundreds of individual Canadians donated Miles to MSF to use for international and domestic travel. On November 5, 3.2 million Aeroplan Miles were donated by members, a total that was doubled by Aeroplan as part of its matching day for MSF. This amounts to over one hundred overseas flights and significant travel savings, which will allow MSF to direct even more resources to providing medical care to people in need.

MSF expenses in 2009

Programs 79.2%

Fundraising 16.7% Administration 4.1%

Finance: Effects of the financial crisis marginal The global economic crisis threatened to make 2009 a challenging year for all charitable organizations. MSF relies chiefly on private donations to support its emergency medical projects and receives more than 30 per cent of that income in the last month of the year, so outcomes are not clear until after the year ends. To ride out the uncertainty last year, MSF prepared a detailed contingency plan to ensure the continuity of aid to populations in danger. We maintained stringent controls on headquarters expenditure, and cash flow was closely monitored. Although cautious budgets for field work were a necessity, priority was placed on maintaining the flow of funding to field projects. After the closing of the 2009 year and the audit of the financial statements, we are relieved that our donors once again proved their commitment to our patients. Final results show a five per cent increase in donations over 2008, which represents a very slight shortfall on income goals. Fortunately, this was partially offset by a higher total amount of Canadian International Development Agency (CIDA) grants and our ratios were only nominally affected.

Click here to download the Auditorâ&#x20AC;&#x2122;s report.

A detailed financial report, from our external auditors KPMG, is available as a separate document. There were no management issues in the audit report and MSF Canada entered the 2010 year in a strong financial position, with sound organization and control.

MSF psychologist talking to an earthquake survivor close to Padang Alei, Indonesia. ÂŠ Juan-Carlos Tomasi 18

Projects Funded by Canadians

8 9

15 2

1 3

4 7

1 2 3 4 5 6 7 8 9 10

Central African Republic Chad Colombia Democratic Republic of Congo Guinea Haiti Kenya Myanmar (Burma) Niger Pakistan

1 1 12 13 14 15 16 17

Papua New Guinea Russia/North Caucasus Somalia Sri Lanka Northern Sudan (Darfur) Southern Sudan Zimbabwe

Central African Republic

A nurse examines a patient in a feeding centre set up by MSF. ÂŠ Jaume Codina 20

Focus on malaria and sleeping sickness CIDA assisted MSF with its activities in the Ouham and Ouham-Pende regions of northern Central African Republic (CAR). MSF teams provided first and second-level health care in the unstable Batangafo-Kabo and Paoua regions. MSFâ&#x20AC;&#x2122;s medical activities aided the rural outskirts by equipping and staffing 14 health stations belonging to the health network of the three sub-prefectures. More than 420,000 consultations were conducted throughout northern CAR. Thirty per cent of the patients were treated for malaria, and more than 24,600 patients needed to be hospitalized. Teams assisted more than 3,600 deliveries and performed over 5,000 surgical interventions. Patients began treatment for tuberculosis and HIV/AIDS as well as malnutrition, and basic relief items were distributed to those who had been displaced by the violence.

Along the Chadian border in the northwest of the country, MSF opened a sleeping sickness program. By the end of the year more than 1,500 patients had been treated using a new treatment known as Nifurtimox-Eflornithine Combination Therapy, or NECT. This drug is less expensive and easier to administer than previous treatments. In the southwest, between July and December, MSF treated more than 7,200 acutely malnourished children

CIDA funds: $1,000,000

Central African Republic

People in the Central African Republic have suffered for years from violence and displacement. In spite of the peace accord signed in mid-2008 between the government and various rebel groups, the situation remained extremely fragile.

Chad

In the Birak district on the border with Sudan, thousands of refugees have escaped from the Sudanese region of Darfur. ÂŠ Espen Rasmussen

Chad Life remained precarious for hundreds of thousands of Chadians affected by conflict, violence and displacement. Health services throughout the country were restricted by lack of funding and qualified personnel, but the situation was particularly severe in the east, where banditry, criminality and insecurity were rife.

Halting progress as insecurity rises

CIDA funds assisted MSF in activities along the Chad-Sudan border region. These included improved basic health care services, quality secondary healthcare services including surgery, and the provision of ante-, peri-, postnatal and reproductive healthcare services including maternity, and emergency response in Adre and Guereda, Goz Beida and Ade regions. MSF also vaccinated more than 226,000 children against measles as part of our response to an outbreak of that disease in the Ouaddai region. In DogdorĂŠ, MSF provided basic primary healthcare through local MSF staff.

MSF also was involved in emergency interventions responding to populations fleeing northern Central African Republic.

CIDA funds: $1,200,000

Colombia

The many years and high level of violence against the civil population in Colombia have caused many displacements to the urban areas and has destroyed the social cohesion of the population. ÂŠ MSF

Colombia

Colombia has suffered from an extremely violent conflict over the last 50 years. In 2009, massacres and forced displacement again reached record levels, but the government provided the victims of violence with little protection. Health care services were scarce and mental health services unavailable to those who needed them most.

Health care in critically short supply in violent areas Teams responded to various emergencies and basic healthcare needs, targeting remote and conflict affected regions. We also have a program targeting patients with Chagas disease in the Arauca department on the border with Venezuela.

In Norte de Santander, MSF teams addressed critical gaps in healthcare provision focusing on displaced people, sex workers and children – and saw about 3,000 patients plus ante-natal, psychosocial support and treatment for sexual violence.

Teams also provided sexual and reproductive healthcare, as well as mental health care and assistance to victims of violence.

The increased presence of other capable healthcare institutions in the Sucre-Bolivar region enabled MSF to hand over its activities in Montes de Maria, Carmen de Bolivar and Sincelejo. Teams refocused their efforts on areas more directly affected by conflict and less accessible to other healthcare actors, such as the Magdalena Medio region.

Contributions by Canadians went to support MSF’s work in three geographic areas. In Bajo Atrato, MSF provided free basic healthcare to internally displaced people living in slums and communities isolated by violence in Urabá Antioqueño and started activities in the Bajo Atrato area. We expect to close the Urabá Antioqueño in 2010. Approximately 6,200 patients received primary healthcare support in those locations, including assistance addressing sexual and gender-based violence, sexually transmitted diseases, sexual and reproductive health and mental health care.

Projects in Colombia only used funds raised from private donors.

Private funds: $1,000,000 25

Democratic Republic of Congo

A woman walks, laden with firewood and her child, in Mweso, in the province of North Kivu. ÂŠ Michael Goldfarb

Suffering amid the violence MSF chose not to accept government funding for its activities. In the Kivus, MSF provided emergency medical care and primary and secondary healthcare to 192,000 patients (including 5,600 rape survivors) in the places most affected by armed conflict, including Rutshuru, Nyanzale, Masisi, Mweso, Kitchanga and Kirotshe, Kalonge district, Bunyakiri, Kayna, Nyamilima and Shabunda Territory. In the northeast, an area plagued by the Lord’s Resistance Army, MSF works in Dungu hospital, Doruma, Faradje, Niangara, Dingila, Ango, and Ariwara providing psychosocial support, vaccination against measles, relief items and basic medical care. Canadian donations assisted MSF’s multi drug resistant TB and HIV treatment activities in in Baraka and Shabunda, which was handed over in September. Funds also supported primary and secondary healthcare in Mweso and Baraka, emergency primary healthcare in the Katchanga and pediatric healthcare in Bunia including emergency healthcare to people who fled violence in the Smililiki area. Teams provided close to 233,000 primary healthcare consultations, hospitalized around 20,400 patients, conducted 1,270 major surgeries, treated 10,400 children for acute under-nutrition, gave 22,900 anti-natal care consultations, and treated 896 rape survivors. Psychosocial support was also provided.

Emergency activities funded include emergency cholera and water and sanitation in Kitchanga, Goma, Mpati, Kivuye, Nyange, Ibuga, Kashuga, Kalembe, Muhanga; and vaccination campaigns in Mweso area, Mpati, Kalengera, Kashuga, Kalembe, Muhanga, Kivuye, Nyange. Insecurity continued to undermine MSF’s attempts to support the weak and overextended national healthcare system. In October, seven vaccination sites came under fire during attacks by the Congolese army against the FDLR in the Masisi district, despite an assurance of safety from the government. MSF denounced this as an unacceptable attack on civilians. Following attacks in the northeast, MSF had to suspend its activities in treatment centres for sleeping sickness (trypanosomiasis) in Bili and Banda, where MSF had treated 228 people in the first three months of the year. MSF will continue its projects in Democratic Republic of Congo and lobby against issues such as forced displacement.

Private funds: $2,500,000

Democratic Republic of Congo

Throughout 2009, civilians continued to suffer at the hands of different armed groups in eastern Congo. Hundreds of people were killed, thousands raped and hundreds of thousands fled their homes. Guerrilla warfare replaced armed clashes in North Kivu: combatants spread terror by looting and burning houses in reprisals against the perceived support of rival communities.

Guinea

From August to October 2009, MSF, in collaboration with the National Program against Malaria (NMCP) distributed mosquito nets to 200,000 inhabitants of Matam, one of four municipalities in the Guinean capital Conakry. ÂŠ Johann Buchot / MSF 28

Guinea

In September, government security forces cracked down violently on a large opposition rally in the capital city of Guinea. Political instability remained throughout 2009, and poverty and limited access to quality health services continued to affect the lives of most Guineans.

Pediatrics and HIV/AIDS care amongst political instability MSF activities in Guinea focused on response to violence, pediatrics, HIV/AIDS care, prisoner health and malaria. By the end of 2009 MSF was supplying more than 4,000 patients with antiretroviral therapy in the city of GuĂŠckĂŠdou, and providing emergency medical and nutrition support in several Guinean prisons. An MSF study found that one in three adult male prisoners suffering from malnutrition. Canadian support helped teams respond, in local hospitals and clinics, to the influx of hundreds of people that had been wounded in the government repression of an opposition protest on Sept. 28, 2009. Funds also assisted MSFs pediatric program in Matam, a district in Conakry, where MSF medical staff performed more than 5,500 consultations treating mostly malaria, malnutrition and diarrhea.

Private funds: $100,000

Haiti

A nurse in the premature children ward in Solidarité, MSF’s maternity hospital in Port-au-Prince. © Espen Rasmussen

Haiti Fragile political stability in Haiti was achieved with the election of a new government in 2006. However, 2009 was marred by rising food prices, chronic unemployment and a dysfunctional health care system, which combined to generate further civil unrest. Slum-dwellers in the capital Port-au-Prince continued to subsist in deplorable conditions.

Mortality rates underline need for affordable care In 2009, before the earthquake on Jan. 12, 2010, MSF was running the TrinitĂŠ Trauma Centre in Delmas 19, where 9,996 patients were treated in the emergency room with 4,266 undergoing surgery. We also ran the Martissant Emergency Centre which saw nearly 48,000 patients where over 60 percent of new patients were victims of trauma. Canadian funds went towards the emergency obstetrics hospital in Port-au-Prince that focused on live-threatening complicated deliveries and ante-natal care in three slum locations. Antenatal teams carried out 1,500 consultations per month and, since the emergency obstetric program was opened in 2006, more than 40,000 babies have been delivered.

The massive earthquake that hit Haiti on Jan. 12, 2010 destroyed both the emergency obstetric hospital and the trauma hospital. MSF lost both patients and staff when the TrinitĂŠ Trauma Centre collapsed.

Private funds: $500,000 31

Kenya

Women wait for medicine to be dispersed inside of an MSF medical station in Dadaab, Kenya, on the border with Somalia. ÂŠ Spencer Platt / Getty Images

Kenya

In early 2009, as people fleeing the fighting in Somalia arrived in Kenya in the thousands, MSF teams re-started working in Dadaab refugee camp in Dagahaley in the northeast of the country after a five year absence.

A cholera epidemic and a new influx of refugees MSF’s activities in Kenya focus on providing healthcare to Somali refugees, responding to emergencies, treatment of kala azar, TB, sexual violence and HIV/AIDs. Our work focused on city slums such as Mathare and Kibera slums, and in Homa Bay. MSF responded to Kenya’s first cholera outbreak in 12 years treating approximately 5,000 people. In Molo, MSF provided care for people that survived the explosion of a fuel tanker in January. Canadians’ support went specifically to medical care for Somali refugees in the Dagahaley camp in Dadaab and treatment for kala azar in Kacheliba, West Pokot District, where 464 patients were admitted for treatment.

The Dagahaley camp, built to accommodate 90,000 people, was struggling to cope with close to 300,000,by the end of 2009. MSF provides healthcare in the camp via a 100 bed hospital that provides around 10,000 patient consultations and admits 600 people per month. In a 5 month period MSF treated 2,200 malnourished children.

Private funds: $143,335

Myanmar (Burma)

Patients waiting to see MSF medical staff. MSF runs a pre-natal and post-natal service in many of its clinics, to encourage mother to child prevention of HIV/AIDS. ÂŠ MSF 34

Myanmar (Burma)

Myanmarâ&#x20AC;&#x2122;s people continued to face an urgent health crisis in 2009. Malaria, HIV/AIDS, and tuberculosis (TB) spread largely unchecked. The government spends just 0.3 per cent of its gross domestic product on health care, the lowest percentage worldwide. International aid to the country remained desperately insufficient, at just $3 per person per year.

Failing system leads to health crisis MSF worked with populations in the remote border states and Yangon, focusing on treatment for HIV, tuberculosis, and malaria. MSF treated approximately 160,000 malaria patients in Rakhine State. At the beginning of 2009 MSF was providing treatment for 14,500 out of the total 21,000 patients receiving anti-retroviral treatment in the country. An estimated 240,000 people are living with HIV in Myanmar. Canadian funds went towards activities focusing on treatment of infections of HIV, TB, STDs, and malaria in Rakhine State, Kachin State, Shan State. In Yangon, MSF teams focused on HIV care and started a multi-drug resistance tuberculosis treatment

program. In addition to treatment of HIV and TB, MSF teams in these programs provided over 740,000 medical consultations. MSF continued to lobby, throughout 2009, for increased response from the government and international community to address the HIV/AIDs crisis.

Private funds: $500,000

Niger

MSF teams working with the Ministry of Health treated patients suffering from meningitis and are vaccinating in the Dosso, Maradi and Zinder regions, Niger. ÂŠ Guillaume Ratel

Niger

The people in this mainly rural, sub-Saharan country have only limited access to healthcare, and facilities that do exist are largely under-equipped and understaffed. MSF has been working to provide nutritional aid to malnourished children as well as general and maternal healthcare, and last year launched a large meningitis vaccination campaign.

Combating child malnutrition and meningitis MSF activities focused primarily on responding to high levels of acute malnutrition, maternity and reproductive health services and emergency response. In 2009 MSF treated more than 34,000 severely malnourished children and provided a further 150,000 people with free healthcare. Throughout the year, the country was repeatedly hit by epidemics requiring emergency responses. In the meningitis outbreak, MSF together with the Ministry of Health treated 3,300 people and immunized 2.17 million in the Zinder and Tahoua regions. In September MSF provided emergency medical assistance to 9,500 people and relief items to 2,000 displaced by flooding in Agadez.

Canadiansâ&#x20AC;&#x2122; support in 2009 helped MSF provide emergency treatment for acutely malnourished children in Zinder and Magaria. Within the first nine months of the year, MSF admitted 6,400 children under five who were suffering from severe malnutrition in Zinder; a third of them needed to be hospitalized. Nearly 12,000 children were admitted to the clinic in Magaria during the same time period with 1,800 requiring hospitalization.

Private funds: $1,016,000

Pakistan

A newborn baby and mother in one of two maternal and child care clinics run by MSF in Kuchlak, in the province of Balochistan, Pakistan. ÂŠ Vali Faucheux Georges

Pakistan

In 2009, the people of Pakistan suffered from the escalation of fighting between armed forces and opposition groups. The impact of the conflict was hardest felt in the Federally Administered Tribal Areas and the North West Frontier Province, but effects reverberated around the country.

Urgent health needs In this highly contested and political environment, support by Canadians allowed MSF to maintain programs without government funding. Activities revolved around critical care for displaced people, trauma treatment, cholera response, basic healthcare, and improving mother and baby care in Mardan District, Lower Dir, Charsadda, Peshawar, Malakand District, Kurram Agency, Eastern Balochistan, Kuchlak, Chaman, and in the eastern districts of Nasirabad and Isafarabad. In June we started providing medical consultations in Kala Dhaka tribal area where the parasitic disease cutaneous leishmaniasis is endemic. Canadian funds supported basic medical and mother-child healthcare in the Kuchlackâ&#x20AC;&#x201C;Chaman area, Kurram Agency and Eastern Balochistan. In both Kuchlak and Chaman MSF teams provided over 102,000 outpatient consultations, over 6,000 antenatal care consultations, delivered over 3,000 babies including

113 by c-section, treated 943 acutely malnourished children, plus psychosocial support. In Chaman the teams started to set up an emergency room and blood bank to improve care for people wounded by weapons. In Kurram agency MSF runs a pediatric and safe motherhood program, but also these teams assisted with the emergency response in Mardan. MSF teams have the same focus in Eastern Baluchistan where in 2009 they treated just over 4,000 children for acute malnutrition. In February, two MSF medical technicians were killed as they travelled in an MSF ambulance on their way to pick up civilians injured in fighting in the Swat District of NWFP leading MSF to withdraw from Swat District. Travel restrictions prevented MSF teams from providing medical support to communities displaced by fighting in South Waziristan.

Private funds: $712,760

Papua New Guinea

Physical and sexual violence against women and children in Papua New Guinea is extreme. Two out of three women experience domestic violence and 50 per cent of women have experienced forced sex, rape or gang rape. ÂŠ Helen Pantenburg

Papua New Guinea

Papua New Guinea, a country in transition, has undergone significant economic and social change since it gained independence from Australia in 1975. Violence, particularly against women and children, is rampant in most communities as a result of the sudden and brutal shift towards modern Western culture, the deteriorating socio-economic situation and overall impoverishment. Many survivors of sexual and gender-based violence and people living in areas affected by tribal violence lack access to adequate medical and psychosocial care.

Pervasive violence

decimates public health Canadian support allowed MSF to offer medical humanitarian assistance in Lae, in Tari and cholera response in the southern Pacific country of Papua New Guinea (PNG). PNG has high levels of extreme physical and sexual violence against women and children, particularly girls. In Lae, MSF worked in the Women and Childrenâ&#x20AC;&#x2122;s Support Centre in Angau Memorial Hospital, providing medical care to 2,300 patients, as well as psychosocial care to 315 survivors of sexual and genderbased violence and 4,430 psychosocial consultations. In the highlands region of Tari, which suffers from very high levels of endemic violence, MSF medical staff consulted 4,150 patients, conducted 243 major surgeries, treated 56 women for

rape, and gave psychosocial support to 200 people. In response to a cholera outbreak, MSF teams supported the Ministry of Health in three provinces affected by cholera, treated 1,800 cases, and worked with the Ministry of Health in cholera preparation and training.

Private funds: $500,000

Russia/North Caucasus

Patients in MSF medical clinic in Angusht settlement for internally displaced people in, Nazran, Ingushetia. ÂŠ Maria Borshova

Russia/North Caucasus

Russia’s North Caucasus region has been in flux during the past year – particularly the republics of Chechnya, Ingushetia and Dagestan. Despite a declared end to the ten-year counter-terrorist operations in Chechnya by the Russian government, targeted killings and violence by several armed groups continued to scar the republic.

Never-ending cycle of violence For MSF, the priorities are to provide treatment for tuberculosis (TB), to offer psychosocial support, and to help vulnerable groups such as displaced people and illegal migrant workers who have experienced neglect or violence.

In July, MSF also ended its surgery and physiotherapy program in the main hospital in Grozny, since fewer patients required treatment for injuries and chronic disabilities that occurred during the war.

MSF doctors continued to offer free pediatric care in two clinics in Grozny in the south and to provide women with free healthcare in two clinics in the nearby Staropromyslovsky district. MSF also supplied drugs and medicines to a hospital in Grozny and to regional health centres in three mountainous villages.

Canadian contributions went to MSF’s tuberculosis treatment program in Grozny and our medical support activities in Ingushetia where in 2010, after a vulnerability study, MSF decided to hand over its primary healthcare activities for displaced in Nazran and focus their energy on supporting ambulance services in the same region.

MSF returned to Dagestan, after several years’ absence, to provide treatment for migrant workers and internally displaced people.

Private funds: $1,000,000

Somalia

A mother and her malnourished child at the MSF clinic in Galkayo, Somalia. ÂŠ Jan Grarup

Somalia

Violence, coupled with severe drought in some areas, continued to aggravate the grievous humanitarian situation for millions of people throughout Somalia in 2009. Despite critical medical needs, the response remained grossly insufficient as attacks against international and Somali aid workers repeatedly thwarted humanitarian efforts. Meanwhile the public health care system remained in near-total collapse. In this challenging context, MSF continued to deliver health care to hundreds of thousands of people thanks to its committed Somali staff, who were supported by a management team in Nairobi, Kenya.

Workers attacked – but needs persist Canadians’ contributions allowed MSF to maintain programs in Somalia, without government funding, in a highly volatile and political environment. Abductions and killings of international and Somali aid workers and ongoing insecurity remained the biggest obstacles to MSF’s efforts throughout the country. Such incidents caused MSF to close activities in the Bakook region, and to suspend activities in its pediatric hospital in Northern Mogadishu and a nutrition treatment centre in Jilib. In December, two mortars hit Belet Weyne Hospital, injuring two MSF staff. In June an MSF employee died in an explosion in the Hiraan region that also killed 30 other people.

Canadian donations specifically supported activities in Afgooye, Dinsor, Marere and Jilip and North and South Galcayo, covering primary and secondary healthcare including tuberculosis treatment, treatment for malnourished children, emergency surgery and emergency response. In the North and South Galcayo regions MSF teams treated approximately 3,500 outpatients/month, 180 inpatients per month, averaged 670 ante-natal care consultations per month, conducted 51 major surgeries (we did not have a surgeon in the project for the first six months), and treated approximately 700 children per month for acute lack of nutrition.

Private funds: $1,000,000

Sri Lanka

MSF staff do their rounds in the Pampaimadu camp near the city of Vavuniya. ÂŠ Voitek Asztabski

Sri Lanka

Sri Lankaâ&#x20AC;&#x2122;s decades-long war in the north reached its final stage in early 2009. Tens of thousands of civilians were trapped for months in a war zone reduced to a narrow strip of jungle and beach where there was no aid and only limited medical care. A few months earlier, the government asked humanitarian aid agencies including MSF to leave the areas most affected by the fighting. Only the International Red Cross was given permission to continue, and it evacuated some of the wounded to Ministry of Health hospitals.

Health needs outlast the fighting MSF teams provided emergency medical and surgical care for almost 4,000 war-wounded between February and June. On April 21, in just one 36-hour period, more than 400 patients were treated for life-threatening conditions in the Vavuniya hospital. In the MSF emergency field hospital near Menik farm, MSF saw more than 4,200 admissions, performed more than 1,600 surgical procedures and conducted more than 13,400 medical consultations. MSF teams also helped provide clean water for 300,000 displaced people in government-run camps and supplementary

feeding for around 10,000 undernourished people. CIDA funds also assisted the MSF teams in Point Pedro in Jaffna district provide surgical, emergency and obstetric treatment for patients at the Ministry of Health hospital. MSF performed more than 2,000 emergency consultations and 1,300 surgical interventions.

CIDA funds: $1,175,000

Sudan / Darfur

In 2009, millions of people in Darfur remained internally displaced and required outside assistance, while war-related violence and clashes over resources continued to take their human toll throughout the year. Improving health indicators masked the sad fact that for most people in Darfur, living conditions remained extremely precarious.

Expulsion leaves 200,000 without health care Due to the political complexity and international involvement in the crisis in the Darfur region of Sudan, our projects there relied solely on funds from private donors. However, in 2009 our financial independence did not prevent the expulsion by Sudanese authorities of two out of five MSF sections from operating in the Darfur region. Thirteen other international aid agencies were also expelled at this time. More than half of MSFâ&#x20AC;&#x2122;s programs were forced to close as a result of the expulsions. Two more projects in Serif Umra, Kebkabiya and Tawila in North Darfur were suspended after four MSF staff were kidnapped.

MSF nonetheless provided over 168,000 consultations, more than 28,000 antenatal consultations, admitted nearly 2,500 people to hospital and treated some 4,500 people for malaria throughout the year in the Darfur region. Projects in Golo and Killin were handed over to the Ministry of Health in October, and in the same month we were able to restart activities in Tawila, as well as opening a project in Um Baru, a remote area of North Darfur.

Private funds: $1,000,000

Sudan (southern)

A man recovers in the MSF clinic after being hit by a bullet in the fighting in the south of Nasir. ÂŠ Finbar Oâ&#x20AC;&#x2122;Reilly

Sudan (southern)

Nearly five years after the Comprehensive Peace Agreement ended Africa’s longest civil war, medical needs throughout southern Sudan were still urgent, and escalating tensions were making the security situation precarious. Violent clashes in the south throughout 2009 left hundreds dead and tens of thousands displaced.

Medical assistance amidst the violence MSF teams responded to increased violence in central southern Sudan and to those fleeing violence caused by the Lord’s Resistance Army operating in Democratic Republic of Congo and Central African Republic. These emergency interventions were in addition to medical care that MSF provides in its longer-term projects in southern Sudan. Throughout the year, 1,400 staff provided treatment and medical care to hundreds of thousands of people in seven states in southern Sudan and in the transitional area of Abyei. Over 431,000 people received care and more than 10,300 were admitted to MSF’s clinics. Nearly 63,000 women had antenatal consultations and over 8,000 children were treated for malnutrition. More than 50,000 people suffering from malaria were treated and 188,000 people were vaccinated.

Canadian contributions assisted MSF’s activities in Abyei, on the border of north and south Sudan. MSF teams in Abyei saw 38,800 patients in two fixed outpatient clinics, mobile clinics in 17 different locations, and a hospital that included an inpatient department, a maternity and reproductive healthcare ward, a nutritional centre. While minor surgeries were possible in the Abyei hospital complicated surgeries were referred to the MSF surgical team in Aweil.

Private funds: $500,000 CIDA funds: $1,300,000 51

Zimbabwe

A cholera patient in MSFâ&#x20AC;&#x2122;s cholera treatment centre in Harare. ÂŠ MSF

Zimbabwe

In June 2009, the cholera outbreak that had gripped Zimbabwe since August 2008 onward was officially declared over. By that time, the UN had reported almost 100,000 suspected cases and more than 4,000 deaths from the disease. MSF treated about 39,900 patients and supported numerous treatment centres throughout the country. Zimbabwe’s humanitarian emergency, however, encompassed more than the cholera epidemic.

Progress still

painfully slow In August 2008, the worst cholera epidemic in Zimbabwe’s recorded history broke out. By its end in June 2009, MSF had treated 65,000 people. MSF also worked in Zimbabwe’s prisons to treat cholera and provide treatment for inmates with severe malnutrition. MSF also treated more than 1,700 severely malnourished children in Epworth, near Harare and Buhere. Before the cholera outbreak MSF’s activities focused on treatment of HIV/AIDs, in which we treat more than 52,000 people including 39,000 on antiretroviral therapy. In Gweru, in collaboration with the Ministry of Health, MSF provided medical and psychological help for over 180 survivors of sexual violence. MSF opened a project in Beitbridge, along the Zimbabwe-South Africa border, to assist migrants travelling between the two countries.

Canadian funds went to assist MSF activities in Gweru, Epworth, Zimbabwe prisons, cholera response, water and sanitation activities in Mabvuku, Tafara and Caledonia Farm. At the end of 2009 these projects were treating 14,600 patients for HIV, and had treated over 23,200 people for cholera. The CIDA grant supported MSF emergency response efforts in the country, most specifically for cholera preparation and response to violent trauma, displacement and malnutrition.

Private funds: $500,000 CIDA funds: $500,000 53

MSF clinic in Kitchanga, North Kivu, Democratic Republic of Congo. The clinic is located next to the sprawling Mungote Camp, home to over 28,000 displaced Congolese civilians who have been uprooted from their homes because of ongoing conflict. ÂŠ Michael Goldfarb

Canadians on mission

Bangladesh Loretta Beaulieu, Logistician Sharla Bonneville, Administrator Amy Hollings, Nurse Kylah Jackson, Nurse

Locations of Canadians in 2009 DRC 5%

Asia 21%

Other Africa

Sudan 6%

Burkina Faso Michele Lemay, Medical doctor Burundi Rachelle Seguin, Nurse Brazil Tyler Fainstat, Financial coordinator/Head of mission Joel Montanez, Mental health officer Brunei Kylah Jackson, Nurse Cameroon Robert Parker, Project coordinator Central African Republic Michele Beaudry, Mental health officer Nicolas Berube, Logistician Patrick Boucher, Logistician Duncan Coady, Financial coordinator Richard Currie, Medical doctor Edith Fortier, Project coordinator Nicholas Gildersleeve, Project coordinator Nathalia Guerrero Velez, Logistician

Central African Republic Chad

Haiti 20% Nigeria 10% 18%

Others

Matthew Hatson, Financial coordinator Miriam Lindsay, Logistician Tara Newell, Project coordinator Robert Parker, Head of mission Elizabeth Poirier, Nurse Richard Poitras, Administrator Simon Riendeau, Medical doctor Rachelle Seguin, Nurse Raghu Venugopal, Medical doctor Daniela Widmer, Nurse Chad Eva Adomako, Administrator Nicolas Berube, Administrator Frank Boyce, Medical doctor Nicholas Gildersleeve, Logistician Griselda Goad, Nurse 55

Nathalia Guerrero Velez, Logistician Guylaine Houle, Logistician Clea Kahn, Head of mission Serena Kasparian, Medical doctor Mathieu Leonard, Logistician Caroline Pelletier, Administrator Audra Renyi, Administrator Sonya Sagan, Administrator Mathew Schraeder, Logistician Ada Yee, Financial coordinator China Peter Saranchuk, Medical doctor Colombia Martin Girard, Project coordinator Elaine Sansoucy, Nurse Democratic Republic of Congo Claire Abdulahad, Logistician Tamiko Andrews, Nurse Daniel Arnold, Logistician Grant Assenheimer, Logistician Marie-Eve Bilodeau, Information education coordinator Charmaine Brett, Project coordinator Owen Campbell, Administrator, Logistician Monica Chaudhuri, Medical doctor Michelle Chouinard, Project coordinator Nadine Crossland, Nurse Marika Daganaud, Nurse Denis Deschenes, Nurse Frederic Elias, Logistician Marc Forget, Medical doctor Frédéric Dubé, Logistician Chantal Gauthier, Nurse Sherri Grady, Nurse Elizabeth Kavouris, Nurse Pierre Langlois, Administrator Reine Lebel, Mental health officer 56

Barbara Leblanc, Medical doctor Joanne Liu, Medical doctor Isabelle Major, Logistician Tricia Newport, Nurse Ali Parandeh, Financial coordinator Nadia Perrault, Nurse Thierry Petry, Medical doctor Gisele Poirier, Nurse Bruce Reeder, Medical doctor Patrick Robitaille, Project coordinator Denis Roy, Mental health officer Elaine Sansoucy, Nurse Sylvie Savard, Financial coordinator Susan Tector, Head of mission Ghislene Telemaque, Nurse Nicolas Verdy, Logistician Jake Wadland, Logistician Djibouti Tricia Newport, Nurse Ethiopia Vanessa Bailey, Nurse Erwan Cheneval, Project coordinator Harry MacNeil, Logistician Anne-Marie Pegg, Medical doctor Michael White, Logistician Guinea Thierry Oulhen, Nurse Haiti Patrick Boucher, Logistical coordinator Michelle Chouinard, Head of mission Annie Dallaire, Financial coordinator Asha Gervan, Administrator Wendy Lai, Medical doctor Patrick Laurent, Logistician Marise Denault, Project coordinator

Gabrielle Pahl, Medical coordinator Nicole Riese, Medical doctor Elaine Sansoucy, Nurse Danielle Trepanier, Logistician Honduras Mathieu Leonard, Project coordinator India Judy Adams, Mental health officer Rhona Bhuyan, Administrator Richard Crysler, Mental health officer Rachiele Diane, Financial coordinator coach Anne MacKinnon, Nurse Catherine Oliver, Medical doctor Wendy Rhymer, Nurse Iraq Adatia Reshma, Project coordinator Israel Mark Kostash, Medical doctor Susan Trotter, Nurse Jordan Steffen de Kok, Logistician Kenya Maguil Gouja, Financial coordinator Lauralee Morris, Medical doctor Mali Martine Verrault, Pharmacist Mozambique Isabelle Casavant, Nurse Serge Kabore, Medical Doctor

Matthew Calvert, Logistician Marilyn Hurrel, Nurse Isabelle Roger, Epidemiologist Niger Marisa Cutrone, Nurse David Descossy, Logistician Sherri Grady, Nurse Marie-Michele Houle, Nurse Michele-Alexandra Labrecque, Medical doctor Catherine Lalonde, Logistician Simon Riendeau, Medical doctor Nigeria Adham Abo Shahba, Administrator Ian Adair, Financial coordinator Nicolas Berube, Logistician Kevin Coppock, Interim Head of mission JL Crosbie, Administrator Megan Hunter, Nurse/Coordinator Sharon Janzen, Nurse Michelle Lahey, Nurse Eva Lam, Epidemiologist Helene Lessard, Financial coordinator Christene MacLeod, Nurse Vivian Skovsbo, Medical doctor Susan Witt, Nurse Nepal Charmaine Brett, Project coordinator Marilyn Hurrel, Nurse Pakistan Darryl Stellmach, Assistant Head of mission Peter Heikamp, Logistician Susan Tector, Medical doctor

Myanmar Anne Josee Boutin-Trudeau, Logistician 57

Papua New Guinea Jaroslava Belava, Nurse Shannon Lee, Project coordinator Harry MacNeil, Project coordinator Nadia Perrault, Nurse Allana Shwetz, Nurse Brenda Vittachi, Nurse Philippines Grant Assenheimer, Logistician Kevin Barlow, Nurse JL Crosbie, Logistician Guillaume Giard, Logistician Isabelle Roger, Epidemiologist Rachelle Seguin, Nurse Somalia Adam Childs, Project coordinator Luis Neira, Medical coordinator James Squier, Logistician South Africa Cheryl McDermid, Medical doctor Sri Lanka JL Crosbie, Logistician Sarah Lamb, Logistician Luella Smith, Medical doctor Dennis Steve, Project coordinator Gracy Tang, Project coordinator Fiona Turpie, Medical doctor Sudan Laura Archer, Nurse Justin Armstrong, Project coordinator Loretta Beaulieu, Logistician Jaroslava Belava, Nurse Edith Cabot, Nurse David Croft, Project coordinator Oonagh Curry, Administrator 58

Marinus De Lange, Logistician Jason Friedman, Medical doctor Sylvain Groulx, Head of mission Kylah Jackson, Nurse Sarah Lamb, Administrator Michael Lawson, Logistician Leanne Olsen, Nurse Jennie Partridge, Nurse Dominique Poissant, Logistician Letitia Rose, Nurse Sheryl Spithoff, Medical doctor Michael White, Project coordinator Turkmenistan Sharla Bonneville, Administrator Uganda Miriam Lindsay, Logistician Alfonsine Mukakigeri, Financial coordinator Emily Shallhorn, Nurse Alia Tayea, Administrator Elaine Wynne, Medical doctor Uzbekistan Ada Yee, Financial coordinator Zambia Jean-Francois Nouveaux, Logistician Zimbabwe Nicolas Hamel, Nurse Ivik Olek, Nurse

Estate gifts MSF is grateful to the individuals who made gifts to MSF through their estates and to the family members and executors who helped to fulfill their wishes to leave this legacy. The late Marnie Morrow, a humanitarian and philanthropist, included MSF in her estate. Her niece, Sally Menill, describes her commitment to MSF: “She supported and championed the mission of MSF, particularly in providing attention to inequalities in global health.” Anonymous (4) Jack Wadsworth Allen Norah Allin Helen Agnes Arthurs Gérald Beaulieu Leonard Wilson Black Peter Josef Block Mary Ellen Bradley Klaus Buehrer Letitia Mae Burke Phyllis Alberta Carufel Laurent Joseph Coquet David George Court Alicja Lipecka Czernic William John Davidson Marian Duncanson Daniel Fabi Winnifred Edith Fakis Laurette Faucher Michael Henry Futrell Gladys Audrey Griffiths Elmer Gyoerffy Annette Elizabeth Hacking Jeanette Barbara Haddad Lorna Hammond Juline Carla Hande Sarah Eleanor Wylie Haydock

Marjorie Louise Kotovich Agnes Jean MacDonald Helen Marie McAninch Joseph Neville McCarthy Rita McDonald Lawrence Bert Morgan Marnie Morrow Jean Paquet Céline Perron Margaret Eleanor Porter Monique Gertrude Lafontaine Riese Neil Rix Lucy May Robertson Vera Eve Rudinicki Ellen Shepherd Clare Neville Smith Helene E Smith Margaret Steckley Phyllis Stoessl Marjorie Sullivan Irene Emily Nicholson Thomson Mary Nancy Vitale George Francis Whinton Robert Hood Wilson Anne Elizabeth Wright Annelies Zelonka 59

A father and his son waiting inthe emergency ward of the Ahmed Shah Baba Hospital in Eastern Kabul. ÂŠ Erwin Vantland

Sans Frontières Society This heritage society includes those who have been inspired to act now and in the future by including MSF in their estate and financial planning. MSF thanks each of these members for their commitment to humanitarian relief, whenever and wherever it is urgently needed. Anonymous (52) Suzanne Ahern Peter Ajello Tasriqul M Alam Jim A Fraser & Carol Alette Jason & Doris Allen Jason & Doris Allen Philip Allt Gloria June Anderson Pierre Zakarauskas & Jennifer Arthur Wendy A Atkinson Sylvia Ayers Denis Baillargeon Margaret Baily Audrey Baird Lise Beauchamp Gisela Bednarsky Raoul Bellavance Pierette Bellavance Marie-Paule Bergeron-Binette Basil L Bernier Murray & Johane Black Kathy Blair Wilfred Blanchard Suzanne Bodner Margaret Bogue Yvonne Bookalam Roberta Boss

Rene Bouffard Sylvie Boutonné Melva Bradshaw John Brennan Eleanor Brent Dorothy Brown Nancy Brown William M Brummitt Margaret A Burkhart Chris Beingessner & Laura Burkhart Anne Burnett Elizabeth Burridge Katrin Buschhausen John & Elaine Butcher Daniel Byrne Margaret Calloway Josephine Campbell Karen Careless Pauline Carey Mary Carmody Carroll Ann Carmody Peter & Caroline Cavelti Claudio Cermignani Elizabeth M Chester Morgan Chiang Margaret Chinn Francine Chisholm Diane Clairmont

Marianne Clarke Kathleen Connors James Cooper André Corriveau Louise Cote James Craig Brian & Doreen Crawley Margaret Crompton Dorothy Cutting Yvonne Dandy Juergen Dankwort Alexander Daughtry W A Dawson Elly De Jongh Rita G deGuire Audrey C Denison Sandra Densmore Patricia R Desjardins JoAnn Dionne Christopher Doll Mary Donato Derek Murphy & Helene Dosteler Marie-Claire Dufour Ann Duggan Violette Lise Duguay L Beth Dulmage Melany Dyer David & Sheilah Dyson James R Easton Jane Ellison Ruby Ewen Sharon Farndale Thomas C Farrell 61

Leila Fawzi Audrey Fernie C Richard Fischer Dennis A Foley Sandra Follett-Bick Rory Fonseca Lucie Forget Ellen V Foulkes Chantal Fournier Lucienne Frenette Geoff Fridd Joy Friesen John J & Mrs Christine Furedy Peter Miller & Carolyn Garlich Valerie Anne Geddes Aimee O Gibson Juliet Gill Paul M Goldring Bill Goulios Angela Goyeau Audrey E Graham Anna E Graham-Cumming Kathleen Grant Thomas J Griffith Richard & Margaret Griffiths Roland Grittani Elizabeth Groen Elizabeth Guilbride Henriette Hadd Jack Charles Hallam Ronald E Hansen Nena Hardie Judith Hardy Elizabeth A Harley Leonard H Harper John & Karin Harrison A Patricia Harrod Robert Hastie Ronda Hauser Judith Hellman Anne Helps 62

Helena H Ho Julie Hodgson John & Reverend Nettie Hoffman Gwen Hopper S Horopw Ruth V Houle Ann House Peter Hovestadt Doris I Huber Norma Huber Elizabeth Lois Hubert Volker & Christiane Hubsch Bert Husband Gary Huston Robert Hutcheon Phyllis Ilsley Bruce Innes Caroline H Iwasaki Jennifer James M L Jayne Helen Johnson Lucy Johnston Jean F Kangas Katharyn Karrys John F Keating Derek G & Mary Keaveney Martyn Kellman Barbara Kingscote Godkin Bill Knight Marianna Korman Marina Kovrig Anna Kowalewski Eva Kushner Philippe Labbe Madeleine P Laing Akbar V A & Shamin Lalani William Landry Georgette Langevin Karen Shklanka & Eric Lanoix MichĂ¨le Laporte John D & Christa Large

Eugene P LaRocque Ann Laughlin Mary W Laurence Lutia Lausane Chi Lang Le Lise Le Tourneux K A Lederer Caroline Lee Lindy Lee Michel Lefranc Jocelyne A Legault Winifred Leigton Rowena V Leivo Joseph Leuwer Joan M Loames Penny Lobdell Robert Love Yuri Drohomirecki & Diane Lyon Marie E MacDonald G Charles MacDonald June MacDonald Bev MacDougall Geoffrey & Ann Machin Paul MacKenzie Heidi Martins Andree Y Martinson Victor Matysik S Diane Mausser Hugh McBride B W McFadden Michael McFadden Margaret McGratten Margaret McGregor Gordon I McIntyre Allison McLaren Michael V McMahon Gordon McMillan Lucie McNeill Ethel M McPhail StĂŠphane Michon Margaret Miller

Glenda Miller Anita Miller Marg Misener E Lorraine Mitchell Gisele Mondou Geertruida Aalida Mooring Hugh Moreland Patricia & David Morton Shelina Musaji Christian Naus Joyce Neale Barbara Neville Gisèle Nguyen Donald & Anne O’Conner Pauline O’Connor Gina Ogilvie Krystyna Ostrowska Jean-Guy Page Anne Patterson Peggy Pedersen Betty Peloquin Anne Perry H Douglas & E Lynne Peter Stan & Helen Petrowski Erica Phillips Ian Plenderleith Margaret Pointing Charles Polcyn Theresa Pook William Poole Patricia & Stephen Poulin Elizabeth Poppink Lawrence R Port Brenda Porter Colin Powell June L Powell Nadine Poznanski Helen Price M Louise Proctor Marjorie Radulovic Robert & Emily Ramin Paul & Margaret Reeve

Christina & Gary Richards Joan Aiken & Herbert Richter Russell Ritchie Marilyn Anne Robertson Paula Rochman Sean Rooney Allan Rosenzveig Pierre-Simon Ross Sarah Roth Jason Roth Stephen & Patricia Salt Hans Schaedel Eva Anneke Schoemaker David Schulze Margrit Schuster Gerd Schwarzkopf Grania Scott Pauline Scott Hendrika Seshadri Rose Shaw Marjorie Shephard George Sheppard Bonnie Shettler Naju Shroff Keki B Shroff Milena Simicic Juliet H Simon Trevor Simpson Augustine Yip & Monica Skrukwa Grace Smeltzer Ronald E Snow Ulrica So S Solty Norman Bih Hwei Soo Carol-Ann Sorensen Édouard Spiegle Laura Spiller Beverly Spring Enid E Squire Jean Stainton Martin St-Amant Jonathan M Standley

Geoff & Janice St-Denis Jancis Stead Mary Stevens Mary F Stevens Mary L Stewart Doris Suzuki Vincent Blaine Szabo Henry & Carol Tabbers Anne Tait Huynh Cong Tam Mary Anne Tangney James & Penelope Thacker Yasmin Thobani Anna Tinker Hilda Tremblett Robert Trépanier Chris & Rocio Tucker Shurli Tylor Marjorie Umezuki Gérard Vallée Simon van der Heym Miriam van Husen Mariette Van Wyk Fred & June Visser Stephen & Susan Vukadinovic Ronald Walker Ella Warrington G Douglas Watson Patricia Waymark Danielle Wenkstern Marjorie Whinfield Elizabeth C White Chuck Wightman Renate E Williams Beryl Wilson Raymond J R Wiss Alan Witherspoon Barbara Wood Joan Wyatt Jacob Ziegel

A two year old girl, with second degree burns on the face, the neck and the upper torso being treated in one of the new inflatable medical structures erected by MSF in Gaza City. ÂŠ Bruno Stevens / Cosmos

Board of directors, MSF Canada Joni Guptill, MD: president

Jim Lane

Bruce Lampard, MD: Vice-President

Luke Shankland

Charles Wong: Treasurer

Raghu Venugopal, MD

Kate Alberti

Jennifer Weterings

Stephen Cornish

Richard Zereik

Nancy Dale, RN Franรงoise Duroch

Colophon Publication MSF Canada 402 - 720 Spadina Ave. Toronto, Ontario M5S 2T9 Canada

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