MSF Australia Annual Report 2007

MÊdecins Sans Frontières Australia 2007 Annual Report

Contents Message from the President

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2007: A Year in Review

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Map: Médecins Sans Frontières projects funded by Australian donors

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Projects funded by Australian donors

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International Field Staff in 2007 Médecins Sans Frontières Australia

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Summary Activity Charts

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Médecins Sans Frontières Australia Financial Report

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Message from the President Dear Médecins Sans Frontières Australia, The past year has again been a challenging and difficult one for Médecins Sans Frontières (MSF), as we faced problems in access to vulnerable populations, threats and murders of our colleagues. Despite the challenges in both conflict and nonconflict zones, we have successfully assisted populations in distress and sought to implement innovative ideas that allow us to better help those in medical need.

As violence in Somalia escalated this year to some of the worst levels in over 15 years, both assistance for and attention to one of the most challenging and acute humanitarian situations in the world seemed to wane. MSF has been working in Somalia for more than 15 years, however in January 2008 we mourned the loss of three of our colleagues: Victor Okumu, a 51-year old surgeon, Damien Lehalle, a 27year old logistician, and Mohamed Abdi Ali (Bidhaan), a Somali driver, who were all murdered in a bomb blast that hit their convoy in Kismayo. As a result we withdrew all international staff from Somalia as a precautionary measure. Medical assistance to the Somali population continued through the skill and dedication of our Somali colleagues in the project locations. At the time of writing I hear that there has been a partial return of our International Field Staff to Somalia, while the Kismayo project has been officially closed. In December, two of our Spanish colleagues were also detained by force while on their way to work in a feeding centre where MSF was assisting some 7,000 malnourished children. They were released unharmed one week later.

Unfortunately we also had to mourn the loss of another colleague in June in the Central African Republic. Elsa Serfass, a logistician, was shot while travelling to areas where MSF provided primary healthcare to the people of Paoua, who are living in precarious conditions in the bush. Not only have our staff and colleagues been attacked but in several separate incidents patients in or on the way to MSF medical facilities have been murdered and become victims of a spiral of escalating violence in many countries, including Sudan and the Central African Republic. We condemn any

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attacks on innocent civilians, patients and our colleagues and the complete lack of respect for humanitarian aid and the space required to provide it.

Populations affected by armed conflict require medical, surgical, psychological and humanitarian care. They are a vulnerable group for whom MSF has rightly considered it their mandate to intervene and assist. Yet providing this much needed support brings with it questions of “how to best do it?”, “are we effective?” and the considerable security issues of operating in a high risk environment. To this extent, 2007 was marked as a year in which we worked remotely to provide help to victims of conflict in Iraq (from Jordan) and there has been considerable debate about how effective such ‘external’ projects are. One thing is clear, although risk-taking is acknowledged as an inevitable part of humanitarian work, as a movement we do not accept loss of life of MSF staff as a sacrifice in exchange for the greater imperative of saving lives. In the end, failure to accept such a limit is to the detriment of all.

In 2007 we were active in many countries and projects. This included: Sri Lanka where we provided surgical support to the public hospitals in the northern conflict zones; in Bangladesh our inpatient units assisted the Rohingya people in several refugee camps; and in Chad and Darfur, Sudan, our teams delivered nutrition, paediatric and maternal health, psychosocial support, assistance to victims of sexual violence and health education to the hundreds of thousands of people affected by war.

The MSF list of the Top 10 Most Underreported Humanitarian Crises of 2007 again highlighted the plight of people struggling to survive violence, forced displacement, and disease in countries where we have been working, including the Central African Republic, Somalia, Sri Lanka and other forgotten crises in the Democratic Republic of Congo, Colombia, Myanmar, Zimbabwe, and Chechnya, where the displacement by war of millions continues as well the ongoing toll of medical catastrophes like tuberculosis (TB) and childhood malnutrition.

MSF internationally has highlighted the importance of innovation. We have successfully initiated outpatient management of acutely malnourished children using nutrient-dense ready to use foods (RUF). This has resulted in a vast increase in the number of children both treated and cured in places like Niger, Darfur and Chad. In March 2007, artesunate and amodiaquine combination formulations for treating malaria were launched, based on the work done by the Drugs for Neglected Diseases 4

Initiative (DNDi), of which MSF is one of the co-founders. MSF has also been using paediatric fixed dose HIV/AIDS combination medicines in our field projects and called for them to become more widely available as they simplify considerably the treatment regimens for children.

In 2008 the Board of MSF Australia plans to review how it is structured, how it oversees local MSF Australia activities and future developments. Further, we will look at taking on new ways to increase our involvement in MSF international issues and potential future developments in the association. To this end, we will continue to keep Association members informed on Board and Associative matters and actively seek feedback and discussion from Association members on issues in a range of different fora.

Finally, I would like to thank our Executive Director, Philippe Couturier, for another tireless effort in 2007 and all the staff at the Sydney office for their hard work. This last year has seen our income grow considerably as well as a relatively smooth introduction of the international remuneration project. Through MSF Australia’s Project Unit, we have seen an essential provision of high quality technical medical advice on women’s health and paediatrics for our field colleagues. And to fulfil MSF’s objective of treating and assisting our fellow humans in need, last year Australians and New Zealanders filled 111 positions in the field. Our support to populations in distress to alleviate their suffering is not possible without the considerable generosity of all our supporters, including pro bono or financial donors and our office volunteers. I thank each and everyone for your support.

Dr Nicholas Wood President, Médecins Sans Frontières Australia

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2007: A Year In Review While the message of our President covers the medical-humanitarian challenges Médecins Sans Frontières (MSF) faced worldwide last year, the purpose of this section of the Annual Report is to provide a brief overview of our activities in the Sydney office.

The 2007 Annual Report marks an important change in the way we report back on the results of the financial year.

Based on a decision by the Board of Directors and legislation which allows us to do so, as from this year the annual report has been made available electronically. This is instead of supplying printed copies for all members as was the case in previous years.

Producing and printing such a report not only incurs significant administrative costs but can also have a negative impact on the environment, therefore we are pleased to provide the 2007 report in the current form you see today.

The second important change is the level of information that this report is providing.

Being almost exclusively distributed to the members of MSF Australia, we have dramatically reduced the level of information regarding the projects themselves.

Instead, we have focused only on the legal requirement for such a report, namely the Directors’ Financial Report, a review of activities and a brief presentation of where the funds have been spent in the field.

I am sure that you will all appreciate this new approach and that you will find this report both informative and responding adequately to the level of accountability you are entitled to expect.

The year 2007 was the first year of a four-year strategic plan that was voted for and accepted by the Board of Directors in January 2007.

It is perhaps important to recall that this plan is a logical step forward from the three year orientation paper (2004–2006). Over this period of time, our section dramatically increased its financial contribution to MSF projects and worked very closely with our primary operational partner (Paris) and the members of this group: MSF USA and MSF Japan. The foundation of our joint operational partnership was established offering the basis for a partnership agreement for the future.

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With more resources as well as a better definition of what we would like to achieve as a group, a new range of possibilities has emerged for our section. This will aim to support the projects in the field and as a secondary objective, to reduce the distance between our section and the field.

In addition, a secondary partnership that was established with MSF Switzerland in 2004, was largely inspired in order to financially support their field projects; to develop our support with regard to field human resources and to assist them with specific field projects.

The ambition for 2007 was based on the following key areas: to further develop our medical support to operations by strengthening the role and the capacity of the Project Unit; to indentify, recruit and better retain Australian and New Zealander field workers; to improve our capacity in communicating on our social mission, and last but not least, to ensure and increase our financial support to the field. All of these areas and therefore the objectives and activities attached to them, focus on a single goal, that is to offer a meaningful contribution and support to our field operations.

The Project Unit’s team was strengthened with the arrival of a third medical doctor (a paediatrician) during the last quarter of 2007. Focusing on women’s and children’s health, several field visits took place with the aim of supporting teams in the field and improving the medical response of our projects. Support and advice with regard to women’s health was provided in Russia and Kenya and exploratory missions were carried out in South Sudan and Yemen. Our other projects in Malawi, Uganda and Kenya also received medical advice on paediatric HIV. Important input was given in the finalisation of the ‘Obstetrics in remote settings’ practical guideline as well as the Prevention of Mother-to-Child-Transmission (PMTCT) and Paediatric HIV guidelines. The Project Unit’s team has developed and strengthened its contribution through training courses such as such as the Refugee Health block of James Cook University’s School of Public Health Tropical Medicine and Rehabilitation Sciences.

Welcome Days (compulsory training prior to a first mission) and various other MSF trainings were conducted internationally on issues covering women’s health and reproductive health.

In Field Human Resources, a second Human Resources Officer was appointed in February 2007 allowing us to further develop our recruitment and training capacity.

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Traditionally seen as a first step toward entering MSF field positions, 20 Recruitment Information Evenings took place throughout Australia and New Zealand in 2007.

Four Welcome Days were organised preparing a total of 68 medical and non-medical candidates to go on their first mission with MSF. In total, 111 field positions were filled by Australians and New Zealanders in 2007 in more than 30 countries. It is encouraging to note that out of the 70 International Field Staff who successfully completed their second mission or more last year, 18% and 8% of the total departures respectively were represented by International Field Staff who had already completed between 4-6 and 7-9 missions. Retention of International Field Staff is crucial for MSF, and such level of experience allows people to take more responsibility throughout the organisation.

In 2007 at least 28 individuals took on a coordination position including three Heads of Mission and three Medical Coordinators. This example is a good illustration of the international reputation of Australian and New Zealand International Field Staff, particularly their high levels of commitment and competency.

Since January, MSF Australia has progressively implemented what is called the International Remuneration Project. This project allows our organisation to offer an equitable level of remuneration throughout the movement and more importantly provide a better and more appropriate coverage with regard to insurance and social benefits for all our field workers. This new contractual situation may allow us to have an influence on one of a large range of factors that impact retention of field workers.

Communications is an important component of our social mission, and in 2007 tireless efforts were made by members of our Communications department, the objective of which is always to raise awareness amongst Australians on the plight of the people that we help. More than 150 major stories, those focusing solely on the work of MSF in crisis situations such as Somalia, Sudan, Democratic Republic of Congo, Kenya, Bangladesh and Iraq were covered by a wide variety of media outlets.

Getting closer by performing more field visits, reporting better on our projects, and developing more meaningful working relationships with our partners are part of the ongoing objectives of the department.

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Ensuring that our supporters and the Australian public are well informed of our projects, their key objectives, the level of resources mobilised, and their achievements, is certainly one of the mechanisms that we employ to ensure greater accountability. We continue to identity ways to further develop this capacity.

Field visits made by the team are part of the process for meeting this objective. For instance, last year our Head of Communications visited projects in Sri Lanka where MSF operates in close proximity to the ongoing conflict. Subsequently audiovisual reports focused on the surgical and obstetric services provided to a population isolated by conflict on the Jaffna Peninsula, and likewise similar reports on the mobile health and logistical efforts for displaced people in Eastern province. However the experiences of individuals also provide an avenue for communicating the social mission. In 2007 the stories of more than 30 individual International Field Staff from MSF Australia were shared with the public through various activities including national, metropolitan and local newspaper coverage; and interviews for radio, internet and television programs. Describing their personal experiences offers International Field Staff another opportunity to raise awareness on the conditions endured by populations they helped during their mission, and is another great way to fulfil their involvement in humanitarian work.

In 2007 the Communications department also strongly supported MSF’s Access to Essential Medicines Campaign, with the participation of MSF in the International AIDS Society Conference in Sydney in June. MSF’s contribution to the conference received warm coverage on paediatric HIV issues and the newest version of the drug pricing guide ‘Untangling the web’ was released.

On a more institutional side, raising general awareness of our organisation is also an important role for the department. In total 470 mentions of MSF in the media were recorded during the year 2007. Since the last quarter of the year, a new position of Marketing Manager was created in order to strengthen our capacity to further develop the level of awareness of MSF in Australia and New Zealand, where it remains at relatively low levels.

In terms of finance, the results for 2007 were on track with the proposed strategic plan and the following pages of the report give an overview of the projects supported by our section. The audited Financial Report will provide you with all the necessary 9

details and main financial indicators. In total we were able to financially support projects in 17 countries for a total of $21,805,677. The generosity of our donors allowed us to meet the commitment taken with both France and Switzerland operational centres and largely contributed to MSF's overall humanitarian-medical responses. Like last year, the MSF international audited accounts are provided in this annual report, demonstrating the full MSF picture.

To conclude this brief review of the year, I would like to thank all donors and supporters including our pro bono suppliers for their generosity and loyalty toward MSF. Being exclusively supported by individual private donors here in Australia allows us to contribute to the vital financial and political independence of our actions.

My thanks also go to all of the Sydney staff for their hard work and commitment, and the office volunteers for the extraordinary support they provide which helps us keep running costs in our office as low as possible.

I wish to extend my thanks to all of the returned International Field Staff as well as the support groups in Perth, Brisbane, Darwin, Cairns, Melbourne, Sydney and New Zealand, for their great contributions to the different events we have organised throughout the year in all parts of the country.

Mr Philippe Couturier Executive Director, MÊdecins Sans Frontières Australia

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MSF field projects are run by five operational centres (France, Switzerland, Spain, Holland and Belgium). MSF Australia is an official partner of the MSF France operational centre, and Australian donors fund projects run by both MSF France and MSF Switzerland.

When needed, MSF Australia also provides human resources and medical support to all operational centres’ projects.

MEDECINS SANS FRONTIERES PROJECTS FUNDED BY AUSTRALIAN DONORS 75

74 66

7

12

3

4

6

11 9 16 1

15

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Country 1. Cambodia 2. Cameroon 3. Chad 4. China 5. Democratic Republic of Congo 6. Iran 7. Iraq 8. Kenya 9. Laos 10. Malawi 11. Myanmar 12. Niger 13. Somalia 14. Sri Lanka 15. Sudan 16. Thailand 17. Uganda

A$ MSF France

A$ MSF Switzerland

2,000,000 1,500,000 700,000 700,000 1,400,000 500,000 1,300,000

530,000 1,265,677 200,000 420,000 590,000

1,300,000 1,300,000 300,000 2,400,000 1,200,000 1,300,000

820,000 500,000 1,300,000

280,000

2

17 9

5

8

10

13

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Projects funded by Australian donors Médecins Sans Frontières (MSF) field projects are run by five operational centres (France, Switzerland, Spain, Holland and Belgium). MSF Australia is an official partner of the MSF France operational centre, and Australian donors fund projects run by both MSF France and MSF Switzerland.

When needed, MSF Australia also provides human resources and medical support to all operational centres’ projects.

Listed below are all the MSF France and MSF Switzerland projects which are directly supported by Australian donations.

If you would like to read more about the MSF projects across all operational centres, please refer to the 2007 International Activity Report at www.msf.org.au Following the instability and violence in Central African Republic, around sixty thousand refugees arrived in eastern Cameroon from July 2007. MSF teams provided food and healthcare to the refugees in various settlements and lobbied the relevant bodies to assist the population.

CAMBODIA HIV/AIDS & tuberculosis Total Field Staff: 245 Projects funded by Australian donors: Phnom Penh, Kompong Cham Funding: A$2,000,000

MSF has worked in Cameroon since 2000.

Dramatically improved health facilities in Cambodia and a strong government commitment to fight HIV/AIDS has ensured critical progress in the scale-up of antiretroviral therapy (ART) programs.

MSF has begun the handover of its HIV/AIDS projects and continues to work closely with the Ministry of Health.

CHAD Nutrition, paediatrics, primary healthcare, reproductive health, surgical, nutrition, obstetric care, vesico-vaginal fistulas Total Field Staff: 1,437

In Phnom Penh and Kompong Cham, MSF continued to run an HIV/AIDS and TB program, including counselling, treatment of opportunistic infections and providing information on HIV/AIDS. In 2007, 30% of patients on ART nationwide received their drugs through MSF-supported clinics. MSF continues to support government clinics in their efforts to increase their capacity of HIV/AIDS care. Treatment and care to HIV-positive inmates in two of Phnom Penh’s main prisons also continued, with 31 inmates on ART.

Projects funded by Australian donors: Kouko, Dogdoré, Adré, Guereda, Goz Beida, Goré Funding: A$2,765,677 Eastern Chad has been the centre of armed fighting since the end of 2005. Insecurity remains high and in 2007, the MSF project in Koukou was temporarily suspended and the Dogdoré project reduced in staff.

MSF’s activities in eastern Chad are designed to provide quality care to all populations, be they residents, internally displaced people, or refugees. Early in April 2007, MSF began working at the general hospital in Adré, providing free treatment for the local population.

Patients who live in the refugee camps at Farchana and who require surgery are also referred to the hospital in Adré, as are serious cases from the camps for internally displaced people at Goz Beida and Dogdoré.

MSF’s paediatric program grew in 2007, particularly in Kompong Cham which saw an increase from 140 to 200 HIV-positive children on ART. MSF’s presence in Cambodia is however decreasing as the capacity of the health system improves.

MSF has worked in Cambodia since 1979.

Also in April, MSF opened a project in Koukou in response to a new population displacement linked to a major attack on the villages of Tioro and Marena. MSF’s response focused on paediatric care, and from mid-June to December, 14,686 consultations with children under five were carried out. A serious security incident led MSF to close this project in December.

CAMEROON Primary healthcare, nutrition, Buruli ulcer, HIV/AIDS Total Field Staff: 123 Projects funded by Australian donors: Douala; Refugees from Central African Republic Funding: A$530,000

In Guereda, about 150km north of Adré on the Sudanese border, MSF is providing primary healthcare services with a particular focus on reproductive healthcare.

In May 2007 antiretroviral medications were made available free of charge to patients by the government, but for many people in Cameroon, the associated costs of hospitalisation and monitoring remain very high. In Douala at Nylon Hospital, MSF decentralised and consequently simplified the treatment for its 7500 patients registered in the HIV/AIDS project. Some of these patients were cared for in other treatment centres overseen by the Unit for the Production of Civic Education Programs while others received care at health facilities in outlying districts.

In Dogdoré, MSF provided medical consultations to 31,711 people, and also carried out two measles vaccination campaigns. MSF’s Goz Beida project was opened in May 2007 and focuses on paediatric care and nutritional screening. In 2007, 1720 malnourished children were treated and 190 were hospitalised.

MSF is also working in Goré, responding to the secondary healthcare needs of the refugees from Central African Republic and the local

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Projects funded by Australian donors This report was based upon four years of medical work in the region.

population. In 2007, there were 11,909 consultations undertaken, including 1469 surgical interventions.

As fighting continued in 2007 between various armed groups in North Kivu, MSF teams also provided healthcare to the displaced people and residents in the Rutshuru, Nyanzale and Goma districts. This included an emergency cholera and measles vaccination intervention. In Rutshuru, MSF treated 1600 cases of cholera and 17,041 children were vaccinated against measles.

At the end of 2007, MSF also signed an MOU to begin a program for vesico-vaginal fistulas in the hospital in Abéché.

MSF has worked in Chad since 1981.

CHINA

MSF has worked in DRC since 1981.

HIV/AIDS Total Field Staff: 63

IRAN

Projects funded by Australian donors: Nanning Funding: A$700,000

Primary healthcare, surgery Total Field Staff: 78

China’s huge economic growth and enormous developments, especially in urban areas, often overshadow the approximately 700 to 800 million citizens, or half of the country’s population, who today still have limited access to basic healthcare. HIV/AIDS, tuberculosis (TB) and hepatitis B are among the top five infectious diseases in China. Latest estimates indicate that there are 700,000 people living with HIV; a 0.05% prevalence. Stigma and discrimination around HIV/AIDS is still very high and patients are reluctant to present themselves at government facilities for testing.

Projects funded by Australian donors: Zahedan, Mehran Funding: A$1,400,000 According to the UNHCR, there are still officially nearly one million documented Afghan refugees living in Iran and approximately the same amount without proper documentation. Many people are reluctant to go back and prefer to remain in Iran.

In 2007, MSF remained the only international medical-humanitarian organisation in the country. MSF provided medical assistance to Afghan refugees in three primary healthcare clinics in three districts of Zahedan – Shirabad, Karimabad and Besat. A total of 78,885 patients were seen in all MSF clinics, which included 3,833 gynaecological consultations and 1496 mental health consultations.

In 2007, MSF continued to provide free anonymous access to testing, diagnosis, treatment and care to HIV/AIDS patients in Nanning, Guangxi Province. At the end of November 2007, 1029 patients were registered in this program, and antiretroviral drugs were provided to 632 patients, including 47 children.

A team of twelve Afghan social workers also participated in providing full case management by following up patients in their homes and identifying the most vulnerable families, particularly new arrivals who were provided with basic necessities including blankets and soap.

In addition to the MSF clinic, three voluntary counselling and treatment facilities have been opened since March 2007.

MSF has worked in China since 1988.

In Mehran, close to the Iraq border, MSF initiated another project for surgical case management for victims of the war in Iraq.

DEMOCRATIC REPUBLIC OF CONGO

MSF has worked in Iran since 1995.

Cholera, measles, nutrition, water, primary healthcare, sexual violence, gynaecology, sleeping sickness Total Field Staff: 2,386

IRAQ Reconstructive and orthopaedic surgery Total Field Staff: 249

Projects funded by Australian donors: Gety, Rutshuru, Goma, Nyanzale Funding: A$900,000

Projects funded by Australian donors: Jordan, Kurdistan Funding: A$920,000

The great majority of people in Democratic Republic of Congo (DRC) have limited or no access to healthcare, epidemics break out with regularity and violence continues to have a devastating impact on people’s lives, particularly in the east of the country.

The war in Iraq is one of the world’s biggest humanitarian crises today with dramatic consequences for the population. UNHCR estimates that more than 1.2 million Iraqis became displaced within their country in the past two years alone while 2.3 million Iraqis sought refuge in neighbouring countries.

MSF teams are working in Gety, in the district of Ituri. In 2007, MSF focused on the treatment of malnutrition, vaccinated 7000 children against measles, supplied drinking water to more than 30,000 people and also provided gynaecological care. In Ituri, civilian populations are still being subjected to high levels of violence, including sexual violence.

In October 2007, MSF issued a report titled “Ituri: Civilians Still the First Victims,” emphasising the persistence of sexual violence as well as the direct humanitarian consequences of military operations in 2007.

Only approximately 30% of medical doctors are still in the country, medicines and medical equipment are lacking, and the country’s health structures, once among the best in the Middle East, are no longer able to provide adequate care. Medical personnel are working under constant threat; simply working in the medical sector in Iraq nowadays means risking one’s life.

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Projects funded by Australian donors time, antiretroviral therapy (ART) was unavailable and it wasn’t until 2004 that the authorities finally allowed MSF to become involved in administering treatment.

MSF pulled out of Iraq in 2004 when its presence in the conflict zone could no longer be considered safe. Since then MSF has investigated various ways to assist the victims of the conflict without putting its own staff at risk. In 2006, MSF decided to open a project offering reconstructive maxillofacial, plastic and orthopaedic surgery in the Red Crescent hospital in Amman, Jordan. As of August 2007, MSF had treated 236 patients in the Amman project.

In 2007, MSF continued to run HIV programs in the district hospital in Savannakhet as well as in Vientiane, ensuring detection, treatment, patient education and counselling. In the two projects, more than 500 patients received ART.

In July 2007, MSF opened a second similar project in Suleymaniyah, in Kurdistan, northern Iraq, providing care to war-related injured as well as to burn victims. Between September and December, this project admitted 616 patients.

MSF has worked in Laos since 1989.

MALAWI HIV/AIDS & tuberculosis Total Field Staff: 652

MSF teams also run projects in Erbil and Dohuk in Kurdistan, providing access to quality emergency healthcare for war wounded in the various surgical hospitals, training staff, providing assistance to displaced populations and donating medical supplies to identified hospitals.

Projects funded by Australian donors: Chiradzulu Funding: A$1,300,000

MSF has worked in Iraq since 2006.

The HIV/AIDS prevalence in Malawi remains one of the highest in the world. Of the 13 million inhabitants in the country, 930,000 live with HIV. The Ministry of Health estimates that 202,319 people are in need of antiretroviral (ARV) treatment. There are more than 86,000 deaths per year due to HIV/AIDS.

KENYA HIV/AIDS & tuberculosis Total Field Staff: 463

In 2007, MSF continued scaling-up access to ARVs for HIV patients in Chiradzulu district; a 10% increase was achieved and there are now 8804 patients receiving ARVs. This increase was achieved through a process of decentralisation, training of clinical staff, as well as recruitment and training of peer counsellors from the cohort of patients. MSF has also increased its capacity for early detection of TB and HIV co-infected patients, with detection rates doubling in 2007.

Projects funded by Australian donors: Nyanze, Nairobi Funding: A$1,300,000 The primary focus of MSF in Kenya is HIV/AIDS treatment. There are an estimated 200,000 adults and 50,000 children in need of antiretroviral therapy in the country.

Homa Bay, located in the western Nyanze province, was MSF’s first HIV/AIDS program in Kenya, opening in 1996. With an HIV prevalence of approximately 35 percent, the densely populated town on the shores of Lake Victoria is one of the worst affected areas in the country. Initially focusing on TB and on reducing HIV transmission through health facilities, free antiretroviral therapy was first introduced in 2001. In 2007, MSF provided antiretroviral drugs (ARVs) to 7000 patients in Homa Bay and continued integrated management of TB/HIV co-infection, including treatment of drug-resistant TB.

MSF has worked in Malawi since 1986.

MYANMAR Primary healthcare, tuberculosis, mobile clinics Total Field Staff: 1200 Projects funded by Australian donors: Kayah Funding: A$820,000

The Mathare slum, on the eastern outskirts of Nairobi, has a population of over 300,000. MSF runs a project known as the “Blue House,” providing care for people living with HIV/AIDS and TB. Last year, 3114 patients received HIV care; of these, 2484 were on ARV treatment, and a program for drug-resistant TB was initiated. Treatment has commenced for 431 patients.

The populations in Myanmar’s most remote zones did not see any improvements in the health situation in 2007. The percentage of public funds that the authorities have invested in health remains very low and, from a medical point of view, the current needs of the population in the zones where MSF is operating are reaching the level of a chronic and silent emergency.

MSF has worked in Kenya since 1987.

Controlled by a military regime since 1962 and largely cut off from the outside world, the health and welfare of people in Myanmar is affected by repression and low intensity conflict. Ethnic minorities, many of whom are displaced and live in border regions, are particularly vulnerable. Provisions for healthcare are inadequate, with 80 per cent of people living in malaria risk areas and thousands going without treatment for conditions such as tuberculosis (TB) and HIV/AIDS.

LAOS HIV/AIDS Total Field Staff: 36 Projects funded by Australian donors: Vientiane, Savannakhet Funding: A$590,000

In 2007, MSF provided primary healthcare with a focus on malaria, diarrhoeal diseases and TB. In Kayah State, MSF provided anti-malarial treatment to over 4500 patients through clinics and outreach activities.

In an effort to address the unmet need for HIV/AIDS care in Laos, MSF started a project in Savannakhet, southern Laos, in 2001. At that

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Projects funded by Australian donors MSF continues to work in the Dinsor hospital in the Bay region and at Beledweyne in the Hiraan region.

MSF was also undertaking a malaria treatment program in Myeik, providing care to people primarily from rural areas, including internally displaced people from ethnic minorities and discriminated religions.

This project was handed over at the end of 2007.

Inhabitants of Mogadishu who fled the violence in the city have also arrived in these two zones. In Dinsor MSF teams provided maternalinfant care and health treatment for the whole population, in addition to managing a centre for the treatment of tuberculosis, which remains a major cause of mortality in Somalia. More than 74,000 consultations and 2,879 hospital admissions were made by MSF teams, who also treated more than 900 malnourished children.

MSF has worked in Myanmar since 1992.

NIGER Paediatrics, nutrition Total Field Staff: 1,278

In March and April, a cholera epidemic broke out in the displacement camps, where the hygiene conditions are very poor. MSF set up an emergency cholera treatment centre that cared for some 400 patients.

At Beledweyne, priority was given to maternal-infant care and surgical activities. As a result, more than 1000 surgical operations were carried out, and 1500 patients were admitted to hospital.

Projects funded by Australian donors: Zinder, Maradi, Agadez Funding: A$1,800,000 In 2007, MSF continued to employ ready to use therapeutic food (RUF) to treat malnourished children. A vacuum packaged, nutrient dense peanut-milk paste, this portable product has allowed MSF to increase its capacity to treat malnutrition 10-fold, as children without medical complications can now be cared for as outpatients. This strategy is much easier for mothers, who can provide this food to their children at home. MSF also showed that this rehabilitation strategy was highly effective for treating moderately malnourished children, who can be cured with RUF in less than a month, on average. The only obstacle is price and MSF is lobbying both for price reductions and for the government and other NGOs to implement wider use of RUF.

MSF has worked in Somalia since 1991.

SRI LANKA Surgery, obstetric care, mobile clinics Total Field Staff: 163 Projects funded by Australian donors: Point Pedro, Batticaloa Funding: A$300,000

Since June 2005 MSF has been operating in two centres for recuperation and intensive nutritional education in the cities of Zinder and Magaria in the Zinder region, as well as in 13 ambulatory centres for treating malnutrition. In 2007, MSF continued an integrated program in southern Niger, by monitoring, screening and treating malnutrition within the framework of regular paediatric healthcare. In Maradi province, RUF was distributed to 62,800 children aged between 6 months and 3 years throughout 53 distribution sites.

Sri Lanka has been in the grips of fighting on and off for nearly 25 years.

MSF had worked in Sri Lanka since 1986 throughout the years of war, with all programs closing gradually after the 2002 ceasefire agreement.

In May 2006, with the resumption of hostilities, MSF decided to return to assist the population in conflict-affected areas in January 2007.

In 2007, MSF was the only international non-governmental organisation present at Point Pedro, on the Jaffna Peninsula. MSF provided medical, obstetric and surgical care to 2690 patients in the Point Pedro Hospital.

The hospital serves a population of approximately 115,000 who are especially at risk because of the proximity of the front-line and the difficulty of moving in the peninsula. The hospital has a shortage of specialists and the transfers to Jaffna are difficult and dangerous.

In June and July 2007, MSF also opened a second project in Dabada in the Agadez region to treat victims of conflict. This was unfortunately closed after only 10 days, due to security reasons. Since then, no other international aid organisation has had access to the region.

MSF has worked in Niger intermittently since 1985.

Since May 2007, MSF teams also provided medical care and relief to 12,000 displaced people in six camps in Batticaloa district. By the end of the year, the situation for the displaced had improved, and so MSF handed over its activities in December.

SOMALIA Emergency care, primary healthcare, nutrition, water and non-food items Total Field Staff: 1061

MSF has worked in Sri Lanka since 1986.

Projects funded by Australian donors: Dinsor, Beledweyne Funding: A$1,300,000

SUDAN

In 2007, conflict once again worsened the situation in Somalia where needs are vast, yet little medical-humanitarian assistance is delivered on the ground. The violent fighting that ravaged inside Somalia’s capital, Mogadishu, led to the displacement of 400,000 people from the city’s immediate outskirts to the rest of the country, as well as to neighbouring countries. There are now a total of one million displaced people in Somalia.

Projects funded by Australian donors: Darfur, Akuem, Bentiu, Aweil Funding: A$2,400,00

Primary healthcare, surgery, nutrition, meningitis, measles, cholera, obstetric/gynaecological care Total Field Staff: 3174

Sudan remains the setting of large scale violence, for example the war continues in Darfur, and the peace agreement signed between the North and the South in 2005 remains fragile.

15

Projects funded by Australian donors In Mae Sot, on the Thai-Myanmar border, MSF began a tuberculosis (TB) project in 1999 with unregistered migrant workers from Myanmar.

TB, highly endemic in Thailand, is a major health problem amongst this population who have limited access to healthcare, particularly if they require long term treatment. MSF is treating patients with TB, multi-drug resistant TB and extensively drug resistant TB, as well as patients who are co-infected with HIV. In 2007, there were 560 patients diagnosed with TB.

Darfur MSF focused on the provision of assistance in three large displaced persons camps in West Darfur – Niertiti, Zalingei and Mornay. In Niertiti, MSF provided primary and secondary healthcare, obstetric care as well as treatment for victims of sexual violence. At the end of the year we rehabilitated an operating theatre in Niertiti hospital in order to provide emergency surgery.

The town of Zalingei is still home to the largest displaced population in Western Darfur with 100,000 people. MSF’s support to the Zalingei hospital continued in the operating theatre, paediatric ward and therapeutic feeding centre. There were a total of 13,614 emergency consultations.

MSF has worked in Thailand since 1983.

UGANDA

In the Mornay camp, MSF teams carried out 13,448 consultations between January and June and then handed over their activities to other medical actors.

HIV/AIDS & tuberculosis, kala azar, meningitis, primary healthcare, shelter, water Total Field Staff: 858

South Sudan At the start of the year, a meningitis epidemic affecting all states in South Sudan led MSF to carry out vaccination campaigns in western and northern Bahr el Ghazal, right through to Juba, covering a total of 480,000 persons.

Projects funded by Australian donors: Arua, Patongo, Gulu Funding: A$1,580,000 The World Health Organisation and UNAIDS estimate that there are more than one million adults and children living with HIV/AIDS in Uganda. Since 1988, the prevalence rate among adults has decreased from 30% to 6% in 2004/5 and Uganda is now one of the countries internationally recognised to have controlled the HIV/AIDS epidemic through its ‘Abstinence Be Faithful’ condom strategy. However the reality remains that 70% of Ugandans do not know their HIV status and approximately 220,000 individuals are estimated to clinically require antiretroviral therapy (ART).

MSF opened a project in Aweil in response to a surge in fighting in the region. In July, MSF responded to a surge in malaria and malnutrition, and provided shelter to displaced populations in Aweil. This project also saw an increase in gynaecological and obstetric care activities.

In Northern Bahr El Ghazal, activities in Akuem were brought to a close in March 2007 and handed over to other agencies. In addition, Bentiu was closed down in October 2007, following a reduction in the number of kala azar patients.

In 2007, MSF continued its Arua program providing fully integrated care for patients co-infected with HIV/AIDS and TB. There were 3959 patients taking first line antiretroviral treatment in 2007.

MSF has worked in Sudan since 1979.

MSF also responded to a meningitis outbreak in the West Nile region and, in Kisoro, provided healthcare, shelter and water to over 12,000 refugees from Democratic Republic of Congo.

THAILAND Primary healthcare, food, water, tuberculosis Total Field Staff: 225

MSF also continued its work in providing shelter and basic psychosocial support to children and adolescents in Gulu, although the project was closed at the beginning of the year. MSF also provided healthcare in Awere camp, home to 20,000 internally displaced people.

Projects funded by Australian donors: Petchabun, Mae Sot Funding: A$1,200,000 In Thailand, health insurance is available only to registered Thai nationals and marginalised groups have limited access to healthcare. MSF has publicised its health concerns for these neglected populations and lobbies the Thai authorities to address their needs.

MSF handed over its Patongo project to the Ministry of Health in July 2007 as all health related indicators had returned to normal levels and peace talks, initiated in 2006, had motivated the population to start returning home.

The healthcare provided by MSF to Hmong Laotian refugees began during an emergency in July 2005. In June 2007, the refugees were moved to a new camp. Surrounded by barbed wire, refugee movements in the camp are rigorously controlled by the military. In September 2007, the Thai and Laotian governments agreed to repatriate the Hmong refugees to Laos despite fears expressed by the camp’s population concerning their security in Laos. In response, MSF issued a public statement calling on the government to stop the repatriation procedures.

MSF is still the only international NGO offering assistance to this population. In 2007, MSF provided healthcare to a total of 26,390 patients and also distributed food and plastic sheeting. MSF also looks after hygiene and water supply.

MSF has worked in Uganda since 1980.

Médecins Sans Frontières positions in the field (In full-time equivalent) National staff International staff Total field employees

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22,354 1,994 24,348

International Field Staff in 2007 Médecins Sans Frontières Australia Armenia Bangladesh Burkina Faso Burundi Cambodia Chad China Congo Brazzaville Côte d’Ivoire

Democratic Republic of Congo Ethiopia

Georgia

Guatemala Haiti India Indonesia Iraq Jordan Kenya

Kyrgyzstan Liberia

Gail de Lucia

nurse

Marilyn Keane

nurse

Penelope Summons

nurse-midwife

Debra-Lee Holman

field coordinator

Anousha Victoire

medical doctor

Amanda Jupp

field admin

Eline Whist

medical doctor

Linda Pearson

nurse

Haydn Perndt

anaesthetist

Richard Smith

medical doctor

Carol Nagy

field coordinator

Susan Thomas

field coordinator

Vidthiya Rajasundaram

medical doctor

Murray Trubshaw

medical doctor

Brian Moller

field coordinator

William Wilson

medical doctor

Jane Lynch

log-watsan

Shelagh Woods

field coordinator

Karen Kiang

medical doctor

Olivia Yacoub

medical scientist

Carolyn Merry

head of mission

Ellie Kamara

admin-fincoordinator

Christina Ambrose

medical coordinator

Lesli Bell

log-watsan

Emily Gill

medical doctor

Malaysia Mozambique Nepal

Niyi Awofeso

medical doctor

Damien Cahill

log-admin

Lesli Bell

field coordinator

Roslyn Brooks

medical doctor

Anne Taylor

log coordinator

Vivienne Cebola

medical doctor

Anne Taylor

head of mission

Arjuna Nagendra

medical doctor

Lisa Trigger-Hay

medical doctor

Shannon Lo Ricco

log-general

Matthew Cleary

field coordinator

Haydar Alwash

surgeon

Trudi Davis

medical doctor

medical coordinator

Philipp Du Cros

medical doctor

head of mission

Jane Greig

epidemiologist

Niger Nigeria

Amy Gildea

nurse-theatre

Jason Andean

log-general

Heidi Cockram

log-general

Penny O'Connor Will Robertson Paras Valeh

medical doctor

Charles Lancaster

nurse

Ruth McKeown

medical doctor

Sean Healy

field coordinator

Alistair McKeown

nurse

Jacqueline Hewitt

medical doctor

Janthi Price

head of mission

Sue Mitchell

psychologist

Shella Hall

head of mission

Thomas Roth

head of mission

Van Tung Bui

anaesthetist

Melanie Leemon

health educator

Jason Andean

log coordinator

Helle Poulsen-Dobbyns

field coordinator

Nikki Blackwell

anaesthetist

Nikki Blackwell

anaesthetist

Pakistan

Devika Tharumaratnam

medical doctor

Glenda Gleeson

nurse-midwife

Palestinian Territories Brian Moller Papua New Guinea Lesli Bell Kara Blackburn

Philippines Somalia

nurse-theatre log-general midwife

Jane Lynch

log-general

Haydar Alwash

surgeon

Paras Valeh

medical doctor

Van Tung Bui

anaesthetist

Julianne Millar

medical doctor

Matthew Cleary

field coordinator

Meena Okera

medical doctor

Jane Connell

med team leader

Sandra Sedlmaier

midwife

Cath Deacon

medical doctor

Heidi Spillane

medical doctor

Lisa Errol

nurse-midwife

Barbara Telfer

epidemiologist

Catherine Moody

field coordinator

Peter Zelas

surgeon

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International Field Staff in 2007 Médecins Sans Frontières Australia continued Sri Lanka

Sudan

Thailand

Abdul Aleem

anaesthetist

Alana Baker

nurse-theatre

Kara Blackburn

nurse-midwife

Stewart Condon

field coordinator

Hannah Eaton

log-admin

Margie Barclay

nurse-midwife

Kate Hardie

medical doctor

Euan Beamont

log coordinator

Stephanie Jones

field coordinator

Andrew Caballero-Reynolds log-admin

Jane Lynch

log coordinator

Maria Cartwright

Mark Patrick

paediatrician

Karen Day

pharmacist

Jenifer Reynolds

anaesthetist

Anthony Flynn

nurse

Shelagh Woods

field coordinator

Rosemary Hay

medical doctor

Deanna Beaumont

log-admin

Malcolm Hugo

psychologist

Margaret Campbell-Low

nurse

Stephanie Johnston

pharmacist

Christopher Clapp

log-admin

Jane Lynch

log-construction

Nick Coatsworth

field coordinator

Tania Martin

medical doctor

Jenny Cross

admin-fincoordinator

Jonathan Ng

medical doctor

Anna Dicker

nurse

Helle Poulsen-Dobbyns

field coordinator

Fiona Gillett

nurse-midwife

Theane Theophilos

nurse

Phil Humphris

head of mission

Stephanie Williams

medical doctor

Abioseh Kamara

log-general

Shelley Wright

nurse

Susan Kelsall

nurse-midwife

Vivien Brown

midwife

Anne Kleinitz

medical doctor

Katrina Penney

nurse-midwife

Peter Koole

log-admin

Jane Lynch

log coordinator

Mark Meredith

log-mechanic

Carol Petrie

nurse

Robert Pickard

admin-fincoordinator

Ruth Priestley

nurse-theatre

Vidthiya Rajasundaram

medical doctor

Natalia Rojas

nurse

Natalia Rojas

med team leader

Robin Sands

field coordinator

Richard Smith

medical doctor

Katrina Swanson

nurse

Theane Theophilos

nurse

Susan Thomas

field coordinator

Greg Thompson

admin-fincoordinator

Sue Wainwright

midwife

Colin Watson

nurse

Richard Wesley

log-admin

Kate Williams

nurse-theatre

Turkmenistan Uganda

Yemen

Zimbabwe

Marianne Gale

medical doctor

Judy Coram

nurse

Simon Janes

medical coordinator

Kwaku Agyemang-Baah

nurse

field coordinator

Paras Valeh

medical doctor

Vanessa Cramond

medical coordinator

Christine Polinelli

medical scientist

This information represents International Field Staff recruited by Médecins Sans Frontières Australia who were in the field in 2007 (although they may have departed prior).

18

Summary Activity Charts 2007 Highlights • In 2007, there were 111 field positions filled by Australians and New Zealanders in more than 30 countries.

Thirty two percent of these were Field Staff on their first mission.

• Funding spent on social mission increased to $25.4 million in 2007 from $23.6 million in 2006.

• Income from fundraising for the year ended 2007 increased to $34.9 million from $27.7 million in 2006.

• At the same time, the total cost of fundraising decreased to 21% in 2007 from 26% in 2006.

• The number of people supporting the work of Médecins Sans Frontières Australia grew from 84,248 to 94,700.

2007 Income Field Partners (57%) Bequests (4%) Other private donations (35%) Income from other MSF sections (3%)

Project Funds by Region

Other income (1%) Gifts in kind (0.2%)

Africa (63%)

Field Human Resources by type

Middle East (11%) Asia (26%)

Medical (25) Paramedical (43) Non medical support staff (43)

Summary Financial Results

Donation Income Total Income Social Mission Costs Total Costs Surplus/(deficit) Reserves

19

$m 2007

$m 2006

$34.9 $36.4 $25.4 $34.3 $2.1 $2.9

$27.7 $28.9 $23.6 $32.9 -$4.0 $0.8

MÊdecins Sans Frontières Australia ABN 74 068 758 654

Financial Report for the Financial Year Ended 31 December 2007