Doctors of the World UK 2011/12 by Médecins du Monde

D CTORS OF THE WORLD C : 100 M : 60 J:0 N:0

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Annual Report 2011/12

ÂŠ2013 Doctors of the World UK. All rights reserved. Neither this publication nor any part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the permission of Doctors of the World UK.

C NTENTS C : 100 M : 60 J:0 N:0

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04 / Delivering healthcare to vulnerable people 05 / President’s introduction 06 / Our international network 08 / Core areas of work: Conflicts and crisis Universal access to healthcare for all vulnerable people Harm reduction International programmes 10 / 14 / 18 / 22 / 26 /

Haiti Somalia Palestine Tanzania Vietnam National programme

28 / 32 / 34 / 38 / 40 / 41 / 42 / 44 / 46 / 48 / 50 / 54 / 56 /

Universal access to healthcare in the UK Our London clinic Advocacy and support Our partners Training community leaders and healthcare professionals Lobbying and affecting change A state of flux: NHS reforms and Doctors of the World UK Advocacy at the European level European Declaration of Health Professionals In the news Fundraising Financial snapshot Volunteers

DELIVERING HEALTHCARE TO ALL VULNERABLE PEOPLE C : 100 M : 60 J:0 N:0

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Doctors of the World UK enables excluded people to realise their right to healthcare by providing medical care and advocacy for the most vulnerable and excluded. Our network of volunteers and healthcare professionals operates more than 300 programmes in over 70 countries around the world. As part of the global Médecins du Monde network, our work covers all four continents, where we respond to emergencies and provide long-term support to local communities.

In the UK we run a clinic that helps some of the most vulnerable people in the community get

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the healthcare they need, such as refugees who have survived torture, those living in poverty, undocumented migrants and anyone who has problems getting healthcare. We believe the right to healthcare is fundamental and governments should make it a priority. Everyone should have access to healthcare regardless of their immigration status or financial means.

PQASSO is a quality standard kitemark for charities. It was awarded to Doctors of the World UK in 2011.

PRESIDENT’S INTRODUCTION In these tough economic times a growing number of people are affected by austerity policies both at home and abroad. Cuts in public spending are having an impact on public healthcare across Europe. In 2011 we stepped in to respond to basic health needs in Greece. Equally, cutbacks in private and public international funds directed to humanitarian projects are affecting the most vulnerable communities. Many of the world’s poorest people are paying the highest price. At Doctors of the World we believe that health is a human right and we will continue to work in those areas where governments fail to live up to this commitment. Thanks to the efforts of our many volunteers, we are making a difference here at home, where undocumented migrants see their rights violated more than others because of their immigration status. Doctors of the World‘s London clinic provides support to vulnerable people who may be prevented from registering with a GP or may be suffering from complex medical issues but without access to care. And we are also tackling emergencies and working on long-term projects internationally. This past year we have continued to work in Haiti, where we have tackled recurring cholera epidemics. We have also worked in projects and refugee camps in Somalia, Ethiopia and on the border of Syria. We focussed on crisis and emergency interventions (for example in Haiti and the Horn of Africa) as well as HIV/ hepatitis, harm reduction programmes (such as those in Vietnam and Tanzania) and reproductive

healthcare. The work we did in conflict zones like Somalia is pivotal in reducing the harm caused by war. Our volunteer teams are working around the clock to meet the essential health and emotional support needs of Syrian refugees in Jordan and Lebanon. Similarly, in west Africa, urgent action is needed to meet the needs of vulnerable people who are bearing the brunt of food shortages, violence, and instability in the Sahel, especially women and girls. Though we have come a long way, there is still a long way to go. For this reason, our advocacy and campaigning efforts will continue and we shall call on governments everywhere to respect the right to health. Thank you to the generous donors and many volunteers who help make our work possible. The people with whom we work are relying on you now more than ever. Janice Hughes

DOCT R F W R INTERNATI N NETW R The Doctors of the World international network is made up of 14 organisations from all over the world. Each organisation is independent and has its own board of directors. We operate in Argentina, Belgium, Canada, France, Germany, Greece, Italy, Japan, the Netherlands, Portugal, Spain, Sweden, Switzerland and, since 2012, the USA.

6 4

The network runs more than 300 programmes in more than 70 countries. Such a widespread presence allows us to effectively make the right to healthcare a reality for vulnerable people.

National and international projects are directed at those who, for various reasons, do not have access to adequate healthcare. While the national projects focus on the lack of medical assistance for those at the margins of the society, the international projects tackle emergencies, conflict/postconflict rehabilitation and deficiencies in health services. Through the support of volunteers, our network members help vulnerable groups such as undocumented migrants, homeless people, and destitute women and children

RS F THE RLD NAL RK to access healthcare. This is in compliance with international conventions which impose equal human rights standards for everyone.

the Arab Spring, Doctors of the World teams aided refugees fleeing Libya at the Tunisian/ Egyptian borders.

As a network, in 2011 we responded quickly in Japan in the aftermath of the tsunami and nuclear accident. In Greece, Spain and Portugal we supported the national health systems which were pushed to the brink after the economic crisis. We continued to support Haitians through their slow recovery from the 2010 earthquake and helped people in the Horn of Africa after the famine. We operated in conflict areas and in refugee camps. During

The support of the international network head office is vital for coordinating the networkâ&#x20AC;&#x2122;s activities and providing strategic guidance to each organisation. We exchange information and promote joint advocacy actions to bring about changes in policy and legislation. By coordinating common initiatives we can manage human and logistic resources across the network more effectively and maximise our impact.

Conflicts and crisis Emergencies Our long-standing presence worldwide helps us to respond promptly and effectively to emergencies and tackle the subsequent crises. Unexpected natural disasters disrupt the already precarious healthcare systems in developing countries, which then require additional support from international organisations present in the area. Thanks to strong relationships we have built over several years with governments, local organisations and communities, we continuously strive to find solutions that improve vulnerable people’s access to healthcare. Conflict and post-war zones are equally challenging. Wars have long-term effects on the local population. It is crucial not only to assist civilians throughout the conflict, as they are often hit in the crossfire, but also to support them in the aftermath. Memories of war and family loss cause longstanding psychological damage for those left behind, particularly to children, and they should receive urgent help. Doctors of the World works with local health professionals

C RE AREAS OF WORK C : 100 M : 60 J:0 N:0

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and values their knowledge and expertise. Our ultimate aim is to strengthen national health systems and make them accessible.

Universal access to healthcare for all – including migrants and refugees The Universal Declaration of Human Rights recognises that all people deserve equal rights, dignity and a good standard of living. Healthcare is among the most important of these rights. Many new national constitutions and anti-discriminatory laws are based on this declaration. From this perspective, nondiscriminatory access to healthcare was a pledge made long ago but is yet to be upheld. In fact, public institutions often ignore this requirement and create obstacles for those trying to obtain their fundamental rights. We strongly believe that there should be no limit to accessing primary healthcare. People’s health is always a priority that should not be put in jeopardy because of someone’s ability to pay. Thus, we work to make the right to health a right in practice as well as in theory. It is currently customary international law.

Harm Reduction – the struggle against HIV and hepatitis In most countries drug users are discriminated against and they often receive no or little assistance from national health services. Our

harm reduction programmes aim to reduce the social and health risks of drug use. We advise drug users, distribute syringes and carry out antiretroviral and substitution therapy. Equally worrying is the risk of sexually transmitted infections among sex-workers. Like drug users, sex workers are invariably marginalised. Through our peer-educators we inform them, distribute condoms, advise them to get tested and help them to protect themselves against violence from clients.

Sexual and reproductive healthcare Sexual and reproductive healthcare is fundamental in both emergency and nonemergency situations. People need to be informed and have access to affordable methods of contraception to have a safe sex life and maintain good reproductive health. Therefore, prevention is essential. Reproductive healthcare is particularly important for women, who may lack access to basic services and can suffer damaging consequences as a result. The death toll stands at 350,000 women per year and the Millennium Development Goal on maternal health is far from being met. In order to help people to manage their own sexual health, our reproductive health programmes set out to give each individual access to a variety of services that include access to contraception as well as information on pregnancy, abortion, HIV and prevention of sexually transmitted infections.

ÂŠ Giorgos Moufatis

HAITI

Conflicts and crises / sexual and reproductive health

Doctors of the World’s teams have worked in Haiti to deliver services such as reproductive healthcare, follow-up care for pregnant women and children, vaccinations, infection treatment, nutritional screening and psychological support for victims of violence and those affected by post-traumatic stress disorder. We have been in the country since 1989. We continue to provide comprehensive care and strengthen a series of services to include homeless and displaced people. In September 2011 our trustee, Catherine Giboin, was in Haiti to organise a workshop on reproductive health and financial accessibility. “Haiti is the most dangerous place to give birth in the Western Hemisphere,” she says. “The removal of user fees for pregnant women has had a real impact in recent years. That is the reason why Doctors of the World supports free healthcare for pregnant women and children under the age of five throughout the country.” As a result of the earthquake in 2010 more than 250,000 people died, 300,000 were injured and 1.3 million people were rendered homeless. Weak institutions and a general lack of resources are making reconstruction very slow. The cholera epidemic that started in October of that year made the situation worse and has caused over 7,000 deaths. After the initial earthquake was tackled, we mobilised teams in Port-au-Prince, Petit and Grande Goâve, Nippes and Grand Anse, running 15 treatment units for rehydration and setting up three larger treatment centres > for severe cases of cholera.

> We contained cholera by decontaminating the houses of those affected. In addition we launched an information campaign via radio, posters, and sent health workers to visit camps and shantytowns to spread the message on best practice for good hygiene.

recovery phase there were 1,200 Doctors of the World workers, of whom 95 per cent were Haitians.

Cholera treatment units were set up, mainly as extensions of our existing clinics, in the affected areas as well as in camps. Patients were treated in isolation; our teams cared for the mild cases and referred more serious ones to the cholera treatment centres. In the

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Dario Archille is a GP who worked with cholera patients in Haiti. He worked with Doctors of the World as the head of the cholera treatment unit in the shantytown of Cité Soleil.

HAITI

“Our role as doctors is to train medical staff in how to treat cholera and show the public how to deal with the disease and to make them aware of the risks,” he says.

•

In 2011 250,000 consultations and surgical procedures were performed by Doctors of the World in Port au Prince, and in the West, Central, Grande Anse and Nippes departments

•

4,000 medical consultations are carried out each week (including vaccinations), 55% were for children under five years old and 11.5% for pregnant women

•

54.9% of the population lives on less than $1.25 a day3

•

Haiti is ranked 158th out of 187 countries in the Human Development Index by the United Nations Development Programme (UNDP) and life expectancy at birth was 62.1 years in 20114

http://data.worldbank.org/indicator/SI.POV.DDAY/countries http://hdr.undp.org/en/media/HDR_2011_EN_Table1.pdf

We are supporting five ‘mother and child’ healthcare centres in partnership with the authorities and local organisations. Around 10,000 pregnant women and 40,000 children under five years old, who are displaced and

living in camps in the heart of the town, stand to benefit. Among other things we are providing essential medicines, vaccinations and equipment training for medical staff, supervising medical consultations and launching medical and nutritional programmes for Somali internally displaced people. Since 2007, Doctors of the World, supported by the UK Department for International Development (DFID), has been working to improve access to healthcare for people displaced in the Merca region of Somalia. The deteriorating security situation in the region forced us to bring this programme to an end > in February 2011. © Médecins du Monde

SOMALIA

Somalia is often referred to as a failed state. The country is struggling to resolve internal conflicts and this has a major impact on civilians. With a high number of internally displaced people and an almost nonexistent national healthcare system, there is an increasing need for international aid. Doctors of the World has introduced a health programme in Bossaso, in the Puntland region. The programme focuses on the most vulnerable women and children within the local and displaced population.

“We are so grateful to Doctors of the World for giving us access to quality services and free medicines. Like everyone else, I’ve benefited. I will never forget the help that the medical staff have given people, whether from majority or minority clans, and rich or poor alike.” Patient

• In Somalia life expectancy at birth was 51.2 years in 2011 C : 100 M : 60 J:0 N:0 Médecins du monde - Identité visuelle ANGLETERRE

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• In Somalia there are 1.1 nurse and midwifery staff for every 10,000 citizens 5 6

http://hdr.undp.org/en/media/HDR_2011_EN_Table1.pdf http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf

SOMALIA

> Internal conflicts and lack of resources make access to healthcare in the Somali region of Ogaden extremely difficult. In addition, the region is regularly affected by the outbreak of epidemics.

Doctors of the World provided training and medical equipment for antenatal, surgical and blood transfusion services at Dehar hospital. Although we handed over activities to the local staff in 2011, we are still operating in

the region by providing support for the health posts in the outlying areas of Kebri Dehar. Following the East Africa food crisis in 2011, we deployed our medical teams in two refugee camps at Dolo Ado, where we provided medical and nutritional care for refugees and the local population alike. These two camps already accommodated more than 70,000 refugees and the crisis increased the arrival of people in need of medical attention.

Joanna Kotcher, who lives in Scotland, was a British-based medical co-ordinator in the refugee camps at Dolo Ado.“There were four camps in the Dolo area and there were many children and women who had not received medical care,” she says. “The water situation was critical and agencies responsible for water were working very hard to supply the minimum needed for drinking and sanitation, but it was a difficult task. Our

focus groups with the refugees revealed many families that had less than eight litres per day to live on. “After several weeks in the camps, we decided that the best use of our resources would be to establish mobile health services in the larger camps. Aid equity is always an issue, especially when a host population needs as much help as the refugees that arrive on their borders.”

In 2011/12, we ran various programmes in the West Bank, in Nablus, Jericho, Halhul and Hebron in partnership with the Palestinian Ministry of Health, the Ministry of Education and Higher Education and a number of local organisations.

In the Palestinian Territories, our French, Swiss and Spanish colleagues at Doctors of the World are working in the West Bank and Gaza mainly focusing on mental health and emergency preparedness. We work closely with young people to help alleviate psychological problems and suffering caused by conflict. Teachers are trained by psychologists so that they can identify children with particular needs. Discussion groups with parents help inform families about how to address vulnerable childrenâ&#x20AC;&#x2122;s issues.

Nablus: Doctors of the World gives support and guidance to those with psychological disorders and provides training to healthcare professionals and school counsellors in handling mental health cases. Jericho: We provide support, supervision and training in crisis intervention for healthcare professionals working in mental health. The aim of the programme is to improve access to services and emergency psychological support. Halhul and Hebron: We also work with local healthcare professionals in order to strengthen their capacity to build an effective referral system and campaign in order to raise awareness on child and adolescent mental health.

PALESTINIAN T Conflicts and crises

British-based Joanna Kotcher is a trained nurse and worked as a Medical Evaluator in Nablus from February to April 2011. “I have worked in the Middle East for several years and worked as an emergency medical coordinator in Gaza during the 2010 bombing,” she says. “I know the region well so the environment was familiar. My first impressions were that the Nablus district was suffering greatly. Although access to food

and other items necessary for daily living was straightforward compared with Gaza, the population is constricted by the police and military presence. “We met with rural families, village leaders, school teachers, and medical staff in the villages. I conducted a survey of the rural health centres, noting the lack of drugs and equipment, and also had the opportunity to speak to other medics about the psychological effects of the occupation on families, especially the children. I focused on villages that were known targets for violence and where access to healthcare is poor because > of the occupation.

TERRITORIES 19

“This region will continue to require our support and care. We need to bear witness to what happens there in order to affect positive change in the future.” Joanna Kotcher, Nurse and Medical Evaluator in Nablus, West Bank

PALESTINIAN TERRITORIES

• 0.3% of the population lives on less than $2 a day (World Bank report)10 C : 100 M : 60 J:0 N:0 Médecins du monde - Identité visuelle ANGLETERRE

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• The Palestinian Territories are ranked 114 out of 187 countries in the Human Development Index by the United Nations Development Programme (UNDP) and life expectancy at birth is 72.8 years in 2011. 10

http://data.worldbank.org/indicator/SI.POV.DDAY/countries

Harm reduction

Tanzania

Doctors of the World has been present in Tanzania for over 15 years. Recently our team has focused attention on tackling HIV, AIDS and hepatitis for high-risk groups such as drug users, ethnic minorities and sex workers who face obstacles in accessing healthcare. In cooperation with the Ministry of Health we started a pilot project in Dar es Salaam after a needs assessment was carried out in

2010. We provide access to basic healthcare and social services at a drop-in centre. Our ultimate aim is to help marginalised people access the mainstream public health system where HIV treatment is available. Harm reduction is a community-based approach that aims to reduce the social and health risks associated with drug use through a series of interventions, such as voluntary

ÂŠ Agnes Varraine

testing and counselling, syringe exchange, antiretroviral and opioid-substitution therapies. The work of peer-educators on the ground makes outreach activities and the overall programme more effective as some of these patients would not have access to healthcare services otherwise. As part of The Big Give Christmas Challenge for 2011, our donations for this project were > doubled.

> Mariam, 23, is an injecting drug user.

She came to Dar es Salaam to be a domestic worker but the family she worked for abused her. From there her life spiralled out of control and she’s started injecting drugs. “I’m homeless right now and I’m always scared of being caught by the police,” she says - “I need to get tested for HIV, I know my health is deteriorating.”

Through this project we are helping Mariam and others like her to get the services they badly need.

• The initial assessment conducted by Doctors of the World in 2011 confirmed that the HIV infection rate among injecting drug users (IDUs) in Dar es Salaam was alarming, with 67% of female drug users and 30% of male drug users testing positive • 28% of sex workers tested positive for both AIDS and hepatitis C • In September 2011, an average of 30 IDUs attended the drop-in centre every day • 67.9% of the population lives on less than $1.25 a day12 • Tanzania is ranked 152 out of 187 countries in the Human Development Index by the United Nations Development Programme (UNDP) and life expectancy at birth was 58.2 years in 201113

TANZANIA

• In Tanzania there are 2.4 nursing and midwifery staff for every 10,000 citizens14 C : 100 M : 60 J:0 N:0 Médecins du monde - Identité visuelle ANGLETERRE

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http://data.worldbank.org/indicator/SI.POV.DDAY/countries http://hdr.undp.org/en/media/HDR_2011_EN_Table1.pdf 14 http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf 12 13

Harm reduction

vietnam

Though HIV appeared relatively late in Vietnam compared to other developing countries, there is a risk of it spreading. Our programme is developed in partnership with the health services in Hanoi and Ho Chi Minh City and focuses on preventing and reducing the risks drug users and sex workers are exposed to.

We identified the best practices in the country for harm reduction in order to transfer them to additional programmes that can be set up in the future. The involvement of peer-educators was key to the overall success of the project as they were giving moral support to patients throughout the programme. British volunteer, Nino Faibene, was general co-ordinator in Hanoi and Ho Chi Minh City for eight months in 2011. “I was interested in the social consequences of HIV/AIDS as well as the medical ones,” she says. “Prevention activities on HIV/AIDS, harm reduction and basic healthcare are needed in Vietnam. Doctors of the World is considered as a model organisation in the HIV/AIDS field.”

At times we would come across a certain amount of stigma and discrimination towards

Through anonymous and free consultations we identify those who need antiretroviral therapy and treatment for opportunistic infections. Additionally, our peer-educators work to raise awareness about the services available for injecting drug users, they distribute condoms and needles to reduce spreading the risk of HIV and AIDS as well as mental health support.

our work with at- risk populations such as men who have sex with men, female sex workers and drug users. On this mission I have learned that despite our differences, people share the same dreams and fears wherever you are. • Our prevention work supported 10,000 people. 6,000 patients were tested and those who needed further treatment were referred to the public healthcare system. 4,000 were undergoing antiretroviral treatment (ARV). C : 100 M : 60 J:0 N:0 Médecins du monde - Identité visuelle ANGLETERRE

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• 16.9% of the population live on less than $1.25 a day16 • Vietnam is ranked 128th in the Human Development Index by the United Nations Development Programme (UNDP) and life expectancy at birth was 75.2 years in 201117 • In Vietnam there are 10.1 nursing and midwifery staff for every 10,000 citizens18 15 People with advanced HIV infection are vulnerable to infections and malignancies that are called ‘opportunistic infections’ because they take advantage of the opportunity offered by a weakened immune system. Source: WWW.UNDP.ORG.VN 16 http://data.worldbank.org/indicator/SI.POV.DDAY/countries 17 http://hdr.undp.org/en/media/HDR_2011_EN_Table1.pdf 18 http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf

Universal access to healthcare for vulnerable people in the UK

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We have experienced an increase in demand for basic healthcare services at our London clinic, which aims to provide information and support to help people access mainstream healthcare. Most of the patients at our clinic are migrants, asylum-seekers, sex workers and homeless people and come from disparate social backgrounds. Sometimes the immigration and legal status of refugees, asylum seekers and migrants can be an obstacle to registering with a GP, denying them access to primary care. Our service users mostly originate from Bangladesh, India, China, Uganda, Brazil, Afghanistan, the Philippines, Sri Lanka and Romania.

Number of service users 2006-2012

Doctors of the World’s clinic

7000

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2006

2007

2008

2009

2010

2011

2012

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834

Medical consultations

1124

Social consultations

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Number of new service users Total number of service users

927

5000

1960

887

4000

680

1369

1275

3000

520

2000

723

1000

283 435 349

349

544 566

955

974

1006

2127

1395

1288

1216

1730

1551

1378

1087

2252

Total number of service users in 2011: 1,7481/ 2012: 1,9141 1

This number includes outreach

2006

China DR Congo UK Eritrea Iran

2007

China DR Congo India Brazil Eritrea

2008

India Brazil Philippines China Eritrea

2009

India China Philippines Eritrea Bangladesh

2010

India China Bangladesh Philippines Brazil

2011

Bangladesh India China Uganda Brazil

2012

Number of service users based on country of origin 2006-2012

Bangladesh China India Philippines Uganda

Our London clinic

Doctors of the World’s London clinic does more than just deliver healthcare. We advocate and campaign on behalf of our patients. We endeavour to make sure that they have access to mainstream services. For these reasons, we train healthcare providers and community leaders to advocate for migrants and refugees and focus on non-discriminatory practices. We do not put forward our service as an alternative to the NHS, but rather we highlight the barriers to and inconsistencies between existing services.

In 2011 and 2012 we introduced a close follow-up scheme for the most vulnerable clients. Frequently, even those who succeed in registering with a GP struggle to receive the specialised support they need. Mental health problems are often triggered by high levels of trauma caused by torture, rape, sexual abuse, domestic violence or assault. Our volunteers try to address service users’ fears and provide moral support until they can access appropriate mental health services. They listen with empathy to build a relationship of trust with the service user.

Rebecca: “I noticed my stomach was getting hard and stiff. I had serious pains. I tried to register with a GP but they wanted my passport, driving licence and all these other documents I couldn’t give them. I didn’t want anybody reporting me to the authorities so I kept it to myself. I felt like I was waiting for a time bomb to explode. “Someone at my church told me about Doctors of the World’s clinic. A doctor saw me there and, given the gravity of the case, he sent me to the hospital with a letter. Despite having very high blood pressure, the GP at A&E sent me home, because I was not able to pay. I ended up self-medicating on painkillers from the supermarket. I eventually called Doctors of the World again and they referred me to a different hospital where I was diagnosed with a blood clot. If it wasn’t for Doctors of the World I would not be able to stand here now. Good health is more important than money or food. Health comes before everything.” Names have been changed to protect identity. All gave consent for use of their case studies. 2

Clinic service users by gender and age

/ //

50%

2011

2012

269 (38.93%) 170 (24.60%) 252 (36.47%)

263 (38.93%) 122 (24.60%) 227 (36.47%)

The table on the right shows service users by gender and age group. The average age for a patient4 is 34 years old yet one third say that their health is bad or very bad. These figures only include services users who came to our clinic. A change in management in 2012 meant the clinic could not provide clinical services for two months, hence the lower figure for this year. 4 Only 1.9% of people we saw in 2011 and 1.3% of people in 2012 had left their country of origin for personal health reasons. This refutes the “health tourism” myth that immigration is for health reasons. 3

39.6%

40%

Proportion of urgent cases UK Not urgent Fairly urgent Urgent

43.4%

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Number of medical consultations in 2011: 1,1243 2012: 8343

Male Female

32.7%

30.5%

29.0%

30%

31.5%

26.6%

20%

18.0%

10%

<30

30-40

40-50

>50

“Despite having very high blood pressure, the doctor at A&E sent me home, because I was not able to pay. I ended up self-medicating on pain-killers from the supermarket.” Service user, Doctors of the World’s clinic

Advocacy & Support

Our support workers do important work every day. They first assess users’ needs, address their fears and offer moral support. They advocate on their behalf with GP surgeries and accompany the service users if necessary. Sometimes language barriers can be challenging and this is one of the reasons that people do not register with a GP. In order to verify the effectiveness of our service, we

generally follow up 12 to 18 months after the first contact and make sure that the patient still has a permanent GP and is in good health. Doctors of the World makes sure that an individual’s basic rights to healthcare are respected. Frequently we find that NHS staff are not adequately trained and assume that people without residency status can be refused primary healthcare.

Out of 1,561 users in 2011, 1,124 sought help from DOTW’s clinic for medical needs. In 2012, out of 1,730 users 977 sought medical care. Additionally, 2,127 people in 2011 and 2,252 people in 2012 sought a social consultation. The majority faced some difficulties in accessing mainstream healthcare. In particular, they:

• were unaware of where they could get help or of their eligibility/entitlement to free healthcare • lacked documentation for registration • had difficulties communicating with the healthcare staff • were afraid or being reported or arrested upon seeking medical care • were refused access to healthcare. C : 100 M : 60 J:0 N:0

Both photos © Spike Johnson

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It is increasingly difficult to help people get the healthcare they are entitled to. A rise in the number of service users to the clinic and the resulting increase in the time needed to help them register with a GP has resulted in a lower number of people who can be successfully registered with a doctor.

Doctors of World is also dealing with an increased number of urgent cases, which are always a priority. We believe that every person has the right to medical care and will advocate tirelessly with those facing barriers.

In addition, NHS reforms mean Primary Care Trusts are in a state of flux so it is difficult to follow up cases at a higher level. As a result, we need more resources and more support to make: • more calls to more GP surgeries • more contact with Practice Managers and GPs directly • more calls to be made directly by DOTW’s doctors when support workers’ calls were unsuccessful • more contact with GP surgeries regarding refusals. Our evidence shows that once registered, users can still face obstacles caused by: • language barriers • complex administrative procedures • GP surgery staff not always being sympathetic to users • surgery staff lacking training in and knowledge of entitlement rules and legislation C : 100 M : 60 J:0 N:0 Médecins du monde - Identité visuelle ANGLETERRE

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Main diagnosis for patients at the Doctors of the World’s clinic

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Frequency of health problems by consultation / No. (%) C : 100 M : 60 J:0 N:0 Médecins du monde - Identité visuelle ANGLETERRE

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Musculoskeletal Digestive Psychological Skin Cardiovascular Pregnancy, Childbearing, Family Planning Respiratory

2011 247

250

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250

2012

222

150

149

136

135

129

13.09% 11.76% 7.9%

7.21%

7.15%

6.84%

6.41%

196

179

153

150

121

100

200

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200

106

109

111

100

24.9%

22.8%

19.5%

13.5%

13.9%

10.4%

14.1%

“They do not want pity or money, they just want to be treated with respect and keep as healthy as Beth Connelly, Support worker they can”

Beth Connelly, is a 27-year-old support worker and midwife who volunteers at DOTW’s clinic. “I am inspired by many of the people that come into the clinic,” she says. “Many have fled war zones, left violent relationships or were forced to leave their homeland due to political corruption. Many people I have seen at the clinic really do believe healthcare is a luxury rather than a human right, and are very grateful for the service. They do not want pity or money, they just want to be treated with respect and keep as healthy as they can. I see a lot of human compassion at the clinic, from both volunteers and the clients we have, and I feel the NHS could learn a lot from this! I have learned so much about immigration rights in the UK and realise how misleading and manipulative the media can sometimes be.” 37

Clinic Partners Praxis is dedicated to advancing the human rights and social justice of people displaced by war, poverty and environmental devastation. Our two services complement each other perfectly as vulnerable migrants need legal advice, moral support and access to healthcare.

ÂŠ Andrew Aitchison

Our partnership with CLASH and Open Doors enables us to assist sex workers who

wish to register with a GP. Additionally Clash and Open Doors provide information on HIV prevention and sexual health, through two clinics and outreach in brothels, saunas and flats. We also run sessions at the Notre Dame Refugee Centre and Tamil Community Centre where we provide healthcare and support to refugees and the Tamil community.

Angela25: “I came to the UK in 2001 with my aunt. I was only 14 and she told me I was coming to study. When we got here things were very different. She made me do all her housework and used me as a slave. She beat me and locked me up. When I turned 21 I called the police. They told me to leave her. I ran away from my aunt, but the police didn’t do anything to her and instead said they would deport me because of my status. C : 100 M : 60 J:0 N:0

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“It was my solicitor who directed me to Doctors of the World. At the clinic they did a pregnancy test, which came back positive. It was a complete surprise to me and I felt //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// very lonely, but Doctors of the World put me in touch with the Women’s Centre and found me a GP. I had all my antenatal appointments and ended up giving birth by emergency caesarean section.”

25 Names have been changed to protect their identity. Everyone has given consent to use their case studies.

Training community leaders & healthcare professionals

We share our knowledge and advocacy expertise in order to ensure the sustainability of our work. Community organisations: We work closely with local organisations and befriending groups in order to inform them on how to deal with healthcare-related issues. We pass on up-to-date information about who is eligible for health services. In this way, we prepare organisations and groups to advocate effectively on behalf of their clients. However, it is important that when patients approach the health system they find a system that is knowledgeable of their rights and open to their needs. Therefore Doctors of the World

has maintained a focus on training sessions with a wide variety of health professionals. There is often a great deal of confusion concerning legal standards regarding the right to healthcare. Frequently, health professionals refuse access to primary healthcare for undocumented migrants or refugees due to their lack of knowledge about entitlement rules. Once laws and regulations are explained, some GPs are more willing to accept vulnerable people as their patients. By lobbying Primary Care Trusts (PCTs), we also prompt them to include exceptions to the rules in their registration guidelines.

In 2011 we conducted 26 training sessions for healthcare professionals and community organisations reaching an audience of over 1000 and working in collaboration with a number of prominent organisations. In 2012 we increased our number of training sessions to 55, reaching an audience of over 1500. Training remains an important focal point of Doctors of the World’s advocacy work. C : 100 M : 60 J:0 N:0

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Lobbying & affecting change

By lobbying PCTs, we encourage them to implement GP discretion and take a flexible approach. We have also submitted evidence on a number of key government consultations and are helping to shape policy, providing our unique input and helping to create a dialogue on issues around migrant health. Inclusion Health: This is a programme established by the Department of Health (DoH) to look at key groups including: sex-working women, the homeless population, vulnerable migrants, and gypsies and travellers. We provided information and evidence about the barriers these groups face when trying to access healthcare.

Greater London Authority, Health Task Finishing Groups: We are involved in three key health task groups (primary care, maternity and mental health services) and have helped create a booklet that explains how someone can register with a GP in London. We have also helped to develop policy briefings that will be shared with GPs and commissioners to understand the barriers migrants face when accessing healthcare. Royal College of General Practitioners – Stakeholder Group for Social Inclusion: We were involved with stakeholder meetings to discuss the issues that vulnerable migrants face when trying to register with a GP. We have also helped to draft a statement regarding the RCGP’s position on access to primary care for refused asylum seekers and vulnerable migrants. The Department of Health’s Review of Access to the NHS by Foreign Nationals’ Consultation: The DoH asked for comments on topics such as NHS debts and health insurance for visitors. In our response we pointed out that legislation which targets ‘health tourists’ and restricts primary care has detrimental impacts on vulnerable members of our society. We also highlighted the negative impact of restricting access to primary care, in terms of additional cost, negative public health consequences, and human rights violations.

A state of flux: NHS reforms & Doctors of the World UK NHS reforms in the Health and Social Care Act will have a significant impact on our work. Proposals have included introducing a stronger profit motive in the NHS, a move seen by many as being akin to privatisation. It means that vulnerable people who already have trouble accessing mainstream healthcare services may have even more difficulty under the new reforms. In order to shape reforms in a positive way we were engaged in the ‘listening process’ (introduced by the UK government to take into account stakeholders’ concerns). In 2011, our Director attended meetings with the Prime Minister at Downing Street. Following this we submitted comments for a consultation paper in order to highlight issues regarding the impact on service users at Doctors of the World’s clinic. A completely sympathetic climate towards vulnerable people would make our service redundant. However, the restrictive interpretation of GP surgeries’ guidelines for registration makes our campaigning efforts vital. As we work on a daily basis with asylum The clinic had 76 active volunteers in 2011 and 101 active volunteers in 2012

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Number of volunteer interpreters: 183

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seekers and migrants, we systematically collect data and use it as evidence in support of our advocacy work. We routinely submit reports to UK parliamentary committees, regional human rights institutions and UN treaty-based committees. Concerns for the future: Authorities tend to argue that universal access to healthcare would boost the number of ‘health tourists’ who come to the UK deliberately to take advantage of NHS services. Nevertheless, we have evidence that shows the inconsistencies in this argument. Only 1.9% of the people we saw in 2011 and 1.3% of people in 2012 had left their country for personal health reasons. Furthermore, three-quarters (74.6%) of those with a chronic health condition did not know they had an illness before coming to the UK and almost half (46.9%) lacked understanding or knowledge of the system and their rights to care. This supports the argument that healthcare is not a reason for people to migrate. Our findings demonstrate that ‘health tourism’ claims are indeed short-sighted and invariably unfounded. Moreover, limiting access to primary healthcare may have negative economic and health consequences for both the individual and the community when conditions go untreated.

Dr Paquita De Zulueta has been volunteering at Doctors of the World’s clinic for over two years. She has worked as a GP in different areas of London and has been in contact with many asylum seekers throughout her career. She feels her contribution to the project can make a real difference. Here is her account about the work she does for Doctors of the World, first published in the British Medical Journal:

GP Testimony

“At Doctors of the World’s clinic I treat those who cannot access primary care. These include those accepted or refused by the asylum system and undocumented migrants. “The stories are varied and at times harrowing. A couple have been refused asylum. Local gangs threatened the husband’s life and they cannot go back home. The pregnant wife is in the third trimester. A depressed young woman fled the house where she had been enslaved since she was 14. A teenager with severe post-traumatic stress disorder has difficulties controlling his anger and is at risk of harming himself or others (he has already made a serious suicide attempt). A woman in her forties has rheumatic heart disease and is breathless with heart failure. These individuals are all in clinical need yet have been unable to access primary healthcare in the UK. “The British Medical Association reminds doctors that there is no requirement to determine someone’s immigration status to

access primary care services. The General Medical Council’s Good Medical Practice requires that doctors do not discriminate unfairly, but provide care and treatment to meet the clinical needs of all patients. “Receptionists and practice managers are exhorted to reject individuals who do not present a range of documents such as utility bills and passports – not easy if you are homeless or someone else holds your passport. These impositions carry no valid legal or ethical authority, but some may believe they do. This does not augur well for the vulnerable and dispossessed in need of humane clinical care.”

Advocacy at the European level

Doctors of the World has been working in Europe since 1986. In total we run over 180 health programmes within Europe.

By documenting the difficulties certain segments of society face in accessing healthcare we aim to highlight inequalities and raise awareness. The data we systematically collect includes information on the patientsâ&#x20AC;&#x2122; health as well as the living conditions and

other factors which can affect their health. This information is used as a basis for advocacy work. Our fieldwork and data are the bedrock of our work with health professionals and institutions to obtain positive and long lasting changes to laws and practices. Since 2004, Doctors of the World has expanded its advocacy work to include the European Union and the Council of Europe.

We have conducted two surveys on access to healthcare for undocumented migrants based on individual interviews obtained when people visited our London clinic, and our other health programmes for social services. Between 2004 and 2008, while debates were underway on the EU Return Directive, we organised an advocacy campaign to seek protection for seriously ill migrants who were

unable to access adequate healthcare in their country of origin. in 2009, we also created the HUMA network and published two reports; one on access to healthcare legislation in 11 EU member states and the second – on access to healthcare in Cyprus, Malta, Poland and Romania – was based on interviews with undocumented migrants in those countries.

ÂŠ Guy Smallman

European Declaration of Health Professionals

In March 2011 we drafted and circulated a petition among European health professionals that was signed by 147 health professional bodies and was submitted to the European Parliament. In the petition, health professionals declared that they will not deny treatment to patients. In the UK, Doctors of the World obtained support for the declaration from the president of the Royal College of Psychiatrists, Professor Dinesh Bhugra, and the Chair of the Royal College of GPs, Dr Clare Gerada. We continue this advocacy work with three main objectives: • to ensure that everyone living in the EU benefits from equal access to healthcare coverage, especially for the most vulnerable. This includes effective access to prevention, diagnosis and adequate healthcare; • to obtain changes in EU policies on measles, HIV, hepatitis and tuberculosis, all of which fall within the EU’s mandate, in order to ensure access to treatment; and • to provide healthcare and protection from deportation for seriously ill undocumented migrants in the EU, who cannot access adequate healthcare in their country of origin, because sending them back to the country where they will not receive adequate care leads to the serious deterioration of their health and, in certain circumstances, death.

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Media coverage raised public awareness of our work and the obstacles faced by vulnerable people who lack access to healthcare. This coverage helped raise funds and encouraged volunteers to work for us.

Haiti BBC Radio 4’s flagship news programme, Today, interviewed UK surgeon Professor Chris Bulstrode alongside Haitian surgeon Dr Oda Mukkuaka. Doctors of the World’s initiative to provide surgical training in the UK to a Haitian surgeon informed listeners about the sustainability of our projects and our aim to help local staff carry on the work once we hand over our projects.

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We were able to highlight this in the UK media by providing first-hand, humaninterest stories. BBC Radio 4 also interviewed Doctors of the World Greece’s President about the repercussions of the situation in a documentary ‘Greece: Broken Marble Broken Future’. Doctors of the World’s health centres in Greece, whose service users used to be mainly migrants, carried out double the amount of consultations for Greek citizens in 2011/12 than in previous years. This story was covered in The Guardian, BBC Online News and The Lancet, highlighting how we work internationally but do not ignore those in medical need closer to home.

Greece

Africa

In 2011, Greece’s financial situation made the headlines as the economic meltdown severely impacted on the Greek population and their ability to pay for healthcare.

Practising Midwife, among others, featured a first-hand account of what it’s like to work on our projects abroad. This encouraged others to come forward.

Bridge to bridge Dr William Shepherd and his friend Rob Pilkington’s extraordinary fundraising challenge travelling by land from London’s Tower Bridge to Sydney’s Harbour Bridge attracted local press coverage thus encouraging more donations. The exhausting feat was also mentioned in

national newspaper The Daily Mirror. In total the fundraisers raised over £6,000. Not content with travelling thousands of miles, Dr Shepherd also completed a climb of the three highest peaks in the UK and our London to Paris bike ride, raising funds and inspiring others to take part in fundraising activities.

FUNDRAISING

Our longstanding supporters have been as ingenious as ever, coming up with some fun and engaging ways to raise money. Organisations such as La Fédération des Associations Françaises en Grande-Bretagne, McKinsey&Company, Barclays and Fairfield hospital in Bury undertook charity events on our behalf in 2011 and 2012. 2011 was a very good year for our famous London to Paris Bike Ride with the cyclists raising almost £50,000. One of our most popular challenges in 2012 was the London Santa Run that took place in December in Greenwich Park. More than 80 participants represented Doctors of the World and ran 5km or 10km, raising more than £9000 for our projects. Anyone can get involved and raise money for our charity in fun ways, send an email to events@doctorsoftheworld.org.uk and we’ll find ideas for you.

Despite the economic climate our dedicated supporters continued to show extraordinary generosity, and in 2011/12 we raised over £280,000 from trusts and foundations, events and our individual supporters.

Fundraising events In 2011 and 2012 we raised over £100,000 from our challenge events, such as the London to Paris bike ride, the Royal Parks Foundation Half Marathon, the London Nightrider, the Virgin Active Triathlon, as well as various fun runs and overseas challenges.

NatWest Community Force We were one of only three NatWest CommunityForce winners in the City of London, thanks to an enthusiastic voting campaign for Doctors of the World’s clinic. We attended the awards ceremony, where we received a cheque from local MP, John Fitzpatrick for £6,000.

Pub Quizzes Pub quizzes held in and around London have also continued to be a popular pastime, raising over £3000 in 2011 and 2012.

â&#x20AC;&#x153;I chose to raise funds for Doctors of the World UK because of the breadth of work they do overseas. I could really see where the money I raised would be going and it could really make a difference with an immediate and practical benefit.â&#x20AC;? Julian Scott, fundraiser 2011

We would like to thank the following for their support: Argus Media, AstraZeneca, Associations Francaises en Grande-Bretagne, Atos Healthcare, Barrow Cadbury Trust, Beatrice Laing Trust, Boots, Canary Wharf Group, City Bridge Trust, Comic Relief, Coutts Charitable Trust, Department for International Development, Department of Health, Doctors. net, Eleanor Rathbone Charitable Trust, Fairfield hospital, Bury, French Huguenot Charitable Trust, Jeune Chambre de Commerce Francobritannique, John Young Charitable Settlement, Leagas Delaney, London Catalyst, McKinsey, Mercers Company, NatWest Community Force, Sir Jules Thorn Charitable Trust, Souter Charitable Trust, Trust for London, Tudor Trust and all those who wish to remain anonymous

FINANCIAL SUMMARY The total income generated for 2012 was £1,021.7k (2011: £825.5k). Of this amount £744.2k (2011: £471.3k) was restricted funds and the expenditure allocated to the restricted funds amounted to £678.2k (2011: £431.4k). There was a net surplus for 2012 of £25.7k (2011: surplus £45.2k) which increased the total reserves to £103.8k (2011: £78.1k). Doctors of the World UK remains committed to maintaining cash reserves equivalent to three months’ running costs (approximately £100k) and to maintaining those reserves at a

level which will ensure that the organisation’s core activity should continue during periods of unforeseen difficulties. Gifts in kind amounted to £90.5k (2011: £149.7k). During the year we were awarded a grant of £1.036m by the Department for International Development (DFID) for the reduction of the immediate impact of the Syrian crisis on the mental and physical health of the Syrian population across the region. The programme was initiated in 2012 and should be completed by Q1 2013.

Summary of income Unrestricted

Restricted

Total 2012 £,000

Total 2012 %

Total 2011 £,000

Total 2011 %

Donations & Legacies Grants Total

277.5 277.5

145.5 598.7 744.2

423.0 598.7 1,021.0

41.3% 58.6% 100.0%

646.5 179.0 825.5

78.3% 21.7% 100.0%

National activities International activities

145.3 598.9

19.5% 80.5%

289.3 182.0

61.4% 38.6%

Total

744.2

100.0%

471.3

100.0%

Donations & Legacies 2012

41.3%

National activities 2012 Grants 2012

19.5%

58.6%

80.5%

International activities 2012

Summary of expenditure

Unrestricted

Restricted

Total 2012

Total 2011

£,000

Cost of generating funds Fundraising

77.4

7.8%

95.1

12.2%

Charitable activities National International

27.0 212.9

526.4 151.8

553.4 364.7

55.6% 36.6%

252.8 422.3

32.4% 54.1%

Total

239.9

678.2

918.1

92.2%

675.1

86.5%

0.5

10.1

1.3%

317.8

678.2

996.0

100.0%

780.3

100.0%

Governance costs Total

V LUNTEERS

Our volunteers make a crucial contribution to Doctors of the World UK and without their help, our projects would not happen. If you wish to volunteer with us in the UK or abroad, please visit our recruitment page of our website doctorsoftheworld.org.uk/work

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A special thanks to... Aamir Iqbal, Abbas Omaar, Adeline Girard, Afsana Akhter, Agnaldo Costa, Agne Cepinskyte, Aisha Wali,Aisha Zarina, Aleida Borges, Alexandra Rostein, Alexia Haysom, Alexis Molho, Alice Fredrikson, Alice Gyamfi Sarpong, Alireza Jafarzadeh, Alisa Ionita, Alison Criado Perez, Alison Goodwin, Aliza Amlani, Allison Cross, Amber Fox, Ana Luisa Alves, Anastasios Toumpanaskis, Anna Hebden, Anna Howey, Annabel Grieve, Anne Thieba, Annie Kalt, April Baller, Arrthi Panagayatselvan, Arzu Altin, Asa Munkhammar, Assia Sahli, Awad Ibrahim, Ayesha Siddiqi, Ayodeji Aaremu, Belen Trujillo, Beth Connelly, Bruno Silva, Camila de Lima, Camila Lima, Camilla Tilbury, Carla Pereira da Silva, Caroline Scott, Catalina Marrin, Cauvery Shelat, Charlie Wilson, Chiara Stella Cochetti, Chrysanthi Iliopoulou, Ciise Musse, Claire Chaumont, Claire Ferraro,

Claire Joels, Claire Tsai, Clare French, Clare Keates, Clare Parsons, Corina Olaru, Corine Thaler, Damilola Coker, Daniel Di Pede, Deji Aremu, Devon Spika, Dhawal Singhal, Diego Maria Ierna, Diya Luximon, Edward Munnangi, Eleanor Barnwell, Elena Beroeva, Elena Ivany, Elizabeth Anderson, Elora Baishnab, Elsa Barbosa, Emma Guesbaya, Emma Le Blanc, Emma Pick, Ernest Jangwa, Farhana Begum, Federica Amati, Ferah El Massudy, Filmawit Kiros, Fiona Sidorowicz, Flora Ogilvie, Frank Hersey, Gabrielle Norrish, Genevieve Repino, Gillian Webster, Hannah Headden, Hannah Roberts, Harvir Sahota, Hasna Siddika, Helen Farebrother, Helen Nguyen, Helga Chinak, Hiba Khan, Hourya Herrou, Ian Ferguson, Irina Vorobieva, Isabelle Modigell, Iyesha Nadim, Jarrard O’Brien, Jayne Ellis, Jennifer Blake, Jessica Darling, Joanna Knight, Joanna Verney, Johanna Bosowski, Johnny Yeboah, Joseph Asghar, Joy Idahosa, Joyce Paul, Juliana Rosa, Julius Daunoravicius, Kajann Pratapann, Karen Jacob, Katherine Breckon, Katy Brown, Kemel Totkomushev, Khadija Hassan, Kimberly Lewis, Kris Harris, Kristina Georgieva, Lauren Taylor, Leonie Marder, Liam Crosby, Lihan Yang, Lisa Hiemer, Liv Raphael,

Liza Bowen, Lori Williams, Louise Cox, Lucia Liu, Lucienne Aguirre, Lucy Wilson, Luz Naranjo, Lynn Qu Lin, M Charlie Toubal, Madhavi Shah, Makeba Roach, Maria Fernandez, Marina Daskalopoulou, Mark Udobang, Maya Sykkari, Megan Eardley, Melania Ishak, Mengyang Li, Mike Eliasz, Minna Hartikainen, Miriem Belhout, Misfa Mollah, Mohamed Dirie, Mohammed Mukhtar, Moni Haque, Muhammed Arshad, Nadine Gnamien, Naomi Hartree, Natalie Cazeau, Neressa Owen, Nicola Bevins, Nitharnie Anastasius, Noah Olweny, Nwakuru Nwaogwugwu, Panayiota Sykioti, Paquita de Zulueta, Patricia Drumard, Pervez Akbar, Phan Thuy, Purnima Jayasuriya, Rachel Walsh, Ramya Ramaswami, Richard Rushworth, Richard Sear, Rik Viergever, Rima Begum, Rmishka Singh, Robert Shady, Roger Pebody, Ros Flowers, Ross Newton, Ruth Willis, Saiful Miah, Samia W Rasselkaf, Sara Robbins, Sarah Giles, Sarah Wookey, Sarika

Bedi, Sattar Taghizadeh, Seema Chaudhari, Shamila Rajanathan, Shashu Graves, Shazia Munir, Shimin Wong, Shirley Hodgson, Shoba Poduval, Shorifa Ali Khanom, Shuaib Muhammad, Shu-Yun Cheng, Shweta Khanna, Shyama Sinha, Silvia Segovia Chacon, Smaranda Cosma, Sofia Rodrigues, Somporn Ferret, Sophie Sakmann, Sue Fraser, Sumona Datta, Sylvia Chandler, Teddy Golob, Tehmina Bharucha, Thuvaraka Thambiah, Tom Campion, Tom Pursey, Tom Woodman, Valerie Moukouelle, Vasiliki Koui, Venetia Lamb, Veronica Padilla, Victoria Hamilton, Virginia Roncaglione, Wing Chee Yuen, Xiaowei Wu, Yaorun Zhang, Ye Lin, Zahra Hekmati Additionally, we would like to thank the Steering Advisory Committee for Doctors of the World’s clinic: Adam Hundt, Nadia Vawda, Ike Anya, Valerie Sosso-Moukouelle, Claire Joels, Maria Gortova, Ian Ferguson

Doctors of the World UK Annual Report 2011/12 – Editors: Mario Umberto Tramontano/ Catherine Allum/Nick Harvey - Graphic Designer: Pervez Akbar Thank you to Argus Media for sponsoring our Annual Report

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