Medair's Annual Report 2010 by Medair

Lives Changed, Life Transformed Annual Report 2010

Table of Contents 10

Medair 2010 Annual Report

2010 Medair Summary

Beneficiary Accountability

Lives Changed, Life Transformed

Emergency Relief

Rehabilitation

Health and Nutrition

Water, Sanitation, and Hygiene (WASH)

Shelter and Infrastructure

Country Programmes: D.R. Congo, Southern Sudan, Sudan (Northern States), Zimbabwe, Somalia/Somaliland 18 Reflections on Change and Transformation

Country Programmes: Indonesia, Haiti, Afghanistan, Madagascar, Uganda

Behind the Scenes

Funding Partners

Accreditations

Audited Consolidated Financial Statements 2010

Credits

Medair 2010 Annual Report Medair entered 2010 with a clear plan for the year ahead. But on 12 January, plans changed. Haiti’s deadly earthquake compelled us to respond with urgency to meet the needs of so many people faced with so much loss. Within months, we were one of the leading shelter-building organisations in the city of Jacmel, and Haiti had become one of our largest humanitarian programmes. In our 2010 Annual Report, we pause to reflect on the impact that major changes like this have on the world’s most vulnerable. We also explore the ways our work—as practical and specific as it is—can open doors for positive change and transformation within communities. Starting the Haiti programme was one of many changes to Medair’s 2010 portfolio. After more than a decade of tireless service, we completed our Uganda programme, with all of our objectives achieved. We also completed our earthquakeresponse programme in Indonesia, and started working in Zimbabwe, implementing our first-ever urban water, sanitation, and hygiene (WASH) project in response to one of the largest cholera outbreaks documented in sub-Saharan Africa. After seven years of exemplary service, 2010 was Randall Zindler’s final year as Medair’s CEO. Under Randall’s leadership, Medair implemented a host of organisational improvements, grew financially stronger, and became strategically well-positioned for the future. Randall helped unify Medair’s focus and purpose: to bring relief and rehabilitation to the people who need it most.

For Medair, change was a constant in 2010. And while so much change is never easy, it can also fortify us and make us more resilient to future challenges. Indeed, at the close of 2010, Medair found itself stronger than ever from an organisational perspective, with significant support from both institutional and private donors. In these pages, we present compelling stories and photos collected in large part by our on-the-ground humanitarian workers as they go about their life-saving work. You will read about two-year-old Nyajang in Southern Sudan, a malnourished child who survived only because of a feeding tube that her mother at first resisted. You will read about Androzo in D.R. Congo, a man forced to flee with his family to protect them from armed militia. And you will read inspiring stories of positive change happening in the floodprone village of Ankadibe, Madagascar. As Medair looks ahead to 2011 and beyond, we do so with renewed faith in our ability to withstand difficult changes, based on our strong professional and spiritual foundation. We also look ahead with the knowledge that our actions, like those of all humanitarian organisations, make us powerful catalysts for positive, transformative change—a responsibility that we take very seriously. We hope you enjoy the 2010 Annual Report.

Photo: N ational and international Medair staff worked together to provide safer shelter for more than 11,000 Haitians in 2010.

AFGHANISTAN • HAITI •

Sudan • (Northern States)

• SOMALIA/Somaliland

SOUTHERN Sudan •

• UGANDA D.R. CONGO •

ZIMBABWE •

Indonesia •

• MADAGASCAR

Nationalities of Medair Staff

2010 Medair Summary • 2,241,200 total beneficiaries • 10 country programmes •9 countries of operation • 1 international headquarters in Switzerland, 63 positions • 5 affiliate offices in France, Germany, the Netherlands, U.K., and U.S. • 115 internationally recruited staff positions in the field (IRS) • 903 nationally recruited staff positions (NRS) • 34 nationalities represented among Medair staff

Photo: M edair team in Melut, Southern Sudan

MEDAIR Annual Report 2010

Afghan American Australian Belgian British Cameroonian Canadian Chinese Congolese Danish Dutch French German Haitian Indonesian Irish Italian Ivorian Kenyan Malagasy Mexican Nepalese New Zealander Nigerian Norwegian Portuguese Romanian Swedish Somalian South African Swiss Sudanese Ugandan Zimbabwean

Beneficiary Accountability When a severe crisis strikes, people are torn away from their familiar routines and forced to use all their resources to survive. These vulnerable people often need assistance, but they also need a voice. You wouldn’t want strangers from other countries telling you what you need without consulting with you. If your community were in crisis, you would want input into the recovery process.

implementation, and monitoring of our projects. Our teams prioritise building positive relationships with local communities in order to understand their real needs. We work with beneficiaries, not instead of or in spite of them. We listen to their needs and respond to them. In this way, we help people recover from crisis with dignity, with integrity, and with hope for a brighter future.

At Medair, we make ourselves accountable to the people we serve. We involve beneficiaries in the design,

Building Bridges to the Community In the jungles of D.R. Congo, armed militia have terrorised people for years with vicious attacks. Countless families have fled from their home villages to live as “IDPs”— internally displaced persons—often living in crowded temporary settlements.

So far, the feedback has been encouragingly positive. “If Medair did not help the clinic to treat IDPs for free, many people would have died—many, many people,” said Rakole Kanyamali, President of Bukiringi’s IDP Committee. “That is why we are grateful for Medair.”

Medair wants to make sure that these people have access to quality health care. We regularly meet with health officials and local medical authorities, confirming the level of need, and gaining a better understanding of the current situation. Our staff often travel to remote villages and IDP camps and assess the conditions. We consult with community groups and individuals about their most pressing needs and how we can best help them. After careful consideration, Medair determines the most needy areas to provide free health care for vulnerable people. We also train and supervise local health clinic staff to help strengthen the overall health system.

Bukiringi IDP representatives give feedback to Medair.

We work closely with community groups as key partners. These partnerships with IDP committees and community health workers help keep us accountable to our beneficiaries. Community groups make us aware of any concerns, and they also help ensure that everyone knows that free services are available to them. “We are like a bridge that connects the health centre to the community,” said Akyenga Rungu, a community health worker in Bukiringi. “If there is a member of the community who is very ill, we mobilise people to bring the person to the health centre. We also receive information from the clinics and pass the messages to the population.” Two months into a recent project, we held focus groups with community members, asking for opinions on the quality of service and for new ideas that might improve services. We provided all IDP representative groups and health officials with a Medair number to call with any complaints.

Medair’s Beatrice Kavira and staff discuss a progress report.

Medair health services staff meet with Congolese district health officials.

Lives Changed In a fleeting instant, everything can change. Disasters strike without warning. Armed men can appear at the door in the night. Change can come at any time, for any reason. In January 2010, Haiti changed in a heartbeat. In a matter of seconds, a powerful earthquake shook houses to the ground, killing more than 220,000 people who moments before had been living their daily lives. They had no advance warning, no time to escape. Shocked survivors stumbled to pick up the pieces of their ruined homes, to confront the new reality of their lives. This year in D.R. Congo, change came at the barrel of a gun. Militia and rebel groups terrorised communities with frequent attacks that forced families to flee their homes to live in camps, where they hoped to be safer. But in the camps, they had no land of their own to farm, no livelihoods, no rights—nothing but the clothes on their backs. While change can come in an instant, it can also be slow, gradual, and deadly. In Somalia/Somaliland, one of the

MEDAIR Annual Report 2010

worst droughts in recent memory led to widespread food and water shortages in 2010. Rural families had to walk away from their traditional farming land, forced to live closer to cities to rely on whatever help they could receive. And in countries around the world, disasters like this are happening with alarming frequency. However, change is not always bad news. Indeed, positive changes—both real and those just hoped for—are what keep many people going when all around them seems lost. In 2010, after decades of civil war and a long process of political negotiation, Southern Sudan embraced an exciting path of change, holding elections in the lead-up to its referendum on independence. Although this much-anticipated change has created new challenges, with hundreds of thousands of people returning home, there is also a new spirit of hope in the region, hope for lasting change. Photo: H aitian man points out the collapsed ruins of a school.

Life Transformed Medair brings relief and rehabilitation to people made so vulnerable by change that they need our help to recover and get back on their feet. In emergencies, our teams work urgently to save the lives of people who are in great need. For instance, our work helped save the lives of thousands of malnourished children this past year alone. Medair also runs projects that aim to protect lives over the longer term. To do this, we support local health systems and build up the capacity of local health workers so that entire regions will receive improved health care in the future. We provide preventative health care, which includes vaccinating children and pregnant women against common diseases, and promoting good health and hygiene practices. We build quality infrastructure to ensure a safe supply of water and hygienic latrines. Our work not only saves and sustains the worldâ&#x20AC;&#x2122;s most vulnerable, it also has the potential to change their lives.

Our goal is to provide practical improvements in areas such as health, safe shelter, and access to clean water, and to do so in a compassionate way that honours the dignity of our beneficiaries. Thatâ&#x20AC;&#x2122;s the heart of our work. At the same time, we see that our work often opens the door for change, for positive transformation within a community. For example, when we drill a water point in a village to protect against waterborne disease, we also provide huge time savings to people who otherwise spend hours every day gathering water. Combine improved health with more time to do things besides getting water, and you create conditions for a community to become healthier, more productive, safer, and better able to take care of itself. In this way, a single water point can become the spark that transforms the life and future of a community.

Photo: O n the banks of the Nile River in Southern Sudan, a family gathers water from a clean water source instead of the river.

Transformation in Action Although people and communities change for complex reasons, our work can act as a catalyst that leads to positive change and transformation. Here are stories of transformation from just three of our country programmes this year:

In Afghanistan In Afghanistan’s mountains, Medair conducts cashfor-work projects that improve infrastructure while giving vulnerable people vital income. In the village of Kalot, where many families faced a food shortage, we ran projects that repaired local access roads and built retaining walls, while also giving workers money to buy much-needed food for their families. “I see 100 percent change in this village,” said Daoud Khalid, Kalot’s village leader. “In the past we had to hold our animals by the tail so they wouldn’t fall off the paths and die. Now we have roads. In the past it would take two days to get to Faizabad. Now it takes six hours. The people of Kalot are so grateful for Medair.”

Women at Work In flood-affected Waras, Medair provided cash-for-work opportunities for women as well as men. The women had never been paid to work before, so it was with both eagerness and anxiety that 50 of them showed up to

MEDAIR Annual Report 2010

make gabion nets—wire cages used to hold rocks in place for flood control. Takiyah, a married mother of three, led the all-woman workforce with confidence, teaching them to make the nets. “Maybe there were one or two husbands who were not so sure about their wives working,” said Takiah. “But most of them were very happy we had jobs and that we were helping to earn money.” By the end of the project, the women had built 854 gabion nets, and had participated in a transformative experience. “The day that the women received their first pay, they were so thrilled because they had never been paid to do work before,” said Takiyah. “The ladies are feeling very good because, in the future, they can use the money they have earned to buy clothes, shoes, and other things for the winter.” Photo: A fghan women earn money for food and clothes by building gabion nets for erosion control.

In Madagascar In cyclone-prone Madagascar, Medair partners with communities to help them reduce the impact of future disasters. Our work also helps improve water and sanitation infrastructure and promote the immense health benefits of good hygiene. In 2010, our hygiene promoters walked 10 kilometres to reach a small village that was inaccessible by road. Our team held a community meeting about hygiene and raised awareness about the health advantages of using a latrine.

In Sudan (Northern States) In 2008, Medair conducted a campaign in West Darfur to provide medical treatment for women with fistulas—a severe condition that causes incontinence, infections, and serious complications during childbirth. In West Darfur, many women with fistulas had been ostracised by their husbands and families, leaving them to suffer in shame on their own.

When Medair returned several weeks later, the community proudly demonstrated a system they had invented to cover their open wells, with a sliding lid to prevent contamination. Our team also saw that many people had begun building their own latrines, using local materials. With the training, Medair had lit a fire for change, and the small village had begun to transform itself from within.

In 2010, we heard a report from four women whose fistulas had successfully healed because of the treatment Medair made available to them. One woman had reunited with her husband, another was newly married for the first time, and yet another was married and had just given birth. “I am sharing with you this information as I felt happy and flattered by knowing that they have started to continue their normal life,” said Hatim, a member of Medair’s West Darfur health team, enthusiastically conveying the great news to fellow staff.

Midwives Earning Trust In South Kordofan, Medair supports midwives in an effort to reduce high rates of maternal mortality in a region where most women still rely on undertrained traditional birth attendants (TBAs). For every midwife we train and support, the impact is magnified immensely, passed on to every expectant mother and infant whom the midwives aid. “I have more patients now that I have completed the Medair training,” said Asha, a Medair-supported midwife. “And my patients seem to trust me more!” After safe motherhood workshops in 2010, 141 women received antenatal care for the first time ever. Another 216 women received their first tetanus vaccinations. “This is a massive behaviour change that is underway,” said Medair’s Rebekka Frick. With our continued support, South Kordofan’s midwives are learning skills and earning trust within their communities. “As midwives become increasingly respected and accepted, they will be able to make a lasting difference for families throughout the region,” concluded Rebekka. “Their work will save many lives.”

A Lot of Changes From small villages to large cities, Medair’s work has been a catalyst for change all over Madagascar. In 2009, we partnered with the urban commune of Maroantsetra to support them in cleaning out their drainage trenches. This year, the city cleaned out the trenches again, but this time they did it on their own, without our assistance. “It is a real encouragement for Medair to see that local authorities are continuing the work, even without our input,” said Yves-Pascal Suter, Medair Country Director. “It’s great that now they have the capacity to do the work themselves.” “Medair has brought a lot of changes to our town,” said Ah-Lone Michel, Mayor of Maroantsetra. “Hygiene is better because of the construction of hundreds of latrines. I have observed behaviour changes: people are talking about sanitation and hygiene and kids especially are adopting safe behaviours.” Photos, left: A midwife accepts an armful of clean delivery kits after a

refresher training session.

right: A family in Maroantsetra, Madagascar, stands beside their

new latrine.

Emergency Relief When a sudden crisis hits or a natural disaster strikes, Medair teams respond rapidly to help save lives and reduce suffering. In 2010, a deadly outbreak of kala-azar swept through Southern Sudan’s Jonglei state. Medair’s Health Emergency Response Team (ERT) responded, often treating afflicted patients for malnutrition at the same time. Nyajang was on the brink of death when her mother carried her into the Medair clinic in Ayod, malnourished and suffering from kala-azar. We tried to feed her, but with painful sores in her mouth, she was unable to eat. Nyajang, just two years old, soon lost even more weight and grew listless. There was only one chance of her survival: a feeding tube. “I had a long discussion with her mother about it, but she was very unsure,” said Dr. Lea Lauridsen, Medair Medical Manager. “People here have never seen feeding tubes and don’t know how they work.” 10

MEDAIR Annual Report 2010

Nyajang’s mother had given up hope. She just wanted to take her child home. But with the encouragement of our local staff, she agreed to the feeding tube. For five days, the ERT fed Nyajang through the tube and treated the sores in her mouth. When we removed the tube, Nyajang started eating normally and gaining weight at a healthy pace. Over the next weeks, Nyajang made a full recovery from her illnesses and was discharged in good health. “This child was already dead when you brought her here, but now she’s alive,” remarked an elderly women in the neighbourhood. “These people have healing in their hands.” In 2010, the ERT provided more than 4,000 people in Jonglei state like little Nyajang with life-saving treatment for kalaazar and/or malnutrition.

Photo: above: Dr. Joy Lomole examines a child with kala-azar outside the Old

Fangak clinic.

left: Dr. Lea Lauridsen feeds kala-azar patient Nyajang with a feeding tube.

Core Competencies

Rehabilitation Once emergency relief needs are met, Medair works alongside vulnerable communities to sustain lives and help improve essential services and infrastructure. In 2010, we trained 10 villages in Sudan (Northern States) in “Community Approaches to Total Sanitation” (CATS), a method that empowers communities to take collective action to stop open defecation. El Shair is a remote village of 100 families, set against a backdrop of large rocky hills that turn lushly green in the rainy season. Residents have a mosque and a functioning hand-pump, but until recently, they faced health risks because they defecated out in the open. “Last year, I only defecated after dark, in the bushes, so that no one would see me,” confessed Asha. “And there was a long trek each time to the bushes.” Although it’s hard to imagine, more than one billion people in the world practise open defecation. This practice is a deadly threat to human health and a barrier to dignity and safety, especially for women. We can build countless latrines for vulnerable communities, but that doesn’t mean they will be maintained or even used. True change needs to come from within the community. In 2010, Medair motivated people to take responsibility for their health through better sanitation. We educated people about the health risks of open defecation and provided them with the basic knowledge and training they needed to improve their own hygiene and build sanitation facilities. “The amazing thing about the sanitation programme is that we did little more than hold a community meeting to discuss the problem of open defecation, conduct a two-day latrine slab-making workshop, and do several follow-up visits to reinforce the training, check on progress, and respond to any questions,” said Medair’s Janna Hamilton. Just four months after Medair’s first discussion with community leaders in El Shair, every household had built themselves a latrine. El Shair became the first village to become “100 Percent Open-Defecation Free” in all of South Kordofan. “An NGO just came to our village and asked us about the sanitation in our community,” community leader Bushara

told us, grinning, his voice full of pride. “I looked at him and told him, ‘You can go to any household in this whole community, and you will find a latrine... and people are using latrines.’ We don’t have any person practising open defecation anymore.” “Boreholes come and go, latrines come and go,” said Janna. “That’s why Medair invests in building relationships with people in communities, relaying hygiene knowledge, and showing them that they can make a difference themselves. That kind of change is really empowering and will stay with them long after we leave.” Photo: E l Shair community members stand in front of one of their

new latrines.

Health and Nutrition Medair works to improve health and nutrition in vulnerable communities. Malaria. Pneumonia. Diarrhoea. Malnutrition. Measles. Complications from childbirth. These are some the deadliest killers on earth. But they shouldn’t be. With proper health care, they can be treated. With sufficient resources, they can often be prevented. Medair works in countries around the world where these kinds of health concerns cause needless sickness and death. Our teams work to improve access to quality health and nutrition services for vulnerable communities. We respond to emergencies like disease outbreaks and malnutrition, while also supporting year-round health clinics so that communities can have regular access to primary health care.

We promote health and hygiene, provide vaccinations for children and pregnant mothers, and distribute mosquito nets to ward off malaria. Wherever possible, we seek to support the existing health care systems by training and supervising local health workers, and providing them with the medicine and medical supplies they need to treat their patients. Key Activities • Emergency responses to disease outbreaks, population displacements, and nutritional emergencies • Maternal and child health programmes • Emergency and integrated nutrition programmes • Providing and supporting primary health care services • Vaccinating for routine coverage and outbreak response • Health and hygiene promotion • Supportive supervision, training, and monitoring of clinics and staff P omen and children wait their turn at a remote mobile immunisation hoto: W

clinic in Southern Sudan.

MEDAIR Annual Report 2010

Sectors of Expertise

Freshness in His Eyes Medair's new nutrition project is helping save thousands of lives in Afghanistan. One-year-old Nematullah had been sick for most of his young life. At six months, he began vomiting up everything he ate, and grew weaker and thinner. Nematullah needed medical help but the winter snow made travel impossible. Finally, when the snow melted, his parents took their son on the four-day mountain trek by donkey to Medair’s nutrition centre in Zeriaki. By that time, Nematullah was severely malnourished. “Anything you can do, please do,” said his mother, Najiba, sitting at her son’s bedside. “Six of my children have already died. Only two remain.”

Malnutrition in Raghistan For up to six months of the year, the higher altitude areas in the Raghistan region of Badakhshan province lie beneath thick layers of snow. Over these months, families rely on the crops they have grown in the summer and sustain themselves on a diet of rice, naan bread, and tea. “With such a limited diet, it’s no wonder that people here are malnourished,” said Medair’s Lesley Stathis. When Medair conducted a nutrition survey in the district, we confirmed high levels of malnutrition among children under five and pregnant and lactating women. In response, Medair began a nutrition project in the region aimed at providing life-saving nutritional support for malnourished women and children while also educating families to help prevent malnutrition in the future. During the year, Medair established nine nutrition sub-centres in strategic locations throughout Raghistan. At these centres, malnourished women and children in the region received nutrient-rich food rations, while more severely malnourished children with medical complications were referred to the stabilisation centre in Zeriaki.

Nematullah’s Story Shortly after Nematullah arrived in Zeriaki, the team assessed that the child had reflux. After his first day of treatment, Nematullah’s condition had already begun to improve, and soon all signs pointed to a full recovery. “The staff have been giving me information about how I can feed my child,” said Najiba. “I am so relieved and happy to be here so that my child can become healthy. I can see the freshness in his eyes already.” In its first year of operation, Medair’s nutrition project provided life-saving care for more than 2,400 women and children like Nematullah, while also teaching families how to improve their level of nutrition. “I am very happy for the nutrition project because it benefits the community and because it is helping our children,” said village leader Mohammad Rabbana, whose malnourished wife also received food rations from Medair. “Eighty percent of the people in Raghistan are helped by Medair. They are helping people in every village.” Photo: M edair nurse Lesley Stathis comforts young Nematullah.

WASH: Water, Sanitation, and Hygiene Around the world, more than a million young children die each year from diarrhoeal disease.1 The U.N. states that 88 percent of all cases of diarrhoeal disease result from unsafe water, inadequate sanitation, or poor hygiene behaviour.2 The impact is clear: improve WASH and you save the lives of countless children.

Medair helps restore health and dignity to people in crisis by bringing WASH to children, women, and men who live in some of the world’s most vulnerable countries. Key Activities

WASH means water that is safe to drink so that families can use it to cook their meals and quench their thirst without fear of getting sick. WASH means water that is nearby so that women and children can spend their days productively rather than walking for hours on end carrying heavy jerry cans of water. WASH means sanitation facilities that are close to home and hygienic to use, where waste is disposed of properly and won’t contribute to disease. WASH means sanitation facilities that give users privacy, bringing dignity and security to women and girls in particular. WASH means hygiene awareness so that families know exactly what they can do to prevent diarrhoeal disease, including how they can safely collect and store their water, dispose of their waste, and wash their hands. Hygiene is a crucial but often significantly less emphasised step in WASH interventions.3 14

MEDAIR Annual Report 2010

•W ater Supply: New systems or rehabilitation of existing boreholes, hand-dug wells, spring protection, rainwater harvesting, gravityfed systems, community and household water treatment systems, emergency water trucking •S anitation: Community Approaches to Total Sanitation programmes, construction of institutional and household latrines, installation of hand-washing and bathing facilities, solid waste collection campaigns and safe disposal • Hygiene Promotion: Protection and safe storage of drinking water, hygienic latrine use, safe stool disposal for infants, good handwashing practice • Training and Capacity Building: Village hygiene promoters, water user committees, and pump mechanics Photo: G irls walk home after gathering water from an unprotected source in Zimbabwe.

T he United Nations World Water Development Report 3: Water in a Changing World, page 89. (2009). 2 UN-water global annual assessment of sanitation and drinking-water (GLAAS) 2010: Targeting resources for better results, page 8. (2010). 3 Technical Notes on Drinking-Water, Sanitation, and Hygiene in Emergencies. N°. 10: Hygiene Promotion in Emergencies. WHO/WEDC. (2011). 1

Sectors of Expertise

Better Hygiene for Better Health In Madagascar, Medair raises awareness about the life-saving importance of proper hygiene. “The first time Medair came into this village, you couldn’t go behind the houses because it was so smelly and dirty,” said Medair’s Dorothée Velonjara. “People had no sanitation system, and they defecated just behind their homes.” The village of Ankazomandroko is surrounded by a narrow, stagnant river. Before Medair came, people drank from the river and frequently became ill. In fact, when we first arrived, young children played naked in the dirty canals and contracted infections from the contaminated water.

in Maroantsetra and afterward the audience engaged in animated conversations about hygiene. “I have a message from today,” said 12-year-old Vanessa after participating in Medair’s World Water Day events. “We must wash our hands before eating and after going to the toilet.” Medair also uses radio broadcasts to reinforce hygiene lessons. Children are invited to speak “on the air” about the sanitation and water problems they face, and what they have learned about how to avoid getting sick.

“People didn’t know that the dirty water was causing illness,” said Dorothée. “They thought it was because the children were eating sugarcane.”

As valuable as radio and movies are, nothing beats faceto-face teaching. And so, Medair trained 71 new hygiene volunteers in 2010 to promote hygiene in their own villages.

Better Hygiene

Better Health

In many Malagasy villages, knowledge about proper hygiene is disturbingly low. Communities need hygienic latrines and safe sources of drinking water, but they also need to practice good hygiene.

Three years ago, Medair’s WASH intervention in Ankazomandroko led to a swift and positive turnaround for the community’s health and hygiene. After mothers learned that the contaminated river water was linked to their children’s infections, children were rarely seen playing naked in the canal anymore.

Medair reaches out to tens of thousands of people every year with hygiene education. Our teams use puppet shows, plays, songs, quizzes, competitions—all kinds of creative methods. The team even made a movie that follows a Malagasy family who learn about good hygiene practices. On World Water Day, 600 people saw the film in an evening screening

“Before Medair came, we used to drink the river water,” said Faustin, a Medair-trained hygiene volunteer. “Now we have water pumps. And now there are latrines in the entire village. You see, I have been to school, but it was Medair who taught me hygiene practice.”

World Water Day features a Medair movie about good hygiene practices.

Photos, left: Children watch eagerly as Medair staff erect a “movie screen.” right: Six hundred people in Maroantsetra enjoy Medair’s hygiene movie.

Shelter and Infrastructure Safe shelter is key to human survival. We all need a safe place to sleep, a safe place for our families to live in peace. In Haiti, newly homeless families told Medair teams that they needed safe shelter more than anything else. When natural disasters destroy people’s homes, Medair works to build them safe shelters that are resistant to future disasters and that can be transitioned to more permanent homes in the future. Although shelter is our highest priority, we also construct or repair key infrastructure to help communities rebuild and recover from crisis. For instance, we build schools, health clinics, roads, bridges, and airstrips. We often run our building projects with the assistance of local community members, paying them for their labour through a highly regarded cash-for-work

MEDAIR Annual Report 2010

programme that provides families with crucial income when they need it most. To mitigate the risk of future disasters, Medair also helps communities plan for and guard against likely threats such as earthquakes, cyclones, and landslides. We provide education and coordination, run disaster response simulations, and build evacuation shelters.

Key Activities •B aseline surveys, shelter and infrastructure assessments, cash-forwork projects •C onstructing or rehabilitating schools, health clinics, homes, roads, bridges, airstrips •D istributing and constructing emergency shelters, with appropriate training for communities •D isaster risk reduction and mitigation, including flood prevention and cyclone shelters Photo: B eneficiaries in Afghanistan volunteer their time and labour to help build a water reservoir for their village.

Sectors of Expertise

New Homes in Terre Rouge In 2010, Medair built and/or repaired 1,862 shelters in Haiti, providing safer housing for more than 11,000 vulnerable people. “I was putting my grandson to bed,” remembered Laurent. “I grabbed him and we ran outside. The wall fell on the bed where my grandson would have been sleeping.”

Beneficiaries told the Medair team that, without their help, it would have taken them between “two years,” “a lifetime,” and “never” to rebuild or repair their homes.

Haiti’s massive earthquake in January 2010 is estimated to have killed more than 220,000 people. In the remote mountain village of Terre Rouge, 58-year-old Laurent Fenel, his partner Laurette, and three grandchildren were among more than 1.5 million people who lost their homes on that terrible day.

“People here now talk about having better health as a result of being safely sheltered at night,” said Medair’s Florance Paul. “Parents talk about the improved health of their children, especially with regard to asthma, influenza, and pneumonia.”

“The whole community started sleeping outside,” said Laurent. “We slept in a place we had used as a kitchen, and we got cold at night. We did not sleep well.”

People in Terre Rouge have resumed farming, children have returned to school, and families have held on to their valuable livestock and livelihoods. In many cases, the new shelters are more spacious and sturdier than their previous homes.

“I didn’t sleep at all because I was scared,” added Loudmia, Laurent’s 16-year-old granddaughter. “It was too crowded and too cold.” Terre Rouge is located near the city of Jacmel, but the journey requires a river crossing and an arduous ascent up steep, pockmarked dirt roads to reach it. “After the earthquake I thought that no NGO would come,” confessed Laurent. “But it was not too long before Medair arrived. It gave me strength when Medair said I would get a house. A house was more important than anything for me and my family.” Indeed, Medair was the first NGO to come to Terre Rouge in response to the earthquake. The team assessed the damage and started to build durable transitional shelters that could be upgraded into permanent houses relatively easily. “It took four days for them to build our house—so quickly!” marvelled Laurent. “The way they put in the timber and cement, it feels so strong. I am very happy with my new house. I can’t even explain.”

“Now I have my own bed as there is more room,” said Loudmia. “I love having my own space. I do my homework here. Everyone in my school has a safe house now. Most of them are ‘Medair houses.’ My friends are happy with their bigger houses too.” Photo: L aurent’s grandson stands in the doorway of the family’s safe new shelter.

C.A.R

SUDAN

Doruma

CAMER. Congo

REP. OF CONGO

GABON

Equator

Isiro Bunia Kisangani

UG. R.W

Lual

BURU.

Kinshasa

Dem. Rep. of Congo

Poko

Dungu

TANZ.

D.R. Congo Deadly conflict continues to destabilise northeast D.R. Congo. Millions of Congolese have been killed during the last decade, and in 2010, frequent attacks from multiple militia groups took place in the regions where Medair works.

ANGOLA

0 0

200

400 km 200

ZAMBIA 400 mi

Strength in the Face of Adversity In 2010, Medair provided health care and WASH to more than a million people who struggled in the face of relentless violence and hardship. “I was working in a farm nearby when I suddenly heard gunshots,” said 25-year-old Androzo Tabu. “I grabbed my hoe and machete and started running towards my house.” Androzo shouted for his wife and three children and together they ran into the forest for safety, while a gang of militia attacked the village of Sorodo. The militia killed three people, terrorised others, and looted the Medair health post.

IDP—because he and his family fled from their home in Mori village thinking they would be safer here. In 2010, Medair responded to the crisis by providing free health care for 191,221 displaced and vulnerable people, and training local health staff at clinics in Ituri, Bas-Uélé, and Haut-Uélé districts. When Androzo’s daughter Sylvie became gravely ill, she was treated for anaemia and malnutrition. Two weeks later, she was discharged in good health. “I did not pay a cent for any of the costs,” said Androzo. “If it was not for Medair, my child would be no more.” “If Medair did not help the clinic to treat IDPs for free, many people would have died: many, many people,” said Rakole Kanyamali, President, Bukiringi IDP Committee.

Paving the Way From January to July, Medair supported 651 health structures and vulnerable areas, training health staff, providing essential medical equipment, and ensuring a good supply of medicines. We also provided vaccinations and supported maternal health care.

When Androzo returned to Sorodo, everything in his home was gone. “I am very angry. I work very hard in the fields to be able to get something for my family, and then these people just come and take it all away,’’ he said. Sadly, this kind of attack was all too common this year in D.R. Congo’s Orientale province, where hundreds of thousands of people have been displaced from their homes by violence. In Sorodo, Androzo must live on borrowed land with no rights—an “internally displaced person” or 18

MEDAIR Annual Report 2010

In July, we successfully achieved our goal of strengthening the local health system sufficiently to hand over support of 373 of the health centres to a local organisation, FASS (Fonds d’Achats de Services Santé). “Medair paved the way for us,” said Dr. Albert Makangila, Provincial Director of FASS. “The support we offer to health structures is much easier now, thanks to all the work that Medair has done with these structures in the past. It is difficult to miss the impact of Medair’s work in this region.”

Improving WASH

Programme Highlights

In 2010, Medair worked to repair springs and hand-pumps, dig new wells, and build school latrines. We learned that Isiro General Hospital urgently needed a clean water supply and more latrines. They didn’t even have enough water to clean the hospital, compromising the quality of health care.

Total beneficiaries in 2010

1,046,897

Medair personnel

13 internationally recruited staff 90 nationally recruited staff

In response, we rehabilitated the hospital’s well, constructed 10 latrines, and trained health professionals about hygiene. “Now, the hospital is a lot cleaner because it is washed everyday, and the patients and caregivers have access to clean drinking water,” said Dr. Jean-Paul Atibu, Chief Medical Doctor. “From a medical perspective, there is bound to be a decrease in the spread of waterborne diseases.”

Fighting Malaria Medair also launched a major new project to prevent and treat malaria—the single largest cause of illness and death in this region. We distributed mosquito nets, treated more than 75,000 pregnant women and children for malaria, and provided education about malaria prevention and care. “Without Medair’s intervention in fighting malaria, the situation here would have been catastrophic,” said Dr. Eugene Kumbodimo, Chief Medical Doctor, Isiro District. “I am so grateful for the assistance I received,” said 28-yearold malaria patient Susana. “If it were not for the free treatment, I would not have dared to come to the clinic.”

Health and Nutrition–Emergency Relief • 1 91,221 IDPs received free heath care •4 ,367 women received free antenatal care •7 ,270 IDP and returnee women gave birth in supervised clinics •2 ,400 mosquito nets distributed; 2,575 clean delivery kits distributed •3 7,278 received subsidised health care •3 77 HIV/AIDS patients received ARVs • 1 ,022 health centre staff trained Rehabilitation • 700,553 new consultations in Medair-supported health clinics • 10,071 insecticide-treated mosquito nets distributed • 1 new medical distribution centre opened in Dingila • 3 health centres supplied with incinerators •9 tonnes of hospital equipment for maternity units given to health centres • 75,249 children and pregnant women treated for malaria • 1 5,536 pregnant women received preventative treatment for malaria; 12,000 rapid malaria diagnostic tests distributed WASH–Rehabilitation • 6 latrine blocks (total 30 stands) constructed • 1 well dug, 1 repaired; 6 protected springs rebuilt; 4 hand-pumps repaired Photos, left: Workers construct a new well to serve the Isiro General Hospital. below: A nurse examines a child with malaria in Isiro, Haut Uélé.

F or more information about D.R. Congo and Medair’s work there, please visit www.medair.org/congo

EGYPT

LIBYA

SAU. AR.

Northern States

CHAD

Sudan Aweil

Khartoum

ERITREA

Akobo

ETHIOPIA

Manyo Melut Malakal

Southern Sudan C.A.R

Juba 0 0

300 km 300 mi

DEM. REP. OF CONGO

UGANDA

KENYA

Southern Sudan Decades of civil war have devastated Southern Sudan’s essential services, including health care, and access to water and sanitation. Children are vulnerable to easily preventable diseases, and acute malnutrition rates are above emergency thresholds. Major changes are underway and a new spirit of hope is rising in the region. Elections were held in 2010 for the first time in decades, and late in the year, former residents began returning to the south, with anticipation rising as January's referendum on independence drew closer.

A Spirit of Hope In 2010, Medair responded to emergencies and offered long-lasting support for communities while also helping coordinate humanitarian activities in Southern Sudan. In the El Salaam schoolhouse of Wadakona, Upper Nile state, children have to walk deep into snake- and scorpion-infested bush when they need to defecate. But in doing so, they contribute to serious health risks because their faeces can wash into the same river that people drink from. In 2010, Medair worked to improve water, sanitation, and hygiene (WASH) in Upper Nile state, rehabilitating water systems to serve 40,000 people. We built latrines and handwashing stations for three schools, and our hygiene promotion teams visited the schools regularly. “I learned today that when you go to defecate, you should use the latrine, and use water to wash your hands afterward,” said five-year-old Hamad, adding, “When I grow up, I want to ride a bicycle.”

north, and a sharp rise in acute malnutrition and kala-azar, one of the lesser-known tropical diseases. Medair’s emergency response teams (ERTs) rehabilitated boreholes, built latrines, trained hygiene promoters, distributed non-food items, and helped treat thousands of people for kala-azar and malnutrition. In March, Medair responded to high levels of acute malnutrition in Akobo county, providing emergency nutritional support in partnership with NGOs Save the Children and IMC. “I can already see my daughter Nyadak’s appetite improving,” said Nyayoung. “If the programme had not opened now, our children would be suffering much more and some children would die.”

But in Southern Sudan, many young children die from easily preventable illnesses. That’s why Medair is actively encouraging healthy behavioural change: to give children like Hamad the best possible chance of growing up in good health. “We will try and follow these hygiene practices,” said schoolteacher Almin Obja. “My hopes for these children are that they will be successful in their learning... so that they can become outstanding leaders in the new Sudan we are hoping for.” In 2010, more than 65,000 people visited our health facilities in Upper Nile state, and we provided training and supervision to local health staff. “Clinical staff trainings are very useful because it’s something sustainable that will last even when Medair leaves,” said Daniela Wittig, Medair Health Manager. “We did a refresher training with nurses who said they had last had training 10 or even 20 years ago.”

Emergency Response A rash of emergencies hit Southern Sudan in 2010, due to increased tribal conflict, an influx of returnees from the 20

MEDAIR Annual Report 2010

When a deadly outbreak of kala-azar swept through Southern Sudan’s Jonglei state, our ERTs responded. We supported more than 4,000 people in Jonglei state with lifesaving treatment for kala-azar and/or acute malnutrition, and we constructed sanitation facilities at overwhelmed clinics. “We work from early in the morning and respond to

emergencies throughout the night,” said Dr. Joy Lomole, a Sudanese national working for Medair. “It’s a lot of work, but we are making a difference where no one else has made a difference.”

Change Coming For much of the year, elections and the upcoming January referendum dominated discussions across the region. Change was coming to Southern Sudan, but no one was sure exactly how the process would unfold.

Programme Highlights Total beneficiaries in 2010

234,266

Medair personnel

29 internationally recruited staff 284 nationally recruited staff

Health Services–Emergency Relief • 1,790 people treated for acute malnutrition •3 ,356 people supported with treatment for kala-azar; 14,550 people received kala-azar awareness messages •2 ,302 people were vaccinated; 5,336 mosquito nets distributed Rehabilitation • 66,314 people attended Medair-supported health facilities • 3,111 children and 1,826 women were vaccinated

In October, huge numbers of former residents began returning “home,” gathering in camps and settlements in border states, creating an urgent emergency situation. In response, Medair teams began a WASH intervention in Aweil at the end of the year. “I’m happy to be here in Southern Sudan,” said Asunta, a returnee who spent the last 20 years in the north. “Even if we have nothing, I’m happy. Here I hope my children will go to school and university to learn and to become doctors or teachers.” Asunta’s words echo the spirit of hope in the hearts of millions of people who look ahead with cautious enthusiasm to a new era of opportunity in their homeland.

• 968 children treated for acute malnutrition WASH–Emergency Relief •4 4 boreholes rehabilitated; 76 emergency latrines installed •2 89 health and hygiene promoters, 193 village water committees, and 52 hand-pump mechanics trained Rehabilitation • 4 rainwater collection systems installed at health facilities •4 0,000 Upper Nile residents benefit from ongoing work to rehabilitate water systems •3 schools received 2 latrine blocks each for boys and girls, plus handwashing points • 5 00 pupils and teachers received hygiene education; 50 hygiene promoters trained Shelter and Infrastructure–Emergency Relief • 13 inter-agency non-food item (NFI) assessments carried out in Upper Nile • 1 8 NFI distributions done providing 6,587 NFI kits to more than 32,000 people Rehabilitation •3 primary health care facilities constructed or rehabilitated in Manyo county Photos, left: Asunta Awok, newly returned to the south, with all her

F or more information about Southern Sudan and Medair’s work there, please visit www.medair.org/southern-sudan

possessions.

above: Children participate enthusiastically in hygiene

promotion activities.

EGYPT

LIBYA

SAU. AR.

Northern States CHAD

Khartoum Geneina

Sudan

West Darfur

Muglad

Kadugli

Southern Sudan

C.A.R 0

ERITREA

300 km 300 mi

DEM. REP. OF CONGO

UGANDA

ETHIOPIA

Sudan (Northern States) Sudan’s northern states are recovering from years of conflict, while persistent violence in Darfur continues to threaten the health and well-being of people living there. The year was one of apprehension and preparation, as Southern Sudan geared up to vote for unity or independence in its January referendum.

KENYA

We Live in a Hot Place In 2010, Medair worked to improve the lives of Sudan’s mothers and young children. On an August day in the village of Beida, Medair’s Emily Chambers spoke to a crowd of hundreds, including authorities from West Darfur. “I met a woman in a clinic with a very healthy and happy four-month-old son,” she told them, speaking Arabic. “He was fat and growing well, while the other mothers nearby had very thin babies.”

of local communities and authorities due to our longterm engagement in the region and our proven capacity to respond effectively to emergencies. We place a strong emphasis on training and capacity building—essential in situations where insecurity limits our ability to work directly with beneficiaries.

“The mother explained that she gave her son only breast milk, and would continue to do so until he was six months old. ‘But how can you do that?’ the other mothers asked, incredulous. ‘We live in a hot place. Without water, the babies will die!’ “‘But her son is fat and healthy, isn’t he?’ I asked them. ‘That’s because her breast milk has enough water in it for the baby, plus it contains enough nutrients to supply all the baby’s needs.’” In Sudan, one in 10 children dies before the age of five. Studies indicate that with proper breastfeeding in the first years of life, child survival rates can improve significantly— more than with any other preventative measure. That’s why, in 2010, Medair made breastfeeding promotion a major part of our effort to improve the health of young children. After Emily’s speech, the dignitaries toured Medair’s primary health care clinic in Beida, and saw the upgrades we had made to improve the facility for safe childbirth. And then, just hours after they arrived in Beida, Emily and the dignitaries were picked up by U.N. helicopters and flown back to El Geneina. This is the sad reality of life in West Darfur, where insecurity sometimes makes it too dangerous for our staff to stay on-the-ground for more than a few hours at a time.

West Darfur Medair is the longest serving international humanitarian agency present in West Darfur. We have earned the trust 22

MEDAIR Annual Report 2010

In 2010, we supported 27 primary health clinics in West Darfur, improved access to safe water and latrines, promoted good health and hygiene practices, screened children for malnutrition, and responded to numerous disease outbreaks. “Medair is like the mother amongst NGOs,” said Manzoul, with West Darfur’s Humanitarian Aid Commission. “Medair was here before any other NGOs and is providing good services.” In July, severe rainfall flooded Sisi camp and damaged Medair’s clinic and more than 100 homes. Our emergency response team rushed to Sisi, the first help the village received. “Because we were there at an early stage, we could help repair houses and latrines, which had an important positive impact on general health in the camp,” said Medair’s Adam Gelaladin. “For example, the number

of people with diarrhoea has not increased, which is pretty amazing in a crowded and flooded camp.”

South Kordofan In June 2010, after four years of improving water, sanitation, and hygiene (WASH) in northeast Kadugli and the Alliri Hills, Medair bid a fond farewell to more than 60 communities, successfully handing over all further WASH activities to their care. One month later, we expanded our health services in the region. We started supporting primary health care, especially for young children and mothers, in addition to our ongoing public health promotion and reproductive health activities —which include training and support for midwives. “Yesterday, I was called to a delivery where I found that the cord was prolapsed,” said Eran, a Medair-supported nomadic midwife. “This is a very high-risk obstetric emergency... many babies die.” Thankfully, Eran had recently attended a five-day course with Medair. “I remembered what was taught at the last refresher training where we discussed obstetric emergencies and we acted them out,” she said. “I followed these instructions and both the mother and baby survived and are now doing well!”

Programme Highlights Total beneficiaries in 2010

378,600

Medair personnel

24 internationally recruited staff 203 nationally recruited staff

Health Services–Emergency Relief and Rehabilitation •3 49,837 patient consultations in 27 Primary Health Care (PHC) clinics (West Darfur); 3,993 beneficiaries assessed in PHCs (South Kordofan) • 5 ,986 cases of diarrhoea treated; 4,523 cases of ARI treated; 3,529 cases of malaria treated •4 ,291 pregnant women given safe delivery packs; 4,075 pregnant women given mosquito nets; 3,535 women given antenatal care •6 ,102 women vaccinated during their pregnancy • 5 6 midwives trained on postnatal care; 34 CHWs and nurses trained on obstetric care; 24 midwives supervised by Medair •2 20,000 beneficiaries given health promotion messages • 1 5,837 children screened for malnutrition; 5,501 children referred for malnutrition; 1,017 children admitted for treatment for severe malnutrition • 32 clinic assistants trained in immunisation and pharmacy management; 33 health workers trained on malnutrition (CMAM); 35 vaccinators trained WASH–Emergency Relief and Rehabilitation • 15 boreholes drilled in 6 locations; 3 jetted wells constructed, with hand pumps; 1 water reservoir built, 1 rehabilitated; 2 water yards rehabilitated • 1 55 community members trained as water user committees • 1 ,505 household latrines built in 5 locations; 4 clinic and 4 school latrines built • 1 0 communities trained on Community Approaches to Total Sanitation • 1 14 new hygiene promotion volunteers trained; 87 received refresher training; 7 handwashing stations constructed • 1 71,000 beneficiaries received hygiene promotion messages; 131,000 received soap • 1 5 locations conducted clean-up campaigns Shelter and Infrastructure–Rehabilitation • 2 antenatal care buildings rehabilitated;5 clinics rehabilitated; 4 reproductive health rooms rehabilitated and 3 new rooms built

F or more information about Sudan (Northern States), please visit www.medair.org/sudan-northern-states

Photos, left: Women visit new clean water points with their children. below: Women gather to celebrate World Breastfeeding Day in Beida.

Zimbabwe

ezi

ZAMBIA

Gokwe

Harare Marondera

Zimbabwe BOTSWANA

50 100 km

In 2008 – 2009, a deadly cholera outbreak struck Zimbabwe and killed more than 4,000 people. Now that the emergency situation has stabilised, communities in urban and rural Zimbabwe urgently need to improve their water and sanitation systems, or else run the risk of future disease outbreaks.

MOZAMBIQUE

100 mi

SOUTH AFRICA

Water Taps Flowing in Marondera In 2010, Medair’s urban water project brought safe drinking water access to 120,000 residents in Marondera, Zimbabwe. Earlier this year in the city of Marondera, 16-year-old Benhilda Dengu made three trips every day to a shallow, untreated well half a kilometre from her house. “We have had no water at the house for eight months now,” said Benhilda.

because of the degraded conditions of water plants and related infrastructure. In response, Medair began working to improve water, sanitation, and hygiene (WASH) in Zimbabwe. In 2010, we conducted a project in Marondera, where deteriorating infrastructure had forced residents in the entire city to gather unsafe water from river beds, shallow wells, and a quarry. “You came at the right time when all the dilapidated equipment had nearly collapsed,” said Shepherd Shingirai, water supply superintendent. “On our own, we were struggling. There was never enough water supplied.”

An Urban WASH Project

Indeed, all over Marondera, the taps had stopped flowing. “People were fetching water from very shallow, dirty wells, susceptible to contamination,” said Medair’s Edson Nyashanu. The reason? The city’s pumps and pipes had failed, preventing water from reaching most homes. “Some people get stomach pains from the water from the shallow wells,” said Jotham Sinoka, foreman of the water treatment plant. But stomach pains are just the beginning. In 2008 and 2009, Zimbabwe’s killer cholera outbreak affected 55 out of 62 districts, one of the largest outbreaks documented in sub-Saharan Africa. Unlike previous outbreaks, this one affected major urban areas which had become vulnerable 24

MEDAIR Annual Report 2010

In March 2010, Medair started rehabilitating Marondera’s water treatment and distribution system, in partnership with the local community. The Marondera Town Council contributed to the project with funds received from the Zimbabwe Ministry of Finance. “The town council has taken their responsibilities and contributed their share in the project,” said Medair’s Pieter Bakker. “It could not have worked without that commitment and work by them.” For the next several months, Medair assisted with the rehabilitation of key infrastructure at pumping and booster stations, working with local sub-contractors and providing equipment and expertise to the project. The pumping stations required new heavy pumps that needed to be installed with great care, as each pump weighed about 1.5 tonnes. “The moment the equipment arrived on site, all staff of the municipality were extremely happy as they saw things happening and moving,” said Pieter. “That was a good moment.” We also refurbished the water distribution system in Dombotombo, the oldest area of Marondera, because the

pipes were almost completely clogged with rust and mud. Working with a local contractor, we installed new pipes for 968 houses. In five other areas of Marondera, Medair and the city council bought materials to rehabilitate the domestic water supply, connecting 100 additional houses to the water system.

“Ultimately, this project will reduce the risk of cholera in Marondera,” said Pieter. “The money is well invested as this is a very straightforward project. It’s easy to see results—you either have water or you don’t. Marondera town will now have water.” F or more information about Zimbabwe and Medair’s work there, please visit www.medair.org/zimbabwe

Medair’s most significant challenge was the lack of reliable electricity in the town. At times, Marondera was without electricity for days on end. Nonetheless, Medair completed the project successfully, and in December, the upgraded water works were officially handed over to the Marondera City Council.

Programme Highlights

Taps are Flowing

WASH–Rehabilitation • 3 clear well pumps replaced; 1 booster pump replaced; 1 sump-pump installed

Now that safe water is reaching people’s homes, life is much better for residents like Ester Hwamiridza, who operates a pre-school in Marondera. “Before, I had to go to the golf course with a wheelbarrow each day and ask if I could fill my water jug so the children could have water for the day,” she said.

Total beneficiaries in 2010

120,000

Medair personnel

4 internationally recruited staff 5 nationally recruited staff

• 4 starters installed for pumps • 2 isolating valves and 2 non-return valves replaced • 1 electrical board replaced at chemical dosing house • 1 pre-chlorination system installed; 1 post-chlorination system replaced • 3 electromagnetic flow meters installed; 5 extra ultrasonic flow meters installed at water treatment works • 1 flow control valve installed

For young Benhilda and her family, the ability to now drink water from their own tap is a real blessing. “The water will help make our daily tasks easier, like cooking, drinking, and bathing,” said Benhilda.

• 2 buildings received new lighting • 1,168 houses connected to water system by installing distribution pipes Photos, left: Benhilda and her siblings look at piping that will connect them

to the city’s water supply.

above: Marondera residents gather water from a local quarry.

Somalia/Somaliland

GULF OF ADEN

DJI.

Hargeisa

Somaliland

One of the world’s worst humanitarian crises continues to take a deadly toll in Somalia and Somaliland. Approximately 2.4 million people need emergency assistance because of violent conflict in Somalia and cyclical drought throughout the region.

ETHIOPIA

Somalia INDIAN OCEAN

Mogadishu KENYA 0 100 200 km 0

100

400 mi

Turning Point As conflict forced families and aid agencies to leave Somalia in 2010, thousands of displaced people settled in peaceful but drought-stricken Burao, Somaliland. “In Mogadishu, fear was my close friend,” said 23-year old Layla Mohamed Ali, mother to six young children. “There were bombs every day killing my friends and family.

However, the level of violence made it too dangerous for our staff to even visit Cadale, so in November 2010 we closed the programme and made the strategic decision to focus on Somaliland for the foreseeable future.

Treating Malnutrition in Burao Somaliland remained relatively stable in 2010, which made it a magnet for thousands of people fleeing from violence in Somalia. But severe drought and the influx of new arrivals compounded a serious food and water shortage in Burao, where approximately 30 displacement camps had been established.

“One night a bomb landed in my house. We had separated our children to stay in different places, because you expect one to die but hope that the others will live.” Her leg injured by shrapnel, Layla fled from Mogadishu’s violence to find refuge in Burao, Somaliland. Her husband stayed behind to make money to send to her, and she had to leave two of her children behind with her sister. “Here no one bombs us or insults us,” said Layla. “We have peace, but it’s a very hard situation.” In 2010, Somalia’s violent conflict continued to tear families like Layla’s apart, while drought led to widespread hunger. In Cadale district, north of Mogadishu, Medair worked through a local partner NGO to provide life-saving care to children and families in need. Together, we treated more than 3,000 malnourished children, provided health care to vulnerable residents, rehabilitated 20 wells, and ran health education sessions for more than 45,000 people. 26

MEDAIR Annual Report 2010

In 2010, Medair provided comprehensive nutritional care for more than 8,000 malnourished children, along with food rations for their families, and nutrition education. “Half of the children living in this village were very weak and malnourished before Medair came here, but now most of them are wellnourished,” said Asha Mohamed in a Burao settlement. “If you were not here now, many children would have died.”

Layla’s Twins Not long after Layla arrived in Burao, her newborn twins became very sick. “When they first came, the twins were in very, very serious condition,” said Asia Addani Muse, a Medair nurse. Thankfully, the twins responded well to treatment and soon began gaining weight. “I’m happy that the twins are now improving with the food that is provided,” said Layla. “Since I joined the Medair programme, I have maize, oil, and porridge. I’m very happy with Medair, they have helped me very much.” While malnutrition treatments remained the heart of our Burao programme, we also vaccinated more than 4,000 children, and trained community volunteers to assist

pregnant women, refer them to health facilities, and promote good health and hygiene in the camps. Access to water was a critical need in Burao. Medair trucked water into parched villages, while also working to repair cracked rainwater cisterns. We distributed handwashing stations and water filters, and we supported the construction of more than 350 latrines.

Turning Point In 2010, a new government took office in Somaliland following elections in June. Meanwhile, the scope of the region’s suffering led to a gradual rise in international concern and support, with more humanitarian interventions taking place. With this increase in new humanitarian and governmental initiatives, Somaliland is now at a crucial turning point. There is much work to do, but now there is new hope. “I can see a big difference in these camps if I compare them with how they were a year ago,” said Henrieke Hommes, Medair Country Director. “The camps are much cleaner and it seems the needs are changing. A year ago, the first thing people would ask us for was water and food, but now women are asking for education for their children. This is a good sign that they are able to look beyond today.” F or more information about Somalia/Somaliland and Medair’s work there, please visit www.medair.org/somalia

Programme Highlights Total beneficiaries in 2010

153,720

Medair personnel

4 internationally recruited staff 37 nationally recruited staff

Health and Nutrition–Emergency Relief • 1 1,524 children treated for malnutrition •4 ,459 children vaccinated up to DPT3; 3,806 children vaccinated for measles •7 ,143 people received health education; 7,000 women received nutrition education •8 ,465 people treated at the mother-child health clinic; 4,843 people treated at the health posts (Cadale) •4 47 children treated for watery diarrhoea (Cadale) •2 7,617 people attended 1,296 health education sessions; 18,049 people received ante- or postnatal education (Cadale) WASH –Emergency Relief •3 2,000 litres of water trucked to 3 villages (Burao) Rehabilitation • 505 latrines constructed; 7,230 people with access to new latrines • 1,540 hand-washing stations distributed •4 1,884 people reached with hygiene promotion •3 00 water filters distributed •6 cisterns (berkads) rehabilitated; 20 shallow wells rehabilitated •6 solid waste skips fabricated and distributed; 13 communal refuse points constructed

Photos, left: Layla Mohamed Ali sits with four of her six children. b elow: Mothers with their children who are undergoing treatment

for malnutrition.

Reflections on Change and Transformation Bethany Kurbis, Human Resources Manager, Juba, Southern Sudan My grandfather did humanitarian aid in the 80s; he saw a lot of people coming to Africa for themselves, for their own selfish purposes. So he advised me: “Don’t go for yourself, go for them. You will be transformed, but don’t go for that reason. This is a complex setting to exist in. We live among things that don’t exist in life at home... physical, concrete barriers and barbed wire, for example. The needs are so immense, we can never meet them all, so we have to keep trying. I encourage people to get in touch with our work on the front lines. It’s important for us in Juba or headquarters to allow the moments of inspiration to be real. They are real.

Photo: View from the Medair headquarters in Juba, Southern Sudan.

André Daniel Théodore, Monitoring and Evaluation Assistant-Quality, Haiti Working for Medair has changed my life because of my employment with them. I can discover the potential that I have and I also feel like I have a stable job. I remember when I first started working and the staff were willing to teach me things I did not know. They are always willing to listen and to bring a solution to your problems. When they see that you have potential, they help you to develop yourself. I have accumulated a lot experience and knowledge. I have learned the technical officer’s job and have acquired a lot of knowledge in construction.

Photo: André, at work at his Medair desk.

MEDAIR Annual Report 2010

Before working for Medair I had heard of the rural areas, but had never been there. When I go and work in remote areas, I can see the seriousness of the problems and the misery in my country. Working with Medair motivates me to work and to use my knowledge to help others.

Patrick Mama, Assistant Shelter Project Manager, Haiti Working for Medair has changed my life. I had never been in rural areas to see how the people live. Now, I can see how these people live in poverty and that they really need help. Working with Medair in remote areas has made me see my life differently. One experience that changed my life was the day that I visited a family in La Croix. That night, we stayed and slept inside the shelter constructed by Medair for this family. From that experience, I learned that life is not about having nice things, such as a comfortable bed. It is simply about having a home.

Photo: Patrick enjoys his visit with the Gideon family in La Croix, Haiti.

Elsbeth Koning, Project Support Manager, Afghanistan I thought about going abroad before becoming a Christian, but I thought I would go somewhere where the sun was always shining, and where everything was nice and easy for me. But God sent me to the complete opposite country. The winters here are really cold. The summers are extremely hot. Even during the hottest days of summer, because of the culture, you have to dress under hot layers and wear a scarf. But it is so good to be here. And I feel so privileged that I have the opportunity to live and work here. Afghanistan has taken a very special place in my heart and I am so glad to be here. I think I am still the same person as a year ago, but I do have much more experience. Being here has made me really appreciate everything we have!

Photos: Elsbeth visits with Afghan families and travels to project sites

on horseback.

Indonesia

MALAYSIA

In September 2009, three powerful earthquakes struck in short succession in West Sumatra province, killing more than 1,000 people and leaving 280,000 families homeless.

Padang Pariaman Padang

Indonesia

(Sumatra)

Jakarta 0

500 310

1000 km 620 mi

A Rewarding Response In 2010, Medair partnered with a local NGO and helped it grow in capacity while delivering a vital shelter programme for the people of Indonesia. Just 36 hours after the earthquakes hit, Medair sent an emergency team to Indonesia to determine how we could best provide assistance. We soon learned that Padang Pariaman district was the most affected area, and families needed shelter urgently. In Padang, Medair’s Mark Wooding met Lynnette Johnstone who worked with local NGO, Creating Foundations for Communities (CFK). They wanted to help, but they lacked expertise in shelter construction.

the most vulnerable households, selected tool kits, and developed training materials. For each T-shelter, CFK’s construction teams provided the footings and framed the walls themselves. To instil a strong feeling of ownership, they encouraged families to complete the rest of the house on their own. “Although they worked at their own pace, which was often slow, many were able to finish their T-shelters themselves,” said Mark. “They were pleased with their own efforts when they realised they could do it!” Families soon realised that their sturdy T-shelters were really first-stage houses that, with their resistance to earthquakes, would last them a long time. “These houses are more than just temporary shelters,” said Joni Friadi, government leader. “They are the foundation of our future homes.”

“This chance encounter led to a very successful partnership in Padang,” said Mark. “Backed by Medair’s shelter expertise, CFK applied its local knowledge and skills to deliver an effective shelter programme for 7,500 people.” We provided technical input to CFK as they implemented the programme directly with the beneficiaries. We trained personnel, designed transitional shelters (T-shelters) for 30

MEDAIR Annual Report 2010

In the first six months of 2010, Medair and CFK built 170 T-shelters for families in Padang. “The assistance CFK/Medair delivered to us after the earthquake encouraged us to have new spirit,” said Syafrizal, in Sungai Tareh village. Medair also developed training materials to teach people how to reinforce homes to make them more resistant to earthquakes, which CFK translated into the Bahasa language, and modified for local use.

Between February and June, CFK held workshops for five mornings each week. In total, 1,500 people received training plus a tool-kit distribution to help with their repairs. “(The) awareness training is very well done, actively involving participants,” wrote Swiss Solidarity, in an evaluation of the shelter programme. “(The) training material developed by Medair is excellent and has been adapted to the local context.”

on their own; and in December, they launched a new emergency response in the Mentawai Islands. For Medair, the Padang earthquake was also an opportunity to stretch our capacity to respond to emergencies swiftly, a capacity which was successfully tested just three months later when another earthquake struck, this time in Haiti.

A Strong Partnership For Medair, partnering with CFK and mentoring their development turned out to be a highly rewarding outcome of the work. In less than a year, CFK doubled in size, added expertise in shelter construction, and gained more professional management systems.

Programme Highlights Total beneficiaries in 2010

“When CFK needed to set up warehouse and tracking systems, they learned by using Medair’s logistics templates,” said Mark. “When they needed to upgrade their financial and accounting procedures, Medair sent a finance officer to help them.”

7,500

Shelter and Infrastructure–Emergency Relief • 1 70 households received transitional shelters or T-shelter materials • 1 ,500 tool kits given to households • 1 ,500 households received construction and DRR awareness training •D emonstration houses completed in each village Photos, left: Beneficiaries participate in awareness training to learn how to

By the time the Padang shelter programme closed in July, CFK had the capacity to take on construction projects

complete their own transitional shelters safely.

above: Female beneficiaries stand in front of their transitional

shelter that they clad in timber themselves.

CUBA

Haiti

ATLANTIC OCEAN

CARIBBEAN SEA

Haiti

GOLFE DE LA GONÂVE

Jacmel

20 40 km

Port-au-Prince

DOMINICAN REPUBLIC

On 12 January 2010, one of the deadliest earthquakes in history struck the poorest country in the Western Hemisphere. In one terrible moment, 222,570 Haitians died and more than 1.5 million people lost their homes.

CARIBBEAN SEA

40 mi

Safe Haven As Haitians rose from the rubble to begin their long road to recovery, Medair provided shelter for more than 11,000 of their most vulnerable. Gideon was sitting in his hillside home when it started to shake violently. He grabbed his cane, fled outdoors, and moments later, his house collapsed before his eyes. In that moment, Haiti’s earthquake toppled tall buildings and small homes alike, leaving a country in ruins.

metal sheets on the roof. They are good quality, so when it is raining we don’t get wet inside.”

Medair quickly sent an emergency assessment team to Haiti. In Jacmel, our team found a city with extensive damage and loss of life, where families were living in unsafe conditions in the streets and in makeshift, unhygienic camps. In response, Medair began a shelter programme in Jacmel and the surrounding rural area in the Sud-Est district. At first, Medair helped organise the community to clear rubble away from damaged homes. Our teams also erected hundreds of emergency shelters that served as a refuge for families. After the initial phase of the emergency response, Medair began building specially designed, durable transitional shelters that are resistant to hurricanes and earthquakes and can be upgraded into permanent homes.

Gideon’s Home High in the mountain village of La Croix, Gideon had moved into a small tent with his wife, four of their children, and three grandchildren. But the space was so crowded that Willianna, their pregnant daughter, had to move to another city. When Medair travelled to La Croix, we made Gideon’s family the first recipients of a transitional shelter in the village. The team constructed the shelter with a solid foundation, a roof, timber-framed walls, and durable plastic sheeting secured tightly to the frame. “I am so happy to have this,” said Gideon. “Because I am disabled, I have no easy way to earn enough money to build anything like this. What I like most about the house is the 32

MEDAIR Annual Report 2010

Once the shelter was built, Willianna returned home so they could all live together again. “I like everything about the house,” a smiling Willianna told us, holding her newborn baby. “I gave birth here. I wanted to have the child here.” In total, Medair built or repaired 1,862 shelters in 2010, providing safer housing for more than 11,000 Haitians. In a country where employment hit rock bottom after the earthquake, Medair employed 84 national staff on contract, along with 77 casual labourers and 242 cash-for-work positions in local communities. “Medair has changed the lives of the people in Jacmel and the surrounding area,” said Florance, a Haitian translator working with Medair. “People who could never afford to build a new house now have a new home. It is hard to start again, but because of Medair, people have hope.”

A Sense of Achievement The year was not without challenges. Working in a devastated country meant that careful planning was required for even the simplest operations. Towns and roads

were choked with tonnes of rubble. Basic office resources were hard to find. Transporting construction supplies from overseas became a logistical nightmare. In addition, Haiti experienced unstable elections and a deadly cholera outbreak that threatened health across the island. In November, Haiti faced another severe challenge when Hurricane Tomas crashed into its south coast. With winds howling outside, the Gideon family calmly took shelter in their new house. “We were not afraid,” said Madame Gideon. “I know my house is strong.” Indeed, all of Medair’s transitional shelters lived up to their design and withstood the hurricane. After the year the Gideons have been through, the year that all Haitians have been through, their newfound security in their homes is a source of hope in this crisis-weary nation. “I have a sense of achievement for the past year,” said Patrick, a former Haitian schoolteacher now working with Medair. “I have been moving all around the areas we are working and I see a lot of people who are in secure places now. I believe we are saving many lives, because we don’t know where they would be if we had not helped them.”

Programme Highlights Total beneficiaries in 2010

12,277

Medair personnel

12 internationally recruited staff 84 nationally recruited staff

Shelter and Infrastructure–Emergency Relief • 5 61 emergency shelters (WWS) erected • 1 ,181 transitional shelters (ESK) built; 2 ESKs converted to permanent homes • 1 20 damaged homes repaired • 1 ,093 residents received temporary employment through cash-for-work programme • 1 2 tents provided for emergency cholera treatment centre • Tools distributed to help with rubble removal • 180 kits of essential non-food items (NFIs) distributed Photos, left: Haitian woman stands beside the ruins of her house. below: Children in Gideon’s family look out the doorway of their

new shelter.

F or more information about Haiti and Medair’s work there, please visit www.medair.org/haiti

UZBEKISTAN TAJIKISTAN

CHINA

Yawan

TURKMENISTAN

Faizabad

Behsud

Jalâlâbâd

Ghazni

Kandahâr

dus

Afghanistan

In a country that has suffered through 30 years of conflict, some of Afghanistan’s most remote regions live in peace but endure frequent natural disasters, unreliable harvests, malnutrition, minimal access to health care, unclean water, and poor sanitation. In these regions, generations have lived in chronic poverty, forgotten and in desperate need of help.

Kabul

Bamian Waras

Afghanistan

PAKISTAN 0 IRAN

100 200 km 100

INDIA 200 mi

Life-Giving Water In 2010, Medair provided aid to chronically poor families living in Badakhshan and Bamyan provinces, two of Afghanistan’s most neglected regions. Sufi Tayeb, 85 years old, sits in the shade of the apple tree that grows outside his home. In all his years, he has never had a drink of clean water. “The water we get from the river is not clean,” he said. “It has made me ill many times. When the children drink the water they get sick and end up vomiting.” In June 2010, Medair completed an ambitious project that provided clean water access to more than 25,000 people in dozens of isolated villages. During the year, our WASH (water, sanitation, and hygiene) team also built more than 700 community latrines and provided hygiene education to almost 50,000 people. And in July, we began a new project which, among its 17,000 beneficiaries, will bring safe drinking water to Sufi Tayeb and 80 other families in Qaber-e-shahid village. “The village really wanted clean water,” said Patrick Galli, Medair WASH Manager. “The community agreed to the investment required—the time and labour they would have to contribute—and now the work can begin.” “When the reservoir opens, I will be the very first person to drink the water,” said Sufi Tayeb with a broad grin.

The Need for Nutrition In Badakhshan province, residents contend with long winters, flooding, landslides, and droughts that can lead to food scarcity, a lack of dietary diversity, and malnutrition. In response, Medair opened nine nutrition sub-centres in 2010 and treated more than 2,400 malnourished women and children, giving them special nutrient-rich food and closely monitoring them to ensure their health improved, referring them to the health centre when necessary. “When you brought this programme here, at first people did not understand the benefit it would bring,” said Agha, a farmer in Jugshude village. “My daughter however was 34

MEDAIR Annual Report 2010

very sick. I have been bringing her here and I have seen her become healthy.” Indeed, the nutrition project successfully reduced the rate of severe acute malnutrition in children in the area, thereby reducing the number of child mortalities. “This programme has saved our children,” said Agha. Medair also took steps to help prevent cases of malnutrition in the future. We taught nutrition lessons, planted demonstration gardens, and gave farmers seeds and tools while also teaching them agricultural techniques to enrich their harvests. “I hope to get enough harvest to feed my family for the whole year,” said Emal, after attending the training. “I will teach my children what I have learned so that they will be ready when they become farmers also.”

Medair also ran a cash-for-work project that helped more than 1,000 families recover from a poor harvest. Residents worked to build or repair their roads while also earning money to buy food. These new roads have brought hope to an isolated region; trucks can now access villages with food rations, and families can more easily travel to the market or health clinic.

Programme Highlights

Disaster Response

WASH–Rehabilitation • 62 wells dug; 165 water points constructed

In May, landslides destroyed the homes of 112 families in Yawan district. Our team responded quickly and distributed emergency supplies, and then provided aid to several other villages hit by seasonal flooding and landslides. Later in the year, our team conducted disaster risk reduction (DRR) workshops with local leaders and led classroom presentations in schools, providing practical ways for communities to prepare for future disasters. Meanwhile, in Bamyan’s Waras district, terrible floods swept through the region. The floods carved away good but sparse agricultural land, damaged critical irrigation systems, and buried crops under mud, destroying the year’s harvest. Medair launched a project to help beneficiaries earn money for food for the winter while also restoring their land, road, and irrigation canals. “I never thought Medair would do all this,” said Haji Solaiman, Governor of Waras. “The people now have a good road which gives them access to the clinic and access to the markets. I am very happy. I see people planting their wheat, and they have irrigation again.”

Total beneficiaries in 2010

89,127

Medair personnel

15 internationally recruited staff 85 nationally recruited staff

Health and Nutrition–Rehabilitation • 1,196 malnourished children treated; 1,210 malnourished women treated • 1,660 people received nutrition education; 75 Ministry of Public Health and CHWs received nutrition training

• 713 community latrines built; 397 bathrooms constructed • 1 33 hygiene educators trained; 49,826 people received hygiene education • 185 water committees established; 20 water mechanics trained Shelter and Infrastructure–Emergency Relief • 1 ,309 beneficiaries received food and emergency non-food items (NFI); 49 families received financial support • 1,136 men and women took part in cash-for-work initiatives • 137 tents distributed Rehabilitation • 1,491 farmers given seeds, tools, and training in vegetable growing • 28 kilometres of road constructed or repaired • 50,000 square metres of crop-growing land restored • 4,700 metres of irrigation canals repaired; 26 irrigation ponds restored • 1,019 metres of retaining wall constructed; 32 diversion dams built • 6,570 students and teachers in 31 schools received DRR training • 59 community/government leaders received DRR training Photos, left: Agha and daughter Yasaman receive food and a hygiene kit. a bove: Cash-for-work beneficiary helps build a road while earning an

income to buy food for his family.

F or more information about Afghanistan and Medair’s work there, please visit www.medair.org/afghanistan 35

Maroantsetra

MOZAMBIQUE CHANNEL

Madagascar Cyclones regularly hit the island of Madagascar, causing widespread flooding and destruction in some of the most vulnerable communities on earth. When people need to rebuild as often as the Malagasy do, it’s a constant struggle for them to improve their living conditions. Thankfully, no cyclones struck in 2010, a welcome respite for the island.

Fénérive-Est Toamasina

Antananarivo

Madagascar INDIAN OCEAN

100 200 km

100

200 mi

Welcome to Ankadibe Medair’s work in Madagascar is exemplified in the positive changes seen in a remote village. Four hours of travel in a dugout canoe is the only way to reach the remarkable village of Ankadibe. Northeastern Madagascar is dotted with hundreds of remote, flood-prone villages like Ankadibe, communities with limited access to safe water, sanitation, or hygiene (WASH). In the past, cyclones have repeatedly devastated Ankadibe, destroying homes, killing livestock, and causing flooding that contaminated their water and led to diarrhoeal disease.

70,000 people with hygiene education. “Medair (has) brought down the number of diarrhoea cases, especially among kids,” said Dr. Rahalason Dery, inspector for Maroantsetra district. Hygiene education is fundamental to Medair’s efforts to reduce diarrhoeal disease. In May, Medair’s Noémie Suter visited Anteviala village and found a store stocked with more than a thousand bars of soap. “Since Medair became active in our village, a lot of people ask for soaps,” explained the grocer. “Now I sell almost 20 soaps per day where before it was 20 soaps per week.”

Reducing the Impact of Disaster In 2010, Medair worked to develop “disaster risk reduction” (DRR) projects including cyclone simulations, workshops, and the formation of DRR committees in 45 villages. We used a participatory approach to help communities develop their own cyclone-preparedness strategies.

For the last three years, Medair has worked with Ankadibe to help them break free of their vicious cycle of devastation and rebuilding. Together, we have built 20 water pumps, constructed latrines, and promoted better hygiene. “Before, we used to draw water from a well or go to the river, but there was a lot of sickness, mostly diarrhoea,” said 28-year-old Suzaline. “Since we have these pumps, we have no more diarrhoea.” In 2010, Medair worked in dozens of villages like Ankadibe. We drilled more than 200 new boreholes, installed hundreds of latrines, equipped schools with hand-washing facilities, and reached at least

MEDAIR Annual Report 2010

In 2010, Medair started a DRR project focused on building homes more resistant to cyclones. “I’m really happy for this new house that will protect my wife and our nine youngest children from floods and cyclones,” said Christophe Marodady, recipient of our first pilot house, nearby to Ankadibe. “A lot of people stop in front of my house and ask where they can buy one like this.”

Hope in Ankadibe Ever since we started working in Ankadibe, residents have been highly motivated to reduce their risks from future cyclones. They have eagerly learned new skills, formed committees, and taken ownership of their new infrastructure. This is how Medair aims to work throughout Madagascar: supporting communities who take the initiative to help themselves.

“I was very impressed during this second visit to Ankadibe: I had the feeling everything had been transmitted,” said evaluation consultant Joseph Ralaivo. “I have rarely seen so many good results before. I think it’s because of Medair’s values, which correspond so well with the values of the village residents.” In 2010, the village welcomed our team to a celebratory feast to inaugurate a new cyclone shelter, a hand-washing facility, and two elevated water pumps. Pierre Malaza gave us a tour of the shelter, showing us space for 130 people, latrines, showers, and a store-room for rice, which every resident is expected to help stock. “We are very proud of our cyclone shelter,” said Pierre. “The shelter brings us hope that we will be protected in case of cyclone or flood. But the shelter also gives us other advantages all year, as some money will be raised from its rental to help develop the village, and as a place for us to meet.”

Programme Highlights Total beneficiaries in 2010

197,597

Medair personnel

7 internationally recruited staff 67 nationally recruited staff

WASH–Rehabilitation • 206 new boreholes drilled and fitted with hand-pumps and drainage • 2 gravity-fed water-supply systems built with hand-washing facilities at schools • 16 schools equipped with hand-washing facilities • 368 family latrines installed • 12 elevated pumps built • 28 WASH workshops held on technical, management, and governance issues • 1 inter-communal platform created to assure sustainability of infrastructure •7 1 hygiene volunteers trained •7 1,692 reached with hygiene promotion and DRR through community meetings, mobile cinema, and puppet shows •4 6 radio programmes promoting hygiene reaching a wide audience Shelter and Infrastructure–Rehabilitation • 1 district and 1 village cyclone simulation organised • 45 new village DRR committees established; 12 communes held DRR workshops • 1 study undertaken to better understand the Maroantsetra Hydraulic Basin • 1 pilot cyclone-resistant house built

In Ankadibe, once-vulnerable people have taken significant steps to improving their living conditions, steps that allow them to look toward a safer and brighter future. “We thank God that Medair is working in our village and partnering with us,” said Pierre. “Although we will be sad to see you go, we are now ready to face a cyclone with confidence and we thank you.”

• 150 tonnes of rice, dried vegetables, and oil pre-positioned for emergency response (in partnership with WFP) Photos, left: Young woman in Ankadibe draws water with a new hand-pump,

elevated for flood-protection.

below: Students discover that learning about good hygiene can be fun!

F or more information about Madagascar and Medair’s work there, please visit www.medair.org/madagascar

0 0

Uganda

100 km 50

SUDAN

100 mi

Kaabong Patongo

Abim

DEM. REP. OF CONGO

Uganda Kampala

KENYA

For more than 10 years, Medair maintained an active presence in Uganda throughout the height of the brutal Lord’s Resistance Army (LRA) conflict, when more than one million Ugandans were forced to live in overcrowded camps for their protection. Today, the conflict is over. Living conditions have improved and most of the population have returned to their villages of origin.

TANZANIA RWANDA

Our Decade in Uganda Reflections at the close of one of Medair’s longest running programmes. Our mission in Uganda began in 1999, in the droughtstricken Karamoja region, where our team worked to prevent the spread of cholera. For the next few years, we increased access to safe water, sanitation, and hygiene (WASH) for hundreds of thousands of people in Karamoja. Yet at the same time, conflict was tearing apart other regions in northern Uganda, forcing residents to flee into overcrowded camps. From our bases in Karamoja, we were the only humanitarian staff able to reach the most underserved camps in Pader district. “Your presence here reminds us that God has not forgotten us,” said a grateful camp resident in 2003. “When I first arrived in Uganda in 2004, the roads were empty, apart from the soldiers,” recalled Medair’s Henrieke Hommes, who worked in Uganda from 2004 until 2008. “People didn’t dare leave the camps for fear of getting abducted or shot. There was almost no water, no health care, very little food, and very poor hygiene.” For the next several years, Medair staff worked tirelessly to provide health care and WASH for hundreds of thousands of vulnerable people in the camps. We also provided psychosocial support to thousands of traumatised children: orphans, victims of abuse, and former child soldiers. When peace finally came to Uganda in 2006, people began moving into smaller satellite camps or back to their damaged villages of origin. Medair worked to help restore the provision of health care and WASH in these home villages. We also conducted projects designed to improve infrastructure, upgrade skills, protect children from harm, and otherwise strengthen the capacity of the recovering Ugandan population. Medair also started working in Karamoja again, making major progress in improving access to water for residents and for their livestock. 38

MEDAIR Annual Report 2010

In April 2010, we officially closed the Uganda programme after completing our final objectives in the Karamoja region. In the first three months of 2010, we provided training for health workers and village health teams, and we completed a cash-for-work project in the region, rehabilitating roads and distributing seeds to farmers. “The people of Uganda are on the road to recovery,” said John Farmer, Medair’s Director of Operations. “As the need for emergency relief has passed, Medair’s role here has been fulfilled. As we leave today, we are gratified to see so many encouraging signs of hope for the future in what was once one of the worst humanitarian crises in the world.”

Programme Highlights Total beneficiaries in 2010

1,216

Medair personnel

7 internationally recruited staff 48 nationally recruited staff

Photo: Cash-for-work beneficiaries rehabilitate a road in the Karamoja region.

Behind the Scenes Meet some of the remarkable people who make our life-saving work happen every day.

Abdullahi Abdi Ahmed Nutrition Project Officer Somalia/Somaliland I was just eight years old when the civil war broke out here in 1988. My family went to live in Ethiopia’s refugee camps for three years. I did not get an education, I did not get anything. I was a refugee boy. But when I came back to Somaliland, I started my education. I started to live in a normal situation where I went to primary school, secondary school, university, everything. I grew up saying I would like to work for a humanitarian organisation. Many difficult things are happening here. If we are not supporting the community we live with, the problems will not be reduced and we will not grow.

Dying Children Sometimes it seems like people here are recovering and heading towards development. But for the last three years, droughts have affected the community very, very hard. Before, the children here were very malnourished. There were lots of children dying every day. But now, since Medair has been working here, we don’t see as many children anymore who are severely malnourished with complications. People who live in the town have now mostly recovered, because we check the malnourished children daily. Most children who are now admitted to the feeding programme come from remote areas. The community knows that we work for children who are very thin and wasting a lot, so they say, “You should go to the Medair sites, they will treat your child, they will give him some food and help, and he will recover.”

were robbed while travelling here, some were raped, and some got into difficulties because they didn’t have money. They often travel very long distances by foot to come to Burao. You will see some of them who are very tired and stressed, and sometimes crying while telling you their stories of how they reached here. When you have left the place you used to live for any reason, and you try to reach another region where you don’t have relatives—where you don’t have a government that recognises you, where you don’t have anything—you are like the way you were when you were born. You are just new, you don’t have anything. Most of the displaced people hope that they can adapt to life here and get a way out of poverty, and some of them are even moving from the camps and going into the community. Those who have professions are trying to find jobs, trying to integrate into the community. When the rains come, those here because of drought may go back home, but those here because of conflict, I think they will stay a long time.

Burao, Before and After The people living in Burao are very proud of the activities that we are doing here. Before Medair was here, things were very different... And of course Medair doesn’t do only nutritional activities, but also water, sanitation, and health. We have reached lots of children with vaccinations, and we hope that we will no longer have our children getting polio and things like that.

Displaced and Distressed

Before working here, I worked in business but I did not feel that I was helping my community and society. Now I’m someone who’s helping people who are really in need.

Many people who flee the violence in Somalia come to Burao. During their journey, these people have many difficulties. Some

Photo: Abdullahi helps organise a large group of women and children in Burao.

determined to be here because vulnerable women and children are also the victims of these kinds of people and their violence. They have no option to leave the situation behind. I am here to serve them and will continue to do that, despite the presence of violence at times.”

Ina Hogendoorn Country Director Afghanistan

Losing her friends and colleagues has made Ina even more appreciative of her friends in Kabul and of the Medair team. “We have enjoyed great team moments,” she says. “When you join Medair, you join a family, not an organisation. It will change your life and take you to new places and experiences.”

Ina worked as an accountant in the Netherlands before joining Medair as a finance manager in 2002. Her management skills led her to positions as deputy country director, desk officer, and now country director in Afghanistan. “I have grown a lot in the last nine years, professionally and as a human being,” she says. “Even though I don’t directly work with the beneficiaries, my efforts make it possible for the team to change the lives of the people they meet,” she says. “My main job is to ensure the projects are implemented well and adhere to quality standards. It is especially important to go out there ourselves to find out the needs of the remote populations that are overlooked by the international community.” Ina’s management skills are put to use on a wide variety of jobs, and no two days are the same: “In a week, my job might involve a field trip on a horse for four days with a donor, a coordination meeting with the U.N. and other NGOs, putting together a security plan before a field trip, and lots of sitting behind a desk emailing people.” Some of the most rewarding moments for Ina are when she meets beneficiaries and sees the powerful impact that Medair’s projects can have on individuals and communities. However, the job also brings its share of heartache and suffering. In August 2010, ten aid workers were murdered in Afghanistan; some were friends of Ina. Their sudden deaths had a profound effect on her and the rest of the Medair team. “All the people who were killed were special people who made an enormous impact in the lives of others,” says Ina. “It has made me more

MEDAIR Annual Report 2010

Claudel Mbotivelo Infrastructure Mgr. Madagascar When Claudel applied to Medair in 2006, he was going through a difficult personal time, grappling with deep questions about the meaning of his life. But when Medair hired him as a hygiene promoter, it brought him a sense of purpose. “It was like a gift from God to meet Medair” says Claudel. “I realised that the purpose of my life was to better understand what God did for me, and to help others.” Despite facing adversity growing up in Madagascar, Claudel’s determination shaped his character. He lost his parents when he was 12 and has taken care of himself ever since. As an adult, he decided to pursue technical studies in engineering, but this was so expensive that he had to work very hard when he was not in school to pay the fees. Eventually, Claudel had to drop out for financial reasons. But with his engineering background, he was a natural fit to become part of Medair’s infrastructure team. “First, I had to learn to use a computer, then an expat taught me how to do specific calculations,” says Claudel. “Then with each new expat I was learning things from them and I was teaching them what I knew in the field. In this

Behind the Scenes

manner, we all were learning from each other and doing a better job together.” In 2009, Claudel became a deputy infrastructure manager and in 2010 he was promoted to infrastructure manager, where he is responsible for supervising all of the construction and managing a team of six people plus many casual workers. He is always smiling, humble, and ready to work hard. “For me, integrity and accountability are important because I have to deal with large amounts of money and it’s so important to be transparent and faithful,” he says. “Faith makes a big difference in our work: knowing that God can give us strength to do our work.” “Medair really changed my life,” says Claudel. “Even if I go through difficulties, I feel confident and have hope that every situation can get better.’’

population by supporting health centre professionals. This approach is different from those NGOs that bring in new systems and attempt to integrate them, which then crumble after they leave. The difference is that even if Medair left today, the system on the ground would remain reinforced.” Dr. John has some amazing memories from his nine years with Medair. “I remember the time of the conflict in Ituri in 2003, the country director and I both had to sleep on the office floor because it was too dangerous to go out,” he explains. “Her humility really touched me. Many expatriates fled during this time, but she, a foreigner with an option to leave, chose to stay. She didn’t forsake us.” For Dr. John, the most remarkable thing about Medair has been its enduring commitment to the people of his country. “When only a handful of NGOs were present during the conflict in Ituri, Medair was there,” he says. “When only few NGOs intervened in Isiro, Medair worked in this area, and now Medair is once again leading the way by taking assistance to those who need it in Ango, a region with immense need.”

Dr. John Kanyamanda Medical Coordinator D.R. Congo “I feel like I am leaving family behind, ” confesses Dr. John Kanyamanda, as he readies himself to leave Medair after nine years of dedicated work. “The most important thing that I take with me as I leave Medair is that sense of belonging, that sense of family and unity among coworkers, people praying and working together.” Dr. John started out as a medical supervisor, but soon climbed the ladder to medical coordinator in charge of all health projects. “I have gained a wealth of experience including managing projects from beginning to end, which will serve me well in my future plans.” Medair’s approach to health care in D.R. Congo strongly resonates with Dr. John. “Medair works directly with the

John Pollard WASH Project Manager Southern Sudan As a young civil engineer, John joined Medair in 2001 and worked in D.R. Congo doing food security and developing small water sources. “I wanted to use my engineering skills in a Christian context in relief and rehabilitation,” he says. During the Medair orientation course, he met Hannah, a doctor who was heading to Angola to work. He could never have imagined that, years later, they would reconnect, fall in love, and get married, let alone that they would both work for Medair together in the same country as a married couple.

They now work in Southern Sudan, where John is overseeing a major WASH project and managing the budget and four staff. “We are working to provide clean water to 40,000 people in five different towns, people who have only the (untreated) water from the Nile River for all their needs,” says John. “We are also doing hygiene promotion and constructing latrines.” “The most fulfilling thing is to see things getting built and to see the benefit that we can provide to the community through that,” he says. In particular, he sees school latrines as a great way to encourage children to attend school and get an education. “The latrines really change especially the girls’ lives. Some girls avoid going to school at all, because of a lack of a safe place for them to go to the toilet.” Over John’s time with Medair, his management skills have grown significantly. “I used to find it difficult to delegate responsibility,” he says. “But I’ve learned to manage that and invest more time into teaching and training staff to do the direct work. I’ve also grown in my communication ability with stakeholders such as local authorities. I feel I will move to the next steps of my career with more self-confidence.”

earthquake struck and devastated her home city. “I saw clouds of dust from buildings collapsing in front of my eyes,” she says. “The city’s human and built landscape was never the same.” In 2004, the destruction caused by the South-Asian tsunami shook Miriam’s spirit. At the time, she was a graduate student in rural planning and development and had to overcome her strong desire to leave her piles of books behind and join the relief effort. She remained in school and went on to work in D.R. Congo, Mexico, and Canada. When the earthquake struck Haiti in 2010, Miriam immediately wanted to help with the emergency response. “The images I saw in the newspapers broke my heart,” she says. “They had no sound, yet screamed to me. From the moment I learned the earthquake news, I wanted to be here to do something.” Miriam’s background in architecture and housing rights made her an ideal candidate to work with Medair in Haiti. As a shelter project manager, Miriam provides leadership, strategic direction, management, and monitoring to the shelter teams in the rural villages around Jacmel. In addition to providing safe housing for beneficiaries, Miriam’s most treasured success has been increasing female participation in Medair’s cash-for-work programme. “Construction is culturally and traditionally regarded as a male task,” she says. “But we have significantly increased female participation in our programme and I continue to encourage women to join our teams.”

Miriam López Villegas Shelter Project Manager Haiti Natural disasters have marked Miriam deeply. When she was a girl growing up in Mexico City, a massive

MEDAIR Annual Report 2010

“I’ve learned the real value of capacity building for local staff,” concludes Miriam. “Just as it is valuable to build more than 3,000 shelters, it is also valuable that we are giving dozens of Haitian employees the opportunity to gain skills by working with an NGO with international standards. That’s also reason enough for us to be here.”

Behind the Scenes

For Paska, the best part of working with Medair is knowing that her work is making a real difference. “The midwives told me that since Medair has been supporting them, they have not had any women die in childbirth,” she says.

Paska Tito Midwife Supervisor Sudan (Northern States) Paska is relatively new to Medair but she is very experienced in her profession. She became a nurse in 1977 and a midwife in 2000. “I delivered many, many, many babies,” says Paska, who was working in a government hospital in Khartoum when she heard that Medair was looking for a midwife supervisor. “I wanted to help my people,” explains Paska. “From the moment Paska arrived, she seemed to be part of the team,” says Medair’s Rebekka Frick. “She was very eager and willing to learn and never too tired to add an extra visit during our day trips in the field.” Paska has become known for her skills and patience in training the numerous midwives under her supervision. “She has a great relationship with the midwives,” says Geoff Koontz, one of Medair’s Health Managers in South Kordofan. “They are always happy to see her and they appreciate her supportive, gentle nature.” She quickly earned the respect of her Medair colleagues. “At the beginning of the programme, it was difficult to find suitable staff but these concerns immediately changed after Paska arrived,” says Rebekka. “I felt that I could hand over responsibilities to very capable hands.” Paska has the relaxed demeanour of someone who has witnessed many things in life. She gets along well with all the other staff and they are happy to help her as she figures out new challenges, like how to use a computer for the first time. She describes the Medair team as Ta-mum: “We are all like one family.”

Pieter Bakker WASH Project Mgr. Zimbabwe Before coming to work for Medair, Pieter worked for eight years for a large international contractor in the Netherlands, performing various project management roles for industrial maintenance projects. Pieter joined Medair because he felt led to support vulnerable people throughout the world, and he found his own values reflected in the mission, vision, and values of Medair. In his three years with Medair, Pieter has worked in the field in Indonesia, Uganda, and most recently in Zimbabwe. “My time with Medair has been like a rollercoaster,” says Pieter. “In the field you are right on the spot where it is happening.” “Successes and challenges come hand in hand,” says Pieter. “In the end you celebrate the success but meanwhile you have to work to get it done, with lots of social, technical, security, staff, and environmental challenges.” For Pieter, highlights of the job include working in beautiful landscapes and alongside great Medair staff. “I value team life very highly,” says Pieter. “You learn a lot from your colleagues. I enjoy and grab every new opportunity with both hands!”

Words from Our Partners “After travelling for two days on horseback, we arrived at Kohestan, a village where Medair was providing safe water and food assistance to the vulnerable population of one of the most isolated and remote areas of Afghanistan. After the visit, I could finally visualise what this area looked like and how challenging it was to reach these people in need in a very challenging environment. I was very impressed with the quality of work Medair was doing.” Abdul Sattar Safi, Programme Officer, E.C. Directorate-General for Humanitarian Aid and Civil Protection

“I visited a lot of projects of disaster risk reduction from all the partners… but I must admit that I was really impressed by the quality of Medair’s work. I also found that their visibility in the field was excellent!” Sylvie Razafindrabe, Communication Manager for ICPM, Coordination Platform for NGOs in Madagascar Photos, above: A farmer (left) in the village of Kohestan shows his vegetable garden plot to Abdul Sattar Safi. below: Medair staff interview a young participant in a puppet show outreach, one of many disaster risk reduction activities in Madagascar. right: Jay Nash, visiting the Dele health centre in Ituri district with Medair staff.

MEDAIR Annual Report 2010

Funding Partners 2010 Listed within each category in descending order of donation size (≥ USD 15,000).

Multi-Donor Partnerships • Basic Services Fund (inc. Department for International

Development, U.K.)

Institutional Partners • Swiss Solidarity • Canadian Foodgrains Bank • BMB Mott Macdonald (NLD) • TEAR Fund (N.Z.) • Mennonite Central Committee (U.S., CAN)

• Multi-Donor Trust Fund (inc. World Bank)

• Mercy Corps (U.S.)

• Pooled Fund, D.R. Congo (inc. U.N. Office for the

• Läkarmissionen (SWE)

Coordination of Humanitarian Affairs) • Global Fund, D.R. Congo

• EO-Metterdaad (NLD)

United Nations and Intergovernmental Partners

• Demaurex & Cie SA – Marchés Aligro (CH)

• E.C. Directorate-General for Humanitarian Aid

and Civil Protection

Private Sector Partners • Oak Foundation (CH) • Foundation Pierre Demaurex (CH)

• United Nations Development Programme

• The National Christian Foundation (U.S.)

• United Nations Children’s Fund

• Mission to the World (U.S.)

• World Health Organisation

• ICAP Charity Day (U.K.)

• United Nations Population Fund

• The Christian Reformed Churches in the Netherlands

• World Food Programme

• UBS Foundation for Social Issues and Education (CH)

Government Partners

• Miss S.F. Morfield Charitable Trust (U.K.) • Georges Wick Foundation (CH)

• United States Agency for International Development

• The Reed Foundation (U.K.)

• Department for International Development (U.K.)

• Emeraude International (FRA)

• Swiss Agency for Development and Cooperation

• Reformed Church Liberated Ten Boer (NLD)

• Swedish International Development Cooperation • EuropeAid Cooperation Office of the European Commission

Gift-in-Kind Partners

• EC Northern Uganda Rehabilitation Programme

• United Nations Children’s Fund • World Food Programme • International Organization for Migration • World Vision

“The people in this region have suffered for a long time due to the conflict. But I am satisfied that we have a partner on the ground that is able to offer medical assistance which is very critical, and we will try to continue to help until these kinds of problems come to an end.” Jay Nash, Senior Program Officer, United States Agency for International Development, D.R. Congo

Accreditations and Affiliations ISO 9001:2008 certification, Worldwide The ISO 9001:2008 quality certification denotes that Medair consistently provides effective relief and rehabilitation services for the well-being of its beneficiaries.

Medair is an active participating agency in the Inter-Agency Standing Committee’s (IASC) Global Shelter Cluster. The IASC is the primary mechanism for coordination of humanitarian assistance involving key U.N. and non-U.N. humanitarian partners.

ZEWO, Switzerland ZEWO certification, only available to state-approved, Swiss nonprofit organisations, testifies to the integrity of Medair’s publications, fund appeals, and the intended and effective use of private donations. ZEWO standards call for optimal accounting and operational transparency, confirmed by continuous independent monitoring.

HAP-I Medair is a full member of HAP International, whose purpose is to achieve and promote the highest principles of accountability, through self-regulation by members linked by common respect for the rights and dignity of beneficiaries.

RfB, The Netherlands The RfB certification gives donors a high degree of certainty that resources received by Medair Netherlands are used for the purpose for which they were given. Awards I ntelligent Giving, U.K. This independent donor advice organisation has rated Medair U.K. its no. 1 ranked religious charity and no. 1 ranked international charity since 2008. Memberships Algemeen Nut Beogende Instelling The Dutch government has granted the ANBI-status to Medair Netherlands. ASAH, France ASAH is a collective of faith-based organisations dealing in international solidarity in fields such as humanitarian aid, international cooperation and development, fair-trade, and societal re-integration. CONCORD Medair’s EU-CORD membership gives it membership into CONCORD, the European confederation for relief and development. Solidarité Urgence Développement

Coordination SUD, France Medair France is a member of this coordinating body of French NGOs, whose aim is to promote their values to private and public institutions, both in France and abroad. EU-CORD Medair is a member of the EU-CORD, a network of relief and development organisations with headquarters in Europe, formed in 1998 with the goal of serving the poor more effectively and improving the conditions of disadvantaged people in the world.

MEDAIR Annual Report 2010

ImpACT Coalition, U.K. Medair U.K. is a member of the ImpACT Coalition, which promotes better understanding of how charities work and the benefits they bring to society. LINGOs This is a consortium of over 55 international humanitarian relief, development, conservation, and health organisations that provides the latest learning technologies and courses from the partnering organisations. People in Aid Medair is a member of the Code of Good Practice in the management and support of aid personnel in areas of health and safety, diversity, and equality. The Fundraising Standards Board, U.K. This board is the self-regulatory body for fundraising in the U.K. Members agree to adhere to the highest standards of good fundraising practice. VOICE Through the membership to EU-CORD, Medair is a member of VOICE, a network of NGOs throughout Europe that are active in the field of humanitarian aid, including emergency aid, rehabilitation, disaster preparedness, and conflict prevention. European Interagency Security Forum (EISF) The European Interagency Security Forum (EISF) is a group of security focal points of European international humanitarian agencies concerned with security and safety of humanitarian relief organisations. Principles Sphere The Sphere Project, launched by humanitarian NGOs and the Red Cross and Red Crescent movement, comprises a handbook, a process of collaboration, and a commitment to quality and accountability. International Committee of the Red Cross Medair is a signatory to the “Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief.”

Medair Ecublens, Switzerland

Audited Consolidated Financial Statements 2010

Medair operates with U.S. dollars as its functional currency The following pages are presented in U.S. dollars (USD)

Report on Financial Performance Mission Statement The mission of Medair is to respond to human suffering in emergency and disaster situations by implementing multi-sectoral relief and rehabilitation projects, in a compassionate and serving attitude inspired by its Christian ethos.

Medair Strategy Our present strategy is to bring life-saving emergency relief and rehabilitation in disasters, crises, and conflict areas by working alongside the most vulnerable. Our strength is in providing health services and nutrition; improved access to safe water, sanitation, and hygiene; and in shelter and infrastructure construction.

Treasurer’s Report During 2010, Medair was able to provide relief and rehabilitation services in 10 country programmes and nine countries, thanks to the generous financial support of our many donors, both institutional and individual. We started a new programme in Haiti early in the year. Our humanitarian expenditure in 2010 was USD 34.9 million compared to USD 29.2 million in 2009. This significant increase was mainly due to the new programme in Haiti. Our private donations increased significantly during this year from USD 5.8 million to USD 8 million. We are very thankful

MEDAIR Consolidated 2010 Annual Financial Statements

for this significant increase to our private funding. Financial support from generous individuals who understand and share our values is essential to fulfilling our mission. Our overhead continues to compare very favourably in the NGO community: 87.6% of all incoming funds are used in field programmes to serve the beneficiaries of our programmes. Our cash position turned around significantly during the year. This increase reflects the improved processing of all financial transactions and reports for our field programmes as well as moving some of our grants to advance cash payment prior to expenditure. However, our reserves are still inadequate to cover the annual ups and downs of our cash-flow cycle. I want to express my personal thanks and sincere appreciation to each member of staff and every donor who made this year possible.

Torsten De Santos Treasurer

Photo : N ewly trained hygiene promoters proudly display their graduation

certificates in Sudan (Northern States).

Leadership of Medair The Board of Trustees is elected from the membership of the Medair Association. There must be a minimum of five board members, who serve for three-year terms. To ensure leadership continuity, no more than one-third of the board can be replaced during a year. The Chief Executive Officer (CEO) is appointed by and responsible to the board for the management and operation of the organisation. The Executive Leadership Team assists the CEO in this responsibility. Board of Trustee and Executive Leadership Team members at 31 December 2010 are presented below, along with the date of their original appointment to this position.

Board of Trustees

Executive Leadership Team

Martin Bauman, 2010 Nelleke Bosshardt, 2009 Christina Bregy, 2009 Hans Gitsels, President, 2001 Max Gove, Secretary, 1998 Nigel Harris, 2010 Ton Jansen, 2008 David Leeper, 2010 Chris Lukkien, 2010 Torsten De Santos, Treasurer, 2010

John Farmer, 2004 Peter Holloway, 2010 Jim Ingram, 2007 Jim Jackson, 2010 Patrice Leguern, 2006 John Rigstad, 2001 David Sauter, 1994 Randall Zindler, CEO, 2003 Photoâ&#x20AC;&#x160;: Father holds his young daughter during an assessment for

malnutrition in Afghanistan.

Financial Statistics Programme Income and Expense 2010 (USD)

8,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000

Afghanistan

D.R. Congo

Haiti

Indonesia

Madagascar

Somalia

North Sudan

South Sudan

Uganda

Zimbabwe

Income

3.944.623

3.779.761

7.951.537

104.584

1.535.535

3.230.656

8.653.440

8.619.091

661.516

921.647

Expense

3.691.383

3.553.745

6.810.490

165.245

1.373.733

3.064.475

8.325.332

8.405.906

496.043

886.005

Photoâ&#x20AC;&#x160;: Medair staff spend hours travelling on the Nile River to reach many of the remote locations where Medair works in Southern Sudan.

MEDAIR Consolidated 2010 Annual Financial Statements

Operating Expense 2010

Humanitarian Expense (direct) 81%

Humanitarian Expense (indirect) 6.6%

Administration 5.5%

Fundraising 6.9%

Operating Income 2010 Gifts-in-Kind 4.7%

Other Income 1.1%

Private Donations 19%

Foundations and NGOs 4.1%

Government, E.U., U.N. 71%

Programme Expense by Sector 2010 Agriculture and Food Security 6.2% Water, Sanitation, and Hygiene 25.1%

Shelter and Infrastructure 33.8%

Nutrition 1.8%

Disaster Risk Reduction 1%

Health Services 31.8% Livelihoods 0.3%

MEDAIR Consolidated 2010 Annual Financial Statements

Balance Sheet as of 31 December 2010 All figures shown are inÂ USD 2010 2009

Note

USD

ASSETS CURRENT ASSETS Cash and bank accounts 5.1 7,809,674 5,264,188 Donor receivables 5.2 20,471,748 11,493,237 General receivables 5.2 91,072 85,041 Inventory 49,734 41,240 Prepaid expense 231,810 407,209 28,654,038

17,290,915

LONG-TERM ASSETS Financial assets 243,237 124,552 Fixed assets 5.3 1,302,374 1,299,777 1,545,611

1,424,329

TOTAL ASSETS

30,199,648

18,715,244

CURRENT LIABILITIES Deferred revenue 5.4 19,445,919 7,811,918 Accounts payable 5.5 778,222 539,498 Short-term debt - 1,926,782 Current maturities of long-term debt - 202,435 Accrued liabilities 355,783 174,375 Provisions 5.6 180,279 193,664 20,760,202

10,848,672

LONG-TERM LIABILITIES 5.7 Severance benefits 162,800 188,847 Long-term debt 162,800

188,847

RESTRICTED FUNDS 2.18 Restricted income funds 660,308 683,916 Restricted programme funds 1,713,950 364,329 2,374,258

1,048,245

UNRESTRICTED FUNDS 2.19 Unrestricted capital 962,827 1,081,161 Allocated capital 5,939,564 5,548,322 6,902,391

6,629,484

LIABILITIES AND FUND BALANCES

TOTAL LIABILITIES AND FUND BALANCES

MEDAIR Consolidated 2010 Annual Financial Statements

30,199,648

18,715,244

Income Statement 2010 All figures shown are inÂ USD 2010 2009

Note

Unrestricted

Restricted

Total

INCOME

Public funding 7.1 31,621,703 31,621,703 Private funding 7.1 4,989,105 2,988,011 7,977,116 Gifts-in-kind 7.2 1,997,565 1,997,565 Other income 7.3 225,047 258,948 483,995

23,007,956 5,778,025 2,650,082 107,719

31,543,782

OPERATING INCOME

5,214,152

36,866,227

42,080,378

EXPENSE Humanitarian expense 8.1 -34,899,316 -34,899,316 Administrative expense 8.2 -4,945,727 -4,945,727

OPERATING EXPENSE

8.5

-39,845,042

-29,197,509 -4,369,351

-33,566,860

RESULT FROM OPERATIONS

-34,630,891

36,866,227

Financial income 46,072 Financial expense -48,943 -157 Realised loss on exchange 8.6 -728,308 19,224 Unrealised gain on exchange 95,406 -635,773 19,068

NET RESULT

-35,266,663

36,885,293

2,235,336

-2,023,078

46,072 -49,100 -709,083 95,406 -616,705

6,119 -93,149 -1,161,127 1,378,372 130,216

1,618,630

-1,892,862

FUND MOVEMENTS DURING THE YEAR Restricted funds income 39,190,800 39,190,800 Restricted funds expense Unrestricted funds income Unrestricted funds expense

-37,869,105 5,700,834 -5,403,896 -37,572,168 39,190,800

-37,869,105 5,700,834 -5,403,896 1,618,630

29,179,403 -29,516,681 3,602,644 -5,158,229 -1,892,862

ALLOCATION OF NET RESULT Restricted funds 1,326,012 Unrestricted funds 292,618 292,618 1,326,012

1,326,012 292,618 1,618,630

-323,356 -1,569,507 -1,892,862

RESULT AFTER ALLOCATION -37,864,787 37,864,787 0

Cash Flow Statement 2010 Note All figures shown are inÂ USD 2010 2009 CASH FLOW FROM OPERATIONS Net result 1,618,630 Net depreciation 653,642 (Increase)/decrease in donor receivables 5.2 -8,978,511 (Increase)/decrease in general receivables 5.2 -6,030 (Increase)/decrease in inventory -8,494 (Increase)/decrease in prepaid expense 175,399 Increase/(decrease) in deferred revenue 5.4 11,634,001 Increase/(decrease) in accounts payable 5.5 238,724 Increase/(decrease) in accrued liabilities 181,408 Increase/(decrease) in provisions 5.6 -13,385 Increase/(decrease) in severance benefits -26,047 Unrealised gain/(loss) on exchange -19,710 5,449,628

-1.892.862 677,001 6,506,833 114,540 -15,894 100,088 -5,745,155 -288,799 5,554 128,288 30,252 -380,153

CASH FLOW FROM INVESTING ACTIVITIES (Investments)/disposals in financial assets -118,741 (Investments) in fixed assets 5.3 -672,188 Disposals in fixed assets 5.3 15,664 Unrealised gain/(loss) on exchange 344 -774,922

1,310 -446,447 48,115 -397,023

CASH FLOW FROM FINANCING ACTIVITIES Increase/(decrease ) in short-term loan Increase/(decrease ) in long-term loan

-1,926,782 -202,435 -2,129,217

505,832 -249,860 255,973

2,545,486

-521,203

CHANGE IN CASH BALANCES 5.1 Opening balance 5,264,188 Closing balance 7,809,674

5,785,391 5,264,188

TOTAL MOVEMENT IN CASH

MEDAIR Consolidated 2010 Annual Financial Statements

2,545,486

-521,203

Statement of Changes in Capital and Funds 2010

2010

All figures shown are inÂ USD

Note

Opening balance

Unrestricted income

Restricted income

Programme expense

Financial gain/(loss)

Fund transfers

Closing balance

RESTRICTED FUNDS Restricted income funds Africa fund 0 1,554,470 156,029 -1,710,498 Emergency response fund 480,997 2,345 - 7,672 - Forgotten victims fund 361 793 110 -325 Medical fund 3 - - 8,419 -8,419 Oak fund - 540,562 -540,562 Medair Germany fund - 62,357 -3,639 -58,718 Water fund 4,266 13,898 - 839 -16,167 Staff care capital fund 144,540 - -157 Staff care & development fund 24,090 - -24,043 Capacity management fund 24,090 -24,043 Staff support & development fund - - - 2,684 -2,684 Private activity fund 5,569 - 62 Cumulative currency translation 683,916 - 2,174,424 - 172,019 -2,385,459 Restricted programme funds Afghanistan 42,950 2,998,791 -3,691,383 -246,185 945,832 Angola 401 -555 - 7,716 - D.R. Congo 29,853 2,861,661 -3,553,745 -221,773 918,100 Haiti - 7,994,095 -6,810,490 -35,262 -42,558 Indonesia 10,116 104,584 -165,245 114,975 - Iran 5,536 - - Iraq 379 - Madagascar 22,777 706,241 -1,373,733 -167,043 829,294 Pakistan 31,453 - - - Somalia 72,691 3,230,012 -3,064,475 7,770 644 Sri Lanka 72 - Sudan - Northern States 30,733 8,145,275 -8,325,332 -353,904 508,165 Sudan - Southern Sudan 95,933 7,816,149 -8,405,906 -167,844 802,942 Uganda 11,331 189,291 -496,043 -176,676 472,225 Zimbabwe 10,102 639,620 -886,005 -30,541 282,027 Cumulative currency translation 364,329 - 34,685,165 -36,772,357 -1,268,767 4,716,670

TOTAL RESTRICTED FUNDS

1,048,245

- 36,859,589 -36,772,357 -1,096,749

0 491,014 938 3 2,835 144,383 48 48 -0 5,631 15,408 660,308

50,004 7,562 34,096 1,105,786 64,430 5,536 379 17,535 31,453 246,642 72 4,937 141,273 129 15,203 -11,087 1,713,950

2,331,211 2,374,258

UNRESTRICTED FUNDS Unrestricted capital Undesignated funds 1,081,161 4,943,422 2,479,155 -7,526,350 Cumulative currency translation - Undesignated funds 1,081,161 4,943,422 - 2,479,155 -7,526,350

977,389 -14,562 962,827

Allocated capital Administrative fund 1,075,378 209,633 6,638 -2,853,056 a) -2,612,375 5,302,978 1,129,196 Capital equipment fund 942,654 -21 -211,029 5,575 202,435 939,614 Operations fund 3,471,781 - 596,762 -294,888 3,773,656 Training fund 58,511 45,730 - -8,600 10,927 - 106,568 Launch fund - 15,387 -15,387 Cumulative currency translation -9,469 5,548,322 270,729 6,638 -3,072,685 -1,999,111 5,195,138 5,939,564 TOTAL UNRESTRICTED FUNDS 6,629,483 5,214,152 6,638 -3,072,685 480,044 -2,331,211 6,902,391

TOTAL CHANGES IN CAPITAL

7,677,728

5,214,152 36,866,227 -39,845,042 -616,705

- 9,276,649

a) This is a net number after the field contribution in support of administrative costs

Notes to consolidated financial statements for 2010 1.

Presentation

Medair is a private, non-profit and non-governmental organisation that brings life-saving emergency relief and rehabilitation in disasters, crises, and conflict areas by working alongside the most vulnerable. Medair was founded in 1988 and established in 1989 as an association under article 60 et seq. of the Swiss Civil Code. Medair is independent of any political, economic, social, or religious authority. The Medair headquarters are located in Ecublens, Switzerland.

2. Significant accounting policies 2.1 Basis for preparing the consolidated financial statements The consolidated financial statements have been prepared in accordance with the Swiss generally accepted accounting principles (Swiss GAAP RPC).

2.2 Valuation principles Cash is stated at its nominal value and any foreign balances are converted at the year prevailing yearend exchange rates. Receivables are stated at their nominal value, less any value corrections. Fixed assets are stated at their historical cost value, less accumulated depreciation. Debts are stated at their nominal value. 2.3 Scope of the consolidated financial statements These financial statements present the consolidated activities of Medair-affiliated offices worldwide. The international headquarters of Medair are located in Ecublens, Switzerland. Medair Chemin du Croset 9 1024 Ecublens Switzerland

The financial statements present a true and fair view of Medairâ&#x20AC;&#x2122;s activities and financial situation. These principles require the leadership to make informed judgments, best estimates, and assumptions that may affect the reported amounts of assets, liabilities, revenue, and expenses. Actual results may differ from these estimates.

Five affiliate offices and one Swiss foundation are consolidated into these financial statements. Each affiliate office is an independent entity with a distinct Board of Trustees, but agrees to support the work of Medair worldwide. Medair Invest-in-Aid is an independent Swiss foundation that promotes long-term financial development and endowment income for Medair.

These financial statements have been prepared using the historical cost principles. The accrual method of accounting has been used for all grant revenue and expenses incurred in Switzerland and the affiliate offices. The cash basis of accounting is in use at field locations for all local revenue and programme expenses. All amounts are expressed in U.S. dollars. Medair uses the fund accounting method in which all revenues and expenses are assigned to a specific fund. Revenues are recorded as restricted or unrestricted, depending on donor designation. All expenses are considered unrestricted. The net result of current-year activities is allocated to fund balances at the close of the fiscal year. Revenues and expenses from the Swiss accounts, including field office transactions, are presented in U.S. dollars. Current-year revenues and expenses per fund from the affiliated offices and the foundation are converted at average annual exchange rates from local currency. The difference between a calculated fund balance (opening balance, plus revenues, minus expenses) and a converted fund balance at closing exchange rate is taken to the cumulative currency translation line within the appropriate fund section. 58

MEDAIR Consolidated 2010 Annual Financial Statements

Medair e.V. Deutschland Im Technologiepark Martin-Schmeisser-Weg 15 D-44227 Dortmund Germany

Medair United States P.O. Box 4476 Wheaton, Ilinois 60189-4476 United States

Medair France 5, Avenue Georges Abel 26120 Chabeuil France

Medair United Kingdom Unit 3, Taylors Yard 67 Alderbrook Road London SW12 8AD United Kingdom

Stichting Medair Nederland Amsterdamseweg 16 3812 RS Amersfoort The Netherlands

Medair Invest-In-Aid Chemin du Croset 9 CH-1024 Ecublens Switzerland

In addition, these financial statements incorporate the income and expenses for all humanitarian programmes at field locations. While some of these programmes may be in countries where there is a legally registered Medair office, operational control (including the power to govern the operating and financial policies of the programmes) is maintained through the international headquarters in Switzerland.

2.4 Change in presentation In order to facilitate the presentation of the financial statements, Medair has reviewed, reorganised, and updated the notes to the financial statements. 2.5 Treatment of inter-company transactions All inter-company transactions have been eliminated from these financial statements. Inter-company transactions consist of donor grants, restricted and unrestricted donations, accounts receivable, and accounts payable. Humanitarian grants from governmental donors have been signed by Medair U.K. and then transferred to Medair (Switzerland) for implementation. These grants have been removed from the revenue and accounts payable figures of Medair U.K. 2.6 Foreign currency and foreign currency translation Medair (Switzerland) maintains its accounts in U.S. dollars. European national offices record their accounts in local currency. In addition, Medair U.K. maintains a financial ledger in euros to account for donor grant activity from the European Commission. All affiliate office accounts have been converted into U.S. dollars at the average annual rates for the income statement and at the closing rates for the presentation of the balance sheet. 2010

2009

Closing exchange rate

CHF / USD

1.06910

0.96360

Average exchange rate

CHF / USD

0.96170

0.92362

Closing exchange rate

EUR / USD

1.33420

1.43330

Average exchange rate

EUR / USD

1.32760

1.39463

Closing exchange rate

GBP / USD

1.55040

1.59280

Average exchange rate

GBP / USD

1.54620

1.56593

Transactions that occur in local currencies on the field are converted into our base currency using the temporal method, as if they had occurred in U.S. dollars. 2.7 Treatment of exchange gains and losses Medair uses the current rate method of reporting currency translations. Currency translations that arise from bringing affiliate office or the foundation accounts in local currency into U.S. dollar base currency are taken to the balance sheet as either restricted or unrestricted capital. This fund is the cumulative currency translation adjustment. Unrealised gains and losses, including the revaluation of balance sheet items, are reported on the income statement in accordance with RPC 2. All realised exchange gains and losses from operating activities are reported on the income statement. Exchange differences on inter-company transactions have been recorded to the income statement as realised gains and losses to either restricted or unrestricted income, depending on the source at the affiliate office.

2.8 Fixed assets Fixed assets are Medair capital assets in use at the international headquarters in Switzerland or in the performance of its humanitarian activities. All capital assets at field locations are considered restricted. These assets are included in the balance sheet and recorded at cost of acquisition. 2.9 Depreciation Depreciation is calculated on a straight-line basis over the expected useful lives of the capital asset category. Depreciation charges begin in the month after purchase. Office equipment

3 years

Computer equipment

3 years

Software

3 years

Communication equipment

3 years

Energy equipment

3 years

Vehicles

3 years

Leasehold improvements (HQ)

5 years

Furniture & fixtures (HQ)

5 years

The value of capital assets is assessed at closing. If there is an indication of impairment where the remaining value of the capital asset is less than its stated book value, an impairment loss is recognised immediately in the income statement. 2.10 Other current assets Inventory consists of material and supplies located in Switzerland and used in field programmes. Stock is recorded to inventory when purchased and is valued at purchase cost. The FIFO method is applied to expended items. Inventory items are used exclusively for field programmes and are not for commercial resale. Prepaid expenses consist of rent payments in advance on the field, flight payments in advance on the field, occupational pension premiums, insurance premiums against data loss, theft, accidents, and salary in case of illness. 2.11 Financial assets These assets consist of blocked deposit accounts and capital deposits in the Medair Staff Assistance Foundation (MSAF). There is no reported revenue from this foundation. 2.12 Short-term debt Short-term debt is the amount of borrowed cash from the cash-flow loan facility not repaid to the lender. As of year-end, the amount was fully paid off. 2.13 Accrued liabilities This item consists of obligations for statutory, consolidated, and donor audits, plus any trailing 59

field grant expenses for which invoices had not been received by year-end. 2.14 Pension plan obligations Medairâ&#x20AC;&#x2122;s employees in Switzerland are insured against the economic consequences of old age, invalidity, and death, according to the provision of the Federal Law for occupational benefits, old age and survivors (LPP), by Winterthur â&#x20AC;&#x201C; Columna Fondation LPP. According to the defined contribution plan covered by the collective foundation, the employees and the employer pay determined contributions. With this plan, net returns on plan assets do not influence contributions and the final provision is not guaranteed. Risks are supported by the collective foundation. 2.15 Revenue recognition Contract revenue is presented as constructively earned according to the percent of completion method (POCM). The portion of a contract constructively earned is determined by calculating actual contract expense to the total contract budget for each donor contract. It is recognised as revenue in respect of the year when the financial expenses are incurred, in order to comply with the principle of correspondence between expenditure and income. Unearned contract revenue or deferred contract revenue is presented on the balance sheet as a payable to the donor on the closing date of the financial statements, inasmuch as there are contractual provisions that specify the possibility of returning this asset to the donor. There are no material cost overruns on contract budgets at year-end. Private donations are recorded as revenue when received and split into restricted or unrestricted funds according to donor designations. Pledges are not treated as revenue. 2.16 Gifts-in-kind (GIK) GIK are an integral part of Medairâ&#x20AC;&#x2122;s humanitarian programme. As of 2008, no distinction is made between GIK that are provided through donor contracts or non-contractual donations for distribution to beneficiaries of our projects. Medair is fully responsible for the receipt, storage, transportation, accounting, and distribution of these materials. GIK received are recorded as income and expense in our accounts. The contributions are valued on the basis of the donation certificate or the contract with the donor. 2.17 Programme expenditures Expenditures on goods and material related to programmes are recorded when the costs are incurred. As a result, the inventories stated on the 60

MEDAIR Consolidated 2010 Annual Financial Statements

balance sheet do not include goods and materials acquired for the projects but still not used at year-end. 2.18 Restricted funds Restricted funds consist of restricted income funds and restricted programme funds. They are used according to the designation of the donor. In the unlikely event that the Board of Trustees needs to redirect the funds or change the purpose of a restricted fund, the prior approval of affected donors will be sought. Restricted income funds Restricted income funds are solicited from private donors for a specific cause. They are used to augment programme funds in certain humanitarian operations. They may also be used for organisational capacity building, such as training courses, relevant materials, conducting staff workshops, etc. Allocation of these funds to specific programmes is at the discretion of the Executive Leadership Team. Restricted programme funds Programme funds are the current liabilities for unfinished humanitarian programmes at year-end. They consist of unspent local grants and private donations given in support of a specific humanitarian operation. A restricted programme fund is maintained for each country in which Medair operates. Africa fund

Restricted to programme activity in Africa. This fund receives an annual block grant from the Swiss government, and is reallocated to country-restricted programme funds.

Emergency response

Facilitates immediate intervention in the event of a new or developing humanitarian emergency.

Forgotten victims

Restricted to programmes that work with vulnerable or displaced persons.

Medical fund

Restricted to programmes with medical or health-promotion activities.

Oak fund

Restricted to capacity improvements at the headquarters.

Medair Germany fund

Restricted to field programmes.

Water fund

Restricted to programmes related directly to water and sanitation activities.

Staff care capital fund

The interest earned from this fund will be allocated to the staff care and development fund. This is a Medair InvestIn-Aid fund.

Staff care development fund

This fund facilitates individual Medair staff care for special needs and training. This is a Medair Invest-In-Aid fund.

Capacity management fund

This fund facilitates the running of the Medair Invest-In-Aid foundation.

Anniversary fund

Restricted to expenses for the 20th anniversary of Medair in 2009.

Private activity

Funds raised by expatriate staff members for special projects.

2.19 Unrestricted funds These funds are the general reserves of Medair. They consist of unrestricted capital and allocated funds that facilitate operational management. Use of these funds is at the discretion of the Executive Leadership Team. Unrestricted capital Undesignated funds

Cumulative currency Allocated capital Administrative fund

Private donations that are not designated to a specific programme or cause by the donor. The accumulated effect of unrealised currency translations. Used for the general administrative costs of the organisation.

Capital equipment fund

Used for the purchase of Medair-owned assets. See Note 16.

Operations fund

Used to support the cash-flow requirements of field programmes.

Training fund

For the professional development of Medair personnel.

2.20 Related parties Medair Staff Assistance Foundation (MSAF) is an independent Swiss foundation that assists expatriate staff with medical expenses, health insurance, and repatriation on behalf of Medair. The financial accounts of this foundation are not included in these consolidated accounts, as the net impact on the financial statements is immaterial. Copies of the 2010 Swiss statutory annual report and the 2010 consolidated annual report are available upon written request to the Medair headquarters at Chemin du Croset 9, 1024 Ecublens, Switzerland.

3. Tax exemption Medair is exempt from Swiss income tax and capital tax according to a decision from the Department of Finance, Canton of Vaud, dated 19 March 1992.

4. Management of financial risks Risks are periodically analysed on an organisation-wide basis by the Executive Leadership Team, which gives rise to a report that is submitted to the Board of Trustees audit and compliance committee. In terms of the financial risks, attention should be addressed to the following items: 4.1 Foreign exchange risk Medair is exposed to exchange-rate fluctuations, insofar as a significant portion of its income and expenses are in foreign currency or non-USD. Medair has no active foreign exchange risk hedging policy and tends to convert currencies as and when they are required. The reserves are kept mainly in USD, euros, and Swiss francs. 4.2 Banking risk Medair tends to avoid concentrating this risk, by working with both a bank in Switzerland and Post

Finance. In the field, Medair works with approximately 25 international and local banks; the policy on the field is to limit the volume of bank deposits to the level strictly required for immediate operational needs. 4.3 Counterparty risk The counterparty risk is limited, insofar as governments or governmental agencies issue most of the receivables for amounts owed by third parties. Other asset positions concern the related parties of the Medair group of organisations and are not significant. 4.4 Liquidity risk Medairâ&#x20AC;&#x2122;s policy is to ensure a sufficient level of liquidity for its operations at all times; consequently funds are kept in liquid form. In order to further mitigate this risk in the short-term, Medair contracted a cash-flow loan facility in 2008. The available loan facility is currently CHF 3,000,000. The interest rate on this loan is 3% per annum. There is no maturity date on the loan. Medair also has a second cash-flow loan facility with a second creditor. The amount available on this second facility is CHF 1,000,000. The interest rate is 4.25%.

5. Detail on balance sheet accounts 5.1 Cash and cash equivalents Cash accounts consist primarily of currency accounts in field locations. Bank accounts include accounts at field locations, headquarters, and the affiliate offices. USD

2010

2009

Field

3,113,106

1,847,026

3,870,918

2,266,716

825,650

1,150,446

7,809,674

5,264,188

HQ Affiliates TOTAL

5.2 Receivables Receivables consist of donor grants, general receivables, and Medair debtors. Donor receivables are recorded when grant contracts are signed. It is reasonable to expect that Medair will conform to the stipulations of the grant contracts, after which collection is reasonably assured. Medair debtors consist of staff receivables and the Medair Staff Assistance Foundation (MSAF). Receivables (USD)

2010

2009

Governmental donors

15,016,791

9,618,895

NGO & institutional donors

3,139,374

1,181,726

United Nations organisations Donor receivables General debtors Medair debtors General receivables Total

2,315,583

692,616

20,471,748

11,493,237

85,900

32,181

5,172

52,860

91,072

85,041

20,562,820

11,578,279

5.3 Fixed assets 2010 USD

Asset Group

Total

Opening book value

Computer Comms

Power

Other

Pumps

Facility

Vehicles

Total

55,720

569,753

30,040

32,081

30,391

8,562

150,261

422,970

1,299,779

260,225

446,412

706,716

Currency translation

121,570

904,297

-300,971

63,103

35,332

23,709

254,657

1,294,672

2,396,368

Opening balance 1.1.10

121,649

1,164,522

145,441

63,103

35,332

23,709

254,657

1,294,672

3,103,083

Reclass

Closing balance 31.12.09

Assets Acc Depreciation

-73,830

-31,399

96,059

-6,000

15,170

2010 Additions

137,174

25,482

6,248

2,156

501,127

672,188

2010 Disposals

-3,485

-43,177

-23,869

-1,909

-28,226

-100,666

Closing balance 31.12.10

44,333

1,227,120

243,113

63,103

35,580

25,866

267,918

1,767,573

3,674,605

Closing balance 31.12.09

6,292

342,391

348,685

Currency translation

-65,929

-601,061

-457,792

-31,021

-4,941

-15,148

-104,396

-871,701

-2,151,989

Opening balance 1.1.10

-65,929

-594,769

-115,401

-31,021

-4,941

-15,148

-104,396

-871,701

1,803,305

2010 Disposals

52,409

19,953

-26,734

1,400

9,748

28,227

85,003

2010 Depreciation

-21,915

-192,333

-51,874

-18,132

-9,532

-8,023

-48,778

-303,056

-653,641

Closing balance 31.12.10

-35,434

-767,148

-194,009

-49,154

-13,073

-23,170

-143,426

-1,146,531

-2,371,946

49,104

13,949

22,496

2,695

124,492

621,042

1,302,374

Pumps

Facility

Vehicles

Reclass

Currency translation

Total

Office

Closing book value

-24

-250

8,874

459,722

-11

-286

2009 USD

Asset Group

Total

Opening book value

73,507

693,456

53,023

37,865

6,242

16,465

199,879

497,063

1,577,501

Closing balance 31.12.09

154,125

1,379,995

121,308

55,075

25,847

23,709

254,657

1,040,739

3,055,455

-2,012

-7,553

-609

-10,173

152,113

1,372,443

121,308

55,075

25,239

23,709

254,657

1,040,739

3,045,281

2010 Additions

5,451

89,864

50,564

13,914

26,315

260,225

446,412

2010 Disposals

-26,430

-5,886

-16,383

-79

-6,292

-390,506

Currency translation

Assets

Opening balance 1.1.10 Reclass

Acc Depreciation 62

Computer Comms

Power

Other

Total

-36,413

-299,023

Closing balance 31.12.10

121,151

1,163,284

145,441

63,103

35,171

23,709

254,657

1,294,672

3,101,187

Closing balance 31.12.09

-79,591

-683,106

-68,285

-17,209

-19,322

-7,244

-54,778

-543,675

-1,473,210

986

4,120

325

5,431

-78,606

-678,986

-68,285

-17,209

-18,997

-7,244

-54,778

-543,675

-1,467,781

2010 Disposals

35,987

269,350

10,246

4,133

16,383

6,292

342,391

2010 Depreciation

-23,016

-184,614

-57,362

-17,945

-2,227

-7,903

-49,618

-334,318

-677,001

Closing balance 31.12.10

-65,635

-594,251

-115,401

-31,021

-4,841

-15,148

-104,396

-871,701

-1,802,394

203

719

55,720

569,752

Currency translation Opening balance 1.1.10 Reclass

Currency translation

Total

Office

Closing book value

61 30,040

MEDAIR Consolidated 2010 Annual Financial Statements

32,081

30,391

983 8,562

150,261

422,971

1,299,777

5.4 Deferred revenue on donor contracts The following table presents the deferral amount for each country programme. At year-end 2010, total donor receivables were USD 20,471,748 with a deferred revenue amount of USD 19,445,919. Deferred revenue is presented on the balance sheet as a payable to the donor. USD

5.6 Provisions In 2010, Medair has booked a provisional expense of EUR 135,120 for the audit of our field programmes related to the years 2006, 2007, and 2008. USD Opening balance

2010

2009

193,664

65,376

2010

2009

Additions

193,664

Afghanistan

-729,808

-778,059

Utilisations

65,376

Angola

-148,422

D.R. Congo

-2,818,319

Haiti

-2,080,314

Dissolutions -345,528

Indonesia

-91,372

Madagascar

-594,701

-423,015

Somalia

-1,278,625

-61,331

Sudan, Northern States

-7,529,825

-2,911,163

Sudan, Southern Sudan

-3,275,304

-2,216,432

-4,846

-189,726

Uganda Zimbabwe

-731,025

Oak Foundation

-204,730

Proctor & Gamble TOTAL

-745,292

-50,000

-19,445,919

-7,811,918

5.5 Accounts payable and current portion long-term debt Accounts payable consist of vendor payables, statutory payables, and Medair staff payables. Payables of USD 63,499 to the Medair Staff Assistance Foundation (MSAF) and USD 30,108 to Medair staff are included in the total. The long-term loan was fully paid off in 2010.

Economic benefit / economic obligation and pension benefit expenses in CHF Pension institutions without surplus/deficit

Surplus / deficit

Economic part of the organisation

31.12.10

31.12.09

Closing balance

13,385 180,279

193,664

5.7 Long-term liabilities These liabilities consist of severance benefits for national staff in our field programmes and a loan from Microsoft Financing for the purchase of new software. The loan was fully paid in 2010. 5.8 Pension plan obligations The annual contributions to the pension plan are recorded to the income statement during the period to which they relate. Expatriate field staff do not benefit from the pension plan, although Swiss expatriates who have retained their Swiss domicile are insured by Winterthur â&#x20AC;&#x201C; Columna Fondation LPP. In 2010 and 2009, two Swiss expatriates were covered by the plan. The employees of each affiliate European office benefit from the pension plan related to a state insurance company. Medair does not maintain an independent pension plan for the affiliate offices.

Change to prior year period or recognised in the current result of the period respectively

Contributions concerning the business period

405,136

Pension benefits expenses within personal expenses 2010

2009

405,136

331,568

Photoâ&#x20AC;&#x160;: C hildren collect unsafe water from a man-made reservoir also used by animals in Zimbabwe.

6. Detail of funds 6.1 Movement between funds 2010 USD Receiving fund

SOURCE FUND Africa fund

Oak fund

FV fund

Staff care Staff sup Capacity Medical mgmt Haiti fund MDE fund & dev & dev fund fund fund fund

Forgotten victims fund

129

24,043 17,479

500,000

454

8,419

16,167

1,088

Haiti

903,766

945,832

416,557

918,100

32,202

500,000

329,294

Somalia

644

1,700

506,464

508,165

347,613

802,942

Sudan Southern Sudan

450,498

4,830

Uganda

150,000

644

Zimbabwe

110,000

Capital equipment fund

321,581

472,225

172,027

282,027

202,435

Undesignated funds

294,888

Administrative fund

540,562 1,710,498

540,562

454

24,043

26,727

24,043

74,760

26,727

24,043

74,760

2009 USD Receiving fund

D.R. Congo

Africa fund

Oak fund

Anniv fund

MDE fund

53,737

Indonesia Madagascar

4,621,500 58,718

8,419

Medical fund

15,387 5,302,978

16,167 7,821,238 294,888

15,387

Water fund

274,035

434,717

726,255

6,167

10,000

5,000

883,516

79,388

1,037,808

10,000

121,980

132,078

10,000

Sudan - Northern States

130

15,139

1,146

10,084

15,109

516,610

1,749

15,000

8,000

Uganda

562,044

651

10,000

Zimbabwe Capital equipment fund 254,708

8,188

1,982

254,708

8,188

14,426

80,223

448,340 49,076

64,345

532,351

558,690 541,359 572,695

10,000

MEDAIR Consolidated 2010 Annual Financial Statements

TOTAL

5,000

Sudan - Southern Sudan

1,570,731

Operations fund

10,000

438,340

Administrative fund

Undesignated funds

2,503

Somalia

294,888

SOURCE FUND

Afghanistan

TOTAL

829,294

644

Sudan Northern States

TOTAL

24,043

Afghanistan

Madagascar

UndesigOperaLaunch nated tions fund fund funds

129

Staff support & development fund

DR Congo

Water fund

53,109

111,274

121,274

249,860

2,251,784

930,571

4,473,876

1,444,676

3,447,233

7. Detail of income

a. Revenue Medair segments its operations geographically by country. The following table presents comparative revenue figures by country. USD

2010

2009

3,944,622

3,766,311

Angola

-555

-8,114

D.R. Congo

3,779,761

3,971,023

Haiti

7,951,538

Indonesia

104,584

Madagascar

1,535,535

1,543,543

3,230,656

3,075,240

Sudan, Northern States

8,653,440

5,921,101

Sudan, Southern Sudan

8,619,091

6,903,107

Uganda

661,517

3,215,358

Zimbabwe

921,647

127,240

Total

8.1 Humanitarian expense Humanitarian expense is the total cost of providing goods and services to Medairâ&#x20AC;&#x2122;s beneficiaries. It includes the costs of implementing these humanitarian programmes, such as project staff, food and living costs, communication and energy equipment, vehicles, transportation and storage of materials, and logistical and financial expenses. It also includes the research, preparation, planning, selection, follow-up, and control of these humanitarian programmes provided by headquarters in Ecublens, Switzerland.

622,630

Somalia

Switzerland/Affiliates

8. Detail of expenditures

Total Revenue

Afghanistan

2,678,543

2,406,343

42,080,378

31,543,782

Programme expense is the total humanitarian cost plus a contribution toward indirect cost. The budget of each humanitarian programme includes a 15% contribution to support the administrative costs of Medair. This cost is not reported with humanitarian expense, but is included in the term programme expense in the Statement of Changes in Capital.

b. Gifts-in-kind (GIK) GIK are an integral part of Medairâ&#x20AC;&#x2122;s humanitarian programme. The total breakdown of GIK activity is presented below. USD

2010

Afghanistan

55,944

2009

D.R. Congo

c. Other income Other income consists of sales income, training fees for our Relief and Rehabilitation Orientation Course (ROC), beneficiary participation in field programmes, and miscellaneous income.

65,274 827,512

Madagascar

88,944

Somalia

1,137,431

976,461

Sudan, Northern States

292,361

267,713

Sudan, Southern Sudan

422,884

458,397

1,997,565

2,650,082

Uganda

54,724

Total

2010 USD

Sectors

Personnel

Afghanistan

1,214,973

D.R. Congo Haiti

The following tables present only the humanitarian expenses by country: Support expenses

1,172,058

227,349

314,549

70,711

80,467

138,800

3,218,908

261,571

3,480,479

1,279,327

1,052,782

164,858

276,415

97,584

32,845

214,960

3,118,771

253,434

3,372,205

3,978,593

858,639

265,815

321,833

49,450

5,468

407,686

5,887,484

478,422

6,365,906

91,062

35,086

5,371

4,902

2,472

2,494

141,387

11,489

152,877

479,559

479,805

57,701

103,168

31,994

2,586

80,168

1,234,981

100,356

1,335,336

Somalia

1,505,703

700,414

109,049

124,026

8,735

4,689

353,461

2,806,077

228,024

3,034,101

Sudan, Northern States

2,692,022 2,605,166

666,098

571,147

204,423

108,024

407,172

7,254,051

589,470

7,843,522

Sudan, Southern

2,709,929 2,523,859

743,293

719,459

236,158

163,407

360,019

7,456,124

605,891

8,062,015

Madagascar

Uganda Zimbabwe Total

Depreciation

Other expense

Admin

Indonesia

Maintenance

Fundraising

Travel

Total

38,512

281,090

-31,553

45,526

10,939

21,895

28,988

395,397

32,130

427,528

328,130

232,529

53,704

49,665

5,043

16,570

77,678

763,319

62,028

825,347

9,941,427 2,261,687 2,530,691

717,508

14,317,809

435,951 2,071,426 32,276,499 2,622,816 34,899,316

2009 USD

Sectors

Afghanistan

Personnel

1,731,813

D.R. Congo Indonesia

Admin

Support Expenses

Total

973,304

200,613

273,704

90,930

55,498

147,819 3,473,680

280,680

3,754,360

168,152

257,298

91,510

6,674

213,944 3,736,922

301,950

4,038,873

40,697

17,655

1,689

4,496

42,016

562,010

190,739

25,585

519,993

719,351

513,745

66,797

98,585

37,728

1,700

101,081 1,538,986

124,353

1,663,339

Somalia

1,407,816

716,499

95,866

168,541

6,257

4,292

377,065

2,776,335

224,333

3,000,668

Sudan, Northern States

1,844,858 2,085,489

579,327

616,070

125,032

106,172

253,212

5,610,160

453,312

6,063,471

Sudan, Southern

1,844,634 2,340,633

812,450

570,886

185,252

154,233

406,297 6,314,384

510,214

6,824,598

Uganda

1,107,200

1,075,767

204,264

197,023

98,519

118,711

136,393 2,937,877

237,386

3,175,263

33,654

31,280

4,523

589

8,592

114,926

10,815,251 9,008,725 2,199,446 2,204,284

636,917

452,365

Zimbabwe TOTAL

8.2 Administrative expense Administrative expense includes the cost of the Medair headquarters in Ecublens, Switzerland, plus the administrative costs of each of the affiliate offices and the Invest-in-Aid foundation. These costs consist of general management costs, including human resources, operations and logistics, finance, as well as marketing and fundraising costs.

36,290

1,697,685 27,014,673 2,182,837 29,197,509

Humanitarian USD

Sectors

Direct

Support

Total revenue

598,657

271,826

1,610,738

578,908

8.4 Insurance Medair (Switzerland) maintains fire insurance on furniture and equipment in the amount of CHF 957,935 for the years 2009 and 2010. 8.5 Operating expenses These expense categories are presented for information only. They present a functional breakdown of operating expenses rather than the activity-based presentation of the financial accounts. 2009

Administration General management Fundraising 1,613,323

2009

Total cost

14,317,809 2,246,676

2010

Number of campaigns

2010

Operating expenses

106,334

USD

8.3 Cost of fund appeals Medair (Switzerland) ran 11 fundraising campaigns during 2010, the results of which are presented below. Results are based on revenue received within 90 days after reception instead of 60 days as in prior years. The results of fundraising campaigns in our European affiliate offices were not similarly tracked and therefore cannot be presented.

Direct

14,317,809

10,815,251

14,563,143

9,008,725

1,909,936

Humanitarian

Administration General Management Fundraising

Support

Total operating expense 10,815,251

9,941,427

Travel & representation

2,261,687

187,519

111,062

61,530

2,621,798

2,199,446

130,952

71,296

45,509

2,447,203

Admin

2,530,691

131,509

559,524

53,526

3,275,250 2,204,284

129,955

635,915

51,245

3,021,399

813,593

636,917

91,285

728,202

653,400

452,365

224,635

677,000

20,582

2,294,855

1,697,685

1,305,199

Maintenance

717,508

96,085

Depreciation

435,951

217,450

2,071,426

57,112

145,734

Fundraising direct Total

32,276,500

2,622,816

2,743,179

761,716

Total operating expense

Personnel

Other

2,202,548 39,845,042 27,014,673

8.6 Realised gain or loss on exchange This is the net result of realised gains and losses, which is recorded to the income statement.

9. Volunteer network Medair is assisted in its administrative activities in Switzerland by a network of volunteers. These people help with administrative tasks in the office, at promotional events, and in the conduct of ROC training courses. In 2010, our volunteers contributed a recorded 8,317 hours or approximately 1,040 daysâ&#x20AC;&#x2122; worth of time to Medair. 66

Other expense

Maintenance Depreciation

1,920,448 1,078,897 239,132

Madagascar

Travel

MEDAIR Consolidated 2010 Annual Financial Statements

11,994 2,182,837

1,238,148

130,178 2,391,458

771,244 12,928,053

37,964

1,877,821

1,071,932

1,977,895 33,566,860

10. Remuneration of the Boards of Trustees Members of the Board of Trustees of Medair (Switzerland) and the respective boards of each European affiliate office volunteered their time in 2010, receiving neither salary nor indemnity. Board members are allowed to submit travel expenses for reimbursement.

11. Post closure Apart from the short-term credit limit being increased by USD 1 million, there have been no significant events post-closure that impact these financial statements for the year 2010.

School hygiene committee members stand in front of the Tely School’s new latrines in Isiro, D.R. Congo.

Editor-in-chief: Jim Ingram, CEO Managing editors: Lynn Denton, Mark Wallace Copywriter: Mark Wallace Image editor: Lynn Denton Contributors: Medair staff around the world Graphic design: Brain4You, Belgium Printing: Drukwerk Consultant, the Netherlands Photo credits: Images were taken by Medair staff, with the exception of pages 9, 22, 48 (Odile Meylan), pages 17, 29, 33 (Colin O’Connor), and page 40 (Fridisoa Rasambainarivo). Names of people and places in articles were sometimes changed when deemed appropriate to protect the identity of beneficiaries and staff. Medair institutional donors ≥ USD 15,000 listed only, due to space constraints. © Medair, 2011 The information contained herein may be reproduced with the prior, written approval of Medair. Medair requires a copy of the publication in question. An electronic version of Medair’s 2010 annual review (available in English and French) is available for downloading at www.medair.org. Disclaimer: The presentation of maps in the review does not imply on the part of Medair the expression of any opinion whatsoever concerning the legal status of any country or territory, or its authorities, or the delimitation of its borders. This document was produced with resources gathered by Medair field and headquarters staff. The views expressed herein are those solely of Medair and should not be taken, in any way, to reflect the official opinion of any other organisation. Detailed and up-to-date information on Medair’s programmes can be found at www.medair.org. Information can also be requested in writing to the Ecublens headquarters. Please contact Medair using the contact information on the back cover of this report.

Medair base staff, like cooks Susan and Rose in Juba, Southern Sudan, keep the wheels turning smoothly in Medair's field offices.

Medair International HQ Chemin du Croset 9 CH-1024 Ecublens Switzerland Tel: +41 (0) 21 695 35 35 Swiss French office, Ecublens Tel: +41 (0) 21 695 35 00 suisse@medair.org

Medair France 5 avenue Abel 26120 Chabeuil France Tel: +33 (0) 475 59 88 28 france@medair.org

Medair Germany Im Technologiepark Martin-Schmeisser-Weg 15 D-44227 Dortmund Germany Tel: +49 (0) 231 15050566 deutschland@medair.org

Medair Netherlands Amsterdamseweg 16 3812 RS Amersfoort The Netherlands Tel: +31 (0) 87 874 11 10 nederland@medair.org

Medair U.K. Unit 3, Taylors Yard 67 Alderbrook Road London, SW12 8AD, U.K. Tel: +44 (0) 20 8772 0100 united.kingdom@medair.org

Medair U.S. P.O. Box 4476 Wheaton, IL 60189 United States of America Toll Free +1 (866) 599 1795 united.states@medair.org

Charity registered in England & Wales no. 1056731 Limited Company registered in England & Wales no. 3213889

Photos,â&#x20AC;&#x2030; front cover: A young child collects water from an unsafe water source in Kohistan district, Afghanistan. back cover: Medair nurse Liselotte Eberhardt treats a patient in Upper Nile, Southern Sudan.

www.medair.org Published in July, 2011 Medair brings life-saving relief and rehabilitation in disasters, conflict areas, and other crises by working alongside the most vulnerable.

ARV10

Swiss German office, Bern Hirschengraben 2 3011 Bern Tel: +41 (0) 31 534 58 41 schweiz@medair.org