MSF Australia 2006 Annual Report by Médecins Sans Frontières (MSF) Australia

MĂŠdecins Sans FrontiĂ¨res Australia 2006 Annual Report

Médecins Sans Frontières Australia Annual Report 2006 © Copyright Médecins Sans Frontières Australia 2007 Apart from any fair dealing for the purposes of study, research, criticism or review, as permitted under the Copyright Act, no part may be reproduced by any process without written permission. Enquiries should be made to MSF Australia, marked for the attention of the Director of Communications, at the address below. First published 2007 by Médecins Sans Frontières Australia PO Box 847, Broadway NSW 2007 Australia ISSN 1834-6871 Writers: Philippe Tanguy, James Nichols and Sally McMillan Editors: Philippe Couturier, Myrto Schaefer and Philippe Tanguy Graphic Design: Marlin Communications Sydney Printing: Emerald Press Sydney Several parts of this report are reproduced online at the MSF Australia website www.msf.org.au. Readers may consult the website for any updates of the 2006 material published here as well as for more information about the work and activities of MSF.

Cover image: © Ron Haviv/VII Patient in ward at MSF’s Bon Marché Hospital in Bunia. Ituri District, DRC. Photo from “Democratic Republic of Congo: Forgotten War” a Médecins Sans Frontières Australia touring photographic exhibition 2006-7.

Contents: 2006 Annual Report 1 3 5 9 11 15 17 21 23

Charter of Médecins Sans Frontières MSF Worldwide in 2005: Audited International Figures La Mancha Agreement Message from the President Retrospective 2006 MSF Australia volunteers around the world Field human resources Special report: conflict emergency response Project Unit

25 27 29 30 33 55 82

Special report: nutrition emergency response Communications Special report: earthquake emergency response Fundraising Projects supported by MSF Australia MSF Australia Financial Report MSF Australia Corporate Supporters

Photo: © Juan Carlos Tomasi. HIV-positive children being cared for by MSF in Phnom Penh, Cambodia’s capital.

Médecins Sans Frontières Australia Annual Report 2006

MĂŠdecins Sans FrontiĂ¨res 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 the Associationâ€™s members agree to honour the following principles:

Photo: © Vincent Maure. Blanket feeding. Nutrition crisis in Tanout, Niger.

Médecins Sans Frontières provides

Médecins Sans Frontières’ members

assistance to populations in distress, to

undertake to respect their professional

victims of natural or man-made disasters

code of ethics and to maintain complete

and to victims of armed conflict. It does

independence from all political,

so irrespective of race, religion, creed or

economic or religious powers.

political convictions.

Médecins Sans Frontières observes

As volunteers, members understand the

neutrality and impartiality in the name

risks and dangers of the missions they

of universal medical ethics and the right

carry out and make no claim for

to humanitarian assistance and claims

themselves or their assigns for any form of

full and unhindered freedom in the

compensation other than that which the

exercise of its functions.

association might be able to afford them.

Médecins Sans Frontières Australia Annual Report 2006—2

MSF Worldwide 2005: Audited International Figures From the International Activity Report 2005/2006 Médecins Sans Frontières (MSF) is an international, medicalhumanitarian organisation that is also private and not-for-profit. MSF comprises 19 national branches located in Australia, Austria, Belgium, Canada, Denmark, France, Germany, Greece, Holland, Hong Kong, Italy, Japan, Luxembourg, Norway, Spain, Sweden, Switzerland, the United Kingdom, the United States, and an international office in Geneva.The figures presented

here (in Euros) describe MSF’s finances on a combined international level. These 2005 combined international figures have been set up in accordance with MSF international accounting standards, which comply with most International Financial Reporting Standards (IFRS). The figures have been jointly audited by the accounting firms KPMG and Ernst & Young according to international auditing standards.

Income

In M€

In%

Private Income Public Institutional European and development funds Public Institutional Other Other income

543.0 44.8 45.5 15.7

83.7% 6.9% 7.0% 2.4%

Total Income

649.0

100.0%

How was the money spent?

In M€

In %

Operations Témoignage Other humanitarian activities Total Social Mission

397.4 15.9 8.0 421.3

78.0% 3.1% 1.6% 82.7%

59.8 28.2

11.8% 5.5%

Total Expenditure

509.3

100.0%

Net exchange gains and losses (realised and unrealised) Surplus/deficit

4.1 143.7

Balance Sheet (year-end financial position):

In M€

Non-current assets Current assets Cash and equivalents

35.5 66.6 352.1

Total assets

454.2

Permanently restricted funds Unrestricted funds Other retained earnings

2.8 384.6 1.5

Total retained earnings and equities Non-current liabilities Current liabilities Unspent temporarily restricted funds

388.9 8.5 49.9 6.8

Total liabilities and retained earnings

454.2

Fundraising Management, general and administration

The search for efficiency has led MSF to create specialised organisations in charge of specific activities such as humanitarian relief supplies, epidemiological and medical research studies, and research on medical-humanitarian action. As these organisations are controlled by MSF, they are also included in the scope of the financial statements presented here.

Explanation of terms:

Context of Interventions Stable: 53% Armed Conflict: 18% Internal Instability: 16% Post Conflict: 13%

Sources of income As part of MSF’s effort to guarantee its independence and strengthen the organisation’s link with society, we strive to maintain a high level of private income. In 2005, 86.1% of MSF’s income came from private sources. More than 3.4 million individual donors and private funders worldwide made this possible. Expenditures Expenditures are allocated according to the operational activities performed by MSF, that is programme-related expenses as well as the headquarters’ support costs. All expenditure categories include salaries, direct costs and allocated overheads.

Project Locations Africa: 63% Asia: 23% America: 7% Europe: 7%

Permanently restricted funds may be capital funds, where the assets are required by the donors to be invested, or retained for actual use, rather than expended, or they may be the minimum compulsory level of retained earnings to be maintained by some of the sections. Unrestricted funds are unspent non-designated donor funds expendable at the discretion of MSF’s trustees in furtherance of our social mission.

Programme expenses by nature

Other retained earnings represent foundations’ capital as well as technical accounts related to the combination process, including the conversion difference. MSF’s retained earnings have been built up over the years by surpluses of income over expenses. As of the end of 2005, their available part (the unrestricted funds decreased by the conversion difference) represents 9.1 months of activity, the main purpose of which is for future major emergencies for which sufficient.

International staff: 24.6% National staff: 23.2% Medical and nutrition: 19% Transport, freight, storage: 17.3% Operational running expenses: 8.4% Logistics and sanitation: 5.6% Other expenses: 1.0% Training and local support: 0.9%

2005 Activity Highlights (non-exhaustive) Outpatient (OPD) Inpatient (IPD) Malaria TF (Therapeutic Feeding) Deliveries Sexual violence Surgery War trauma HIV ARV (Antiretroviral) TB Mental health Measles vaccinations Yellow fever vaccinations

Definition Total number of outpatient consultations Total number of admitted patients Total number of confirmed cases treated Total number of children treated with therapeutic feeding in 2005 Total number of women who delivered babies Total number of cases for any type of sexual violence treated Total number of major surgical interventions Total number of conflict trauma surgeries Total number of hiv patients registered under care at end 2005 Total number of patients on antiretroviral treatment at end 2005 Total number of new admissions to tuberculosis treatment in 2005 Total number of individual participants in individual or group mental health activities Total number vaccinated for measles Total number vaccinated for yellow fever

Total 10,000,000 382,000 2,249,000 130,000 91,000 12,000 75,000 8,000 161,000 60,000 22,000 149,000 806,000 361,000

2005 HR Statistics · International Departures (full year) 4768 · Field Positions 28,083 · National staff 25,855

Médecins Sans Frontières Australia Annual Report 2006—4

· First time departures (full year) 1466 · International staff 2227

La Mancha Agreement Athens, 25 June 2006 The La Mancha process grew out of a need to address internal and external challenges facing MSF’s work. After over a year of discussion and debate, it is clear that all sections of MSF have a common understanding of the basis for our action as both medical and humanitarian, and inextricably linked with the expression of public positions and describing our experiences (“temoignage”) to the point that the separation of the concept of “temoignage” from operations has disappeared. Our basic principles remain those expressed in the Charter and Chantilly documents. These principles should be referred to when taking and reviewing decisions, with the acknowledgement that every decision is a singular act and not made by the mechanical application of principles. Complementary to the Charter and the Chantilly Principles, the La Mancha Agreement is not a comprehensive description of MSF action. It outlines aspects of our action on which we agree and feel are indispensable, taking into account our past experience, and identifying current and future challenges to this action. As such, the La Mancha Agreement is a reference document and the issues it raises will be regularly reviewed. Our past experiences, including both failures and successes and related contradictory discussions, have had a great deal of influence on the evolution of the conception of our role. Some of these successes, failures and challenges are outlined below, and some of the conclusions we have reached on our action, in conflict as well as in response to specific medical issues, are contained in the document. Due to our increasing interdependence within the MSF movement and our shared goals, we recognise that to continue to improve our work, we need a clearer and stronger governance structure based on what we value most, namely our social mission (our operations and public positions) and our associative nature. The La Mancha Agreement commits MSF to clarifying and strengthening our international associative governance. The La Mancha Agreement also recognises the urgent need to address any issues of discrimination within MSF that are undermining our ability to realise our full operational and associative potential.

To explain how the La Mancha process came to these understandings, it is essential to recognise the role played by the diversity of opinions and ongoing internal debate – one of the major strengths of our association – on both our failures and successes, and the challenges we are facing in various contexts. In conflict settings in the past, MSF has called for specific political solutions, for example, military intervention in Zaire (1996). We have witnessed the failure of implicit or explicit “international protection” in Kibeho (Rwanda, 1995) and Srebrenica (1995). We have also been confronted with the massive diversion of humanitarian aid, including ours, for the benefit of war criminals (Rwandan refugee camps between 1994 and 1996, Liberia between 1991 and 2003). And, we are currently at risk due to a false perception of our involvement in International Justice in northern Uganda (2005). We have learned to be cautious in our actions in such circumstances without precluding MSF from denouncing grave and ignored crimes such as the bombing of civilians, attacks on hospitals or diversion of humanitarian aid. Taking public positions in reaction to such situations and confronting others with their responsibilities remains an essential role of MSF. In recent years we have seen the multiplication of military interventions that includes the deployment of a “humanitarian” component among their strategic goals (Kosovo 1999, Afghanistan 2001, Iraq 2003) and the emergence of political and military forces that reject our very presence. This reality has led us to define our understanding of risk, and to reaffirm our independence from political influence as essential to ensuring the impartial nature of our assistance. MSF has intervened in crises with medical consequences that are not armed conflicts, but can often be characterised as catastrophic. The numbers of people affected and the type of specialised care required in such situations has been beyond the capacity of local health structures. In these contexts, many people have been excluded from care due to a variety of factors, including the limited use of preventive medical techniques known to be effective, the unavailability of treatments for certain pathologies, the use of inefficient treatments for others and the existence of various barriers to treatment.

Our experience in such contexts has shown us that we cannot rely solely on the transfer of knowledge and techniques from the practice of wealthy countries to overcome such obstacles to care. Even when the pathologies encountered resemble those found in wealthy countries in a biological sense, their epidemiological profiles and the life circumstances of both patient and caregivers are often so radically different that they require innovations and adapted medical protocols and practices. In addition, certain pathologies are confined to populations who rarely constitute a focus for research and development. Therefore, we have learned to adapt, campaign for, and find innovative solutions to improve the medical care for patients in our programs and beyond.

1. Action

There is no doubt that we have ignored or failed in various medical issues over time, including a lack of attention to the information given to patients, to consideration of their concerns and choices, to the management of pain, and to the prescription of the most appropriate medicines. We must question our acceptance of this status quo and try to address what we are neglecting today.

1.3. The individual medical-humanitarian act, as carried out by all MSF staff, the majority of whom live and work in the countries of intervention, is central to the work of MSF.

Our actions, both through our field medical interventions, as well as the Campaign for Access to Essential Medicines, have been concrete and led to significant results for those in our programs and beyond, but do not attempt to propose global or comprehensive solutions. We have also learned that our support for some global solutions in the past, while in good faith, turned out to be incompatible with our basic principles: a particular example of this being MSF’s support of cost recovery systems that have led to the exclusion of a great number of people from treatment both within and outside our programs. We are challenged by the very nature of the AIDS pandemic as a life-long disease and it has forced us to re-examine our modes of intervention. We have had some success: the introduction of antiretrovirals in our programs and the comprehensive approach to treatment, care and prevention. Our medical action has not provided a solution to the global pandemic, but has assisted a number of people and has underlined the necessity for an improved medical, political and social response to this disease. MSF International Council, 25 June 2006, Athens

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1.1. Providing medical assistance to the most vulnerable people in crisis due to conflict and, when necessary, exposing obstacles encountered, remain at the core of MSF’s work. 1.2. In catastrophic situations that temporarily overwhelm individuals, communities and local health structures – especially in the absence of other actors – we strive to provide quality medical and other relevant care in order to contribute to the survival and relief of as many people as possible.

1.4. Considering the current poor response of humanitarian aid to meet the needs of people in crisis, MSF’s primary responsibility is to improve the quality, relevance and extent of our own assistance. 1.5. Obtaining quality clinical results while maintaining respect for the patient must be the major criteria used to evaluate the progress of our medical practice. 1.6. MSF affirms its willingness to pursue essential innovation and to continue to undertake initiatives in the constant search for relevant and effective action. Consequently, different approaches and operational strategies can naturally co-exist within the MSF movement. Considering that diversity of action within the framework of MSF’s common purpose and ambition is critical in improving our operations, different operational strategies can and should be implemented at national and international levels. 1.7. While building on our direct experience with innovative strategies, MSF must measure its own impact and abandon ineffective therapeutic strategies and intervention methods, and make the best possible use of those that have been proven effective.

La Mancha Agreement Athens, 25 June 2006 (continued) 2. Governance 1.8. We should make the results and critiques of our actions public, and analyse and document our actions and any obstacles (medical, political, economic, etc.) preventing patients in our programs from access to quality care, underlining the necessity for change. This can and, at times, should contribute to elements of a response that can benefit people outside of our programs. 1.9. In the case of massive and neglected acts of violence against individuals and groups, we should speak out publicly, based on our eyewitness accounts, medical data and experience. However, through these actions we do not profess to ensure the physical protection of people that we assist. 1.10.MSF intervenes by choice – not obligation or conscription – and may decide not to be present in all crises, especially when targeted threats against aid workers exist. 1.11.We strive to prevent the work we do and our assets, both symbolic (i.e. our trademark and image) and material, from being diverted or co-opted for the benefit of parties to conflicts or political agendas. 1.12.Although justice is essential, MSF differs from justice organisations by not taking on the responsibility for the development of international justice and does not gather evidence for the specific purpose of international courts or tribunals. 1.13. MSF actions coincide with some of the goals of human rights organisations; however, our goal is medical-humanitarian action rather than the promotion of such rights. 1.14.The diversity of contexts, circumstances and cultures in which we practice requires us to turn each medical choice into a singular act rather than a mechanical application of principles. We must make such choices together with those we assist and with a careful consideration of the possible alternatives and a grave concern for the potential consequences. This entails being explicit and transparent in our choices and dilemmas related to medical ethics, which remain, for us, core points of reference.

2.1. All MSF sections are linked together by a common name and logo, and common principles as expressed by the Charter and Chantilly documents. The statutes of ‘MSF International’, the La Mancha Agreement, resolutions of the IC and a high level of interconnection and interdependence complete these links. 2.2. Mutual accountability and active transparency in MSF, both at sectional and international levels, are essential to improving the relevance, effectiveness and quality of our interventions. 2.3. MSF is accountable and actively transparent to those we assist, our donors and the wider public. Accountability to those we assist may be difficult to achieve in certain situations, but the minimum requirement is that we are actively transparent about the choices made and the limits of our ability to assist. This external accountability is also essential to improving the quality of our interventions. 2.4. Informed and active associations and their representatives are crucial to assuring the relevance of our action and the maintenance of a strong MSF international movement. Invigorating participation in the associative at all levels of MSF is essential to building and maintaining credible, competent and relevant international governance. 2.5. MSF staff members are personally responsible and accountable for their own conduct, in particular regarding abuse of power. MSF is responsible for establishing clear frameworks and guidelines for holding staff accountable for their conduct. 2.6. National Boards are accountable for the actions and the use of resources of their section to the other sections of MSF. 2.7. For practical reasons of international coherence, the responsibility delegated by national sections to their respective presidents for taking international decisions should be uniform throughout the movement.

2.8. Among other issues, the IC is charged with the responsibility to: — Oversee the implementation and guide the strategic direction of MSF’s social mission, in regards to both operations and public positioning, especially through the critical review of its relevance, effectiveness and quality; — Provide a framework for managing the growth and the sharing of resources of MSF as an international organisation; — Uphold mutual accountability among sections. Practically, a large part of this responsibility is delegated to and implemented by the sectional General Directors as members of the GD19. 2.9. In carrying out its responsibilities, the IC is accountable to MSF associations. Timely and transparent reporting is essential. The IC is responsible for putting mechanisms in place to ensure and evaluate the quality of its work and the ability of its members to fulfill their responsibilities. 2.10. In order to encourage diversity and innovation of action, a decentralised MSF movement should be maintained. However, for the sake of coherence and the overriding interests of the MSF movement, binding international decisions by the IC, to which all section must adhere, are required on some core international issues. These include: — The development, direction and growth of MSF as an international organisation. This includes the opening and closing of sections and operational centers. — Issues that affect the Charter, the Chantilly Principles, the MSF trademarks and the La Mancha Agreement. — Issues relating to MSF’s responsibilities as an employer, including abuse of power. — Active transparency and accountability, both internal and external, among sections.

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2.11. Participation in international operational support projects is an option for sections and a way to encourage innovation to improve operations. However, there must be accountability and monitoring of the relevance and effectiveness of such projects as well as the appropriate use of MSF’s resources. 2.12. When formulating an international MSF public position, serious effort should be made to seek a common voice in order to ensure more coherence, in the field and externally. However, considering that diversity of opinion in MSF is critical to the vitality of the movement, if agreement on a common position is not possible, it is acceptable that a majority (the international position) and a minority position coexist. If, after taking into consideration the impact of their action on the movement, the minority decides to publicly express its position, the minority is obliged to clarify that it is not expressing the “MSF position”, but its own. The minority sections, however, should not obstruct the implementation of the decision and should be involved in its follow up. 2.13. We acknowledge MSF’s urgent need to provide fair employment opportunities for all staff based on individual competence and commitment rather than mode of entry into the organisation (either through national or international contract). This is to address the underutilization of human resources and inclusiveness in decision-making in MSF. This issue must be urgently and concretely addressed in order to fully engage our staff, thereby strengthening our operations. 2.14. We must take proactive steps to ensure fair opportunities for access to meaningful membership in associations, while preserving the spirit of volunteerism. In doing so, we accept the need to explore new avenues for associative participation, giving priority to regions where MSF is underrepresented – including, for instance, through the creation of new MSF entities.

Message from the President In 2006 we faced yet another challenging year for MSF’s work, responding to human crises in a pragmatic, medical and human way. The high-profile emergency resulting from the intensification of fighting between the Israeli Defence Forces and Hezbollah fighters in South Lebanon brought into sharp relief the challenges of gaining access to civilians caught up in modern warfare. With a high intensity bombardment underway, it was essential that MSF use all the tools at its disposal, including public statements denouncing the restriction of access to civilians, to improve the security of our teams and our ability to assist. At the same time, it was essential to maintain our neutrality within that conflict by not passing judgment on the rights and wrongs of specific military decisions, or giving advice as to how the conflict could be solved. Likewise in Darfur, as the crisis entered its fifth year in 2006. Many of the aid actors on the ground in Darfur, notably some UN agencies, started calling for “no fly zones” and for military intervention there. This is not the position of MSF, and these calls have certainly encouraged a confusion to occur between the political and humanitarian roles, exacerbating an already fragile and dangerous situation on the ground. These calls have curtailed our ability to assist hundreds of thousands of people in Darfur who are living, at best, a survival existence, completely dependent on aid. One of the operational goals of MSF over the last year was to demonstrably improve the quality of the medical assistance we provide. With the current numbers of consultations, over ten million a year, there is no doubt we are treating more people than we were a few years ago. However these numbers mean little unless the patients under our care get a humane consultation with the right diagnosis and treatment. The reinforcement of operational research, the development and use of new treatments, a focus on training, specifically of national staff and the further development of the international operational typology are some of the necessary steps that have

been taken to achieve the simple goal of improving the “deal” that our patients get. In 2006 MSF also went through a process to redescribe our principles, ambitions and aspirations and how we govern ourselves to achieve them. The “La Mancha Agreement” was the result of this process. I encourage you to read it in this Annual Report. MSF Australia strengthened its ability to support operations over the year, with the development of the Project Unit as part of the operational directorate based in Paris, focusing on the quality of paediatric and obstetric care, as well as providing field support in those areas. This was a functional result of the move over the last few years for MSF Australia to go beyond its current essential tasks of providing high-quality field volunteers, significant financial support and communications back-up for operations. This occurred in conjunction with a development in the relationship that MSF Australia has built with the various Operational Centres of MSF. We are now one of four sections (France, USA, Japan and Australia) who have responsibility for the operational direction based in Paris. In November each year, the operational results are reflected upon by a combined Board meeting of all the four sections, and input is given to the operational direction for the coming year, giving an opportunity for the Association and Executive of MSF Australia to have a say in one of the five operational directions in MSF. The first major topic of influence put forward by MSF Australia, that of the improvement of the quality of perinatal care, is one that was taken on by Paris last November, and we look forward to reflecting on the results obtained in this operational area later this year. Furthermore, the appointment of the Director of Operations based in Paris is now made by the four General Directors of the four sections, indicating the operational responsibilities that now rest with MSF Australia. In addition to this, we are developing a relationship with MSF Switzerland, and we have also clarified and strengthened our

relationship with the “Amsterdam group” in field and operational human resources. I feel it is essential for MSF Australia to have volunteers coming from various operational directions: it broadens our thinking, and thus our input into operations, and it allows a space for the “classical” differences that exist between operational approaches within MSF to be discussed from our own perspective. Hopefully this will lead to distilling the different operational philosophies and getting the best from them, to add to our own antipodean approach. The only danger here is if our debates within MSF Australia’s Association become just a debate about the perceived strengths and weaknesses of the various operational directions. Occasionally the debate within our Association has become a reflection of some of the ridiculous caricatures that various European sections have of each other, which can be based on rumour and anecdotes as much as on fact. Whatever their basis, such wasteful rivalries detract from the valuable time we should be spending on discussing what we should be doing for those we assist in the field and on benefiting from the diversity we have within MSF. There is no doubt that the Association of MSF Australia has developed significantly over the past two years, reflecting the hard work done by the support groups, the Association Liaison Officer and the Board members who have taken specific responsibilities for a number of areas. It is important that we define the role of the Association vs the role of the Board and the role of the Executive within our organisation, so that we can maintain and build on our early and promising steps such as the reproductive health group and the La Mancha debates. This requires a fair bit of “learning by doing”, however the results of a vibrant association are worth the hard work. The goals of the Association are really those of MSF, they are to improve the quality and relevance of what we do in the field. The forms that this can take are numerous. They can range from having volunteers from MSF Australia who acquire important knowledge about the debates currently taking place inside and out of MSF as a result of associative life, to more tangible benefits such as the results of the perinatal push from the Australian Association to improve MSF operations.

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Time and again I have met volunteers in the field who have come through MSF from Australia and New Zealand, and I keep being impressed by the depth of their commitment, their good humour, humanity and sheer competence. Their ability to get the work done is certainly a result of their individual actions, but also that of a hard-working staff in the Sydney office, led by Philippe Couturier. On behalf of the Board and the Association I would like to thank the Executive Director and his team for another year of solid and impressive work. The results speak for themselves. Finally I would like to thank the donors of MSF. It is easy for a doctor or a nurse to “demand the right treatment” for someone at risk of dying, It is a little more difficult for the logistician and administrator to “make it happen”; but without the strong and increasing support from our donors in Australia and elsewhere in the world we would not be able to respond in some places where others don’t go. A number of crises over the last year, including Darfur, Sri Lanka, DRC and Lebanon had countries or governments refuse or reduce their contribution for emergency aid or relief, for either political reasons or because of the crisis not being deemed important enough. The support of our donors allows us to provide a medical-humanitarian response based on needs alone in places where others cannot. This support allows us to reject pressure from donor governments to go to “politically correct” crises, and more importantly it allows us to act, to assist people, to reduce their suffering and to stop them dying. As well, the funding that our donors provide to MSF enables us to speak out and to denounce those crises that endure, like uncomfortable sores, on the smooth veneer of the international community. So to them, our donors, I would like to say thank you.

Rowan Gillies President, MSF Australia

Retrospective 2006 The year 2006 has been a challenging year again for our teams all over the world. Wars, epidemics and natural disasters have been the three main contexts in which our medical and non-medical teams have been deployed over the year, so as to respond to the needs of populations affected by crises each of a very different nature. In this Annual Report of MSF Australia for 2006, particular efforts have been made in order to provide the reader with a comprehensive description of MSF’s medical-humanitarian activities. You will have noticed that the first pages of this report present an overview of MSF operations as conducted in the world in the year 2005. As MSF is an international organisation composed of 19 branches I thought that it was important to reflect on what has been collectively achieved at an international level before focusing more specifically on what our section has been able to contribute over the past 12 months. Over ten million outpatient consultations were carried out last year and, as highlighted by Dr Rowan Gillies, our capacity to offer the right diagnoses and treatments to these patients is crucial. The overview of MSF operations that we have provided to you also includes a list of the main medical activities we have conducted during the year and the contexts in which we have intervened. This list certainly gives some indication of the challenges and difficulties our teams have faced, but more importantly it shows the scale and extent of people’s medical needs in the specified context. Over 3.4 million individual donors and private funders worldwide have made these operations possible. The tremendous generosity of individual donors, representing over 86% of our international level of income, allows us to respond quickly and to provide independent medical-humanitarian care for people who would otherwise have none. Still at the international level, the transparency of our actions and the concrete development of our accountability toward those that we assist as well as to our donors are commitments that we have taken. In this regard, for two years now we are in a position to provide you with international combined figures,

which comply with most International Financial Reporting Standards (IFRS). These figures for years 2004 and 2005 have been jointly audited by the accounting firms KPMG and Ernest & Young, according to international auditing standards. In this report the 2005 figures are presented to you in addition to the MSF Australia audited financial statement. Moving now from the international overview to our direct contribution here in Australia, this introduction of the Médecins Sans Frontières Australia Annual Report 2006 is an opportunity for me to report back to you on some of the key achievements resulting from our 3-year strategic plan that ended in December 2006. Field human resources Since its early days our section has played a significant role in the area of field human resources. In total, volunteers have contributed to no less than 1000 missions over the past 12 years. There is no doubt that their skill and commitment greatly contributes to the quality of our projects. As reflected in the Field Human Resources department’s activity described in the present report, 2006 was no exception in this regard – with 176 field positions filled by Australian and New Zealand volunteers. During the last 3 years, constant efforts have been made to improve our capacity to better identify, recruit, train and retain medical, paramedical and non-medical professionals. In order to better plan our recruitment processes and better place volunteers who are recruited and followed up by our office, working relationships with our principal operational partners have been strengthened and better defined. This process was cemented during 2006 by the signing of a Memorandum of Understanding with MSF Holland and MSF Switzerland in which clear and common objectives were set. With regard to MSF France, the process has gone further. MSF Australia is a member of an operational partnership with Paris, and all partners (USA, Japan, France and Australia) have further

developed their collaboration at departmental level. A common human resources policy for the all the partners is currently under construction, aiming to better jointly respond to the human resources needs of our field projects. Last year also saw the final steps of an ambitious international project that MSF Australia is part of. The International Remuneration Project (IRP) aims to create a responsible and adaptive remuneration framework for international staff going to the field to support MSF missions. The IRP addresses specifically the following objectives: the need for a coherent and equitable remuneration system for the movement, and to ensure that expatriates have access to their national social systems and services after their mission. The decentralisation of the contracts from the Operational Centres to the Partner Sections is also a vital component of this project. Matching the voluntarism of our organisation with the necessity for MSF to act as a responsible employer is certainly one of the best outcomes of the IRP. MSF Australia will start the implementation of this project in early January 2007. Toward more operational responsibilities If our capacity to support operations by sending highly qualified field volunteers remains an essential task, the board of directors and the executive platform of MSF Australia – as a part of the strategic plan – have been critically engaged over the past 3 years in the development of our operational partnership with MSF France, USA and Japan. This process has led us to be more involved with and have more responsibility in the operational direction based in Paris. This operational partnership is based on a common understanding of the operational role, the responsibilities of MSF and on the will to share such responsibilities. As stated by Dr Gillies, we now have the possibility to participate fully in the construction (from the elaboration to the implementation) of one of the five MSF operational plans, which is a major progress for MSF Australia. Sharing such responsibilities with our partners also means that we need to further develop our capacity to exchange information in a timely fashion so as to contribute to and ensure the mobilisation of the necessary resources in common to support the joint operational plan.

Médecins Sans Frontières Australia Annual Report 2006—12

As already presented, field human resources is part of this necessary support. The second direct contribution towards field operations results from the medical support that MSF Australia is now able to provide with the Project Unit (PU). The Project Unit was set up in 2004 in regard to the process of sharing operational responsibility between the Operational Centre and Partner Sections. Initially the Project Unit was a tentative approach, aiming to develop a technical support being provided to the field from our office under the supervision of the Medical Department of the Paris office. The identification of a first medical theme that was not technically supported at the time by the medical department in Paris was the basis of a further development. Avoiding duplication of existing positions and applying the principles of complementarity and decentralization of activity and responsibility has been the model that has guided the development of the Project Unit. At the beginning of 2005 therefore, a first position was created and a first medical doctor was appointed to the Project Unit, to be in charge of the paediatrics dossier with a specific focus on HIV/AIDS and TB. In addition to her medical responsibility, Dr Myrto Schaefer also assumed the responsibility of being Head of the Project Unit. Under her leadership and in close collaboration with the Director of the Medical Department in Paris, a second medical theme was identified mid-2006 and thus a second medical doctor was recruited in the Project Unit, to focus on Women’s health related topics. At the end of 2006 and as a result of the development of a secondary partnership with the Operational Centre of MSF Switzerland, a strategic review on Buruli Ulcer Disease (BUD) was launched by the Project Unit in close collaboration with the Operational Center of Geneva. Information on BUD and on the activities of the Project Unit for 2006 are presented in this report. Increased financial capacity Our third contribution is based on our growing financial capacity to support operations. My thanks go to all our donors for their ongoing support and fantastic generosity.

Retrospective 2006 Continued In 2006, AUD$21 million of private income has contributed to MSF responding to the medical needs of populations in 19 countries. This represents an increase of more than 480% from 2003, when our financial support to field operations was of the order of AUD$3.6 million. The support of our donors is essential, as is the safeguarding of our capacity to act independently and to be present in some places where other organisations are not. We are extremely conscious of the fact that such invaluable financial support requires a solid mechanism of reporting, in order to properly inform our donors on what has been achieved with their support. The audited international figures for 2004-2005, and the section on the audited MSF Australia accounts for 2006 as presented to you in this report, are certainly a fulfilment of this requirement. However, and with this clear responsibility for reporting in mind, this 2006 MSF Australia Annual Report has also been marked by the aim of developing our accountability toward our donors even further. As from this year, in addition to a fuller and more comprehensive description of the actual MSF field projects supported by the Australian donors, we provide you also with more information such as the Operational Centre which runs the specific projects, the total cost of running the respective projects and the financial contribution coming from the Australian supporters. We hope you find this information useful and interesting. In conclusion To conclude this retrospective 2006, I would like to highlight two other major activities that took place in the year 2006. First, with the launch of the Australian tour of the Democratic Republic of Congo (DRC) photo exhibition “Forgotten War” from July, we were able to raise major public awareness on the plight and suffering of the Congolese population, Australia-wide. Témoignage, or speaking out, is part of the medicalhumanitarian mission of MSF and plays a key role in furthering the public’s understanding about the suffering endured by the civilian populations that we take care of.

The DRC photo exhibition certainly provided us with a unique opportunity for témoignage in Australia. Its nine-month ninecities tour began in Brisbane, and by December it had travelled to Townsville, Melbourne, Canberra, Adelaide and Hobart, with its final 3-month leg scheduled in 2007. Coinciding with city festival times, the exhibition received a high level of exposure with a strong response, and was the occasion for us to devise presentations about MSF generally and also our work in DRC, often with the help of returned volunteers. The year 2006 being at the end of a 3-year strategic plan, over its last few months a large number of consultations took place with a view to developing the next strategic plan, for the years 2007-2010. This process has involved the board of directors, members of the Association and also of course our main operational partners. The 3-year plan 2007-2010 was finalised and presented to the board of directors in December, and was subsequently approved in early January 2007. This brings me to the second activity of 2006 that I wanted to mention here. The very last day of 2006 was in a way a day specifically dedicated to MSF in Sydney, when Médecins Sans Frontières was invited by the City of Sydney to be the Official Charity Partner for the 2006 Sydney New Year’s Eve Celebrations. Advertisements offered by the City of Sydney, along with the set-up of information tents where field volunteers and the Sydney office staff were able to engage with the public, combined with a large media coverage to provide fantastic opportunities for us to raise our public profile. But most of all the last day of 2006 gave us a great chance to talk about the populations to whom our medical-humanitarian assistance is directed. I would like to thank each and every one who has contributed to the results achieved by Médecins Sans Frontières Australia in 2006: all the donors for their fantastic support and extraordinary level of encouragement, the companies that have generously offered pro bono assistance, the more than 30 office volunteers who have helped us with their outstanding energy and enthusiasm, and all the office staff and field volunteers for their commitment and invaluable work.

Philippe Couturier Executive Director

“On the frontline helping the people of the Congo, where their government can’t, is the staff of Médecins Sans Frontières, an international agency of dedicated professionals… Photographers Ron Haviv, Gary Knight, James Nachtwey, Antonin Kratochvil and Joachim Ladefoged went on assignment with MSF personnel to provide a rare and powerful insight into the ongoing human disaster in the Congo.

Viewing photos of such a world of suffering isn’t easy, and there is the urge to turn away. But empathy is required because it’s a small world, and despite the horrors that are occurring, mostly in the Third World, we in the wealthy First World have a responsibility and can make a practical difference by supporting organisations such as Médecins Sans Frontières. That may be one of the reasons for this exhibition’s world tour.” Phil Brown, Brisbane News, July 26 2006 – review on the opening of the MSF/VII exhibition.

Médecins Sans Frontières Australia Annual Report 2006—14

MSF Australia volunteers around the world 1. Angola

2. Armenia

3. Bangladesh 4. Burundi 5. Cambodia 6. Chad 7. China

8. Colombia

Natalia Rojas: Damien Brown: Jason Andean: Gail de Lucia: Julie Harman: Charles Lancaster: Debra-Lee Holman: Tracey Leslie: Sean Healy: Carol Nagy: Brian Raleigh: Lesli Bell Powell: Margaret Ward: Wei-Yuen Su: Linda Pearson: Paula Llavallol:

Robert Delacour: Hedwig van Asten: 9. Democratic Republic of Congo Anne Taylor: Bettina Kolker: 10. East Timor Greg Elder: Geoff Smith: 11. Ethiopia Sarah Moberley: Peter Morris: Penny Oâ€™Connor: Will Robertson: Michael Bala: Paras Valeh: Fariba Saadvandi: Joanne Sage: Catharine Webb: Nicolette Jackson: 12. Georgia

13. Haiti 14. India 15. Indonesia

16. Ivory Coast 17. Jordan

Field coordinator Medical doctor Logistician Nurse Nurse Nurse Field coordinator Water and sanitation Field coordinator Field coordinator Field coordinator Logistics coordinator Field coordinator Medical doctor Nurse Administratorfinancial coordinator Nurse Midwife

Logistics coordinator Nurse Head of mission Logistics coordinator Medical team leader Field coordinator Medical coordinator Head of mission Medical doctor Medical doctor Nurse Nurse Nurse Communications officer Janthi Price: Field coordinator/ head of mission Robin Briant: Medical doctor Malcolm Hugo: Psychologist Anne Taylor: Logistics-construction Brian Moller: Theatre nurse Melanie Leemon: Other Jason Andean: Logistics coordinator Catherine Moody: Field coordinator Vanessa Andean: Anaesthetist Nikki Blackwell: Anaesthetist Peter Zelas: Surgeon Robin Barbar: Nurse Barry Kirker: Psychologist Pauline Vandenberg: Nurse Jane Lynch: Logistician Lauren Cooney: Medical coordinator Nikki Blackwell: Anaesthetist

18. Kenya

19. Lebanon 20. Liberia

21. Malawi

22. Malaysia 23. Mozambique 24. Nepal

25. Niger

26. Nigeria

27. Pakistan

Helen Cox: Heidi Spillane: Barbara Telfer: Abioseh Kamara: Matthew Everitt: Susan Thomas: Shelagh Woods: Haydar Alwash: Debra Blackmore: Nikki Blackwell: Ian Smith: Murray Trubshaw: William Wilson: Jane Connell: Sue Daebritz: Lisa Errol: Maurisse Mausolf: Linda Pearson: Olivia Yacoub: Amanda Jupp: Teresa Carney: Amanda Jupp:

Epidemiologist Medical doctor Epidemiologist 62 Logistician 13 59 61 Logistics coordinator 63 Field coordinator Field coordinator 8 57 Surgeon 58 Medical doctor Anaesthetist 64 Anaesthetist Medical doctor Medical doctor Nurse-midwife Nurse-midwife Midwife Midwife Nurse Medical scientist Field administrator Field coordinator Administrator-financial coordinator Nicholas Lawson: Head of mission Karen Day: Pharmacist Olivia Yacoub: Medical scientist Abioseh Kamara: Logistician Carolyn Merry: Head of mission Ellie Kamara: Administrator-financial coordinator Christina Ambrose: Field coordinator/ medical coordinator Cath Deacon: Medical doctor Anna Jenkins: Medical doctor Stephanie Jones: Medical doctor Arjuna Nagendra: Medical doctor Jacqui Shand: Medical doctor Lisa Trigger-Hay: Medical doctor Shannon Lo Ricco: Logistician Matthew Cleary: Field coordinator Danielle Courtin: Administratorfinancial coordinator Caroline Murphy: Medical doctor Robin Sands: Logistician Abdul Aleem: Anaesthetist John Parker: Medical doctor Brian Moller: Theatre nurse Raewyn Turner: Theatre nurse Stephen Green: Field coordinator Sean Healy: Field coordinator Thomas Roth: Head of mission Nikki Blackwell: Anaesthetist Robin Briant: Medical doctor

29 71 69 65 67 76 68 6

73 70 74 66

12 39 2 34

72 19 77 28

35 53 52 42

49 377

33 24 46

47 27 14 40 19 13 12 25 10 16 30 15 20

25 22

3 2 26 23

31. Somalia 32. Sudan

51 5 1

36 5 11 11

89 24

29 34 18 14 4 4 30 21 17 23 21 36 32

Felicity Brims: Stewart Condon: Jacqueline Hewitt: Robin Barbar: Glenda Gleeson: Marilyn Keane: Susan Kelsall: Sue Mitchell: Francesca Pinzone: Amy Radford: 28. Palestinian Territory Gregory Pead: Timothy Williams: 29. Russian Federation Matthew Reid: 30. Sierra Leone Jenny Cross:

44 4

45 50 33

8 32 6

35 35

26 31

22 41 15 10

Medical doctor Medical doctor 27 Paediatrician Nurse Nurse-midwife Nurse-midwife Nurse-midwife Psychologist Nurse Nurse Field coordinator Psychologist

Medical coordinator Administratorfinancial coordinator Felicity Brims: Medical doctor Rebecca Caporn: Nurse Vicki Gaffney: Nurse Amy Gildea: Nurse Amy Radford: Nurse Sue Todd: Nurse Kelly Wilcox: Nurse Megan Long: Nurse-midwife Lindel Cherry: Assistant head of mission Sue Wainwright: Midwife Matthew Cleary: Field coordinator Phil Humphris: Head of mission Catherine Moody: Field coordinator Kristi Payten: Field coordinator Janthi Price: Field coordinator Jeff Stewart: Field coordinator Greg Thompson: Administratorfinancial coordinator Vivienne Cebola: Medical doctor Shawny John: Medical doctor Rogan Thavarajah: Medical doctor

Médecins Sans Frontières Australia Annual Report 2006—16

33. Thailand

34. Uganda

35. Uzbekistan 36. Zimbabwe

Kara Blackburn: Midwife Lisa Blaker: Nurse Lisa Errol: Midwife Ruth Priestley: Theatre nurse Natalia Rojas: Nurse Deanna Stewart: Nurse PenelopeSummons: Nurse-midwife Bianca Collier: Field admin Peter Koole: Logistician- administrator Jane Lynch: Logistician Richard Wesley: Logistician-administrator Matthew Everitt: Logistics coordinator Sally Stevenson: Head of mission David Friend: Medical doctor Melissa McRae: Medical doctor Richard Smith: Medical doctor Paras Valeh: Medical doctor Kusum Churcher-Wells: Nurse-midwife Katrina Swanson: Nurse Sally Warriner: Nurse Kate Williams: Nurse-theatre Daniel Moore: Logistician-construction Roslyn Brooks: Medical doctor Euan Beamont: Logistician-administrator Cath Deacon: Medical doctor Ngaire Caruso: Medical team leader Kristi Payten: Medical coordinator Helle Poulsen-Dobbyns: Field coordinator Tania Martin: Medical doctor John Parker: Medical doctor Margie Barclay: Nurse-midwife Karen Day: Pharmacist Anthony Flynn: Nurse Nicole Trim: Nurse Andrew Caballero-Reynolds: Logisticianadministrator Helen Cox: Epidemiologist Janice Forrester: Nurse Christine Polinelli: Medical scientist

Field human resources The recruitment and deployment of human resources is a crucial element of our field operations; and the quality of our programmes is directly related to our capacity to identify, recruit, train and subsequently retain both medical and nonmedical professionals with the skills and experience required to go on assignment in one of the nearly 80 countries worldwide where populations are suffering and in crisis. MSF seeks and recruits individuals who are not only medical and non-medical professionals of the highest calibre and who go beyond the minimum essential requirements, but who also embody the principles of independent medical-humanitarian action and adhere to the fundamental MSF value of voluntarism. It is in that spirit of voluntarism that in MSF publications our staff deployed in the field are often referred to as volunteers. Although other terms are also employed (eg “field workers”) the practice of using the term “volunteers” is maintained in this MSF Australia Annual Report 2006. Within this context, the year 2006 has been another busy one for the Field HR team in the Sydney office. Humanitarian crises in conflict and post conflict areas received much needed support from our Australian and New Zealand-based field staff. Throughout the year over 30 volunteers filled positions in missions in Sudan alone, to assist in crises in Darfur and in South Sudan. Fifteen were in placement in Liberia in 2006, eight worked in Sierra Leone in West Africa, and a further eight were in Nepal to provide primary and secondary health care to civilians caught in fighting between Maoist rebels and government forces.

Twenty-one volunteers participated in MSF projects developed in response to recent and past natural disasters (the Indian Ocean Tsunami, the Pakistan and Yogyakarta earthquakes). Other MSF projects in more stable contexts also saw the placement in the field of a significant number of MSF Australia personnel during 2006: ten volunteers were in field positions in Uganda as well as in Ethiopia, four worked in Georgia, also four in Niger and in Kenya.

Independent Medical-Humanitarian Action MSF's decision to intervene in any country or crisis is based solely on an independent assessment of people's needs — not on political, economic, or religious interests. MSF does not take sides or intervene according to the demands of governments or warring parties. MSF volunteers frequently work in the most remote or dangerous parts of the world. When crises unfold, they make themselves and their skills available on short notice, usually dedicating six to twelve months to each assignment. Their expenses are covered and they receive a modest monthly salary. Among the additional benefits offered are comprehensive insurance, transportation and accommodation for the mission and reimbursement of mission-specific vaccinations. MSF teams in the field are composed of international volunteers and skilled national staff.

Figure 1 – Number of deployments and breakdown by professional sector 1995 – 2006 150

120

Medical Paramedical Non-medical Total

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

The overall number of deployments to the field from MSF Australia slightly decreased (124) in 2006, further illustrating the greater needs covered in 2005 due to the Indian Ocean Tsunami and the Pakistan earthquake (see Figure 1). In all, 84 of the total 124 volunteers deployed to the field in 2006 were made up of experienced field personnel, the highest annual figure achieved in MSF Australian history, and a statistic that highlights the fact that volunteers from Australia and New Zealand are both highly regarded and successful within the organisation. An increasing number of staff with several missions’ experience are now taking on roles of MSF Australia Field HR responsibility in MSF field operations. statistics 2006 ·

124 Deployments

176 Field positions

31 Countries

40 First mission volunteers (32%)

84 Experienced volunteers (68%)

The specific medical expertise involved in our projects is clearly demonstrated by the types of roles that our volunteers undertake. For example, in 2006 more than 75% of the volunteers that we sent to the field were classified as medical or paramedical professionals (see Figure 2). Recruitment Nineteen recruitment evenings were held in 2006: in Adelaide, Brisbane (2), Canberra, Darwin, Hobart, Melbourne (2), Newcastle, Auckland (2), Christchurch and Wellington, Perth, Sydney (3), Townsville and Wollongong. These visits were also an opportunity

Figure 2 – Percentage of 2006 deployments by professional sector

Medical: 32% Paramedical: 45% Non-medical: 23%

Médecins Sans Frontières Australia Annual Report 2006—18

for the department to interview local applicants and to address questions from potential candidates. To ensure the best attendance possible for each of our recruitment evenings, the department received the support of an office volunteer in order to develop better planning, promotion and networking with the help of MSF Australia’s Association support groups in each of the locations listed above. In 2006, more than 700 people in total attended the recruitment evenings. Formal applications lodged for volunteering numbered 172 for the year; and of these candidates 100 were deemed suitable for interview. A small number of applicants were further advised to obtain appropriate additional experience or further training prior to reapplying, and subsequent to the selection process 76 candidates were accepted to go on mission. Training activities Preparation, support and retention of our field staff remained as core objectives for our HR activities in 2006. Three “Welcome Days” or departure-preparation courses were organised in Sydney. Additionally seven volunteers (with MSF Australia support) attended preparation courses organised by other MSF sections overseas. In total, 38 new volunteers attended these courses. Within the framework of its long-existing partnership with the James Cook University in Townsville, the Field HR department again in 2006 jointly coordinated the Refugee Health course with the University’s School of Public Health and Tropical Medicine. Four experienced volunteers were sponsored by MSF Australia to attend the two-week course which was held in August.

ÂŠ Greg Constantine. Because of the lack of safe drinking water and sanitation, most patients come to the MSF clinic in Teknaf, Bangladesh, with skin diseases or water-borne illnesses. The Teknaf camp is home to more than 5000 Rohingya refugees, ethnic Muslims who have fled neighbouring Myanmar where they are subjected to widespread marginalisation.

Field human resources Continued The main part of our retention strategy however consisted of accessing the internal training courses organised by MSF’s Operational Centres (OCs) in Europe. In this regard a significant number of MSF Australia volunteers attended internal OC courses: eight in technical training, seven in management, and one volunteer undertook language training. Structure The department maintained its structure in 2006 of four members in the team, with Emmanuel Lavieuville as Head of Department and Geoff Smith in the HR Officer role managing experienced volunteers. The other HR “Experience matters…” Officer role that manages first mission recruitment was filled by Carol Nagy, In 2006 the number of who was replaced in May by Katrina coordination roles filled by Penney, an experienced NurseMSF Australia volunteers midwife from New Zealand. Thanda increased to the highest Bennett continued to be the ratio for six years (26% of our Administrator for the Department. departures). Coordination roles include positions such Development of partnerships as head of mission, medical In 2006 our partnerships with the coordinator and project MSF international global network coordinator. These positions were strategically developed so that are commonly filled by the deployment of volunteers is now volunteers who have targeting specific recruitment areas completed three or more which are of concern for the missions and have attended organisation. This targeting is relevant one of the MSF management courses.

to issues of staff retention while maintaining strong medical, logistical and administrative support for our projects in the field. Partnerships were developed and/or formalised with several Operational Centres in 2006. The on-going partnership with MSF France was developed further, laying down specific guidelines and objectives for the partnership to be enhanced in 2007. Within this framework specific recruitment targets were set and followed through. Furthermore, the MSF Australia HR Officer in charge of first mission volunteers participated at the MSF France group recruitment meeting held in Paris in September. Our relationship was also formalised with Operational Centre Amsterdam (OCA) with the signing in May of a Memorandum of Understanding in Sydney between the two Field HR departments. The MSF Switzerland recruitment coordinator also visited the Sydney Office, which culminated in the signing of another MOU in December. Figure 3 demonstrates the number of all field positions accounted for by MSF Australia’s Field HR department, according to the Operational Centre responsible for the management of the project.

Figure 3 – Percentage of all MSF Australia field positions divided by operational centre in 2006 MSF France: 55% Operational Centre Amsterdam: 23% Other OCs (Brussels & Barcelona): 13% MSF Switzerland: 9%

Médecins Sans Frontières Australia Annual Report 2006—20

Special report: conflict emergency response Lebanon Mid-2006 The first MSF team entered Lebanon on 20 July, just one week after the beginning of the conflict. Within two weeks the team had rapidly grown to 37 international and 63 national staff working in Lebanon and also Syria. The teams worked in nine areas: Beirut, Saïda, Tyre, Jezzine, Nabatiye, West Bekaa, Aley, Baalbek and Damascus.

Before and after the ceasefire, the majority of medical needs were addressed directly by Lebanese health structures. MSF’s work consisted mainly in supporting them. With the acute phase of the humanitarian emergency ending towards the end of August, and many organisations arriving to help with the reconstruction, MSF decided to scale down its activities.

There were two phases to MSF’s emergency response as the needs on the ground evolved rapidly. The first phase was characterised by ongoing fighting, bombings and significant population displacements. MSF’s operations therefore focused on three main activities:

Throughout the conflict more than 60,000 displaced in Lebanon and 3500 refugees in Syria received relief items from MSF such as cooking and hygiene kits, mattresses, blankets, bed sheets, baby formulas and tents.

Providing assistance (relief items, medical care, water and sanitation activities) to the hundreds of thousands of displaced people.

Supporting the local health structures that were running out of medical supplies, and pre-positioning emergency supplies ahead of transportation routes being cut.

Seeking access to populations trapped in combat areas, mainly south of the Litani river and in the Bekaa Valley.

After the ceasefire started to come into effect (from 14 August), the majority of displaced people were keen to return home. The process happened quickly. Within days after the beginning of the truce, most displaced peoples’ centres were empty. In this second phase MSF refocused its activity on: ·

Assessing needs in areas that had been previously inaccessible.

Bringing support – medical and non-medical – to returnees and to those who stayed behind, mainly in the south and in the Bekaa Valley.

Providing medical supplies to health facilities in the most affected areas to facilitate their prompt reopening.

Replenishing host populations’ drained resources after the displaced had left.

More than 300 tonnes of material were sent to Beirut, including relief items, medical supplies (material for dialysis, medicines, surgical kits, etc.) and logistical materials (sanitation equipment, water bladders, etc.). All MSF activities in Lebanon were financed through private donor funds, including AUD$16,080 received from donors in Australia. MSF Australia sent one volunteer logistician to Lebanon at the height of the crisis. MSF Australia President Rowan Gillies, in his then capacity as MSF International President, was also present on the ground in Lebanon during the conflict.

Limited humanitarian access was a continuing factor throughout the crisis that hampered aid efforts. “To forbid all forms of movement, without distinction, will lead to even more civilian deaths and suffering,” said MSF’s International President. On 7 August, Israel stated that any moving vehicles south of the Litani River would be destroyed. “We refuse to accept this paralysis of humanitarian assistance and will continue to assist those in need,” stressed Dr Rowan Gillies in an interview. 10 August 2006.

© Zohra Bensemra/ REUTERS. Lebanon, August 2006. At the height of the crisis, the level of violence made it extremely difficult for MSF to reach people, especially in the south and in the eastern Bekaa valley. The last crossings over the Litani River were destroyed by air strikes, rendering it impossible to reach the south by truck. In order to secure supply lines to the areas in and around Tyre, MSF had to transport medical aid and fuel to the northern bank and then carry the goods by hand across the river and load them onto vehicles on the other side. Four tonnes of supplies were carried by hand, and a tree trunk spanning across the river was used as a makeshift bridge.

Médecins Sans Frontières Australia Annual Report 2006—22

Project unit The year 2006 has been quite a busy one for the Project Unit (PU). The primary rationale and raison d’etre of bringing shared responsibility for operations to the Australian MSF section, hand in hand with the initial objective of being of direct support to the field, was significantly reinforced with a number of major developments. The PU – now a team As planned the PU grew from being a one-person department to a two- and (temporarily) three-person department. In August Tonia Marquardt, a doctor from Geelong with extensive MSF field experience as well as a specific training background in obstetrics & gynaecology joined the department. Thus, in addition to paediatrics the PU is now able to further complement the MSF France medical department, by giving medical and operationally adapted support to the MSF France projects specifically with regard to women’s health. Furthermore, in December Jeff Stewart also joined the PU on a short-term contract. Being a partner section of MSF Switzerland as well as MSF France, MSF Australia decided this year jointly with Geneva to conduct a strategic review on Buruli Ulcer Disease (BUD), a mycobacterial disease prevalent mainly in Western Africa, but also in pockets of Australia (Victoria) and the Asia Pacific region (e.g. PNG). BUD is one of the most neglected diseases worldwide; and as part of his assignment Jeff has traveled to Switzerland as well as to field projects in order to get a firsthand impression of how the different projects are run as well as meeting with experts, stakeholders and project managers. The PU activities of 2006 can be divided into three major areas: 1.

Field visits by members of the department and providing operational support

Keeping ﬁeld operations at the heart of our activity in the Sydney oﬃce

Interaction with the medical public and other stakeholders within and outside Australia.

Field visits and operational support In total the department carried out five support visits to field projects in 2006.Three field visits were carried out by Myrto Schaefer, paediatrician and head of the PU, all of which were to MSF France projects and were targeted at improving care in paediatrics and more specifically HIV/AIDS in children .The first visit was to the two HIV/AIDS programmes in Kenya, one in Mathare (a big slum in Nairobi) the other one in Homa Bay district, an area bordering Lake Victoria with high adult HIV prevalence (35%). In both programs combined, MSF is treating 674 children under the age of 15 years with ART (antretroviral treatment). The second field visit took MSF is currently providing ART Myrto to Niger where MSF France is to 80,000 patients in 65 projects responsible for the response to in over 30 countries: of these, malnutrition in the area of Maradi. 5700 (7%) are children. By Myrto’s visit was aimed at giving September 2006, MSF France’s support to the field with regard to HIV/AIDS programs alone were paediatric care as well as looking into providing 1810 children with the possibility of treating children highly active antiretroviral with HIV in our programmes. During treatment (HAART). her last field visit to Cambodia Myrto visited the HIV/AIDS programmes in “Tackling HIV in children is both Phnom Penh as well as up the a multidisciplinary and Mekong River in the province of multilateral effort” says the PU’s Kampong Cham. In both Dr. Schaefer. “Children with HIV programmes combined MSF is are forgotten in the world of treating 258 children with ART. profitable pharmaceutical markets. In our projects our Tonia carried out two field visits national and international between August and December: the teams enthusiastically work first to Nigeria where she visited the together daily with the aim of programme in Port Harcourt and improving the quality of life for gave advice and support with regard each patient.” to care of victims of sexual violence; subsequently she visited the north of the country to assess the situation with regard to VVF (Vesicovaginal fistula) which largely is a consequence of lack of quality obstetric care and leads to medical as well as severe social problems for the affected women. Tonia visited several health structures in the north of the country and met with one of the rare experts in the field of repair of VVFs. Her second visit took her to Chad where she visited the programme in Adre and assessed the activities on women’s health.

When not on field visits members of the PU continued to provide technical support to the projects in their field of expertise. Both Myrto and Tonia went to the Joint Board Meeting (MSF France/Japan/US/Australia) that took place in November 2006 in Paris as well as to the project discussion meetings in Paris that followed at the end of the year. On both occasions they were able to participate in valuable discussions regarding the operational plan and quality of care for the respective projects of MSF France in 2007. Prior to these meetings in Paris Myrto also attended an extensive desk meeting in September with MSF Japan in Tokyo, in order to also feed into the operational discussion. MSF Japan is responsible “What makes vesico-vaginal for MSF France projects in Kenya, fistula (VVF) a devastating Indonesia and Armenia. disease is its social impact with patients rejected, isolated and Further input into field support and neglected. The disease cannot be improved quality of medical care was hidden so the patients become given by members of the PU through hidden. Whilst surgery is the final their input into the respective input into fistula this is not just a HIV/AIDS/TB and reproductive health surgical issue. On a recent trip to working group as well as by Nigeria (where there are contributing to MSF training estimates of up to 1,000,000 activities, be it during the medical women living with VVF), I visited week in Paris, the reproductive health some maternity units which had training in Geneva or the HIV training seen maybe 1 or 2 fistula cases in course in Berlin. the preceding 6 months. It is anyone’s guess how many don’t Field operations at the heart of our make it to the hospital. Fistula activity in the Sydney office will always be a direct indicator In terms of being the cornerstone for of areas of inadequate obstetric the sharing of an understanding of care.” operations at MSF Australia, the PU plays an important role in providing Dr Tonia Marquardt support to the Sydney office and in further developing our internal and external communication on our partners’ field activities. The main objective here for the PU is to improve the quality of our communications on medical issues as reported in our publications, and also to develop a sense of ownership of operations in the Sydney office.

Médecins Sans Frontières Australia Annual Report 2006—24

How far this objective was successfully tackled is difficult to ascertain. Certainly, the presence of members of the PU, with their frequent “hands-on” link to the field, adds to the office developing more ownership of MSF field operations. This is achieved through briefings, slide-presentations and feedback sessions being organised after field visits, as well as through informal conversations on an ad hoc basis with members of the different departments, particularly Communications and Fundraising. Putting a more structured framework to these activities is part of the PU’s objectives in 2007. Interaction with the medical public and other stakeholders Networking was carried out beyond the direct PU-related activities and was twofold; on a medical level, but also with giving interviews and talks for communication purposes. This included participation at the International AIDS Conference (IAC) in Toronto in August as well as in the symposium held prior to the conference on HIV in children (“Envisioning the Future”), where Myrto presented the paediatric outcomes of MSF HIV programmes . During the IAC Myrto represented MSF in a press conference on Paediatric HIV and gave numerous interviews to the written and oral press. In Australia Myrto gave a presentation at the ASHM (Australasian Society of HIV Medicine) conference in Melbourne. In addition Myrto and Tonia made a number of presentations at university courses at Sydney University, James Cook University in Townsville and the Albion Centre in Sydney. These “formal” activities were accompanied by numerous and continuous exchanges with colleagues in Australia and in the region on technical issues. Non-medical communications specifically included a presentation at the conference on humanitarian aid in Melbourne on “Field Protection in Practice” as well as assisting in panel discussions during MSF specific events. In summary, 2006 was a successful year for the PU, maintaining a healthy balance between presence in the field as well as in the operational headquarters, providing technical support as well as helping to enhance and promote MSF presence in the office as well as the medical and Australian community.

Special report: malnutrition emergency response Niger 2005-06 Each year in Niger the most severe forms of acute malnutrition affect more than 100,000 children aged 3 years or less, and each year about 190,000 children under the age of 5 die from malnutrition and associated diseases such as pneumonia and diarrhoea. The under-5 mortality rate in Niger is 1 in 4 children, or 259 per 1000 live births. Malnutrition is endemic in Niger, it occurs year-long and particularly in the south and poorest part of the country. It is not linked to any deficit in agricultural production, but rather to an economic system which promotes a free-market approach to the purchase of food, resulting in high prices. This system often prevents the poorest pockets of the population of Niger from purchasing essential food items at critical times.

Results obtained in Niger by MSF in using RUTFs to rehabilitate large numbers of severely malnourished children in 2005 were as follows: ·

Over 91% of severely malnourished children from the Maradi region in Niger (34,247 children) exited the MSF programme cured, that is, no longer acutely malnourished

Over 65% of the severely malnourished children were admitted directly into outpatient care and with the use of

“The introduction of Ready to Use Therapeutic Foods (RUTFs) is changing perceptions and practices. These nutrient-rich products designed for rapid weight gain, do not require preparation or the addition of water, and the energy-dense paste is impossible to contaminate. They are tailored for malnourished children with poor appetites and small stomachs who need to consume high quantities of calories…

Thus, while the region of Maradi in the south of Niger is a granary for excess cereal production, it is at the same time also one of the areas hardest hit by malnutrition. The peak period for fatalities due to malnutrition among Maradi children occurs during the “hunger gap” period, from May to October, when the crop stores of millet and sorghum have all been sold and can’t be replenished until the next harvest.

“These factors make such products ideal for outpatient use, and mothers quickly grasp the therapeutic nature of the product. The experience in Niger in 2005 shows that most cases of severe, acute malnutrition can be cured through attendance at outpatient centres at regular, weekly intervals.”

Niger experienced a major malnutrition crisis in 2005. Consequently, during that year and then also throughout 2006, MSF intervened so as to dramatically expand the way malnutrition is treated in children in Maradi. In order to try to break the cycle of endemic malnutrition, MSF made extensive use of “Ready-to-Use-Therapeutic-Foodstuffs”, or RUTFs. James Nichols, MSF Australia Press & Information Officer visiting the field in Niger: I met Hadiza, a 38-year-old mother of six children, patiently awaiting for the discharge of her two-yearold boy from MSF's intensive care in Maradi. “Last year was catastrophic for my family. I was obliged to come into town and beg for food in order to feed my children,” she explained. Now, fortunately for her son, Mougihadou, his severe diarrhoea could be treated easily and they could receive a daily ration of therapeutic food to assist his recovery. “I am very happy – I’ve seen a quick recovery... and I am very happy with the child's health now.”

Dr Milton Tectonidis, MSF Nutrition Expert

RUTFs the majority never required hospitalisation during the entire course of their treatment ·

Almost 85% of all admissions finished their treatment as outpatients

Average time to cure a child’s malnutrition was less than a month

The results obtained with the use of RUTFs in MSF’s expanded malnutrition programme in Niger in 2006 were as follows: ·

There were more than 73,000 admissions in the programme in the Maradi region The vast majority of the children were treated with RUTFs as outpatients, they were under 3 years of age and suffering from moderate acute malnutrition

partners to join an international campaign to reduce the costs of RUTFs as patented and to develop future generic versions which would be cheaper. However, at least half of the production costs of RUTFs involves the processing of raw materials (milk, sugar and peanuts), and so the problem goes beyond the question of bypassing existing patents and creating generic versions. It will in fact be very difficult to produce any generic form of RUTFs unless the primary raw materials listed above are no longer subject to

Susan Shepherd, MSF paediatrician in Maradi, explains the changes that RUTFs have made possible: “With the advent of Ready-to-Use-Foods firstly it was the design of the packaging, there was no manipulation required and the kids would just eat the fortified peanut paste as is. Second of all, it doesn’t need to be refrigerated and it has a rather long shelf life and so you can give two weeks’ worth or a month’s worth to a family and they can go home and the child can eat it and they can come back. It really makes the ambulatory part of our programme possible. “So now that kids don’t have to stay in a hospital setting, you can take care of an order of magnitude of children that is greater” explains Susan. “If you can have reasonably managed 100 or 200 children in an inpatient setting, then you can manage 10,000 or 20,000 kids in an outpatient setting.” © Dieter Teleman. Child with Ready-to-Use-Therapeutic Food.

Fewer than 2000 children living in the intervention area were admitted as inpatients and hospitalised during the severe acute malnutrition phase

The cure rate in the programme was above 90%

The efficacy of this new approach in the treatment of malnutrition on a large scale is now proven, but one major obstacle that remains is the price. With further data analysis MSF hopes to convince other major organisations and national

Médecins Sans Frontières Australia Annual Report 2006—26

world market pricing regulations and become exempted from them, so as to become cheaper for RUTF production. Until this exemption becomes a reality, the global public health catastrophe of millions of deaths among the world’s children, as caused every year by malnutrition, will continue. At the international level, malnutrition affects 60 million children who are 5-years old or less. Of these children, five million die from malnutrition each year.

Communications Introduction Three major trends characterised the work and activities of the Communications department in 2006, as part of a reorientation to shift away from institutional awareness-raising and to move towards improving the public’s understanding of MSF in terms of its operations. What MSF does and also what MSF says are both central to the concept of “operational communications”. This direction is fully aligned with all the efforts being made at the Executive level to concurrently enhance the operational partnerships we have set up and consolidated in 2006, with MSF France notably and also MSF Switzerland. In this context, a number of activities were undertaken in 2006 specifically in the communications area so as to create further synergies with our two operational partners. These synergies provide solid ground for future joint communications initiatives in the years to come. A few of the joint activities with MSF France and MSF Switzerland are briefly detailed at the conclusion of this report, however the thrust of Communications 2006 focuses on the three major trends which characterised the year. Press and Information Coverage Press and Information coverage for MSF, as for other organisations, can generally occur in two major ways: a “mention” in the media, usually done by sources other than MSF, or else a “major story”, which in the case of MSF consists of a substantial exposé of the work done by the organisation. Such “major stories” often involve and require labour-intensive, media relations work. In 2006, the perception was significantly reinforced of MSF as a generator of “major stories” in the Australian media landscape. In parallel with this, communications became increasingly perceived, in the spirit of La Mancha, as an integral component or tool of the medicalhumanitarian mission of MSF. More than 270 “mentions of MSF”, in all media outlets combined, were noted for the year, representing an average of 22.5 mentions per month. As shown in the graph below, these mentions were specifically related to the field and operational activities undertaken by MSF as an international organisation and in response to specific news-breaking world events. The

biggest monthly spike for this category of “mentions of MSF” occurred in August as the Lebanon crisis unfolded, and this was followed in December with a second big spike, reflecting the conflict breakout in Somalia. The spike of December can also be explained by a surge in our activities relating to the DRC “Forgotten War” exhibition and to the announcement and build-up of MSF as the chosen Charity Partner of the City of Sydney for the New Year’s Eve celebrations. Media Relations Comparing the two columns in the graph below, the spikes of August and December still occur for “major MSF stories” as they do for “mentions”. However the difference between the two columns is noteworthy. For “major MSF stories”, the biggest monthly spike was actually reached in May, which was when the Yogyakarta earthquake occurred. With this event came the specific interest generated in the local media for MSF’s work, which enabled us to do important journalistic networking from the Sydney office. Another peak for “major stories” occurred earlier in the year as shown, in March, with the broadcasting on the ABC of the widely followed “Australian Story” programme about a volunteer.

“It is clear that all sections of MSF have a common understanding of the basis for our action as both medical and humanitarian, and inextricably linked with the expression of public positions and describing our experiences (‘témoignage’) to the point that the separation of the concept of ‘témoignage’ from operations has disappeared.” La Mancha Agreement, 25 June 2006, Athens.

Overall, “major MSF stories” numbered 121 during the year and accounted for 45% of the total figure for “mentions”. Some of these stories on MSF’s work gave the organisation very substantial exposure in 2006. These were stories explicitly about volunteers or about projects (eg “Darkness falls on the night commuters” in the SMH of 22-24 December) or they were in-depth interviews and/or analyses provided by expert field staff or leading MSF representatives

Mention and major stories per month, 2006

60 Mention in the media per month Major media stories per month

50 40 30 20 10 0

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Dec

(“Dodging the UN bullet” by Dr Rowan Gillies in The Bulletin in October). The work done in this area of media relations by our Press/Information officers (James Nichols and Sally McMillan) yielded very positive results. The difference in terms of coverage between “mentions of MSF” and “major MSF stories”is further illustrated by the type of media outlets involved. For both categories, the print media (newspapers) led the way. For “mentions’the internet was the second prime outlet in 2006 (38%), with Radio and TV well behind (20% in total). However, more “major stories”were generated on Radio and TV (38% in all, 31% and 7% Because such people do not respectively) than on the internet crave recognition or reward, (21%). In this context, special mention we often do not know must be made of such broadcasts as about them… One look at the full-length ABC Background Médecins Sans Frontières Briefing programme of website and the extensive Dr Rowan Gillies’public lecture for the role played by volunteers is “Sydney Ideas”series, or else the obvious. A New Zealand numerous interviews he was able to nurse, Dennis Kerr, appears give on MSF prior to the New Year’s Eve typical of the hundreds of Sydney celebrations, as well as the TV volunteers who spend years footage of Christopher Stokes (then treating patients in troubled Director of Operations for MSF parts of the world such as Belgium) concerning MSF during the the Sudan, Uganda, India, Lebanon conflict. Central African Republic and Nigeria… Event Coordination and Multi Media Capacity Building Merrilyn Walton, The third major trend to be noted for Sydney Morning Herald MSF Australia’s communications 3 October 2006. development in 2006 was the significant improvement in the department’s capacities, first for organising and managing events where MSF’s work is shown to the public at large and then for reinforcing these events through a continuous presence and enrichment online through additional multi media tools and mechanisms. One example of this occured when, as a result of the experience gained from the DRC Exhibition and NYE, Events Coordinator

MSF mentions 2006:

Major MSF stories 2006:

· Newspapers: 42% · Magazine: 0% · TV: 4% · Radio: 16% · Internet: 38%

· Newspapers: 36% · Magazine: 5% · TV: 7% · Radio: 31% · Internet: 21%

Médecins Sans Frontières Australia Annual Report 2006—28

Alexandra Brown in the department managed to devise “core” display materials for MSF which quickly became the MSF mobile display kit. From 2007, this kit will stand packed and completely event-ready, to be deployed very rapidly depending on demand and need. Online, a web minisite was developed by Web Manager Jiann Hughes for the DRC photographic exhibition, which “followed” the schedule as the exhibition moved from city to city and which constantly updated it and enhanced its impact with relevant information on DRC itself and on the many differing contexts that this country presents for MSF intervention. In parallel a number of stories were published online from MSF volunteers, and additionally new supporting materials were developed, such as web videos, podcast articles and slide shows. A distinct Volunteers section for the website was also developed and became a special area where articles and letters from MSF Australia field staff were regrouped and presented in terms of their relevance to field issues. Furthermore, the end of 2006 saw the launch of another section of the website, to highlight those specific issues and topics covered by the Australian media in regard to MSF. All in all, and again, in this major area of activity (events) and of production (multi media) the capacity of the department of communications increased significantly during 2006. Conclusion As mentioned above, several meetings and visits took place in 2006, especially to Paris and to Geneva, which yielded a number of useful exchanges. As a result, synergies with our operational partners MSF France (including the partner sections of MSF USA and MSF Japan) and MSF Switzerland were created. Following a number of visits some joint projects were launched. Two such projects were completed in the year. At the initiative of MSF Australia, a 4DirCom meeting (a first) was held in October in Paris between the four Directors of communications of MSF France, USA, Japan and Australia. Other meetings attended by our staff members included the MSF international Web meeting (Athens in February) and the IO communications workshop and training seminar in Barcelona. Conversely, the Director of Communications of MSF Japan came to Sydney in November. In April Philippe Tanguy went on a field trip to Bunia’s Bon Marché hospital in DRC, in preparation for the DRC exhibition, and in September James Nichols undertook a field visit to Niger, and saw the work that MSF does in the nutrition crisis which affects particularly children in Niger. The slide show on Bunia and the podcast article on Niger are available on the website.

Special report: earthquake emergency response Pakistan and Java 2005-06 Pakistan – Saturday 8 October 2005 A 7.6 magnitude earthquake hit northeast Afghanistan, the north of Pakistan and northwest India. The epicentre of the quake was approximately 100 kilometres north of the Pakistani capital Islamabad and caused massive destruction in the surrounding regions with an estimated 76,000 people killed. By far the most affected area was the north of Pakistan, where almost 80,000 people were wounded and over 3 million people were left homeless. In Pakistan, MSF concentrated its medical emergency efforts in the districts of: · Mansehra (North West Frontier Province) · Bagh and Muzaffarabad (both in Azad Kashmir) The Mansehra District Hospital was partially damaged by the earthquake and was completely overloaded by the number of casualties. As a result of the disaster the hospital was unable to provide any proper nursing care, nor could it fulfil its role as a referral hospital for the rest of the population in the district seeing that all other hospital services were just as non-functional. The wounded from the earthquake were simply placed in the hospital courtyard or left on mattresses in the open air. However many of the wounded were developing serious complications and requiring complex surgical interventions. In response to this situation, MSF set up a 9-module inflatable hospital and situated it right next to the hospital. This was so as to be able to rapidly tend to the patients to be found in the vicinity of, and on, the hospital’s grounds. MSF’s inflatable hospital was made up of 120 beds and had 4 operating theatres, an emergency room and an intensive care unit, and also provided orthopaedic care for the injured. As part of MSF’s hospital services psychosocial care and physiotherapy was also provided for the patients. Australian anaesthetist Ian Smith assisted in setting up the inflatable hospital. “We put extraordinary effort into getting the hospital up and working as quickly as possible. After 200 operations in three weeks, we knew it was working well. This was the first time, to my knowledge, that a tent hospital has been made and used by MSF or any other aid organisation,” said Dr Smith.

hit Yogyakarta in Indonesia. According to Indonesian authorities, the earthquake killed 5749 people, left 38,568 wounded and made homeless hundreds of thousands. In the first few days following the earthquake many patients were discharged from the hospitals sooner than is normally recommended due to the overcrowded conditions. This led to the risk of the development of infections, or of further medical complications for the patients.

“It is central to our work,” said Australian volunteer and head of mission for MSF in Pakistan, Nick Lawson, about the inflatable hospital. “Our hospital is the only one that can provide orthopaedic care for the wounded. It has become the district’s referral centre for these patients”. Above left: © Remi Vallet / MSF. MSF inflatable tent hospital in Pakistan set up in front of the Mansehra district hospital. Below left: © Andre SardoInfirri/ MSF. MSF field hospital in Yogyarkarta.

MSF decided to concentrate on post-operative care to help these patients, and teams again made use of the inflatable tent system, this time in the middle of a football pitch in downtown Yogyakarta. The facility had 100 beds. It was staffed by both Indonesian and international MSF medical teams. The interconnected tents were fully equipped with electricity and running water and also a pharmacy.

The Mansehra project was closed by MSF in October 2006. Java – Saturday 27 May 2006 Just seven months after first delivering emergency medical aid to areas affected by the Pakistan earthquake, MSF teams were responding to another, when an earthquake of 6.2 magnitude

The MSF inflatable tent hospital is an innovative facility that permits teams to provide urgent medical care to vulnerable populations when permanent healthcare facilities have been destroyed or are overrun. The tents come in modules and provide the possibility of devising new operational strategies for the future, particularly in the context of natural disasters such as earthquakes.

Fundraising Medical humanitarian action seeks to save lives and alleviate the suffering of those most at risk as a result of an acute crisis. Our commitment to respond to people’s needs in such situations not only requires the commitment of our field staff, but just as importantly, the commitment of those who donate funds to our work.

important to recall here that the financial independence through the contributions provided by our donors allows us to: ·

Choose freely where to intervene based on medical needs.

Intervene quickly, particularly in emergency situations, without waiting for political actors or the media to mobilise, and to ensure that activities can continue should our income decline.

Decline accepting government funding that would compromise the ability to implement effective programmes or would come from parties involved in the particular crisis.

Commit resources and teams to innovative projects to improve the situation of those individuals we aid and demonstrate their appropriateness in specific interventions.

MSF's decision to intervene in any crisis is based solely on our independent assessment of people's needs. We feel it is

The 3-year strategic plan called for an increase in the Australian section’s capacity to support field operations, and to facilitate this, increasing the income to be raised to $16,000,000 per annum by the end of 2006. By the end of the 2006 financial year, 84,000 Australians were supporting the work of Médecins Sans Frontières contributing a total $27,749,521: exceeding the original 3-year plan target by almost $12,000,000.

Brand new MSF Australia donor signed up by senior Face to Face fundraiser (Eastgardens, NSW). © MSF Australia

Through the use of direct response television, Face to Face fundraising, direct mail and a range of other engagement techniques we have seen the regular giving program grow to over 48,000 Field Partners, representing 57% of our donor base. In addition, the work of MSF Australia was supported through single gifts, bequests, responses to emergency appeals and through various trusts and foundations.

MSF Australia income 1995 – 2006 $30,000,000 $25,000,000

Total All other Income

$20,000,000

Institutional Income Fundraising Income

$15,000,000

Total private income

$10,000,000 $5,000,000 0 1995

1996

1997

1998

1999

Médecins Sans Frontières Australia Annual Report 2006—30

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Fundraising Continued Face to Face fundraising remains one of the key components of the MSF Australia fundraising program. During 2006, 18,506 people signed up to become Field Partners after stopping at an MSF stall in a shopping centre or after meeting a fundraising team member on the street, and just as importantly, thousands more had conversations about our organisation and learnt a little more about our work in the field and presence in Australia. Face to Face fundraising continues to attract an exciting new demographic of supporter to the organisation â€“ generally a younger person. MSF Australia can look forward to the support of those recruited through Face to Face fundraising for a long time to come. MSF Australia can also be pleased that our ongoing communication with Face to Face recruited supporters, as with all of our supporters, reveals a high level of satisfaction with their interaction with the organisation. Indeed the impact of the growing contribution the Australian public has made to the medical-humanitarian work of Medecins Sans Frontieres operations cannot be understated. It is a crucial contribution that ensures our capacity to act independently in responding to the medical and humanitarian needs of the people we help. As a result of this generous support, MSF Australia was able to help fund projects in Cambodia; Chad; China; Democratic Republic of Congo; Indonesia; Iran; Iraq/Jordan; Kenya; Laos; Liberia; Malawi; Myanmar; Nepal; Niger; Somalia; Sri Lanka; Sudan and Thailand. Contributions were also used to assist a number of emergency interventions that arose during the year. As we continue to improve the quality of patient care, take on the challenge of neglected diseases and extend the breadth of our work: the support of our donors will become more and more crucial. In the coming years, we know we need to plan ahead for an increase in funds needed for HIV/AIDS healthcare, outbreaks of disease, natural disasters, malnutrition, wars, conflicts and other situations where people have been excluded from access to healthcare. As the challenges facing MSF grow, so too we hope, will the support of the Australian community in meeting these challenges. To all those who made contributions to the work of MSF though out the year, and helped our work to treat many men, women and children: thank you for your enduring commitment and generosity.

Bequests In 2006 Medecins Sans Frontieres Australia received just over $1.4 million in legacy gifts from 14 generous individuals who remembered MSF in their wills. We are deeply grateful for this incredible commitment to the future of the organisation. We also thank the many other supporters who have taken the time to advise us that they had made a provision to continue their support of MSF in their wills. To date, some of MSF Australiaâ€™s largest private donations have been from legacy gifts. These donations have made a considerable impact on our ability to respond to crises over the years while bequest pledges have allowed us to plan with confidence for the future. In 2006 we focused our resources on building on our support base in this area and successfully increased bequests pledges from 180 to 735 donors. At the same time the number of donors considering a gift to MSF in their will increased from 704 to 1829. To the many hundreds more who are thinking of making a similar statement of belief, irrespective of your final decision, we thank you for considering such a personal gift in support of our work.

Médecins Sans Frontières Australia Annual Report 2006—32

Projects supported by MSF Australia Cambodia HIV/AIDS 5

4 3 4

Many of Cambodia’s 14 million people continue to lack access to even the most basic healthcare. HIV/AIDS is one of the major health crises, with more than 180,000 Cambodians affected by the virus. Of these, between 25,000 and 30,000 patients are in urgent need of antiretroviral (ARV) treatment. 46

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MSF has been working in Cambodia since 1989. Total international staff: 18 National staff: 258 The HIV/AIDS programme that MSF runs in Cambodia is its largest in South East Asia. Teams are working in several provinces including Takeo, Kompong Trach, Kompong Cham and Siem Reap providing ARV treatment (ART). In Siem Reap, MSF runs a Chronic Diseases Clinic (CDC) treating HIV/AIDS and TB, one of the most common opportunistic infections and a major cause of death in HIV patients. Here, teams also provide treatment for diabetes, hypertension and cardiac disease. In 2006, MSF introduced a community TB program in 180 remote villages in Sotnikum and adjacent districts to Siem Reap. Village volunteers are assigned patients and help ensure that medication is taken, increasing adherence to drugs. Two field coordinators from Australia worked in Siem Reap in 2006.

MSF France Projects: Phnom Penh and Kompong Cham International Staff: 11 National staff: 119 Total budget: $4,696,847 (€2,814,000) MSF Australia funds: $2,000,000 In the Cambodian capital Phnom Penh, where MSF has been providing care to HIV patients for more than five years, teams provided ambulatory care in 2006, and also “Cambodia is going through worked in the infectious diseases a transition period in the ward in the Khmer-Soviet Friendship fight against AIDS. When we Hospital. Here, they also offered started our programme, we integrated treatment for patients cowere more or less the only infected with HIV and TB. In 2006, MSF people involved. Now there's treated 2745 patients with ART, a political readiness to including 108 children. Since 2005, commit to the issue, and there has been a significant increase national policy is becoming in the number of patients who have a reality, particularly with developed resistance to first-line large numbers of health treatment, meaning they now have to centres introducing ARV take the more expensive and therapy.” complex second-line treatment. In 2006, 129 patients were treated with Dr Jean-Francois Corty, second-line treatment. MSF deputy programme manager for Cambodia. In Kompong Cham, the most populated province in Cambodia, November 2006. MSF provided outpatient HIV care and support to the infectious diseases ward in the Kompong Cham District hospital in 2006. MSF provided care for 2222 HIV-positive patients, of whom 1676 patients were treated with first-line ARV drugs, including 142 children. As this program is much younger than the one in Phnom Penh, only eight patients needed to be switched to second-line treatment. MSF was also involved in preventing HIV transmission to the child during pregnancy and childbirth. Teams provided clinical follow-up, care and early detection or exclusion of HIV for infants.

Chad EMERGENCY ASSISTANCE TO VICTIMS OF CONFLICT/CARE TO REFUGEES AND INTERNALLY DISPLACED

71 69

The year 2006 saw a marked increase in the level of violence and instability in Chad. Several attempted coups on the government culminated in a large-scale rebel attack on N’Djamena in April, resulting in hundreds of civilian and military casualties. In November and December, violent fighting throughout the east of the country led to the displacement of about 40,000 Chadians. At the same time, the conflict in Darfur in western Sudan exacerbated the already existing problems in Chad, with around 200,000 Darfurian “Barely arrived we were refugees moving to camps along the confronted with 15 Chad-Sudan border. malnourished children for whom we luckily could MSF has been working in Chad organise follow-up since 1981. Total International treatment,” recalls NZ nurse staff: 89 National staff: 743 Dennis Kerr, working near Chad’s border with the Four operational sections of MSF were Central African Republic. active in Chad during 2006, with a “For two days a week an focus on surgical capacity to treat MSF mobile clinic set out in people affected by violence. MSF also the vicinity of the camps to provided basic healthcare and treat people. In 10 days the responded to outbreaks of disease team treated 506 patients, such as measles, meningitis and most of them suffering from cholera. MSF also conducted a malaria diseases like watery project on the Cameroon border diarrhoea and malaria.” providing treatment with artemisininbased combination therapy (ACT). April 2006. MSF assisted refugees from the Central African Republic providing paediatric and maternal care and psychological support. Teams were also involved in addressing the consequences of sexual violence and malnutrition. MSF Australia volunteers to Chad in 2006 included a logistics coordinator from New South Wales and a nurse and emergency team member from New Zealand.

MSF France projects: Adré, Dogdoré, Goré, Adé, Koloye International staff: 32 National staff: 350 Total Budget: $10,405,169 (€6,234,000) MSF Australia funds: $1,000,000

65 67 76 68 6

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8 24

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MSF teams assisted victims of the conflict in Adré (eastern Chad), providing basic healthcare and emergency surgery to residents as well as Sudanese refugees. Between January and November MSF undertook 510 surgical interventions in Adre hospital, including trauma procedures and caesareans. There were 3346 admissions to the emergency unit of the hospital during 2006. Dogdoré, in the south-east, saw a large influx of internally displaced persons in July. MSF responded to this by providing primary and secondary healthcare, non-food items and access to water. From July to December, MSF carried out over 13,000 outpatient consultations, treated 1342 cases of malaria and undertook a measles vaccination for over 700 children. A project in Goré (south-eastern Chad) was opened in July in order to provide secondary healthcare to the district’s population and to 30,000 refugees from the Central African Republic. MSF teams carried out war-related surgery, TB treatment and gynaecological consultations. Following an attack on Koloye and surrounding villages in November, nearly 12,000 people were forced to flee to Adé. MSF responded by providing primary healthcare and access to water. MSF Switzerland projects: Iriba, Guereda, Biltine International staff: 18 National staff: 155 Total Budget: $483,126 (CHF476,049) MSF Australia funds: $200,000 The marked increase in the fighting towards the end of 2006 between the ANT (government armed forces) and Chadian rebels led to a further expansion of emergency medical assistance. More surgical and emergency staff moved into Iriba near Guereda. MSF also responded to an increase in admissions, due mainly to gunshot wounds in Abeche. In addition, teams took over responsibility of the Guereda and Bitline hospitals.

Médecins Sans Frontières Australia Annual Report 2006—34

Projects supported by MSF Australia Continued

China HIV/AIDS According to the UN, up to 650,000 people in China are infected with HIV. Antiretroviral therapy (ART) is being expanded throughout China with the support of international donors. However patients still have to cover the costs of laboratory tests, related fees and treatment for opportunistic infections. In southeast China an estimated 15,000 HIV-positive people live in Nanning in Guangxi province, a city of 3.5 million inhabitants. Two-thirds of these patients are from high-risk groups (sex workers, homosexuals or intravenous drug users). Moreover, access to care and treatment through the Chinese national health programme remains minimal due to cost, fear of breach of confidentiality and social stigmatisation associated with the disease. 53

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authorities to establish a programme in neighbouring Henan province, where an estimated 300,000 people at least are in need of HIV/AIDS treatment.

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MSF has been working in China since 1988. International staff: 18 National staff: 79 MSF decided to intervene in China with the aim to set up an accessible HIV/AIDS programme, offering comprehensive care including counselling, testing, treatment of opportunistic infections and antiretroviral treatment. MSF’s Access to Essential Medicines Campaign has also been present in China since 2003, working to improve drug supply for MSF projects and advocating for fixed-dose combination (FDC) pills that can simplify treatment. Intellectual property protection and other factors currently block the use of FDCs, resulting in restrictions in drug choice, lack of availability of needed drugs, and high prices for some medicines. In Central China, in Xiangfan, Hubei province, MSF manages a treatment clinic in collaboration with the Xiangfan Centre for Disease Control. Most people here contracted HIV from unhygienic blood collection and transfusion practices when selling their blood plasma. More than 360 patients are registered in the clinic and 140 patients receive antiretroviral drugs (ARVs). In 2006 MSF was refused permission by the

Three volunteers from MSF Australia, including a nurse, a medical doctor and a field coordinator, worked in China during 2006. MSF France projects: Nanning International staff: 12 National staff: 34 Total budget: $3,515,125 (€2,106,000) MSF Australia funds: $800,000 Since December 2003 MSF has been working together with medical personnel from the local infectious diseases hospital in Nanning, providing ART and also financing hospitalisation costs for patients needing referral. MSF offers comprehensive care including counselling. MSF treated 692 HIVpositive patients, 439 of whom received highly active antiretroviral treatment (HAART). Treatment of opportunistic infections such as TB, penicilliosis (a fungal disease found in the region) and specialised care for HIV-positive pregnant women was also provided.

“My son was in hospital and he needed a blood transfusion to replace the white blood cells. The doctor was scared of AIDS patients, and we were told we had to get out of the hospital. My son, Wei Tingfeng, died three days later.” Wei Tingfeng was five years old when he died at the local hospital. His mother Mrs Lan and her husband now receive free ARV treatment at the MSF clinic in Nanning.

Since 2000, MSF had been running a project for street children in Baoji, Shaanxi province, providing medical, psychological and social care. After advising a local NGO on taking over the management of this project, MSF withdrew from Baoji in March 2006.

Democratic Republic of Congo (DRC) ASSISTING VICTIMS OF CONFLICT, DISEASE, DISPLACEMENT AND SEXUAL VIOLENCE The year 2006 saw democratic parliamentary and presidential elections held for the first time in over 40 years in the Democratic Republic of Congo (DRC). Despite the relatively peaceful election process, throughout the year millions of Congolese still endured extreme deprivation and the devastating effects of ongoing violence. Fighting continued in the east of the country, and thousands of civilians everyday were the targets of various armed groups. The legacy of the decade of conflict (which according to the UN “We decided to try and save has led to 3.8 million deaths in DRC) is them,” said Anne Taylor of a that hundreds of thousands of people mother in the middle of have been displaced. giving birth while travelling to an MSF hospital on a Five surveys conducted by MSF in bicycle pushed by her DRC in 2005 showed the mortality husband. “It would have rate to be more than double the taken the husband 8 hours commonly accepted threshold. The to push his wife on a bike, it MSF surveys also noted either the was getting dark and the complete absence of, or exclusion mother and baby would from, medical care for an extremely have died. At the hospital a large part of the population. Remote surgeon did a caesarean, regions of this vast country, for saving the mother and instance nearly the whole of baby. It was a happy Katanga, are inaccessible and remain moment.” today without even one single road. The lack of any means of Anne Taylor, logistician from transportation and communication New Zealand working in in many areas of the country makes Katanga in 2006. for considerable difficulties in the delivery of urgent aid and emergency healthcare, with the resulting toll from disease and epidemics often reaching staggering proportions. MSF has been working in DRC since 1981. Total international staff: 207 National staff: 1933 Apart from caring for victims of conflict and disease, in 2006 in DRC MSF responded to outbreaks of meningitis, malaria, cholera and measles throughout the country, and also treated sexual violence victims whose numbers continued to rise alarmingly on a daily basis. In Katanga province, fighting between local militias and the FARDC (government forces) flared again displacing thousands, blocking the supply of aid and causing a malnutrition crisis.

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Responding to urgent needs MSF started a programme around Lake Upemba, opening a healthcare centre, launching a major measles vaccination campaign and distributing shelter and cooking materials for the families affected by the crisis. MSF also worked in Nyunzu, Pweto, Mitwaba, Shamwana, Ankoro and Mukubu. In North Kivu MSF worked in Kayna, and Rutshuru while in Ituri, apart from its usual comprehensive activities in Bunia’s Bon Marché Hospital MSF dealt with a pneumonic plague outbreak in the area of Rety. 39

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In South Kivu MSF teams provided comprehensive HIV/AIDS care with counselling, testing and treatment of opportunistic infections, as well as antiretroviral treatment (ART). In addition to a long-running project in Kinshasa which treated about 1900 patients with ART, an HIV/AIDS programme in Dungu in Orientale Province continued to expand access of HIV/AIDS patients to antiretroviral drugs. In the same province, which is situated near the border with Sudan, MSF provided medicine and also training (for Congolese staff ) for the treatment for the deadly disease Human African Trypanosomiasis (sleeping sickness). MSF Australia sent a logistics coordinator and a paediatric nurse to work in DRC during 2006. MSF France Projects: Ankoro, Mukubu, Nyonga, Kikondja, Butumba/Mukanga, Beni/Linzo, Kayna, Kanyabayonga, Rutshuru, Nyanzale International staff: 29 National staff: 469 Total budget: $9,667,427 (€5,792,000) MSF Australia funds: $2,481,920 North Kivu Within an extremely unstable political environment and limited humanitarian space, MSF continued to work in Kayna, in North Kivu province. There MSF was responsible for surgical, paediatric and emergency healthcare, and also for the treatment of malaria, malnutrition and victims of sexual violence. In 2006 there were 4422 emergency admissions and 1482 surgical interventions. In Rutshuru, MSF teams operated within yet another insecure context. In January, there was an attack against the MSF team which was subsequently evacuated (they were able to return three weeks later). In 2006 there were 7779 emergency

Projects supported by MSF Australia Continued

Democratic Republic of Congo (DRC) CONTINUED admissions and 3733 malaria cases that were treated. MSF also undertook specialised sexual violence consultations of which there were 1519. Due to a marked increase in sexual violence cases in the region, MSF opened an additional project in Nyanzale in October. Teams also treated malaria and malnutrition in Rutshuru. Katanga MSF worked in Ankoro at the general reference hospital continuing to assist direct and indirect victims of violence and conflict. In one of the largest operations conducted by MSF in 2006, teams supported and trained national staff in several different medical areas: paediatric care, and also gynaecological, obstetric and surgical services. In 2006 MSF carried out 47,567 outpatient consultations, treated 17,166 malaria cases and undertook 878 surgical procedures. MSF also treated patients affected by TB and malnutrition. In Mukubu MSF assisted indirect victims of conflict and IDPs from the south, providing treatment for malaria as well as malnutrition. Sexual violence consultations and gynaecologicalobstetric care were also undertaken. Following a distinct improvement in the overall situation in Mukubu, the project was scheduled to close in January 2007. Emergencies In addition to these projects, MSF also carried out five emergency programmes in 2006 in DRC: In Kikondja, MSF responded to a large cholera outbreak, treating 2143 cases. A large measles vaccination campaign was undertaken in the Butumba and Mukanga health zones, with more than 350,000 children being vaccinated in just over three weeks. In Beni and Linzo, MSF responded to wounded casualties of the government military offensive against Ugandan rebels who had crossed the frontier to seek refuge in DRC. A similar operation took place in Nyonga when an FARDC military offensive was launched against the Mai-Mai rebels in February. MSF carried out another large-scale measles vaccination, treated cholera cases and malnutrition, distributed basic needs kits and undertook gynaecological consultations.

Also in Kanyabayonga, MSF assisted 40,000 IDPs following an attack in the region by an armed group belonging to the dissident general Laurent Nkunda, carrying out paediatric, maternity and gynaecological-obstetric care as well as sexual violence consultations. MSF Switzerland Projects: Bunia International staff: 20 National staff: 340 Total budget: $5,577,266 (CHF5,495,565) MSF Australia funds: $600,000 Ituri In 2006 MSF continued to treat victims of the ongoing conflict in Ituri province at the Bon Marché Hospital, situated in the provincial capital of Bunia. The hospital offers a full range of medical care including surgical and orthopaedic facilities. In 2006 MSF carried out 8238 surgical interventions in Bunia. The Bon Marché Hospital has a capacity of 250 beds and also offers the full range of in- and outpatient services, as well as important maternity and paediatric services.

“The mortality rate at Bon Marché remains high. It’s heartbreaking that on average 4 children die on any bad day. Malaria, diarrhoea and meningitis are all treatable if dealt with early, but patients usually arrive too late. Exhausted pregnant women often walk for days from the outlying areas so as to come and give birth at Bon Marché. The challenge for our medical aid programme in Bunia can be put simply: to provide access to quality healthcare as widely as possible for the Ituri area and its population, which is at the complete mercy of conflict.”

Philippe Tanguy, Sexual violence continued to be a Director of Communications major problem in Ituri, with 1784 MSF Australia following his April female rape victims treated in 2006. 2006 visit to Bunia DRC. MSF provided medical care to victims of rape and sexual assault (mainly women and children) with emergency prophylactic contraception within 72 hours, prevention of sexually transmittable infections including HIV, emergency repair surgery, tetanus and hepatitis B vaccination. Midway through 2006 (from July onwards) MSF Australia launched a major awareness-raising and témoignage campaign with the international photographic exhibition from New York, Democratic Republic of Congo: Forgotten War. A nationwide tour of the exhibition was organised. In 2006, the exhibition went to Brisbane, Townsville, Canberra, Melbourne, Adelaide and Hobart.

Indonesia SURGERY FOR CONFLICT AND TSUNAMI VICTIMS / EARTHQUAKE EMERGENCY RESPONSE Following the 2004 Indian Ocean Tsunami that devastated Aceh Province, Indonesia continues to suffer natural disasters and health crises. Sections of the population in Aceh are in need of healthcare and surgical services remain lacking because of the legacy of the 29-year conflict between the Free Aceh Movement (GAM) and the Indonesian government. The isolated province of Papua remains subject to epidemics and suffers from the worst health indicators in all of Indonesia. Also, an earthquake measuring 6.2 on the “The worst areas are about Richter scale shook the island of Java 30 minutes drive – villages on 26 May, killing 5760 people and are just totally flattened. We injuring more than 37,000 in areas are starting to move out around Yogyakarta. there with facilities for physiotherapy and psychMSF has been working in care patients once they are Indonesia since 1995. discharged. Because of the Total international staff: 99 need for beds in the big National staff: 1016 hospitals, a lot of patients have been sent home very In 2006 MSF maintained a more early and need follow-up in streamlined team in Aceh, focusing these areas.” on mental healthcare in three districts for people affected by the protracted Catherine Moody, conflict. A team also performed Wollongong nurse working surgery in Sigli Hospital on Sumatra’s as a field coordinator during north coast and provided primary MSF’s Yogyakarta health care to a population of earthquake response. approximately 475,000 through clinics, training, drug donation and August 2006. health promotion. MSF responded to outbreaks of disease, for instance malaria in Alor and measles in Sumba, and further developed a tuberculosis project in Ambon. An MSF emergency team also responded to simultaneous epidemics of cholera and measles in Papua, particularly in the Asmat area, where teams vaccinated 13,500 children against measles. The first team members arrived in Yogyakarta on the same day as the 26 May earthquake and emergency supplies soon followed. An MSF surgical team worked alongside Indonesian and other international teams to help clear the backlog of patients waiting for surgery. MSF Australia deployed eight field volunteers to Indonesia in 2006. These included two anaesthetists, two nurses, a psychologist, a

Médecins Sans Frontières Australia Annual Report 2006—38

field coordinator, a logistics coordinator and a surgeon.

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MSF France projects: Sigli (Aceh) and Yogyakarta earthquake (Java) International staff: 27 National staff: 197 Total budget: Aceh $2,049,655 (€1,228,000) Java $2,336,740 (€1,400,000) MSF Australia funds: Aceh $530,000 Java $100,000 In regard to the orthopaedic and reconstructive surgery programme in Sigli (Aceh), MSF decided to continue to provide care for patients with disabilities due to conflict (and also the tsunami) for the first six months of 2006. In July, the Sigli Hospital project was deemed ready for a closure to occur at the end of 2006. Following the consolidation of the 2005 accord between the Free Aceh Movement and the Indonesian government, most of the patients in the latter months of 2006 in Sigli were no longer conflict victims, but were wounded in other circumstances such as road and traffic accidents. By the end of the project, 1546 consultations were carried out and 787 operations were performed (including minor surgery under anaesthesia). During the year MSF also assessed more than 700 patients for psychological problems, with 58% of them found to be suffering from post-traumatic stress disorder and 19% from depression. In December MSF closed the project in Sigli. Local MSF emergency teams also responded quickly to the Yogyakarta earthquake in May, treating the most urgent wounds within the first few days. In total, about 5000 surgical interventions were carried out. Over a period of two weeks, an average of five complex surgical interventions per day were carried out by an MSF orthopaedic surgeon in one of the hospitals in Yogyakarta. However, local hospitals were overwhelmed by the enormous number of patients, making it difficult to cope with the needs and to provide proper post-operative care for their recovery. MSF set up an inflatable hospital in a local football stadium where 240 outpatients; 318 admissions and 240 patients received physiotherapy. An additional 651 patients received medical follow-up for their injuries. MSF’s emergency intervention in Yogyakarta came to an end in September.

Projects supported by MSF Australia Continued

Iran PRIMARY AND SECONDARY HEALTHCARE/REFUGEES 75

Iran has been receiving millions of refugees for decades, whether Kurdish, Iraqi or Afghan in origin. There are an estimated 1.2 million documented Afghan refugees in Iran and an even greater number (1.5 million at least) who are undocumented. Afghans have come to Iran in different waves from the time of the Soviet occupation of Afghanistan (1979) then the civil war (1992) followed by the arrival of the Taliban (1995) and finally of the American-led coalition (2001). 71

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MSF France Projects: Mashad and Zahedan International staff: 3 National staff: 72 Total budget: $2,316,711 (â‚Ź1,388,000) MSF Australia funds: $500,000

There is very little international assistance for these Afghan refugees in Iran, and since 2002 Iran has promoted their return to Afghanistan by actively making life difficult for them while staying in Iran. Their access to jobs and schooling has been prevented. Fines have been imposed on them, and if they are documented sudden changes have been made to the requirements for access to any social services including healthcare. This may take the form of exclusion from health insurance, denunciation and rejection when seeking treatment and hospitalisation or retention of their documents as a guarantee for payment of any hospital bills. For the undocumented among them the situation is even worse: the lack of legal status as refugees has completely excluded them from the most basic social services including any provision of healthcare. However during 2006 Afghan refugees were still coming into Iran, due to a severe drought in the north of Afghanistan and also renewed fighting in the south between the resurgent Taliban and the Coalition forces. MSF has been working in Iran since 1995. Total international staff: 6 National staff: 107 MSF has responded to various crises, man-made as well as natural, affecting Iran for more than a decade. During 2006 MSF provided primary and secondary healthcare for both documented and undocumented Afghan refugees. This was carried out through MSF clinics and Home Visitor programmes, and included paying bills to hospitals when payment was required for the urgent referral of the patient to proceed, if the referral fitted MSF criteria.

From January to October 2006, 25,816 patients were received for consultation in four clinics in Mashad, which is the second largest city in Iran and situated in the northThe majority of the eastern part of the country. Of those population in Zahedan is of patients 893 were referred to Baluchi ethnicity and hospitals (45% were emergency mostly Sunni Muslims. cases) and 4317 were referred for Iranian authorities have pathology and/or paramedical always neglected this examinations. In October the project province, which is part of was handed over to the United the smugglers route. The Nations High Commissioner for Afghans here are Refugees (UNHCR). For the last 10 particularly stigmatised months of the Mashad project, MSF because they are held to be strengthened its identification of and responsible for the illegal attention to the most vulnerable trade. In March and April patients, particularly those with 2006, allegedly to ensure the chronic illnesses or high-risk safety of Iran the National pregnancies. A full triage of 17,000 Chief of Police sent 4000 patient files was conducted prior to members of the Iranian the closure so as to identify the special forces into the critical cases, and by October 1800 province so as to closely patients had been identified as monitor the Afghan requiring follow-up with the UNHCR. refugees. Zahedan is the capital of SistanBaluchistan, the poorest province of Iran often strongly affected by drought. The majority of the population is from Balush ethnicity and is mostly Sunni (see box). In Zahedan MSF runs three clinics in the northern and eastern parts of the city, where most Afghan refugees and their families are gathered. There MSF provides free medical consultations, nursing care, free drugs and also supports the sick children particularly if their health problems are associated with malnutrition. In 2006 teams performed 55,520 consultations in the outpatient department. In March, MSF also distributed hygiene kits and food to 1000 families in two villages following an earthquake in Lorestan, approximately 400 km southwest of Tehran. Medical assistance was provided to people in rural areas.

Iraq/ Jordan SURGICAL ACTIVITIES AND REFERRAL FROM BAGHDAD TO AMMAN MSF began working in Amman, Jordan, in response to the ongoing violence in Iraq where on average 20,000 people are wounded each month from bombings and armed attacks. The Iraqi health system is collapsing and the capacity of hospitals to treat emergency cases is seriously threatened. Medical personnel are targeted and are fleeing the country en masse. Supply of drugs is erratic and the safety of patients is also a serious concern given the dire security conditions. Given the continued targeted attacks on Project Objectives: international aid organisations, in · Supply selected hospitals 2006 MSF established a project in with essential items for Amman because of the danger posed treating casualties to staff by staging operations inside · Refer and treat selected Iraq and the absence of any secure victims of violence from humanitarian space. Iraq in Amman. Principles of patient selection: · Victims of violence who are unable to be treated inside Iraq · No discrimination between ethnic or religious groups, gender or age · Patients must require one of the following specialties: orthopaedic, maxillofacial surgery, reconstructive surgery, physiotherapy.

MSF has been working in Jordan since June 2006. Total international staff: 5 National staff: 31 The project was opened in Jordan in August with the objective of providing surgical post-trauma care for people in Iraq, to whom this level of care is currently not available. MSF started operating in a surgical facility in the Red Crescent Hospital in Amman, effectively increasing the capacity of the hospital with two more operating theatres. The hospital has a capacity of 80 beds which can be almost doubled in case of a surge of patients.

Concurrently MSF set up a liaison office in Baghdad in cooperation with a network of Iraqi physicians. The role of this network is to inform Iraqi doctors and patients of the existence of the MSF surgical programme in Amman, to help with the triage of patients and to organise their transfers to Jordan. MSF also responds to requests from hospitals in Baghdad for drugs and medical equipment. 71

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MSF France projects: Baghdad/Amman International staff: 5 National staff: 31 Total budget: $8,437,301 (€5,055,000) MSF Australia funds: $800,000 The team in Jordan operated on 61 patients in 2006, 42 of whom were referred by the network in Baghdad. More than 120 surgical interventions were performed on those patients (45 orthopaedic; 76 maxillofacial; and reconstructive surgical procedures). An Australian anaesthetist, Nikki Blackwell, describes one of the difficult and unfortunately, common issues faced by the surgical team in Amman: “In contrast to other missions I’ve worked on, at the beginning of this project we are seeing a great many patients who need maxillofacial surgery, which calls for a highly sophisticated anaesthesia technique that is difficult to apply but essential in these cases. This technique requires the fibroscopic intubation of a patient whose facial anatomy has been largely destroyed. To avoid losing the patient’s airway during induction of the anaesthesia, we have to verify what we are doing very carefully, while remaining ready to take action in case of suffocation.” Through the network of Iraqi physicians in Baghdad, MSF also made five donations of medical and surgical equipment to different hospitals covering the needs of an estimated 7500 patients. The programme will continue in 2007 in the same way the project has worked so far in 2006.

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Kenya HIV/AIDS/EMERGENCY RESPONSE 7

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For the past decade, MSF’s primary focus in Kenya has been the treatment of HIV/AIDS. The HIV/AIDS epidemic in Kenya has reached such proportions that an estimated 200,000 adults and 50,000 children are in need of antiretroviral treatment (ART), while in certain regions the HIV/AIDS prevalence has reached a level of 35%. However, there are just 90,000 people (including 6000 children) under ART in Kenya. 70 74 66

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MSF has been working in Kenya since 1987. Total international staff: 42 National staff: 399 MSF provides a comprehensive package of care for HIV/AIDS, from testing through to treatment, in the Kibera and Mathare slums of Nairobi as well as in the Homa Bay district on Lake Victoria and in Busia in the west of the country. In northern Kenya, a drought that had started in 2005 caused a nutrition crisis by early 2006. More than 37 districts across the country were in need of assistance. In January MSF intervened in the northeastern town of El Wak and the Marsabit district. In El Wak, a nutritional survey carried out by MSF in March showed 30% of children to be severely malnourished. MSF set up a therapeutic feeding program and treated over 500 children for severe acute malnutrition and immunised 19,000 against measles. When the rains began in April, the children (already weakened by malnutrition) developed diarrhoea and respiratory infections and their nutritional status worsened. In May, the monthly admission rate in El Wak increased by 50 per cent. MSF Australia sent four volunteers to work in Kenya in 2006: two epidemiologists, one doctor and one logistician. MSF France Projects: Homa Bay (Lake Victoria), Mathare (Nairobi) International staff: 16 National staff: 196 Total budget: $8,677,651 (€5,199,000) MSF Australia funds: $1,600,000 MSF provides HIV/AIDS care in the Homa Bay district of Nyanza province (Lake Victoria) working in the district hospital as well as in several peripheral health centres. In 2006 teams provided

voluntary counselling and testing for HIV, ambulatory and inpatient care for HIV infected patients including integrated management of TB/HIV co-infection, treatment of other opportunistic infections and, most importantly, ART. MSF had 5491 patients (including 721 children) under care for HIV/AIDS by the end of November. Of these, 3748 were on ART. In Nairobi, MSF provides care for people living with HIV/AIDS and tuberculosis in the sprawling Mathare slum – one of the biggest slums in East Africa. Here MSF offers medical consultations for adults and children with HIV/AIDS as well as TB, including nutritional support where needed and also prevention of transmission of HIV from mother to child. At the clinic called the “Blue House”, where MSF conducts its project in Mathare, there were 2619 patients under HIV care and 331 admissions for supplementary nutrition at the end of November 2006. Of these, 1719 were on ART. In response to the nutrition crisis following the 2005 drought, MSF started an emergency nutritional intervention in May in Marsabit District that ended in August. Two mobile teams provided biweekly mediconutritional assistance in 35 sites in villages or peripheral settlements.

“Co-infected patients tend to have severely weakened immune systems and for about 70% of them, it is extremely difficult to detect pulmonary TB. A high proportion of co-infected patients develop what we call extra-pulmonary TB, which is hard to detect due to the lack of adapted diagnostic tools.” Christine Genevier, Head of Mission in Homa Bay, explains the challenges of treating TB in resource-poor settings such as Kenya. March 2006.

Ironically, abnormal rainfalls in Kenya from the beginning of November led to disastrous flooding that affected low-land areas. The worst hit areas were the plains bordering the Tana River in the eastern part of the country where 700,000 people came to rely on emergency assistance. In December an outbreak of Rift Valley Fever, a haemorrhagic fever, occurred in the Garissa district in the north-east of the country and MSF responded with another emergency operation, providing medical care to the affected population.

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National authorities and many international organisations do not perceive HIV/AIDS to be a major health problem in Laos. However, in 2006 a national strategy on HIV/AIDS was validated, with the Ministry of Health recognising HIV/AIDS as a serious health issue in the country. Access to testing and antiretroviral (ARV) drugs remains very limited and in 2006 MSF continued to focus on providing treatment and care to patients affected by the HIV epidemic, particularly in the southern part of the country. “My unhappiness in being MSF has been working in Laos infected with HIV was largely since 1989. Total International relieved the day that the MSF staff: 4 National staff: 17 treatment centre was opened here in Savannakhet. MSF remains the only organisation in I was so lucky because in Laos providing antiretroviral some way, I’d been given a treatment (ART) for people with new life, like many others HIV/AIDS. In September 2003, the first here. Other patients in Laos MSF patient in Laos was treated with also have the right to this ARVs. By the end of 2004, 160 patients new life and it’s for this were receiving these medicines. MSF reason that I’m calling on the has since that time expanded its government to follow in treatment capacity and the number MSF’s footsteps and take its of patients receiving ARV drugs has full responsibility in treating tripled – at the end of 2006, nearly all of us.” 500 people were receiving ARV drugs. Kinoy Phong, president of The Association of Patients Living with AIDS in Laos. August 2006.

Médecins Sans Frontières Australia Annual Report 2006—42

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MSF works in the district hospital in Savannakhet, where it has been running an HIV programme since 2003. MSF provides ART for patients with HIV/AIDS and opportunistic infections. At the end of 2006, there were 452 registered HIV-positive patients of whom 369 were receiving ART. MSF also supported decentralised voluntary counselling and testing (VCT) for HIV/AIDS, now available in 14 district hospitals and one health centre in Savannakhet province. In 2006, MSF also opened an HIV/AIDS project at the Setthatirat hospital in the capital, Vientiane. This project allows care to be provided for local residents who are living close to the hospital in Vientiane as well as patients coming from the northern provinces. This is a significant advantage, especially for the latter as previously they had to travel very long distances to Savannakhet in the south to be treated. Between May and November 2006, a total of 125 patients were transferred progressively from Savannakhet to Vientiane, where MSF provided ARV treatment and VCT services.

Projects supported by MSF Australia Continued

Liberia ASSISTING VICTIMS IN A POSTCONFLICT SITUATION 7

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After a protracted 14-year civil war, Liberia still lacks operational health facilities and personnel. Most Liberians continue to be in need of access to basic healthcare and still suffer from high rates of preventable diseases and poor maternal and child health. 43

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decrease significantly at the hospital. For instance, it fell from 30% in May 2006 to 20% in December. As more than one-third of the patients who were hospitalised were suffering from a chronic disease, MSF also opened a follow-up care centre within the hospital for these patients.

MSF has been working in Liberia since 1990. Total international staff: 96 National staff: 1288 MSF teams undertake a variety of healthcare activities in Liberia including full support to the hospitals in Monrovia, the capital. With the security environment stabilising, MSF is developing health programmes focusing on TB, HIV/AIDS, malnutrition and reproductive health. Additionally, MSF provides medical treatment and psychological care for survivors of sexual violence. MSF Australia sent 15 volunteers to Liberia in 2006. MSF France Projects: Mamba Point in Monrovia and Lofa International staff: 21 National staff: 410 Total budget: $3,999,164 (€2,396,000) MSF Australia funds: $800,000 Following the violence that broke out in the Liberian capital and its environs in June 2003, MSF started working in Monrovia towards the end of that year, at the Mamba Point hospital (155 beds). At the hospital, MSF focused on the provision of emergency medical care and surgery. The high mortality rate at the inpatient ward of the hospital (reaching up to 30% during certain months) was due not only to the fact that there was a significant number of HIV/AIDS patients but also to the serious lack of diagnostic capacity and even treatment capacity in a number of areas. MSF decided on an expansion and improvement of the ward’s diagnostic capacity, and also on the treatment of opportunistic diseases associated with HIV/AIDS. As a result the inpatient mortality rate has continued to

MSF carried out 25,784 emergency consultations at Mamba Point. These included treatment of malaria and gynaecological cases, and also treatment for victims of “Among the many victims sexual violence and trauma. There treated here was a seven were 6278 admissions to the general year-old girl who was raped hospital, including 2930 surgical by a man staying in the interventions. VVF (vesico-vaginal family home. Her fistula) was also treated. grandmother brought her to us with multiple lacerations, MSF opened its Lofa project in the but it was too late for her to north in January 2004 when the zone receive HIV prevention was controlled by the rebel group medications… LURD (Liberians United for Unfortunately this is just one Reconciliation and Development). At case among many in Liberia.” that time, about 35,000 people lived there. However, with the end of the Susan Thomas, a nurse war, families have kept returning to the from Sydney, describes one outlying villages of Foya and Kolahun encounter in Nimba and the current population has county, Liberia. increased seven-fold to 250,000. This population includes about 4000 April 2006. Liberian refugees from Sierra Leone who are arriving each week, repatriated by the United Nations High Commissioner for Refugees (UNHCR). MSF teams carry out their medical activity in their own facilities in Foya and Kolahun. In 2006, MSF undertook 96,600 outpatient department consultations and 3404 inpatient department admissions. MSF also treated malaria, malnutrition, HIV/AIDS, TB and sexual violence.

Malawi HIV/AIDS TREATMENT AND TESTING In Malawi close to one million adults and children are HIVpositive. HIV/AIDS causes the highest number of deaths in the 20-49 years age group and because of the epidemic, lifeexpectancy in Malawi is now 38.5 years. MSF has been working in Malawi since 1986. Total international staff: 30 National staff: 314

“ARVs have totally changed my life. I used to get ill the whole time. Since I’ve been on ARVs I’ve been fine. I haven’t had any problem. Now I can work, I can cut trees without any problem. I don’t feel ill. When people who saw me when I was very ill see me now, they think that the HIV has been cured.”

MSF is working in Malawi in collaboration with the Ministry of Health, tackling health issues related to HIV/AIDS. Highly active antiretroviral therapy (HAART) was introduced in 2001. The programme in Malawi is one of MSF’s largest HIV/AIDS programmes. It has been used as a case study for showing that it is possible to deliver life-saving antiretroviral therapy (ART) to patients in Africa on a larger scale

Apart from Chiradzulu (see opposite) MSF is also working in the southern district of Thyolo, where the number of treatment sites has risen from one to seven, and close to 6000 patients were using antiretroviral drugs (ARVs) November 2006. by July 2006. Here MSF also conducts a programme at the district hospital to prevent mother-to-child transmission of HIV. MSF also provides a comprehensive HIV/AIDS programme in the country’s central Dowa district, with teams at district hospitals and several health centres. By the end of April 2006, 424 patients including 22 children were receiving ARVs from MSF in Dowa.

Mountain, a Malawian HIV parient who works as a forrester in Chiradzulu.

Six volunteers from MSF Australia worked in numerous locations in Malawi in 2006, including a head of mission, a pharmacist, a medical scientist, a logistician, field coordinator, and an administration and finance coordinator.

Médecins Sans Frontières Australia Annual Report 2006—44

MSF France projects: Chiradzulu International staff: 8 National staff: 251 (including 114 Ministry of Health staff on incentives) Total budget: $7,207,174 (€4,318,000) MSF Australia funds: $800,000 1

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Chiradzulu is a rural area near the southern provincial capital of Blantyre, where the majority of the population earn a living by farming. Here, as in many other parts of Malawi, about 15 to 20% of the adult population is HIV-positive. In 2006 increased attention has been paid by MSF to HIV/TB co-infection. TB is the main opportunistic infection and one of the major causes of death in HIV patients in sub-Saharan Africa. Early detection of TB and HIV co-infected patients in Chiradzulu started in March, with a ‘one-stop’ service including referral of the patients to the HIV clinic. This means that patients with both infections do not need to visit multiple health facilities, underlying the advantage of integrated health care. By the end of 2006 MSF had started 9499 patients on antiretroviral therapy (ART) including 605 children. Throughout the year 4605 patients were tested by MSF, 2937 patients were started on ART, and 48 who had developed resistance were switched to the more complex second-line treatment. MSF also expanded its activity in the rural districts by providing more frequent HIV-related services in the health centres.

Projects supported by MSF Australia Continued

Myanmar MALARIA / PRIMARY HEALTHCARE With a national health budget of just 0.30 Australian dollars per person per year, the majority of the population of Myanmar has little or no access to basic healthcare. MSF has been responding to this health crisis for the past fourteen years. Myanmar has been under military rule since 1962 and is largely cut off from the outside world. Gaining access to carry out independent humanitarian action has been challenging for MSF, but teams continue to press the military authorities to gain access to the people in need. 71

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MSF has been working in Myanmar since 1992. Total international staff: 39 National staff: 925 At the end of March 2006, after four years of operation, the French section of MSF decided to withdraw from Myanmar. With further restrictions being imposed on MSF France teams in the Mon and Karen states (the military junta having issued new NGO “guidelines”) they could not secure adequate humanitarian space to operate their programs independently. “We had to face facts”, said Dr. Hervé Isambert, the programme’s manager, “the Myanmar authorities do not want independent, foreign organisations to be close to the populations they want to control. It is impossible to assist people living in these conflict areas given the conditions required to carry out independent humanitarian action. The space for working just kept on shrinking until there was none left. It goes without saying that the people are the ones who suffer the consequences of the hardening of the regime.” Sections other than MSF France have nevertheless decided to continue to work in different regions throughout Myanmar, as long as they do not face similar problems of access to the population in the regions they work in. The issue remains whether they wil still be able to provide quality care to their patients in the future, without making unacceptable compromises with the authorities.

Teams are providing primary care to people who would otherwise receive no medical attention, with a particular treatment focus on malaria, tuberculosis and sexually transmitted infections including HIV/AIDS. MSF Holland and MSF Switzerland are working in several areas of the country, including the capital, Yangon, as well as Rakhine, Kachin, Shan and Kayah states and the Dawei district. MSF Switzerland Projects: Kayah International staff: 6 National staff: 75 Total budget: $1,259,065 (CHF1,240,623) MSF Australia funds: $500,000 MSF Switzerland has worked in the Kayah state since 2004 and due to limited humanitarian access, it is the only international NGO present there. Responding to the health needs of conflict victims, MSF teams use three fixed clinics and two mobile clinics to treat patients suffering from malaria, diarrhoea, dysentery, acute respiratory infections, malnutrition and also injuries due to landmines.

“For humanitarian organisations, the issue is to recognise when our role has been reduced to being a technical service provider of the Myanmar authorities, subject to their political agenda and no longer to the goals we have set for ourselves as a humanitarian organisation. Speaking for the French Section’s programmes, we believe that we have crossed that line. It is with a great bitterness that we have had to decide to leave the country.”

Between January and November, MSF Press Release, almost 30,000 consultations were March 2006. carried out by MSF teams. A TB program was also opened in July and twelve patients were placed on treatment: this number is expected to increase in 2007 as teams carry out active case finding.

Nepal ASSISTING VICTIMS OF CONFLICT A new phase of the Nepalese conflict began in early 1996, when Maoist rebels from the rural areas began a new offensive against the monarchy. Their aim was to gain full control of the mountainous zones of the country, and within a few years of guerrilla warfare they were successful in holding approximately 70% of the Nepalese territory.

“ A 16-year old girl was in labour, panting, sweating, straining and moaning in the delivery room. Manu, the staff nurse, told me the baby was too big to be delivered normally and was developing foetal distress. With encouragement for the patient to push and a vacuum extractor Manu managed to pull the poor little guy out into the big dark rainy world. I almost fainted with relief when he took a few pitiful breaths by himself and let out a weak wail of insult.” Stephanie Jones, New Zealand doctor working for MSF in Nepal. August 2006.

The year 2006 saw initially a renewal and intensification of the Nepalese conflict. At the beginning of the year cities in the southern Terai region of Nepal were besieged by the Maoists, and strict curfews were implemented by the government forces. However King Gyanendra ended his direct rule in April, and a peace agreement with the Maoists was eventually signed in November. The violent struggle between the rebels and government forces has caused mostly civilian casualties, with more than 13,000 people estimated to have died in the bloodshed since 1996. Hundreds of thousands have been displaced. The fighting has significantly worsened health conditions for the population and severely limited its access to healthcare.

MSF has been working in Nepal since 2002. Total international staff: 28 National staff: 179 MSF is working in Nepal in the areas around Rukum, and in the Kalikot and Khotang districts. In the western Kalikot district, MSF provides basic and secondary healthcare, reproductive healthcare, TB treatment and emergency services. Teams have also improved the power and water supply systems. In the Khotang district, MSF offers 24-hour healthcare to local residents including inpatient care and emergency obstetric care.

Médecins Sans Frontières Australia Annual Report 2006—46

MSF Australia sent nine volunteers to work in Nepal in 2006, in various regions: six doctors, one field coordinator, one medical coordinator and one logistician.

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MSF France Projects: Rukum, Rukumkot and Arviskot International staff: 11 National staff: 101 Total budget: $1,011,475 (€606,000) MSF Australia funds: $1,000,000 5

MSF France is working in Nepal in Rukum, a rural district with a government hospital, and also at two health posts (Rukumkot and Arviskot) that are accessible only by foot and are in Maoist controlled zones. In Rukum MSF runs the 15-bed Salle Hospital. In 2006, teams carried out 27,311 outpatient consultations, treated 104 malnutrition cases, undertook 1728 antenatal consultations and treated 79 tuberculosis patients. The Rukumkot health post is situated an eight-hour hike from the hospital in Salle. There, in an isolated setting, MSF put in place an inpatient facility and also provided ambulatory care to the local population, particularly obstetric services. Throughout the year, MSF undertook 15,142 outpatient consultations and also treated 238 patients for malnutrition. More than 150 patients were placed on TB first-line drugs in 2006. In Arviskot, another Maoist zone situated even further (a fourteen-hour walk from the Salle Hospital) the MSF health post and ambulatory clinic in 2006 undertook 20,430 outpatient consultations, along with 1402 antenatal consultations. Additionally, 238 malnutrition cases, and 96 tuberculosis patients, were treated. With the peace process between the Maoist insurgents and the government underway, MSF France aims at phasing out its activities in Nepal in the course of 2007.

Projects supported by MSF Australia Continued

Niger NUTRITION/PRIMARY HEALTHCARE 7

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Niger, the poorest country in the world according to UNDP figures, continued to suffer from the devastating effects of malnutrition in 2006. However, MSF’s treatment strategy has recently expanded, and now utilises outpatient clinics and ready-to-use therapeutic foods (RUTF), to allow treatment of many more children suffering from severe as well as moderate malnutrition. 70 74 66

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RUTFs, consisting generally of a peanut milk paste enriched with micronutrients, have caused a radical new approach to the problem of malnutrition. Advantages of these products are numerous. Treatment need not be restricted to a hospital as RUTFs can be supplied in sachets, which children can consume easily at home. Malnutrition can therefore be addressed on a much larger scale and its treatment can apply at any time to children who suffer from acute as well as global malnutrition. RUTFs enable them to gain weight quickly, while providing essential nutrients. (See the feature on RUTFs in this Annual Report.) MSF has worked in Niger since 1985. Total international staff: 66 National staff: 713 In 2006, MSF teams worked in the regions of Aguié, Zinder, Magaria, Maradi and Tahoua treating both severe and moderate cases of malnutrition. By June 2006, more than 25,000 children were receiving malnutrition-related medical care from MSF teams and about 2000 children were being admitted to its nutritional programmes each week. By the end of the year, 73,000 children in the area of Maradi alone had been admitted to this groundbreaking MSF programme using RUTFs. The vast majority of these children were under three years of age and suffering from moderate acute malnutrition. The recovery rate among them was a staggering 90%.

In February, a meningitis outbreak occurred in the southern districts of the Maradi province. MSF started a vaccination campaign, immunising more than 800,000 people. Also in Maradi, two paediatric units handled cases of severe malaria, acute respiratory infection and acute diarrhoea. From January through to May 2006, MSF carried out 30,000 consultations and 900 hospitalisations. MSF Switzerland Projects: Zinder and Magaria International staff: 20 National staff: 350 Total budget: $8,100,425 (CHF7,981,769) MSF Australia funds: $1,650,000 MSF Switzerland works in the Zinder and Magaria regions, both located in the south of the country. In 2006, a total of 17,096 children were treated for malnutrition. Among these, 11,185 were severely malnourished, 5134 were moderately malnourished and 777 were aged under 6 months. The recovery rate was 70.3% for severely malnourished children, and 89.6% for moderately malnourished children.

“I’ve been at the MSF feeding centre for the past 20 days. My son is getting better: he’s put on lots of weight. When we arrived here, he couldn’t walk anymore, he was dehydrated and his skin was covered in boils and blisters. I’m 20 years old and I’ve already had six children. Three of them have died. Tomorrow, I’ll be able to return home. Fortunately, I’ll have food rations from MSF. I don’t know how I would feed my children without them.”

A Nigerien mother at the Teams also responded to other MSF feeding centre in emergencies in the area. In August, Zinder, October 2006. floods hit the city of Zinder and teams responded quickly, handing out 354 non-food item kits (generally consisting of cooking sets, plastic sheeting and blankets) to the most affected families. Additionally, nearly 230 people were treated when a cholera epidemic occurred in September.

Pakistan EMERGENCY EARTHQUAKE RESPONSE/PRIMARY HEALTHCARE Pakistan has endured surges of refugees fleeing drought, persecution and fighting in neighbouring Afghanistan since the Soviet invasion of the latter in 1979. Currently there are slightly over one million refugees in camps and a further 1.5 million in urban areas. In October 2005 an earthquake measuring 7.6 on the Richter scale hit northeast Afghanistan, north Pakistan and northwest India. The epicentre was approximately 100 kilometres north of the Pakistani capital Islamabad, causing massive destruction and killing an estimated “One boy whose leg had 76,000 people, while 3.3 million people been broken in the were made homeless. earthquake developed osteomyelitis. The bone had MSF has been working in Pakistan not healed and was since 2000. Total international infected. Without the care staff: 33 National staff: 308 we gave him, he could have died or his leg would have Since 2001 MSF has worked in the had to be amputated,” said border camps of Chaman and later Dr Stewart Condon from Mohammed Kheil in Baluchistan Avoca (NSW). “But after six Province - providing medical care, months in the hospital, his supplying clean drinking water, and leg was saved and he building sanitary facilities for those walked out of the hospital.” who had fled the war in Afghanistan. Elsewhere in northwestern Pakistan in Mansehra, Kurram Agency, MSF staff also worked October 2006. in the paediatric ward of Sasho Hospital. These activities ceased between 2004 and 2005, until the October 2005 earthquake triggered a massive emergency medicalhumanitarian relief operation by MSF. Teams worked ceaselessly alongside national health authorities and medical personnel deployed from across the country, whilst the Pakistani authorities and other actors mobilised transportation (e.g. helicopters) to carry out evacuations and help reach out to the most remote regions where urgent aid was desperately needed. In the first week after the quake MSF was treating complications such as wounds and infected fractures, gangrene and the first cases of tetanus. MSF Australia deployed 12 volunteers to bolster teams in the field, dealing with the enormous task of assisting the tens of thousands of injured people. In the period that followed the disaster and during the early months of 2006 MSF undertook over 116,000 outpatient consultations, to treat wounds and also general pathologies. Over 30,000 people were vaccinated against diseases such as measles. Three hospitals were set up in Mansehra, Bagh and Hattian and 11,000 mental health

Médecins Sans Frontières Australia Annual Report 2006—48

consultations were performed. On 199 sites MSF conducted water and sanitation activities – constructing over 1400 latrines and distributing around 30,000 hygiene kits in six months.

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Despite the earthquake response requiring such a massive deployment, MSF carried on other activities in Pakistan, including starting a project in Kuchlak, a slum near Quetta (Baluchistan province) where ethnic Pashtuns reside after fleeing Afghanistan. An MSF field coordinator was sent there via MSF Australia’s Field HR department. In Kuchlak MSF conducted about 130 mother and child consultations per day and screened children for signs of malnutrition. Mother and child health was also the focus of MSF’s basic healthcare programme in Leepa Valley and Lamnian, close to the Line of Control between Pakistan and India-administered Kashmir. MSF conducted 15,000 consultations before permission to work there was retracted by authorities. MSF France projects: Mansehra and Kaghan International staff: 17 National staff: 83 Total budget: A$9,847,690 (€5,900,000) MSF Australia funds: $800,000 MSF supported the Mansehra District Hospital in North West Frontier Province by erecting an inflatable hospital that included orthopaedic surgery, an emergency department and several intensive care functions. The overflow of post-operative patients were housed and cared for in medical tent-villages that provided changing of dressings, follow-up and physiotherapy (many suffering from severe complications and secondary problems). In total, the outpatient department (OPD) performed 1336 orthopaedic consultations while 678 patients were admitted. Over 800 orthopaedic surgical interventions were performed. More than 15,000 families also received material assistance in the form of 25 blankets, a tent, one cooking kit and one hygiene kit per family. The programme was eventually concluded in October 2006, and activities were handed back to the Ministry of Health. When the population began returning to their villages after the earthquake, MSF also provided support through the OPD and inpatient department (IPD) of the Kaghan Civic Hospital, located in the Khagan Valley. MSF performed 5650 consultations in the OPD; 68 were admitted into the IPD and 11,799 children were vaccinated for measles. This project also ended in October and was handed over to another nongovernment organisation.

Projects supported by MSF Australia Continued

Somalia PRIMARY HEALTHCARE, SURGERY AND EMERGENCY NUTRITION 7

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Somalia is a country that has lacked any form of a functional central government for more than fifteen years and has been run by warring factions and warlords, ruling over specific parts of the territory. In 2006 the Transitional Federal Government (TFG) which was elected with the backing of the international community was overrun by the Council of the Islamic Tribunals. In the last three months of the year fighting erupted again when the TFG sought to regain its hold on the capital and surrounding areas, with support from Ethiopia and other neighbouring countries. Somalia has been characterised as one of the most insecure contexts to be found in the world, and has as a result some of the worst health indicators, unequalled by any other country. Healthcare has been and continues to be unavailable to major sections of the population. No Ministry of Health is operational in either south or central Somalia. Infant mortality is 132 per 1000 live births, and the under-five mortality rate is 211 per 1000. Tuberculosis is also endemic in Somalia – in 1999 MSF estimated the annual infection rate to be the highest in the world. 70 74 66

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conflict, e.g. children injured while playing with grenades. In 2006, MSF Australia deployed a nurse-midwife to work in MSF’s antenatal clinic in Galkayo.

MSF has been working in Somalia since 1991. Total international staff: 41 National staff: 487 MSF operates projects in seven locations across south and central Somalia, including the capital Mogadishu where a clinic in the city’s north is one of the few public health facilities. In Middle Shebelle, MSF provides primary healthcare in two districts – Jowhar and Mahady – through six outpatient clinics. Measles vaccination campaigns are regularly undertaken in this region. With the problem of malnutrition being compounded in 2006 by an ongoing drought, MSF projects in Galkayo, Marare, Bakool, Galgaduud and Dinsor also offer nutritional care. In Bakool MSF also treats diseases such as tuberculosis and kala azar. (Kala azar or visceral leishmaniasis is a parasitic disease caused by sand-fly bite.) MSF also opened new projects in the towns of Dhusa and Galgaduud in 2006. With MSF support, the two hospitals there had already treated a combined total of nearly 3000 patients per month by mid-2006. Presentations at the clinics were for injuries resulting from gunshots and trauma indirectly related to

MSF Switzerland projects: Dinsor International staff: 7 National staff: 131 Total budget: $2,077,400 (CHF2,000,000) MSF Australia funds: $800,000 MSF has been supporting the Dinsor Rural Hospital in the Bay region in southern Somalia since 2002 when the inpatient department (IPD) had just 30 beds. By 2006 MSF had increased the hospitalisation capacity to 85 beds in the IPD (including medical, paediatric, maternity and surgery wards). The outpatient department (OPD) covers antenatal care (ANC) and the extended programme of immunisation (EPI), and treatment for TB and kala azar.

“We are deeply concerned by our ability to adequately assist victims of the current fighting in Somalia, which is compounding the already dramatic humanitarian situation in southern and central Somalia. The situation can only get worse with the continuing conflict as well as natural disasters like the recent floods. We want to send our expatriate teams back to the field as soon as conditions will allow.”

In 2006 an average of 191 patients per month were admitted to the Dinsor Dr Gustavo Fernandez, IPD. The number of OPD consultations head of mission in Somalia, increased to 4456 per month and 418 MSF Press Release antenatal care (ANC) visits a month. By December 2006. the end of September, a total of 245 patients were receiving treatment for TB. Surgical interventions, while mostly minor (90 cases per month and 8 major operations), were also an important part of the programme. In 2006 also, a severe drought decimated livestock and left many parts of south Somalia with only dwindling reserves of food and water. Early in the year, MSF also bolstered its Dinsor team so as to provide mobile outreach activities. The therapeutic feeding centre treated more than 600 children for severe malnutrition between January and June, a figure almost ten times higher than 2005.

Sri Lanka ASSISTING VICTIMS OF CONFLICT 71

The 2002 ceasefire agreement between the Sri Lankan Army (SLA) and the Tamil rebel movement, the Liberation Tigers of Tamil Eelam (LTTE) was broken in 2006 and violence resumed in the middle of the year. The conflict quickly reached its most intense phase in the east and northeast of the country. Insecurity and limitations placed on humanitarian organisations made it increasingly difficult to deliver aid to people most affected by the conflict in several regions. An estimated 200,000 people became displaced in “Within this context, like in any Sri Lanka. Additionally, 15,000 people armed conflict, our fled to India in 2006 to escape the independence and neutrality violence. Official figures indicate that must be respected. If we are to 3800 people died due to the conflict help the civilian population throughout the year and that affected by the conflict, we need civilians continued to struggle in a the false allegations and general climate of insecurity where inaccurate statements made in murders and kidnappings became the media cleared up. We have frequent occurrences. made a commitment to work in Sri Lanka, and are prepared MSF has worked in Sri Lanka since to honour that commitment, 1986. Total international staff: 10 We have grave concerns for the National staff: 30 populations living in the waraffected areas.” Prior to the resumption of violence in 2006, MSF’s most recent Dr. Guillermo Bertoletti, Director intervention in Sri Lanka had been in of Operations of MSF-France, response to the 2004 tsunami. calling on the Sri Lankan However, with MSF’s medicalgovernment to allow humanitarian assistance being humanitarian access . initially allowed by the Sri Lanka October 2006. Government and the Ministry of Health, teams decided to return to Sri Lanka. They were faced with an extremely insecure context, and initially authorisation was not given to them to work in the Tamil-controlled zones. MSF decided to continue to negotiate access so as to treat the conflict-affected population in areas not controlled by the government.

Médecins Sans Frontières Australia Annual Report 2006—50

MSF France Projects: Point Pedro International staff: 10 National staff: 30 Total budget: $1,084,915 (€650,000) MSF Australia funds: $270,000

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In August 2006 MSF was given permission to open a medical programme in Point Pedro Hospital on the Jaffna Peninsula in the north. The hospital serves a population of 150,000 and includes a surgical program, nutritional care, cholera treatment and consultations for victims of sexual violence as well as women’s health. However, a decision had to be made to suspend this programme only two months later, on 30 September 2006, as a result of false allegations being made that MSF was collaborating with the LTTE. Also, the authorities had begun to impose many visa restrictions to make the running of the programme a near-impossible task. At this time the entire region of the Jaffna peninsula became the target of intense bombing. It is worth recalling that prior to those events, in early August, 17 staff from the aid organisation Action Contre La Faim were killed in Muttur, just over 150km from Point Pedro. Within days of the killing MSF demanded that access to victims of conflict and security of humanitarian aid workers be guaranteed, and issued a press release which stated in part: “The targeted killings of members of Action Against Hunger are unprecedented, and constitute a worsening of the humanitarian situation in Sri Lanka and the failure to respect the security of teams providing aid in the combat zones there. This is of concern to the entire humanitarian community worldwide.” MSF was subsequently able to reopen the Point Pedro project in December.

Projects supported by MSF Australia Continued

Sudan PRIMARY AND SECONDARY HEALTHCARE, SURGERY AND NUTRITION 71 69 65 67 76 6 68

Despite the 2005 peace agreement between the Khartoum government in the north and the Sudanese People’s Liberation Movement (SPLM) in the south, the resurgence of fighting and slow rate of change have heightened fears in 2006 that the long-sought stability in Sudan may not last the six-year period before the south votes in a referendum on selfdetermination. Armed conflicts still simmer in the south and particularly in the east of Sudan, while in Darfur in the west wave after wave of fighting and violence against the population continue unabated after three years. Refugees travel vast distances to pour from this region into Chad. In addition, international aid is slow in coming into the now (relatively) stable south to which thousands of internally displaced Sudanese are returning, only to find that health infrastructure, as mostly elsewhere in the country, is simply non-existent. 70 74 66

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MSF has worked in Sudan since 1979. Total international staff: 313 National staff: 6242 In southern Sudan MSF runs health clinics in the isolated Upper Nile region, including Nasir, Lankien and Pieri. MSF also offers primary health care in multiple locations including Marial Lou and Akuem in the Bahr El Ghazal province and Ler and Wudier, also in Upper Nile. MSF operates a 200-bed hospital in Kajo Keji in Equatoria, offering treatment for sleeping sickness and HIV/AIDS. To the east in the town of Pibor, MSF carries out another 5000 consultations monthly, and in Unity State MSF works in the Bentiu Hospital where up to 17,000 consultations are performed yearly. In 2006 a new project was opened in Bor in Jonglei Province where MSF is upgrading the local hospital for a population of thousands of returnees. After three years since MSF first began to work in Darfur, there are still 170 international and over 2000 Sudanese staff working in 18 locations throughout the troubled region. Attacks on several locations caused evacuations of teams many times in 2006 and serious security incidents have occurred to put MSF field staff in danger. In spite of this, a number of new projects were opened, particularly in Jebel Marra.

As before in North Darfur, primary healthcare services are provided by MSF for the displaced living in the Shangil and Shadat camps and Shangil Tobaya village. Also in the north, Kebkabiya and Serif Umra towns receive emergency healthcare and nutritional support. In the south MSF runs a primary health clinic in Kalma camp with a programme for women’s health and treatment for sexual and gender based violence. In West Darfur MSF continues to support the displaced population. “The only disappointing MSF also provides support to the part of it [the north-south Tagadom hospital near Port Sudan to peace agreement] is that the east, where a marginalised not much actually changed population coming from nearby in the areas where we were shantytowns is excluded from operating, particularly in healthcare. the Upper Nile region. There is still no access to MSF Australia had 32 of its field water and people are still volunteers working in Sudan in 2006. walking three or four days to access our clinics so MSF France Projects: Mygoma, even we can not provide Darfur, Bentiu, enough healthcare for Akuem, Kotobi the population.” International staff: 46 National staff: 409 Thomas Roth, Total budget: $13,898,596 Head of Mission, (€8,327,000) South Sudan. MSF Australia funds: $1,600,000 May 2006. MSF’s Mygoma orphanage project in Khartoum, which began in 2003, was handed over to local partners in December 2006. When the project opened, the mortality rate of children was a staggering 80%. After MSF teams collaborated with local authorities, rehabilitated the institution and provided psychological, medical and nutritional care to the children, the mortality rate within the orphanage was reduced to 2.9%. In Darfur, as fighting has intensified since May 2006, tens of thousands more have been displaced. Consequently the camps where the internally displaced persons (IDPs) have gathered are closed in. People are afraid to leave for fear of being raped or

killed, and as a result, the camps have been transformed into “islands of assistance”, with the IDPs depending even more on international assistance for access to water, food and healthcare. At the end of August, a UN Security Council resolution was adopted in favour of deploying armed forces to Darfur. The Sudanese Government has been heavily opposed to this proposal, considering it to be an interference in internal Sudanese affairs. On the ground in Darfur, this “In talking with the newlyhas led to an intensification of displaced persons, I was hostilities. Numerous aid actors in the particularly struck by the region have been attacked or seriously total lack of hope and sense harassed. Some zones have become of their future. Their daily completely inaccessible to lives are governed by fear of humanitarian assistance. attack by armed groups,” said Australian Phil MSF activities in 2006 were focused Humphris, MSF head of on three IDP camps in West Darfur: mission for Darfur. ” Despite Mornay, Zallengei and Niertiti. The the problems, our presence Mornay camp, home to 74,000 in Darfur with these displaced people, was affected by a populations is still cholera outbreak in August. MSF important. Many people responded by establishing a cholera there are completely treatment centre and setting up a dependent on system for supply of water – in total, humanitarian aid.” 150 severe cholera cases were treated. In Zallengei camp, MSF and other aid actors responded to a meningitis outbreak, by carrying out a largescale vaccination. Within the camp, MSF also undertook paediatric care and malnutrition treatment. In 2006, teams carried out 781 surgical interventions. Activities in Niertiti were marred by an attack on an MSF team on the road to Zallengei in September. Throughout the year in Niertiti, MSF carried out 48,677 outpatient consultations and undertook 3642 antenatal care (ANC) consultations. The political climate remained insecure in south Sudan, and as a result the MSF sleeping sickness project in Kotobi was closed in April because of security problems. In Bentiu, MSF continued its work in treating patients with tuberculosis,

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HIV/AIDS and kala azar. MSF also responded to outbreaks of meningitis and cholera. In 2006, in Akuem, MSF treated 2596 malnutrition cases and 400 TB cases. When a meningitis outbreak occurred in March, MSF responded by vaccinating more than 25,000 people. MSF Switzerland Project: Marial Lou and Kajo Keji International staff: 16 National staff: 342 Total budget: $4,600,364 (CHF4,532,973) MSF Australia funds: $600,000 In Tonj County of Bahr-el-Ghazal province in South Sudan, MSF continued to operate the 46-bed hospital at Marial Lou. Here the outpatient department (OPD) saw an average of 1400 patients a month, while the inpatient department (IPD) activities covered typical pathologies including lower respiratory tract infections, diarrhoea, malaria, meningitis, tetanus and other trauma. Between September and December there were 639 admissions. Approximately 100 surgical interventions including c-sections and trauma operations were performed each month at Marial Lou while the nutritional program for malnourished children received over 100 admissions per month in the therapeutic feeding centre (TFC), and up to 800 admissions occurred in the supplementary feeding centre (SFC). In the obstetric ward at Marial Lou over 1200 antenatal consultations were performed in the third quarter of 2006. Since 1997 MSF Switzerland also has been working in another part of South Sudan in Kajo Keji, with the objective to provide appropriate medical services to the rural population of Western Equatoria (Bahr el Jabal province). Here, the Kajo Keji Referral Hospital supported by MSF offers IPD (140 beds) and OPD services; emergency surgery; delivery services; screening and treatment for sleeping sickness; integrated HIV/AIDS prevention and treatment; and TB treatment. Between January and September, the OPD made 17,099 consultations and 6053 patients were treated for malaria. The IPD saw 2981 admissions; and the therapeutic feeding centre had 122 children while 2823 women received care in the antenatal clinic. Over 90 surgical interventions were performed and 162 patients received treatment for sleeping sickness.

Projects supported by MSF Australia Continued

Thailand CARING FOR REFUGEES Free access to healthcare in Thailand is available only to registered Thai nationals or to persons with a specific registration status. Vulnerable groups such as ethnic minorities and migrant workers are often excluded from the health system, causing them to go without treatment for serious medical conditions including HIV. MSF has responded by providing healthcare to marginalised groups throughout the country. 53

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51 51

MSF has been working in Thailand since 1983. Total international staff: 21 National staff: 640 MSF teams provide basic medical care to undocumented migrant workers in Thailand. Mobile clinics and a newly opened health centre in Phang Na have focused on mother and child health, treatment of sexually transmitted infections and ensuring the supply of clean water and sanitation. MSF’s HIV/AIDS programmes in Thailand began in the late 1990s. Treatment capacity has expanded ever since, with care now provided in the Chiang Rai and Kuchinarai provinces. Teams also provide clinical support for HIV for two prisons in Bangkok. Further, MSF works closely with its own Access to Essential Medicines Campaign, local partners and the Thai government, advocating for large-scale generic production of antiretroviral drugs (ARVs) in the country. MSF France Projects: Petchabun and Mae Sot International staff: 11 National staff: 117 Total budget: $3,525,139 (€2,112,000) MSF Australia funds: $800,000 MSF began working in Petchabun in northern Thailand in July 2005 caring for 6000 Laotian Hmong people who had taken refuge there. The Hmong are an ethnic minority who were largely aligned with the Americans during the Vietnam War, and cite persecution as reason for fleeing their country. Their marginalisation in Laos continues even today. In mid-2006, 2500 more Hmong people arrived in the Petchabun camp to increase the camp’s population to 8500.

MSF improved the living conditions in the camp by providing water, constructing latrines and establishing a system of waste disposal. As MSF is the only international NGO delivering assistance to the population, teams have distributed plastic sheeting and blankets and each month, coal is given out. In August 2006, MSF undertook blanket feeding following an increase in the number of children suffering from acute malnutrition. Throughout the year, MSF carried out 24,195 outpatient consultations and 1796 antenatal consultations. MSF also took charge of hospitalisation costs. Thirteen patients were provided with first-line TB treatment, and a routine measles vaccination was also undertaken, with 1727 children being immunised. MSF Australia sent a doctor and a logistician/administration officer to Petchabun in 2006.

“The people I have listened to all tell a story with a common theme: they need to belong somewhere where they can build a life for themselves and their children. Above all, there is a need for somewhere to belong and a sense of security for the future.” Roslyn Brooks, MD from Cooma NSW, on her first MSF mission in Petchabun.

In Mae Sot, in the Tak province, MSF runs a TB program for migrant August 2006. workers from Burma. TB is endemic in Thailand and Myanmar and a major health problem for the population who have very limited access to healthcare. In 2006, MSF treated 799 new cases of TB with first-line drugs, 70% of whom either recovered or completed their treatment. Treating TB in an environment of migration and uncertain legal status remains a challenge and MSF constantly adapts its programme to the reality of the context. In 2006 MSF treated 13 cases of multi-drug resistant TB in Mae Sot.

Médecins Sans Frontières Australia Annual Report 2006—54

MĂŠdecins Sans FrontiĂ¨res Australia ACN 068 758 654

Financial Report for the financial year ended 31 December 2006

Contents 3 6 7 9 10 11 12 13 14 15

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—2

Directors’ report Auditors independence declaration Independent audit report Directors’ declaration Declaration by a principal officer in respect of fundraising appeals Income statement Balance sheet Statement of changes in equity Cash flow statement Notes to the financial statements

Directors’ report The directors of Médecins Sans Frontières Australia submit herewith the annual financial report of the company for the financial year ended 31 December 2006. In order to comply with the provisions of the Corporations Act 2001, the directors report as follows: The names and particulars of the directors during or since the end of the financial year are: Dr Rowan Gillies

President, Médecins Sans Frontières Australia, from January 2002. Re-elected 6 May 2005. MBBS. President of International Council of Médecins Sans Frontières (term finished December 2006). Attended six out of nine directors’ meetings.

Dr Catherine Hewison

Re-elected 27 May 2006. Citizen of Australia. MBBS. General practitioner. Medical reference Tuberculosis and Meningitis Médecins Sans Frontières France. Attended nine out of nine directors’ meetings.

Mr Peter Hooker

Treasurer, Médecins Sans Frontières Australia. Re-elected 27 May 2006. Resident of Australia. CEO of Fertile Mind Pty Ltd, an importer/exporter of maternity wear and baby goods. Attended eight out of nine directors’ meetings.

Ms Emma Timmins

Elected 27 May 2006. Resident of Australia. Registered nurse. Attended six out of nine directors’ meetings.

Mr Pierre Salignon

Director-General, Médecins Sans Frontières France. Nominated to the board of Médecins Sans Frontières Australia on 10 December 2003. Resident of France. Lawyer. Attended two out of nine directors’ meetings.

Mr Matthew Melhuish

Re-elected 1 May 2004. Resident of Australia. Chief Executive Officer of BMF Advertising Pty Limited advertising agency, Sydney. Attended seven out of nine directors’ meetings.

Dr Michael Toole

Founding statutory member of the Council of Management, Médecins Sans Frontières Australia. Re-elected 6 May 2005. Resident of Australia. Doctor of Medicine. Epidemiologist and public health physician. Head, Centre for International Health, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne. Attended eight out of nine directors’ meetings.

Mr Christopher Daley

Elected 6 May 2005. Resident of Australia. Médecins Sans Frontières logistician. Attended eight out of nine directors’ meetings.

Dr Nicholas Wood

Vice President Médecins Sans Frontières Australia Elected 1 May 2004. Resident of Australia. Doctor of Medicine. Paediatrician, The Children’s Hospital Westmead. Attended nine out of nine directors’ meetings. The above named directors held office during and since the end of the financial year except for: Ms. Emma Timmins – elected 27 May 2006.

Company Secretary Mr. P.R. Couturier, executive director and company secretary, aged 42. Joined Médecins Sans Frontières Australia in 2003. Company secretary since 2006. Worked for Médecins Sans Frontières in various roles since 1997. Holds a Bachelor’s degree in Political Science from the Faculty of Economics and Social Sciences at the University of Geneva, Switzerland. Principal Activities The principal activities of the company during the financial year to 31 December 2006 have been: ·

Operational participation in the field projects of the international movement of Médecins Sans Frontières, through assignment of field staff humanitarian relief workers; participation as faculty in various Australian and international training courses for such field staff; and exploratory and evaluation missions to field projects. Community education in the form of dissemination of public information on humanitarian and development issues; provision of materials and source people to journalists in the print and electronic media; publication of newsletters; participation in seminars; and guest lectureships at secondary schools and universities. Liaison with institutions and individuals in Australia and internationally, with a view to obtaining funding or other operational support for field projects, and for coordination with other organisations involved in overseas humanitarian relief. Fundraising from the general public in order to finance the field operations of Médecins Sans Frontières.

The nature of each of these activities has not changed significantly during the year. They are described in full in the Activity Report section of the annual report of Médecins Sans Frontières Australia, to be presented to members at the Annual General Meeting and available to the general public from that date. Review Of Operations The net operating deficit for the financial year to 31 December 2006 was $4,001,177 (2005: $2,988,994 surplus).

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—4

Changes in State of Affairs During the financial year there was no significant change in the state of affairs of the company, other than that referred to in the financial statements or notes thereto. Médecins Sans Frontières Australia continued the strategy of face to face fundraising whereby the organisation contracts a third party to approach members of the public, in public places, to recruit new field partners. The financial impact continues to be that a cost is created at the outset that is more than made up over subsequent years of income. Médecins Sans Frontières Australia is in the fourth year of increasing its fundraising in Australia, to diversify its sources of funding, and to increase the proportion of funding that comes from regular field partner donations. Donations in Kind Over the course of the year the company has received donations in kind from a number of sources. These donations may be physical assets for use in the company, items to be sent to the field or services provided to Médecins Sans Frontières at reduced rates. The directors estimate the value of donations in kind received during the year to 31 December 2006 to be $382,171 (2005: $157,327). This amount relates to services and has been brought to account in the financial statements. Voluntary Assistance and Field Staff In addition to donations in kind the company recruit a number of volunteer staff in the field for Médecins Sans Frontières Operational Centres. There are five Médecins Sans Frontières Operational Centres and they are located in Belgium, France, Holland, Spain and Switzerland. Many of the field volunteers are professional staff. The company estimates the total salaries forgone for the year ended 31 December 2006 by volunteer field staff to Médecins Sans Frontières Operational Centres to be approximately $2,116,312 (2005: $2,075,715). This amount relates to service to Médecins Sans Frontières Operational Centres and consequently it has not been brought to account in the financial statements. The company estimates that the total salaries forgone by field volunteers to Médecins Sans Frontières Operational Centres who undertook missions of less than three months is $398,907 (2005: $321,959). This amount relates to services to Médecins Sans Frontières Operational Centres and consequently it has not been brought to account in the financial statements.

Directors’ report Continued Money Spent In Social Mission The mission of Médecins Sans Frontières Australia is to provide humanitarian assistance to populations in danger and to increase awareness of the plight of these populations. The international Médecins Sans Frontières movement as a whole targets and achieves an ‘80/20 rule’ whereby at least 80% of expenditure is directly devoted to this social mission. However, Médecins Sans Frontières Australia did not achieve this ratio this year: In 2006 Médecins Sans Frontières Australia spent $23,940,213 to the social mission therefore representing 73% of total expenditure (2005: $15,752,064 or 73%). A number of factors contributed to this 7% shortfall:

Dividends Under the terms of the company’s constitution, the company is not authorised to pay dividends. Indemnification of Officers And Auditors During the financial year, the company paid a premium in respect of a contract insuring the directors of the company (as listed on page 3 of the financial report) against a liability incurred as such a director to the extent permitted by the Corporations Act 2001. The contract of insurance prohibits disclosure of the nature of the liability and the amount of the premium.

The continuation of the face to face fundraising campaign. The financial impact of this campaign in the current financial year will be more than made up over subsequent years of income.

The company has not otherwise, during or since the financial year, except to the extent permitted by law, indemnified or agreed to indemnify an officer or auditor of the company or of any related body corporate against a liability incurred as such an officer or auditor.

Nil institutional funding in 2006 (2005: $Nil; 2004: $704,350; 2003: $709,799; 2002: $639,137; 2001: $2,215,866), which is expected to continue.

Auditors Independence Declaration The auditors’ independence declaration is included on page 6 of the financial report.

Subsequent Events There has not been any matter or circumstance, other than that referred to in the financial statements or notes thereto, that has arisen since the end of the financial year, that has significantly affected, or may significantly affect, the operations of the company, the results of those operations, or the state of affairs of the company in future financial years.

Signed in accordance with a resolution of the directors made pursuant to s.298(2) of the Corporations Act 2001.

Future Developments The likely developments in the operations of the company in subsequent financial years are as follows: increasing support (operational support, financial support and human resources) to the field operations of Médecins Sans Frontières; increasing volume of income from private fundraising but no income from institutional fundraising; and continuing steps towards possible establishment of a presence in New Zealand. From January 2007, Médecins Sans Frontières Australia will start to contract and pay field staff directly from Australia when they go to the field. Field staff will be seconded and managed by the Operational Centre running the project. The financial impact of this is not expected to be significant as the salary cost to be incurred by Médecins Sans Frontières Australia will be recharged to the Operational Centres that have actually incurred the salary cost.

On behalf of the Directors

Mr Matthew Melhuish Director Sydney, 3rd April 2007

Mr Peter Hooker Director Sydney, 3rd April 2007

Auditor’s independence declaration Deloitte Touche Tohmatsu A.B.N. 74 490 121 060 The Directors Médecins Sans Frontières Australia Suite C Level 1 263 Broadway Glebe, NSW 2037

Grosvenor Place 225 George Street Sydney NSW 2000 PO Box N250 Grosvenor Place Sydney NSW 1220 Australia DX 10307SSE Tel: +61 (0) 2 9322 7000 Fax: +61 (0) 2 9322 7001 www.deloitte.com.au

2nd April 2007

Dear Directors Médecins Sans Frontières Australia In accordance with section 307C of the Corporations Act 2001, I am pleased to provide the following declaration of independence to the directors of Médecins Sans Frontières Australia. As lead audit partner for the audit of the financial statements of Médecins Sans Frontières Australia for the financial year ended 31 December 2006, I declare that to the best of my knowledge and belief, there have been no contraventions of: (i)

the auditor independence requirements of the Corporations Act 2001 in relation to the audit; and

(ii) any applicable code of professional conduct in relation to the audit. Yours sincerely

DELOITTE TOUCHE TOHMATSU

J.P. Winter Partner Chartered Accountants Sydney

Member of Deloitte Touche Tohmatsu Liability limited by a scheme approved under professional Standards legislation

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—6

Independent audit report Deloitte Touche Tohmatsu A.B.N. 74 490 121 060 Grosvenor Place 225 George Street Sydney NSW 2000 PO Box N250 Grosvenor Place Sydney NSW 1220 Australia DX 10307SSE Tel: +61 (0) 2 9322 7000 Fax: +61 (0) 2 9322 7001 www.deloitte.com.au INDEPENDENT AUDIT REPORT TO THE MEMBERS OF MÉDECINS SANS FRONTIÈRES AUSTRALIA Scope The Financial Report and Directors’ Responsibility The financial report comprises the balance sheet, income statement, statement of changes in equity, cash flow statement, a summary of significant accounting policies and other explanatory notes and the directors’ declaration for Médecins Sans Frontières Australia, for the financial year ended 31 December 2006 as set out on pages 11 to 29.

We performed procedures to form an opinion whether, in all material respects, the financial report is presented fairly in accordance with Accounting Standards in Australia and the Corporations Act 2001 so as to present a view which is consistent with our understanding of the company’s financial position, and performance as represented by the results of its operations, its changes in equity and its cash flows.

The directors of the company are responsible for the preparation and true and fair presentation of the financial report in accordance with Accounting Standards in Australia and the Corporations Act 2001. This includes responsibility for the maintenance of adequate financial records and internal controls that are designed to prevent and detect fraud and error, and for the accounting policies and accounting estimates inherent in the financial report.

Our procedures included examination, on a test basis, of evidence supporting the amounts and other disclosures in the financial report, and the evaluation of accounting policies and significant accounting estimates made by the directors.

Audit approach We have conducted an independent audit of the financial report in order to express an opinion on it to the members of the company. Our audit has been conducted in accordance with Australian Auditing Standards to provide reasonable assurance whether the financial report is free of material misstatement. The nature of an audit is influenced by factors such as the use of professional judgement, selective testing, the inherent limitations of internal controls, and the availability of persuasive rather than conclusive evidence. Therefore, an audit cannot guarantee that all material misstatements have been detected.

While we considered the effectiveness of management’s internal controls over financial reporting when determining the nature and extent of our procedures, our audit was not designed to provide assurance on internal controls. The audit opinion expressed in this report has been formed on the above basis. Qualification Donations are a significant source of revenue for Médecins Sans Frontières Australia. Médecins Sans Frontières Australia has determined that it is impracticable to establish control over the collection of donations prior to entry into its financial records. Accordingly, as the evidence available to us regarding revenue from this source was limited, our audit procedures with respect

Member of Deloitte Touche Tohmatsu Liability limited by a scheme approved under professional Standards legislation

to donations had to be restricted to the amounts recorded in the financial records. We therefore are unable to express an opinion whether revenue from donations obtained is complete.

Monies received as a result of fundraising appeals conducted during the year have, in all material respects, been properly accounted for and applied in accordance with the Charitable Fundraising Act 1991 and its regulations.

Auditor’s Independence Declaration In conducting our audit, we have complied with the independence requirements of the Corporations Act 2001. Audit Opinion In our opinion, except for the effects of such adjustments, if any, as might have been determined to be necessary had the limitation on the scope of our audit work, described in the qualification paragraph not existed: 1.

The financial report of Médecins Sans Frontières Australia is in accordance with the Corporations Act 2001, including: (a) giving a true and fair view of the company’s financial position as at 31 December 2006 and of its performance for the year ended on that date; and (b) complying with Accounting Standards in Australia and the Corporations Regulations 2001.

The financial report gives a true and fair view of the financial results of the fundraising appeal activities for the financial year ended 31 December 2006.

The financial report and associated records have been properly kept, in all material respects, in accordance with the Charitable Fundraising Act 1991 and its regulations;

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—8

DELOITTE TOUCHE TOHMATSU

J.P. Winter Partner Chartered Accountants Sydney, 3rd April 2007

Directors’ declaration

The directors declare that: (a) In the directors’ opinion, there are reasonable grounds to believe that the company will be able to pay its debts as and when they become due and payable; (b) In the directors’ opinion, the attached financial statements and notes thereto are in accordance with the Corporations Act 2001, including compliance with accounting standards and giving a true and fair view of the financial position and performance of the company. Signed in accordance with a resolution of the directors made pursuant to s.295(5) of the Corporations Act 2001. On behalf of the Directors

Mr Matthew Melhuish Director Sydney, 3rd April 2007

Mr Peter Hooker Director Sydney, 3rd April 2007

Declaration by a principal officer in respect of fundraising appeals

I, Peter Hooker, director of Médecins Sans Frontières Australia declare that in my opinion: (a) the financial statements and notes thereto give a true and fair view of all income and expenditure of Médecins Sans Frontières Australia with respect to fundraising appeals conducted by the organisation; (b) the Balance Sheet as at 31 December 2006 gives a true and fair view of the state of affairs with respect to fundraising appeals conducted by the organisation; (c) the provisions of the Charitable Fundraising Act 1991 and the regulations under that Act and the conditions attached to the authority have been complied with by the organisation; and (d) the internal controls exercised by Médecins Sans Frontières Australia are appropriate and effective in accounting for all income received and applied by the organisation from any of its fundraising appeals.

Mr Peter Hooker Director Sydney, 3rd April 2007

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—10

Income statement for the financial year ended 31 December 2006 Note

2006 $

2005 $

Revenue Field costs Fundraising costs Other project costs Community education expenses Administration expenses

28,913,439 (21,270,984) (6,881,429) (1,274,828) (1,394,401) (2,092,974)

24,887,439 (13,838,842) (4,631,335) (1,243,035) (670,187) (1,515,046)

(Loss)/Profit before tax

(4,001,177)

2,988,994

â€“

(4,001,177)

2,988,994

Income tax expense (Loss)/Profit for the year

Notes to the financial statements are included on pages 15 to 29

Balance sheet as at 31 December 2006

Current assets Cash and cash equivalents Trade and other receivables

Note

2006 $

2005 $

20(a) 8

1,687,433 185,966

5,459,613 184,684

1,873,399

5,644,297

229,405 40,839

129,253 19,200

270,244

148,453

2,143,643

5,792,750

1,181,244 88,152

879,748 88,845

1,269,396

968,593

72,562

21,295

72,562

21,295

1,341,958

989,888

801,685

4,802,862

801,685

4,802,862

801,685

4,802,862

Total current assets Non-current assets Plant and equipment Other

7 9

Total non-current assets Total assets Current liabilities Trade and other payables Provisions

10 11

Total current liabilities Non-current liabilities Provisions

Total non-current liabilities Total liabilities Net assets Equity Retained earnings Total equity

Notes to the financial statements are included on pages 15 to 29

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—12

Statement of changes in equity for the financial year ended 31 December 2006 Note

Total equity at the beginning of the period Profit/(loss) for the period Total equity at the end of the period

Notes to the financial statements are included on pages 15 to 29

2006 $

2005 $

4,802,862

1,813,868

(4,001,177)

2,988,994

801,685

4,802,862

Cash flow statement for the financial year ended 31 December 2006 Note

Cash flows from operating activities Receipts from donors/supporters Payments to field Payments to suppliers and employees Interest received Net cash (used in)/provided by operating activities

20(b)

Cash flows from investing activities Payments for plant and equipment Proceeds from disposal of plant and equipment Net cash used in investing activities Net increase/(decrease) in cash and cash equivalents Cash and cash equivalents at the beginning of the financial year Cash and cash equivalents at the end of the financial year

Notes to the financial statements are included on pages 15 to 29

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—14

20(a)

2006 $

2005 $

27,777,146 (21,270,983) (10,387,170) 294,057

23,637,037 (13,838,842) (7,834,197) 352,700

(3,586,950)

2,316,698

(185,230) –

(105,151) 8,000

(185,230)

(97,151)

(3,772,180) 5,459,613

2,219,547 3,240,066

1,687,433

5,459,613

Notes to the financial statements for the financial year ended 31 December 2006 1.

General Information Médecins Sans Frontières Australia is a public company limited by guarantee, incorporated and operating in Australia. Principal registered office and principal place of business: Suite C Level 1 263 Broadway Glebe, NSW 2037 Tel: (02) 9552 4933

Summary of Accounting Policies Adoption of new and revised Accounting Standards In the current year, the company has adopted all of the new and revised Standards and Interpretations issued by the Australian Accounting Standards Board (the AASB) that are relevant to its operations and effective for annual reporting periods beginning on 1 January 2006. The adoption of these new and revised Standards and Interpretations has resulted in changes to the company’s accounting policies in the following areas that have affected the amounts reported for the current or prior years: ·

investments as at fair value through profit or loss (AASB 2005-04 “Amendments to Australian Accounting Standards”);

financial guarantee contracts (AASB 2005-09 “Amendments to Australian Accounting Standards”); and

rights to cash reimbursement for expenditure required to settle a provision (AASB2005-5) “Amendments to Australian Accounting Standards”).

These changes in accounting policies do not have an impact on the company’s financial statements. At the date of authorisation of the financial report, the following Standards and Interpretations were in issue but not yet effective: — AASB 7 “Financial Instruments: Disclosures”: Effective for annual reporting periods beginning on or after 1 January 2007 — AASB 101 “Presentation of Financial Statements” – revised standard: Effective for annual reporting periods beginning on or after 1 January 2007

— AASB 2005-10 “Amendments to Australian Accounting Standards” – consequential amendments to other accounting standards resulting from the issue of AASB 7: Effective for annual reporting periods beginning on or after 1 January 2007 — Interpretation 7 “Applying the Restatement Approach under AASB 129 Financial Reporting in Hyperinflationary Economies” : Effective of annual reporting periods beginning on or after 1 March 2006 — Interpretation 8 “Scope of AASB2”: Effective for annual reporting periods beginning on or after 1 May 2006 — Interpretation 9 “Reassessment of Embedded Derivatives”: Effective for annual reporting periods beginning on or after 1 June 2006 — Interpretation 10 “Interim Financial Reporting and Impairment”: Effective for annual reporting periods beginning on or after 1 November 2006 The directors anticipate that the adoption of these Standards and Interpretations in future periods will have no material financial impact on the financial statement of the company, as the issue of Interpretation 7, Interpretation 9 and Interpretation 10 do not affect its present policies and operations. The application of AASB 101 (revised ), AASB7 and AASB 2005-10 will not affect any of the amounts recognised in the financial statements, but will change the disclosures presently made in relation to the company’s financial instruments and the objectives, policies and processes for managing capital. These Standards and Interpretations will be first applied in the financial report of the company that relates to the annual reporting period beginning after the effective date of each pronouncement, which in all cases will be the Company’s annual reporting period beginning on 1 January 2007.

Statement of Compliance The financial report is a general purpose financial report, which has been prepared in accordance with the Corporations Act 2001, Accounting Standards and Interpretations and complies with other requirements of the law. Accounting Standards include Australian equivalents to International Financial Reporting Standards (‘A-IFRS’). A statement of compliance with IFRS cannot be made due to the application of not for profit sector specific requirements contained in the A-IFRS. The financial statements of Médecins Sans Frontières Australia for the year ended 31 December 2006 were authorised for issue by the Directors on 3 April 2007. Basis of Preparation The financial report has been prepared on the basis of historical cost. Cost is based on the fair values of the consideration given in exchange for assets. All amounts are presented in Australian dollars, unless otherwise noted. The following significant accounting policies have been adopted in the preparation and presentation of the financial report. (a) Cash and cash equivalents Cash comprises cash on hand and demand deposits. Cash equivalents are short-term, highly liquid investments that are readily convertible to known amounts of cash and which are subject to an insignificant risk of changes in value. (b) Donations in kind and voluntary assistance Over the course of the year the company has received donations in kind from a number of sources. These donations may be plant and equipment for use in the company, items to be sent to the field or services provided at reduced rates. Donations in kind of plant and equipment are recorded at fair value. Items to be sent to the field and services provided for no consideration are also brought to account in the financial statements at the fair value of the services received. In addition to donations in kind, both office volunteers and field staff sent to the field donate their time to Médecins Sans Frontières Australia. This time donated by office volunteers and salaries foregone by volunteers sent to the field are not brought to account in the financial statements since they cannot be reliably measured.

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—16

(c) Employee benefits A liability is recognised for benefits accruing to employees in respect of wages and salaries, annual leave and long service leave when it is probable that settlement will be required and they are capable of being measured reliably. Liabilities recognised in respect of employee benefits expected to be settled within 12 months, are measured at their nominal values using the remuneration rate expected to apply at the time of settlement. Liabilities recognised in respect of employee benefits which are not expected to be settled within 12 months are measured as the present value of the estimated future cash outflows to be made by the company in respect of services provided by employees up to reporting date. Defined contribution plans Contributions to defined contribution superannuation plans are expensed when incurred. (d) Fundraising expenses Fundraising expenses include those costs, which are directly attributable to fundraising, such as function expenses, promotions, printing and mailing and employee expenses. These expenses are brought to account in the period in which they are incurred. (e) Financial assets Loans and receivables Trade receivables, loans and other receivables that have fixed or determinable payments that are not quoted in an active market are classified as ‘loans and receivables’. Loans and receivables are measured at amortised cost using the effective interest method less impairment. Interest is recognised by applying the effective interest rate. (f ) Goods and services tax Revenues, expenses and assets are recognised net of the amount of goods and services tax (GST), except: i. where the amount of GST incurred is not recoverable from the taxation authority, it is recognised as part of the cost of acquisition of an asset or as part of an item of expense; or ii. for receivables and payables which are recognised inclusive of GST.

Notes to the financial statements for the financial year ended 31 December 2006 The net amount of GST recoverable from, or payable to, the taxation authority is included as part of receivable as payables. Cash flows are included in the cash flow statement on a gross basis. The GST component of cash flows arising from investing and financing activities which is recoverable from, or payable to, the taxation authority is classified as operating cash flows.

(h) Income tax Section 50-5 of the Income Tax Assessment Act provides that certain bodies will be exempt from income tax. The company is exempt from income tax in accordance with the Act; accordingly no provision for income tax has been recorded. (i)

Leases are classified as finance leases when the terms of the lease transfer substantially all the risks and rewards incidental to ownership of the leased asset to the lessee. All other leases are classified as operating leases.

(g) Impairment of assets At each reporting date, the company reviews the carrying amounts of its tangible and intangible assets to determine whether there is any indication that those assets have suffered an impairment loss. If any such indication exists, the recoverable amount of the asset is estimated in order to determine the extent of the impairment loss (if any). Where the asset does not generate cash flows that are independent from other assets, the company estimates the recoverable amount of the cash-generating unit to which the asset belongs.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term, except where another systematic basis is more representative of the time pattern in which economic benefits from the leased asset are consumed. Contingent rentals arising under operating lease are recognised as an expense in a manner consistent with the basis on which they are determined.

Recoverable amount is the higher of fair value less costs to sell and value in use. In assessing value in use, the estimated future cash flows are discounted to their present value using a pre-tax discount rate that reflects current market assessments of the time value of money and the risks specific to the asset for which the estimates of future cash flows have not been adjusted. If the recoverable amount of an asset (or cash-generating unit) is estimated to be less than its carrying amount, the carrying amount of the asset (cash-generating unit) is reduced to its recoverable amount. An impairment loss is recognised in profit or loss immediately, unless the relevant asset is carried at fair value, in which case the impairment loss is treated as a revaluation decrease. Where an impairment loss subsequently reverses, the carrying amount of the asset (cash-generating unit) is increased to the revised estimate of its recoverable amount, but only to the extent that the increased carrying amount does not exceed the carrying amount that would have been determined had no impairment loss been recognised for the asset (cash-generating unit) in prior years. A reversal of an impairment loss is recognised in profit or loss immediately, unless the relevant asset is carried at fair value, in which case the reversal of the impairment loss is treated as a revaluation increase.

Leased assets

Lease incentives In the event that lease incentives are received to enter into operating leases, such incentives are recognised as a liability. The aggregate benefits of incentives are recognised as a reduction of rental expense on a straightline basis, except where another systematic basis is more representative of the time pattern in which economic benefits from the leased asset are consumed. (j)

Payables Trade payables and other accounts payable are recognised when the company becomes obliged to make future payments resulting from the purchase of goods and services.

(k) Plant and equipment Plant and equipment, leasehold improvements are stated at cost less accumulated depreciation and impairment. Cost includes expenditure that is directly attributable to the acquisition of the item. Depreciation is provided on plant and equipment and is calculated on a straight-line basis so as to write off the net cost of each asset over its expected useful life to its residual value. Leasehold improvements are depreciated

(l)

over the period of the lease or estimated useful life, whichever is the shorter, using the straight-line method. The estimated useful lives, residual values and depreciation method are reviewed at the end of each annual reporting period, with the effect of any changes recognised on a prospective basis.

Government grants include government assistance where there are no conditions specifically relating to the operating activities of the company other than the requirement to operate in certain countries or industry sector. Such grants are recognised as revenue in the period they are received.

Provisions

Interest revenue is recognised on a time proportionate basis that takes into account the effective interest rate.

Provisions are recognised when the company has a present obligation (legal or constructive) as a result of a past event, it is probable that the company will be required to settle the obligation, and a reliable estimate can be made of the amount of provision. The amount recognised as a provision is the best estimate of the consideration required to settle the present obligation at reporting date, taking into account the risks and uncertainties surrounding the obligation. Where a provision is measured using the cash flows estimated to settle the present obligation, its carrying amount is the present value of those cash flows. (m) Revenue recognition The timing of the recognition of donations, fundraising, legacies and bequests depends when control of these contributions or right to receive these contributions is obtained, which is usually upon receipt of the monies. Where monies are received for a specific pledged field operation but are not expended at balance date, an accrual is made. Where monies are received relating to a specific project to take place in the following year, the amount so received is brought to account as income received in advance on a time proportionate basis.

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—18

Critical Accounting Judgements and Key Sources of Estimation Uncertainty In the application of A-IFRS management is required to make judgments, estimates and assumptions about carrying values of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and various other factors that are believed to be reasonable under the circumstance, the results of which form the basis of making the judgments. Actual results may differ from these estimates. The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or in the period of the revision and future periods if the revision affects both current and future periods. Judgments made by management in the application of AIFRS that have significant effects on the financial statements and estimates with a significant risk of material adjustments in the next year are disclosed, where applicable, in the relevant notes to the financial statements.

Notes to the financial statements for the financial year ended 31 December 2006

Revenue (a) Revenue Revenue from operations consisted of the following items: Fundraising revenue: Donations

Interest revenue: Bank deposits Sales revenue: Sales of merchandise Other revenue: Recharge for services to Médecins Sans Frontières International entities Other income Non monetary income (gift-in-kind)

(b) Profit before income tax Profit before income tax has been arrived at after crediting/(charging) the following gains and losses: Net gain/(loss) from sale of plant and equipment Net gain/(loss) from foreign exchange rate movement Profit before income tax has been arrived at after charging the following expenses: Depreciation of non-current assets Employee benefits Operating lease rental expenses: Minimum lease payments

2006 $

2005 $

27,749,521

23,894,190

27,749,521

23,894,190

283,088

352,700

2,929

3,628

409,966 85,764 382,171

462,133 17,461 157,327

28,913,439

24,887,439

– 5,611

6,470 –

85,078 27,541

62,233 10,133

138,130

103,849

Key Management Personnel Remuneration The directors and other members of key management personnel of Médecins Sans Frontières Australia during the year were: · Dr Rowan Gillies (President, Non-executive) · Dr Catherine Hewison (Non-executive) · Mr Peter Hooker (Treasurer, Non-executive) · Ms Emma Timmins (Non-executive), appointed 27 May 2006 · Mr Pierre Salignon (Non-executive) · Mr Matthew Melhuish (Non-executive) · Dr Michael Toole (Non-executive) · Mr Christopher Daley (Non-executive) · Dr Nicholas Wood (Vice president, Non-executive)

· Mr Philippe Couturier (Executive director) · Ms Nicola Dent (Head of fundraising) · Mr Emmanuel Lavieuville (Head of field human resources) · Mr David O’Kane (Head of finance and administration) · Dr Myrto Schaefer (Head of project unit) · Mr Philippe Tanguy (Head of communications) The aggregate compensation of the key executive management personnel of the company is set out below:

Key Management Personnel Remuneration (continued)

2006 $

2005 $

494,306 3,267

466,908 2,350

497,573

469,258

50,360 1,957

35,000 22,554

52,317

57,554

Office equipment at cost $

Furniture and fittings at cost $

Total $

Gross carrying amount Balance at 1 January 2005 Additions Disposals

213,524 114,849 (67,816)

48,488 3,802 –

262,012 118,651 (67,816)

Balance at 1 January 2006 Additions Disposals

260,557 64,874 –

52,290 120,356 –

312,847 185,230 –

Balance at 31 December 2006

325,431

172,646

498,077

Accumulated depreciation and impairment Balance at 1 January 2005 Depreciation expense Disposals

(163,647) (52,825) 66,286

(24,000) (9,408) –

(187,647) (62,233) 66,286

Balance at 1 January 2006 Depreciation expense Disposals

(150,186) (60,382) –

(33,408) (24,696) –

(183,594) (85,078) –

Balance at 31 December 2006

(210,568)

(58,104)

(268,672)

Net book value As at 31 December 2005

110,371

18,882

129,253

As at 31 December 2006

114,863

114,542

229,405

Short term employee benefits Other long term benefits

Remuneration Of Auditors Audit of the financial report Other non-audit services – accounting advice

The auditor of Médecins Sans Frontières Australia is Deloitte Touche Tohmatsu. 7.

Plant And Equipment

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—20

Notes to the financial statements for the financial year ended 31 December 2006 7.

Plant And Equipment (Continued) The following estimated useful lives are used in the calculation of depreciation:

· · ·

Office furniture and equipment: 5 years Computer equipment: 3 years Leasehold improvements (ii) : Over the term of the lease (ii) Leasehold improvements have been included into the category of Furniture and Fittings above. Aggregate depreciation allocated, whether recognised as an expense or capitalised as part of the carrying amount of other assets during the year:

Office equipment Furniture and Fittings

Trade And Other Receivables Amounts due from Médecins Sans Frontières International entities Goods and services tax (GST) recoverable Other (i)

2006 $

2005 $

60,382 24,696

52,825 9,408

85,078

62,233

37,964 102,791 45,211

99,031 49,547 36,106

185,966

184,684

(i) The Other Receivables account balance is comprised of miscellaneous receivables from external parties such as bank interest earned from the Westpac 11am account.

Other Non-Current Assets Rental bond

40,839

19,200

10. Trade And Other Payables Trade Payables Accruals

912,911 268,333

452,873 426,875

1,181,244

879,748

88,152 –

68,845 20,000

88,152

88,845

11. Current Provision Employee benefits Make good provision (note 12)

Make Good Provision $ 12. Provisions Balance at 1 January 2006 Additional provisions recognised

20,000 23,033

Balance at 31 December 2006

43,033

The provision for make good represents the present value of the directors’ best estimate of the future sacrifice of economic benefits to remove leasehold improvements from leased property.

13. Non-Current Provision Employee benefits Make good provision (note 12)

14. Retained Earnings Balance at the beginning of the financial year Net (loss)/profit Balance at end of financial year

2006 $

2005 $

29,529 43,033

21,295 –

72,562

21,295

4,802,862 (4,001,177)

1,813,868 2,988,994

801,685

4,802,862

15. Members Guarantee The company is incorporated under the Corporations Act 2001 and is a company limited by guarantee. If the company is wound up, the Constitution states that each member is required to contribute a maximum of $10 each towards meeting any outstanding obligations of the company. At 31 December 2006, the number of members was 217. 16. Related Party Disclosures Médecins Sans Frontières Australia provides services to and receives services from Médecins Sans Frontières international entities. The board of Médecins Sans Frontières Australia approved the payment of the following business expenses incurred by the directors of the company in the course of their duties as a director. · Mr. Peter Hooker $95 · Mr Christopher Daley $2,372 · Dr Catherine Hewison $530 · Dr Nicholas Wood $393 Médecins Sans Frontières Australia received provision of marketing services, printing and related production services through BMF Advertising Pty Limited, a company of which Mr Matthew Melhuish is also a director. These services were provided by third party suppliers unrelated to BMF Advertising Pty Limited and were passed onto Médecins Sans Frontières Australia at a cost of $10,146 (2005: $2,645).

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—22

Notes to the financial statements for the financial year ended 31 December 2006 17. Subsequent Events Starting from the 1 January 2007, Médecins Sans Frontières Australia has undertaken the contract and direct payment of field staff, working on field projects managed by Médecins Sans Frontières Operational Centres. Other than the event stated above and that referred to in the financial statements or notes thereto there has not been any other matter or circumstance, that has arisen since the end of the financial year, that has significantly affected, or may significantly affect, the operation of the company, the results of those operations, or the state of affairs of the company in future financial years. 18. Leases Operating leases Leasing arrangements There is one operating lease. The operating lease relates to office facilities and for the term of 4 years between 1/7/06 to 30/6/10. This operating lease contract contains a greater of CPI review and market review clause. The lease contract does not have an option to renew the lease nor the option to purchase the leased asset at the expiry of the lease period. This lease contract also contains a clause whereby the lessor can provide MSF Australia with written notice to vacate the leased premises within 9 months. This notice can be provided at any time from 1/10/2007. 2006 $

2005 $

146,500 366,250

31,231 –

512,750

31,231

In respect of non-cancellable operating leases, the following liabilities have been recognised: Current: Make good provision (note 11) – Non-current: Make good provision (note 13) 43,033

20,000

43,033

20,000

Non-cancellable operating lease payments Not longer than 1 year Longer than 1 year and not longer than 5 years

–

19. Segment Information The company predominantly raises charity funds in Australia for the purpose of providing funding to Médecins Sans Frontières Operational Centres for field projects managed by the Operational Centres running the projects.

20. Notes To The Statement Of Cash Flows (a) Reconciliation of cash and cash equivalents For the purposes of the statement of cash flows, cash includes cash on hand and in banks and investments in money market instruments, net of outstanding bank overdrafts. Cash at the end of the financial period as shown in the statement of cash flows is reconciled to the related items in the statement of financial position as follows:

Cash and cash equivalents (b) Reconciliation of (loss)/profit for the period to net cash flows from operating activities (Loss)/profit for the period Depreciation (Gain)/loss on disposal on assets (Gain)/loss on contributed assets Changes in net assets and liabilities: (Increase)/decrease in assets: Current receivables Non-current assets Increase/(decrease) in liabilities: Current payables Current provisions Other current liabilities Other Net cash from operating activities

2006 $

2005 $

1,687,433

5,459,613

(4,001,177) 85,078 – –

2,988,994 62,233 (6,470) (13,500)

(1,282) (21,639)

101,537 (236)

301,496 (693) – 51,267

14,101 30,693 (841,912) (18,742)

(3,586,950)

2,316,698

21. Financial Instruments (a) Financial risk management objectives The company does not enter into or trade financial instruments for speculative purposes. The company does not use derivative financial instruments. The company’s activities expose it primarily to the financial risks of changes in interest rates. (b) Significant accounting policies Details of the significant accounting policies and methods adopted, including the criteria for recognition, the basis of measurement and the basis on which income and expenses are recognised, in respect of each class of financial asset, financial liability and equity instrument are disclosed in note 2 to the financial statements. (c) Liquidity risk management The company manages liquidity risk by maintaining adequate reserves by continuously monitoring forecast and actual cash flows. (d) Interest rate risk management The company is exposed to interest rate risk as it invests its surplus finds in variable rate instruments. The risk is managed by regular review of its variable interest rate investments.

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—24

Notes to the financial statements for the financial year ended 31 December 2006 21. Financial Instruments (Continued) Maturity profile of financial instruments The following table details the company’s exposure to interest rate risk as at 31 December 2006:

2006 Financial Assets Cash Other current assets

Weighted average effective rate (%)

Variable Interest Rate $

Non-Interest Bearing $

3.383

1,687,433 –

– 185,966

1,687,433 185,966

1,687,433

185,966

1,873,399

–

1,181,244

–

1,181,244

Financial Liabilities Trade payables & accruals

Total $

The following table details the company’s exposure to interest rate risk as at 31 December 2005:

2005 Financial Assets Cash Other current assets

Financial Liabilities Trade payables & accruals

Weighted average effective rate (%)

Variable Interest Rate $

Non-Interest Bearing $

4.486

5,459,613 –

– 184,684

5,459,613 184,684

5,459,613

184,684

5,644,297

–

879,748

–

879,748

Total $

(e) Credit risk management Credit risk refers to the risk that a counterparty will default on its contractual obligations, resulting in financial loss to the company. The company has adopted the policy of only dealing with creditworthy counterparts. The company does not have any significant credit risk exposure to any single counterparty or any group of counterparties having similar characteristics. The carrying amount of financial assets recorded in the financial statements, net of any allowances for losses, represents the company’s maximum exposure to credit risk. (f ) Fair value of financial instruments The directors consider that the carrying amount of financial assets and financial liabilities recorded in the financial statements approximates their fair values (2005: net fair value).

21. Financial Instruments (Continued) The fair values and net fair values of financial assets and financial liabilities are determined as follows: the fair value of financial assets and financial liabilities with standard terms and conditions and traded on active liquid · markets are determined with reference to quoted market prices; and · the fair value of other financial assets and financial liabilities are determined in accordance with generally accepted pricing models based on discounted cash flow analysis. Transaction costs are included in the determination of net fair values.

2006 $

2005 $

Revenue: Donations and gifts – monetary and non monetary Legacies and bequests Investment income Revenue from other sections Other income

26,673,567 1,458,124 283,088 409,966 88,694

20,428,917 3,622,600 352,700 462,133 21,089

Total revenue

28,913,439

24,887,439

21,270,984 1,274,828 – 1,394,401

13,838,842 1,243,035 – 670,187

6,881,429 – 2,092,974

4,631,335 – 1,515,046

Total expenses

32,914,616

21,898,445

Excess of revenue over expenses (shortfall) from continuing operations Extraordinary Items

(4,001,177) –

2,988,994 –

Excess of revenue over expenses (shortfall) after extraordinary items Funds available for future use at the beginning of the financial year Amounts transferred to reserves

(4,001,177) 4,802,862 –

2,988,994 1,813,868 –

801,685

4,802,862

22. Detailed Income Statement For The Year Ended 31 December 2006 The following disclosure has been made to satisfy the requirements of the Charitable Fundraising Act 1991 and the requirements of the Australian Council for International Development.

Expenses: Overseas projects Funds to overseas projects Other project costs Domestic projects Community education Fundraising costs Public Government and multilaterals Administration

Funds available for future use at the end of the financial year

Médecins Sans Frontières Australia Annual Report 2006—Financial Report—26

Notes to the financial statements for the financial year ended 31 December 2006 2006 $

2005 $

Assets Current assets Cash and cash equivalents Financial assets Non current assets Property, plant and equipment Other

185,966 1,687,433 – – 229,405 40,839

184,684 5,459,613 – – 129,253 19,200

Total Assets

2,143,643

5,792,750

Liabilities Current liabilities Trade and other payables Non current liabilities Payables Provisions

– 1,181,244 – – 160,714

– 879,748 – – 110,140

Total Liabilities

1,341,958

989,888

Net Assets

801,685

4,802,862

Equity Reserves Funds available for future use/retained earnings

– 801,685

– 4,802,862

Total Equity

801,685

4,802,862

23. Detailed Balance Sheet For The Year Ended 31 December 2006

Retained Earnings $ 24. Detailed Statement Of Changes In Equity For The Year Ended 31 December 2006 Balance at 31/12/05 Excess of revenue over expenses (shortfall) Amounts transferred to reserves Balance at 31/12/06

Reserves $

–

Total $

4,802,862 (4,001,177) –

–

4,802,862 (4,001,177) –

801,685

–

801,685

2006 $

2005 $

903,903 121,212 2,195,621 1,419,179 7,121,969 757,019 511,743 8,101,938 2,433,971 3,608,672 574,294

766,893 1,176,596 1,918,707 3,622,600 4,051,458 857,793 499,882 6,337,401 1,532,817 3,130,043 –

27,749,521

23,894,190

206,332 25,325 815,912 64,055 774,417 362,569 130,384 3,612,569 5,150 348,897

121,678 25,408 837,819 6,981 303,251 372,287 73,742 2,441,909 2,489 –

6,345,610

4,185,564

21,403,911

19,708,626

21,403,911

19,708,626

(21,270,984) (1,710,803)

(13,838,842) (1,357,719)

Balance applied to operational support at Médecins Sans Frontières Australia

(1,577,876)

4,512,065

The transfer to the field was expended by the following parties on behalf of Médecins Sans Frontières Australia: Médecins Sans Frontières International Médecins Sans Frontières Switzerland Médecins Sans Frontières Spain Médecins Sans Frontières France

270,984 5,100,000 – 15,900,000

90,539 2,055,000 99,470 11,593,833

21,270,984

13,838,842

25. Details Of Fundraising Appeals Details of aggregate gross income and total expenses of fundraising appeals: Newspaper, magazine advertisements & inserts Fax campaign Acquisition Bequest Newsletters/appeals Other general campaign Events Field partners On line Miscellaneous income Telemarketing

Less: total direct costs of fund raising appeals Newspaper, magazine advertisement & inserts Fax campaign Acquisitions Bequest Newsletters/appeals and other general campaign Other general campaigns Events Field Partners On line Telemarketing

Net surplus obtained from fundraising appeals 26. Funds Received From The General Public Applied In Charitable Purposes Net surplus from all fundraising activities This was applied to the charitable purposes in the following manner: Transfer to the field Administration expenses (ii)

(ii) This number is different than that in the Income Statement due to the fact that non monetary expense has not been included in this balance as it is not funds received from the general public. Médecins Sans Frontières Australia Annual Report 2006—Financial Report—28

Notes to the financial statements for the financial year ended 31 December 2006 2006 $

2005 $

2006 %

2005 %

27. Comparisons Of Certain Monetary Figures & Percentages Total cost of fundraising Gross income from fundraising

6,881,429 27,749,521

4,631,335 23,894,190

Net surplus from fundraising/ Gross income from fundraising

20,868,092 27,749,521

19,262,855 23,894,190

Total cost of services/ Total expenditure (excluding costs of fundraising)

23,940,213 25,651,015

15,752,064 17,109,783

Total cost of services/ Total income received (net of fundraising costs)

23,940,213 21,649,839

15,752,064 20,098,777

111

28. · · · · · · · · ·

List Of Fundraising Appeals Conducted During The Financial Period Newspaper, magazine advertisements and inserts Fax campaigns Acquisition Newsletters/appeals Events Field partners On line Other general campaigns Bequest Appeal

No single appeal or other form of fundraising for a designated purpose generated 10% or more of total income for the period under review.

29. Funds Relating To The Tsunami Appeal The following disclosure has been made to satisfy the requirements of the Australian Council for International Development. Cash available at beginning of financial year $

Cash raised during financial year $

Cash disbursed during financial year $

Cash available at end of financial year $

Tsunami appeal Total for other purposes

– 5,459,613

– 28,071,203

– 31,843,383

– 1,687,433

Total

5,459,613

28,071,203

31,843,383

1,687,433

MSF Australia corporate supporters MSF Australia gratefully acknowledges the support given by the following organisations and agencies in 2006. · · · · · · ·

ACT Teleconferencing Acute Communications AirRoad Foundation AvantCard BMF Advertising Brisbane Powerhouse City of Sydney

· · · · · · ·

Dobsons Printing Gilbert & Tobin Health Communication Network Intaserve Medical Journal of Australia Mr Moto Nursing Agency Australia ·

· · · · · · ·

Office of Film & Literature Classification Onsite Rentals Seymour Theatre Centre TMVC Brisbane Torch Digital Valerie Etienne Productions Wendy Rae & Associates

As Charity Partner for Sydney New Year's Eve 2006 MSF enjoyed broad exposure in Sydney for weeks prior to NYE. Our awareness-raising activities continued right up to midnight on 31 December and MSF's logo during the evening appeared on the Sydney Harbour Bridge pylon at least once every hour, as pictured. Coinciding with the theme of Sydney New Year’s Eve 2006, “A Diamond Night in Emerald City”, the Bridge Effect sparkled with 1000 lights.

Médecins Sans Frontières Australia Annual Report 2006—82

Each sparkling light represented at least five children with AIDS who are currently being treated by MSF. At the end of 2006, there were over 5000 children in the world living with HIV/AIDS who received antiretroviral (ARV) drugs from MSF. With better access to diagnosis and treatment even more can survive beyond their early years and live a normal, active life.

Médecins Sans Frontières Australia ABN 74 068 758 654 Postal Address: PO Box 847, Broadway NSW 2007, Australia Street Address: Suite C, Level 1, 263 Broadway, Glebe NSW 2037, Australia Phone: +61 2 9552 4933 or 1300 13 60 61 (for the cost of a local call anywhere within Australia) Fax: +61 2 9552 6539 Email: office@sydney.msf.org Website: www.msf.org.au