March 2015

Activity Report is an independent organization. EMERGENCY provides free, high quality MANAGING DIRECTOR Roberto Satolli medical and surgical treatment to the DIRECTOR Gino Strada EDITOR victims of war, landmines and poverty. Simonetta Gola

WITH THE ASSISTANCE OF Raffaela Baiocchi, Andrea Bellardinelli, Maurizio Cardi, Maria De Pasquale, Christian Elia, Simonetta Gola, Hawar Mustafa, Mimmo EMERGENCY promotes a culture of peace, Risica, Emanuele Rossini, Cecilia Strada, Gino Strada, Manuela Valenti PHOTOGRAPHS solidarity and respect for human rights. EMERGENCY archive, Marco Affanni, Gianluca Cecere, Simone Cerio, Salvatore Colloridi, Michael Duff, Massimo Grimaldi, Baudouin Mouanda, Gianluca Panella, Mattia Velati, Christopher Williams GRAPHIC DESIGN In order to assert the right to healthcare for everyone, EMERGENCY: Angela Fittipaldi, Giulia Ferranti - provides assistance totally free of charge; PRINTED BY - guarantees treatment to anyone in need of assistance, without any sort of discrimination; Special issue, supplement to the Quarterly - - practices high quality and employs standardized therapeutic and working protocols already tested in emergency situations; Litografica Cuggiono, Registration with the Court of Milan no. 701 of 31.12.1994 - trains local staff thoroughly until complete operational independence is achieved. DISTRIBUTION 260,000 copies, of which 190,330 sent to registered supporters EMERGENCY designs, builds and manages through its international staff: EDITORIAL TEAM - hospitals for victims of war and surgical emergencies; via Gerolamo Vida, 11 - rehabilitation and social reintegration centres; 20127 Milano T +39 02 881 881 - first aid posts for emergency treatment; F +39 02 863 163 36 [email protected] - basic health centres for primary healthcare; www.emergency.it - paediatric and maternity centres; - outpatient and mobile clinics for migrants and destitute people; - centres of excellence.

Between 1994 and 2014, in the hospitals, clinics and rehabilitation centres run by EMERGENCY, over 6 million people received high quality medical care free of charge.

2 — Report 2014 Report 2014 — 3 A YEAR TOGETHER by Cecilia Strada, President

Sierra Leone, October. Momoh, aged five, Teresa contacts the social services to sort arrives at our Ebola treatment centre in something out. Goderich with his mother. She doesn't make it. She's already dead when the Central African Republic, May. Ismae ambulance reaches the gates of the is seven and has got second and third centre. Momoh is very ill: vomiting, degree burns on his feet and legs. His diarrhoea and a high temperature. Gina father tells us their village was attacked gives him fluids intravenously. Three weeks at night and all the houses were set fire are needed to get him out of danger. to. They walked fifteen days through the forest to get to the “Complexe pédiatrique” , July. Shamsullah, aged where the EMERGENCY doctors and nurses twelve, was going to the market with are. His father thanks Ombretta again and his father when a mine exploded and again. overturned their cart. He lost both legs. Abdul Ahad, aged ten, is on the same Iraq, April. Naby and Said are learning ward. He was shot, playing on a roof. Ivan, how to use a sewing machine. They're the ward nurse, gives them some felt tip on a vocational training course at the colouring pens and a smile. This too is Sulaimaniya Rehabilitation and Social healthcare. Reintegration Centre, where disabled and maimed people can learn a work Sudan, June. Omer arrives at the paediatric skill compatible with handicap. Faris and centre with his parents. He is aged five Hawar, the directors of the centre, look on but with the weight of a two-year-old and proudly. This too, for us, is healthcare; like suffers from Tetralogy of Fallot. When he the healthcare we provide to refugees – arrives at the centre he is unconscious new civilian victims of yet another war – at and in a state of respiratory failure. He has the Arbat camp. to be resuscitated and admitted. Sofia, a cardiologist, is at the centre at the time on This year too, we have treated many, far a screening mission, selecting patients for too many, people at EMERGENCY centres operation at the Salam for throughout the world and in Italy. At every Centre. Omer will be one of these. single patient's side there has been a doctor, a nurse and a mediator ready to Italy, May. One of the two EMERGENCY give help, a smile, a pen. And at the side of minivans is working around Bari station, each one of them there's been you, making providing primary healthcare and advice all this possible. Thank you. to the many needy people in the area. Amongst the patients waiting for us is Goran, a Kurdish boy just arrived in Italy. He acts as if he already knows us and, after a few questions, smiles and says “It really is you!”. Goran had been a patient of ours in Sulaimaniya, in Iraqi Kurdistan; we operated on him there when he was eighteen and fitted him with two leg prostheses. Now he's here, a war refugee with nowhere to sleep. Maria

Afghanistan, Kabul - Surgical Centre for war victims 4 — Report 2014 Report 2014 — 5 1994

HUMANITARIAN PROGRAMMES Missions of war surgery and in Kigali, Ruanda

1995 CAMPAIGN AGAINST 1999 THE LANDMINES

Opening Anabah Surgical and medical Centre, 1996/2005 Afghanistan Surgical Centre of Sulaimaniya, Iraq 1998 1999 Opening the Rehabilitation Centre in Sulaimaniya, Iraq Jovanovic Zmaj Jova support the orphanage in Belgrade, Serbia 1998/2005 2000 Surgical Center of Erbil, Nord Iraq Mission of war surgery in Asmara in Eritrea 1998/2012 Surgical Centre of Battambang and 5 First Aid Posts, Cambodia 2001

Opening the Surgical Centre in Kabul, Afghanistan 2002

2001 Opening the Paediatric Centre in Goderich, CAMPAIGN “A SHRED OF PEACE” Sierra Leone 2001/2002 Centre Prosthesis and Rehabilitation to Diana, Iraq 2003 2001 CAMPAIGN “CEASE FIRE” Aid program for war widows in Panjshir, Afghanistan 2003 2001 Support at Al-Kindi hospital in Baghdad and Kerbala, Iraq Opening the Surgical Centre of Goderich, Sierra Leone 2002 CAMPAIGN “ITALY OUT OF THE WAR” 2003 2003/2012 Online newspaper PeaceReporter Opening the Maternity Centre of Anabah, Afghanistan 2004 2003/2004 Centre Prosthesis and Rehabilitation in Medea, Algeria Opening the Surgical Centre of Lashkar-gah, Afghanistan 2003/2004 Centre Prosthesis and Rehabilitation in Dohuk, Nord Iraq 2004 2003/2004 Aid to the people of Falluja, Iraq Renovation of health Centres in Benguela, Angola Mission of surgery to the public hospital in Jenin, Palestina 2004/2005 Delivery of drugs to the Casa de la mujer, Nicaragua Reconstruction of the department of emergency surgery in Al Fashir hospital in North Darfur, Sudan 2003/2007 Support for widows and destitute women of the Panjshir Valley, 2005 Afghanistan Sierra Leone, Goderich - Ebola Treatment Centre Support the hospital in Kalutara, Sri-Lanka 6 — Report 2014 Report 2014 — 7 2005 2014 2006 Opening the Paediatric Centre of Mayo, Sudan 2005/2007 Assistance to inmates Rebibbia New Complex, Rome Opening Clinic in Palermo, Italy 2005/2008 MARCH Reconstruction of houses in the village of Punochchimunai, Sri-Lanka 2007 Start of preventive medicine activities in Start of emergency surgery courses, Afghanistan 2008 Port Sudan, Sudan MANIFESTO FOR A HUMAN RIGHTS Opening of FAP in Urmuz (Helmand area) Opening the Salam Centre for Cardiac BASED MEDICINE Surgery in Khartoum, Sudan

APRIL 2009 2010 Start of project for the prevention of sexually transmitted diseases in sex workers, Italy

Opening the Paediatric Centre of Bangui, Central African Republic Opening of FAP in Tagab (Kabul area) Opening Clinic in Marghera, Italy 2011 2010/2011 June Pediatric centre in Nyala, Darfur

Start of mobile clinics, Italy Start of blood bank project, Central African 2010 Republic MANIFESTO “I STAY WITH EMERGENCY”

Mission of war surgery in Misrata, Libya JULY CAMPAIGN “IT CAN ONLY BE ABOLISHED” 2012 Opening of FAP in Arbat camp, Iraq, for Syrian refugees Opening of health centre in Khanaqin refugee camp, Iraq

Opening new First Aid Posts, Afghanistan Opening of FAP in Andar (Kabul area)

Opening the Paediatric Centre of Port Sudan, 2012 Sudan Information desk for social and health orientation in Sassari, Italy SEPTEMBER 2011 MANIFESTO “THE WORLD WE WANT” Opening of Ebola Treatment Centre in Lakka, Opening of second health centre in Arbat camp, Sierra Leone Iraq, for Iraqi refugees

2013 Opening of FAP in Sheikhabad (Kabul area)

NOVEMBER

Politruck, Italy

Information desk for social and health orientation in Sicily; Opening a Clinic in Polistena, Italy; Launching of 2 new mobile clinics in Italiy; DECEMBER Opening 4 new FAPS in Afghanistan; Mission of war and emergency surgery in Bangui, Central African Republic. Opening of FAP in Waterloo, Sierra Leone Opening of Ebola Treatment Centre in Goderich, Sierra Leone

8 — Report 2014 Report 2014 — 9 “The aim of our centre is to provide maximum care to the patient. This is what guides us in our work every day. THE EBOLA EMERGENCY IN SIERRA LEONE Doing this it is difficult, though, when you have to look after your own safety, working with instruments that restrict your movements. Despite this, we're looking at ways of increasing the time we can dedicate to patients and, compared to other centres, we're very satisfied with what we're achieving. In our work – and elsewhere too – the risks are many. You think about the risks, of course, but you concentrate on your work and your patients, and all the rest comes after that. Because, with quality and professionalism, Ebola can and must be cured.” Gina, coordinator of the Ebola Treatment Centre in Goderich. «In August, when the Ministry for Health in Sierra Leone asked us to open an isolation centre in Lakka for suspected Ebola cases, in just three weeks our logistics team put up a system of tents with a total of 22 beds. This soon had to be transformed into a treatment centre, because there were so many patients collapsed outside the gates, worn out by the “I got here in February, just before the outbreak. The situation came to a head in August, when the virus hit the illness and waiting for a bed. So the rush began to organise ourselves so that we could capital where they weren't equipped to deal with it – and the international community was doing nothing. We actually treat the patients, not just isolate and observe them, and this meant: ensuring decided to stay and help these people. We opened the Ebola centre when the disease was spreading, and it reliable water and power supplies, guaranteeing safety procedures and protocols, installing can now accommodate a hundred patients. I'm glad to be here because, knowing this country, you can only imagine what it would have been like if we'd left.” Leonardo, logistician. air conditioning to reduce the physical fatigue of operators in very hot protective suits and, finally, starting to treat the ill; even though there is no specific cure for the illness, many lives can be saved with adequate support therapies. Little by little, with huge difficulties, we set up a biochemical laboratory, then a virology laboratory, then the monitors and the infusion pumps arrived, and the ventilators for intubating the more critical patients, and “Every day, with my work, I realise how important this hospital is for my people. We examine a hundred children the dialysis machines. In just three months, we were able to set up an intensive therapy unit a day. We're sustaining the future of Sierra Leone with free, excellent treatment. If this hospital had closed, and if at the level of those in specialist centres in Europe and the USA. In wealthy nations, two EMERGENCY hadn't decided to work with the Ebola centres, it would have been a nightmare. In Sierra Leone you out of three patients are cured; in poor Africa, two out of three patients die, from lack of can still die from the simplest of illnesses, let alone Ebola. I'm proud to be a part of this story.” healthcare. Mariama, paediatrician at the Paediatric Centre in Goderich.

In mid-December, we opened the new 100-bed centre in Goderich. In the 24-bed intensive care unit, the only one of its kind in West Africa, we are able to provide a level of care comparable to that available in the West. We are proud of this, because it proves that something can be done in Africa too. For us there “I was part of the team that opened the hospital at Goderich in 2001. The local health system, unfortunately, has can be no double healthcare standards: one for "them" and one for "us". Over the years, in the got enormous problems. The Ebola outbreak made everything even more difficult. Our Surgical Centre is a point of many hospitals we have created, we often ask ourselves "what does a hospital have to be? – reference for the whole country; how could we close? We've been involved in the lives of these people since the in Iraq, in Central African Republic, in Sudan or in Afghanistan? What facilities do they war. That's what we'll carry on doing and we have never regretted that choice.” have to be, what equipment, what treatments?” Luca, EMERGENCY programme coordinator in Sierra Leone. And the answer, for us, is the simplest and most human of all: if it's an “EMERGENCY” hospital, it can only be good enough for "them" if it's good enough for us, our loved ones and everybody. Equality means this as well, sharing the same rights and being part of a common destiny». “Our work is dangerous, of course. We're well-prepared, though, and we know that when you're in the red zone – when you go in and out of it – you have to really concentrate. Sometimes it's hard, repeating the same movements all the time. You really suffer from the heat in those suits and you lose a bit of your manual dexterity. Gino Strada, Freetown - Sierra Leone We can’t let anything stop us, though: the work we do here is too important for my people, for my country.” Jakob, cleaner at the Ebola Treatment Centre. 18 January 2015

10 — Report 2014 Report 2014 — 11 Guinea

SIERRA LEONE Freetown Goderich

Golf of Guinea Liberia

The first cases were in Guinea, then Liberia, and the Ebola outbreak finally hit 01 03 05 Sierra Leone in May 2014. To respond to this new crisis, EMERGENCY already had its Surgical and Paediatric Centre in Goderich – the traumatology centre of reference for West Africa for many years – reorganised and ready by more or less the beginning of the year. All staff were specifically trained in new procedures for containing the spread of the disease and preventing infection. The hospital was completely reorganised: a new triage area was set up to limit contact between waiting patients and prevent suspected Ebola cases from entering the hospital; patients with possible Ebola symptoms were isolated in two separate tents while waiting for laboratory results to confirm the diagnosis; visits from family members were stopped and new procedures were implemented to 02 04 06 monitor the health conditions of all staff. This was all done to prevent Ebola entering protection systems and often didn't even first centre on 18 September in Lakka, a – equipped to the standard of hospitals in crammed into overcrowded, makeshift left to its own devices: malaria, typhoid, the confines of the hospital. have adequate protective materials, so a short way from the capital. This gave us 12 western nations, with ventilators, dialysis shelters. infections and surgical emergencies This was a considerable undertaking, since large number of the personnel in public isolation beds and 10 care beds, 22 in all. machines, infusion pumps and monitors, The camp, like many other parts of the continued to be daily problems that the most of the 100 children arriving every hospitals fell ill. The main purpose of the centres set up at allowing us to provide patients with the capital, had no healthcare facilities could no longer be dealt with by public morning at the clinic had symptoms very that time was to isolate infected patients. best possible care. At the Centre, we set capable of providing a quick response to health facilities. The Ebola emergency similar to Ebola: nausea, diarrhoea and The Ebola treatment centres EMERGENCY decided to take the further up a polymerase chain reaction (PCR) suspected infection cases. further exacerbated the endemic lack of high temperature. As soon as we started diagnosing the first necessary step – despite doubts about test laboratory, working together with the We had four nurses working at Waterloo doctors and nurses that has so hindered Meanwhile, the disease, initially only in cases of Ebola in the patients in isolation its achievability amongst those working “Lazzaro Spallanzani” National Institute of using triage for suspected cases and the development of the health system in northern districts, spread to the rest of the in our hospital, we came up against the to contain the epidemic – of curing the Infectious Diseases to test patient blood transferring them to the Treatment Centre if this country. The Ebola virus cost Sierra country. By mid- September 1,600 Sierra total inadequacy of Sierra Leone's health patients. samples as positive or negative for the necessary. To stop the spread of the virus, Leonean healthcare workers dearly. Leoneans were ill, 100 of these in the system. We tried many times to find beds With the virus spreading rapidly at the rate Ebola virus. The laboratory has made it we involved the entire community. We capital, Freetown. to transfer the patients to for treatment, of 100 new illnesses every day, the Lakka EBOLA possible to reduce the time lost between trained 90 healthcare operators to identify The overcrowding in the city's shanty but the few, poorly equipped available Centre beds were always full, so we began TREATMENT testing and diagnosis, thus ensuring the people in the camp that had come into towns and the terrible hygienic conditions facilities were unable to cope with the planning a 100-bed Ebola treatment centre. CENTRES CO- speedier treatment for patients. contact with Ebola patients and monitor multiplied the number of cases. outbreak. The Goderich Centre, constructed in FUNDED BY them daily. Our Paediatric and Surgical More than 20 people a day were Faced with an emergency that was just 6 weeks and funded by the British First aid post at Waterloo camp Centre worked ceaselessly throughout contracting a virus that is potentially fatal becoming more and more evident each Government's Department for International As well as treating patients, we've also the Ebola emergency. While hospitals in up to 90% of cases in the absence of day, in response to requests from the Development (DFID), was opened on 13 been working to prevent the spread of the everywhere were closing due to lack of 01 Training in the use of protective suits adequate healthcare facilities. Sierra Leone Ministry of Health and December. infection. doctors and nurses, the EMERGENCY centre 02 The Goderich 100-bed centre Sierra Leone, just 13 years after a civil President, we started work on a new In just a few weeks, we set up an Ebola To do this, at the beginning of December was the only surgical and paediatric 03-05 The intensive care unit in the Ebola Treatment Centre, Goderich war, was totally unprepared for the project: an Ebola treatment centre. intensive care unit – the only one of its we opened a First aid post at Waterloo, a centre in the entire country to remain open. 04 Training volunteers at Waterloo epidemic. Local staff had no knowledge of In a race against time, we opened our kind in the countries hit by the epidemic refugee camp where 22,000 people are For many months, the population was 06 Inside the Ebola Treatment Centre, Goderich

12 — Report 2014 Report 2014 — 13 THE IRAQI EMERGENCY

Turkey

Sulaimaniya Arbat Syria Khanaqin Iran IRAQ Bagdad Jordan

Saudi Arabia Kuwait

In Northern Iraq, hundreds of thousands of refugees from Syria and displaced persons from Iraq are seeking shelter from the fighting and bloodshed affecting the entire region. Fleeing either the conflict in Syria or 01 03 the advance of Daesh (Isis) in Iraq, they ARBAT REFUGEE CAMP PROJECT STAFF AT abandon their homes to face hard, often CO-FUNDED BY WORK: dangerous journeys. ARBAT DISPLACED Tens of thousands of people continue PERSONS CAMP to flee the war, seeking help. While the 12 luckier ones are able to stay with friends ARBAT REFUGEE and relatives or rent houses and rooms in CAMP safe areas, the rest are housed in hurriedly 46 erected camps organised by the Kurdish KHANAQIN CAMP authorities and international organisations. 20 Living conditions are difficult: the tents ARBAT DISPLACED PERSONS CAMP aren't always sufficient, water and power PROJECTAND KHANAQIN CAMP PROJECT supplies are intermittent and the weather CO-FUNDED BY – scorching hot in the summer, below-zero temperatures and snow in the winter – makes life even harder for the refugees.

To deal with this humanitarian emergency, in July 2014 we began to intensify our ARBAT DISPLACED PERSONS CAMP PROJECT CO-FUNDED BY presence in Iraq, opening three clinics to provide free treatment to refugees and displaced persons in the Arbat and Khanaqin camps. From July to December, EMERGENCY doctors treated over 14 thousand people. Many of these were children, actually born 02 04 in the camps. The clinics also provide gynaecological and midwifery care for The illnesses we encounter are a respiratory infections. their professional skills back into use, work another two clinics in the Kalar area, for the 01 Arbat Camp for displaced Iraqis women and vaccinations and growth consequence of the living conditions Local doctors and nurses, often refugees alongside the international staff. people in the Qoratu and Tazade camps. 02 Arbat Camp for Syrian refugees checks for children. in the camp: gastrointestinal, skin and themselves recruited by EMERGENCY to put At the end of 2014, we started building 03-04 Inside the Arbat clinic

14 — Report 2014 Report 2014 — 15 Uzbekistan Tagikistan WAR SURGERY Turkmenistan Kabul AFGHANISTAN

Iran Gino Strada Surgeon and founder of EMERGENCY Kabul More than twenty-five years have gone Surgical Centre for since I first went to Quetta, in south-west war victims Pakistan, not far from the Afghan border. As a surgeon, I was familiar with some of the best surgical centres in Europe and OPENED: April 2001 North America. I went to Quetta hospital ACTIVITIES: Surgical Centre for war and out of curiosity. I wanted to see with my landmine victims. own eyes what it would be like doing my job in a poor country – mere professional interest. Little did I know that it was FACILITIES: Emergency department, there where I was to first experience war. outpatient department, 2 operating Little did I know that, from then on, I'd be theatres, sterilization, intensive care working all too often amidst war and its unit, sub-intensive care unit, surgical horrors, or that all this would lead to the wards, physiotherapy, CT scan, radiology, foundation of EMERGENCY. laboratory and blood bank, pharmacy, For months, in Quetta, I operated classrooms, playroom, auxiliary on patients hit by bullets and bomb facilities, maintenance department. fragments, torn to pieces by landmines. For months, I had neither the time nor NUMBER OF BEDS: 95 the capacity to think. I was overwhelmed and stunned by work. I was familiar with in these years, and operated on many of work in later years, weren't an exception LOCAL STAFF: 293 emergency surgery, but I had never seen them. - they were just the tragic normality of such terrible wounds and devastating After my first war hospital experience, I today's conflicts. AS OF 31 DECEMBER 2014: injuries as these. Not only the sight but the started asking myself a lot of questions. This bitter awareness of the “disasters of Admissions: 32,997 smell of those sometimes unrecognisable And the most important question of these war”, and the realisation of the possibility Outpatient consultations: 94,771 human beings still comes to mind. Now, was: who are the casualties in present-day to bring help to suffering humans, led to Surgical operations: 43,229 On 28 December 2014, NATO’s mission in Afghanistan officially ended. more than 20 years later, I still feel the wars? In the First World War civilian deaths the idea of EMERGENCY. It wasn't founded After 13 years of war, with more than 130 thousand foreign troops in the country and 4.2 billion dollars spent on same physical malaise and sickness and injuries accounted for just over 10% on a set of principles or statements, but the Afghan security forces, the situation had worsened drastically, especially for civilians. when I see the effect that war has on the of the total number, a slaughter that took on a realisation and on the consequential We arrived in Kabul six months before the offensive of the international coalition, in 2001, to open a Surgical bodies of human beings: limbs torn to place mainly on battlefields – perhaps for behaviour that emerges as an immediate, TRIAGE COURSES FOR NURSES AND Centre for victims of the war then raging between the Taliban and the Mujahideen. shreds, ruptured intestines and arteries the last time. In subsequent conflicts, the obvious need. I'd say that the idea of EMERGENCY SURGERY AND TRAUMA In just a few months, we had transformed a former nursery school into a hospital specialised in war surgery. to stitch together again. These were the enemy was of a different kind; villages EMERGENCY was born on the operating MANAGEMENTCOURSES CO-FUNDED BY In subsequent years, the centre was enlarged with the addition of an intensive care unit, the acquisition of things I was having to deal with, month replaced the “front line” and people's tables and in the wards. And so we began monitors and respirators and the installation of a CT scan unit – to this day, the only free one in the entire after month, in the work we know as “war homes replaced trenches. It was no longer treating the victims of the 1994 genocide country. Thanks to the new equipment and the experience of our surgeons, the hospital had become the surgery”. And often – quite surprisingly, a question of striking at English or German in Rwanda. And we carried on doing it, traumatology centre of reference for the whole of the country. Owing to the worsening safety conditions and the given the context – this work proved itself enemy soldiers, but rather of razing cities sending specialised teams around the increasing numbers of patients, however, from July 2010 admission criteria had to be limited to war surgery only. capable of resolving the most difficult, like Coventry and Dresden to the ground. world and building surgical centres for war Over the last few years, fighting and attacks have become daily occurrences, even in and around the capital. To dramatic situations and being of real use Two out of three victims in the Second victims in Afghanistan, Iraq, Cambodia, KABUL HOSPITAL improve care for the increasing numbers of war victims, we began enlarging the hospital in 2014, building a new to the wounded. World War were civilians. The nature of war Sierra Leone, Libya and the Central African CO-FUNDED BY operating unit and reorganising the intensive and sub-intensive care units. That year, I had my first experience of had changed, perhaps for ever. Republic. Our international staff have always been committed to training local staff, and the Kabul hospital has been landmines. Children brought into the And the non-fighting victims (1 out of 10 Because treating the wounded isn't officially recognised by the Afghan Public Health Ministry as a centre for emergency surgery and traumatology hospital with a rag to stop the blood, after at the beginning of the 20th century) had generous or charitable - it's simply right. training. Also, on request of the World Health Organisation, in 2014 we ran a triage course for 45 Afghan nurses their hands had been blown off. Children become 9 out of 10 by the start of the new and an emergency surgery and trauma management course for 131 Afghan surgeons, selected from 32 of the losing both arms, children blinded by a millennium. For every three victims, one country's provinces by the Ministry. mine exploding in their face. I have seen is a child. The slaughterhouse of Quetta, hundreds of child victims of landmines and the other war hospitals where I was to

16 — Report 2014 Report 2014 — 17 Uzbekistan Cina Uzbekistan China Tagikistan Tagikistan Turkmenistan Turkmenistan

Anabah

Kabul Kabul AFGHANISTAN AFGHANISTAN

Lashkar-gah Lashkar-gah Iran Pakistan Iran Pakistan

Lashkar-gah Afghanistan Surgical Centre for First Aid Posts and war victims health centres

OPENED: September 2004 LOCATIONS: Anabah, Abdara, Ahangaran Dara, Darband, Dasht-e-Rewat, Khinch, ACTIVITIES: Surgery for war and landmine Paryan, Gulbahar, Kapisa, Koklamy, Oraty, victims. Changaram, Anjuman, Sangi Khan, Shutul, Said Khil, Poli Sayad, Mirbachakot, FACILITIES: Emergency department, Maydan Shahr, Ghazni, Chark, Gardez, outpatient department, 2 operating Pul-I-Alam, Grishk, Sangin, Garmsir, theatres, sterilisation, intensive care Musa Qala, Marjia, Urmuz, Tagab, Andar, unit, surgical wards, physiotherapy, Sheikhabad. radiology, laboratory and blood bank, pharmacy, classrooms, playroom, EMERGENCY also provides healthcare auxiliary facilities, maintenance services for the boys' and girls' department. orphanages in Kabul.

NUMBER OF BEDS: 90 AS OF 31 DECEMBER 2014: LOCAL STAFF: 227 Outpatient consultations: 3,012,241 Patients refderred to hospital: 56,865 AS OF 31 DECEMBER 2014: LOCAL STAFF: 280 Admissions: 23,414 Outpatient consultations: 98.476 Surgical operations: 29,902 In 2004, Emergency opened a hospital in Lashkar-gah, chief town of Helmand Region, to offer treatment to the FIRST AID POSTS AND HEALTHCARE CENTRES people of a huge area where – in the face of violent fighting – there were no free healthcare facilities or facilities Healthcare for prisoners Accessing medical care is very difficult for Afghan people: free medical facilities are few and far between and the specialised in treating war victims. terrain makes it hard to travel. In 10 years, Helmand has become one the most dangerous regions in the country: kamikaze attacks, bombing by Duab prison: 694 patients examined and This is why EMERGENCY has built up a widespread network of healthcare facilities around the country, offering the international forces and landmines have caused thousands of victims, especially amongst the civilians. treated from 2001 to 2003 treatment for the people of the most remote villages, with an ambulance service for transferring those needing War surgery and orthopaedic and (for patients up to the age of 14) were the two main admission surgery into hospital. Shebergan prison: 13,338 patients LASHKAR-GAH HOSPITAL criteria but, because of the increase in the number of wounded, since June 2013 those criteria have been limited Because of the worsening safety conditions, we extended the network of First Aid Posts in 2014 with the opening CO-FUNDED BY to war surgery alone. examined and treated from May 2002 to of 4 new facilities: at Urmuz, in the Lashkar-gah area, and at Sheikhabad, Andar and Tagab, in the Kabul area. And the situation got even worse in 2014: from 2013 to 2014, our records show a 13% increase in the number of June 2004 On 11 August, an EMERGENCY ambulance on its way to our First Aid Post in Tagab, where some of the wounded patients admitted with war wounds. had been taken after violent clashes, became caught up in the fighting. Our ambulance driver, Hamza Khan, was To cope with this situation, in July 2014 we transformed the pharmacy into an orthopaedic ward. Lashkar-gah prison: 1,880 patients killed trying to evacuate injured people to Kabul hospital. examined and treated from February Because of deteriorating safety conditions, in recent years we have opened 5 new First Aid Posts in villages close 2006 to December 2007 HEALTHCARE FOR PRISONERS to the main town in order to guarantee immediate aid for the wounded and quick, safe transport into hospital EMERGENCY provides healthcare to the inmates of Kabul's main prisons. Since 2003, we have opened 5 health when necessary. Prisons in Kabul (Government Prison, centres in 5 of the blocks in Pol i Charki, Afghanistan's largest prison, with 9,000 detainees. Here, each month, The Lashkar-gah Surgical Centre is linked 24/7 with an ambulance service at EMERGENCY’s First Aid Posts in the Investigation Department, Pol i Charki, our doctors attend to 5,000 inmates, treating mainly infectious diseases and respiratory and digestive tract villages of Grishk, Sangin, Garmsir, Marjia, Musa Qala and Urmuz (opened March 2014). Lashkar-gah hospital Juvenile Rehabilitation Centre, Female complaints, caused by the terrible living conditions inside the prison. has been officially recognised by the Afghan Public Health Ministry as a centre for emergency surgery and Prison): 614,174 patients examined and Our staff also run health centres in the government prison, the investigative prison, the female prison and Kabul's traumatology training: 4 Afghan surgeons are currently completing their training programmes. treated as of 31 December 2014 Juvenile Rehabilitation Centre. LOCAL STAFF: 22

18 — Report 2014 Report 2014 — 19