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MÊdecins Sans Frontières Australia Annual Report 2010


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Contents

Part A Médecins Sans Frontières – Charter

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Message from the President

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2010 – Year in Review

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Map – Médecins Sans Frontières projects funded by Australian donors

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Médecins Sans Frontières Australia Australian and NZ field staff 2010

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Projects funded by Australian donors

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Summary Activity Charts

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Médecins Sans Frontières worldwide 2009: Extract from International Activity Report 2009

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Part B Médecins Sans Frontières Australia Financial Report

Cover photos clockwise from top: Democratic Republic of Congo, October 2010. © Stella Evangelidou /MSF Dadaab refugee camp, Kenya, March 2010. © Frédéric Baldini /MSF Pakistan floods, September 2010. © Seb Geo Haiti earthquake, January 2010. © Frederic Sautereau

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Médecins Sans Frontières Charter

Médecins Sans Frontières is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honor the following principles: Médecins Sans Frontières offers assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict, without discrimination and irrespective of race, religion, creed or political affiliation. Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and demands full and unhindered freedom in the exercise of its functions. Médecins Sans Frontières’ volunteers undertake to respect their professional code of ethics and to maintain complete independence from all political, economic and religious powers. As volunteers, members are aware of the risks and dangers of the mission they undertake, and have no right to compensation for themselves or their beneficiaries other than that which Médecins Sans Frontières is able to afford them.


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Message from the President Dr Nicholas Coatsworth

Dear Friends, At the beginning of 2010 I visited a tuberculosis treatment project in Cambodia where I found a French head of mission working with an Argentine medical coordinator, a Liberian doctor, a Spanish logistician and a Kiwi nurse (there is always a Kiwi nurse!), all working alongside a Cambodian team, some of whom were preparing to leave on their first field placement with Médecins Sans Frontières outside their home country. Seeing that group of people work together reminded me of the common purpose that delivering medical care can create amongst individuals from different cultures and circumstances. It showed me just what Médecins Sans Frontières had become – far from a Euro-centric, Western aid organisation, here was a team that was clearly ’without borders’, but whose purpose was the same as those who founded the organisation in 1971. As Médecins Sans Frontières approaches its 40th year in 2011, looking back on 2010 gives us pause to reflect on the challenges our teams faced in the field. These challenges were met with the same principles that have always united us: our impartiality, our independence, our neutrality and our fundamental respect for medical ethics in the treatment of our patients. The year was book-ended by two major emergencies in Haiti. On January 12 an earthquake flattened Port-au-Prince. Médecins Sans Frontières had worked with the Haitian people for nearly two decades and amongst the staggering number of victims were twelve Haitian Médecins Sans Frontières staff that had been working at the time of the earthquake. Of our three medical facilities that existed in the minutes before the earthquake, only one was operational immediately afterward. From that immediate post-earthquake phase through to the end of October our teams treated 360,000 patients. The response of Médecins Sans Frontières to the Haitian earthquake and cholera outbreak has been detailed in the excellent and reflective report Haiti One Year After, but it is worth highlighting several points. The Haiti earthquake showed two sides of humanitarianism in stark contrast. On the one hand was a world that saw the need for (and was prepared to deliver) a rapid and efficient response to a humanitarian disaster. But, on the other hand, there were very real questions raised about the effectiveness and coordination of the humanitarian response. In the days following the disaster, as the rescue crews were flown to

Port-au-Prince to an airport controlled by the US military, aircraft carrying supplies for Médecins Sans Frontières were denied permission to land. In what was later labelled as “the most powerful ‘tweet’ of 2010”, American journalist Ann Curry saw a tweet from our New York office, took up the cause and herself tweeted “@usairforce find a way to let Doctors without Borders planes land in Haiti: http://bit.ly/8hYZOKTHE most effective at this”. Within 24 hours Médecins Sans Frontières logistics was again able to supply teams that had been treating patients in the immediate post-quake phase. At the end of the year, Haiti suffered a second blow as a cholera outbreak spread throughout the country. Our teams – made up of 7,500 Haitian and 400 international staff – treated more than 110,000 patients for this preventable disease in cholera treatment centres across the country. A single death from cholera is unnecessary; in Haiti there were 3,600 deaths. Despite there being around 12,000 non-government organisations present, Médecins Sans Frontières was the major provider of care during the epidemic, and alongside doctors from neighbouring Cuba, treated more than half of all victims. The anger and fear generated by an epidemic of such a scale led to violence against some aid workers. There was a breakdown of trust between the Haitian people and the United Nations (UN) and its affiliated agencies, a breakdown that had the potential, and in some cases did, compromise patient access to life-saving treatment. The quality of care from Médecins Sans Frontières teams and recognition of

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Message from the President continued our independence from the UN allowed our medical staff to continue to treat cholera victims across the country. There is clear value to our patients in remaining an independent aid organisation, and the experience of our teams in Haiti once again reinforced our commitment to this position. Haiti also offered lessons for Médecins Sans Frontières as a global organisation. It has always been the character of the organisation to constantly question the relevance and efficacy of its action. Our Association of returned and active field workers acts as a check on our action and source of constant reflection. And it would be correct to say that our own response was far from perfect. Lessons have been learnt about interaction with other agencies in the field and about the provision of medical care in chaotic circumstances. Our experience has also sparked debate on longer-term integration into the health system in contexts like Haiti with ‘permanent’ humanitarian emergencies. Having returned to Afghanistan in late 2009 after a five year absence following the murder of five of our staff in Bagdhis province, Médecins Sans Frontières scaled up our response to the conflict there in 2010. Our teams support Boost Hospital in Lashkarhah in Helmand Province and Ahmed Shah Baba Hospital in eastern Kabul. In 2010, more than 1200 patients were treated each month in Boost Hospital. Through our complete financial independence and constant communication with all warring parties we have managed to carve out operational space in the most difficult of circumstances. Médecins Sans Frontières teams see first hand the difficult position Afghan patients find themselves in: accessing care from facilities affiliated with one side can make them a target for reprisals from the other. The very act of seeking medical attention can in fact put patients in a worse position. This situation contradicts international humanitarian law, which enshrines the provision of medical care independently of warring parties. But it also debases fundamental medical ethics. For these reasons we refuse to be co-opted as part of the counterinsurgency strategy of Western forces. To facilitate the work of our teams in the field, Médecins Sans Frontières Australia has maintained dialogue in 2010 with the Australian Defence Force and other civil-military forums where we continue to assert our independence from the military and other nongovernment organisations. 2010 also saw Médecins Sans Frontières undertake a unique intervention in northern Nigeria, treating children and

pregnant women suffering from unprecedented levels of lead poisoning as a result of small-scale gold extraction. Supported by an international network of toxicologists, our team delved into unknown territory, designing a treatment protocol that could not only address extremely high levels of poisoning, but also be rolled out on a large scale with limited resources and adapted to address what would be culturally acceptable for local communities. Of course, these examples are a fraction of the work done in 2010 by our doctors, nurses, administrators and logisticians, work that is undertaken in the most precarious of contexts. We continue to offer medical care to patients forgotten by the global community, in the Democratic Republic of Congo, the Caucasus and the Sahel region of Africa. Alongside our direct patient care we continue to advocate for improved access to essential medicines, to ensure that generic drugs are made available for patients living with HIV and to develop new research initiatives into neglected tropical diseases such as sleeping sickness and kala azar, and remain at the forefront of the fight against multi- and extremely- drug resistant tuberculosis. As a final word I would like to thank everyone who works with Médecins Sans Frontières Australia for their efforts over the past year. There were a record number of departures to the field in 2010. Staff in the Sydney office provided high level and valued support to the organisation’s operations. I constantly received messages of thanks from our colleagues in operations for the work of all our departments from Communications to Finance and Administration to Human Resources and Fundraising. That is of course testimony to the work of those individuals, but also to the work of our departing Executive Director, Philippe Couturier, who led Médecins Sans Frontières Australia to its position as a valued contributor within the international movement on so many levels. I wish Philippe well in 2011 and into the future. Thanks also to my colleagues on the Board for their work as volunteer representatives and directors of Médecins Sans Frontières Australia. Finally, thank you to our donors who have in 2010 made it possible for us to make an even greater contribution to the benefit of our patients. Sincerely, Dr Nicholas Coatsworth ustrralia President, Médecins Sans Frontières Australia


w w w.m sf. org. a u Paul McPhun

2010 Year in review 2010 was a remarkable year, not only for Médecins Sans Frontières Australia, but for the Médecins Sans Frontières movement as a whole. As already well elaborated in the President’s message, Haiti is for many reasons the country most will associate with natural disaster and humanitarian action in 2010. The earthquake that struck Haiti resulted in the largest scale medical humanitarian response Médecins Sans Frontières has ever launched, and this was possible only given the immense support we continue to receive from our Australian donors. This support has enabled multiple, complex and large scale emergency activities to be launched simultaneously in response to the massive needs generated in this horrific disaster. It also enabled us to scale up rapidly, where other organisations depended first on securing sufficient funds. As a result, this emergency response had a significant impact on all Médecins Sans Frontières offices around the world, where huge pressure was placed upon all departments to support the operational needs of this immense response. By contrast, the devastating floods in Pakistan garnered less media attention, and risks now slipping into the ‘forgotten crisis’ category as new events worldwide in 2011 emerge. It is worth remembering that over 20 million people (twice the population of Haiti) lost their homes and their livelihoods in this natural disaster, and the long term impact of this will also take many years to resolve. Médecins Sans Frontières has committed to continue its medical activities in recognition of the chronic ongoing needs of this highly vulnerable population, on top of our continuing programs for populations in conflict affected regions such as Balochistan and Khyber Pakhtunkhwa Province. 2010 was also a year of multiple outbreaks of infectious disease. Again Haiti and the failure of the international community at large to prevent cholera-related deaths drew the attention of the world as already highlighted. But it is also worth noting that across the organisation, while this was going on, many other Médecins Sans Frontières field staff were also managing large scale cholera emergencies, in Chad, South Sudan, Central African Republic, Democratic Republic of Congo, Nigeria, Papua New Guinea and more. Again, all offices of Médecins Sans Frontières around the world were called upon to support, with the provision of field staff, specialist medical support, communications support and fundraising efforts to enable our field teams to manage the scope of these outbreaks.

The greatest impact of these emergencies in addition to our regular planned programs surely fell on our Field Human Resources (HR) department. They rose to the challenge, filling 198 field placements with Australians and New Zealanders compared to 118 in 2009. Emergencies were not limited to large scale international disasters. Our Field HR team also played an integral role in supporting rapid assessments and emergency responses locally in the Asia-Pacific region. In addition to their regular focus on recruitment and placement, the team has also been active on an international level to further the quality and efficiency of HR management within the international organisation. They were and still are engaged in projects such as the End of Mission Survey, the National Staff Common Remuneration Project, the International Retention Benefits Scheme and the development of an International Human Resources Database/Management System. Our communications teams were no less active, as a significant demand for information fell to Médecins Sans Frontières, as a key and hugely relevant actor in emergencies worldwide. The relevance of Médecins Sans Frontières Australia in support of field communication needs has been undeniable this year. Our own Head of Communications travelled to Pakistan and assumed the role of Emergency Communications Officer on behalf of the organisation in response to the floods there. Our Press and Information Officer travelled to South Sudan to support Médecins Sans Frontières activities, and was called upon to relocate again to South Sudan for two months to support the organisation through Sudan’s unstable referendum process at the start of 2011. Our Communications Officer was also in the field in Kenya, producing material on paediatric tuberculosis and Prevention of Mother-to-Child Transmission of HIV. Of significant note and direct relevance to field operations, our communications and fundraising departments jointly developed a unique online visual presentation of a Haiti Cholera Treatment

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2010 Year in review continued Centre, a tool used for visibility and leverage where the international response to the emergency was seen to be lacking. On the home front, the communications department worked with the Project Unit - Médecins Sans Frontières Australia’s medical team - to launch the inaugural International Child Health Seminar and for the second year, organise a series of lectures for International Women’s Day, this time on the topic of sexual violence. Our regular publications to keep our donors and association members up to speed continued despite additional workloads, as did the regular input in support of all department activities. Although Médecins Sans Frontières Australia does not subscribe to fundraising appeals linked to international crises, the impact of the disasters in Haiti and Pakistan were nevertheless significant on the workload of our fundraising and administration teams. Every effort was made to ensure our supporters understood the needs we faced elsewhere, and secure their pledges as open and not earmarked donations. This was very successful, as was the planned activities of our fundraising department, which raised over $56 million in 2010, an increase of over $13 million on the previous year’s activities. The finance and administration departments also achieved a huge amount in 2010, ensuring administrative and IT support to all departments and our partners within the movement, updating internal policies and procedures, completing a remuneration review and deploying a new system of performance management. The Project Unit continued to prove invaluable in providing technical support in the fields of women’s health and paediatrics to field projects. The head of the Project Unit based in Sydney assumed the dual role of supervisor for all Project Unit activities as well as deputy medical director to the Operational Centre Paris (OCP). Members of the Project Unit conducted nine field visits in support of medical activities in Democratic Republic of Congo, Sudan, Congo Brazzaville, Kenya, Uganda, Laos and Central African Republic. Much input was given to improving medical guidelines, protocols, tools, and trainings.

missions were launched in Papua New Guinea and Indonesia in response to cholera outbreaks and a tsunami. In 2011 a new department will be formed under the direction of the emergency desk in Paris to assume an even greater responsibility for regional emergency management from the Sydney office. Last, but far from least, 2010 marked a significant turning point in the relationship between the Médecins Sans Frontières sections contributing to the OCP group. Following years of careful, slow and sometimes frustrating progress, the sections of Médecins Sans Frontières USA, Japan, France and Australia reached formal agreements on a new common governance structure, and a commitment to a shared social mission supported by all as equal partners. Although each section remains independently managed through its boards and executives, two new international group platforms will now ensure greater collaboration and participation in group decision making, and strategic development in support of OCP operational objectives. The outcome of this is to better utilise the capacities and experiences of all partners to enhance decision making, limit areas of duplication, and provide for great resource security to operations, whilst also enabling us as a group to start thinking in terms of longer commitments to operations over a period of years, instead of on annual cycles of support. As our own field interventions become ever more complex, and as Médecins Sans Frontières takes on longer term commitments in specialised hospitals, and to large cohorts of patients with complicated diseases such as HIV and tuberculosis, the OCP group will be better positioned to support these ambitions through a reliable and committed partnership. None of the impressive achievements in 2010 would have been possible without the outstanding support of our loyal donor community, and the impressive commitment of our office staff and volunteers and board of volunteers. I would like to take this opportunity to sincerely thank everyone for their extraordinary commitment to our patients overseas, and I very much look forward to reporting on the exciting plans and outcomes of 2011. Sincerely,

A lot of effort went into better management of Médecins Sans Frontières Australia’s regional emergency surveillance capacity. A regional mapping exercise was undertaken, baseline tools and resources introduced, and exploratory

Paul McPhun Executive Director, Médecins Sans Frontières Australia

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Médecins Sans Frontières projects funded by Australian donors

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Médecins Sans Frontières field projects are run by five operational centres (France, Switzerland, Spain, Holland and Belgium). The Australian section is an offical partner of the French operational centre, and Australian donors fund projects run by both the French and the Swiss operational centres. When needed, Médecins Sans Frontières Australia also provides human resources and medical support to all operational centres’ projects.

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Country 1. Burkina Faso 2. Cambodia 3. Cameroon 4. Central African Republic 5. Chad 6. Democratic Republic of Congo 7. Djibouti 8. Ethiopia 9. Haiti 10. Iran 11. Iraq 12. Kenya 13. Kyrgyzstan 14. Malawi 15. Mali 16. Mozambique 17. Myanmar 18. Niger 19. Occupied Palestinian Territory 20. Pakistan 21. Republic of Congo 22. Somalia 23. Sudan 24. Swaziland 25. Uganda 26. Yemen Other countries

A$ MSF France

A$ MSF Switzerland

1,360,000 700,000

74 66

900,000 480,000 690,000 2,990,000 400,000 421,902 2,560,000 1,680,000 2,300,000

1,300,000 680,000 500,000

9

10

18

5

26

23

7 8

4

3 21 9

6

25 12 22

14 16 1,200,000 600,000 800,000

24

1,300,000 1,500,000 2,000,000

1,000,000 700,000

Note: An amount of A$200 was specifically directed to MSF Belgium to be donated for a project in Afghanistan.

300,000

20 17

15 2

3,368,500 900,000

900,000 1,601,500 640,000 1,900,000 50,000

11

19

1 300,000 800,000 200,000

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www.msf.org.au

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Australian and NZ field staff 2010 Afghanistan Raewyn Turner Armenia

OT nurse

Colombia

Stephanie Johnston

pharmacist

Democratic

Janthimala Price

field coordinator

Republic of

Melinda Staunton

counsellor

Congo

Peter Wigg

psychiatrist medical coordinator

Bangladesh Stewart Condon Robert Gardner

administration/

Katrina Harper

medical doctor

financial coordinator

Rachel Creek

logistician/administrator

Emily Berry

logistician/administrator

Jean-Paul Margot

logistician

Michael Rowell

administration/ financial coordinator

Ethiopia

Margie Barclay

nurse-midwife

Kaye Bentley

administration/

Burundi

Henri Stein

logistician

Cambodia

Gina Bark

field coordinator

Linda Pearson

field coordinator

Jennifer Gibson

logistician/administrator

Rolands Selis

nurse

Stella Smith

nurse

Colin Watson

nurse

Central African Republic

Chad

Georgia

Kaheba Clement Honda nurse

Judy Coram

psychologist

Suman Majumdar

medical doctor

Louise Johnston

nurse

Guinea

Devi Lalloo

nurse

Alan Scott

surgeon

Haiti

Ahmose Abrahim

logistician

Eline Whist

medical doctor

Sarah Andrews

medical doctor

Cassandra Arnold

medical doctor

Alana Baker

nurse

Sita Cacioppe

nurse

Margie Barclay

midwife

Mireia Coll Cuenca

nurse

Margaret Bell

midwife

Stephanie Johnston

pharmacist

Virginie Whiteway-Wilkinson China

financial coordinator

Rebecca Bennett

psychologist

nurse

Franck Boulay

logistician

Brian Willett

logistician

Sita Cacioppe

nurse

Matthew Apostola

logistician

Cath Deacon

medical doctor

Lee-Anne Cameron

administration/

Robert Delacour

nurse

financial coordinator

Matthew Everitt

logistics coordinator

Helle Poulsen-Dobbyns field coordinator

Nerida Greenaway

OT nurse

Kelly Wilcox

Rosemary Hay

medical doctor

field coordinator

Australian nurse-midwife Margaret Bell in Haiti, February 2010. Š Benoit Finck /MSF

Debra-Lee Holman

nurse

Malcolm Hugo

psychologist

Louise Johnston

nurse

Tracey Leslie

water/sanitation

Rachel Marsden

OT nurse

Damien Moloney

logistician

Michael O’Brien

nurse

Sneha Parghi

medical doctor

Katrina Penney

midwife

Stuart Perry

anaesthetist

Lesli Bell Powell

logistics coordinator

Amy Ruede

OT nurse

Arnold Santiago

logistics coordinator

Alexandra Serri

field coordinator

Robert A Simpson

medical doctor

Henri Stein

logistician

Mohamad-Ali Trad

medical doctor

Raewyn Turner

OT nurse

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Australian and NZ field staff 2010 continued Haiti

India

Paras Valeh

epidemiologist

David Walkley

logistician

Colin Watson

nurse

Sally Stevenson

head of mission

Devika Tharumaratnam medical doctor Indonesia

Kate Ferguson

logistics coordinator

Helle Poulsen-Dobbyns medical coordinator

Iraq Jordan

Sally Stevenson

head of mission

Anne Taylor

head of mission

Susan Petrie

psychologist

Susan Petrie

medical coordinator

Michael Rowell

administration/ financial coordinator

Kenya

Kyrgyzstan

Malawi

Prue Coakley

field administrator

Jennifer Gibson

field administrator

Jacinta Hurst

field coordinator

Janine Issa

midwife

Australian nurse Monica Burns in Malawi, May 2010. Š Nabila Kram

Nigeria

Haydar Alwash

surgeon

Don McCallum

logistician

Kevin Baker

anaesthetist

Catherine Moody

head of mission

Debra Blackmore

medical doctor

Rebecca Bennett

psychologist

Prue Coakley

field administrator

Erin Calabrese

nurse

Chris Daley

logistician

Malcolm Hugo

psychologist

Judith Forbes

anaesthetist

Jonathan Nichol

nurse

Jacinta Gibson

logistician

Toby Barton

logistician

Fiona Gillett

midwife

Roslyn Brooks

medical doctor

Aisleen Glasby

nurse

Monica Burns

nurse

Eileen Goersdorf

OT nurse

Heather Cook

field administrator

Alan Hughes

obstetrician/gynaecologist

Chris Daley

logistician

Nicole Hunter

field administrator

Chris Fletcher

nurse

Kamalini Kalahe-Lokuge epidemiologist

Rosemary Hay

medical doctor

Abi Kamara

logistician

Serene Hu

medical doctor

Janet Loughran

anaesthetist

Abi Kamara

logistician

Jenny Mackenzie

medical doctor

Ellen Kamara

administration/

Uma Naguleswaran

medical doctor

financial coordinator

Melinda Perrottet

logistician

nurse

Kelly Saunders

nurse

Natasha Martin

pharmacist

Alan Scott

surgeon

Lisa Mazlin

nurse

Sally Thomas

logistician

Henri Stein

logistician

Bill Wilson

logistician

Laura Margison

Pakistan

Lisa Trigger-Hay

medical doctor

Haydar Alwash

surgeon

Shelagh Woods

head of mission

Eugene Athan

epidemiologist

Sofie Yelavich

medical doctor

Michael Bala

medical doctor

Mongolia

Maria Cartwright

field coordinator

Toby Barton

logistician

Niger

Daniel Baschiera

logistician

Monica Burns

nurse

Warren Keen

logistician

Frederick Cutts

logistician

Christopher Lack

medical doctor

Fiona Gillett

midwife

Awras Majeed

medical doctor

Julianne Millar

medical doctor

Damien Moloney

logistician

Brian Moller

field coordinator


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Australian and NZ field staff 2010 continued Sudan

Australian nurse Sam Bartlett in South Sudan, November 2010. © Kate Geraghty/ Fairfax Media

Pakistan

Sam Bartlett

nurse

Terry Coffey

logistician

Janet Coleman

midwife

Anthony Flynn

field coordinator

Anthony Flynn

medical team leader

Lisa Gray

nurse

Alan Hughes

obstetrician/gynaecologist

Peter Labattaglia

surgeon

Robyn Lea

midwife

Lesley Ludkin

HR officer

Matthew Merrington

logistician

Wedyan Meshreky

pharmacist

Danielle Moss

field administrator

Wanda Tan

medical doctor

Alexander Wilson

paediatrician

Ruth Dabell

nurse

Uganda

Liz Bannister

medical doctor

logistics coordinator

Rebecca Caporn

nurse

Ruth Priestley

nurse

Will Robertson

head of mission

Lisa Searle

medical doctor

Mark Ward

logistician

Michael Seawright

field coordinator

Sofie Yelavich

medical doctor

Kevin Baker

anaesthetist

Hannah Jensen

psychologist

Julie Guy

medical doctor

Carol Nagy

medical coordinator

Carolyn Merry

head of mission

Kelly Wilcox

field coordinator

Joanne Sage

nurse

Lesli Bell Powell

Amy Ruede

OT nurse

Raewyn Turner

OT nurse

Peter Wigg

psychiatrist

Chris Daley

logistics coordinator

Kate Ferguson

logistician/administrator

Papua New Guinea

medical doctor

Swaziland

Yemen

Palestinian Territories

Philippa Boulle

Janet Loughran

anaesthetist

Clair Mills

field coordinator

Carol Nagy

medical coordinator

Penny O’Connor

medical coordinator

John Parker

medical coordinator

Karina Severin

medical doctor

Somalia

David Nash

field coordinator

Sri Lanka

Kevin Baker

anaesthetist

Jessica Cooper

OT nurse

Juliet Donald

psychologist

Kathleen Leach

psychologist

Jayne Martin

field coordinator

Susanne Weress

pharmacist

Zimbabwe

Michael Bala

medical doctor

Veronique De Clerck

medical coordinator

Cath Deacon

field coordinator

Andrew Dimitri

medical doctor

Australian logistician Toby Barton in Malawi, May 2010. © Nabila Kram


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Projects funded by Australian donors Médecins Sans Frontières’ field projects are run by five operational centres (France, Switzerland, Spain, Holland and Belgium). The Australian section is an official partner of the French operational centre, and Australian donors assist in the funding of projects run by both the French and the Swiss operational centres. When needed, Médecins Sans Frontières Australia also provides human resources and medical support to all operational centres’ projects. Listed below are all the French and Swiss projects which are supported by donations received by Médecins Sans Frontières Australia. If you would like to read more about our projects across all operational centres, please refer to the 2009 International Activity Report. The 2010 International Activity Report will soon be available online at www.msf.org.au.

BURKINA FASO Nutrition, malaria Total Field Staff: 251 Funding: A$1,360,000 (approx 25% of total project costs) Project locations: Titao, Yako Malnutrition is a chronic problem in Burkina Faso, but hits particularly hard in the period between the two annual harvests, known as the ‘hunger gap’. Since 2007 Médecins Sans Frontières has been treating malnutrition in children under the age of five in the northern districts of Yako and Titao. Our treatment programs are based in 16 local health centres, bringing care closer to more people’s homes. We expanded the hospital in Titao in 2010, building an extra structure that increased capacity from 80 to 150 beds. In 2010, more than 11,700 children received care for malnutrition. Since the project started in 2007, more than 50,000 children have

A TB consultation in a prison in Phnom Penh, Cambodia. Overcrowding, lack of ventilation and generally poor living conditions in prisons mean there tends to be a high risk of TB infection. In 2010, Médecins Sans Frontières extended its HIV and TB services in Phnom Penh prisons to provide comprehensive testing, counselling and treatment for both diseases. © Brigitte Breuillac/MSF

received care. 3000 HIV patients were transferred to the care of the health Malaria is very common in Burkina Faso and in 2010 we

authorities, and Médecins Sans Frontières shifted its focus

increased our efforts to combat the disease, offering testing

to tuberculosis (TB) care.

and treatment to every person at every centre where we were working. Between August and December, approximately

Cambodia is one of 22 countries listed by the World Health

74,300 people received treatment, including 780 children

Organization as having a high burden of TB. In Kampong

who had more serious forms of malaria.

Cham, the most populous province in the country, our teams worked to improve the diagnosis and care of people with TB

CAMBODIA

and drug-resistant TB (DR-TB). Staff established a chest clinic

HIV/AIDS, tuberculosis, response to epidemics Total Field Staff: 76

within the TB ward of Kampong Cham provincial hospital, and

Funding: A$700,000 (approx 32% of total project costs) Project locations: Kampong Cham, Phnom Penh

patients who had been admitted to hospital for other reasons.

began to actively seek patients with TB, and offer TB testing to

By the end of 2010, the number of TB patients had increased by In 2010, Médecins Sans Frontières completed the handover

25 per cent, and revealed a need for improved patient follow-up.

of its activities in the infectious disease department of the

Médecins Sans Frontières had carried out an assessment of

Khmer-Soviet Friendship Hospital in Phnom Penh. More than

facilities for TB care in four districts of Kampong Cham, and


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Projects funded by Australian donors continued had begun providing TB care in local health centres.

received care in 2010. Médecins Sans Frontières is conducting outreach activities from the pavilion so that people living

Overcrowding, lack of ventilation and generally poor living

further away can access care more easily. In 2010, the Ministry

conditions in prisons mean there tends to be a high risk of TB

of Health declared the pavilion a national reference point for

infection. Médecins Sans Frontières extended its HIV and TB

the treatment of Buruli ulcer.

services in Phnom Penh prisons to provide comprehensive testing, counselling and treatment for both diseases. Teams

CENTRAL AFRICAN REPUBLIC

also provided general healthcare.

Primary healthcare, emergency healthcare, surgery, obstetrics, paediatrics, HIV/AIDS, tuberculosis Total Field Staff: 253

In Phnom Penh men’s prison, more than 80 per cent of inmates agreed to be tested, and results showed 3 per cent prevalence of HIV in comparison with 0.6 per cent among the general

Funding: A$480,000 (approx 7% of total project costs) Project locations: Paoua, Mongoumba, Carnot, Bocaranga

population, and 3.9 per cent prevalence of TB in comparison with 0.7 per cent among the general population. Prevalence

The Central African Republic (CAR) has suffered armed conflict

was slightly lower in the city’s women’s and children’s prison,

between rebel groups and the government for the past five

at 2.7 per cent and 2 per cent, respectively.

years. People face enormous difficulties in accessing healthcare. Many live in extremely isolated regions, and travelling is

Our teams also assisted during cholera outbreaks across the

dangerous as banditry is widespread.

country in 2010. Staff provided technical support and cholera kits that were adapted for use in national treatment centres. In

Since 2006, Médecins Sans Frontières has been working in the

collaboration with other organisations, Médecins Sans Frontières

referral hospital in the town of Paoua in the northwest of the

helped to strengthen the surveillance system for communicable

country. Teams provide paediatric, surgical, maternal, emergency

diseases, especially cholera, dengue fever and measles. Staff

and outpatient care. More than 35,150 consultations were

are working with health programs at national and provincial

carried out in 2010, and more than 6900 patients were admitted

levels, investigating suspect cases and analysing the performance

to hospital. Staff held more than 7400 antenatal consultations,

and challenges of the care given. This should enable timely

and assisted more than 1500 births. Teams also cared for 320

identification of outbreaks and a more efficient response.

patients with HIV/AIDS, including patients coinfected with both TB and HIV. Staff worked in seven health centres in the surrounding

CAMEROON

area, carrying out nearly 4000 consultations every month.

Buruli ulcer Total Field Staff: 52

Médecins Sans Frontières also provided a paediatric service

Funding: A$900,000 (approx 45% of total project costs) Project locations: Akonolinga

in Bocaranga hospital, 100 kilometres west of Paoua. Teams admitted around 160 children to the hospital and held an average of 1000 consultations with children under five every

Buruli ulcer is an infection related to leprosy and TB, which can

month. During the seasonal peak of malaria, teams provided

cause painful wounds and physical deformations, and often

supplementary support to this zone’s health posts.

leads to social stigma for people with the disease. Early diagnosis and treatment are vital to prevent irreversible deformities, but

In November 2009, Médecins Sans Frontières launched an

treatment is complicated, expensive, and can take over a year,

emergency program along the Ubangi River to bring aid to the

involving antibiotics, skin transplants, special wound dressings

tens of thousands of Congolese (DRC) refugees in exile in the

and physiotherapy.

south of CAR and in the Republic of the Congo. In January 2010, the program was extended to provide medical care to

Since 2002, more than 1000 patients have been treated at

15,000 refugees who had settled in the south of CAR. Our teams

Médecins Sans Frontières’ program in Akonolinga, a town

brought primary and secondary healthcare to refugees and

in central Cameroon. Médecins Sans Frontières has set up a

residents of Mongoumba and the surrounding area. There

“Buruli pavilion” in the town’s hospital, where 120 patients

were an average of 5000 consultations per month. In February


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Projects funded by Australian donors continued 2010, 12,500 children aged six months to five years were

In Dogdoré, 30 kilometres from the border with Sudan, residents

vaccinated against measles. The presence of other organisations

live alongside a large number of displaced people. Médecins

providing healthcare in the area allowed us to close the project

Sans Frontières teams carried out more than 12,100 medical

in Mongoumba at the end of August 2010.

consultations and treated 430 patients in hospital during the first seven months of 2010. They provided 2460 antenatal

In 2010, Médecins Sans Frontières began a new HIV/AIDS

consultations, assisted more than 200 births and vaccinated

project in the south-eastern city of Carnot, where we had been

some 1060 children against measles. More than 400 people

running a nutritional program since 2009. The program aims

were admitted to the nutritional rehabilitation program.

to develop a sustainable strategy for providing HIV care in a context with very poor health infrastructure.

In July 2010, however, Médecins Sans Frontières was forced to close the program. Repeated security incidents made it

CHAD

impossible to maintain a team in Dogdoré. Before leaving,

Nutrition, obstetrics, vesico-vaginal fistula, response to epidemics Total Field Staff: 492

Médecins Sans Frontières donated drugs and medical supplies

Funding: A$1,990,000 (approx 7% of total project costs) Project locations: Abéché, Dogdoré, Hadjer Lamis, Moissala, N’Djamena

to the hospital to help ensure the continuation of medical care after the team’s departure. In the city of Abéché, Médecins Sans Frontières continued running Project Papillon (Project Butterfly), treating 144 women with obstetric fistula. We also supported the regional maternity

In 2010, the heaviest rains for 40 years destroyed crops, flooded

hospital, with the objective of improving obstetric care in order

wells and cut off entire villages in Chad. These floods followed a

to prevent new cases of fistula occurring. In 2010, our staff

long drought in 2009, which had already resulted in a significant

assisted with more than 3400 deliveries.

drop in farm production. Chadians faced a major food crisis and several outbreaks of disease, including cholera, meningitis,

In several health centres in Moissala, a district in southern Chad,

measles and malnutrition. One quarter of children under the

our staff trained community health workers to screen patients

age of five were suffering from acute malnutrition in the Sahel

for malaria and offer early treatment for uncomplicated cases.

region of western Chad in 2010.

People suffering from complicated malaria were referred to

A child is vaccinated against measles during an outbreak in N’Djamena, Chad. Médecins Sans Frontières teams vaccinated more than 290,000 children during the vaccination campaign. © Mathieu Bichet/MSF

Moissala hospital, where Médecins Sans Frontières runs a 50-bed malaria treatment unit. More than 20,000 patients were treated for malaria over five months. More than 1030 patients were hospitalised in the malaria treatment unit. During the first months of 2010, there was an outbreak of measles in the capital city, N’Djamena. More than 400 patients were hospitalised and more than 290,000 children were vaccinated. While responding to the measles outbreak, our staff observed high rates of acute malnutrition among children. This led to the opening of a nutrition program in N’Djamena in March. An emergency program was also opened in the western region of Hadjer Lamis. More than 1500 malnourished children were admitted to the inpatient therapeutic feeding centre set up by our team in Massakory, while more than 19,700 children benefited from a system of 35 ambulatory therapeutic feeding centres throughout the region. In September, our teams treated 858 cases of cholera during an outbreak in N’Djamena.


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Projects funded by Australian donors continued DEMOCRATIC REPUBLIC OF CONGO

range of care, including surgery, paediatrics, mental healthcare,

Primary healthcare, secondary healthcare, emergency healthcare, obstetrics, surgery, paediatrics, nutrition, sleeping sickness, response to epidemics Total Field Staff: more than 648

emergency healthcare and obstetrics. The area is also affected

Funding: A$3,670,000 (approx 17% of total project costs) Project locations: Katanga, Rutshuru, Nyanzale, Haut et Bas Uélé

Médecins Sans Frontières also has a team based in Katanga

by African Human Trypanosomiasis, or sleeping sickness. Our staff treated 829 patients for this deadly disease, which is transmitted to humans through the bite of the tsetse fly.

province in south-eastern DRC, which monitors and responds to emergencies in the province as they arise. In 2010, the team responded to cholera, measles and nutritional emergencies and

In the east of the Democratic Republic of the Congo (DRC),

also provided assistance to groups of internally displaced persons.

civilians have borne the brunt of more than a decade of violent conflict. Villages have been pillaged and destroyed, armed

DJIBOUTI

men have forced people to flee, and rape has been used as a

Nutrition, response to epidemics Total Field Staff: 131

tool of war. In 2010, thousands more people were displaced from their homes by violence. Throughout the country, decades of neglect of the health system have resulted in a rise in infant

Funding: A$500,000 (approx 14% of total project costs) Project locations: Djibouti City

and maternal mortality rates and, according to the World Health Organization, life expectancy is among the lowest in the world.

Drought, rising food prices and increased numbers of migrants passing through the country have had a profound impact on

Médecins Sans Frontières has been working in the referral

Djibouti. Levels of malnutrition exceeded emergency thresholds

hospital in Rutshuru in North Kivu since 2005. The hospital has

in a number of locations in 2010. Médecins Sans Frontières

grown from being a general referral hospital with a capacity of

has concentrated its efforts on reducing malnutrition among

120 beds, to a provincial hospital with over 300 beds. In 2010,

children in the slums of Djibouti City.

there were 5082 surgical interventions, 10,867 admissions in the emergency department and 4284 deliveries in the

In 2010, we provided medical care for malnourished children

hospital. There were also more than 3600 admissions to the

in the districts of Balbala, Hayableh, Arhiba and PK12. These

paediatric department and 67 admissions each month to the

districts are home mainly to migrants, asylum seekers and

intensive care unit.

Djiboutians who have moved to the city from rural areas.

Meanwhile, in the health centre in Nyanzale in North Kivu, we

In order to reach as many of the 200,000 inhabitants of the

provided treatment to 1372 survivors of sexual violence. There

slums as possible, teams travelled from door to door to identify

were more than 2000 admissions to the nutrition program and

acute malnutrition in children and to raise awareness about the

more than 35,000 consultations took place in the outpatient

condition. According to their level of malnutrition, children were

department. Each month, an average of 171 deliveries took place

referred to one of six Médecins Sans Frontières feeding centres

in the facility. Teams also vaccinated 2700 children against

that provide outpatient care, or to our 35-bed therapeutic

measles in response to an outbreak taking place throughout DRC.

feeding centre, where children suffering from malnutrition with complications receive 24-hour medical care. Almost 1030

In Haut-Uélé and Bas-Uélé in Orientale Province in the country’s

malnourished children were hospitalised in 2010 and more

north, insecurity means that many displaced people can only

than 3620 received outpatient care.

be reached by plane. By the end of October 2010, it was estimated that there were more than 264,000 displaced people in Haut-Uélé

Our teams also vaccinated young patients against measles and

and Bas-Uélé. Médecins Sans Frontières has been working in

provided medical follow-up. In 2010, almost 140 malnourished

the area for nearly ten years and the situation has deteriorated

children in the feeding centres tested positive for TB. Staff

significantly since 2008. In Dungu, Doruma and Dingila, Médecins

treated the children for both TB and malnutrition before referring

Sans Frontières is the only medical organisation providing a full

them to the national TB program.


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Projects funded by Australian donors continued homeless in Haiti, Médecins Sans Frontières mobilised the largest emergency response in the organisation’s 40-year history. Funding from Médecins Sans Frontières Australia contributed to the running of Saint Louis Hospital – the inflatable tent hospital that replaced the destroyed La Trinité hospital – which provided emergency medical care as well as more specialised trauma and orthopaedic surgical care. Sadly, 12 Haitian Médecins Sans Frontières staff members were killed in the earthquake. Thousands of Haitians, most of whom were directly affected by the disaster, mobilised along with hundreds of international staff to help Médecins Sans Frontières provide assistance. The existing group of 800 field staff in Port-au-Prince quickly expanded to 3400 A team travels to a remote village in the Gambella region of Ethiopia. Depending on the season, mobile teams travel by car or by boat to provide care to the most isolated populations, carrying out 6800 consultations between April and December 2010. © Guillaume Clatot / MSF

people working in 26 hospitals and four mobile clinics. From 12 January to 31 October, medical teams treated more than 358,000 people and performed more than 16,500 surgeries.

ETHIOPIA

The Médecins Sans Frontières obstetric and trauma hospitals

Primary healthcare, secondary healthcare, obstetrics Total Field Staff: 150

were destroyed. Only the Martissant emergency facility, in

Funding: A$400,000 (approx 19% of total project costs) Project locations: Gambella

overwhelmed. Within hours of the earthquake, more than

The Nuer population of the Gambella region, in the far west

At the centre in Pacot, which provided post-operative care,

of Ethiopia, has grown as people have crossed the border to

only one operating table was available for minor operations.

escape violence in southern Sudan. In May 2010 Médecins Sans

In and around the collapsed La Trinité hospital, surgery was

Frontières moved into a new health centre. Staff held close to

carried out in tents and, after a few days, in a converted

29,000 consultations, and 873 patients were hospitalised.

shipping container. Within approximately 48 hours, our

The main illnesses suffered by patients were respiratory tract

teams identified available rooms and a dressing station at

infections, diarrhoea and malaria. Maternity staff assisted an

the Ministry of Health’s Choscal hospital and managed to

average of 10 births per month. Depending on the season,

start surgical activities in two operating theatres there. By

mobile teams travelled by car or by boat to provide care to the

15 January, major surgery was also being provided in tents

most isolated populations, carrying out 6800 consultations

around Carrefour hospital. Our surgeons performed more

between April and December.

than 5700 major surgical procedures during the first three

south Port-au-Prince, was still operational, but it was quickly 400 critically injured patients had arrived at Martissant.

months, 150 of which involved amputations.

HAITI Primary healthcare, secondary healthcare, surgery, obstetrics, emergency healthcare, mental healthcare, response to epidemics Total Field Staff: 3104 (including earthquake

Emergency field hospitals were set up in all kinds of structures

response for all Médecins Sans Frontières sections) Funding: A$421,902 (approx 1% of total project costs) Project locations: Port-au-Prince

and post-operative care. More than 500 patients underwent

In the wake of the devastating earthquake of 12 January 2010,

Médecins Sans Frontières to help patients recover and adapt

which killed an estimated 222,000 people and left 1.5 million

to prosthetics. Mental healthcare was also provided.

– a dental clinic at Bicentenaire, a school in Carrefour, and semi-permanent buildings in Léogâne, west of Port-au-Prince. In Sarthe, we opened a centre for post-emergency surgery specialised orthopaedic or reconstructive surgery. Handicap International physiotherapists worked in collaboration with


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Projects funded by Australian donors continued Jacmel, a town on the south coast, was also badly hit by the

other health providers. Médecins Sans Frontières provided

earthquake, and our teams started supporting the 80-bed Saint

psychosocial or psychiatric support to more than 40,000

Michel hospital on 22 January. Staff carried out 662 surgical

people during the initial emergency phase.

operations and delivered 1443 babies over the course of the year. By the end of June, Médecins Sans Frontières had distributed As our emergency obstetric hospital had been destroyed,

more than 28,640 tents, approximately 2800 rolls of plastic

Médecins Sans Frontières started offering staff, drugs and

sheeting, and close to 85,000 relief supply kits (made up of

obstetrics expertise to support the Ministry of Health maternity

items such as cooking utensils, hygiene products and blankets)

hospital, Isaïe Jeanty, which had not been damaged by the

to people living near the epicentre of the earthquake.

earthquake. Isaïe Jeanty treats pregnant women with medical complications such as eclampsia and malaria, and provides

Much of Médecins Sans Frontières’ water and sanitation work

neonatal and postnatal services and a blood bank. In Léogâne,

focused on creating the appropriate hygiene conditions to

our staff set up a 120-bed field hospital, which was later replaced

carry out medical and surgical programs. Teams ensured the

with a more permanent container hospital. More than 15,000

supply of safe water, constructed or rehabilitated latrines, and

babies were delivered in Médecins Sans Frontières supported

set up the safe evacuation of waste at our 26 facilities.

facilities in 2010. In mid-October, suspected cases of cholera, a disease not When Médecins Sans Frontières’ La Trinité hospital was destroyed,

reported in the country for decades, emerged in the Artibonite

Haiti lost its only specialised treatment unit for severe burns.

region, western Haiti. Médecins Sans Frontières dispatched

Re-establishing this unit became a priority, especially given

teams to the town of Saint Marc and they immediately began

the dangerous living conditions. By late March, a new 30-bed

treating patients for severe dehydration from diarrhoea in the

burns unit had been set up under canvas within the nearby

Ministry of Health hospital.

Saint Louis hospital compound. The outbreak would eventually touch every province in the Psychiatric care was also organised at Saint Louis hospital for

country. From 22 October until the end of the year, our teams

patients who required mental health services and could be

treated more than 91,000 of the 171,300 people reported as

referred from other Médecins Sans Frontières programs or

having cholera nationwide. Specialised treatment centres were set up for pregnant women in Isaïe Jeanty hospital and in

A field worker speaks with a patient trapped under the collapsed La Trinité hospital in Port-au-Prince, Haiti. Following the earthquake, he was trapped under the building for four days before being rescued. © Ron Haviv/VII

Léogâne. Teams established over 4000 beds in 47 facilities around the country. More than 1000 tons of medical and logistical supplies were delivered, and more than 5500 staff dedicated to cholera treatment.

IRAN Primary healthcare, maternal and child healthcare Funding: A$2,560,000 (approx 62% of total project costs) Project locations: Zahedan One to two million undocumented Afghans are estimated to be living in Iran. People are continually crossing the border between the two countries, both voluntarily and under pressure from Iran’s policy of repatriation. Most of the Afghans living in Iran are longstanding residents. For more than a decade, Médecins Sans Frontières’ assistance in Iran has focused on medical support for vulnerable and


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Projects funded by Australian donors continued IRAQ Surgery, emergency healthcare, dialysis Total Field Staff: more than 76 Funding: A$1,980,000 (approx 20% of total project costs) Project locations: Kirkuk, Ninewa, Amman (Jordan) The seventh year of violence and political tension since the war began saw continuing pressure on the emergency capacity of the health system in Iraq. The needs are not only for trauma care following explosions but for a whole range of specialist services. Direct access to victims of the violence in the most densely populated areas remains limited for international and independent humanitarian organisations. Activities are still considerably restricted by the remaining threats to staff, but the response to pressing needs in the country developed in new directions in 2010. The ability to travel and work in some of the more stable parts of the country has increased Médecins Sans Frontières’ A child is assisted during a rehabilitation session in Zahedan, Iran. For more than a decade, Médecins Sans Frontières’ assistance in Iran has focused on medical support for vulnerable and minority groups. In 2010 staff held more than 6300 consultations per month in three clinics in Zahedan. © Marit Helgerud/MSF

capacity to support more complex areas of medicine and to raise standards of care. Although many health facilities are functioning, the quality of

minority groups. We have opened three clinics in Zahedan,

care has been affected by a shortage of specialised staff and

the provincial capital of Sistan-Baluchestan. In 2010 staff held

lack of training. According to the Iraqi health ministry, hundreds

more than 6300 consultations per month. Médecins Sans

of medical employees have been killed in the course of the

Frontières refers patients requiring specialist medical and

conflict and great numbers have fled the country.

surgical care to Ministry of Health structures, covering the costs of emergency care, specialist consultations, treatment

Iraq is short of nurses and of specialist doctors and there has

and hospitalisation. All referrals are followed up by a Médecins

been no upgrading of skills since the early 1990s. Iraq’s doctors

Sans Frontières doctor.

once provided some of the highest quality and best resourced services in the region, but now the quality of some medical

In a fourth clinic, our team focuses on maternal and paediatric

services is seriously impaired.

care. Our staff ensures that uncomplicated deliveries are performed at the national safe delivery centres, and high-risk

The pattern of remote support for Iraqi staff and for Ministry

births are referred to the city’s hospitals. A home visitor team,

of Health facilities still prevails, with Médecins Sans Frontières

which includes midwives, ensures postnatal care directly in

providing more general support to four hospitals in Kirkuk

patients’ homes.

and Ninewa by providing medical supplies and supporting emergency response and health education campaigns.

There is also a team responsible for identifying vulnerable people and ensuring that they get the care they need. Staff

Médecins Sans Frontières has carried out training in on-the-

make home visits in Zahedan to find returnees, identify their

spot triage, a process for determining the priority of patients’

needs, and offer training in basic hygiene and distribute relief

treatments based on the severity of their condition. As a result,

items such as food, cleaning materials, blankets and heaters.

a functioning triage system has now been implemented in all four emergency departments. In Kirkuk, Médecins Sans Frontières also supports the dialysis unit of the public hospital and started a renal treatment


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Projects funded by Australian donors continued program in June 2010 for patients with severe kidney failure. The target is to treat around 80 people who need the complex dialysis procedure. In the northern city of Hawijah, a Médecins Sans Frontières surgical team of Iraqi doctors in the general hospital performs around 300 operations a month. The reconstructive surgery program in the Jordanian capital of Amman, which was started in 2006, continued to receive Iraqi patients. In 2010, more than 300 people benefited from the orthopaedic, maxillofacial and plastic specialties. Treatment and follow-up are complex, requiring months of hospitalisation. The team carried out 19,000 individual physiotherapy sessions over the year.

KENYA HIV/AIDS, tuberculosis, sexual violence, primary healthcare, obstetrics, surgery, paediatrics, nutrition Total Field Staff: 368

In the Kenyan capital Nairobi, Médecins Sans Frontières provides HIV/AIDS and TB treatment in the slum area of Mathare. Here, 3170 people living with HIV/AIDS are receiving care at the Blue House clinic, with 2522 on antiretroviral treatment. © William Martin/MSF

Funding: A$3,100,000 (approx 21% of total project costs) Project locations: Homa Bay, Nairobi, Dadaab

refugees, there is little solace to be found on the Kenyan side of the border. Médecins Sans Frontières has taken charge of the healthcare needs of refugees living in Dagahaley camp,

There are 1.5 million people living with HIV/AIDS in Kenya,

part of a complex of refugee camps near Dadaab. There are

and Médecins Sans Frontières’ work in the country continues

300,000 people living in a space made for 90,000 in the Dadaab

with a strong focus on HIV care. In an effort to improve access

camps. With the camps already overcrowded, new arrivals have

to treatment, Médecins Sans Frontières has extended its

been forced to settle in makeshift shelters outside.

decentralised care program in Homa Bay, the district most affected by the epidemic. In collaboration with the Ministry of

Each week, there are 1400 to 1500 new arrivals from Somalia.

Health, our team ensured that treatment is available in eight

Médecins Sans Frontières has been working in the camp since

healthcare clinics across Homa Bay: 10,000 people living with

2009, running a 110-bed hospital and four health posts. In

HIV received care, of whom, 850 were children under 15 years old.

2010, an average of 10,000 general consultations were held and 600 patients were admitted to the hospital every month.

In the capital Nairobi, Médecins Sans Frontières provides

In addition to providing medical services in Dagahaley camp,

HIV/AIDS and TB treatment in the slum area of Mathare. Here,

our team also provided shelter material to 700 families and,

3170 people living with HIV/AIDS are receiving care at the Blue

with other organisations, ensured the supply of clean water

House clinic, with 2522 on antiretroviral treatment.

for the new arrivals.

In Mathare, the team also started operating a 24-hour on-call

KYRGYZSTAN

service for sexual and gender based violence. The clinic offers

Tuberculosis Total Field Staff: 34

post-exposure prophylaxis – medication that greatly reduces treat around 70 patients every month, many of whom are children.

Funding: A$200,000 (approx 10% of total project costs) Project locations: Bishkek

In eastern Kenya, near the Somali border, teams provided

Médecins Sans Frontières has been treating prisoners infected

healthcare where hundreds of thousands of Somali refugees

with TB in Kyrgyzstan since 2005. The incidence of the disease

live in camps around the town of Dadaab. For many Somali

in prisons has declined over the years: the number of patients

the risk of HIV infection – counselling and social support. Staff


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Projects funded by Australian donors continued MALAWI HIV/AIDS, response to epidemics Total Field Staff: 2283 Funding: A$3,368,500 (approx 30% of total project costs) Project locations: Chiradzulu In 2010, Malawi experienced its worst outbreak of measles since 1997: 105,000 cases and 251 deaths were reported. Between April and August, Médecins Sans Frontières teams helped authorities deal with the outbreak, conducting a vaccination campaign in nine districts for 3.3 million children aged between six months and 15 years. Our teams also supported the treatment of nearly 23,000 people for measles in 15 districts across the country, with a particular focus on the hard-hit southern region. The response to the emergency involved almost 1800 Médecins Sans Frontières staff. Colony 31 prison in Bishkek, Kyrgyzstan. Médecins Sans Frontières has been treating prisoners infected with TB in Kyrgyzstan since 2005. In 2010, our team treated 230 new TB patients. Around two-thirds of infectious TB patients in the penitentiary system have drug-resistant TB. © William Daniels / Panos pictures

Malawi has an ambitious HIV/AIDS treatment plan, but it continues to face a severe shortage of healthcare professionals. A lack of international donor commitments from governments

detected each year dropped from 700 to 350 between 2006

or the Global Fund to implement the treatment plan makes the

and 2010. This is mainly because of a reduction in the prison

fight against HIV a mammoth task. In 2009, more than 920,000

population. Around two-thirds of infectious TB patients in

people (11 per cent of people aged between 15 and 49 years)

the penitentiary system have drug-resistant TB (including all

were estimated to be infected with HIV, while the country had

forms of drug-resistant TB). The treatment program for drug-

an average of only two doctors per 100,000 inhabitants.

resistant TB is often very long and difficult. In 2010, our team treated 230 new TB patients.

By the end of 2010, more than 345,000 people had been enrolled in the national antiretroviral (ARV) treatment program,

Prisoners diagnosed with TB are referred to treatment facilities in three prisons in and around Bishkek, where staff work in collaboration with the Ministry of Health, the prison authorities and international organisations such as the International Committee of the Red Cross. One of the most important challenges is to assure uninterrupted treatment after release, as one-third of TB patients are released from prison before treatment is completed. Médecins Sans Frontières provides medical and social support to former prisoners with TB and is working to find ways to motivate them to complete their treatment. In 2010, 78 TB patients were released from prison, and 57 of them were still receiving treatment at the end of the year. Médecins Sans Frontières is advocating for a national TB control policy in the penal system.

Children line up to be vaccinated against measles during an outbreak in Lilongwe, Malawi. In 2010, Malawi experienced its worst outbreak of measles since 1997: 105,000 cases and 251 deaths were reported. Between April and August, Médecins Sans Frontières teams helped authorities deal with the outbreak, conducting a vaccination campaign in nine districts for 3.3 million children aged between six months and 15 years. © Nabila Kram


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Projects funded by Australian donors continued representing an estimated 63 per cent of patients requiring

We helped to increase the capacity of the paediatric department

ARV treatment.

in the district hospital of Koutiala. A team of Médecins Sans Frontières and Ministry of Health staff set up a paediatric

In 2003 Médecins Sans Frontières started providing ARV

intensive care unit, built wards to allow the hospitalisation of

treatment to people with HIV in Malawi and its programs

children with complicated malnutrition, offered staff training

soon evolved to include the prevention of mother-to-child

and assured a regular supply of drugs and medical material.

transmission, the detection of treatment failure, and the

More than 9900 children were admitted to the hospital in

provision of paediatric HIV care. Médecins Sans Frontières is

2010. More than 82 per cent of these children had malaria.

also assisting the Ministry of Health in instituting the provision of decentralised healthcare for HIV and TB from district-level

The Ministry of Health and Médecins Sans Frontières began

hospitals to community clinics and rural health posts.

a joint project in the district of Konseguela, also in Sikasso region, in March 2010. The project aims to find new approaches

In the district of Chiradzulu, our team supports HIV programs

to reducing mortality among children under five, and focuses

in 11 health centres, offering testing, holding consultations,

on simplifying and decentralising the treatment, early detection

supplying medicines, and providing dedicated TB treatment

and prevention of the main killer diseases – malaria, malnutrition,

services. By the end of 2010 more than 18,000 people living

pneumonia and diarrhoea.

with HIV in Chiradzulu were receiving ARV treatment, with some 650 new patients starting the program each month.

A clinic is held at the health centre in Konseguela, offering regular check-ups for children under two. These children

Despite having ambitious HIV treatment program guidelines

regularly receive ready-to-use food in an effort to compliment

in line with new World Health Organization recommendations,

their dietary intake in micronutrients, protein and calories to

implementation of these plans will be delayed or staged

prevent severe malnutrition. In December 2010, more than

according to available resources. Malawi did not receive

1250 children were enrolled in the program. Families with

much-needed money from the Global Fund’s most recent round

young children also receive mosquito nets. Almost 50 per cent

of funding, which ended in December 2010. These dwindling

of the 15,000 consultations held at the health centre in 2010

funding commitments point to a growing disconnect between

related to malaria.

the international community’s bold and ambitious visions for achieving global health goals, and its inability to fully support

Every month, a team visits all 17 villages in this district and

such recommendations.

carries out routine immunisations against TB, polio, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, Haemophilus

MALI

influenza type b (which can cause meningitis and pneumonia),

Paediatrics, nutrition, malaria, meningitis Total Field Staff: 305

measles and yellow fever.

Funding: A$900,000 (approx 11% of total project costs) Project locations: Konseguela, Koulikoro, Koutiala

In July 2010, trained staff in all of the villages began carrying out early screening for malaria, offering a rapid diagnostic test and treatment in order to reduce the development of severe

In the southern district of Koutiala in Sikasso region, near the

forms of the disease. Staff treated 9400 children under five

border with Burkina Faso, more than one in five children die

for non-complicated malaria in 2010.

before reaching the age of five. In July 2009, Médecins Sans Frontières started offering paediatric care, including treatment

A sharp decrease in child mortality has been reported by local

for malnutrition, to children under five in Koutiala town and

authorities and communities since Médecins Sans Frontières

in five of the 42 health areas in the district. In 2010, staff

began activities in Konseguela.

conducted 48,100 paediatric consultations, 33,300 of whom were diagnosed with malaria. A further 5360 children were

In December 2010, Médecins Sans Frontières participated in

treated for severe malnutrition.

the national preventive vaccination campaign against meningitis using a new vaccine that provides extended coverage against


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Projects funded by Australian donors continued the disease (over ten years) and stops transmission by eliminating

Sans Frontières also provides a buffer supply of HIV and TB

the carriage of the germ. With Ministry of Health staff, 85 teams

drugs to health facilities.

vaccinated more than 728,900 people aged between 1 and 29 years in three districts of the Koulikoro region.

MYANMAR

MOZAMBIQUE

HIV/AIDS, tuberculosis, primary healthcare Total Field Staff: 92

HIV/AIDS, tuberculosis Funding: A$1,200,000 (approx 30% of total project costs) Project locations: Maputo

Funding: A$600,000 (approx 22% of total project costs) Project locations: Dawei Low national and international investment in the health sector

Despite Mozambique’s recent economic growth many people

combined with tensions and low intensity conflicts limit access

in the country remain dependent on international aid. Of the

to healthcare in many areas of Myanmar. The country remains

1.6 million people living with HIV, about 430,000 are in urgent

largely isolated on the international stage and faces severe

need of life-extending antiretroviral (ARV) treatment. Along

restrictions from the international aid community. Despite the

with HIV, TB presents a serious public health concern, and up

return of the Global Fund, the country continues to suffer from

to 60 per cent of TB patients are also infected with HIV. For the

a chronic lack of resources to tackle diseases like HIV/AIDS, TB

majority of Mozambicans, access to healthcare remains very

and malaria.

limited and the frail healthcare system struggles with the high number of people infected with both HIV and TB.

More than 240,000 people are living with HIV in Myanmar, and an estimated 120,000 are in need of lifesaving antiretroviral

Over the past decade, Médecins Sans Frontières has established

(ARV) treatment. However, treatment is currently available to

standardised procedures for HIV care and treatment, paying

only 21,000 people.

special attention to treating HIV and TB co-infections. The comprehensive HIV/AIDS programs offer testing, pre- and

In Dawei district, in the south of Myanmar, Médecins Sans

post-test counselling, treatment and prevention of opportunistic

Frontières runs an HIV and TB clinic for a local population

infections that can occur as a result of a compromised immune

consisting mainly of migrant workers and fishermen. Staff also

system, psychological support, paediatric diagnosis and

conduct outreach activities in the surrounding district, going

treatment, and prevention of mother-to-child transmission.

out in the community to test people and see patients who may not be following their treatment regime. At the end of 2010,

Our teams support the Ministry of Health in providing integrated

there were 2126 enrolled in the HIV program, with 1836 patients

HIV/AIDS and TB care in five health centres in the health zone

receiving ARV treatment. There were also 421 patients registered

of Chamanculo in the capital Maputo. By the end of 2010,

in the TB treatment program. Médecins Sans Frontières also

there were 58,044 patients enrolled in the HIV treatment

provides primary healthcare to particularly vulnerable populations

program, with 12,132 receiving ARV treatment. Médecins Sans

in Thayetchaung and Palaw townships through a network

Frontières also supported the referral centre Alto Mae, where

of mobile clinics. The main morbidities are respiratory tract

more complicated patients were admitted.

infections and malaria.

To ensure that patients get care and treatment despite the

NIGER

country’s shortage of healthcare workers, Médecins Sans

Nutrition, paediatrics Total Field Staff: 782

Frontières is trying to develop programs such as task-shifting. Task-shifting trains nurses to independently assess patients, diagnose and treat opportunistic infections, and initiate and

Funding: A$800,000 (approx 13% of total project costs) Project locations: Zinder

monitor ARV treatment, thereby taking on some of the responsibilities of doctors.

Nutritional crises are a chronic problem in Niger, but a particularly poor harvest in 2009 made the 2010 crisis far worse. Global

Where the supply of HIV and TB drugs falls short, Médecins

acute malnutrition rates among children passed the emergency


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22

Projects funded by Australian donors continued threshold of 15 percent, with more than three percent of

An ambitious target was set: to reach more than 650,000

under-fives suffering from severe acute malnutrition.

children. Médecins Sans Frontières provided supplementary food rations to thousands of children aged six months to

The extent of the food crisis was recognised early, and the

three years, and results of a survey carried out in Zinder region

Ministry of Health, international organisations and national

during the second half of 2010 show that this strategy had a

associations treated 328,000 children for severe acute malnutrition.

significant impact on mortality rates.

Even when receiving good care in a high-quality nutrition

In Zinder region, Médecins Sans Frontières supported 19 health

program, between three and five per cent of patients suffering

centres in the departments of Mirriah and Magaria with feeding

severe acute malnutrition will die. For some years, Médecins

programs, providing extra staff and essential drugs to ensure

Sans Frontières’ nutrition projects in Niger have been implementing

free healthcare for children under five. A network of 250

a preventive approach. Children under two years of age who

community health workers was built up and dispatched across

are suffering moderate malnutrition or are at risk of malnutrition,

Magaria to screen children for signs of malnutrition and encourage

are given ready-to-use supplementary food before their condition

parents to seek treatment for their children. Médecins Sans

can deteriorate to the level of severe acute malnutrition.

Frontières managed two therapeutic feeding centres. More than 34,000 malnourished children received treatment for severe

In 2010, this innovative approach was taken up for the first time

and acute malnutrition in these centres. The supplementation

by the Niger government, the UN and their partner organisations.

program in Mirriah district reached more than 106,500 moderately malnourished children or children at risk of malnutrition. Our teams also provided technical support to BEFEN/ALIMA, a local association running 15 outpatient feeding centres and one therapeutic feeding centre in Mirriah department. In Zinder, Médecins Sans Frontières also treated more than 72,500 cases of malaria. Over a quarter of the children hospitalised for malnutrition were also suffering from malaria.

OCCUPIED PALESTINIAN TERRITORY Surgery, post-operative care, mental healthcare Total Field Staff: 119 Funding: A$900,000 (approx 16% of total project costs) Project locations: Gaza The conflict with Israel and the inter-Palestinian conflict within the Occupied Palestinian Territory continued to traumatise the population in 2010. Economic, social and political pressures are all making an already poor health situation far worse. The demand for psychological care is high, but capacity is limited because of a significant shortage of trained medical staff. It can be difficult for people in need of mental healthcare to find help. The team in Gaza provides psychological care as well A mother walks home carrying a supply of supplementary food in Niger. Nutritional crises are a chronic problem in Niger, but a particularly poor harvest in 2009 made the 2010 crisis far worse. As well as providing treatment for malnourished children, Médecins Sans Frontières also provided supplementary food rations to thousands of children aged six months to three years to prevent them becoming severely malnourished. © Anthony Bourasseau / MSF

as medical and social support to address the traumatic and violent consequences of the conflicts. Médecins Sans Frontières teams have been working in the Gaza Strip since 2000, adapting their activities according to the needs


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23

Projects funded by Australian donors continued The floods that hit Pakistan in 2010 affected around 14 million people. The waters swept down from the mountainous northeast into the heavily populated river valleys and plains, driving desperate people ahead of them. In a country already suffering gaps in healthcare provision the need for assistance grew enormously. Médecins Sans Frontières was the first international emergency organisation to respond to the disaster in many flood-hit areas. Along with local organisations, our teams were able to react immediately to meet the needs of people affected by the floods. As the disaster unfolded, we expanded operational activities, based on our independent assessment of people’s needs, following the path of the worst flooding from Balochistan, to Khyber Pakhtunkhwa, Punjab and finally Sindh. Funding from Médecins Sans Frontières Australia contributed to the flood response in Peshawar, Nowshera and Hangu in Khyber Pakhtunkhwa, as well as in Kot Addu in Punjab province. As the exceptional monsoon rains fell, rivers broke their banks, A patient is assisted at the post-operative care clinic in Gaza City, Occupied Palestinian Territory. In 2010, more than 180 surgical operations were performed and mental health staff held almost 3400 consultations. The rehabilitation team carried out more than 33,000 physiotherapy sessions. © Isabelle Merny / MSF

washing away bridges, roads, villages and livelihoods. Food

of the population. In 2010, despite having been partially lifted,

for the relief effort.

and safe water were in short supply. The risks of illness and contagion, and the sheer number of vulnerable people completely exposed to the elements were major challenges

the blockade was still affecting healthcare, restricting availability, provision for people with special needs, and the general quality

At the height of the flood response, more than 1600 Médecins

of care. One of the main objectives is to transfer expertise to

Sans Frontières staff were supporting hospitals, treating injuries

local Palestinian staff, who are unable to leave the territory for

and illnesses, running mobile clinics and distributing tents,

professional training. Médecins Sans Frontières is also filling

shelter materials, and washing and cooking kits. One of the

specific gaps in medical care, providing specialised surgery

most urgent needs was for safe drinking water and our teams

(reconstructive and orthopaedic) and rehabilitation for trauma

distributed up to 2.1 million litres a day. Set against the

patients, as well as medical and psychosocial assistance to help

requirements of so many uprooted people, even these figures

patients cope after experiencing trauma. In 2010, more than

were dwarfed by the scale of the disaster.

180 surgical operations were performed and mental health staff held almost 3400 consultations. The rehabilitation team

Overall in the emergency, Médecins Sans Frontières conducted

carried out more than 33,000 physiotherapy sessions.

over 100,000 consultations in five hospitals, seven mobile clinics and six diarrhoea treatment centres. Our teams conducted 434

PAKISTAN

complicated deliveries and 82 caesarean sections and treated

Primary healthcare, obstetrics, surgery, response to epidemics Total Field Staff: 1936 (including flood response

more than 8800 malnourished children.

from all Médecins Sans Frontières sections) Funding: A$1,601,500 (approx 18% of total project costs) Project locations: Peshawar, Hangu, Kurram, Nowshera, Punjab, Darband

before, during and after the floods, as it had for the last five

Fighting continued in the northern regions of the country years and our teams continued to provide emergency services for people affected by conflict. In Khyber Pakhtunkhwa and the Federally Administered Tribal Areas (FATA), the violence


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24

Projects funded by Australian donors continued shut down hospitals, access roads and the transport of medical

leishmaniasis, a parasitic disease transmitted by sand flies.

supplies. Even if emergency patients found their way to hospital,

The disease causes ulcer-like lesions and can lead to

the limitations of nursing care and low standards of equipment

severe disfigurement.

and hygiene did not ensure good quality services. More than one million people depended on Médecins Sans Frontières to

In May 2010, Médecins Sans Frontières closed its project in the

provide free emergency surgery.

town of Darband, where the team had been supporting the hospital to provide care to the population of the remote and

A new project covering emergency department services and

difficult to access Kala Dhaka valley.

emergency surgery was opened in Hangu district, close to the tribal areas, and treated around 1300 patients a month. The

REPUBLIC OF CONGO

team also supports maternity activities in the hospital.

Primary healthcare, emergency healthcare, surgery, obstetrics/gynaecology, paediatrics, response to epidemics

In Peshawar, our teams supported up to seven basic health units with medical personnel, drugs and medical supplies in order to provide primary healthcare to hundreds of thousands

Funding: A$640,000 (approx 7% of total project costs) Project locations: Bétou, Impfondo, Pointe-Noire

of internally displaced people who had fled to the area in 2008 and 2009 due to conflict. The project was closed in October

At the end of 2009, tens of thousands of people crossed the

2010 after the majority of people had returned home.

Ubangi River to the Republic of the Congo, seeking refuge from fighting in Equateur province of the Democratic Republic

In Kurram Agency, in FATA, Médecins Sans Frontières runs

of the Congo. The population of Likouala province, in the

paediatric outpatient departments in two villages and also

Republic of the Congo, doubled as a result. Médecins Sans

launched a program to treat people suffering from cutaneous

Frontières teams have been working along the river to improve the availability of healthcare in the area. When our team arrived in the town of Bétou, only the hospital and one of the three district health centres were functioning. The hospital had been built by Médecins Sans Frontières in 2003, and teams reorganised the emergency, outpatient, medical, paediatric and surgical departments and added gynaecological, obstetric, nutrition and laboratory services. Each month, 340 patients were admitted to the hospital and around 3000 consultations were held, mostly in relation to respiratory infections, malaria and diarrhoea. There are now six functional health centres in the district. To reach more remote settlements, mobile medical teams travel up and down the river by boat, providing general consultations and antenatal care, and treating severe malnutrition. These teams carried out an average of 10,000 consultations a month, with the most urgent cases being referred to Bétou hospital. Further south, in the town of Impfondo, Médecins Sans

In 2010, Médecins Sans Frontières opened a new project supporting emergency department services and emergency surgery was opened in Hangu district, Pakistan, and treated around 1300 patients a month in 2010. © Vali

Frontières started the year supporting the medical, emergency, maternity, surgical and paediatric wards in the general hospital. Teams also worked in health centres and operated


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25

Projects funded by Australian donors continued The health authorities and international agencies carried out a polio vaccination campaign, targeting around three million people. Médecins Sans Frontières lent logistical support for the vaccination of some 90,000 people living around Bétou.

SOMALIA Primary healthcare, secondary healthcare, emergency healthcare, obstetrics, nutrition, response to epidemics Total Field Staff: 362 Funding: A$3,200,000 (approx 38% of total project costs) Project locations: Mogadishu, Jamaame, Belet Weyne The security situation in Somalia deteriorated further in 2010 and while needs have grown, basic medical services continue to dwindle. Despite a number of incidents directly affecting our staff in recent years, Médecins Sans Frontières is still working Constructing a well in the Republic of Congo. At the end of 2009, tens of thousands of people crossed the Ubangi River to the Republic of the Congo, seeking refuge from fighting in Equateur province of the Democratic Republic of the Congo. Médecins Sans Frontières teams have been working along the river to improve the availability of healthcare in the area. © Roselouise Cadot / MSF

in the country. International staff are unable to stay for long periods in Somalia due to the security risks, so Médecins Sans Frontières’ projects

mobile clinics to the north and south of the town, carrying

depend heavily on the commitment of Somali staff, supported

out around 3600 consultations a month. In July, Médecins

by teams of specialist staff based in Nairobi who visit the

Sans Frontières moved its activities to the 20-bed hospital in

projects when possible.

Bolembé, 60 kilometres south of Impfondo, to be closer to the refugee population.

Fighting in Mogadishu was continuous in 2010, with major offensives in February and during Ramadan in August. It is

At the end of 2010, a polio epidemic broke out in the southeast

estimated that only 500,000 people remain in the capital. For

of the country, centred in the city of Pointe-Noire. In total, 542

these remaining residents, healthcare facilities are virtually

cases were recorded by the national health authorities, and

non-existent. There are two public hospitals, which provide

220 people died. The resurgence of the disease, the extremely

surgery only for war-related injuries. The few clinics that are

high mortality rate, and the fact that males aged 15 to 30 were

running charge fees for services that are of unreliable quality.

the most affected group were all cause for concern. Daynile hospital is nine kilometres northwest of Mogadishu. At the request of the Ministry of Health and the World Health

Médecins Sans Frontières provides free emergency surgery and

Organization, Médecins Sans Frontières began work in the

care for the war-wounded. The hospital has 59 beds and is

intensive care unit at a hospital in Pointe-Noire at the beginning

equipped with two operating theatres and an intensive care unit.

of December. The peak of the epidemic had already passed

Médecins Sans Frontières also provides financial support and

by the end of the year, but dozens of patients were still being

medical supplies. In 2010, more than 5500 patients were admitted

admitted every day. Medical teams treated the symptoms of

to the emergency department. Staff performed 1136 surgeries.

the disease (such as breathing difficulties and muscle spasms) and two outpatient physiotherapy centres were set up to help

In Jamaame in the south of the country, Médecins Sans Frontières

patients who had left hospital before their treatment was

supported the inpatient and outpatient departments of the 61

complete. The program will end in 2011 with the association

bed hospital and provided treatment for patients with malaria

Handicap International taking on the provision of physiotherapy

and malnutrition. They also conducted more than 5800 antenatal

and mobility aids to patients.

consultations and assisted in 127 deliveries.


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26

Projects funded by Australian donors continued In the town of Belet Weyne, not far from the Ethiopian border, our team runs a 120 bed hospital and provides comprehensive secondary level healthcare including an emergency room, surgery, an inpatient department, a maternity department and nutritional activities. In January, the area experienced significant insecurity and teams treated wounded patients suffering multiple fractures, abdominal and chest injuries. On 12 January, the hospital was hit by a mortar and two Médecins Sans Frontières staff members were injured. In 2010, staff assisted 483 deliveries, conducted 875 surgical interventions and carried out 14,102 consultations in the emergency room.

SUDAN Primary healthcare, obstetrics, paediatrics, nutrition, response to epidemics Total Field Staff: 553 Funding: A$1,550,000 (approx 4% of total project costs) Project locations: Aweil, Abyei/Agok, Al Gedaref Medical needs among the people of Sudan remain significant, with security and administrative constraints hampering efforts

Dr Nina Doench with the medical team during their ward rounds at the hospital in Agok, Abyei Special Area, Sudan. In Agok Médecins Sans Frontières teams provide primary and secondary healthcare, including reproductive healthcare and treatment for malnutrition. Between January and November 2010, staff carried out over 27,812 outpatient consultations and there were 668 deliveries in the maternity ward. © Kate Geraghty

to reach the most vulnerable. In the south, access to healthcare is particularly poor.

more than 37,000 antenatal consultations, assisted more than 3000 births, and treated some 2600 children for malnutrition.

A five-year-old peace agreement between the government in Khartoum and southern rebels has ended 22 years of brutal

Médecins Sans Frontières has been working in the transitional

civil war, but conflict persisted in south Sudan as economic

area of Abyei since 2006. Our teams provide primary healthcare

and political changes following the agreement have resulted

services through an outpatient clinic in Abyei town, offering

in violent struggles for power. Nonetheless, in anticipation

nutritional support for children under the age of five, as well

of the January 2011 referendum on secession, hundreds of

as maternity and paediatric services, and also respond to

thousands of people made the journey back to south Sudan,

emergencies. Médecins Sans Frontières was running five mobile

adding to the two million who had already returned since the

clinics in the northern part of Abyei up until July 2010, when

peace agreement was signed.

mobile clinic activities were suspended due to security concerns.

Médecins Sans Frontières has been working in the emergency,

In May 2008, following violent clashes in the transitional area

maternity and paediatric departments of Aweil Civil Hospital,

of Abyei, nearby Agok became a host town to thousands of

in Northern Bahr El Ghazal state, since 2008. Our team works

displaced people. Médecins Sans Frontières responded quickly

with the Ministry of Health to reduce maternal and paediatric

by setting up an emergency medical program caring for the

mortality, treat malnutrition and respond to emergencies.

wounded and displaced. There are 60 inpatient beds and the

Staff perform surgery, including caesarean sections, provide

medical teams provide primary and secondary healthcare,

gynaecological consultations including antenatal and postnatal

including reproductive healthcare and treatment for malnutrition.

care, as well as vaccinations. The hospital has an inpatient

Between January and November 2010, Médecins Sans Frontières

therapeutic feeding centre and an outpatient feeding program.

staff carried out over 27,812 outpatient consultations, 1450

More than 18,000 returnees moved to camps around the town

patients were admitted to the inpatient department and more

in 2010. Médecins Sans Frontières helped the hospital to cope

than 3164 pregnant women were seen in the antenatal clinic.

with increased demand for medical care and staff conducted

In the same period, there were 668 deliveries in the maternity


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Projects funded by Australian donors continued ward, 10,141 nutrition screenings and 2283 children were

The results of TB treatment, which is a notoriously long and

treated for severe malnutrition.

difficult process for the patient, also saw marked improvement.

In the east of the country, Médecins Sans Frontières launched

Managing DR-TB is a growing challenge. Médecins Sans Frontières

emergency nutrition programs in Al Gedaref state. Staff treated

supported the decentralisation of DR-TB care to the three main

more than 6000 malnourished children under the age of five.

health facilities in Shiselweni in an effort to improve patients’

Following the emergency response, we began an observation

access to treatment. A new DR-TB ward with a laboratory is

project with the Ministry of Health in order to formulate a

being built, and will be finished in June 2011.

quicker response if needed in the future. Swaziland is desperately short of doctors, and because of limited

SWAZILAND

resources, not enough nurses are being trained. For Médecins

HIV/AIDS, tuberculosis

Sans Frontières, the solution is to entrust more tasks and

Funding: A$2,000,000 (approx 25% of total project costs) Project locations: Shiselweni

responsibilities to other personnel by training nurses to prescribe medicine or treat cases of uncomplicated, nonresistant TB, for example.

Swaziland is facing a health emergency of immense proportions. According to the World Health Organization, HIV prevalence

In line with this idea, Médecins Sans Frontières has enlisted

is the highest in the world, at 25.9 percent among adults

the support of “expert patients”. These are people living with

aged 15 to 49, and there are more than 1250 cases of TB per

HIV/AIDS who carry out screening, advise and inform new

100,000 people. TB is the leading cause of mortality among

patients about treatment, and raise awareness of HIV in their

people living with HIV and, to make matters worse, cases of

communities. In 2010, 80 expert patients were working for

drug-resistant TB are increasing: 10 per cent of all TB cases

Médecins Sans Frontières in Swaziland.

diagnosed are resistant to TB medication. Life expectancy in the country has plummeted over the past two decades – from

UGANDA

an average of 60 years to 41 years.

HIV/AIDS, tuberculosis, nutrition Total Field Staff: 206

Swaziland is a rural country of many small, isolated villages.

Funding: A$1,000,000 (approx 15% of total project costs) Project locations: Arua

The cost of long and frequent journeys to health facilities is often prohibitive for patients, so Médecins Sans Frontières has developed a decentralised, community-based approach to

It is estimated that more than one million adults and children

care. People living in the community have been trained as HIV

are living with HIV/AIDS in Uganda. The prevalence rate among

counsellors and to test for the disease. The aim is to increase

adults is estimated to be 6.3 percent.

the overall number of people being tested, so that more people with HIV can begin treatment earlier. By decentralising care,

Médecins Sans Frontières has been working in Arua in the West Nile

Médecins Sans Frontières hopes that fewer patients default

region in north-western Uganda since 2002. The Arua Hospital

from their treatment and, in general, patients’ state of health

Aids Program offers treatment for people with HIV/AIDS and/or

will improve.

TB as well as interventions to prevent the transmission of HIV from mother to child. Staff also provide nutritional support for

Throughout 2010, our teams supported all 21 clinics in Shiselweni,

malnourished adults and children living with HIV. Of the more

the poorest and most remote region in the country. Each of

than 8000 patients currently registered at the hospital, almost

these clinics now provides fully integrated care for HIV/AIDS

5500 are receiving antiretroviral (ARV) treatment and 432 pregnant

and TB. Médecins Sans Frontières tested some 14,500 people

women were registered in the Prevention of Mother-to-Child

overall for HIV, tripling the number of tests given each month.

Transmission program. In 2010, 631 patients were treated for TB.

The number of people starting antiretroviral (ARV) treatment doubled. More than 2550 new TB patients began treatment,

Our teams also supported the Ministry of Health in decentralising

including over 100 patients infected with drug-resistant TB (DR-TB).

HIV care by providing support to a health centre in Oli, an


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Projects funded by Australian donors continued area from which more than half of the patients in at Arua

Médecins Sans Frontières provided medical care for 10,000

come from. By October 2010, more than 5000 patients were

internally displaced people living in four camps. The project

receiving ARV treatment there.

was closed in November once the majority of the displaced population had returned home.

Médecins Sans Frontières also runs a paediatric nutrition program in Arua. In the first ten months of the year, 435 patients were admitted to the program. Our team also expanded the intensive care area of the specialised HIV/nutrition paediatric unit used to treat severe cases.

YEMEN Primary healthcare, emergency healthcare, surgery, obstetrics, nutrition, response to epidemics Total Field Staff: 367 Funding: A$700,000 (approx 12% of total project costs) Project locations: Saada, Amran The sixth round of conflict in the northern governorate of Saada, between the Yemeni government and the al-Houthi armed group, was the most intense since the beginning of the war in 2004. A ceasefire was negotiated in February 2010, but sporadic clashes continued to occur throughout the rest of the year. After having had to suspend activities for several months due to the intense fighting, Médecins Sans Frontières resumed work in Al Talh hospital, just outside the town of Saada, in March, and in Razah hospital, near the Saudi border, in April. In total, our staff carried out more than 32,000 consultations. During a measles outbreak between April and June, Médecins Sans Frontières and Ministry of Health staff treated more than 1500 patients, 400 of whom were hospitalised, and carried out a vaccination campaign. In July, Médecins Sans Frontières opened a nutrition program in Al-Jamouri hospital, also in the town of Saada, and treated 820 severely malnourished children. Staff also supported the teaching hospital in Saada. Our teams provided water, relief items and medical care to people displaced by the conflict but still living within Saada. Thousands more moved to neighbouring governorates. In Amran, capital of Amran governorate, Médecins Sans Frontières supported three health structures. Staff provided emergency, postnatal and outpatient services at the Beit-el-Sultan health centre to help the facility cope with the increased number of people needing care. We also began assisting the emergency, surgery, maternity and reproductive health departments. In Mandabah, near the Saudi border,

28


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Summary Activity Charts 2010 Highlights • In 2010, there were 198 field positions filled by Australians and New Zealanders in 36 countries. Twenty eight percent of these were Field Staff on their first mission. • Funding spent on social mission increased 17% to $43.1 million in 2010 from $36.7 million in 2009. 7 million in 2009. • Income from fundraising for the year ended 2010 increased to $56.9 million in 2010 from $43.7 • At the same time, the total cost of fundraising decreased from 16% in 2009 to 14% in 2010. rew from 11 16,300 to 130,800. • The number of people supporting the work of Médecins Sans Frontières Australia grew 116,300

2010 income Field Partners (54.6%) Bequests (5.4%) Other private donations (33.6%) Income from other MSF sections (5.0%) Other income (1.2%) Gifts in kind (0.2%)

Project funds by region

Africa (68.9%)

Field human resources by type

Asia (10.6%) Middle East (19.2%) Americas (1.3%)

Medical (28.8%) Paramedical (43.4%) Non medical support staff (27.8%)

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

$m 2010

$m 2009

56.9 60.6 43.1 53.3 7.3 14.0

43.7 46.8 36.7 45.9 0.9 6.7


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Médecins Sans Frontières worldwide 2009: Extract from International Activity Report 2009 The figures presented here describe Médecins Sans Frontières’ finances on a combined international level. The 2009 combined international figures have been set up in accordance with Médecins Sans Frontières international accounting standards that comply with most of the International Financial Reporting Standards. The figures have been jointly audited by the accounting firms of KPMG and Ernst & Young in accordance with international auditing standards. A copy of the full 2009 financial report may be obtained upon request. The figures presented here are for the 2009 calendar year. All amounts are in millions of Euros.

Income Private Public International Other Total Income

In M€

In %

572.4 77.9 15.1 665.4

86 12 2 100.0

In M€

In %

462.4 21.7 6.4 490.5 87.4 38.9 126.3 616.8 2.9 51.5

75 4 1 80 14 6 20 100

In M€

In %

433.3 68.5 36.6 538.4 2.5 475.5 -9.8 468.2 70.2 538.4

80 13 7 100 0 89 -2 87 13 100

No. of Staff

In %

1,239 1,459 2,046 4,744 2,015 20,447 22,462 874

26 31 43 100 9 91 100 18

How was the money spent? Operations* Témoignage / Awareness raising Other humanitarian activities Total social mission Fundraising Management, general & administration Other expenses Total expenditure Net exchange gains & losses (realised and unrealised) Surplus / deficit * Programmes & HQ programme support costs

Balance Sheet Cash & equivalents Other current assets Non-current assets Total assets – net Permanently restricted funds Unrestricted funds Other retained earnings Retained earnings and equities Current liabilities Total liabilities and retained earnings

HR statistics Medical pool Nurses and other paramedical pool Non-medical pool Total international departures (full year) International staff National staff Total field positions First time departures (full year)

30


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MÊdecins Sans Frontières Australia ABN 74 068 758 654

Financial Report for the Financial Year ended 31 December 2010

31


Médecins Sans Frontières Australia ABN 74 068 758 654 PO Box 847, Broadway NSW 2007, Australia Tel: +61 2 8570 2600 1300 136 061 Fax: +61 2 9552 6539 Email: office@sydney.msf.org www.msf.org.au © 2011 Médecins Sans Frontières Australia


Médecins Sans Frontières Australia Annual Report 2010