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Aiding Civilians

Caught in Ivory Coast


Violence
In early November, Doctors Without Borders/Médecins Sans
Frontières (MSF) medical teams responded to emergencies in
northern and southern Ivory Coast in the wake of a government
offensive on the rebel-held cities of Bouaké, in north-central
Ivory Coast, and Korohgo, on the northern border with Mali. MSF
works in both government- and rebel-controlled areas.

On November 4, 2004, MSF treated 39 people who were


injured during an air strike on Bouaké. The wounded were
An MSF surgical team operates on a patient at a public hospital in the north-central
referred to Bouaké’s public hospital, where an MSF medical city of Bouaké, where MSF has been working since the start of the civil war in
and surgical team has been working since October 2002, the October 2002. 2004 © Jacques Kahn/MSF

start of the country’s civil war. The same air strike killed
several French peacekeepers and was followed by retaliatory Throughout the fighting, MSF has continued to support the
attacks by the French military, which precipitated riots and 160-bed main hospital in Bouaké. In addition to running
mob violence in the capital, Abdijan. pediatric, maternity, and other wards, medical teams have
run two 24-hour operating rooms in the hospital. In Korohgo,
MSF donated medical and surgical equipment, including an MSF medical team operated two health centers and a
antibiotics, analgesics, sterile bandages, and gloves, to three maternity department, with 250 deliveries per month, until
hospitals in Abidjan to assist the staff in providing emergency December 2004.
medical care for those wounded during the week of violence.
In addition, MSF airlifted eight tons of emergency relief Medical teams also performed surgery, provided health care,
materials to the Ivory Coast. Some international volunteers and ran a therapeutic feeding center in Man Hospital in
were evacuated when mobs began targeting foreigners. western Ivory Coast. In Danané, an MSF-supported hospital
treated approximately 70 patients each day. An MSF medical
Prior to the recent violence, MSF’s aid work in Abdijan had team continues to provide consultations and emergency care
focused on providing medical assistance to the prisoners in at Bin Houyé Hospital, which is on the country’s western border
the city’s main prison, the Maison d’Arrêt et de Correction with Liberia. In Guiglo, in the south, MSF assists vulnerable
d’Abidjan. Recently, MSF teams provided medical assistance and internally displaced people at an outpatient clinic, and
in the aftermath of a riot in the prison that resulted in more attends to malnourished children in a feeding center.
than 45 injuries and at least 10 deaths.

TABLE OF CONTENTS
AIDING CIVILIANS CAUGHT IN IVORY COAST VIOLENCE 2
UNENDING SUFFERING IN NORTHERN UGANDA 3
FIGHTING MEASLES IN DARFUR 4-5
THE HIDDEN SCARS OF WAR: PROVIDING MENTAL
HEALTH CARE IN TIMES OF CONFLICT 6-7
ON THE FRONTLINES OF HIV/AIDS TREATMENT 8-9
RESPONDING TO EMERGENCIES IN CONGO 10-11
NEWS&EVENTS 12
MSF STOPS ACTIVITIES IN IRAQ 13
FIELD UPDATES 14-15 MSF IN IVORY COAST
SNAPSHOTS 16 PRESENT SINCE 1991
INTERNATIONAL STAFF: 60
COVER PHOTO: MSF mobile clinic in Lira, Uganda. 2004 © Francesco Zizola NATIONAL STAFF: 850

IVORY COAST VIOLENCE 2


An MSF nurse examines a child at a mobile clinic in a displaced-persons camp

Unending Suffering in outside the northern Ugandan town of Lira. 2004 © Francesco Zizola

— 63 percent reported the disappearance or abduction of a


Northern Uganda family member;
— 58 percent reported the death of a family member due
A recent study conducted by Doctors Without Borders/Médecins to the insurgency;
Sans Frontières (MSF) in northern Uganda found alarming daily — 79 percent had witnessed torture;
mortality rates. People in the region continue to suffer the con- — 40 percent had witnessed a killing; and
sequences of the country’s 18-year civil war, and reports of torture, — 5 percent had been forced to physically harm someone
abductions of children, and killings are commonplace.
Responding to Growing Needs
The retrospective mortality study was conducted in six camps MSF has been expanding its emergency programs throughout
for internally displaced people in Lira and Pader Districts. The northern Uganda. In Lira District, MSF runs a 350-bed thera-
teams found a crude mortality rate of 2.8 deaths per 10,000 peutic feeding center and a supplementary feeding program,
people per day for the general population, and an even more and operates clinics in four camps for internally displaced
alarming rate of 5.4 deaths per 10,000 children a day among people. MSF mobile clinics serve two additional camps every
those under five years of age. The rate climbed to 10.5 deaths week, and teams conduct water-and-sanitation activities in
per 10,000 children a day in one location. eight rural camps for displaced people.

“The extent of suffering is overwhelming, and the situation In Pader District, MSF runs water-and-sanitation and medical
remains critical,” said Monica de Castellarnau, MSF head of activities as well as a mobile clinic that visits a camp outside
mission in Uganda. “Not only do people live under constant the main town. A little farther north, MSF medical teams
threat, they lack basic resources and safe access to water, recently found tens of thousands of people living in squalid
food, and health care. We are doing what we can, but more conditions with little access to health care.
assistance is needed immediately.”
MSF runs a night shelter for the nearly 4,000 children who
seek a safe place to sleep each night on the grounds of Lacor
Traumatized People Hospital in the town of Gulu. The children fear abduction
A mental health survey in Pader revealed that almost all of and forced conscription by the Lord’s Resistance Army, the
the residents surveyed had been exposed to severe traumatic rebel group that has been fighting the Ugandan government
events since 2002. for more than a decade.

Also in Gulu District, MSF supports a clinic in Pabbo camp for


MSF IN UGANDA internally displaced persons, and treated nearly 100 people
PRESENT SINCE 1986 for cholera following a recent outbreak.
INTERNATIONAL STAFF: 67
NATIONAL STAFF: 510

3 SUFFERING IN NORTHERN UGANDA


Early in the morning, MSF staff and local health workers prepare the vaccines for the campaign. Measles vaccines require the maintenance of a
“cold chain”—dependable refrigerators and coolers that keep the vaccines at a constant temperature—a difficult task in a town where generators
are the only source of electricity. At one of the vaccination sites, an MSF nurse and local health-care worker maintain the “cold chain” by placing
vaccines in smaller coolers to be used by each vaccinator.

A vaccinator fills syringes with the appropriate Children line up to be vaccinated at one of the sites. Some come alone, and others are accompanied
amount of vaccine so that many children can by a parent or older sibling.
be immunized quickly.

Each child receives an immunization card to show that he or she has been vaccinated against measles. MSF staff tally the numbers of children
being vaccinated, and each child’s sex and age, to calculate the success of the vaccination campaign.

FIGHTING MEASLES IN DARFUR 4


Recognizing that many parents are unable to bring their children to the vaccination points, MSF A community leader walks through the market in
deploys a mobile vaccination team to the local market to reach children there. Kebkabiya announcing the measles-vaccination
campaign and urging parents to bring their
children to be vaccinated.

Children are vaccinated.

All photos: 2004 © Kris Torgeson/MSF

FIGHTING MEASLES IN DARFUR


Measles kills 500,000 children in sub-Saharan Africa each year. The measles. MSF proposed a mass vaccination campaign for all children
disease can spread quickly, especially in crowded, unhygienic between six months and 15 years old living in Kebkabiya and the
conditions, which are often found in conflict zones and in places nearby town of Serif Umra—a total of more than 35,000 children.
where poverty and lack of health care has prevented children
from being vaccinated. MSF worked with local community leaders to identify the best sites
in the towns for the vaccination campaign and enlisted locally
When Doctors Without Borders/Médecins Sans Frontières (MSF) hired staff to get the word out to Kebkabiya residents and dis-
arrived this past spring in Kebkabiya in North Darfur, Sudan, local placed people. After overcoming difficulties securing permis-
leaders, parents, and health-care workers told of children dying sions for the campaign and getting the vaccines and medical
of measles despite a vaccination campaign that had been carried staff in place, MSF launched its measles-vaccination program in
out by the ministry of health. Kebkabiya’s population swelled from late September. Over a 12-day period, nearly 27,000 children
12,000 to 60,000 over the past year as people fleeing fighting were vaccinated in Kebkabiya alone. The campaign continues
in the region settled in and around the town. MSF surveys found in three MSF clinics and in the local hospital for new arrivals
that merely 63.2 percent of the people had been vaccinated against and those not previously vaccinated.

5 FIGHTING MEASLES IN DARFUR


THE HIDDEN SCARS OF WAR: PROVIDING
MENTAL HEALTH CARE IN TIMES OF CONFLICT
Doctors Without Borders/Médecins Sans no longer want to live. They may have The Bosnia program was a departure, in
Frontières (MSF) has for more than 30 years witnessed the killing of their family.” both size and scope, from earlier mental
responded to wars, famines, epidemics, and health interventions MSF had undertaken
natural disasters by providing emergency From 1993 to 1997, MSF implemented in the Gaza Strip, Uganda, and India. Under
medical care to people in crisis. However, a comprehensive program to address de Jong’s coordination, MSF established
it was on the killing fields of Bosnia in the emotional trauma of thousands of 10 counseling centers in Sarajevo and
the 1990s that MSF volunteers recognized people, including children, affected by trained 70 local counselors to help bridge
that it was not enough to meet the physical the Bosnian war. the cultural divide between MSF volunteers
needs of people caught up in conflict. The and the Bosnians they aimed to assist.
psychological and emotional scars of war “I would like a new house like a castle and
—wounds that may continue in people’s I would like the people who destroyed it Training local counselors, which is at the
minds long after the fighting has ended— to be punished by making them rebuild a heart of MSF’s mental health approach, was
were being neglected. castle,” said Matja, a 7-year-old Bosnian also crucial to building up the community’s
girl who lived in Croatia during the war, capacity to deal with the ongoing conflict.
“What do you do if there is enough food, in response to a question from an MSF Through a mix of individual and group
but no one wants to eat?” asks Kaz de Jong, psychologist. “I also want them to give counseling the program aimed to help
MSF’s mental health advisor. “Sometimes me back the boat they stole. I want the Bosnians restore the bonds among family,
people are unable to eat because they little brook next to my house, the water- friends, community, and society.
falls, and the things I had in the house.
photo: A Bosnian woman attends a funeral for victims I want my grandmother to come back MSF used radio programs to teach Bosnians
of the war. 1992 © Tom Stoddart alive from Bosnia.” about emotional reactions to traumatic

THE HIDDEN SCARS OF WAR 6


events. “The stigma of weakness, the Integrating Mental Health Care Jong. “The incidence of depression is
acknowledgment of suffering, and the In most cases, mental health specialists very high among this group. All end-stage
shame that so often surrounds traumatized work within MSF’s existing emergency HIV/AIDS patients suffer from dementia
people became a collective experience,” medical programs. In Darfur, western or conditions seen in much older people.
says de Jong. The program reached more Sudan, MSF psychologists are training We need to develop strategies to help
than 10,000 people. community health workers to identify our patients cope with these conditions.”
and support survivors of sexual violence.
From Bosnia to Gaza to Sudan Coping with Natural Disasters
Since the Bosnian war, MSF has conducted “Women are afraid to tell their husbands MSF sends mental health teams to help
mental health interventions in more than they have been raped since they don’t people cope with the traumatic stress
40 countries. Generally, MSF’s mental health want them to go and fight,” a 20-year- of natural disasters. Currently, teams are
volunteers provide psychological education old displaced woman in West Darfur told working with families that have been
and train local counselors to assist their MSF. “They only say they have been left homeless by the flooding in Gonaives,
neighbors. They also bring home-based care beaten. But men are fully aware that their Haiti, and with the government workers
to people too traumatized to leave their wives have been raped.” who have buried the dead. In late 2003,
homes and establish walk-in clinics. MSF sent psychologists to Bam, Iran,
“WHAT DO YOU DO IF THERE following the severe earthquake there.
With mental health programs operating IS ENOUGH FOOD, BUT NO
from Colombia to Nepal, MSF volunteers ONE WANTS TO EAT?” Care for the Neglected
design their interventions to account MSF operates mental health programs
for cultural differences. In Sierra Leone, The health workers tell the people living not only in response to conflicts and
for example, MSF volunteers found the in displaced-persons camps about the natural disasters, but also for the most
greatest success using group therapy for opportunities for psychosocial care and vulnerable groups in relatively stable
people affected by the country’s civil refer women for medical treatment. societies. MSF has worked with institu-
war. But in Chechnya, people were tionalized people, for example, in
reluctant to speak within groups and In therapeutic and supplementary feeding Armenia, Tajikistan, Albania, and in other,
favored one-on-one sessions in formal centers, volunteers are trained not only less-stable countries like Sierra Leone
health structures, according to MSF’s to focus on the malnourished children but and Kashmir. In the town of Baoji,
Kaz de Jong. also to look for signs of emotional trauma China, MSF offers psychosocial support
in mothers. The most telling signs are to orphaned and abandoned children,
“We made it less formal in Sierra Leone,” mothers who no longer care for their many of whom have been abused.
says de Jong. “The sessions often took children—who do not hold them anymore
place sitting under a tree. People would and hardly interact while feeding them. “Eighty percent of the children have
walk by and join the group.” been mistreated or beaten—often by
Volunteers try to rebuild the mother- the ‘adoptive’ families who took them
Since 2000, MSF psychologists have con- child bond by addressing the mother’s in—before being abandoned on the
ducted counseling sessions for families psychosocial needs through counseling streets of Baoji,” says Francoise Oppenot,
trapped amid the ongoing conflict in groups or helping the women get back an MSF volunteer and child psychiatrist
the Palestinian Territories. During an to their daily routine from before their who has treated children there. “They
Israeli offensive into the Gaza Strip in displacement, like making clothes or wander the streets, collecting empty
October 2004, MSF mental health teams cooking meals. bottles that they sell by weight, and
were denied access for several weeks to have to beg to stay alive.”
the families they had been treating. Supporting AIDS Patients
Mental health care is an integral part The goal of the program is to offer a
Indeed, one of the greatest challenges of MSF’s HIV/AIDS-treatment programs. stable environment for the children and
of treating emotional and psychological All of the 23,000 patients receiving the right conditions for their recovery,
trauma in conflict zones is the risk antiretroviral therapy in MSF clinics which includes temporary housing and
that patients will become separated from and hospitals have access to psycho- access to medical and psychosocial care,
their therapists. For this reason, the social support. as well as access to schooling.
counselors and therapists focus their
intervention on enhancing psychological “But we need to improve this support The program has reached more than 300
self-help mechanisms. for people living with AIDS,” says de children since 2001.

7 PROVIDING MENTAL HEALTH CARE


ON THE FRONTLINES OF
HIV/AIDS TREATMENT
Doctors Without Borders/Médecins Sans Frontières (MSF) has been caring for people living
with HIV/AIDS in developing countries since the mid-1990s, and first launched treatment
programs in 2000 in Thailand and South Africa. MSF currently provides antiretroviral
(ARV) treatment to more than 23,000 people in 27 countries—a 150 percent increase
from December 2003. But there are more than six million people living with HIV/AIDS
worldwide who are desperately in need of ARV treatment today while fewer than 500,000
people have access to it.

A week’s worth of ARV medicines for an HIV/


AIDS patient in Siem Reap Provincial Hospital
in Cambodia. The boxes are color-coded to
With the counseling and guidance of an MSF medical team, an 11-year-old, HIV-positive Thai girl is able to prepare her ARV distinguish pills to be taken at different
medicines without help from her mother. 2004 © Joanne Wong times in the day. 2004 © Espen Rasmussen

Two MSF national staff members operate a bicycle-ambulance service to transport an HIV/AIDS patient to the MSF clinic in
Malawi’s Thyolo province. A relative accompanies the patient to the clinic. MSF provides ARVs to more than 4,000 people —
more than 90 percent of the people receiving treatment for HIV/AIDS in Malawi. 2004 © Gael Turine

ON THE FRONTLINES OF HIV/AIDS TREATMENT


Eric Goemaere, MD, MSF head of mission in South Africa, exam- A nurse at Odessa City Hospital in Ukraine, where MSF supports a comprehensive HIV/AIDS treatment pro-
ines an HIV/AIDS patient in an MSF clinic in the town of gram, brings food to eight-year-old Maxim. Maxim is HIV-positive and was abandoned by his parents. Some
Khayelitsha. MSF treats more than 2,000 South Africans living with 1,000 mother-child pairs participate in MSF’s program to prevent mother-to-child transmission of the virus,
HIV/AIDS. 2003 © Francesco Zizola and 120 adults and approximately 30 children now receive ARV treatment. 2003 © Alexander Glyadelov

Esther, a five-year-old girl, is examined at A young woman waits with her daughter to receive ARV treatment at an MSF clinic in Mozambique. MSF
the MSF HIV/AIDS clinic in the Mathare provides ARVs to more than 2,800 people—more than 60 percent of those receiving HIV/AIDS treatment in
slums of Nairobi, Kenya. A neighbor who this country. “Before, only treatment for opportunistic diseases existed,” says Dominique Arthur Delley,
receives ARV treatment at the clinic has coordinator of MSF’s AIDS program. “We were trying to delay death. Now we are supporting a life project.”
brought Esther here. 2004 © Martin Beaulieu
2003 © David Levene

ON THE FRONTLINES OF HIV/AIDS TREATMENT


RESPONDING TO EMERGENCIES IN CONGO
A delicate peace agreement has been reached in the Democratic One of the MSF emergency teams intervened in a measles epidemic
Republic of Congo (DRC), but many people are still in a state of in the Yahuma region of Eastern Province. “This started right
crisis. Among them are at least 9,000 Congolese who fled their at the beginning of August when we received an alert from
villages after violence broke out in the Mitwaba region of south- our mobile team in Lobutu, verified by village chiefs and nurses
east Katanga Province. from the local health centers,” says Dr. Kisamba. “So we were
off to investigate and intervene.”
“It is hard to say how many people have been forced to leave
their villages due to continuing violence between the Congolese With 326 measles cases in two weeks across four villages, the
army and local militia groups because many are still hiding in team had to work fast to stop the spread. “We quickly set up
the forest,” says Doctors Without Borders/Médecins Sans Frontières four diagnostic and treatment centers,” says Dr. Kisamba, “first
(MSF) head of mission Alain Decoux. “The people are caught treating the infected cases and creating isolation facilities to
in the crossfire. Both sides prey on the villages for their survival. cut the transmission chain. Then, we began a public-awareness
When it is suspected that a village is backing the other side, campaign to inform parents of the need to separate healthy
the result is often that the village is razed to the ground and from ill children.”
the people are forced to flee into the bush.”
Measles is one of the biggest health threats in the region
In November 2004, MSF dispatched one of its DRC emergency because vaccination coverage is very low, malnutrition is rife,
teams to assist the displaced people in Katanga. MSF set up and the health system has been ruined by the war. Says Dr.
four health centers in and around Mitwaba, providing 1,500 Kisamba, “These factors help the rapid spread of disease, and
consultations in the first week alone. children are just not protected.” The MSF emergency teams
treated more than 12,000 people for measles in 2004.
Currently, each health center is receiving 60 to 120 patients
every day, with the most common ailments being bloody diarrhea, BATTLING 13 DISEASES
malaria, and acute respiratory infections. On the day that one Measles is only one of the 13 diseases covered by the emergency
of the health centers opened, 45 of the 54 patients were team. Others include common killers such as cholera, malaria,
found to be malnourished. and diarrhea-related diseases, as well as rare diseases like
Ebola and bubonic plague.
“Being forced to flee means that people can’t tend to their crops,”
says Decoux. “Although even if cultivation were possible, the An MSF emergency team was recently sent to Dingila in Eastern
harvest is vulnerable to pillaging by any one of the numerous Province to deal with monkeypox, a disease that kills 15 percent
armed forces. It has reached the point that people prefer to of the people it infects. It is virtually unknown to the medical
eat seeds than to risk attempting to cultivate.” profession and therefore extremely difficult to treat.

“This animal pox can be transmitted to humans,” says Dr.


RAPID RESPONSE Kisamba. “Hunters often get infected, as do those who’ve been
The situation in Katanga is just one of more than 40 emergencies in contact with dead animals.”
to which the MSF emergency teams in the DRC have responded
this year. From addressing outbreaks of measles and cholera, to Monkeypox causes eruptions on the skin, which are entry
aiding abused Congolese diamond miners who were expelled into points for other microbes. By isolating the patient and raising
the jungles of southwestern DRC by the Angolan government, public awareness, the transmission chain can be broken, but
the emergency teams try to intervene within five days of without MSF’s assistance the local hospitals would not have
receiving a call for assistance. This is no easy task in a country the means to treat patients effectively.
the size of Western Europe, many of whose communities are
only accessible by boat or motorcycle. But Dr. Kisamba’s greatest fear is an outbreak of viral hemorrhagic
fever, more commonly known as Ebola, a highly contagious
“Our team is capable of carrying out three simultaneous inter- virus that can kill 90 percent of all people who have clinical
ventions. But two is more reasonable,” says Charles Kisamba, MD, a signs of the disease. “We do rehearsals before going to the
member of the Kisangani-based MSF emergency team. The teams field because if you commit the smallest error, there is no safety
Maintaining the cold chain, an MSF volunteer removes
are based in Kinshasa, Mbandaka, Lubumbashi, and Kisangani. net,” says Dr. Kisamba.
vaccines from a refrigerator. © Frederic Sautereau

RESPONDING TO EMERGENCIES IN CONGO 10


MSF IN THE DEMOCRATIC
REPUBLIC OF CONGO
PRESENT SINCE 1981 An MSF emergency team unloads its motorcycles along the banks
INTERNATIONAL STAFF: 217 of the Tshuapa, a tributary of the Congo River. The team still has
to travel more than 20 miles before reaching the health center in
NATIONAL STAFF: 1,829 Equateur Province. 2003 © Carl De Keyzer

DEMOCRATIC REPUBLIC OF CONGO


POPULATION: 53.6 MILLION
INTERNALLY DISPLACED PEOPLE: 3 MILLION
LIFE EXPECTANCY 1970-75 VS. 2000-05: 45.8 YEARS VS. 41.8 YEARS
PROBABILITY AT BIRTH OF NOT SURVIVING TO AGE 40: 47.2%
UNDER-FIVE CHILD MORTALITY RATE PER 1,000 LIVE BIRTHS: 205
CHILDREN UNDER WEIGHT FOR AGE: 31%
MATERNAL MORTALITY RATIO PER 100,000 LIVE BIRTHS: 990
PHYSICIANS PER 100,000 PEOPLE: 7
Source: Human Development Report 2004

11 RESPONDING TO EMERGENCIES IN CONGO


After its six-week run at the 92nd Street Y, the exhibit moves
to Los Angeles, where it will appear at the 14th International
LA Photographic Art Exposition from January 20-23, 2005. The
photographs are also viewable online at:
www.doctorswithoutborders.org/afghanphotos

THE HIDDEN SCARS OF WAR


In November, broadcast journalist and MSF-USA Board of Advisors
member Garrick Utley hosted a discussion of MSF’s mental health
programs at an event hosted by NYU Medical Center and attended
by more than 150 mental health professionals and others.

Sudan. 2004 © Ton Koene

SPEAKING OUT ON DARFUR


Doctors Without Borders/Médecins Sans Frontières (MSF) held
a number of public events this fall in New York and Los Angeles.
In September, NBC’s Ann Curry moderated a discussion on the
catastrophe in Darfur, Sudan, which was hosted by the New
School University in New York City and attended by 500 people.
Curry was joined by MSF-USA Executive Director Nicolas de
Malawi 2004 © Gael Turine
Torrenté; MSF field volunteer Jonathan Spector, MD; Salih
Booker of Africa Action; and journalist Scott Anderson. AIDS TREATMENT FILM SCREENING
To mark World AIDS Day on December 1, a documentary featuring
MSF AIDS-treatment programs in Guatemala, Malawi, and
Thailand, was screened at the University of California at Los
Angeles. The documentary, “AIDS Treatment: Reaching the
People?” was screened again that evening at the Laemmle
Theatre in Santa Monica, followed by a discussion hosted by
KPCC radio’s Kitty Felde, with MSF doctors Gildon Beall,
Rick Hamner, and Deborah Milligan.

“HUMANITARIAN AID IS AN
APOLITICAL ACT”
On November 11, 2004, King Abdullah of Jordan presented
Doctors Without Borders/Médecins Sans Frontières (MSF) with
the King Hussein Humanitarian Leadership Prize.
Afghanistan 2002 ©Sebastian Bolesch

PHOTOGRAPHS FROM AFGHANISTAN The $50,000 prize came into existence in 2000 and was award-
In October, the 92nd Street Y in New York City opened “Doctors ed by the King Hussein Foundation, named for the late king
Without Borders: Photographs from Afghanistan,” an exhibit of Jordan.
documenting MSF’s long history in this war-torn country.
Speakers at the opening reception included writer Sebastian “In these times of renewed fighting in Ivory Coast, with
Junger, MSF Operations Director Kenny Gluck, and photojournalist great needs in the Darfur region of Sudan, and in many
Didier Lefevre. Lefevre traveled with MSF medical teams in less-known contexts such as northern Uganda or Chechnya,
the 1980s as they undertook clandestine cross-border operations this recognition from civil society makes us realize our work
from Pakistan to reach Afghans stranded in areas that were is supported and not forgotten,” said MSF International
most affected by the Soviet occupation. President Rowan Gillies, MD.

NEWS & EVENTS 12


MSF STOPS ACTIVITIES IN IRAQ
In November 2004, Doctors Without
Borders/Médecins Sans Frontières (MSF)
closed its humanitarian aid programs in
Iraq after nearly two years of working
there. MSF made the decision because of
the extreme risk that aid workers are
currently facing in the country.

Escalating violence in Iraq forced MSF to


conclude that it was no longer acceptable
to expose its staff to the serious risks that
have become an apparent part of being
associated with an international human-
itarian organization.

“It has become impossible for MSF as an


organization to guarantee an acceptable
level of security for our staff, be they
foreign or Iraqi,” says Gorik Ooms, MSF
general director. “We deeply regret the
fact that we will no longer be able to
provide much-needed medical help to
the Iraqi people.”

MSF has always adhered strictly to its


principle of providing assistance on the
basis of human needs. MSF strives never
to allow political, military, or other motives
to interfere with its objective of assisting
those who urgently need medical aid. In
Iraq, however, the warring parties have
repeatedly shown their disrespect for
independent humanitarian assistance.

MSF has worked in Iraq since December


2002. During the bombing of Baghdad, a
small team of international aid workers
stayed in the city to assist in the hospi- ambulance service to its activities in Sadr
tals. Soon after, MSF set up three clinics City and had only recently begun caring
in Sadr City and began supporting a for people displaced from Fallujah.
referral hospital. From top to bottom:
A women on her way to work walks past a wall riddled
with bulletholes in Baghdad.
The clinics provided some 100,000 medical
2003 © Geert van Kesteren
consultations from January to November
2004. During the course of the year, MSF A boy receiving first aid from an MSF volunteer in
June 2003 at the primary health clinic in Sadr City,
assessed needs in cities that had endured
north Baghdad.
heavy fighting—Fallujah, Najaf, and 2003 © Andrew Stern
Karbala—and supported health workers
The former MSF health clinic in Sadr City.
there. The organization also added an
2003 © Andrew Stern

13 MSF STOPS ACTIVITIES IN IRAQ


GUATEMALA REPEALS LAW
RESTRICTING ACCESS TO MEDICINES
In November 2004, the Guatemalan Congress
repealed a law that could have severely restricted
people’s access to affordable essential medicines.
MSF has recommended that the government take
advantage of this decision to ensure treatment for
greater numbers of Guatemalans living with HIV/
AIDS and other infectious diseases. MSF also has
warned that this step forward could be reversed
by similar intellectual-property provisions found in
the recently signed United States-Central America
Free Trade Agreement (CAFTA). MSF has been
treating people living with HIV/AIDS in Guatemala
since 2001. The organization treats more than
RESPONDING TO FLOODS IN HAITI 1,600 patients with antiretroviral (ARV) therapy in
In response to the hurricane and floods that killed
a hospital and clinic in Guatemala City and in health
thousands and left nearly 200,000 people homeless
centers in Coatepeque and Puerto Barrios.
in the Haitian city of Gonaives, Doctors Without
Borders/Médecins Sans Frontières (MSF) medical
teams established in September 2004 a health
center in Raboteau, a slum in the western part of
the city. “The center existed before the disaster but
was not operational at all,” says Silvien Auerbach,
MSF head of mission in Haiti. “Thanks to people
in the community who helped us remove the mud
and clean the building, we were able to use it for
consultations.” MSF volunteers performed more
than 900 medical examinations a day in the clinic
in the weeks following the floods. Today, a mental
health team is also offering psychosocial therapy
to people receiving care in the Raboteau center,
to local government staff who were charged with
recovering the dead, and to rural populations out-
side the city. Another MSF team has supported the
hospital in Port de Paix, north of Gonaives, since
October, and has organized mobile clinics in the
village of Chansolme, also hit by the hurricane.
2004 © Dieter Telemans

FIELD UPDATES
DOCTORS WITHOUT BORDERS/
MÉDECINS SANS FRONTIÈRES USA
TREATING AIDS IN KENYA Executive Director
In October, MSF and the Kenyan Ministry of Health Nicolas de Torrenté, Ph.D
opened a health center and HIV/AIDS-treatment Board of Directors & Officers
Darin Portnoy, MD, MPH
program for the people living in the Kibera slum of
President
Nairobi. Kibera is one of the largest slums in Africa Martha Carey
with a population of more than 600,000. Those living Vice President
in Kibera will have access to outpatient consultations, David A. Shevlin, Esq.
mother-and-child health care, treatment for victims Secretary
Jean-Hervé Bradol, MD
of sexual violence, and comprehensive HIV/AIDS William Conk
treatment. “Disease is rife, with the biggest killer Roshan Kumarasamy
in the slum being HIV/AIDS-related diseases,” says Bruce Mahin
MSF head of mission Christine Jamet. MSF has been Christine Nadori, RN
John E. Plum
working in Kibera since 1997. Currently, 150 people
Treasurer
living with HIV/AIDS are receiving antiretroviral Myles Spar, MD, MPH
treatment through MSF. MSF runs similar programs Board of Advisors
in other areas of Nairobi, as well as in Busia and Richard Rockefeller, MD
Homa Bay. Chairman of the Board
Robert Bookman
Chairman, West Coast Council
Creative Artists Agency
Donald Mark Berwick, MD, MPP
Institute for Healthcare Improvement
Victoria B. Bjorklund, Esq., Ph.D
Simpson Thacher & Bartlett
A. Bruce Brackenridge
J.P. Morgan & Co., Inc. (Ret.)
Marek T. Fludzinski, Ph.D
Thales Fund Management, LLC
Peter Grose
Kennedy School of Government, Harvard
Jean Karoubi
The LongChamp Group
Susan Liautaud
James Ottaway, Jr.
Dow Jones & Co. (Ret.)
Ottaway Newspapers, Inc.
Kevin Patrick Ryan
DoubleClick, Inc.
Garrick Utley
Neil D. Levin Graduate Institute, SUNY
AID TO SUDANESE REFUGEES IN CHAD Robert W. van Zwieten
Lehman Brothers, Inc.
MSF continues to work near the Chad-Sudan border,
Marsha Williams
assisting some 200,000 refugees who have fled Blue Wolf Productions
violence in the Darfur region of western Sudan. More New York Office
than 1.5 million Sudanese have been displaced in 333 Seventh Avenue, 2nd Floor
New York, NY 10001-5004
Darfur since fighting broke out there in 2003. In
Tel: 212-679-6800
September, MSF medical teams provided con- Fax: 212-679-7016
sultations to nearly 5,600 refugees living in two main Email: doctors@newyork.msf.org
camps, Iridimi and Toulum. Consultations increased Web: www.doctorswithoutborders.org
to more than 6,800 people in October. The nutritional West Coast Office
2525 Main Street, Suite 110
situation is improving: in the MSF therapeutic
Santa Monica, CA 90405
feeding center for severely malnourished children Tel: 310-399-0049
in one of the camps, the number of children en- Fax: 310-399-8177
rolled dropped by 75 percent from August to October. Alert is a quarterly newsletter sent to friends and
In the supplementary feeding program for the supporters of Doctors Without Borders/Médecins Sans
moderately malnourished, the number of children Frontières. As a private, international, nonprofit
enrolled dropped from 2,042 in August, to 1,965 in organization, MSF delivers emergency medical relief
to victims of war and disaster, regardless of poli-
September, to 1,658 in October. However, the
tics, race, religion, or ethnicity.
refugees are still entirely dependent on food
Editor: Jason Cone
assistance, and any interruption in aid could result
Editorial Advisor: Kevin Phelan
in drastically increased malnutrition among the Design: CoDe, Jenny 8 del Corte Hirschfeld
people in the camps. MSF is also working in Iriba
Doctors Without Borders is recognized as a nonprofit,
Hospital, which acts as a referral hospital for the
charitable organization under Section 501(c)(3) of
most serious cases from Iridimi and Toulum. the Internal Revenue Code. All contributions are
2004 © Gael Turine tax-deductible to the fullest extent allowed by law.

FIELD UPDATES
2004 © Patricia Rincon Mautner

Ana Milena, the mother of a 3-year-old girl, was “I think the MSF rehabilitation center is great
stabbed in the stomach and back by her ex-husband. because I was able to learn how to walk again,”
The attack left her paralyzed. Milena was brought says Milena. “The staff helped me to learn on a chair,
to the Doctors Without Borders/Médecins Sans then on crutches. Now, I only need a stick to go up
Frontières (MSF) rehabilitation center in Cali, Colombia, stairs or cross the street.” Milena has also been
where she was one of more than 2,700 survivors of able to go back to work as a toymaker. “I see life in
urban violence who have received free, comprehensive a different way now—I love it more. I value myself
rehabilitative care since 1998. MSF recently handed more, and I enjoy each day as a gift.”
the project over to the local government.

333 Seventh Avenue, 2nd Floor


New York, NY 10001-5004
Tel: 212-679-6800
Fax: 212-679-7016
www.doctorswithoutborders.org