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2009 DOCTORS OF THE WORLD ANNUAL REPORT

DOCTORS OF THE WORLD ANNUAL REPORT 2009


CONTENTS // 03 Our work

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// 10 2009: key figures

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// 14 International programmes

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16 Scope of programmes

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22 Africa

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32 Latin America

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42 Asia

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52 Eastern Europe

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60 Near and Middle East

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69 Future programmes

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// 70 International network

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// 94 Cross-cutting projects

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// 104 Programmes in France

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// 122 Action and advocacy

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// 135 Regional delegations

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// 151 Our organisation

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// 162 Glossary

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// 166 Acknowledgements

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DOCTORS OF THE WORLD ANNUAL REPORT 2009

OUR WORK EDGAR MORIN

“This century is shaped by the decline of solidarity at an individual level and a reliance on organisations.”

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Mayotte Š Jobard/MdM/Sipa


DOCTORS OF THE WORLD ANNUAL REPORT 2009

OUR WORK Doctors of the World France has reached its thirtieth year. It has not only matured, but is confident in its achievements and strength of purpose. Always mindful of the reality we see on the ground, we have been able to adjust our course accordingly, and build an independent organisation. It is from this perspective, after my first year as president, but fully aware of our rich history, that we can make a first assessment of 2009.

© DR / AFP

IN FRANCE AND IN EUROPE, CONFRONT AND INNOVATE

» Dr OLIVIER BERNARD PRESIDENT, DOCTORS OF THE WORLD FRANCE

• Tougher policing in relation to the vulnerable groups Doctors of the World/Médecins du Monde (MdM) supports against a backdrop of economic crisis that hits the poorest and most excluded hardest. In spite of a number of plans, housing provision for those most in need has still not been addressed in any concrete fashion. On a daily basis, our teams see the lack of suitable housing for people supported by our programmes.

pricing, drugs being removed from the approved reimbursement list and the introduction of medical franchise payments. There has been no notable improvement in access to care for the vulnerable people we support. As for the structures set up as a consequence of the law passed in 1999 — namely, universal health insurance (CMU), State medical aid (AME) and healthcare access offices (PASS) — with the exception of improvements in provision of home care thanks largely to our lobbying work, we have seen a net deterioration.

• Profound changes in the provision of care. Although there have certainly been some improvements, such as greater representation of local-level government in the managment of services, there is increasing emphasis on financial considerations, with a new system of hospital

• A new security policy targeting organisations working with vulnerable people has been put into place: MdM, having protected a group of Roma people camped out on the Quai SaintOuen on the outskirts of Paris, was taken to court in June 2009 for illegally

The year has been shaped by a number of developments:


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occupying state-owned land. Later acquitted, MdM was recognised by the courts for its humanitarian stance. DOCTORS OF THE WORLD HAS BEEN ABLE TO ADAPT TO THESE CHANGING NEEDS Firstly through resistance. We chose to: • continue to offer care through our healthcare and advice clinics (CASOs) in 22 French towns and to collect data about the barriers faced by our service users in accessing care; • maintain our outreach work, which allows us to offer care and document the difficulties faced in accessing care by those most excluded (homeless people, Roma communities, sex workers); • denounce the appalling treatment suffered by the Roma community, and the repressive government policies aimed at migrants in Calais, Paris and Mayotte; • join the Delinquants Solidaires group to show our ability and determination to reject the authorities’ approach of mixing up organised trafficking and humanitarian duty. Next, through innovation. Our programmes targeting sex workers have been altered to address worrying changes introduced under the Internal Security Law. Examples include our mobile Funambus project in Nantes and the Lotus Bus in Paris. To respond to the situation faced by psychotic patients living on the streets,

and the infernal cycle of prison-streetshospital, we have set up new projects focusing on mental health in Marseille, Strasbourg and Paris.

DYNAMIC INTERNATIONAL PROGRAMMES

OUR INDEPENDENCE MUST BE CLEAR Confusion persists in the field over how so called “humanitarian workers”, working side by side with, or amongst, NGOs are perceived. These may include military personnel involved in crisis management or private security firms tasked with reconstruction, as in Iraq or Afghanistan. It also includes, of course, In French Guiana, the introduction of governments themselves, who send aid rapid tests has become a necessity due directly to the field or send civilian personto the high prevalence of HIV, particularly nel to areas hit by crisis, and who are sometimes the main, or even only, NGO amongst the migrant community. funders. In Mayotte, access to care for migrant children from the Comoros was almost Whilst these groups may not always impossible; we set up a programme to be acting from a humanitarian improve access to care and to advocate perspective, they are often confused with those who do. For our teams in for this vulnerable group. conflict zones, the work is becoming Moreover, MdM continues to create increasingly complex and it is difficult to links between healthcare professionals, reach those in need. academics and humanitarian workers through the development of university Our independence from governments qualifications dedicated to the study of and political, economic or military agendas is crucial and should be reinforced to health and poverty. ensure that we are able to continue our Finally, we should highlight the work in places such as Afghanistan, Iraq, achievements of the hospital buddying Colombia, Sudan/Darfur and Somalia. It is scheme and its Head of Programme who also important in Pakistan, where civilians recognised very early on the need to sup- suffer most from the regular clashes betport children who were alone in hospital. ween government and insurgents that have led to mass displacement of an estimated two million people.

To address the HIV and hepatitis C epidemics we continue to work on innovative new initiatives, in relation to testing for the most vulnerable and reducing risks for drug users. With a focus on prevention, we have set up a scheme to educate people on the risks associated with injecting.

SOLIDARITY AS A CRIME “If acts of solidarity become a crime, we want to be prosecuted for them” is the slogan of the Délinquants Solidaire group, to which MdM belongs. This collective was set up in response to the increased pressure from police on volunteers, social workers and the deposition of the penal code L. 622-1 pertaining to conditions of entry and residency for foreigners and the right to asylum.

ROMA Doctors of the World won the court case against Seine-SaintDenis council in July 2009. The Bobigny court rejected the complaint filed against MdM. As a result the courts did not uphold the government's demand that the emergency camp set up in Saint Denis by MdM for homeless Roma families be evacuated. Thus, there was a legal recognition of the humanitarian emergency facing Roma families in the Ile-de-France region, highlighted at every opportunity by MdM.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

GAZA Operation Cast Lead, carried out by the Israeli army between 27 December 2008 and 18 January 2009, in the Gaza strip has had serious repercussions for the health system: 16 health professionals were among the 1,380 victims; 185 hospitals, 41 health centres and 29 ambulances were damaged. This conflict led to a deterioration in a humanitarian situation which was already worrying in light of the blockade imposed on the population of Gaza, the most densely populated area in the world.

DARFUR Following the arrest warrant issued by the International Criminal Court against the Sudanese president Omar Al-Bashir for war crimes and crimes against humanity in Darfur, the Sudanese authorities decided to expel about 10 NGOs. Although MdM was not targeted in this way, we remain very worried about the impact of this largescale withdrawal of humanitarian aid on the people of Darfur, who still have enormous health needs. An estimated 2.7 million people remain highly dependent on humanitarian aid.

community-led projects working on disaster risk reduction to lessen the impact on health of recurrent natural disasters. But we will also take inspiration from the example of our work on the effects of lead poisoning on children in France.

In other words, whilst dialogue remains open with representatives of the state, funders and the United Nations, we refuse to become subordinate to their respective agendas, which are often far removed from the needs of the people.

children in the most vulnerable countries. In addition, we are advocating for cheaper access to care for pregnant women and children under five.

On 12 January 2010 Haiti was hit by a violent earthquake, killing 200,000 people, leading to the displacement of 500,000 people, and leaving 1.1 million people without a home.

The way in which our European societies treat the question of migration at the start of the 21st century will be seen, as we look back through history, as a tragedy. How can one understand silence when young Afghans who came to find refuge in Europe are sent back to their war torn country and who, having faced repressive migration policies, now face desAs for AIDS, the epidemic is not over. titution and are forced to survive on the Whilst real advances have been made in beaches or public squares of Paris or the fight against this pandemic, the risk of other French towns? transmission amongst the most vulnerable — namely, migrants, sex workers and As frontline humanitarian workers caring people who use drugs (Afghanistan, China) for the most vulnerable, most marginali— must be fought with both prevention and sed, and those without rights here in care. This means access to rapid testing, Europe, and also providing care in the treatment (free access to antiretrovirals), countries where many of them come from, and support for our partner healthcare pro- we see day after day how precarious their viders. MdM is committed to decentralising health is. Providing more support through access to antiretroviral care, through provi- both physical and mental health services ding medicines to rural clinics, in order to for this population, working in partnership reach those most in need in Zimbabwe, with key organisations in developing Tanzania and Burma. We will continue to countries and working to document this frightening inhumanity will continue to be roll out this care model. one of our key priorities in the years to Health and the environment are ever come. more pressing concerns for the future. The failure of the Copenhagen Summit has done little to provide reassurance. Already in Madagascar, and perhaps tomorrow in other areas, we have set up

MdM, like many other NGOs, swung quickly into action, bringing in equipment, medical materials (more than 30 tons) and essential medicines that allowed us to provide surgical and medical aid and to offer psychological support. All this was made possible thanks to our presence in Haiti for the last 15 years, in Port-au-Prince and in the Grand’ Anse region, and our local partnerships. This strong community focus and our links with local partners enabled us to work quickly and efficiently to help those affected, in coordination with local authorities and other NGOs. We will continue our work to help rebuild the healthcare system for many years to come. KEY AREAS OF WORK The health of mothers and children is of fundamental importance. We are supporting healthcare systems to improve the delivery of care to both mothers and

We will continue our work to fight gender-based violence and discrimination, and the medical and social consequences it entails, as we are currently doing in DRC. This work is aimed both at war torn countries and at improving access to appropriate services for women living in shantytowns and in poverty across Latin America, Asia and Africa.

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MdM remains a key player in international adoption, whilst continually reevaluating its position in the face of evolving contexts, for example in Haiti and Vietnam.

DEVELOPING MORE BALANCED AND LONGERLASTING PARTNERSHIPS Whilst of course NGOs are not completely neutral, we believe the strength of an international NGO, such as MdM, probably lies in the impartiality of our analyses of needs and responses to those needs as we understand them. Without under-estimating the importance of international or national agendas, our work is fundamentally about caring for the most vulnerable. To do this, we must continue to develop networks and to work in partnership, locally and on a regional level, to roll out an approach more firmly anchored in local cultural practices. Partnerships at home and abroad with service user representatives and local NGOs will ensure that our humanitarian action is more balanced and leads to a healthy interdependence, necessary in this complex and globalised world.

OUR OPERATIONS After 25 years at the heart of our organisation, including 17 as General Director of Humanitarian Operations, Dr. Michel Brugière left MdM for a retire-

ment that we hope will be very happy and militant. This is our opportunity to thank him once again for the way in which he has guided and supported us during this time. His successor will need to help us to face profound changes in the future, relating to the role and context of humanitarian action, whilst not forgetting MdM’s volunteer-led and campaigning nature. Today, Doctors of the World in France is a network of 15 regional delegations. This allows us to work as closely as we can to those we help. This year, as in previous years, we have continued our support of these offices. This policy of working together more closely grew from our need to address regional health policies, but also to ensure better consistency in our work responding to local needs. Conscious of the influence Brussels exerts on access to care for migrants in Europe, we are working towards Europe-wide actions — care and advocacy — through the MdM international network. This is illustrated perfectly by the publication of the second European Observatory Report on Access to Healthcare and of the HUMA report on legislation relating to access to care for undocumented migrants and asylum seekers in 10 European Union countries. This is yet another clear example of the relevance of our international expansion and the need for MdM to support the development of its international network members in order to increase its operational capacity and coherence when speaking out.

2010 will be the 30th anniversary of Doctors of the World France. It is time to take stock of our past and reflect on the development of an organisation that — thanks to all those involved as volunteers, employees, members or donors — has remained radical. It is also an excellent time to take the opportunity to express our vision for the future, at home and abroad, with clarity and conviction.

HUMA REPORT This investigation into legislation in Europe confirms that the right to health is not guaranteed in the EU. Undocumented migrants did not benefit from “the highest attainable standard of physical and mental health”, as required by international texts on the protection of human rights, in any of the countries included in the survey.


Pakistan © Lâm Duc Hiên


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2009: KEY FIGURES INTERNATIONAL NETWORK

HUMAN RESOURCES*

152

284

210 14

international programmes in 64 countries

MDM FRANCE RESOURCES

employees

EXPENDITURE

national projects in 14 countries

BREAKDOWN members of the network

Argentina Belgium Canada France Germany Greece Italy Japan Netherlands Portugal Spain Sweden Switzerland United Kingdom

179 37 12 56

headquarters employees employees in the field employees in the regional offices

76.64% social programmes 16.73% fundraising 6.63% overheads

employees on programmes in France

INCOME

219 134 367 1,315

expatriate departures for the field expatriate volunteers** field visits for needs assessments and technical support local staff on the programmes

* Staff numbers are expressed as Full-Time Equivalents (FTE) ** Number of expatriate volunteers in the field on 31 December 2009

58.64% public generosity 34.98% institutional grants 4.72% private grants and other private funds 1.66% other


people who have benefited from one or more services provided by MdM

social consultations

680,000

programmes in 29 towns

medical consultations carried out

17,979 104

8,609 people on antiretrovirals 75 programmes 47 countries

Africa Latin America Asia and Central Asia Eastern Europe Near and Middle East Cross-cutting projects

dental consultations

4,806

Near and Middle East

1,370,000 beneficiaries

34 11 16 5 9

Near and Middle East

medical consultations

35,535

Eastern Europe

people who could access services provided by MdM

GEOGRAPHICAL BREAKDOWN OF PROGRAMMES

Eastern Europe

service users attending 21 Healthcare and Advice Clinics

Asia and Cental Asia

11,600,000 target population

Asia and Central Asia

volunteers

Latin America

1,966 25,863

Africa

INTERNATIONAL PROGRAMMES

Africa

IN FRANCE

Latin America

MDM FRANCE BUDGET € 57.3M

GEOGRAPHICAL BREAKDOWN OF INTERNATIONAL PROGRAMMES EXPENDITURE

51% Africa 12% Latin America 18% Asia and Central Asia 3% Eastern Europe 11% Near and Middle East 5% Cross-cutting projects Adoption, Opération Sourire, needs assessments


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HUMAN RESOURCES PRIORITISING OUR LOCAL STAFF: HARMONISING MEDICAL AND SOCIAL POLICIES IN THE FIELD IN 2009 2009 was marked by the strengthening of our international human resources policy, with a particular emphasis on national staff around the world. Our efforts were focused primarily on signing off and implementing a common remuneration policy for our national teams, as well as updating management tools and materials. This first stage was essential in order to be able to work towards a more comprehensive human resources policy, allowing us to manage individuals and offer career development based on merit, rather than status or nationality.

CAREER PATHS FOR LOCAL EXECUTIVE STAFF In the same way that we offer career development for our expatriate staff or volunteers within MdM, it is vital that we are able to work with local executive staff

to map out a career path within the organisation, whether that be in their own country or as expatriates. In order to achieve this it is essential to train and raise awareness among our co-ordinatiors of the importance of individual supervision, skills development, training and mobility. Recognition of the individual’s career needs within the organisation has been, and remains, of key importance.

SOCIAL AND MEDICAL POLICY Currently, in every country where we operate our national employees benefit from medical cover. This can vary from country to country and indeed can be very different according to each country’s provision (the public health system, private insurance companies or MdM’s internal systems).

We want to take this further and set out a medical and social policy which offers the same provision across all our projects. A qualitative and quantitative study of policies in place in our programmes was undertaken in order to give us a clear picture of the current provision. The results of this study will enable us to define a common minimum as regards medical and social cover for all national staff, regardless of where they work.


Liberia Š Georges Gobet/AFP


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INTERNATIONAL PROGRAMMES


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CONTENTS 16 Map 22 Africa 32 Latin America 42 Asia 52 Eastern Europe 60 Near and Middle East 69 Future plans


16 INTERNATIONAL PROGRAMMES

Algeria Mexico

Mali Haiti Guatemala Nicaragua

Niger Chad Senegal Burkina Faso Guinea Liberia

Colombia

Peru

EMERGENCY AND LONG TERM PROGRAMME LONG TERM PROGRAMME

EMERGENCY PROGRAMME


Russia

Serbia Romania Bulgaria Moldova

Turkey

Afghanistan Iraq

Lebanon

Syria Palestinian Territories

China Nepal

Egypt

Burma Pakistan

Vietnam India

Yemen Cambodia

Eritrea Sudan Ethiopia Somalia Rwanda Dem. Rep. of Congo Tanzania

Angola

Madagascar

Zimbabwe

Indonesia


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INTERNATIONAL PROGRAMMES Internationally, MdM works AREAS OF in almost all continents, in INTERVENTION various contexts and on We intervened in five key contexts: fragile multiple themes. Let’s look regions, internal conflicts, armed conflicts, first at the areas where we natural disasters and stabilised zones. intervened in 2009, and then focus on the different FRAGILE REGIONS OR INTERNAL CONFLICT ZONES themes covered. (67.9% of the budget) It is in these regions that the majority of MdM programmes are located, and where the majority of our budget is spent. The term “fragile region” is derived from the concept of fragile governance. Governmental structures and institutions in these countries seriously under-perform when compared with the usually accepted obligations of the state towards its citizens, in particular in relation to health. In these countries, the capitals are often less “fragile” than the rural areas, which is why we talk about fragile regions rather than fragile countries. This state of affairs is often related to internal conflict which is characterised by acts of revolt and violence coming from different factions fighting against the authorities or amongst themselves. These zones differ from those defined as areas of civil war where the acts

of revolt or violence are more intense. It is in these “fragile regions” that we develop the most varied projects. ARMED CONFLICT ZONES (21.7% of the budget) In 2009, MdM continued and reinforced its activities in Somalia, Ethiopia (Somali region), Sudan (Darfur), Gaza (Palestinian Territories), Afghanistan, Colombia (Meta region) and Iraq. MdM opened two new programmes to help people who had been displaced by armed conflicts: in Pakistan’s North West Frontier Province and in the north of Yemen. The majority of our projects in these areas offer access to medical care. Kabul, however, is an exception. There are 1.5 million drug users in Afghanistan, the majority living in Kabul, creating a serious public health problem — MdM has set-up a harm reduction programme for people who use drugs.

PROGRAMMES IN AFRICA 34 programmes in 18 countries and one region that is common to three countries: Algeria, Angola, Burkina Faso, Chad, DRC, Eritrea, Ethiopia, Guinea, Liberia, Madagascar, Mali, Niger, Rwanda, Senegal, Somalia, Sudan, Tanzania, Zimbabwe.

PROGRAMMES IN LATIN AMERICA 11 programmes in six countries: Colombia, Guatemala, Haiti, Mexico, Nicaragua, Peru.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PROGRAMMES IN ASIA 16 programmes in 10 countries: Afghanistan, Burma, Cambodia, China, India, Indonesia, Nepal, Pakistan, Russia, Vietnam

PROGRAMMES IN EASTERN EUROPE Five programmes in four countries: Bulgaria, Moldova, Romania, Serbia

PROGRAMMES IN THE NEAR AND MIDDLE EAST Nine programmes in seven countries: Egypt, Iraq, Lebanon, Palestinian Territories, Syria, Turkey, Yemen.

NATURAL DISASTER ZONES (1.9% of the budget) This year, MdM responded to only one natural disaster — the earthquake which hit Padang, on the island of Sumatra, in Indonesia. The tremor, which measured 7.9 on the Richter scale, officially caused 1,117 deaths and affected 1.2 million people. Half of the health centres and 85% of maternity wards could no longer function. 4,000 consultations and nearly 800 mental health appointments were carried out by our mobile teams in one month. Four health centres were reopened thanks to the teams. At the beginning of year, the emergency cyclones programmes in Haiti finished. It had been set up because of the three successive cyclones (Gustav, Hanna and Ike) in 2008, which left 793 dead, of whom more half came from Gonaïves; there were also 500 missing and 830,000 people affected. In five months, the mobile teams carried out nearly 20,000 consultations. STABILISED ZONES (8.5% of the budget) Using our own definition, these zones exclude the preceding ones. Here we work on specific themes: migrants, people who use drugs, human trafficking, HIV/AIDS, reproductive health and support the development of local partners (Russia-Great North, Romania, Bulgaria).

67.9% of MdM’s budget is devoted to the development of programmes in fragile regions or where there is internal conflict FIVE KEY PRIORITIES 1. FIGHTING EPIDEMICS (HIV/AIDS, MALARIA AND TUBERCULOSIS) (12% of the budget) The bulk of our work within this framework relates to HIV/AIDS; half in Africa, the rest in Asia. The activities, although different from one programme to another, aim to train the health and non-health workforce, and to work on communications which focus on behavioural change. They also include the distribution of condoms, testing for HIV (and sometimes hepatitis), psycho-social support for people living with HIV, prevention of mother-to-child transmission, pre antiretroviral therapy care and antiretroviral treatment. The North-Kivu (DRC) HIV/AIDS project includes a safe transfusion element. All these projects are aimed at helping everyone touched by the virus; an exception is one which targets only people who are more at risk, like sex workers (men and women) and people who use drugs (Burma-Yangoon).

In total, more than 9,500 people benefited from antiretroviral treatment this year. 2. ACCESS TO CARE • For the general population (50.5% of the budget) These programmes aim to improve access to basic healthcare; they include people affected by epidemics. It is the most developed theme in areas of armed conflict and in fragile regions or areas of internal conflict. Our programmes may, depending on the area, also focus on training. (e.g. Liberia, Burma - Irrawady Delta, Yemen, Niger), construction or refurbishment of infrastructure (e.g. DRC, Liberia, Somalia), the organisation of care systems (e.g. Liberia, DRC), drugs and

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medical equipment supplies (in almost all Two of these programmes focus on • Specialised care, including surgery, cases), and partnerships with institutions women who have suffered from vesico-va- mental health and nutrition or other organisations in every case. ginal fistulas due to difficult childbirth, with (6.8% of the budget) poor or no medical assistance, or pre- Surgical inventions continued in MadaExcept in the first weeks or months follo- gnancy at a young age (Chad, Mali). gascar and in the Palestinian Territories wing a natural disaster, for example the (Gaza), but also in Cambodia, Mongolia, Padang earthquake or Gonaïves cyclone, • For people living on the streets Benin, Mali, Niger and Chad within the or in complex emergency situations, such (4.7% of the budget) framework of Opération Sourire. In addias Colombia or Pakistan-NWFP, MdM Kinshasa and Cairo are the two big cities tion, MdM set up an emergency surgical provides little direct aid (i.e. medical where we continue to develop this type programme in Madagascar in response consultations by MdM teams). When the of programme, in partnership with local to the political crisis at the beginning of cholera epidemic flared up in Tanganyika NGOs. the year when there was a surge of bullet (DRC) in 2009, 2,050 cases of cholera wounds and many people needed treatwere treated in Kalemy, with a death rate • For prisoners ment after being crushed by the crowds. of only 0.78%, in line with what would be (1.4% of the budget) expected in the circumstances. Madagascar and Guinea are the two Whilst many programmes have mental countries where these activities continue. health components, three are dedicated In Madagascar, the programme is working to mental health. These are in the Middle • For pregnant women and children to make Malagasy government prisons East: Iraq-Kerbala, Palestinian Territories(6.2% of the budget) Nablus and Lebanon-Palestinian camps. more humane. In 2009, this population was specifically They all contain a training element. targeted by nine programmes in Bulgaria, Chad, Eritrea, India, Mali, Nepal, Niger, 3. CARE AND TREATMENT As for nutrition, it is generally integrated Nicaragua and Peru. These programmes • Gender-based violence into broader access to care projects. offer pre- and post-natal consultations, (7% of the budget) care during deliveries, basic care for chil- In 2009, seven programmes evolved widren under five and health education. thin this theme in Algeria, DRC (NorthSometimes there is work on the organisa- Kivu), Guatemala, Haiti, Moldova, tion of care systems, as in Haiti, for Nicaragua and Pakistan. The care we example, where we piloted a financial offer is multi-disciplinary and does not accessibility project for pregnant women only address medical needs but goes and children under five. This resulted in a beyond that, aiming to limit the risks of threefold increase in the numbers coming future harm. All these projects involve a training component. for consultations.

GENDER-BASED VIOLENCE This may take the form of beliefs, traditions, behaviours or attitudes which are detrimental to individuals because of their gender. It includes physical, sexual, emotional and psychological violence, as well as economic and social violence (prevention of access to care, education) and traditional prejudicial practices (genital mutilation, forced marriage, selective abortion).


DOCTORS OF THE WORLD ANNUAL REPORT 2009

4. REDUCTION OF HEALTH RISKS • As a result of being displaced (refugees, displaced people, migrants) (0.7% of the budget) In 2009, MdM worked on this set of themes on two sites: Moscow in the Russian Federation, and Bamako in Mali. The programme in Moscow relates primarily to basic and specialised healthcare access, that of Bamako to mental health for those who have been expelled or sent back from Europe. Both have a strong partnership with a local NGO.

Target population: people who could use the services delivered by MdM. Beneficiary population: people who have benefited from one or more services delivered by MdM.

• Related to high risk behaviours (people who use drugs, sex workers…) (7.6% of the budget) Four programmes devoted to, or involving, harm reduction continued in 2009: Afghanistan, Burma, China and Serbia. All these projects target people who use drugs and some, like Burma, also focus on male and female sex workers. Project structures vary from one country to another and may entail prevention (needle exchange, information, condoms), training, HIV and hepatitis testing, treating sexually transmitted diseases and AIDS, opiate substitution therapy and setting up patient self-help groups. • Related to the environment (working conditions, climate, pollution…) (1.1% of the budget) The only programme in this category is in

Madagascar on the east coast, often battered by cyclones. It aims to better prepare communities and health authorities so that they can respond more effectively to this type of disaster. This year several elements were rolled out: a network of trained first-aid workers, epidemiological follow-up, treatment of children suffering from severe malnutrition and four community-based disaster preparation projects. 5. SUPPORT FOR LOCAL PARTNERSHIP DEVELOPMENT (2% of the budget) In general MdM works in partnership with a local NGO or national institution, and some of our programmes go further, aiming directly to develop these partner organisations. This is the case in Romania-Satu Mare, in Bulgaria-Sofia, in Russia-Great North, in Mexico-Chiapas (representing the indigenous people; helping the indigenous health system to work towards autonomy), Cambodia (partner organisation SEAD; HIV/AIDS, micro-credit); Rwanda (partner organisation IBUKA; medical and mental health support for genocide survivors) and Angola-Lobito (partner organisation OMUNGA; children living on the streets).

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ZIMBABWE

“In Tuzuka health centre, role-playing, songs and condom distribution help to prevent cholera and HIV/AIDS.”

ZIMBABWE © Lahcène Abib


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PROGRAMMES IN AFRICA

DRC © Lâm Duc Hiên


24 PROGRAMMES IN AFRICA

ZIMBABWE © Lahcène Abib


DOCTORS OF THE WORLD ANNUAL REPORT 2009

ZIMBABWE Tandiwa, 25 years old, nine months pregnant

“In a few days I should give birth. I live three days walk away. At the health centre, they told me to come to the hospital before. Here, we are welcomed with other pregnant women. We can cook our meals and sleep, and so we are in hospital when the baby comes. The risks are lower than at home and all the care is free.”


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Mali Š Isabelle Eshraghi


DOCTORS OF THE WORLD ANNUAL REPORT 2009

KEY EVENTS IN AFRICA © Isabelle Eshraghi

CHAD A NEW PROGRAMME

SAHEL

LOWERING THE COST OF ACCESS TO HEALTHCARE LAUNCHED IN NOVEMBER 2009, THIS NEW PROGRAMME AIMS TO REMOVE THE COST BARRIER TO ACCESS TO HEALTHCARE IN THREE SAHEL COUNTRIES: NIGER, MALI AND BURKINA FASO.

Programme in Niger

“With this Sahel project, we aim to remove the cost barrier to access to healthcare for the population. If patients are treated quickly, earlier and in the best conditions, the health costs in the end will be lower,” explains Thierry Comte, joint head of MdM’s Africa Group. This programme should last for four years and will be rolled out into three countries: Niger, Mali and Burkina Faso. Since 2006, MdM has already helped the government of Niger to introduce free healthcare for children under the age of five and pregnant women. But other approaches may be developed. In addition to an evaluation of the costs of access to healthcare in these areas, the Sahel project will lobby donors, local health authoritites and partners, such as community health organisations, to highlight government responsibility, influence public policies and reduce the costs of healthcare for patients.

With the increase in maternal mortality in recent years in Chad, we decided, in July 2009, to launch a maternal and neonatal health programme, including treatment for obstetric fistulas. The project supports five health facilities and Mao hospital in Kanem region in the west of the country. Four components have been developed: surgical treatment and psychosocial support for women suffering from fistulas, with the aim of performing around 100 operations a year; improving obstetric and neonatal care, particularly for emergency cases; health education in villages covering mother and child health issues; and, finally, training of traditional birth attendants. In 2009, the programme has already enabled four women suffering from fistulas to have surgery and 3,400 people participated in health education sessions on neonatal and maternal health and fistulas.


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TANZANIA

END OF A LONG PROGRAMME ON HIV/AIDS After more than 17 years, the MdM programme in Kagera region is ending in February 2010. Throughout this time, the programme has supported the implementation of a comprehensive strategy to tackle HIV/AIDS. This has been done by developing innovative approaches, particularly in relation to decentralising prevention and access to treatment, and integrating both into primary care.

© Lâm Duc Hiên

Programme in Kinshasa

DRC

A HUGE CHALLENGE The Democratic Republic of Congo (DRC) is ganisation’s priority themes in 2009) and, lastly, one of the key countries for Doctors of the to support the local health system in the prevenWorld. “We are still supporting this country in its tion of epidemics in Tanganyika district. reconstruction process, through three large programmes,” explains Thierry Comte, joint head of MdM’s Africa Group. These programmes aim to protect street children in Kinshasa, to tackle HIV/AIDS in Goma and Karisimbi and to support local organisations there in tackling violence against women (one of our or-

OUR OBJECTIVE: TO HELP WITH THE RECONSTRUCTION OF THIS BATTERED COUNTRY”

In order to draw out the lessons of this experience, we have started a process to ensure that we can capitalise on our experience in Tanzania — this will be useful for MdM’s other HIV/AIDS programmes and will enable us to develop some recommendations for our strategic and technical approach. Doctors of the World, however, is not leaving Tanzania. We are launching an exploratory mission in the first quarter of 2010 to assess the needs of high-risk groups, such as people who use intravenous drugs, sex workers and gay men in Dar es-Salaam.

1,474 new patients registered this year


DOCTORS OF THE WORLD ANNUAL REPORT 2009

ALGERIA

A CONFERENCE TO END THE WOMEN’S PROGRAMME MdM’s programme in Algiers supported our local partner, Wassila by improving a free, anonymous telephone helpline for women affected by violence. This programme ended in September 2009. By the end, training on listening, welcoming and on providing care had been introduced for women working on the helpline. More generally, awareness-raising activities had been carried out on this issue among professionals working with women affected by violence. In June 2009, a conference brought together professionals from medicine, the law, social work and psychology, along with representatives of civil society and the Ministry of Solidarity.

MdM is still active in Algeria, and a feasibility study has been carried out exploring a new programme working with migrants.

80 PROFESSIONALS AND REPRESENTATIVES OF CIVIL SOCIETY TOOK PART IN THE INTERNATIONAL CONFERENCE ON CARING FOR VICTIMS OF VIOLENCE

MADAGASCAR

EMERGENCY IN ANTANANARIVO When the political crisis in Madagascar reached its height in January 2009, MdM decided to launch an emergency programme to help the victims of political violence. This threemonth project supported the local health services in caring for people injured during the demonstrations.

107

people were operated on, and all the injured people admitted to the hospital emergency department between 7 and 14 February 2009 were treated.

MALI SUPPORTING MIGRANTS MdM launched a new programme, in 2009, centred on the issue of migration in subSaharan Africa. Based initially in Mali, the project relies on a network of many partners, particularly the Malian Association of Deportees, and on the support of the former Malian Minister of Culture, politician and writer Aminata Traoré. The aim is to train members of the association to provide psychological support to migrants and deportees, a particularly stigmatised group.


30 AFRICA Algeria

Mali

3 3

Niger Chad

Eritrea

Senegal 3

Burkina Faso Guinea

Sudan

Liberia

Ethiopia Somalia

Rwanda Dem. Rep. of Congo

3

Tanzania

Angola

Zimbabwe Madagascar

EMERGENCY AND LONG TERM PROGRAMME LONG TERM PROGRAMME

EMERGENCY PROGRAMME

3


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CD You will find the detailed country files for all the programmes in Africa on the interactive CD attached to this report.

// ALGERIA

// NIGER

// ANGOLA

// RWANDA

// BURKINA FASO

// SAHEL

// CHAD

// SENEGAL

// DRC

// SOMALIA

// ERITREA

// SUDAN

// ETHIOPIA

// TANZANIA

// GUINEA

// ZIMBABWE

// LIBERIA // MADAGASCAR // MALI


32

HAITI

“Since the earthquake in January 2010, MdM has redirected its programme tackling violence against women towards emergency aid for those affected in Port-au-Prince.”

HaIti © Lahcène Abib


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PROGRAMMES IN LATIN AMERICA

Nicaragua © Lâm Duc Hiên


34 PROGRAMMES IN LATIN AMERICA

Guatemala © Lâm Duc Hiên


DOCTORS OF THE WORLD ANNUAL REPORT 2009

GUATEMALA Rosa, a worker in a maquila, a textile export factory

“I have been working since I was 16 years old and here what matters is the work, the targets and to be able to export. We are highly exploited, tired and exhausted when we get home from work. I studied to be a health promoter because I am fed up that as workers we’re exploited in this way. I’m interested in studying for our health and for our rights as workers. When we listen to what these educated women have to say, we are changing.”


36

HaIti © Lâm Duc Hiên


DOCTORS OF THE WORLD ANNUAL REPORT 2009

KEY EVENTS IN LATIN AMERICA

Programme in Chiapas (Mexico)

PROMOTING THE RIGHT TO HEALTH GIVEN THE COMPLEXITY AND DIVERSITY OF LATIN AMERICAN COUNTRIES, IT IS IMPOSSIBLE TO BREAK IT DOWN INTO PRIORITY AREAS GEOGRAPHICALLY. MDM HAS CHOSEN INSTEAD TO FOCUS ITS WORK ON PROGRAMME THEMES, SUCH AS THE RIGHT TO HEALTH, PARTICULARLY FOR VULNERABLE GROUPS, OR THOSE WHO FACE DISCRIMINATION.

© MdM

In Mexico, the project supporting indigenous communities in Los Altos has been extended for an additional six months to enable the progamme to close in the best possible conditions. This symbolic programme, which we have been working on for more than 10 years, aimed to support the implementation of an autonomous healthcare system in Chiapas state. The handover to local partners, namely the representatives of the Zapatista movement and of the Las Abejas indigenous movement, is planned for June 2010.

“IN TOTAL, MORE THAN 9,000 CHILDREN UNDER FIVE WERE SEEN BETWEEN APRIL AND JULY 2009 IN HAITI, THREE TIMES AS MANY AS THE SAME PERIOD IN THE PREVIOUS YEAR.

by supporting nine local health services. MdM was running a research-action project on mechanisms for user fee exemptions and/or free healthcare for pregnant women and children under five. The earthquake on 12 January 2010 had a major impact on the situation in the Grand’ Anse area, particularly with the arrival of more than 100,000 people displaced from Port-auPrince. The MdM programme was adapted to reflect this new context, particularly with an expansion of free healthcare in 11 health facilities.

This health system finally became autonomous for all primary care. Today it includes 400 health promoters who run 11 micro-clinics and 40 health posts. These services provide vaccination for all children under the age of five and pregnant women, as well as providing screening and follow-up for communicable diseases such as tuberculosis. This system facilitates selfmanagement and includes referral to the Mexican government’s state healthcare system MdM also reacted immediately to the emerfor further care. gency situation in Port-au-Prince after the In Haiti, the programme in Grand’ Anse was earthquake by developing surgical activities, prihelping to reduce maternal and infant mortality mary healthcare and psychological support.


38 © Lâm Duc Hiên

“THE SITUATION IN LATIN AMERICA CONCERNING ABORTION HAS DETERIORATED, PARTICULARLY IN URUGUAY AND NICARAGUA.

REDUCING THE RISKS OF UNWANTED PREGNANCY A TOUGHENING OF THE LEGISLATION RELATING TO ABORTION WAS WITNESSED THROUGHOUT 2009. THAT IS WHY WE HAVE MADE REDUCING THE RISKS ASSOCIATED WITH UNWANTED PREGNANCIES A PRIORITY FOR OUR WORK ON THE CONTINENT.

Programme in Guatemala

In Latin America, 2009 was marked in Uruguay by backward steps in relation to abortion. When, in November 2008, the National Assembly legalised abortion, the president, Tabaré Vásquez, a doctor, used his veto to oppose the bill, so that abortion remains illegal. This affects more than 33,000 women each year, who resort to illegal abortion. “We’ve seen dramatic backsliding by Latin-American governments on the issue of legalisation of abortion or availability of the morning-after pill. Whether in Nicaragua, where the law on medical abortion which had been in existence since 1893 was repealed in 2006, or in Mexico or Uruguay,” outlines Flavia Stea, joint head of MdM’s Latin American Group. Doctors of the World carried out an exploratory mission in Uruguay with a view to developing a pilot project. “This meant understanding the treatment protocol for patients, before and after their medical abortion, which has been

updated by our partners in a local hospital, and continuing to help these partners to develop it across the province, in an unfavourable national context,” explains Flavia Stea. For many sexual and reproductive health programmes, a new initiative should be launched in 2010, with the creation of a basic treatment kit (family planning, emergency contraception, treatment for rape victims), in particular in Nicaragua, Peru, Guatemala and Mexico. Despite the availability of human resources, maternal mortality remains very high on the continent, because of a lack of political will. In 2010, MdM will support numerous movements campaigning to legalise abortion, depending on the precise needs of each of our partners.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

COLOMBIA

IN AREAS OF CONFLICT © Michel Redondo

© Lahcène Abib

Emergency programme in Port-au-Prince

HAITI

EMERGENCY FIRST Programme in the Medio Atrato river region

In Colombia, MdM launched an exploratory mission in the Nariño region, between the Pacific ocean and the Amazon rainforest. The new programme aims to promote access to healthcare for populations affected by the armed conflict in the south of the country. This programme is taking place in the heavily militarised department of Meta and that will be extended to Guaviare during 2010. Finally, in the Medio Atrato river region, a programme is providing long term support for access to healthcare for vulnerable groups.

57 mobile clinics took place, including 20 jointly carried out between MdM and the State-run services in Meta

In 2009, an exploratory mission was carried out in Ouanaminthe, on the border with the Dominican Republic to assess the needs of migrants in terms to access to healthcare. However, the launch of this project has been suspended, because of the earthquake on 12 January 2010, which has turned the country upside down. In fact, we are concentrating our efforts on an emergency programme, which will undoubtedly go on for a long time, before the reconstruction phase to rebuild the health system.


40 LATIN AMERICA

Mexico

Haiti

Guatemala 2

Nicaragua

2

Colombia

Peru

EMERGENCY AND LONG TERM PROGRAMME LONG TERM PROGRAMME

3


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CD You will find the detailed country files for all the programmes in Latin America on the interactive CD attached to this report.

// COLOMBIA // GUATEMALA // HAITI // MEXICO // NICARAGUA // PERU


42

BURMA

Moegang Health Centre “Every day, people who use drugs come to receive care, participate in recreational activities or rest. It’s a way of recreating social connections.”

Burma © Sophie Brändström


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PROGRAMMES IN ASIA

Nepal © Benoit Guénot


44 PROGRAMMES IN ASIA

Indonesia, Sumatra © Dorothée Frénot


DOCTORS OF THE WORLD ANNUAL REPORT 2009

INDONESIA Zas Mother of five children, victims of the earthquake in Sumatra

“When the earthquake happened, I was working in another house a bit further away. I ran towards my house, where my children were—it had completely collapsed. One of my children had a head injury. Today, I am still afraid that the earth might start to shake again, and, above all, of landslides. I wouldn’t know how to get away. I don’t know how I am going to get my house rebuilt, I don’t have any money to pay for the work.”


46 KEY EVENTS IN ASIA

CONFLICT IN SRI LANKA

INDONESIA

A STRATEGIC POSITION INDONESIA IS STILL AT THE MERCY OF CURRENT EVENTS. THE EARTHQUAKE IN PADANG LED MDM TO LAUNCH AN EMERGENCY PROGRAMME IN 2009. ELSEWHERE, MDM CLOSED THE PROGRAMME ON LEMBATA, BUT IS STILL RUNNING THE PROJECT IN PAPUA AND AN OFFICE IN JAKARTA. Emergency in Padang With 40 million people living below the poverty line, and frequent natural disasters, Indonesia is one country where MdM is maintaining a considerable presence. In October 2009, an emergency team went to the north of Padang after the earthquake. Outreach teams were set up to take care of the injured and to support the health centres overwhelmed by the flow of patients. Closure of the project in Lembata On the island of Lembata, the anti-malaria programme came to end in March 2009. The project aimed to screen for cases and provide appropriate treatment, by supporting mobile clinics and also training health professionals in prevention and treatment of malaria. There were nearly 100,000 direct or indirect beneficiaries.

© MdM

After the tsunami emergency programme MdM decided to stay in Sri Lanka, but was unable to do so for security reasons. In 2009, the launch of a contact programme in Colombo, the capital, enabled us to renew links with the network of local organisations with a view to going back into the Tamil zone in the north and east of the country, to be able to provide care to a population which has been largely deprived of it. The opening of this programme will depend on how the Sri Lankan political situation develops and on being able to obtain the necessary permission from the government.

Earthquake in Sumatra

Still working in Papua The programme set up in western Papua commemorated its tenth anniversary in 2009. “In the first place, we created a primary healthcare mission and then we developed care for sexually transmitted infections and HIV/AIDS. Today, the new phase involves implementing mother and child health activities,” explains Patricia Gaillard-Olokose, joint head of the Papua programme and joint head of MdM’s Asia Group. With persistent separatist tendencies and a strong police presence, the area remains unstable. For this reason, MdM — one of the few NGOs working there — has chosen to maintain this programme while reinforcing our part-

nerships with local actors, with view to our withdrawal in the future. A base in Jakarta In view of the Indonesian capital’s strategic position, MdM continues to keep an office in Jakarta, comprising one expatriate and a small local team. This base enables us to maintain links with partners and to be able to intervene quickly in emergencies.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

© Myriam Pomarel

PAKISTAN

Emergency programme in the Swat valley

SUPPORT FOR DISPLACED PERSONS In May 2009 hostilities between pro-Taliban militants and the Pakistani army provoked the displacement of 2.5 million people across the Swat valley in the north-west of Pakistan.

medical consultations and nutrition, health education and community awareness-raising activities. The teams remain ready to react to other crises which could affect the region.

MdM quickly set-up mobile clinics and came to the assistance of the Swabi hospital staff. Access to healthcare in the zone having deteriorated, MdM ensured access to healthcare with

RUSSIAN FEDERATION

VIGILANCE IN CHECHNYA

21,000 patients received care in rural areas and 79 health professionals received training

that we’ve seen in the last year,” says Françoise Parrot, joint head of MdM’s Eastern European Group. The support visits to health centres in inaccessible mountain areas and the training for doctors in several hospitals in Grozny finished in April 2009, in line with our planned withdrawal. “2009 WAS A MdM will not, however, be completely leaving the DIFFICULT YEAR country. Since November 2009, a process of FOR CHECHNYA” capitalising on our experience has enabled us to evaluate the outcome of the programme. This 2009 was another difficult year for Chechnya. process was based on meetings with many fugees are Chechen — in collaboration with the There were more assinations of journalists, beneficiaries and all our partners. European advocacy project, Huma. An office lawyers and representatives of human rights organisations. “The appearance of the process In addition, MdM is particularly interested in the remains in Grozny and a local co-ordinator is of normalisation underway in Chechnya, does situation of Chechen migrants. A needs assess- monitoring the political, social and health situation. not reflect the very real attacks on human rights ment is underway in Poland — where 90% of re-

MDM’S PROGRAMME IN CHECHNYA ENDED IN 2009 AFTER 15 YEARS. WE CONTINUE, HOWEVER, TO KEEP A WATCH ON THE POLITICAL AND HEALTH SITUATION THERE.


48 © David Delaporte

RUSSIA

STRATEGIC POSITION IN MOSCOW

Tackling tuberculosis in Ulan-Bator

MONGOLIA

NEW PROJECTS: TO BE CONTINUED? MdM’s programme of reducing mortality related to alcohol, tuberculosis and hepatitis in Ulan-Bator finished at the end of 2008. Since then two Mongolian associations are carrying on with the screening services and accompanying patients to treatment facilities, while MdM considers possible new programmes in Mongolia.

AFTER CLOSURE AT THE END OF DECEMBER 2008, THE PROGRAMME IS CARRYING ON THROUGH OUR LOCAL PARTNERS

30% of the population lives below the poverty line

In 2009 Médecins du Monde decided to keep a base in Moscow in order to maintain a strategic presence in Russia and in order to develop new programmes. Our organisation is particularly interested in the issue of access to healthcare for undocumented migrants in the Russian capital. The UN estimates that there could be between three and ten million such migrants, whether refugees or internally displaced. It is practically impossible for these migrants to obtain a residency permit because the Russian authorities require official permission to go from one city to another. This population is marginalised and has no access to healthcare. For this reason, MdM has set-up a telephone advice line for medical consultants to refer migrants to Russian doctors who will treat them. So far, 24 organisations have already taken part in four conferences. The Moscow base also plays a vital role in steering the programme supporting community health services in the Great North (training health agents, raising awareness of the risks of excessive alcohol consumption). In 2009, a local association, Community Health Partnership, was created to continue with MdM’s work and to take over the activities in a few years.

1,100 MIGRANTS WERE REFERRED TO RUSSIAN DOCTORS


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CAMBODIA

FINAL WITHDRAWAL

CHINA HANDING OVER ACTIVITIES

“The Cambodia programme is symbolic, in as far as it has followed key moments in MdM’s history since the early 1990s,” says Patricia Gaillard-Olokose, joint head of MdM’s Asia Group. The most recent project carried out there involved providing medical care and psychosocial support for people affected by HIV/AIDS in Calmette hospital in Phnom Penh. Over time the programme has put people living with HIV on antiretroviral treatment, trained local doctors and enabled creation of a support network for patients. In November 2008, the project was transferred to SEAD, our Cambodian partner organisation which MdM continued to support financially until © Lahcène Abib November 2009. Our withdrawal is now complete.

AIDS programme in Phnom Penh

BURMA

STAYING ON AFTER THE CYCLONE Having already been working in Yangon and Kachin state on the prevention and treatment of STIs and HIV/AIDS and on reducing the risks associated with drug use, MdM is running a long-term programme in the Irrawaddy Delta region as an extension of the emergency programme, carried out in 2008, to come to the aid of the victims of cyclone Nargis.

MdM is still the only international medical organisation working in this affected district. We are working in 99 villages: training community health agents, mobilising health committees through prevention and health education sessions among villagers. At the end of 2009, 99 community health agents had been trained and 59 village health committees had been created or restarted. In 2010, this programme should expand to 33 new villages to the south-west.

The harm reduction programme among people who use drugs in Chengdu, in Sichuan province, was transferred to our local partners last year. According to the UN, nearly 700,000 people are living with HIV in China. Since needle sharing is the main mode of transmission, MdM’s activities comprise welcoming, informing and caring for drug users in two drop-in prevention centres. Since 2005, 2,700 people have registered at the centres. This programme has now been handed over to the Centre for Disease Control (CDC), but MdM will finalise its withdrawal in early 2010. MdM will also stay involved in China. Economic development is still leaving most of the population behind and civil society remains weak.


50

Russia

ASIA

Afghanistan

China Nepal

Burma

India

Vietnam

Pakistan

Cambodia

Indonesia

EMERGENCY AND LONG TERM PROGRAMME LONG TERM PROGRAMME

3


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CD You will find the detailed country files for all the programmes in Asia on the interactive CD attached to this report.

// AFGHANISTAN // BURMA // CAMBODIA // CHINA // INDIA // INDONESIA // NEPAL // PAKISTAN // RUSSIA // VIETNAM


52

BULGARIA

“In the Nadezhda area of Sliven, the Roma population lives in deplorable conditions. In 2009, mother and child health was the priority.”

Bulgaria © Gaëlle Girbes


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PROGRAMMES IN EASTERN EUROPE

Moldova © Lizzie Sadin


54 PROGRAMMES IN EASTERN EUROPE

Moldova © Lâm Duc Hiên


DOCTORS OF THE WORLD ANNUAL REPORT 2009

MOLDOVA Oxanna, 33 years old, trafficking victim

“I had a friend in Saudi Arabia. She suggested that I went there. In the beginning, I didn’t go out and I was learning the language. Then, gradually, I began to go out to discos, bars... I worked as a prostitute but I didn’t earn much. I was always trying to get home. I tried to improve my life back home, but it didn’t work and I left. Everything was horrible, it was insulting. They beat me and didn’t pay. I will never go again.”


56 KEY EVENTS IN EASTERN EUROPE

© Lâm Duc Hiên

MOLDOVA

REFINING OUR WORK Preventing trafficking in Balti

“MORE THAN 31,000 THE ANTI-TRAFFICKING PROGRAMME IN MOLDOVA, IN PLACE SINCE JULY 2007, IS THE FIRST OF ITS KIND WITHIN MDM. IT IS GOING TO BE EXPANDED TO SEVERAL OUTLYING AREAS.

The fight against human trafficking is essential across Europe. In two and a half years of work our teams have been able to identify and care for 31,000 direct, indirect or potential victims of trafficking. The victims are men and women who left Moldova and found themselves in situations of slavery through their work in construction, agriculture or in the sex industry. Well established in five regions in Moldova, MdM has been asked by new actors to expand its activities in the country. Our organisation is also interested in Transnistria, a grey area not under Moldovan rule of law that has proclaimed itself independent without any international recognition and which is under the influence of Russia. Human trafficking is also a major issue there.

DIRECT OR POTENTIAL VICTIMS OF TRAFFICKING HAVE BEEN IDENTIFIED AND CARED FOR IN MOLDOVA.” In addition, we are in the process of setting up partnerships with Ukranian organisations to be able to work together on the trafficking networks. In fact, the trafficking problem is just as serious in Ukraine as it is in Moldova.

657 local professionals have been trained in Moldova


DOCTORS OF THE WORLD ANNUAL REPORT 2009

© Gaëlle Girbes

BULGARIA

WITHDRAWAL AND A NEW PROGRAMME Started by MdM Aquitaine’s programme in Sofia, a project training the staff of Bulgarian institutions came to an end in June 2009, after 10 years. Initially, this programme enabled 700 people working in institutions for children under three years old to receive training. The project then trained 300 people working in centres for disabled children. Finally, a training programme on neonatal resuscitation was introduced for various Bulgarian professionals. The impact of this programme can be seen throughout the country.

“MORE THAN 1,000 PROFESSIONALS WORKING IN CHILDREN’S INSTITUTIONS WERE TRAINED”

A Bulgarian association, Child and Space, has now taken over the work. MdM, however, will stay in Bulgaria with the launch, in 2009, of a mother and child health programme with the Roma community in Sliven.

Roma camp in Sliven

ROMANIA PROTECTING CHILDREN

SERBIA

HARM REDUCTION Harm reduction is a priority in Eastern Europe since the HIV/AIDS epidemic is still flourishing in high-risk groups. MdM transferred the needle exchange programme in Belgrade to Veza, a local organisation, at the end of 2008.

Since November we have been able to deliver substitution therapy to people who use drugs.

MdM is still working in the Serb capital—with a methadone programme which has been on hold pending official authorisation. After a two year wait, permission was finally granted for the implementation of a programme within primary care and the green light was given to health centres in July 2009.

“TODAY PEOPLE WHO USE DRUGS CAN HAVE ACCESS TO SUBSTITUTION THERAPY IN HEALTH CENTRES”

MdM’s PACA delegation supports the work of its local partner, the COPII association, and Romanian civil society in their fight against child abuse and abandonment. The aim is to train professionals on this specific issue. More than 300 childcare assistants have benefited from this type of training.


58 EUROPE

Moldova Romania

Serbia

Bulgaria

LONG TERM PROGRAMME


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CD You will find the detailed files for all the programmes in Eastern Europe on the interactive CD attached to this report.

// BULGARIA // MOLDOVA // ROMANIA // SERBIA


60

LEBANON

“In Nahr El Bared makeshift camp, Palestinian refugees live in very difficult conditions: poor housing, little access to water, sub-standard health infrastructure…”

Lebanon © Viviane Joakim


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PROGRAMMES IN THE NEAR AND MIDDLE EAST

Yemen © Jean-Baptiste Lopez


62 PROGRAMMES IN THE NEAR AND MIDDLE EAST

Gaza © Pauline Beugnies


DOCTORS OF THE WORLD ANNUAL REPORT 2009

GAZA Jean-Philippe Rigaud, Trainer in emergency medicine

“I came to train doctors and nurses in Gaza in emergency respiratory care techniques. The aim was to update their theoretical knowledge and to teach them new techniques by using mannequins to practise intubation techniques to be able to reach airways and enable artificial respiration. Once this key step has been completed, doctors are ready to use their new skills in a surgical unit or an emergency department. In Gaza the theoretical skills are solid, but there are still real needs for training in new techniques.�


64 KEY EVENTS IN THE NEAR AND MIDDLE EAST

© MdM

YEMEN

ACCESS TO HEALTHCARE Programme in Hajjah

LAST YEAR YEMEN EXPERIENCED ITS SIXTH WAR SINCE 2004. HAVING ALREADY WORKED SEVERAL TIMES IN THE NORTH, AN AREA BADLY HIT BY THE CONFLICT, MDM TOOK ACTION IN 2009 AND WAS ABLE TO REOPEN TWO HEALTH PROJECTS IN FEBRUARY 2010.

In August 2009, the conflict between Houthi rebels and the Yemeni government was particularly violent in Saada region in the north of the country. Telephone communications were cut off, and no international or national media had access. The roads were blocked. The resumption in fighting, therefore, prevents the population from accessing any health services or supplies. For security reasons, MdM had to close its health programme in schools. We had already carried out 15 missions to Saada, providing first aid training to around 300 people. Emergency kits were also distributed. It was only in February 2010 that MdM was finally able to re-open two

health projects — involving mobile clinics. The first takes place around the town of Saada, where the health system is no longer working. The second has been set-up in the displaced persons’ camps around Haradh, near to the border with Saudi Arabia. MdM is also supporting health units in several villages. Lastly, the primary healthcare programme, in place since early 2007 in Hajjah, ended in October 2009. This has been transferred to the local authorities.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

MENTAL HEALTH © Viviane Joakim

IMPROVING CARE Mental health is a growing element of Médecins du Monde’s work in the Middle East. Since 2008, a specialist mental health programme in the Nahr El Bared and Badawi Palestinian refugee camps in the north of Lebanon has offered training in general psychology, psychopathology and psychopharmacology for the staff of two clinics and has provided psychological and psychiatric consultations.

In Iraq, a new mental health component was added, in late 2009, to the Iraqi training programme on pre-hospital care for medical emergencies. The programme’s objective is to train health workers to take mental health into account during primary care consultations. Finally, in the Palestinian Territories, we are still running a medical and psycho-social care programme in Nablus district. Lebanon: mental health of Palestinian refugees

GAZA

SUPPORTING HEALTH CENTRES Israel’s Operation Cast Lead in the Gaza Strip from 27 December 2008 to 18 January 2009 resulted in many victims in the most densely populated area in the world (4,500 inhabitants/km2). 1,380 Palestinians were killed and 5,380 injured. 15 hospitals and 41 health centres were damaged.

© Pauline Beugnies

Emergency following Operation Cast Lead

Doctors of the World supported 25 of the 56 primary healthcare centres set up by the Ministry of Health, by providing equipment and training medical staff. We were able to provide 1,800,000 consultations in 2009. Health education sessions were also carried out in the 25 centres. The emergency services, which were in high demand, were supported in three

hospitals, particularly in relation to orthopaedics. One year after the Israeli offensive, the health system remains inadequate and very weak in Gaza.

AFTER THE ISRAELI OFFENSIVE, THE EMERGENCY SERVICES WERE IN HIGH DEMAND. MDM SUPPORTED THESE SERVICES IN THREE HOSPITALS IN GAZA.


66 NEAR AND MIDDLE EAST

Turkey

Iraq Syria Lebanon Palestinian Territories

Egypt

Yemen

LONG TERM PROGRAMME


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CD You will find the detailed country files for all the programmes in the Near and Middle East on the interactive CD attached to this report.

// EGYPT // IRAQ // LEBANON // SYRIA // PALESTINIAN TERRITORIES // TURKEY // YEMEN


68

Nepal © Benoit Guénot


DOCTORS OF THE WORLD ANNUAL REPORT 2009

EXPLORATORY MISSIONS 2010 AFRICA • Zimbabwe Harare • Somalia Bossasso (migrants) • Algeria (migrants)

OUTLOOK NEW PROJECTS IN 2010 AFRICA

ASIA

• Tanzania (harm reduction) • Chad Kanem (primary healthcare) • Niger Keita, Abalak, Tchintabaraden (nutrition) • Angola Kwanza Norte (primary healthcare) • South-Sudan Jonglei (primary healthcare) • Nigeria Niger Delta (MdM would like to develop a four year project to reduce the effects of oil exploitation on health and improve the situation of the population of the Delta)

• China (harm reduction) • India Orissa state

LATIN AMERICA

LATIN AMERICA • Southern Cone in South America (harm reduction) • Bolivia Sucre, Chuquisaca (mother and child health and genderbased violence)

EUROPE • Poland (Chechen refugees) • Chechnya

MIDDLE EAST • South Lebanon Palestinian refugee camps (mental health)

CAPITALISATION PROGRAMMES 2010 • Mexico Chiapas; primary healthcare: from 1997 to 2010 13 years of Doctors of the World’s presence • Tanzania Bukoba; HIV: from 1992 to 2010 18 years of Doctors of the World’s presence • Chechnya; primary healthcare: from 1997 to 2010 13 years of Doctors of the World’s presence

• Guatemala Escuintla (right to sexual and reproductive health women working in the export industries) • Uruguay Montevideo (mother and child health and reproductive health) • Peru Lima (mother and child health and reproductive health) • Mexico Tapachula (sexual and reproductive health in female migrant sex workers and domestic workers) • Colombia Nariño (Support to the Unipa indigenous health centres in four Awas indigenous reserves)

ASIA • Laos Champassak (mother and child health and reproductive health) • Nepal Sindhupalchok district (mother and child health and reproductive health)

EASTERN EUROPE • Georgia Tbilisi (harm reduction)

69


70

INTERNATIONAL NETWORK


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CONTENTS // 72 Renewed energy at the heart of the network // 74 Map // 76 Scope of international programmes 78 Argentina 79 Belgium 80 Canada 81 Germany 82 Greece 84 Japan 85 Netherlands 86 Portugal 87 Sweden 88 Spain 90 Switzerland 91 United Kingdom

92 European Observatory on Access to Healthcare

71


72

INTERNATIONAL NETWORK 2009 BUILDS ON LAST YEAR'S IMPETUS 2009 has been a year of stabilisation for the network. Following the Board of Directors’ decision to end brand licensing agreements that linked MdM France with MdM Cyprus and MdM USA, both organisations left the network, the latter in August 2009.

his has been a year of stabilisation for the network. Following the Board of Directors’ decision to end brand licensing agreements that linked MdM France with MdM Cyprus and MdM USA, both organisations left the network, the latter in August 2009. The number of network members has gradually evolved and numbered 14 organisations on 31 December 2009.

T

The reinvigoration of the international network triggered visits to the international offices throughout 2009, including technical and bilateral or multilateral policy meetings. These all led in various ways to the organisations working together on common initiatives and facilitated co-ordination and dialogue within the network. Publication of the second European Observatory on Access to Healthcare report (in September), the increase in operational co-ordination in the field (Palestine, Mali, Haiti, etc.) and financial support of network member projects by, or through, other members, have been so successful in 2009, confirming the international network’s new approach.

The International Network Head Office (DRI in its French acronym), led by both MdM France and MdM Spain, has also taken part in the development and improvement of tools and procedures necessary to ensure effective healthcare delivery and advocacy. The International Network Head Office, which was created in 2008 to push forward and co-ordinate the operational revival of the network, got into its stride. A team of six people based in Paris and Madrid will now support the network members in their institutional development according to their means and needs, and by doing so, create the best conditions for MdM as a whole to develop. From now on, through shared management by MdM Spain and MdM France (which represent between them nearly 90% of the network operations), the DRI is charged with developing healthcare delivery and advocacy for all network members. It drives exchanges and facilitates partnership working in both international and national projects, and also in areas such as communications, advocacy, financial and human resources.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

Relaunching the network means both the reinforcement of operational links between network members, for healthcare and advocacy projects, and better collaboration on financial and human resources. The DRI focused on two key areas of work. One was the development of operational partnerships: - strengthening collaboration in terms of communication, advocacy and local actions; - strengthening collaboration on international programmes (emergency and development). Secondly, there was a focus on sharing resources: - developing financial resources partnerships; - developing human resources partnerships. Lastly, in an international network where we have to communicate in a number of languages, we have added an employee to the team who is now in charge of monitoring the quality of institutional document translations produced by all network members.

All network members agree to respect the international aims of MdM, reaffirming the values and founding principles of the network.

THE INTERNATIONAL NETWORK MEMBER ASSOCIATIONS » Doctors of the World Argentina http://www.mdm.org.ar » Doctors of the World Belgium http://www.medecinsdumonde.be » Doctors of the World Canada http://www.medecinsdumonde.ca » Doctors of the World France http://www.medecinsdumonde.org » Doctors of the World Germany http://www.aerztederwelt.org » Doctors of the World Greece http://www.mdmgreece.gr » Doctors of the World Italy www.medicidelmondo.it

» Doctors of the World Japan http://www.mdm.or.jp » Doctors of the World Netherlands http://www.doktersvandewereld.org » Doctors of the World Portugal http://www.medicosdomundo.pt » Doctors of the World Spain http://www.medicosdelmundo.org » Doctors of the World Sweden http://www.lakareivarlden.org » Doctors of the World Switzerland http://www.medecinsdumonde.ch » Doctors of the World UK http://www.doctorsoftheworld.org.uk


74 SCOPE OF INTERNATIONAL PROGRAMMES

United Kingdom Canada France Spain Portugal

Algeria Cuba

Mexico

Dominican Republic Haiti

Honduras

Guatemala El Salvador Nicaragua

Curaçao

French Guiana (Fr)

Colombia

Mali Niger Mauritania Chad Senegal Burkina Faso Guinea-Bissau Guinea Sierra Leone Liberia Benin

São Tomé and Príncip

Ecuador

Peru

Bolivia

Namibi

Argentina

INTERNATIONAL PROGRAMMES

NATIONAL PROGRAMMES


Sweden Russia Belgium Netherlands Germany Serbia Romania Bulgaria Moldova

m Switzerland

Turkey

Afghanistan

Greece Iraq

Lebanon

Syria Palestinian Territories

China Nepal

Egypt

Burma Pakistan

Vietnam India

Yemen Cambodia

Eritrea Sudan Ethiopia Uganda Somalia

pe

Rwanda Dem. Rep. of Congo

Indonesia

Tanzania Timor-Leste Mozambique Mayotte (Fr)

Angola

Madagascar a

Reunion (Fr)

Zimbabwe


76

SCOPE OF INTERNATIONAL PROGRAMMES In 2009, the international MdM network as a whole carried out 152 international programmes in 64 countries and 210 national projects in 14 countries. The international network works across all continents to restore, or quite simply to enable, access to care for the most vulnerable.

PROGRAMMES ON ALL CONTINENTS Africa, the continent whose countries have some of the worst health indicators in the world, remains top of the list in terms of the international Doctors of the World network projects. Most of the international members have projects running in Africa. Examples are: the HIV care and prevention programme carried out by MdM Portugal in the district of Namaacha (Mozambique); the primary and reproductive healthcare project carried out by MdM Spain in Mauritania; the programme to support the central pharmacy of the Ministry of Health for Sahrawi people supervised by MdM Greece; and the support given to children living on the streets of Bamako put in place in Mali by MdM Belgium. These examples demonstrate the diversity of our programmes across Africa. Latin America is, after Africa, the continent where the greatest number of our international programmes are carried out — nearly a quarter take place there, mainly (outside the Caribbean) run by MdM Spain and MdM Argentina. Here again, the programmes are extremely diverse. MdM Switzerland runs a project to fight malnutrition in Petit Goave and Grand Goave in Haiti.

MdM Argentina runs community health projects, as well as a programme to fight Chagas disease, in the northern provinces of Argentina, whilst MdM Spain works on an integrated sexual and reproductive health programme for vulnerable women in Chiquimula, Guatemala and MdM Netherlands has an HIV/AIDS prevention project in Curaçao. In Asia and the Middle East, where the global network is less active (with less than one fifth of our programmes), our work is focused on crisis zones like the occupied Palestinian territories where MdM Switzerland and MdM Spain carry out programmes in the fields of mental health and surgery respectively, or in the least developed areas of a country, as in Indonesia where there is a programme focused on improving access to care for mothers and children run by MdM Netherlands in Bener Meriah, Banda Aceh. A COMMON GOAL: ACCESS TO CARE All the international network programmes aim to restore, or quite simply to facilitate, access to care for the most vulnerable people. As in Europe, MdM Argentina and MdM Canada work on national projects concerning access to


DOCTORS OF THE WORLD ANNUAL REPORT 2009

care for people who are de facto excluded from the health system. The network members’ international programmes also focus on access to care for those who are excluded for economic, social or legal reasons. These programmes also aim to ensure access to care for people excluded for religious or ethnic reasons. The health of women and children is at the heart of our work. The most striking demonstrations of our organisation’s commitment to these areas of health, which represent a third of international network activities, are: a programme committed to improving the sexual and reproductive health of women living in the Matagalpa region in Nicaragua run by MdM Canada, programmes developed on the same themes by MdM Spain in several countries in Central America (El Salvador, Honduras, Guatemala…) and the street children projects set up by MdM Belgium in Bamako, Mali and by MdM France in Kinshasa. MdM carries out programmes to help ethnic minorities, such as the one for food security for indigenous communities living in Mollepata (Cuzco, Peru) run by MdM Argentina, and the fight against tuberculosis amongst the indigenous communities in Chiapas (Mexico) led by MdM Switzerland. Other actions target “high risk populations” such as sex workers, people who use drugs and migrants, (e.g. the harm reduction project in Kachin, Burma) or access to care for migrants and asylum seekers in prison (e.g. MdM France’s programme in Lebanon).

While this approach is based primarily on themes, it nevertheless tallies with people's needs. Because our international network members strive to give access to care for the most vulnerable people living in areas deprived of health systems, almost two thirds of the programmes are focused on access to care or on primary care. Examples include those implemented by MdM Spain in the Sahrawi refugee camps, by MdM Belgium in Eastern Kasaï and Western Kasaï (DRC), by MdM Portugal in Mavinga in Angola or by MdM Canada in San Luis, Dominican Republic. Prevention, and care for those living with HIV/AIDS, remain an important part of our work throughout the international network. This is demonstrated by the diversity of programmes to fight the spread of this disease which include the multi-country prevention and care programme (Angola, Mozambique, Senegal, Namibia) run by MdM Spain, the project focused on prevention of mother-to-child transmission of HIV in Choscal, Cité-Soleil, Port-au-Prince, in Haiti and prevention and testing for HIV/AIDS led by MdM Portugal in São and Príncipe. Lastly, mental health programmes, like those developed by MdM Spain, MdM France and MdM Switzerland in Palestine, represent a smaller but growing part of our network’s activity.

FOR MORE INFORMATION ON THE PROGRAMMES RUN BY OTHER MEMBERS OF MDM’S INTERNATIONAL NETWORK: WWW.MDMINTERNATIONAL.ORG

77


78

ARGENTINA

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Médicos del Mundo Argentina Alberti 48 - Ville Vs. As. Tel/Fax: (00 54 11) 4954 0080 www.mdm.org.ar medicosdelmundo@mdm.org.ar CONTACT

» President: Gonzalo Basile medicosdelmundo@mdm.org.ar BOARD OF DIRECTORS

» President: G. Basile » Vice-presidents: J. Meritano, M. Gorban » General Secretary: C. Tcholakian » Treasurer: A. Dones » Other Board Members: A.-C. Cafaro, D. Cordoue, P. Sale, N. Lucatelli, M. Quartier, M. Otamendi, J. Radesca Registered as a charity under Argentinian law in November 1998.

ACKNOWLEDGEMENTS The Alliance Francaise of Buenos Aires, Australian Embassy in Argentina, Spanish Embassy in Argentina, French Embassy in Argentina, New Zealand Embassy in Argentina, Aprodes Association, Association of Healthcare Professionals of Buenos Aires Region, Credicoop Bank of Argentina, Argentinian National Bank, Civil Society Advisory Counsel, Argentinian Chancellery Esonos, Baxter Foundation, Bambini Foundation, Fondation Navarrese Viole HSBC, OTC AECID Argentina, OTC AECID Peru, others.

» NATIONAL PROJECTS MdM Argentina works with socially excluded people living in metropolitan Buenos Aires and the surrounding area. There are four target groups: • children living on the streets and homeless adults in Buenos Aires; • migrants living in Buenos Aires; • pressure groups and community organisations from the Buenos Aires region; • prisoners in the Buenos Aires region. Outside Buenos Aires, MdM Argentina runs a programme to re-establish access to care for the indigenous communities of Santiago del Estero, Formosa and Chaco and combats the dengue epidemic in these zones by improving prevention and health promotion activities amongst vulnerable communities. The Altiplano Jujuy project aims to improve primary healthcare and access to care for women and children who are part of the indigenous communities in the Puna Jujeña plateau (Jujuy region: Cochinoca, Rinconada, Susques and Santa Catalina departments).

» INTERNATIONAL PROJECTS Internationally, MdM Argentina concentrates its work on the South American continent: • In Peru, following the earthquake in August 2007, MdM set up a primary healthcare programme (with a focus on food security for women and children). MdM Argentina is currently seeking funds to extend this programme and to open, in partnership with a Peruvian association, a food security programme for indigenous communities in the Mollepata zone (close to Cuzco). • In San Pedro, Paraguay, in 2009 MdM Argentina carried out an exploratory mission with the aim of supporting food security for rural and indigenous communities and offering primary healthcare. MdM Argentina collaborates with the community health department of the National University of

Paraguay and delivers training in community health and epidemiology. • MdM Argentina also plans to work in Brazil with communities living in Joao Pessoa and Belem, Nordeste region.

» COMMUNICATION AND EVENTS • MdM Argentina co-ordinates the national round table for the Argentinian Social, Health and Environment Forum. • As a member of the Executive Committee of the World Social Health Forum, MdM will organise the Social Forum on Health for the southern chapter. • MdM Argentina participates in the international health commission as part of the MERCOSUR civil society council and delivery of recommendations at the MERCOSUR Social Summit. • Presented the Luis Valtueña exhibition in Buenos Aires. • Organised several academic events to celebrate 10 years of MdM Argentina, including a debate entitled International crisis and community health in Latin America and a training seminar on cross-cultural working, migration and indigenous people.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

BELGIUM » INTERNATIONAL NETWORK

CONTACT DETAILS

» Médecins du Monde Belgique Rue de l’Éclipse, 6 1000 Brussels Belgium Tel: +32 (0)2 648 69 99 Fax: +32 (0)2 648 26 96 www.medecinsdumonde.be infos@medecinsdumonde.be CONTACT

» Director: P. Verbeeren info@medecinsdumonde.be EMPLOYEES

» Director: P. Verbeeren International Programme Coordinator: P. Pauwels Belgian Programme Co-ordinator: F. Vanbiervliet Human Resources: A. Saunders Secretary: A. Al Badaoui Marketing Manager: D. Baise Communications Manager: N. Rodembourg Finance Director: A. Puligheddu Accountants: L. Stokart, M. Castelain » 10 paid staff in Belgium; 150 permanent volunteers in Belgium; 10 expatriates in Africa; 66 paid national staff in Africa. BOARD OF DIRECTORS

» President: M. Degueldre » Vice-president: E. Struys » Board Representative: M. Bellis » Secretary: P. Deltour » Other Board Members: D. Van Osta, P. Viart, E. Gatera Registered as a charity under Belgian law May 1999.

ACKNOWLEDGEMENTS PSF, Ulysses, the Red Cross, MSF, Cire, Vluchtelingenw erk Vlaanderen, Caritas, City and CPAS of Antwerp, Welzijnszorg, Umicore, P& V, Ackermans - Van Haaren, Wild Wood, GBL, Mr. Paul Emmanuel Jansen, L.Bégault, Euro-RSCG.

» NATIONAL PROJECTS Healthcare and Advice Clinic in Antwerp. MdM has taken over and extended the activities of the access to care project set up by MSF. Priorities: access to antenatal care, access to mental healthcare, campaigns to raise public awareness about access to care for migrants. In 2009, the clinic carried out 1,123 consultations, 188 psychiatric consultations, 1,703 social consultations and 276 psychological consultations. Brussels – Project to support asylum seekers. MdM carried out a paramedical project for two and a half months in response to the asylum seeker reception crisis. The mobile teams carried out 563 consultations (first aid, screening for medical and psychiatric problems, advice, etc.) A symbolic act of setting up “a refugee camp in the middle of Europe” was carried out in collaboration with four other NGOs — MSF, Vluchtelingenwerk Vlaanderen, Cire and Caritas — in November in Brussels.

» INTERNATIONAL PROJECTS Mali. Improvement of public health in Mopti through delivering better access to primary healthcare. This project, set up in May 2009, works on four fronts: • training for “bush health workers” and traditional birth attendants; • supervising health services, raising awareness and providing treatment; • refurbishing medical structures and equipping them with drugs and medical materials; • setting up local support groups to refer people on to a hospital with a surgical department and a doctor. Democratic Republic of Congo. Revitalisation of healthcare provision in the Ndesha region. The project aims to restore medical provision in this region by supporting the health centres, hospitals and the regional head office. It focuses on four areas:

• refurbishment of health infrastructure (construction of three maternity units and three dispensaries); • supplying drugs, medical consumables and equipment; • supervision of the health centres and hospitals; • training and development for healthcare professionals; • malaria treatment.

» COMMUNICATION AND EVENTS • Public awareness campaign highlighting access to care for homeless people (mid-November to mid-December 2009). • Organisation in Brussels of the press conference for the launch of the second report of the European Observatory on Access to Healthcare. • Presentation of the Darkroom of Neglect photographic exhibition at Antwerp Station in October 2009 (6,000 visitors over seven days.) • Organisation of an official VIP reception in aid of MdM, on 26 September 2009 (more than 150 guests).


80

CANADA

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Médecins du Monde Canada 338, rue Sherbrooke-Est Montreal, QC, H2X 1E6 Canada Tel: 514 281 8998 Fax: 514 281 3011 info@medecinsdumonde.ca www@medecinsdumonde.ca CONTACTS

» info@medecinsdumonde.ca General Director: André Bertrand

» NATIONAL PROJECTS The Montreal project, launched in 1999, aims to offer healthcare for travellers and those who are marginalised and excluded from healthcare provision in Quebec. Implemented in collaboration with community organisations in Montreal, the project also offers psychological support and clinical supervision for community health agents. MdM undertook a needs assessment in Quebec and is exploring the possibility of developing a project for vulnerable migrants without medical cover.

EMPLOYEES

» General Director: A. Bertrand, P. Boudreault, A. Houle, I. Mas, Y. Messier, R. Rajaonarison, M.-M. Ross, A. Sirois, F. Sinzinkayo, V. T. Huynh BOARD OF DIRECTORS

» President: N. Bergeron » Vice-president: C. Galand » Treasurer: F. Scarborough » Secretary: H. Duong » Officer (without right to vote): A. Bertrand » Other Board Members: Z. Brabant, M. Duniewicz, M.-F. Hervieu, S.-R. Hypollite, M.-R. B. Lajoie, M. Milne Registered as a charity under Canadian law in May 1999.

ACKNOWLEDGEMENTS Canada International Development Agency (CIDA), United Nations Population Fund, Quebec Ministry for International Development, the World Food Programme, UNICEF, Canadian centre for decentralized fund management for Haiti, Canada Fund for Local Initiatives (CFLI) in Haiti, Martin Duquette pharmacies, AstraZeneca Canada Inc., J. Armand Bombardier Foundation, the Montreal Regional Office for Health and Social Services, Bazinet and partners, and Human Resources and Skills Development Canada.

» INTERNATIONAL PROJECTS In Haiti, seven projects are ongoing in partnership with the Sainte-Catherine-Laboure Hospital (Choscal) in the Cité-Soleil district, in Port-au-Prince: • programme to prevent transmission of HIV/AIDS from mother to child; • reproductive healthcare programme to improve the quality of care offered to expectant mothers, those of childbearing age or victims of sexual violence; • support for the vaccination unit and nutritional care for children and women of childbearing age; • comprehensive care for people living with HIV/AIDS: prevention, care and treatment (including antiretrovirals), psychological and nutritional support; • child development training aiming to offer 6,380 vulnerable children — through parental coaching — better emotional, intellectual and social development; • support for a paediatric unit which aims to reduce infant mortality; • hospital treatment and palliative care for people living with HIV. Finally, work in 2009 was dominated by emergency responses to hurricanes Gustav, Hanna and Ike. In the Dominican Republic, the project for people living in San Luis and the surrounding area aims at increasing and improving

access to primary healthcare, and supports the prevention of HIV/AIDS transmission from mother to child. In Nicaragua, there is a project to improve sexual and reproductive health for women who are victims of sexual violence in Matagalpa.

» COMMUNICATION AND EVENTS • To celebrate its 10th anniversary, MdM Canada organised several events including a fundraising event. • Organisation of four conferences in secondary schools, universities and hospitals in Quebec, on the topics of poverty, AIDS and women's health. • Organisation, in partnership with the Sexperts group, of interactive conferences with young people from secondary schools (14-17 years) on sexual health. • Participation in International Development Week through hosting information stands in Montreal, Quebec and Gatineau to disseminate information about MdM's work.

» FINANCIAL SUPPORT Zimbabwe: AIDS programme run by MdM France.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

GERMANY

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Aerzte der Welt e.V Baumbachstr. 15 81245 Munich Germany Tel: +49 89 45 23 081 - 0 Fax: +49 89 45 23 081 - 22 www.aerztederwelt.org info@aerztederwelt.org CONTACT

» Director: M. Gemeiner info@aerztederwelt.org EMPLOYEES

» Human Resources: O. Beniflah National Projects Co-ordinator: M. Chenevas Secretary: S. Erwied Health and Development: L. Feszczak Director: M. Gemeiner Communications: D. Perrot MedMobil Stuttgart: I. Scherrenbacher Open.med. Project Assistant: E. Yüksekdag BOARD OF DIRECTORS

» President: H. Zenker » Vice-president: P. Rosenstiel » Honorary President: W. Schilli » Treasurer: M. Rudolf W. Schmitt » Other Board Members: M. Heinzlmann, B. Stambul, F. Scheffer, K. Schwenzer, H. Schneider, N. Schmidt, G. Lauer Registered as a charity under German law on 19 March 1999.

ACKNOWLEDGEMENTS The German Ministry of Foreign Affairs, Munich Council, Aktion M ensch, Tollwood GMBH, Eine-W eltH aus M ünchen, Bürgerstiftung Zukunftsfähiges M ünchen, München North-South-Forum, Sternstunden e.V., Cafe 104, Bayerischer Flüchtlingsrat, M ünchnerAids-H ilfe, ConSol* Consulting & Solutions Software GMBH, Olympus Europa Holding GMBH, Stuttgart Council, Renovabis e.V., Am bulante H ilfe Stuttgarte.V., M ünchnerAids-H ilfe and all the volunteers who supported us in 2009.

» NATIONAL PROJECTS

» HUMAN RESOURCES SUPPORT

• Development of the Open.med healthcare and advice clinic in Munich, with the opening of a paediatric clinic. • Launch of MedMobil project in Stuttgart, intended for people in difficulties and/or homeless.

• Opération Sourire in Cambodia: 16 volunteers: (surgeons, anaesthetists, pediatricians, nurse, theatre nurse, dentist). • Two German doctors joined MdM France missions to work in Ethiopia and Afghanistan.

» INTERNATIONAL PROJECTS • Three Opération Sourire missions sent to Cambodia (in Kampong Cham, O Reang OV and Phnom Penh).

» COMMUNICATION AND EVENTS • Organisation of a round table discussion in Berlin with fellow NGOs, administrative and political representatives, and of a press conference for the presentation of the second European Observatory on Access to Healthcare report. • Presentation of the photographic exhibition Darkroom of Neglect at the Tollwood winter festival in Munich (more than 30,000 visitors, four events showcasing the work of MdM in Germany and internationally, to visiting school parties). • Joint organisation of XIth Theory and practice of humanitarian aid congress in Berlin. • Presentation of the Luis Valtueña photographic exhibition in Berlin.

» FINANCIAL SUPPORT • Liberia: primary healthcare, mental health and community health. • Sudan: primary healthcare. • Haiti: primary healthcare and mother and child care (Grand' Anse). • Bulgaria: primary healthcare.


82

Haiti © Sophie Brändström


GREECE » INTERNATIONAL NETWORK

CONTACT DETAILS

» Doctors of the World Greece Sapfous Street, 12 10553 Athens Greece Tel: + 210 32 13 150 Fax: + 210 32 13 850 info@mdmgreece.fr http://www.mdmgreece.gr CONTACT

» info@mdmgreece.fr BOARD MEMBERS

» President: K. Nikitas » Vice-president: A. Christos » 2nd Vice-president: K. Spiridon » General Secretary: E. Mouloudaki » Treasurer: S. Christos » 2nd General Secretary: F. Olympidis » Other Board Members: G. Ioannis, M. Ioannis, A. Antonios

ACKNOWLEDGEMENTS

» NATIONAL PROJECTS Open polyclinics Three polyclinics have been open in Athens (since 1997), in Thessalonika (since 2001) and Candie (since 2007). Teams of volunteer doctors, nurses, social workers and psychologists provide medical care including medicines and psychosocial support for people living without access to care, such as refugees, undocumented migrants and the homeless. In 2009, MdM extended its activities by opening a polyclinic close to Piraeus. Reception Centre for Refugees The reception centre for refugees re-opened in October 2009. 198 people were helped. With the capacity to help 70 people, this centre offers food and shelter and is open 24 hours a day. Located in the same building as the polyclinic, it allows refugees to access care and provides health promotion. The social support also offered by the reception centre helps people to solve their social problems.

Alpha Bank, Stavros Niarchos Foundation, Vodafone.

Mobile Medical Units MdM created four mobile care units to offer primary care to people living in remote regions with limited access to medical services. The mobile care projects include: • the Lito project, which makes it possible to provide paediatric and dental care for children living in zones where access to care is difficult. Nearly 4,000 children benefited from the Lito programme in 2009; • the Iris project which provides eye care for children and the elderly with serious eye problems. More than 3,600 people benefited from the Iris programme in 2009; • the Roma project, offering weekly medical, pharmaceutical and psychosocial support in the Roma camps situated on the outskirts of Athens. In 2009, more than 1,200 children were vaccinated. Home Care Project (Thessalonika) MdM organises home consultations for patients without access to the national heathcare system who are unable to

travel to the MdM healthcare centres. Streets of Athens harm reduction programme Targeting people who use intravenous drugs in the centre of Athens, it enables us, within the framework of weekly consultations, to promote needle exchange and substitution treatment, to administer primary care, to offer psychological support and to carry out prevention and publicity campaigns. It offers, moreover, the possibility for intravenous drug users to benefit from HIV and hepatitis B and C testing. In 2009, more than 3,000 contacts were made.

» INTERNATIONAL PROJECTS Sahrawi Refugee Camps in Southern Algeria Provision of drugs and medical consumables and improvement of pharmaceutical system management in the Sahrawi refugee camps (Tindouf, Algeria). The goal is to support the medical system and, in particular, the central pharmacy in order to support the supply, storage and distribution of pharmaceutical products. Uganda Support for the medical departments of the Kampala orthodox archdiocese hospital and support for Monte village healthcare centre (200 km north of Kampala).

» COMMUNICATION AND EVENTS Since November 2009 MdM has been part of a network of 47 organisations which monitors the Convention on the Rights of the Child. The goal of the network is to oversee proper application of the Convention. MdM is responsible for monitoring health rights. Organisation in December in Athens of a conference entitled “The Western Sahara, a forgotten crisis.”


84

JAPAN

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Doctors of the World Japan PMC Building 4F 1-23-5 Higashi-Azabu Minato-ku, Tokyo 106-0044 Japan Tel: 0081 3 3585 6436 Fax: 0081 3 3560 8073 http://www.mdm.or.jp info@mdm.or.jp CONTACTS

» info@mdm.or.jp P. Helfter (Director) EMPLOYEES

» S. Hatanaka, P. Helfter (Director), Y. Kumano, N. Kuroyanagi, A. Nakamura, M. Seki BOARD OF DIRECTORS

» President: G. Austin » Other Board Members: A. Bourdé, P. David, F. Foussadier, M. Harada, H. Isomura, A. Kiuchi, N. Oura, N. Yamada, S. Terashima, S. Yoza

ACKNOWLEDGEMENTS Alsok, Anne Fontaine, Asahi Pretec, American Express, Astellas, Cathay Pacific, Chanel, Christofle, Club Med, Comptoir des Cottoniers, Daiichi Sankyo, Expert Alliance, Felissimo, French Food Culture Centre, French Blue Meeting, Fund Creation, Greeting Life, Health Cooperative Association, HR Institute, Ichiyoshi Shoken, International Japan Co-operation Fund, JM Weston, Johnson & Johnson, Mitsui Sumitomo Bank, Perfumes Givenchy, Poiray, Sonia Rykiel, Tamada Projects Corporation, Victorian Box, Villeroy & Boch, Wafrica

» NATIONAL PROJECTS MdM Japan designed its first domestic project, due to begin in spring 2010. It aims to improve the health and quality of life for homeless people in Tokyo, in particular of those suffering from mental health problems. In the needs assessment phase, several seminars aimed at an audience of medical and non-medical volunteers were organised on exclusion and mental health. A survey was carried out amongst 200 homeless people in order to better respond to their mental health needs. In the context of disaster risk reduction MdM Japan conducted a study looking at public and private plans in Japan for the response to natural disasters. The study will serve as a template for response in the event of a natural disaster affecting this country.

» INTERNATIONAL PROJECTS Opération Sourire MdM Japan organised four Opération Sourire missions in 2009: two in Cambodia (Battambang) and two in Bangladesh (Dakka). More than 150 patients were operated on during the year.

» COMMUNICATION AND EVENTS Lobbying the Japanese government on the financial aspects of access to care. A three week project in Nepal financed by the Japanese Agency of International Co-operation (JAIC) in order to produce a paper on the policy implemented by the Nepalese Government on free access to care. MdM Japan also gave its support to a campaign in favour of better social protection for asylum seekers in Japan. Other actions: • Organisation of nine seminars presenting the work of MdM in colleges and universities for more than 1,000 young people.

• Stands at festivals: Tokyo Pride, Earth Day, Earth Garden, Lifestyle Forum, Global Festa, African Festa and others… • Organisation of a conference on humanitarian action with 120 participants at the Tokyo Franco-Japanese Institute. There were three speakers: Dr. Keiko Akahane, Dr. Pierre Micheletti and Dr. Satoshi Yoza, all experienced humanitarian workers involved in MdM Japan or MdM France.

» FINANCIAL SUPPORT • Angola: primary healthcare • Gaza: emergency • Indonesia: emergency • Moldova: violence against women • Nepal: mother and child health • Niger: mother and child health • Opération Sourire • DRC (Kinshasa): young girls on the streets • DRC (Tanganyika): primary healthcare • Somalia: primary healthcare • Sudan: primary healthcare • Zimbabwe: HIV/AIDS mission

» HUMAN RESOURCES SUPPORT 17 Japanese volunteers sent to three countries: • Bangladesh (five surgeons and four nurses) • Cambodia (five surgeons and two nurses) • Sudan (one nurse)


DOCTORS OF THE WORLD

NETHERLANDS

ANNUAL REPORT 2009

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Dokters van de Wereld Nieuwe Herengracht 20 1018 DP Amsterdam Netherlands Tel: 0031 20 465 2866 Fax: 0031 20 463 1775 info@doktersvandewereld.org www.doktersvandewereld.org CONTACT

» info@doktersvandewereld.org Director: M. Koppe

» NATIONAL PROJECTS MdM Netherlands continues to implement projects targeting the most vulnerable people in the Netherlands and administrative territories like the Dutch Antilles. Roma and Sinti Advice and access to care for women and young people. Training and health education for Roma and Sinti people in the Netherlands.

EMPLOYEES

» S. Godschalk, A. M. Scholten, A. Bovend’eerdt, S. Zwaan, A. de Jong, P. Nieuwenburg, S. Voogt, R. Arts, M. van Welie, B. Jurg, C. Paulussen » Left during the year: A. van der Voorn, H. van Nes BOARD OF DIRECTORS

» President: F. Sivignon » Secretary: M. Diaz » Treasurer: C. van Rijn » Other Members: H. Teunisse, B. Juan B. ten Kate, D. Jan Pot Registered as a charity under Dutch law on 28 April 1997.

ACKNOWLEDGEMENTS Aids Fund/SBL, Cordaid, Icco Kerk in Actie, Oxfam Novib, Ministry of Foreign Affairs (Matra, MFS), Euro-RSCG, MPG, Sandra van Noord - Bureau voorteksten redactie, PIN, Skan Fund, Fondation Maagdenhuis, NutsOhra Fund, Unicef, Doen Foundation, Maria Stroot Fondation, Kerk in Actie, Charity Works, Friesland Foods, Loterie Actions Foundation, CCI IT Group, Hampshire Inn Amsterdam, Sibiu Design, Youngwoods, Senshake, 100 % NL, BNR Newsradio, National Geographic, NS, QMusic, Radio 538, RTL, SBS, Skyradio and thanks to all of our volunteers, interns and thousands of private donors.

Undocumented migrants programme Improving access to care for undocumented migrants in Amsterdam, The Hague, Utrecht and Rotterdam. Distribution of medical documents for undocumented migrants and an information campaign for undocumented migrants and healthcare professionals on access to care. Curaçao (Dutch West Indies) Programme for reproductive health and prevention of HIV/AIDS.

• Organisation of the debate Zorgplicht in knel featuring medical professionals discussing difficulties in access to care for migrants. • Organisation of a campaign around the publication of the Niet Vergeten report (Medoc programme on access to care for immigrants) with a call to action targeting health authorities and policymakers.

» FINANCIAL SUPPORT • DRC: Kinshasa • Darfur • Opération Sourire • Zimbabwe: HIV/AIDS • Gaza • Burma: Pyapone • Pakistan: earthquake emergency • Indonesia (Western New Guinea): HIV/AIDS and primary care • Burma: HIV/AIDS

» HUMAN RESOURCES SUPPORT » INTERNATIONAL PROJECTS MdM Netherlands has started international projects in Indonesia and in Serbia in partnership with MdM France. In Aceh-Bener Meriah, Indonesia, the programme aims to improve access to care for mothers and children. In Serbia, the programme, in partnership with local NGO Veza, aims to prevent HIV/AIDS amongst drug users.

» COMMUNICATION AND EVENTS Distribution of the European Observatory on Access to Healthcare report led to the publication of many articles and interviews in newspapers and the broadcast of a programme on national radio. • Bimonthly publication in a national newspaper featuring Suzanne Viveen, volunteer in Colombia. • Presentation of the exhibition Darkroom of Neglect at the central station in The Hague.

12 expatriates on nine projects run by MdM France: • Burma: a programme co-ordinator, an administrative coordinator • Darfur: a nurse • Liberia: a mental health advisor • Indonesia: a nurse • Colombia: a doctor • Palestine: a co-ordination assistant, a site co-ordinator • Zimbabwe: an administrator, a medical co-ordinator • Iraq/Jordan: an administrator • Ethiopia: a midwife


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PORTUGAL

» INTERNATIONAL NETWORK

CONTACT DETAILS

» NATIONAL PROJECTS

» COMMUNICATION AND EVENTS

» Médicos do Mundo Portugal Av. de Ceuta, Sul Lote 4, Loja 1 1300-125 Lisbon Tel: + 351 213 619 520 + 351 213 619 521 Fax: + 351 213 619 529 www.medicosdomundo.pt mdmp-lisboa@medicosdo mundo.pt

Lisbon: Noite Saudável (‘healthy night’) project The project aims to reduce the prevalence of STIs, HIV and opportunistic infections for people living on the streets. During 2009, 1,150 people benefited from this project which works directly with people living on the streets. Maintaining quality in the confidentiality, professionalism and integrity of outreach activities and follow-up of the cases, is essential to the teams.

MdM Portugal organised Corrida Solidária for the second year running. Thanks to this project, 740 schools were involved in supporting MdM in Portugal and Timor-Leste. In November 2009, Portugal Radio Television (RTP in its Portuguese acronym) galvanised the support of its viewers in aid of MdM. The broadcast of the RTP programme generated 50,000 calls to the number dedicated to MdM's work.

CONTACT

» joaoblasques@medicos domundo.pt J. Blasques (Director of Operations) EMPLOYEES

» International Projects Department: P. Fernandes, A. Oliveira, S. de Deus National Projects Department: C. Fernandes Marketing, Communication and Events Department: S. Peres, R. Pereira, S. Castilho Adminstration and Finance Department: V. Domingos, M. Tavares, D. Mameri Human Resources and Volunteer Department: F. Cordeiro BOARD OF DIRECTORS

» President: A. Antunes » Vice-president: A. Andrade » Vice-president: P. C. Seixas » Treasurer: M.-M. Santa Maria » Other Board Members: C.-V. Velho, C. Palma, F. Luís

Alentejo: HIV/AIDS prevention programme This programme aims to decrease HIV/AIDS infection rate in Alentejo, through promotion of safe sex.

» INTERNATIONAL PROJECTS Timor-Leste: Comunidade Saudável (healthy community) The project aims to support access to care for rural Timorese communities by implementing an integrated community health programme with the Ministry of Health. The intervention focused on three areas: • operational improvement and access to healthcare services for mothers and children; • information campaign to improve access to mother and child health consultations; • development of collaboration between key health workers (private organisations, civil society groups and state health services). Guinea-Bissau: “Protege a tua Vida / Tadja bu Bida“ (Protect your life)

ACKNOWLEDGEMENTS Câmara Municipal de Oeiras, Comissão Europeia, Coordenação Nacional para a Infecção VIH/sida, Direcção Geral de Saúde, French embassy in Mozambique, French embassy in São Tomé and Príncipe, ESSO, Calouste Gulbenkian Foundation, Fundo Global Gebalis, Instituto Português de Apoio ao Desenvolvimento (Ipad), ISS – Instituto de Segurança Social, Plan International, UNDP, Projecto de Apoio ao Sector Social (Pass), Programa Escolhas 3ª Geração, Programa Nacional de Luta Contra a Sida (São Tomé and Príncipe), Secretariado Nacional de Luta contra a Sida (GuineaBissau), Sidaction (São Tomé and Príncipe), UNICEF

This project (which is in its third year) includes four areas of the country (Bissau, Bubaque, Bafatá and Gabú) and aims to reduce prevalence of HIV/AIDS and STIs in Guinea-Bissau.


DOCTORS OF THE WORLD

SWEDEN

ANNUAL REPORT 2009

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Läkare i världen Sverige Box 39006 SE-100 54 Stockholm Sweden Tel: +46 8 664 66 87 Fax: +46 8 663 66 86 www.lakareivarlden.org info@lakareivarlden.org CONTACT

» L. Gamble (Director) EMPLOYEES

» L. Gamble (Director), C. Lidén, C. Brunnström BOARD OF DIRECTORS

» President: L. Jansson » Vice-president: M. Morin » Treasurer: K. Fransson » Other Board Members: A. Björkman, A. Dorazio, K. Johnsson, L. Lavicka, M. Rickman Törnqvist, K. Meseret Andersson » Substitutes: S. Hultén, J. Mair, M. Lengquist, D. Shakely » MdM Sweden has around 100 active volunteers working primarily on our national project. Registered as a charity under Swedish law in October 1991.

ACKNOWLEDGEMENTS Right to Health Network, Care Initiative, RBK advertising agency, Swedish Red Cross

» NATIONAL PROJECTS Medical and Social Care Centre in Stockholm In 2009, as the Swedish law remains unchanged, MdM Sweden continues to manage the medical centre for undocumented migrants created in 1995 in Stockholm. In 2009, the centre provided 1,105 consultations: 837 with a general doctor, 147 with a physiotherapist, 39 with a psychologist/psychotherapist and 82 with a midwife. The majority of the patients came from: Azerbaïjan, Mongolia, Bangladesh and Bolivia. In all, the patients were of 54 different nationalities. There were about as many women as men. Since the beginning of the year, undocumented women can, in the Stockholm region, benefit from maternity care. MdM can now refer patients to medical centres offering maternity care in the region and as a consequence, the number of midwife visits fell. Holistic Support Unit Undocumented people are constantly afraid of being denounced and do not feel safe. Consequently, MdM volunteers offer legal advice on human rights and Swedish law, and can advocate to the authorities on their behalf. The clinic doctors provide medical certificates when necessary. In 2009, the team helped 390 people.

» COMMUNICATION AND EVENTS Testimony Two working groups were created in the autumn of 2009 to collect case studies from people going to the private clinic. The objective being, on one hand, to testify to the difficulties of life for undocumented migrants and and their children, and on the other, to raise awareness about the medical problems encountered due to lack of access to healthcare.

Information and Education Most of MdM Sweden's work consists of informing and educating health professionals and patients on rights in relation to access to care. During the autumn of 2009, MdM Sweden prepared a presentation document aimed at both external institutions — such as hospitals and medical and social care centres — and internal use (e.g. for presentations given at information meetings for new volunteers). European Observatory on Access to Healthcare In September 2009, MdM Sweden distributed the report of the European Observatory on Access to Healthcare. MdM Sweden volunteer, Anna Rydmark Venegas, midwife, received the title of “Swedish hero” given each year by the Aftonbladet newspaper to a Swedish citizen having shown a strong humanitarian engagement.


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SPAIN » INTERNATIONAL NETWORK

CONTACT DETAILS

» Médicos del Mundo España Conde de Vilches 15 28028 Madrid Tel: 91 543 60 33 Fax: 91 543 79 23 informacion@medicos delmundo.org www.medicosdelmundo.org CONTACT

» Director of Organisational Development: R. Schleissner BOARD OF DIRECTORS

» President: T. González » Vice-president: J.-L. Engel » Vice-president: F. Noya » General Secretary: P. Garcia » Treasurer: A.-M. Aburto » Other Board Members: J. Moyano, Á. González, C. F. Arroyo, C. Artundo, A. Pérez, N. Castaño, P. González, I. Ugarte, M. Torres, C. Colomo, B. Nogués, T. Maura, M. Reyero, A. Beguiristain

» NATIONAL PROJECTS

» INTERNATIONAL PROJECTS

Prevention of genital mutilation and the promotion of women's rights in sub-Saharan Africa within a genderrelated inter-cultural community health project. As a result of migration towards Western countries, female genital mutilation (FGM) is now practised in some Spanish cities. The presence of African families coming from cultures where FGM is practised highlighted the need for the development of preventive actions. MdM decided to implement a project aimed at decreasing the risk of FGM within the population originating from sub-Saharan Africa by bearing witness and helping these vulnerable people. In collaboration with African migrant organisations, MdM set up training and focused on communicating the risks involved to the sub-Saharan groups living in the areas of El Vallés, Maresme and Gerona (Catalonia), Zaragoza and Huesca (Aragon) and Navarra. In 2009, 1,330 women and girls mainly from Gambia, Senegal, Mali, Cameroon, Nigeria and Ghana benefited from this programme. During sexual and reproductive health trainings focused on FGM, gender and cross-culturalism were gradually introduced. In parallel, because of the role men play in the practice of FGM, discussions and workshops were set up amongst people coming from the same countries in order to educate them about the risks related to this practice. During these workshops, special attention was given to the physical and mental health of young girls and teenagers. In addition, community leaders were enlisted to help communicate the risks amongst the men. Lastly, the project included sessions aimed at empowering women originating from sub-Saharan Africa, with gender equality as a long term objective.

Transfer of the HIV/AIDS project to San Carlos University, Guatemala. In 2009, MdM passed the baton to San Carlos University after four years of collaboration on the development of a sexually transmitted infections (STI) and HIV/AIDS prevention project. The project was integrated into its existing programmes and a team of six will ensure effective delivery. Recent budgetary approval guarantees its continuity and testifies to its recognition within the University. The introduction of HIV prevention as a topic on academic courses, both general and specialised courses, and also at events such as parties, festivals and celebrations held at the University is a great success. In addition, the programme became a national model and is being taken up by private universities. Free rapid testing is now offered at the health unit. A project focused on research, traditional medicine and access to healthcare in Velingara, Senegal. An analysis, using surveys and interviews, of behaviours and factors which govern access to health — as well as research and activities intended to develop and understand traditional medicine as a therapeutic and cultural resource — were carried out in Velingara. Activities undertaken as a result of the study will make it possible for the Velingara medical district to improve primary healthcare. Programme in response to the cholera epidemic in Guinea-Bissau. Although disaster risk reduction and epidemic prevention are proven to be effective, finance from major donors for these activities remains low (under 5%). Following MdM’s emergency programme in response to a cholera epidemic which hit Guinea-Bissau in 2008, MdM developed new activities focused on better preparation and management of health emergencies. The aim was to reinforce the organisation's capacity to react immediately to outbreaks in the worst affected regions.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

» COMMUNICATION AND EVENTS

» FINANCIAL SUPPORT

Programme against human trafficking and sexual exploitation. Human trafficking is the slavery of the 21st century. Millions of people, 80% of whom are women and girls, are victims of this, the third largest illegal trade after arms and drugs. In the case of human trafficking for sexual exploitation, this phenomenon arrived in Spain as a result of immigration. 90 % of those involved in prostitution are migrants. In order to raise public awareness of this topic, MdM rolled out three series of documentaries across Spanish cities in December and November to coincide with a number of symbolic dates such as the International Day for the Elimination of Violence Against Women or the first anniversary of the approval of the integrated plan against trafficking, held on 2 December. The films chosen focused on the lives of those affected by trafficking. In December, Madrid hosted an international exhibition entitled Journey which looked at the emotional and physical journey of a victim of sexual trafficking. The project, supported by the British Helen Bamber Foundation and endorsed by the actress Emma Thompson, came to Spain thanks to a collaboration between the Ministry of Justice and various public and private institutions including members of the Spanish Network Against HumanTrafficking, to which MdM Spain belongs.

• Colombia: Primary healthcare for people living in rural zones affected by armed conflict in 34 indigenous communities and Afro-Colombians and four municipalities within the Antioquia and Choco regions (AECID). • Colombia: Re-establishment of access to medical emergency care and health promotion in rural indigenous communities and amongst Afro-Colombians (AECID). • Nicaragua: Holistic care for victims of sexual and domestic violence in Puerto Cabezas, Nicaragua (AACI). • Indonesia: Emergency response to the Padang earthquake and 15 villages in the Pariaman district (Cajamadrid).


90

SWITZERLAND » INTERNATIONAL NETWORK

CONTACT DETAILS

» Médecins du Monde Suisse Rue du Château-19 2000 Neuchâtel Switzerland Tel: +41 (0)32 725 36 16 Fax: +41 (0)32 721 34 80 www.medecinsdumonde.ch administration@medecins dumonde.ch CONTACT

» Director: P. Giron-Lanctuit pascale.giron@medecins dumonde.ch BOARD OF DIRECTORS

» President: N. Humbert » Vice-presidents: X. Onrubia, D. Schmid » Secretary: T. Tschoumy » Treasurer: D. Monnin » Other Board Members: Y. Groebli, G. de Torrente de la Jara, V. Kernan, C. Persoz, A.-P. Pittet EMPLOYEES

» P. Giron-Lanctuit, M.-C. Wittwer Perrin, K. Almeida, M. Crettenand Registered as a charity under Swiss Law in April 1994.

» NATIONAL PROJECTS The Migration Health network aims to improve access to care and promote migrant health in the Neuchâtel region. It aims to: • develop and consolidate the medical reception network; • help and give advice to people needing care; • systematise and make more effective the care of migrants offered by the health network; • establish a relationship of trust between our target groups and health professionals; • inform the communities of the possibilities for accessing care and their right to health; • offer the opportunity for discussion and dialogue with the migrant population. The Permanences blanches provide healthcare and advice for sex workers in Lausanne. They aim to: • run nurse clinics at the sites where sex workers are, in order to answer sex workers’ questions; • reinforce prevention activities by stressing the medical element; • direct, if necessary, these people towards a support network of organisations able to help them; • accompany these people in the process of accessing other services.

» INTERNATIONAL PROJECTS Haiti: programme supporting the Goâvienne communal health unit to enable access to a quality health system integrating care for acute malnutrition in Haiti. The programme also aims for long-term improvement of the supply of the Minimum Package of Services (MPS) in the dispensaries of Daneau, Meyer, Dufour and Baudin. Palestinian territories: the project to support the setting up of a psychiatric support centre for children and adolescents in Hebron aims to: • prepare the opening of the CPIJ (centre for psychiatric care for children and adolescents) by assisting the recruitment process;

• put in place a local training programme taking into consideration MOH requirements through clinical seminars for all centre employees; • support the CPIJ team technically: continuing education and mentoring for professionals; • set up a network of partners and ensure coordination; • raise awareness amongst the population of Hebron. Mexico: project to combat tuberculosis centred on the marginalised indigenous communities of the Tzeltal forest, in Chiapas, Mexico, aims to: • facilitate treatment for tuberculosis by community health promoters; • optimise the clinical care and laboratory services at San Carlos hospital. This project stopped at the beginning of 2010, because the hospital is now able to care for patients with TB. Benin: the project supporting the integration of sickle cell anemia treatment in the Abomey departmental hospital aims to: • support the opening of a departmental unit to deal with sickle cell anemia in the CHD Zou-Collines; • promote practices and behaviours which reduce the effects of the illness on the daily lives of the patients, by empowering families, and offering care for sickle cell anemia within community health programmes in Zou and the Collines; • use the approach developed as a model for roll out.


DOCTORS OF THE WORLD

UNITED KINGDOM

ANNUAL REPORT 2009

» INTERNATIONAL NETWORK

CONTACT DETAILS

» Doctors of the World UK 14 Heron Quays London E14 4JB United Kingdom Tel: +44 20 7515 7534 Fax: +44 20 7515 7560 info@doctorsoftheworld. org.uk www.doctorsoftheworld. org.uk CONTACT

»swright@doctorsofthe world.org.uk Susan Wright (Director)

» NATIONAL PROJECTS Fourth anniversary of Project:London, national project for the improvement of access to care for vulnerable people, including asylum seekers, refugees and undocumented migrants, homeless people and sex workers. Three sessions per week offering medical care and advice to help people access medical care. • Recruitment, training and management of a team of 80 voluntary staff. • Participation in the European Observatory survey on access to healthcare for undocumented migrants in Europe.

EMPLOYEES

» S. Wright (Director), E. Middleton, F. Qureshi, S. Soldati, C. Alllum, L. Ottisova, G. Norman, T. Pastena

BOARD OF DIRECTORS

» J. Hughes, R. Rogers, R. Lion, S. Pickworth, Lord Rogers of Riverside, A. Cavey, S. Hargreaves, B. Gazzard, C. Giboin, W. Farah Registered as a charity on 13 January 1998.

ACKNOWLEDGEMENTS Action for Bow; Alliance Pharmacy; Aspect Capital; AstraZeneca; Big Lottery Fund; Boots; Cabot Hall; Canary Wharf Group; City Parochial Foundation; Clifford Chance; Coutts; Department for International Development (DfID); Elton John Aids Foundation; French Huguenot Church of London Charitable Trust; Freshfields; GLA; Grazia; Guernsey Overseas Aid Commission; Hewlett Packard Computers; Isle of Man Overseas Aid Committee; Jeune Chambre de commerce francobritannique; Leagas Delaney; London to Paris Bike Riders 2009; London Catalyst; Medsin; Microsoft; MVM Charitable Trust; Rayne Foundation; Refugee Community Development Fund; Tudor Trust.

» COMMUNICATION AND EVENTS • Evidence given to the Home Affairs Committee hearing. • Broadcast on Channel 4 and Sky News featuring Susan Wright in response to the Department of Health decision on access to care. • Broadcast on BBC London of a report on the work of Project: London and on access to care for vulnerable people. • Publication of several articles in medical journals denouncing the lack of access to care for vulnerable people in the United Kingdom and in Europe. • Presentation of our international projects through two volunteer testimonies in specialist medical publications, The Practising Midwife and The Nursing Times. • Broadcast on several radio stations (regional and national) featuring our volunteers in Haiti, Gaza and Sudan (BBC Radio 4, BBC Radio Devon, BBC Radio Oxford). • Alertnet website posting of three photograph galleries. • Organisation of “Charity Challenge” MdM UK's London to Paris Bike Ride 2009: 55 cyclists took part in this event connecting London to Paris and raised more than £45,000 for MdM in the UK. • Organisation of the third Royal Parks Half Marathon Challenge. • Publication of ENews, news bulletin on the organisation's activities, sent out to donors, volunteers and supporters. • Participation in 31 forums to introduce Doctors of the World

and its activities to doctors, nurses, midwives, psychologists, surgeons, logisticians, administrators and students, all potential volunteers. • Participation in 28 public presentations intended for volunteers and potential givers. • Publication of two volunteer profiles in three medical newspapers and on the web.

» FINANCIAL SUPPORT • Somalia: medical assistance programme for displaced people. • Sudan (Darfur): medical assistance programme for displaced people. • Madagascar: Action Enfance.

» HUMAN RESOURCES • Burma: an administrator. • Cambodia: a theatre nurse. • Colombia: a doctor. • Ethiopia: a midwife. • Gaza: an orthopaedic surgeon. • Jordan: a co-ordinator. • Indonesia: a nurse. • Liberia: a midwife. • South-Sudan: a medical co-ordinator, a midwife, an administrator. • Sudan-Khartoum: a human resources officer, a site co-ordinator. • Sudan-Darfur: a doctor, a midwife, two logisticians. • Tanzania: a co-ordinator.


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EUROPEAN OBSERVATORY » INTERNATIONAL NETWORK

On 24 September, the European Observatory venture came to an end. It involved some 200 voluntary and paid staff working together through their different languages and legislative contexts in order to expose the obstacles to basic rights and their consequences on the health of the people with whom we work.

Doctors of the World’s European Observatory on Access to Healthcare, a joint venture

» 1- See the report on: www.romeurope.org » 2- Médecins du Monde. M. Moradell, C. Moncorgé, N. Simonnot, V. Halley des Fontaines; “Inequalities in access to care in Europe. Initial findings” October 1999.

» Essential reading: see www.mdm-international. org: “Access to Care for Undocumented Migrants in 11 European Countries”, second European Observatory report.

» A BRIEF HISTORY • The Romeurope project, launched in 1997 (France, Spain, Portugal, Greece), culminated in a European conference (October 2001) and creation of the Romeurope collective.1 • The “Inequalities in access to care in Europe: Initial findings” report by the Mission France co-ordinating office published in October 1999. • April 1999 and May 2000: first and only meetings of Directors (or equivalents) of network members’ national programmes took place. All want to work together with undocumented migrants and prisoners. • October 2002 in Corsica, at the annual summer school the idea of a European observatory on Access to Healthcare to document and to lobby was launched. There was also a recommendation: to build a case from the ground up, starting from frontline workers. • Mission France meeting in Lyon (October 2003). A major focus on MdM in Europe: brainstorming on the objectives for the future observatory amongst 200 participants! • February 2004, 36 participants from 12 countries proposed two initial topics in common: access to care for undocumented migrants and the protection of seriously ill migrants. The Observatory on Access to Healthcare in Europe was born. The small team carries out two surveys 2005-2006 (published in September 2007), then 2008 (published in September 2009).

» 2009 A KEY YEAR (UNDER THE DOOR?) In 2008, the testimonies received from the patients were translated, selected and integrated into the report. Up to date legislative checks were included. Statistical analysis was compared to the knowledge accumulated by the teams on the ground. At the end of January 2009, the report in French and English was sent to all the teams for proofing and validation.

Next it was translated into nine languages (German, English, Spanish, Greek, Italian, Portuguese, Dutch and Swedish), with the help of the teams from each country. The report, printed in nine languages, enables all MdM network members in Europe to lobby policy makers and health authorities with proof of the need to improve access to care of all, without ignoring the most vulnerable people, undocumented migrants, and, in particular, children and expectant mothers. During the summer of 2009, a press kit (24 pages) was published in eight languages, illustrated with photographs taken by Olivier Jobard, professional photographer, for the photographic exhibition Exile-Exit in 2010. Press conferences took place at the same time on 24 September in Brussels, with chairpeople from Belgium, Spain and France, and in Athens, Geneva and Stockholm. Press conferences also took place in Amsterdam on 15 October and in Berlin on 23 November. All this resulted in more than 300 items of coverage in press, on television, radio, and web, including two articles of note, in the BMJ and Prescrire, to appear in 2010. Finally, public debates on the health of undocumented migrants in Europe and legislation in 11 European countries were carried out and the Observatory was chosen as the subject for a Masters 2nd cycle assignment. Many articles were written and there are many presentations at international conferences in 2010 as a result. This text, in fact, should serve as an immense thank you to everyone who has been involved since 2004. To the undocumented people who took part in our surveys and offered their case studies — we would like to salute their courage. A very special thank you to Anne and Nadege, who were the backbone of the project. Network-wide projects continue: in 2010 we hope to see the birth of an International Observatory.


Paris Š Jobard/MdM/Sipa


94

CROSS-CUTTING PROJECTS


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CONTENTS // 96 Analysis, technical support and advocacy unit 97 Action for Global Health 98 Sociocultural determinants – access to care 99 Access to free care 100 HUMA project 101 Gender-based violence 102 Adoption 103 Opération Sourire

95


96

ANALYSIS, TECHNICAL SUPPORT AND ADVOCACY UNIT Within the Operations Division, the department offering analysis, technical support and advocacy (S2AP) is a new department born from the merger, in 2009, of the STAO (technical support unit) and the advocacy department.

n collaboration with the other departments and divisions, the new S2AP supports and works alongside the teams in order to ensure the relevance and quality of MdM's programmes. The advocacy activities extend the work in the field and reinforce our ability to influence policy makers.

I

The S2AP activities are carried out in collaboration with all those involved in programmes: the heads of programme (RM in its French acronym), the co-ordinators and teams in the field and the desk officers at headquarters. The key areas of work for this department are as follows: • analysis of the context in which programmes are implemented; • validation of the context and methodological and technical coherence of programmes; • targeted support for particular programmes; • technical expertise on cross-cutting themes; • training support; • support for rolling out advocacy strategies.

The S2AP brings together technical advisers from a number of different fields: • primary healthcare; • reproductive health; • HIV/AIDS, hepatitis, tuberculosis, harm reduction; • malaria; • pharmaceutical products; • human rights and international humanitarian law; • surveillance of geopolitical context and security risks; • gender-based violence; • access to care and sociocultural determinants; • financial accessibility of care; • human resources for health; • health financing and the Millennium Development Goals; • advocacy for access to care in conflict zones; • advocacy for access to care for undocumented migrants and asylum seekers in Europe.


ACTION FOR GLOBAL HEALTH

DOCTORS OF THE WORLD ANNUAL REPORT 2009

Created in October 2006, Action for Global Health is a European advocacy network made up of 15 NGOs working on health and development. Doctors of the World France and Médicos del Mundo Spain are members. Its aim is to encourage political decision makers in the European Union to play a more active part in reaching the Millennium Development Goals for health by 2015, especially by improving funding and by strengthening health systems in developing countries.

Keeping European health pledges

» ACTIVITIES The advocacy activities undertaken by Action for Global Health (AfGH) aim to raise awareness amongst European policy makers in order to alter their position regarding health financing and improving the effectiveness of aid. With this in mind, MdM works in France with another network member, Avocats pour la santé dans le monde (Advocates for Global Health), and with government, members of parliament, international institutions and civil society actors concerned with reaching the MDGs. The principal advocacy themes for the AfGH network are: • financing of health — to increase government aid allocated to health sector development; innovative finance mechanisms to generate more funding; • reinforcement of health systems, with a particular focus on the shortage of health workers; • equitable access to care by promoting exemptions from user fees for essential care, particularly for the most vulnerable populations. AfGH’s third annual report, Health in Crisis, was published in April, and looks at the consequences of the economic crisis on the commitments entered into by Europe to achieve the health Millennium Development Goals (MDGs). Published in five languages, it is used as lobbying tool for European decision makers.

» OUTLOOK In 2010, the network will continue to advocate for the health MDGs and the recognition of the right to health. At the European level, a high level conference will be organised in Brussels in March on this subject. At the French level, AfGH will conduct a campaign in partnership with other NGOs on the topic of maternal health.

CO-ORDINATORS

» Volunteer member: C. Giboin » Headquarters: M.-A. Delerue » Board member with responsibility for the project: C. Giboin FUNDING

» ActionAid International, recipient of grant from the Bill and Melinda Gates Foundation . BUDGET

» €110,000 Year 3 (09/2008-08/2009) COUNTRIES

» France, Germany, Italy, Spain and the United Kingdom. A team is also based in Brussels to work closely with European institutions. » The health-related Millennium Development Goals are targets aimed at reducing maternal mortality, child mortality, and the spread of serious diseases (AIDS, tuberculosis and malaria) which severely affect developing countries. TO FIND OUT MORE

» http ://www.actionforglobal health.eu


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SOCIO-CULTURAL DETERMINANTS

- ACCESS TO CARE

Access to care for programme beneficiaries is linked to health-related norms, values, knowledge and practices. Illness, over and above biological causes, is also social and cultural. Because illness and its causes are interpreted in different ways according to the context, learning about the culture of the people you are caring for is essential. Raising awareness, training and offering tools to enable a better understanding of these determinants in project design, piloting, and assessment, are the main priorities for this project which began in July 2008.

Learning about people’s culture to be able to provide better care

» ACTIVITIES This project aims to improve the integration of the socio-cultural determinants of access to care into the heart of programmes, through raising awareness, training, and development of tools that will enable MdM to better take these determinants into account. It aims to enable better design, planning and co-ordination of our work in order to improve the quality, relevance and impact of health programmes, as well as the knowledge, expertise and personal skills of humanitarian workers. It offers an understanding of both individual and group conduct of beneficiaries and healthcare professionals alike. It focuses on the questions most frequently raised in the field: the way illness is represented, the patient-carer relationship, illness as social phenomenon with its norms and constraints, different types of treatment, the social dynamics of traditional medical systems and the relationship between different medical systems. There are three priorities: • raising awareness about the effects of socio-cultural determinants on access to care for existing and future humanitarian workers; • exchange and documentation of humanitarian workers experience; • improving humanitarian workers’ skills by developing and providing training in the use of methodology that takes into account the consequences of socio-cultural determinants on access to care in daily practice, and in planning projects. This third priority also incorporates an anthropologist accompanying workers in the field in the needs assessment, set up and evaluation phases. This model was introduced in response to a call from the teams in the field, who sometimes struggle to understand the way in which beneficiaries react to programmes.

» OUTLOOK In 2010, MdM will continue its awareness-raising campaign but, above all, will reinforce the training component for humanitarian workers and be the catalyst for exchange and capitalisation of experiences between these workers. This will be done by organising workshops, publishing new guides (three in 2010) and through the project blog (www.mdm-scd.org). Support for field workers will remain an important element of the project.

CO-ORDINATION

» Volunteer members: M.-L. Deneffe-Dobrzynski, M.-A. Vincent » Headquarters: M. Bouchon, S. Gumucio, B. Moquard » Board member with responsibility for the project: B. Luminet FUNDING

» French Development Agency (AFD), MdM. BUDGET

» €100,000 Year 1 (07/2008-08/2009) » €188,640 Year 2 (09/2009-08/2010) » €211,360 Year 3 (09/2010-08/2011) COUNTRIES Geographic zones covered

» The project relates to all MdM programmes, in France and internationally. Project support in 2008 related to Burma, Madagascar and Chad. In 2009 this was provided to Madagascar, Colombia, Algeria and the Democratic Republic of Congo.


FREE ACCESS TO HEALTHCARE

DOCTORS OF THE WORLD ANNUAL REPORT 2009

In low-income countries, charging by healthcare providers constitutes an insurmountable barrier to care for millions of people. This means that improving financial accessibility of primary care constitutes one of the most important areas that public health policy should tackle. For nearly three years, MdM has worked on this theme both through setting up programmes on the ground and through lobbying institutions and international donors to obtain real technical and financial support to encourage the introduction of user fee exemption policies.

Access to primary care free of charge

» ACTIVITIES On the ground MdM continues its involvement in Haiti, Niger and Liberia to promote the implementation of payment exemption mechanisms for the most vulnerable, in particular pregnant women and children under five. This year, two activities deserve to be highlighted: • a study was carried out to document the impact of user fee exemptions on the use of healthcare facilities in Grand' Anse, Haiti (study is available on www.medecinsdumonde.org); • launch of the Sahel programme in Niger, Mali and Burkina Faso. One of the major themes of this new programme is the reduction of financial barriers hindering access to primary care. Strong advocacy is key to this project, and the team on the ground now has a staff member in charge of this aspect of the programme. Advocacy targeting donors and international institutions In support of the activities undertaken on the ground, MdM is raising awareness amongst donors and international institutions during conferences and high level events. Notable activities carried out this year include: • MdM's participation in the international expert consultation organised by UNICEF in February 2009 in New York; • MdM's participation in the conference on social health protection in developing countries organised by the European Commission in March 2009; • lobbying the French government prior to the G8 held in Aquila, Italy, in July 2009. This lobbying activity bore fruit as the G8’s final declaration included a clear offer of support for countries that would like to guarantee free access to primary care.

» OUTLOOK In 2010, MdM intends to join a campaign to engage the public in the run up to the United Nations MDG Summit (September 2010). Support for user fee exemption policies is high on the campaign agenda. On the ground, special attention will be given to the Sahel programme, with the advocacy case for financial accessibility being developed in the next few months.

CO-ORDINATION

» Volunteer members: O. Bernard, C. Giboin » Headquarters: N. Guihard » Board members with responsibility for the project: O. Bernard, C. Giboin FUNDING

» MdM COUNTRIES:

» The project relates to all MdM international programmes. In 2009 the programmes that have been supported are Niger, Haiti, Liberia and the Sahel programme.


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THE HUMA NETWORK

The HUMA network (formerly the Averroès project) is a European advocacy project, which calls for greater equality in access to care for asylum seekers and undocumented migrants in the European Union. Begun in 2008, it will extend in the long term to 19 countries, combining nine new partners and the members of MdM’s European network. The advocacy activities of the network at the national or European level stem from work on the ground and the research tasks carried out by the HUMA network and by MdM.

Advocacy at the European level

» ACTIVITIES Development of a European network: in 2009 three new partners joined the HUMA network, which is now present in 13 countries; visits to identify and support key partners were made; two workshops with the aim of building an overall strategy, supporting national advocacy strategies and exchanging lobbying experiences were organised; an internet site (www.huma-network.org) and a newsletter were created. • Learning and development: a first comparative report on legislation concerning access to care for asylum seekers and undocumented migrants was written by the HUMA team and partners; it was launched in September 2009, with the European Observatory Report on Access to Healthcare 2009. • Support for lobbying at the national level: training on development of advocacy strategies was offered to the partners; two of them organised national events (conferences intended to increase awareness and lobby key decision makers). • Development of an advocacy message at the European level: HUMA proposed an amendment (which was finally rejected) for the directive on the reception conditions for asylum seekers; a campaign was launched targeting European Parliamentary candidates; representatives of the network met European Commission policy makers; participation in European conferences and a seminar with the Council of Europe on the topic Migrants and Health were also key advocacy moments.

» OUTLOOK 2010 will be devoted to the organisation of advocacy-focused national events by the partners, to activities designed to engage healthcare professionals and to conducting research. We will also consolidate the network and identify partners in six more member states. Lobbying of European institutions will continue (in particular around the topic “inequalities in health and reception of asylum seekers”, aimed at the European Parliament).

CO-ORDINATORS

» Programme advisors: F. Giraux (MdM France), T. Gonzalez (MdM Spain), M. Deguledre (MdM Belgium) » Headquarters: C. Intrand, J. Poirson, A. Dupont, B. Blondel (Brussels), S. Collantes (Madrid) FUNDING

» DG Sanco (European Commission), Epim (Network of European Foundations)

BUDGET

» 2008-2011: €1,325,958 COUNTRIES

» 19 European Union countries. Currently Germany, Belgium, Cyprus, France, Greece, Italy, Malta, Netherlands, Portugal, Poland, Spain, Sweden, the United Kingdom; and to come: Austria, Finland, Hungary, Czech Republic, Romania, Slovenia


GENDER-BASED VIOLENCE

DOCTORS OF THE WORLD ANNUAL REPORT 2009

For years MdM has been running projects to prevent and take action on gender-based violence. These projects cover almost all forms of violence against women. In response to this wide-ranging problem, MdM has established a holistic and multidisciplinary approach. Providing care is our first priority, but medical care alone is not sufficient. It is also important to identify the problem, listen to the women affected, and refer them appropriately for psychological, legal and social care.

For a holistic and multidisciplinary approach to genderbased violence

Through the development of an international programme to fight gender-based violence, MdM is now concentrating on ensuring consistency throughout its range of activities, whilst respecting the specific context of each programme. At an international level: holistic care for victims and prevention of gender-based violence; sharing information on this topic.

» ACTIVITIES • Documentation of the knowledge and tools used by the different MdM projects tackling genderbased violence. • Setting up forums to facilitate the exchange of information and tools: creation of a thematic space entitled “Gender-based Violence” on the intranet; creation of a database bringing together all the tools used in the field; organisation of a regional workshop in Cairo in September on prevention and responses for gender-based violence. • Creation of a guide on how to integrate socio-cultural determinants into programmes fighting gender-based violence. • Training for MdM staff and volunteers: organisation of a workshop for exchange and awarenessraising for field workers involved in violence against women projects. • Reinforcing the operational skills of local people working against gender-based violence. • Raising awareness amongst political authorities, national civil society and international actors on the issues surrounding violence against women.

» OUTLOOK • Development of a methodology handbook entitled “Prevention and response to gender-based violence”. • Development of a guide on the management and protection of sensitive data entitled “Ethics in practice: managing sensitive data”. • Organisation of a regional workshop in Kinshasa in April on prevention and response to gender-based violence. • Organisation of a photographic exhibition, featuring case studies. • Finalising a guide to signs of violence against women and a condensed list of cross-cutting indicators. • Continuation of the work to encourage regular exchange between the programmes. • Organisation, in Paris, of an international conference which brought together the key players in the fight against gender-related violence. • Formalisation of a document setting out key MdM advocacy messages on the theme of tackling gender-based violence.

CO-ORDINATION

» Headquarters: J. Branchat » Board member with responsibility for the project: J. Larché FUNDING

» French Development Agency, Ministry of Foreign Affairs BUDGET

» €5,300,000 (36 months) COUNTRIES

» Since July 2007, the programme has been operational in 11 countries: Algeria, Egypt, Guatemala, Haiti, Liberia, Moldavia, Nicaragua, Niger, Pakistan, Peru, Democratic Republic of Congo (Kinshasa and Goma). » Over and above the programmes devoted to combating gender-based violence, activities undertaken across all programmes aim to improve identification of, and care for, victims of violence.


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ADOPTION

Doctors of the World is the only medical, humanitarian organisation to have integrated an international adoption programme into its mandate. The status of Approved Adoption Agency (AAA) was granted in 1988. Our objective as an AAA is consistent with our overall mission to stand up for those who are most vulnerable, namely children (often the first to suffer in crises or conflict) and to defend their fundamental rights: to have a family and an education.

Putting children first

In 2009, MdM’s adoption programme remained the largest in France and the only one integrated into a medical NGO. The priority is to find families for children who could not be adopted in their country. Moreover, MdM accompanies and prepares the candidates for complex adoptions: adoption of multiple siblings, children over seven years old, and adoption of children with medical conditions.

» ACTIVITIES MdM has supported the adoption of more than 3,500 children. 3,503 children were adopted between 1990 and 2009. In 2009, in spite of a difficult international context, 152 children arrived in France and were adopted by 125 families. Type of adoption: one in two was a complex adoption: 47 children (30.9%) were adopted with siblings, primarily from Colombia, Brazil, Haiti and Russia. 20 children (13%) were older than seven, and, of these, 10 were adopted with siblings. Eighteen children (11.8%), mainly from China and Vietnam, had medical conditions. Countries of origin: China and Vietnam: 48%; Brazil and Colombia: 24.3%; Russia and Albania: 9.9%; Haiti and Madagascar: 17.8% (second year of operation, accredited in July 2006). Sex: 51% of the children were boys and 49% were girls. The notable drop in adoptions from China rebalanced the percentage between girls and boys. Age: 63% of the children were under three years old; 24% were between three and six years and 13% were over seven years old. MdM supports the children and their families for two years, as and when needed. In 2008, MdM carried out 850 home visits.

» ORGANISATION AND HUMAN RESOURCES MdM is authorised for adoption in 80 French departments and, in addition to the work at HQ, has 16 adoption hubs in its regional offices. Workforce: 243 people (98% volunteers) work for the adoption programme, with 175 in the regional hubs. The adoption programme benefits from a highly qualified voluntary workforce: 27% doctors, child psychologists and paramedical personnel; 40% are psychologists and/or psychoanalysts, social workers or childhood professionals; 11% teachers or assistants; 11% administrative or data processing specialists and 11% are from other professions (including legal professionals).

» OUTLOOK Accreditation requests for new countries and continuing the risk prevention approach: adoptive family preparation, financial transparency.

CO-ORDINATION

» Headquarters: G. Andre-Trevennec (paediatrician) » Board members with responsibility for the project: O. Bernard (paediatrician), L. Jarrige FUNDING

» Adopting families, private grants, Ministry of Foreign Affairs (SAI), MdM and donors. BUDGET

» €380,000 (provisional for 2009) COUNTRIES

» Asia: China, Vietnam » Eastern Europe: Russia, Albania and resumption of Bulgaria with signature of an agreement with a Bulgarian foundation enabling international adoption. » Haiti and Madagascar, Philippines (accreditation obtained on 7 July 2009) » Countries not operational in 2009: Bolivia, Ecuador and Romania.


OPÉRATION SOURIRE

DOCTORS OF THE WORLD ANNUAL REPORT 2009

Created in 1989, Opération Sourire is a plastic surgery programme that reaches out to the poorest and most in need. Carried out in close co-operation with our partners in Asia and Africa, our teams work on specific surgical needs ranging from the face, to limbs, or the whole body.

Give back a smile to those disfigured by illness, war or malnutrition

» ACTIVITIES In 2009, the voluntary teams from MdM France carried out 15 missions in seven countries, namely: Benin, Cambodia, Chad, Madagascar, Mali, Mongolia and Niger. An exploratory mission was carried out in Armenia in order to evaluate the needs for caring for the after-effects of burns. It will not be followed up by an operational programme, as it was found that the medical personnel are able to master the surgical techniques and satisfactorily respond to local needs. In addition, the teams supported the organisation of the seven missions carried out by MdM Japan and MdM Germany, in Bangladesh and Cambodia. 515 people were operated on in 2009, which brings us to 7,115 patients since the creation of the programme. The number of interventions actually performed is much greater as certain cases require several operations. The most frequent pathologies are cleft lips, the after-effects of noma disease and burns, meningoceles, malformations and injuries. Once the operations have been performed, considerable improvements are noted by the patients, both from the physical point of view and as regards their psychological and social welfare. They smile again or are able to move their limbs normally once more. Physical improvements are reflected in the improved social integration of the patients, who, for the majority, lived “hidden” because of their “abnormality.” Training and exchange with local staff are key elements of this project because the long-term objective is capacity building. Training is rolled out through practical involvement in the operations and also theoretically, through the courses given by Opération Sourire teams. This year, publicity for Opération Sourire was reinforced thanks to the partnership with the L'Oreal Foundation. As a result, we were able to produce three mission diaries on programmes in Mongolia, Cambodia, Madagascar and make a short film presenting the project. We also had a stand at the 54th Congress of Plastic Surgeons held in Paris in November.

» OUTLOOK In 2010, we would like to develop areas of the programme: surgeons and anaesthetists recruited in the United Kingdom and the Netherlands will join the current teams. At least two new exploratory missions are planned. In all, we plan to carry out 18 missions in eight countries. In Cambodia, where local experts have been trained for twenty years by our teams, we are exploring ways to support local staff and hand over the project.

CO-ORDINATION

» Head of Programme: François Foussadier » Headquarters: Lavinia Ilié FUNDING

» L’Oréal Foundation BUDGET

» €340,566 COUNTRIES:

» Benin, Cambodia, Chad, Madagascar, Mali, Mongolia, Niger.


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PROGRAMMES IN FRANCE


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CONTENTS // 110 Programmes in France 112 Asylum seekers 113 Vulnerable migrants 114 Buddying hospitalised children 115 Sex workers 116 Harm reduction 117 Roma 118 People who are homeless or in poor housing 119 Child lead poisoning 120 Prevention of HIV, hepatitis, STIs and TB 121 Observatory on Access to Healthcare

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Dunkirk

106 PROGRAMMES IN FRANCE

Saint-Denis

HEALTHCARE AND ADVICE CLINICS OUTREACH ACTIVITIES SEX WORKER PROJECTS BUDDYING CHILDREN IN HOSPITAL HARM REDUCTION PROGRAMMES PAEDIATRIC CLINICS

Saint-Denis


Homelessness Š Benoit GuÊnot


108 PROGRAMMES IN FRANCE

Roma © Jordi Espel


DOCTORS OF THE WORLD ANNUAL REPORT 2009

SAINT-DENIS Mrs S., 38 years old, mother of six, urgently put up in an emergency camp in Saint-Denis in May 2009

“On the day of the fire in Bobigny hangar, where my children and I were staying, everyone was running and shouting. I collected as many children as I could and took them out. Firefighters came to put the fire out, but there was already nothing left and a 10 year old child died... They chase us from everywhere, we don’t know where to go. I always carry my papers and important documents with me. You never know what could happen.”


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PROGRAMMES IN FRANCE During 2009 there was a notable deterioration in the living conditions of undocumented migrants in France and a worrying change in the relationship between humanitarian organisations and the government.

1- http://www. delinquantssolidaires.org 2- Law n° 98-657 of 29 July 1998 relating to tackling exclusion

Expulsions of groups of Roma and undocumented migrants became more common, with repeated harrassment of migrants, particularly in Calais. Furthermore, new forms of barriers to humanitarian action appeared at several different levels: a primary healthcare insurance office reported undocumented migrants to the authorities in March; legal action against Doctors of the World for having come to the rescue of Roma families in May; expulsion of migrants in Calais during a scabies epidemic and destruction of essential survival equipment provided by the voluntary sector; identity checks near health services and pressure on our teams working at festivals. The climate of fear created by these arrests and repeated expulsions is not only damaging to public health interventions, but also makes it difficult for humanitarian organisations to do their work. A permanent fear of attending health services leads to breaks in the continuity of care and creates a second-class health system. In this context, MdM’s involvment in the Délinquants solidaires1 group became essential to fight against the idea of solidarity as a crime, a serious obstacle to the work of social and humanitarian organisations.

MdM calls for humanitarian organisations to be able to continue to carry out their work in France without being treated as suspected criminals. During 2009 MdM also launched a number of emergency programmes in France — to react to real health crises among groups rendered extremely vulnerable by a deliberate, harsh migration policy and weather conditions which made their living conditions unbearable. A camp was set up for Roma families in Saint-Denis — the courts recognised this camp as justified, after a legal process started by a complaint from the council. Moreover, several times we distributed survival equipment to the migrants in Calais. This new way of working, largely inspired by the standards developed during international crises, has strengthened our actions, which include 100 medium and long term programmes focused on the most vulnerable groups. Namely, homeless people, migrants, asylum seekers, people who use drugs and sex workers.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

Throughout the year, MdM continued to call for a single health coverage system, by incorporating the State Medical Aid (known as the AME) into the Universal Health Insurance (CMU) for everyone living below the poverty line in France. We continued to fight against the deportation of seriously ill foreigners and for the regularisation and access to healthcare of seriously ill foreigners. We also campaigned for better provision of information for individuals on their rights. In relation the 1998 law against exclusion2, which has still not been fully implemented, MdM carried out a survey to evaluate the arrangements for the Healthcare Access Offices (known as PASS). We expect the results during 2010. MdM remains involved in groups of advocacy organisations to carry out these campaigns. MdM remains committed, both politically and operationally, to tackling the hepatitis C and HIV epidemics in an innovative way, particularly in the field of harm reduction. In partnership with other organisations, we have developed an education project on the risks associated with injection for drug users particularly at risk of hepatitis C. The first people will benefit in 2010. In order to tackle the widespread HIV epidemic in French Guiana, we trained our teams in the use of rapid diagnostic tests in our Healthcare and

MdM calls for humanitarian organisations to be able to continue to carry out their work in France without being treated as suspected criminals. Advice Clinic in Cayenne from the beginning of 2010. Clearly this practice could be used in some of our projects in mainland France, if an evaluation (planned for the end of 2010) confirms that this is appropriate. In addition, MdM remains very involved in the prevention of, and screening for, sexually transmitted infections and tuberculosis. Another area where MdM is taking an innovative approach is mental health. In Marseille, in partnership with Marseille hospitals, our flagship project aims to respond to the needs of rough sleepers, for whom the care arrangements remain inappropriate. Finally, MdM redirected its activities in Mayotte during 2009 in the context of a huge number of deportations (19,000 compared to 26,000 in mainland France in 2009). This territory, which is currently under consideration to become a department and which is half the size of a French department, does not have either State

Medical Aid or Universal Health Insurance. By opening a new programme in December to provide medical and social care for children living in a shantytown, MdM is aiming to improve paediatric care which has been affected by the security conditions and price of medical treatment. In doing so, we advocate for unconditional access to healthcare in line with the international conventions on children’s rights. Dr Jean-François Corty, Co-ordinator, Mission France Doctors of the World France

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ASYLUM SEEKERS PROGRAMMES IN FRANCE

The 2007 immigration law resulted in a toughening of all legislation relating to the right to asylum, and 2008 saw a profound change in the application of the rights of migrants in detention. The Eurodac system and the increase in applications treated by the fast-track procedure make asylum seekers arriving in France even more vulnerable. The detention centre in Mayotte still holds the unfortunate national record for deportations, with more than 16,000 people deported, including between 2,000 and 3,000 children.

Helping exiles

» PARIS (CAFDA) + 21 CASO

» ACTIVITIES Healthcare and advice clinics (CASOs): In 2009, 27% of the patients seen in the 21 CASOs were asylum seekers. MdM clinics refer people to mainstream health services. Some of the CASO doctors also support asylum applications by providing medical certificates documenting potential evidence of ill-treatment or injuries. Migration journeys, which create physical and psychological suffering, are taken into account by our teams and psychological support services are being developed in some centres. CAFDA programme: MdM has set up a health consultation and referral service for newly arrived asylum-seeking families in the premises of our partner, CAFDA (Reception centre for asylum-seeking families). In 2009, MdM saw 332 families, equivalent to 37% of the families attending CAFDA.

» OUTLOOK

COMMON CONDITIONS

» Anxiety-stress-somatic problems, depressive syndrome, respiratory infections, asthma, abdominal/gastric pain, gastrointestinal infection, gum and teeth problems, back problems, parasitic conditions/candidosis, skin infections, high blood pressure… FUNDING

MdM continues to advocate for all asylum seekers to be able to have healthcare coverage and to access mainstream health services. MdM is also lobbying so that seriously ill foreigners who cannot access appropriate care and/or treatment in their countries of origin are given visas on medical grounds.

» RANGE OF SERVICES • Our programmes provide consultations, disseminate prevention messages and refer asylum seekers to partner organisations and mainstream health services. Testimonies about their difficult living conditions and data about their social and medical situation are collec-

» 27% of first-time patients in the Healthcare and Advice Clinics are affected by an asylum claim (whether their request is under consideration, has not yet been submitted or has been rejected).

ted in each centre. These provide content for our programme activity reports and for our lobbying of the relevant authorities.

» Regional public health groups, Regional councils, General councils, Town councils… PARTNERS

» CASP, CIMADE, GISTI, LDH, COMEDE, local or regional civil society co-ordination mechanisms.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

VULNERABLE MIGRANTS PROGRAMMES IN FRANCE

Recent legislation on immigration has led to further deterioration in the situation of foreign nationals in France. This has included removal of the right to regularisation after 10 years, modification of the law on granting visas for medical reasons, the publication of a circular recommending intervention within medical establishments, and the “crime of solidarity.” Access to free healthcare in hospitals remains an objective to aim for: many healthcare access offices (known as PASS) still don’t see all vulnerable patients — the regulation enabling coverage for emergency care is an advance, but has not yet been implemented everywhere.

Supporting vulnerable migrants

» ACTIVITIES Spotlight on two programmes: Mayotte and Calais • Following the dismantling of the “jungle” in Calais in 2009, our teams witnessed inadequate access to healthcare for people in transit, despite their acute health problems linked to their dreadful living conditions. Our emergency operations were carried out in partnership with local organisations, with distribution of essential equipment (duvets, rain capes etc.). • Having organised a vaccination campaign among children not attending school in 42 sites in Mayotte, a paediatric care centre was organised in a deprived area of the capital. The centre mainly sees women and children who have difficulties accessing healthcare (e.g.for fear of going out and being arrested because of their migration status, lack of money). With local organisations we lobbied succesfully for a review by the High Commission against discrimination and for equality (March 2010), which recommends the introduction of arrangements for healthcare coverage for undocumented migrants (e.g. PASS, social security for children).

» OUTLOOK MdM continues to campaign for everyone to have healthcare coverage and to be able to access healthcare, irrespective of their status. Prevention, screening (HIV, hepatitis and tuberculosis) and mental health programmes are being developed. MdM’s European Observatory on Access to Healthcare, in liaison with the programmes in France, is committed to improving access to healthcare for undocumented migrants in Europe and to speaking out about the problems facing this population.

» 90% of first time service users in the Healthcare and Advice Clinics (CASOs) were migrants, and 88% of them do not have healthcare coverage. However, 90% should, in theory, have access to State Medical Aid (AME). 72% of adult migrants do not have a residency permit. » Most common nationalities: Romanian, Algerian, Moroccan, Tunisian, Cameroonian… » Common reasons for medical consultations: acute respiratory infections, uncomplicated hypertension, non-insulin dependent diabetes, pregnancy, gum and teeth problems, anxiety, depression… NUMBER OF PROGRAMMES

» All programmes. VOLUNTEERS

» More than 2,000. FUNDING

» Regional public health groups, General and Regional councils, Town councils…

» RANGE OF SERVICES • Medical and social consultations and referral to health and social services. • Lobbying for the implementation of appropriate health services: healthcare access offices (PASS), nursing beds in

» Health centres: the 21 Healthcare and Advice Clinics saw 25,863 patients.

shelters etc. • Health promotion outreach activities. • Collecting medical and social data, as well as personal case studies concerning this population’s living conditions and pro-

blems with access to healthcare, preventive services and other rights.

PARTNERS

» CASP, CIMADE, GISTI, LDH, Anafé, CFDA, COMEDE, participation in the ODSE (Observatory on migrants’ right to health), the MOM collective, local and regional voluntary sector co-ordination bodies.


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BUDDYING CHILDREN IN HOSPITALS PROGRAMMES IN FRANCE

Many children, often from disadvantaged backgrounds, from France and elsewhere in the world, are admitted to hospitals in and around Paris for conditions that cannot be treated closer to home. Not all of these children can be accompanied by their parents. The Buddying Programme volunteers aim to ease the difficulties caused by this separation. The importance of the volunteers’ presence is recognised — doctors today confirm that emotional support is essential for the psychological wellbeing of these isolated children.

Supporting sick and isolated children » Since 1988, the buddying programme has accompanied 1,817 isolated children, including 227 in French Guiana, while they were in hospital.

NUMBER OF CHILDREN BUDDIED

» ACTIVITIES To help children to deal with the solitude and suffering better, the buddying must be set up as quickly as possible, as an ‘emergency programme.’ Three visits a week are essential to establish a structured relationship with the child, which will, in turn, help him or her to overcome hospitalisation. Prevention — the programme aims to minimise psychological problems caused by unfilled emotional needs and the abrupt separation from parents. Support — the children are supported throughout their hospital stay, sometimes moving from one facility to another, helping them to find the resources within themselves to cope with their illness. The programme’s volunteers also help to maintain links, and sometimes to help restore damaged relationships, with parents. Sadly, in 15% of cases, the volunteers accompany the child to the end of his or her life. The complementary support provided by volunteers and by healthcare staff reinforce one another at such difficult times.

» In 2009: 179 » In the Parisian region: 130 » In French Guiana: 49 COUNTRY OF ORIGIN

» France (French Guiana, Réunion, Mayotte, Antilles), Africa, North Africa NUMBER OF VOLUNTEERS

» 115 » In the Parisian region: 94 » In French Guiana: 21 VOLUNTEER HOURS

» 14,558 PARTNERS

» OUTLOOK Carrying out a review on “relay buddies” when parents are present; provision of IT equipment for children to facilitate communication with their families (Vivendi support); research on new hospital partners.

» RANGE OF SERVICES Paris and the Parisian region/ French Guiana • Three visits a week to children, including one weekend visit. The schedule and length of visits depends on the child’s age and medical condition.

• Potential outings when the child is well enough. • Accompanying children when they return home, if requested by the medical team.

Volunteer recruitment and training is carried out by Doctors of the World. Volunteer follow-up is carried out by volunteer co-ordinators. Discussion groups are organised in all the places where volunteers work (with support from the Fondation de France).

» In Île-de-France: Paris hospitals: Necker Sick Children’s Hospital, Armand-Trousseau Hospitals, Robert-Debré Hospital, SaintLouis Hospital, Édouard-Rist medical and educational clinic. Centres in the Parisian region: Centre des Côtes - Les Logesen-Josas, Margency Children’s Hospital, the French Red Cross, Bullion paediatric and rehabilitation hospital, Paul-Parquet Foundation- Neuilly-sur-Seine, Montreuil medical centre for young children. » In French Guiana: Andrée-Rosemon hospital, Cayenne


DOCTORS OF THE WORLD ANNUAL REPORT 2009

SEX WORKERS PROGRAMMES IN FRANCE

Since the introduction of the Internal Security Law1 the conditions facing sex workers have deteriorated. Migrant sex workers, the majority of whom are undocumented, suffer both from repressive immigration measures and from the criminalisation of passive soliciting. Access to healthcare and to health insurance is increasingly difficult for this group, despite their high risk of exposure to sexually transmitted infections. Victims of violence and abusive arrests, sex workers are increasingly driven to hide, making the work of support organisations more difficult.

Providing support and facilitating access to healthcare for sex workers

BENEFICIARIES

» ACTIVITIES

» Around 1,100

Since 1999, MdM has been supporting sex workers through prevention activities and information. In practice, this includes the following activities: • organisation of night and day outreach sessions in places where prostitution takes place, in order to provide prevention materials and to offer a listening service; • development of more individualised support (consultations, screening, listening…) during clinic sessions and in health workshops; • physical accompaniment to mainstream health services, and facilitating communication for those who don’t speak French; • adapting and translating health promotion information relating to STIs, HIV and individual’s rights.

» OUTLOOK » MONTPELLIER, NANTES, PARIS, POITIERS, ROUEN.

The Internal Security Law has resulted in a shift in the places where prostitution takes place. Today, the teams know that they will not be able to reach all sex workers. In Nantes, an indoor project has been offering information and advice to sex workers operating in private places (at home, bar hostesses etc) since 2007. An analysis of the initial results will enable the impact of this project to be assessed. In order to raise awareness and to improve access to HIV testing, the teams will develop specific outside screening activities, in partnership with the CDAG service and some other organisations.

» RANGE OF SERVICES

1- ISL: Law n° 2003-239 of 18 March 2003 on internal security (1).

• Montpellier: town-centre evening outreach sessions once a week. • Nantes: the bus goes out twice a week. Day-time clinic sessions. Physical accompaniment to hospital and to other services (to access health services or other rights and to provide support during legal processes). Setting

up health workshops. Making contact and prevention work among sex workers in private places (the indoor project). • Paris: three to four outreach sessions a week. Provision of adapted information (translated into Chinese), referrals and physical accompaniment, with interpreters when needed.

Monthly thematic health workshops. • Poitiers: Two outreach sessions a week. Day-time and night-time bus sessions as part of the Abri collective. • Rouen: fortnightly bus outreach sessions, alternately with AIDES; screening for infectious diseases.

NUMBER OF VOLUNTEERS

» 97 COMMON CONDITIONS

» Gynaecological problems, illnesses linked to conditions on the streets, psychological problems linked to stress, isolation, abuse or addiction… FUNDING

» Regional public health groups, General councils, Regional councils, Town councils, Ensemble contre le sida - Sidaction, Paris observatory on gender equality, European Commission. PARTNERS

» Aides, Arcat, CDAG, Cimade, Friends of the Women’s Bus, Droits d’urgence, Red Cross


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HARM REDUCTION PROGRAMMES IN FRANCE

Because of the legislation and considerable supervision of legal technivals, there has been a levelling off in the number of participants in this type of event. Nonetheless, an increasingly young and ill-informed population continues to be attracted to the techno scene. We have noticed growing poly-drug use and have seen new drugs emerging. For several months, the techno scene has witnessed police pressure blocking MdM’s work. Following the official recognition of the needle exchange programmes as medico-social services (CAARUDs), MdM transferred its programmes in Bordeaux, Marseille and Paris to independent organisations.

Reducing the risks of drug use

» 6 RAVE PROGRAMMES BAYONNE, MEDITERRANEAN (PROJECT BASED IN MARSEILLE AND NICE), MONTPELLIER, NANTES, PARIS AND TOULOUSE 1 NEEDLEEXCHANGE PROGRAMME IN PARTNERSHIP WITH AIDES (ANGOULÊME) 1 XBT/DRUG ANALYSIS PROGRAMME

DRUGS

» ACTIVITIES Since 1997 MdM has been running prevention and harm reduction activities at techno festivals. A changing context has led us to develop our work: • in free parties and in cross-border clubs; • in squats, during parties but also, more importantly, on an everyday basis. The Paris Rave project has redirected some of its activities towards squats; • in technivals, where our work includes four components: – welcome (prevention table, provision of prevention materials such as injection kits, roll-yourstraw…); – healthcare (medical and nursing care); – reassurance (supervised chillout zones, place for caring for and diagnosing collapses); – drug analysis with thin layer chromatography, the only method which is legal.

» Alcohol, cannabis, ecstasy, cocaine, LSD and other hallucinogens, amphetamines, heroin, anaesthetic substances (GHB, ketamine). HEALTH PROBLEMS

» Hepatitis C, HIV, psychiatric breakdowns, anxiety crises, bad trips, dependency, various somatic problems, headaches, vomiting, feeling unwell. MOST COMMON RISKS

» Hepatitis C transmission, HIV, psychiatric breakdowns, dehydration, hyperthermia/ hypothermia, hypoglycemia. BENEFICIAIRES

» OUTLOOK • Adapting our working methods to the needs of our target groups (information on the risks of injection). • Updating MdM’s communication on harm reduction issues. • For squats: ensuring the long term sustainability of the current arrangements, particularly in terms of medico-psycho-social sessions.

» Approximately 28,000 contacts during parties or festivals and around 1,000 for the needle exchange programme. NUMBER OF INTERVENTIONS

» 117 Rave programme interventions, including 1 technival, and 177 outreach sessions by the Angoulême needle exchange programme. NUMBER OF VOLUNTEERS

» 163

» RANGE OF SERVICES • All the projects provide first aid, information and drug analysis as part of a harm reduction approach. • We work in places where young people gather: free parties, technivals, discotheques, clubs, squats…

FUNDING

• In 2009, 285 samples (total of all drugs) were collected, documented and analysed by the XBT project. • Distribution of sterile injecting equipment and collection of used equipment.

» Ministry of Health, Regional public health groups, Regional councils, INTERREG (Europe)… PARTNERS

» Techno Plus, AIDES, L’Orange bleue, ASUD, Tipi, Act Up, Acothé, Espace Indépendance, Sida Paroles, Association Liberté, Bizia, La Fratrie, ANPREF, AFR, Harm Reduction Collective


DOCTORS OF THE WORLD ANNUAL REPORT 2009

ROMA PROGRAMMES IN FRANCE

Since Romania and Bulgaria joined the EU, the rights of EU citizens have been changed. At the end of 2007, a circular was issued stating that “European citizens without sufficient resources and/or health insurance cannot access the basic Universal Health Insurance (CMU) or the complementary CMU” and now have to resort to State Medical Aid. The main barriers include: eligibility conditions, poor understanding of the French health system, language barriers, instability and repeated expulsions and the length of time to access State Medical Aid. These difficulties lead to delays in seeking healthcare.

Working with Roma to improve health

» AIX-EN-PROVENCE, BANLIEUE/SAINTDENIS, BORDEAUX, LYON, MARSEILLE, NANTES, STRASBOURG

BENEFICIARIES

» ACTIVITIES • Aix-en-Provence: 87 medical consultations and 100 paediatric consultations. • Banlieue project, Saint-Denis: 161 outreach sessions. 1,702 medical consultations for 1,046 people (including 646 children), 273 people vaccinated, 86 women received ante-natal monitoring. • Bordeaux: visiting seven different squats. Around 300 Roma were seen. • Marseille: regular visits to 14 places where Roma live (squatted land or buildings), 459 medical consultations for 310 people (around 700 people surveyed in different places). • Lyon: 45 places monitored, 479 medical consultations and 1,259 people seen. • Nantes: 97 outreach sessions in 9 places, 741 medical consultations and 456 people seen. • Strasbourg: 51 outreach sessions in 8 places, 398 medical consultations for 1,400 people.

» Approximately 3,500 beneficiaries NUMBER OF VOLUNTEERS

» 129 NUMBER OF PROGRAMMES

»7 FUNDING

» Regional public health groups, General councils, Regional councils, town councils… PARTNERS

» OUTLOOK In partnership with other organisations, MdM is continuing to lobby the public authorities for a better standard of living for the Roma population. A health mediation project, run by MdM Nantes, Romeurope and four organisations, aims to facilitate reception and access to health services in four places (Saint-Denis, Nord-Pas-de-Calais, Var, Nantes) for women and young children.

» RANGE OF SERVICES • Medical follow-up: primary healthcare and helping people access mainstream health services. • Facilitating schooling for children: raising awareness, adminstrative procedures and vaccinations. • Sanitation: lobbying councils for improved hygiene conditions

in settlements (e.g. refuse collection, access to water) and to find appropriate housing. • Maternity care: Prevention of abortions, ante-natal monitoring, information on contraception, child immunisation, accompaniment to mother and child health protection services and family planning services.

• Bearing witness to the living conditions, repeated expulsions and other obstacles that hinder the Roma population’s access to healthcare and other rights. • Mobilisation of support committees for Roma families, health actors, town councils and public services.

» Romeurope, support committees, shelters, mother and child health protection services, Comité d’aide médicale…


118

HOMELESSNESS AND POOR HOUSING PROGRAMMES IN FRANCE

MdM kicked off widespread debate on homelessness by distributing 400 tents to rough sleepers. As a result, there was a significant advance in relation to the right to housing — a fundamental right — in 2007, with the adoption of the Dalo law (realising the binding right to housing). This law imposes an obligation on public authorities to provide shelter to those who don’t have any. Two years after the law came into force, France still has more than 3.5 million people who are homeless or poorly housed and the vast majority of Mission France service users are homeless or live in insecure accommodation.

Taking action for homeless people » ANGOULÊME, AJACCIO, BORDEAUX, CALAIS, DUNKIRK, CAYENNE, GRENOBLE, LE HAVRE, LYON, MARSEILLE, METZ, MONTPELLIER, NANCY, NANTES, NICE, PARIS AND ITS SUBURBS, POITIERS, REUNION (ST-DENIS), STRASBOURG, TOULOUSE, VALENCIENNES.

HOMELESS IN FRANCE

» ACTIVITIES

» 100,000 people1

Since 1993, our mobile teams have been reaching out to homeless people, who are often vulnerable and marginalised. Our objectives are to: • identify vulnerable people who need to be accompanied to mainstream health and welfare services and relevant voluntary sector services; • organise medical, social and prevention services; • inform people of their rights and accompany them if necessary; • receive people who do not have access to healthcare in MdM clinics, until they can realise their right to health coverage. Based on our work, MdM France bears witness to the damaging health consequences of homelessness and poor housing. We also provide social support through our outreach teams on patrol and our visits to squats, medical consultations in night shelters etc.

POORLY HOUSED

» 3.51 million people, an increase of almost 15,000 since 2008 MOST COMMON HEALTH PROBLEMS

» Back problems, gum and teeth problems, gastric problems, viral hepatitis, respiratory infection, asthma, parasites/candidosis, skin infections, anxiety-stresssomatic problems, depressive syndrome, hypertension, diabetes… NUMBER OF PROGRAMMES

» 20

» OUTLOOK • To continue our healthcare, prevention and accompaniment activities. • To continue our lobbying for public institutions to meet the health needs of homeless people and to develop mobile teams. • To begin the withdrawal of volunteer teams from the ‘nursing beds’ facilities in shelters which are increasingly being integrated into public services.

NUMBER OF VOLUNTEERS

» 279 CONTACTS WITH HOMELESS PEOPLE

» Approximately 31,500. FUNDING

» Regional public health groups, General councils, Regional councils, town councils… KEY PARTNERS

» RANGE OF SERVICES

1- 86,500 homeless people – an estimate by Insee 2001. But all observers and voluntary sector organisations agree that, eight years later, there are now at least 100,000 homeless people.

• Medical and social consultations, street outreach work: Ajaccio, Angoulême, Le Havre, Lyon, Montpellier, Marseille, Metz, Nice, Paris, Poitiers, Rouen, Strasbourg, Toulouse, Valenciennes.

• Consultations with other organisations (e.g. Restos du cœur, Salvation Army, Abbé Pierre shops, Secours catholique, AIDES, Point Écoute Santé jeunes): Grenoble, Le Havre, Lyon, Metz, Nancy, Nantes, Reunion, Toulouse, Valenciennes.

• Consultations in emergency shelters: Lyon, Metz, Nantes, Nice, Toulouse. • Interventions in squats: Bordeaux, Calais/Dunkirk, Paris and its suburbs, Rouen. • Mobile mental health teams: Marseille.

» Abbé Pierre Foundation, Secours catholique, Emmaüs, Red Cross, Restos du cœur, Samu social, DAL, local organisations (La Péniche, les Amis de la rue, le Fournil, GAF, Enfants du monde Droits de l’homme…)


DOCTORS OF THE WORLD

CHILD LEAD POISONING

ANNUAL REPORT 2009

PROGRAMMES IN FRANCE

Faced with exclusion, poverty and sickness, children are vulnerable. According to a report by the Council on employment, income and social cohesion (CERC), two million children live below the poverty line. The number of children in France affected by lead poisoning is estimated to be around 85,000. Since 1993, Doctors of the World has been running programmes to tackle lead poisoning, with a view to identifying and protecting children, as well as informing families and health actors.

Protecting poisoned children » BANLIEU PROJECT, TOULOUSE

BENEFICIARIES

» ACTIVITIES Lead poisoning results from ingestion of lead from paint on the walls of buildings built before 1948. When a building gets very run down, the paint flakes and the dust can be ingested by children, causing poisoning which affects the central nervous system. There is no treatment and the only solution for child lead poisoning is prevention.

» OUTLOOK In 2009, the lead poisoning programme in Val-de-Marne extended its scope to include the consequences of insalubrious housing on health: the programme is starting an analysis on the broader theme of “health and housing” with a view to developing new projects not solely focused on lead poisoning.

» 545 buildings visited, more than 140 families informed, and more than 90 referrals for lead poisoning carried out in Val-deMarne. » In Toulouse, 40 children and 20 health professionals were informed/trained, 20 buildings were visited and 20 referrals for lead poisoning were carried out. » 85,000 children potentially affected (Source: study by Inserm 1999). COMMON HEALTH PROBLEMS

The Toulouse programme will continue its awareness-raising/information activities in the social and medical field in order to increase screening of affected or at-risk children. These activities are carried out in the town centre and could be extended.

» RANGE OF SERVICES • Identifying urban areas at risk, informing families, evaluating the risks of exposure for children, organising medical interviews and referring for screening. • Informing and accompanying families in the administrative processes and in protecting their children, by encouraging them to take up screening. • Follow-up procedures related to housing until the children are protected: refurbishment, emergency shelter, rehousing.

• Ensuring follow-up to treatment when the children are exposed or intoxicated. • Mobilising various actors by organising meetings and developing tools. • Encouraging meetings and mobilising different actors in the field of health, housing and law. In addition, in 2007 the Banlieue programme, in partnership with the Abbé Pierre Foundation, produced a tool kit “From lead to lead poisoning: we’re all affec-

ted” which brings together various tools to facilitate setting up health, housing and law networks. This kit was disseminated to nearly 1,000 actors in 2008.

» Lead poisoning, lung conditions, respiratory infections, dermatological problems… FUNDING

» Regional public health groups (DDASS), Caisse d’Épargne Foundation, Île-de-France regional council NUMBER OF VOLUNTEERS

» 15 PARTNERS

» Abbé Pierre Foundation, mother and child health protection services, local health and hygiene services, local and regional voluntary organisations…


120

PREVENTING HIV, HEPATITIS, STI AND TUBERCULOSIS PROGRAMMES IN FRANCE

MdM teams see people who live in deprivation and migrants, who come from regions with higher prevalence of HIV, hepatitis and tuberculosis. In France, migrants represent 41% of new HIV cases, and the number of tuberculosis cases in people born overseas is eight times higher than that of people born in France. The prevalence of hepatitis B and hepatitis C is three times higher in the vulnerable people who are covered by the CMU (Universal Health Insurance).

Tackling HIV, hepatitis and tuberculosis

» CLINICS: LYON, MARSEILLE, ROUEN, TOULOUSE, PARIS, SAINT-DENIS, PAU, NICE, CAYENNE » PROSTITUTION PROGRAMMES: LOTUS BUS, PARIS, FUNAMBUS NANTES » HOMELESSNESS PROGRAMMES: METZ, LYON

BENEFICIARIES

» ACTIVITIES Objectives: • to strengthen prevention and improve access to testing and to treatment for service users we see in our Healthcare and Advice Clinics and through our outreach work among sex workers and homeless people; • to intensify prevention efforts: providing prevention materials (flyers, condoms etc.), individual interviews and group sessions; • improving access to screening: encouraging service users to go for testing, partnerships with free, anonymous testing services and local laboratories; • facilitating access to healthcare: partnership with mainstream health services, physically accompanying service users; • bearing witness to people’s experience in relation to these diseases.

» OUTLOOK We would like to continue these efforts in relation to prevention, access to testing and to healthcare for these vulnerable groups, and to extend them to all programmes across France. More specifically, we would like to: • work with people who use drugs through education activities focusing on the risks of injection; • setting up screening with rapid diagnostic tests in order to develop access to relevant, innovative screening for groups who don’t have adequate access.

» RANGE OF SERVICES • Nine pilot Healthcare and Advice Clinics carry out prevention activities on a daily basis, with access to professional interpreting.

• Two sex worker outreach programmes, focusing on reducing the risks associated with prostitution, inform, refer and physically accompany people in the process of accessing healthcare, prevention and other rights.

• Two homeless outreach programmes go out into the streets and deliver prevention messages in emergency shelters or in the premises of other organisations.

» The 21,265 service users attending the pilot programmes HEALTH PROBLEMS

» HIV/AIDS, hepatitis B and C, sexually transmitted infections, tuberculosis FUNDING

» Ministry of Health, Médecins du Monde’s own funds


DOCTORS OF THE WORLD ANNUAL REPORT 2009

OBSERVATORY ON ACCESS TO HEALTHCARE PROGRAMMES IN FRANCE

Mission France’s Observatory on Access to Healthcare was created in 2000 to bear witness to the difficulties which vulnerable groups have in accessing healthcare. This essential tool for understanding the situation of our service users enables us to show the links between their living conditions, their rights and their health. It also allows us to highlight any discrimination they experience when trying to access care or any flaws in the current arrangements, as well as positive experiences.

Bearing witness to barriers to healthcare for vulnerable groups

The Observatory helps us to develop understanding of vulnerable groups, which are often excluded from official public health statistics. The data include a significant number of homeless people and undocumented migrants. It enables us to develop, and make the case for, proposals from the perspective of our work on the ground. Doctors of the World can then lobby or inform political decision-makers and health professionals to improve access to prevention and to care for vulnerable groups. It also enables the teams working on the ground to have access to indicators with a view to enabling them to monitor and assess how their work changes over time. An annual report is published each year to mark the International Day for the Eradication of Poverty. This report is based on: • medical and social data collected in the 21 Healthcare and Advice Clinics in an electronic format; • data collected by a growing number of outreach projects; • testimonies from service users; • observations from those involved in the programme on the current arrangements for access to healthcare and the problems which exist; • programme activity reports; • monitoring of legislative and regulatory developments relating to access to healthcare; • comparisons with other studies and reports in relation to health and deprivation.


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ACTION AND ADVOCACY


DOCTORS OF THE WORLD ANNUAL REPORT 2009

CONTENTS 124 January 125 February - March 126 April - May 128 June - July 130 August - September 132 October 133 November 134 December

123


124

JANUARY © Pauline Beugnies

©RD

Gaza, Palestinian Territories

6 billion others exhibition by Yann Arthus-Bertrand

KEY EVENTS

AND ALSO

• 7 JANUARY Two MdM volunteers liberated. The two Doctors of the World volunteers kidnapped on 22 September 2008 in Ethiopia, and detained since in Somalia, are freed on 7 January.

• 17 JANUARY Gaza: Operation Cast Lead. An international MdM team is finally able to enter the Gaza Strip to support the local MdM team and the health centres facing such difficult circumstances.

• FROM 10 TO 12 FEBRUARY Given the absence of any mortality data for homeless people in France, MdM publishes a groundbreaking study entitled Mortality of homeless people in Marseille. The 44 files examined point to an average life expectancy of 41 years for women, 56 for men and 37 years for people with mental health problems. This report got a lot of publicity and allowed us to highlight the possible link between mortality among homeless people and the lack of access to healthcare and accommodation.

Doctors of the World is a partner of Yann Arthus-Bertrand’s 6 Billion Others exhibition at the Grand Palais and mobilises volunteers to welcome visitors and discuss issues such as challenges, divisions, war, communication, identity, etc.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

FEB

MARCH

© Damien Roudeau / Les yeux dans le monde

© Lâm Duc Hiên

© MdM

Lotus Bus, prostitution programme in Paris

Kinshasa, Democratic Republic of Congo

Darfur, Sudan

KEY EVENTS

KEY EVENTS

AND ALSO

• 8 MARCH

• 2 MARCH

On International Women’s Day, MdM publishes the results of a study carried out in 2008 on exploitation of and sexual violence against girls living on the streets in Kinshasa. Having access to these data allows us to work with the Congolese authorities to be able to improve the situation of young girls on the streets. MdM is calling for coverage of up to 50% of hospital charges, access to contraception for underage girls and the introduction of legally-recognised medical-legal certificates, which could be used as proof when prosecuting rapists or perpetrators of violence.

Because of the deterioration in security conditions, the Doctors of the World team working in the Deribat region, in the Jebel Marra, are temporarily evacuated to Nyala.

Publication of a survey of Chinese sex workers in Paris carried out by the Lotus Bus team: MdM denounces the living conditions of these vulnerable women and highlights their lack of access to healthcare and to information. New cinema screenings for the awarenessraising campaign entitled It’s only human to forget — and to take action, with the publicity film shown in half of French towns.

• 12 MARCH Forum: How can NGOs communicate with the Arab media? MdM organises a debate on the question of relationships (inadequate) with the media in North African and Middle Eastern countries and their correspondents in France and Europe.

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APRIL

MAY

© RD

© RD

© Bruno Fert

Action for Global Health report

Humanitarian review

Olivier Bernard is elected as President of Doctors of the World France

KEY EVENTS

AND ALSO

KEY EVENTS

• 7 APRIL

• 22 APRIL

• 16 MAY

On World Health Day, Action for Global Health issues its third report and organises a debate: Health in crisis: the economic crisis must not be a pretext for abandoning the health Millennium Development Goals.

Type A meningitis cases appear in the eastern Jebel Marra in Darfur in early April. Doctors of the World launches, in partnership with the Ministry of Health and local communities, a large vaccination campaign against this epidemic. The objective being to vaccinate everyone under 30 years old, approximately 65,000 people.

During MdM’s General Assembly, Olivier Bernard is elected as the organisation’s president. Head of the paediatrics department of Aubagne hospital (Bouches-duRhône), this 40 year-old doctor joined MdM in 2000 as a medical co-ordinator, first in Kosovo then in Guinea. In line with the legislation now in place, he will be remunerated.

Publication of the latest issue of Humanitarian Review: Humanitarian fiction.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

© MdM

© Benoit Guénot

Harm reduction in France

Roma programme in Saint-Denis

AND ALSO • 19 MAY

• 26 MAY

On World Hepatitis Day, and in light of Installation of a Roma camp in Saintthe epidemic emergency, MdM calls for Denis: Doctors of the World, with the help effective action with real collaboration bet- of other organisations, sets up an ween political decision-makers and those emergency “displaced persons camp” on working in harm reduction. MdM is also Quai Saint-Ouen in Saint-Denis for around urging the immediate introduction of a 100 Roma people who are exhausted by research-action programme on “education being repeatedly moved on and traumaon the risks of injecting”, as promised by tised by a fire which killed a child. the Ministry of Health in 2008.

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JUNE

JULY

© Benoit Guénot

© Lahcène Abib

Roma programme in Saint-Denis

Tigray, Ethiopia

KEY EVENTS

AND ALSO

• 26 JUNE

• 1 JUNE

Writ issued against MdM. Following the installation of the emergency Roma camp in Saint-Denis, we called for a meeting between the town council, local authorities, public services and everyone concerned. In response, all MdM received was a writ, on 26 June, for illegal occupation of government-owned land.

On 1 June, in the run up to the European elections, MdM asks candidates whether they will commit to access to healthcare for all in Europe, irrespective of their immigration status or financial situation.

KEY EVENTS Following the support provided to the Roma population, the Bobigny tribunal issues its judgement in response to the complaint submitted by the Seine-SaintDenis council against MdM for illegal occupation of land. The tribunal rejects the council’s request for expulsion. In his decision, the judge recognises that “Doctors of the World intervened with a humanitarian aim to come to the assistance of people in difficulty and to provide them with medical and material aid by installing tents so that they could have some shelter, taking into account the emergency and the time needed to find a lasting solution.”


DOCTORS OF THE WORLD ANNUAL REPORT 2009

© Tanguy Rozenn

© RD

© MdM

Pakistan emergency

Humanitarian review

London to Paris bike ride

AND ALSO • 22 JULY The UN Economic and Social Council (ECOSOC) is responsible for looking at questions of sustainable development as well as economic, social and medical international co-operation. At its annual meeting in Geneva, MdM presents two projects: harm reduction in Kabul (Afghanistan) and the programme to strengthen emergency obstetric care by, among other things, training nurses in Tigray to perform caesarian sections (Ethiopia).

In Berre, the government continues its oppressive approach towards migrant farm workers by tearing down Gourbi, on private land on the Plaine des Gravons. For more than 20 years, around 60 people — mainly from Tunisia and Morocco — had been living in this shantytown until the authorities began to dismantle it in July 2007. Doctors of the World, CIMADE, the human rights league and CODETRAS (the Collective defending migrant farm workers’ rights in Bouches-du-Rhône) • 22 JULY denounce this coercive response which Following the confrontations between does not really address the problem: the the Pakistani army and the Taliban which illegal agricultural economy in the region. resulted in more that two million displaced persons, MdM sets up mobile clinics in Swabi district in the North West Frontier Province.

Publication of Humanitarian Review: International attention on the Horn of Africa. 4th London to Paris Bike Ride. For three days around 60 cyclists rode 318 km between the two capitals. The ride had several objectives: to raise money to support programmes to improve access to healthcare, to raise awareness of Doctors of the World, and to create an opportunity for exchange between people wanting to undertake a sporting challenge to support an organisation. This event is jointly organised by MdM-UK and MdM-France. Twenty-seven participants raised nearly 35,000 euros in France alone.


130

AUGUST

SEPTEM

© Benoit Guénot

© MdM

© Dorothée Frénot

Migrants in Calais

Hajjah, Yemen

Earthquake in Sumatra

KEY EVENTS

AND ALSO:

KEY EVENTS

• 11 AUGUST

• 26 AUGUST

• 7 SEPTEMBER

In response to the increase in scabies cases reported by organisations working with migrants in the Calais region, and confirmed by the medical teams of the hospital healthcare access office, MdM and MSF call for more health resources for migrants. On 11 August, the council finally launches an emergency scabies treatment programme. Nonetheless, humanitarian organsiations remain sceptical about the medium-term impact of this one-off intervention unless further action is taken to tackle the factors promoting the spread of scabies.

The conflict in the north of Yemen forces thousands of civilians from their villages, and these people have no humanitarian aid. In the absence of available, reliable information, this resumption in fighting takes place amid widespread indifference. Over the last few months MdM has trained medical and community workers in first aid, in case the conflict returns.

Earthquake in Sumatra (Indonesia). A team provides healthcare and supports health centres in the affected areas in the north of Padang. Mobile clinics are set up to be able to reach people in remote villages.

We expressed our great concern and called on the parties involved in the conflict to protect the lives of all civilians. We also got ready to be able to intervene as soon as possible among the victims of conflict.

• 15 SEPTEMBER Doctors of the World, providing aid to Afghans in Calais (as it has been doing in Afghanistan for more than 20 years) calls on the government to abandon its plans to charter a plane for repatriation. An editorial in Le Monde co-signed by Bernard Granjon, Pierre Micheletti and Olivier Bernard is published the day after the government’s decision to repatriate Afghan refugees in Calais.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

BER © DR

© Julien de Weck

© DR

Observatory on Access to Healthcare in Europe report

Roma programme

Dark room of neglect exhibition in Toulouse

AND ALSO • 24 SEPTEMBER

• 29 SEPTEMBER

Two years after the publication of its first European survey, Doctors of the World publishes a second report by the European Observatory on Access to Healthcare for undocumented migrants. This survey, based on 1,220 interviews in 11 European countries reveals the living conditions, health status and access to rights and to healthcare of undocumented migrants, often the poorest and most discriminated against in our societies. The focus is on lack of access to care for pregnant women and children. MdM kickstarts a campaign for access to healthcare for migrants in Europe by launching this report in Brussels and several cities across Europe.

As winter approaches, Doctors of the World, the Abbé Pierre Foundation and Secours catholique issue a reminder that the currently inadequate support, particularly in relation to health, for Roma groups is further hampered by repeated expulsions. The three organisations call for the winter truce (housing protection during winter months) to be applied to vulnerable inhabitants, including the Roma camps.

Retrospective of the Luis Valtueña international humanitarian photography competition in Le Havre, as part of a voluntary sector day. Second regional workshop on violence against women in Egypt with field actors, to facilitate an exchange between programmes and to encourage the sharing of experiences on the ground.

• FROM 17 TO 30 SEPTEMBER The Dark Room of Neglect exhibition is in Toulouse, as part of the ManifestO festival. A new step for the exhibition which was launched behind the Hôtel de Ville, in Paris, on 6 October 2007 for the Nuit blanche. Anvers and Marseille host the exhibition in October.


132

OCTOBER © RD

International Day for the Eradication of Poverty

© MdM

Dark Room of Neglect exhibition (overseas)

KEY EVENTS

AND ALSO:

• 17 OCTOBER

• FROM 29 OCTOBER TO 9 NOVEMBER

For International Day for the Eradication of Poverty, MdM issues a reminder that health is a fundamental right. The latest figures (2008-2009) clearly show that access to healthcare in France is not going well and that those providing care to the most vulnerable can, sometimes, be seen as suspects: the reporting of an undocumented migrant by a local health insurance office, the legal action against MdM for having come to the aid of Roma families in May, expulsion of migrants in Calais in the middle of a scabies epidemic in September, patients’ permanent fear of attending health and welfare services, etc.

The Dark Room of Neglect exhibition is shown in Seville, at the Andalusian parliament until 9 November. The exhibition is then shown in the Hague from 16 to 19 November in the railway station.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

NOVEMBER © Lâm Duc Hiên

© Benoit Guénot

© RD

Goma, DRC

Migrants in Calais

Gérard Rondeau exhibition in Reims

KEY EVENTS

AND ALSO

• 25 NOVEMBER

• 9 NOVEMBER

For International Day for the Elimination of Violence Against Women MdM bears witness to the situation of women and children in Nord-Kivu, in Democratic Republic of Congo. The region has seen an increase in sexual violence since 2008, and this violence is not always perpetrated by soldiers but is increasingly civilian. In response, MdM publishes a report to raise public awareness, including the accounts of the psycho-social counsellors in Goma, trained by MdM to welcome, listen to and advise people affected by violence.

In response to the emergency situation and with temperatures around 0°C, a group of organisations, including MdM, distributes survival material to about 300 migrants in Calais: plastic sheets, sleeping bags, rain clothes, blankets etc. Since the dismantling of “the jungle” in September, the camps and squats where the migrants had found refuge have been destroyed. MdM denounces the inhumane living conditions these migrants have to suffer, combined with intense pressure from the police on a daily basis. All the makeshift shelters are often too damaged to use and the material distributed by the associations is confiscated by the police.

MdM is involved in the Ultimatum Climatique group, which launches a petition with the aim of mobilising public opinion and putting pressure on politicians before the UN climate summit in December.

• FROM 19 NOVEMBER TO 15 DECEMBER In Reims, MdM presents around 100 black and white photographs by Gérard Rondeau, an extract from the collection Missions, Médecins [jusqu’au bout] du Monde (published by Seuil).

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134

DECEMBER © RD

© Jobard / MdM / Sipa

World AIDS day

Vaccination campaign in Mayotte

AND ALSO

KEY EVENTS • 1 DECEMBER On World AIDS Day, MdM, in collaboration with AIDES, calls for a new approach to screening, using rapid detection tests. Such tests are a useful tool for the highestrisk populations who have little access to the usual services and to facilitate response to emergencies, such as the situation today in French Guiana. Without waiting for legal approval, MdM proposes to begin using the rapid tests on patients attending the MdM centre in Cayenne from the beginning of 2010.

Gaza; the most densely populated place on earth. Doctors of the World highlights the serious repercussions of this operation on the health system, through its surgery programmes and support of health centres.

During the three weeks of the offensive, 21 of the 56 basic health centres had to close, leading to breaks in access to healthcare. The surgical services and the maternity units were used for war surgery, resulting in interruptions and delays to “normal” health services. We estimate that 40% of people with chronic diseases • 23 DECEMBER How is access to healthcare one year had to interrupt their treatment. after Operation Cast Lead? The Israeli army’s Operation Cast Lead from 27 December 2008 to 18 January 2009 worsened a humanitarian situation that was already worrying because of the blockade imposed on the population of

• 15 DECEMBER Opening of a paediatric health centre in Mayotte. The introduction of user fees for healthcare, combined with a very hard-line immigration policy, hinders access to healthcare for many people. Given these difficulties with access to healthcare, particularly for children, MdM opens a paediatric care centre in Koungou shantytown, in the north of the island. This centre will provide medical and social consultations, distribute medicines, plan vaccination campaigns and run prevention activities and screening, particularly for malnutrition. The Dark Room of Neglect exhibition is in Munich, as part of the Tollwood Winter Festival, an alternative festival focused on the environment. Publication of the latest issue of Humanitarian Review: Are NGOs the new guardians of the Geneva conventions?


DOCTORS OF THE WORLD ANNUAL REPORT 2009

REGIONAL DELEGATIONS CONTENTS 136 Alsace 137 Aquitaine 138 Corsica 139 Franche-Comté 140 Île-de-France 141 Languedoc-Roussillon 142 Lorraine 143 Midi-Pyrenees 144 Nord-Pas-de-Calais 145 Normandy 146 Indian Ocean 147 Provence-Alpes-Côte d’Azur 148 Pays de la Loire 149 Poitou-Charentes 150 Rhône-Alpes-Bourgogne

135


136

ALSACE » REGIONAL DELEGATIONS

CONTACT

» Médecins du Monde Alsace 24, rue du Maréchal-Foch 67000 Strasbourg Tel: 03 88 14 01 00 Fax: 03 88 14 01 02 mdmalsac@club-internet.fr REGIONAL BOARD

» Representative: J.-M. Salen » Secretary: C. Frapard » Treasurer: S. Py » Other Board Members: M.-L. Arbogast, A. Kriegel, M. Le Gac, C. Minard » Number of members: 73 » Delegation secretary: B. Fanteguzzi

» PUBLICITY EVENTS AND ACTIVITIES • Five TV interviews on France 3 and Alsace 20 (“Homelessness in winter”, “Roma”, “The end of unused medicines”, “Copenhagen summit”, “World AIDS Day”; Three radio interviews (France Bleu Alsace); 4 press articles (DNA, L’Alsace) • Three presentations to Strasbourg journalism school. • Participation in the “Democracy and health” conference in February at the Maison des associations, Strasbourg. • Participation in February in the Regional Health Conference, Selestat. • Presentation to the National Health Conference in Strasbourg in April. • Participation in the workshop organised by Fnars/Ddass on care at Colmar hospital in April. • Round-table discussion during Anti-Poverty Week in Strasbourg. • Round-table discussion “Young people and humanitarian work”, with pupils from Mulhouse, Le Sémaphore and the Ministry of Youth and Sports. • In December, presentation during a concert organised by the Soroptimists in aid of MdM. • Presentations to humanitarian organisations. • Awareness-raising presentations in middle schools and high schools.

ce (four or five meetings per year). • Monthly meetings of Strasbourg Circle of Silence. • Board of Migration Santé Alsace (an organisation very involved in interpreting). • Recruitment activities among doctors’ organisations and the medical faculty. • Regional health conference and working groups for members.

» ADOPTION Number of children adopted: 8 children arrived this year. Many of the adoptions were complex: special needs, older childrens, second adoption (four children came to Doubs, two to the Lower Rhine and two to the Upper Rhine). Number of requests accepted: 14 dossiers were approved. Among them, three couples dropped out because the children’s country of origin did not reflect their plans and three women have since become pregnant. The relevant departments are Upper Rhine, Belfort and Doubs. Number of adoption requests: 108 dossiers were received at the branch. Countries of origin of the children: Five children from China (special needs and second adoption), two from Vietnam and one from Haiti (over seven years old).

» PARTNERSHIPS

» INTERNATIONAL PROGRAMMES

Supporting the Health Precarity platform in the 67 DDASS. Involvement in the steering committee and co-chairing the Mental Health group. This network brings together nearly all the actors working on deprivation in the Lower Rhine.

The Senegal regionally-managed project continued its development work and support of the rural community in Gamadji. The programme includes training, as well as building and equipping a dispensary, in partnership with a local NGO, the local health authorities and Illkirch town council

» ACTIVITIES • Involvement in the Stasbourg Hospitals Healthcare Access Office (PASS) steering committee. • Regular meetings with CIMADE. • A Joint Prefecture-CIMADE-MdM-CASAS Commission to study the plight of people under legal obligation to leave Fran-


DOCTORS OF THE WORLD ANNUAL REPORT 2009

AQUITAINE

» REGIONAL DELEGATIONS

CONTACT

» 2, rue Charlevoix-de-Villers 33300 Bordeaux Tel: 05 56 79 13 82 Fax: 05 56 52 77 69 medecinsdumonde.bx@ wanadoo.fr REGIONAL BOARD

» Representative: F. Cougoul » Secretary: F. FavarelGarrigues » Treasurer: A. Borgne » Other board members: J.-P. Daulouède, P. Henry, V. Latour » Delegation secretary: M.- C. Chauveau » Number of members: 132 BORDEAUX HEALTHCARE AND ADVICE CLINIC

» Representative: C. Adam » Co-representative: A. Perot Tel: 05 56 48 52 52 mfbordeaux@wanadoo.fr SQUAT AND ILL MIGRANTS PROGRAMME

» Co-ordinators: G. and L. Mayer Tel: 05 56 48 52 52 PAU BRANCH

» Representative: R. Lafourcade » Co-representative: M. Mignonnat Tel: 05 59 83 74 28 mdmpau@wanadoo.fr BAYONNE BRANCH RAVE PROGRAMME

» Representative: J.-P. Daulouède » Co-representative: J.-L. Pradeille Tel: 05 59 44 31 05 mdm.bayonne@wanadoo.fr ADOPTION PROGRAMME

» Representative: C. Seguin Tel: 05 56 79 69 56 mdm.adoption.bdx@ wanadoo.fr

» PUBLICITY EVENTS AND ACTIVITIES • Presentations in middle schools and secondary schools. • Participation in voluntary sector forums. • Reportage by Olivier Jobard on Ginette for the Exile, Exit exhibition. • Participation in the International Human Rights Film Festival in Gironde. • Events for Mission France days in October, with more than 200 participants and Maxime Couturier’s photo exhibition.

» ACTIVITIES • Collection of hygiene products in a middle school, on the students’ initiative. • Participation in ONG Conseil’s training for street fundraisers. • Collaboration with University staff on the development of a diploma course on “Health and Deprivation” for 20102011. • Teaching third stage medical students on “humanitarian medicine” and “health and deprivation”. • Traineeships for student nurses, medical students as part of the optional module on “health and deprivation”, medical residents, and IUT (technology institute) and IRTS students.

» HEALTHCARE AND ADVICE CLINIC • 4,276 attendances at the clinic • Number of patients’ registered: 1,215 • Medical and dental consultations: 2,805 • Social consultiations: 2,177 • Outreach work: - programme with pregnant women; - programme with Moroccan veterans; - medical consultations in partnership and at the premises of Relais du Cœur; - ophthalmology consultations in partnership, and in the premises of, the national union of blind and people with impaired vision (UNADEV);

- outreach action with Roma; - French as a foreign language courses.

» SQUAT AND MIGRANTS PROGRAMME • 63 outings to squats • 157 new files on seriously ill migrants

» ADOPTION PROGRAMME • Number of children adopted: 5 • Number of requests accepted: 26 • Number of requests received: 96 • Countries of origin for children adopted: China and Vietnam • In 2009: on 20 June an information meeting on distinctive children and, on 10 October, a picnic bringing together adoptive families and families in the process of adoption.

» INTERNATIONAL ACTIVITIES Bulgaria: in 2009, the Bulgarian organisation Child and Space became independent, with the withdrawal of Médecins du Monde. Nicaragua: second year of the regionally-managed international programme aimed at detecting and treating pre-cancerous cervical lesions and at training local staff. Haiti: at the end of 2009, the closure of the region’s programme at Esperance hospital in Pilate and plans for a new programme on cervical cancer screening.


138

CORSICA » REGIONAL DELEGATIONS

CONTACT

» Délégation Corse de Médecins du Monde Résidence Monte Cinto 22, rue du Dr-Del-Pellegrino 20090 Ajaccio Tel: 09 75 33 18 99 Tel/Fax: 04 95 10 25 49 mdmcorse@wanadoo.fr REGIONAL BOARD

» 5 members: 1 represenative (retiring) 1 secretary (retiring) 1 treasurer 1 project officer 1 Head of Programme for M ission France FUNDING

» Grants Urcam: €7,000 Ajaccio town council: €1,000 CTC: €1,000 Médecins du Monde’s private funds: €7,853 (Clinic + Delegation + Adoption) Total: €16,853

» PUBLICITY EVENTS AND ACTIVITIES Because of its high degree of involvement in local life, the delegation is invited to various events, such as the voluntary sector Forum, and asked to speak in middle schools.

people, known as Umappp, seeks to encourage people to engage with, or to return to, healthcare for people experiencing psychiatric problems.

» ADOPTION » ACTIVITIES Healthcare and Advice Clinic The clinic takes place once a week in the Secours catholique premises. The team is made up of 24 volunteers who take turns to see patients: 11 health professionals, two support workers, seven social workers and four psychologists. In 2009, there were 258 attendances at the clinic for 94 different patients (including 34 new patients). The main reasons for consultation were: musculo-skeletal (25%), psychological (18%), respiratory (13%) and the digestive system (10%). Voluntary sector action on exclusion The involvement of MdM volunteers is ongoing, as part of the Coordination interassociative de lutte contre l’exclusion (CLE). Other activities: As part of its partnership with Falep, MdM provides one doctor and one nurse. The social, psychological and financial components of the project are carried out by Falep. 517 consultations were provided to 189 patients (104 new patients). The consultations mainly related to psychological problems (29%) and cardiovascular problems (17%).

» PARTNERSHIPS Pharmacists, dentists, nurses, specialist doctors, hospitals. Ava Basta, Red Cross, Culture et Solidarité, Falep, Fraternité du partage. A partnership with the psychiatric outreach unit for vulnerable

Several families have been seen this year. Two files were presented to the national commission; the first was rejected and the second didn’t succeed because of the withdrawal of the person adopting. The adoption processes are changing, particularly with the length of the adoption process which, after approval, could be up to four years, depending on the legislation in the country of origin.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

FRANCHE-COMTÉ

» REGIONAL DELEGATIONS

CONTACT

» Delegation 7, rue du Languedoc, Apt. 168 003 25000 Besançon Tel: 03 81 51 26 47 Fax: 03 81 52 70 28 mdm.fc@wanadoo.fr REGIONAL BOARD

» Representative: J. Guitard » Secretary: V. Llorca » Treasurer: B. Badey » Deputy treasurer: E. Lagnien » Board: B. Badey, V. Llorca, J. Guitard, E. Lagnien, M.-C. Tisserand » Funding: Employees of the Credit Agricole staff committees donated 4,000 euros for Haiti.

» ACTIVITIES The work of the Healthcare and Advice Clinic remain modest because of a shortage of volunteers (10 people). A year of reflection on our work and the role of MdM in our region. The dissertation of one student, Caroline, on the clinic’s work, its location (rather decentralised), its reputation amongst other humanitarian organisations (Cauda - asylum seekers, Restos du cœur, Secours populaire and Secours catholique) and the needs for new activities. This inquiry enabled us to understand that: • MdM’s location is not a problem for service users; • other organisations know about us. They would like us to be able to provide prevention services and psychological support. As a result we are likely to recruit a psychologist for our team.


140

ÎLE-DE-FRANCE » REGIONAL DELEGATIONS

CONTACT

» 62, bis av. Parmentier 75011 Paris Tel: 01 43 14 81 99 01 48 06 63 95 Fax: 01 48 06 68 54 mdm.idf@medecinsdu monde.net REGIONAL BOARD

» Representative: G. Robert until August 2009, G. Pascal » Secretary: M. Melchior » Treasurer: A. Peyré » Other Board Members: I. Chabin-Gibert, J. Guérini M.-A. Silicani » Volunteer responsible for recruitment: A. Grejon » Delegation secretary: L. Kosikila » Number of volunteers: 408 ILE-DE-FRANCE PROJECTS: 10

» The 10 Ile-de-France programmes are: the Healthcare and Advice Clinics (Parmentier and St Denis) and the Roma, Lead Poisoning, homelessness, rave & squats, XBT, CADFA, Lotus Bus projects and the Buddying programmes for hospitalised children.

» PUBLICITY EVENTS AND ACTIVITIES • Round-table discussion of MdM’s regionalisation programme to improve understanding of this process and to encourage exchange between those involved in MdM Ile-de-France. • Round-table discussion on the challenges of the HospitalPatients-Health-Territories for Ile-de-France in April 2009. • Invitation from Julie Bellenger to present the challenges of regionalisation and communication. • Participation in the second night of solidarity at the Bastille and in the 11th arrondissement’s Solidarity Days. • Reporting, at the Sorbonne, the results of a survey of people on the streets met by the outreach teams of six organisations, as part of the 2008 - 2012 priority work areas on shelter and access to accommodation for homeless people and those in poor housing. • Participation of an Ile-de-France board member in a meeting on the restriction of humanitarian work in the international context at Kremlin-Bicêtre town hall. • Presentation at a conference on the theme of “Radiology and humanitarian work”. • Press conference in October at the Paris Healthcare and Advice Clinic, on International Day for the Eradication of Poverty. • Regional health conference, as a permanent member, and represented in the commission monitoring the Healthcare Access Offices (PASS) in the Ile-de-France region. • Participative conference of Ile-de-France regional council. • Publication of the 25th issue of the regional journal, “Le Fil”.

» ACTIVITIES • Fundraising for Ile-de-France activities. • Creation of a collective to fight against the “crime of solidarity”. • Information meeting on swine flu (H1N1) at the Parmentier Healthcare and Advice Clinic. • Quarterly meetings at the Paris Healthcare and Advice Clinic.

• Recruitment of volunteers for Ile-de-France programmes. • Coordination of modules for the University Diploma on Health, Solidarity and Deprivation, in partnership with ParisDescartes University. • Training sessions in nursing, physiotherapy and social service colleges, secondary schools and universities. • Contact programme with the occupants of a squat on rue Baudelique, at the Local Health Insurance Office of the 18th arrondissement. • Intervention for the population expelled from a Roma camp in Nanterre, from a squat in rue Hermel, in the 18th arrondissement and for the Afghan migrants on the streets in the 10th arrondissement. • Visits to assess hunger strikers. • A breakfast debate for the banlieue programme in the St Denis Healthcare and Advice Clinic. • Organisation of a social networking evening for all the Ilede-France programmes. • Preparatory meeting between the Ile-de-France delegation and the Ile-de-France Fnars (National federation of reception and social integration organisations), at Fnars’ request, to share MdM’s experience in working with vulnerable groups.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

LANGUEDOC-ROUSSILLON

» REGIONAL DELEGATIONS

CONTACT

» 18, rue Henri-Dunant 34090 Montpellier Tel: 04 99 23 27 17 Fax: 04 99 23 27 18 mdmlr34@wanadoo.fr REGIONAL BOARD

» Representative: M. Mercier » Treasurer: F. Jourdan » Secretary: M. Gonzales » Other board members: C. Aiguesvives, J.-L. Colas, M. Yaghmaei-Astruc, A. Longo » Number of members: 87

» PUBLICITY EVENTS AND ACTIVITIES • Luis Valtueña photo exhibition at Hérault general council. • Debate, for publication of Pierre Micheletti’s book Humanitarian work: adapt or give up. • MdM presentation at the medical faculty for second year students. • Presentations in secondary schools and nurse training institutes in the region. • Stand at the voluntary sector fair in Montpellier. • Debate on the programme in Nicaragua at the Third World documentation centre at Martin Luther King place. • MdM presentations as part of the University Diploma on public health practices in developing countries.

» PARTNERSHIPS • Pass-Umipp. • 34 Hérault international humanitarian platform. • Hérault food bank - La Babotte. • France-Palestine association 30 Gard. • Harm reduction organisations (harm reduction, AIDES, Axess-MEP). • CIMADE, CICADE, Halte Solidarité. • Health and Vulnerability collective, Regional health conference. • Praps, Regional department for health and social affairs, General Council, Montpellier town council. • Montpellier medical faculty.

» ACTIVITIES • Work on the development of a University Diploma on “Health and vulnerability” in Montpellier. • Work on developing a Rave programme in Montpellier (starting January 2010). • Reflection on the possible development of a regionallymanaged international programme in Côte d’Ivoire. • Inter-regional harm reduction training (Midi-Pyrenees, PACA and Languedoc). • Member of the steering committee on “prevention eve-

nings” with students, MEP Emips, AIDES, in collaboration with the arts, science and law faculty.

» ADOPTION • Number of children adopted: 16 • Number of requests accepted: 13 • Number of requests received: 87 • Countries of origin: – Haiti (7) – Vietnam (4) – Madagascar (2) – China (1) – Colombia (1) – Bulgaria (1)


142

LORRAINE » REGIONAL DELEGATIONS

CONTACT

» 5, rue de l’Armée-Patton 54 000 Nancy Tel: 03 83 27 87 84 Fax: 03 83 28 42 55 del.lorraine@free.fr REGIONAL BOARD

» Representative: A.-M. Worms » Secretary: F. Sommacal » Treasurer: A.-M. Marchetto » Regionally-managed international programme co-ordinators: V. Gorsic » Other Board Members: M. David, J.-P. Legait » Employee: 1 secretary (0.25 FTE) NANCY BRANCH

» Mission France co-ordinator: J.-F. Le Corvoisier » Adoption programme coordinator: J.-M. Gilgenkrantz » Secretary: Aurore Romain medmond.nancy@free.fr METZ BRANCH

» 7, rue Clérisseau 57000 Metz Tel - Fax: 03 87 66 60 93 » Mission France and adoption programme co-ordinator: R. Moutier

» PUBLICITY EVENTS AND ACTIVITIES • Participation in the International Day for the Eradication of Poverty. Welcoming several journalists to the Healthcare and Advice Clinic. • Stand at the Marché du monde solidaire,organised by LorSud during International Solidarity Week and at the voluntary sector event organised by the regional council in Chambley. • Ongoing reflections on internal communication problems. Publication of a quarterly newsletter, En passant par la Lorraine.Updating the delegation’s intranet page. • Constitution of the Roma 54 network with voluntary sector partners and institutional partners. Meetings with institutions and elected officials with a view to a conference on Roma issues. • Meetings with journalists from l’Est républicain,France 3 Lorraine, Radio France Lorraine and other media • Participation in several meetings between regional representatives. • Making contact with the future Regional Health Conference. • Participation in the regional public health group. • Participation in teaching public health at Nancy medical school: DCEM1, licence, masters and university diploma in public health. • Information sessions at various organisations. • Organisation of a hike and a golf competition in aid of the regionally-managed international programme in Burkina Faso.

» ACTIVITIES • Setting up an outreach project, working with Roma in greater Nancy, and medical consultations in Adoma shelter in Essey-lès-Nancy. • In Metz, provision of prevention sessions and outings with the Abbé-Pierre Foundation bus.

» ADOPTION • 70 adoption requests • 10 dossiers accepted

• 11 children adopted from the following countries: – China (3, including siblings) – Brazil (3, siblings) – Vietnam (2) – Haiti (2) – Russia (1)

» INTERNATIONAL PROGRAMMES The regionally-managed international programme in Burkina Faso, now in its third year, is ongoing: Support for improving mother and child health care in Gnagna province. The focus has been on home-based care for marginalised families not integrated into the health system, training and the creation of obstetric and neonatal emergency response units.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

MIDI-PYRENEES

» REGIONAL DELEGATIONS

CONTACT

» 5, boulevard de Bonrepos 31000 Toulouse Tel: 05 61 63 78 78 Fax: 05 61 62 04 15 mdmmidipy.delegation @laposte.net REGIONAL BOARD

» Representative: F. Rigal » Secretary: H. Bonnet » Treasurer: C. Remiot » Other Board Members: F. Arcelin, C. Gorisse, G. Molina, J. Sanchez » Project officer: T. Wingefeld » Delegation secretary: I. Malet ALBI BRANCH

» Co-ordinator: N. Cany Tel: 05 63 45 08 15

» PUBLICITY EVENTS AND ACTIVITIES

» PUBLICATIONS

• Organising a conference for the National Day for Suicide Prevention in February. • A stand for the voluntary sector day at the Toulouse volunteering centre for the 60th anniversary of Emmaüs. • Book signing by Pierre Micheletti in Ombres blanches bookshop for the publication of “Humanitarian work: adapt or give up”. • Organisation of a conference by the IEP students. • Public conference on India in Isle-en-Dodon and participation in an evening organised by public health postgraduate students; evening on Knowledge and Communication; presentation of the regionally-managed international programme in India to Insa students. • “Spotlight on neglect”, presentations by Olivier Bernard, Jacky Naegelen, Marie Pierre Buttigieg and Florence Rigal at the Dark Room of Neglect photo exhibition. • Speeches at the regional economic and social council on difficulties with access to health, and at CIMADE and the municipal health council on children’s rights. • Participation in International Day for the Eradication of Poverty with other Toulouse organisations in Capitole place and organisation of a press conference. • Organisation of a “Health and Habitat” day (presentation by MdM on lead poisoning) in partnership with the Case de santé. • Photo exhibition on India at Isle-en-Dodon, in the Photon laboratory, in the municipal health community, at Bazacle, and at St-Gaudens tourist office. • Photo exhibition “Roma in Roguet MJC”, at Minimes multimedia library. • Dark room of neglect at Port-Viguerie, Toulouse. • Participation, with the Group for the defence of social work, in the “Evening and Night of Solidarity”, place du Capitole, with organisations running reception and accommodation services. • Cross (Foulée pour la Vie, Solidarité en pays de Save), present wrapping in shops during the Christmas period.

• Quarterly newsletter Lettre et débats (3 issues).

» ACTIVITIES • Various presentations in nurse training institutions (Auch, Toulouse Red Cross, Marchant Toulouse), secondary schools (Toulouse, Tarbes), Ifras, external examiners for the Red Cross nurse training institution; welcoming student nurses (Rangueil, Toulouse Red Cross, Pamiers, Cahors) to the delegation. • Participation in the training organised by ONG conseil for street fundraisers. • HIV training for clinic volunteers (two days), training on new data entry procedures for medical and social files (half day); participation of around a dozen volunteers (from the clinic, outreach and rave programmes) in Mission France Days. • Regular visits to a Romanian camp and work, in partnership with the mother and child protection service and DDVLAT, taking part in a seminar on Roma at MdM in Paris andin the Romeurope network meeting in Bordeaux.

» ADOPTION 213 telephone requests for information; 229 letters received; 240 letters sent; one or two public information meetings per month (80 people attended); 36 couples waiting for 44 children; seven children arrived in 2009; five parent support meetings to help prepare future parents for the arrival of the child.

» PARTNERSHIPS Haute-Garonne general council, Toulouse city council, HauteGaronne District Department of Health and Social Affairs, Midi-Pyrenees Regional Department of Health and Social Affairs, Midi-Pyrenees regional council.

» INTERNATIONAL PROGRAMMES Regionally-managed international programme in India (mother and child health in 10 shantytowns in Jaipur).


144

NORD-PAS-DE-CALAIS » REGIONAL DELEGATIONS

CONTACT

» 10-12, rue du Grand-Fossart 59300 Valenciennes Tel: 03 27 47 40 08 Fax: 03 27 30 19 16 mdmvalenciennes@free.fr REGIONAL BOARD

» Representative: G. Dehaut » Head of programme: E. Lamorisse » Secretary: F. Ducatez » Other Board Members: C. Leleu, J.-L. Merle, B. Tilmont » Number of members: 21 » Number of volunteers: 29 GRANTS

» CPAM (Local health insurance office: €3,500 General Council: €7,000 Valenciennes town council: €800 Saint-Saulve town council: €190 Convention hospital: €3,842

» PUBLICITY EVENTS AND ACTIVITIES

» ACTIVITIES

• Mobilisation for 17 October: International Day for the Eradication of Poverty with local organisations. • Participation in the local health programme. • Organisation of the voluntary sector Forum.

• Bi-monthly accompaniment of the outreach team (26 outreach sessions per year). • Advising patients at the Espace Baudelaire. • Distribution of covers, sleeping bags, gloves, socks, hats, shoes and hygiene kits to homeless people. • Outreach consultations once a week at the Boutique Solidarité. • Flu vaccination sessions in the shelters and at our clinics (more than 100 vaccinations). • Collection of used glasses restored by an optician. • Participation in the Valenciennes territorial health programme (Dr Dehaut).

» PARTNERSHIPS • Emergency shelter associations, the CHRS (Accommodation and Social Reintegration Centres) in Valenciennes, and day centres, including: Accueil de jour, Accompagnement Réinsertion, Accueil Promotion Échange, Midi-Partage, La Pose. • Rimbaud outreach team. • Pass (Espace Baudelaire). • Red Cross. • Boutique Solidarité. • Social services, CCAS, CPAM. • S.O.S. Bébé (supporting families in financial difficulty). • Avenir et coopération humanitarian logistics. • Valenciennes national and municipal police. • Emergency services, fire brigade, ambulances.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

NORMANDY

» REGIONAL DELEGATIONS

CONTACT

» 5, rue d’Elbeuf 76100 Rouen Tel: 02 35 72 56 66 Fax: 02 35 73 05 64 REGIONAL BOARD

» Representative: C. Cartier » Secretary: V. Scetbon » Treasurer: R. Hacquet » Other Board Members: A. Seiffert, M. Vache-Picat, R. Picard ROUEN BRANCH

» Co-ordinator: C. Cartier 02 35 72 56 66 mdmrouen@wanadoo.fr » Secretary: S. Benegis LE HAVRE BRANCH

» Representative: A. Seiffert Tel: 02 35 21 68 66 mdmlehavre@wanadoo.f » Secretary: L. Lecomte ADOPTION BRANCH

» Co-ordinators: A. Seiffert, R. Poupel

» PUBLICITY EVENTS AND ACTIVITIES

» PARTNERSHIPS

• Participation in the conference organised by the regional mental health co-ordinators on the theme of “Deprivation and suicide”. • Organisation of a meeting to present MdM, at the international, national and local levels, following a request from the Autobus association. • Presentation to Dieppe nursing school on travellers’ health. • Participation in the event organised for the 50th anniversary of Caucriauville district in Le Havre. • Participation in the steering group “A French account: Tziganes during the Second World War, 1939-1945”, as well as the commemoration of the deportation and internment of Tziganes during this time, at the request of the Fnasat-Travellers association. • Reportage on the parliamentary TV channel (LCP) featuring the Healthcare and Advice Clinic to mark the 10th anniversary of Universal Health Insurance (CMU), as part of a programme on access to healthcare. • Meetings throughout the year with various partner organisations in order to work on new joint projects. • Volunteer recruitment in the local press. • Participation in the DDASS steering committee for the H1N1 flu vaccination campaign. • Participation in the thematic group “Promoting access to healthcare” as part of a local social project implemented by Saint-Étienne-du-Rouvray council. • Participation in outreach patrols with the Healthcare for All association and Autobus. • MdM’s presence at the Healthcare Access Office Copil.

AIDES, La Boussole, UMAPP (Mobile psychiatric team for vulnerable people), Relais gens du voyage, Atelier Santé Ville, CDAG, Committee for Action and Social Promotion (CAPS).


146

INDIAN OCEAN

» REGIONAL DELEGATIONS

CONTACT

» 250, bis rue Général-Rolland Bât. K - SHLMR Bouvet BP 964 97479 Saint-Denis Cedex Tel: 02 62 21 71 66 Fax: 02 62 41 19 46 medecinsdumonde.reunion@wanadoo.fr

REGIONAL BOARD

» D. Coyez, R. Grosse, C. Henry, P. Luciani Lehoucq, J. Manceau, C. Ottenwaelder, E. Rachou » Representative: P. Luciani Lehoucq » Secretary: E. Rachou » Deputy secretary: R. Grosse » Treasurer: J. Manceau » Secretariat: J. Alamélu

» PUBLICITY EVENTS AND ACTIVITIES Participation: • in an Indian Ocean Observatory on the Rights of the Child and UNICEF seminar in Mauritius (presenting results of a study on migration flows of children on Indian Ocean islands); • in the International Day for the Eradication of Poverty on 17 October with ATD Quart Monde; • in the forum on humanitarian aid, NGOs and first aid in the regional social work institute (IRTS) on 27 November; • in events to mark World AIDS Day organised by Gabriel-Martin hospital; • in the white march fighting violence against women on 28 November, at the invitation of the Collective fighting violence against women.

» ACTIVITIES • Medical evacuation to Necker for separation of Malagasy conjoined twins, in January - February. • Appeal for funds for those injured by riots in Madagascar. • Direct marketing mailing for homeless people in Saint-Denis in Réunion. Mission France - homelessness project Head of Programme: Joachim Manceau. Preparation for opening of a clinic for homeless people in StPierre (in the South). Mission France Mayotte Head of Programme: Dr Gilbert Potier Joint Head of Programme: Dr Marie Pierre Auger Opening of a paediatric health centre in Mayotte. Disaster risk reduction programme Head of Programme: Dominique Coyez Joint Head of Programme: Emmanuelle Rachou The disaster risk reduction programme is ongoing.

Support programme in prisons in Madagascar Head of Programme: Pascale Luciani Lehoucq. Ongoing programme in 16 prisons. Objectives: access to healthcare, hygiene, tackling malnutrition. Improving detention conditions (human rights). Action Enfance Head of Programme: Christophe Ottenwaeldert. Joint Head of Programme: Jean-François Delambre. Cardiac surgery in Madagascar (military hospital). Two missions per year. Operation Sourire Head of Programme: Christophe Ottenwaeldert. Joint Head of Programme: Jean-Luc Michel. Child surgery in Madagascar. 2 missions per year. Emergency programme in Madagascar to respond to political events (February 2009) Head of Programme: Dominique Coyez. Surgical team and orthopaedic equipment. One surgical programme co-ordinated by the Emergency Desk.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PACA (Provence-Alpes-Côte d’Azur)

» REGIONAL DELEGATIONS

CONTACT

» 4, avenue Rostand 13003 Marseille Tel: 04 95 04 59 60 Fax: 04 95 04 59 61 mdmpaca@medecinsdu monde.net REGIONAL BOARD

» Representative: P. de Botton » Secretary: M.-F. Négrel » Treasurer: P.-F. Pernet » Other Board Members: M. Glass, J. Pasinetti, M. Picard, C. Roux » Project Officer: I. Malaval » Accounts: G. Vincenti » Delegation secretaries: A.-M. Combe, D. Imbert, M. Semat » Number of members: 155

» PUBLICITY EVENTS AND ACTIVITIES

» PARTNERSHIPS

• Press coverage: – La Provence,“With the Roma, in the hell of squats invaded by scabies” / “Around twenty slums in the town” / “Roma beyond the reality” ; “Life expectancy is 44 for a homeless person in Marseille” (April); “Roma, a new expulsion drama” (June); “The end of Berre bidonchamp” (July). – La Marseillaise,“International Roma Day” (April); “Welcoming the Roma population, a provisional response” (July); “The work of the mental health outreach team” (August). – AFP, “Sixteen people questioned during the demolition of Berre slum” (July). • Homeless programme sardinade and tent at the Vieux Port (July). • Dark Room of Neglect exhibition in Marseille, in October. • Television programme on La Chaîne Marseille on the homelessness programme. • Awareness-raising day on the homelessness programme at the Vieux Port, in December.

Mediterranean action on social integration and accommodation, Rencontres tziganes, Human Rights League, CIMADE, Support association for Berre farm workers, the Collective for the defence of migrant farm workers, the Salvation Army, Marceau day centre, Jeanne-Panier women’s shelter, the Restos du cœur, Lits Halte Santé, the Edouard-Toulouse hospital psychiatric outreach team, the friends of Emmaüs, Les Petits Frères des pauvres, Samu social 13, Baumettes prison psychiatric service, Goel’en association, Marseille Hospitals Public Assistance.

» ACTIVITIES • Among homeless people in Marseille and Nice. • Working closely with homeless people suffering from psychiatric illness in Marseille, in partnership with Marseille Hospitals- Public Assistance. • Outreach project working with Roma in Marseille. • Medical surveillance of migrant farm workers in Berre-l’Étang (le Gourbi). • Harm reduction activities among young people at festivals across the region. • Approved presence of two college members in waiting areas. • Three Healthcare and Advice Clinics in Marseille, Aix-en-Provence and Nice.

» INTERNATIONAL PROGRAMMES Burkina Faso, Diebougou: programme on access to dental care (dental surgery and village mobile clinic, prevention and awareness-raising) and care for, and prevention of, child malnutrition in the province. Romania, Satu Mare: programme focused on children: prevention of abandonment and abuse, training professionals working with young children and preparing children to return to their families. Turkey: programme on access to healthcare for isolated and vulnerable migrants in Istanbul.

» ADOPTION 118 adoption requests; 27 requests accepted; 9 children adopted, from Vietnam, Haiti, Brazil and Colombia.

» FUNDING PACA regional council - 13 departmental council, Marseille, Aix-en-Provence and Nice town councils, Bouches-du-Rhone council, Agency for social cohesion and equality of opportunity, District Department of Health and Social Affairs, Marseille and Nice local health insurance offices, 06 Departmental Council, Nice local social services centre.


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» REGIONAL DELEGATIONS

CONTACT

» 33, rue Fouré 44 000 Nantes Tel: 02 40 47 36 99 Fax: 02 51 82 38 09 mdm.nantes@free.fr REGIONAL BOARD

» Representative: P. Jarrousse » Secretary: A.-L. Guéguen » Treasurer: C. Boulinguiez » Other Board Members: J.-Y. Rocher, J.-P. Clauzel » Delegation secretary: C. Lepert ADOPTION

» Head of programme: M. Rousseau Telephone answering service on Tuesdays from 10.30 to 4pm » Number of members: 70 ANGERS BRANCH

» Joint Head of Programmes: A.-C. Vétillard, G. Brochard Tel: 02 41 43 65 66 mdm.angers@free.fr

» PUBLICITY EVENTS AND ACTIVITIES

» OTHER ACTIONS

• Presentations in secondary schools, Nantes nurse training institution, to EDF staff, to Gynaecology without Borders. • Presentation during an afternoon of Marseille Ateliers Santé Ville on access to healthcare in Nantes. • Participation in a debate after projection of a film Sur les routes perdues with students at the training, research and social and educational careers (Iframes) in Nantes. • Presentation of our work with sex workers to the training centre for social and paramedic professionals. • Presentation of our work with Roma during the gathering of the global movement for christian workers. • Participation in the organistion of “At look at...., voices of..., Roma migrants”, with the Maison des citoyens du monde in Nantes. • Participation in round table discussions. • Loan of the “Opre Roma” exhibtion. • Support for the development of an exhibition “Roma children in Nantes”: distribution of disposable cameras to children in a Roma settlement.

• Harm reduction training for the Aanpa.

» ACTIVITIES • 787 medical, social consultations, nursing care, psychological support (for 248 patients) in the Healthcare and Advice Clinics. • 741 medical consultations (for 456 patients) among Romanian Roma living in or around Nantes. • 151 medical consultations (for 79 patients) in an emergency shelter and a day centre. • 101 people monitored by the sex worker programme, through 1,220 contacts per year. • 1,512 contacts during the Funambus’ night-time outreach sessions with 153 different individuals. • 1,027 telephone contacts to reach 134 sex workers through classified ads and the internet (figure for 2008).

» PARTNERSHIPS PASS, CIMADE, humanitarian food bank, Asamla, Federation prevention and screening centre (Clat, CDAG, vaccination centre), Restos du cœur, Romeurope Nantes collective, Revih.

» ADOPTION • Number of children adopted: 7 • Number of requests accepted: 8 • Number of requests received: 45 • Children’s countries of origin: China, Vietnam, Eastern Europe countries.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

POITOU-CHARENTES

» REGIONAL DELEGATIONS

CONTACT

» 22, allée du Champ-Brun 16 000 Angoulême Tel: 05 45 65 07 47 Fax: 05 45 61 18 85 mdm-poitoucharentes @aliceadsl.fr REGIONAL BOARD

» Representative: M.-L. Ferrari » Secretary: M. Delage » Treasurer: M. Massé » International project officer + CCN: P. Bouet » Other Board Members: J. Cailleton, D. Devedec, P. Boulanger » Delegation secretary: P. de Sède ANGOULÊME BRANCH

(outreach programme) » Representative: M.-L. Ferrari Tel: 05 45 65 11 82 Tel: 06 83 01 30 05 » Number of volunteers: 20, including 17 members » 7 doctors, 1 psychotherapist, 5 nurses, 5 receptions, 1 accountant and 1 employee FUNDERS

» DDASS, Charente department council, town councils: Angoulême, Saint-Yrieix, L’Isle-d’Espagnac, Jarnac, MSA (Mutuelle Santé agricole), Regional public health groups POITIERS BRANCH

» Responsable : P. Bouet 21, Rue Boncenne 86000 - Poitiers Tel: 05 49 01 77 77 » Number of volunteers: 25 including 15 members

ANGOULÊME CENTRE » PUBLICITY EVENTS AND ACTIVITIES • Publication of an activity report presented to the press. • New Year’s eve party on 31 December 2009 in aid of the most disadvantaged populations. • MdM stand at the Musiques métisses event. • Participation in the Health Forum. • Participation in a radio programme on Radio Attitude for the International Day for the Eradication of Poverty and setting up a stand in the town centre. • Participation in the Citizen Café conference on the theme of “The situation of homeless people”. • Media coverage of the winter outreach patrols by France 3 (in partnership with Omega and the Red Cross). • MdM’s participation in the Soyaux and Angouleme Santé Ville workshops.

» ACTIVITIES • Partnership with Jean-Rostand secondary school to prepare an activity report and raise awareness of humanitarian work. • Mental health support for travellers. • Medical consultations. • Weekly discussion sessions. • Collaboration with the Le Toit du monde organisation to improve access to healthcare for asylum seekers.

POITIERS CENTRE » PUBLICITY EVENTS AND ACTIVITIES • Presentation (on humanitarian medicine, deprivation) at the nurse training institute in Poitiers. • Presentation in Angouleme nurse training institute (anthropology and humanitarian action, deprivation). • Stand at the “Le monde en fete” event in Poitiers. • Conference, in collaboration with the preventive medicine department at the University and students, on student prostitution, in Poitiers.

» ACTIVITIES • Outreach patrols to support homeless people (La caravane). • Outreach patrols to support sex workers, with the L’Abri group. • Mother and child programme with the mother and child protection service. • Information sessions organised by external speakers on migration (Migrinter) and French as a foreign language (Child migrant workshop).

» PARTNERSHIPS Angouleme Omega (Association of street mediators), Red Cross, Federation of social emergency workers (Afus), AIDES, L’Éclaircie (Emmaüs day centre), Baobab (asylum seekers organisation), Jean-Rostand secondary school. Poitiers Le Toit du monde, Secours catholique, Red Cross, Cada, Relais Charbonnier, Mother and child protection service, DDASS, Local social services centre (CCAS), Town-hospital network, medical university (association of Poitiers students).


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RHÔNE-ALPES » REGIONAL DELEGATIONS

CONTACT

» 13, rue Sainte-Catherine 69001 Lyon Tel: 04 78 29 59 14 Fax: 04 26 84 78 08 delegation.regionale@ mdmlyon.net REGIONAL BOARD

» Representative: B. Longin » Secretary: M. Roelens » Treasurer: G. Faizant » Other Board Members: R. Allemand, M. Blancher, G. Faizant, G. Caussé » Delegation secretary: C. Guillerm » Project officer: P. Baril » Number of volunteers: 177 GRENOBLE BRANCH

» Representatives: R. Allemand, G. Caussé 19 rue René-Thomas Tel: 04 76 84 17 31 mdm.grenoble@free.fr » Secretary: A. Giannini

» PUBLICITY EVENTS AND ACTIVITIES

» ACTIVITIES

• Cross country skiing event, La Foulée blanche, in Autrans (Vercors) in aid of MdM in January. • Arvel annual general meeting in March with the partner organisation in solidarity tourism. • Donors’ evening in April, in partnership with Lyon city hall and caterers MichéaToque blanche and Bahadourian. • Concert in June with the Lyon Civilian Hospitals orchestra. • Participation in June at the conference on the Regional Council’s decentralised development assistance. • Fête de la musique, with the electronic label, Jarring Effects, in Lyon. • Questioning of candidates for the European elections on access to healthcare in Europe. • Harm reduction at the Foreztival and Trevins events, in August. • Film-debates in Lyon, Sol’enfilms festival and a forum in Grenoble for the Week of International Solidarity, in November. • Organisation of a forum on children to mark the 20th anniversary of the convention on the rights of the child. Les Francas, Lyon city hall. • Participation in conferences, training and presentations in schools on humanitarian action and access to healthcare for vulnerable groups in Grenoble and Lyon (EM Lyon, nurse training institute, medical faculty, universities etc.). • Press conferences and press releases.

Healthcare and Advice Clinics in Grenoble and Lyon, Outreach patrols (Grenoble), Bus (Lyon) and Squats (Lyon). • Advocacy project on “health and accommodation”. • Health promotion project among Roma women (Lyon). • Advocacy to reinforce the activities of Grenoble and Lyon healthcare access offices (PASS). • Advocacy for the creation of a “street nurse” post (Grenoble). • Support for the Nord-Pas-de-Calais coastal migrants programme (Grenoble team). • Agreement with the Wertheimer neurological hospital (Lyon) for the buddying programme for hospitalised children.

» PARTNERSHIPS • Rhone-Alpes Caisse d’Épargne, Bus programme (Lyon). • Master-2 “Humanitarian action and solidarity”, Lyon-II University. • Imprimerie Valette, Lyon. • Michéa caterer.

» ADOPTION Programmes in Grenoble, Lyon and Saint-Etienne. • Number of children adopted: 20 • Number of requests accepted: 50 • Number of adoption requests: 319 • Children’s countries of origin: Russia, Colombia, Haiti, China and Vietnam.

» INTERNATIONAL PROGRAMMES Health in prisons in Guinea: partnership with Kindianaise assistance to prisoners (KAD) in Kindia, to improve detention conditions. Health education in Algeria: partnership with Cirta Oxygène, in Constantine, on health education in relation to chronic diseases. Needs assessments in the Sahraoui camps (Algeria).


DOCTORS OF THE WORLD ANNUAL REPORT 2009

OUR ORGANISATION CONTENTS 152 Doctors of the World and its management 154 Department news 156 Partner organisations 158 International institutions and Doctors of the World 160 Civil society in France 161 Board of directors

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DOCTORS OF THE WORLD AND ITS MANAGEMENT Doctors of the World is Thanks to this diversity, MdM always organisation’s management. dependent on qualified operates on the basis of debate, the members with field experience, views of civil society, and the operational To carry out its tasks properly the Board efficiency of its programmes for benefi- relies on: volunteers in France, expatriate ciaries. As a result, MdM has an original • an advisory structure of MdM members; voluntary workers for organisational structure which is strong • a permanent operational structure; international operations and a and distinctive among large NGOs. • joint decision-making bodies bringing together the staff and MdM members; permanent paid staff. The • the regional delegations. support of hundreds of DECISION-MAKING thousands of donors ensures WITHIN MDM Once a year, MdM members (1,120 in THE ADVISORY Doctors of the World’s 2009), come together at the General STRUCTURE financial independence. Assembly (GA), the highest decision- This includes the continental groups making body and the only one with the authority to modify the organisation’s statutes. The GA elects 12 members of the Board of Directors, and three substitute members. From among its members, the Board elects the President and the organisation’s Bureau for one year: the vice-Presidents, the Treasurer, the Deputy Treasurer, General Secretary and Deputy General Secretary and a Representative. The Board, the organisation’s executive body, meets monthly and takes any decisions concerning the

and thematic groups. Each of these groups, made up of volunteer members with project experience or involved in projects, advises on the continent or theme for which it is responsible. The role is vital in terms of analysing contexts, working methods and drawing on the experience of projects. MdM has five continental groups, four thematic groups and a France group, which combines the Mission France steering committee and the Harm Reduction committee. The members of the advisory groups are elected in line with the internal regulations.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

THE PERMANENT OPERATIONAL STRUCTURE This is led by two Directorates. The Humanitarian Aid Directorate includes the international operations department, the Mission France co-ordinating office, project logistics, the adoption department, and the communication department. The Management Directorate includes the human resources department, the development department, the finance and IT department and the legal department. Non-strategic operational decisions are made each week by the International Operations Division during a ‘project meeting’ for programme-related decisions and at a ‘management meeting’ for other aspects. International programmes are managed by the programme’s medical co-ordinator, who reports to the Head of Programme (who deals with aspects of policy or specific expertise) and is in operational contact with the desk officer in headquarters or the project officer in some regional delegations. Heads of programme are nominated by the different internal bodies and ratified by the Board.

THE JOINT DECISIONMAKING BODIES These include the Executive Committee, which brings together the staff and volunteers involved in management each week and examines strategic decisions concerning projects and takes a close look at decisions about bearing witness, political lobbying and publicity. Other joint decision-making bodies include the human resources group, which meets monthly to define human resources and management policies which are then finalised and ratified by the Board.

REGIONAL DELEGATIONS Across France, Doctors of the World has set up regional delegations. Elected every two years, the regional boards represent MdM in the regions. The delegations carry out international or regional projects, within the overall framework defined by the Board.

THE DONORS’ COMMITTEE Donors are represented by the Donors’ Committee. The Committee is made up of 12 co-opted members and it provides constructive criticism and consensual analysis of MdM’s projects, finance or communication strategy. It is given funding to go and evaluate projects in France and abroad. Through its Chair, it can express its views to the Board and to the Annual General Meeting. This specific set-up encourages debate at all levels. It allows MdM to be an active organisation which is both politically and financially independent. It encourages voluntary commitment by health workers in the service of the most destitute and vulnerable people, and has a constant concern for the quality and effectiveness of its international or local projects.

All of the regional members, the Heads of Programme, the group co-ordinators, the regional representatives and the board members meet three times a year for a National Advisory Council meeting.

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DEPARTMENT NEWS HUMAN RESOURCES

mixture of income from the general public, foundations, businesses and national or European institutional donors.

This year the Human Resources Department worked on three key projects: • finalising a harmonised salary scale in our international projects; • a study on the medical and social coverage of our national staff on international projects; • development of an agreement on the employment of older people.

The global financial crisis which emerged in 2008 has not impacted on the organisation’s income, in 2008 or 2009. Because of the financial crisis and the earthquake in Haiti in early 2010, the organisation will require very careful financial management throughout 2010.

MANAGEMENT

HUMANITARIAN ACTION

Doctors of the World’s approach to development and diversification of funding over the last few years bore fruit in 2008 and 2009.

renamed to become the S2AP department (Analysis, Technical Support and Advocacy Unit), with a new manager at its head. These skills are brought together with a view to being able to meet the support needs of the teams in the field; • strengthening the management of long termteams with the arrival of a new desk officer; the division is emergency desk, Africa and Latin America long term desks and Asia, Middle-EastNorth-Africa and East European long-term desks; • strengthening the emergency desk with the transfer of one long-term desk officer to the emergency desk; • Board approval for the development of medical skills within programme teams; • Board approval for long-term ‘flying co-ordinators’ with a view to easing some of the difficulties on the ground. These last two decisions will be put into action in 2010.

In 2009, as in other years, there were a number of departures and some arrivals: some people left to pursue training, others left to go The organisation’s annual accounts showed a back to the field, while some came back from the surplus, characterised by a 4% increase in social field to work in headquarters. A few also left to programmes, a 2% increase in donations from the pursue new opportunities outside MdM. general public and a 7% decrease in funds from institutional or private grants. This result is the out- The key events of the year include, as expected, come of the investment programme followed by the beginning of a reorganisation of the Interna- Beyond the international projects (see the programme files), some other key areas of MdM for the last five years, which had led to a tional Operations Division. In particular: 50% increase in the volume of programmes, and • the merging of the advocacy department and work began in 2009. These include: which are financially covered by a balanced the programme technical support department, • development of MdM’s policy towards malaria.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

The document is available for consultation on MdM’s intranet (intranet.medecinsdumonde.net/ DOI/S2AP); • development of MdM’s position towards governmental and non-governmental armed forces; • production of a guide Data collection, qualitative methods; this helps humanitarian workers to familiarise themselves with these methods and how to use them; • preparation of a guide on Violence against women - gender, culture and societies; this outlines socio-cultural determinants of such violence and offers methods and tools to help identify such determinants and to ensure they are taken into account in projects tackling violence against women. These guides are available on the MdM intranet, the website (www.medecinsdumonde.org) under the publications tab and on the www.mdmscd.org blog (see “tool box”). As usual, throughout the year project teams took part in conferences and symposia. Two projects were presented to the annual ECOSCOC meeting in Geneva: harm reduction in Kabul (Afghanistan) and strengthening emergency obstetric care by, among other things, training nurses to do caesarian sections in Tigray (Ethiopia).

The emergency desk, which manages ongoing projects and reacts to acute crises managed the following emergency projects in 2009: one epidemic (meningitis in Darfur), two natural disasters (earthquake in Padang, Indonesia and Haiti cyclone), an episode of civil unrest (Madagascar) and three armed conflicts (North Yemen, Gaza and North-West Frontier Province, Pakistan).

DOCTORS OF THE WORLD MANAGEMENT ON 31 DECEMBER 2009 » General Director, Humanitarian Action: Dr Michel Brugière » General Director, Management: François Dupré » Director of International Operations: Dr Carole Dromer » Director of Finance and IT: Thierry Barthelemy » Director of Human Resources: Thomas Durieux » Director of Administration and Legal: François Rubio » Director of Communication and Development: Juliette Chevalier » Director of Adoption: Dr Geneviève André-Trévennec » Director of the International Network Head Office: Benjamin Nguyen

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PARTNER ORGANISATIONS Doctors of the World bases its work around local partners to provide links that will ensure the work we set up will continue. If no partners exist, MdM supports the creation of organisations, often formed on the initiative of, and based around, MdM’s local team. The partners gradually become autonomous and are supported for, on average, one to two years. The structures created in this way remain MdM’s natural partners in the region.

INDEPENDENT ORGANISATIONS INITIATED BY MDM » In Europe Bosnia-Herzegovina, Sarajevo Duga (Reception and Psychological Support Centre for Children and Adolescents). Created in 1994, autonomous since 2002. info_duga@yahoo.com Activities: supporting children, preventing HIV/AIDS. Russian Federation, St-Petersburg Humanitarian Action. Created in 2001, autonomous since 2003 www.haf-spb.org; office@haf-spb.org Activities: HIV prevention, supporting street children, harm reduction, access to healthcare and support programme for migrant workers. Russian Federation, Great North, Siberia Chukotka. Doverie. (Confidence society Chukotka’s Society Sobriety Movement) Created in 2001 doverie@anadyr.ru Poland, Warsaw Nobody’s Children Foundation. Created in 1990, autonomous since 2003. www.fdn.pl Activities: supporting children. Romania, Bucharest FICF (International Foundation for Children and Families). Created in 1993, autonomous since 2003. Fax: +40 21 311 19 15/23 05 Activities: supporting children, tackling HIV/AIDS, harm reduction.

» In Africa Mozambique, Maputo Meninos de Moçambique (Children of Mozambique) Created in 2000, autonomous since 2001. Fax: +258 30 41 16 Activities: supporting children. Madagascar, Tuléar Association Sisal (Doctors for the Right to Health). Created in 2002, autonomous since 2005. Uganda, Kyotera Cipa (Community Initiative for the Prevention of HIV/AIDS/STI). Organisation created in October 2003, autonomous since December 2005. cipacp@yahoo.com Activities: fighting HIV/AIDS.

» In Latin America Salvador MDS (Doctors for the Right to Health). Association created in 1998. www.mds.org.sv Activities: promoting the right to health.

ORGANISATIONS INITIATED BY MDM AND REQUIRING SUPPORT FROM MDM » In Africa Tanzania, Bukoba Tadepa (Tanzania Development and Prevention of Aids). Created in 2001. Activities: fighting HIV/AIDS.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

Côte d’Ivoire, Abidjan Mesad (Movement for Education, Health and Development). Organisation created in 2001. mesad_ci@yahoo.fr Activities: supporting children, tackling HIV/AIDS.

» In Eastern Europe Bulgaria, Sofia Child and Space Association. Created in July 2005. Activities: supporting children. def@bulinfo.net Serbia, Belgrade Veza. Created in June 2005. vezango@gmail.com Activities: tackling AIDS, harm reduction.

MDM’S PARTNER ORGANISATIONS » In Africa Angola, Lobito Omunga Activities: advocating for the recognition of street children’s rights, working with young people to improve their skills and help them become independent. Burkina Faso, Gnagna Icodev (Community Initiatives for Development). Created in 2005. Activities: health, literacy, land management, rural routes. Guinea, Kindia KAD (Kindianese Assistance to Prisoners). Created in 2000. Activities: supporting prisoners. Mali, Bamako AME (Malian Association for Deportees). Created in 1996. Activities: legal and social support to people deported and returned, advocating for their rights.

Rwanda, Kigali Ibuka (Memory and Justice). Created in 1995. Activities: defending the rights of victims of genocide. DRC, Kinshasa AED (Aid to Disadvantaged Children) Created in 1966. Activities: supporting adolescents. Senegal, Podor Asradec (Senegalese association for research and support for community development) www.asradec.org Created in 1981. Activities: health, income-generating activities, environment and sanitation, literacy. Zimbabwe, Chipinge Fact (Family Aids Caring Trust). Created in 1987. Activities: tackling HIV/AIDS.

» In Latin America Guatemala, Chimaltenengo Ames, (Asociación de Mujeres en Solidaridad). Created in 1996. Activities: access to healthcare for lowincome groups and Maquila (factory) workers’ rights. Haiti, Port-au-Prince Uramel (Medico-Legal Research and Action Unit). Organisation created in July 2002. www.uramel.net Activities: promoting justice, in partnership with health professionals. Nicaragua, Puerto Cabezas Nidia White (Women’s association) Created in 1990. lakisha81@hotmail.com Activities: defending the rights of women as part of the law on autonomy.

» In the Middle-East Algeria, Algiers Wassila Network. Network of voluntary organisations established in 2000. Activities: supporting victims of violence. Association Cirta Oxygène. Created in 2007 Activities: prevention, health education Egypt, Cairo El Ma’wa Foundation; Nour el Hayat; Caritas Cairo; Egyptian Association for Societal Consolidation; Ana el Masry. Activities: social support for street children. Iraq, Erbil PAO (Public Aid Organization) Created in 2003 http://pao-org.com Activities: civil society intervention, health, human rights. Lebanon, Beirut Ajem (Justice and Mercy Association) Organisation created in January 1998. ajem@intracom.net.lb Activities: supporting refugees, asylum seekers and detained migrants. Syria, Alep Sarc (Syrian Arab Red Crescent) Activities: health centres.

linaosoianu@yahoo.com Activities: medical, psychological and youth health consultations. Centre Nufarul Alb, Fa˘les¸ti, Glinjeni village Created in 2009 Activities: shelter and psycho-social consultations. Social Assistance Section (SAS) Activities: supporting victims of human trafficking. Romania, Satu Mare Copii Created in 2001. Activities: promoting the rights of children.

» In Asia India, Jaipur JKSMS, (Jan Kala Sahitya Manch Santha) Created in 1983. www.jksms.org Activities: working with vulnerable groups in shantytowns: education, awareness-raising, reintegration, training, advocacy. Papua, Mulia Primari, Created in 1999 primaripapua@yahoo.co.id Activities: preventing HIV/AIDS and primary healthcare.

» In Europe Kosovo, Pristina Vita Kosova Created in 2006. Activities: health, human rights, civil society, gender. Moldova, Balti TDV (Tinerii Pentru Dreptul la Viata) btdv@mtc-bl.md Activities: supporting children. Sotis (Family Crisis Centre) Created in 2009 ognatiuc@mail.ru Activities: shelter for women affected by violence and psycho-social rehabilitation. Atis Created in 2005

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DOCTORS OF THE WORLD AND INTERNATIONAL ORGANISATIONS Links with international institutions are essential for NGOs working in the humanitarian field. As well as being important donors, these institutions are important policy makers. Doctors of the World is involved in different groups which facilitate access to the international decision-making authorities. At the same time, MdM is developing partnerships with other international organisations.

EUROPEAN UNION (EU) • The mandate of ECHO (the European Commission’s Humanitarian Aid Office) is to provide aid and emergency relief to populations affected by natural disasters or conflict outside the EU. ECHO works in more than 60 countries, with more than 200 partners (NGOs, ICRC, UN agencies such as the World Food Programme and UNHCR). ECHO allocates more than 700 million euros to finance humanitarian projects. • EuropeAid (Co-operation office) is charged with implementing the European Commission’s external aid mechanisms. The EU is one of main institutional donors for development assistance. More than 150 countries or organisations receive this aid which is managed by the EuropeAid office.

• MdM relates to EuropeAid via CONCORD (European Confederation of Relief and Development NGOs) through the French NGO collective, Coordination SUD, which lobbies EU institutions and participates in the development of common positions on European development policy and other major issues in NorthSouth relations. • For several years, MdM has been particularly active in VOICE, the interface between aid organisations and ECHO, which brings together 90 European emergency relief NGOs. MdM France is a member of the Task Force which negotiates with ECHO on behalf of VOICE’s NGO members. Thus, during the last few years, MdM has played a large part in the revision of ECHO’s framework partnership agreement through the group set up by VOICE to monitor the partnership agreement.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

• MdM France and other MdM organisations regularly participate in ECHO’s strategic planning meetings. MdM supports the clauses of the new European Consensus on humanitarian aid and will support their implementation in its field programmes.

COUNCIL OF EUROPE (COE) • The Council of Europe brings together 46 European states. Set up in 1949 to defend human rights, it has particularly focused since 1989 on helping central and eastern European countries to implement and consolidate political reforms. • MdM’s international network has consultative status with the COE and is part of OING Service, a liaison group for NGOs with this status.

UNITED NATIONS (UN) • The Economic and Social Council is the main co-ordinating body for the economic and social activities of the UN and its specialist bodies and institutions. MdM’s international network has special consultative status which means that it can carry out lobbying activities, especially in relation to the Human Rights Commission. It has observer status in this subsidiary body of ECOSOC and is one of the few medical NGOs present in this public arena

addressing human rights violations. At the Commission’s annual meeting, MdM can intervene on each agenda item and submit texts. • MdM’s international network has representation at the High Commission for Refugees (UNHCR), the World Health Organization (WHO) and the UN Office for the Co-ordination of Humanitarian Affairs (OCHA). This political representation is supplemented by an operational partnership agreeement between MdM and UNHCR. There is an information exchange partnership between OCHA and MdM and operational monitoring through Reliefweb.

The Council relates to the UN authorities, especially as an interface with UNHCR, by tackling different themes such as the relationship between humanitarian workers and the military, or the protection of civilians during armed conflicts.

• Some MdM programmes are in contact with the UN Development Programme (UNDP) through operational collaboration and policy, notably on the theme of children in conflicts. The same occurs with the United Nations Children’s Fund (UNICEF), with which MdM works on several projects. • MdM is a member of the International Council of Voluntary Organisations (ICVA), a network of NGOs involved in human rights, which concentrates on humanitarian issues relating to refugees. ICVA brings together more than 80 international NGOs.

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CIVIL SOCIETY IN FRANCE CO-ORDINATION GROUPS Coordination SUD (Solidarity Emergency Development Co-ordinating body) A co-ordinating body for French humanitarian and development NGOs which it represents in France and internationally. As a Board Member, MdM represents the group in the Development Cooperation Commission, a joint body informing NGOs on public institutions’ development policies. National Council of Voluntary Organisations (CNVA) An independent authority attached to the Prime Minister’s office, through which all the French organisations relate to the Prime Minister. MdM monitors issues relating to humanitarian activities. Youth and popular education cooperation fund (FONJEP) A jointly-managed organisation bringing together public authorities and voluntary organisations to facilitate voluntary work and fund volunteers’ social charges. MdM monitors volunteering issues. Charter committee A committee bringing together organisations that fundraise from the general public, in accordance with the Charter and recommendations.

National Union of Fundraising Organisations (Unogep). International Council of Voluntary Agencies (ICVA).

THEMATIC PLATFORMS Health and Welfare • UNIOPSS (National Inter-federal Union of Private Health and Welfare Organisations). It works with institutions promoting the recognition of the voluntary sector in health and welfare in European social policy. MdM belongs to the poverty and exclusion commission of the health and Europe groups. Link with the Alerte group. • CNLE (National Council Against Exclusion). It checks that the government is enforcing all measures in the fight against exclusion. MdM has set up a group to monitor the CMU (universal health insurance), investigating issues relating to asylum seekers and refugees. • ODSE (Observatory on Migrants’ Right to Health). • Platform for the Fight Against Human Trafficking. • French Co-ordinating Body on the Right to Asylum. • Romeurope. • International Harm Reduction Association. • Afta (French Association of Voluntary Organisation Treasurers).

Human rights • CNCDH (National Advisory Committee on Human Rights). It delivers opinions and recommendations on human rights to the Prime Minister. International Action • URD (Emergency Rehabilitation Development Group): group of relief organisations working on quality assurance in humanitarian activities. • Volunteering NGO liaison committee (effective from 2004).

GEOGRAPHICAL PLATFORMS Mixed commissions: Joint body of NGOs and public authorities. Exchanges on working methods in a country. Palestine platform: Group of voluntary organisations. MdM has observer status.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

BOARD OF DIRECTORS The General Assembly elects 12 members of the Board for three years, along with three substitute board members. The Board in turn elects the President and the Bureau: the vice-presidents, the treasurer, the deputy treasurer, the general secretary and the deputy general secretary. As the executive body of the organisation, the Board meets every month and takes decisions on the management of the organisation.

At the General Assembly on 16 May 2009, Doctors of the World members elected the Board: » President: Dr Olivier Bernard Paediatrician

» Vice-presidents: Dr Thierry Brigaud

» Deputy treasurer: Dr Fabrice Giraux General practitioner, Paris

• Other board members: Dr Pierre Micheletti Public health doctor, associate professor at IEP in Grenoble

Dr Christophe Adam General practitioner, Bordeaux

Prevention doctor, Valenciennes

Claire Boulanger Lambert

Dr Patrick David

Manager, Le Mans

Anaesthetist, intensive care doctor, Reims

Dr Armelle Desplanques-Leperre

» General secretary Dr Frédéric Jacquet

Doctor, healthcare quality and safety, Haute Autorité de santé, Saint-Denis

Public health inspector,

Dr Luc Jarrigue

Montpellier

Hospital intensive care doctor, Moulins

» Deputy general secretary: Dr Béatrice Luminet Public health doctor, Lyon

» Treasurer: Catherine Giboin Public health consultant, London

• Substitute Board Members: Dr Patrick Beauverie Hospital pharmacist, Fontenay-sous-Bois

Dr Xavier Carrard General practitioner, Marseille

Dr Jérôme Larché Medical intensive care doctor, Narbonne

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GLOSSARY A ACF: Action Contre la Faim (Action against Hunger) ACP: Africa Caribbean Pacific ACRO: Association pour le contrôle de la radioactivité dans l’Ouest (Western Association for Radioactivity Control) ADIL: Agence départementale d’information sur le logement (District Office on Housing Information) ADS: Agence de développement social (Social Development Agency) AED: Aide à l’enfance défavorisée (Aid for Disadvantaged Children) AFD: Agence française de développement (French Development Agency) AFEV: Association de la fondation étudiante pour la ville (Urban Student Foundation) AFR: Association française pour la réduction des risques (French Harm Reduction Association) AFTA: Association française des trésoriers et responsables d’associations (French Association of Treasurers and Managers of Voluntary Organisations) AFUS: Association of Former Unesco Staff members AFVS: Association des familles victimes du saturnisme (Association of Families affected by Lead Poisoning) AIDS: Acquired immune deficiency syndrome AIDES: Association de lutte contre le VIH-Sida et les hépatites (Association fighting AIDS and hepatitis) AJAR: Association des jeunes anesthésistes réanimateurs (Association of Young Anaesthetists and Resuscitation Specialists) AJEM: Association for Justice and Mercy ALCS: Moroccan Association Against AIDS ALD: Long term condition ALPIL: Action Lyonnaise pour l’insertion par le logement (Lyon Action for Housing and Inclusion) ALS: Association fighting AIDS AMCP: Action médicale contre la pauvreté (Medical action against poverty) AME: Aide médicale de l’État (State Medical Aid) AME: Malian association for deportees AMP: Medical-psychological support

AMP: Childcare assistants ANIT: Association nationale des intervenants en toxicomanie (National Association for People working with Drug Users) ANPAA: Association nationale de prévention en alcoologie et addictologie (National Association for Prevention of Alcoholism and Addictions) APE: Agence des participations de l’État (State Participation Agency) ARCAT: Association pour la recherche et la communication pour l’accès aux traitements (Research and Communication for Access to Treatment) AP-HP: Assistance publique-hôpitaux de Paris (Social Services - Paris Hospitals) ARV: Anti-retroviral ASAV: Association pour l’accueil des gens du voyage (Association for Welcoming Travellers) ASDES: Accès aux soins, aux droits et l’éducation à la santé (Access to healthcare, rights and health education) ASE: Aide sociale à l’enfance (Social support for children) ASRADEC: Association sénégalaise de recherche (Senegalese Research Association) ASUD: Auto-support des usagers de drogues (Drug users’ self help) ATD: Aide à toute détresse (Help to All Distressed) ATIS: Centre de santé ami des jeunes (Friends of Young People - health centre) AULIA: Indonesian street children foundation

B BCZ: Bureau central de zone (Central Area Office)

C CAARUD: Centre d’accueil et d’accompagnement à la réduction des risques pour les usagers de drogues (Harm reduction centre for drug users) CADA: Centre d’accueil des demandeurs d’asile (Asylum seeker reception centre)

CAFDA: Coordination d’accueil des familles demandeuses d’asile (Co-ordinating body for asylum seeking families) CAIMCA: Centre de Atencion Integral a la Mujet Caribena CAM: Centre for migrants in Rabat CASE: Centre d’animation, de soutien et d’écoute (Support, listening and activity centre) CASO: Centre d’accueil, de soins et d’orientation (Healthcare and Advice Clinic) CAPS: Comité d’action et de promotions sociales (Committee of social promotion and action) CASP: Centre d’action sociale protestant (Protestant Social Action Centre) CCAS: Centre communal d’action sociale (Local Social Services Centre) CCD: Commission Coopération Développement (Development Co-operation Commission) CCFD: Comité catholique contre la faim et pour le développement (Catholic Committee against Hunger and for Development) CCMP: Centre communautaire médicopsychologique (Medico-psychological community centre) CCN: Convention collective nationale (Joint national agreement) CDAG: Consultations de dépistage anonyme et gratuit (Free and anonymous screening) CCP: Contrat-cadre de partenariat (Partnership agreement) CDC: Center for Disease Control CEADEL: Centro de Estudios y Apoyo al Desarollo Local (Centre for Study and Support of Local Development) CEMLORAL: Cercle d’éthique médicale Lorraine Alsace (Alsace Lorraine Medical Ethics Group) CENHOSOA: Soavinandriana hospital CERC: Conseil de l’emploi, des revenus et de la cohésion sociale (Council on Employment, Income and Social Cohesion) CFDA: Coordination française pour le droit d’asile (French Co-ordinating body on the Right to Asylum) CGSS: Caisse générale de Sécurité sociale (Social


DOCTORS OF THE WORLD ANNUAL REPORT 2009

Security Fund) CHRS: Centre d’hébergement et de réinsertion sociale (Accommodation and re-integration centres) CHU: Teaching hospital CHW: Community health worker CICADE: Centre pour l’Initiative citoyenne et l’accès au droit des exclus (Centre for Citizen Initiative and Access to Rights for the Excluded) CIEN: Centre interdisciplinaire de l’enfant (Multidisciplinary children’s centre) CIMADE: Comité intermouvement auprès des évacués - Service oecuménique d’entraide (Ecumenical Mutual Aid Service) CIPA: Community Initiative for the Prevention of HIV AIDS/STIs CLE: Collectif inter associatif de lutte contre les exclusions (Voluntary section collective against exclusion) CMA: Commonwealth Medical Association CMP: Centre de médecine préventive (Preventive medicine centre) CMU: Couverture maladie universelle (Universal health insurance) CMU-C: Couverture maladie universelle complémentaire (Complementary universal health insurance) CNCDH: Commission nationale consultative des droits de l’homme (National Consultative Commission on Human Rights) CNS: Centre nutritionnel de supplémentation (Supplementary Feeding Centre) CNLE: Conseil national des politiques de lutte contre la pauvreté et l’exclusion sociale (National Council on Poverty and Social Exclusion) CNVA: Conseil national de la vie associative (National Council of Voluntary Organisations) COE: Council of Europe COMEDE: Comité médical pour les éxilés (Medical Committee for Exiles) COM: Orientation centre for children CONCORD: European confederation of emergency and development NGOs CORE: Co-operation For Rehabilitation

CORDAID: Catholic Organisation for Relief and Development Aid CPAM: Caisse primaire d’assurance maladie (Local Health Insurance Office) CRAM: Caisse régionale d’assurance maladie (Regional Health Insurance Office) CRAMIF: Caisse régionale d’assurance maladie d’Île-de-France (Ile-de-France Regional Health Insurance Office) CREN: Centre de récupération et d’éducation nutritionnelle (Nutritional recuperation and education centre) CRESIF: Comité régional d’éducation pour la santé d’Île-de-France (Ile-de-France Regional Health Education Committee) CRIPS: Centre régional d’information et de prévention du Sida (Regional Centre for Prevention and Information on AIDS) CSA: Centre de santé d’arrondissement (District health centre) CSCAD: Chambre syndicale des cabarets artistiques et discothèques (Union of Cabarets and Night Clubs) CSPS: Healthcare and special protection centre CSSI: Centre de support en santé internationale (Centre of support for international health) CSST: Centre spécialisé de soin aux toxicomanes (Specialist Drug Treatment Centre)

D DDASS: Direction départementale des affaires sanitaires et sociales (District Department of Health and Social Affairs) DG: Direction générale (General Directorate) DGS: Direction générale de la Santé (Ministry of Health) DGSNR: Direction générale de la Sûreté nucléaire et de la Radioprotection (Department of Nuclear Safety and Radioprotection) DIC: Drop in Center DRASS: Direction régionale des affaires sanitaires et sociales (Regional Department of Health and Social Affairs)

DRC: Democratic Republic of Congo DRDJS: Direction régionale et départementale de la Jeunesse et des Sports (Regional and District Office for Youth and Sports) Duga: Children and young people’s psychological support centre

E ECHO: European Commission Humanitarian Office ECHR: European Court of Human Rights ECOSOC: Economic and Social Council of the United Nations EDSI: Espace dionysien de solidarité et d’insertion (Dyionesien Place for Solidarity and Integration) EGO: Association Espoir Goutte-d’Or (Golden Drop of Hope Association) ENSP: École nationale de la santé publique (National Public Health School) ESC: École supérieure de commerce (Business School) ESTES: École supérieure en travail éducatif et social (Education and Social Work College) EU: European Union EuropeAid: European Commission Development Office

F FACT: Family Aids Carring Trust FARC: Armed Revolutionary Forces in Colombia FARN: Foyers d’apprentissage et de réhabilitation nutritionnelle (Nutritional recovery and learning centres) FED: European Development Fund

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FICF: Fondation internationale pour l’enfant et la famille (International Foundation for the Child and the Family) FNARS: Fédération nationale des associations d’accueil et de réinsertion sociale (National Federation of Reception and Social Reintegration Organisations) FNPEIS: Fonds national de prévention, d’éducation et d’information sanitaires (National Prevention, Education, Health Education and Information Fund) FONJEP: Fonds de coopération de la jeunesse et de l’éducation populaire (Youth and Popular Education Co-operation Fund) FOSA: Formation sanitaire (Health training) FTE: Full-time equivalent

G GAF: Groupe Amitié Fraternité (Friendship and Brotherhood Group) GDP: Gross domestic product GHB: Gamma-Hydroxybutyrate Acid (“date-rape drug”) GISTI: Immigrants Information and Support Group GRSP: Groupement régional de santé publique (Regional public health group) GK: Gonoshasthaya Kendra

H HALDE: Haute autorité de lutte contre les discriminations et pour l’égalité (High Level Body Fighting Against Discrimination and Promoting Equality) HDI: Human development index HIV: Human immunodeficiency virus HJRA: Joseph-Ravohangy-Andrianavalona Hospital (Madagascar) HMU: Hanoï Medical University HSSEP: Sous-Département des affaires sociales pour la prévention des maux sociaux (SubDepartment of Social Affairs for the Prevention of Social Problems)

I IBUKA: Memory and Justice ICODEV: Community Initiatives for Development ICRC: International Committee of the Red Cross IEC: Information, education, communication IFRAMES: Institut de formation, de recherche et d’animation des métiers (Training, research and professional development institute) IFRAS: Institut de formation et de recherche en action sociale (Training and Research Institute on Social Action) IFSI: Institut de formation en soins infirmiers (Nursing training institute) INSEE: Institut national de la statistique et des études économiques (National Institute for Statistics and Economic Studies) INSERM: Institut national de la santé et de la recherche médicale (National Institute for Health and Medical Research) IRD: Institute for Research and Development IRSN: Institut de radioprotection et de sûreté nucléaire (Institute for Radioprotection and Nuclear Safety) ISPED: Institut de santé publique, d’épidemiologie et de développement (Public Health, Epidemiology and Development Institute) IUT: Institut universitaire de technologie (University Technology Institute) IVDU: Intravenous drug users

J

League) LSD: Lysergic acid diethylamide LSI: Loi de Sécurité Intérieur (Internal Security Law)

M MAAIONG: Mission d’appui à l’action internationale des ONG (Support for International NGOs Programme) MAE: Ministère des Affaires étrangères (Ministry of Foreign Affairs) MAI: Mission Adoption internationale (International Adoption Programme) MCH: Mother and Child Health MDGs: Millenium Development Goals MDM: Médecins du Monde (Doctors of the World) MDS: Médecins pour le droit à la santé (Doctors for the Right to Health) MESAD: Mouvement pour l’éducation, la santé et le développement (Movement for Education, Health and Development) MF: Mission France MFS: Mécanisme de financement supplémentaire (Supplementary Funding Mechanism) MILDT: Mission interministérielle de lutte contre les drogues et la toxicomanie (Inter-Ministerial Task Force on Drugs and Addictions) MIR: Mission internationale régionale (Regionallymanaged international programme) MRAP: Mouvement contre le racisme et pour l’amitié entre les peuples (Movement against Racism and for Friendship between People)

JKSMS: Jan Kala Sahitya Manch Sanstha

N

K KAD: Kindianaise d’assistance aux détenus (Kindianese Support for Detainees)

NC: Non classified NGO: Non-governmental organisation NOVIB: Nederlandse Organisatie Voor Internationale Betrekkingen

L

O

LDH: Ligue des droits de l’homme (Human Rights

OCHA: UN Office for the Co-ordination of


DOCTORS OF THE WORLD ANNUAL REPORT 2009

Humanitarian Affairs ODSE: Observatoire du droit à la santé des étrangers (Observatory on Right to Health for Migrants) OFDT: Observatoire français des drogues et des toxicomanies (French Observatory on Drugs and Drug Dependence) ONLF: Ogaden National Liberation Front OPEC: Organisation of Petroleum Exporting Countries ORPAN: Office des retraités et personnes agées de Nantes (Nantes Office for Retired and Older People) OS: Opération Sourire

P PACA: Provence-Alpes-Côte d’Azur PACT: American consortium of NGOs and voluntary organisations PASS: Permanence d’accès aux soins de santé (Healthcare access office) PEKABO: Perma, Kanisa pe Bongwana PHI: Pharmacie humanitaire internationale (International Humanitarian Pharmacy) PMI: Protection maternelle et infantile (Mother and child health protection service) PMRS: Palestinian Medical Relief Society POPB: Palais omnisport de Paris-Bercy PPMU: Programme de proximité en milieu urbain (Urban outreach programme) PRCS: Programme de projets de recherche concertée sur la santé (Health research project programme) PROSES: Programme Sciences, Environnement et Société (Science, Environment and Society Programme) PTMCT: Prevention of mother-to-child transmission

R REEJER: Réseau des éducateurs des enfants et jeunes de la rue (Network of street children educators)

S SALFA: Health Department of the Lutheran Church in Madagascar SEAD: Sharing Experience for Adapted Development SETHS: Société Européenne Toxicomanies Hépatites, SIDA (European Society on Addictions, Hepatitis and AIDS) SMUR: Service mobile d’urgence et de réanimation (Mobile Emergency and Recovery Service) SNEG: Syndicat national des entreprises gaies (National Union of Gay Businesses) SRH: Sexual and reproductive health STEP: Fair Trade label and network STI: Sexually transmitted infections

T TADEPA: Tanzania Development and Prevention of Aids TAMPEP: European Network for HIV Prevention and for Health Promotion among Migrant Workers TB: Tuberculosis TDV: Young People for the Right to Live TLC: Thin Layer Chromatography TIM: Temporary international mechanism

UNHCR: United Nations High Commissioner for Refugees UNICEF: United Nations Children’s Fund UNIFAF: Assurance funds from the nonprofit health, social and socio-medical branch UNIOPSS: Union nationale interfédérale des oeuvres et des organismes privés sanitaires et sociaux (National Inter-federal Union of Private and Social Organisations) UNOGEP: Union nationale des organismes faisant appel à la générosité du public (National Union of Fundraising Organisations) URAMEL: Unité de recherche et d’action médicolégale (Medico-legal Research and Action Unit) URCAM: Union régionale des caisses d’assurance maladie (Regional Union of Health Insurance Offices) URD: Groupe Urgence Réhabilitation Développement (Emergency Rehabilitation Development Group) UNRWA: United Nations Relief and Work Agency UTC: Unité de traitement du choléra (Cholera Treatment Centre)

V VOICE: NGO collective

U

W

UCS: Unité communale de la santé (Communal health unit) UMAPP: Unité mobile d’action psychiatrique pour les personnes précarisées (Mobile psychiatric outreach unit for vulnerable people) UMATSO: Unité mobile pour l’accès au traitement de substitution aux opiacés (Mobile unit for access to opiate substitution treatment) UN: United Nations UNADEV: Union nationale des aveugles et déficients visuels (National union of blind and partially sighted people) UNDP: United Nations Development Programme UNFPA: United Nations Population Fund

WADB: West African Development Bank WFP: World Food Programme WHO: World Health Organization

X XBT: Drug analysis

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OUR THANKS TO: OUR PRIVATE PARTNERS ADL Partner, San Martinu Association, Aviation Club de France, Compagnie du Pari mutuel SA, Emmaüs Toulouse, ETS Auboueix, Felpasa Établissement, Francetruck, Imerys Ceramics France, l’Acoustics SA, Les Éditions Ivoire, Les Éditions Maréchal, Matmut Assurances, Michea Traiteur, MSM, Prêt charitable et gratuit, Sanofi Aventis, SARL 2 A S, Sel de Radiologie Et, Solidarpresse, Ste Flinvest, Vision Services… Foundations: Norwegian Church Aid, Annenberg Foundation, Arradon Foundation, Bois Brillou Foundation, Deniber Foundation, Drosos Foundation, Fondation de France, Air France Foundation, CMA CGM Foundation, L’Oréal Foundation, Marcel Lepoutre Foundation, Mc Call Mac Bain Foundation, Niarchos Foundation, Ousseimi Foundation, Optic 2000 Foundation, Renovabis Foundation, Seviajer Foundation, Sternstunden Foundation, Fubon Cultural & Educational Foundation, Tourism for Development, PPR Foundation for dignity and women’s rights, Union des blessés de la face et de la tête… INSTITUTIONAL PARTNERS Multi-lateral organisations: European Union: DG ECHO, DG Aid Co; United Nations agencies (UNDP, UNFPA, UNHCR, UNICEF, OCHA, UNAIDS), Global fund against AIDS, tuberculosis and malaria, World Bank, 3 Diseases Fund… Bilateral organisations: German official development assistance, US development assistance: Usaid; UK official development assistance: Department for International Development (DFID); Canadian official development assitance (ACDI), Spanish official development assistance (AECID); French official development assistance: Agence française de développement (AFD), French Ministry of Foreign Affairs crisis centre (CDC), Japanese official development assistance (JICA); Dutch official development assistance (MFS); Swiss official development assistance (DDC); Center for Disease Control, Columbia University, Junta de Andalucia, International Organization for Migration (IOM), Organisation internationale de la francophonie (OIF), Population Services International (PSI)… French local authorities: Paris city council, PACA region, Rhône-Alpes region, Safer de l’Île-de-France, Villes unies contre la pauvreté (Towns united against poverty)… Town councils: Paris, Saint-Etienne-du-Rouvray, Chilly-

Mazarin, Nice, Briscous, Choisy-le-Roi, La Chapelle-deGuinchay, Mulsanne, Ramatuelle, Rilhac-Rancon, SaintSylvestre-sur-Lot, Treport, Trith-Saint-Léger, VendaysMontalivet… For our regionally-managed international projects: Departmental councils: Bouches-du-Rhône, Alpes-deHaute-Provence, Gironde, Charente-Maritime, Vosges, Doubs, Réunion, Midi-Pyrénées, PACA; Regional councils: Provence-Alpes-Côte d’Azur and Rhône-Alpes; présidence des régions, Guadeloupe préfecture. Programmes in France: Regional public health groups, National Health Insurance Office (CNAM), family allowance funds (CAF), regional health insurance funds (CMR), local health insurance offices (CPAM), regional health insurance offices (Cram), local social services (CCAS), centres for free, anonymous screening (CDAG), departmental councils, regional councils, town councils, Délégation interministérielle à la Ville (DIV), Ministry of Health (DGS), Ministry of Social Affairs (DGAS), Regional and departmental health and welfare services (DRASS and DDASS), préfectures, Healthcare Access Offices (Pass), territorial army, department of social work, childhood and health (Dases), Inter-ministerial programme against drugs and addiction (MILDT), Department of Health and Society (DSS), Union of regional health insurance offices (Urcam), hospitals, French Guiana office of social security (CGSS), Mutualité sociale agricole (MSA), French observatory on drugs and addictions (OFDT) OUR PARTNER ASSOCIATIONS AIDES, ALC Nice, Amnesty International, ANEF, Association de communication et d’action pour l’accès aux traitements, Association des régions de France, AFR, Association des familles victimes du saturnisme, Association d’autosupport et de réduction des risques des usagers de drogues, Association des gens du voyage, Santé sans frontières, Association des inadaptés des PO, Association des médecins du Pays de Retz, Association Cercle central, Association Gérer son stress, Association médicale Pascal, Association Partage et Fraternité, Association Régul 31, Association Rencontre avec des hommes remarquables, Association Une Foulée pour la vie, association Le Foyer, association Setton, association Sanatatea, ATD QuartMonde, Avenir et Coopération, Banque humanitaire, Bus 31-32, centre de planification des Pays de la Loire,

Coordination française pour le droit d’asile (CFDA), Collectif Alsace d’associations intervenant auprès des personnes se prostituant, collectif interassociatif sur la santé (CISS), collectif Romeurope, collectif Migrants outre-mer (MOM), collectif Alerte, Collectif de soutien aux victimes de Bam, Comité des amis d’Emmaüs, Communauté mariste, Congrégation des sœurs augustines, Cordaid, the Red Cross, CSF, Coordination française pour le droit d’asile, Coordination nationale des réseaux (CNR), Cyclamed, Droit au logement, D’une rive à l’autre, DHL Liens, Emmaüs, Entraide majolane, Équipe mobile Rimbaud, Fédération des associations pour la promotion et l’insertion par le logement (Fapil), FIDH, Fédération nationale des associations d’accueil et de réinsertion sociale (Fnars), Sonacotra shelter, St-Benoît shelter, Gaïa paris, Gisti, International Harm Reduction Association (IHRA), the Order of Malta, La Case, les Amis du bus des femmes, les Mondes solidaires, les Restos du cœur, le Stade rennais FC, Ligue de Bretagne de football (and the clubs of Britanny), Ligue des droits de l’homme, Max Havelaar, Novib, Observatoire du droit à la santé des étrangers (ODSE), International Observatory on Prisons (IOP), Pact, Passerelle la Santé sans frontières, Pharmacie humanitaire internationale (PHI), Plateforme contre la traite des êtres humains, Secours catholique, Sidaction, Sid’espoir, Solidarité Sida, SOS Drogue international (SOS DI), SOS Femmes, Rasko, Techno Plus, UNIOPSS, Veille sociale, Vialtis, Tourism for Development (TFD). AS Kiwanis Club, Addocuiation, Les Jardins du livre, association École de Karaté traditionnel, Rotary Club Saint-Nazaire Atlantique, Association Notre-Dame des Aides, Aviation Club de France…

AND ALL OUR OTHER PARTNERS WHO HAVE SUPPORTED OUR WORK AT HOME AND ABROAD DURING 2009, AS WELL AS OUR INDIVIDUAL DONORS.


EDITOR-IN-CHIEF OLIVIER BERNARD CO-ORDINATION HÉLÈNE VALLS EDITORIAL COMMITTEE JULIETTE CHEVALIER, GISELDA GARGANO, ISABELLE BIOH-JOHNSON, KASIA BONKOWSKA

EDITORS STÉPHANIE SENET, GISELDA GARGANO

MAPS JULIEN BOUSAC, VINCENT GIAVELLI

THANKS TO EVERYONE WHO HELPED WITH THIS 2009 EDITION

EDITORIAL SECRETARY THÉRÈSE BENOIT

GRAPHIC DESIGN AND CD-ROM PRODUCTION L’ÉCLAIREUR

PRINTED BY LES IMPRIMERIES PATON

PICTURE EDITOR AURORE VOET

ARTWORK ISABELLE MARTIJA-OCHOA


ALGERIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Civil society is very active in Algeria, with many movements, personalities and organisations working to improve the living conditions of vulnerable groups. Violence against women is widespread, mainly in the domestic context. MdM has decided to strengthen the capacity of local actors to tackle this violence.

LONG TERM LIFE EXPECTANCY HDI 0.754; RANK

72.2 YRS 104/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 400 PERSONNEL

» Local: 1 » Expatriate: 1 CO-ORDINATORS

» Programme: Julia Masson » Field: Clarisse Brunelle » HQ: Isabelle Bruand FUNDING

» ADF, MdM BUDGET

» 2009: €172,441

Caring for women affected by violence

» Algiers

» ACTIVITIES MdM supported the listening centre run by our partner organisation Wassila, and provided ongoing training for helpline workers. During the last year of the project, MdM strengthened the network of professionals working with victims of violence, in the medical, legal, social and psychological fields. In June 2009, we organised an international conference to bring together professionals, civil society and representatives of the Ministry of Solidarity. The work has since been transferred to all our partners.

» RESULTS In June 2009, 80 professionals and members of civil society participated in the conference.

» OUTLOOK With this project now finished, MdM has been exploring how we can work with migrants in Algeria. More specifically, we are looking at how we can work with the growing numbers of migrant women and children, who are particularly vulnerable to violence and health problems during their migration journeys.


ALGERIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Civil society is very active in Algeria, with many movements, personalities and organisation working to improve the living conditions of vulnerable groups. MdM has decided to strengthen the capacity of local actors.

LONG TERM LIFE EXPECTANCY HDI 0.754; RANK

72.2 YRS 104/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 300 » Target: 30,000 CO-ORDINATORS

» Programme: Robert Allemand » Field: Zohra Boukabache » Monitoring: Rhône-Alpes Regional Delegation, Angélique Véré

Health education

» Constantine

» ACTIVITIES Our partner organisation, Cirta Oxygène (ACO), relies on volunteer doctors who, after diagnosis, provide one-to-one health education sessions in two districts in Constantine. They follow-up on screening for diabetes and cardiovascular risk factors with a medical interview for at-risk individuals. The aim is to help reduce prevalence of, and to improve treatment for, chronic diseases (in particular, type 2 diabetes and high blood pressure) through a community-based approach to health education.

» RESULTS The ACO doctors carried out 300 individual consultations with patients.

FUNDING

» Isère Council, Grenoble Isère Council, MdM private funds BUDGET

» 2009: €14,233

» OUTLOOK ACO is continuing with the activities on screening and follow-up for chronic diseases in Constantine. In 2010, training on health education will be offered to those involved in public sector health education in Constantine, in partnership with Éducation Santé Isère. ACO will continue to fundraise, with a view to becoming more autonomous.


ANGOLA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Although Angola is getting ready to become the biggest oil producer in Africa, with economic growth of 15% per year, and health reforms which began in 2006, the level of healthcare provision is often just as poor as it was at the end of the civil war. In this context, access to primary healthcare, including for HIV/AIDS, for the most vulnerable (particularly women and children) remains a priority.

LONG TERM LIFE EXPECTANCY HDI 0.564; RANK

46.5 YRS 143/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 190,235 » Target: 427,496

Strengthening the health system

» Huila province, Caconda, Caluquembe and Chicomba municipalities

» ACTIVITIES In Huila province, MdM is supporting the health system and Angolan civil society organisations to improve primary healthcare, including HIV/AIDS. Training and supervision visits were carried out for around a hundred healthcare workers at the health posts and health centres. Tools have also been developed.

PERSONNEL

» Local: 4 » Expatriate: 6 CO-ORDINATORS

» Programme: Luc Jarrige » Field: Mélanie Quétier » Headquarters: Émilie Vallat

MdM has also generated links between different actors involved in health (nurses, community health workers, activists...) through meetings and a workshop on HIV/AIDS. Three Angolan organisations were supported in the introduction of awareness-raising activities on HIV/AIDS and support for people living with HIV. Finally, a survey on the state of health services was carried out to analyse the problems that the population has in accessing healthcare.

FUNDING

» Unicef, other private funds, MdM BUDGET

» 2009: €308,069

» RESULTS Almost 100 people (political decision-makers, healthcare workers and members of civil society) in the province participated in the HIV/AIDS workshop.

» OUTLOOK Since there were differing expectations of the various health actors in Huila province, MdM has decided to terminate this project at the end of 2009. An exploratory mission, with a view to setting up a project in Uige and Kwanza Norte provinces with MdM Spain, is planned for February 2010.


ANGOLA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Although Angola is getting ready to become the biggest oil producer in Africa, with economic growth of 15% per year, and health reforms which began in 2006, the level of healthcare provision is often just as poor as it was at the end of the civil war. In this context, access to primary healthcare, including for HIV/AIDS, for the most vulnerable (particularly women and children) remains a priority.

LONG TERM LIFE EXPECTANCY HDI 0.564; RANK

46.5 YRS 143/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 170 » Target: 450 PERSONNEL

» Expatriate: 1 CO-ORDINATORS

» Programme: Luc Jarrige » Field: Mélanie Quétier » Headquarters: Émilie Vallat FUNDING

» Other European private funds, MdM BUDGET

» 2009: €143,629

Supporting an NGO working with street children

» Benguela province, Lobito town

» ACTIVITIES After working for four years with the Angolan organisation Omunga to improve the situation of children living on the streets in Lobito, particularly to improve their access to healthcare, MdM brought this project to an end in May. The year 2009 was focused on evaluating the activities carried out and on providing institutional support to enable Omunga to continue the work on a long-term basis.

» RESULTS In November 2009, Omunga received the national Human Rights Prize for civil society from the Open Society.

» OUTLOOK MdM wants to maintain contact with Omunga on the situation of street children in Angola and also on the situation of Angolan activists working to defend the rights of these children.


BURKINA FASO

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

With one of the poorest health records in West Africa, economic growth which has not impacted on living conditions and a lack of political will to improve the health system, access to healthcare remains very difficult for most Burkinabés — 45% of whom live below the poverty line. MdM’s work relates to malnutrition, oral healthcare and mother and child health.

LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

52.7 YRS 177/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 2,000 » Target: 20,000 PERSONNEL

» Local: 5 » Expatriate: 0 CO-ORDINATORS

» Programme: Philippe de Botton » Monitoring: PACA Regional Delegation, Isabelle Bouju-Malaval FUNDING

» AFD, MdM BUDGET

» 2009: €52,145

Treating child malnutrition

» Diébougou (South-west region)

» ACTIVITIES MdM is strengthening the care for, and prevention of, malnutrition among children who are being monitored and/or accommodated in a Nutritional Recovery and Education Centre (NREC), by providing nutritional and medical supplies. Three weekly sessions have been introduced to provide nurse consultations and better medical and nutritional monitoring. Training in awarenessraising and nutritional education have been carried out in villages with 20 representatives of the NREC and the PRAH.

» RESULTS 99 malnourished children have received medical follow-up in the NREC. Consultations were provided to 617 children (nutritional advice and distribution of a flour supplement).

» OUTLOOK MdM wants to introduce a data collection system and strengthen the partnership with the district hospital, by including the NREC in the general arrangements for treating child malnutrition across the province. The work on screening, prevention and awareness-raising will continue.


BURKINA FASO

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

With one of the poorest health records in West Africa, economic growth which has not impacted on living conditions and a lack of political will to improve the health system, access to healthcare remains very difficult for most Burkinabes — 45% of whom live below the poverty line. MdM’s work relates to malnutrition, oral healthcare and mother and child health.

LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

52.7 YRS 177/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 10,000 » Target: 180,000 PERSONNEL

» Local: 2 » Expatriate: 0 CO-ORDINATORS

» Programme: Fanny Bensoussan » Field: Abbé Dieudonné Hien » Monitoring: PACA Regional Delegation, Isabelle Bouju-Malaval FUNDING

» AFD, MdM BUDGET

» 2009: €52,145

Access to oral healthcare

» Diébougou (South-west region)

» ACTIVITIES The dental surgery (open five days a week) continues its work. 77% of new patients are followed-up, at the health district level, by a specialist dental nurse. Extraction is still the most common procedure. The mobile clinic has increased its work during the year, with 47 outreach sessions and increased attendance.

» RESULTS 50 patients attend the dental surgery every month. 684 patients benefited from consultations with the mobile clinic.

» OUTLOOK The objective is to expand the programme, to ensure that it becomes autonomous and sustainably funded after MdM’s withdrawal (reduced cost of extraction, better information for health centre nurses to encourage them to refer to the surgery).


BURKINA FASO

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

With one of the poorest health records in West Africa, economic growth which has not impacted on living conditions and a lack of political will to improve the health system, access to healthcare remains very difficult for most Burkinabés — 45% of whom live below the poverty line. MdM’s work relates to malnutrition, oral healthcare and mother and child health.

LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

52.7 YRS 177/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 17,984 » Target: 368,846 PERSONNEL

» Local: 0 » Expatriate: 0 CO-ORDINATORS

» Programme: Véronique Gorsic » Field: Véronique Gorsic » Monitoring: Lorraine Regional Delegation FUNDING

» MdM BUDGET

» 2009: €82,116

Mother and child healthcare

» Bogandé and Manni health districts, Gnagna province

» ACTIVITIES The programme implemented by MdM Lorraine carried out a community health assessment, awareness-raising sessions, compiled a register of reluctant families and made home visits in order to identify the barriers which hinder attendance at the healthcare and social protection centres (CSPS). A register of community health agents was prepared and these agents have been trained and equipped to improve links between the villagers and health services. Within the six CSPS, equipment was supplied and training/refresher courses in mother and child health have been provided. To ensure the sustainability of the programme, MdM is helping the local organisation ICODEV with management, monitoring and evaluation of activities, and is organising meetings with the population, the provincial administrative authorities and the local health authorities.

» OUTLOOK The programme will end in the first quarter of 2010 with a final evaluation. The methodology and implementation of obstetric emergency teams could be the subject of a specific programme, building on the experience gained throughout this mother and child health project.


DOCTORS OF THE WORLD

CHAD

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Despite plentiful resources, Chad is weakened by political instability and regional conflicts. In relation to health, maternal mortality has increased in recent years. Humanitarian crises are not confined to the areas where refugees and IDPs are gathered. In July 2009, MdM started a programme in the west of the country to provide maternal and neonatal care, including treatment for obstetric fistulas. LONG TERM LIFE EXPECTANCY HDI 0.392; RANK

48.6 YRS 175/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,400 » Target: 55,048 PERSONNEL

» Local: 25 » Expatriate: 4 RESPONSABLES

» Programme: Éric Peterman » Field: Basile Ema Bede » Headquarters: Bertrand Bréqueville FUNDING

» UNICEF, UNFPA, Swiss institutional funding, MdM BUDGET

» 2009: €253,905

Improving access to healthcare for women and children

» Mao district (Kanem region)

» ACTIVITIES In partnership with the local authorities, MdM is starting to support five health services and the region’s hospital, by supporting the implementation of the national mother and child health policy. There will be four components to the project. MdM provides surgical and psycho-social care to women suffering from fistulas (around 100 operations per year) and provides support to the maternity unit and the surgical unit to carry out emergency caesarians. The health services receive support in maternal and neonatal care (antenatal consultations, pregnancy monitoring, treating birth complications, referral of seriously complicated deliveries to hospital by ambulance). Villagers receive health education on mother and child health issues. Finally, traditional birth attendants are trained.

» RESULTS Four women suffering from fistulas were operated on in 2009 and 3,400 people received health education on maternal and neonatal health or fistulas.

» OUTLOOK MdM will reinforce its support to the health services in the region by expanding to more centres. At the hospital, we will expand the surgery for women suffering from fistulas and promote the training of national surgical teams to improve quality treatment for patients.

Leïla 20-year old patient operated on for a fistula

“I was normal before, and I went to other people’s homes. This condition made me want to die. I couldn’t eat. I became very introverted. I didn’t go out any more. I felt that I was suffering on my own. It is only when I arrived at Mao hospital that I understood that other people had the same condition. I discussed it with them.”


DRC

DOCTORS OF THE WORLD ANNUAL REPORT 2009

DEMOCRATIC REPUBLIC OF CONGO

INTERNATIONAL PROGRAMMES » AFRICA

Nord-Kivu, in Eastern DRC, is beginning to re-stabilise after a gradual return to peace, despite repeated incidents and some areas of insecurity. MdM is supporting local institutions and civil society in tackling HIV/AIDS and gender-based violence, two issues which affect the population in this post-conflict setting.

LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

47.6 YRS 176/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 55,903 » Target: 800,000 PERSONNEL

» Local: 25 » Expatriate: 1 CO-ORDINATORS

» Programme: Almouner Talibo and Frédéric Jacquet » Field: Billy Sivahera, Pascale Barnich » Headquarters: Catherine Courtin FUNDING

» UNDP, UNICEF, Dutch public institutions, MdM BUDGET

» 2009: €823,242

Tackling HIV

» Goma and Karisimbi health zones, Nord-Kivu province

» ACTIVITIES Since 2003, this project has involved an integrated approach to tackling sexually transmitted infections (STIs) and HIV/AIDS. MdM provides technical and financial support to the health authorities and to national organisations to implement basic measures. These include: six pilot STI services integrated within health centres; two testing services integrated into health centres; two HIV services within Goma general hospital and Virunga hospital (care and ARV treatment); one adolescent health service covering STIs, HIV/AIDS and reproductive health; two prevention of mother-to-child transmission of HIV services; blood transfusion safety in Goma hospital services; psychological and social support for people living with HIV, and awareness-raising and social mobilisation among the general public in Goma and Karisimbi.

» RESULTS 4,000 patients in follow-up, of which more than 700 are on ARV treatment. 6,000 people were tested and 600,000 people benefited from awareness-raising activities by our local partners.

» OUTLOOK The local actors involved in the fight against HIV have reached a level of maturity and experience necessary to take over the activities. MdM is providing technical and financial support, with a view to complete transfer of responsibilities to ensure the programme is sustainable.


DRC

DOCTORS OF THE WORLD ANNUAL REPORT 2009

DEMOCRATIC REPUBLIC OF CONGO

INTERNATIONAL PROGRAMMES » AFRICA

Nord-Kivu, in Eastern DRC, is beginning to re-stabilise after a gradual return to peace, despite repeated incidents and some areas of insecurity. MdM is supporting local institutions and civil society in tackling HIV/AIDS and gender-based violence, two issues which affect the population in this post-conflict setting.

LONG TERM LIFE EXPECTANCY 47.6 YRS HDI 0.389; RANK 176/182 Source: UNDP 2007

POPULATION

» Beneficiaries: 55,903 » Target: 800,000 PERSONNEL

» Local: 25 » Expatriate: 1

Tackling violence against women

» Goma and Karisimbi health zones, Nord-Kivu province

» ACTIVITIES In 2009, this pilot project continued to strengthen the capacity of psycho-social counsellors working for local NGOs in Nord-Kivu. These community agents, who support victims of sexual violence, are usually the first point of help for the victims. In parallel with this training programme, MdM supports an information and resource centre on gender-related violence, offering the centre’s counsellors support and the opportunity to pool their experiences. In addition, awareness-raising activities, in partnership with local actors involved in tackling gender-related violence, are helping to create a mental health culture.

RESPONSABLES

» Programme: Christian Laval » Field: Tatiana Kourline, Pascale Barnich » Headquarters: Catherine Courtin FUNDING

» AFD, MdM BUDGET

» 2009: €141,877

» RESULTS 107 psycho-social counsellors of 26 local NGOs benefited from capacity building activities, to help them support victims of sexual violence.

» OUTLOOK As part of a re-organisation of civil society, MdM is expanding its programme to provide comprehensive support for the local organisations for which the psycho-social counsellors work. This includes supporting community projects and developing an individual and collective culture of mental health, specific to gender-related violence.

Makuta 53 years old, psycho-social counsellor for the organisation PPSSP in Beni

“We are an entry point for these women. We put them in contact with other organisations for psycho-social counselling, legal support, economic reintegration. Often they don’t want to register a complaint because of the stigma. It’s hard, but we support them. We help them to find their strength again and, where possible, we refer them to centres where they can do an activity, such as embroidery or knitting.”


DRC

DOCTORS OF THE WORLD ANNUAL REPORT 2009

DEMOCRATIC REPUBLIC OF CONGO

INTERNATIONAL PROGRAMMES » AFRICA

Despite its plentiful resources, DRC is still affected by the successive civil wars. Although a gradual return to peace has brought stability to most of the country, the reconstruction process still presents enormous challenges. MdM supports policies in relation to health and tackling gender-based violence, as well as promoting access to healthcare for vulnerable groups, either by providing direct support or through partnerships with civil society. LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

47.6 YRS 176/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 5,186 » Target: 13,877 PERSONNEL

» Local: 25 » Expatriate: 3 CO-ORDINATORS

» Programme: Didier Cannet » Field: Cécile Marchand, Pascale Barnich » Headquarters: Catherine Courtin FUNDING

» AFD, UNICEF, French government, other private funds, MdM BUDGET

» 2009: €860,688

Providing care and protection for street children

» Kinshasa

» ACTIVITIES The project aims to improve access to healthcare for children, particularly girls, living on the streets and to improve the recognition of their rights. A solid partnership with a local organisation and a wide network of local actors are vital components. Primary healthcare consultations are provided in four clinics in Kinshasa with referral towards health services providing HIV testing and care for HIV/AIDS. A welcome centre for girls and young women living on the streets takes care of their specific needs: reproductive health, protection against sexual violence, psycho-social support and help with professional and social reintegration. In addition, lobbying and capacity building activities are carried out with the national authorities and other partners, in order to improve the health situation and how street children are dealt with.

» RESULTS 24,806 consultations took place and 1,013 girls living on the streets were seen by the welcome centre in 2009.

» OUTLOOK In 2010, the project would like to focus more precisely on outreach services for HIV patients, on psychological and legal follow-up for victims of violence and on lobbying for access to contraception for under-age girls. Finally, the project will also continue to help develop the capacity of our local partner.

Bijoux 16 years old

“To be able to eat, you have to sell yourself. My body has become worthless, because of my illness.”


DRC

DOCTORS OF THE WORLD ANNUAL REPORT 2009

DEMOCRATIC REPUBLIC OF CONGO

INTERNATIONAL PROGRAMMES » AFRICA

In south-east DRC, the huge Katanga province is divided in two: the cobalt belt in the south and the rural, agricultural area in the north. Tanganyika district, which borders the conflict area, is a transition area where the health system remains extremely fragile. Cholera is endemic in lakeside areas and flourishes along the rivers and the communication routes.

LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

47.6 YRS 176/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 756,055 » Target: 2,100,236 PERSONNEL

Supporting local health services

» 11 health zones of Tanganyika district, Katanga province

» ACTIVITIES MdM is improving the accessibility and quality of primary healthcare in the district by developing the skills of care workers in health centres and maternity units by providing advice, training and joint supervision. The administrative teams also receive technical and financial support. In addition, health education sessions are carried out in the village communities, to encourage training and involvement in the surveillance of disease.

» Local: 42 » Expatriate: 3

» RESULTS

CO-ORDINATORS

121 health centres are supported, as well as five maternity units.

» Programme: Xavier Joubert » Field: Jean-François Caremel, Pascale Barnich » Headquarters: Catherine Courtin FUNDING

» EuropAid, Dutch public institutions, MdM BUDGET

» 2009: €1,972,326

» OUTLOOK The programme is moving towards the provision of technical, operational and financial support for the administrative teams of the district and the health zones, in partnership with the health authorities. MdM is supporting the restoration of the health zones, as set out in the five-year development plan.


DRC

DOCTORS OF THE WORLD ANNUAL REPORT 2009

DEMOCRATIC REPUBLIC OF CONGO

INTERNATIONAL PROGRAMMES » AFRICA

In south-east DRC, the huge Katanga province is divided in two: the cobalt belt in the south and the rural, agricultural area in the north. Tanganyika district, which borders the conflict areas, is a transition area where the health system remains extremely fragile. Cholera is endemic in lakeside areas and flourishes along the rivers and the communication routes.

LONG TERM LIFE EXPECTANCY HDI 0.389; RANK

47.6 YRS 176/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 756,055 » Target: 2,100,236 PERSONNEL

Preventing and tackling epidemics

» 11 health zones in Tanganyika district, Katanga province

» ACTIVITIES MdM supports surveilance of epidemics (such as cholera), prevention and epidemic responses. Healthcare workers benefit from training and joint supervision. Health services are furnished with epidemiological surveillance tools and communication equipment (data collection, IT equipment, radios, etc.). In addition, cholera treatment centres are refurbished and therapeutic inputs are placed in outlying facilities, to improve immediate treatment for patients.

» Local: 42 » Expatriate: 3

» RESULTS

CO-ORDINATORS

2,050 cholera cases were treated in Kalemie when the epidemic flared up in 2009.

» Programme: Xavier Joubert » Field: Jean-François Caremel, Pascale Barnich » Headquarters: Catherine Courtin FUNDING

» DG Echo, UNICEF, MdM BUDGET

» 2009: €324,218

» OUTLOOK Bolstered by partnerships built up over eight years with actors involved in tackling cholera, in 2010 MdM is developing a programme to support the health authorities in implementing a pilot project, at the district level, of the national cholera eradication policy.


ERITREA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Weakened by the recurring tension with neighbouring Ethiopia, Eritrea is one of the poorest countries in the world. In recent years, this country, with a mainly rural economy, has suffered from an ongoing drought, leading to population movements and chronic malnutrition. Since 2006, MdM has been working on a project to improve mother and child health, since women and children are particularly vulnerable in this context. LONG TERM LIFE EXPECTANCY HDI 0.472; RANK

59.2 YRS 165/182

Source: UNDP 2007

PERSONNEL

» Local: 9 » Expatriate: 1 CO-ORDINATORS

» Programme: Sophie Rhodes » Field: Enni Hadzimustafic Dzekovar » Headquarters: Bertrand Bréqueville FUNDING

» DG Echo, SCACembassies, MdM BUDGET

» 2009: €209,695

Developing health projects for women and children

» Afabet, north of the country, northern Red Sea district

» ACTIVITIES At the end of July 2009, after having had to suspend our activities following administrative complications, MdM had to leave the country at the authorities’ request. MdM had been working there since 2006 to provide technical support to Afabet hospital (maternity ward and surgical unit). Since 2008, the project had been expanded to three district health centres. MdM’s support has helped to improve medical care for mothers and children in several ways. The capacity of hospital medical staff and health agents has been strengthened by training sessions within the hospital (mentoring the surgical team) and the health centres. Joint supervision of the health agents has also enabled monitoring of epidemiological data in the health centres. Finally, the conditions in the hospital have been improved by renovation works. Village women in the district have received awareness-raising training in health education.


ETHIOPIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

The Somali region in the south-east of Ethiopia is one of the least developed areas in the country. The health services are inadequate. Access to healthcare is particularly difficult in this region, and the internal conflict which is ongoing in the area isolates the population, making inhabitants even more vulnerable. In addition, the region is regularly affected by epidemics.

EMERGENCY LIFE EXPECTANCY HDI 0.414; RANK

54.7 YRS 171/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 40,000 » Target: 320,369 PERSONNEL

» Local: 69 » Expatriate: 8

Improving provision of healthcare

» Kebri Dehar, Korahe zone, Somali region

» ACTIVITIES MdM is strengthening the availability and quality of secondary care provided by Kebri Dehar hospital. Training and equipment are provided to support ante-natal care within the hospital maternity unit and to support the surgical and blood transfusion services. MdM is also supporting the hospital management in data collection and the organisation of the central pharmacy. Finally, in the outlying areas, community health agents and traditional midwives are trained and epidemiological surveillance is carried out, and a response is mounted when epidemics are identified.

CO-ORDINATORS

» RESULTS

» Programme: Gérard Pascal » Field: Tarak Bach Baouab » Monitoring: Blandine Contamin

Every month, 2,000 consultations are provided in Kebri Dehar hospital. 150 patients are admitted and 85 surgical operations are carried out.

FUNDING

» DG Echo, MdM BUDGET

» 2009: €1,033,811

» OUTLOOK Since the end of 2008, access to Kebri Dehar’s outlying rural areas has no longer been permitted. In 2010, the objective is to restart the programme in these outlying areas in order to improve access to primary healthcare (support to health centres).


GUINEA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

The hopes resting on president Dadis Camara were dashed with the violent repression of an opposition demonstration in September 2009. The economic and social context remains fragile, and the situation in prisons is not a priority. With a local partner, MdM is tackling malnutrition in a prison and aims to improve detention conditions.

LONG TERM LIFE EXPECTANCY 57.3 YRS HDI 0.435; RANK 170/182 Source: UNDP 2007

POPULATION

» Beneficiaries: 200 » Target: 400 CO-ORDINATORS

» Programme: Philippe Orcier » Field: Cellou Balde » Monitoring: Rhône-Alpes Regional Delegation FUNDING

» MdM BUDGET

Improving health in prisons

» Kindia

» ACTIVITIES The objective of the partnership between MdM and the organisation Kindianaise Assistance to Detainees (KAD) is to improve detention conditions in Kindia central prison in terms of the environment (hygiene and sanitation, improvements, refurbishment and maintenance of the premises), health (medical consultations, supplying a pharmacy, nutritional support for people with malnutrition), and reintegration (education, literacy, income-generating activities). MdM provides technical, moral and financial support to KAD with a view to our withdrawal.

» RESULTS 150 malnutrition cases were treated in 2009 by KAD, in partnership with the International Committee of the Red Cross.

» 2009: €16,474

» OUTLOOK MdM intends to increase support for the income-generating activities, as well as for fundraising approaches to new funders, in order for KAD to become increasingly autonomous when the political situation permits.


LIBERIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Almost six years after the end of the civil war, Liberia continues the process of reconstruction. Despite strong political will, the health system remains fragile and the government’s contribution to the health sector is limited in relation to the scale of the needs. In collaboration with the Ministry of Health and the local health authorities, MdM supports the implementation of health reforms and the training of healthcare workers. LONG TERM LIFE EXPECTANCY 57.9 YRS HDI 0.442; RANK 169/182 Source: UNDP 2007

POPULATION

» Beneficiaries: 112,901 » Target: 213,071 PERSONNEL

» Local: 70 » Expatriate: 10 CO-ORDINATORS

» Programme: Patrick Hirtz » Field: Alice Vahanian » Headquarters: Bertrand Bréqueville FUNDING

» Other European private funds, DG Echo, AFD, MdM, MCMB BUDGET

» 2009: €1,464,833

Improving the provision of healthcare for rural populations

» Bong County

» ACTIVITIES MdM provides technical and financial support for the reconstruction of the health system, to ensure the continuity of care between the community, the district, the county and the government, and their sustainability. Our organisation has also been actively involved in the development, piloting and implementation of recent policies and plans in relation to mother and child health, community and mental health, tackling HIV/AIDS, funding and human resources. Thus, 10 health facilities are supported in the provision of general and mother and child heatlh consultations (including the prevention of sexually transmitted infections), prevention, screening and reduction of mother-to-child transmission of HIV. Gbarnga health centre has been refurbished and has become the first rural hospital in the country to specialise in mother and child health and obstetric care. Training of specialist health staff has enabled provision of psychiatric consultations and psychological support sessions. Awareness-raising sessions on different health themes — such as violence against women — were carried out in the villages to strengthen links between the communities and health services. The county medical school receives support and the ongoing training of healthcare personnel is strengthened in order to tackle the shortage of human resources in rural areas.

» RESULTS 112,901 general consultations were carried out in 2009 and 2,433 births were assisted (including transfers), 2,654 pregnant women had HIV tests and 5,687 children received BCG vaccinations.

» OUTLOOK MdM will continue to support the county health services, to increase its support for the medical training programmes, to play an active role in the start of activities in the country obstetric reference hospital and to be involved in the implementation of national policies.


MADAGASCAR

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

On 24 January 2009, the mayor of Antananarivo, Andry Rajoelina, called for a general strike to protest against President Ravalomanana. This was followed by numerous demonstrations and riots in the Malagasy capital. On 7 February, the demonstrators marched to the presidential palace. When the crowd arrived at the palace, the presidential guard fired live ammunition, resulting in 28 deaths and 400 people wounded, according to official sources. EMERGENCY LIFE EXPECTANCY HDI 0.543; RANK

59.9 YRS 145/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 107 PERSONNEL

» Local: 6 » Expatriate: 6 CO-ORDINATORS

» Programme: Dominique Coyez » Field: Thierry Gontier » Headquarters: Blandine Contamin

Medical and surgical assistance to victims of unrest on 7 February 2009

» Antananarivo

» ACTIVITIES MdM has been working in Antananarivo for several years, where solid partnerships have been developed with the Joseph-Ravoahangy-Andrianavalona hospital (HJRA). The intervention provided support to the hospital to strengthen and complement the Malagasy surgical teams operating on the wounded. Reinforcements were sent from Paris and Réunion. Surgical equipment was sent to make up for the shortage of equipment given the large number of people wounded in the riots — this enabled the victims, particularly those who were seriously wounded, to receive treatment. Following this one-off intervention, MdM and the Red Cross movement drew up a national plan, which enabled a response to further episodes of violence, particularly at the end of February in Fianarantsoa.

FUNDING

» Local government, MdM, CDC

» RESULTS

BUDGET

Between 7 and 18 February, 107 surgical operations were carried out jointly by the hospital staff and MdM teams.

» 2009: €59,135


MADAGASCAR

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Magagascar, a country regularly exposed to extreme weather, has been through a period of political violence creating new socioeconomic difficulties. MdM’s work supports the key priorities of the Malagasy authorities in terms of helping the most vulnerable: gunshot victims, prisoners, the inhabitants of rural areas affected by cyclones, and children waiting for surgery.

LONG TERM LIFE EXPECTANCY HDI 0.543; RANK

59.9 YRS 145/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,500 » Target: 3,500 PERSONNEL

» Local: 5 » Expatriate: 1 CO-ORDINATORS

» Programme: Pascale Lehoucq » Field: Carole Berrih » Headquarters: Bertrand Bréqueville FUNDING

» SCAC-embassies, EuropAid, MDM BUDGET

Healthcare and legal and social support for detainees

» Boeny, Sofia and Diana regions (north-west of the island)

» ACTIVITIES In 2009, the previous results of the programme were consolidated in relation to care for prisoners: identifying and treating malnutrition, prison hygiene and respect of prisoners’ human rights. Despite a difficult financial situation, the prison administration continues to fulfil its responsibilities. Innovative mechanisms have been introduced to ensure more transparent management and greater respect of detainees’ rights. Local organisations have been supported in pharmacy management with a view to MdM’s progressive withdrawal. We have since expanded our activities to new prisons. MdM is working with other organisations to develop national advocacy activities to lobby the authorities to tackle overcrowding in prisons and to tackle the underlying causes of the detainees’ situation.

» RESULTS In 2009, MdM was involved in 16 of the 82 penitentiary establishments in the country and worked with 3,500 prisoners.

» 2009: €336,603

» OUTLOOK We must pay particular attention to prisoners’ nutritional status, because international sanctions may lead to budget cuts. In 2010, we will support four new establishments in Sava region.


MADAGASCAR

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Magagascar, a country regularly exposed to extreme weather, has been through a period of political violence creating new socioeconomic difficulties. MdM’s work supports the key priorities of the Malagasy authorities in terms of helping the most vulnerable: gunshot victims, prisoners, the inhabitants of rural areas affected by cyclones, and children waiting for surgery.

LONG TERM LIFE EXPECTANCY HDI 0.543; RANK

59.9 YRS 145/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 73,277 » Target: 234,599 PERSONNEL

» Local: 13 » Expatriate: 2 CO-ORDINATORS

» Programme: Emmanuelle Rachou » Field: Alban Bonnet Casson » Headquarters: Bertrand Bréqueville FUNDING

» Maroantsetra district, north-east of the island

Reducing the » ACTIVITIES In this enclosed area, which has been abandoned and is extremely exposed to cyclones, risks of MdM supports the health authorities in epidemiological surveillance and care for severly malnourished vulnerability children within basic health centres. This work reflects national policies and strengthen’s the health systo disasters tem’s capacity to respond to natural disasters. A network of emergency workers has been trained and equipped in all the villages in the at-risk zone. With traditional singing contests and puppet shows, and the population has been informed about disaster preparedness. Committees have been set up in atepidemics risk communes, with the support of the authorities, in order to identify priorities and prepare how to respond. In addition, the programme supports four community pilot projects in damage limitation to reduce the risks associated with natural disasters.

» RESULTS 32 villages have prepared their own plans to enable them to deal with a natural disaster and to limit the consequences.

» DG Echo, MdM BUDGET

» 2009: €291,896

» OUTLOOK In 2010, MdM would like to improve how the basic health centres work, consolidate the local committees and roll-out the damage-limitation projects, which could be carried out by a general development NGO. We also plan to expand this disaster preparedness work into other at-risk districts.


MADAGASCAR

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Magagascar, a country regularly exposed to extreme weather, has been through a period of political violence creating new socioeconomic difficulties. MdM’s work supports the key priorities of the Malagasy authorities in terms of helping the most vulnerable: gunshot victims, prisoners, the inhabitants of rural areas affected by cyclones, and children waiting for surgery.

LONG TERM LIFE EXPECTANCY HDI 0.543; RANK

59.9 YRS 145/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,625

Paediatric surgery

» Antananarivo and Antsiranana

» ACTIVITIES MdM cares for children in need of cardiac surgery. Vascular surgery is carried out, as well as reparatory surgery (which takes place under the auspices of Opération Sourire). Expatriate medical and surgical teams make regular visits to work with their Malagasy counterparts in three public hospitals. During these visits, they make diagnoses, perform operations and provide training.

PERSONNEL

» Local: 13 » Expatriate: 4 CO-ORDINATORS

» Programme: Christophe Ottenwaelder » Field: Nivohanta Ramamojisoa » Monitoring: Indian Ocean Regional Delegation

MdM works with a network of Malagasy partners to refer patients, and with French NGOs to organise medical evacuations for patients who cannot be operated on in Madagascar (open heart surgery and conjoined twins) and to ensure that patients receive follow-up.

» RESULTS 764 children received consultations, 122 were operated on in situ and 33 medical evacuations were organised.

FUNDING

» Local authorities, other private funds, MdM BUDGET

» 2009: €50,184

» OUTLOOK A seminar on cardiac surgery, originally planned for 2009, still depends on a return to political stability. A new technical and financial partnership with Monaco is in preparation. In addition, the development of university training in reparatory surgery, linking Antananarivo and Clermont-Ferrand universities, is being explored.


DOCTORS OF THE WORLD

MALI

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Mali, situated at the crossroads of seven sub-Saharan countries, is a transit country for many people who want to reach Europe. Many Malians, of all socio-economic groups, also attempt this journey, deemed to be worthwhile, to the north. At the same time, European immigration policies are hardening. A growing number of people who have been deported or refused entry find themselves forced back to Bamako. LONG TERM LIFE EXPECTANCY HDI 0.371; RANK

48.1 YRS 178/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 313 » Target: 4,000 PERSONNEL

Improving access to mental healthcare for migrants

» Bamako

» ACTIVITIES MdM is helping to build the capacity of the Malian association for deportees (known as AME) to treat the psychological suffering of people who have been deported or refused entry. Training is provided and a network of mental health professionals is being established. The project also intends to raise awareness of the situation and the effects of forced return, in order to tackle the stigma associated with migrants and their rejection by their families.

» Local: 4 » Expatriate: 1

» RESULTS

CO-ORDINATORS

313 individuals who had been deported or sent back were seen by AME.

» Programme: Brigitte Maître and Marie-Élisabeth Hochet » Field: Haddia Diarra » Headquarters: Isabelle Bruand FUNDING

» EuropAid, MdM

» OUTLOOK MdM will continue these activities in partnership with AME. A seminar on mental health and forced return will be organised at the end of the project to bring together mental health professionals, civil society representatives and institutions.

BUDGET

» 2009: €40,121

Djalamakan 20 years old, expelled from Libya on 30 September 2009

“I arrived in Libya in 2008. I was locked up, with six other people, in a very small space without any water. For two months, we had to put up with unimaginable beatings and racist insults. We were often sick, but there was no healthcare. Finally, they put us on a plane for Bamako. I am ill and very tired. AME has supported me and helped me go back to my village. The interviews made me feel better because now I understand what is happening to me.”


DOCTORS OF THE WORLD

MALI

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Mali, situated at the crossroads of seven sub-Saharan countries, is a transit country for very many people who want to reach Europe. Many Malians, of all socio-economic groups, also attempt this journey, deemed to be worthwhile, to the north. At the same time, European immigration policies are hardening. A growing number of people who have been deported or refused entry find themselves forced back to Bamako. LONG TERM LIFE EXPECTANCY HDI 0.371; RANK

48.1 YRS 178/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 25,500 » Target: 462,458 PERSONNEL

» Local: 3 » Expatriate: 0 CO-ORDINATORS

» Programme: Brigitte Maître and Marie-Élisabeth Hochet » Field: Françoise Marquis » Headquarters: Isabelle Bruand FUNDING

» Other private funds, MdM BUDGET

Caring for women with obstetric fistulas

» Mopti

» ACTIVITIES For fifteen years MdM has been training surgeons at Mopti regional hospital in treatment of obstetric fistulas. The hospital team provides psycho-social support for patients. Awareness-raising activities are carried out throughout the year in villages in the region, in order to encourage women to deliver their babies in health facilities, to identify women affected by fistulas and to reduce the associated stigma. MdM ensures that these patients have access to free care, from start to finish.

» RESULTS 144 surgical operations were carried out and 8,026 people in villages participated in awarenessraising activities carried out by community health workers.

» OUTLOOK MdM would like to capitalise on our experience to be able to lobby the national authorities on comprehensive care — medical, psychological and social — for women. Awareness-raising activities will also be expanded into the most remote areas in the region.

» 2009: €91,182

Aminata 20 years old

“When I was two months pregnant, my husband divorced me. I went back to my parents’ place, where I gave birth. I lost my baby and I had a fistula after the delivery, seven years ago. For a year, I didn’t know what it was. My uncle took me to a health centre to get treatment and the centre sent me to Mopti. I’ve already had several operations. I’m not completely cured, but I haven’t given up hope.”


DOCTORS OF THE WORLD

NIGER

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Niger has very high infant and maternal mortality rates. The health system does not have enough resources to be able to fully deliver. In 2006, the government of Niger declared access to free healthcare for pregnant women and children under five. MdM supports 10 district health centres in Keita in the implementation of these new measures in relation to access to healthcare.

LONG TERM LIFE EXPECTANCY HDI 0.34; RANK

50.8 YRS 182/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 121,658 » Target: 293,630 PERSONNEL

Supporting the health system

» Keita

» ACTIVITIES MdM is helping to strengthen the capacity of the district administrative team to manage health services, plan and supervise activities. New centres are equipped and have extra human resources. A new mechanism for funding referrals and medical evacuations has been introduced. The performance of the centres is also evaluated and optimised. In addition, advocacy work aims to convince the authorities to provide free care during childbirth.

» Local: 11 » Expatriate: 0

» RESULTS

CO-ORDINATORS

121,658 consultations were carried out in the district in 2009, representing a 10% increase since 2008.

» Programme: Joël Le Corre » Field: Mamoudou Barro » Headquarters: Isabelle Bruand FUNDING

» DG Echo BUDGET

» 2009: €319,674

» OUTLOOK Because of the good results that have been recorded in Keita since 2006, MdM is expanding the work across the region, under the auspices of a long term project in three countries in the Sahel. Lobbying of the authorities in Niger, and international organisations, will have to be strengthened to improve the finance and operation of the system of free healthcare.

A resident of Tamaské

“Since the introduction of this system of medical evacuation, we’re no longer worried. Now it is not a question of selling a goat or a sheep to pay for transport in serious or complicated cases. We only have to go to the health post or health centre and the ambulance will take you completely free of charge.”


DOCTORS OF THE WORLD

NIGER

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Niger has very high infant and maternal mortality rates. The health system does not have enough resources to be able to fully deliver. In 2006, the government of Niger declared access to free healthcare for pregnant women and children under five. MdM supports 10 district health centres in Keita in the implementation of these new measures in relation to access to healthcare.

LONG TERM LIFE EXPECTANCY HDI 0.34; RANK

50.8 YRS 182/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,192 » Target: 36,205 PERSONNEL

» Local: 20 » Expatriate: 1 CO-ORDINATORS

» Programme: Joël Le Corre » Field: Karine Dyskiewicz » Headquarters: Isabelle Bruand FUNDING

Providing treatment for malnutrition and family planning services

» Tahoua, Abalak and Tchintabaraden districts

» ACTIVITIES MdM is developing an advocacy programme, specifically adapted to the culture and aimed at improving the community’s knowledge and practices in relation to nutrition and family planning (birth spacing). Community link workers are trained to run learning and nutritional recovery centres (known as FARN) as well as counselling sessions, group discussion sessions on family planning and distribution of contraception to women who have received prescriptions from trained health workers. These health workers supervise the link workers in their family planning work, organised during monthly visits. In addition, awareness-raising activities are organised around theatre events, sermons taken by imams and thematic workshops with the authorities.

» RESULTS Of a total of 2,073 children screened, 363 children had moderate malnutrition and were cared for in the FARN facilities.

» EuropAid, MdM BUDGET

» 2009: €521,345

» OUTLOOK Home-based follow-up for the children seen in the FARN and their mothers is carried out regularly for 12 months after their discharge. A survey will enable us to measure the behavioural changes in relation to nutrition and family planning. Advocacy activities will pass on information about the lessons learned to the communities and the authorities.

A 35-year old father Agouloum Toudou (Tahoua region)

“The travelling sermons helped me to understand that Islam doesn’t forbid us to choose to have a gap between pregnancies. In fact, it is encouraged, so the mother can rest and for the well-being of the children. Family planning doesn’t mean limiting the number of births, rather choosing to space births out for the well-being of all my family.”


RWANDA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Rwanda was decimated in 1994 by the genocide in which more than a million people died. Today, the country is rebuilding itself on the basis of a policy of unity and reconciliation. An important aspect is the Gacacas, popular juridictions inspired by the country’s culture and tradition in relation to resolving conflict. This process may result in a re-opening of the wounds of 1994. MdM supports an organisation, Ibuka, which provides psychological support to survivors. LONG TERM LIFE EXPECTANCY HDI 0.46; RANK

49.7 YRS 167/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 392 » Target: 66 647 CO-ORDINATORS

» Programme: Gilles Foucaud, Frédéric Jacquet » Field: » Headquarters: Catherine Courtin FUNDING

» MdM BUDGET

Medical and psychological support for genocide survivors

» Kigali, Buhoro, Kibeho, Gatonde, Kibilizi, Busogo, and Musanze sectors

» ACTIVITIES The project targets the psychological and social recovery of Rwandan genocide survivors. The victims involved in the Gacacas benefit from support that continues beyond their involvement in the judicial process and which is based on therapeutic group work to enable the healing of trauma and the development of social links. The project also places emphasis on developing the skills of medical and paramedical staff, by way of training, the exchange of practices, and learning from experience. MdM provides institutional support to Ibuka on methods of collaboration.

» OUTLOOK As part of this partnership, the therapeutic groups will be extended until 2011. The community-based approach will be strengthened and the training in mental health will be intensified. The position of this partner within Rwandan civil society will be consolidated by the strengthening of its technical, financial and institutional resources.

» 2009: €20,009

Solange Genocide survivor

“The psychological support project initiated by Ibuka and MdM has enabled us all to find a framework for expression and comfort. There, I could cry, I could count on others to be there to listen to me. We feel that we are less alone. It is as if we had created a new family. I was then able to find the strength to face up to the popular justice Gacaca process.”


SAHEL INTERNATIONAL PROGRAMMES » AFRICA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

NIGER, MALI, BURKINA FASO

The Sahel region has very high infant and maternal mortality rates, and is also exposed to recurrent nutritional crises. A guarantee of access to healthcare — in both geographical and financial terms — is essential to improve the overall health of these populations. The three target districts are similar in geographic and demographic profile.

LONG TERM Niger, Keita LIFE EXPECTANCY HDI 0.34; RANK

50.8 YRS 182/182

Source: UNDP 2007

Burkina Faso LIFE EXPECTANCY HDI 0.989; RANK

52.7 YRS 177/182

Source: UNDP 2007

Mali LIFE EXPECTANCY 48.1 YRS HDI 0.371; RANK 178/182 Source: UNDP 2007

Improving access to primary healthcare

» Keita (Niger), Douentza (Mali) and Djibo (Burkina Faso)

» ACTIVITIES MdM is fighting for better financial accessibility of primary healthcare. Based on our experience over several years in Keita district, in Niger, we would like, for the first time, to develop a programme across three different countries where the challenges are similar. We are working in partnership with the health district administrative teams to improve the management in each district, and to optimise the use of existing equipment and human resources. We plan to equip, train and supervise the 54 health centres involved in the programme. Local initiatives to improve financial access to healthcare will be documented and used to lobby different levels of the health system and international donors.

» RESULTS The project only began in November 2009.

PERSONNEL

» Local: 5 » Expatriate: 4 CO-ORDINATORS

» Programme: Joël Lecorre, Thierry Comte » Field: Olivier Evreux » Headquarters: Isabelle Bruand

» OUTLOOK A health economics survey will provide a better analysis of the detailed functioning on each district involved in the programme. The results will enable us to propose new management and finance mechanisms, adapted to the context and according to locally defined priorities. The activities will begin in Mali and Burkina Faso.

FUNDING

» EuropAid BUDGET

» 2009: €88,880

Health centre manager, Keita district

“Free healthcare is a good thing, because not everyone has what they need to be able to bring their child to the centre when he is sick. Now, because it is free, women come earlier and there are fewer serious cases.”


SENEGAL

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Gamadji Saré is a rural community of 24,000 inhabitants, situated 500 km from Dakar in Saint-Louis region, in the north of the country. This is part of the semi-desert Sahel region, towards the south Sahara. The environment and the subsistence conditions are precarious. Furthermore, access to healthcare is difficult for this scattered rural population.

LONG TERM LIFE EXPECTANCY HDI 0.464; RANK

55.4 YRS 166/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 24,000 » Target: All the inhabitants of Gamadji Saré rural community

Strengthening the health system

» Gamadji Saré

» ACTIVITIES MdM is seeking to improve the health status of Gamadji Saré inhabitants. To do so, the organisation is strengthening the human and material resources required to supervise the community cases de santé (health posts), by paying the salary of a visiting Senegalese nurse and providing medical equipment for a new health post and the cases de santé associated with it. In addition, MdM is helping to develop the skills of healthcare workers through mentoring and training (by the nurse) for the matrons.

PERSONNEL

» Local: 1 » Expatriate: 0 CO-ORDINATORS

» Programme: Paul André Befort, Maryvonne Le Gac, Béatrice Lux » Monitoring: Alsace Regional Delegation FUNDING

» Other private funds, MdM BUDGET

» 2009: €47,074

» OUTLOOK We are working in partnership with a Senegalese development organisation, Asradec, which is working in Gamadji. We are also working with the district health authorities and doctor representative of MdM in Dakar. The aim is that these local partners will take over all these medical activities to improve the quality of healthcare in this rural community.


SOMALIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Since 1991 Somalia has not been stable enough to maintain its health system. In 2009, the withdrawal of Ethiopian troops preceded huge attacks by the radical islamist opposition against the transitional government, prompting the collapse of the government and leaving political chaos. Civilian populations, particularly those who fled the fighting, find themselves without any aid.

EMERGENCY LIFE EXPECTANCY 49.7 YRS HDI NC; RANK NC Source: UNDP 2007

POPULATION

» Beneficiaries: 40,000 » Target: 100,000 PERSONNEL

» Local: 16 » Expatriate: 2 CO-ORDINATORS

» Programme: Bernard Juan » Field: Philippe Durand » Headquarters: Stéphane Berdoulet FUNDING

» British government (DfID), United Nations, MdM

Providing care to the population

» Marka, Lower Shabelle region

» ACTIVITIES By supporting two health centres, the project provides treatment for civilians affected by the instability in the area. The healthcare workers, trained and supervised by MdM, offer free healthcare, without discrimination, and dispense quality medicines. General medical consultations, ante-natal monitoring, assisted deliveries and immunisation for children and pregnant women are the main activities.

» RESULTS More than 30,000 medical consultations and nearly 7,000 ante-natal consultations were carried out in 2009.

» OUTLOOK MdM would like to consolidate the project by expanding the geographical coverage and by developing the provision of care. An extra medical centre should be opened and the re-opening of the hospital obstetric department is a priority.

BUDGET

» 2009: €603,614

A patient

“There is no doubt that the MdM project means a lot to us. It really helps us by giving us access to quality healthcare and free medicines, without any social or economic discrimination. Daily life here is fraught with difficulties.”


DOCTORS OF THE WORLD

SUDAN

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

After more than 20 years of war, and despite the North-South peace agreement, the current situation is not conducive to a real reconstruction process. The health system is the first to suffer. Since 2004, MdM has been trying hard to help restore access to healthcare for the populations along the Nile, south-west of the town of Malakal.

EMERGENCY LIFE EXPECTANCY HDI 0.531; RANK

57.9 YRS 150/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 5,000 » Target: 30,000 PERSONNEL

Primary healthcare

» South Sudan: Tonga (Upper Nile state), Phom el-Zeraf (Jonglei state)

» ACTIVITIES Until 2009, MdM was working to improve access to, and quality of, primary healthcare by developing activities in two health centres, reaching 30,000 beneficiaries. This involved introducing minimal provision of care including medical consultations, vaccination, health education, communicable disease surveillance and provision of essential medicines. In addition, MdM provides resources to enable a rapid response to epidemics and to population displacements (common when there is tribal fighting).

» Local: 76 » Expatriate: 5 CO-ORDINATORS

» Programme: Géraldine Lang » Field: Benoît ClémentBollée » Headquarters: Stéphane Berdoulet FUNDING

» AFD, EU institutions, other private funds, MdM BUDGET

» 2009: €250,637

» RESULTS 1,000 consultations are carried out, on average, each month in the health centres.

» OUTLOOK The project finished in May 2009 with the handover of the health centres to the Ministry of Health. Since then, MdM has been carefully monitoring the political, economic and health developments in the region, with a view to intervening if necessary.


DOCTORS OF THE WORLD

SUDAN

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

In 2009, Sudan epitomised the case of huge humanitarian needs in a difficult operating context for an NGO. In Darfur, in particular, there are some areas where the health system is non-existent (Jebel Marra) or is not compatible with the notion of equitable access to quality healthcare.

EMERGENCY LIFE EXPECTANCY HDI 0.531; RANK

57.9 YRS 150/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 100,000 » Target: 167,000 PERSONNEL

Supporting civilian populations

» Jebel Marra, South Darfur

» ACTIVITIES MdM is reinforcing its support to five health centres providing primary healthcare. Medical staff have been recruited and trained. High quality essential medicines and medical equipment have been provided. The premises have been refurbished. The populations have since been able to offer a full range of care: curative consultations, pre- and post-natal care, assisted deliveries, nutritional monitoring, vaccination, health education and, where needed, referral to hospital.

» Local: 178 » Expatriate: 12

» RESULTS

CO-ORDINATORS

More than 5,000 consultations take place each month, and more than 700 ante-natal consultations.

» Programme: Jérôme Larché » Field: Marc van der Mullen » Headquarters: Tarik Kadir FUNDING

» DG Echo, German government funding, United Nations, MdM BUDGET

» 2009: €1,474,043

» OUTLOOK MdM is preparing the services for an autonomous future and is looking to expand the area of the programme. Having worked in and around Deribat, the programme will now be developed around Feina and Golumbai, where the target population is estimated to be 160,000 people. MdM is also planning to work outside the Jebel Marra, by providing institutional support to the South Darfur health authorities.


TANZANIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

Despite its political stability and economic growth, Tanzania still struggles to ensure universal access to HIV/AIDS treatment and to contain the epidemic, which affects more than six per cent of the population. Access to healthcare for the rural population remains a challenge. MdM is supporting the health services in three rural districts in the north-west of the country, to bring healthcare closer to the population. LONG TERM LIFE EXPECTANCY HDI 0.53; RANK

55 YRS 151/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 65,000 » Target: 887,761 PERSONNEL

» Local: 25 » Expatriate: 3 CO-ORDINATORS

» Programme: Michel Cayrol » Field: Pierre E.D. Sallah » Headquarters: Émilie Vallat FUNDING

» PEPFAR, MdM BUDGET

Ensuring access to HIV/AIDS treatment

» Ngara, Biharamulo and Chato districts (Kagera region)

» ACTIVITIES MdM is working on the integration of HIV-related services into primary healthcare, in close collaboration with the teams of the three rural districts, and in line with national policy. In 2009, the project was extended to four new sites for starting antiretroviral (ARV) treatment. It has now been developed in 16 centres. This enables improved access to healthcare, particularly for children, and better compliance with HIV treatment, even in remote areas. MdM is supporting the introduction of prophylactic treatment to reduce mother-to-child transmission of HIV during pregnancy and delivery in 68 facilities. Thirty-two new screening services have also opened, as well as three early diagnostic centres for babies and one pilot treatment site for children. Finally, equipment has been repaired and the follow-up of patients has been improved in order to strengthen the local health system.

» RESULTS 1,474 new HIV patients have been registered. Of these, 725 have received ARV treatment, 30,504 pregnant women have been tested and 382 mother-child couples have received prophylaxis.

» 2009: €537,325

» OUTLOOK MdM is leaving Kagera region in 2010, but the provision of care will be maintained in the three districts, thanks to the support of Icap/Columbia University and the handover of activities to our partner organisation Tadepa. A project to capitalise on the experience of the programme has been started. Finally, an exploratory mission to Dar es Salaam and to Zanzibar is planned to identify the needs of at-risk groups.

Samwuel

“I tested positive in 2007, but for that first year I couldn’t get treatment because of the distance. As my health got worse, I started getting ARV treatment by going to Biharamulo, 38 km away. But this was irregular because of the transport costs. Since the HIV service opened at Ruganzu Disp, I can get my medicine there every month. It is near home and there is no queue.”


ZIMBABWE

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

In 2009, in full-blown political and economic crisis, the Zimbabwean health system practically collapsed. Many health workers had left the country, the availability of medicines was greatly reduced while the HIV pandemic grew to affect 23% of the population and the country was hit by a food crisis and a cholera epidemic. MdM redirected its activities towards maintenance of the existing health system in Chipinge district in the south-east of the country. LONG TERM LIFE EXPECTANCY HDI 0.513; RANK

43.4 YRS 151/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 79,630 » Target: 350,000 PERSONNEL

Access to primary healthcare

» Chipinge district, Manicaland province

» ACTIVITIES MdM supports 23 of the 40 rural clinics in the district, as well as the maternity services and laboratories and pharmacies in three hospitals (provision of medicines and equipment, refurbishing buildings). The training and supervision of healthcare staff, along with the provision of medicines and topup salaries, help to motivate the staff who have stayed in the country and to improve the quality of care for the population.

» Local: 59 » Expatriate: 5

» RESULTS

CO-ORDINATORS

36,000 consultations were provided for children under five years old.

» Programme: Vincent Faucherre and Simona Zompi » Field: Joe De Koning » Headquarters: Émilie Vallat FUNDING

» DG Echo, MdM BUDGET

» 2009: €627,719


ZIMBABWE

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » AFRICA

In 2009, in full-blown political and economic crisis, the Zimbabwean health system practically collapsed. Many health workers had left the country, the availability of medicines was greatly reduced while the HIV pandemic grew to affect 23% of the population and the country was hit by a food crisis and a cholera epidemic. MdM redirected its activities towards maintenance of the existing health system in Chipinge district in the south-east of the country. LONG TERM LIFE EXPECTANCY HDI 0.513; RANK

43.4 YRS 151/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 90,250 » Target: 350,000 PERSONNEL

» Local: 59 » Expatriate: 5

Treating HIV/AIDS

» Chipinge district, Manicaland province

» ACTIVITIES The programme aims to decentralise treatment for HIV and opportunistic infections across the district health services. An important part of the programme is the community-based activities, which promote health committees and the involvement of village health agents in raising awareness of the population on HIV, sexually transmitted infections and health problems in general. Other community-based activities (nutritional gardens, support groups for people living with HIV/AIDS, training young peer educators, supporting orphans and vulnerable groups, etc.) help to reduce the stigma facing people living with HIV/AIDS.

CO-ORDINATORS

» Programme: Vincent Faucherre and Simona Zompi » Field: Joe De Koning » Headquarters: Émilie Vallat

» RESULTS 1,637 new patients have received antiretroviral treatment. Almost 1,200 patients who are no longer able to travel have received follow-up in their homes.

FUNDING

» EuropAid, Dutch government funding, other national institutions, other private funding, MdM BUDGET

» 2009: €962,043

Elton 19 years, a mechanic in Chipinge

“I am HIV-positive and my parents died of AIDS. I met the MdM team at school. They paid for my school fees and supplies, and gave me a school uniform. I also met other HIV-positive orphans. Once a week, we did role playing and spoke about our situation. Gradually I came to accept my status. With medication I’ve become stronger. Life is getting back to normal.”


COLOMBIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

Since 2003, MdM has been supporting local indigenous rural populations and afro-Colombian victims of the armed conflict, the intensity of which has been marked by the resurgence of paramilitaries, the presence of drug traffickers and the desire of the government to use military means to overcome the guerillas (who have strong support and a solid financial base). This instability worsens the isolation of these populations and makes access to healthcare difficult. LONG TERM LIFE EXPECTANCY HDI 0.807; RANK

72.7 YRS 77/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 7,750 » Target: 24,850 PERSONNEL

» Local: 15 » Expatriate: 3 CO-ORDINATORS

» Programme: Christian Raggioli, Karina Morales » Field: Jaime Hernandez, Vicente Gavidia » Headquarters: Yves Le Corgne FUNDING

» DG Echo, Spanish public institutions,MdM BUDGET

» 2009: €450,549

Access to health care for indigenous and Afrocolombian populations

» Chocó and d’Antioquia deparments, Medio Atrato region

» ACTIVITIES MdM is carrying out prevention activities, as well as providing medical consultations, for groups who are isolated by the local geography or by the armed conflict. These mobile clinics use canoes to reach the communities, and are carried out in collaboration with Colombian health services. By training community volunteers we can develop health promotion projects, activities to tackle malnutrition and can monitor pregnant women and young children. MdM is also very involved in strengthening a long-term project as part of a network of health actors (advocacy). This work has been developed while respecting local socio-cultural characteristics, particularly the promotion of traditional plant-based medicine.

» RESULTS 65 information and education activities, 18 mobile clinics and 14 promotion and prevention “brigades” have been carried out in 34 communities.

» OUTLOOK The project will strengthen the capacity of the communities and of health professionals in relation to prevention and response to medical emergencies. The number of medical consultations will be reduced to make way for more health education activities, involving the trained community health promoters.


COLOMBIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

Since 2003, MdM has been supporting local indigenous rural populations and afro-Colombian victims of the armed conflict, the intensity of which has been marked by the resurgence of paramilitaries, the presence of drug traffickers and the desire of the government to use military means to overcome the guerillas (who have strong support and a solid financial base). This instability worsens the isolation of these populations and makes access to healthcare difficult. LONG TERM LIFE EXPECTANCY HDI 0.807; RANK

72.7 YRS 77/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 5,243 » Target: 110,970 PERSONNEL

» Local : 15 » Expatriate: 2 CO-ORDINATORS

» Programme: Christian Raggioli, Karina Morales » Field: Blanca Arevalo and Vicente Gavidia » Headquarters: Yves Le Corgne FUNDING

» DG Echo, MdM BUDGET

» 2009: €445,273

Access to healthcare for populations affected by armed conflict

» Meta

» ACTIVITIES MdM has set-up mobile clinics offering primary healthcare directly to these targeted communities, in collaboration with the state-run health services. Priority is given to women of reproductive age and to children. The development of psycho-social activities, and training volunteers from the heart of the communities to provide "psychological first aid" ensures that victims and their families have some support. A sexual and reproductive health training programme has been set up in schools in the area. Involvement of the communities and public health organisations is ensured by training community health promoters and by lobbying government institutions.

» RESULTS 57 mobile clinics were carried out, 20 of which were in collaboration with state-run services.

» OUTLOOK The presence of MdM will no longer be needed as soon as safe conditions — which depend on how the conflict evolves — allow health authorities to respond on their own to the needs of isolated, rural populations. In 2010, it is likely that the conflict will move towards Guaviare department, where MdM will start up activities.


GUATEMALA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

The textile industry (‘maquilas’), and the food processing sector are growing rapidly. They employ a predominantly female work force, which is very deprived and badly paid. Despite legal provisions protecting workers, it is acknowledged that these rights are largely ignored. Since 2006, MdM has been running a programme aimed at promoting the effective application of these rights, and, in particular, access to healthcare for these women. LONG TERM LIFE EXPECTANCY HDI 0.704; RANK

70.1 YRS 122/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 1,685 » Target: 28,800 PERSONNEL

» Local: 6 » Expatriate: 1

Protecting the health of ‘maquila’ workers

» Chimaltenango and Sacatepéquez departments

» ACTIVITIES Medical consultations for workers are carried out in the MdM centre and in maquilas. MdM helps women with the process of obtaining access to the national social security system. Capacity building is ensured by training health promoters. Their knowledge is immediately shared with their peers by way of information sessions. Political authorities from the appropriate ministries are made aware of the state of health, the difficulty of access to healthcare and the violation of rights, in order that the legal obligations are respected. Thanks to working groups, MdM strengthens a network of partners fighting to defend workers’ rights.

CO-ORDINATORS

» Programme: Pilar Giraux and Sylvie Bianchi » Field: Aurélie Leroyer » Headquarters: Ernesto Herrera FUNDING

» AFD, MdM BUDGET

» 2009: €134,750

» RESULTS 1,577 people have benefited from a medical consultation in MdM’s facility and 58 workers have received a health promoter qualification.

» OUTLOOK A capitalisation and awareness-raising project was started amongst the different involved parties, and will finish in 2010 with an international conference on the rights of women working in the maquilas. The project will gradually be transferred to the local organisation, Ames, in order to ensure the continuation of the activities when MdM withdraws the year after.

Maria Works in a maquila

“The only thing that matters to our employers is that we deal with the orders and reach our quota. So they hurry us, they punish us in order that we work quicker. It doesn’t matter how many hours we work, or that we are exhausted. The working day starts at 7.30 and finishes at 18.30. If the working hours are not enough, we have to do extra hours.”


DOCTORS OF THE WORLD

HAITI

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

Despite political stabilisation and the reinstatement of international aid, Haïti is still in a very difficult socio-economic situation. The poorest are excluded from a healthcare system which always expects payment on the spot. In addition, domestic and genderrelated violence represents a major public health problem. MdM is working to improve women's health and to ensure recognition of their rights. LONG TERM LIFE EXPECTANCY HDI 0.532; RANK

61 YRS 149/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 12,200 » Target: 154,830 PERSONNEL

» Local: 28 » Expatriate 2 CO-ORDINATORS

» Programme Sophie Lasserre » Field: Jean Kith Dely and Ernesto Bafile » Headquarters: Yves Le Corgne FUNDING

» DG Echo, German private funds, MdM BUDGET

» 2009: €875,477

Free access to mother and child healthcare

» Grand’ Anse department

» ACTIVITIES MdM supports nine local health facilities to help reduce maternal and infant/child mortality. MdM ensures that healthcare for pregnant women and children under five is free of charge. The programme is helping to build capacity in terms of screening for, and treating, acute malnutrition, monitoring at-risk pregnancies and dealing with complicated births. The training of personnel and regular provision of essential medicines and therapeutic foods to these facilities has been achieved. MdM also supports Jérémie hospital by setting up a nutritional stabilisation unit for children suffering from severe malnutrition. Lastly, in Roseaux, a domestic latrine construction programme, together with health education activities, has helped to reduce the incidence of diarrhoea.

» RESULTS 9,228 consultations were held for children under five from April to July 2009 (compared to 3,023 consultations in the previous year over the same period).

» OUTLOOK MdM will continue this programme in 2010, taking into account the arrival of large populations affected by the earthquake in Port-au-Prince. Free healthcare for all will be ensured for six months. The nutritional and maternal health components will be strengthened, working closely with the departmental health authorities.


DOCTORS OF THE WORLD

HAITI

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

In 2008, Artibonite department was hit by Gustav, Hanna and Ike; three cyclones one after the other, all intensely powerful. The centre of the town of Gonaïves was mostly flooded and destroyed, leaving more than 50,000 families homeless. Originally lodged in temporary shelters in makeshift camps, these families were then relocated to the support camps situated on the edge of the town.

EMERGENCY LIFE EXPECTANCY HDI 0.532; RANK

61 YRS 149/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 19,000 » Target: 105,000 PERSONNEL

» Local: 24 » Expatriate: 5 CO-ORDINATORS

» Programme: Sophie Lasserre, Anne Urtubia » Field: Myriam Pomarel » Headquarters: Blandine Contamin FUNDING

» DG Echo, German private funding, MdM BUDGET

» 2009: €107,411

Caring for populations affected by cyclones

» Gonaïves

» ACTIVITIES The emergency intervention, originally planned for six weeks, was extended until 28 February 2009. Mobile health clinics were set up for primary healthcare, which made access to quality healthcare possible for the populations, whilst ensuring the screening and monitoring of nutrition in outpatient children aged between six and 59 months. These mobile clinics relate to a pro-active strategy to reach affected and isolated populations, notably those that have difficulty in reaching health services. In this way MdM enabled access to free healthcare while accompanying affected families who had been evicted from temporary shelters or relocated, but the situation remains extremely serious.

» RESULTS More than 20,000 consultations were carried out in five months. 750 children were cared for by the nutrition programme.


DOCTORS OF THE WORLD

HAITI

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

Despite political stabilisation and the reinstatement of international aid, Haiti is still in a very difficult socio-economic situation. The poorest are excluded from a healthcare system which always expects payment on the spot. In addition, domestic and genderrelated violence represents a major public health problem. MdM is working to improve women's health and to ensure recognition of their rights. LONG TERM LIFE EXPECTANCY HDI 0.532; RANK

61 YRS 149/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,635 » Target: 500,000 PERSONNEL

» Local: 29 » Expatriate: 2

Supporting victims of violence

» Port-au-Prince

» ACTIVITIES Since 2006, MdM has been involved with five public and private hospitals to support the surrounding communities and victims of violence. This involvement is undertaken working closely with a network of participants drawn from Haitian civilian society. Awareness-raising campaigns about the problem of violence have been carried out in target areas, and institutional lobbying aims to achieve greater respect for the rights of victims. Finally, the training and supervision of local actors (communities, health services, civil society etc.) has begun in order to guarantee quality medical and social support, especially in relation to mental health.

CO-ORDINATION

» Programme: Anne Urtubia » Field: Carine Thibaut and Ernesto Bafile » Headquarters: Yves Le Corgne FUNDING

» AFD, UN, ACDI, other private funds, MdM BUDGET

» 2009: €548,651

» RESULTS Close to 500 psychological consultations were carried out in 2009 in the general teaching hospital.

» OUTLOOK Following the earthquake on 12 January 2010, the project had to be suspended. An emergency aid programme took over. Supported by the experience and the network of teams already there, the programme was quickly operational. Surgical care, general medical care and mental health services were provided for the population of Port-au-Prince.


DOCTORS OF THE WORLD

HAITI

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

Despite political stabilisation and the reinstatement of international aid, Haiti is still in a very difficult socio-economic situation. The poorest are excluded from a healthcare system which always expects payment on the spot. In addition, domestic and genderrelated violence represents a major public health problem. MdM is working to improve women's health and to ensure recognition of their rights. LONG TERM LIFE EXPECTANCY HDI 0.532; RANK

61 YRS 149/182

Source: UNDP 2007

POPULATION

Training staff

» Pilate

» ACTIVITIES MdM supports Esperance hospital, situated in a rural area in northern Haïti, which has a surgical unit, but no surgeon. We send out a surgical team to perform surgical operations over a two-week period.

» Target: 50,124 PERSONNEL

» Local: 0 » Expatriate: 0 CO-ORDINATORS

» Programme: C. Castaing » Monitoring: Aquitaine Regional Delegation FUNDING

» Local government, French private funds, MdM BUDGET

» 2009: €11,302

» OUTLOOK In 2011 this programme will give way to a training programme in the screening for cervical and uterine cancer, and the treatment of pre-cancerous lesions. This will be set-up in Cap-Haïtien teaching hospital in the north.


MEXICO

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

In Mexico, and particularly in Chiapas state, the indigenous communities face perilous life conditions and they find themselves isolated, partly because of their political resistance towards the government. MdM respects the rights and autonomy of these communities and responds, as accurately as possible, to the needs they express for support in the development of their own healthcare system. LONG TERM LIFE EXPECTANCY HDI 0.854; RANK

76 YRS 53/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 670 » Target: 44,879 PERSONNEL

Promoting the right to health for indigenous populations

» Los Altos zone, Chiapas

» ACTIVITIES The project supports the tzotzil, tzeltal, tojolabal and chol indigenous populations in promoting autonomy in their healthcare system. MdM trains local health representatives to deal with health problems. Health promoters provide primary healthcare, with particular attention to the integration of women within these activities. Finally, advocacy work aims to raise the state authorities' awareness of the communities’ rights and cultural practices.

» Local: 7 » Expatriate: 2

» RESULTS

CO-ORDINATORS

650 health promoters and 70 health representatives have participated in the training.

» Programme: Flavia Stea » Field: Carlos Escobar » Headquarters: Ernesto Herrera FUNDING

» Europaid, MdM BUDGET

» 2009: €275,106

» OUTLOOK With a view to preparing the ground for MdM's withdrawal, our partners will take on a greater involvement in 2010. Strategies concerning economic viability will be put in place in order to perpetuate activities. A new project will be opened in the state. It looks at promoting the right to health for female migrant sex workers and domestic workers.


NICARAGUA 1/2

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

In 2001, with a high prevalence of domestic and sexual violence, in particular against women and children, the government has made this problem a public health priority. MdM is involved with the victims in one of the poorest regions, where the population suffers from various diseases related to social or sanitary conditions, undoubtedly a risk factor for violence.

LONG TERM LIFE EXPECTANCY HDI 0.699; RANK

72.7 YRS 124/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 2,424 » Target: 58,567 PERSONNEL

» Local: 16 » Expatriate: 1

Caring for victims of domestic and sexual violence

» Puerto Cabezas, North Atlantic Autonomous Region

» ACTIVITIES MdM is building up a network consisting of civil society and institutional partners in order to provide comprehensive care for victims of domestic and sexual violence. Part of the project assures the continuation of the CAIMCA (Centro de Atención Integral a la Mujer Carabeña) centre by way of building the awareness of key actors, and training personnel and health promoters. In this way, free and quality services are guaranteed for the beneficiaries. Also, prevention of this violence from within the male population has been achieved by promoting new types of family relations based on respecting the dignity and the rights of each individual.

CO-ORDINATORS

» Programme: Robert Chaluleau and Margara Gonzalez » Field: Carmen Rodriguez » Headquarters: Ernesto Herrera FUNDING

» Spanish public institutions, AFD, MdM

» RESULTS 3,456 medical consultations were carried out at CAIMCA in 2009.

» OUTLOOK MdM continues to support its partners, in preparation for eventual withdrawal while guaranteeing that the work will continue. Lobbying of governmental decision makers will continue in order to improve provision of care for victims.

BUDGET

» 2009: €206,833

In 2010, a project on sexual and reproductive health is planned in the same region.


NICARAGUA 1/2

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

In 2001, with a high prevalence of domestic and sexual violence, in particular against women and children, the government has made this problem a public health priority. MdM is involved with the victims in one of the poorest regions, where the population suffers from various diseases related to social or sanitary conditions, undoubtedly a risk factor for violence.

LONG TERM LIFE EXPECTANCY HDI 0.699; RANK

72.7 YRS 124/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 4,000 » Target: 20,000 PERSONNEL

» Local: 0 » Expatriate: 0 CO-ORDINATORS

» Programme: Anne-Marie Lechartier, William Sampietro » Monitoring: Aquitaine Regional Delegation FUNDING

» French private funds, MdM BUDGET

» 2009: €3,867

Tackling cervical cancer

» Quilalí and San Bartolo

» ACTIVITIES For two years MdM has helped and trained personnel at Quilalí and San Bartolo to screen for and treat pre-cancerous cervical lesions. Five women affected by this type of cancer were identified and were able to be evacuated to the capital for treatment. In the next six months the team will be completely autonomous and the Ministry of Health will take over this programme.

» RESULTS More than 4,000 smear tests were carried out. 200 pre-cancerous lesions of the cervix were identified and treated.


DOCTORS OF THE WORLD

PERU

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » LATIN AMERICA

Despite the improvement in the health situation, there are still problems in relation to sexual and reproductive health. The situation amongst adolescents is particularly worrying: higher numbers of unwanted pregnancies, illegal abortions and maternal mortality, etc. Initiatives devoted to tackling these issues are rare. MdM is improving access to sexual and reproductive healthcare in the most disadvantaged quarters of Lima. LONG TERM LIFE EXPECTANCY HDI 0.806; RANK

73 YRS 78/182

Promoting sexual and reproductive health amongst adolescents

» Three districts in the south of Lima

» ACTIVITIES

CO-ORDINATORS

MdM has organised a community awareness-raising campaign around sexual and reproductive health and violence against adolescents, for communities, religious groups and civil society. A campaign for the government to make this problem a priority has been started. Thanks to the training of groups of adolescent advocates and the creation of 10 specific municipal centres, young people have access to information on sexual and reproductive health, educational material and means of contraception. Educational sessions on sexual and reproductive health are led by school teachers in the area. Finally, the personnel in the 10 health centres have received technical training, enabling them to give quality attention to adolescents, especially in dealing with pregnancy.

» Programme Maryse Boscameric and Christine Batard » Field: Nancy Melgar » Headquarters: Ernesto Herrera

2,505 adolescents participated in 14 awareness campaigns on the theme of sexual and reproductive health.

Source: UNDP 2007

POPULATION

» Beneficiaries: 14,407 » Target: 47,500 PERSONNEL

» Local: 10 » Expatriate: 1

» RESULTS

FUNDING

» AFD, American private funds, MdM BUDGET

» 2009: €308,429

» OUTLOOK MdM withdrew at the end of 2009. Successful transfer of the project to the authorities and the beneficiaries has been achieved. A new project in the same geographical area is being put together to reinforce the right to sexual and reproductive health for women.

S.

“At first I thought that, with only having one partner, I didn’t need to be careful. Now I know that is not the case. So that’s why I now use condoms. At the beginning my husband told me he didn’t want to, that I was forcing him, but in the end he got used to it.”


AFGHANISTAN

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

More than 90% of the opium sold in the world is produced in Afghanistan, where domestic consumption is growing. In 2009, there were an estimated 1.5 million people using drugs. The number of heroin injectors is thought to be growing fast, and this group represents the major risk factor in the transmission of HIV/AIDS and hepatitis. Faced with a repressive culture and a discriminatory healthcare system, MdM is supporting a harm reduction programme. LONG TERM LIFE EXPECTANCY HDI 0.352; RANK

43.6 YRS 181/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 750 » Target: 150,000 PERSONNEL

» Local: 34 » Expatriate: 1

Harm reduction programme for people who use drugs

» Kabul

» ACTIVITIES Since 2006, MdM has been developing an ambitious strategy of harm reduction amongst Afghan drug users. There are two parts to this work: the setting up of a prevention project and access to primary healthcare and to treatment, as well as the creation of a resource and training centre for local actors involved in the struggle against HIV/AIDS. This health centre and refuge, that monitors the health of 230 drug users on a weekly basis, has been recognised as a model programme for the Middle East-North African region. In May 2009, MdM prescribed the first antiretrovirals in the country and set up the first self-help groups for people living with HIV/AIDS.

CO-ORDINATORS

» Programme: Guy Caussé, Olivier Maguet » Field: Olivier Vandecasteele » Headquarters: Valérie Brunel

» RESULTS Some 118,733 syringes and 34,295 condoms were distributed. 750 drug users are monitored within the scope of the programme.

FUNDING

» World Bank, WHO, Global Fund, other UN funds, French private funds, MdM BUDGET

» 2009: €433,278

» OUTLOOK From February 2010 MdM will introduce methadone as a substitution treatment. The programme should extend to 120 patients by the end of the year. MdM plans to train local actors in harm reduction and HIV/AIDS. Finally, the programme will support the creation of an independent Afghan organisation involved in harm reduction.

Rahim embodies the aims of MdM’s programme. He was one of the first drug users registered in 2006. Following this, he became a peer educator in April 2009, then social worker, criss-crossing the streets of Kabul in the patrols organised by MdM. As a member of the team of trainers, he specialises in dealing with overdoses as well as in drug users’ human rights. It is in this capacity that he was involved with the launch of the first ARV programmes in the country.


BURMA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

The military junta should organise general elections in 2010, but there is little hope of real change. Poverty, due to political economic restrictions and an under-investment in health and education, increases, while the HIV/AIDS epidemic does not diminish. Two years after cyclone Nargis, reconstruction is necessary and important. MdM remains the only international medical organisation present in the affected area. LONG TERM LIFE EXPECTANCY HDI 0.586; RANK

61.2 YRS 138/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 9,033 » Target: 39,000 PERSONNEL

» Local: 143 » Expatriate: 3 CO-ORDINATORS

» Programme: Françoise Sivignon » Field: Anne Lancelot » Headquarters: Valérie Pardessus FUNDING

» EuropAid, Dutch public institutions, DG Echo, MdM BUDGET

» 2009: €1,101,538

Prevention and care for sexually transmitted infections (STIs) and HIV/AIDS

» Kachin State (Myitkyina & Moegaung) and Yangon

» ACTIVITIES MdM’s programme has two aims: the reduction of sexual transmission and harm reduction. In Yangon, comprehensive care is provided to sex workers and gay men by way of psychosocial actions, prevention, screening and care for STIs, HIV/AIDS and opportunistic infections, as well as by providing access to antiretrovirals (ARV). These activities are carried out in a day centre doubling as a clinic and in the town, in the areas of prostitution. In Kachin state, harm reduction for people who use drugs is carried out through a needle exchange programme, and access to a substitution treatment (methadone). The same prevention, screening and care activities that are conducted in Yangon are carried out in two day centres, as well as by mobile outreach teams.

» RESULTS At the end of 2009, 600 people were on ARV treatment, 63 were on methadone and 1,100,000 syringes had been distributed.

» OUTLOOK MdM will continue lobbying in favour of access to ARVs for marginalised populations and harm reduction for people who use drugs. The aim for the end of 2010 is to have 1,060 patients on ARVs and 200 on methadone. MdM is preparing a new phase in 2011-2015, that will provide technical assistance to the public health services and local organisations.

Z. 26 years old, ex drug user and now peer educator

“Here I have learnt everything about AIDS and the ways in which to protect yourself. I would have liked to know that then, so I didn’t share syringes. Today it is my knowledge that I share with my friends at the centre or outside. The role of educator gives me an aim in life instead of the search for more drugs, which dominated the last ten years of my existence.”


BURMA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

The military junta should organise general elections in 2010, but there is little hope of real change. Poverty, due to political economic restrictions and an under-investment in health and education, increases, while the HIV/AIDS epidemic does not diminish. Two years after cyclone Nargis, reconstruction is necessary and important. MdM remains the only international medical organisation present in the affected area. LONG TERM LIFE EXPECTANCY HDI 0.586; RANK

61.2 YRS 138/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 25,933 » Target: 148,350 PERSONNEL

» Local : 43 » Expatriate: 1 CO-ORDINATORS

» Programme: Françoise Sivignon » Field: Anne Lancelot » Headquarters: Valérie Pardessus FUNDING

» DG Echo BUDGET

» 2009: €229,316

Strengthening community health systems

» Pyapon Township

» ACTIVITIES The intervention, planned for a total of 99 villages without any health care facilities, is concentrated on three major areas: training and supervision of community health agents, the reactivation, or creation of, village health committees and their mobilisation to run prevention activities, and finally, health education sessions for villagers. MdM’s programme is integrated into the national healthcare policy. Since the cyclone hit the delta area, MdM has been actively involved in defining what is meant by ‘reinforcing the health system’, in collaboration with the Ministry of Health and other health actors (NGOs and UN bodies).

» RESULTS By the end of 2009, 99 community health agents were trained and 59 village health committees were created or reactivated.

» OUTLOOK In 2010, MdM will extend its geographical cover to the south-west of Pyapon township, an area that is particularly difficult to access, and will add 33 villages to its programme. A new financial arrangement should allow the start up of mother and child health activities.


CAMBODIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

In spite of strong economic growth and political stability bestowed on the country by its authoritarian regime, the health system remains weak. Although the joint efforts of NGOs and the government are helping to curb the progression of AIDS, the ways in which the disease is spread (such as internal migration, poverty, human trafficking and prostitution) continue to bring the threat of a resurgence in the epidemic. LONG TERM LIFE EXPECTANCY HDI 0.593; RANK

60.2 YRS 137/182

Source: UNDP 2007

PERSONNEL

» Expatriate: 1

Caring for people living with HIV

» Phnom Penh

» ACTIVITIES In the last year, we have continued to support the local NGO SEAD, including some work on restructuring the organisation. On 1 November 2009, SEAD took over all of MdM’s activities: the medical and psycho-social care of destitute patients affected by HIV, the training of doctors and access to micro-credit for people living with HIV/AIDS.

CO-ORDINATORS

» Programme Éric Peterman » Field: Jean-Philippe Dousset » Headquarters: Valérie Pardessus

» RESULTS At the end of October 2009, 2,345 patients were receiving ARV therapy and 119 people benefited from micro-credit.

FUNDING

» MdM

» OUTLOOK

BUDGET

At the end of August 2010, (the end of financial contributions from the Global Fund), SEAD will cease its activities, with the medical component being taken over by the national programme in collaboration with the NGO Aids Healthcare Foundation (AHF). SEAD is looking for funds to allow it to continue and extend the psycho-social care, mainly focusing on the provision of quality care for destitute people living with HIV.

» 2009: €57,742

Chea Thavy 55 year-old living with AIDS

“Since the death of my husband in 2001 I have been bringing up my three children on my own and try to face up to my disease. Sometimes I despair, thinking how difficult it will be for them to get by without me. But at the health centre, my doctor and the psychologists reassure me and tell me that they won’t give up on me.”


DOCTORS OF THE WORLD

CHINA

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

In 2009, there were an estimated 740,000 people living with HIV in China. People who use intravenous drugs are the main risk group for HIV/AIDS and hepatitis, with needle sharing being the most widespread method of transmission in the country. It is in this context that, since 2005, and notably at Chengdu, MdM has been running a harm reduction project to help injecting drug users.

LONG TERM LIFE EXPECTANCY HDI 0.772; RANK

72.9 YRS 92/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 2,700 » Target: 30,000 PERSONNEL

» Local: 3 » Expatriate: 2

Harm reduction for people who use drugs

» Chengdu (Sichuan Province)

» ACTIVITIES In partnership with the Center for Disease Control (CDC) in the town of Chengdu, MdM is working in two drop-in centres (with needle exchange) located in Chengdua and Jinniu districts. The team provides drug users with injection kits and information materials related to drug use, while at the same time offering access to basic healthcare and psychological support. The continuation of this programme rests partly on the dedication of peer educators who lead educational sessions on health. MdM supports the development of this group with the aim of strengthening the involvement of each individual.

CO-ORDINATORS

» Programme: Béatrice Luminet, Michèle Roelens, Romolo Baglioni » Field: Cyril Poulopoulos » Headquarters: Valérie Brunel FUNDING

» MdM BUDGET

» 2009: €167,131

» RESULTS By the end of November 2009, 2,608 users were enrolled in the two centres. At least 48,000 syringes were distributed each month in 2009.

» OUTLOOK MdM passed on the two reception centres and needle exchanges to CDC at the end of 2009, while still maintaining support for this local health entity over the course of the first few months of 2010. An exploratory mission will take place in Chengdu on the access to and quality of methadone substitution programmes. And MdM will certainly continue its support for the peer educator organisation, San Ye Cao.


DOCTORS OF THE WORLD

INDIA

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

Despite exceptional economic growth, India is slow in improving the lot of the 600 million people living on less than a euro per day. MdM Midi-Pyrénées has been involved since March 2007 in Jaipur, the capital of Rajasthan, supporting the most vulnerable populations in 10 shantytowns. The organisation improves their access to healthcare, with particular attention to women and children who are the most vulnerable. LONG TERM LIFE EXPECTANCY HDI 0.612; RANK

63.4 YRS 134/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,000 » Target: 5,000 PERSONNEL

Caring for women and children in shantytowns

» Jaipur, Rajasthan

» ACTIVITIES The mission, in partnership with the Indian organisation JKSMS, has assured an almost daily presence in the 10 shantytowns in the programme. Health education sessions, whether in groups or individually, have been carried out on the subjects of maternal-infant and community health. At the same time, the important task of setting up a network was carried out with the health authorities, hospitals and communities themselves to fill the vast gulf that separates them.

» Local: 9 » Expatriate: 1

» RESULTS

CO-ORDINATORS

In 2009 the percentage of medically-supervised births rose from 35% to 45% in the target populations.

» Programme: Dr Isabelle Hainzelin, Dr Maya Laporte-Vergnes » Field: Willy Bergogné » Headquarters: Midi-Pyrénées Regional Delegation, Tom Wingefeld FUNDING

» Local government, French private funds, MdM

» OUTLOOK In 2010, the focus will be on the training of link workers from within these communities, who will replace, over time, the social workers. At the same time, MdM will concentrate on developing advocacy to raise awareness in Jaipur of the need to improve care for pregnant women and children in the shantytowns.

BUDGET

» 2009: €50,732

Sunita A few days after the birth of her daughter in hospital

“I knew that giving birth in hospital was important both for the mother and for the baby. In the shantytown, conditions for giving birth are difficult: no help, no doctors, no medicines… Women deliver by themselves. When my daughter grows up I will tell her how important it is to go to hospital.”


INDONESIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

The country is in a very fragile health and socio-economic situation. Lembata province displays a high level of social inequality in terms of health and high prevalence of communicable diseases. In Western Papua, the AIDS epidemic spreads and maternal and infant mortality is rising. The supportive links that MdM shares with the local NGO Primari and the health authorities facilitate access to healthcare. LONG TERM LIFE EXPECTANCY HDI 0.734; RANK

70.5 YRS 111/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 4,431 » Target: 60,000 PERSONNEL

» Local: 18 » Expatriate: 4 CO-ORDINATORS

» Programme: Patricia GaillardOlokose, Remco van de Pas » Field: Amélie Courcaud » Headquarters: Valérie Pardessus FUNDING

» EuropAid, Dutch public institutions, MdM BUDGET

Primary healthcare and preventing infectious diseases

» Western Papua

» ACTIVITIES MdM works closely with Primari, its local partner. Teams have organised mobile clinics to the villages. They have supported two health centres and the screening centres in the hospital and Mulia health centre. At the same time they have carried out HIV/AIDS prevention activities and trained some staff in the health structures and other community health workers (kadersand bidan). MdM has intensified its lobbying of the country’s authorities for access to healthcare.

» RESULTS 27 community health agents and 18 traditional midwives were trained and supervised by MdM. 24 different information, education, communication (IEC) resources were created in 2009.

» OUTLOOK In 2010 MdM will refocus its programme towards sexual and reproductive health, always supporting its two local partners, Primari and the Students Club of Mulia. All this, with the objective of withdrawing in the not too distant future. In the meantime, support for the health system management and the advocacy for access to healthcare will be maintained.

» 2009: €324,191

Magdalena Tabo 18 years old, she is involved in defending women’s rights and works with MdM in the struggle against AIDS. She also helps with the education of the women and young girls in her village.,

“I have no problem talking about condoms. They are a method of prevention. That does not mean that I am against the church, it just means that I am for the condom.”


INDONESIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

On 30 September 2009, at 17.16 local time, an earthquake with the magnitude of 7.9 on the Richter scale, followed by an aftershock of 6.2, struck the west coast of Sumatra. From its base in Jakarta, MdM immediately rallied to respond to the medical needs. 250,000 people were affected by the disaster.

EMERGENCY LIFE EXPECTANCY HDI 0.734; RANK

70.5 YRS 111/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 14,400 » Target: 90,000 PERSONNEL

» Local: 31 » Expatriate: 5

Aid to earthquake victims

» Padang (Sumatra)

» ACTIVITIES MdM supported the people affected by the disaster by running mobile clinics and bringing aid to those who were suffering from physical injuries. Four puskesm as (health centres), three of them damaged, were supported in terms of data collection, diffusion of information and the management of the cold chain for vaccination. Pertinent information on natural disasters and mental health was broadcast in partnership with two radio stations. Shelters, tarpaulins, blankets and hygiene kits were distributed to families. Finally, tents were set up in seven health centres and 11 schools.

CO-ORDINATORS

» RESULTS

» Programme: Arnaud Bourdé » Field: Frédéric Robin » Headquarters: Luca Beltrame

4,000 medical consultations were carried out. 790 people benefited from psychological support. 2,400 families received shelters and hygiene kits.

FUNDING

» Spanish private funds, French private funds BUDGET

» 2009: €156,326

» OUTLOOK This project enabled MdM to capitalise on information and facilitates a better preparation and better response in case of future emergencies. What happened at the end of September 2009 is likely to happen again on the archipelago.

MdM staff

“They had a normal situation: ordered, with a home, a job, future prospects… Then from one day to the next it had all collapsed. So of course there is shock, psycho-trauma. “


INDONESIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

The country is in a very fragile health and socio-economic situation. Lembata province displays a high level of social inequality in terms of health and high prevalence of communicable diseases. In Western Papua, the AIDS epidemic spreads and maternal and infant mortality is rising. The supportive links that MdM shares with the local NGO Primari and the health authorities facilitate access to healthcare. LONG TERM LIFE EXPECTANCY HDI 0.734; RANK

70.5 YRS 111/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 40,228 » Target: 107,000 PERSONNEL

» Local: 4 » Expatriate: 1

Tackling malaria

» Lembata

» ACTIVITIES MdM carries out its programme tackling malaria in the heart of the most affected communities on the island, where the disease in endemic (above 20%). Two mobile teams are in charge of the early identification and the treatment of the illness. In addition to an entomological study, MdM has carried out two ‘malaria-metric’ studies, the first at the beginning and the second at the end of the programme, that will allow us to measure its impact. The teams have also provided training on prevention and treatment of malaria to healthcare personnel, technicians from eight laboratories in district health centres and community health agents.

CO-ORDINATORS

» Programme: Arnaud Bourdé » Field: César Wong Alcazar » Headquarters: Valérie Pardessus

» RESULTS 100% of the laboratory technicians have been trained in identifying malaria. 8,300 mosquito nets were distributed, benefiting 14,082 people.

FUNDING

» Spanish public institutions

» OUTLOOK

BUDGET

The programme, as envisaged, ended after the second malaria-metric study in March 2009.

» 2009: €142,138


DOCTORS OF THE WORLD

NEPAL

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

Nepal has among the highest maternal and infantile mortality rates in the world. In the district of Sindhulpachowk, maternal and reproductive health figures are particularly alarming: only 5% of births take place within health centres compared with the national average of 20%. Throughout 2009, the political and security situation remained fragile and unstable.

LONG TERM LIFE EXPECTANCY HDI 0.553; RANK

66.3 YRS 144/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 2,448 » Target: 13,558 PERSONNEL

» Local: 16 » Expatriate: 1 CO-ORDINATORS

» Programme: Patrick Baguet » Field: Karina Cantazino » Headquarters: Valérie Brunel FUNDING

» French private funding, MdM BUDGET

» Sindhupalchowk district

Reproductive » ACTIVITIES The programme aims to improve the access to, and quality of, maternal, neonatal care, and health and emergency obstetric care given in nine health centres. MdM also supports microfinance groups micro-credit led by women from disadvantaged castes. Together, these services contribute to an improvement in health services in Sindhupalchowk. They enable most emergency obstetric services to operate 24 hours a day, medical personnel benefit from training and referrals increase. Women are informed about the risks associated with pregnancy and birth, and benefit from better access to antenatal care. These actions encourage and promote community interest, especially with regards to reproductive health.

» RESULTS Emergency obstetric services are available 24 hours a day in five centres. 4,143 women have benefited from educational sessions in reproductive health. 4,568 groups benefit from microfinance activities.

» 2009: €173,841

» OUTLOOK 2010 will be a pivotal year. MdM enters into a withdrawal phase, transferring its activities to local district authorities, hoping to duplicate the previous programme in a new area.

Yanuko 24 years old, member of one of the microfinance groups at Thulopakhar

“I realised the importance of prenatal visits when they told me that I would have to give birth in hospital because the baby was showing signs that it was suffering. I managed to convince my family, who were opposed to it. Thanks to this programme, we were able to take out a loan at a low rate of interest, and so face up to this type of emergency. We hope that other women will be given this chance.”


PAKISTAN

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

The Pakistani military offensive of May 2009 against the Taliban insurgency caused the biggest population displacement in the country’s history. Before this crisis, living conditions were already perilous and the health system inadequate. The impact on health that this event had, both on the displaced populations and the residents, who share what little they have, was immediate.

EMERGENCY LIFE EXPECTANCY HDI 0.572; RANK

66.2 YRS 141/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 70,000 » Target: 145,000 PERSONNEL

» Local: 86 » Expatriate: 5 CO-ORDINATORS

» Programme: Marc Tyrant » Field: Myriam Pomarel » Headquarters: Stéphane Berdoulet FUNDING

» DG Echo, CDC BUDGET

» 2009: €414,996

Mobile care in a conflict area

» North west frontier province (NWFP)

» ACTIVITIES MdM offers comprehensive primary healthcare to the civilian population, both the displaced persons and the residents, bringing with it a programme of nutritional support and vaccination. This is achieved via four mobile clinics with a qualified national team visiting 12 sites. Preparation for epidemics has been carried out (monitoring and contingency plans). Attention was particularly concentrated on children under five, pregnant women and women of reproductive age.

» RESULTS 25,000 medical consultations were carried out in the second semester. 306 children were cared for within the nutritional support plan.

» OUTLOOK In the not too distant future, MdM is looking to move its mobile clinic activities to new areas depending on the needs and any crises. The aim is to continue to provide primary healthcare in a structurally fragile and economically unsettled area.

Father of a family

“I’ve given my last food and savings to help the displaced. The local economy is slow in starting up again and I haven’t been able to find decent work. I bring my daughters to the MdM clinic because the closest place for healthcare is kilometers away.”


PAKISTAN

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

Pakistan has seen recent economic and political upheaval, and was subjected to numerous attacks in 2009. Against this difficult backdrop, the situation for women remains precarious. Since 2005, MdM has been devoted, together with the Department of Social Affairs, to the creation of new refuges, called Dar Ul Aman (‘house of peace’), in which female victims of domestic violence can find protection. LONG TERM LIFE EXPECTANCY HDI 0.572; RANK

66.2 YRS 141/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,704 » Target: 19,237 PERSONNEL

» Local: 45 » Expatriate: 3 CO-ORDINATORS

» Programme: Mondane Jactat, Barbara Ten Kate » Field: Benoît Tallec » Headquarters: Valérie Brunel FUNDING

» EuropAid, AFD, French private funds, other private funds BUDGET

» 2009: €437,688

Helping female victims of domestic violence

» Punjab region

» ACTIVITIES The aim of the project is to help women who are victims of domestic violence. In bringing them medical, psychological and legal support, the teams work in the Dar Ul Aman (refuges for these women). The Department of Social Affairs wanted to open 27 new centres, bringing the number from eight to 35 in Punjab. The Dar Ul Aman supported by MdM’s programme allow a growing number of women to benefit from mulitidisciplinary support. The personnel in these refuges are trained in the prevention of violence, to care for women and to help them recover from violence. The close collaboration between MdM and participants from Pakistani civil society ensures the continuation of these activities and the promotion of a greater awareness within the population towards this problem.

» RESULTS Out of 11,340 residents, 71% accessed free medical care and 60% had access to group psychological support. 765 lawyer visits took place.

» OUTLOOK MdM will continue to support the Department of Social Affairs in Punjab with a programme that is now running in 35 Dar Ul Aman refuges.

Humayra, 28 years old, took refuge in the Faisalabad Dar Ul Aman centre with her two daughters in order to protect themselves from a violent husband and in-laws. Over seven months she received psychological, medical and legal support, prepared her divorce, made plans and learnt to sew. Humayra today lives happily with her children and her new husband. She has become a dressmaker working from home, which also gives her greater financial independence.


DOCTORS OF THE WORLD ANNUAL REPORT 2009

RUSSIAN FEDERATION INTERNATIONAL PROGRAMMES » ASIA

The Russian Federation continues its economic development. But the number of people left behind is huge. In Moscow, migrant workers have very limited access to healthcare. Much the same as the 225,000 indigenous peoples of the Great North who suffer as a result of geographical isolation and meager financial support from the regional authorities. MdM supports a programme of community health designed for the indigenous people, and medical care adapted for migrants in Moscow. LONG TERM LIFE EXPECTANCY HDI 0.817; RANK

66.2 YRS 71/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 481 » Target: 15,250 PERSONNEL

» Local: 1 » Expatriate: 0 CO-ORDINATORS

» Programme: Armelle Desplanques-Leperre » Field: Maarten Kockelkoren » Headquarters: Anne Landaes

Supporting a community health programme for indigenous peoples

» Great North and Siberia

» ACTIVITIES As the training of health agents continues, MdM looks to extend its programme to new regions, notably those of Amour and Yakutsk. Two regions have already taken over the activities, officially recognising the profession of Health Agents (HA). In 2009, an awareness campaign linked to the excessive consumption of alcohol was also set up. Some French doctors were able to organise an initial training in Yakutsk, using an early identification method and the involvement of the HA in their communities. Finally, MdM works towards helping and supporting a Russian NGO, the Community Health Partnership, which co-ordinates the network of different participants within the project that has been getting together for working groups every six months since 2008.

» RESULTS 20 new health agents were trained and 11 health personnel benefited from training on alcohol.

FUNDING

» French private funds, MdM BUDGET

» 2009: €131,013

» OUTLOOK The takeover of the project by the NGO Community Health Partnership, with support from MdM, will be made official with a partnership agreement between the two NGOs. The priorities for 2010 are the training of health agents and the prevention of alcoholism and tuberculosis.

Extract of the 2009 report by the Deputy Director of emergency services in Yakutsk.

“According to the medical notes of five community health agents, the total number of emergency consultations necessitating an evacuation was 55. Of these, 21 were for children and 34 were for adults. Most often patients come to the HAs with wounds, upper respiratory tract infections, gastric or intestinal infections and dermatological or dental problems.”


DOCTORS OF THE WORLD ANNUAL REPORT 2009

RUSSIAN FEDERATION INTERNATIONAL PROGRAMMES » ASIA

The Russian Federation continues its economic development. But the number of people left behind is huge. In Moscow, migrant workers have very limited access to healthcare. Much the same as the 225,000 indigenous peoples of the Great North who suffer as a result of geographical isolation and meager financial support from the regional authorities. MdM supports a programme of community health designed for the indigenous people, and medical care adapted for migrants in Moscow. LONG TERM LIFE EXPECTANCY HDI 0.817; RANK

66.2 YRS 71/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 1,100 PERSONNEL

» Local: 7 » Expatriate: 1 CO-ORDINATORS

» Programme: Julie Bellenger » Field: Maarten Kockelkoren » Headquarters: Anne Landaes FUNDING

Migrant health

» Moscow

» ACTIVITIES MdM has undertaken many different specific actions. A telephone helpline, staffed by a doctor, makes it easy for migrants to be pointed towards a network of practitioners (“friends”) who are sensitive to the problems faced by this population. These are professionals who meet every six months with the aim of improving care (diseases encountered, women’s health etc.). MdM strongly encourages organisations working with, and on behalf of, migrants to become involved in a network and to coordinate their actions. To this end, four round table discussions were organised, and 24 organisations took part. At the same time, an outreach worker is conducting awareness-raising activities in the places where migrants work, distributing leaflets on the prevention of infectious diseases, condoms and information on the telephone helpline.

» MdM

» RESULTS

BUDGET

1,100 migrants were referred by MdM’s medical consultants and 420 received care. 197 field visits were carried out.

» 2009: €99,993

» OUTLOOK An assessment, anticipated at the start of the development of the programme, has been planned for the beginning of the year 2010. This evaluation in the middle of the programme will redirect the project, if needed.

Olimi Shirinbek Medical consultant for the project

“We received a call from a young Tajik woman. Her nine month baby was coughing and had had a fever for a week. Diagnosed as suffering from pneumonia, he was quickly transferred to the paediatric hospital of Tushinsky. We have since contacted his mother and he is getting better. The child should come out of hospital soon.”


DOCTORS OF THE WORLD ANNUAL REPORT 2009

RUSSIAN FEDERATIONCHECHNYA INTERNATIONAL PROGRAMMES » ASIA

Despite an apparent political stabilisation and a massive material reconstruction in the areas ravaged by the war, the Chechen Republic lives through a worrying time: assassinations, corruption, violations of human rights… The population does not have access to free healthcare. Moreover, medical personnel are scarce and/or lacking in training. LONG TERM LIFE EXPECTANCY HDI 0.817; RANK

66.2 YRS 71/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 21,000 » Target: 114,238 PERSONNEL

» Local: 1 » Expatriate: 0

Support for health centres and primary health centres

» Chechnya

» ACTIVITIES Until March 2009, MdM supplied the medical structures situated in the rural and isolated areas with medicines, and assured the training of healthcare personnel. Good co-ordination with the health authorities made it possible to prepare the withdrawal of the teams and to plan the transfer of the programme. MdM’s activities in Chechnya ended in March 2009. Meanwhile, the co-ordinator of the project still pays close attention to the political, health and economic situation in the region. A mission to capitalise on the knowledge gathered over the 15 years of MdM’s presence in the country was carried out in November and December 2009.

CO-ORDINATORS

» Programme: Joseph Dato » Field: Maarten Kockelkoren » Headquarters: Anne Landaes FUNDING

» RESULTS 21,000 patients benefited from care in rural areas and 79 health professionals profited from medical training.

» DG Echo, MdM BUDGET

» 2009: €156,816

» OUTLOOK The report reviewing MdM’s 15 years of presence, circulated in March 2010, will make recommendations for new projects. A new direction for MdM in Chechnya will be defined in spring of 2010.

U.L. A Ministry of Health general practitioner

“I was surprised to learn that MdM wanted to develop a programme in the primary healthcare centres of Nojai-Yourt and Vedeno, the most dangerous mountainous areas of the Republic. In those days the Ministry of Health had no information on the health structures of that region. MdM arrived at the most critical moment and was able to restore the health system.”


VIETNAM

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » ASIA

Although HIV appeared relatively late in Vietnam at the beginning of the 1990s, and remains confined within the marginalised populations and people labeled as social outcasts, such as people who inject drugs or sex workers, the risk of general widespread propagation remains high. It is estimated that close to 310,000 people live with HIV, and that 10,000 die each year, statistics which mean that this epidemic is a public health priority. LONG TERM LIFE EXPECTANCY HDI 0.725; RANK

74.3 YRS 116/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 10,146 » Target: 116,000 PERSONNEL

» Local: 30 » Expatriate: 2 CO-ORDINATORS

» Programme: Karine Lacombe, Maud Lemoine » Field: Olivier Franchi » Headquarters: Valérie Brunel FUNDING

» USAID, AFD/Scac, embassies, MdM BUDGET

» 2009: €862,788

Prevention and care for people living with HIV

» Hô Chi Minh-City and Hanoi

» ACTIVITIES The HIV programme developed by MdM is in partnership with the health services of Hanoi and Hô Chi Minh City. It consists firstly of prevention and harm reduction. Teams of peer educators enlighten and raise awareness, distributing condoms and syringes, assuring the promotion of anonymous and free screening at places of risk (places where people inject, notable prostitution areas). MdM also assures medical care. If screening shows that a person is HIV-positive, the patients are offered regular medical checkups. They then have free access to ARVs and treatment for opportunistic infections. Finally, the teams offer support to patients. Beyond its health effects, HIV profoundly alters people’s lives. Therefore MdM and its partners provide a wider plan of care, including psychological support, tackling prejudice against people living with HIV and supporting families.

» RESULTS Prevention activities reached 6,500 people, 3,600 were screened and medico-social health checks were provided to 2,071 patients (leading to 1,440 on ARV).

» OUTLOOK MdM will maintain this programme for at least four more years. It hinges on three long term objectives: assuring its sustainability by transferring technical experience to its partners, adapting the initial model to urban areas and encouraging access to healthcare in closed areas (detox centres).

Mrs Nguyen Thi discovered she was HIV-positive after a test in 2007. Since then, her pregnancies have been monitored in a centre for the prevention of mother-to-child transmission. Thanks to regular medical attention and the courses of ARV, her two children are not HIV-positive.

“I do my best to follow the treatment, be in good health and take care of my children, because they are my gift from God. They are my reason for living and fighting”


BULGARIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » EUROPE

The healthcare reforms started in Bulgaria in 2000 introduced a system of paid health insurance. But most Roma are excluded from the health system because of a lack of information about the system or because they find it impossible to pay the premiums. The figures are alarming, especially in relation to vaccination, infant mortality, hygiene practices and reproductive health. LONG TERM LIFE EXPECTANCY HDI 0.84; RANK

73.1 YRS 61/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 440 » Target: 10,000 PERSONNEL

» Local: 10 » Expatriate: 1

Better access to healthcare for Roma

» Sliven, Nadezhda district

» ACTIVITIES The programme restarted in June 2009 with activities established in September. An investigation of the living conditions and access to healthcare of 200 young women from the Nadezhda quarter allowed MdM to evaluate the needs of the community. Four local mediators have been trained by professionals on maternal and infant health, reproductive health and access to healthcare. Methods of raising awareness have been developed by the team and are introduced to the community by way of group discussions and educational workshops. Finally a system to refer people to mainstream health services is being developed.

CO-ORDINATION

» Programme: Patrick Contois » Field: Margarita Salteri » Headquarters: Anne Landaes FUNDING

» RESULTS 14 religious leaders and 44 parents participated in the group discussions. 440 school children were made aware of matters relating to hygiene

» German private funds, MdM BUDGET

» 2009: €72,816

» OUTLOOK After several evaluations, the project is being revised. In 2010, the principal focus of the programme will be centred on maternal and infant health education, family planning and hygiene. Moreover, the role of the local mediators will be intensified.

M. 35-year old woman

“I had twins, but one of them died. We didn’t have the money for his care. The other has problems with his liver. I took my daughter, who is married, to the doctor so that she would take the pill. Her husband agrees because he sees that life is difficult. But no one explains anything to us. We don’t know how to protect ourselves. It is terrible.”


BULGARIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » EUROPE

The healthcare reforms started in Bulgaria in 2000 introduced a system of paid health insurance. But most Roma are excluded from the health system because of a lack of information about the system or because they find it impossible to pay the premiums. The figures are alarming, especially in relation to vaccination, infant mortality, hygiene practices and reproductive health. LONG TERM LIFE EXPECTANCY HDI 0.84; RANK

73.1 YRS 61/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 237 childcare professionals 749 institutional professionals trained » Target: 1,130 children in institutions PERSONNEL

» Local: 3 » Expatriate: 0 CO-ORDINATION

» Programme: Françoise Parrot » Monitoring: Aquitaine regional delegation FUNDING

» Local collectivities, French private funds, MdM BUDGET

» 2009: €25,729

Training childcare professionals

» Sofia and the rest of the country

» ACTIVITIES Since October 1998, MdM Aquitaine has been working with Bulgarian childcare professionals to improve the situation of children cared for in institutions. A closing conference was organised in June 2009 in Sofia to assess these 10 years of activity in Bulgaria. It was chaired by the French ambassador and was attended by around one hundred people.

» RESULTS In 10 years, 700 people working in institutions for children under three have been trained, as well as 300 personnel in centres for disabled children.

» OUTLOOK The partner organisation created by MdM, Child and Space, is taking over the programme concerning disabled children and will develop many other projects within institutions.


MOLDOVA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » EUROPE

Moldova is one of the principal countries in the world for human trafficking. There are about 60 000 victims, suffering from serious psychological health problems, and encountering difficulties with reintegration. But only a few are identified and taken care of. MdM is working in the North, running a prevention programme and providing assistance to victims.

LONG TERM LIFE EXPECTANCY HDI 0.72; RANK

68.3 YRS 117/182

Preventing human trafficking

» Balti

» ACTIVITIES

CO-ORDINATION

Three areas of focus have been developed. Firstly, MdM raises awareness of the phenomenon of human trafficking in schools and amongst vulnerable adolescents and organises a regional media campaign. In order to identify actual and potential victims, MdM trains medical and socio-educational professionals and works in rural areas, bringing help to very poor families, by way of two mobile teams, composed of a psychologist and a social worker, which provide psychological consultations. Finally, MdM supports a network of national and local partners to ensure the multidisciplinary care of victims (medical, psychological, social and legal assistance at home, help towards professionalisation and socio-economic reintegration).

» Programme: Françoise Parrot » Field: Laura Pasquero » Headquarters: Anne Landaes

These actions are carried out in partnership with local organisations and the national referral system.

Source: UNDP 2007

POPULATION

» Beneficiaries: 2,133 » Target: 60,000 PERSONNEL

» Local: 10 » Expatriate: 1

FUNDING

» AFD, MdM

» RESULTS

BUDGET

326 direct, indirect and potential victims were assisted. 1,150 adolescents were made aware of the subject and 657 local professionals were trained.

» 2009: €216,618

» OUTLOOK In 2010 MdM will intensify its activities to take care of direct or indirect (close to those who have left) victims of trafficking. A campaign to lobby the national system will complete the programme.

MdM’s team on the ground

“We met a family comprising nine children aged between two and 17 years old. The parents and the eldest children had been direct victims of human trafficking. The little 12 year old girl looks after her three brothers and sisters. The others are at school. The family lives in absolute destitution. When we arrived, the little girl was making bread. They have nothing else to eat. The food parcel that we brought was more than welcome.”


ROMANIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » EUROPE

Despite joining the European Union and the structural reforms of the 1990s, Romania does not seem to be able to overcome its political instability and economic difficulties. This situation hinders the government’s work on child protection. Doctors of the World’s PACA regional delegation supports the work of the COPII organisation and civil society in the fight against the abuse and abandonment of children. LONG TERM LIFE EXPECTANCY HDI 0.837; RANK

72.5 YRS 63/172

Source: UNDP 2007

POPULATION

» Beneficiaries: 304 childcare assistants » Target: 457 children

Protecting children

» Satu Mare region

» ACTIVITIES In the absence of Romanian specialists in the prevention of abuse, MdM PACA supports the local organisation COPII in the monitoring and supervision of new child protection professionals. The training of professional childcare assistants and the organisation of support groups for these professionals who look after children under one year old is carried out. Also, a scheme has been put in place to return children in state care to their natural families.

PERSONNEL

» Local: 1 » Expatriate: 0

» RESULTS 304 child protection professionals benefited from training, which helped 457 children in care.

CO-ORDINATION

» Programme: Hélène Picon » Field: M. Veres » Monitoring: PACA regional delegation, Isabelle BoujuMalaval FUNDING

» Local collectivities, MdM BUDGET

» 2009: €6,588

» OUTLOOK MdM hopes to develop, together with the COPII organisation, a better understanding of the causes of abandonment, carrying out a retrospective community study in the different locations or communities of Satu Mare. Following this, the medico-social workers will work to detect signs of distress in pregnant mothers and find alternatives to abandonment for these vulnerable mothers.


SERBIA

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » EUROPE

Despite the prospect of European Union membership, and the numerous reforms undertaken, the provision of healthcare remains hugely problematic in Serbia, particularly for the most vulnerable communities. People who use drugs continue to be highly stigmatised, and MdM is involved in facilitating their access to substitution treatments and, more generally, to the national healthcare system. LONG TERM LIFE EXPECTANCY HDI 0.826; RANK

73.9 YRS 67/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 43 PERSONNEL

» Local: 6 » Expatriate: 1 CO-ORDINATION

» Programme: Patrick Gassmann » Field: Julien Collette » Headquarters: Anne Landaes

Access to substitution treatment

» Belgrade

» ACTIVITIES After years of work, negotiation and awareness campaigns on the authorities, MdM has finally obtained the authorisation to develop a methadone project within Savski Venac primary healthcare centre in Belgrade. It is a first in Serbia, where no service of the kind exists at this level. The centre opened in October 2009 and is totally integrated within the local health system. MdM works in close collaboration with the Ministry for Health and organises training and awareness activities for local partners. A network has also been set up, bringing together organisations working on harm reduction in Serbia.

» RESULTS In three months of existence, 43 patients living in Belgrade have been admitted to the centre.

FUNDING

» MdM

» OUTLOOK

BUDGET

In 2010 the aim is to admit and monitor 120 patients. Also, the project looks at developing a network of practitioners at the primary healthcare level. Finally MdM envisages consolidation of its advocacy activities in relation to harm reduction.

» 2009: €100,445

A patient at the methadone centre

“Before, nothing like the MdM methadone centre existed in Belgrade. I tried many different treatments but this is the first time that I have been able to stop without physical or mental problems linked with withdrawal. I feel less isolated. The people that work here are attentive and kind. It is very different to what I experienced before.”


DOCTORS OF THE WORLD

EGYPT

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

Social inequalities are very marked in Egypt and even more so in Cairo, home to about 20 million people. There are growing numbers of street children, often fleeing violent homes, and they are increasingly discriminated against in terms of access to healthcare. Local organisations provide social services, but these services do not include medical and psychological skills.

LONG TERM LIFE EXPECTANCY HDI 0.703; RANK

69.9 YRS 123/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 3,660 » Target: 25,000 PERSONNEL

» Local: 8 » Expatriate: 2 CO-ORDINATORS

» Programme: Raul Heimann » Field: Marika Macco » Headquarters: Isabelle Bruand FUNDING

» Other European private funds, EuropAid, MdM BUDGET

Promoting street children’s right to health

» Cairo

» ACTIVITIES MdM trains the social workers and medical staff of five local partner organisations in better quality medical and psychological care for street children. We are also working directly with the children to improve health education and to support a specific clinic for them within a prevention centre in one Cairo teaching hospital. MdM co-ordinates a network of actors working with street children, to promote their access to mainstream health services.

» RESULTS 827 consultations for boys and girls were carried out in Basma Clinic for street children, in the premises of a teaching hospital.

» OUTLOOK In 2010, the work will continue along the same lines, with better links with the Ministry of Health. The staff of several health centres in Cairo will be trained on the situation and specific needs of street children.

» 2009: €214,038

A young girl of 17 years living on the streets, at the Caritas centre

“I’ve been on the streets since I was 10 years old, because of several problems at home. I have never been back home since. Now, I am trying to get an identity card, to be able to work and have a better future. For that, someone has to act as a guarantor and educate me. At Caritas, they try to help me to get this card.”


DOCTORS OF THE WORLD

IRAQ

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

The violence against civilian populations continues, with a resurgence in attacks since the American withdrawal in June. Although the Kurdish region has seen apparent prosperity, tensions with the central government mean that the future is uncertain. Despite the efforts of the authorities and Iraqi NGOs, our key partners, access to essential services, particularly primary healthcare, remains limited. LONG TERM LIFE EXPECTANCY 67.08 YRS HDI NC; RANK NC Source: UNDP 2007

POPULATION

» Beneficiaries: 60 health workers PERSONNEL

» Local: 8 » Expatriate: 1 CO-ORDINATORS

» Programme: Marie-Ange Silicani » Field: Sofia Janjua » Headquarters: Cristina Thevenot FUNDING

» CDC, Swiss public institutions, MdM BUDGET

» 2009: €296,955

Responding to medical emergencies

» Dohuk, Erbil, Kirkuk, Sulaymanieh, Ninewa, Tamim, Diyala, Bagdad, and Kerbala governorates

» ACTIVITIES MdM is building capacity for health workers in three areas of work. Firstly, training in prehospital emergency care, developed in collaboration with Qatar’s Hamad medical centre, for emergency services’ medical assistants and ambulance workers in six governorates. In relation to mother and child health, MdM is working with the Iraqi NGO Fuad to train community midwives in Kirkuk, Diyala and Bagdad governorates. Finally, in Kerbala governorate, MdM is helping to integrate mental health into primary healthcare by developing a pilot programme training care workers in 10 main health centres. The team, which regularly works in northern Iraq from Amman, has also had an office in Baghdad since 2009.

» RESULTS 18 medical assistants from six governorates are participating in the training for trainers in prehospital care.

» OUTLOOK MDM is looking to re-establish a permanent presence in Iraq to be able to respond better to the primary care needs and to support health actors involved in Iraqi civil society, including Iraqi NGOs. This project will be rolled out to different regions, representative of different communities, to ensure that the programme remains impartial.

Dr Osama Participant in mental health training

“As doctors, we didn’t know about what the trainers taught us today. We see many patients in our health centres and we now understand that we’ve neglected their mental health. If we are to do a good job, we’ll have to reduce the number of patients who suffer.”


LEBANON

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

Lebanon is one of the main host countries for Palestinian refugees. Of these, 53% live in 12 official camps, under the auspices of the UN agency for Palestinian refugees (UNRWA). This is also one of the countries where the living conditions for this population are hardest. UNRWA provides primary care in the camps. Since 2007, MdM has been providing support to enable access to mental healthcare, which had been non-existent before. LONG TERM LIFE EXPECTANCY 73.8 YRS HDI 0.847; RANK 55/182 Source: UNDP 2007

POPULATION

» Beneficiaries: 958 » Target: 43,000 PERSONNEL

» Local: 15 » Expatriate: 1

Mental health and psychological support for refugees

» Tripoli and Nahr El Bared and Baddawi palestinian camps

» ACTIVITIES MdM’s programme takes place in two refugee camps, with provision of psychiatric and psychological consultations in UNRWA clinics. The focus is on expanding the scope of mental health training, started in 2008, for UNRWA and Palestinian Red Crescent health workers and on the training of local organisations’ support workers. The objective is to enable early detection of patients, and to refer patients and help them to reintegrate into their communities when their conditions have been stabilised. Finally, there is a campaign of awareness-raising and destigmatisation among the general public.

CO-ORDINATORS

» Programme: Hugo Tiffou, France Arrestat and Jean Deaux » Field: Émilie Boyer » Headquarters: Cristina Thevenot FUNDING

» CDC, MdM BUDGET

» RESULTS in 2009, 5,816 consultations and home visits were carried out.

» OUTLOOK We want to ensure the long-term continuity of this psychiatric and psychological care. In 2010, the objective is to create the ideal conditions for our health partners working in the camp to take over the activities, while ensuring continuity of care for the service users.

» 2009: €247,936

Sana Sana lives in Baddawi camp with her husband and children

“When I first visited the clinic, I was worried about what my friends and family would think of me, but I hoped I could be cured. The staff explained that patient confidentiality is extremely important to MdM. That helped me to feel more at ease and encouraged me to talk. I regained my selfconfidence and that has lifted my spirits.”


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PALESTINIAN TERRITORIES

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

After the Israeli military offensive between 27 December 2008 and 18 January 2009, which killed more than 1,300 people, the humanitarian situation continues to deteriorate. The Israeli blockade prevents the repair of the water network, as well as the reconstruction and supply of hospitals and health centres destroyed by the war. The health services are unable to overcome the effects of the crisis which is leading to a deterioration in the population’s health. LONG TERM LIFE EXPECTANCY HDI 0.737; RANK

73.3 YRS 110/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 47,889 » Target: 1,500,000 PERSONNEL

» Local: 20 » Expatriate: 1 CO-ORDINATORS

» Programme: Marie Rajablat » Field: Fabrice Martin » Headquarters: Cristina Thevenot

Emergency care and primary health care

» Gaza

» ACTIVITIES MdM supports 25 of the 56 primary health centres of the Ministry of Health in Gaza with training, health education sessions and provision of essential equipment and medicines. To build capacity to deal with emergencies, the setting up of emergency care rooms is supported in 11 centres. The aim is to stabilise the condition of the injured and to decentralise referral to patients to ease the pressure on hospital emergency services which receive many minor cases. In addition, MdM has been running a project for three years to improve the quality of orthopaedic surgery, by mentoring surgical teams and providing medical equipment and supplies in three hospitals. This allows the hospitals to treat some cases on site, and to avoid the need to refer cases abroad for care.

» RESULTS Each month, 170,000 patients have received primary healthcare in the centres supported by MdM.

FUNDING

» DG Echo, local authorities, French private funds, MdM

» OUTLOOK

BUDGET

Environmental health, particularly linked to water pollution, is a major problem in the Gaza Strip. In 2010, MdM would like to carry out a study to assess the impact of water quality on the population’s health.

» 2009: €1,223,852


DOCTORS OF THE WORLD ANNUAL REPORT 2009

PALESTINIAN TERRITORIES

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

After the Israeli military offensive between 27 December 2008 and 18 January 2009, which killed more than 1,300 people, the humanitarian situation continues to deteriorate. The Israeli blockade prevents the repair of the water network, as well as the reconstruction and supply of hospitals and health centres destroyed by the war. The health services are unable to overcome the effects of the crisis which is leading to a deterioration in the population’s health. LONG TERM LIFE EXPECTANCY HDI 0.737; RANK

73.3 YRS 110/182

Source: UNDP 2007

POPULATION

Medical and psychological care

» Nablus and Jenin, West Bank

» ACTIVITIES In order to improve mental healthcare, MdM supports two community medico-psychological centres (CCMP) in line with the Ministry of Health’s national plan. This involves supporting the recruitment, training and supervision of medical and paramedic staff in Nablus and Jenin.

» Beneficiaries: 4,006 » Target: 130,000 PERSONNEL

» Local: 16 » Expatriate: 1 CO-ORDINATORS

» Programme: Marie Rajablat » Field: Fabrice Martin » Headquarters: Cristina Thevenot FUNDING

» DG Echo, AFD, MdM

MdM is also carrying out psycho-social activities for school children, educational teams, parents’ discussion groups and teachers in five villages in Nablus governorate. Since September, we have been supporting the Ministry of Education to take over these activities. In addition, a referral system is being introduced between schools, three primary healthcare centres in the villages and the Nablus CCMP, with the building of local capacity.

» RESULTS Around 40 service users a day receive medical and psychological support in each of the supported centres.

BUDGET

» 2009: €543,936

» OUTLOOK The activities in schools will be gradually handed over to the teachers and personalised psychosocial advice will be offered to children. The reinforcement of these primary health centres will enable them to offer listening, diagnosis and orientation of patients in order to improve the local provision of mental healthcare.


DOCTORS OF THE WORLD

SYRIA

ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

The Alep branch of the Syrian Red Crescent (SARC, MdM’s partner) is developing a network of health centres in the towns of this governorate, the most densely populated in Syria. For a long time it has not been possible to run programmes in the northern area, which borders Turkey — this has now been made possible by the thaw in relations between Syria and Turkey. SARC has opened health centres in this place where there remains much work to be done. LONG TERM LIFE EXPECTANCY HDI 0.742; RANK

74.1 YRS 107/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 15,799 » Target: 1,294,000 PERSONNEL

» Local: 5 » Expatriate: 1 CO-ORDINATORS

» Programme: Fyras Mawazini, Marie-Ange Silicani » Field: Guéla Sekhniachvili » Headquarters: Cristina Thevenot FUNDING

» Other European private authorities, MdM BUDGET

Access to primary healthcare for refugees

» Alep governorate

» ACTIVITIES MdM, in partnership with SARC, is developing a programme to improve access to healthcare for the rural population by supporting clinics in Alep governorate. Equipment, medicines and training for healthcare workers were provided. MdM is promoting the opening of cardiology and ear, nose and throat (ENT) consultations and dental clinics. In addition, women’s groups are trained in sexual and reproductive health as well as in mother and child health.

» RESULTS Around 3,500 patients per month attend the health centres (a figure which is increasing since the collaboration with SARC).

» OUTLOOK In 2010, MdM would like to strengthen its work in health centres. Prevention and health education are essential, particularly among people under 25 years old (more than half of the country’s population). SARC, encouraged by the results of this partnership, wants to continue to open health centres in other parts of the governorate.

» 2009: €274,164

Fares Kady Medical co-ordinator

“It is extraordinary to see how a new phase of health development is starting in our most vulnerable regions in three dimensions which seem essential to me: provision of medical services, health education and the voluntary spirit of those involved.”


TURKEY

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

Due to its strategic geographical position, its commercial influence and its proximity to the Greek coast, Turkey attracts migrants from North Africa, sub-Saharan Africa, the Middle East and Asia, in pursuit of the imagined European dreamland. The country refuses, however, to provide the usual protection to asylum seekers, abandoning this growing, destitute population.

LONG TERM LIFE EXPECTANCY HDI 0.806; RANK

71.7 YRS 79/182

Source: UNDP 2007

POPULATION

» Beneficiaries: all the migrants concentrated in Kumkapi district in Istanbul. » Target: internally displaced persons, migrants in transit trying to reach Europe via Greece. PERSONNEL

» Local: 5 » Expatriate: 0 CO-ORDINATORS

» Programme: B. Granjon » Monitoring: PACA Regional Delegation FUNDING

» Bouches-du-Rhône departmental council BUDGET

» 2009: €10,000

Access to healthcare and defending migrants’ rights

» Istanbul

» ACTIVITIES MdM, in partnership with a Turkish human rights organisation, advocates for migrants to be to able to access the health system and denounces violations of their human rights, particularly when they are locked up in Kumkapi detention centre. To this end, the organisation collects medical and social information and highlights European countries’ responsibilities in this context. In addition, operational and financial support has enabled a socio-medical centre for information, exchange and harm reduction to be opened. Finally, MdM supports organisations defending human rights.

» OUTLOOK MdM wants to focus, with Turkish organisations, its work on internally displaced persons (mainly Kurds) and migrants passing through the county. As part of this, we will compare our data with those of the host countries and, in this way, contribute to a review of European policy towards refugees and asylum seekers.


YEMEN

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

Yemen is the most densely populated and poorest country in the Arabian peninsula. The lack of an administrative system and skilled human resources, regular medical supplies and the shortage of equipment all contribute to the deficiencies in the health system. MdM’s programme aims to reinforce the health centres in order to improve access to quality primary healthcare for the population.

LONG TERM LIFE EXPECTANCY HDI 0.575; RANK

62.5 YRS 140/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 9,250 » Target: 64,127 PERSONNEL

Programme to improve primary healthcare coverage

» Hajjah

» ACTIVITIES MdM works throughout Beni Kays and aims to support seven primary healthcare services to improve healthcare provision. The programme implemented aims to make the centres operational. Training has been introduced to strengthen staff skills, and thus the quality of care for better treatment of common conditions. MdM is also supporting these centres with equipment. Prevention and awareness-raising actions, covering health and hygiene issues, have been developed.

» Local: 9 » Expatriate: 3

» RESULTS

CO-ORDINATORS

139 training days were carried out for 27 members of the medical staff of nine health centres.

» Programme: Françoise Jeanson » Field: Claire Haduong » Headquarters: Cristina Thevenot FUNDING

» EuropAid, MdM BUDGET

» 2009: €232,154

» OUTLOOK The MdM programme in Hajjah’s governorate ended at the end of October 2009, with handover to the Yemeni health authorities. In the same governorate, in Hajjah district, MdM will start a new programme of aid for displaced persons from Saada region in 2010, following the conflict which took place in this area in 2009.


YEMEN

DOCTORS OF THE WORLD ANNUAL REPORT 2009

INTERNATIONAL PROGRAMMES » MIDDLE-EAST

MdM organises first aid training to improve emergency care in the north of Yemen, scene of the conflict between the Houthi rebels and the government. Since August, intense fighting in Saada governorate resulted in mass displacement of the population. The health system is badly affected: the health centres are targeted in attacks and health workers have fled the area.

LONG TERM LIFE EXPECTANCY HDI 0.575; RANK

62.5 YRS 140/182

Source: UNDP 2007

POPULATION

» Beneficiaries: 124 » Target: 124 PERSONNEL

» Local: 7 » Expatriate: 3 CO-ORDINATORS

» Programme: Françoise Jeanson » Field: Claire Haduong » Headquarters: Cristina Thevenot FUNDING

» EuropAid, CDC, MdM BUDGET

» 2009: €113,679

Improving care for emergencies

» Saada

» ACTIVITIES Given the deterioration in access to healthcare during the last Saada war, and the reduced mobility of health actors, the development and expansion of the training provided by MdM in 2008 was deemed necessary. In addition, training for trainers in first aid was provided for 45 volunteers among staff from the Ministry of Health, Yemeni Red Crescent, local NGOs, the civilian defense and the Women’s Union. In addition, one teacher in each of 40 schools in three districts (Sahar, Safrah and Saada) was trained in first aid in order to be able to transfer these skills to their colleagues and students.

» RESULTS 45 volunteers and 40 teachers have been trained as first aid trainers; 40 other teachers were trained in health education.

» OUTLOOK With the resumption of fighting in Saada governorate, MdM will redirect its activities to come to the aid of people displaced by the conflict.


Ethiopia © Julie Beis Nepal © Benoit Guénot

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Annual report 2009