Doctors of the World Impact report 2014

IMPACT REPORT 2014

The field of global health met unparalleled challenges in 2014. The Ebola crisis in West Africa required an intensive, coordinated international response while conflicts in Syria, South Sudan and countless other places continued to displace millions.

An unprecedented number of people fled violence and instability, crossing borders to reach refugee camps – both in neighbouring countries and in European bottlenecks such as Calais – often via treacherous routes presided over by exploitative people-smugglers.

With all of this turmoil and movement comes need. Need for essential medical care, mental healthcare and general support. Doctors of the World does this worldwide, bringing the most basic care to those that have none. Crucially, they don’t just do quick fixes, but invest in long-term, sustainable health systems so that populations can better cope with future crises.

I’ve experienced first-hand the complexities of the Ebola response and commend Doctors of the World UK for their invaluable work towards creating a treatment centre in Sierra Leone – they will no doubt be at the forefront of the post-Ebola response as new cases decline.

Dr Chris van Tulleken Infectious Diseases Expert and Television Presenter

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© Nick Harvey

© MdM

© Sébastien Duijndam

Foreword 2014 was a year of growth, in response to unprecedented challenges.

We answered the UK Government’s urgent call to help treat and beat Ebola in West Africa by partnering with the Department for International Development (DFID) to run a treatment centre in Sierra Leone, the first time we’ve taken on this type of work.

UK Aid also enabled us to continue to meet the health needs of Syrian refugees and host communities in Lebanon and Jordan, where tens of thousands of people continue to suffer the devastating effects of Syria’s four-year-long civil war.

In our evermore interconnected world, wars like this know no boundaries as innocent civilians are forced to flee – often at the mercy of ruthless, violent people-smugglers – in search of a better life. Nowhere is this more apparent than in the Pas-de-Calais region of northern France, where we provided essential medical care to hundreds of migrants trapped there. In farmers’ fields near St Omer, we worked to relocate unaccompanied Syrian children living in rain-sodden, muddy ditches only for them to be replaced by families fleeing other far-flung conflicts in Sudan and Afghanistan, and from Eritrea’s despotic regime.

In Tanzania, destitute women are especially at risk of harm.

With support from the Elton John AIDS Foundation we are helping thousands to transform their lives through our pioneering harm reduction project which is helping to reduce heroin and cocaine dependency while at the same time working closely with community groups and the police to help victims of drug trafficking.

Globally we campaigned for the health rights of women and girls by signing up to DFID’s ‘Keep her Safe’ initiative and by taking our ‘Names not Numbers’ campaign for better access to sexual and reproductive health services to the Global Summit to End Sexual Violence in Conflict that was co-hosted by Britain’s Foreign Secretary and UN Ambassador Angelina Jolie.

None of this work is possible without the generosity of our donors, or our remarkable volunteers who give their time and talent to enable excluded patients to claim their right to health.

Much more needs to be done to bring vulnerable people the healthcare they desperately need. Thank you for your support.

Humanitarian medical aid and long-term support to weak health systems transforms lives. But the answer to the systemic issues our patients face is in the hands of governments.

That’s why we partnered with Demos and worked with the Department of Health to ensure that new restrictions on migrants’ access to healthcare services in the UK do no harm to those we see at our London clinics, who are often among the most marginalised in our society. Trafficked, exploited women and those in late-stage pregnancy with no antenatal care continue to struggle to get the care they need.

Leigh Daynes Executive Director

Janice Hughes President

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Treating and beating Ebola In 2014 West Africa was gripped by the biggest Ebola outbreak ever known, causing thousands of deaths and devastating already fragile healthcare systems. In September the UK Government announced its intention to help contain, control, treat and ultimately defeat Ebola in Sierra Leone and Doctors of the World was one of its chosen partners.

Š Luke Kane

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With our Spanish counterparts Médicos del Mundo and in partnership with Sierra Leone’s Ministry of Health we set up and ran an Ebola treatment centre in the district of Moyamba, five hours’ drive inland from the capital Freetown.

The centre, which was built in six weeks by British Army Royal Engineers, opened its doors to patients in December, initially with 10 beds and scaling up to 30 beds to give many more Ebola patients in Sierra Leone the best possible chance of survival.

We’re here to help, but West Africans are the ones affected, and they are the ones dealing with it.

Dr Luke Kane (picture opposite), a trainee GP in Lewisham, was one of the first UK workers to arrive at the centre. “It’s been tough living with the fear of Ebola for three weeks so I can’t imagine how it must be to live like that for eight months, which is the case for the people living here,” he said. “Lots of people can’t work, children can’t go to school, healthcare capacities have been massively reduced … it’s been a real disaster.”

He added: “It’s easy to think that we’re the big saviours and we’re going to sort it out, but the people have been doing an amazing job themselves. We’re here to help them in a small way, but West Africans are the ones affected and they are the ones dealing with it.”

Over 150 staff worked at the centre including NHS doctors and nurses, as well as clinicians from Norway and Spain. Specialist water, sanitation and hygiene services were provided by Solidarité International.

Leigh Daynes, executive director of Doctors of the World UK, who visited staff working at the treatment centre in Sierra Leone, said: “Britain generously led the international response to Ebola in Sierra Leone. The outbreak, while devastating for so many, is an opportunity to build back a more resilient and better functioning health system. That’s why we’ll stay in Moyamba for as long as it takes.”

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On the Ebola frontline Dr John Wright (pictured below) was one of the first UK doctors to head to Moyamba and played an integral part in setting up the Ebola centre. Here is an extract from a documentary aired on BBC Radio 4, Ebola Junction, about the early days of that process:

© John Wright

“There is a maxim for Ebola hospitals: expect the unexpected.

This afternoon we were taken by complete surprise when two ambulances turned up in quick succession. It is the second that causes the greatest problem. On the adult-sized stretcher lies a tiny two-year-old girl, silent with fear. There are now seven of us in full personal protective equipment. I pick her up in my arms. I know there is a risk she may pull at my goggles but she is so small, so fragile, so afraid and I cannot resist.

She clings to me with the reflex of a toddler and the stoicism of an African child. She is beautiful. I ask the ambulance nurse about the child but she knows little. We have no name, no parent, no record, no history. The nurse had been at the primary healthcare clinic when the child was brought in from the orphanage. The story is that the mother has Ebola. The story is that the mother is here at our hospital.”

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Lanphia’s story Lanphia Ngegba (pictured opposite) was studying to be a surgeon when his elder brother, already a surgeon, was infected with Ebola in August 2014 while performing an operation and died soon after.

His father and younger brother soon became infected and also died, leaving Lanphia and his three sisters as orphans. Lanphia and two of his sisters also contracted Ebola but after harrowing weeks in various hospitals and treatment centres across Sierra Leone, all three survived. Lanphia and his sister Haja now work in the Doctors of the World treatment centre in Moyamba to help others beat the disease.

Lanphia said: “My daddy and my brother were with my elder brother in the hospital when he was dying and they were giving me updates about signs and symptoms: ‘he’s coughing now, he’s vomiting, he’s complaining of muscle pain.’ When I saw my father and brother starting to have the same symptoms on their return I knew it was not going to be easy. I realised that I wanted to get away, but how could I leave them?

“With Ebola there is so much pain, muscle pain, all-over body pain, pain like I’ve never felt before and it started gradually but soon became very severe. It’s a kind of pain I don’t ever want to feel again in this world.

“The country can only move forward if we come together and put our heads together. We need to maintain the structures that have been set up. If there was a hospital like this treatment centre in Moyamba before, then my father and brothers would probably be alive now, but there was no specialist hospital for Ebola treatment anywhere in the country.

“I want to encourage other survivors to join the fight in their own little way so we can get rid of Ebola from Sierra Leone.”

© Nick Harvey

IMPACT REPORT 2014 • 7

Syria 2014 was the deadliest year of the conflict in Syria, with at least 76,000 Syrians killed.

Our medics helped provide more than 836,000 healthcare consultations to refugees and internally displaced people in Syria, an increase of 30 per cent on the previous year. As well as giving training to medics, we provided 70 Syrian healthcare facilities with essential medicines and equipment.

In Lebanon the refugee situation was particularly severe.

By the end of 2014 more than one million Syrian refugees had fled to Lebanon, making up more than a quarter of the country’s population.

In response to this unprecedented crisis we opened a fifth primary healthcare centre for vulnerable refugees in Lebanon’s Bekaa Valley with a special focus on pregnant women and children under five.

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© George Butler (See Page 16)

We also continued to strengthen our work in Jordan in our primary healthcare clinics in Ramtha and the Zataari refugee camp.

From the UK we campaigned with others for greater aid access in Syria. Three UN Security Council resolutions were passed in 2014 that called for an end to attacks on civilians and an increase in aid, and also allowed the UN to operate more widely in Syria.

Calais In October 2014 a team from Doctors of the World UK visited the region and was shocked to see Syrian orphans as young as ten living in ditches under tarpaulins far out in the countryside. Subsequent media coverage about their plight prompted local charities to help these boys with regular food and clothing. Our French colleagues at Médecins du Monde relocated them to more appropriate shelters, with a kitchen area and toilets.

© Nick Harvey

In the previous two years, the number of migrants in and around Calais increased tenfold, from 300 to around 3,000 at the end of 2014. These migrants live in appalling conditions, including very young children, many of them unaccompanied, and pregnant women. They all lack essentials such as safe drinking water, adequate food, sanitation and proper shelter. This is causing a huge number of health problems among the migrants including respiratory and skin problems, diarrhoea as well as mental trauma. In 2014, Doctors of the World stepped up its operations to provide access to water and sanitation such as shower cubicles, toilets, waste management systems, as well as the distribution of hygiene kits, tents and sleeping bags.

IMPACT REPORT 2014 • 9

Tanzania Background

About the project

HIV is declining in Tanzania but not among people who use drugs (PWUD). Urban poverty is driving drug use, increasing the risks of disease transmission and challenging national prevention efforts. Tanzania’s largest city, Dar es Salaam, has the highest concentration of drug users and the second highest HIV incidence in the country. Drug use is also highly stigmatised, marginalising people with dependency problems and leading to them being denied access to basic health services.

Following a successful pilot, which an external evaluation commended for adopting “a truly harm reduction approach – not abstinence focused nor judgemental of drug use [which is] rare in Tanzania,” Doctors of the World established a two-year harm reduction programme in Dar es Salaam to support PWUD to access HIV prevention, treatment and care services.

The impacts of the project in 2014 • 12,500 people at high risk of, or living with, HIV were able to access improved harm reduction services

The programme, partly funded by the Elton John AIDS Foundation, includes the direct provision of harm reduction services as well as help to others running nine new drop-in centres for PWUD. These centres have increased the number of needle syringe exchange services, condom use and access to HIV testing and treatment.

• 2,755 people tested for HIV (185 diagnosed and enrolled in a care and treatment programme) • 5,600 frontline workers trained in harm reduction and HIV prevention (including medical staff and police officers)

Before Doctors of the World started the programme, there were no harm reduction services available in Tanzania.

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Before Doctors of the World started the programme there were no harm reduction services available in Tanzania; the programme is now seen as truly innovative. A key achievement is raising awareness that harm reduction services work in improving PWUD’s health and position in society, strongly reducing marginalisation. This message is now gaining ground across the country.

Rehema’s story Rehema, 46, lives in Dar es Salaam. In 2007 her boyfriend was selling heroin and asking her to test the quality. She’d been using for years and working as a sex worker when she met Doctors of the World. After testing positive for HIV, she decided to educate herself and is now much more aware of sexual health, STIs and harm reduction practices such as safe injection.

In July 2014 she participated in a training session on HIV testing and counselling following which she became one of the first employed HIV counsellors from the PWUD community.

Rehema’s life has changed drastically. She quit the drugs and sex work. She explains how her health is much stronger but says: “The virus is still hiding. I have changed physically, of course, but I know that I shouldn’t stop taking my antiretrovirals. I can forget to eat one day, but I won’t forget my treatment!”

© Mia Collis

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UK Our UK Programme provides direct healthcare services and advocacy that enable excluded people to claim their right to health. We also seek to influence wider health policy in order to improve access to care for excluded groups. Spanning local-level needs and national-level policy, the breadth of our UK work is ever increasing.

Our main London clinic provides a range of essential medical and support services to individuals who are unable to access mainstream care. This may be because they are unaware of their rights to access such services, or are fearful of doing so.

Many do not have the documents surgeries request of them or can’t communicate because of language barriers.

As well as providing basic medical treatment we advocate on behalf of those excluded to make sure they get the healthcare they need and are entitled to. In 2014, 96 per cent of our service users had their cases resolved.

Mary’s story When arriving in the UK eight years previously Mary hadn’t thought to register with a GP. She didn’t think she’d need one and wasn’t sure she’d be entitled to access healthcare. So when she contracted tuberculosis she felt she had nowhere to turn after collapsing on a crowded high street. “It came on suddenly and I started sweating,” she recalls. “My breathing was bad and I couldn’t speak.”

Doctors of the World helped Mary access a GP so she could get the treatment she needed. “Without this place, without the love of the people during that time, I don’t think I’d be here,” she says. “Before I was very ill and frail, helpless like a baby. With their help I can live again.”

EXPANDING OUR SERVICE Hackney Clinic

Supported by the City and Hackney Clinical Commissioning Group Innovation Fund, in December 2014 we launched a new pilot initiative in the London borough of Hackney.

Here we provide support to people in vulnerable situations who seek access to healthcare, such as undocumented migrants and rough sleepers. The weekly service, based in a local church, works closely with other community partners, including Homerton Hospital and the Hackney Migrant Centre.

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Family Clinic

Responding to the need for more specialised care, in 2014 we launched a monthly clinic offering dedicated services to pregnant women and children. Last year 11 per cent of our patients were pregnant at the time of consultation.

Helpline

We set up a service where people can call to seek advice on registering with a GP or locating additional support. In 2014, our helpline received on average 75 calls a week, with caseworkers spending over 12 hours a week making calls on behalf of users.

In 2014 we conducted 1,454 social and medical consultations at our London clinic.

© Katherine Fawssett

14%

ASYLUM SEEKERS

54%

UNDOCUMENTED

32%

OTHER / UNDEFINED

Patients’ top 5 countries of origin: PHILLIPPINES 12.6% BANGLADESH 11.6% INDIA 11.6% UGANDA 9% CHINA 8.3% © David Brunetti

TWO THIRDS

89%

67%

11%

WERE LIVING IN POVERTY

WERE LIVING IN UNSTABLE ACCOMODATION

WERE NOT REGISTERED WITH A GP

WERE PREGNANT WOMEN

44%

HAD EXPERIENCED VIOLENCE

© Katherine Fawssett

AVERAGE NUMBER OF YEARS SPENT IN THE UK BEFORE ACCESSING OUR SERVICE

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Advocacy We work hard to advocate for every person’s right to health, regardless of income or immigration status. We do this by working both on our own and through partnerships to influence healthcare policy and practices that jeopardise this right.

Working with government In 2014, we worked with a group of charities to explain to the UK Department of Health that imposing charges on migrants to access certain health services would further deter already vulnerable groups from accessing the care they need. Our concerns were successfully incorporated into the government’s planning. The timeline for implementing such charges was deferred to a later date and further exemptions to charges were implemented including for victims of sexual and domestic violence and torture receiving treatment for their injuries. The government also agreed that people who receive refugee status should have previous health charges cancelled.

Lack of understanding among healthcare professionals about the eligibility of migrants to register with a GP is another significant barrier to vulnerable people accessing care. Through our work, we were able to secure a commitment in the House of Lords that the Department of Health and NHS England would produce guidance on current entitlements to register with a GP. NHS England has commissioned Doctors of the World to develop an information leaflet for patients.

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Demos Amid growing concerns about the consequences of Government proposals to extend charges for migrants to access certain health services, Doctors of the World commissioned a report from the renowned think tank Demos to explore the realities of healthcare access for migrants living in the UK, and to debunk some commonly held myths.

The report, Do No Harm, found that encouraging early detection of health conditions amongst migrant communities would reduce NHS spending on treatment in the long-term, while reducing wider public health risks by reducing the spread of communicable diseases.

The report also addressed misconceptions about so-called “health tourism,” highlighting that migrants are, in fact, less likely than other groups to seek healthcare services across the board, even services for which they are eligible. In 2014, 89 per cent of service users at our London clinic were not registered with a GP, even though they were eligible for registration.

As Leigh Daynes, UK director of Doctors of the World, says: “The patients we see are not health tourists, they live here – on average for more than six years before seeking a doctor’s help.”

In its recommendations, the report urged the NHS to implement a campaign to educate administrative staff about the charging system and people’s entitlements and to exempt children from all charging.

It received significant media coverage, including from Sky News, the Independent newspaper and many radio outlets.

With that attention came the opportunity to shed light upon these issues to the public and to government, and to highlight the very real challenges faced by migrants accessing medical care in the UK.

© Olivia Amos

Names not Numbers In July Doctors of the World were part of the Global Summit to End Sexual Violence in Conflict. Sexual violence in conflict is widespread. It affects not only large numbers of women and girls, but also men and boys. As well as causing physical and psychological trauma, sexual violence adds to ethnic, sectarian and other divisions, further entrenching conflict and instability.

The high-profile international summit, co-hosted by UK Foreign Secretary William Hague and UN Special Envoy Angelina Jolie, was the largest ever on this issue, gathering government ministers and civil society representatives from 140 countries to agree ways to put an end to sexual violence in conflict.

We asked attendees to add their signatures to our ‘Names not Numbers’ campaign, calling for better access to sexual and reproductive health services, for both survivors of sexual violence and women and girls generally.

We built a special machine that printed off a woman’s name every minute to represent the 300,000 women who die every year from lack of access to sexual and reproductive health services and safe, legal abortions.

More than 20,000 people signed the petition globally which we presented to UN Secretary General Ban Ki-moon before he met with world leaders in New York for a special session of the UN General Assembly.

Women and girls are an important focus of work for Doctors of the World, and shining the spotlight on this issue goes hand in hand with our programmes on the ground to help the huge number of women who are affected each year by sexual violence, pregnancy complications and unsafe abortions.

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Your support Thanks to our generous supporters over the past year, we raised over £6,846,000 with individuals donating more than £129,000 to help us provide essential medical care to vulnerable people all over the world.

Christian’s story From service user to fundraiser Christian Jualo (pictured, above left) moved to the UK from the Philippines and was later joined by his wife. But when she fell pregnant she was unable to get antenatal care because she did not have the right documents at the time. Doctors of the World helped her to get a hospital appointment and their son was born safe and well. Due to his positive experiences, Christian has become a dedicated supporter and fundraiser. He has participated in two running events, and plans to volunteer at our London clinic in the future.

People have donated their time, skills and money – some even jumped out of planes – to contribute to our vision of a world without barriers to healthcare.

We are extremely grateful for their generosity – our work would not be possible without them.

Awareness raising We host regular events to highlight and raise money to support our work in some of the world’s most challenging contexts, with some of the world’s most vulnerable people.

We organised an exhibition at the Victoria and Albert museum to highlight our work with Syrian refugees living in camps in Bekaa Valley, Lebanon. In “Stories of Devastation and Hope”, artist George Butler (pictured, bottom right) drew illustrations on his visits to our clinics in Lebanon, meeting some of the people who benefit from our services.

Our fundraising gala – “Stepping Up for Women and Girls” – focused on the extraordinary challenges of healthcare provision for vulnerable women and girls around the world. It was a fantastic success, raising over £63,000.

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© Nick Rice

Christian explains: “I chose to raise funds for the organisation because they have helped me and my wife get the healthcare we needed. They were also one of the first people to help in Tacloban, where my family are from, when typhoon Haiyan hit in 2013. This was my motivation for doing multiple events, a way of thanking them for the good work that they do.”

How you can help Make a donation

A small amount can go a long way.

Donating just £2, for instance, could help us provide treatment to prevent a child dying from pneumonia. You can donate online at: doctorsoftheworld.org.uk/donate or text DOTW10 £10 to 70070 to donate £10.

© Dimitra Nikitaki / Maxmasses Productions

Philanthropy

Would you like to invest in one of our global projects such as maternal health in Nepal, or harm reduction in Tanzania? Please get in touch to find out how your support can make a positive impact on some of the world’s most vulnerable people.

Fundraise for us

You can take part in a sports challenge such as a fun run, a half marathon, a bike ride, triathlon or a skydive to raise much-needed funds for our work.

You can organise your own event – invite your friends for dinner, organise a cinema evening, clothes swap or something completely different. Or you can ask friends and family to give to us, instead of to you, on your birthday, wedding anniversary or at Christmas.

Volunteer for us

Whether you’re a medical professional or just want to help others, there are regular opportunities to volunteer for us in the UK or work for us abroad. See our website for more details.

Legacies

Bequests provide essential development funding for Doctors of the World. To find out more about how your legacy could help, please contact us.

Your help can make a huge difference to people’s lives all over the world. info@doctorsoftheworld.org.uk Telephone: 020 7167 5789 DoctorsoftheWorldUK @DOTW_UK and @DOTW_UK_Events

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Thank you We would not be able to work without the help of our generous partners. We’d especially like to thank the following donors for their support in 2014:

As well as: Department of Health Souter Charitable Trust Eleanor Rathbone Charitable Trust Canary Wharf Group plc Hackney and City CCG Chime for Change The British Medical Journal John Young Charitable Settlement To support us please contact a member of our development team on 020 7167 5789.

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© Etienne Laurent

2014

REVENUE

2014

EXPENDITURE

£5,829,500 Statutory

£6,107,500 International activities

£619,200 Trusts & foundations

£256,800 Cost of generating funds

£89,200 Events

£657,700 National activities

£40,300 Individuals £244,700 Other £190,100 Benefits in kind £23,100 Corporate

Figures are unaudited

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Limited by guarantee and registered in England No. 3483008 • Registered Charity in England and Wales No. 1067406 Photograph: © Luke Kane • Front cover: © Guillaume Pinon

doctorsoftheworld.org.uk

Doctors of the World UK, 34th Floor, One Canada Square, London, E14 5AA

April 2015