MSF / OPERATIONAL CENTRE GENEVA Activity Report 2020 ot only was 2020 an unprecedented year of a global pandemic which affected everyone and all Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation that aspects of our functioning in every corner of the world, it was also a year of exceptional deployment delivers emergency to people affected by armed conflict, epidemics, exclusion from healthcare and of capacity by MSF to adapt to this context. Responding to emergencies or any type of health natural disasters. crisis in the world is in our DNA. Nevertheless, the challenges faced were so complex and global that even an emergency humanitarian organisation like ours had to demonstrate more creativity As an independent and self-governed organisation, MSF’s actions are guided by medical ethics and thanN ever to keep assisting those in need. Indeed, distributing equipment and supplies and – most importantly – the principles of neutrality and impartiality. MSF offers assistance to people based only on need and providing the necessary human resources, when half of humanity was under lockdown required a Herculean effort irrespective of race, religion, gender or political affiliation. in terms of innovation and solution-finding at a time when global mechanisms were severely challenged.

MSF strives to ensure that it has the power to evaluate medical needs freely, to access populations 2020 was also the first year of implementation of our new 2020-2023 Strategic Plan, and given the global pandemic, without restriction and to control the aid it provides directly, giving priority to those in most grave emergency responses were at the forefront. For the first time, the whole organisation, from HQ to project danger. MSF does not take sides in armed conflict and demands unhindered access to patients and teams, were operating both proactively and responsively, with the objective of ensuring continuity of care while the space it needs to carry out emergency medical interventions. In addition, MSF accepts only private overcoming the multiple constraints and difficulties related to the pandemic. Despite the COVID constraints, we donations and never accepts funds from parties directly involved in any conflict or medical emergency managed to scale up emergency responses in DRC, deploying measles vaccinations and a mass drug administration that MSF is dealing with. to fight malaria. We also responded to emergency flooding in , and Niger and two category-four hurricanes in Honduras. The increasing frequency and severity of natural disasters are an inevitable consequence MSF is a non-profit organisation founded in , , by doctors and journalists in 1971. Today, MSF of the climate crisis and responding to those events reflects the importance of planetary health in our strategy. is a worldwide movement of 26 associations with an international office in Geneva, Switzerland, which Reveka Papadopoulou provides coordination, information and support to the MSF Movement, and implements international Based on MSF’s experience of alternative models of care, OCG continued to push for complementary responses President projects and initiatives as requested. All of the associations are independent legal entities, registered to COVID beyond hospital-based case management. A more conventional inpatient approach was implemented under the laws of the countries in which they are based. Each association elects its own board of in Iraq, Yemen, Senegal and , while home-based care was provided in Eswatini, Ukraine and Kyrgyzstan to directors and president. They are united by a shared commitment to the MSF Charter and principles. support the Ministries of Health in dealing with the COVID pandemic. In addition, in Switzerland and the Czech The highest authority of the MSF Movement is the International General Assembly, which meets yearly. Republic we supported health authorities and local associations fighting COVID. Decentralising care and relying more on communities was also a key part of our response plan in 2020, with an ambitious project to deliver The movement has six operational centres – MSF France, MSF , MSF Switzerland, care (advice and patient follow-up) via video and mobile phone in Eswatini. This is directly linked to the strategy MSF Holland, MSF Spain and MSF West Africa – which directly manage the missions. The partner sections of partnering with our patients and their communities to empower them in relation to their health care and contribute to the action of MSF through their recruitment efforts and by collecting funds, gathering increasing the deployment of digital technologies. information and providing medical and operational support. As usual, we had to make some tough decisions, to ensure we have enough space and capacity to respond to emerging needs. Thus, we decided to close our missions in Syria and Colombia, as well as regular projects such as in Mykolaiv (Ukraine) and Naga (Myanmar). Meanwhile, we massively scaled up our operations in Burkina Faso, and opened new projects in Kaya and Kongoussi while continuing our operations in Barsalogho. DRC remained a major Stephen Cornish context of intervention and Sudan also kept us busy this year as we were working on three fronts: flooding and General Director COVID in Khartoum and, at the end of the year, the Tigray crisis. This Activity Report takes the place of the Performance Report. It was prepared in accordance with the provisions of the Swiss GAAP, FER/RPC 21. The audited financial statements are available on the website COVID served as a crash course for the HQ and coordination teams on how to manage operations in emergency of MSF Switzerland. This report is a translation. Only the French version is legally binding. mode, and in looking for creative and innovative solutions when faced with HR and supply shortages. This also represented a shift in our way of working and something we will build on in the future as decentralised, more agile emergency response is in line with our long-term operational strategy.

The pandemic also prompted an acceleration of our digital transformation, beyond what we could have anticipated. Indeed, we stepped up the deployment of online resources and Information and Communication Technologies to respond to challenges as they arose. However, this wonderful capacity to deliver services and care remotely using technology also underlined the fact that we are, above all, a ‘people organisation’. Therefore, direct access to patients and colleagues working physically together is crucial, bedside training, proximity, and sans-frontierism remain key as is the diversity, equity and inclusion of our global workforce.

In addition to our operational COVID response, we advocated and pushed for personal protective equipment, masks, drugs and other key supplies to be provided, while calling for all countries to have equal access to the COVID vaccines.

We would like to end this introduction by thanking all our supporters around the world, and all our colleagues, patients and their communities, for their trust in our social mission and for their commitment, however big or IMPRESSUM small, to give their best and offer support through a strong sense of solidarity that remains at heart of MSF. Imprint: Médecins Sans Frontières Suisse – Publisher: Laurence Hoenig Managing Editor: Florence Dozol – Contributors: Manuel Albela, Imad Aoun, Pierre-Yves Bernard, We hope you enjoy reading this report, Simon Beswetherick, Kristina Blagojevitch, Juliette Blume, Jan Bohm, Marianne Burkhardt, Arjun Claire, Mélodie Duval, Lucille Favre, Candice Geinoz, Mersiha Grabus, Marjorie Granjon, Fanny Hostettler, Nicolas Joray, Joanna Keenan, Florence Kuhlemeier, Etienne L’Hermite, Benoît Lécorché, Patrick Lloyd, Alexandra Malm, Eveline Meier, Solen Mourlon, Jennifer Ocquidant, Laura Panqueva Otálora, Fabrice Ressicaud, Alexandre Roux, Guilaine Thebault Diagne, Jena Williamson, Marie Zimmerman Design: Latitudesign.com Office in Geneva: Rue de Lausanne 78, Case postale 1016, 1211 Genève 1, tel. 022/849 84 84 Office in Zurich: Kanzleistrasse 126, 8004 Zürich, tel. 044/385 94 44 www.msf.ch Reveka Papadopoulou Stephen Cornish PC account: 12-100-2 President of MSF Switzerland/OCG General Director Bank account: UBS SA, 1211 Genève 2, IBAN CH 180024024037606600Q 02 ACTIVITY REPORT 2019 EDITORIAL 1 Contents SWITZERLAND CZECH REPUBLIC LEBANON IRAQ Since 2020 Since 2020 Since 2008 Since 2007 2020 Timeline ...... 4 Projects: Haute-Savoie, Project: Prague Projects: Beirut, Bekaa Valley, Projects: Mosul, Sinuni Overview of the year ...... 5 Geneva, Jura, Neuchâtel, Vaud HR: staff from MSF Czech Tripoli HR: 391 incl. 50 international The year in pictures ...... 8 HR: 2 section HR: 180 incl. 21 international Costs: CHF 16,080,000 Costs: CHF 352,000 Costs: CHF 58,000 Costs: CHF 7,950,000

Activities by country ...... 12 Burkina Faso ...... 13 GREECE UKRAINE SYRIA Cameroon...... 13 Since 2016 Since 2015 Since 2013 Projects: Athens, Samos Projects: Donetsk, Mariopol, Project: Derek Chad ...... 14 HR: 123 incl. 18 international Mykholaiv HR: 49 incl. 6 international Colombia ...... 14 Costs: CHF 6,108,000 HR: 64 incl. 10 international Costs: CHF 1,576,000 Czech Republic ...... 15 Costs: CHF 2,605,000 Democratic People’s Republic of Korea 15 CHAD Democratic Republic of Congo ...... 16 Since 2020 Project: Goundi Eswatini ...... 17 HR: 4 international Greece ...... 18 Costs: CHF 893,000 KYRGYZSTAN Honduras ...... 19 Since 2005 Iraq ...... 20 Project: Kadamjay ...... 21 NIGER HR: 67 incl. 5 international Costs: CHF 1,665,000 Kyrgyzstan ...... 21 Since 2005 Projects: Magaria, Niamey Lebanon ...... 22 HR: 619 incl. 31 international Mexico ...... 23 Costs: CHF 12,142,000 DPR OF KOREA Mozambique ...... 23 Since 2019 Myanmar ...... 24 Project: North Hamgyong Niger ...... 24 BURKINA FASO Province HR: 6 incl. 4 international ...... 25 Since 2017 Projects: Barsalogho, Dori, Costs: CHF 1,325,000 Senegal ...... 25 Djibo, Kaya, Ouagadougou Somalia ...... 26 HR: 396 incl. 29 international Costs: CHF 10,635,000 MYANMAR South Sudan ...... 26 MEXICO Sudan ...... 27 Since 2000 Since 2013 Projects: Dawei, Kachin, Naga Syria ...... 28 Projects: Matamoros, Reynosa SENEGAL HR: 118 incl. 9 international Costs: CHF 2,588,000 Switzerland ...... 28 HR: 69 incl. 15 international Since 2020 Tanzania ...... 29 Costs: CHF 4,070,000 Project: Dakar Ukraine ...... 29 HR: 3 Costs: CHF 273,000 Yemen ...... 30

Human resources ...... 31 Financial results ...... 32 Acknowledgements ...... 34 HONDURAS NIGERIA Governance structure of Since 1998 Since 2016 YEMEN MSF Switzerland ...... 36 Projects: Choloma, Tegucigalpa Projects: Ngala, Rann Since 2015 HR: 147 incl. 11 international HR: 207 incl. 15 international Projects: Hodeidah, Ibb Costs: CHF 4,066,000 Costs: CHF 4,773,000 HR: 710 incl. 29 international Costs: CHF 18,065,000 CAMEROON Since 2000 TANZANIA SOMALIA Projects: Douala, Kribi, COLOMBIA Since 2015 Since 2017 Maroua, Mora, Yaoundé 28 countries Project: Nduta Project: Jubaland Since 2019 HR: 387 incl. 25 international HR: 327 incl. 19 international HR: 4 international Project: La Guajira Costs: CHF 10,681,000 HR: 19 incl. 2 international Costs: CHF 8,489,000 Costs: CHF 1,553,000 projects Costs: CHF 768,000 80 SUDAN Since 2004 MOZAMBIQUE KENYA Projects: East Darfur, Al-Gedaref, Since 1992 Since 2007 Khartoum, South Kordofan Project: Maputo Projects: Dadaab, Likoni HR: Human resource data is provided on a HR: 312 incl. 39 international HR: 171 incl. 11 international HR: 469 incl. 19 international full-time equivalent (FTE) basis. Costs: CHF 12,827,000 Costs: CHF 3,788,000 Costs: CHF 13,038,000 Statistics do not include casual employees, or staff from ministries of health working within our programmes. SOUTH SUDAN CONGO (DRC) ESWATINI Since 1996 Since 2001 Since 2007 Project: Agok Projects: Angumu, Boga, Project: Nhlangano HR: 477 incl. 31 international Bunia, Drodro, Mambasa, Nizi, HR: 129 incl. 10 international Costs: CHF 11,904,000 Somé/Mayuano Costs: CHF 3,153,000 HR: 697 incl. 72 international Costs: CHF 23,064,000

2 ACTIVITY REPORT 2020 2020 PROGRAMME OVERVIEW 3 2020 Timeline Overview of the year 2020

JANUARY FEBRUARY MARCH

Iraq: Violent protests against COVID-19: On 11 March, the APRIL the Iraqi government break out COVID-19 epidemic is declared Switzerland: MSF continues in Baghdad. MSF teams respond a pandemic by the WHO. All to operate in Switzerland, by donating emergency medical over the world, the number of working closely with the Although the COVID-19 pandemic imposed medical facilities and civil society organisations supplies and treating injured confirmed cases increases. MSF health authorities and other patients in MSF’s rehabilitation supports the most vulnerable organisations to assist the exceptional constraints on the way we respond to help set up the response. Our main contribu- centre in the city. communities, while ensuring the people most at risk during the to medical needs in humanitarian crises in 2020, tion was sharing our experience of responding to continuity of medical care and the pandemic. While distributing it also pushed us to speed up some of the large epidemics, something European countries safety of health workers in all its Burkina Faso: The country faces food in Geneva, MSF and the changes we had been implementing over recent have not had to deal with for many decades, and missions. Geneva teaching hospital assess an unprecedented humanitarian years. It reaffirmed our identity as an emergency filling in gaps in the initial response, as we do in crisis as COVID-19 begins to the health needs of the most spread. Growing insecurity vulnerable groups organisation that is agile, creative and dedicated any emergency situation. In Switzerland, and and violence hamper access to to finding solutions and maintaining assistance in later in Czech Republic, where we worked for the healthcare. MSF launches several the most challenging of situations. The events of first time, we supported the local authorities and emergency projects to meet this year reminded us that there is no room for civil society organisations to implement IPC essential medical needs. complacency: whatever expertise we may have measures. In both countries, we urged the on a particular issue may need to be completely authorities to ensure equitable access to care for MAY revised from one day to the next. the most vulnerable and marginalised groups. As the virus reached other countries where we work, we implemented a range of responses, Switching to emergency mode in from setting up inpatient and isolation wards for JULY JUNE all our missions critical patients in Iraq, Yemen, Kenya, Lebanon, Cameroon, Niger, Senegal and Mexico, to offer- Afghanistan: On 12 May, In 2020, all our missions in the 24 countries ing testing and home-based care in Ukraine, Brazil: COVID-19 spreads 25 people are killed in a brutal where we worked were suddenly forced to Kyrgyzstan and Eswatini. In all our interventions, exponentially in Brazil, attack on MSF’s maternity switch to emergency mode and prepare to health promotion was a key component of our threatening to overwhelm hospital in Dasht-e-Barchi in respond to the COVID-19 pandemic. At the same COVID-19 response. Kabul. As a consequence, MSF the country’s health system. time, it was essential to ensure continuity of care MSF launches six emergency ceases its activities in the facility. interventions in some of the for all the patients we treat for other diseases. In Responding to emergencies and ensuring biggest cities and supports each project, we focused on finding the right continuity of care isolated communities in the balance according to the level of needs. In addition to tackling the COVID-19 pandemic, Amazon region. Honduras: As the number of MSF continued to respond to emergencies, for Lebanon: On 4 August, a COVID-19 cases increases in Responding to a new disease example scaling up activities to assist the grow-

AUGUST Central and Latin America, massive explosion tears through To respond to COVID-19, we had to quickly learn ing numbers of displaced people in Barsalogho, the port area of Beirut. MSF MSF starts treating severely ill 437,487 how this new disease spread and affected Kaya and Djibo in Burkina Faso and Ituri in the teams, already on site, provide patients in the Honduran capital malaria cases treated assistance to the victims. This Tegucigalpa. An annexe of the patients while also developing strategies to Democratic Republic of Congo (DRC). In Lebanon, event, and the rapid spread of National University is converted tackle it. Field and headquarters staff worked where the deteriorating situation was already COVID-19, add further distress in into a treatment centre for the closely together, drawing on MSF’s complemen- giving cause for concern, our teams provided a country already suffering from most serious cases. tary expertise in medicine and operations. Our emergency assistance in the first hours after the years of systemic crises. 197,803 epidemiologists and medical department pro- massive explosion in the port area of Beirut on 4 COVID-19: Since pharmaceutical vided new guidelines for responding to the virus, August, which killed over 200 people and injured children vaccinated companies generally have a very against measles poor track record on transparency, while our logistics and HR teams worked to thousands more. The last acute emergency of MSF calls on governments to overcome the daily challenges that it presented: the year occurred along the Ethiopian border SEPTEMBER OCTOBER NOVEMBER demand more information from for example difficulties in moving staff and sup- with Sudan, following the outbreak of conflict in them to ensure equitable access plies and shortages of personal protective Tigray region. The MSF teams already working in to vaccines. equipment. For the first months of the pan- Khartoum and Darfur immediately deployed to 11,545 Greece: During the night of 8-9 demic, we focused on training Ministry of Health the border-crossing points and the official camps HIV patients on antiretroviral treatment September, several fires break out in Moria camp on the Greek island staff and our own teams in infection prevention near Al-Gedaref, setting up medical facilities and of Lesbos, forcing over 12,000 Sudan: There has been a large and control (IPC). We addressed staffing issues trucking in water supplies for the increasing people to evacuate. MSF informs influx of following the by deploying international staff in their own numbers of people fleeing the violence. the European authorities about outbreak of conflict in neighbour- countries and asking international staff who 970 the terrible living conditions ing . Most of them arrive were unable to return home after they finished In our established projects, we adapted quickly tuberculosis patients in the camp. in Hamdayet, where no food, SAR: Sea-Watch 4, the ship on shelter or sanitation facilities their missions to extend their contracts. To to continue our regular activities, further expand- which MSF teams provide care are available. MSF works at this overcome supply shortages, we tried to find ing our range of models of care. For example, to for migrants rescued from the transit point and in the new camp, local sources for essential protective equipment help our patients reduce their risk of catching Mediterranean Sea, is detained by DECEMBER providing healthcare and assess- for our teams, and partnered with local organi- COVID-19, we brought care even closer to their 139 the Italian port authorities. During ing the nutritional needs of its first lifesaving expedition, the new arrivals. sations in countries such as Tanzania and Niger homes, so they could limit visits to health cen- multidrug-resistant TB patients ship rescued 354 people. to produce non-surgical masks to distribute to tres and avoid unnecessary journeys by public the population. All our activities had to be transport. In Eswatini, for many years, MSF has adapted or redesigned and everybody worked been developing community-based models of together to find solutions. care to provide better access to treatment for 80,587 patients with multidrug-resistant tuberculosis in non-communicable diseases The first wave of COVID-19 hit Europe the hardest, rural areas. To protect the most at-risk patients, consultations and MSF was asked by various health ministries, teams started to use a new technology called

4 ACTIVITY REPORT 2020 OVERVIEW OF THE YEAR 5 one in which the environment (exposure to agro- This year, more than any before, has shown us Programme costs by continent chemicals) and working conditions seem to play the vital role of solidarity in enabling us to over- an important role. This orientation towards plan- come a pandemic and protect each other. It’s etary health and seeing health situations through been amazing to see how staff, patients and the lens of environmental degradation is a strong supporters have all got involved in unprece- positioning we want to maintain. As a responsi- dented ways. The COVID-19 pandemic and the % ble organisation, this also means addressing our emergency at the Sudanese border are continu- 5 own environmental footprint. ing into 2021, as are the conflicts and crises in 3% many other parts of the world where we work. 5% Negotiating More than ever, we remain committed to allevi- Negotiating is central to MSF’s daily work and it ating pain and setting up sustainable activities is usually a long process. One example of suc- that will last beyond MSF’s presence. % cessful negotiation in 2020 was managing to 24 deploy teams to the border between Ethiopia 63% and Sudan as the first Tigrayan refugees started Christine Jamet and Kenneth Lavelle to arrive following the outbreak of fighting. Directorate of Operations Negotiating access to non-governmental con- trolled areas of Ukraine and reaching people in Dr Monica Rull need in the anglophone zone in Cameroon Medical Director remained major challenges in 2020. We also tried to negotiate access to Karabakh from Azerbaijan video-observed therapy, which meant that important in DRC, Niger and Nigeria, where inse- as another MSF section was already intervening patients who had to be supervised in person by a curity makes it difficult for us to reach patients. on the Armenian side. This behind-the-scenes community member or a health worker when work requires deep knowledge and understand- taking their medication (as per the treatment The closure of medical facilities and staff short- ing of a region, something in which we invest a protocol) could now film themselves doing so ages further complicated access to care this great deal of effort, along with strong advocacy. with a smartphone. In addition, small mobile clin- year. In Iraq, in addition to supporting the COVID- ics were deployed to carry out medical check- 19 response, our team at the maternity hospital Advocating and raising awareness ups and deliver drug refills. In every project, the in Nablus, near Mosul, assisted more than 10,000 Giving voice to people directly impacted by adapted, locally designed model of care allowed deliveries (a 55% increase compared to 2019). political choices is also part of our mission. As in us to continue helping the patients most in need. Patients chose to give birth in our facility because previous years, we continued to raise awareness they were concerned about the lack of infection regarding the plight of migrants in Central prevention and control measures for staff and America as we worked at the border entry Reaffirming our medico-operational patients in other hospitals. Access to family plan- points between Honduras and Mexico. The sit- humanitarian mission ning is a challenge in many of the places where 1,778,088 uation of refugees in Greek camps further dete- 124,942 we work. However, in our project in Mambasa, in outpatient consultations riorated due to COVID-19 and the lack of patients admitted Medical expertise DRC, women now have the option of injecting isolation facilities for patients. In autumn, the 2020 was definitely a year of epidemics, and in themselves with a new contraceptive treatment, burning of Samos and Moria camps illustrated many countries, we put to use our considerable called Sayana Press. Our teams also treated the growing tensions with part of the host pop- experience of taking care of patients, as well as numerous victims of sexual violence and pro- 107,934 ulation, reaffirming the necessity to evacuate 11,146 organising vaccination campaigns in collaboration vided safe abortion care to decrease maternal antenatal consultations these vulnerable people to safer places. We reit- children admitted to inpatient with local authorities. Teams administered mea- deaths due to unsafe practices. erated our call to European countries to assume feeding programmes for acute sles vaccinations in Ituri, Haut-Uélé, Bas-Uélé and their responsibilities and implement humane malnutrition Tshopo in DRC, in Kario in Sudan, and in Planetary health is an important strategic pillar migration policies. Our 2020 advocacy activities in Somalia. Because the rainy season was particu- for MSF, and a field on which we plan to increase 36,194 also focused on improving access to tests and larly heavy this year, we saw a rise in cases of focus in our operations and emergency protective equipment during the COVID-19 children admitted to outpatient malaria, a deadly disease, especially when com- responses. In 2020, we responded to health pandemic. In collaboration with the Access 14,610 bined with malnutrition. MSF teams organised needs triggered by unexpected or unusually feeding programmes Campaign, we repeatedly asked stakeholders to mass drug administration against malaria in severe climate events, including floods in Niger, give up benefits on patents, future treatments surgical procedures Angumu, north of Ituri, reaching a total of 75,874 Sudan and Somalia that led to mass displace- and vaccines for this disease and to provide people. They also launched an emergency inter- ments of people, outbreaks and higher 51,022 equitable access to care. Finally, to facilitate vention Niamey, in Niger, following massive than usual cases of malaria and other diseases future strategic decisions, we conducted in- 32,445 floods, and organised community workers in transmitted by mosquitoes such as dengue. We individual mental health consultations depth operational context analyses in central Agok, South Sudan, to tackle the disease through also assisted people in Honduras affected by the Asia and Greece. This data will help us deter- births assisted the CMAP (Community Malaria Agent Project). In worst hurricanes to hit the country in 20 years. In mine the type and scope of any future medical Burkina Faso, teams responded to hepatitis E as Guatemala, we are in the process of opening a activities in these areas. well as COVID-19. Our decentralised approach to project to tackle the high level of chronic kidney 15,431 nutritional screening and support was particularly disease, a condition that has many causes, but group mental health consultations

6 ACTIVITY REPORT 2020 OVERVIEW OF THE YEAR 7 The year in pictures Cameroon, 2020 © Patrick Meinhardt Honduras, 2020 © Cecilia Duran/MSF Ukraine, 2020 © Marta Znak/MSF

COVID-19 knows no borders, so neither must solidarity. As the pandemic continues to affect people around the world, MSF teams are busier than ever, ensuring continuity of care and saving lives. Sudan, 2020 © Thomas Dworzak/Magnum Photos Sudan, 2020 © Florence Dozol/MSF Yemen, 2020 © Majd Aljunaid/MSF Yemen,

Improving access to medical assistance as well as the quality of healthcare provided in hospitals is a key part of MSF’s work, whether at admission, in emergency rooms, or in operating theatres. Cameroon, 2020 © Patrick Meinhardt Niger, 2020 © Mack Alix Mushitsi/MSF Niger,

8 ACTIVITY REPORT 2020 THE YEAR IN PICTURES 9 Sudan, 2020 © Florence Dozol/MSF Kyrgyzstan, 2020 © Maxime Fossat

MSF continues to address maternal mortality in its projects. The provision of medical care RD Congo, 2020 © Franck Ngonga/MSF during pregnancy, and during and after Yémen, 2020 © Majd Aljunaid/MSF birth, can reduce the causes of maternal death such as haemorrhage and infection. For women who are victims of sexual violence, access to emergency medical and psychological care is essential. COVID-19 knows no borders, so neither must solidarity. As the pandemic continues to affect people around the world, MSF teams are busier than ever, Kyrgyzstan, 2020 © Maxime Fossat ensuring continuity of care and saving lives. Mexique, 2020 © Sergio Ortiz/MSF Iraq, 2020 © Gabriele Casini/MSF Yémen, 2020 © MSF RD Congo, 2020 © Franck Ngonga/MSF

10 ACTIVITY REPORT 2020 THE YEAR IN PICTURES 11 Activities by country

In the country since: 2017 Reason for intervention: epidemics, displacement BURKINA FASO Main activity: hospital care, general healthcare Delivering assistance to displaced Emergency intervention: COVID-19, hepatitis E, water and sanitation Human resources: 369 staff including people (FTE) 29 international staff Cost for 2020: CHF 10,635,000 Noelie Sawagodo/MSF Noelie Sawagodo/MSF

The general humanitarian situation in Burkina Faso Centre-Nord, a town where many people fleeing vio- In Djibo, in Sahel region, MSF continued to provide deteriorated further in 2020, due to an escalation in lence in Sahel have sought refuge, MSF teams con- general healthcare, conducting a total of 61,943 armed conflict. The number of people displaced by tinued to provide general health services, emergency outpatient consultations during the year. Many of fighting in the country surged from around 560,000 care, nutritional support and referrals to Kaya hospi- these were carried out by community health work- at the end of 2019, to over one million by Decem- tal. In July, MSF also responded to a hepatitis E out- ers, who have been trained by MSF to treat the ber 2020, a 75% increase during the year. The break in the town. MSF’s activities in Kaya, most common diseases and conditions: malaria, regions of Sahel, Nord and Centre-Nord were the Kongoussi and Bourzanga focused on improving diarrhoea and acute respiratory infections. MSF most affected, with thousands of people forced access to curative and preventive care through further consolidated its emergency and surgical from their homes, leading to a significant increase health posts in urban areas as well as rural communi- activities through capacity building, staff training, in demand for basic necessities. MSF teams assisted ties. During emergency phases, teams distributed medical supplies and rehabilitation of buildings displaced people and host communities in these hygiene and relief items such as jerrycans, soap and in Djibo, as well as Oudalan, in Gorom-Gorom areas, but the rising insecurity posed a significant mosquito nets. In addition, mobile teams worked to health district. barrier for MSF and other humanitarian organisa- strengthen epidemiological surveillance and emer- tions attempting to deliver care. gency response capacity. Overall, 123,951 outpatient To respond to the COVID-19 pandemic, MSF consultations were carried out and 35,325 doses of a launched short-term interventions in the capital, As well as opening new projects in the towns of multi-antigen vaccine were administered to children Ouagadougou. MSF teams also offered training, Kaya, Pissila, Pensa, Kongoussi and Bourzanga in under five. support and epidemiological surveillance in existing Centre-Nord, MSF responded to emergencies in the projects and to other health facilities in the areas region and in neighbouring Sahel. In Barsalogho, where they work.

In the country since: 2000 Reason for intervention: armed conflict, displacement CAMEROON Main activity: hospital care, general healthcare Assisting people displaced by insecurity Emergency intervention: cholera, COVID-19 Human resources: 387 staff including and affected by disease outbreaks (FTE) 25 international staff Cost for 2020: CHF 10,681,000

The year was marked by repeated outbreaks of address some of the gaps in healthcare. In 2020, national COVID-19 response in the capital Yaoundé, armed violence, followed by new waves of dis- the team in Maroua concluded their activities at by constructing isolation zones, donating oxygen placement, particularly in Northwest and South- the regional hospital, which included training spe- supplies, training healthcare staff, conducting west regions. By December, a total of 705,000 cialist staff and refurbishing the intensive care unit health promotion and research, and treating people were displaced, according to the United and other parts of the facility. A new general patients. In collaboration with the Ministry of Nations Office for the Coordination of Humanitar- healthcare project was launched in Kolofata, and Health and the epidemiological institute Epicentre, ian Affairs (OCHA). The conflict has had a severe the project at Mora was extended to include emer- MSF carried out research on the efficiency of rapid impact on access to healthcare services in these gency surgery. Previously, many of the trauma and serological and antigenic COVID-19 tests and found regions. In 2020, MSF continued to provide lifesav- obstetric surgery patients treated in Maroua were them to be a reliable alternative for resource-lim- ing care in its projects in Far North region, while referred from Mora. The Mora project also contin- ited contexts. supporting the national response to COVID-19 and ued to treat malaria, diarrhoea and paediatric mal- outbreaks of other diseases, such as cholera. nutrition, providing a total of 69,313 consultations MSF also responded to cholera outbreaks in Kribi, during the year. In addition, MSF community health deploying community outreach teams to make People in Cameroon’s Far North continue to suffer workers who have been trained to treat simple more than 80,000 home visits to raise awareness of the consequences of daily armed clashes, while fac- cases of common diseases, such as malaria and diar- prevention measures. ing high levels of food insecurity due to the unpre- rhoea, conducted more than 32,261 consultations in Greece, 2020 © Enri Canaj/Magnum Photos dictable climate. MSF teams work in this region to localities around the town. MSF supported the

12 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 13 In the country since: 2020 Reason for intervention: epidemics CHAD Emergency intervention: measles CZECH REPUBLIC Tackling measles Human resources: 4 international staff Supporting the response to In the country since: 2020 (FTE) Reason for intervention: epidemics Cost for 2020: CHF 893,000 the second wave of COVID-19 Emergency intervention: COVID-19 Human resources: staff from MSF Czech section (FTE) At the beginning of 2020, large swathes of Chad suspected cases. In Goundi district, MSF teams pro- the district hospital. The COVID-19-related restric- Cost for 2020: CHF 58,000 were still gripped by the measles epidemic, espe- vided care for simple cases in the local health cen- tions prevented MSF from proceeding with a vac- cially the southern regions, which saw a sharp tre and referred patients with complications to the cination campaign, a key component in tackling the The Czech Republic managed the first wave of conducting a needs assessment, MSF decided to MSF set up two mobile teams which supported a increase in infections. During the first quarter of the hospital isolation unit by ambulance. MSF also sup- disease. COVID-19 in spring 2020 well, with very low num- open a small project to support care homes in the total of 83 facilities and trained staff in infection year, the Ministry of Public Health reported 7,412 ported the management of severely ill children in bers of infections and deaths. However, from Czech Republic, to fill the gaps in care caused by prevention and control to avoid further contamina- August, when it was hit by a second wave, the epi- the COVID-19 pandemic. tion among the residents. These activities were demiological situation deteriorated rapidly, and by handed over to NGOs and local civil society organi- late October the country had some of the worst Working closely with the Czech Ministries of Health sations at the beginning of 2021. In the country since: 2019 numbers in Europe, pushing the health system to and Social Affairs, MSF focused on residential and Reason for intervention: healthcare exclusion its limits. For this reason, in November, after nursing homes in Bohemia and Moravia regions. COLOMBIA Main activity: general healthcare, mental healthcare, sexual and reproductive healthcare Assisting Venezuelan refugees Human resources: 19 staff including (FTE) 2 international staff Cost for 2020: CHF 768,000

Colombia saw a resurgence of violence in 2019, as trapped by violence and implementing protective adapted and training was provided to ensure the armed groups fought over disputed territories. In measures against COVID-19. safety of patients and staff. In August, MSF decided the midst of this panorama of increasing violence to withdraw from La Guajira, as the number of resulting from the irregular implementation of the MSF continued to work in the border area of La migrants and refugees with unmet needs had peace agreements, Colombia has become a coun- Guajira, providing general healthcare, mental health greatly diminished, thanks to the increased pres- try of transit and refuge for millions of people flee- support and sexual and reproductive healthcare to ence of other NGOs and funding from the govern- ing Venezuela’s social, political and economic crisis. Venezuelan migrants. MSF teams conducted a ment and other organisations. According to official figures, there are around total of 7,092 outpatient consultations, including 1.8 million Venezuelans in Colombia. In 2020 MSF 2,003 antenatal consultations. When COVID-19 focused on supporting vulnerable communities arrived in Colombia, activities in the project were Nikola Tenevová/MSF Nikola Tenevová/MSF

DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA Improving access to tuberculosis In the country since: 2019 Reason for intervention: epidemics, healthcare exclusion © Mélanie Tribalet/MSF treatment Main activity: tuberculosis, general healthcare Human resources: 6 staff including (FTE) 4 international staff Cost for 2020: CHF 1,325,000

Approximately nine million people are deemed to within the country. According to the authorities, as diagnosis and management of patients with TB. be living with inadequate access to food, drinking a result of these measures, the country has had The programme supports two TB hospitals in the water, sanitation and healthcare in the Democratic no confirmed cases of COVID-19. However, the province, a general hospital at county level, as well People’s Republic of Korea (DPRK), and in dire need lockdown has taken a heavy toll on the economic as a smaller healthcare facility at community level. of humanitarian assistance. The country has one and humanitarian situation. Unfortunately, the commencement of direct TB of the highest burdens of tuberculosis (TB) and activities planned for 2020 was not possible due to multidrug-resistant TB (MDR-TB) in the world, The border closure meant that MSF’s programme the border closure. yet the capacity for diagnosing and treating the in North Hamgyong province was effectively put disease is extremely limited. Nevertheless, activities on standby. During the year, the team maintained In March, we were granted a sanctions exemption planned by MSF in the DPRK largely stalled in 2020, regular contact with national authorities to discuss by the UN to deliver a cargo of COVID-19 due to border closures triggered by the pandemic. strategies for resuming medical activities as supplies, including personal protective equipment, In January, DPRK completely closed its borders to soon as possible. The programme was launched diagnostic materials and antibiotics (for any people and most cargo – the first country in the in late 2018, with the aim of strengthening associated infections), following a request by the © Mélanie Tribalet/MSF world to do so – and implemented a strict lockdown general medical care and improving treatment, DPRK authorities.

14 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 15 In the country since: 2007 Reason for intervention: epidemics DEMOCRATIC REPUBLIC OF CONGO ESWATINI Main activity: HIV/AIDS, tuberculosis Responding to measles and In the country since: 2001 Adapting our model of care to treat Emergency intervention: COVID-19 Reason for intervention: epidemics, displacement Human resources: 129 staff including the needs of displaced people Main activity: hospital care, general healthcare, sexual and reproductive healthcare, mental healthcare COVID-19 and HIV (FTE) 10 international staff Emergency intervention: Ebola, measles Cost for 2020: CHF 3,153,000 Human resources: 697 staff including (FTE) 72 international staff Cost for 2020: CHF 23,064,000

COVID-19 brought an additional burden to the cover all health zones with routine vaccination and and distributed mosquito nets and relief items in Democratic Republic of Congo (DRC), a country the delay in organising supplementary campaigns the makeshift camps where the displaced people with immense medical needs caused by years of are among the reasons this outbreak was so big. live. A total of 147,186 outpatient consultations overlapping crises and a weak, underfunded health As in 2019, MSF teams ran mass vaccination cam- were carried out in health centres, mobile clinics system. Despite repeated upsurges in violent con- paigns in the four provinces, reaching a total of and community care sites, a large proportion of flict and restrictions imposed by the pandemic, 194,729 children. The outbreak was declared over them for malaria, and 12,906 patients were admit- MSF provided vital humanitarian and medical assis- in August by the Ministry of Health. ted for care. However, the escalation of violence in tance in the provinces of Ituri, Bas-Uélé, Haut-Uélé 2020 and its impact on teams operating in some and Tshopo. In Ituri and North-Kivu, the tenth, and the big- of the affected areas led to a reduction in MSF’s gest, Ebola outbreak in the country’s history was activities. During 2020, MSF started to consider The impact of the COVID-19 pandemic was felt in declared over on 25 June. By then, it had infected ways to adapt its way of working so that it can all of MSF’s projects in DRC. In the provinces where 3,470 people and claimed 2,287 lives. MSF sup- maintain its assistance to people in need, without MSF runs projects, facilities were adapted to ensure ported the response by providing care in treat- exposing patients and staff to the high risks they continuity of care. Teams launched a campaign on ment and transit centres, collaborating in the currently face. Facebook to address the lack of information that vaccination programme and distributing health had led to mistrust, rejection and sometimes vio- promotion information, as well as treating other Until March, MSF offered reproductive healthcare, lent reactions towards medical staff. health conditions. including safe abortion and medical and psycho- logical treatment for victims of sexual and gender- While much of the world’s attention was focused In Ituri province, which has been plagued by conflict based violence, in Mambasa territory. The team on the COVID-19 pandemic, the DRC was still in for many years, MSF maintained general and spe- conducted consultations for 4,649 patients with the grips of the world’s biggest active outbreak cialist healthcare in long-term projects in Djugu and sexually transmitted infections, before suspending of measles, which started in mid-2018. During Mahagi territories, ensuring continuity of lifesaving activities due to restrictions on movement related the year, MSF treated 5,418 patients for measles care while responding to epidemics and mass dis- to the COVID-19 pandemic. After this date, MSF in Tshopo, Ituri, Haut-Uélé and Bas-Uélé. Measles placement, among other emergencies. Teams pro- continued its support by donating drugs and medi- is a vaccine-preventable disease, but the failure to vided outpatient consultations and hospital care, cal supplies to local health facilities. © MSF © Solen Mourlon/MSF In Eswatini, around one-third of adults are currently medication, food, psychological support and COVID- community team to provide home-based care and living with HIV, and many of them are co-infected 19 preventive equipment (masks, sanitisers). Video- refer critically ill patients for oxygen therapy. with tuberculosis (TB). MSF supports the Ministry observed therapy allowed these patients to film of Health by working on reducing the incidence themselves taking their medication at home instead MSF also incorporated care for NCDs into general and transmission of these diseases and improving of travelling to health facilities for nurse-observed healthcare facilities, and increased the services treatment. In 2020, MSF adapted its activities to therapy. In addition, MSF increased its support to offered at the MSF community site in Nhlangano respond to the COVID-19 pandemic, while continu- the national DR-TB ward in Nhlangano by providing to cover HIV self-testing, pre-exposure prophylaxis ing to treat patients suffering from HIV, TB and nursing care, implementing COVID-19 prevention and to prevent HIV infection, family planning and treat- non-communicable diseases (NCDs), like diabetes detection protocols, and donating medicines. ment for HIV and sexually transmitted infections. A and hypertension. total of 8,214 HIV self-testing kits were distributed To relieve pressure on health facilities as COVID- in the community and 7,567 patients were enrolled In Shiselweni region, the pandemic forced MSF to 19 cases surged, teams set up mobile clinics and on the HIV programme. In 2020, MSF completed a change how care was delivered to ensure that the a health post to offer care for TB, HIV and NCDs, study looking at diagnosing and treating HIV ear- most vulnerable people had uninterrupted safe access including testing, screening, medication refills and lier during the window period – the time between to lifesaving therapy. Teams strengthened com- advice on COVID-19 prevention. Other COVID-19 infection and the point when a test gives an accu- munity-based drug-resistant TB (DR-TB) care, with activities included supporting the health authorities rate result. This will guide our future work on HIV © Avra Fialas/MSF © Avra Fialas/MSF © Avra health workers visiting patients’ homes to give them to increase testing capacity and deploying an MSF epidemic control.

16 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 17 In the country since: 2016 In the country since: 1998 Reason for intervention: displacement Reason for intervention: healthcare exclusion GREECE Main activity: general healthcare, sexual and reproductive healthcare, mental healthcare, water and HONDURAS Main activity: sexual and reproductive healthcare, mental healthcare Assisting migrants and refugees sanitation Providing medical care for victims of Emergency intervention: COVID-19, natural disasters Human resources: 123 staff including Human resources: 147 staff including (FTE) 18 international staff violence and responding to COVID-19 (FTE) 11 international staff Cost for 2020: CHF 6,108,000 Cost for 2020: CHF 4,066,000

Honduras has experienced years of social, eco- mental health follow-up for victims of sexual vio- In November and December, when Honduras was nomic and political instability, which is reflected in lence. Overall, 4,489 mental healthcare consulta- hit by hurricanes Eta and Iota – the worst storms in the high rates of homicide, sexual violence and tions were conducted in 2020. In the department Central America since hurricane Mitch in 1998 – forced displacement of vulnerable people. In 2020, of Choloma, MSF teams ensured continuity of 250,000 people were left with limited access to the combination of COVID-19 and natural disasters care at a mother and child clinic, the only one in health services. MSF teams responded by providing had a devastating effect on the country, exacerbat- the area offering family planning, ante- and post- medical and psychological care, as well as health ing the already high levels of unemployment and natal consultations and psychological support to promotion, in the shelters located in the most food insecurity. During the year, MSF continued to victims of violence. They also assisted a total of affected areas. They also assisted victims of sexual assist victims of violence, while carrying out emer- 910 births. violence. Widespread destruction of infrastructure, gency responses to the COVID-19 pandemic and caused by the storms, means that a long-term hurricanes Eta and Iota. In June, as COVID-19 cases rose dramatically, MSF period of reconstruction will be required. started to offer comprehensive medical services to In February, when the government declared a patients at a treatment centre set up in the During the year, as migrant caravans gathered to state of emergency due to the pandemic, the National University sports facility in Tegucigalpa, in travel north towards the , MSF lockdown measures confined women and children collaboration with the Ministry of Health and the deployed teams to offer first aid and psychosocial in violent domestic environments without the regional authorities. In addition, MSF established support at different points along the route. possibility of seeking support. In response, MSF COVID-19 triage and provided oxygen treatment at rapidly introduced helpline services and organised Nueva Capital health centre. © Enri Canaj/Magnum Photos © Deiby Yanes/MSF © Deiby Yanes/MSF © Enri Canaj/Magnum Photos © Enri Canaj/Magnum Photos

Since the implementation of the EU-Turkey deal in originally planned for 650. The authorities’ COVID- In Athens, MSF runs a specialised clinic for victims March 2016, thousands of people on the move have 19 response was inadequate, with only a handful of of torture and a day care centre that offers social remained trapped for an indeterminate period of medical staff and unacceptable quarantining and legal assistance, as well as health services. From time in reception centres in Greece and forced to options for infected people. During 2020, MSF pro- July, MSF staff supported an increasing number of live in inhumane and degrading conditions while vided toilets and thousands of litres of water per refugees with severe health and psychological they wait for a decision on their asylum claims. day to help prevent health problems associated issues who had been evicted or were at risk of evic- Throughout 2020, MSF continued to provide medi- with poor water and sanitation. In Vathy town, tion from their accommodation. In total, MSF cal services to migrants and refugees in Athens and MSF’s day care centre continued to offer mental teams conducted 18,602 medical consultations. on the island of Samos, while dealing with the health support and sexual and reproductive health- spread of the COVID-19 pandemic. care, with a focus on sexual violence. A total of To address the serious humanitarian and medical 5,982 consultations were carried out at the MSF consequences of Greece’s restrictive migration On Samos, at times there were as many as 8,000 facility in the camp. policies, MSF continues to call for long-term inte- people living in Vathy reception centre, which was gration programmes for refugees. © Fernando Silva/MSF © Fernando Silva/MSF

18 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 19 In the country since: 2007 In the country since: 2007 Reason for intervention: armed conflict, displacement Reason for intervention: displacement, epidemics IRAQ Main activity: hospital care, sexual and reproductive healthcare, mental healthcare KENYA Main activity: hospital care, general healthcare, sexual and reproductive healthcare, mental healthcare Providing hospital care and support Emergency intervention: COVID-19 Delivering care to the most Emergency intervention: COVID-19 Human resources: 391 staff including Human resources: 469 staff including to the COVID-19 response (FTE) 50 international staff vulnerable (FTE) 19 international staff Cost for 2020: CHF 16,080,000 Cost for 2020: CHF 13,038,000

In 2020, the arrival of COVID-19 in Iraq presented MSF supported the response to the COVID-19 pan- clinics and the interruption of cross-border refer- Kenya continues to host nearly half a million refu- to the pandemic by treating patients and training healthcare, emergency obstetric surgery, medical new challenges to a country still reeling from the demic in Mosul, in Ninewa governorate by opening rals, the maternity and paediatric teams in west gees and asylum seekers, over half of them from health staff. and psychological assistance to victims of sexual effects of years of conflict and instability. Many a 15-bed intensive care unit at Al-Salam hospital in Mosul saw a sharp increase in demand for care Somalia. According to the UN refugee agency, and gender-based violence, psychosocial counsel- healthcare facilities have been destroyed and there mid-November, offering advanced care for patients and admissions. In 2020, MSF staff conducted UNHCR, at the end of 2020 there were more than The MSF project in Likoni, in Mombasa county, ling, home-based insulin treatment, palliative care are not enough medical specialists and services to with critical and severe forms of the virus. At other 41,075 emergency room consultations and assisted 224,000 people living in Dadaab, a offers maternal and neonatal care. In 2020, it con- and specialist referrals. In 2020, MSF teams con- address urgent healthcare needs, such as violence- facilities in Ninewa, as well as in Erbil and Dohuk 10,825 deliveries in Nablus, in Mosul. complex on the border with Somalia, where MSF ducted 6,137 postnatal care consultations and ducted more than 149,948 outpatient consulta- related trauma. From early 2020, it was immedi- governorates, MSF provided training sessions, with has a long-running comprehensive care pro- assisted 6,165 births, including more than 874 cae- tions, admitted 8,671 patients for care and assisted ately clear that the health system would struggle to a focus on infection control. There was also a considerable increase in medical gramme. In 2020, despite the restrictions imposed sarean sections. 2,956 births. In response to the COVID-19 pan- cope with the increased demands and challenges needs in Sinuni, in Sinjar district, where MSF teams on access to healthcare by COVID-19, and strikes demic, MSF ran a 40-bed isolation facility in the generated by the pandemic. In 2020, MSF therefore Throughout the year, MSF continued to run general assist deliveries and provide paediatric care and by healthcare workers, MSF continued to provide In Dagahaley camp in Dadaab, MSF runs a 100-bed camp and trained staff working for Garissa and decided to scale up its lifesaving medical activities and specialist health services for displaced people, sexual and reproductive health services to Yazidis care for refugees and victims of sexual violence, hospital and two health posts offering comprehen- Wajir district health authorities. for people affected by conflict and respond to the returnees and vulnerable communities. In all loca- and other communities. A total of 14,725 patients while responding to public health challenges such sive healthcare to both refugees and the host com- pandemic, strengthening infection prevention and tions, including MSF COVID-19 centres, emergency were treated in the emergency room in 2020 as HIV. Teams also supported the national response munity. Services include sexual and reproductive control measures and putting in place triage and room and mental health services were maintained. in Sinuni. referral procedures to protect patients and staff. As a result of the pandemic, the closure of private © MSF © MSF

In the country since: 2005 KYRGYZSTAN Reason for intervention: healthcare exclusion Main activity: general healthcare, sexual and reproductive healthcare Emergency intervention: COVID-19 Providing general healthcare and Human resources: 67 staff including treatment for COVID-19 in rural (FTE) 5 international staff communities Cost for 2020: CHF 1,665,000 In the largely rural and remote region of Aidarken, 2020, MSF started a cervical cancer screening pro- addition, they worked with government mobile bri- MSF offered strong support to the COVID-19 gramme, but was unable to scale up activities as gades to gather samples for testing and supported response, while continuing to run healthcare pro- planned due to the COVID-19 pandemic. Although epidemiological surveillance by assisting with data grammes in Batken province. MSF supports district the team was forced to reduce outpatient consul- collection. When COVID-19 peaked in the coun- health authorities to screen, diagnose and prevent tations, they nevertheless managed to conduct a try in July, MSF opened a COVID-19 home-based a range of chronic diseases including diabetes total of 5,855 during the year. care programme for moderate and mild patients and hypertension. The high prevalence of non- in Alamedin and Sokuluk, in Chuy province, to communicable diseases in this region is potentially As early as March, MSF started to reinforce COVID- prevent hospitals from being overwhelmed. This linked to soil and water pollution; however, plans 19 preparedness measures in four of the main programme was also extended to Kadamjay. The to carry out further environmental assessments hospitals in Kadamjay, Batken province. Teams home-based management of COVID-19 was a first were delayed because of COVID-19. MSF teams in adapted infrastructure to improve patient flow, in the country and was introduced in collaboration Aidarken also run health services for women and offered advice and training on infection preven- with the Ministry of Health. In October, following children, with an emphasis on sexual and reproduc- tion and control, and provided disinfectants and political unrest, MSF supported the Kyrgyz Red © Gabriele Casini/MSF tive health, including ante- and postnatal care. In personal protective equipment for health staff. In Crescent by donating first-aid kits.

20 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 21 In the country since: 2008 In the country since: 2013 Reason for intervention: displacement, healthcare exclusion Reason for intervention: healthcare exclusion LEBANON Main activity: general healthcare, sexual and reproductive healthcare, mental healthcare MEXICO Main activity: general healthcare, mental healthcare Providing relief aid to refugees and Emergency intervention: COVID-19 Fighting the COVID-19 pandemic Emergency intervention: COVID-19 Human resources: 180 staff including Human resources: 69 staff including vulnerable communities (FTE) 21 international staff and assisting migrants (FTE) 15 international staff Cost for 2020: CHF 7,950,000 Cost for 2020: CHF 4,070,000

In Mexico, thousands of migrants continue to be mild to severe COVID-19 in two dedicated centres carried out 7,950 consultations, including 4,188 for trapped in dangerous cities along the border with the set up in the campuses of Reynosa and Matamoros mental health, in its projects in Mexico in 2020. US, due to migration policies that are based on crimi- universities. These activities ended in October. nalisation, deterrence and containment. In 2020, in MSF continued to denounce the harmful policies addition to running activities to assist people in these MSF continued to run its project in Reynosa, which and asylum restrictions implemented by the US in locations, MSF organised a range of COVID-19 emer- provides medical, psychological and social work cooperation with Mexico and other countries in the gency responses in Mexico, a country with one of the consultations for victims of violence, including sex- region, which force people to return to places of highest numbers of deaths from the virus in the world. ual violence, and Mexican returnees from the US. danger, putting their lives at risk. In February, MSF Teams worked in all the migrant shelters in Nuevo published a report entitled No Way Out on the As the number of coronavirus cases rose quickly, Laredo, Reynosa and Matamoros, including an damaging impact on health of US-Mexico migra- MSF adapted its activities to care for patients with improvised asylum seekers camp. In total, MSF tion policies. © Karine Pierre/Hans Lucas © Karine Pierre/Hans Lucas © Karine Pierre/Hans Lucas © Arlette Blanco/MSF

The arrival of COVID-19 and a massive explosion in by the authorities further aggravated the economic country. In Hermel, Arsal, Majdal Anjar and Baalbek, Beirut dealt further blows to Lebanon’s health sys- crisis. As the number of cases increased, MSF MSF ran clinics providing reproductive health ser- tem, already fragile following years of economic, adapted activities in all its projects to tackle the vices, maternity care, mental health support and In the country since: 1992 political and social unrest. The blast, which tore virus. Health promotion teams reinforced messages treatment for non-communicable diseases (NCDs). MOZAMBIQUE Reason for intervention: epidemics through the capital on 4 August, killed at least regarding infection prevention and control in the A total of 28,898 consultations for NCDs and Main activity: HIV/AIDS, tuberculosis, hepatitis C, mental healthcare Responding to COVID-19 and Emergency intervention: COVID-19 200 people and destroyed many homes and busi- community and organised awareness-raising ses- 10,750 antenatal consultations were conducted Human resources: 177 staff including nesses. It also caused a spike in COVID-19 cases, as sions in MSF facilities. MSF staff also provided train- during the year. Activities in Majdal and Baalbek supporting treatment for chronic (FTE) 11 international staff thousands of injured and traumatised people took ing and worked with the Ministry of Health and were handed over to the Ministry of Health and diseases Cost for 2020: CHF 3,788,000 to the streets to seek treatment for their wounds or other organisations to coordinate the response. other organisations in October. search for missing family members, abandoning all In Mozambique, around 2.2 million people are living The MSF programme in Maputo offers specialised World Health Organization. These include needle precautionary measures. MSF assisted residents of For MSF, preventing the pandemic from disrupting Until December 2020, MSF ran a project in Tripoli with HIV, of whom 36 per cent are co-infected with care for patients with advanced HIV and TB and is and syringe distribution, opioid substitution therapy the devastated areas by providing medical care and other essential health services was of fundamental offering treatment for chronic diseases, family plan- tuberculosis (TB). While continuing to provide care working to improve the detection and rapid treat- and overdose treatment. In Mafalala slum, MSF and mental health support, distributing hygiene kits and importance in Lebanon. During the year, existing ning services and mental health support. As all for patients with these diseases, MSF gave logisti- ment of opportunistic infections. a local organisation run a drop-in centre for people installing water tanks. activities were maintained, to ensure access to free, patients have now been transferred to national cal and technical support to the main COVID-19 who use drugs, offering testing for HIV, TB high-quality healthcare for vulnerable people in programmes, the project was closed at the end of referral hospitals in the capital Maputo to assist the MSF’s harm reduction programme for people who and hepatitis C and referrals for treatment. The spread of COVID-19 overwhelmed the health- need of medical or humanitarian support, such as the year. national response to the pandemic. use drugs is the only one in the country, and imple- In 2020, teams conducted 9,944 consultations in care system, and the series of lockdowns imposed Syrian refugees – there are over a million in the ments all the interventions recommended by the this centre.

22 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 23 In the country since: 2000 In the country since: 2016 Reason for intervention: epidemics, healthcare exclusion Reason for intervention: armed conflict, displacement MYANMAR Main activity: HIV/AIDS, tuberculosis, hepatitis C, general healthcare NIGERIA Main activity: general healthcare Treating the most vulnerable Human resources: 118 staff including Providing general healthcare to Human resources: 207 staff including (FTE) 9 international staff (FTE) 15 international staff Cost for 2020: CHF 2,588,000 displaced people in Borno state Cost for 2020: CHF 4,773,000

In Myanmar, access to medical treatment remains focusing on key groups such as migrant workers, Zone, Sagaing region. The project developed a In northeast Nigeria – particularly in Borno state – assistance. In the areas MSF could access, teams The remote town of Rann is cut off from the out- limited, particularly for marginalised communities fishermen and sex workers. Activities were adapted community-based model of care, strengthened more than a decade of conflict between the Nige- continued to provide lifesaving care to people side world during the rainy season, between June and certain ethnic groups. In 2020, it became even to ensure continuity of care for patients in remote community health worker networks in Lahe town- rian government and non-state armed groups has affected by conflict, displacement and disease and January. Due to the particularly long rainy sea- more restricted, due to the COVID-19 pandemic. locations, who were unable to reach our clinic due ship and supported referrals. In July, these activities taken a severe toll. The United Nations estimates outbreaks. son and flooding in 2020, teams were unable to During the year, MSF continued to address gaps in to COVID-19 movement restrictions. A total of were handed over to Medical Action Myanmar, a that over 2.1 million people have already been dis- access Rann for a longer period than usual. For this healthcare in hard-to-reach areas of the country. 2,192 patients received antiretroviral therapy well-established organisation with whom the MSF placed, and the numbers continue to rise. More In 2020, malaria was a focus of MSF activities in reason, the seasonal malaria prophylaxis and health through the MSF programme in 2020. team had been working informally for the past than a million have been completely cut off from displacement camps in Ngala and Banki. The team promotion activities carried out earlier in the year In Dawei, Tanintharyi region, MSF maintained its two years. MSF continued to support the health aid for years. In 2020, as the situation deterio- in Ngala also offered specialist healthcare in the were of key importance in reducing cases. The programme for patients with HIV, including those Since 2015, MSF had been providing general and authorities in Dawei to respond to the seasonal rated, a series of brutal mass murders, abductions camp and the local community. In Banki, where teams in Rann also conducted 22,522 outpatient co-infected with tuberculosis and hepatitis C, specialist healthcare in Naga Self-Administered dengue outbreak. and kidnappings took place, but only people living malnutrition remains a concern, 13,480 children consultations, mainly for acute diarrhoea related to in government-controlled areas in and around the were screened to identify the ones in need of ther- a lack of clean water. state capital, Maiduguri, were able to obtain apeutic feeding treatment.

In the country since: 2005 NIGER Reason for intervention: epidemics, displacement Main activity: hospital care, general healthcare In the country since: 2020 Tackling the annual malnutrition Emergency intervention: malnutrition, malaria, COVID-19 Reason for intervention: epidemics Human resources: 619 staff including SENEGAL and malaria peak Emergency intervention: COVID-19 (FTE) 31 international staff Responding to COVID-19 epidemic Human resources: 3 staff Cost for 2020: CHF 12,142,000 (FTE) Cost for 2020: CHF 273,000 Niger is a country chronically affected by , supported the COVID-19 call centre in Niamey and As in previous years, MSF supported the Ministry of underdevelopment, natural disasters and recurrent some health facilities in other major cities. Public Health by boosting inpatient capacity for the epidemics. Floods, droughts and agricultural short- treatment of acutely malnourished children in falls exacerbate food insecurity and people often In Magaria, where MSF manages the paediatric unit, Magaria. In 2020, MSF admitted 14,906 children struggle to access basic services, including health- teams treated more patients with malaria than in under the age of five to the facility, 7,508 of whom care. The first few months of the year are usually 2019, mainly due to a longer and heavier rainy sea- were suffering from severe acute malnutrition with the least busy for MSF teams in this country, but son, a shortage of antimalarial medicines and the complications. MSF is developing preventive and everything changed in March 2020 with the spread COVID-19 crisis. From October to December, MSF community-based approaches to reduce the num- of COVID-19. also supported a regional hospital in Niamey to ber of patients with complications from malnutri- improve care for children under the age of 15 by tion, for example by providing early treatment for In the capital Niamey, the city with the most cases, increasing its inpatient capacity, training staff and malaria, acute respiratory infections and diarrhoea. MSF built a treatment centre to care for patients in donating drugs. the first months of the pandemic. Teams also © Mack Alix Mushitsi/MSF © Sylvain Cherkaoui

When the COVID-19 epidemic reached Senegal, cases rose, teams boosted capacity for patients MSF team of epidemiologists worked with other MSF deployed a response team in the country for requiring oxygen therapy. They also worked to national and regional entities to strengthen case the first time to help with patient care, epidemio- improve patient care management, as well as pre- surveillance, supporting data analysis to better logical surveillance and health promotion. In March, vention and control measures in the facility. In addi- understand the epidemic. MSF’s COVID-19 activi- the team from MSF’s regional office in the capital, tion, MSF ran community engagement and health ties in Senegal continued until the end of Septem- Dakar, which supports operations in West and Cen- promotion activities at district level in Guédiawaye, ber, when teams saw a clear reduction in both tral Africa, mobilised to assist the national response. one of Dakar’s most densely populated suburbs. transmission and severity of cases. Teams collaborated with the national response MSF worked with national and regional partners to team on prevention activities within communities, Experience from this first project in Senegal was prepare for an increase in severely ill patients and where they collected feedback in order to dissemi- implemented in MSF’s COVID-19 response projects improve communication around the virus. At Dalal nate messages to combat fear, misinformation and in other West and Central African countries, such as Jamm hospital, MSF supported a 200-bed COVID- stigma around the virus. Community-based surveil- Cameroon, Niger and Burkina Faso. © Mack Alix Mushitsi/MSF © Mack Alix Mushitsi/MSF 19 treatment centre. As the number of complex lance was a key component of the response. An

24 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 25 In the country since: 2018 In the country since: 2004 Reason for intervention: epidemics Reason for intervention: displacement, healthcare exclusion SOMALIA Main activity: general healthcare SUDAN Main activity: general healthcare, sexual and reproductive healthcare, water and sanitation Supporting child healthcare Emergency intervention: COVID-19, floods Responding to COVID-19 pandemic Emergency intervention: COVID-19, floods Human resources: 4 international staff Human resources: 312 staff including (FTE) and other emergencies (FTE) 39 international staff Cost for 2020: CHF 1,553,000 Cost for 2020: CHF 12,827,000

The COVID-19 pandemic aggravated the overall Throughout the year, MSF managed to maintain treatment facilities. MSF also provided training for humanitarian situation in Somalia and Somaliland, most of its activities, including support to paediatric Ministry of Health staff in Jubaland and put in place where people were already struggling with the care. In Afmadow and Bardhere, in southern Juba- hygiene, emergency preparedness and preventive effects of climate hazards, locust infestations and land, teams continued to carry out frequent short measures to protect staff and patients. recurrent outbreaks of fighting. Malnutrition rates interventions focusing on nutritional care for mal- among children were well above the emergency nourished children. Some of the planned activities Following a cholera outbreak in February, teams threshold in many areas and the number of deaths were delayed due to the pandemic. However, MSF supported the local authorities to provide treat- during pregnancy and childbirth remained among was able to run eye surgery camps, which provide ment. In addition to these activities, MSF launched the highest in the world. In 2020, 2.6 million peo- screening and treatment for cataracts and other emergency responses to assist people affected ple were displaced, mainly due to conflict and common eye conditions. by flooding in Bardhere town after the Juba river floods, while 4.1 million people were considered burst its banks in April, and again in May in food insecure. MSF adapted its medical programmes to screen Beletweyne. COVID-19 patients and referred them to designated

In the country since: 1996 Thomas Dworzak/Magnum Photos Thomas Dworzak/Magnum Photos Reason for intervention: armed conflict, epidemics, healthcare exclusion SOUTH SUDAN Main activity: hospital care, general healthcare, malaria Offering access to hospital care and Emergency intervention: COVID-19 Human resources: 477 staff including tackling COVID-19 (FTE) 31 international staff Cost for 2020: CHF 11,904,000

Two years after the signing of a peace agreement, In Abyei, a disputed area between Sudan and an already dire humanitarian situation led MSF to and despite the formation of a unity government, South Sudan, our 180-bed hospital in Agok town integrate COVID-19 measures in Agok hospital. the situation in South Sudan remains fragile. The continued to offer surgery, neonatal and paediatric In the facility, teams provided care for confirmed country was hit by multiple emergencies in 2020, care and treatment for snakebites and diseases such cases and COVID-19 testing in the laboratory. MSF including escalating violence, COVID-19, severe as HIV, tuberculosis, malaria and diabetes. During teams also trained healthcare workers, donated flooding and high levels of food insecurity. A the year, MSF teams conducted 10,555 outpatient supplies, conducted health promotion activities total of 7.5 million people – around two-thirds of consultations and admitted 7,349 patients for care. and set up handwashing points in several public the population – were in need of humanitarian locations. In addition, MSF supported the Ministry assistance. As the COVID-19 pandemic spread globally in early of Health hospital in Abyei with technical support 2020, concerns that an outbreak would exacerbate and training. Thomas Dworzak/Magnum Photos Thomas Dworzak/Magnum Photos

In 2019, Sudan was the scene of mass protests, in Omdurman teaching hospital, in partnership with newborns affected by the humanitarian crisis in the sparked by its deepening economic and political the Ministry of Health, for patients with moderate region. From August, MSF started running mobile crisis. It led to the ousting of the president and to a to severe symptoms of the virus. During the year, clinics to deliver care to communities in remote political transition that is still ongoing. The arrival of teams also conducted health promotion and locations in the state. COVID-19 in the country had a severe impact on awareness-raising sessions on COVID-19 in local the already fragile healthcare system, especially in communities and healthcare centres where MSF In May, MSF began to hand over its kala azar (vis- the densely populated capital, Khartoum. In 2020, works. ceral leishmaniasis) activities in Al-Gedaref state, MSF assisted with the COVID-19 response and pro- eastern Sudan. MSF has been working on the man- vided emergency assistance to people affected by In East Darfur, MSF runs a clinic in Kario, a camp agement of this disease in Tabarak Allah village and violence and displacement within the country, as that hosts around 30,000 South Sudanese refugees. Bazura since 2010 and 2016 respectively. well as refugees from neighbouring Ethiopia, flee- After reinforcing infection and prevention control ing conflict in Tigray region at the end of the year. measures, teams continued to offer general health- In September, the Blue Nile burst its banks, causing care, such as maternity services and nutritional sup- devastating floods that affected more than three From April, MSF started supporting the national port for children, carrying out a total of 91,011 million people across 17 of Sudan’s 18 states. MSF response to the pandemic in Khartoum, by running outpatient consultations and 6,864 antenatal con- launched an emergency response in Khartoum and training to improve infection prevention and con- sultations in 2020. In response to a higher than Sennar states, running mobile clinics and distribut- trol measures, ward and triage circuits and water usual malaria peak this year, MSF set up a malaria ing relief items such as hygiene kits. and sanitation provision inside health facilities. This treatment unit to treat simple cases and organise training, run in collaboration with the Ministry of referrals for patients with complications. Health In November, when conflict broke out in Ethiopia, Health and the World Health Organization, was promotion activities, conducted by a network of thousands of people fled across the border into provided to healthcare professionals in leadership community health workers, are another key com- Sudan. Teams were sent to assist refugees in Al- roles at 90 hospitals in Khartoum state. In addition, ponent of the Kario project. Gedaref state, providing screening for malnutrition, staff were trained so that they could replicate the general healthcare consultations, and water and training sessions in hospitals in other states. In In South Kordofan, MSF continued to focus on sex- sanitation in two camps, and at the main border © Damaris Giuliana/MSF August, MSF opened a COVID-19 treatment centre ual and reproductive health, assisting women and crossing points.

26 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 27 In the country since: 2013 In the country since: 2015 Reason for intervention: armed conflict, healthcare exclusion Reason for intervention: displacement SYRIA Main activity: sexual and reproductive healthcare, general healthcare TANZANIA Main activity: hospital care, general healthcare, mental healthcare Providing care to displaced people Human resources: 49 staff including Offering care to refugees Emergency intervention: COVID-19, floods (FTE) 6 international staff Human resources: 327 staff including Cost for 2020: CHF 1,576,000 (FTE) 19 international staff Cost for 2020: CHF 8,489,000 By the end of 2020, over 11 million people in Syria Many were killed, wounded or displaced as a result paediatric care and services for pregnant women needed humanitarian assistance. Hundreds of thou- of this escalation in violence, and MSF had to evacu- and patients with chronic diseases. MSF started sands have been killed or wounded in a war that is ate teams from several projects. In areas where they working in northeast Syria in 2013 as an emergency still raging after 10 years. MSF continued to operate could continue to work, MSF staff carried out gen- response, offering medical and humanitarian sup- in Syria, but its activities remained limited by inse- eral healthcare consultations for displaced people. port to people who had been directly or indirectly curity and access constraints. affected by the ongoing conflict and political insta- At the beginning of 2020, MSF handed over its bility. During this period, MSF teams ran general The Turkish military intervention and the activi- activities at the general healthcare clinic it had been healthcare services for internally displaced people ties of allied Syrian armed opposition groups had supporting in Tel Kocher to the local health authori- in camps. They also rehabilitated Hassakeh and a severe impact on the people of northeast Syria. ties. The team at the clinic had been providing Derek national hospitals.

In the country since: 2020 Reason for intervention: epidemics SWITZERLAND Emergency intervention: COVID-19 Supporting the response to COVID-19 Human resources: 2 staff (FTE) Cost for 2020: CHF 352,000

Like most European countries, Switzerland has night shelters to test for the virus and monitor was quickly brought under control in Switzerland been and remains affected by COVID-19. At the patients, and MSF psychologists supported medical and MSF’s support was only needed for two beginning of the pandemic, the Swiss health sys- staff working in retirement homes. MSF also months. tem struggled to adapt to the new reality and the assisted with the implementation of infection pre- needs of the population. This unprecedented situa- vention and control measures and conducted Between November and February 2021, MSF set up tion led MSF to develop activities to help reduce health promotion activities in public services, shel- a partnership with the cantonal doctors’ services – transmission of the virus, focusing on the most vul- ters and nursing homes. In addition, MSF collabo- which are the focal point for COVID-19 care – and nerable groups in society. rated with the city of Geneva and several local Geneva teaching hospital. Teams continued to sup- © Petro Jengela/MSF organisations to distribute food parcels to around port nursing homes in several cantons and in neigh- When the first wave hit the country in March, MSF 3,000 people. The need for this kind of support in a bouring French localities. After sharing its worked to reinforce staff capacity in medical facili- wealthy European country exposed the increasing field-based emergency response expertise with After violence erupted in Burundi in 2015, thousands hosting refugees in Kigoma. Four health posts linked sexual and reproductive healthcare consultations ties and organisations supporting vulnerable peo- poverty and precariousness faced by many during relevant partners, MSF concluded its activities in of people fled into Tanzania. In 2020, some 20,000 to a hospital help to cover the medical needs of and assisted 4,262 deliveries. A total of 11,468 men- ple. Mobile teams were deployed to migrant and the COVID-19 crisis. The first wave of the pandemic the country as the second wave came to an end. returned home, but more than 147,000 are still living nearly 70,000 refugees in the camp and around tal health consultations were also carried out. there in camps, as they do not believe that their 20,000 people from surrounding villages. MSF country is safe. Restrictions on movement outside teams offer health services for women and children, Throughout 2020, MSF supported emergency pre- the camps prevent them from seeking work, forc- including care and counselling for victims of sexual paredness and response activities. A team ran a ing them to rely solely on ever-­dwindling humani- and gender-based violence, as well as mental health 100-bed COVID-19 quarantine facility in Nduta tarian assistance. The refugee response in Tanzania consultations and treatment for tuberculosis, HIV camp and trained more than 430 staff to respond is one of the most chronically underfunded in the and a range of non-communicable diseases. The to a potential outbreak. In April, following floods in world. In 2020, MSF continued to provide healthcare hospital has both paediatric and adult wards, as well Lindi, MSF donated medicines to prevent and treat for Burundian refugees and local communities in as a maternity room, and provides emergency surgi- malaria, acute diarrhoea and dehydration. In May, a Kigoma region. MSF remains the main healthcare cal and obstetrical referrals to the nearby govern- team organised a measles vaccination campaign provider in Nduta camp – one of three camps ment facility. Overall MSF teams conducted 24,243 after an outbreak in the camp.

In the country since: 2018 Reason for intervention: armed conflict UKRAINE Main activity: general healthcare, hepatitis C Providing care to patients with Emergency intervention: COVID-19 Human resources: 64 staff including chronic conditions (FTE) 10 international staff Cost for 2020: CHF 2,605,000

As the conflict in eastern Ukraine entered its sev- have switched from running mobile clinics to work- MSF teams also supported the COVID-19 response enth year, access to healthcare remained limited ing in general healthcare facilities, providing techni- in Donetsk, by training Ministry of Health staff in for people living along the frontline. Since 2015, cal and practical assistance to staff. They are also infection prevention and control and offering psy- MSF has run a range of activities in the country, strengthening community healthcare through the chological support to patients and healthcare including tuberculosis care. In 2020, MSF teams involvement of local volunteers. workers. In Mariinka district, MSF mobile teams opened new projects in Donetsk and Luhansk and provided home-based care and transported COVID- supported the national COVID-19 response. In Mykolaiv, MSF treated hepatitis C patients living 19 samples for testing. with HIV, using a new direct-acting antiviral regi- MSF is collaborating with the Ministry of Health to men. MSF handed this project over to the Mykolaiv improve basic healthcare in Donetsk region’s Regional Centre of Palliative Care and Integrated © Nora Teylouni/MSF © Nora Teylouni/MSF remote, conflict-affected communities. MSF teams Services in May.

28 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 29 In the country since: 2015 Human Resources Reason for intervention: armed conflict, epidemics YEMEN Main activity: hospital care Responding to COVID-19 and Emergency intervention: COVID-19 Human resources: 710 staff including providing emergency care (FTE) 29 international staff Cost for 2020: CHF 18,065,000

Although the COVID-19 pandemic hit Yemen hard and a population too poor to simply stop working teams performed a total of 1,783 surgical interven- 2020 was an exceptional year in every way and Geneva and Zurich to Mexico, Dakar and the identify the barriers staff see in our organisation in 2020, it was just one of many crises unfolding in and stay at home. There was also a widespread tions and conducted a total of 34,519 emergency the pandemic probably created the largest human 28 countries where we have field operations. Policies structure and practices. The introduction of a the country, still at war after five years. More peo- reluctance to believe that the virus was real, or a room consultations during the year. Staff in these resources challenge our organisation has ever faced. and support practices were developed globally DEI coordinator in 2020 has allowed us to bring ple than ever before were left without healthcare, threat to Yemen. MSF immediately began work- areas also saw how the fighting further limited As an emergency humanitarian organisation, we are and implemented locally. For example, we had to together the various initiatives that have emerged as many of the last parts of the already crippled ing with the health authorities, opening a small people’s access to care for snakebites and diseases used to having to change and adapt, but this crisis ensure that staff vulnerable to COVID-19 were not in recent years and ensure a more coordinated healthcare system stopped functioning during the treatment centre in Ibb and running health promo- such as malaria and dengue. was, and continues to be, global. It impacted all our exposed to unnecessary risks, with similar policies and comprehensive approach in the future. We outbreak. Restrictions imposed by the local authori- tion activities to raise awareness about the virus. headquarters and missions, tested our capacities and practices being put in place in our workplaces have seen change in 2020, with more of our ties on the work of aid organisations further com- Prevention measures were put in place in all MSF Both Ansar Allah and the Saudi-led coalition contin- and systems, and put a strain on our resources and around the world but adapted to each local locally recruited staff moving into higher levels plicated MSF’s work, and healthcare facilities and projects so that they could continue to offer essen- ued to impose movement restrictions on humani- our people. We quickly had to adapt to a scenario context. In the early stages of the pandemic we of responsibility, and our international workforce workers continued to be attacked. Many civilians tial healthcare. The number of cases appeared to tarians inside Yemen, hampering activities such as where international mobility was suddenly severely faced a potential shortage of personal protective is becoming more and more diverse. These are were killed or injured in shelling, air raids or shoot- reduce sharply during the summer, and by Septem- needs assessments and the deployment of mobile restricted and we had to ensure the health and equipment and had to take decisions about how positive signs, but ensuring inclusion of the highly ings. Despite these challenges, MSF continued to ber, the majority of MSF’s COVID activities had been clinics. Administrative difficulties around obtaining wellbeing of our staff in response to a disease that to balance operational needs with the safety of diverse MSF workforce remains a daily challenge provide essential care by supporting hospitals in handed over to the local health authorities. How- visas for specialist staff and importing supplies also we knew little about. our staff. The psychological impact of the crisis has and a commitment we continue to invest in. Ibb and Hodeidah governorates and responding to ever, teams continued training and other activities complicated the provision of aid. taken a toll on our people: countless staff have dealt COVID-19. in preparation for a potential second wave. The unprecedented drop in flight availability and with personal and family tragedy while continuing Our common objective was to ensure that our restrictions on movements meant that the usually their work; field staff reported to mental and operations were affected as little as possible and The potential for COVID-19 to devastate Yemen Despite the heavy toll that COVID-19 took on routine activity of sending our international staff to emotional distress due to limitations in responding that quality care continued to be available for the was evident from the beginning: a country frag- Yemen, the number of air strikes and active front- the field and arranging for them to return home all the needs they were confronted with; and many people we serve. While we all greatly miss working mented by fighting, with a collapsed health system lines increased. In Hodeidah and Ad-Dahi, MSF became a highly complex challenge. That we staff were fatigued by the seemingly never-ending physically side by side, 2020 showed us new ways were able to continue to provide care to patients workload. We stepped up the psychosocial support of providing care for our patients. is testament to the dedication of our field teams for all our staff, but the impact of this crisis is still and the problem-solving capacity of our HR teams. being felt by many of the people working with us. I want to sincerely thank our staff for their amazing Over the last 15 years we have made progressive work in this exceptional year. 2020 demonstrated changes in our approach to field staffing, including In some ways this year also proved to be an the creativity, motivation and dedication of our investing in and promoting local capacity and interesting catalyst for change. We continued to people. While those were qualities we already diversifying recruitment, so that we now have provide Learning and Development opportunities valued, seeing them reaffirmed under such more than 140 nationalities represented in the to our staff and our L&D team did a remarkable circumstances was moving and we are grateful global MSF workforce. These changes enabled us job of adapting the learning offer to the context. to all our staff for their efforts. The crisis is not to implement local and regional staffing solutions For instance, numerous courses were developed over and despite the constraints and challenges, at a time when international movements were so online, bedside training was conducted remotely I am convinced we will continue to find ways to restricted, providing a solid foundation for our field and remote mentoring was offered for staff taking keep MSF operating as an international movement activities to continue even in this extraordinary up higher levels of responsibility. without borders and remaining true to our identity. situation. This experience has also confirmed that while international mobility is an essential aspect In last year’s report I mentioned the efforts we are of our identity and necessary for humanitarian making to become a more inclusive organisation. Kate Mort responses, the approaches adopted during Diversity, equity and inclusion discussions were Human Resources Director this pandemic will inform and strengthen our amplified this year with the ‘Black Lives Matter’ emergency interventions in the future. movement and it was clear from the voices of our own staff that even if advancements have been The pandemic also required us to consider staff made, they are not enough. While these expressions health in a truly global way. Workplaces across are not always easy to hear, they have allowed us the whole organisation were impacted, from to accelerate our work in this area and to better © Majd Aljunaid/MSF Staff per occupation (FTE) Field mission departures 2020 - 2019 2020 - 2019

525 544 Medical Regular staff 456 programmes 658 6,224 field staff Paramedical 2,234 staff 2,516 283 Emergency 3,464 interventions 319 headquarters staff Non-medical 476 staff 3,509

1,489 volunteer hours in 2020 in 2019 Total numbers in 2020 in 2019 Total field staff: 6,224 6,440 on their first mission: 126 142

© Majd Aljunaid/MSF © Majd Aljunaid/MSF in Switzerland

30 ACTIVITY REPORT 2020 HUMAN RESOURCES 31 Financial results Programme costs per country** Income (%) Others 1% Ukraine 1% Switzerland 1% Income and expenditure Myanmar 1% Mexico 2% (in millions of Swiss francs) Our activities in 2020 were unquestionably defined of operational capacity (procurement challenges, In East Africa and Southern Africa, our spending fell Honduras 2% revenue was CHF 280.6 million, a CHF 5.4 million Kyrgyzstan 1% by the COVID-19 pandemic. Never before has MSF reduced mobility, etc.). by 6.3% to CHF 56.2 million. The largest decrease increase (+2%) compared with 2019. Funds totalling Democratic People’s Greece 3% 249 249 institutional 250 Public had to contend with a situation that simultaneously was recorded in Mozambique,Republic of Korea where 1% the process CHF 132.7 million were raised in235 Switzerland,234 which affected all its countries of intervention, as well as OCG carried out projects in direct response to the of withdrawing from certainSyria activities 1% is under way, was 13.2%DRC (CHF 12% 15.5 million) more than the previ- donors Switzerland 48% its headquarters. All our activities were disrupted. COVID-19 pandemic in several countries, at a total with a view to the complete closure of the mis- ous year.200 This increase is partly attributable to a Lebanon 4% AMERICAS 5% 4% An extremely high level of responsiveness and cost of CHF 23.3 million. sion in 2021. Meanwhile, the largest increase in EUROPE 5% number of contributions received in relation to our Czech Republic 1% dedication was required from our teams in order spending was recorded in Sudan, where three new ASIA 3% COVID-19150 activities. RevenueKenya 7% from our MSF partner to adapt all our projects to the new constraints projects were set up, including two emergency sections totalled CHF 135.2 million, compared with 2% Programme costs 100 imposed by this pandemic and provide adequate interventions. MSF also continued its activities in CHF 149.1 million in 2019. This decrease is due to South Korea 2% Iraq 9% support and care to the patients and people per reason of intervention Eswatini, Kenya, South Sudan, Somalia and Tan- a new resource-sharing agreementSudan 7% within the MSF assisted by MSF. We set up numerous emergency zania. In the Middle East, our teams ran a total of MIDDLE EAST 24% movement.50 Indeed, the majority of MSF sectionsIncome AFRICA 63% Expenditure Australia 4% Private projects directly linked to the COVID-19 pandemic 13 projects in Iraq, Lebanon, Syria and Yemen, at worldwide recorded net growth in 2020 com- donations* in several countries, including Switzerland. a total cost of CHF 44.2 million, 23% less than in pared with0 2019. Finally,Burkina 4% Faso of 6%our revenue came Armed conflict 2017 2016 96% 57% 2019. The majority of this reduction was linked to from the public sector. This revenue increased by Canada 4% At the end of 2020, we had a surplus of CHF 28.6 the closure of our mission in Syria in early 2020, as 42.3% to CHF 12.4 million, including CHF 10.2 mil- Cameroon 6% mil­lion. This exceptional result follows losses of well as the closure of our Tripoli projectYemen and 10%two lion from the Swiss Agency for Development and CHF 1.6 million in 2019 and CHF 30.7 million in 2018. clinics in the Bekaa Valley in Lebanon, the Al-Udayn Cooperation. Austria 6% South Sudan 6% project in Yemen and the Zummar project in Iraq. Niger 6% 13% 30% Total programme expenditure was CHF 189 million, In 2020, we had teams working in Asia (Myanmar, Swiss private donations Germany 14% a decrease of 14% (or CHF 30.6 million). More than Kyrgyzstan and the DemocraticSomalia People’s 1% Republic Mozambique 2% USA 14% Eswatini 2%

half of this reduction was due to a scaling back of Social violence Endemic and of Korea), Latin America (Mexico,Chad Honduras 1% and Nigeria 3% 300 263,015 contributions to other MSF operational sections, as and healthcare epidemic disease Colombia) and Europe (Ukraine, Greece, the Czech Tanzania 4% donors exclusion 225,340 reflected by the fact that within the framework of Republic and Switzerland). Our total programme 250 donors a resource-sharing agreement, in 2019 MSF Swit- expenditure across these three continents was zerland financed projects implemented by other Once again, in 2020 the Democratic Republic of the CHF 24.1 million, up 11.5%. 200 * Private donations from MSF Switzerland and other MSF partner sections sections to the sum of CHF 20 million, whereas in Congo (DRC) was the country where programme 150 2020 this figure was just CHF 2 million. expenditure was highest, at CHF 23.1 million, and Headquarters spending on supporting our pro- also where we conducted the largest number of grammes and on témoignage, awareness-raising 100 Operational Centre Geneva (OCG) directly carried interventions. Expenditure on our three projects and other humanitarian activities decreased by out 80 projects in 28 countries. Africa accounted to assist displaced people in Ituri province totalled 2.5% and 3.9%, respectively, in 2020. Management 50 Programme costs per country** 46,253 New donors 32,462 for 63% of our programme spending and the Mid- CHF 12.4 million, accounting for 54% of the overall and administration expenses, meanwhile, were New donors 0 dle East 24%; Europe, America and Asia accounted costs in DRC. down by 5.4%. These reductions are in part due 2020 2019 Income (%) for 5%, 5% and 3% of the total, respectively. This to MSF Switzerland’s policy of cutting headquarters Active donors Others 1% Ukraine 1% geographical distribution remained broadly stable In West Africa, programme expenditure was up costs, but also to the COVID-19 pandemic, which Switzerland 1% compared with 2019. In 2020, spending on these 17% to CHF 39.4 million, an increase of CHF restricted mobility and the implementation of This boosted our reserves to 7.5 months of activ- Myanmar 1% Mexico 2% Honduras 2% projects stood at CHF 187 million, a reduction of 5.8 million. The bulk of this increase was linked to activities. Nonetheless, MSF Switzerland invested ity, which will allow us to maintain our agility and Kyrgyzstan 1%

6.3% (or CHF 12.7 million). This decrease was pri- our projects to support displaced people in Barsa- 11.5% more resources in fundraising in Switzerland responsiveness to emergencies and resume pro- Democratic People’s Greece 3% institutional Public marily due to the COVID-19 pandemic. Although logho and Kaya in Burkina Faso. MSF Switzerland to bolster its revenue in the medium term. jects that have been temporarily suspended or Republic of Korea 1% DRC 12% Switzerland 48% MSF was able to respond to numerous emergen- provided medical assistance to people in the region reduced because of the COVID-19 pandemic. It will Syria 1% donors cies, some activities, mainly in our ongoing pro- through 19 projects in Burkina Faso, Cameroon, Following on from a positive 2019, 2020 was a also make us better able to cope with future uncer- Lebanon 4% AMERICAS 5% 4% jects, had to be cut back or postponed for reasons Niger, Nigeria, Chad and Senegal. very good year in terms of fundraising. Our total tainties regarding the economic situation. EUROPE 5% Czech Republic 1% ASIA 3% Kenya 7% In 2020, we allocated 91.4% of our budget to our Japan 2% Expenditure (in thousands of Swiss francs) TOTAL ASIE social mission, 3.2% to administrative costs and South Korea 2% Iraq 9% 5.4% to fundraising. Sudan 7% MIDDLE EAST 24% 2020 2019 Income and expenditure AFRICA 63% Australia 4% Private (in millions of Swiss francs) We warmly thank all the private and institutional donations* Programme 189,040 76.0 % 219,624 78.6 % donors who supported us in 2020, making our Burkina Faso 6% 96% 300 Programme support 34,170 13.8 % 35,050 12.5 % 281 275 279 activities possible, and thank them in advance for Canada 4% 249 their support in 2021. Advocacy, awareness raising & other humanitarian 250 Cameroon 6% 3,861 1.6 % 4,018 1.4 % Yemen 10% activities 200 Austria 6% South Sudan 6% Social mission expenses 227,071 91.4 % 258,692 92.6 % Nicolas Joray Niger 6% 150 Fundraising in Switzerland 13,532 5.4 % 12,134 4.3 % Finance Director Germany 14% Somalia 1% Mozambique 2% USA 14% Management and administration 8,036 3.2 % 8,493 3.0 % 100 Eswatini 2% Chad 1% Nigeria 3% Income Tanzania 4% Administration expenses 21,568 8.6 % 20,627 7.4 % 50 Expenditure

TOTAL EXPENDITURE 248,639 100.0 % 279,319 100.0 % 0 2020 2019 ** Excluding financing of projects carried out by other MSF sections

32 ACTIVITY REPORT 2020 FINANCIAL RESULTS 33

Swiss private donations

250 243,432 248,749 Donors Donors 200

150

100

50 35,447 42,508 New Donors New Donors 0 2018 2017 Active donors Acknowledgments

We would like to thank all the donors who made the work of Médecins Sans Frontières Switzerland possible in 2020. This year, 263,015 people generously supported our organisation – we thank them all for their confidence in our work.

We would like to thank the governments, We would also like to thank the following We would like to sincerely thank: • Fondation W. et E. Grand d’Hauteville • Stiftung NAK Humanitas We also extend thanks to our governmental agencies and international foundations, businesses, towns and cantons: • Gemeinde Baar • Stiftung Primavera event partners: organisations that have supported our • A. Saesseli & Co. AG • Gemeinde Küsnacht • Stiftung Sonnenschein projects: • IKEA Foundation • ACE International SA • Gemeinde Riehen • Stone Age Gems Ltd • M.E.T.I.S • UBS Optimus Foundation • Alfa Klebstoffe AG • Georges Birchler Stiftung • Stumme Brüder Stiftung • BFB Bildung Formation - Biel • DDC: Swiss Agency for Development and • Ocean Foundation • Ameos Gruppe • Georges und Jenny Bloch Stiftung • SYNERGON AG • Kino im Uferbau – Solothurn Cooperation • Glückskette - Chaîne du Bonheur • Anne Frank Fonds • Google Switzerland • Teleios Capital Partners GmbH • Skino – Schaan • Global Fund • Anne und Peter Casari-Stierlin Stiftung • Hans Lüscher Stiftung • The GivenGain Foundation • Foraus - Forum Aussenpolitik • UNHCR: UN Refugee Agency • Ai Weiwei Mask Project team • Barbara Keller-Stiftung • Hans-Eggenberger-Stiftung • The Swatch Group SA • Espace des inventions • UNICEF • Cartier Philanthropy • Be Happy Foundation • Heinis AG • The Tanner Trust • WFP: World Food Programme • CHUV • Blaser Swisslube AG • Hemmi Fayet Architekten AG • Thurgau Travel AG • Erika und Conrad Schnyder-Stiftung • BÜCHI Foundation • HR Campus AG • Treuhand von Flüe AG Finally, we would like to thank • Ernst Göhner Stiftung • C + S AG • Jean Wander Stiftung • Ville de Genève all those who volunteered time • Gebauer-Stiftung • CA Indosuez (Switzerland) SA • Karl Zünd Stiftung • Ville de Meyrin and energy to help MSF in 2020: • Hilfswerk GL Zürich • Capital Group • Katholische Kirchgemeinde Bülach • Ville du Grand-Saconnex • Hilti Foundation • Carl und Elise Elsener-Gut Stiftung • Koch AG • von Duhn Stiftung • Romaine De Rivaz • IF! International Foundation • Catherine und Harry Morath-Stiftung • Krister and Lena Jonsson Foundation • Wellington Partners Advisory AG • Sonia Bouhali • J&K Wonderland Stiftung • Charlotte und Nelly Dornacher Stiftung • Krüger Foundation • Yellow Bird Foundation • Brenda Nelson • Kanton Zürich • Commune de Bernex • Link Marketing Services AG • Z Zurich Foundation • Silja Greber • Oak Foundation • Commune de Collonge-Bellerive • Lumentum Switzerland AG • Zimelien Stiftung • Maryvonne Grisetti • République et canton de Genève • Commune de Cologny • Martin Nösberger Stiftung • Eden Habtemicael • Stanley Thomas Johnson Stiftung • Commune de Plan-les-Ouates • Merumpress AG • Carole Isler • Stiftung Symphasis • Commune de Troinex • Mitarbeiter der Zurich Insurance Group • Agatino Lucifora • Swiss Re Foundation • Consa Treuhand AG • Musgrave Charitable Trust Ltd We would like to express our special • Eva Rust • Wietlisbach Foundation • Crédit Suisse AG • PartnerRe, Zurich Branch appreciation for the following supporters: • Cécile Thiery • Daniel Swarovski Corporation AG • Procuritas Partners GmbH • Gillie Wuidart • Doris Dietschy und Denise Dietschy-Frick- • Profilsager AG • Anita Gurtner-Fehr, Meilen Stiftung • Provisa AG • Antoinette Poschung, Schindellegi For her loyal support over the years, we would • Dr. Guido und Frederika Turin Stiftung • Raab-Verlag und Versandhandel GmbH • Dietlind Antretter, Zürich like to extend our special thanks to^ • Dr. Margrit Schoch-Stiftung • René und Margrit Waibel Stiftung • Jutta Prager, Mettmenstetten • E. Schellenberg Textildruck AG • République et canton du Jura • Marcel Zemp, Bern • Madeleine Meyer • Eckenstein-Geigy-Stiftung • Rolf Hänggi AG • Margrit und Hans Rudolf Heinimann, Zug • Elbro AG • Rosa und Bernhard Merz-Stiftung • Peter Flubacher, Affoltern am Albis • Elisabeth Nothmann Stiftung • Rüegg Bollinger Stiftung • EM2N, Mathias Müller, Daniel Niggli, • Rütli-Stiftung and numerous other generous supporters^ Architekten AG, ETH SIA BSA • Schaad-Keller Stiftung • Erica Stiftung • Schumacher & CHIngS Ingénieurs SA • Ernst & Elsbeth Blind-Stiftung • Schweizerische Ärzte-Krankenkasse • Familie Scheller Stiftung • Senn Resources AG • Fent AG • Spitalinternist.ch AG • Fight4Sight Foundation • Stadt Bern • fleurs suisse gmbh • Stadt Biel / Ville de Bienne • Fondation Albatros • Stadt Luzern • Fondation Alfred et Eugénie Baur • Stadt Rapperswil-Jona Many thanks to our • Fondation Charitable Bienvenue • Stefanie und Wolfgang Baumann Stiftung • Fondation de bienfaisance du Groupe Pictet • Stiftung Corymbo 263,015 • Fondation Dr. Corinne Schuler • Stiftung Dr. Valentin Malamoud donors • Fondation Hubert Looser • Stiftung Freie Evangelische Schule Zürich (FES) • Fondation Johann et Luzia Graessli Adolf Hugentobler • Fondation Pierre Demaurex • Stiftung Fürstlicher Kommerzienrat • Fondation Rifké Guido Feger • Fondation Stella • Stiftung Helene Arnold • Fondation Tellus Viva • Stiftung Mano

We apologise for any inadvertent omissions.

34 ACTIVITY REPORT 2020 ACKNOWLEDGMENTS 35 Governance structure of MSF Switzerland

Médecins Sans Frontières Switzerland is an associa- - Ian Adair, Treasurer of MSF Canada Board of Directors in May 2014 and has performed tion registered under Swiss Civil Code in 1981 and - Lionel Bally, Financial Expert this function since then. governed by legal articles of association, updated in May 2016. The Board of Directors convenes a Human Resource Commission, composed of Board Mem- The General Assembly is the supreme governing bers and other partners. Its purpose is to assist Risk evaluation body of MSF Switzerland. It elects members to the the Board to fulfil its governance responsibilities Board of Directors, approves the President’s report for human resources and human resource man- MSF Switzerland has conducted within its annual as well as the annual financial statements and the agement. It provides guidance and advice on the planning process an analysis of potential strategic, annual report (also referred to as the activity report), human resources of the organisation to ensure operational and financial risks to the organisation. and deliberates on all matters indicated on the that it attracts, develops and retains the people This analysis is led by the Management Team and is agenda. needed to deliver its mandate and achieve its subject to approval by the Finance Committee and social mission. the Board of Directors. The report covers risks asso- ciated with the environments in which MSF oper- MSF Switzerland’s ates, as well as internal processes and procedures. Board of Directors in 2020 MSF Switzerland’s Human Resources This analysis allows MSF Switzerland to identify risk Commission in 2020 events, the likelihood of their occurrence and their - Reveka Papadopoulou, President impact, and decide on mitigation measures. - Vinh-Kim Nguyen, Vice-President (until June - Beth Hilton-Thorp, Member of MSF Australia 2020, member until August 2020) and Chairperson of the Human Resource The analysis completed at the end of 2019 high- - Karim Laouabdia, Treasurer Commission lighted a number of risks within nine risk areas: - Bruno Lab, Secretary - Reveka Papadopoulou, President of MSF strategy, safety and security, legal and compliance, - Philippe Sudre Switzerland human resources, medical, fraud and corruption, - Miriam Kasztura, Vice-President (from June 2020) - Margaretha Maleh, President of MSF Austria information management, financial and fundraising, - Tahar Hani (until February 2020) - Ulrich Holtz, Member of MSF Germany and communication. - Meklis Nday (from May 2020) - Meklis Nday, Member of MSF Switzerland (from - Manuel Brunner (from May 2020) July 2020) - Jean-Hervé Jézéquel (from May 2020) - Miriam Kasztura, Member of MSF Switzerland - Philippe Sudre, Member of MSF Switzerland (until July 2020) Co-opted Board Members: - Andreas Wigger (until May 2020) The Board of Directors elects a General Director, - Jean-Hervé Jézéquel (until May 2020) who is responsible for executing decisions made by - Ian Wadley (from June 2020) the Board of Directors and overseeing the smooth running of daily operations at MSF Switzerland. The The Board of Directors is responsible for the overall General Director is supported by a Management management and supervision of MSF Switzerland, Team of Directors. including setting the organisation’s strategic direc- tion, action plans and annual budget. MSF Switzerland’s Directors in 2020 The Board of Directors has appointed a Finance Commission, composed of Board Members and - Liesbeth Aelbrecht, General Director (until external representatives. The Commission’s November 2020) mandate is to assist the Board of Directors to - Stephen Cornish, General Director (from supervise the financial management of MSF November 2020) Switzerland. - Ralf de Coulon, Deputy General Director - Christine Jamet, Operations Director - Monica Rull, Medical Director MSF Switzerland’s - Nicolas Joray, Finance Director - Kate Mort, Human Resources Director Finance Committee in 2020 - Jose Luis Michelena, Communication and - Karim Laouabdia, Treasurer of MSF Switzerland Fundraising Director and President of the Finance Commission - Mathieu Soupart, Logistics Director (until - Reveka Papadopoulou, President of MSF Septembre 2020) Switzerland - Stéphane Cavin, Logistics Director (from - Monika Weiszmann, Treasurer of MSF Austria September 2020) - Hans Isler, Financial Expert - Philippe Gras, Information System Director - Philippe Sudre, Member of MSF Switzerland - Manuel Brunner, Member of MSF Switzerland The General Assembly appoints an auditor to audit (from July 2020) MSF Switzerland’s annual accounts. Pricewater- - Beth Hilton-Thorp, Member of MSF Australia houseCoopers SA, Geneva, was appointed by the

36 ACTIVITY REPORT 2020 ACTIVITIES BY COUNTRY 37 MSF SWITZERLAND / OPERATIONAL CENTRE GENEVA

THE MSF CHARTER Activity Report Médecins Sans Frontières is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principles:

Médecins Sans Frontières provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. They do so irrespective of race, religion, creed or political convictions.

Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions.

Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic or religious powers.

As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them.

Rue de Lausanne 78 P.O. Box 1016 1211 Geneva 1 Switzerland Tel.: +41 22 849 84 84 Email: [email protected] www.msf.ch ccp 12-100-2

Burkina Faso, 2020 © Mack Alix Mushitsi/MSF 38 ACTIVITY REPORT 2020