This is all occurring as the Global Fund to Fight AIDS, Malaria and Tuberculosis prepares to celebrate its tenth anniversary on 28th January.

Horrific conditions

The conditions surrounding access to care for people living with HIV/AIDS in DRC are horrific.

At the Centre Hospitalier de Kabinda (CHK) in Kinshasa, MSF has observed an excessively high number of patients arriving with serious complications resulting from lack of treatment.

Their advanced illness creates unacceptable suffering.

André, 42 year old man, in MSF's HIV centre, Kabinda Hospital, Kinshasa, January 2011
© Mario Travaini/ MSF

"I have worked with HIV-positive patients in many countries in central and southern Africa, but what I'm seeing in DRC has not existed elsewhere for years," says Anja De Weggheleire, MSF's medical coordinator in DRC.

"The situation here reminds me of the time before any antiretroviral (ARV) treatment was available.

"Our doctors face serious complications every day that could be prevented if patients received early ARV treatment."

Eighty-five percent of patients lack treatment

The number of HIV-positive people in DRC is currently estimated at more than one million, 350,000 of whom could benefit from ARV treatment. However, only 44,000 are receiving treatment at this time.

This represents a 15 percent ARV coverage rate, one of the lowest in the world (of all African countries, only Somalia and Sudan have similar rates).

DRC is also one of the two lowest-ranked countries in western and central Africa in terms of the prevention of mother-to-child transmission of HIV (PMTCT).

Only one percent of pregnant women estimated to be HIV-positive have access to PMTCT treatment here. Without treatment, approximately one-third of the babies who are exposed to the virus will be born with HIV.

Reducing funding threatens lives

Despite these disastrous indicators, donors have not given DRC the priority it deserves. What is worse, some donors – such as the Global Fund – are withdrawing or sharply reducing their funding.

While the Global Fund is the leading supplier of ARV drugs in the DRC, the countries that finance the Fund have not kept their promises. As a result, the Global Fund is having to lower its sights.

This pull-back by donors is directly threatening the lives of thousands of people in DRC.

De Weggheleire sounds the alarm. "If nothing is done, it is highly likely that the 15,000 people currently on the waiting list and in urgent need of ARV drugs will be dead within three years.

"As horrifying as that number is, it represents only the tip of the iceberg when you realise that most people living with HIV/AIDS in DRC do not know their HIV status. Many will die in silence and neglect."

Commitment critical

It is crucial that Congolese authorities meet their commitment to provide free prevention services and free treatment for people living with HIV/AIDS.

It is also critical that donors immediately mobilise the necessary resources to ensure that patients waiting for ARV treatment are not condemned to die.

MSF has been working in DRC for more than 30 years, operating HIV/AIDS programmes since 1996. In October 2003, MSF was the first organisation to provide free ARV treatment to patients in DRC.

Through its healthcare support programmes and its AIDS project in Kinshasa, MSF treats more than 5,000 patients in six provinces, more than 10 percent of the number receiving ARV treatment throughout the country.

In Kinshasa, MSF is treating 20 percent of the total number of patients on ARV treatment in the Congolese capital.

Today, MSF is launching a communications and advocacy campaign that will continue throughout 2012 to raise public awareness of the very serious situation facing people with HIV/AIDS in DRC and to encourage all actors to expand ARV coverage.

The patients were taken to MSF’s hospital in Nasir, Upper Nile State, where they are receiving urgent surgical treatment. Five adult women and two adult men had gunshot wounds and the remaining six patients were children under five, with beatings or gunshot wounds.

Violence

“We are very concerned that the majority of the wounded in this latest wave of violence are women and children,” said MSF Head of Mission for South Sudan, Jose Hulsenbek.

“These 13 patients have survived the night, but some of the children are still in critical condition with severe trauma to the head,” she said. 

MSF supports a small outreach clinic in Yuai, northern Jonglei State, about two hours outside of Wek, Uror County, where the latest violence took place.

Wounded

MSF is continuing to monitor the situation and if further severely wounded people continue to arrive at Yuai clinic, they will be referred to the MSF-run hospital with surgical facilities in Nasir, Upper Nile State.

This latest round of inter-communal violence follows an attack in Pibor County in late December 2011/early January 2012, where the MSF-run hospital in Pibor town was looted and ransacked.  MSF emergency teams resumed medical activities in Pibor town on Sunday 8th January.

Impartiality and neutrality

MSF has demonstrated its complete impartiality and neutrality over the years, working in many different communities in South Sudan.  In 2011, three MSF medical facilities were targeted in Jonglei State.

We condemn the targeting of medical facilities by any armed group. MSF commits to continuing to bring humanitarian aid and medical assistance to the population of Jonglei State.

These attacks on aid workers must be condemned in the strongest of terms. They put in jeopardy life-saving medical projects that are already far from adequate in addressing the scope of the medical needs of the Somali population.

Needs great and risks high

MSF is confronting the difficult dilemma of working in a context like Somalia where the needs are not only extremely great but the risks are also exceptionally high for the safety and security of all our staff.

As we consider this dilemma, MSF is requesting that all people, especially the authorities in control of areas in Somalia where our kidnapped colleagues are being detained, do everything possible to facilitate the safe release of Blanca Thiebaut and Montserrat Serra.

MSF in Somalia

MSF has been present in Somalia continuously since 1991 assisting Somalis in need on all sides of ongoing fighting and conflicts. Over the last six months, MSF has treated 225,000 patients in Somalia, vaccinated 110,000 children and cared for 30,000 malnourished children in 14 projects. 

MSF also provides assistance to Somali refugees in nine projects in Kenya and Ethiopia, where finding the balance between the massive medical needs of the population and the risks that MSF teams are forced to endure is increasingly challenging. The net result is that the Somali population - extremely vulnerable after 20 years of civil war, international interventions and institutional collapse - receives less assistance than it needs.

“To effectively continue our medical humanitarian work in Somalia to support the population affected by the conflict, MSF needs all parties to the conflict, the leadership as well as the people of Somalia to support us in this work and help ensure the safety and security of humanitarian workers,” says Dr.Unni Karunakara, International President of MSF.  “For our colleagues Philippe and Kace, this failed tragically. For Blanca and Mone, the leadership and people of Somalia have the responsibility to facilitate the safe and prompt resolution of their abduction.”

We will sorely miss Philippe and Kace; their energy, humour and commitment (both are 10 year MSF veterans). Our heartfelt sympathy goes out to their loved ones. MSF still doesn't have all the facts, but we can share further details of what happened, following staff debriefings.

Philippe Havet (right) and Andrias Karel Keiluhu, better known as ‘Kace’ (left). © MSF

Despite stringent security rules (for example, metal detector use) an MSF Somali logistics assistant got into the MSF compound with a gun.

The staff member opened fire inside the MSF office. Philippe died immediately, Kace later in the evening following surgery.

We believe the shooting was a result of the non-renewal of the individual's contract, a decision taken with clear support from the community, as he was suspected of theft.

This was an act of violence by an individual, not related to any politics. Somalia is a lawless environment and every man has a gun.

MSF is faced with a terrible dilemma now. Our medical teams wish to maintain life-saving activities in Mogadishu and Somalia but must now review levels of exposure and risk. The people of Somalia are the victims of this violence as much as MSF is. Abandoning them is the last option for us.

Also, while we grieve for Kace and Philippe, we continue to ask for the release of our MSF colleagues kidnapped on the 13th October, 2011 in Dadaab, Kenya, currently thought to be in held in Somalia.

MSF teams have worked in Somalia since 1991 and currently operate 13 projects there. MSF also assists Somali refugees in Kenya and Ethiopia

09:50 Friday 30th December

It is with great sadness that Médecins Sans Frontières / Doctors Without Borders (MSF) confirms that two MSF staff members were killed on Thursday as a result of a shooting in the organisation’s compound in Mogadishu.

While one of the aid workers died during the shooting, the other was transferred to a hospital and died after surgery.

The victims are Belgian and Indonesian nationals. Philippe Havet, a 53-year-old from Belgium, was an experienced emergency coordinator who had been working with MSF since 2000 in many countries, including Angola, the Democratic Republic of Congo, Indonesia, Lebanon, Sierra Leone, South Africa and Somalia.

Andrias Karel Keiluhu, better known as ‘Kace’, was a 44-year-old medical doctor who had worked with MSF since 1998 in his native Indonesia as well as in Ethiopia, Thailand and Somalia.

The exact circumstances of the shooting are not yet clear. Our priority is to take care of those most affected by this tragedy, in particular the families and the colleagues of the victims.

MSF will be relocating some staff for security reasons, but remains committed to continuing our humanitarian work in Mogadishu and elsewhere in Somalia.

Philippe and Kace were in Mogadishu working with the MSF teams to provide emergency medical assistance to displaced persons and residents of the city.

We are deeply shocked by this tragic event and we will greatly miss Philippe and Kace. We extend our heartfelt sympathy and condolences to their families and friends.

MSF has been working in Somalia continuously since 1991 and currently operates 13 projects in the country, including medical activities related to the ongoing emergency, vaccination campaigns, as well as nutritional interventions. MSF also assists Somali refugees in camps in Dadaab, Kenya and Dolo Ado, Ethiopia.

Emergency mortality rates

Baby is examined in MSF clinic in Besse, Central African Republic. © Anna Surinyach/MSF

The report draws on four mortality studies conducted by MSF in the past 18 months, which reveal mortality rates in some regions at three times the emergency threshold.

The areas with the highest mortality rates are not affected by violent conflict and do not host large numbers of displaced people.

Mortality rates at this level constitute a humanitarian crisis,* and indicate that the situation is out of control.

Medical aid is insufficient

In the report, MSF concludes that existing levels of medical assistance are nowhere near enough to meet the scale of the needs.

The report outlines the necessity for increased efforts to conduct larger medical operations that reach more of the population.

"The country’s health system has been torn apart by years of political and military instability, major organisational problems, and a lack of security in the northern and eastern regions, all of which have had a catastrophic effect on the health of the population,” says Olivier Aubry, MSF’s head of mission in the Central African Republic.

Forgotten humanitarian crisis

The country has the second lowest life expectancy in the world, at 48 years, and the fifth highest death rate from infectious and parasitic diseases.

So far the catastrophe has gone unnoticed by the outside world, despite its severity.

Aubry says: “Last July, in Carnot, the mortality rate for children under five was three times as high as that seen amongst under-fives in Dadaab refugee camp, in Kenya. But, in Carnot, the crisis was unknown.”

Donors scaling down

Despite the health emergency, the report argues that commitments shown by the government and by the international community are moving in the wrong direction.

The government has been scaling down its investments in health, as have international donors, while humanitarian assistance has failed to reduce the widespread medical crisis.

Both the government and international donors appear to be actually disengaging from health provision in the country.

MSF calls on all parties, including the government and the international community, to expand assistance provided for people’s health in the Central African Republic, and reminds them that if old models of assistance are not working, new ones must be created.

MSF’s programmes in Central African Republic

MSF has been working in the Central African Republic since 1997 and, at the end of 2010, had 1,243 staff working in the country.

MSF projects support nine hospitals and 36 health centres and health posts. In almost all cases, MSF works in Ministry of Health facilities, seeking as close cooperation as is possible.

In 2010, MSF staff in the Central African Republic treated 582,253 people as outpatients and 24,185 people as inpatients.

* The 'crude mortality rate' is used to define a humanitarian crisis. The emergency threshold is above one death per 10,000 people per day. (World Health Organization)

• Read about a typical day working in an MSF hospital in CAR

Visceral leishmaniasis, also known as ‘kala azar’, is a neglected parasitic disease spread through the bite of a sandfly.

The Leishmaniasis parasite is transmitted to humans by biting sand flies. Photo by MSF

Visceral leishmaniasis is endemic in 76 countries worldwide. In East Africa, regions in Ethiopia, Kenya, Sudan and South Sudan are particularly affected.

The disease is fatal without treatment.

Hiv and kala azar

“People living with HIV are particularly vulnerable, so it’s critical that HIV programmes kick start a response to this neglected disease,” said Dr. Rachel ter Horst, medical advocacy advisor with MSF, (who presented MSF field experience and research on the management of HIV/VL co-infection at ICASA).

“In countries like Ethiopia where HIV and visceral leishmaniasis interact and co-infection is a problem, HIV programmes are essentially faced with the same paradigm as with tuberculosis.

HIV programmes have learnt to think TB – they also need to learn to think visceral leishmaniasis.”

North-western Ethiopia has the highest burden of HIV/VL co-infection, as around one in three patients with visceral leishmaniasis is also HIV-positive.

HIV

Visceral leishmaniasis interacts with HIV in many ways:

• People living with HIV are at much higher risk of developing this disease.

• Visceral leishmaniasis accelerates progression to AIDS.

• Relapses are almost inevitable in people living with HIV. 

• HIV-positive patients respond less well to anti-leishmanial treatment with each subsequent relapse.

But successful treatment of the first episode of visceral leishmaniasis and early initiation of antiretroviral therapy may delay and reduce relapses.

“As a first step, HIV programmes in areas that are endemic for visceral leishmaniasis should actively screen people living with HIV for this life-threatening disease,” said Dr Ter Horst.

“Co-infected patients should then be given antiretrovirals as soon as possible after starting anti-leishmanial therapy.”

Combination therapy

New data presented at ICASA by MSF suggests that the use of high-dose combination treatment regimens for co-infected patients can improve survival in the longer-term.

Early results suggest that treatment with liposomal amphotericin B at higher doses, combined with miltefosine, may have higher safety and efficacy than other options.

“Until now, treating people living with HIV who also suffer from visceral leishmaniasis has led to pretty bleak outcomes,” said Dr. Koert Ritmeijer, MSF health advisor.

“Existing treatments were failing – some like SSG are too toxic and lead to high mortality in co-infected patients, others like liposomal amphotericin B are safe but aren’t effective enough. 

"We’re now seeing high-dose combination therapies have led to better initial cure rates, including in patients who had been cured of VL but have since suffered a relapse.”

Further research

Two clinical trials co-sponsored by MSF, the Drugs for Neglected Diseases initiative (DNDi), and the Institute of Tropical Medicine in Antwerp (ITM), and in collaboration with Gondar University in Ethiopia, will be implemented in 2012, both to confirm these promising results and to investigate the benefits of preventive therapy to reduce the occurrence of relapses. 

“With the prospect of better treatment options, if the studies confirm these results, we hope that improved treatment guidelines will be implemented throughout the region in the near future,” said Dr Ritmeijer.

MSF's December 2011 briefing document, The Double Burden:HIV/visceral leishmaniasis co-infection in East Africa is available from msfaccess.org.

In East Africa, MSF diagnoses and treats HIV and visceral leishmaniasis in several areas where the latter is endemic: Jonglei, Unity and Upper Nile States in South Sudan, Gedaref in Sudan, Abdurafi in Ethiopia, Pokot in Kenya.

MSF has treated more than 100,000 patients for visceral leishmaniasis worldwide since 1988.

“This commitment today is the shot in the arm that the global HIV/AIDS response needs right now. We hope this marks the end of donors walking away from supporting global HIV/AIDS, despite evidence that the epidemic can be reversed.

"People living with HIV around the world will be watching closely to make sure this commitment is turned into reality.

"Now it is time for all governments – both donors and affected countries alike – to step up, fund the Global Fund, and increase the pace of HIV treatment scale-up, so that the effort to end AIDS is not derailed.

"Our doctors and nurses started treating people with HIV in developing countries a decade ago, in the face of widespread skepticism, and yet today half of the people who need treatment now have it. 

"This is the best time to charge full speed ahead and get treatment to everyone who needs it so we can save lives and get ahead of the wave of new infections.”

Dr. Tido von Schoen-Angerer – Executive Director, Access Campaign, Médecins Sans Frontières 
 
CONTACT: MSF UK Broadcast Relations Manager Sophie Scott,  44 (0)7889 178 473.

• Update January 2012: MSF have been providing psychological support to the people of Van since December 2011

Collaborating with the Turkish Ministry of Health and the Van Crisis Coordination Centre, MSF teams will address urgent needs for mental health support in Van.

Psychological impact

“Many people are still in shock after the terrible experience of the quakes," explains Patrick Wieland, MSF head of mission.

“Many of them have lost family members and friends, and some have no one left. Their houses have collapsed, they have lost all their belongings and they have to deal with a harsh new reality and extremely cold weather conditions, which will take months to improve.

“Every day we see that there is a clear need to address the psychological consequences of this earthquake, which has taken a significant toll on the local population.” 

Mental health workers

A team of mental health workers will be working in the villages around Van, carrying out group and individual counselling sessions for both adults and children. MSF will also offer psychological care to refugees and asylum seekers that have been affected by the earthquake and are living in camps and settlements in the area.

An MSF emergency team arrived at the earthquake-affected areas of Van and Ercis on 25th October.

Since then, in collaboration with two Turkish organisations, Hayata Destek, Helsinki Citizens’ Assembly (hCa) and other local partners and authorities, MSF has provided thousands of people in villages in the Van region with tents suitable for winter conditions and cooking kits.

The Global Fund will provide for a ‘transitional funding mechanism,’ whereby countries known to be facing a disruption of programs for HIV, TB and malaria before 2013 will be offered a chance to apply for funding to cover their most essential needs.

An MSF nurse examines the lungs of a TB/HIV co-infected patient in Chiradzulu District Hospital, Malawi.
© Julie Remy

For HIV, this funding can cover medicines for people already on treatment, but does not provide for scale-up of HIV treatment.

Funding will also be restricted for treatment of drug-resistant forms of TB.

Global Fund donors

MSF calls on the Global Fund and donors to immediately raise the resources necessary for the minimum lifeline the Fund has extended to countries otherwise facing disruptions this year, as well as providing a new regular funding opportunity.

The dramatic resource shortfall comes at a time when the latest HIV science shows that HIV treatment itself not only saves lives, but is also a critical form of preventing the spread of the virus, and governments are making overtures that there could be an end to the AIDS epidemic.

HIV treatment on the ground

Yet on the ground in hard-hit countries where MSF works, the devastating effects of the overall funding crunch are becoming apparent.

For example, Cameroon and Zimbabwe are facing shortfalls in the near future to support people already on treatment, and the Democratic Republic of Congo severely caps the number of people able to start on life-saving HIV treatment.

In other countries, such as Mozambique, funding problems have prevented the country from providing earlier treatment and better drugs, per WHO-recommended guidelines.

Plans on hold

Further countries may have to put important plans on hold, such as Malawi, which in addition to wanting to scale up HIV treatment, wants to provide earlier and life-long treatment for all HIV-positive pregnant women to not only protect their babies, but keep themselves healthy. 

Some countries, including Kenya, Lesotho, and South Africa, had already been told by the Global Fund that they weren't eligible to apply for funding from Round 11 because of lacking funding.

In those countries, HIV treatment coverage lies at 52 percent, 66 percent and 49 percent, respectively.

Governments must act

“There’s a shocking incongruence between both the new HIV science and political promises on one hand, and the funding reality that is now hitting the ground on the other,” said Dr. Tido von Schoen-Angerer, executive director of MSF’s Access Campaign. 

“Donors are really pulling the rug out from under people living with HIV/AIDS at precisely the time when we need to move full steam ahead and get life-saving treatment to more people. 

"All governments must chip in to the effort to curb HIV, but especially those with the capacity to really make a difference must urgently step up and support a new funding opportunity for countries by the Global Fund.” 

The medical aid organisation has suspended a portion of its operations in the Masisi area and is concerned about the fate of its patients.

Shooting

The MSF ambulance travelling from Mbitsi health clinic to Masisi hospital. © Yasuyoshi Chiba

During the night of 20th to 21st November, a number of armed men forced their way into the MSF residence compound and opened fire.

One member of the team was wounded by a bullet to the shoulder. He was treated by his colleagues and is now in stable condition.

To maintain the safety of its teams, MSF has been forced to suspend the project’s mobile treatment activities until further notice.

However, MSF will continue to provide a minimum level of emergency support service at the Masisi General Referral Hospital.

MSF deplores violence

MSF deplores this violence that has once again hampered its ability to provide help and assistance to the population.

“In addition to the shock experienced by our team, this incident prevents us from properly carrying out our field medical activities and so negatively affects the local population,” stated Gaël Hankenne, MSF head of mission in Kinshasa.

Regular attacks

This incident comes at a time when MSF’s teams are regularly being targeted for attacks. In April 2011, in South Kivu, two members of MSF were wounded by gunfire and the organisation was also forced to temporarily suspend a portion of their activities in the region.

MSF has been present in DRC since 1981 and delivers primary and specialised hospital care in health centres or mobile dispensaries throughout the country.

MSF has had a presence in the Masisi health area since 2007 and provides the full range of secondary health care in the Masisi General Referral Hospital and primary health care out of the Masisi and Nyabiondo health centres.

MSF has also established a system of mobile clinics to provide assistance to the sick in the Bukombo displaced persons camp and in areas impacted by a lack of security.

Last year, MSF provided over 108,952 consultations and carried out 1,783 surgeries in the Masisi area alone.

• More about MSF in DRC
  

The Israeli embargo of the Gaza Strip, which began in 2007, together with years of financial crisis within the Palestinian Authority in Ramallah and the chronic lack of cooperation between the Palestinian Authority and Gaza authorities, have caused harm and threaten Gaza's health system and its patients. 

Drug companies stop supply

Health facilities in the Gaza Strip face a serious shortage of drugs and medical supplies. While MSF makes regular donations, no aid actor can meet the full range of needs. © Juan Carlos Tomasi

Last spring, drug companies stopped supplying the Palestinian Authority.

The situation, which had been worsening steadily for several years, deteriorated further in 2011 and has reached an alarming level.

As Israeli bombs struck the Gaza Strip in mid-August, local health authorities called on international aid actors working in the area for help.

Since that time, they have asked for donations on a regular, long-term basis.

However, no humanitarian actor – including MSF – has the financial and/or logistical resources to provide the drugs and medical supplies needed by the Territory's health facilities.

Essential medicines

Thirty six percent of essential medicines are lacking. Stock-outs represent a real threat to patient health.

In late September 2011, 164 essential drugs – 36 percent of necessary supplies, compared to 25 percent in 2010 – were completely unavailable. Only 260 of the 900 required medical supply items (specifically, single-use items) were supplied. 

For now, UNRWA clinics, run by the UN relief agency for Palestinian refugees, provide patients with chronic illnesses access to treatment.

The medical areas most affected are:

• Surgery

• Intensive care (certain anesthetics are lacking altogether)

• Hemodialysis

• Treatments to prevent organ transplant rejection

• Oncology

• Hematology (no coagulants)

• Psychiatric medications (only 33 of the 46 essential psychiatric drugs are available)

• Ophthalmology (all eye surgeries have been halted)

• Maternity

• Pediatrics

• Catheterisation laboratory procedures for the diagnosis and treatment of heart disease

Patients' lives in danger

The five medical centers that treat kidney disease in Gaza will face drug shortages within a few weeks and their patients' lives will then be in grave danger.

Throughout 2011 MSF made periodic donations when specific, urgent needs arose.

Since 2008, the organisation has regularly criticised the politicisation of the Palestinian health sector and the impacts of the conflicts – both internal and external – on patients deprived of critical medications and medical care. 

While MSF, an emergency medical aid organisation, can establish an action and donation plan, it cannot provide the full range of drugs and medical supplies. We remain particularly concerned about the future of Gaza's patients and ill residents.

• Update 31/10/2011 11.30am: MSF can confirm five casualties and is currently treating 45 wounded, 31 of whom are children. The lesser number is due to people dismissed from hospital since last night.

At the time of writing at least three people are reported dead and 52 injured, mostly women and children.

MSF is transporting the wounded to the hospital in Marere, in Lower Juba, southern Somalia,  for stabilisation and treatment, and may have to refer some patients to other facilities due to limits to the surgical capacity at the hospital.

Somalia has been hit by a severe humanitarian crisis since May this year and hundreds of thousands have been displaced due to violence and drought.

Jilib houses a population of around 1,500 displaced households and MSF had been providing them with medical care, including therapeutic feeding for acutely malnourished children. The organisation also distributes basic relief items such as soap, cooking oil, blankets and sheltering materials.

MSF urges all parties to the conflict in Somalia to respect the rights of civilians in conflict.

MSF has been working in Somalia continuously since 1991 and currently operates 13 projects in the country, including medical activities related to the current emergency, vaccination and nutritional interventions. 

In Dadaab, Kenya, MSF resumed operations in 2009, while assisting Somali refugees in the camps of Dolo Ado, Ethiopia.

After a first phase of assessment in order to identify the major needs and gaps, MSF will now focus on providing relief goods in rural areas where assistance has been more difficult, in collaboration with Turkish NGOs.

Population outside the main cities in need of assistance

“The main hospitals have not been affected by the earthquake. The health system was strong and is responding adequately to the medical needs. In Van and Ercis, the two main cities, the response by the Turkish authorities has been globally good,” explains Jerome Souquet, MSF emergency programme manager.

“However, the MSF team has identified a number of villages outside the main cities where people are living in very harsh conditions with temperatures below zero at night.

"Some have lost their homes and others are afraid of aftershocks and do not want to go back to their houses. Some people are sleeping in cars, in very precarious conditions, and need assistance.”

Aid distribution

In collaboration with Turkish NGOs, MSF will distribute winterised tents, blankets and cooking sets to some 10,000 people.

Two cargo planes with 140 tonnes of relief material are being sent from Dubai, where MSF has a logistical base. At the same time, the team on the ground is being reinforced in order to prepare the distribution.

Water supply and psychological assistance

As the water system in these villages has been damaged by the earthquake MSF is also exploring temporary solutions in order to resume water supply. 

The team is also in conversation with local teams of psychologists in order to start providing mental health assistance to the affected population, an important need in the aftermath of an earthquake.

This area, located in the southern department of Escuintla, is the most affected, where some 5,000 people have not yet been assisted.

MSF works to improve living conditions

"The most urgent food and medical needs have been covered locally," said Stefano Zannini, MSF’s emergency coordinator.

"However, we will distribute blankets, mattresses and hygiene kits to improve the living conditions of some 1,000 families living in remote areas. Some of them are still displaced, while others were able to return to their homes, but in some cases people have lost everything."

“It is important to prevent an increase in respiratory infections and other diseases related to poor sanitation."

Mobile clinic and free consultations

In Honduras, where torrential rains have affected thousands of people, MSF has deployed a mobile clinic and offered more than 140 medical consultations to the Marcovia communities in the southern department of Choluteca.

An assessment of the health and medical needs has shown that the health system has quickly responded and that patients have free access to primary health care. MSF is thus focusing on the epidemiological surveillance of infectious diseases, such as dengue, malaria and leptospirosis, and on the disinfection of 20 contaminated wells identified in the area.

The organisation will also conduct a mass distribution of doxycycline to support health centers in the prevention of leptospirosis, which is endemic in the region.

MSF has been working in Guatemala since 1984 in various projects. The organisation currently provides medical, psychological and social assistance to victims of sexual violence in Guatemala City.

MSF has worked in Honduras since 1974. In the capital city, Tegucigalpa, teams are currently providing medical services to the most vulnerable population, victims of violence.

Given the frequency of natural disasters in Central America, MSF is ready to provide emergency assistance to disaster victims in the region and maintains an emergency team based in Panama.

The campaign had been scheduled to last three weeks and to reach 35,000 children. Measles is currently wreaking havoc in Somalia. Sixty thousand have been already vaccinated against measles over the last two months.

"Combined with malnutrition, measles is now the main killer of children in Somalia,” says Duncan McLean, head of MSF programmes in Somalia. “Only vaccination can stop the spread of the epidemic.”

Unstable security situation

During the first five days of the campaign, 4,831 children aged six months to 15 years were vaccinated in different parts of Dayniile. But clashes between the forces of the Transitional Federal Government, supported by AMISOM (the African Union Mission in Somalia), and Al Shabaab, put a stop to the vaccinations.

"As long as the security situation is not stabilised, it will not be possible to resume the vaccination campaign,” observes McLean.

“And when this happens, we will have to completely rethink our strategy because many people have fled the combat zones. Tens of thousands of displaced people were living in camps in Dayniile, many for a long time and some who had arrived recently from drought-affected regions.”

In addition, many people were wounded during the clashes. On 20th ctober and the day after, MSF teams at Dayniile Hospital received 83 patients who had been injured by gunshots or explosions. Forty one were hospitalised and eleven surgical procedures were performed.

Malnutrition

MSF has supported management of emergencies for the hospital in Dayniile since August 2007.

Starting this past April, MSF has also supported the treatment of severe malnutrition. Twenty four malnourished children were receiving intensive treatment before the fighting erupted. In most cases, frightened mothers chose to leave with their children; only six currently remain under care.

MSF continues to work in the Dayniile hospital and in Mogadishu, where our teams provide medical and nutritional assistance to displaced populations.

MSF has been working in Somalia continuously since 1991 and currently operates 13 projects in the country, including medical activities related to the current emergency, vaccination and nutritional interventions.

MSF resumed operations in Dadaab, Kenya, in 2009, and it also assists Somali refugees in the camps of Dolo Ado, Ethiopia

All wounded patients must have access to care and must be able to receive treatment without discrimination and fear of reprisal.

Hospital damage

Ibn Sina Hospital in Sirte has borne much of the brunt of the fighting that has raged. Last week, MSF teams based in Misrata were able to travel to Sirte and observe the damage at the hospital.

"Ibn Sina Hospital came under fire and was attacked," said Barbara Frederick, MSF emergency coordinator.

"An explosion destroyed an operating room and most of the windows were damaged. As a result of the fighting over the last few weeks, patients had to be moved into the hallways."

Patient security

Security was not ensured at the hospital.

"Last week, there were many fighters coming in and out of the hospital with their weapons, checking the patients," said Frederick. "We don't know who they were looking for."

After assessing the needs at Ibn Sina, MSF provided surgical supplies, organised the resumption of surgery in the hospital's two refurbished operating rooms and delivered 150,000 litres of water. 

The hospital, which had been without water and electricity, is now fully functional once again. Libyan medical officers have arrived to assist, making it possible to resume surgical services.

Access to care

Security, however, remains critical to ensuring that all wounded patients have access to care, regardless of which 'side' they belong to, as stipulated by international humanitarian law, said MSF.

Most of population of Sirte has fled the city, which now resembles a ghost town. Some civilians are still unable to leave, however, because of fighting in northern areas.

MSF is calling on the warring parties to ensure that civilians have access to care, and to respect the security and integrity of the wounded people inside medical facilities.

“Haitian authorities and international aid actors need to do much more to treat and prevent cholera,” said Romain Gitenet, MSF head of mission in Haiti.

MSF teams loading mules with medical material destined for the Cholera Treatment Center of Cheno village.        © Frederik Matte

“There is an urgent need to improve healthcare, provide access to clean water, and ensure proper sanitation.

"Clean water and sanitation are essential to halting the spread of cholera.

“Even though the international community has pledged huge sums of money to assist Haiti, thousands of Haitians are still getting sick from cholera every week, and some are still dying.”

Cholera deaths

Since the first cases of cholera were identified in October 2010, more than 465,000 Haitians have fallen ill and more than 6,500 people have died, according to Haiti’s Ministry of Health. The ongoing rainy season is facilitating the spread of the disease.

At the same time, MSF is seeing international organisations involved in healthcare, water and sanitation withdrawing from the fight against cholera in Haiti. Yet the needs remain significant and urgent.

There continue to be dangerous and unpredictable fluctuations in the number of cholera cases. For example, in the fourth week of August MSF treated 281 patients for cholera in Port-au-Prince; by the end of September, cases jumped to 840 per week.

Cholera response

It is likely that cholera will continue to be present in Haiti for years to come. Haitian authorities will ultimately have to take responsibility for responding to the disease. But they have not yet been able to mount an effective response countrywide.

While ensuring that Haitians’ urgent needs for cholera care are adequately met, international aid actors should do more to assist the Haitian government in rapidly integrating proper cholera treatment into healthcare facilities, and in implementing prevention plans.

MSF has been working to transfer management of the healthcare facilities it has been supporting back to the Ministry of Health.

Saving lives

Port-au-Prince, two patients affected by cholera are receiving a treatment in one of the MSF cholera treatment center. © Frederik Matte

Meanwhile, the focus must be on saving Haitians’ lives.

According to Gitenet:  "Cholera patients continue to die from dehydration in remote areas of the country simply because there are no oral rehydration points or treatment facilities nearby, or because of a lack of trained healthcare personnel or community outreach workers. This is unacceptable."

About cholera and MSF’s response to the epidemic

Cholera is a bacterial infection that spreads primarily through contaminated water and food, and through interpersonal contact. It can kill quickly, but is easy to treat if appropriate healthcare services are available.

It is also easy to prevent through access to clean water, regular hand washing and hygienic food handling. But a majority of Haitians living in rural areas and urban slums can’t access potable water or proper hygiene and sanitation facilities.

Since the beginning of the cholera epidemic in October 2010, MSF has treated more than 160,000 patients for cholera, about 35 percent of total cases reported nationwide.

MSF teams are currently responding to cholera in the Martissant, Carrefour, Delmas, Choscal, and Drouillard neighborhoods of Port-au-Prince; and in the Ouest, Nord, and Artibonite departments. 

Contact

Hannah Ward, Press Officer
Direct line: 44 (0) 20 7067 4265
Out of office hours press line: 44 (0)7889 178 472
e-mail: hannah.ward@london.msf.org

MSF firmly and clearly disassociates itself from any armed activities and related declarations launched following the abduction.

Military actions

Blanca Thiebaut, age 30, from Madrid, was abducted from the Dadaab camp. © MSF

MSF is actively and fully engaging with all relevant actors in order to seek a safe resolution of the abduction.

Abductions are extremely complex and need to be handled with care, therefore MSF is very concerned that security and the resolution of the incident could be compromised by any use of force being related to the case.

“MSF is currently engaging with all relevant actors to seek the safe and swift release of our colleagues and any use of force could endanger this,” says Jose Antonio Bastos, president of MSF in Spain.

“We want to strongly distance ourselves from any military or other armed activities, declarations or presumptions of responsibility related to this case.”

MSF's work continues

MSF continues to provide assistance to people affected by the current crisis in Somalia, Kenya, Ethiopia and Djibouti, despite the already highly complex security environment.

As a result of the attack, MSF has temporarily suspended activities in Ifo two camp, Dadaab, where the abduction took place.

These activities include two health posts and mobile clinics that were providing primary healthcare, reproductive health and antenatal care, routine vaccination programmes and referral services for secondary healthcare.

MSF hospital

Montserrat Serra, age 40, from Girona (Palafrugell) was abducted on 13th October. © MSF

In Dagahaley camp, MSF has ensured the continuation of life-saving medical activities in the 243-bed hospital, with nearly 200 patients being treated in the in-patient therapeutic feeding centre.

However, five health posts had to be momentarily suspended and medical teams are currently on stand-by, ready to resume all activities as soon as security conditions allow it. Part of the nutritional program, which was treating 15,000 people, was also put on hold.

Dadaab and Somalia

MSF has been working in Somalia continuously since 1991 and currently operates 13 projects in the country, including medical activities related to the current emergency, vaccination and nutritional interventions.

In running such programs, MSF maintains an ongoing dialogue with key actors on the ground.

In Dadaab, Kenya, MSF resumed operations in 2009, while it also assists Somali refugees in the camps of Dolo Ado, Ethiopia.

“We are deeply concerned about the fate of our two colleagues. MSF is committed to continue providing healthcare to the Somali population in and outside Somalia,” says Bastos, “but the level of assistance to populations is being deeply impacted by such attacks. It is extremely alarming”. 

12 year old Ahmed (name changed) is being treated for a gunshot wound in the MSF surgical hospital in Kunduz. © Olof Blomqvist/MSF

The hospital, which opened on 29th August, provides urgent surgical care and follow-up treatment for people suffering life-threatening injuries.

Northern Afghanistan's only trauma centre

Fighting over the last year in Kunduz has led to large numbers of people who have sustained bomb blast, shrapnel and gunshot wounds, and who are in need of specialised surgical care.

The new hospital is the only trauma centre of its kind in northern Afghanistan and is equipped with an emergency room, two operating theatres, intensive care, as well as X-ray and laboratory facilities. There are separate male and female inpatient wards.

Right to receive treatment

MSF services are completely free of charge and available to anyone meeting the admission criteria – which includes anyone that is either violently or accidently injured.

"The only label we use is ‘patient,’” said Dr Dorian Job, MSF medical coordinator in Afghanistan. “Every injured person has the right to receive medical treatment, and we make no distinction between civilian or combatant.”

The MSF surgical hospital in Kunduz is the only trauma centre of its kind in northern Afghanistan.
© Olof Blomqvist/MSF

MSF works impartially

In all locations where MSF is working in Afghanistan, a strict no-weapons policy is implemented to ensure patient safety and security.

It is imperative that no armed people are present in medical structures. Such a presence could make the facilities targets of attack.

MSF relies solely on private donations for its operations in Afghanistan, and does not accept any government funding.

It is the duty of all parties to a conflict to respect the rules of international humanitarian law, including those concerning the protection and respect of medical structures, medical personnel and patients.

MSF teams also work in Ahmed Shah Baba Hospital in eastern Kabul, and Boost Hospital in Lashkargah, Helmand Province. In both locations, MSF provides free-of-charge lifesaving medical care, working in all wards of the hospitals.

MSF relies solely on private donations for its work in Afghanistan and does not accept any government funding.

The emergency team of medical doctors, nurses and logisticians, conducted medical assessments starting in early October after typhoons Nesat and Nalgae hit the northern part of the Philippines.

MSF teams conduct mobile clinics in Calumpit in Bulacan province, Luzon, the Philippines.
© Cecile Aslanian/MSF

Although to date most of the government operated evacuation centres in the affected areas are closing, MSF finds that there are still six areas in the Bulacan province (Bulusan, San Jose, Panducot, Sapang Bayan, St Lucia, Meyto) inundated, with limited accessibility and healthcare provision.

MSF mobile teams

In Bulacan, two MSF mobile teams (including two medical doctors, two nurses and two midwives from the Ministry of Health) run primary healthcare consultations for the affected populations.

For patients who require life-saving treatments and hospitalisation, they are referred to the provincial hospital by a 20 minute ride by the ambulances operated by the Ministry of Health.

Rice crops destroyed

“We have been taking mobile medical clinics by boat and car to the most vulnerable population still in areas completely inundated, sometimes up to two floors,” said Pierluigi Testa, MSF emergency coordinator.

“The team is now paying attention to the nutritional status of children under the age of five years because almost all of the rice crops in the region have been destroyed, including the next harvest.

"They will also be monitoring for any outbreaks of acute watery diarrhoea and leptospirosis [a bacterial infection].”

Relief supplies

MSF also conducts epidemiological follow up in relocation centres, and facilitates the proper functioning of the remaining health centres, and fills the gaps of drugs and equipments if necessary.

MSF will continue to assess medical needs in other areas including Hagonoy and Tarlac, and has already visited the district hospitals of Malolo, Hagonoy and Calumpit, where healthcare provision is limited.

Other than providing healthcare assistance, MSF is also assessing the need for provision of relief supplies to the affected populations. Eight hundred jerrycans have already been distributed.

With the expectation that another potential tropical depression may strike the Philippines, an MSF team is on the ground to be on standby for further assessments.

• Read more about MSF's work in the Philippines
  

Two international staff, both Spanish, were taken. As yet, MSF has not been able to establish contact with the two staff taken. A crisis team has been set up to deal with this incident.

Blanca Thiebaut, age 30, from Madrid. © MSF

Staff named

The two Spanish colleagues abducted are Montserrat Serra, age 40, from Girona (Palafrugell) and Blanca Thiebaut, age 30, from Madrid, both working as logisticians for MSF in the Dadaab refugee camp.

Their families have been informed. MSF is calling on all media to respect the privacy of the families in this difficult time.

Aid jeopardised

"We are in regular contact with the families of our colleagues involved and relevant authorities since the first moments.

"We are doing all we can to ensure their safe and swift return. Our thoughts are with them and their families," says Dr José Antonio Bastos, president of MSF in Spain.

Following the attack, MSF has evacuated part of its team working in Dagahaley and Ifo, two of the three refugee camps in Dadaab. As a consequence some crucial medical activities have had to be stopped. However, MSF is still maintaining life-saving activities.

This attack jeopardises assistance to thousands of people in urgent need of humanitarian aid and a quick and satisfactory solution is necessary.

Montserrat Serra, age 40, from Girona (Palafrugell).
© MSF

No further comment

These incidents call for prudence and discretion. In order to facilitate the best and swiftest resolution of the incident, MSF will not provide further information for the moment nor will it comment on statements, rumours or public information related to it.

MSF is also calling on all actors involved to refrain from commenting publicly about this incident.

“The current publicity around the incident is particularly unhelpful, for it can only hurt the families and jeopardise efforts to get our colleagues back,” says Dr Bastos.

• MSF started providing medical assistance in Dadaab in 2009.

• MSF will provide an update on its ongoing activities in Dadaab in due course
  

MSF staff member delivering Chagas treatment in Aiquile, Bolivia. © Vania Alves/MSF

Thousands of people with Chagas disease will go untreated in coming months due to a shortage of benznidazole, the first-line drug used in most endemic countries.

As a number of countries are actively seeking to reverse the long neglect of Chagas disease, the supply of this treatment threatens to run out.

Therefore, the medical-humanitarian organisation MSF is urging the Brazilian Ministry of Health, which is responsible for the only laboratory in the world manufacturing benznidazole, to respect its commitment to Chagas patients and take immediate measures to make the drug available. 

Chagas treatment

Chagas treatment currently depends wholly on a single pharmaceutical company to produce benznidazole tablets, the Brazilian State laboratory LAFEPE (Laboratorio Farmaceutico do Estado de Pernambuco). Responsibility for producing the active pharmaceutical ingredient (API) used by this laboratory was recently transferred to one sole private company, Nortec Química.

There is not enough API at present to produce the tablets needed, and Nortec has yet to validate production. In addition, LAFEPE has breached its promise to publish and fulfil a manufacturing schedule that would ensure availability of the drug.

As a result, various national Chagas programmes in Latin America are already struggling to meet the demand for new treatment and are expected to run out of stock in the next few months.

Future availibility unknown

No information has been provided by the Brazilian Ministry of Health on what is happening, and the World Health Organization (WHO) and the Pan American Health Organization (PAHO) have not put a contingency plan in place to maintain stocks of this drug for acute cases of Chagas.

Future availability of the drug is not currently known, although according to various estimations it is unlikely to be before mid-2012.

“This situation is unacceptable. In Boquerón, an area with one of the highest rates of Chagas in Paraguay, we are forced to stop diagnosing patients because we simply don’t have the drugs to treat them,” explains Dr Henry Rodríguez, MSF’s head of mission in Bolivia and Paraguay.

“For decades Chagas was a completely neglected disease and just when diagnosis and treatment were finally being made a priority, we’ve run out of medication. We must not allow this to continue; an urgent solution must be found for our patients.”

MSF forced to delay treatment

In recent years, demand for treatment has increased significantly because adults are now being treated as well as children. Besides, the WHO and the PAHO have strongly endorsed diagnosis and treatment at the primary healthcare level. However, all progress made to date is now jeopardised by the shortage of benznidazole.

“Although we know that current treatment is more effective and more likely to prevent complications the sooner a patient is treated, we will be forced to delay it,” says Dr Unni Karunakara, MSF's international president.

Call for swift action

In view of this critical problem, MSF has called upon the Brazilian Ministry of Health to commit to speeding up the current benznidazole manufacturing process by streamlining its validation with the API produced by Nortec.

Given that the production, distribution and sales process will last for several months, Brazil must spearhead a regional contingency plan – with the support of the PAHO – for the rational use of the benznidazole stocks among the most vulnerable groups in endemic countries.

MSF is also urging the Ministries of Health of endemic countries to demand this contingency plan to be put in place as soon as possible, while finding a definitive solution for the long term.

“The Brazilian government has been pioneering in the production of generic drugs, showing its commitment to people who need access to treatment. It must now act swiftly to keep its commitment to Chagas patients worldwide,” concludes Dr Karunakara.

Chagas disease, also known as Human American Trypanosomiasis, is an infectious disease caused by the parasite Trypanosoma cruzi. Endemic in several Latin American countries, it causes 12,500 deaths per year and it is estimated that eight to 10 million people have the disease.

Case numbers are rising in the US, Europe, Australia and Japan as a result of greater international travel.

In most Latin American countries the disease is primarily transmitted by the assassin bug although it can also be transmitted from mother to child, in blood transfusions, organ transplants, contaminated food and laboratory accidents. 

As the disease progresses, around 30 percent will develop heart lesions and 10 percent gastrointestinal damage that may be fatal.

MSF Home Visitor in the field in Zahedan.
© Siavash Maghsoudi

Zahedan, capital of the province of Sistan-Baluchistan, is an Iranian city located approximately 70 kilometers (20 kilometers as the crow flies) from the border with Pakistan and Afghanistan.

Since 2001, MSF has been providing free medical care to Afghan refugees and Iranians lacking the resources to pay at clinics located in the city's poorest neighborhoods: Shirabad, Karimabad and Besat.

Iranian authorities

For the last several years, Iranian authorities have been returning Afghan refugees in the region to their country. In addition, in 2007, Sistan-Baluchistan was placed off-limits to foreigners for reasons of "internal security".

MSF has continued its activities there since 2008, thanks to the presence of its local staff and has been the only international organisation still "tolerated".

"We received ultimatums a number of times from Iranian authorities instructing us to leave the area," says Karine Gillain, head of mission in Tehran. "We would negotiate each time and always managed to delay closure for several months, but last week we had no choice and had to end our activities." 

Patients risk losing access to care

MSF's doctors, nurses and midwives held an average of more than 5,000 free medical consultations per month in the two clinics that remained open until now, including one dedicated to maternal and child care. Most of the patients were women and children from poor families.

"We hope that the Ministry of Health facilities will care for the patients who came to our clinics, just as we have been sending them the most urgent cases up to now," says Gillain.  "However, we fear that the poorest patients will not be able to pay for treatment or will be afraid to seek care."

• Read more about MSF's work in Iran

MSF nurses reported irregularities on the appearance of the product such as friability and discoloration of the tablets.

Supply lapse

Last week, these ARVs were confirmed to be falsified versions of World Health Organization (WHO) quality-assured (‘prequalified’) drugs that were purchased via a distributor certified by the Kenya Pharmacy and Poisons Board.

These antiretrovirals contain lamivudine (150mg), zidovudine (300mg), and nevirapine (200mg).

“MSF takes this supply lapse seriously and is focused on ensuring that patients are informed and receive appropriate medical follow-up,” says Dr. Alexandra Vandenbulcke, MSF medical coordinator in Kenya.

Ministry of Health

As soon as the quality alerts were reported by the MSF nurses, MSF informed the Kenyan Ministry of Health, WHO and other international partners involved in procurement of medicines. MSF put the drugs under quarantine and the falsified batches were sent back to the supplier.

MSF has started to trace and notify patients who have received the falsified products, and has secured adequate replacement drugs for affected patients.

MSF will offer adapted medical follow-up to these patients and optimise treatment options when necessary.

MSF places great importance on the quality of the drugs used in its projects, using WHO-prequalified ARVs. MSF is demanding a full investigation into the circumstances of this supply lapse to ensure the best quality of medicines for patients.

On 15th September the Executive Council in charge of humanitarian affairs in Saada announced new conditions under which all humanitarian and non governmental organisations have to work in this region.

A view od Al Talh Hospital, Saada, Yemen. MSF has suspended work in the region.                                        © Arnaud Drouart/MSF

Among other measures, these new conditions include:

• an end to all independent assessments of medical needs within the governorate.

• a ban on international staff supervising activities.

• the obligation to replace all Ministry of Health staff working with MSF with staff proposed by the Executive Council.

MSF in Yemen

“These new conditions would greatly affect our possibility to guarantee the quality and effectiveness of our work,” says Dr Vipul Chowdhary, MSF representative in Yemen. “We had no choice but to suspend our activities”.

In Al Talh and Razeh, MSF was supporting two Ministry of Health hospitals covering a catchment area of almost 400,000 people.

In Al Talh, secondary healthcare, including surgical services, were provided. In Razeh, MSF provided primary and emergency healthcare, nutritional recovery and maternity.

Discussions with authorities

The organisation is currently willing to engage in discussions with local authorities to define acceptable conditions in which to run independent humanitarian activities.

“We hope to find a common ground with local authorities in order to restore previous conditions which have allowed us to provide valuable medical services for the past four years. MSF is willing to continue its medical emergency activities for the sake of the population,” says Dr. Chowdhary.

MSF has been running medical activities in war-torn Saada governorate since 2007. After the ceasefire of February 2010 put a stop to hostilities between the Yemeni government and the forces of Al Houthi, MSF was able to restart and develop its activities in several areas of the governorate.

In the first six months of 2011, almost 20,000 outpatient consultations were provided in Al Talh hospital, with an average of 30 emergency consultations each day. Between February and August 2011, MSF teams performed 428 surgical interventions.

MSF has also been running primary healthcare activities, including antenatal care for pregnant women and screening for malnutrition in children, in Al Talh and Razeh hospitals and in four health units in Saada governorate.

MSF activities in Al Talh and Razeh were suspended respectively on 21st and 26th September .

Médecins Sans Frontières MSF (Doctors Without Borders) is a private international association, providing humanitarian medical relief in more than 65 countries around the world.

MSF does not accept funding from any government for its work in Yemen and relies solely on private donations.

• Read more about MSF's work in Yemen
   

Seven people died before arriving to the hospital. Medical teams carried out emergency surgery and stabilized many patients. Eight people with head injuries and open fractures have been referred to Peshawar for further treatment.

Casualty department

“Most of the patients are severely injured, with open fractures and limb, chest, and abdominal injuries,” said Dr. Zaheer, assistant medical officer for MSF in Timergara. “As of late this afternoon, seven patients underwent emergency surgery.”

Since 2009, MSF has been supporting the casualty departments at Timergara District Hospital,including the resuscitation room, observation area, and emergency operating theatre. MSF has also worked with hospital staff on mass casualty preparedness.

MSF surgical teams

More than 1,300 patients are treated each week at the hospital’s emergency room, both by Ministry of Health and MSF medical teams. Approximately 100 surgeries are conducted each month in the MSF emergency operating theatre.

MSF also supports the delivery room in the mother-and-child healthcare ward, as well as the hospital’s blood bank, laboratory service, and sterilization and waste management systems.

Temporary diarrhoea treatment centres

Starting in July, MSF has opened temporary diarrhoea treatment centres in existing hospitals in Mingora in Swat district, in Timergara in Lower Dir district and in Hangu in KPK, as well as in Sadda in Kurram.

MSF is also providing treatment to patients suffering from acute watery diarrhoea in the isolation ward of Tehsil Headquarter (THQ) hospital in Dargai and in the outpatient department of THQ hospital in Alizai in Kurrum.

As of 4 September, a total of more than 5,400 patients have been treated.

Of the four temporary diarrhoea treatment centres, the one in Mingora has seen the highest number of patients, with an average of 200 per day.

Sharp increase around Eid holiday

In late August, the number of cases increased sharply over the course of a week, rising from 73 patients per day to 270 patients per day. About 25 percent of these were children under five years old.

“Acute watery diarrhoea is an easily treatable disease, but it can spread quickly, so prevention is as important as treatment,” says MSF Medical Coordinator Dr Jacob Maikere.

“The number of cases that we saw, especially in Swat, increased significantly during and after the Eid holiday (week of 29th August).

"The situation is now stabilising, but we still need to continue the treatment with patients and our efforts to control the spread of disease.”

MSF is reinforcing its medical teams in Swat and Timergara with three extra international staff and around 30 extra Pakistani staff, who are working alongside Ministry of Health staff on the ground. It has also brought in extra specialised medical supplies.

Water and sanitation support

To prevent the spread of the disease, MSF is providing water and sanitation support in affected areas in collaboration with local communities and medical authorities.

This has included cleaning, disinfecting and chlorinating of wells and springs in villages in Swat and Timergara.

Training for medical staff

MSF teams are also providing training in hospitals to existing medical staff, to strengthen their capacity to deal with the patient cases. 

MSF is also closely monitoring the situation in neighbouring areas. Following an assessment in Nowshera and Mardan, MSF has donated treatment materials, including IV fluids and oral rehydration solution, and has carried out staff training in local health facilities.

MSF is a medical humanitarian association providing free emergency medical assistance to people in need, independent of any political or military groups, in more than 65 countries around the world.

Since 1986, MSF has been working in Pakistan with Pakistani communities and Afghan refugees who have been affected by armed conflict, natural disasters or a lack of access to medical.

MSF teams are currently providing free emergency medical care in Kurram Agency in FATA, Hangu, Peshawar, Lower Dir, Malakand and Swat districts in Khyber Pakhtunkhwa province, and in Baluchistan province.

MSF relies solely on private financial contributions from individuals around the world and does not accept funding from any government, donor agency, or from any military or politically-affiliated group for its activities in Pakistan.

The medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF) is deeply concerned about the implications of the current economic crisis in Swaziland on people living with HIV/AIDS.

To pre-empt stock ruptures, which are already affecting patients, MSF has supplied a contingency stock of antiretroviral (ARV) drugs that will serve some 18,000 AIDS patients in its project areas for at least one month.

This stock will only cover the needs of a fraction of the 70,000 patients currently on ARV treatment in Swaziland, and will not be sufficient to address the needs of those still waiting to be enrolled.

MSF calls on the government of Swaziland and the Ministry of Health to act decisively in ensuring proper management and supply of ARV drugs to the Swazi health facilities and ensure that funds are secured and reserved for supplies of ARV drugs, for laboratories, and for drugs for treating opportunistic infections.

“For all people currently on antiretroviral treatment, and for those eligible to get started on antiretroviral drugs, an uninterrupted supply of medication is crucial to the success of their treatment and thus to their survival,” says Aymeric Péguillan, head of mission for MSF in Swaziland.

Depending on a patient’s health status and the length of the treatment interruption, ARV ruptures can lead to the development of drug resistance, to a rapid decline in a patient’s health and even to death. In addition to the HIV patients who are receiving treatment, MSF is worried that those not yet on ARV drugs may also be affected by the funding gap in the general health system.

“The threat to the capacity for HIV testing and counselling is real, and laboratory services are now becoming affected, as the reagents needed for tests are in extremely short supply at the moment,” says Péguillan.

MSF, together with the Ministry of Health of Swaziland, has been providing HIV and TB care to patients in Shiselweni region since late 2007, and to patients in Manzini region since mid-2010.

By the end of June 2011, out of almost 18,000 HIV-positive people in need of treatment in Shiselweni region, 13,083 patients were on antiretroviral treatment, including more than 5,000 managed at clinic level. There are currently 4,279 patients on antiretroviral treatment in the Mankayane area, and 305 at the Matsapha industrial site clinic, both situated in Manzini region.

• Read about MSF's efforts to reach the most vulnerable in Somalia

• View locations of MSF activities in Somalia on a map
  
  

Clashes claim civilian lives

Women queueing in front of the therapeutic feeding centre at the MSF-run hospital in Galcayo South.
© Sven Torfinn

The hospital in Galcayo North, partly supported by MSF, has treated 60 wounded, most of them civilians, while 20 wounded have been treated so far at an MSF-run hospital in the southern part of the city.

Until now, the fighting is reported to have claimed 18 lives.

"MSF extremely concerned"

“MSF is extremely concerned about the high number of civilian casualties that this round of fighting has caused,” said Rolland Kaya, MSF’s project coordinator.

“We will continue to monitor the situation up close and provide more medical assistance if necessary.”

MSF activities in Galcayo

MSF has provided the hospital in Galcayo North with additional surgical materials and other medical stocks needed to cater for the influx of wounded people.

MSF is working in the hospital’s outpatient department, focused on providing medical care to children under 12.

In July, MSF opened a new inpatient paediatric department, while the organisation also provides therapeutic feeding for malnourished children.

In Galcayo South, MSF provides an extensive package of healthcare, including surgery services.

Galcayo is experiencing serious medical needs, not only among the local population but also among the thousands of displaced people who have fled violence and drought in other parts of the country during the ongoing nutritional emergency.

MSF is the main provider of free healthcare services for hundreds of kilometres around Galcayo.

MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions.

Over 1,400 Somali staff, supported by approximately 100 staff in Nairobi, provide free primary healthcare, surgery, treatment for malnutrition, as well as support to displaced people through providing healthcare, supplying water and distributing relief items in nine locations in south and central Somalia.

MSF is also providing medical care to Somali refugees in Kenya (Dagahaley and Ifo camps, Dadaab) and Ethiopia (camps in the Liben region).

The international medical humanitarian organisation, which has started providing basic health care to two communities of displaced foreign nationals, says they need urgent protection and assistance.

About 1,000 migrants are living in and around boats at this abandoned military base on the outskirts of Tripoli in fear of harassment and violence. © Ron Haviv/VII

One community of about 1,000 refugees and migrants lives in and around boats on an abandoned military base in Tripoli, while another group of 200 have sought shelter on a farm since fighting broke out in southern areas of Tripoli.

"Many of these people already fled from fighting in their home countries, such as Somalia, Sudan or other African countries", says Simon Burroughs, MSF’s emergency coordinator in Tripoli.

"Some people came to these makeshift camps looking for a way to cross by boat to Europe – while others came to seek refuge from the fighting in Tripoli. All of them remain trapped with nowhere to go."

MSF has provided medical consultations in both locations and is planning to distribute clean drinking water and hygiene items.

"Many suffer from respiratory infections, skin diseases and gastro-intestinal complaints,’" describes MSF medical coordinator Dr. Paulo Reis.

"These medical problems are linked to their very poor living conditions. Most of the medical conditions we have treated are also stress-related – including difficulty sleeping at night due to extreme and constant fear."

Patients have told MSF how they are unable to leave the makeshift camps due to the fear of being harassed, beaten or arrested within the city.

They told the MSF team that they have been threatened at night by unidentified armed men. Those migrants staying on the farm have been ordered to leave immediately.

National authorities, the United Nations High Commissioner for Refugees (UNHCR) and the International Organisation for Migration (IOM) need to ensure the protection and basic needs of these refugees and migrants trapped in and around Tripoli.

MSF staff and port residents help build a water bladder at the makeshift camp where around 1000 migrants are taking refuge. © Ron Haviv/VII

MSF, which provides assistance to refugees and migrants in Tunisia and in southern Italy, stresses that international borders must remain open; both neighbouring states and European governments must ensure access to asylum procedures and humane reception conditions.

In Tripoli, MSF continues to support strained medical facilities with medical supplies and staff when needed.

MSF medical and surgical teams are supporting Libyan medical staff in Tripoli’s Central Hospital and in the Ben Ashour clinic.

A boat with more than 10 tons of medical and logistical supplies will arrive in Tripoli today, 30th August.

For more information or interviews, please contact Hannah Ward on 44 (0) 207 067 4265 or Hannah.Ward@london.msf.org

MSF has been present in Libya since February 25 and currently provides impartial medical and humanitarian assistance in Benghazi, Misrata, Tripoli, Yefren, Zawiyah, Zintan and Zlitan.

To ensure the independence of its medical work, MSF relies solely on private financial donations to fund its activities in Libya and does not accept funding from any government, donor agency, or from any military or politically affiliated group.

The international relief organisation Médecins Sans Frontières MSF (Doctors Without Borders) has treated over 100 patients in the town of Pieri and referred another 57 to hospitals in Leer and Nasir following last week’s raid on the town of Pieri and 12 surrounding villages in Jonglei State, South Sudan. The majority of the referred cases were women and children with gunshot wounds.

Several hundred people – including women and children – are believed to have been killed in last Thursday’s dawn attack. Hundreds more are reportedly wounded. Numbers of deaths and wounded are difficult to confirm.

However, villagers report to MSF staff members that over 400 people have been killed in Pieri alone, and almost half of the houses in the town have been destroyed.

At least one of MSF’s South Sudanese staff members is confirmed to have been killed together with all of her household members.

Another staff member reported that he has had to bury 16 members of his family as a result of the violence.

A further 17 of MSF's South Sudanese staff still remain unaccounted for. The organisation’s compound and clinic have also been targeted by the raiders, who looted medical equipment, drugs and other valuable items and burned down parts of the MSF facilities.

“We condemn this attack on our medical facilities and the killing of our staff in the strongest terms,” said MSF Head of Mission Jose Hulsenbek, “This is totally unacceptable. Medical facilities should always be respected as places of neutrality where patients and medical staff should have no fear of attack.”

“It is difficult to imagine the scale of this attack, this is so huge, we are still trying to assess all the casualties, the wounded and the damage,” added Ms. Hulsenbek, explaining that vital water points have been destroyed and that most villagers spend the nights out in the bush for fear of new attacks.

“The South Sudanese authorities, the international community and other aid organisations should quickly step in to assist the victims of these large scale killings.” said Ms. Hulsenbek.

In addition to the assistance MSF is already providing, there is an urgent need for shelter materials, food assistance and drinking water.

MSF is also concerned about the situation in areas that haven’t yet been reached due the remoteness and seasonal rains.

Authorities should step up their efforts to ensure the safety of its population. MSF continues to send in relief items and additional medical teams and equipment to scale up its assistance in the region.

For more information or interviews, please contact Heather Whelan on  44 7770 235 740 or Heather.WHELAN@london.msf.org

MSF welcomes the release of Saeed Mahdi, and recognises that he has now been granted access to a lawyer.

MSF firmly maintains that Saeed Mahdi was working with the organisation in the capacity of driver and translator. We remain concerned about the circumstances in which he was arrested.

MSF is still unable to resume working in Bahrain without guarantees that its premises and personnel would be respected.

The international medical humanitarian organisation Médecins Sans Frontières MSF (Doctors Without Borders) today condemned an armed raid on its premises in Bahrain and the subsequent detention of one of its staff members.

On 28th July, armed security personnel violently raided MSF’s premises in Manama, damaging office property and confiscating all medical and office equipment and supplies. A Bahraini MSF volunteer, Saeed Mahdi, who works with the organisation as a translator and driver, was arrested.

Salmaniya Hospital, Bahrain
© REUTERS/Hamad I Mohammed

Since February, when demonstrations began in Bahrain, MSF has seen almost 200 injured and ill patients who did not seek care in health facilities because they feared being arrested for any involvement in the protests or for any affiliation with the protestors.

The MSF team has seen patients in villages across the country who have refused urgently needed hospitalisation due to the high risk of arrest, and others who were severely beaten in jail.

Violation of MSF facilities

“MSF has been transparent about its work and its intentions with the authorities in the country, including the Ministries of Health and Interior,” said Jerome Oberreit, MSF director of operations in Brussels. “As such, we find the violation of MSF facilities and the detention of our volunteer both unwarranted and unacceptable.”

Last week, a patient with a serious head injury arrived at the MSF premises. An MSF doctor provided first aid and an ambulance was called to transport the patient to the Salmaniya Medical Complex. It is MSF’s obligation to provide treatment regardless of a patient’s ethnicity, religion, or political affiliation.

Despite only assisting MSF and a patient by calling an ambulance, Saeed Mahdi remains detained. Repeated requests by MSF, his family, and his lawyer to have access to him have been denied. MSF has also not been able to obtain any information about the original patient, even after visiting Salmaniya to inquire about him.

Neutral medical humanitarian organisation

Though MSF had been open about its work in the kingdom over the past several months, these events constitute a breach of the sanctity of an office maintained by a neutral medical humanitarian organisation, and a violation of the rights of a patient to receive medical care. MSF has a raised its concerns following these incidences in a letter to the Bahrain Ministry of the Interior.

In March, MSF proposed establishing an emergency medical response in Bahrain, whereby MSF teams would provide first aid and accompany patients to health facilities to ensure that care is not obstructed or used as bait, that patients regain trust in health services, and that health workers are again able to conduct their duties impartially and without fear of reprisal. To this day, however, MSF has not been able to secure guarantees that patients would not be targeted.

It now appears that in Bahrain today, acting within the common boundaries of the duty of care principle – in this case, providing first aid and calling an ambulance for a critically ill person – is no longer possible without negative repercussions on MSF’s ability to work in the country
 
MSF calls on the Bahraini authorities to respect the integrity, security, and privacy of its premises and personnel, and to allow the lawyer and family of its detained staff immediate access to him.

The international medical aid agency Medécins Sans Frontières MSF (Doctors Without Borders) is deeply concerned by the relocation of Somali refugees in Dadaab to Ifo 3 extension camp. The relocation, which began yesterday under the auspices of the UNHCR, has been carried out with little transparency or consultation with other agencies on the ground and the refugee community.

Some 200 families per day are being relocated to Ifo 3, a camp with little existing basic services, including water and sanitation. It is expected that the camp will hold a total of 60,000 refugees, which is 20,000 more people than it was originally designed for. NGOs were alerted only last Friday of the relocation exercise and although water is currently being trucked to the new camp and latrines are rapidly being dug, the camp does not meet the minimum humanitarian standards.
 
Further this camp has no hospital structure, which will force MSF to refer patients in need of hospitalization or in-patient therapeutic feeding to either Dagahaley camp or Ifo camp hospitals, both of which are already operating beyond full capacity.
 
Meanwhile, just a few kilometers away lies Ifo 2, a camp which was due to open last November, and is already equipped with boreholes, latrines and showers, electricity, some shelter and schools. MSF calls on the Government of Kenya and the UNHCR to ensure the immediate relocation of refugees to Ifo 2 as announced by the government 12 days ago.
 
Refugees fleeing drought and conflict in Somalia continue to arrive in large numbers in Dadaab, and last week alone, 5,117 new refugees arrived in Dadaab, bringing the total of new arrivals since January to 81,463 and the total number of refugees in Dadaab to 387,893. Whilst many of these refugees remain on the outskirts of the camps they are still not receiving adequate assistance, with delays in registration and access to food, water and shelter is tipping them over the edge.

MSF is currently treating over 2400 children in its ambulatory therapeutic programme in Dadaab and 138 in its in-patient therapeutic feeding centre. 5047 children with moderate acute malnutrition are enrolled in the supplementary feeding programme.
 
MSF has been working in Dagahaley camp since March 2009, providing medical care including surgery and maternal health services, in a 170-bed hospital, and offers vaccinations, antenatal care and mental healthcare in six health posts in the camps and outskirts. In addition, since earlier this year MSF is working on the outskirts of Ifo camp, providing primary health care and nutritional assistance to the new arrivals.

A one-year-old Somali girl is given emergency treatment at an MSF hospital across the border in Kenya
©Ap/Press Association Images

The current crisis is mostly affecting Somalis. To assess the full needs of the population in Somalia, and to expand the emergency response in this complex environment, independent and immediate access inside Somalia is essential.

Refugee camps

With limited assistance available in Somalia, thousands of Somalis are arriving each week at camps in the border areas of neighbouring Kenya and Ethiopia.

MSF teams report extremely high malnutrition rates amongst new arrivals, with one child out of three suffering from acute malnutrition.

Together with their families, they face long delays in receiving aid because of an official ‘closed border’ policy, and because of administrative hurdles at reception sites in the camps, before having to compete for the limited aid available in overstretched, chaotic and overpopulated refugee camps such as Dadaab in Kenya and Dolo Ado in Ethiopia.

MSF feeding centres and clinics

Throughout the affected region, MSF is treating over 10,000 severely malnourished children in its feeding centres and clinics.

“Every affected person should receive aid, inside Somalia or when fleeing to neighbouring countries,” says Jean Clément Cabrol, MSF’s Director of Operations. “Kenya and Ethiopia host the vast majority of Somali refugees and should prioritise the opening of new camps and improve the existing ones.

"But the international community has a shared responsibility to help Somalis seeking refuge by ensuring efficient registration, adequate food rations and shelter in existing and new camps. The current bureaucratic restrictions and obstacles are causing unnecessary delays and all measures should be taken to respond to the emergency.”

Beyond capacity

Weakened by 20 years of armed conflict, the condition of the Somali population is aggravated by failed harvests due to drought, by dying livestock and by high food prices. Ongoing restrictions on the movement of international aid workers and on the supply lines of their organisations have further delayed and limited the aid available to the population.

“Our feeding centres are operating beyond their original capacity and, compared to last year, are receiving weekly up to seven times more patients in certain locations,” says Arjan Hehenkamp, MSF’s General Director.

“We are currently treating more than 3,000 malnourished children inside Somalia: some 600 children under the age of five in intensive therapeutic feeding centres, and more than 2,500 children in ambulatory feeding centres.

"We urgently need to get more resources in to help all those new arrivals and increase our response in all affected regions.” 

Lower Juba Valley

In various locations, such as in the Lower Juba Valley, spontaneous camps are emerging, populated by up to 5,000 people at a time who have fled their villages and rural areas in search of food and help.

“Fighting in Somalia, restrictions on supply flights and international support staff, and administrative hurdles have all contributed to the current hardship faced by the Somali population today,” says Unni Karunakara, MSF’s International President.

“It is essential that both restrictions and obstacles to humanitarian aid are removed as the situation continues to worsen.”

MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions of southern Somalia.

Over 1,400 Somali staff, supported by approximately 100 staff in Nairobi, provide free primary healthcare, malnutrition treatment, healthcare and support to displaced people, surgery, and distributions of water and relief supplies in nine locations in South Central Somalia.

MSF does not accept any government funding for its projects in Somalia; all of its funding comes from private donors.

ROME, 18 July 2011 – Several pharmaceutical companies have abandoned HIV drug discount programmes in middle-income countries, according to an HIV drug price report released today by Médecins Sans Frontières MSF (Doctors Without Borders) at the International AIDS Society Conference in Rome.

The report Untangling the Web of ARV Price Reductions – which analyses the prices of 23 antiretrovirals with information provided by 19 manufacturers – also shows continued trends of price reductions for drugs not blocked by patents.

“While there is continued progress to reduce prices for the poorest countries, a significant number of people with HIV/AIDS live in countries that are now excluded from price reductions,” said Nathan Ford, medical director of MSF’s Campaign for Access to Affordable Medicines. 

Tibotec/ Johnson & Johnson exclude all countries classified as ‘middle-income’ from their price reductions; Abbott excludes low-income and lower middle-income countries from discounts for one of its drugs; and ViiV (Pfizer GlaxoSmithKline) no longer offers reduced prices to middle-income countries, even when programmes are fully funded by the Global Fund to fight AIDS, TB and Malaria or the US-government’s PEPFAR programme.

In a reversal, Merck has now announced that it will no longer issue price discounts for 49 middle-income countries for its new drug raltegravir.  This move leaves out countries with large numbers of people living with HIV/AIDS, such as India, Indonesia, Thailand, Viet Nam, Ukraine, Colombia and Brazil.  Today, Brazil is paying $5,870 per patient per year (ppy) for just this one HIV drug; in least-developed countries, Merck charges $675 ppy for the drug, which is already four times the price of the recommended triple first-line combination (TDF/3TC/EFV).

This development comes on the heels of a number of developing countries being excluded from last week’s agreement between drug company Gilead and the new Medicines Patent Pool, which aims to increase access to affordable ARVs by negotiating licensing that can be used by generic manufacturers. 

MSF started HIV treatment programmes in Latin America and Asia over ten years ago, but has since handed many of them over to local authorities in the confidence that people would be able to access the treatment they need from government programmes.  People in these countries in particular have been on HIV treatment for a number of years now, and therefore need access to newer drugs – but patents block access to more affordable generics.

“Drug company discount programmes have proven not to be a long-term solution,” said Janice Lee, HIV/AIDS pharmacist at MSF’s Campaign for Access to Essential Medicines.  “When patents get in the way and drug companies refuse to cut prices, governments are going to have to start overriding patents so that they can afford to keep their HIV-positive people alive.”

‘Compulsory licenses’ issued by Thailand and Brazil for HIV medicines in 2006 and 2007 helped dramatically bring prices down when patents formed a barrier to people’s access.  But despite the fact that these measures are authorized by international trade rules, countries have faced retaliatory measures from pharmaceutical companies and governments.

The MSF price report also shows good news. Thanks to continued generic competition, the critical drug tenofovir now costs $76 ppy which is cheaper than the price of zidovudine (AZT) which costs $88 ppy.  This means it is becoming more affordable for countries to shift to using World Health Organization-recommended improved combinations with tenofovir and move away from the drug stavudine (d4T), which has significant long-term side effects.

The price of a one-pill-once-a-day combination that contains tenofovir has come down by 70% since the WHO recommended people move to less-toxic treatment five years ago, from US$613 to $173 ppy today. 

“We’re seeing drug prices continue to decline when patents do not form a barrier to generic production,” said Janice Lee, pharmacist at MSF’s Campaign for Access to Essential Medicines. 

“These reductions increase the feasibility of reaching the new UN goal of getting 15 million people on treatment by 2015.”

MSF provides antiretroviral treatment to 170,000 people in 19 countries.

PRESS CONTACT:

Jean-Marc Jacobs: 44(0)7889178472

The United States government’s alleged misuse of a vaccination campaign in Pakistan for counter-terrorism purposes constitutes a dangerous abuse of medical care, which threatens the trust essential for health agencies and humanitarian aid workers to provide lifesaving medical services, the international medical humanitarian organisation Médecins Sans Frontières MSF (Doctors Without Borders) said today.

“Whether true or not, the mere suggestion that the provision of medical care was carried out under false pretenses damages public perception of the true purpose of medical action,” said Dr. Unni Karunakara, MSF’s international president.

“With all populations in crisis, it is challenging enough for health agencies and humanitarian aid workers to gain access to, and the trust of, communities - especially populations already skeptical of the motives of any outside assistance.”

Putting humanitarian assistance at risk

Deceptive use of medical care also endangers those who provide legitimate and essential health services.

Furthermore, carrying out an act of no therapeutic or preventative benefit purely for military or intelligence purposes violates medical ethics, which require acting solely on the needs
of patients and doing no harm.

Impartial humanitarian assistance requires acceptance from all communities and warring parties – whether national governments, armed opposition movements, international forces, or even criminal groups.

In all conflicts or highly politicised environments, this access can only be achieved by actions that demonstrate humanitarian providers are acting only in the interests of those receiving care.

"Grave manipulation"

“The alleged fake CIA vaccination campaign constitutes a grave manipulation of the medical act,” said Dr. Karunakara.

“The risk is that vulnerable communities—anywhere—needing access to essential health services will understandably question the true motivation of medical workers and humanitarian aid.

"The potential consequence is that even basic health care, including vaccination, does not reach those who need it most.”

MSF is an independent medical humanitarian organization that provides assistance to people affected by armed conflicts, epidemics, man-made and natural disaster, and exclusion from health care in more than 65 countries.

MSF has been working in Pakistan since 1986, providing free medical assistance to displaced communities and to Afghan refugees, to victims of conflict, and to people with limited access to care.

In Khyber Pakhtunkhwa Province and the Federally Administered Tribal Areas, MSF teams are present in Kurram Agency, Hangu, Lower Dir, Peshawar, Malakand and Swat districts.

MSF is also working in Balochistan and Sindh Provinces. To ensure its independence in Pakistan, MSF solely relies on private financial contributions from individuals around the world and does not accept funding from any government, donor agency, or from any military or politically-affiliated group.

In a briefing paper released today, entitled From a Rock to a Hard Place: The Neglected Victims of the Conflict in Libya, MSF highlights the consequences of poor reception conditions and insufficient protection in the countries where they have sought safety.

Over 600,000 migrants have crossed Libyan borders since the beginning of the war. If many have already been repatriated to their country of origin, thousands are still stranded and continue to arrive in transit facilities in Tunisia, Egypt, Italy or Niger.

In Shousha camp in Tunisia, some 4,000 people – mainly Sub-Saharan Africans – cannot be repatriated, primarily due to dangerous situations in their countries of origin. In the meantime, 18,000 people have landed on Italian shores since the beginning of the conflict, risking their lives in overcrowded, unseaworthy boats in a bid to flee the war.

Since February, MSF teams have provided more than 3,400 mental health consultations to people fleeing the conflict, both in Italy and Tunisia. Staff have heard numerous stories from patients of their migration journeys in search of a better life. Some had already been victims of violence in their home countries, while many faced extremely dangerous situations on their way to Libya.

A number of people suffered various traumatic experiences in Libya itself: they fled NATO bombings, were targeted or held in Libyan jails and detention centres – as a result of lacking the right documents, or of being ‘pushed back’ when they tried to reach Europe.

As their freedom of movement is severely limited, confinement in transitory camps and reception centres is tantamount to detention. “The process of determining who qualifies for asylum in Italy is extremely lengthy and many people express total desperation at the idea of spending months or even years in these centres”, says Francesca Zuccaro, MSF’s head of mission in Italy.

In Shousha camp, living conditions are inadequate for a long-term stay and safety has become a growing concern, as demonstrated by the violent clashes in the camp in May. The violence exacerbated widespread feelings of despair amongst those in the camp. Some have left the camp to attempt journeys across the Mediterranean Sea, risking their lives in the hope that their reception will be better in Europe.

“As they have no prospects in sight, dozens have gone back to Libya in the past days, ready to risk their lives again in a desperate search for a future. This is an extremely worrying situation,” says Mike Bates, MSF’s head of mission in Tunisia.

By invoking the fight against illegal immigration, European states risk denying the protection and humane treatment that these people deserve, condemning them to a situation of uncertainty which increases their suffering.

The influx of people arriving by boat on Italian shores does not constitute ‘illegal immigration’, but a flight towards survival, safety and protection.

MSF reminds all belligerent parties and neighbouring countries of their responsibility, under international law, to keep their borders open and offer protection to those fleeing Libya and to ensure that poor reception conditions and lack of protection in no way hinder refugees and asylum seekers from seeking safety.

• Read personal stories

MSF is shocked that a belligerent State involved in the Libyan conflict would take such measures while a war is still underway. Furthermore, the persons arriving by boat from Libya are fleeing violence and need international protection. Repatriating these individuals or pushing them back on the sea to Libya would constitute a violation of the international obligation of non-refoulement.

MSF wishes to underscore the inconsistency of such an agreement and the double standard applied by the European countries involved in this war. It is unacceptable that a country that is bombing in the name of protecting civilians would simultaneously turn back the victims of that war. "This agreement constitutes a death sentence for the populations who risk being trapped in this conflict again," says Christopher Stokes, MSF's general director. 

In 2009, MSF expressed its concern following the signing of the “Friendship Treaty” between Libya and Italy because it provided for forced repatriation of migrants. MSF can now see the terrible consequences of this kind of agreement for the persons who sought, unsuccessfully, to reach Italy before the conflict broke out.

As part of its activities, MSF is treating persons who have sought refuge in the centre of Mineo (Sicily) and the Choucha camp (Tunisia). Testimonies reveal the cruelty, the degrading, inhuman treatment and the resulting trauma experienced by migrants sent back to Libyan detention centres. “Near Lampedusa, the Italians caught us, tied a rope to our boat, and towed us back into Libya where we were thrown back in detention, tortured, and forced to call our families for ransom money," said a Somali man at the Choucha camp, who was turned back before the war began. "I escaped when the war started in Libya.”

MSF asks the European Council to consider the dangers of this kind of agreement as part of its discussions. MSF again reminds every State of its obligation to honour the fundamental rights of all persons under their jurisdiction, regardless of nationality. The European States must, at all times, guarantee the non-refoulement of migrants, refugees and asylum seekers from territorial lands and waters and ensure that those persons receive decent treatment upon arrival, including access to an efficient and equitable asylum procedure. 

For more information or for interview requests, please contact: Jean-Marc Jacobs: jean-marc.jacobs@london.msf.org or 447889178472

Although this is an important victory for the global mobilisation against the potential negative impact of the FTA on access to medicines, further harmful measures remain on the negotiating table, the international medical humanitarian organisation Médecins Sans Frontières (MSF) said today.
 
“MSF and other treatment providers depend on a sustainable flow of affordable generics from India to treat people across the developing world. Saying ‘no’ to data exclusivity will reach far beyond India’s borders in terms of ensuring access to affordable medicines in developing countries”, said Dr Tido von Schoen-Angerer, Executive Director of MSF’s Campaign for Access to Essential Medicines.  “This is a big victory, but we’re not letting up until we see all the potentially harmful policies off the table”.

By delaying the registration of generic versions of a medicine by up to ten years, data exclusivity would effectively have given a backdoor monopoly status to companies, even for drugs that do not deserve a patent under India’s law. The clause, which was criticised by global health actors including the Global Fund, WHO, UNAIDS, and UNITAID, threatened to further limit price-busting generic competition in India, thanks to which the price of HIV medicines has fallen by 99 per cent over the last 10 years. 

The announcement by India at the AIDS Summit now means both the EU and India have officially confirmed data exclusivity will not be part of the FTA text. MSF is now calling on Europe to remove other harmful clauses from the EU-India FTA negotiations.

“Europe is still pushing provisions on the enforcement of intellectual property that are of great concern for procurers and suppliers of medicines, like MSF, as they put us at risk of litigation or court orders that prevent us from delivering medicines to patients,” said Michelle Childs, Director of Policy/Advocacy of MSF’s Access Campaign.

By allowing patent holders to target all persons involved in the production, manufacture and delivery of medicines suspected of infringing an intellectual property right, these provisions could draw in treatment providers like MSF into legal proceedings and increase the risk of medicines being seized at Indian borders.

A second area of concern is the investment chapter of the FTA which includes measures to protect the commercial interests of foreign companies investing in India. Pharmaceutical companies would have the right to bypass Indian courts and sue the Indian government in secret international arbitration panels that do not balance public health against private profit.  This could lead to the Indian government facing long legal battles over millions of dollars in damages if, for example, a drug company sees its patent or trademarks (its ‘investment’) threatened by the actions of the government – even if those actions are lawful means to protect public health.

“At the recent AIDS Summit, governments – including European governments – committed to reaching 15 million people with HIV treatment by 2015”, said Michelle Childs. “Yet at the very same time, Europe is also pushing policies that will limit access to low-cost versions of the newer drugs that people need to stay alive. This is unacceptable. The EU must drop the remaining clauses that are harmful to public health.”

ENDS

For more information or interviews, please contact Alice Klein on 020 7067 4230 or via alice.klein@london.msf.org

Notes to editor

In 2010, MSF launched the HANDS OFF campaign to call on the EU to drop the policies harmful to access to medicines being pushed as a part of the EU-India free trade agreement.  MSF sources more than 80% of the HIV medicines it uses to treat more than 170,000 people living with HIV/AIDS from manufacturers of generics in India.

In March 2011, around 4,000 people from across Asia living with HIV/AIDS and other life-threatening diseases marched in the streets of New Delhi to protest the impact the FTA could have on access to affordable medicines.

To read more about MSF’s HANDS OFF campaign, visit www.msfaccess.org

According to MSF medical data, more than 60 percent of the medical problems faced by detained migrants – who have attempted to cross the border between Turkey and Greece – are directly caused by or linked to the degrading conditions in which they are being held.

Out of the 1,809 patients treated by MSF doctors between December 2010 and March 2011, 1,147 were diagnosed with respiratory tract infections, body pains, diarrhoea, gastrointestinal disorders, psychological complaints and skin diseases.

“Most of the migrants we have treated were not ill when they first entered the detention facilities. They fell sick having being held in overcrowded cells lacking proper ventilation, with water and sanitation problems, no quality food and no possibility to spend time outdoors,” says Ioanna Pertsinidou, coordinator of MSF’s project for migrants in Greece.

During the first two months of 2011, at least 22 people died in their efforts to cross the border in Evros.

From MSF’s experience working in the detention centre at Filakio and border police stations at Tychero, Soufli and Feres, there is no evidence indicating that migrants entering Greece pose a public health risk to Greek society, as recently stated by Greece’s Minister of Health.

On the contrary, it is the inhumane living and hygiene conditions in these facilities – where some migrants are kept for up to six months – that are causing significant deterioration to their physical and mental health. These conditions increase the risk of communicable disease outbreaks, as was also stated in a report published in May 2011 by the European Centre for Disease Prevention and Control and the World Health Organization.

MSF urges Greek authorities to ensure dignified living conditions in detention facilities, including appropriate accommodation, sufficient distribution of food, clothing and personal hygiene items, and adequate periods of time outdoors.

It is essential to ensure migrants receive adequate medical care and mental healthcare, to initiate systematic medical screening for new arrivals, and to support timely follow-up of chronic diseases. The Ministries of Health and Citizens Protection should ensure coordination among the involved stakeholders – locally, nationally and at EU level – and maximise the timely use of existing funds and resources.

In early March 2011, MSF handed over its medical activities to teams deployed by the Ministry of Health, but continues to distribute relief items to detained migrants. Despite the availability of European funds, conditions in the detention facilities have not improved.

ENDS

For more information or interviews, please contact Alice Klein on 020 7067 4230 or via alice.klein@london.msf.org

Notes to editor

To download the full report, click here.

MSF has been providing medical care and psychosocial support to migrants and asylum seekers in Greece since 1996. Since the beginning of December 2010, MSF teams have been providing healthcare and working to improve living and hygiene conditions in the border police stations of Tychero, Soufli and Feres and in the detention centre of Filakio. MSF doctors have treated 1,809 migrants, 18 of whom were under five years old. MSF psychologists have provided mental health support to 75 migrants. MSF staff have distributed over 8,480 sleeping bags, over 15,500 pairs of socks, 4,500 pairs of gloves, 4,500 hats and 10,000 hygiene kits.

Glastonbury Festival-goers will be transported to the wreck and ruin of Haiti’s earthquake and the subsequent cholera* outbreak when the aid organisation introduces a new interactive venue.

The venue – fronted by a spectacular earthquake set complete with crumbling hospital – will transport the public to the streets of Haiti’s capital Port au Prince. Alongside live music, it will feature an emergency operating theatre converted from a shipping container, a photo exhibition and Haitian-inspired graffiti.

A cholera treatment centre, once used to treat the life-threatening illness in Haiti, will be transported to Glastonbury, kitted out like a real field hospital with chlorinated hand wash and rehydration drinks. But the real-life experience doesn’t stop there – visitors will be invited to lie on so-called ‘cholera beds’ and watch short films on iPads suspended above each bed that show MSF’s life-saving work around the world.

“MSF is excited at the opportunity to show Glastonbury-goers some of the important work MSF does in Haiti and elsewhere in the world. We are still working in Haiti, 18 months after the devastating earthquake, currently responding to a second cholera outbreak.” says Ruby Siddiqui, an MSF Epidemiologist.

‘MSF Live’ will be located in the Latin American themed area, ‘The Common’, and will feature acoustic performances from some of the UK’s finest artists including Ghostpoet, Ed Sheeran, Dizraeli and Joe Driscoll.

MSF frontline field staff, who have worked in Haiti and other emergencies, will be running the live exhibitions and providing audiences with a unique opportunity to ask questions about what it’s really like working in some of the most dangerous places around the world and engage with MSF’s work first-hand.

They, and many more like them, worked tirelessly after the earthquake of magnitude seven which virtually collapsed Haiti’s capital city, killing 222,000 people and leaving 1.5 million homeless.

Alongside treating injuries caused by the earthquake, MSF has treated 130,000 Haitians for cholera (43 percent of total cases). As soon as the first cases were confirmed in October 2010, MSF teams deployed to nine of Haiti’s 10 departments to support local health facilities.

MSF Live will run from Wednesday to Sunday and on Friday night, collaborating with Lyrix Organix to present a one off event called ‘Zona Bassline’.

The night will feature circus performers, video walls and favela stages alongside musicians from the realms of Hip Hop, Grime, Reggae/Dub, Dubstep, Latin and Beatboxing including chart-topping Example, beatbox supremo Shlomo and The Boxettes.

Never before seen by a charity in the UK, this piece of history will be streamed live online via www.lyrixorganix.com and www.facebook.com/msf.live.

Secret gigs will also be revealed over the course of the festival via Twitter (http://twitter.com/#!/MSF_Live). This is a life-changing experience not to be missed!

ENDS

For photo opportunities or to interview MSF field staff, please call Pete Masters at Glastonbury on 07921781518 or Alice Klein in the MSF London office on 020 7067 4230 alice.klein@london.msf.org.

Notes to the editor:

Médecins Sans Frontières is an independent humanitarian medical aid organisation, committed to providing medical aid where it is most needed – regardless of race, religion, politics or gender.

Founded by doctors and journalists in 1971, MSF is now a worldwide movement with offices in 19 countries. For more information, please visit www.msf.org.uk

* Cholera causes profuse diarrhoea and vomiting, and infected people can die of profound dehydration, sometimes within a matter of hours. It often breaks out when there is overcrowding and inadequate access to clean water, rubbish collection, and proper latrines.

This situation can be especially problematic in rainy seasons when houses and latrines flood and contaminated water collects in stagnant pools. For more information, visit: /cholera.focus. 

MSF has been working in partnership with Lyrix Organix for two years to expose its work to new demographics, producing numerous successful events for emergency appeals including Haiti, Chad, Somalia and Pakistan.

MSF will be hosting the two major venues, MSF Live and Zona Bassline, on a shoe-string budget and in collaboration with an incredible team of volunteering professionals – from MSF field doctors to production crew, to top graffiti artists.

MSF’s Glastonbury partners include: Land Rover, THTC (The Hemp Trading Company), London West Bank, Proper Productions, Global Motion.

Original release:

An employee of the international medical organisation Médecins Sans Frontières MSF (Doctors Without Borders) has been detained for weeks in Bahrain after being severely beaten upon arrest by authorities, with no information provided about his condition and whereabouts, including to his family and lawyer. 

Saeed Mahdi was arrested in Bahrain on the 6th May 2011, two days after his house was burned down by security personnel.

“Since Saeed Mahdi’s arrest, we don’t have any information about where he is being detained, why he was arrested, or what charges are pending,” said Jerome Oberreit, MSF director of operations in Brussels.

Despite assurances by the Ministry of Interior and the Ministry of Social Development that he could be visited, neither his family nor his lawyer has yet been granted access to him.

“Considering the types of injuries people have sustained due to mistreatment in detention, as witnessed by MSF medical personnel, we are extremely concerned about the safety of  Saeed Mahdi,” continued Oberreit.

MSF is calling on the authorities to allow his family and lawyer immediate access to him.

MSF first had a team on the ground in Bahrain two days after protests began in February 2011. Since then, MSF has seen close to 100 people too afraid to leave their homes to seek care in health facilities.

MSF raised concerns about the loss of neutrality of Bahrain’s medical facilities, and the related deprivation of care to numerous sick and wounded people in a report issued in April 2011.

Latest Research Shows Expanded Treatment Could Turn AIDS Tide

NEW YORK, June 6, 2011 – At a time when HIV treatment has proven to reduce HIV transmission by 96 percent, governments meeting for the UN Summit on AIDS must agree today to put nine million people on treatment over the next four years, despite strong opposition from several key funders, the international medical humanitarian organisation Médecins Sans Frontières MSF (Doctors Without Borders) said today.

“After weeks of contentious negotiations, will governments today sign up to a proposed target to have 15 million people on HIV/AIDS treatment by 2015?” asked Sharonann Lynch, HIV/AIDS policy advisor for MSF’s Campaign for Access to Essential Medicines, speaking at a press conference at the UN in New York. “The world needs an ambitious HIV/AIDS treatment target with a plan attached to make it a reality – because it will be meaningless if countries aren’t willing to come up with the cash and actions needed to break the back of the epidemic.”

The summit comes on the heels of fresh scientific evidence that shows that treatment is a form of prevention, as it reduces transmission of the virus from one person to another by 96 percent.
 
“Over the last ten years, we’ve watched treatment save lives, and now we know it can also protect entire communities, because treatment is prevention.” said Dr. Tido von Schoen-Angerer, executive director of MSF’s Campaign for Access to Essential Medicines, who worked in MSF’s first HIV/AIDS treatment project in Thailand. “You’d have to be out of touch with reality not to want to turn this landmark evidence about HIV treatment into policies that will get ahead of the wave of new infections. Countries meeting in New York have the power to change the course of the AIDS epidemic.”

An additional $6 billion will be needed each year by 2015 to help avert twelve million new infections and more than seven million deaths by 2020, according to new research by UNAIDS. This would also help bring the number of annual infections down from 2.5 million in 2009, to one million by 2015. However, funding in 2009 and 2010 declined, leaving the Global Fund to Fight AIDS, TB and Malaria, the US-government’s PEPFAR and other programmes short of needed resources to make use of the benefits of ‘treatment as prevention.’ 

Governments also need to ensure the cost of medicines remains affordable. Increased patenting of medicines is already impacting access to the newer HIV/AIDS medicines needed to treat people as they navigate the life-long disease. Newer drug combinations can cost nearly 50 times as much as the first generation of drugs. Countries must immediately stop pushing trade policies which block the production, export, transit, and importation of more affordable generic medicines. Such policies are part of a number of new bilateral free trade agreements, such as one currently under negotiation between the European Union and India. 

“Ten years ago, our patients came to clinics in wheelbarrows, often moments away from death, because treatment was priced out of reach,” said Dr. von Schoen-Angerer. “Thanks to affordable generic drugs, we’ve watched treatment transform lives.  Rich countries need to stop the double-speak of claiming to tackle HIV/AIDS when at the same time they are pushing policies that will block the price-busting generic competition needed to get more people on treatment for life.”

Governments must also stop opposing the implementation of strategies directed toward groups most vulnerable in the epidemic – women, men who have sex with men, people who inject drugs and sex workers.

“It’s way past high time for leaders to get their heads out of the sand when it comes to the most marginalized groups affected by this plague,” said Nonkosi Khumalo, chairperson of the Treatment Action Campaign in South Africa.  “Treatment and prevention strategies targeting the most-at-risk groups are irrelevant if you deny these people’s very existence.”

MSF currently provides antiretroviral treatment to 170,000 people living with HIV/AIDS in 19 countries and sources more than 80 percent of the antiretroviral medicines it uses in its projects from generic manufacturers in India.

To read MSF’s report – Getting Ahead of the Wave:  Lessons for the Next Decade of the AIDS Response, click here

CONTACT:  Jean-Marc Jacobs - Mob: 447889178472

“This is a real step forward—until now it was difficult for countries to find out what companies were charging for specific vaccines,” said Daniel Berman, Deputy Director of the Campaign for Access to Essential Medicines at Médecins Sans Frontières (MSF).

“Full price transparency facilitates competition and will allow buyers to make the best choices for immunisation programmes.”

UNICEF is one of the largest vaccine purchasers, spending US$757 million on vaccines in 2010.

Before January 2011, UNICEF only published average weighted prices of vaccines, rather than list the specific prices charged by each producer. This made it difficult for governments to know if they were getting reasonable prices from vaccine producers.

A voluntary price reporting system was established earlier this year that covered the annual prices paid by UNICEF over the last decade. Despite initial reluctance, most companies have now given their green light for UNICEF to publish retrospective prices. From now on, price reporting will be systematic and company prices will be routinely published.

”By getting access to these prices, buyers will be able to take advantage of the increasing capacity of emerging countries to develop and produce quality vaccines at significantly lower costs,” Mr Berman said.

The GAVI Alliance, a major financer of vaccines for low income countries, can also help to bring down prices. Médecins Sans Frontières MSF (Doctors Without Borders) urges GAVI to use their buying power to stimulate competition and to create incentives for emerging country producers to speed up the development of low-cost, adapted versions of vaccines.

“Developing countries would benefit from vaccines that are easier to store and transport, do not need refrigeration and that are easier to administer – orally or through patches, for example rather than with needles. GAVI should flex its purchasing muscles to encourage manufacturers down this path,” said Mr Berman.

For further comment or questions, please contact Daniel Berman on 41 79 293 0270 or Julia Hill on 41 22 849 8475.

The international medical humanitarian organisation Médecins Sans Frontières (MSF) is responding to the consequences of fighting in the Abyei region of Sudan following violent clashes that began on the night of Friday 20 May. Whole towns have emptied and thousands of people are on the move in a bid to escape the fighting. The situation in the area remains extremely volatile. The population left their homes with few belongings, and travelling conditions are particularly harsh now that the rainy season has started and the roads are muddy.

“We have witnessed a massive movement of people out of Agok (40 km south of Abyei) towards the south –especially on Monday night,” says MSF head of mission Raphael Gorgeu. “We have seen thousands of people – mainly women and children – carrying bags on their heads, or sitting on mats on the side of the road, exhausted by hours of walking.  The populations of both Abyei and Agok have been displaced and are spread out in several different areas: near Turalei, near Mayen-Abun and on the road to Agok.”
 
MSF medical teams have been assisting the displaced as they flee the fighting. “Our teams have been on the roads between Turalei and Agok, where the displaced people are scattered,” says Gorgeu. “There are severe signs of dehydration among many children who are on the move. We are very concerned about the harsh conditions the displaced population has to endure on the roads. Their health condition can deteriorate rapidly if assistance is not delivered promptly. Our efforts are oriented towards delivering assistance in an effective and timely manner.”
 
The fighting occurred principally in the town of Abyei. By Saturday 21 May, the whole town lay empty after the entire population had fled their homes. MSF suspended all primary healthcare activities in the town, while MSF’s hospital in Agok, 40 km south of Abyei, received 50 wounded in the fighting over the weekend.

A rehydration point was set up within Agok hospital. Most of the inpatients in Agok were discharged and given two weeks’ rations of ready-to-use therapeutic food. The hospital currently continues to provide basic healthcare services to the population. MSF is also setting up a base in Turalei, to support surgical activities in an existing health centre. Medical supplies and basic non-food items such as shelters, mosquito nets, soap and plastic sheeting were also sent to Turalei.

Médecins Sans Frontières (MSF) has been providing emergency medical humanitarian assistance in Sudan since 1979. MSF currently runs 27 projects across 13 states of the country.

MSF has been working in the Abyei region since 2006, providing primary healthcare services in Abyei town, including antenatal care and treatment for malnutrition. In 2010, the team provided 18,534 outpatient consultations.

Deliveries and other serious cases are referred to the MSF hospital in Agok, which provides a wide range of services including surgical, maternity, inpatient and outpatient care, a paediatric unit, a tuberculosis ward and a therapeutic feeding centre for malnourished children.

In 2010, there were 31,199 outpatient consultations. In January 2011, a fully-functioning operating theatre was opened in the hospital in Agok.

Mortality rates were observed to be 50 percent lower among a large group of young children in the west African nation of Niger in 2010 after they received a highly nutritious supplemental food, according to preliminary findings in a study by the international medical humanitarian organisation Médecins Sans Frontières MSF (Doctors Without Borders).

The encouraging findings – which should still be treated with some caution – reinforce the need for international donors and policymakers to make high-quality foods a cornerstone of childhood health programmes, especially in areas where malnutrition is rife.

Malnutrition weakens the immune system, exposing a child to higher risk of death from other illnesses, such as malaria, respiratory infections, and diarrhoea. Adding a quality supplemental food to an essential package of care, including includes vaccination and effective treatment and prevention of primary ‘killer diseases’ of young children, will accelerate the fight against child mortality.

Last year in Muskoka, Canada, G8 member states committed to refocus efforts over the next five years to cut mortality rates of children under five years of age, by two-thirds from 1990 levels. At their meeting this week in Deauville, France, G8 members should commit to ensure that appropriate foods reach vulnerable children, MSF said.

“Our preventive strategies focused on getting a nutritionally appropriate food to children during the most crucial time—the critical window of six months to two years of age—instead of waiting for them to start losing weight, and we observed child mortality rates to be lower by half,” said Dr. Isabelle Defourny, MSF programme manager for Niger.

“If donors and policymakers are serious about reducing child mortality rates, then providing child-appropriate foods must be made a standard component of any pediatric programme in the world’s ‘malnutrition hotspots’.”

At any given time, an estimated 195 million children are affected by malnutrition worldwide. It contributes to at least one-third of the eight million annual deaths of children less than five years of age.

For several years, MSF has been developing preventive approaches to malnutrition – based on quality supplementary foods – in order to lower the burden of deaths in ‘malnutrition hotspots’, such as in the Sahel region of Africa. The Sahel features child mortality rates among the highest in the world.

During a severe food and nutrition crisis in 2010 in the Sahelian country of Niger, local authorities, together with MSF and the Nigerien organisation FORSANI (Forum Santé Niger), implemented the largest-ever distribution of supplemental foods designed to prevent malnutrition in young children.

Between July and December, 2010, three-to-six-month supplies of a ready-to-use paste rich in milk, minerals, and vitamins were distributed to approximately 150,000 children – most between six months and two years-of-age – in five districts of the Tahoua, Maradi, and Zinder regions. Some of the children also benefitted from protection rations (mainly cereals and fortified flours) provided by WFP. 

Pediatric healthcare for common childhood illnesses, such as malaria, and acute malnutrition, was also available in the distribution areas, including for the children who did not receive a nutritional supplement.

Epicentre, MSF’s epidemiology branch, conducted monthly surveys among a cohort of several thousand young children living in the distribution zones. All benefitted from monitoring for signs of malnutrition and illness. Children requiring medical care were referred to MSF and its partners working within Nigerien health-care facilities.

The mortality rate was seen to be more than 50 percent lower among those who received the foods tailored specifically to the nutritional requirements of young, growing children.

In the Madarounfa district in Maradi region, the observed mortality rate among children who received the enriched foods was 2.2 deaths per 10,000 children per day, compared to 5.3 deaths per 10,000 children per day among those who did not receive supplements. In the Guidan Roumji district of Maradi, mortality rates were 1.1 per 10,000 per day compared to 2.5 per 10,000 per day. In the town of Mirriah in Zinder region, the rates were 1.2 per 10,000 per day versus 3.2 per 10,000 per day.

“Providing young children with high quality nutritious foods has long been one of the foundational principles of successful malnutrition and child mortality reduction programmes in Europe, Latin America and the United States, along with immunisation, for instance,” said Dr. Susan Shepherd, MSF child nutrition advisor. “It’s time to stop applying different standards for children living in malnutrition hotspots. We can save children’s lives today if the appropriate resources are put behind similar interventions we deployed last year in Niger.”

Countries such as Mexico, Thailand, the United States, and many European nations, have successfully reduced early childhood malnutrition and mortality through programmes that ensure infants and young children from even the poorest families have access to nutritious foods, such as milk and eggs. However, many food-insecure families cannot afford these animal-sourced foods, which contain the high-quality proteins, fats, and other essential nutrients that children require. National programmes that fill this nutritional gap for young children are essential.

The development in recent years of a new generation of nutritional foods tailored to the needs of the most vulnerable children, which are simple to use, make possible the establishment of a new standard in childhood mortality prevention.

In 2010, in addition to malnutrition prevention activities, MSF and its partners, FORSANI and BEFEN/ALIMA, carried out pediatric and nutritional activities in 64 primary care facilities and nine hospitals in Niger’s Tahoua, Maradi and Zinder regions. 

Approximately 150,000 children suffering from malnutrition were treated – nearly half of all the malnourished children treated in the country in 2010 – of whom approximately 24,000 were hospitalised. Between 85 and 92 percent of children were discharged.

MSF and its partners also treated 216,330 cases of malaria among children less than five years of age, conducted more than 370,000 pediatric consultations, and admitted more than 13,000 children to hospital.

Clashes between pro-government forces and demonstrators led to intense fighting near Kuwait Hospital, as protestors attempted to march to the former prime minister’s office. Throughout the afternoon MSF ambulances referred close to 30 severely wounded people in need of surgical care from the scene of the clashes to hospitals and private clinics. The vast majority of patients suffered gunshot wounds. At least one of those people died.

At around 10:30 PM, as one of the MSF ambulances approached the conflict zone, the vehicle was hit by a stray bullet. There were no casualties among medical staff on board.

“The bullet entered through the back window,” said Dr. Vipul Chowdhary, MSF’s representative in Yemen. “Luckily, no patients were inside the vehicle at the time and the driver and nurse who were inside were not harmed. MSF reminds all parties of the absolute need to respect humanitarian medical work and staff in Sana’a and the rest of the country.”

On Wednesday, MSF teams visited medical facilities in Sanaa, including public hospitals, private clinics, and health centres set up by demonstrators in order to assess needs and provide medical support. MSF continues to support a private clinic with donations of medical materials and drugs. Fourteen severely wounded people underwent surgery in the clinic.

Since the beginning of unrest, MSF teams have been intervening in Sanaa, Taiz, and Aden to help medical facilities cope with the influx of wounded people. MSF is donating medical materials and drugs, providing training to Yemeni medical staff, and offering additional ambulances to refer severely wounded people to surgical facilities.

In Taiz, where heavy clashes have also occurred over recent days, MSF ambulances referred eight people with severe gunshot wounds between Sunday evening and Monday morning, among whom five died.

In addition, MSF continues to operate regular medical programs in Saada, Hajjah, Amran, Aden and Lahj governorates, as well as in the city of Sanaa. 

Médecins Sans Frontières MSF (Doctors Without Borders) is a private international association, providing humanitarian medical relief in more than 65 countries around the world, including Ivory Coast, Pakistan, Democratic Republic of Congo, Libya, and Sudan. MSF does not accept funding from any government for its work in Yemen and relies solely on private donations.

At the weekend, 12 boats carrying 2,665 refugees, asylum seekers and migrants landed on Italian shores, while a further 715 people were rescued from another off-shore boat.

Three quarters of the boats were carrying people fleeing the conflict in Libya. Most were met with a wholly inadequate response by Italian authorities, further compounding their suffering.

On 19th April 2011, 760 migrants arrived from Libya after three days on an old fishing boat. © Mattia Insolera

Inadequate response

”Despite knowing that the number of boats arriving always increases every summer and that this year the war in Libya would inevitably force many thousands more to flee, the Italian authorities continue to respond in an ad-hoc and wholly inadequate manner,” says Rolando Magnano, MSF Head of Mission in Italy.

”This weekend the authorities even ran out of dry clothes and water for people who arrived in shock and with hypothermia. Hundreds of people were then forced to sleep outside, while hundreds others were put in over-crowded centres, lying on dirty mattresses without sufficient towels, blankets or soap. This is clearly unacceptable.”

Fleeing violence

These new arrivals last weekend added to the more than 27,000 people who already reached Italy by boat this year. Many were pushed to attempt the dangerous sea journey as a result of uprisings and violence since December 2010 across the North African Arab world.

The majority of people arriving in the earlier months of 2011 were Tunisian, but the numbers of new arrivals from Libya is increasing, culminating in the biggest landing on Italian shores ever of people crammed into a single boat on April 19.

The majority of those arriving from Libya are of Ethiopian, Somali and Eritrean origin, with many having already fled violence in their home country, before then also fleeing inhumane detention conditions or extreme violence in Libya.

Dangerous crossings

”Those who arrived from Libya speak of the threats and the violence they experienced – some were shot at, others were beaten or saw their friends die before their eyes,” continues Rolando Magnano.

”Others still tell us of horrendous detention conditions there – with 65 people held in one tiny room for a month without water, and so forced to drink from two toilets to survive.

"Others have seen relatives drown as they made the perilous journey by sea to reach Italy. Yet, when they  arrive  the suffering merely continues. Depression and anxiety increase, with some women telling us they are too afraid to sleep, to change their clothes or to even go to the toilet, because they have not been properly separated from the men.”

Italian centres

Last Monday, 1,200 migrants are crammed in the CSPA (Centro di Soccorso e Prima Accoglienza) reception centre on Lampedusa, which only has capacity for 800 people.

Usually, after spending a few days in Lampedusa, migrants and refugees are then transferred to new reception centres throughout Italy, including Kinisia, Manduria, Catalanissetta and Mineo.

According to European standards, Italy has the duty to provide asylum-seekers who have experienced violence with priority treatment adapted to their needs, including specialised health care and mental health support. Currently such measures are completely inadequate.

In addition, there is insufficient separation between men and women, while people receive little information about their rights and legal procedures. Added to this, children and unaccompanied minors are kept in closed, prison-like centres, which contravenes the best interests of the child.

Relieve suffering

Initial mental health assessments conducted by MSF in the reception centres in April point to the risk of widespread depression, anxiety and hopelessness, partly as a consequence of living in uncertainty under unacceptable conditions.

Loris De Philippi, MSF Operation Director, adds: "While constant political discussions about the future of migrants and refugees in Europe persist, boats will continue to land and people will continue to suffer unnecessarily.

"Italy absolutely must step up and take its responsibility to ensure adequate, humane reception conditions for people continuing to arrive in distress on its shores,” 

Notes to the editor:

• Last weekend, April 29 to May 1, MSF teams distributed 1,000 blankets, 900 bottles of water. 
• On May 3 2011, MSF issued a briefing paper, entitled "Seeking Refuge, Finding Suffering" documenting the unacceptable conditions currently facing migrants, asylum-seekers and refugees in Italy. The briefing paper also includes their stories of the hazardous boat journey to Italy, including details of the dire conditions  from which they had escaped in North Africa in order to survive or flee violence. 
• MSF started providing medical care and mental health support to migrants, refugees and asylum-seekers in Italy in 1999 in response to the Kosovo crisis. From 2002 to 2009 MSF worked in Lampedusa and Sicily, both common landing points for migrants. 
• Since February 2011, MSF has looked after the triage of patients at the military port and their medical follow-up in the island’s reception centres in Lampedusa. In addition, MSF has conducted almost 800 medical consultations for migrants and refugees in Lampedusa, and has provided them more than 2,500 hygiene kits and 4,500 blankets.

ZARZIS, TUNISIA/LONDON, April 16, 2011 – Médecins Sans Frontières (MSF) completed a medical evacuation of almost 100 people by boat from Misrata, Libya to Tunisia. The majority of the patients had suffered war-related injuries.

The boat departed Misrata on 15th April, arriving in Zarzis, Tunisia, early this morning, with 64 war-wounded patients and 45 other people. While in Misrata yesterday, the MSF team was able to assess medical facilities in the city, where ongoing fighting has cut off the population from external assistance and hospitals and clinics are overwhelmed with casualties.

The evacuation followed a similar one on 4th April, when 71 people were transferred from Misrata. 

“For weeks now, health structures have been struggling to cope with the influx of patients,” said Dr. Morten Rostrup, an MSF doctor who participated in the med-evac operation. “They have been lacking medical equipment and personnel to treat the wounded and the sick suffering from chronic diseases.

"With the latest heavy bombardments in Misrata, the situation is worsening as hospitals have to discharge patients before their treatment is completed in order to treat those wounded by fighting. Many of the injured cannot even access medical facilities without further risking their life.”

The MSF team also assessed the situation in a camp near Misrata’s port, where thousands of migrants have taken refuge and are awaiting repatriation.

“What we have seen is that these people live in extremely difficult conditions, lacking proper shelter and food,” said Dr. Rostrup. “They are desperate to go back to their home countries.”

The MSF team on the boat included seven doctors, six nurses, and one psychologist, among them nine Tunisian volunteers, providing emergency medical care to the 64 wounded patients.

Among the injured, ten people were in critical condition, three were on mechanical ventilation, and one patient was suffering from anemia, requiring blood transfusions.

The boat docked in the port of Zarzis early this morning. Tunisian health authorities and the Red Crescent are organising the transfer of the patients to the city of Sfax, which features several hospitals and clinics.

The medical evacuation from Misrata was carried out independently from all the parties involved in the conflict, in accordance with MSF’s principles of neutrality and impartiality. While conflict persists inside Libya, MSF is scaling up its assistance to people affected by the violence, regardless of their affiliation or origin, and independently of any political considerations. 

MSF reiterates its call on all belligerents to allow unhindered access to medical assistance for all Libyans affected by the violence. MSF also calls for the respect of medical facilities, healthcare personnel, and vehicles transporting patients.

MSF in Libya and Tunisia

From the onset of violence in Libya, MSF’s priority has been to access areas with the largest needs. During a first medical evacuation by boat on 3rd April, MSF evacuated 71 patients from Misrata.

Six tons of emergency medical materials were donated to the Libyan medical committee in order to help health facilities cope with the influx of patients.

On 21st March, MSF sent a first shipment of surgical kits for 300 wounded to the hospital in Misrata, where large numbers of injured persons and severe shortages of medicine had been reported.

In the eastern city of Benghazi, MSF teams continue to work with the medical committee and to provide support wherever needed, including technical support to the Benghazi central pharmacy in Al Jalaa Hospital, the main trauma hospital and referral facility for eastern Libya, MSF medical teams are supporting hospital staff with nursing care organization.

MSF continues to send medical supplies to Libya, dispatched to areas where ongoing fighting has created the most needs. Since 24th February, 44 tons of medicine and medical materials, including treatment for burns, have arrived in Benghazi.

A report released today by MSF illustrates how Bahrain’s hospitals and health centres are no longer safe havens for the sick or injured, but rather places to be feared.

“Wounds, especially those inflicted by distinctive police and military gunfire, are used to identify people for arrest, and the denial of medical care is being used by Bahraini authorities to deter people from protesting,” said Latifa Ayada, MSF medical coordinator. “Health facilities are used as bait to identify and arrest those who dare seek treatment.”

Since clashes began between government forces and protestors in February, health facilities in Bahrain—generally well functioning in terms of materials, infrastructure, and skilled staff—no longer serve the medical needs of the whole population. Salmaniya, the only public referral hospital in Bahrain, was virtually empty when visited by MSF recently.

Injured people admitted to Salmaniya have told MSF how members of the military beat them, including on their wounds. Other patients have been arrested within health facilities upon discovery that their injuries are related to the protests. The risks of going to hospitals or health centres mean that patients often do not attempt to seek treatment.

The use of Salmaniya Hospital by protestors as a venue for demonstrations, and its subsequent occupation by the military, followed by the targeting of other health facilities and medical workers, have undermined the ability of health facilities to provide impartial medical care.

MSF has proposed establishing an emergency medical response in Bahrain, whereby MSF teams would accompany patients to health facilities to ensure that they are treated and not targeted for arrest, and that health workers are able to conduct their duties impartially and without fear of reprisal. Unfortunately, MSF has not been able to secure guarantees that the patients it would accompany would not be targeted.

“The action by the military to declare the hospital a legitimate military target, and the use of the health system as a tool by the security apparatus, completely ignores and undermines the fact that all patients have a right to treatment in a safe environment, and that all medical staff have a fundamental duty to administer treatment without discrimination,” said Christopher Stokes, MSF general director. 

Every step must be taken to restore the population’s ability to receive treatment without fear, especially by removing the military from Salmaniya Hospital. The opposition protestors should also guarantee that the hospital will not be used as a rallying point for demonstrations.

MSF also wishes to stress the necessity and duty of the authorities to respect relevant rules of international humanitarian law, especially those concerning the protection and respect of medical structures and medical personnel. These rules also extend to the protection of civilians, the sick or injured, and to prisoners. The responsibility for restoring the functioning of health services is today in the hands of the authorities.

The police, military, and intelligence services must stop using the health system as a way to crack down on protestors, and must allow medical staff to return to the primary duty of providing health care regardless of patients’ political or sectarian affiliations.

"We get telephone calls asking us to come pick up wounded people and patients, but it's impossible to move around," said Dr. Salha Issoufou, MSF head of mission in Abidjan.

Abobo Sud is the only hospital still functioning in the northern half of the city. A system for transporting wounded to the hospital had been set up, but gunfire and looting prevented its implementation. Ambulances cannot move in the city.

The paralysing violence is also preventing MSF from resupplying Abobo Sud with drugs and medical materials. "If this continues for a few more days, the hospital will run out of anaesthetics, sterile compresses, and surgical gloves," Dr. Issoufou said.

On April 3, thanks to the efforts of the Ivoirian Red Cross, an MSF team was able to provide the Treichville University Hospital Centre in southern Abidjan with materials for treating the wounded. However, the overall needs are enormous and many public hospitals that have received MSF donations can no longer be resupplied because of the violence. Patients with chronic illnesses, among them people who need dialysis treatments, are already in danger.

The situation in the western part of the country is also chaotic, inter-communal tensions there have aroused grave concern.

MSF is calling on the authorities to do everything in their power to ensure that the country's civilians are not targeted by violence. MSF teams in the western towns of Bangolo and Duékoué treated large numbers of wounded patients between March 28 and April 3 (146 at Bangolo Hospital and 285 at the Duékoué facility).

"New wounded patients continue to arrive, even though the offensive in this area has ended, which suggests that violence is continuing," said Renzo Fricke, MSF emergency coordinator.

Tens of thousands of people have fled fighting in the west, heading as far as neighbouring Liberia.

Duékoué, where neighbourhoods were recently ransacked, is home to a camp housing 15,000-20,000 displaced persons. While MSF is providing medical care at the camp, residents need considerable quantities of food and water. MSF teams are also treating people in Man, Danané, and Guiglo, as well as inside Liberia.

MSF, an impartial medical humanitarian organisation, observes strict neutrality in its operations. Its activities in Ivory Coast are funded exclusively by private donors, ensuring the organisation’s complete independence.

Medecins Sans Frontieres (MSF) evacuated 71 patients by boat on Sunday 3 April from the Libyan city of Misrata, where ongoing violence has overwhelmed medical facilities with the injured.

"We managed to dock at Misrata on Sunday afternoon, despite intense fighting in the city over the past few days" said Helmy Mekaoui, an MSF doctor who coordinated the medical evacuation. "The violence caused an influx of wounded people and it was fortunate we could be there and get them onboard". Among the evacuated patients were three people on life support, 11 people suffering from major trauma, and many others with abdominal wounds and open fractures. Intensive medical care was provided on board as the boat sailed to Tunisia.

The hospital in Misrata has reportedly been bombarded Sunday early morning, while the remaining functioning clinics are overflowing with severely injured patients and are desperately running short of medical supplies.

In Misrata, six tons of emergency medical materials—including 300 surgical kits to perform 1000 surgical operations, drugs, sterilization materials, and intravenous fluids—were donated to the Libyan Health Committee in Misrata, in order to help health facilities in the city cope with the influx of war-wounded people.

The boat arrived early today at the port-city of Sfax, Tunisia and the patients were transferred to hospitals to receive urgent medical care. The MSF medical team on board was composed of seven doctors, three nurses, and one psychologist, including seven Tunisian medical personnel who volunteered to be part of the operation. Upon arrival in Sfax, the Tunisian health authorities organized the transfer of the patients to a dozen medical facilities. Thanks to their support as well as the efforts of the medical staff in Misrata who risked their safety, the evacuation and medical treatment of the patients was made possible.

The evacuation was carried out independently from all the parties involved in the conflict in accordance with the organisation’s principles of neutrality and impartiality.

As conflict continues inside Libya, MSF is scaling up its assistance to people affected by the violence, regardless of their affiliation or origin. The organization is reinforcing its teams on the ground, sending additional medical supplies, and facilitating the evacuation of wounded and sick patients. However, it remains very concerning that many injured people reportedly cannot safely access life-saving medical care without further risking their life.

MSF reiterates its call on all belligerents to allow unhindered access to medical assistance for all Libyans affected by the violence. MSF also calls for the respect of medical facilities, healthcare personnel, and vehicles transporting patients.

The situation remains extremely tense and violent in and around several cities in western Ivory Coast, despite the ending of major fighting on 31st March between armed forces in the area.

Many wounded people suffering from gunshot or machete wounds have arrived in hospitals in the western towns of Danané, Man, and Bangolo. MSF surgical teams in Bangolo are supporting the hospital there.

“The number of new casualties is extremely disturbing and indicates that violence continues in the area,” said Renzo Fricke, MSF emergency manager. “Intercommunal tensions are extremely high.”

On 1st April, 20 injured people requiring surgery were transported to the hospital in Bangolo, where 10 people were still waiting to be operated on today.

Access to care is threatened because the ongoing tensions and violence in the area have forced thousands of people to flee from several localities in the west. Many have fled from the town of Blolequin to Zouian-Hounien. 

Meanwhile, more than 15,000 displaced persons remain within the confines of the Catholic mission in the western town of Duekoue.

"These people are terrorised, and they lack everything, including food,” said Fricke. “They fear for their lives if they leave the confines of the mission to search of food.”

MSF medical teams working in the mission’s compound have treated 240 wounded people since 29th March; fourteen people have been referred to Bangolo Hospital for surgery.

Together with the International Committee of the Red Cross, MSF is the only international organisation in the west of Ivory Coast providing care to wounded people, addressing other medical emergencies and attempting to bring medical care to others affected by violence and displacement.

The MSF team at Bangolo Hospital has treated 121 wounded people since 28th March. Additionally, 45 people have received emergency treatment at the hospital in the town of Man, and 29 at the hospital in Danané, where MSF has donated medical equipment and drugs to help health staff respond to mass casualties. MSF teams working in mobile clinics and fixed health centres in the west treat more than 500 patients per day. 

In Abidjan, people face enormous difficulties accessing medical treatment amid ongoing fighting. The MSF team in the Abobo neighborhood continues to treat people that manage to reach the hospital there. Thirty seven wounded people were treated on 1st April, among them 30 people with gunshot wounds. 

Fifteen wounded people arrived today at the MSF-supported hospital in the capital, Yamoussoukro.

Medical facilities across Ivory Coast can no longer provide medications and they lack basic medical equipment. MSF teams donate supplies when security conditions allow. The needs are immense and there is great concern for people who cannot receive treatment.

MSF, an impartial medical humanitarian organisation, observes strict neutrality in its operations. Its activities in Ivory Coast are funded exclusively by private donors, ensuring complete independence.

New outbreaks of fighting in Ivory Coast are severely restricting already-limited civilian access to medical care, the international medical humanitarian organisation Médecins Sans Frontières (MSF) said today.

An advancing front line has forced thousands of residents to flee in the western region of Ivory Coast over recent days. And in the city of Abidjan, it is now extremely difficult, if not impossible, to move around within certain neighborhoods, especially with armed men looting and firing in the streets.  It has become impossible to obtain access to medical care under these conditions. 

"Access to care is critical," said Dr. Mego Terzian, MSF emergency coordinator. "Civilians must not be targeted and patients must be able to obtain medical care."

MSF has been working with health authorities in Abidjan since early March, treating 450 people, among them 314 victims of violence. The teams are working at the Abobo Sud Hospital, the only health facility still functioning in the city's northern neighborhoods. On March 31, 15 patients with gunshot wounds were taken to the hospital, although ambulances stopped transporting people some time ago. 

While masses of people fled Abidjan last weekend, many remain in the city, taking refuge with host families or hiding in their homes. People come to the few medical facilities still operating only as a last resort. Most health care workers have left; many of those who remain do not come to work because of the insecurity. In addition, medicines and medical supplies are lacking.

Over the last three days MSF teams have treated more than 230 wounded patients in the towns of Bangolo and Duékoué, in western Ivory Coast.

"The population is yet again suffering the consequences of fighting," said Renzo Fricke, MSF emergency coordinator. "Our teams transfer patients who need emergency surgery—for example, three women with gunshot wounds recently—but there are many other patients facing problems, ranging from severe malaria to complicated labour and deliveries. They require urgent treatment too, but the difficulty of moving from one place to another is threatening patients' lives.” 

In Duékoué, a town in the west severely affected by fighting, an MSF team is treating patients and stabilizing people requiring surgery for transfer to Bangolo, 30 kilometers away, where another MSF team is working in the town’s only functioning hospital.

The Catholic mission in Duékoué is housing a camp for displaced persons, where the numbers have doubled in just a few days. Confrontations in the region have also led thousands of people to converge on the western town of Guiglo, where health needs have increased. An MSF team there treats patients to the extent it can, but insecurity makes it very difficult to evacuate wounded people to Duékoué and Bangolo.

When wounded patients streamed into hospitals in Yamoussoukro and Bouaké, in the center of Ivory Coast, an MSF team contributed medical supplies. "This illustrates a problem resulting from a general paralysis of economic life," said Fricke. "Health care facilities lack medicines and supplies."

MSF, an impartial medical humanitarian organisation, observes strict neutrality in its operations. Its activities in Ivory Coast are funded exclusively by private donors, ensuring complete independence.

The two grenade attacks against the MSF compound in Medina’s Wadajir district took place after nearly two months of MSF operations there. In the second incident, two guards were slightly injured.

“MSF considers this a serious incident due to the direct attacks on our premises, which were aimed at causing heavy casualties and damage to MSF,” said Joachim Delville, MSF head of mission.

MSF reaffirms its commitment to Somali communities, but insists it will not continue operations at any cost, and certainly not at the cost of the security of MSF staff and its patients.

“Following these incidents, we need to re-engage with local authorities and communities to re-evaluate if acceptable security conditions can still be guaranteed,” said Delville. “MSF calls upon all parties in Somalia to respect the lives of the civilian population and to ensure that humanitarian workers can safely access people in need.”

Of particular concern is the fate of people lacking access to free medical care in the area, especially malnourished children.

"We currently have 414 children registered in our malnutrition programmes, of which 59 (14 percent) are severely malnourished and therefore facing high risk of deterioration in the absence of appropriate nutritional care,” said Delville.

Plans to open a second health facility for malnourished children in Wadajir will also have to be put on hold.

MSF had just recently opened a health facility in the Dharkenley neighborhood of Medina, offering free medical services to all, including the resident community and displaced populations. In its first two months of activities, MSF treated 3,217 children, 60 percent of whom are under five. Among them, 856 children were admitted to the nutrition programme.

NOTE TO EDITORS: For more information, please call the MSF UK press office on 44 7966 677 725

MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions of south central Somalia. Over 1,300 Somali staff, supported by approximately 100 staff in Nairobi, provide primary health care, malnutrition treatment, health care and support to displaced people, surgery, water and relief supply distributions. MSF does not accept any government funding for its projects in Somalia, all its funding comes from private donors. 

“The measles epidemic is spiralling out of control,” says Gaël Hankenne, MSF head of Mission in the DRC. “Since September 2010 we have vaccinated more than 1.5 million children in response to the crisis. But the disease is spreading like wildfire. All parties involved in health in the DRC must now make this epidemic a national priority.”

Over the past months MSF has provided a complete emergency response (treatment, vaccination and epidemiology) in Katanga, Kasaï Occidental and South-Kivu. New outbreaks have flared up in Bandundu, Kasaï Oriental and Maniema provinces, and the epidemic is rapidly moving north.

The treatment and vaccination needs are huge and the requirements in terms of human resources, finances and logistical capacity mean that MSF cannot be the only organisation providing a hands-on response throughout the entire country. “We are asking the Ministry of Health to launch a response immediately to outbreaks that occur in the other provinces or in any new health zone that is affected,” says Geza Harzi, MSF head of mission in Katanga. “At the same time, we are asking international donors and institutions, and health organisations with activities in the DRC – particularly UN agencies (such as the WHO and UNICEF) and NGOs – to take action immediately. We request that they either release emergency funding or take hands-on action as part of the epidemic response. If this international response is not rapid, it will be impossible to check the spread of measles in the DRC.”

Measles is an extremely contagious disease that can cause medical complications such as pneumonia, malnutrition, severe dehydration, ear infections and eye infections that can lead to blindness. Mortality rates vary considerably depending on the context. When a population has not been vaccinated, measles can kill between 1 and 15 percent of afflicted children. Among vulnerable groups (such as people who have been displaced or are malnourished), the mortality rate can rise to 25 percent if people have limited healthcare, as is the case in many health zones in the DRC.

MSF is expanding its emergency response in three provinces: Tshikapa in Kasaï Occidental province, at Fizi in South-Kivu province and at Kolwezi and Likasi in Katanga province. More than a million children will be protected by these emergency vaccinations. “Since September 2010 we have counted more than 21,000 measles cases in the DRC,” says Hankenne. “Concerted action needs to happen right now.”

In Abidjan, health authorities report that nearly all medical workers in six hospitals have fled as a result of the insecurity. Only one hospital in the Abobo neighbourhood, Abobo Sud, is functional. MSF has been working in the hospital since late February, handling medical and surgical emergencies in cooperation with the Ministry of Health. Medical teams there have treated 273 emergency patients over the past three weeks, 225 of whom had bullet wounds. Women and children have died of their injuries.

"We heard gunfire in Abobo every day," said Dr. Okanta Chibuzo, an MSF emergency doctor who recently returned from an assignment in Abidjan. "We admitted 10 to 15 wounded people every day."

"Some of the wounded were brought in trucks that usually transport food,” said Dr. Chibuzo. “All of them were urgent cases."

Patients with common illnesses also need care. However, access is very limited, particularly for children with acute illnesses, pregnant women and people living with chronic diseases. People are also afraid to leave their homes to seek treatment. 

The outburst of violence in Ivory Coast has led people to seek refuge in locations believed to be more secure. In Abidjan, residents have fled en masse to improvised reception sites, or have returned to their home villages.

Tens of thousands of Ivoirians have sought refuge in neighbouring Liberia, where MSF's mobile teams are providing care. Population movements in the western part of Ivory Coast began in December. While some people have returned to areas south of Danané, the front line is shifting further south and increased fighting in the Guiglo area has led to further displacements of people.

The population’s access to assistance in the western region is a serious challenge.

“Health centres no longer operate—or provide extremely limited services—because medical staff has left, they lack drugs and medical supplies, and because some have been looted,” said Renzo Fricke, MSF emergency coordinator.

MSF teams are providing primary healthcare in many towns and villages on both sides of the front lines and are supporting several hospitals. However, the proximity to the fighting complicates the teams' ability to travel.

The country’s banking system and business networks are also paralysed. Coupled with transportation problems, this has led to serious disruptions in the distribution and supply of medicines in several regions of the country.

MSF is a medical humanitarian organisation that observes strict neutrality and impartiality in its operations. Its activities in Ivory Coast are funded exclusively by private donors, ensuring its complete independence. MSF works in Abidjan, providing emergency medical assistance. In the western part of the country, it provides primary healthcare services and supports hospitals in Duékoué, Guiglo, and Bangolo. MSF also provides primary healthcare services in Nimba County, Liberia. MSF teams in Ivory Coast are comprised of 35 international staff and 135 Ivoirian staff. Five international staff and 25 Liberian staff work in MSF projects in Liberia.

"These patients—including men, women, and children—suffered wounds from gunshots and shell explosions," said Dr. Mego Terzian, MSF emergency manager. "Eight of the 66 patients admitted to the hospital died shortly after arrival. Nine additional bodies were brought to the hospital, for a total of 17 deaths registered there."

Over the past few weeks, increasingly intense confrontations have had serious repercussions for the population at large, much of which has been trapped in the conflict. Since late February, MSF has been providing emergency medical care in Abobo Sud Hospital, working in close cooperation with the Ministry of Health. Over the two weeks prior to 16th March, the teams treated 129 patients. However, seeking treatment is not a simple matter for people who require care but are afraid to leave their homes. Travel within the city is risky because of fighting and because groups of young men have erected blockades in the streets.

The fighting has also forced many people to flee. In recent weeks, displaced persons from Abidjan have set up camps in 24 sites in and around the city. Thousands of others are housed with host families. The situation is the same in the western part of the country, where fighting has forced most healthcare workers to abandon health facilities—which are running low of medicines—and forced many people in the area to flee to neighboring Liberia.

The instability makes it difficult to access populations, particularly in areas close to the front lines.

"In this context, patients must have access to care, medical teams must be able to work freely, and healthcare workers—and medical facilities and ambulances—must be respected," says Dr. Terzian.
 
In addition, commercial and financial sanctions imposed by the international community, together with transportation problems, have led to shortages of medicines and medical supplies. Health facilities in many regions lack basic medicines for treating chronic and acute illnesses. MSF's donations of medicines and medical supplies to health facilities are thus critical, but they cannot meet all the needs in a country caught in a worsening crisis.

MSF is an impartial medical humanitarian organisation that observes strict neutrality in its operations. Its activities in Ivory Coast are funded exclusively by private donors, ensuring its complete independence. MSF works in Abidjan, providing emergency medical assistance. In the western part of the country, it provides primary healthcare services in Duékoué, Guiglo, and Bangolo, and supports hospitals. MSF also provides primary healthcare services in Nimba County, Liberia.

Fighting has led to new displacements of people in the capital, Abidjan, and in the western region of the country. Insecurity and shortages of medicine resulting from international sanctions have made it very difficult for victims of violence—and all those in need—to obtain care.

Only one hospital continues to function normally in Abidjan’s Abobo district, home to approximately two million residents. The violence there has forced most of the health workers at the district's two other hospitals to flee. Since late February, Médecins Sans Frontières has been working with the Ministry of Health to provide emergency care at the Adobo Sud Hospital.

"Over the course of two weeks, we treated 129 people in the emergency room, including 81 with gunshot and knife wounds, and we operated on 31 serious cases," said MSF Emergency Manager Dr. Mego Terzian. In addition, MSF increased the number of hospital beds from 12 to 20, in order to respond to the influx of wounded patients.

However, people are afraid to leave their homes to seek treatment at the hospital. Travel within the city is risky because of outbreaks of fighting and blockades erected in the streets by young men armed with clubs and machetes. The insecurity has also caused many people to flee. In recent weeks, displaced persons in Abidjan have set up approximately twenty camps, where health conditions are uncertain. 

The confrontations have also led to major population movements in the western part of the country, with more than 82,000 people taking refuge in neighboring Liberia, including 45,000 over the last three weeks.

Since December, MSF teams have been working in Liberia and western Ivory Coast, where they are providing primary healthcare in facilities abandoned by healthcare staff and lacking in medicines. The recent resumption of fighting has further worsened the situation for the population. 

MSF teams in Ivory Coast are providing care to displaced persons and residents in the cities of Duékoué and Guiglo, and are preparing to provide care in Bangolo and Zouan-Hounien. However, instability makes it difficult to access the displaced populations, particularly in areas close to the front line.

"In this context of difficult access to care and population displacement, our teams must be able to reach people, particularly so that they can conduct epidemiological monitoring," said MSF Emergency Coordinator Renzo Fricke.

Armed conflict is not the only obstacle to treatment. Commercial and financial sanctions imposed by the international community against Ivory Coast, coupled with transportation problems, have led to shortages in medicines and medical supplies. Health facilities in many regions of the country lack basic medicines and treatment supplies for chronic and acute illnesses, particularly for kidney dialysis.

While they cannot meet all the needs in the country, MSF donations of medicines and medical supplies to various health facilities are critically important.

MSF's activities in Ivory Coast are funded exclusively by private donors, ensuring its complete independence.

Ivory Coast/Liberia, 4th March, 2011 - The international medical humanitarian organisation Médecins Sans Frontières (MSF) today expressed concern over the deteriorating situation in the west of Ivory Coast and the border region with Liberia. As the population flees violence, medical personnel are deserting health posts. Faced with this increasing volatility, MSF medical teams are adapting their operations and the organisation is asking all parties to the conflict to allow its medical teams to care for patients, regardless of their affiliations.

In the west of Ivory Coast, where local medical personnel have abandoned health centres, a mobile MSF team has begun providing primary healthcare services in the north of the Duékoué district. However, on 3rd March, as residents of this area began to flee, MSF was forced to halt its activities due to security concerns. Displaced persons around the city of Toulepleu, located near the Liberian border and currently inaccessible, have also taken flight.

“It is critical for patients to have access to health facilities,” said Mego Terzian, MSF emergency coordinator. “MSF medical teams, who strictly adhere to the principles of impartiality and neutrality, must be able to care for patients, regardless of their affiliation.”

MSF has been present in the west of Ivory Coast since the end of December, providing medical care in the city of Guiglo and in a camp in Duékoué housing 12,000 displaced people. MSF has also been working for the last five weeks in Duékoué’s hospital, where it is caring for 63 wounded patients. Although the MSF surgical team withdrew after local personnel returned, MSF is continuing to provide consultations in the hospital. 

In the town of Danané, near the border with Liberia, MSF last week treated about 10 wounded patients in the area hospital, where teams had pre-positioned medical equipment. Because electricity is no longer available in the area, access to potable water is problematic.

MSF has also witnessed a worrisome deterioration in the city of Abidjan, and is working to provide support for hospital facilities there.

Across the border in Liberia, where more than 70,000 refugees have been registered in the district of Nimba, MSF teams have increased their assistance to the local and refugee populations.

“The health centres need medical staffing support and drugs,” said Helga Ritter, MSF coordinator in Liberia. “The refugees urgently need shelter and water." 

MSF teams are providing support to the health centres and are also operating mobile clinics and a medical facility in the Bahn refugee camp. Roadways have been made nearly impassable by rainfall, so the movement of refugees toward the camp, which was designed to house 15,000 people, has been slowed.

“In Liberia, starting on 24th February, we have witnessed the arrival of a second wave of refugees,” said Ritter. “People are afraid and do not speak of returning. And they fear for those who have remained in Ivory Coast. It is important to continue to provide assistance wherever the refugees are found, and wherever the local population has been made vulnerable by this massive influx of people.”

MSF opened its first project in Ivory Coast in 1991. Until 2007, MSF teams were working in MACA prison in Abidjan, in the hospital of Bouaké city, and in the western regions in the hospitals of Danané, Man, Bangolo, and Zouan Hounien. The teams conducted primary and secondary healthcare activities as well paediatric and obstetric care. During the crisis period, MSF also provided surgical treatment to wounded people, ran a nutrition project and an integrated HIV/AIDS and tuberculosis treatment programme. MSF withdrew in September 2007, when the situation in the country had stabilised.

MSF has worked in Liberia since 1990. In June 2010, MSF transferred the last of its hospital-based healthcare projects to local authorities. MSF continues its work in the capital of Monrovia, supporting the Ministry of Health and Social Welfare with the medical needs of victims of sexual violence.

MSF team continues medical services in Abyei area

Following the clashes to the North of Abyei town last week, the MSF team keeps running medical activities in the town and surrounding villages where displaced people have arrived. The situation was relatively calm on Monday morning, allowing our teams to work in the area, although we are still waiting for the permission to give assistance to population in the north of the Abyei area.

On Saturday a mobile clinic was conducted in the village of Mading-Achueng, a few kilometres south of Abyei, where MSF suspects there are at least 1,000 newly displaced people. The mobile clinic treated 100 patients and one person was referred to the MSF hospital in Agok, 40km south, for further treatment.

On Monday morning, the outpatient department in Abyei already received 50 patients.

Hospital activities, including surgical capacity for treating wounded continue in Agok.

MSF is currently responding to the consequences of fighting in various locations north of the disputed border district of Abyei, in Sudan. The latest outbreak of violence began on 27th February, some 20 kilometres north of Abyei town. Since yesterday, tens of thousands of people have fled the town, leaving it mostly empty. MSF’s priority is to be able to reach and treat all patients.

The MSF hospital in Agok, 40 kilometres south of Abyei, received 21 wounded patients during the afternoon and evening of Wednesday 3rd March. All patients had sustained gunshot wounds, and three required surgery. All have now been stabilised. The MSF team in Abyei also made a donation of drugs and equipment to the Ministry of Health hospital in Abyei in support of their efforts to treat wounded patients.

MSF is particularly concerned for the wounded seeking medical care in the north of the Abyei area, some of whom have been evacuated to Muglad hospital. MSF is currently in discussion with authorities to provide assistance to the people most in need in this area.

“MSF is an independent and neutral medical organisation and reiterates its objective to reach all patients and provide them care in complete impartiality” says Bruno Jochum, director of operations. “It is imperative that medical assistance can be provided to all affected by the latest surge in violence.”

Although the situation remains relatively calm today, the team reports that tensions remain high in Abyei town and surrounding areas. MSF mobile teams from Agok and Abyei are conducting assessments in the Abyei area in order to respond to the medical needs of the population displaced as a result of the fighting.MSF staff in Agok are also on standby to respond to a further influx of wounded if fighting continues.

MSF has been working in the Abyei region since 2006. In response to clashes which occurred in 2008, forcing thousands to flee south, MSF set up a hospital in Agok.

MSF provides primary healthcare services in Abyei town, including antenatal care and treatment for malnutrition. In 2010, the team has provided 18,534 outpatient consultations. Deliveries and other serious cases are referred to the MSF hospital in Agok, which provides a wide range of services including surgical, maternity, inpatient and outpatient care, a paediatric unit, a tuberculosis ward and a therapeutic feeding centre for malnourished children. Since January, the hospital has been equipped with a full operating theatre. In 2010, 31,199 outpatient consultations were carried out.

MSF has been providing emergency medical humanitarian assistance in Sudan since 1979. MSF currently runs 27 projects across 13 states of the country.

On 1st March, the MSF team in the eastern Libyan city of Benghazi received a plea for help from a medical doctor in the western city of Misurata, where clashes have reportedly left many people wounded. Like other areas in the west, Misurata has so far been inaccessible to aid workers because of insecurity.  

“The doctor is asking us for drugs and medical supplies to treat wounded people,” said Anne Châtelain, MSF’s medical coordinator in Benghazi. “But we cannot deliver the supplies. The road to Misurata has been blocked by armed men who are stopping traffic.”

While eastern Libya remains relatively calm, the west of the country is reportedly plagued by violence, creating a deeply worrying situation that is impossible to assess and respond to since access is prevented. MSF teams present at the Tunisian-Libyan border are blocked from entering Libya.

MSF has received information that many wounded people in Tripoli are not seeking treatment at hospitals for fear of reprisals by militias.

“Volunteer medical doctors are treating the wounded in private locations,” said Rosa Crestani, MSF emergency coordinator. “But they are appealing to us for drugs—including pain medication—and surgical equipment to ensure treatment of the injured. For the moment, this is impossible.”

In addition to requesting access to violence-affected areas in order to provide assistance, MSF is demanding respect of medical facilities, especially the right for people to safely seek and receive treatment.

In Benghazi, MSF has supported hospitals with donations of drugs and medical supplies. The hospitals have coped with an influx of more than 1,800 people wounded in fighting between 17th and 21st February. 

MSF has an eight-person team in Benghazi, as well as 17 people on the Tunisian border. Two trucks from Egypt have already arrived in Benghazi to deliver 17 metric tonnes of drugs and other medical supplies to city hospitals.

"People fled suddenly and arrived with nothing but their clothes. Initially they set up makeshift shelters made out of their clothes and grass, to help protect them from the cold nights. MSF is providing plastic sheeting, blankets, mats, soap and jerry cans that will help people cope with their most basic needs", explains Cristina Falconi, MSF head of mission in Sudan. “Now that all the attention is focused on southern Sudan’s referendum, we shouldn't forget that there are pressing medical needs in Darfur."

Ten days ago in the aftermath of fighting in the area of Tabit, MSF distributed essential household items to more than 500 people who have sought refuge in nearby Jerno locality. This fighting was the latest in a series of clashes that began in mid-December with heavy clashes in Shangil Tobaya. During the hostilities, the Ministry of Health hospital, supported by MSF, was caught in the crossfire, forcing patients and staff to flee. Following this incident, some 7,000 newly displaced people gathered in two different camps near Shangil Tobaya town.

Some days after the fighting in Shangil Tobaya, MSF managed to provide a medical emergency response in the camps to help the newly displaced people cope with their immediate needs. A new clinic has been set up inside one of the camps and is currently providing 100 outpatient consultations per day. MSF has also distributed highly nutritious, vitamin-rich food to around 4,000 children under the age of five. Additional needs are being addressed by other organisations in the area.

MSF is also supporting a vaccination campaign sponsored by UNICEF and the Ministry of Health, reaching more than 3,000 children and 200 pregnant women in and around Shangil Tobaya.

Elsewhere, in South Darfur state, fighting in early December 2010 also displaced thousands of additional families. Currently, an MSF team is finalising an assessment to determine the most urgent needs of hundreds of displaced families in Shaeria locality. MSF is also setting up a nutrition program, in collaboration with the Ministry of Health, to address serious levels of malnutrition for people that have been suffering from continuing violence and poor provision of healthcare.

MSF continues to provide primary and secondary healthcare in Darfur, including paediatric and reproductive healthcare, and counselling services, in Kaguro, Dar Zaghawa, Tawila and Shangil Tobaya.

MSF has been working in Sudan since 1979 providing free-of-charge medical assistance to people suffering from the effects of armed conflict, poor provision of healthcare, floods, droughts, disease outbreaks and nutritional emergencies. Today, MSF continues to provide medical and humanitarian assistance through several projects in different regions in North and South Sudan that include: Warrap, Jonglei, Upper Nile, Unity, Northern and Western Bahr-el-Ghazal, Western and Central Equatoria, the transitional area of Abyei, Red Sea, Al-Gedaref, South and North Darfur. MSF is an independent and neutral organisation that serves all people based on medical needs, regardless of racial, political, tribal or religious affiliation.

Most of the rape survivors MSF treated yesterday said they were ambushed around Nakatete on 19th January as they returned from the market. They told MSF they had been held hostage throughout the day, raped multiple times and had been subjected to degrading treatment. Patients ranged in age from 13 years old to 60 years old. Women and girls had been separated from men and their clothes and belongings were stolen.

A woman gestures as she describes her rape to a health worker in Congo (DRC)2006 Photo by Spencer Platt / Getty Images

Eleven women MSF treated yesterday said they were ambushed on 20th January in Kitumba on their way back from the market, and were robbed and raped by a group of armed men. MSF also treated two women and a man who were similarly attacked in the same location the next day.

These new incidents of mass rape come a few weeks after a mass rape on New Year’s Day in the Fizi region.

“In the space of a few weeks alone, MSF has provided medical treatment for nearly 100 women, men and children – all of whom have been raped in mass attacks,” said Annemarie Loof, MSF Head of Mission in South Kivu. “We are extremely concerned about the fate of civilians in this area – normal people who have nothing to do with the conflict and who bear the brunt of a recent increase in violence and insecurity in this part of eastern Congo (DRC).”

For years civilians in eastern Congo (DRC) have suffered sexual violence related to the conflict. But MSF has not provided medical treatment for rape on this scale in South Kivu since 2004. In an already volatile context, MSF is confronted with what appears to be a further deterioration in the situation which directly impacts on the civilian population.

MSF has provided medical care to those affected – caring for wounds and injuries and providing preventative treatment for possible sexually transmitted infections. The survivors were also vaccinated against Hepatitis B and tetanus. Those girls and women who were seen in time were offered the morning-after pill to prevent unwanted pregnancy.

NOTE TO EDITORS: For more information or to contact spokespeople, please call the MSF UK press office on 44 7966 677 725

In South Kivu, MSF provides emergency health care to a population suffering from violence, sexual violence, displacement, malaria, malnutrition and disease outbreaks such as cholera and measles. In 2010, MSF medical teams in the Fizi region treated 20,000 malaria patients, gave 65,000 medical consultations, cared for 10,000 inpatients at Baraka hospital and helped to deliver 4,000 babies.

Throughout the Kivus, MSF runs hospitals, mobile clinics, health centres, vaccination campaigns and cholera programmes, and provides treatment and psychosocial care to survivors of sexual violence. In 2009 alone, MSF provided medical and psychosocial care for 5,600 rape victims in North and South Kivu.

In one of the cells of Tychero border police station in the region of Evros, migrants are obliged to sleep on the floor next to the toilets. Greece, December 2010 Photo by Julia Kourafa / MSF

For the last two months, MSF teams have been assisting detained migrants and asylum seekers inside three border police stations and one detention centre in the Evros region of northern Greece. They are witnessing a situation that can only be described as unbearable and inhumane.

“No human being should be subjected to such treatment,” said Ioanna Pertsinidou, MSF’s emergency coordinator. “Every day we are seeing people who are obliged to stay for weeks or even months in extremely overcrowded and squalid cells, without the right to go out in the yard. There are so many people detained that they don’t have the space to even lie down in the cells, while the heating often does not work, leaving migrants freezing in sub-zero temperatures. In one of the detention centres, the toilet often does not work and excrements flood sections of the cell where migrants live and sleep.”

This situation is having serious implications on the physical and mental health of the migrants. In the border police stations of Soufli and Tychero, MSF doctors have treated more than 850 migrants, who suffer mostly from respiratory infections, gastrointestinal problems and skin infections, because of the poor living conditions. The situation is further aggravated by the sub-zero temperatures in Evros. In recent weeks, several people have died because of the cold weather, while trying to cross the border. Others have arrived in a serious medical condition. In the first week of 2011, MSF doctors provided care to 15 migrants who had managed to cross the border and were suffering from frostbite, four of them in severe condition.

MSF is calling for immediate action, and for the Greek authorities to respond to the emergency medical and humanitarian needs of the detained migrants and asylum seekers in Evros. “The situation we are witnessing poses major humanitarian concerns; the Greek government should immediately put in place a coordinated emergency response to improve the reception conditions at the border and the living conditions in detention facilities,” says Ioanna Pertsinidou.

Measures that enhance border controls, such as the creation of a fence at the border and the deployment of FRONTEX teams, should not be considered a viable response. Migrants and asylum seekers who are escaping conflict and violence, deprivation or human rights’ violations, will continue trying to enter Europe. Restrictive measures will only force them to risk their lives on longer, more hazardous journeys, and will leave them vulnerable to falling prey to trafficking or smuggling networks. The European Union’s increasingly restrictive asylum and migration policies are putting in danger the lives and well-being of the migrants, and particularly vulnerable groups such as women, children and unaccompanied minors.

MSF has been providing medical care and psychosocial support to migrants and asylum seekers since 2008 in Greece. Since the beginning of December 2010, MSF teams have been providing healthcare and working to improve living and hygiene conditions in the border police stations of Tychero, Soufli and Feres and in the Detention Centre of Filakio. MSF doctors have treated more than 850 patients; they have referred 15 patients to local hospitals and have distributed 3,500 sleeping bags and 2,500 personal hygiene kits.

The Ifo Two refugee camp, near Dadaab in eastern Kenya, is meant to house the constant influx of new arrivals fleeing war and drought in Somalia. Instead, two months after the refugees were due to be relocated (on 2 November), the Ifo Two camp lies empty whilst thousands of refugees live in appalling conditions on the outskirts of the already congested Dagahaley camp.

In the first two weeks of January alone, almost 6,000 refugees made the perilous journey from Somalia to Dadaab. However, instead of finding the assistance and protection they need, refugees – caught in the middle of the negotiations for opening the new camp - are being left to live in undignified and unacceptable conditions outside the camp.

“The minimum international humanitarian standards are not being met. The refugees have scarce access to water, food, non-food items and shelter. There are no latrines, making open defecation the only option, and increasing the risk of the spread of disease, particularly in this vulnerable population group that is already fleeing years of war,” says MSF Humanitarian Affairs Officer, Elena Estrada.

Last November, MSF warned that the situation of refugees in spontaneous settlements outside Dagahaley was deteriorating after their makeshift shelters and food supplies were destroyed following heavy rains. Since then, the health status of the refugees has got worse and their living conditions more squalid.

Insecurity is another problem faced by the refugees. The majority of the new arrivals are children, women and the elderly. Living outside the camps mean they have little or no protection and are vulnerable to further violence.

In Ifo Two, aid agencies are waiting to resettle the refugees in an area equipped with clean water, sanitation, schools and health services. An MSF medical team has been on standby since last October, ready to assist refugees in a temporary health facility whilst a 45-bed hospital is being built.

Established in early 1991, the Dadaab camps were intended to house 90,000 refugees. In 2008 the three camps were declared full and unable to host more refugees. Dadaab currently hosts over 308,000 refugees. After negotiations with the local community, elected leaders, provincial administration and member of parliament, in December 2009 the UNHCR was granted permission to extend Ifo camp, with the capacity to accommodate 80,000 refugees. In July 2010, MSF committed to providing healthcare services in Ifo Two. Despite MSF’s commitment towards the refugee population and its redeployment of resources, MSF has not been able to assist the refugees, as Ifo Two is still not operational.

MSF urgently calls on the responsible parties involved in the negotiations to allow for the immediate reallocation of the refugees from Dagahaley camp in Dadaab to Ifo Two extension camp.

MSF has been assisting Somalis since 1992. The medical humanitarian organisation started work in Dagahaley camp in March 2009, providing medical care, including surgery and maternal health services, in a 110-bed hospital. The four MSF health centres offer vaccinations, antenatal care and mental healthcare, with an average of 10,000 patient consultations every month.

New Delhi, 12th January 2011 – India should resist pressure from the European Union to accept, as part of a free trade agreement, harmful provisions that will have a major negative impact on the availability of affordable medicines, the international medical humanitarian organisation Médecins Sans Frontières (MSF) said today. As discussions on the sensitive intellectual property chapter in the free trade agreement resume, reports now indicate the Indian Prime Minister’s Office (PMO) may be ready to concede to European demands, imposing severe limitations on the ability of Indian generic manufacturers to produce affordable medicines.

“We urge the Indian Prime Minister to stand strong against Europe and defend India’s role as pharmacy of the developing world,” said Dr. Unni Karunakara, MSF International President. 

MSF relies on affordable medicines produced in India to treat more than 160,000 people living with HIV/AIDS across the developing world. India is also the source of 80% of the AIDS medicines purchased by donors like the Global Fund. But in a leaked draft of the trade deal, the Europeans are pushing several provisions that would limit competition from generic manufacturers.

“The Indian negotiating position has been committed to systematically opposing Europe’s attempts to impose greater restrictions on generic medicines production than required under international trade rules,” said Leena Menghaney, of MSF’s Campaign for Access to Essential Medicines. “But latest reports now suggest the Prime Minister is ready to reconsider in order to conclude the agreement fast. We appeal to the Indian Prime Minister to resist the EU’s demands.”

Generic medicines from India have played a critical role in scaling up AIDS treatment across the developing world because until 2005, the country did not grant patents on medicines. This allowed manufacturers to produce more affordable drugs, pushing their price down by more than 99% over the past decade. But World Trade Organization rules obligated India to start granting medicines patents in 2005. This is having a negative impact on the production of affordable versions of the newer generation of HIV/AIDS drugs, some of which have already been patented in India. 

Now the policies the EU are pushing would restrict the production of affordable medicines even further. In particular the EU is seeking to impose ‘data exclusivity’ which would act like a patent and block the marketing of generic medicines for up to ten years. Alarmingly, data exclusivity would apply even for products that didn’t deserve a patent in the first place under India’s law. Acting as a way to secure monopolies through the backdoor, it would block the development of new fixed-dose combinations, where several medicines are combined into one pill, even though these cannot be patented in India.

“The European Trade Commissioner has confirmed to us that he continues to ask India for data exclusivity,” said Dr. Karunakara. “We ask India to reject data exclusivity and any other aspect of the European trade agenda that exceeds what is required under international trade rules and threatens the lifeline of affordable medicines for the developing world.”

MSF issues review of emergency response and current gaps in medical care; shelter, water and sanitation, and secondary healthcare challenges

10th January, 2011 -- One year after the devastating earthquake killed an estimated 222,000 people and left 1.5 million people homeless, Haitians continue to endure appalling living conditions amid a nationwide cholera outbreak, despite the largest humanitarian aid deployment in the world, said the international medical humanitarian organisation Médecins Sans Frontières (MSF).

While overall the availability of basic healthcare has improved since the earthquake, the rapid spread of cholera across the country underscores the limits of the international aid system in responding effectively to new emergencies. International agencies must live up to the commitments made to the Haitian people and to donors by turning promises into more concrete actions, said MSF.

Urgent humanitarian needs must be met while long-term reconstruction plans are pursued. The overall health of the population and the ability to contain the risk of disease outbreaks depend on improving water and sanitation and ensuring that the one million people still living in tents are able to find sufficient transitional shelter.

“The massive devastation wrought by the earthquake provoked an extraordinary outpouring of generosity from private individual donors around the world and promises from the international community to ‘build Haiti back better,’” said Stefano Zannini, MSF head of mission in Haiti. “But the sad reality today is that even as Haitians try to rebuild their lives, many people remain extremely vulnerable, especially as they face a second and largely preventable disaster in a cholera epidemic that so far has claimed at least 3,600 more lives.”

MSF today issued a review of its own emergency response following the earthquake and an assessment of the existing gaps in secondary healthcare services that it will attempt to address in the year ahead. MSF’s response in Haiti since the earthquake and the cholera epidemic constitutes the largest disaster operation in the organisation’s history.

By the end of 2010, MSF estimates that it will have spent all of the 104 million euros (£86.5 million) donated by private individuals to mobilise its earthquake relief effort and respond to the cholera epidemic. From 12th January to 31st October, 2010, MSF medical teams treated more than 358,000 people, performed more than 16,500 surgeries, and delivered more than 15,000 babies. More than 5,700 major operations were carried out over the first three months alone, making MSF one of the largest providers of surgical care.

Since the start of the cholera epidemic, MSF and MSF-supported cholera treatment centres have treated more than 91,000 people out of the 171,300 cases reported nationwide up to 1st January, 2011.

“As the anniversary of the earthquake approaches, it is important to reflect even more on the shortfalls of the past year given the immense needs of the population and the trust bestowed by individuals worldwide to help meet those needs,” said Dr. Unni Karunakara, MSF international president. “With the ongoing generous support of our private donors and commitment of our staff - many of whom continued to work despite the deaths of family members and friends - MSF is dedicated to using our experience in Haiti to sustain and improve our programmes in the country and to remain prepared for future emergencies.”

MSF’s operational budget projections for Haiti for 2011 are 46 million euros (£38.3 million) to maintain a network of six private hospitals in Port-au-Prince, with a total capacity of up to 1,000 beds, and to maintain support of two Ministry of Health hospitals. Three of the facilities in the capital will be newly constructed in 2011—including the only functioning burn treatment unit in the capital, replacing temporary facilities established in the aftermath of the earthquake.

Outside the capital, in Léogâne, MSF will continue to run a newly constructed 120-bed general hospital. Among MSF’s operational priorities in Haiti are obstetric, emergency, and trauma care.

For more information, please contact the MSF UK press office on 44 207 067 4256 or 44 7889 178 473.

A 54-year-old rape survivor from Mungoti IDP camp, on the outskirts of Kitchanga, Congo (DRC). September 2009. Photo by Martin Beaulieu

The women were raped on the night of 1st January in Fizi town and surroundings in a coordinated attack. MSF medical teams treated 14 women at the hospital in Fizi on 3rd January, and 19 the next day. In addition, two severely wounded people were transferred to Baraka Hospital, one with serious head injuries after being beaten with a rock, the other having been shot in the chest.

“Women had been restrained with ropes or beaten unconscious with the butt of a gun before being attacked, some in front of their children.” said Annemarie Loof, MSF head of mission in South Kivu. “Up to four armed men were involved at a time and homes and shops were looted.”

MSF provides specialised medical care to women and girls who have been raped, including post-exposure prophylaxis, which protects against the HIV virus and other sexually transmitted infections. Many women are afraid to seek treatment because of fear of being stigmatised by their families, or the risk of further harassment by armed groups.

“MSF is extremely concerned about the current situation in and around Fizi. People are fleeing the area fearing further violent attacks” said Loof.

In 2009 alone, MSF provided medical and psychosocial care for 5,600 rape victims in North and South Kivu.

MSF started supporting Tagadom Hospital in 2005, initially by providing general medical consultations, antenatal care, trainings for the hospital’s staff, equipping the laboratory, and providing drugs and medical supplies to the hospital. In 2006, MSF inaugurated a delivery room, laboratory, waiting area, latrines and waste management area and the entire hospital ground floor

In 2007, MSF supported the Ministry of Health in opening and setting up the only reproductive health unit in the area. At the time, the majority of the women of Tagadom and the neighbouring areas delivered in their homes with the assistance of a traditional birth attendant. Today more and more women come to deliver in the hospital, including women with complicated deliveries, all benefitting from high-quality medical care.

In coordination with the Ministry of Health, the reproductive health unit provides a range of free services, including antenatal and postnatal care, delivery services, family planning, sexually transmitted infection (STI) treatment and reproductive health counselling.

De-infibulation, the de-stitching of the vaginal outer lips, is performed when preparing an infibulated woman for delivery. In the MSF-run reproductive health unit mothers are not re-infibulated, or stitched back, after delivery because of the grave medical consequences.

The women in Tagadom and the nearby areas endure the most harmful form of female genital cutting (FGC): type 3 or pharaonic. This involves the removal of the outer female genitals, and infibulation or the stitching of the remaining outer vaginal labia, leaving but a small hole for urine and menstrual flow to pass through. This painful procedure is often performed on babies as young as seven-days-old and affects a female from childhood, into puberty and adulthood, with serious consequences for motherhood.

MSF health promoters explain that female children and adults who have undergone this procedure may face fatal bleeding, infections such as tetanus, develop cysts, experience painful menstruations and recurrent urinary tract infections. Many women will suffer acute pain during sexual intercourse. If they give birth, their labours are likely to be prolonged, increasing medical risks for the newborn.

In 2006 about 69% of females in Sudan and 80% of females in the Red Sea state had undergone some form of FGC. In Tagadom and neighbouring areas the numbers were even higher, with 98% of females undergoing some form of FGC .

“MSF’s health promotion team has achieved remarkable results in reaching out to the women and communities, discussing reproductive health issues and in particular the medical effects of FGC. Giving women complete information about their health, together with free, quality reproductive healthcare, is key to the increase in hospital attendance by women,” said Guilhem Molinie, MSF head of mission in Sudan.

From 1st January, 2007 to 30th December, 2010, Tagadom Hospital’s medical teams helped deliver 5,352 babies, conducted 51,506 antenatal consultations, and 7,838 women attended family planning sessions. Earlier this year MSF built and furnished an operating theatre to assist women with complicated deliveries and caesarean section; since then 71 caesarean sections were performed.

MSF is confident that the work it started in Tagadom Hospital will carry on under the auspices of the Ministry of Health.

Dr Massara Mohamed Osman Menyan, Tagadom Hospital’s Director said, “For the last five years, MSF in collaboration with the Ministry of Health, provided free, first-rate reproductive healthcare. Before MSF’s support, the hospital did not have a reproductive health unit; now there is one with all services available, including an operating theatre for complicated deliveries. With MSF leaving, the reproductive health unit will continue under the care of the Ministry of Health.”

MSF has been working in Sudan since 1979, and currently provides medical assistance in Warrap, Jonglei, Upper Nile, Unity, Western and Northern Bahr El-Ghazal, Western and Central Equatoria, the transitional area of Abyei, North and South Darfur, Red Sea and Al-Gedaref states.

Médecins Sans Frontières (MSF) is an independent medical humanitarian non-governmental organisation, and works in more than 60 countries. MSF teams assist people in distress irrespective of their religion, race or political beliefs.

Juba, 16th December 2010: As southern Sudan heads towards a January 9th referendum on secession, it is battling to contain its biggest kala azar outbreak in eight years. The severity of this outbreak is just one symptom of the wider medical humanitarian crisis facing the region, warns the international emergency aid agency, Médecins Sans Frontières (MSF), which includes an abysmal lack of healthcare, chronic malnutrition, regular outbreaks of preventable diseases, and insecurity that displaces communities and destroys lives.

Kala azar, or visceral leishmaniasis, is a neglected tropical disease contracted through the bite of a parasite-carrying sandfly, and is endemic in southern Sudan. Symptoms include an enlarged spleen, fever, weakness, and wasting. It thrives in poor, remote and unstable areas with extremely limited healthcare.

“With kala azar, it’s always a race against time to save lives. Yet the race is too often lost before it ever begins, as three-quarters of people are unable to access even basic medical care and the weak health system cannot cope with such emergencies,” says MSF medical coordinator Elin Jones. “This epidemic then further compounds the already dire medical humanitarian situation facing the population.”

If untreated, kala azar is fatal in almost 100 percent of cases within one to four months, but timely treatment can mean a success rate of up to 95 percent. By the end of November 2010, MSF had treated 2,355 people for the disease in Upper Nile, Unity and Jonglei states - eight times more than for the same period in the previous year.

This outbreak was further exacerbated by the reality that peoples’ immune systems were already weakened by increased levels of malnutrition this year. In the first ten months of 2010, MSF admitted 13,800 patients with severe malnutrition to its clinics, a 20% increase in numbers treated compared to the same time in 2009 and a 50% increase compared to all 2008.

On top of this, tens of thousands of southerners are returning from northern Sudan and further abroad in advance of the upcoming January referendum, and will thus be exposed to diseases endemic in the South, such as malaria, measles, meningitis, tuberculosis. Their presence will put enormous additional strain on already limited resources, including food, water and healthcare provision.

In addition, insecurity remains an ever-present reality in southern Sudan. Throughout 2010, it is reported that over 900 people were killed and 215,000 people displaced, due to inter-tribal violence, rebel groups like the LRA, and new militias.

”As the world focuses on the politics of the approaching referendum, it must not lose sight of the people, who are plunging from one emergency to the next,” says Rob Mulder, MSF Head of Mission in southern Sudan. “Southern Sudan remains mired in a humanitarian crisis, and as a viable health system will still take years to fully build, peoples’ immediate needs for food, shelter and healthcare must be better met. This will require a sustained and robust emergency response from the government and international community.”

MSF has been providing emergency medical humanitarian assistance in Sudan since 1979. Currently MSF runs 27 projects across 13 states of the country, providing a range of services, including primary and secondary healthcare, responding to emergencies as they arise, nutritional support, reproductive health care, kala azar treatment, counseling services, surgery, paediatric and obstetric care.

Geneva, 15th December 2010 – The Global Fund to Fight AIDS, Tuberculosis and Malaria has rejected ambitious proposals to turn back the AIDS epidemic in several high-burden sub-Saharan African countries. It has also decided to significantly delay the next opportunity for countries to apply for funding until December 2011, which leaves dangerous gaps for countries whose proposals were rejected. These decisions will hamper scale up of HIV treatment and implementation of state-of-the art strategies to prevent the spread of the virus, according to international medical humanitarian organisation Médecins Sans Frontières (MSF).  

The World Health Organization and other experts have recognised that early initiation of treatment is key to turning back the AIDS pandemic. For example, in a two-year study by MSF in Lesotho, patients who started treatment earlier were 68% less likely to die, 27% less likely to get new infections such as tuberculosis and 39% more likely to remain in care compared to patients who started treatment when their disease was more advanced. 

However, countries’ proposals to initiate early treatment, implement WHO guidelines and aggressively reduce transmission both between mother and child, and between adults, have been denied.

For example, Malawi’s proposal to reduce transmission may have been regarded as too ambitious. The proposal focused heavily on tackling transmission of HIV from mother to child by providing lifelong HIV/AIDS treatment to all HIV-positive pregnant women. They had also planned to spend more to retain health workers and scale up voluntary male circumcision to help slow down the spread of HIV. Similarly, Uganda’s proposal was also rejected. It had planned to dramatically increase its coverage rates of prevention of mother-to-child transmission, which currently stand at just under 50%.

Other countries are in a similar situation: Swaziland, Mozambique, DRC and Zimbabwe are among the high-burden countries that will receive no additional funds for AIDS treatment or prevention by the Global Fund in 2011. 

“These countries are among those hardest hit by the AIDS epidemic, so they must be given an opportunity to put in place programmes that will alleviate this enormous burden,” said Dr. Jennifer Cohn of MSF. “It is crucial that countries ensure the money is used to fund the most sound treatment approaches and governments are accountable, but without additional funding, these countries will not be able to turn the tide on AIDS.”

MSF calls on the Global Fund board to reconsider its decision to delay the next funding round.  MSF is also calling on donors to pledge additional funds to fill the US$8.3 billion deficit which resulted from weak donor pledges at the October replenishment conference. Donors such as Italy, the Netherlands and Sweden that have provided no support, and those that did not provide their fair share, such as Germany, need to do so urgently.

MSF also underlined the urgency of creating innovative financing mechanisms such as a financial transaction tax for health to support the Global Fund and global health.

Migrants and asylum seekers kept in detention facilities in the Evros region of northern Greece are in a critical situation. During the last two months the number of migrants without official papers crossing the border from Turkey to Greece has increased significantly, with 200 to 300 new arrivals each day. As a result of the recent influx, detention facilities are overcrowded, while conditions in the cells are appalling. To respond to the urgent needs of detained migrants, Médecins Sans Frontières (MSF) has started an emergency intervention in the Evros region, providing medical and humanitarian assistance.

During an assessment carried out in November in two detention centers (Venna, Fylakio) and three border police stations (Soufli, Tychero and Feres), MSF documented the harsh and inhumane conditions in which detained migrants are being kept. Most of the detention facilities are very overcrowded, operating at two or three times their capacity. Due to the lack of space, men, women, young children and unaccompanied minors are being kept together in the same cells. People have to sleep on the floor next to the toilets. Detention facilities holding more than 100 people typically have only two toilets and two showers, and there is a significant lack of materials for cleaning and personal hygiene. Despite the presence of Ministry of Health medical staff in most of the detention facilities (including doctors, nurses and one psychologist), medical services are still inadequate for the detainees’ needs due to the insufficient number of medical personnel, the absence of interpreter services, and the lack of medical screening and follow up of new arrivals. In addition, migrants and asylum seekers receive little or no information about their legal status and the detention system.

“The situation is critical for all the people who have been detained. Migrants have no place to sleep, they are not allowed to go out into the yard, and many of them are obliged to live for weeks or even months in unacceptable living conditions,” says Ioanna Pertsinidou, MSF’s emergency coordinator. “We decided to intervene immediately for the provision of medical care and humanitarian assistance.” Since the beginning of December, an MSF team has been in the Evros region providing healthcare and working to improve living and hygiene conditions in the detention facilities. Two MSF doctors are working in Tychero and Soufli border police stations treating patients who are mostly suffering from respiratory and skin infections due to the harsh living conditions. A logistician is working to improve sanitation inside the facilities and the MSF team is also distributing sleeping bags.

“What we witness every day inside the detention facilities is not easy to describe. In Soufli police station, which has space for 80 people, there are days when more than 140 migrants are detained there. In Tychero, with a capacity of 45, we counted 130 people. In Feres, with a capacity of 35, last night we distributed sleeping bags to 115 detained migrants. One woman, who had a serious gynaecological problem, told us that there was no space to sleep and she had no other option but to sleep in the toilets. In the detention centre of Fylakio, a few days ago several cells were flooded with sewage from broken toilets. MSF has ensured the disinfection of the cells and the toilets. In Soufli, where winters are known to be harsh, with below-zero temperatures, the heating is not working and there is no hot water. In many detention facilities, we saw many unaccompanied minors detained in the same cells as adults for many days without being allowed out in the yard,” says Pertsinidou.

An immediate and coordinated response is needed to respond to the current unacceptable situation and to ensure humane and dignified conditions for detained migrants. MSF urges the Greek government to immediately implement measures providing for the reception of asylum seekers and migrants under conditions which respect their human dignity. MSF also urges the EU and its member states to share the responsibility of receiving asylum seekers and migrants, rather than focusing on restrictive measures, such as the deployment of FRONTEX rapid border intervention teams.

UK, Germany and France pushing to undermine India’s pro public-health law

Brussels/London 10 December 2010 – As leaders from India and the European Union meet for a summit in Brussels, Médecins Sans Frontières (MSF) – together with AIDS groups protesting in Africa, Asia and Europe – demand the EU stop pursuing measures that undermine India’s role as producer of affordable life-saving generic medicines. More than 80% of the AIDS medicines used to treat more than five million people across the developing world come from producers in India.

“A decade ago, people wouldn’t even bother getting tested for AIDS because they knew the drugs to treat them were too expensive anyway,” said Dr. Peter Saranchuk, HIV doctor for MSF in South Africa. “I refuse to go back ten years. We cannot let the Europeans shut down the supply of affordable medicines we and others rely on to treat patients around the world.”
 
India’s 2005 patent law, which fully respects international rules, is strict about what does and what does not deserve a patent, in the interest of public health. Patents are only granted for medicines that show significant innovation, which is a fact that has long upset the pharmaceutical industry in wealthy countries. European drug companies have actively – but so far unsuccessfully - sought to challenge the law in Indian courts. Earlier this month, German firm Bayer failed in its latest legal attempt to introduce a further barrier to generic competition in India. Having lost in the courts, the companies are now using the European Commission’s trade policies to try to block generic competition in India.

“We know that behind the scenes, the UK, Germany and France are the ones doing the bidding for their pharmaceutical industries to try to stamp out the competition from India,” said Michelle Childs, Policy Director at MSF’s Campaign for Access to Essential Medicines, speaking at a protest outside the summit in Brussels.  

As a part of the negotiations for a free trade agreement with India, the Europeans are pushing several provisions that would limit competition, in particular ‘data exclusivity’ which would act like a patent and block the marketing of generic medicines for up to ten years. Alarmingly, data exclusivity would apply even for products that didn’t deserve a patent in the first place under India’s law. It would block the development of new fixed-dose combinations, where several medicines are combined into one pill, even though these cannot be patented in India.

“The EU is trying to give their pharmaceutical companies a backdoor route to monopoly status, when they can’t get a patent through the front door,” said Childs.  

Generic medicines from India have played a critical role in scaling up AIDS treatment across the developing world because until 2005, the country did not grant patents on medicines. This allowed manufacturers to produce more affordable drugs, pushing their price down by more than 99% over the past decade. But World Trade Organization rules obligated India to start granting medicines patents in 2005. This is having a major impact on access to affordable versions of the newer generation of HIV/AIDS drugs, some of which – for example raltegravir and etravirine – have already been patented in India. Now the policies the EU are pushing would restrict the production of affordable medicines even further.  

“European leaders can’t turn a deaf ear to the growing number of voices around the world asking them to take their hands off affordable medicines,” said Childs. “Vague reassurances that the EC is not seeking to harm the production of affordable medicines are not enough, as the devil is very much in the details. At this point, we want a clear statement from the EC that data exclusivity and other damaging provisions are out of the free trade agreement text.”

Protests are taking place this week in Nairobi, Bangkok, Jakarta, India and Brussels in opposition to the impact of the EU’s trade policies on access to medicines.  

To support MSF’s ‘Europe! Hands Off Our Medicine’ campaign, click here

A promising new vaccine that could prevent future outbreaks of the deadliest form of meningitis in Africa will be provided to people in Mali and Niger this month with the support of international medical organisation Médecins Sans Frontières (MSF). The vaccination campaign against meningococcal Meningitis A is being carried out in collaboration with health authorities in both countries.  

“This vaccine could effectively prevent new outbreaks of Meningitis A in the future,” said Florence Fermon, MSF’s vaccination policy advisor. “But for the impact to really be felt, there needs to be a plan to roll out the new vaccine sufficiently in the 25 African countries that are most at risk of epidemics.”

MSF’s efforts are part of a larger vaccination campaign led by the Ministries of Health in Niger, Mali and Burkina Faso and the WHO. MSF is planning to provide support to the Ministry of Health in Niger in vaccinating 600,000 people between the ages of 1 and 29 in the Dosso and Boboye districts. In Mali, MSF teams will vaccinate 800,000 people in the Koulikoro, Kati and Kangaba districts.

For years, MSF has been mounting emergency responses to outbreaks in Africa’s ‘meningitis belt’, an area stretching from Senegal to Ethiopia which is regularly hit by epidemics - in 2009, MSF vaccinated more than seven million people for Meningitis A. But the polysaccharide vaccine that has been available until now offered protection for only up to three years, which limited MSF’s response to trying to slow and stop an epidemic once it was under way.

“There are big benefits with this vaccine: protection can last for 10 years which means we can vaccinate people before epidemics hit and actually prevent the epidemics” said Florence Fermon. “Also, it can be used for children under the age of two years. But most importantly, there are wider benefits: the vaccine will stop transmission of the bacteria within a population by eliminating the carriage of the germ. It means that people who are vaccinated will not pass on the bacteria to those who are not.”

But challenges remain – the funds to vaccinate people in the other 22 countries across the meningitis belt have yet to be identified, and a phased plan for rolling out the vaccine also needs to be developed.  

“Thanks to an innovative way of doing research and development where the need for an affordable product was factored in from the very start, this vaccine costs only 40 US cents per dose” said Dr Tido von Schoen-Angerer, Director of MSF's Access to Essential Medicines Campaign. “But despite its low price, no donor has yet come forward to offer financial support to implement the vaccine beyond the first three countries. National authorities should receive the necessary support to vaccinate in sufficient numbers. Also, it has to be ensured that when children turn one year of age, they receive this vaccine as a part of routine immunisation activities. We can not afford to miss the opportunity to tackle such a deadly disease.”

Notes to editor

Meningitis A is the most common strain of the disease in the meningitis belt. Symptoms include sudden and intense headache, fever, nausea and vomiting, and death can follow within hours of the onset of symptoms. Without treatment, those people infected stand only 50% chance of survival.

The new vaccine, MenAfriVac, is the product of an alternative model for conducting research and development that cost between two and six times less than typical vaccine development projects run by multinational pharmaceutical companies. The result is that a vaccine with characteristics specifically tailored to a particular population has been developed, with provisions to ensure it is affordable built in from the start.  

Geneva, 29th November 2010 – HIV/AIDS treatment in developing countries is being dealt a double blow that will mean treatment recommendations cannot be implemented and the promises of new science remain unfulfilled, said the international medical humanitarian organisation Médecins Sans Frontières (MSF). 

“The price of the newer medicines we need is set to go through the roof, just as donors decided to retreat from their commitment to expand AIDS treatment,” said Dr. Gilles van Cutsem, MSF’s medical coordinator for South Africa and Lesotho.  “As doctors trying to treat people with HIV/AIDS, we feel like our hands are being tied behind our back.”

The World Health Organization’s (WHO) latest recommendations for AIDS include treating people with better tolerated drugs, and earlier. The revised strategy calls for treating people before they become ill from opportunistic infections such as tuberculosis. Data just published from MSF’s project in Lesotho shows the value of this new strategy: providing people with treatment earlier led to a 68% reduction in deaths, a 27% reduction in new diseases, a 63% reduction in hospitalisation, and a 39% reduction in people defaulting from care.

This “treat early” strategy has a benefit to individuals, but also to society, as it makes people with HIV less infectious and hence less likely to transmit the virus. Research in Africa has shown that treating AIDS can reduce heterosexual transmission of the virus by 92%.

“The evidence of what we need to do in order to turn the tide of the epidemic is mounting,” said Dr. van Cutsem. “But just as we’re seeing the promise of the latest treatment recommendations, the money that donors are allocating to HIV/AIDS is stagnating. Even South Africa, a middle-income country with the largest ART programme in the world, will struggle to implement the full WHO recommendations if its Round 10 proposal to the Global Fund is not approved.”   

The Global Fund recently received only US$11.7 billion in pledges, compared to the $20 billion it has said it needed. The US-funded PEPFAR program, which supports at least half of all people on HIV/AIDS treatment in developing countries, is flat-lining funding for the third year in a row.   

At the same time, rich countries are working to give unfair advantages to companies that make patented products, limiting access to generic medicines and raising prices. 80% of the AIDS medicines MSF uses to treat 160,000 people come from generic producers in India, the so-called ‘pharmacy of the developing world,’ as do more than 80% of donor-funded AIDS medicines on a global scale.  India’s position as key producer of affordable medicines has already been compromised by World Trade Organization rules that obligate the country to grant patents on medicines. 

Yet India has a patents law that imposes strict limits on what can and cannot be patented, in the interest of public health. Multinational pharmaceutical companies have tried and failed to have this law overturned, and now the EU is taking up their fight. As a part of free trade agreement negotiations with India, the EU is pushing for policies such as ‘data exclusivity,’ which would act to restrict even further generic producers’ ability to put more affordable generic medicines on the market. If the EU wins, the availability of affordable generic versions of newer medicines needed to tackle HIV/AIDS will be severely compromised.

“We can’t afford to simply watch rich countries chip away at our ability to treat people living with HIV/AIDS,” said Dr. Tido von Schoen-Angerer, Executive Director of MSF’s Campaign for Access to Essential Medicines.  “We urge people to take a stand and say they do not support the European Commission doing the bidding of drug companies.”

To join MSF’s effort EUROPE! HANDS OFF OUR MEDICINES click here.

MSF has been providing antiretroviral therapy since 2000 and today treats more than 160,000 people living with HIV/AIDS. Five million people are on treatment in developing countries today.  This represents important progress, but ten million people are still waiting in line and will die within the next several years if left untreated.

Port-au-Prince, Haiti, 19th November, 2010 — Critical shortfalls in the response to the cholera epidemic are undermining efforts to stem the ongoing crisis, said the international medical humanitarian organisation Médecins Sans Frontières (MSF) today.

Despite the huge presence of international organisations in Haiti, the cholera response has to date been inadequate in meeting the needs of the population.  According to national authorities, more than 1,100 people have died and at least 20,000 have fallen sick since the beginning of the outbreak.

“MSF is calling on all groups and agencies present in Haiti to step up the size and speed of their efforts to ensure an effective response to the needs of people at risk of cholera infection,” said Stefano Zannini, MSF head of mission in Haiti. “More actors are needed to treat the sick and implement preventative actions, especially as cases increase dramatically across the country. There is no time left for meetings and debate – the time for action is now.”

The following actions must be prioritised:

• Reassuring a population frightened by a disease that is completely unknown in the country, including by publicly communicating the low risk and positive benefits of having properly-run cholera treatment centres in close proximity to communities;
• Providing safe, chlorinated water to affected and at-risk communities nationwide, in addition to blanket distributions of soap;
• Building latrines and safely removing waste on a regular basis;
• Ensuring waste management and removal at medical facilities, in order to prevent contamination;
• Establishing waste disposal sites close to urban areas in appropriate and controlled environments
• Establishing adequate oral rehydration points in areas where cholera cases are appearing;
• Maintaining a safe and efficient network for referral of severe cases to cholera treatment centres;
• Ensuring safe removal and burial of dead bodies

Since the beginning of the epidemic, MSF has set up more than twenty cholera treatment facilities throughout the capital, Port-au-Prince, in the Artibonite region, and in the north of Haiti. MSF teams working around the clock treated more than 16,500 people from 22nd October to 14th November. Over 240 tons of medical and logistical supplies have been brought into the country and MSF has more than 1,000 Haitian staff dedicated to cholera treatment, working alongside 150 international staff.

“Cholera is an easily preventable disease,” said Caroline Seguin, MSF emergency medical coordinator. “It may be new to Haiti, but the ways to prevent and treat it are long established. Without an immediate scale up of necessary measures by international agencies and the government of Haiti, we alone cannot contain this outbreak.”
In Port-au-Prince, the number of people seeking treatment at numerous MSF-run and MSF-supported medical structures jumped from 350 for the week ending on 7th November, to 2,250 cases for the week ending on 14th November. In the north of the country, MSF medical structures logged 280 cases during the week ending on 7th November, but that number jumped to 1,200 cases for the week ending on 14th November.

MSF has more than 3,000 Haitian and international medical and non-medical staff providing assistance to the population through its other ongoing programs. They run seven free of charge, secondary-level care hospitals and support two Ministry of Health structures in Port-au-Prince, accounting for nearly 1,000 hospital beds in the capital city. Outside the capital, MSF supports Ministry of Health hospital in the city of Jacmel with nearly 80 beds of patient capacity. In Leogane, MSF has been running a private emergency hospital since January and has replaced it with a 120-bed container hospital in September.

“Swaziland has the highest HIV prevalence in the world among adults. Disturbingly, more than 80 percent of TB patients are also co-infected with HIV,” says Aymeric Péguillan, MSF’s head of mission in Swaziland. “Life expectancy has halved within two decades, plummeting from 60 to just 31 years. People are dying in large numbers, and tuberculosis is currently the main cause of mortality among adults. As a result, many children are being made orphans and the adult workforce is declining.”

Swaziland also has an alarmingly high prevalence of multidrug-resistant TB (MDR-TB), which accounts for 7.7 percent of all new TB cases and places Swaziland amongst the countries with the highest prevalence of MDR-TB (revealed by the joint MSF/National TB Programme 2009-10 Drug Susceptibility Survey). Tackling this crisis is hindered by an acute shortage of local health staff, inadequate diagnostic facilities and by patients failing to complete their treatment, often because of the prohibitive cost of making long and frequent journeys to distant health facilities.  

In November 2007, MSF and the Ministry of Health introduced a decentralised, integrated and patient-centred approach to fight the co-epidemic in Shiselweni, the country’s poorest and most remote region. As a result, innovative ‘one-stop services’ for HIV and TB care are today available in 21 health facilities. The number of people tested for HIV each month has more than tripled in 18 months, reaching 1,617 in June 2010.

“Decentralising integrated HIV and TB services all the way down to rural clinics and communities has dramatically improved patients’ access to care, and significantly reduced the number of patients defaulting from treatment,” says Péguillan.

Other innovative approaches have been implemented with great success, in particular making better use of human resources by shifting responsibilities from doctors to nurses, and from nurses to lay community.

The challenge now is to build on these successes. Improved infection control measures, implementation of new diagnostic techniques and task-shifting amongst health workers to manage the growing number of people with HIV in need of treatment (set to increase in line with the latest WHO recommendations*) need to be expanded nationwide.

“Introducing these measures is vital. The scale of the co-epidemic in Swaziland demands urgent political commitment translated into immediate action. We can save thousands of lives if we act now,” says Péguillan.

In 2006, the then Prime Minister of Swaziland made an urgent request for external help to fight the HIV and TB crisis sweeping the country. Since late-2007, Médecins Sans Frontières (MSF), together with Swaziland’s Ministry of Health, has been providing HIV and TB care to patients in Shiselweni. By the end of June 2010, out of almost 20,000 HIV-positive people in need of treatment in Shiselweni region, close to 11,000  patients were on antiretroviral treatment, including 2,845 managed at clinic level. An average of 2,450 patients have been initiated on anti-TB treatment annually since January 2008. A total of 140 patients have been initiated on treatment for drug-resistant TB treatment since January 2008.    

* In 2009, the WHO recommended earlier initiation of treatment for patients, from a CD4 count of 200 to a CD4 count of 350. The CD4 count refers to the number of infection-fighting white blood cells in a cubic millimetre of blood, and indicates the state of a patient’s immune system.

Brussels, 8th November 2010 – As negotiations on an EU-India free trade agreement (FTA) resume in Brussels today, international medical humanitarian organization Médecins Sans Frontières (MSF) is calling on Europe’s highest trade official to halt actions that will dramatically restrict access to affordable generic medicines produced in India. 

“European Trade Commissioner Karel De Gucht is attempting to give Europe’s pharmaceutical industry a backdoor to monopolies that lead to high drug prices and will keep pills out of reach of patients,” said Dr. Tido von Schoen-Angerer, Director of MSF’s Campaign for Access to Essential Medicines. “India has a patents law that is strict about what does and what doesn’t deserve a patent, but Europe is using dirty legal tricks to get around this law and block cheaper generic medicines.”

Europe is pushing ‘data exclusivity’ policies that would hamper generic competition for up to ten years. These block the standard practice, recommended by the World Health Organization, of generic makers using existing studies on identical products to get their medicines approved for sale. When India rejected a patent on an AIDS medicine for children, nevirapine syrup, in 2008 for example, it meant generic producers could be certain that they can produce and sell more affordable versions of the syrup.

But if data exclusivity had been in place in India, as the EU now wants, producers would have had to wait up to ten years before selling this drug, even though it did not deserve a patent in the first place. 

“Our medical programmes depend on a constant supply of affordable medicines. For people with HIV/AIDS who need medicines to stay alive, a ten-year wait to get a newer drug is not viable. They’ll die waiting,” said Ariane Bauernfeind, Operational Coordinator for MSF projects in South Africa, Malawi, Lesotho and Zimbabwe. “Half of all children born with HIV/AIDS won’t make it to their second birthday without treatment. We can’t let the EU shut down our supply of affordable newer medicines.”

Trade Commissioner Karel De Gucht is also pursuing policies harmful to access to medicines through ACTA, the Anti-Counterfeiting Trade Agreement that has been negotiated in secret.  The deal claims to be an effort to protect consumers from fake medicines, but it will inhibit the production of legitimate, affordable and safe medicines by giving companies far reaching powers to block competitors’ products.

“The EU has been far less than truthful in response to our concerns. The devil is in the detail, and we demand Trade Commissioner De Gucht quit the spin that hides the health impact his policies will have for people across the developing world,” said von Schoen-Angerer, as MSF delivered an open letter for the Trade Commissioner. “People whose lives depend on Indian generics have taken to the streets in Delhi, Bangkok, Jakarta and Kathmandu, amplifying the message that EU Trade Commissioner De Gucht needs to back off.” 

Note to editors:
India has been called the ‘pharmacy of the developing world,’ because it produces affordable versions of medicines that are the cornerstone of treatment programmes everywhere. MSF sources more than 80% of the medicines it uses to treat more than 160,000 people with HIV/AIDS from producers in India, and a recent study in the Journal of the International AIDS Society found that more than 80% of all donor-funded HIV medicine purchases for developing countries from 2003-2008 were for generic drugs from India. 

Until 2005, the country did not grant patents on medicines. Since 2005, WTO rules required India to start granting patents on medicines, and already a number of newer HIV drugs are patented, raising serious concerns about their affordability. Fortunately for access to medicines, the Indian patent law reserves patents only for drugs that show a therapeutic benefit over existing ones. But the EU intends to override India’s public health safeguards and the right of the county to balance patents and public health concerns.

Pictures and video of MSF delivering the letter to the commission will be available early afternoon on www.msfaccess.org

Click here to tell Europe to keep their hands of our medicine!

The world’s top food aid donors, including the United States, Canada, Japan, and the European Union, continue to supply and finance nutritionally substandard foods to developing countries, despite conclusive scientific evidence of their ineffectiveness in reducing childhood malnutrition, said the international medical humanitarian organisation Médecins Sans Frontières (MSF) in advance of World Food Day on 16th October.

Malnutrition – a preventable and treatable condition – affects 195 million children worldwide, the majority of whom live in areas not affected by armed conflicts. It is the underlying cause of at least one-third of the 8 million annual deaths of children under 5 years of age. Malnutrition is not merely the result of too little food. The first two years of life are a critical window when children need a diet consisting of high-quality protein, essential fats, carbohydrates, vitamins, and minerals in order to avoid impaired growth and development, increased risk of death from common illnesses, or life-long health and developmental impairment. Yet food aid largely does not include these essential ingredients for early childhood growth and development.

“Food aid donors have to put the nutritional needs of young children at the centre of their policies to address childhood malnutrition,” said MSF International President Dr. Unni Karunakara. The vast majority of childhood nutrition programmes in developing countries that are supported by international food assistance rely almost exclusively on fortified blended flours such as corn- and soy-blend (CSB) cereals. CSB cereals do not meet international standards for the nutritional needs of children under two years of age.

“Foods we would never give our own children are being sent overseas as food aid to the most vulnerable children in malnutrition hotspots in sub-Saharan Africa and parts of Asia,” said Dr. Karunakara. “This double standard must stop.”

Countries that have successfully reduced early childhood malnutrition – including Mexico, Thailand, the U.S., and many European countries – have done so through programmes that ensure infants and young children from even the poorest families have quality foods, such as milk and eggs. International food assistance has failed to keep up with advances in nutritional science for childhood development. In October 2008, a World Health Organization panel of nutrition experts recognised that CSB is inappropriate for treating malnourished children, including because it can inhibit the absorption of important proteins and other nutrients essential to a young child’s recovery from malnutrition.

“Despite an international consensus on the most appropriate nutritional composition of foods for malnourished children, donor countries continue to subsidise and supply a one-size fits all product that we know fails to meet this standard and to decrease the risk of death due to malnutrition,” said Dr. Susan Shepherd, MSF nutrition advisor.  “We have seen huge advances in the ways to protect children from malnutrition. No child should have to reach the brink of death before getting the nutrition they need to grow and thrive.”

MSF medical teams witness the human devastation caused by malnutrition throughout the world. In 2009, MSF treated 250,000 children suffering from acute malnutrition in 116 programmes in 34 countries. MSF has launched an international campaign, “Starved for Attention,” to urge countries making the largest contributions to food assistance – including the U.S., Canada, the European Union, and Japan – to supply the right foods and adequate resources for nutrition programs in countries most affected by malnutrition. MSF is sending letters to the heads of these governments to call for the reform of their food aid policies. Tens of thousands of people have already signed the petition at www.starvedforattention.org, which will be presented to leaders on the eve of the G8 Summit in France in 2011.

As stipulated in Moroccan law, pregnant women, children and other vulnerable groups of migrants must not be expelled to the border and MSF is deeply concerned about this deterioration in the medical and humanitarian situation for sub-Saharan migrants in Morocco.

“This intensification of restrictive measures to control migration in Morocco has a direct impact on the health and the dignity of migrants and refugees,” says Jorge Martin, MSF’s head of mission in Morocco.

Police operations took place between 19th August and 10th September in cities throughout Morocco including Oujda, Al-Hoceima, Nador, Tangiers, Rabat, Casablanca and Fez. In many of the raids, police forces used bulldozers, and in Nador, helicopters, to destroy migrants’ tents and houses.

An estimated 600 to 700 migrants were arrested during the raids and taken to the border between Morocco and Algeria. There, migrants were left to fend for themselves, without food or water. Among them were pregnant women, women with children and people with medical problems or injuries directly or indirectly related to the police raids. They faced the choice of returning to Oujda on foot or trying to cross to the Algerian side of the border. Abandoned there in the middle of the night, they were also at risk of being attacked and robbed by bandits and smugglers who operate in the area. Those who managed to reach the city of Oujda are completely destitute, without money, shelter or personal belongings.

“Our team has witnessed the direct impact of these mass raids and expulsions on the medical condition and mental health of the migrants,” says Jorge Martin. “We provided medical support to a woman who had given birth to her child just six days before. She was arrested by the police forces and spent five days in a police cell with her newborn child. Then she was taken back to the border. She has managed to come back to Oujda, but is now suffering from acute gastrointestinal syndrome. ”

During the past few weeks, MSF teams have seen an alarming increase in patients with medical problems related to incidents of violence. Of the 186 patients who have received medical care from MSF, 103 had lesions and injuries directly or indirectly linked to the violence during the arrests. The harsh living conditions and the lack of proper shelter have also contributed to the increase in medical problems. Almost half of the migrants who sought medical care from MSF teams had medical symptoms linked to the difficult and insanitary conditions in which they are living. Eighteen percent had skin infections, ten percent had respiratory infections and 11 percent had digestive problems.

MSF has been working in Morocco since 2000, carrying out healthcare projects in Tangiers, Casablanca, Rabat and Oujda, providing sub-Saharan migrants with medical and humanitarian assistance and advocating for better access to healthcare and respect for migrants’ human dignity. Currently, MSF is running a project in Oujda providing medical and psychological care to migrants and refugees.

New York, NY, September 20, 2010 — World leaders assessing progress of the United Nations Millennium Development Goals (MDGs) in New York this week could transform the fight against two of the leading causes of childhood deaths—malnutrition and HIV/AIDS—by implementing an innovative funding mechanism for global health, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

The World Health Organization reports that an additional $37 billion needs to be spent on global health every year by 2015 in order to meet the health-related MDGs. The intergovernmental Leading Group recently estimated that a financial transaction tax—a levy as little as 0.005 percent on transactions of the world’s four most traded currencies—could generate an estimated $33 billion a year to implement the latest medical advances against global health threats, including malnutrition and HIV/AIDS.

“For many diseases, we know what we need to do to save lives,” said Sophie Delaunay, executive director of MSF in the U.S. “Our field teams are using new tools and approaches to release children from the deadly grip of malnutrition and to ensure children are born free of HIV, but there is not enough funding for long-term, widespread implementation of effective health interventions. A financial levy for health, by providing a dedicated and predictable funding stream, could mean that patients’ lives are no longer at the mercy of volatile markets and political agendas.”

The political response to recent global financial volatility has had a catastrophic effect on the reliability of funding and foreign aid commitments for global health issues. This has left considerable gaps in the financing of key institutions such as the Global Fund to Fight AIDS, TB, and Malaria, as some donor governments such as the United States, Germany, Italy and Spain, renege on previous commitments or stagnate or decrease their funding.

In Malawi, the government has submitted a Global Fund application for funding to provide lifelong antiretroviral treatment to all pregnant HIV positive women. This would dramatically reduce the transmission of HIV from pregnant women to their children.  But given the Global Fund’s constrained budget and the pessimistic predictions around future contributions from donor nations, there is a risk that Malawi will not receive this grant and will not be able to fully implement a program that could greatly reduce the number of children born with HIV. Some countries have already been forced to implement 10 percent “efficiency cuts” to funds approved in the last round of grants

“It is no longer enough to reiterate a commitment to access to care and treatment – to maternal and child health, to the global AIDS fight," said Delaunay. “Unless alternative funding models are put in place to guarantee long-term and sufficient funding, countries will continue to be limited and these stated commitments will be nothing but rhetoric.”

The lack of sustainable global health funding also undercuts the potential to expand the implementation of highly effective programs to prevent childhood malnutrition, a condition that contributes to the deaths of between 3.5 and 5 million children under five years of age every year. MSF has demonstrated how new treatment tools and approaches make it possible to not only cure, but also to prevent malnutrition for hundreds of thousands of children in the world’s malnutrition “hotspots.” For example, working alongside local organizations in Niger, MSF has treated 77,000 severely malnourished children so far this year. Since July, MSF has also been distributing food supplements to more than 143,000 young children to prevent them from becoming malnourished.

Efforts to combat malnutrition at an earlier stage, such as the ongoing Niger intervention, are crucial in dealing with the recurrent nutritional crises affecting many countries in Africa’s Sahel region. These efforts can only be sustained through long-term financial commitments from main international donors.

According to a World Bank evaluation, it costs $12.5 billion annually to adequately fund recognized effective nutrition interventions in the most-affected countries. An MSF analysis estimates that only a small fraction of this is actually spent annually – just $350 million in 2007.

A financial transaction tax for health could transform some of the world’s malnutrition “hotspots” and put governments much closer to adequately treating and preventing a main cause of childhood deaths worldwide. 

One such funding mechanism for health already exists in the form of UNITAID, the international agency that finances HIV/AIDS treatment programs through miniscule taxes on airfares. The International Monetary Fund recently deemed financial transaction taxes feasible, and at the MDG Summit, France and Japan will endorse and promote financial transaction taxes as a promising method to raise funds for development aid.

Brice De Le Vingne, Médecins Sans Frontières (MSF) operations coordinator for Afghanistan and Pakistan, told Channel 4 News the situation was mass case emergency with two distinct challenges: those stranded on the mountain hills due to washed out bridges, and those marooned in the valley still wading through two meters of water.

The around 50 per cent of the valley's 1.7m population are stranded, he said. He added: "It is a major emergency - there are pockets of people completely out of reach."

Mr De Le Vingne said MSF is currently opening mobile drinking water centres in the Swat Valley and is awaiting clearance from the Pakistan authorities for a helicopter to assess those stranded in the mountains.

Recent heavy rainfall in Pakistan’s north-western region has directly affected 400 000 people and caused widespread destruction to houses and infrastructure. MSF is currently assessing the situation in order to tailor its response to this emergency.

MSF is carrying out exploratory missions in Swat, Lower Dir, Dargai and Peshawar districts to assess the damage and the subsequent needs of the affected populations in these areas.

An exploratory mission in the town of Bakthirabad in Sibi district in the province of Baluchistan is already complete and the team will return on Sunday to distribute hygiene kits, plastic sheeting and ready-to-use food items.

“There is widespread destruction on the ground, and we still need to get a clearer picture of where MSF is needed the most” says Benoit De Gryse, MSF’s Head of Mission in Pakistan. “What complicates matters is that destruction is patchy, and there are pockets of people that are very hard to reach due to the flooding.”

MSF’s project in the town of Timurgara, Lower Dir is inaccessible from all areas, as all bridges providing access to the area have been destroyed. MSF is continuing its activities in Timurgara, and received and treated 10 trauma cases in the MSF-supported emergency room in the town hospital. MSF is currently focusing on providing safe drinking water to the hospital.

MSF is also erecting 3 temporary cholera treatment centres in the Swat, Lower Dir and Dargai districts. MSF’s cholera treatment centre in the Hangu district is continuing its activities.

“These are the worst floods in these areas for generations. A lot of houses are built out of mud, which makes them more vulnerable to damage. Many people are unable to reach health structures, due to areas being cut off by the water. For those who have been affected, it is of vital importance to attend to immediate basic needs such as sanitation and hygiene.”

Following three separate security incidents in one of its remote healthcare clinics, international emergency medical aid organisation, Médecins Sans Frontières (MSF) has been forced to suspend all activities in Gumuruk, Jonglei State, Southern Sudan.

MSF is calling on all armed groups, community members and political parties in Southern Sudan to respect the neutrality of MSF medical staff, activities and facilities, so that life-saving aid can be urgently delivered to people in need.

“Attacks on our staff and clinics prevent us from providing essential medical aid. These incidents are totally unacceptable as they stop us from treating patients and put our staff at risk,” said Rob Mulder, MSF head of mission in Southern Sudan.

In Jonglei State, MSF runs a healthcare centre in Pibor town, and two smaller outreach clinics in more remote areas, Lekwongole and Gumuruk, which are only accessible by plane or boat during the current rainy season.

On 1st July an armed group entered Gumuruk clinic, stealing boxes of Plumpy Nut, a peanut-based food needed to treat severely malnourished children. Three days later, on 4th July, Plumpy Nut was again stolen, in addition to medical equipment. Then, on 27th July, while travelling by boat from Pibor to Gumuruk, four MSF staff members were violently robbed by armed men.

“Though we are fully committed to providing emergency medical aid to Gumuruk community, we have been left with no other choice than to suspend all medical activities in our outreach clinic,” added Mulder.

The Gumuruk outreach clinic serves a population of more than 30,000 people, providing basic medical care, including general consultations, treatment for malnutrition, ante-natal care and vaccinations. Complex medical cases requiring hospitalisation are referred to MSF’s bigger clinic in Pibor, from where serious cases in need of surgery are evacuated by MSF plane to hospitals in Boma, or in the capital, Juba.

“More than 160 malnourished children were receiving treatment in our Gumuruk clinic. In addition, there were up to 20 severely malnourished children arriving each week. Unless the situation improves, it is impossible to evacuate those who need hospitalisation or surgery, including women with obstructed labour, children with cerebral malaria or severe anaemia who need blood transfusions,” said Gbane Mahama, MSF medical coordinator for Southern Sudan. 

Apart from a small Ministry of Health facility in Pibor town, MSF is the only primary healthcare provider in this part of Jonglei State, home to around 150,000 people, where villages are separated by large distances and roads are often impassable.

MSF has been working in Sudan since 1979 providing free-of-charge medical assistance to people suffering from the effects of poor access to healthcare, floods, droughts, disease outbreaks, armed conflict and nutritional emergencies.

MSF runs clinics and hospitals across ten Sudanese states, including Warrap, Jonglei, Upper Nile, Unity, Northern Bahr-el-Ghazal, Western Equatoria, Central Equatoria, the transitional area of Abyei, Red Sea, Al-Gedaref and North Darfur.

MSF is an independent and neutral emergency medical organisation that serves all people based on impartial assessments of need, regardless of race, political, tribal or religious affiliation.

Field research presented today by the international medical humanitarian organisation Médecins Sans Frontières at the International AIDS Conference in Vienna provides further evidence that implementing early treatment initiation and an improved first-line regimen significantly reduces mortality rates and makes treatment adherence easier for patients, even in remote settings. This focus on patients is neglected in the dominating messages heard throughout the conference calling for more financial efficiencies in a time of economic recession.

In a two-year study of 1,128 patients from rural Lesotho, where the government has adopted new World Health Organization (WHO) guidelines, patients starting treatment earlier (at CD4 counts of less than 350) were 70 per cent less likely to die, 40 per cent more likely to remain in care, and more than 60 per cent less likely to be hospitalised compared with those started when their disease was already advanced (< 200).

“Treating people before they get very sick is better for the individual, better for the community and actually lessens the burden on the health system,” said Dr Helen Bygrave, HIV physician for MSF in Lesotho. “In all this talk about efficiency, the patient gets lost.”

MSF also presented findings from its project in Mozambique where antiretroviral therapy was distributed within the community via community groups. This simplified approach shows that patients in remote and poor areas can remain healthy and adhere to their treatment with a limited reliance on health centres, showing similar outcomes as in clinic-based programmes and an extremely low loss to follow-up (less than 1%).

However, treatment scale-up is threatened by insufficient financial resources and increasing drug costs. The cost of the improved WHO-recommended first-line regimen and increasingly needed second-line drugs are coming down slowly and patent protection is limiting generic competition for newer drugs.

In another study from Lesotho, MSF showed that the new WHO-recommended first-line combination with tenofovir not only leads to better health outcomes, but that a further 30 per cent reduction in the drug’s price will make its cost equal to the more toxic old regimen (containing stavudine), when taking into account measures of quantity and quality of life.

“Drug companies have not been challenged at all on prices at this conference and the head of a major foundation even stated that drug costs are low enough and efficiencies need to be found elsewhere,” said Dr Tido von Schoen-Angerer, director of the MSF Access to Essential Medicines Campaign. “What we really need are efficiencies that will benefit people with HIV. That means reducing drug costs much more aggressively, making treatment easier for patients and ensuring more resources to increase access to treatment as early as possible.”

International donors are disregarding scientific evidence on the benefits of earlier and expanded treatment. They do so at the expense of the ten million people in need of treatment in order to achieve short-term cost savings, said Médecins Sans Frontières (MSF) at the International AIDS Conference on Monday. 

“Today international donors expect doctors to tell patients to come back for treatment when they’re at death’s door,” said Dr Eric Goemaere, medical coordinator at MSF in South Africa. “This is bad medicine. As a doctor I’d much rather give a patient pills today and send her home than delay treatment and see her in six months at the hospital with complicated tuberculosis.”  

MSF will present evidence, including data from its project in the Southern African country of Lesotho, at the international AIDS conference this Thursday that shows how earlier treatment reduced the mortality rate and hospitalisation among HIV patients by more than 60 per cent.
 
But this type of research is being ignored by international donors, particularly the United States – the world’s primary HIV treatment donor – which is now advising countries to restrict treatment to those in the more advanced stages of HIV disease.

In addition to medical and financial benefits of earlier treatment initiation, studies are also showing that making treatment widely available at community level is one of the most effective ways to prevent HIV.

Despite this evidence, there is a general trend toward backtracking on HIV funding which will increasingly mean treatment being delayed, deferred, or denied. The Global Fund – the world’s principal funding mechanism for HIV treatment – faces a major financing gap. The US is proposing both continued PEPFAR program flat-funding and a decrease in its contribution to the Global Fund. Just this week, the German media reported top-level discussions to cut its contribution to the Fund three-fold. Austria, the International AIDS Conference host country, has not contributed a single dollar to the Fund since 2001.

This retreat comes after a decade of progress – more than 5.2 million people alive on treatment today – made possible by the emergence of affordable generic drugs and the commitment of donor countries. With 1.2 million people starting treatment in 2009, progress has been rapid. Yet there are still 10 million people waiting to start treatment and the current climate suggests a decreased commitment to fund treatment for those waiting in line.

“Donors repeatedly promised millions of people a lifeline to treatment,” said Goemaere. “It is a matter of choice: will donors help pay for treatment or let people die?”

Dr Unni Krishnan Karunakara first became involved with MSF in 1995, when he was tasked with setting up a tuberculosis control programme in Jijiga, Ethiopia. He went on to become Medical Coordinator for MSF’s activities in Azerbaijan, providing basic health care services to forced migrants from Nagorno-Karabakh, in Brazil for health care aimed at the indigenous population in the Amazonas province, and for a sleeping sickness programme in the Republic of Congo. In 2002, Dr Karunakara joined the Public Health Department of MSF in Amsterdam, advising country programmes in the Middle East, southern Africa and south and central America, and three years later became Medical Director for of MSF’s Campaign for Access to Essential Medicines.  In 2007, he was part of the medical emergency response team that treated victims of cyclone Sidr in Mathbaria, Bangladesh.

Dr Karunakara received his medical degree from Kasturba Medical College in India and degrees in public health from Yale and Johns Hopkins Universities in the United States. He has held various academic and research fellowships at universities in South Africa, Zimbabwe, Uganda, Germany and the United Kingdom, focusing on the demography of forced migration and the delivery of health care to neglected populations affected by conflict, disasters and epidemics.  Since 2008, Dr Karunakara worked at Columbia University, USA, as Deputy Director of Health for the Millennium Villages Project at the Earth Institute, and has been an Assistant Clinical Professor at the Mailman School of Public Health.

As President, Dr Karunakara will be based at MSF’s International Office in Geneva, Switzerland, where he will work alongside the organisation’s Secretary General, Kris Torgeson.

Requests for interviews with Dr Unni Karunakara can be forwarded to Heather Whelan, MSF press officer on: 44 7770 235 740.

“Liberia was devastated by 14 years of brutal civil war, with its health system in ruins by its end,” says Dr. Dhammika Perera, MSF Head of Mission for Liberia. “Recovery is always slow, but today the Ministry of Health takes over MSF’s last hospital services. We remain in the country, but after two decades, it is an important milestone for us and symbolic of how far Liberia has come in providing healthcare to its people again.”

Following the 2003 end of the war and 2005 elections, MSF began to progressively hand over its emergency projects and hospitals in many of Liberia’s fifteen counties. At the start of this year MSF was still running two free hospitals in the capital, Monrovia - Benson Hospital in Paynesville and Island Hospital in Bushrod Island - treating more than 20,000 women and children in total per year.

“As an emergency organisation, MSF provides medical aid to people in extreme crisis,” continues Dr. Perera. “As Liberia moves steadily towards stability, our role greatly diminishes and the government’s further increases. However, major challenges remain to ensure that the most vulnerable, women and children, continue to receive much needed free care. There are no cheap solutions - as Liberia reconstructs the international community must step up and provide increased support.”

To minimise the gaps that could be created by the closure of its final two hospitals MSF built a new hospital, transferred its services there and donated it to the Ministry of Health and Social Welfare. MSF also added 80 paediatric beds and increased the paediatric services available in Monrovia’s main public hospital, Redemption Hospital.

Longer term support rather than emergency aid is now needed. There are currently less than 100 doctors in a country of 3.6 million, and just over 250 children’s hospital beds in Monrovia, a city of more than 1 million people. In addition to increasing the paediatric care available, Liberia also needs greater free emergency obstetric and gynaecological capacity and better access to free women’s health hospital services.

“We came a long way since the war, but there is a great deal of work ahead,” says Dr. Gwenigale, Liberian Ministry of Health and Social Welfare. “We face difficult obstacles to making our promise of free care a reality for people who cannot even afford their daily bread. To overcome these we will need continued commitment from international donors to increase the numbers of hospitals beds, guarantee staff salaries, ensure drug supply in hospitals and train new medical staff.”

From July 2010, MSF will work in collaboration with the Ministry of Health and Social Welfare (MoH&SW) to provide much needed free medical and psychological care to survivors of sexual violence in up to three MoH&SW health structures.

MSF has provided medical humanitarian aid in Liberia since 1990. This handover of its last hospital services is the most significant reduction of MSF activities in its two decade presence in Liberia.

For further information, or to interview an MSF spokesperson, please contact Heather Whelan, press officer MSF UK on heather.whelan@london.msf.org or 44  7770 235 740

World leaders meeting at the G8 and G20 summits will not succeed in improving mother and child health in the developing world unless they fundamentally change how they address malnutrition and establish new sustainable funding sources to combat this treatable and preventable condition, the international medical humanitarian organisation Médecins Sans Frontières (MSF) said today.

Malnutrition affects 195 million children worldwide and is the underlying cause of at least one-third of the eight million annual deaths of children under five years of age, and causes stunting, cognitive impairment and greater susceptibility to disease. The problem is inextricably linked with mother and child health, as malnourished mothers give birth to underweight children, perpetuating a vicious cycle. Many mothers living in areas of high food insecurity do not have access to foods like milk and eggs that contain the high-quality protein and other essential nutrients that their children need. Currently, most international food aid consists of nutritionally inadequate fortified corn-soy flours, which do not provide the nutrients young children need most. 

“Foods we would never give our own children to eat are being sent overseas as food aid to the most vulnerable children in malnutrition hotspots in sub-Saharan Africa and parts of Asia,” said MSF International President Dr. Christophe Fournier. “This double standard must stop. As the world’s leading food aid donors, G8 countries are uniquely positioned to have a major impact on reducing malnutrition. If world leaders in Muskoka and Toronto want to truly roll back mother and child mortality, it is imperative they commit to reforming key parts of the global food aid system. We know what works and what children need – let’s simply get it to them.”

In addition to improving the quality of food aid provided to young children, an effective overall nutrition response will require substantial financial resources. The World Bank estimates it will cost $12 billion per year to address malnutrition in the most-affected countries. In a time of global economic austerity, current funding from donors is insufficient, volatile and unpredictable. This requires sustainable sources of funding through innovative financial mechanisms,such as the financial transaction tax currently promoted by the European Union. A share of the funds raised by such means must be earmarked to global health issues such as nutrition, HIV/AIDS treatment and tuberculosis research.

“Non-governmental agencies should not be expected to carry such a huge burden in fighting malnutrition,” said Dr. Fournier.“Donor governments need to step up to fill the gap and help the most-affected countries follow lifesaving nutrition programmes that have been successfully implemented in countries like Mexico, Thailand and Brazil. We need sustainable sources of funding, such as the proposed financial transaction levy, that dedicate a share to global health – not the one-shot pledges that G8 summits are prone to deliver.”

The G8 gathering coincides with the onset of a particularly harsh “hunger gap” season in Africa’s Sahel region, the period when staple food crops are exhausted before the next harvest. Most countries in the region are already experiencing increasing rates of childhood malnutrition. MSF is operating emergency nutrition programmes – and reinforcing existing ones – in Burkina Faso, Chad, Niger, Mali and Sudan.

In 2009, MSF treated 208,000 children affected by severe acute malnutrition in its programmes. Although this is barely 1 per cent of the 20 million children estimated to be affected, this represents more than 15 per cent of the 1,200,000 children who received treatment.

MSF recently launched “Starved for Attention,” a global multimedia campaign to highlight the crisis of childhood malnutrition and how increased childhood sickness and death can be prevented with effective nutrition interventions: www.starvedforattention.org. From June 19–25, MSF is hosting the Starved for Attention multimedia exhibition at the Toronto Reference Library.

The Sahelian belt of Chad is facing one of its worst nutrition crises in recent years. Médecins Sans Frontières (MSF) is calling for faster and larger deployment of humanitarian assistance to meet the needs of the most vulnerable people, particularly children under the age of 5.

Several factors including erratic rains, failed harvests, soaring food prices, food stocks running out and poor access to healthcare have contributed to the increase of malnutrition rates. In the Hadjer Lamis region, recent rapid nutrition screening shows that more than 5% of children under five are suffering from severe acute malnutrition and are at risk of dying. Today, in this region alone, an estimated 5,000 children are in urgent need of nutritional assistance.

“We are very worried about the number of severely malnourished children that our medical teams are seeing – close to 3,000 children were admitted in our programmes in the month of May,” explains Dr Benoit Kayembe, MSF emergency medical coordinator in Chad.

This current rise in malnutrition is a warning that the situation will get worse as the 'hunger season' is only just beginning. More children are at risk of becoming severely malnourished in the coming weeks, until the next harvest is expected to begin in October.

National authorities, local and international actors have initiated a response to this severe food security crisis. Despite these efforts, there are still many communities who are not receiving food and nutritional assistance. MSF calls for an acceleration of the emergency response in all affected areas to meet the needs of the most vulnerable, particularly children under five.

MSF is currently implementing emergency nutrition interventions in the Hadjer Lamis, Batha, Guéra, Salamat and Quaddai regions as well as in the capital N’Djamena. Our activities include in-patient and ambulatory therapeutic feeding centres and targeted food distributions for over 60 000 children in the coming weeks.

Chad is not the only country facing this malnutrition crisis. Most countries located in the Sahel region are experiencing an increased number of malnourished children. MSF has also already started emergency nutrition programmes, or reinforced existing ones, in Niger, Mali, Burkina Faso and Sudan. 
        
MSF recently launched Starved for Attention, a global campaign to highlight the crisis of childhood malnurition and how increased childhood sickness and death can be prevented with effective nutrition interventions: www.starvedforattention.org

A mother brings her child to the MSF feeding centre in the Massakory hospital in Chad. May 2010.
Photo by MSF

MSF is an international medical humanitarian organisation that has been working in Chad since 1981. MSF is presently providing medical assistance to the Chadian population, resident and displaced, in Abéché, Adé, Kerfi and Dogdoré as well as to refugees having fled the neighbouring Sudanese region of Darfur and Central African Republic. MSF has also intervened in Chad in response to medical emergencies such as measles and meningitis outbreaks.

The international medical humanitarian organisation Médecins Sans Frontières (MSF) and the VII Photo agency today launched “Starved for Attention,” a global multimedia campaign presenting a unique and new perspective of childhood malnutrition, a preventable and treatable condition that nonetheless claims the lives of millions of children each year. 

The collaboration challenges established notions of malnutrition through a seven-part mini-documentary series: clichéd images are substituted with those of parents and health workers struggling to meet the nutritional needs of young, growing children. Starved for Attention highlights how increased childhood sickness and early death can be prevented with effective nutritional interventions. The campaign launch coincides with the onset of a particularly harsh “hunger gap” season in Africa’s Sahel region, the period when staple food crops run out before the next harvest and malnutrition typically increases. 

The documentaries will be released over a seven-week period beginning today at:  
http://www.starvedforattention.org/

“Documenting malnutrition has been one of the toughest challenges our agency has faced,” said VII Photographer Ron Haviv. “There is a sense that this story has already been told through the body of work produced by photojournalists who covered famines of the 20th century. Yet we believe that we have found a completely new visual language to tell this story – one that has the potential for great impact.”

At any given time, an estimated 195 million children are affected by malnutrition worldwide. It contributes to at least one-third of the eight million annual deaths of children under five years of age. These deaths are preventable if the nutritional requirements of young children are met. Starved for Attention underscores the possible, focusing on successful strategies implemented daily to address malnutrition, and how they can, and must, be expanded.

The most vulnerable are children up to two years of age, when their nutritional needs are especially high. If children in that time-frame do not receive quality foods that provide balanced nutrition, they face stunting, cognitive impairment, and increased vulnerability to disease. At worst, they can face early death.

“Our medical teams working in more than 30 countries with high levels of malnutrition, in sub-Saharan Africa and South Asia, have demonstrated that with early intervention with quality, balanced foods, countless children can be spared the consequences of malnutrition,” said Dr. Christophe Fournier, president of MSF’s International Council  “We know what children need.  It’s simply a matter of ensuring they get it.” In 2009, MSF treated 250,000 malnourished children in 34 countries.

VII photojournalists Marcus Bleasdale, Jessica Dimmock, Ron Haviv, Antonin Kratochvil, Franco Pagetti, Stephanie Sinclair, and John Stanmeyer contributed to Starved for Attention. They travelled to rural villages, war zones, teeming capitals and mountain hideaways to document childhood malnutrition and its varied faces: the incongruity of malnourished children in lush and bountiful Congo; the cyclical nature of malnutrition in Bangladesh; and the impact of the annual “lean season” in the Sahel. Highlighting successful treatment and prevention programmes in countries such as Mexico and the United States, Starved for Attention emphasises the great potential for combating early childhood malnutrition.

The Starved for Attention campaign seeks to build a critical mass of awareness that will translate into reforms of humanitarian food assistance and nutrition programmes for malnourished children, and the mobilisation of resources needed to scale up programmes to prevent and treat malnutrition. Visitors to starvedforattention.org can add their names to a global petition entitled “Overcoming Childhood Malnutrition: The Time to Act is Now.”

Currently, international food donors mostly provide cereal-based fortified flours. While these foods can relieve hunger, they do not meet the nutritional requirements of young, growing children. For example, the US, the world’s largest food aid donor, is sending sub-standard foods that do not meet basic nutrition requirements for infants and young children. These foods would not be provided to children in the US. Starved for Attention exposes this double standard. 
 
Tested strategies to address malnutrition are effective and are showing promising results in many countries. Some, including Mexico, Thailand, and Brazil, have reduced early childhood malnutrition through direct nutrition programmes that ensure infants and young children from even the poorest families have access to quality foods, such as milk and eggs. At the same time, there is growing political will in Asian and African countries to replicate successful programmes. The Starved for Attention petition calls for support to these efforts.

Alongside the multi-lingual website, the global campaign launches in New York City tonight with an exhibit and panel discussion event, followed by an exhibit at the VII Gallery in Brooklyn, New York. The multimedia exhibit will travel to Toronto, Milan and Rome, among others.

Starved for Attention is made possible with the support of LG Electronics, which has provided financial support and its latest generation INFINIA flat panel television screens to display the project’s documentaries in exhibitions.

Backtracking by international donors in HIV/AIDS funding risks undermining years of positive achievements and will cause many more unnecessary deaths, warns humanitarian aid group Médecins Sans Frontières (MSF) in a new report.

Entitled “No time to quit: HIV/AIDS treatment gap widening in Africa”, the report builds on analyses made in eight sub-Saharan countries to illustrate how major international funding institutions such as PEPFAR, the World Bank, UNITAID, and donors to the Global Fund have decided to cap, reduce or withdraw their spending on HIV treatment and antiretroviral drugs (ARVs) over the past year and a half.

“How can we give up the fight halfway and pretend that the crisis is over? Nine million people worldwide in need of urgent treatment still lack access to this lifesaving care - two thirds of them in sub-Saharan Africa alone. There is a real risk that many of them will die within the next few years if necessary steps are not taken now. Also, the current donor retreat will prevent more people from accessing treatment and will threaten to undermine all the progress made since the introduction of ARVs” says Dr. Mit Philips, Health Policy Analyst for MSF and one of the authors of the report.

The US President’s Emergency Plan for AIDS relief, PEPFAR, reduced its budget for the purchase of ARVs in 2009 and 2010, and also introduced a freeze on its overall HIV/AIDS budget. Other donors, such as UNITAID and the World Bank, have announced reductions over the coming years in the funding for antiretroviral drugs in Malawi, Zimbabwe, Mozambique, Uganda and the Democratic Republic of Congo (DRC).

The Global Fund, the largest funding institution in the fight against HIV/AIDS, faces a major funding shortfall. The US, the Netherlands and Ireland have already announced that they will be providing lower contributions to the Global Fund. In 2009-2010, contributions to already approved country grants were reduced by 8 to 12 percent.

Overall funding cuts have translated into a reduction in the number of people able to start their ARV treatment, as seen in South Africa and Uganda, and in DRC – where the number of new patients able to start ARV treatment has been cut six-fold. Already fragile health systems will become increasingly strained by an increasing patient load requiring more intensive care.

Drug stock-outs and disruptions in drug supply are already a reality, and will become more frequent if sufficient funding is not made available. MSF has recently been requested by the government and other actors to assist with emergency drug supplies in Malawi, Zimbabwe, DRC, Kenya and Uganda.

“If there is reduced funding, then it will mean more people will die, and we will have more orphans. The ones that are positive often need to assist others, like their children. People will lose hope and die. It will be the end. If there are no drugs there is no future” says Catherine Mango, an HIV patient from Kenya.

ARV treatment is lifesaving but also lifelong. This means that the number of patients under treatment increases cumulatively each year, thus requiring incrementally growing and sustainable funding.

“The HIV / AIDS crisis remains a massive emergency that still requires an exceptional response. MSF calls for a sustained and renewed commitment by donors and national governments in the fight against HIV/AIDS, so that this disastrous public health crisis can be addressed appropriately,” concludes Dr. Philips.

For more information, please contact:
Heather Pagano Whelan, MSF UK Press Officer
Mobile: 44 7770 235 740
E-mail: Heather.WHELAN@london.msf.org

Click here for a full MSF briefing paper.

“After more than 10 years of experience, MSF has successfully treated thousands of patients with Chagas. We would like to see equal importance given to treatment and diagnosis as with prevention strategies,” says Fran Román, MSF Vice-President in Barcelona. “The countries affected must agree to integrate diagnosis and treatment at the primary health level if they want to reach all patients; children and adults, in both acute and chronic phases of the disease,” he adds.

The intention of the resolution is to control and eliminate Chagas disease, yet there is no clear statement addressing diagnosis, treatment once patients are diagnosed, or the research and development of new tools.

“Chagas patients have been forgotten because they are poor and fall outside the mainstream market interest, but science exists to develop better treatments and diagnostic tools for all,” says Bernard Pecoul, Executive Director of DNDi. “The first steps to making progress at an international level are through sustainable, predictable funding and strong public support. The delegates at WHA have now the opportunity to move forward and take concrete action,” adds Pecoul.

This is an opportunity for millions of people infected by this disease, which remains the leading parasitic killer in the Americas, with an estimated 10 to 15 million being infected and 14,000 people dying each year.

In 2009, the Member States of Pan American Health Organization (PAHO) adopted the resolution ´Elimination of neglected diseases and other poverty-related infections´, where the primary strategy includes etiological treatment of children and medical care for adults, which is in line with the key messages of MSF and DNDi.

Urgent actions and measures to increase medical response must be taken to scale up diagnosis, treatment and patient access to care and to boost research and development for new tools. MSF and DNDi also call on Member States to reinforce the supply chains of existing treatments so that they are available to health staff and national programmes and to promote much needed research and development, which is virtually non-existent. They also urge a focus on better treatment (less toxic, shorter and more efficient treatment courses in all stages of the disease for children and adults), diagnostic tools adapted to the limited resources settings and a test of cure to control the Chagas disease.

For more information, please go to www.dndi.org or www.msf.org or contact:

Jean-Marc Jacobs on 44 (0)7889 178 472.

About American Trypanosomiasis or Chagas Disease

Each year over 10 to 15 million people across the world are infected with the Chagas disease.  Every year 14,000 people die as a consequences of the disease. Endemic in 21 Central and Latin American countries, it also has growing presence in non-endemic countries through migration of people. In Central and South America, Chagas kills more people than any other parasite-borne disease, including malaria. Occuring in two stages, the disease is caused by the parasite Trypanosoma cruzi transmitted primarily by insects known as “kissing bugs”. The existing treatments have an unsatisfactory cure rate and can have toxic side effects. DNDi aims to develop affordable, safe, and efficacious treatments for children and adults, which ideally treat both stages of Chagas

Médecins Sans Frontières/Doctors Without Borders (MSF) has screened more than 60,000 people for Chagas and has treated over 3,000 patients with the disease since 1999. In Honduras, MSF opened its first Chagas project in 1999. Since then, the medical organisation has developed several programmes in Nicaragua, Guatemala and, currently , MSF screens, diagnoses and treats children and adults in Bolivia and Colombia and is now starting a new project in Paraguay.

About DNDi

The Drugs for Neglected Diseases initiative (DNDi) is a not-for-profit product development partnership working to research and develop new and improved treatments for neglected disease, in particular human African trypanosomiasis, leishmaniasis, Chagas disease, and malaria. With the objective to address unmet patient needs for these diseases, DNDi was established in 2003 by the Oswaldo Cruz Foundation from Brazil, the Indian Council for Medical Research, the Kenya Medical Research Institute, the Ministry of Health of Malaysia, the Pasteur Institute, and Médecins sans Frontières (MSF).  WHO/TDR acts as a permanent observer. Working in partnership with industry and academia, DNDi has the largest ever R&D portfolio for kinetoplastid diseases. Since 2007, DNDi has delivered three products, two fixed-dose anti-malarials “ASAQ” and “ASMQ”, and a combination treatment for the advanced stage of sleeping sickness “NECT” (nifurtimox-eflornithine combination therapy).

The first Chagas treatment for children, pediatric strength benznidazole, will be made available  in the near future by DNDi and Pharmaceutical Laboratory of Pernambuco (LAFEPE) in Brazil. Furthermore, in 2009 DNDi signed a collaboration and license agreement with the Japanese pharmaceutical company Eisai Co. Ltd. for the clinical development of the promising compound E1224, to treat Chagas disease.

Click here for a full MSF briefing paper.

MSF is providing healthcare to migrants and refugees at its clinics in the border town of Musina and in Johannesburg.

In Musina, near the Zimbabwean border, MSF has witnessed an increase in the number of attacks, robberies and rapes by violent gangs active on both sides of the border since the beginning of 2010. MSF has treated 103 survivors of sexual violence in the first four months of this year, 71 since 1st March alone.

While providing consultations to an average of 2,300 patients a month in Johannesburg, MSF sees its patients continue to face serious health risks related to overcrowding and unhygienic living conditions. While some still seek shelter in the Central Methodist Church, thousands more people live in abandoned buildings often without electricity, water or basic sanitation, putting their health and safety at risk.

In June of 2009, MSF released a report raising the alarm about the dangerous health situation of people entering and struggling to survive on the margins in South Africa. Now almost one year later, their situation remains dire and largely ignored.

“What has changed for our patients in the last year? Very little. They are still risking their lives when they cross the border, raped in shocking numbers by gangs, and then facing uncertainty about their status in the country. Many go on to a life in Johannesburg that continues to endanger their health,” says Mickael Le Paih, head of mission for MSF in South Africa.

The threat of sexual violence for those crossing the border from Zimbabwe must be acknowledged. They need access to a formal status to be legally allowed in the country so they are not forced to cross the border irregularly and be exposed to this extreme violence. Access to both emergency shelter and primary healthcare should be ensured for migrants, refugees and vulnerable South Africans living in inhumane conditions.

Without access to basic medical care, safety and shelter, the lives of migrants and refugees in South Africa remain precarious and uncertain.

Click here to read the MSF Report "No refuge, access denied" released June 2009

For more information about the briefing document, interviews or more on MSF activities in South Africa, please contact Jean-Marc Jacobs on 44 (0)7889 178 472.

Note to Editors

Since 2007, MSF has been providing basic primary health care, referral to secondary and specialised care, emergency medical treatment for victims of violence and epidemic outbreaks, and care for survivors of sexual violence. MSF has been working in South Africa since 1999 and operates medical humanitarian projects in Musina, Johannesburg and Khayelitsha near Cape Town.

“The report, entitled Giving Developing Countries the Best Shot, shows how, because of the fundamental nature of the vaccine market, it still takes years for expensive new vaccines developed for wealthy countries to reach children across the developing world, and that products emerging from the research pipeline are often insufficiently adapted to developing country needs and conditions,” said Dr. Tido von Schoen-Angerer, director of the MSF Campaign for Access to Essential Medicines.

The Global Alliance for Vaccines and Immunization (GAVI), which leads international efforts to boost immunisation rates in developing countries, has reported considerable success in expanding access to vaccines against Hib and Hepatitis B, two diseases that cause considerable mortality. But the organisation is now facing an acute cash crisis due to high prices for new vaccines and stagnating donor resources. Without an additional US$2.4 billion in donor contributions, GAVI will have to make significant cut-backs that will reduce access to vaccines in poor countries.

GAVI’s attempts to speed up the introduction of pneumococcal conjugate vaccines (PCV) are an illustration of the hurdles faced by the organisation. Used for a number of years in wealthy countries, PCV have prevented hundreds of thousands of cases of pneumonia, meningitis and other serious infections. They have also generated billions of dollars in revenue for multinational drug companies. But the joint efforts of GAVI and donor countries to improve uptake of these blockbuster products in resource-poor settings have stumbled.

Despite repeated announcements heralding the impending roll-out of PCV across developing countries, PCV will remain out of reach for most children due to problems with supply and a lack of funds. Kenya is the only GAVI-eligible country that will receive the newer version of this life-saving vaccine in 2010 and the cost will be US$21 per child. This is an unacceptably high price for donors and developing countries to bear.

“The newest vaccines continue to be produced by only a handful of multinational pharmaceutical companies whose oligopoly status allows them to charge high prices,” said Rohit Malpani, senior policy advisor at Oxfam. “Despite GAVI’s negotiating power, the price of new vaccines is too high. The Best Shot report highlights novel ways of developing affordable vaccines to improve children’s access to them, increasing their chances of survival.”

One of these novel ways is illustrated by the collaboration between the World Health Organization, the U.S. non-profit PATH and the Serum Institute of India, which has resulted in a meningitis vaccine that will cost no more than $0.50 per dose. This vaccine, which is tailored to the needs of countries in the so-called “Meningitis Belt” in sub-Saharan Africa, should be available by the end of the year.

MSF and Oxfam are calling for changing the current system so that donor funds incentivise the development of adapted vaccines and ensure affordable prices.

In addition to these reforms, routine immunisation needs to be strengthened.  In developing countries, two million children die every year because of the failure to vaccinate with existing vaccines.  

“Again during the past two years MSF has responded to major outbreaks of measles and meningitis,” said Dr. Tido von Schoen-Angerer. “This is because an increasing number of children are missing their measles vaccination and because there is not yet a long-duration meningitis vaccine accessible. The overall goal needs to be to increase rates of routine immunisation and to ensure access to newer vaccines.”

In 2009, MSF treated over 50,000 cases and vaccinated more than 7.4 million people against meningitis. In 2008, the organisation treated more than 32,000 measles cases and vaccinated more than 1.9 million children in response to measles outbreaks.

For more information, please contact Jean-Marc Jacobs on 44 (0)7889 178 472

The new report “Giving developing countries the best shot: An overview of vaccine access and R&D” is available here.

Valganciclovir is primarily used as treatment and prevention of an infection caused by cytomegalovirus (CMV) in organ transplant patients, a highly lucrative market which Roche has sought to defend by patenting the medicine. But CMV also affects people living with HIV, and if left untreated, can cause blindness and death.

“Roche was attempting to patent a new form of a drug that was really invented in the 1980s,” said Leena Menghaney, project manager of the MSF Campaign for Access to Essential Medicines in India. “This decision shows that Section 3(d) of India’s Patents Act, which prevents companies from filing unjustified patents, is working. Equally importantly, the Patent Office also found separately that the patent claims were obvious and therefore not patentable.”

Through this decision, the Indian Patent Office has also confirmed the right of patients groups to oppose a patent after it has been granted, a matter on which Roche claimed there was ambiguity. This follows a similar recognition in 2002 in Thailand of patients as ‘persons interested’ in the outcome of a patent application.
 
“For people living with HIV/AIDS in developing countries, accessing valganciclovir at Roche prices was difficult,” said Loon Gangte of the Delhi Network of Positive People (DNP ), one of the patient groups that filed an opposition to the patent. “The decision will provide much needed relief as it secures the way for generic competition, which is the most effective and sustainable way of bringing drug prices down.”

To date, the price of valganciclovir is prohibitively expensive – Roche markets the drugs for up to US$8,500 for a four-month treatment course in high-income countries. In India, the Roche price for a standard protocol is approximately $5,950. In December 2006, MSF approached Roche for a discount, but even the ‘discounted’ price was so high that some MSF AIDS projects opted out of providing this treatment for CMV.

“This is one victory for access to medicines, but we have to be careful not to lose an even bigger fight,” said Leena Menghaney. “India is currently negotiating a free trade agreement with the EU.  If the country agrees to introduce stricter intellectual property provisions such as data exclusivity as a part of these talks, this would allow companies to create new monopolies on medicines – even where patents have been rejected as in the present case.”

MSF will continue to follow this issue closely should Roche decide to appeal.

For further information, please contact:
Stephan Grosse Rueschkamp, MSF, Geneva 41 79 293 0270
Leena Menghaney, MSF, India 91 98 113 65 412

Background to the case

In June 2007, Roche was granted a patent for valganciclovir in India, but the Chennai Patent Office (one of four offices that make up the Indian Patent Office) took this decision without hearing the arguments of public interest groups, including the Indian Network for People Living with HIV/AIDS (INP ) and the Tamil Nadu Networking People with HIV/AIDS (TNNP ), that opposed the granting of the patent.

In December 2008, the Madras High Court in Chennai therefore decided to set aside Roche’s patent until these arguments could be heard. The Chennai Patent Office, during the course of this hearing, refused to hear all the arguments made by the oppositionists and rejected the pre-grant opposition, after which the public interest groups approached India’s Supreme Court.

The Supreme Court directed the groups to join the post-grant opposition proceedings that were already taking place through oppositions filed by generic companies and the Delhi Network of Positive People (DNP ).  At this stage Roche challenged the legal standing of DNP to oppose the patent after it had been granted, claiming an ambiguity in India’s patent law.

Having heard the arguments of all the public interest groups and the generic companies, the Indian Patent Office has now determined that Roche’s claims for a product patent on valganciclovir were invalid and recognised only the validity of one of the process claims made by Roche. It has also held that patients groups can file post-grant oppositions.

As the European Commission (EC) and India meet for closed-door negotiations on a Free Trade Agreement (FTA) this week, international medical humanitarian organisation Médecins Sans Frontières (MSF) warns this is the last chance to remove provisions that will block access to life-saving medicines for people living in the developing world.

“Neither Indian Trade Minister nor the EU Trade Commissioner have given a public commitment that the provisions that affect generic competition and access to medicines are off the table,” said Michelle Childs, director of Policy & Advocacy at MSF’s Campaign for Access to Essential Medicines. “We will continue to fight until they are officially and unequivocally out of the agreement.”

India is the source of 80% of the AIDS medicines used in MSF projects. Without quality affordable medicines from Indian sources, it would have been impossible to scale up treatment to the levels seen today and millions of lives would not have been saved. 

Through their governments’ contributions to the Global Fund and other international health agencies, European taxpayers pay for programmes that can treat far more people thanks to affordable medicines from India. But MSF and other groups are concerned that the EC is now trading this away. The draft agreement contains several alarming provisions on intellectual property and enforcement, much stricter than anything required under the international trade rules, that threaten the supply of essential medicines from India. 

“The right to life and health of people in developing countries is being sacrificed in this deal,” said Loon Gangte, president of the Delhi Network of Positive People (DNP ). “Do not put profits before patients. This trade agreement must not undermine India’s ability to provide people living with HIV/AIDS here and outside India with life-saving medicines in the name of open markets.”

One of the harmful provisions in the FTA is ‘data exclusivity’. If India introduces data exclusivity, generic companies wishing to register a medicine will be obliged to repeat clinical studies. This not only creates huge financial barriers that act as a disincentive to generic companies, but it is also in violation of medical ethics, as people are subjected to the risks of clinical studies for something that is already known. Data exclusivity therefore creates a new patent-like barrier to access to medicines and vaccines, even when these products are not protected by a patent.

“The impact of this proposed agreement is truly global, as treatment will become considerably more expensive, and countries and funders may have to ration the numbers of people they can put on treatment”, said Ariane Bauernfeind, HIV/AIDS programme manager for MSF projects in South Africa, Malawi, Lesotho and Zimbabwe.  “We are already concerned that newer medicines have been patented in India. The FTA threatens to make an already bad situation worse.”

Also in the draft FTA is a provision that extends the duration of a patent term beyond 20 years. In addition, after multiple incidents of Indian generic medicines being detained while in transit to other developing countries in Latin America, Asia and Africa, the EU is now seeking to legitimise such measures by forcing India to adopt them.

Formal talks between European and Indian negotiators are opening in Brussels this week. The EU has indicated that it wants to conclude the FTA negotiations ahead of the EU-India summit in October.

For more information, please contact Guillaume Bonnet (Brussels) 41 79 203 13 02 or Leena Menghaney (New Delhi) 91 98 11 365 412

During its ten years providing medical care in the country, MSF has witnessed how people’s lives are put at risk by everyday medical negligence and widespread hazardous medical practices, with blood transfusions frequently performed without screening for HIV or Hepatitis C. Healthcare workers are operating in a culture of fear with critically ill patients being turned away so as not to negatively impact sensitive statistics on maternal or infant mortality, or communicable disease. People in Turkmenistan are being failed by a healthcare system more concerned with its image abroad than with tackling the real threat to public health posed by infectious disease. 

“It is undeniable that tuberculosis and sexually transmitted infections including HIV/AIDS are more prevalent than reported figures would suggest and the Turkmen government is refusing to acknowledge this reality” said Dr Leslie Shanks, MSF’s Medical Director. “International organizations in the country, such as the World Health Organisation (WHO) and UNICEF, are perpetuating these problems by giving a veneer of legitimacy to misinformation from the government and to practices that are not only ineffective but often dangerous.”

Tuberculosis (TB), particularly in its multidrug-resistant form is perhaps the country’s most serious public health threat. Given its prevalence in neighbouring countries, MSF fears a serious TB crisis in Turkmenistan, which without an immediate and significant intervention, will lead to a major health crisis with broader regional implications. Rapid diagnosis and treatment of drug-resistant TB should be implemented immediately with the support of international experts if this is to be avoided.

MSF took the difficult decision to leave in 2009, after its activities were further restricted. The organisation concluded that it was at risk of becoming complicit in masking problems in the healthcare system rather than being able to address them.

“International organisations must take up their responsibility to actively promote transparency in the health system and cease to report as fact data that are contradictory” Dr Shanks urged.

MSF has been working in Turkmenistan since 1999, when it first introduced internationally recognised standards for TB treatment in the country. For the last five years, MSF has been working in the district hospital in Magdanly, eastern Turkmenistan, to improve the quality of paediatric and reproductive health care. MSF took the difficult decision to leave Turkmenistan in 2009.

The international medical organisation, Médecins Sans Frontières (MSF) is calling for free and efficient healthcare for Haitians ahead of the UN donor conference to be held in New York tomorrow.

Whilst the majority of people in Haiti are still extremely vulnerable, the UN donor conference to be held in New York on 31st March must not take measures that would limit the availability of healthcare for Haitian people.

Since the earthquake of 12th January, nearly all public and many private medical centres have offered healthcare free of charge. However plans have been disclosed to progressively reinstate hospital fees as early as mid April.

“Making people pay for healthcare would totally ignore the reality of the situation that we see in the streets and makeshift camps in Haiti,” says MSF emergency coordinator Karline Kleijer. “Hundreds of thousands of people have been displaced and live in rickety huts made of plastic sheeting, tents or ruined houses, with one latrine serving several hundred people. Shelter, hygiene, water and medical care remain a priority need. Massive short term humanitarian needs remain unmet and the arrival of the rainy and hurricane seasons threatens to cause further deterioration of people’s living conditions. We have already seen large parts of camps collapsing during the recent rains. The collapse or flooding of shelters and tents could force many of the displaced to move again.”

Respiratory infections and diarrheal diseases are the two main conditions that MSF is currently treating. Earthquake victims continue to need post-operative and rehabilitative care, physiotherapy as well as psychological counseling. In addition, the wider population needs obstetric, paediatric and trauma care.

“Haitians are in desperate need of an efficient health system,” says Dr. Christophe Fournier, MSF international president. “Financial resources to pay for health services cannot be drawn from a population living in extremely precarious conditions.”

International aid must consider giving direct financial support to the health system in Haiti. It is imperative that the decisions at the New York conference allow the Haitian health system to continue to address the population’s immediate medical needs.

For more information contact Jean-Marc Jacobs, MSF press officer on 44 7889 178 472 or at jean-marc.jacobs@london.msf.org

MSF has been assisting Haitian communities for 19 years. Today, some 3,300 Haitian and international MSF staff are supporting government hospitals and running facilities. Since the earthquake, MSF teams have performed more than 4,000 surgeries, provided psychological counseling to over 20,000 people, and treated 53,000 patients. MSF has distributed 14,000 tents and close to 20,000 emergency relief kits (including kitchen and hygiene kits, jerry cans, blankets and plastic sheeting). MSF is funding its activities in Haiti exclusively with private donations and is therefore not a stakeholder in the donor conference in New York.

A violent crackdown against stateless Rohingya in Bangladesh is forcing thousands of people to flee in fear. Driven from their homes throughout Cox’s Bazaar district by local authorities and citizens, many have sought refuge at Kutupalong makeshift camp. Here, medical organisation Médecins Sans Frontières (MSF) is treating victims of beatings and harassment, including people the Bangladeshi Border Force has attempted to forcibly repatriate to Myanmar. As camp numbers continue to swell, conditions pose a significant risk to people’s health.

In a report released today, 18th February 2010, MSF calls for an immediate end to the violence, along with urgent measures by the Government of Bangladesh and United Nations High Commission for Refugees (UNHCR) to increase protection to Rohingya seeking asylum in the country.

“More than 6,000 people have arrived at the makeshift camp since October, 2,000 of those in January alone. People are crowding into a crammed and unsanitary patch of ground with no infrastructure to support them”, explains MSF head of mission for Bangladesh Paul Critchley, “Prevented from working to support themselves, neither are they permitted food aid. As the numbers swell and resources become increasingly scarce, we are extremely concerned about the deepening crisis.”

For decades, thousands of Rohingya, an ethnic and religious minority from Myanmar, have sought refuge in Bangladesh. However, a mere 28,000 are recognised as prima facie refugees by the Government, and live in official camps under the supervision of UNHCR.  In sharp contrast, more than 200,000 people struggle to survive unrecognised and largely unassisted. In a densely populated country in which strong competition over work, living space and resources is inevitable at a local level, the stateless Rohingya are left highly vulnerable.

“It is imperative that the Government of Bangladesh act immediately to stop the violence and provide these people with the protection to which they are entitled”, Mr Critchley concludes, “UNHCR also needs to take greater steps toward developing a clear policy to tackle the issue, and must not let the terms of its agreement with the government undermine its role as international protector of those who have lost the protection of their state, or who have no state to turn to.”

As the Thai boat crisis of 2009 made clear, regional solutions are needed to the situation of the stateless Rohingya. The international community must support the Government of Bangladesh and UNHCR to adopt measures to guarantee the unregistered Rohingya’s lasting dignity and wellbeing in Bangladesh.

A medical consultation in the Kutupalong makeshift camp. December 2009
Photo by Giulio Di Sturco/VII Mentor

MSF has been providing healthcare in Bangladesh since 1992. Currently, as well as the basic healthcare programme in Kutupalong, MSF has opened a kala azar treatment programme in Fulbaria Upazila, and runs a  basic healthcare programme in the Chittagong Hill Tracts.  MSF also assisted tens of thousands of people affected by Cyclone Aila, which struck Bangladesh in late May, 2009.