Dispatches (Winter 2007) by Doctors Without Borders / Médecins Sans Frontières (MSF) Canada

Vol.9, Ed.1

Dispatches MSF

CANADA

NEWSLETTER

IN THIS ISSUE 2

Living in fear: Colombia’s cycle of violence

First day in Habilah

Upholding impartial humanitarian action

Emergency response and creative solutions

Not a single pill

Eyes in the field: Providing care and bearing witness

Knowing Marilyn ... Introducing MSF Canada’s new general director

1999 Nobel Peace Prize Laureate

COLOMBIA LIVING IN FEAR

Colombia

LIVING IN FEAR

COLOMBIA’S CYCLE OF VIOLENCE olombia is a thriving country with a lively culture and growing level of progress. It has modern cities, flourishing scientific and education centres, and the global aspirations of a decidedly developed country. Behind this upbeat image, an extremely violent internal conflict has carried on unabated for four decades. Fuelled by drug trafficking and foreign military assistance, the struggle by guerrillas, paramilitary groups, and government forces to control territory and resources continues to take a high toll on the civilian population. The human cost is immense.

Massacres, executions, intimidation and the massive consequent fear have become an inescapable part of everyday life for Colombians living in conflict-affected areas. The homicide rate for males between the ages of 15 and 44 stands at a startling 221 per 100,000. Violence is now also the leading cause of death for women between 15 and 39 years old (17 per 100,000), overtaking complications from pregnancy and childbirth. However, the impact of violence cannot be reduced to a simple body count. For every person killed a family is left behind: chil-

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dren without parents; parents without children; a wife without a husband; families without an income or a home. For every person who dies as a result of violence, many more struggle to survive it, often burdened by a range of physical and mental health problems. “It is difficult for MSF [Médecins Sans Frontières] to speak out about the situation in Colombia because we must take into account the safety and potential threats to our staff, or worse yet, to the people we’re trying to help,” says Paul McPhun, former head of mission with MSF in Colombia and now operational director for MSF in Canada. Arguably, the most worrisome feature of this conflict is the way in which violence has become entrenched in every aspect of social life, normalized in daily existence. The weight of this burden and its negative impact on people’s well-being and quality of life cannot be overestimated. People who live in conflict zones in rural Colombia are often perceived as supporters of the armed actors who operate locally. In this way, ordinary citizens become

stigmatized and identified with armed actors on all sides of the conflict. This situation creates not only a direct threat to their lives but also limits their ability to travel safely, even in cases of a medical emergency. Due to the conflict, health services barely exist in these isolated communities. Immunization programmes fail to extend vaccination coverage into rural Colombia, with coverage rates for some diseases such as polio as low as one per cent. The resulting risk of infection or outbreak constitutes a severe public health risk to populations in some of these areas. People forced by violence to flee their rural home areas typically settle in urban slums. There they must struggle against the harsh conditions, lack of opportunity and rampant violent criminality of the urban slum environment. Their displacement sadly creates another form of stigma, a mark for life, to the point where many displaced are unwilling to register for assistance programmes out of fear of the stigma. In these slums, provision of health services for displaced persons is inadequate. Vaccination coverage among displaced populations is disproportionately lower than national averages. Even so, the far greater risk of an

outbreak of infectious diseases comes from the appalling living conditions.

MSF has worked in Colombia since 1985, providing medical care to civilian populations isolated by the conflict, and more recently to those internally displaced in urban settings. More than 40 international staff and 150 Colombian staff provide assistance to thousands of people affected by the ongoing conflict in various parts of the country.

In Cordoba province on the northwestern coast, MSF staff use mobile clinics to provide healthcare to people living in remote rural villages. The teams offer basic healthcare, prenatal care, maternal and child healthcare, dentistry, and psycho-social support. In addition, the teams also treat people with malaria and cutaneous leishmaniasis.

Physical health is already one serious issue. Yet the greatest health impact of the conflict among the displaced is upon their mental well-being, and consequently upon their ability to adjust and cope with the formidable challenges of flight, displacement, and return. Ironically, mental healthcare receives woefully We’ve been here for a year and still we’re not low priority in these places of well. When the dogs bark my husband gets greatest need, and some up and sits out on the patio to see if someprovinces have few psychologists one is coming. There are more nights that we available to provide clinical care.

don’t sleep than we do. How are you going to forget the things you saw, the people they killed? I only sleep when I go somewhere else. It’s a nightmare here. People says that those people will come back.

— A woman living in a community of return

It is hard for the MSF workers to deal with the volume of violence their patients are dealing with, says McPhun. Even staff have counselling and debriefing every few months to help them cope with what they see and hear.

MSF report Living in fear: Colombia’s cycle of violence

Go to www.msf.ca to read the full MSF report, which includes photos as well as stories of Colombians affected by the conflict.

In the northeastern province of Norte de Santander, MSF conducts medical outreach activities in isolated rural areas, providing general consultations, vaccinations, reproductive health care, psychosocial care and dentistry.

MSF is trying very hard through its work to monitor the health of Colombians affected by the violence, says McPhun. “We must not let this be a silent conflict.”

The return of internally displaced people to their home areas is often perceived as a positive development, an escape from displacement and a return to “normality” for the families involved. Although this may be the case for some, return is often a traumatic experience, one presenting new threats and continued instability, with a demonstrable impact on people’s mental state. In the end, Colombia’s cycle of violence often transforms the salvation of return into yet another phase of temporary displacement. Programmes promoting return by the government and independent agencies should be scrutinized to ensure they respond effectively to the complexity of the problem.

In northeastern Sucre province, MSF has set up a clinic in the urban slums of the city of Sincelejo to provide urgently needed care to the local population. MSF teams are also working in rural and urban areas in the provinces of Caqueta, Choco, Narino, Tolima, Huila, and in Bogota.

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Letter from the field

FIRST DAY IN

HABILAH arrived yesterday by helicopter and had my first small tour of Habilah while flying, while landing, then once on the ground. The village is surreal, with an earthly beauty in spite of its history and its poverty. The landscape and all structures upon it are shades of brown and red, caked with the dust that permeates the entire atmosphere.

The people, however, dress in brilliant, vibrant colours that show an incredible contrast with the setting. Men in white hats

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and long, white robes sit on the sides of the road in the shade, mostly telling the children who are following us to leave us alone. The women walk down the “roads” carrying huge bundles of wood or pots on their heads and babies strapped to their backs. The children run around barefoot sporting torn, filthy clothes. These children don’t fit the criteria for being malnourished, but they certainly aren’t anywhere close to being considered well-nourished. This is in danger of changing when the UN World

Photography by Amy Osborne (pictured here, top left) and MSF

Food Program cuts the food rations in half due to a lack of funding. There has already been a big increase in the number of children being admitted to the Médecins Sans Frontières (MSF) therapeutic feeding centre at the hospital. Each dwelling is set apart by a fence of sorts, some of them made with woven straw, some with brick, others with dried, spiky brush. Each fence encloses a perfect square, and within that square compound

are the tukuls (huts) of the people. Some are fairly well built, while others look thrown together with whatever material happens to have blown by. The village of Habilah, once home to around 5,000 people, has swelled to around 25,000 with the influx of internally displaced people (IDPs). However, rather than living separately from the villagers, the IDPs here are integrated into the village, making it hard to know who is displaced and who isn’t. Over the past two and a half years, the people have started to try to make a life for themselves here.

MSF hospital Our little hospital is adorable. I got to meet our staff, and see the different sections of the hospital, getting a small idea as to what it is that we’re doing here in Habilah. There are examination rooms for the outpatients who come in daily for the more minor illnesses and injuries. The inpatient ward is where the patients who have to be admitted stay. One of the patients in the ward is a beautiful 10-year-old boy whose hand was blown off when he picked up and played with a random grenade — the third victim from his village in the last little while. He lay in his bed with one stump and his three remaining limbs wrapped in white gauze and he still managed to give us a blinding smile. When we got to the women’s centre, the women I’m going to be working with came out dancing and singing, while one of them emitted what sounded like a high pitched war-cry. One of them came running to hug me and they started to show me the small, handwritten signs on their clothes that read, “well come mrs Amy.” There’s a little room with two beds for the women in labour, and a small adjoining room for deliveries. Behind the two rooms is a private courtyard where the labouring women can walk around, rinse off or use a private latrine.

other hungry children) and at 5 p.m. they go home with a bag of food for the night. Once the child reaches a level of “moderate” malnutrition, they graduate to the SFC (supplementary feeding centre), where the family comes to pick up two weeks worth of food at a time. Next we saw the small room that has been converted to an operating theatre. Surgical cases are referred to El Geneina, West Darfur’s provincial capital, unless it’s night and travel is forbidden, or it’s a life or death emergency. The last surgery was a C-section on a woman who had an obstructed labour for two days. When she went into shock the team set up an impromptu operating table and performed the surgery. My first real conversation with Andi, the logistician, was him telling me about standing over the table, trying to hang a light so they could see what

they were doing, and looking down and making eye contact with the patient, and how it felt when they delivered her of a dead baby, then lost her as well three hours later. Not something that a former businessman deals with in Austria very often. My team here consists, thus far, of myself, Carmenza, Milena and Andi. Carmenza is a doctor from Colombia, Milena is a nurse from Switzerland, and Andi is the former businessman from Austria.

Amy Osborne Midwife Habilah, Darfur, Sudan

Amy Osborne is a midwife from Vancouver, British Columbia. She spent five months working with MSF in Darfur in 2006.

We went to the TFC next, which is the therapeutic feeding centre. One large tent contained 10 small, malnourished children, each with a mother or older sister to care for them. They stay all day so the families can be taught how to care for them (and so the mother doesn’t divide the food between her

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Afghanistan © Carl De Keyzer/Magnum Photos

Democratic Republic of Congo © Francesco Zizola

Humanitarian action

UPHOLDING IMPARTIAL he desire and ability to make impartial choices are at the core of humanitarian action. What does impartiality mean? Like triage, impartiality focuses on the greatest human suffering. Impartial decisions are based on the level of need rather than factors such as ethnicity, religion, political affiliation, economic status or nationality. Impartiality is an integral element of both medical ethics and the principles of humanitarianism.

rebel zone, fearing their operations would prop up the notorious rebel group. Médecins Sans Frontières (MSF) chose to have part of its operations in the rebel area due to the magnitude of human suffering we witnessed there. We disregarded the political pressure not to do so. It can be difficult to establish peace and democracy or long-term protection without sacrifice. Impartial humanitarian action, by its definition, seeks those that are sacrificed.

Within the context of humanitarian emergencies, the desire to make impartial choices is increasingly being undermined in various ways.

Second, strategic objectives relating to national political interests make it difficult for states and their military to make impartial choices. Western governments increasingly speak about a three-pronged approach in failed states where states engage simultaneously in three activities: provision of assistance to civilians (sometimes referred to as humanitarian action); diplomacy to encourage stabilization; and military combat or peace operations. This kind of policy tries to align various aspects of government (diplomacy, development, defense) behind the general strategic objectives. Within this

First, long-term objectives such as reconstruction, peace, good governance, democracy and stability can be compromised by immediate impartial choices to alleviate human suffering. During the civil war in Sierra Leone, for example, there was massive suffering and unmet needs in the rebel-controlled zone. Many aid agencies, as well as the UN, refused to operate in the

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mind-set, addressing immediate human suffering will not be prioritized unless doing so helps achieve the original objectives. Third, the desire to make impartial choices can be clouded by the increasingly complex working environments in which humanitarians do their jobs. It is easy to lose sight of priorities. The MSF team in Katanga, Democratic Republic of Congo, launched a nutritional survey in 2006 after alarming observations of malnutrition in the province. The UN health coordination group decided to block and boycott the results of the survey on the procedural bureaucratic grounds that MSF had not asked the coordination group for permission to proceed. If actors at the field level spend most of the time attending coordination meetings and writing reports, obvious priorities such as the provision of life-saving food and medical care would take a back seat. The ability of humanitarians to carry out impartial action is also being undermined.

Sudan ÂŠ Robert Maletta

HUMANITARIAN ACTION Security concerns can quickly undermine the ability of MSF to access populations with the greatest needs. Neutrality, both real and perceived, is crucial. Local armed actors must accept the presence of MSF. This acceptance is easily compromised, however, if one side in a conflict lays claim to all humanitarian work. By doing so, the opposing armed group may feel justified in targeting humanitarians. Early in the war in Afghanistan, for example, coalition forces dropped leaflets on Taliban areas in the south. The leaflets stated: â&#x20AC;&#x153;The attacks on allied forces are an obstacle to delivering humanitarian aid to your area.â&#x20AC;? The message was that if locals cooperated with coalition forces, they would receive aid. Aid cannot be seen as impartial when it hinges on cooperation with military forces. This type of blurring of lines not only kills humanitarians, it also kills the ability to impartially alleviate suffering. The difficulty humanitarian groups experience in carrying out impartial assistance

is also exemplified in the ongoing conflict in Darfur, Sudan. The UN Security Council called for a UN peacekeeping force (Aug. 31, 2006, resolution 1706) to assist or replace African Union forces in Darfur. The Sudanese government rejected the UN force. The resulting tensions have transferred to the field level, with some armed groups supporting the UN mission and others rejecting it. MSF and other humanitarian organisations on the ground are caught in the middle and unfortunately have experienced increased targeted attacks and a decreased ability to assist populations in need. Financial restraints can also hinder impartial action. Nongovernmental organisations that rely on governments (or even militaries) to carry out their action can easily find their work controlled or influenced. Thankfully, MSF has a strong private donor support and can make independent, impartial choices with minimal external influences. In India-controlled Kashmir in 2004, MSF received institu-

tional funds from the humanitarian branch of the European Union (EU). The EU was perceived as a neutral player in the conflict. When the EU began taking political statements regarding the situation in the Kashmir, MSF decided to suspend that funding. This action allowed MSF teams to continue a transparent dialogue with the various players in the conflict without the negative impact of perceived bias. Now more than ever MSF must uphold impartial humanitarian action. To do so, MSF must continue to operate independent of all economic, political and religious affiliations. Humanitarian action is and must remain motivated by the unacceptability of human suffering, and the desire to do something about that suffering.

Kevin Coppock Programme officer

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Lebanon

linking the two countries anymore. At that point, by accepting the Greenpeace offer to use the Rainbow Warrior to transport the material, MSF was able to get around this further obstacle. The problems of internal transportation required another creative solution. Since trucks and vans were targeted and it was impossible to find anybody willing to drive them to the south, MSF set up a system of taxis. Small convoys composed of three cars were organised to transport materials on a regular basis from Beirut to other places where MSF teams were working. During the conflict bombing completely destroyed bridges on the Litani River, a geographic division separating north and south Lebanon. This posed yet another challenge for delivering aid to some of those in need.

Emergency response and creative solutions n July 12, 2006 war broke out between Israeli military and armed Hizbollah forces from Lebanon. Retaliatory air strikes and ground offensives against Lebanon destroyed infrastructure, effectively cutting it off from the outside world. Assistance was offered on the Israeli side dealing with civilian deaths and injured from rocket attacks; however the nature of the conflict was such that there were greater needs and less available assistance in Lebanon.

head of the MSF emergency response team for Lebanon.

Médecins Sans Frontières (MSF) was no longer present in Lebanon and restarting operations from zero was no easy challenge. “At the beginning of the war it was not clear how it could evolve,” says Jean de Cambry,

“The international airport of Beirut had been bombed several times and wasn’t functioning anymore,” says de Cambry. “To find a good and safe point to cross the Syrian border was not that easy; and sea checkpoints made it very long and sometimes impossible to reach Lebanon from Cyprus.”

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Israel imposed a sea and air blockade at the start of the month-long war. At the same time, air strikes hit several bridges and important roads, trucks, vans, ambulances and cars were targeted several times, making any land transportation for Lebanon extremely difficult and dangerous.

While the first difficulty, how to get people inside Lebanon, was partially and temporarily overcome, the bringing in of humanitarian aid and organising internal transportation proved to be extremely problematic throughout the war. The first major problem was getting huge quantities of medical and logistical materials into the country. The only way to do so was by boat from Cyprus. But by the end of July more than 100 tonnes of material were stacked on the island because there were no civilian boats

“One day, when there was a lull in the bombing for 24 hours, my driver George and I drove west along the river looking for a crossing. We drove for five hours, going down every major and minor road only to find a crater in the road or a blown up bridge. In the end, we got as far as the coast without seeing a person or an extant crossing of the river. At the coast the main bridge had been blown up days before and a temporary sandbridge had been erected,” remembers Adam Childs, MSF head of mission in Lebanon. On Aug. 7, 2006 MSF set up a human chain across the Litani River, and from hand to hand to hand moved three trucks worth of medical supplies to MSF teams on the other side. Throughout the conflict more than 60,000 people displaced in Lebanon and 3,500 refugees in Syria received relief items such as cooking and hygiene kits, mattresses, blankets, bed sheets, baby formulas and tents. More than 300 tonnes of material were sent to Beirut, including relief items, medical supplies (material for dialysis, medicines, surgical kits) and logistical materials (sanitation equipment, water bladders).

Sergio Cecchini Emergency press officer

All MSF activities in Lebanon were financed through private funds.

Access to essential medicine

NOT A SINGLE PILL Not a single pill. So ran the headlines in Canada during the XVI International AIDS Conference in Toronto in August 2006. Since coming into force in 2004, not one drug has been exported under Canada’s Jean Chrétien Pledge to Africa (JCPA). This fact became a major Canadian media story during the AIDS conference and led to a commitment from the Conservative government to “immediately” review the legislation. s reported previously in Dispatches (Summer 2005), Médecins Sans Frontières (MSF) in Canada has been involved in trying to ensure that Canadian initiatives to allow the export of generic versions of patented essential drugs would lead to drugs for patients in developing countries. This would happen under a socalled compulsory licence to developing countries, part of the JCPA. Once the Canadian framework was in place in mid 2004, MSF committed to placing an order under the legislation. Despite optimism that this legislation could deliver, the past few years of effort have not borne fruit.

International rules unworkable in practice Apotex, a Canadian generic company, developed a combination AIDS treatment urgently needed in developing countries in April 2005. However, we have still not managed to get this drug out of Canada. The reasons stem from the complexity of

the legislation and bureaucracy. The Canadian rules are based on a tortuous international decision. In particular, this decision (referred to as the August 30th Decision) requires a series of negotiations between the generic manufacturer and the pharmaceutical company holding the rights to the drugs. In practice, this has meant interminable discussions mired in legalistic squabbling stretching over months. Meanwhile, patients who could be saved by Apotex’s formulation continue to die. Negotiations combined with potential exposure to lawsuits and overly stringent measures to prevent the diversion of drugs back into developed markets (which is irrelevant as these drugs hold no appeal for developed markets) have eroded away the interest and confidence of Apotex. In turn this discourages the already lukewarm Canadian generic companies from participating.

The Canadian compromise As if the international framework were not already complicated enough, the Canadian rules have added additional hurdles. They restrict which medicines can be exported under the legislation, they require drugs to be approved by Health Canada — something not required by international trade rules — and they limit the quantity and export of drugs even further. The Canadian legislation was a compromise legislation from the start. It attempted to find middle ground where no middle ground can exist. Trying to balance the interests of a for-profit pharmaceutical industry with the interests of patients in poor countries dying at catastrophic rates — one child dies every 30 seconds of malaria; 8,000 people die every day from AIDS, and the list goes on — is untenable from the start.

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Hope for change at IAC By May 2006, it was clear to MSF that the legislation was an ineffective and inadequate solution to the global access to medicines crisis. The International AIDS Conference in Toronto was to be the ideal time for MSF and other Canadian nongovernmental organisations to prove the impotence of the Canadian and international access to medicines rules.

• The August 30th Decision was a failure and had to be urgently reviewed by the WTO member states on the basis of the Canadian attempt to implement it domestically. • The Canadian government had to urgently revise the Canadian legislation to ensure medicines could be exported to developing countries.

New promise by Canadian government? During the conference, MSF released a report entitled, Neither expeditious nor a solution: The WTO August 30th Decision is Unworkable, with its two-fold message:

By the third day of the AIDS conference, the Canadian Minister of Health, Tony Clement, announced that he would “launch an immediate review of why Canada has

failed to deliver on its pledge to get low-cost AIDS drugs to countries in need.” (Toronto Star, 16 Aug 2006, front page). At the time this publication went to print, four months after that statement, nothing has happened. A consultation paper, promised to kick off the “immediate” review, has yet to be issued. Such a consultation risks becoming another untenable compromise putting patients lives into the balance with corporate profits.

What next? It is clear that the Canadian government had to revise the JCPA (also known now as the Canadian Access to Medicines Regime). But this should mean more than merely tinkering with a few clauses here and there. The legislation must be fundamentally overhauled, this time keeping the urgent needs of patients in developing countries at the heart of the legislation. This means seeking innovative solutions that go beyond the text of the international rules which we know to be unworkable. It also means not making compromises on the objectives by kowtowing to the corporate interests of the pharmaceutical industry. The international economic community, which so publicly committed to “ensuring access to medicines for all” in its Doha Declaration in 2001, has to take notice of what happened in Canada, of the fact that despite the implementation of the legislation in five countries, not a single pill has gone out under these provisions. It has a responsibility to remedy the situation, urgently. Meanwhile MSF will continue to try and make the drug order a reality and push the Canadian government and international actors to make the international rules meaningful for patients in poor countries. But the time for compromise is past. New solutions have to be found. Everybody recognises and acknowledges the problem. Government and pharmaceuticals have the power to change the situation. It is time for them to do just that.

Rachel Kiddell-Monroe Access campaign coordinator

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Chad

EYES IN THE FIELD PROVIDING CARE AND BEARING WITNESS recently spent nine months working in Chad as a logistician with Médecins Sans Frontières (MSF). During that time I provided support to refugee camps, as well as aid to some local and outlying populations. I spent time at MSF’s HadjerHadid project in eastern Chad, including refugee camps in Breijing and Farchana.

MSF's Hadjer-Hadid project provides assistance to two main groups: Sudanese refugees who have fled the tragic ongoing events in Darfur, and internally displaced Chadians in the unstable Chad/Darfur border area fleeing violence and attacks from armed forces in the conflict in Darfur.

What this actually means is that basic healthcare is provided for two large refugee camps, Breijing and Farchana, in clinics run by MSF. As well, mobile clinics and other outreach activities such as vaccination campaigns to the border area are also carried out. At the time I was there, there were approximately 27,000 people living in Breijing camp, and roughly 17,000 people in Farchana. One of the most shocking things for a newcomer like me was the normalcy of the camps and the very humble resilience of the refugees. It's not all crushed defeat and desperate horror,

although that exists. But people also get happy, sad, confused, married, angry and hopeful. I found humanitarian work to be as much about the simple gesture of solidarity being made as it is about actual programme objectives. Even for a medical organisation like MSF, for instance, the act of really and sincerely “being there” and establishing proximity (much easier said than done) is just as important as offering health services.

Text and photography by Omar Odeh

BELOW LEFT: A local staff nurse gives a shot to a patient seen in the observation unit at the Breijing refugee camp health centre. BELOW RIGHT: A mother and her child at the foot of a water reservoir in Breijing camp.

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TOP LEFT: Nurse Benoit Wullens treats a three-day-old gunshot wound in a village about 15 minutes from Alacha. TOP RIGHT: Local MSF nurse Brigitte (white tshirt) conducts triage at a mobile clinic in Alacha. BOTTOM: A child with acute conjunctivitis awaiting treatment at a mobile clinic in Borota village.

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TOP: MSF driver Abakar translates followup care instructions to a patient recovering from a bullet wound to his leg. BOTTOM LEFT: South-looking view of a section of Farchana camp. BOTTOM RIGHT: A mother and child during supervised feeding at the nutrition centre in Breijing camp.

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MSF in Canada

“They knew what they were getting when they hired me.” hat’s the kind of line Marilyn McHarg delivers with a mirthful smile. There’s no question McHarg comes to the general directorship of Médecins Sans Frontières (MSF) in Canada with a global reputation. Nine years of field experience coupled with several years of MSF leadership positions in European capitals have earned her a certain renown. Time and again, her colleagues throughout MSF openly share their admiration for McHarg. Clear. Quietly authoritative. Compassionate.

McHarg was among the founders of MSF in Canada back in 1990 when Dr. Richard Heinzl succeeded in bringing the then Europe-based organisation closer to home. She was working as an intensive care unit nurse in Toronto at the time. Being a Canadian section founder, however, was not enough to win the confidence of recruiters at MSF in Holland. They rejected her first application to work in the field on the grounds that she lacked experience in a developing country. McHarg got

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herself a backpack and a plane ticket. She travelled solo throughout Africa for six months, stopping by MSF missions as she went. It worked. In May 1991 McHarg began an overseas journey that would last 15 years. She started as a field nurse in Soroti, Uganda. She then went to Sudan, a country that captivated her heart. She spent time in Northern Sudan, including Darfur – training other nurses and working as MSF’s medical coordinator in Khartoum. She went on to be a medical coordinator in south Sudan. She was medical coordinator and head of mission in Liberia, as well. McHarg returned to south Sudan for several more years, most notably as head of mission overseeing nine clinical sites across two factional lines in the conflict. That longevity went a long way toward establishing her credibility in the MSF headquarters in Amsterdam and in Geneva, where McHarg has held leadership posts since the year 2000. Most recently, as director of operations for MSF in Switzerland, she was responsible for missions in 20 countries and a budget of $50 million.

Now she’s home again. The new general director commutes to the national office in Toronto from her house near Hamilton. There are many demands on her time, both from her counterparts in other MSF sections around the world and from the team she is leading in Toronto, Montreal, Ottawa and Vancouver. Being a known quantity ought to make it easier. McHarg has been earning respect since her first MSF mission in Uganda, when armed gunmen barged into the compound for a looting. The gunmen made it clear they were not happy with the results. They wanted more. “Will you take the medicines?” she offered. They expressed shock at her suggestion. “We can’t take your pills. You are treating our own families!” With Marilyn McHarg, MSF Canada gets the sang froid of a field veteran, the compassion of a nurse, the pluck of a backpacker, and the experience of a CEO – all in one.

Avril Benoît MSF director of communications

CANADIANS ON ANGOLA Frank Boyce ARMENIA Robert Parker BURUNDI Fanny Morel CAMBODIA Carlo Testa CENTRAL AFRICAN REPUBLIC Marie-Claude Ally Laura Archer Annie Desilets Sylvain Deslippes Benoît Émond Ivan Gayton Sherri Grady Sylvain Groulx Jean-François Harvey Mélanie Marcotte

COLOMBIA Tyler Fainstat DEMOCRATIC REPUBLIC OF CONGO Lindsay Bryson Matthew Calvert Erwan Cheneval Mario Fortin Gisèle Fournier Dolores Ladouceur Wendy Lai Joanne Liu Frédéric Manseau Daniel Nash Marlene Power Isabelle Rioux Leslie Shanks ETHIOPIA Jaroslava Belava Ivan Zenar INDIA Indu Gambhir Gordon Hutton

CHAD Isabelle Chotard Geneviève Côté Marise Denault Lori Huber Claudine Maari David Ponka James Squier Grace Tang

INDONESIA Jacques Caron Diane Rachiele

CHINA Michelle Chouinard

JORDAN Louisa Zebic

IVORY COAST Penny Bayfield Andrea Boysen Steve Dennis Beverly Winder

MISSION

KENYA David Michalski Omar Odeh LIBERIA Don Chambers Alanna Shwetz MALAW I Eva Lam Chantal St-Arnaud MALAYSIA Adrienne Carter MYANMAR Nadine Crossland Frédéric Dubé NIGER Marisa Cutrone NIGERIA Michel Lacharité Luke Shankland

SIERRA LEONE Concetta Buonaiuto Lara Sergovich Jennifer Yeo SOMALIA Reshma Adatia José Godbout Audrey St-Arnaud Darryl Stellmach SOUTH AFRICA Cheryl McDermid

720 Spadina Avenue, Suite 402 Toronto, Ontario, M5S 2T9 Tel: 416.964.0619 Fax: 416.963.8707 Toll free: 1.800.982.7903 Email: msfcan@msf.ca www.msf.ca

Editor: linda o. nagy Editorial director: Avril Benoît

SRI LANKA Adam Childs SUDAN Lori Beaulieu Steffen (Tom) De Kok Julia Payson Joli Shoker TANZANIA Mireille Roy

P AKISTAN Justin Armstrong Fahreen Dossa Dawn Keim

UGANDA André Fortin Mathieu Léonard

PERU Yanik Delvigne

ZAMBIA Ian Adair Chris Warren

REPUBLIC OF CONGO Ahmed Alas Brenda Holoboff Judy MacConnery Nicolas Verdy

Dispatches Médecins Sans Frontières/ Doctors Without Borders

ZIMBABWE Joe Belliveau David Croft Cara Kosack

Copy editors: Corinne Cécilia Daniel Ivorra Gregory Vandendaelen

Contributors: Avril Benoît, Sarah Burdeniuk, Sergio Cecchini, Kevin Coppock, Rachel Kiddell-Monroe, Omar Odeh, Amy Osborne Circulation: 80,000 Layout: Artshouse Communications Inc. Printing: Warren's Imaging and Dryography

Winter 2007

Cover photo: Stephan Vanfleteren ISSN 1484-9372

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MAKING AN IMPACT hanks to loyal supporters like you, in 2006 Médecins Sans Frontières (MSF) provided independent medical care to more than 13 million people in 71 countries. With your help, we treated 650,000 children for malnutrition and provided hospital care to more than half a million people. One of the most rewarding aspects of my role at MSF is knowing that people like you have a positive impact on the lives of some of the most vulnerable people in the world.

What we also know at MSF, however, is that the medical needs our volunteers address every day in the field are interminable. Armed conflicts, natural disasters, epidemics, and nutritional crises will continue to threaten peoples’ health. And MSF will continue to strive to address such needs. The long-term commitment of our supporters ensures our teams will be able to provide shelter and basic materials to victims of the next

earthquake, establish a therapeutic feeding centre to address the next nutritional crisis, and provide improved medicine for children with HIV/AIDS. If and when the time is right for you to include MSF in your will, please be in touch. I would love to discuss how you can help MSF be where we are needed most. Nancy Forgrave Director of fundraising

Just a few words in your will... Create a legacy to provide life-saving medical care for populations in need around the world.

For information about making a gift in your will to Médecins Sans Frontières, please use the enclosed envelope or contact: Nancy Forgrave Director of fundraising (416) 642-3466 / 1 800 982-7903 nforgrave@msf.ca Charitable registration number: 13527 5857 RR0001