EMERGENCY SWITZERLAND FOUNDATION www.emergency-japan.org EMERGENCY HONGKONG www.emergencyusa.org www.emergencyhkg.org www.emergencybe.org www.emergencyuk.org EMERGENCY BELGIUM www.emergency.ch EMERGENCY JAPAN EMERGENCY USA EMERGENCY UK
March 2015 Activity Report 1994/2014 Organization in Special Consultative Status with the Economic and Social Council since 2015. EMERGENCY is an independent organization. EMERGENCY provides free, high quality medical and surgical treatment to the victims of war, landmines and poverty. Managing Director Roberto Satolli Director Gino Strada Editor EMERGENCY promotes a culture of peace, Simonetta Gola
WITH THE ASSISTANCE OF solidarity and respect for human rights. Raffaela Baiocchi, Andrea Bellardinelli, Maurizio Cardi, Maria De Pasquale, Christian Elia, Simonetta Gola, Hawar Mustafa, Mimmo Risica, Emanuele Rossini, Cecilia Strada, Gino Strada, Manuela Valenti Photographs In order to assert the right to healthcare for everyone, EMERGENCY: EMERGENCY archive, Marco Affanni, Gianluca - provides assistance totally free of charge; Cecere, Simone Cerio, Salvatore Colloridi, Michael Duff, Massimo Grimaldi, Baudouin - guarantees treatment to anyone in need of assistance, without any sort of discrimination; Mouanda, Gianluca Panella, Mattia Velati, - practices high quality medicine and employs standardized therapeutic and working protocols already tested in emergency situations; Christopher Williams - trains local staff thoroughly until complete operational independence is achieved. Graphic design Angela Fittipaldi EMERGENCY designs, builds and manages through its international staff: - hospitals for victims of war and surgical emergencies; - rehabilitation and social reintegration centres; - first aid posts for emergency treatment; Editorial team via Gerolamo Gerolamo Vida, 11 - basic health centres for primary healthcare; 20127 Milano - paediatric and maternity centres; T +39 02 881 881 F +39 02 863 163 36 - outpatient and mobile clinics for migrants and destitute people; [email protected] www.emergency.it - centres of excellence.
Between 1994 and 2014, in the hospitals, clinics and rehabilitation centres run by EMERGENCY, over 6 million people received high quality medical care free of charge.
2 — Report 2014 Report 2014 — 3 A YEAR TOGETHER by Cecilia Strada, President
Sierra Leone, October. Momoh, aged five, Teresa contacts the social services to sort arrives at our Ebola treatment centre in something out. Goderich with his mother. She doesn't make it. She's already dead when the Central African Republic, May. Ismae ambulance reaches the gates of the is seven and has got second and third centre. Momoh is very ill: vomiting, degree burns on his feet and legs. His diarrhoea and a high temperature. Gina father tells us their village was attacked gives him fluids intravenously. Three weeks at night and all the houses were set fire are needed to get him out of danger. to. They walked fifteen days through the forest to get to the “Complexe pédiatrique” Afghanistan, July. Shamsullah, aged where the EMERGENCY doctors and nurses twelve, was going to the market with are. His father thanks Ombretta again and his father when a mine exploded and again. overturned their cart. He lost both legs. Abdul Ahad, aged ten, is on the same Iraq, April. Naby and Said are learning ward. He was shot, playing on a roof. Ivan, how to use a sewing machine. They're the ward nurse, gives them some felt tip on a vocational training course at the colouring pens and a smile. This too is Rehabilitation and Social Reintegration healthcare. Centre in Sulaimaniya, where disabled and maimed people can learn a work Sudan, June. Omer arrives at the Paediatric skill compatible with handicap. Faris and Centre with his parents. He is aged five Hawar, the directors of the centre, look on but with the weight of a two-year-old and proudly. This too, for us, is healthcare; like suffers from Tetralogy of Fallot. When he the healthcare we provide to refugees – arrives at the centre he is unconscious new civilian victims of yet another war – at and in a state of respiratory failure. He has the Arbat camp. to be resuscitated and admitted. Sofia, a cardiologist, is at the centre at the time on This year too, we have treated many, far a screening mission, selecting patients for too many, people at EMERGENCY centres operation at the Salam Centre for Cardiac throughout the world and in Italy. At every Surgery. Omer will be one of these. single patient's side there has been a doctor, a nurse and a mediator ready to Italy, May. One of the two EMERGENCY give help, a smile, a pen. And at the side of minivans is working around Bari station, each one of them there's been you, making providing primary healthcare and advice all this possible. Thank you. to the many needy people in the area. Amongst the patients waiting for us is Goran, a Kurdish boy just arrived in Italy. He acts as if he already knows us and, after a few questions, smiles and says “It really is you!”. Goran had been a patient of ours in Sulaimaniya, in Iraqi Kurdistan; we operated on him there when he was eighteen and fitted him with two leg prostheses. Now he's here, a war refugee with nowhere to sleep. Maria
Afghanistan, Kabul - Surgical Centre for war victims 4 — Report 2014 Report 2014 — 5 1994
HUMANITARIAN PROGRAMMES Missions of war surgery and obstetrics in Kigali, Ruanda
1995 CAMPAIGN AGAINST 1999 THE LANDMINES
Opening Anabah Surgical and Medical Centre, Afghanistan 1996/2005 Surgical Centre of Sulaimaniya, Iraq 1998 1999 Opening the Rehabilitation Centre in Sulaimaniya, Iraq Jovanovic Zmaj Jova Support to the orphanage in Belgrade, Serbia 1998/2005 2000 Surgical Center of Erbil, Nord Iraq Mission of war surgery in Asmara in Eritrea 1998/2012 Surgical Centre of Battambang and 5 First Aid Posts, Cambodia 2001
Opening the Surgical Centre in Kabul, Afghanistan 2002
2001 Opening the Paediatric Centre in Goderich, CAMPAIGN “A SHRED OF PEACE” Sierra Leone 2001/2002 Centre Prosthesis and Rehabilitation to Diana, Iraq 2003 2001 CAMPAIGN “CEASE FIRE” Aid program for war widows in Panjshir, Afghanistan 2003 2001 Support at Al-Kindi hospital in Baghdad and Kerbala, Iraq Opening the Surgical Centre of Goderich, Sierra Leone 2002 CAMPAIGN “ITALY OUT OF THE WAR” 2003 2003/2012 Online newspaper PeaceReporter Opening the Maternity Centre of Anabah, Afghanistan 2004 2003/2004 Centre Prosthesis and Rehabilitation in Medea, Algeria Opening the Surgical Centre of Lashkar-gah, Afghanistan 2003/2004 Centre Prosthesis and Rehabilitation in Dohuk, Nord Iraq 2004 Aid to the people of Falluja, Iraq 2003/2004 Renovation of health Centres in Benguela, Angola Mission of surgery to the public hospital in Jenin, Palestina 2004/2005 Delivery of drugs to the Casa de la mujer, Nicaragua Reconstruction of the department of emergency surgery in Al Fashir hospital in North Darfur, Sudan 2003/2007 Support for widows and destitute women of the Panjshir Valley, 2005 Afghanistan Sierra Leone, Goderich - Ebola Treatment Centre Support the hospital in Kalutara, Sri-Lanka 6 — Report 2014 Report 2014 — 7 2005 2014
2006 Opening the Paediatric Centre of Mayo, Sudan 2005/2007 MARCH Assistance to inmates Rebibbia New Complex, Rome Opening Clinic in Palermo, Italy Start of preventive medicine activities in Start of emergency surgery courses, Afghanistan 2005/2008 Port Sudan, Sudan Reconstruction of houses in the village of Punochchimunai, Sri-Lanka 2007 Opening of FAP in Urmuz (Helmand area), Afghanistan 2008 MANIFESTO FOR A HUMAN RIGHTS Opening the Salam Centre for Cardiac BASED MEDICINE APRIL Surgery in Khartoum, Sudan Start of project for the prevention of sexually transmitted diseases in sex workers, Italy 2009 2010 Opening of FAP in Tagab (Kabul area), Afghanistan
Opening the Paediatric Centre of Bangui, Central African Republic
Opening Clinic in Marghera, Italy JUNE 2011 Start of blood bank project, Central African 2010/2011 Republic Pediatric Centre in Nyala, Darfur, Sudan
Start of mobile clinics, Italy 2010 MANIFESTO “I STAY WITH EMERGENCY” JULY
Mission of war surgery in Misrata, Libya Opening of FAP in Arbat camp, Iraq, for Syrian refugees Opening of Health Centre in Khanaqin IDP camp, CAMPAIGN “IT CAN ONLY BE ABOLISHED” Iraq 2012 Opening of FAP in Andar (Kabul area), Afghanistan
Opening new First Aid Posts, Afghanistan SEPTEMBER Opening the Paediatric Centre of Port Sudan, 2012 Sudan Information desk for social and health orientation in Sassari, Italy Opening of Ebola Treatment Centre in Lakka, Opening of second health centre in Arbat camp, Sierra Leone Iraq, for Iraqi IDP 2011 MANIFESTO “THE WORLD WE WANT” Opening of FAP in Sheikhabad (Kabul area)
2013 NOVEMBER
Politruck, Italy
DECEMBER Information desk for social and health orientation in Sicily, Italy; Opening a Clinic in Polistena, Italy; Launching of 2 new mobile clinics in Italiy; Opening of FAP in Waterloo, Sierra Leone Opening of Ebola Treatment Centre in Goderich, Opening 4 new FAPs in Afghanistan; Sierra Leone Mission of war and emergency surgery in Bangui, Central African Republic.
8 — Report 2014 Report 2014 — 9 “The aim of our Centre is to provide maximum care to the patient. This is what guides us in our work every day. THE EBOLA EMERGENCY IN SIERRA LEONE Doing this it is difficult, though, when you have to look after your own safety, working with instruments that restrict your movements. Despite this, we're looking at ways of increasing the time we can dedicate to patients and, compared to other Centres, we're very satisfied with what we're achieving. In our work – and elsewhere too – the risks are many. You think about the risks, of course, but you concentrate on your work and your patients, and all the rest comes after that. Because, with quality and professionalism, Ebola can and must be cured.” Gina, coordinator of the Ebola Treatment Centre in Goderich. «In August, when the Ministry for Health in Sierra Leone asked us to open an isolation centre in Lakka for suspected Ebola cases, in just three weeks our logistics team put up a system of tents with a total of 22 beds. This soon had to be transformed into a treatment centre, because there were so many patients collapsed outside the gates, worn out by the “I got here in February, just before the outbreak. The situation came to a head in August, when the virus hit the illness and waiting for a bed. We began to organise ourselves so that we could actually treat capital where they weren't equipped to deal with it – and the international community was doing nothing. We decided to stay and help these people. We opened the Ebola Centre when the disease was spreading, and it the patients, not just isolate and observe them, and this meant ensuring reliable water and can now accommodate a hundred patients. I'm glad to be here because, knowing this country, you can only power supplies, guaranteeing safety procedures and protocols, installing air conditioning to imagine what it would have been like if we'd left.” reduce the physical fatigue of operators in very hot protective suits and, finally, starting to Leonardo, logistician. treat the ill; even though there is no specific cure for the illness, many lives can be saved with adequate support therapies. Little by little, with huge difficulties, we set up a biochemical laboratory, then a virology laboratory, then the monitors and the infusion pumps arrived, and the ventilators for intubating the more critical patients, and the dialysis machines. In “Every day, with my work, I realise how important this hospital is for my people. We examine a hundred children just three months, we were able to set up an intensive therapy unit at the level of those in a day. We're sustaining the future of Sierra Leone with free, excellent treatment. If this hospital had closed, and if specialist centres in Europe and the USA. In wealthy nations, two out of three patients are EMERGENCY hadn't decided to work with the Ebola Centres, it would have been a nightmare. In Sierra Leone you cured; in poor Africa, two out of three patients die, from lack of healthcare. can still die from the simplest of illnesses, let alone Ebola. I'm proud to be a part of this story.” Mariama, paediatrician at the Paediatric Centre in Goderich. In mid-December, we opened the new 100-bed centre in Goderich. In the 24-bed intensive care unit, the only one of its kind in West Africa, we are able to provide a level of care comparable to that available in the West. We are proud of this, because it proves that something can be done in Africa too. For us there can be no double healthcare standards: one for "them" and one for "us". Over the years, in the “I was part of the team that opened the hospital at Goderich in 2001. The local health system, unfortunately, has many hospitals we have created, we often ask ourselves "what does a hospital have to be? – got enormous problems. The Ebola outbreak made everything even more difficult. Our Surgical Centre is a point of in Iraq, in Central African Republic, in Sudan or in Afghanistan? What facilities do they reference for the whole country; how could we close? We've been involved in the lives of these people since the have to be, what equipment, what treatments?” war. That's what we'll carry on doing and we have never regretted that choice.” Luca, programme coordinator in Sierra Leone. And the answer, for us, is the simplest and most human of all: if it's an “EMERGENCY” hospital, it can only be good enough for "them" if it's good enough for us, our loved ones and everybody. Equality means this as well, sharing the same rights and being part of a common destiny». “Our work is dangerous, of course. We're well-prepared, though, and we know that when you're in the red zone – when you go in and out of it – you have to really concentrate. Sometimes it's hard, repeating the same Gino Strada, Freetown - Sierra Leone movements all the time. You really suffer from the heat in those suits and you lose a bit of your manual dexterity. We can’t let anything stop us, though: the work we do here is too important for my people, for my country.” Jakob, cleaner at the Ebola Treatment Centre. 18 January 2015
10 — Report 2014 Report 2014 — 11 Guinea
SIERRA LEONE Freetown Goderich
Golf of Guinea Liberia
The first cases were in Guinea, then Liberia, and the Ebola outbreak finally hit 01 03 05 Sierra Leone in May 2014. To respond to this new crisis, EMERGENCY already had its Paediatric and Surgical Centre in Goderich – the traumatology centre of reference for West Africa for many years – reorganised and ready by more or less the beginning of the year. All staff were specifically trained in new procedures for containing the spread of the disease and preventing infection. The hospital was completely reorganised: a new triage area was set up to limit contact between waiting patients and prevent suspected Ebola cases from entering the hospital; patients with possible Ebola symptoms were isolated in two separate tents while waiting for laboratory results to confirm the diagnosis; visits from family members were stopped and new procedures were implemented to 02 04 06 monitor the health conditions of all staff. This was all done to prevent Ebola entering protection systems and often didn't even first centre on 18 September in Lakka, a – equipped to the standard of hospitals in crammed into overcrowded, makeshift left to itself: malaria, typhoid, infections the confines of the hospital. have adequate protective materials, so a short way from the capital. This gave us 12 western nations, with ventilators, dialysis shelters. and surgical emergencies continued to This was a considerable undertaking, since large number of the personnel in public isolation beds and 10 care beds, 22 in all. machines, infusion pumps and monitors, The camp, like many other parts of the be daily problems that could no longer the most of the 100 children arriving every hospitals fell ill. The main purpose of the centres set up at allowing us to provide patients with the capital, had no healthcare facilities be dealt with by public health facilities. morning at the clinic had symptoms very that time was to isolate infected patients. best possible care. At the Centre, we set capable of providing a quick response to The Ebola emergency further exacerbated similar to Ebola: nausea, diarrhoea and The Ebola treatment centres EMERGENCY decided to take the further up a polymerase chain reaction (PCR) suspected infection cases. the endemic lack of doctors and nurses high temperature. As soon as we started diagnosing the first necessary step – despite doubts about test laboratory, working together with We had four nurses working at Waterloo that has so hindered the development Meanwhile, the disease, initially only in cases of Ebola in the patients in isolation its achievability amongst those working the “Lazzaro Spallanzani” italian National doing triage for suspected cases and of the health system in this country. The northern districts, spread to the rest of the in our hospital, we came up against the to contain the epidemic – of curing the Institute of Infectious Diseases to test transferring them to the Treatment Centre if Ebola virus cost Sierra Leonean healthcare country. By mid- September 1,600 Sierra total inadequacy of Sierra Leone's health patients. patient blood samples as positive or necessary. To stop the spread of the virus, workers dearly. Leoneans were ill, 100 of these in the system. We tried many times to find beds With the virus spreading rapidly at the rate negative for the Ebola virus. The laboratory we involved the entire community. We capital, Freetown. to transfer the patients to for treatment, of 100 new illnesses every day, the Lakka has made it possible to reduce the time trained 90 healthcare operators to identify EBOLA The overcrowding in the city's shanty but the few, poorly equipped available Centre beds were always full, so we began TREATMENT lost between testing and diagnosis, thus the people in the camp that had come into towns and the terrible hygienic conditions facilities were unable to cope with the planning a 100-bed Ebola treatment centre. CENTRES CO- ensuring speedier treatment for patients. contact with Ebola patients and monitor multiplied the number of cases. outbreak. The Goderich Centre, constructed in FUNDED BY them daily. Our Paediatric and Surgical More than 20 people a day were Faced with an emergency that was just 6 weeks and funded by the British First aid post at Waterloo camp Centre worked ceaselessly throughout contracting a virus that is potentially fatal becoming more and more evident each Government's Department for International As well as treating patients, we've also the Ebola emergency. While hospitals in up to 90% of cases in the absence of day, in response to requests from the Development (DFID), was opened on 13 been working to prevent the spread of the everywhere were closing due to lack of 01 training in the use of protective suits adequate healthcare facilities. Sierra Leone Ministry of Health and from December. infection. doctors and nurses, the EMERGENCY centre 02 the Goderich 100-bed centre Sierra Leone, just 13 years after a civil the President, we started work on a new In just a few weeks, we set up an Ebola To do this, at the beginning of December was the only surgical and paediatric 03-05 the intensive care unit in the Ebola Treatment Centre, Goderich war, was totally unprepared for the project: an Ebola treatment centre. intensive care unit – the only one of its we opened a First aid post in Waterloo, a centre in the entire country to remain open. 04 training volunteers at Waterloo epidemic. Local staff had no knowledge of In a race against time, we opened our kind in the countries hit by the epidemic refugee camp where 22,000 people are For many months, the population was 06 inside the Ebola Treatment Centre, Goderich
12 — Report 2014 Report 2014 — 13 THE IRAQI EMERGENCY
Turkey
Sulaimaniya Arbat Syria Khanaqin Iran IRAQ Bagdad Jordan
Saudi Arabia Kuwait
In Northern Iraq, hundreds of thousands of refugees from Syria and displaced persons from Iraq are seeking shelter from the fighting and bloodshed affecting the entire region. Fleeing either the conflict in Syria or 01 03 the advance of Daesh (Isis) in Iraq, they ARBAT REFUGEE CAMP PROJECT STAFF AT abandon their homes to face hard, often CO‑FUNDED BY WORK: dangerous journeys. ARBAT INTERNALLY Tens of thousands of people continue DISPLACED to flee the war, seeking help. While the PERSONS CAMP luckier ones are able to stay with friends 12 and relatives or rent houses and rooms in ARBAT REFUGEE safe areas, the rest are housed in hurriedly CAMP erected camps organised by the Kurdish 46 authorities and international organisations. KHANAQIN CAMP Living conditions are difficult: the tents 20 ARBAT INTERNALLY DISPLACED PERSONS aren't always sufficient, water and power CAMP PROJECT AND KHANAQIN CAMP supplies are intermittent and the weather PROJECT CO-FUNDED BY – scorching hot in the summer, below-zero temperatures and snow in the winter – makes life even harder for the refugees.
To deal with this humanitarian emergency, in July 2014 we began to intensify our ARBAT INTERNALLY DISPLACED PERSONS presence in Iraq, opening three clinics CAMP PROJECT CO-FUNDED BY to provide free treatment to refugees and internally displaced persons in the Arbat and Khanaqin camps. From July to December, EMERGENCY doctors treated over 14 thousand people. Many of these were children, actually born 02 04 in the camps. The clinics also provide gynaecological and obstetrics care for The illnesses we encounter are a respiratory infections. their professional skills back into use, work another two clinics in the Kalar area, for the 01 arbat Camp for displaced Iraqis women and vaccinations and growth consequence of the living conditions Local doctors and nurses, often refugees alongside the international staff. people in the Qoratu and Tazade camps. 02 arbat Camp for Syrian refugees checks for children. in the camp: gastrointestinal, skin and themselves recruited by EMERGENCY to put At the end of 2014, we started building 03-04 inside the Arbat clinic
14 — Report 2014 Report 2014 — 15 Uzbekistan Tagikistan WAR SURGERY Turkmenistan Kabul AFGHANISTAN
Iran Pakistan Gino Strada Surgeon and founder of EMERGENCY Kabul More than twenty-five years have gone Surgical Centre for since I first went to Quetta, in south-west war victims Pakistan, not far from the Afghan border. As a surgeon, I was familiar with some of the best surgical centres in Europe and OPENED: April 2001 North America. I went to Quetta hospital out of curiosity. I wanted to see with my ACTIVITIES: Surgical Centre for war and own eyes what it would be like doing my landmine victims. job in a poor country – mere professional interest. Little did I know that it was FACILITIES: Emergency department, there where I was to first experience war. outpatient department, 2 operating Little did I know that, from then on, I'd be theatres, sterilization, intensive care working all too often amidst war and its unit, sub-intensive care unit, surgical horrors, or that all this would lead to the wards, physiotherapy, CT scan, radiology, foundation of EMERGENCY. laboratory and blood bank, pharmacy, For months, in Quetta, I operated classrooms, playroom, auxiliary on patients hit by bullets and bomb facilities, maintenance department. fragments, torn to pieces by landmines. For months, I had neither the time nor NUMBER OF BEDS: 95 the capacity to think. I was overwhelmed and stunned by work. I was familiar with in these years, and operated on many of work in later years, weren't an exception LOCAL STAFF: 293 emergency surgery, but I had never seen them. - they were just the tragic normality of such terrible wounds and devastating After my first war hospital experience, I today's conflicts. AS OF 31 DECEMBER 2014: injuries as these. Not only the sight but the started asking myself a lot of questions. This bitter awareness of the “disasters of Admissions: 32,997 smell of those sometimes unrecognisable And the most important question of these war”, and the realisation of the possibility Outpatient consultations: 94,771 human beings still comes to mind. Now, was: who are the casualties in present-day to bring help to suffering humans, led to Surgical operations: 43,229 On 28 December 2014, NATO’s mission in Afghanistan officially ended. more than 20 years later, I still feel the wars? In the First World War civilian deaths the idea of EMERGENCY. It wasn't founded After 13 years of war, with more than 130 thousand foreign troops in the country and 4.2 billion dollars spent on same physical malaise and sickness and injuries accounted for just over 10% on a set of principles or statements, but the Afghan security forces, the situation had worsened drastically, especially for civilians. when I see the effect that war has on the of the total number, a slaughter that took on a realisation and on the consequential We arrived in Kabul six months before the offensive of the international coalition, in 2001, to open a Surgical bodies of human beings: limbs torn to place mainly on battlefields – perhaps for behaviour that emerges as an immediate, TRIAGE COURSES FOR NURSES AND Centre for victims of the war then raging between the Taliban and the Mujahideen. shreds, ruptured intestines and arteries the last time. In subsequent conflicts, the obvious need. I'd say that the idea of EMERGENCY SURGERY AND TRAUMA In just a few months, we had transformed a former nursery school into a hospital specialised in war surgery. to stitch together again. These were the enemy was of a different kind; villages EMERGENCY was born on the operating MANAGEMENT COURSES CO-FUNDED BY In subsequent years, the centre was enlarged with the addition of an intensive care unit, the acquisition of things I was having to deal with, month replaced the “front line” and people's tables and in the wards. And so we began monitors and respirators and the installation of a CT scan unit – to this day, the only free one in the entire after month, in the work we know as “war homes replaced trenches. It was no longer treating the victims of the 1994 genocide country. Thanks to the new equipment and the experience of our surgeons, the hospital had become the surgery”. And often – quite surprisingly, a question of striking at English or German in Rwanda. And we carried on doing it, traumatology centre of reference for the whole of the country. Owing to the worsening safety conditions and the given the context – this work proved itself enemy soldiers, but rather of razing cities sending specialised teams around the increasing numbers of patients, however, from July 2010 admission criteria had to be limited to war surgery only. capable of resolving the most difficult, like Coventry and Dresden to the ground. world and building surgical centres for war Over the last few years, fighting and attacks have become daily occurrences, even in and around the capital. To dramatic situations and being of real use Two out of three victims in the Second victims in Afghanistan, Iraq, Cambodia, improve care for the increasing numbers of war victims, we began enlarging the hospital in 2014, building a new KABUL HOSPITAL to the wounded. World War were civilians. The nature of war Sierra Leone, Libya and the Central African CO-FUNDED BY operating unit and reorganising the intensive and sub-intensive care units. That year, I had my first experience of had changed, perhaps for ever. Republic. Our international staff have always been committed to training local staff, and the Kabul hospital has been landmines. Children brought into the And the non-fighting victims (1 out of 10 Because treating the wounded isn't officially recognised by the Afghan Public Health Ministry as a centre for emergency surgery and traumatology hospital with a rag to stop the blood, after at the beginning of the 20th century) had generous or charitable - it's simply right. training. Also, on request of the World Health Organisation, in 2014 we ran a triage course for 45 Afghan nurses their hands had been blown off. Children become 9 out of 10 by the start of the new and an emergency surgery and trauma management course for 131 Afghan surgeons, selected from 32 of the losing both arms, children blinded by a millennium. For every three victims, one country's provinces by the Ministry. mine exploding in their face. I have seen is a child. The slaughterhouse of Quetta, hundreds of child victims of landmines and the other war hospitals where I was to
16 — Report 2014 Report 2014 — 17 Uzbekistan Cina Uzbekistan China Tagikistan Tagikistan Turkmenistan Turkmenistan
Anabah
Kabul Kabul AFGHANISTAN AFGHANISTAN
Lashkar-gah Lashkar-gah Iran Pakistan Iran Pakistan
Lashkar-gah Afghanistan Surgical Centre for First Aid Posts and war victims Health Centres
OPENED: September 2004 LOCATIONS: Anabah, Abdara, Ahangaran, Dara, Darband, Dasht-e-Rewat, Khinch, ACTIVITIES: Surgery for war and landmine Paryan, Gulbahar, Kapisa, Koklamy, Oraty, victims. Changaram, Anjuman, Sangi Khan, Shutul, Said Khil, Poli Sayad, Mirbachakot, FACILITIES: Emergency department, Maydan Shahr, Ghazni, Chark, Gardez, outpatient department, 2 operating Pul-I-Alam, Grishk, Sangin, Garmsir, theatres, sterilisation, intensive care Musa Qala, Marjia, Urmuz, Tagab, Andar, unit, surgical wards, physiotherapy, Sheikhabad. radiology, laboratory and blood bank, pharmacy, classrooms, playroom, EMERGENCY also provides healthcare auxiliary facilities, maintenance services for the boys' and girls' department. orphanages in Kabul.
NUMBER OF BEDS: 90 AS OF 31 DECEMBER 2014: LOCAL STAFF: 227 Outpatient consultations: 3,012,241 Patients refderred to hospital: 56,865 AS OF 31 DECEMBER 2014: LOCAL STAFF: 280 Admissions: 23,414 Outpatient consultations: 98,476 Surgical operations: 29,902 In 2004, EMERGENCY opened a hospital in Lashkar-gah, chief town of Helmand province, to offer treatment to the FIRST AID POSTS AND HEALTHCARE CENTRES people of a huge area where – in the face of violent fighting – there were no free healthcare facilities or facilities Healthcare for prisoners Accessing medical care is very difficult for Afghan people: free medical facilities are few and far between and the specialised in treating war victims. terrain makes it hard to travel. In 10 years, Helmand has become one the most dangerous provinces in the country: kamikaze attacks, bombing Duab prison: 694 patients examined and This is why EMERGENCY has built up a widespread network of healthcare facilities around the country, offering by the international forces and landmines have caused thousands of victims, especially amongst the civilians. treated from 2001 to 2003 treatment for the people of the most remote villages, with an ambulance service for transferring those needing War surgery and orthopaedic and trauma surgery (for patients up to the age of 14) were the two main admission surgery into hospital. Shebergan prison: 13,338 patients LASHKAR-GAH HOSPITAL criteria but, because of the increase in the number of wounded, since June 2013 those criteria have been limited Because of the worsening safety conditions, we extended the network of First Aid Posts in 2014 with the opening CO-FUNDED BY to war surgery alone. examined and treated from May 2002 to of 4 new facilities: at Urmuz, in the Lashkar-gah area, and at Sheikhabad, Andar and Tagab, in the Kabul area. And the situation got even worse in 2014: from 2013 to 2014, our records show a 13% increase in the number of June 2004 On 11 August, an EMERGENCY ambulance on its way to our First Aid Post in Tagab, where some of the wounded patients admitted with war wounds. had been taken after violent clashes, became caught up in the fighting. Our ambulance driver, Hamza Khan, was To cope with this situation, in July 2014 we transformed the pharmacy into an orthopaedic ward. Lashkar-gah prison: 1,880 patients killed trying to evacuate injured people to Kabul hospital. examined and treated from February Because of deteriorating safety conditions, in recent years we have opened 5 new First Aid Posts in villages close 2006 to December 2007 HEALTHCARE FOR PRISONERS to the main town in order to guarantee immediate aid for the wounded and quick, safe transport into hospital EMERGENCY provides healthcare to the inmates of Kabul's main prisons. Since 2003, we have opened 5 Health when necessary. Prisons in Kabul (Governmental Jail, Centres in 5 of the blocks in Pol i Charki, Afghanistan's largest prison, with 9,000 detainees. Here, each month, The Lashkar-gah Surgical Centre is linked 24/7 with an ambulance service at EMERGENCY’s First Aid Posts in the Investigation Department, Pol i Charki, our doctors attend to 5,000 inmates, treating mainly infectious diseases and respiratory and digestive tract villages of Grishk, Sangin, Garmsir, Marjia, Musa Qala and Urmuz (opened March 2014). Lashkar-gah hospital Juvenile Rehabilitation Centre, Female complaints, caused by the terrible living conditions inside the prison. has been officially recognised by the Afghan Public Health Ministry as a centre for emergency surgery and Jail): 84,868 patients examined and Our staff also run health centres in the government prison, the investigative prison, the female prison and Kabul's traumatology training: 4 Afghan surgeons are currently completing their training programmes. treated as of 31 December 2014 Juvenile Rehabilitation Centre. LOCAL STAFF: 22
18 — Report 2014 Report 2014 — 19 Uzbekistan China Tagikistan EMERGENCY SURGERY Turkmenistan Anabah
Kabul AFGHANISTAN
Iran Pakistan
Anabah, Panjshir Valley Medical-Surgical centre
OPENED: December 1999
ACTIVITIES: Surgery for war and landmine victims, emergency surgery, general surgery, traumatology, internal medicine, paediatrics.
FACILITIES: Emergency department, outpatient department, 2 operating theatres, sterilisation, intensive care unit, surgical-medical wards, physiotherapy, radiology, laboratory Access to basic surgical assistance is In past years, EMERGENCY has made and blood bank, pharmacy, classrooms, recognised as a fundamental element of free, high-quality surgery available to playroom, auxiliary facilities, primary healthcare. anyone who needed it, without making maintenance department. Maurizio Cardi In fact, surgery is essential in various any distinction based on gender, ethnic Surgeon NUMBER OF BEDS: 56 situations such as caesarean sections, group, or political and religious beliefs - to amputations due to gangrene, and inguinal the benefit of tens of thousands of people LOCAL STAFF: 230 hernia repair, but above all in the case of in Rwanda, Iraq, Cambodia, Afghanistan, EMERGENCY was founded in 1994 to offer traumatic injuries. Sierra Leone, Libya, Eritrea and the Central AS OF 31 DECEMBER 2014: free medical and surgical treatment to the African Republic. Admissions: 27,416 When we arrived in the Panjshir Valley in 1999, we turned a former barracks in Anabah into a surgical centre victims of war and landmines. According to the World Health Outpatient consultations: 199,191 providing free treatment for the victims of war and landmines. Organisation, traumatic injuries lead to 95% of the staff in our hospitals is Surgical operations: 22,338 Landmines had been strewn across the valley at the time of the Russian offensive, but continued to claim victims We began in Rwanda, providing treatment around 5 million deaths per year in the made up of local people - only 5% are twenty years later, and there were no free healthcare facilities anywhere in the valley. for the victims of one of the most developing countries. They're a neglected international personnel. Even now, fifteen years after our arrival, the EMERGENCY hospital is still the only point of reference for about terrible wars of the African continent. We epidemic and yet they cause a number The international staff has always been 250,000 people. continued in Iraq and Cambodia, where of deaths comparable with those caused involved in the training of local staff too, landmines were a constant threat, then in by HIV, malaria and tuberculosis all put in countries where training programmes Over the years, the surgical centre has become a general hospital, extending its work to cover emergency Afghanistan and Sierra Leone. And as the together. don't include an appropriate level of surgery, general surgery, traumatology, internal medicine and paediatrics. contexts gradually changed, the needs In the eastern Mediterranean region (from specialisation. In 2014, at the Anabah hospital, a team of international eye specialists provided specialist treatment for the and requests of the people changed too: northern Africa and stretching as far as valley's population. when a slight reduction in the number of Afghanistan), the first cause of traumatic Sometimes, this work gets official war victims allowed it, we widened our injuries is war (31%), followed by road recognition: our hospitals in Kabul and The hospital is the hub of a network of First Aid Posts and health centres in 18 of the most isolated villages of the admission criteria to include traumatology, accidents and common violence. Lashkar-gah, in Afghanistan, have been valley and in the provinces of Kapisa, Parwan, Badakhshan and the Salang Pass. we began emergency surgery, and we In that area, the expected increase in formally recognised by the Afghan Public At these facilities, local staff, supervised by our international colleagues, provide basic healthcare and first aid organised ophthalmological surgery and traumatic injuries between 1990 and 2020 Health Ministry as training centres for to those in need. EMERGENCY ambulances work around the clock transporting patients requiring admission into reconstructive plastic surgery mission. is 108%, far higher than the impact of emergency surgery and traumatology hospital. In developing nations, and generally in cardiovascular illnesses, tumours and HIV. and the WHO recently commissioned us those countries where technology is a to organise a trauma surgery course for rarity, surgical treatment is hardly ever free Afghan surgeons. or of good quality.
20 — Report 2014 Report 2014 — 21 Guinea Sudan Chad Nigeria
SIERRA LEONE Freetown South Sudan Goderich CENTRAL AFRICAN REPUBLIC Cameroon Bangui
Golf of Guinea Democratic Republic Liberia of Congo Congo Uganda
Goderich Bangui Surgical Centre Complexe Pédiatrique OPENED: November 2001 OPENED: April 2013 ACTIVITIES: General and emergency surgery, orthopaedic and reconstructive ACTIVITIES: War and emergency surgery, traumatology. surgery.
FACILITIES: Emergency department, FACILITIES: 2 operating theatres, outpatient department, 3 operating sterilisation, ward, sub-intensive care theatres, sterilisation, intensive unit, radiology, outpatient departments, care unit, surgical-medical wards, pharmacy, laundry. physiotherapy, radiology, laboratory and blood bank, pharmacy, classrooms, NUMBER OF BEDS: 28 playroom, auxiliary facilities, maintenance department, guest house. LOCAL STAFF: 49
NUMBER OF BEDS: 85 AS OF 31 DECEMBER 2014: LOCAL STAFF: 239 Admissions: 1,888 Outpatient consultations: 10,155 AS OF 31 DECEMBER 2014: Surgical operations: 3,198 Admissions: 30,207 Outpatient consultations: 258,587 Surgical operations: 34,565 2014 was a terrible year for Sierra Leone. The war in the Central African Republic began in 2012 and has not yet ended. The outbreak of Ebola in May brought the country's already precarious health system to its knees. By the time The critical stage is over, but the situation in the country is still highly unstable: the war between the opposing Ebola reached the capital, Freetown, our Surgical Centre was the only fully operative hospital remaining in the Seleka and Anti-Balaka factions has resulted in thousands of deaths and millions of displaced persons. The city. situation in the capital, where international troops are stationed, is more under control, but shootings and Private hospitals were not able to handle the emergency; nor were they legally required to stay open. The widespread crime have kept tensions running high. operating theatres at the Connaught Hospital, the main public hospital, were closed due to a lack of doctors Immediately after the coup d'état in March 2013, and at the request of the director of the paediatric hospital, we and nursing staff, frightened by the spread of the disease and of contracting the virus. In Sierra Leone, many sent a specialised war surgery team to the country to care for wounded children. In just a few days, our team healthcare operators - more than in the other two countries involved - were infected by the virus: of the 143 got the operating theatres of the city's paediatric hospital, the Complexe pédiatrique, up and running again, reported as having contracted the disease by 31 December, 110 did not survive. collaborating closely with local staff.
Since opening in 2001, EMERGENCY's Surgical Centre has become the point of reference for surgery and In 2014, we renovated both the surgical unit and the wards. traumatology throughout the country. With security conditions improving, war surgery operations have become less frequent, with more emergency Even at the height of the epidemic, our hospital was the only facility left for people requiring treatment for surgery. Our operating theatres are still the point of reference for paediatric surgery for the entire country. accidents and surgical emergencies occurring on a daily basis. Following a request by the World Health Organisation, in 2014 we worked to reopen the local blood bank, which To increase hospital capacity at this time, the accommodation block built for the mothers of inpatient children had been badly affected by the war. and sheltered discharge patients, was transformed into a ward, but there were still too few beds to cope with the Two EMERGENCY laboratory technicians taught local staff how to use the new machines and reorganised blood huge demand. donation campaigns and distribution methods. Blood is now available again at all hospitals, with improved quality and safety guarantees.
22 — Report 2014 Report 2014 — 23 Turkey
Sulaimaniya PHYSIOTHERAPY AND REHABILITATION Arbat Syria Khanaqin Iran IRAQ Bagdad Jordan
Saudi Arabia Kuwait
Sulaimaniya Rehabilitation and Social Reintegration Centre
OPENED: February 1998
ACTIVITIES: Prostheses and orthoses production, physical rehabilitation, vocational training for the disabled, setting up of workers' cooperatives.
FACILITIES: Physiotherapy, indoor pool, orthopaedic workshops, vocational training workshops, technical and auxiliary services.
NUMBER OF BEDS: 41
LOCAL STAFF: 74
AS OF 31 DECEMBER 2014: Patients treated: 8,058 Physiotherapy, the application of artificial Former patients can attend training Physiotherapy sessions: 44,993 Hawar Mustafa limbs, and rehabilitation are essential courses in tailoring, carpentry, Upper limb prostheses: 930 Director of the elements in the assistance for war victims, leatherwork, woodwork… and, once they Lower limb prostheses: 7,035 We arrived in Iraqi Kurdistan in 1995 to treat victims of both the war and – above all – the landmines that had Sulaimaniya but then social reintegration is the next get their diploma, they also receive help Orthoses: 903 been laid throughout the area. Rehabilitation Centre major step. from EMERGENCY to open cooperatives or Trainees graduated: 510 We built two war surgery centres, in Sulaimaniya and Erbil, followed by two burns units, a spinal unit and 22 First artisan workshops. Cooperatives set up: 320 Aid Posts for victims with no other possibilities for receiving free, high quality medical treatment. And it was precisely in a highly mined Cardiological examinations: 385 We soon realised though that, in many cases, treatment was still needed after patients were discharged. Often, Looking after the survivors, especially country like Iraq that EMERGENCY Economic independence is a fundamental when discharged, amputees found themselves alone, having to cope with their disability in a poor, war stricken if they're disabled, is one of the biggest opened its first Rehabilitation Centre, in part of the reintegration of victims in their country. difficulties that a country at war has to Sulaimaniya. Thanks to that experience, it communities. face. went on to build, equip open another one For non-medical roles, EMERGENCY's To help them, we opened a Rehabilitation and Social Reintegration Centre in 1998. Here, patients receive Landmines were often used – and still two others centres in Diana and Dohuk, recruitment policy at all its hospitals gives physiotherapy and have their artificial limbs fitted; they can also attend professional training courses in metal are, in many conflicts – to compromise a then another one in Medea, in Algeria. priority to the most vulnerable members structural work, woodwork, tailoring, leatherwork and shoe-making – a chance to learn a job that is compatible country's chances of recovery: an impaired The Centres of Diana, Dohuk and Medea of the population, like widows and the with their handicap. population that's not self-sufficient and are now run by the Iraqi and Algerian disabled. At the end of the courses, they are given financial aid to set up artisan workshops or workers' cooperatives. We needs economic and health support is an health authorities, while the one in At Sulaimaniya, for example, over half the have contributed to the setting up of more than 300 workshops. extremely heavy weight for a country just Sulaimaniya is still managed directly by workers are former patients. emerging from a war. EMERGENCY. The Rehabilitation and Social Reintegration Centre is still run directly by EMERGENCY, while the hospitals and First Apart from his physical and psychological Aid Posts have been managed by the local authorities since 2005. disability, in many cases the casualty is As well as physical rehabilitation, the completely unable to look after himself Sulaimaniya centre provides another type and his family, with the risk of being of help that's equally important in terms of marginalised within his community. social reintegration.
24 — Report 2014 Report 2014 — 25 Uzbekistan China Tagikistan GYNAECOLOGY AND OBSTETRICS Turkmenistan Anabah
Kabul AFGHANISTAN
Iran Pakistan
Anabah, Panjshir Valley Maternity Centre
OPENED: June 2003
ACTIVITIES: Obstetrics, gynaecology, neonatology.
FACILITIES: Emergency department, outpatient department, operating theatre, intensive care unit, wards, nursery, ultrasound room, delivery room, A recent health survey** on the Afghan The hospital provides a first aid service diagnostics, technical and auxiliary population fully confirms the existence and antenatal care both within its walls services shared with the Medical- of these conditions in Afghanistan: and in the surrounding area, with the Surgical Centre. Raffaela Baiocchi each woman has an average of 5 support of a series of First Aid Posts linked NUMBER OF BEDS: 39 Gynaecologist pregnancies (figure scaled down to by an ambulance service. allow for the fact that the survey was And it does this free of charge, thereby LOCAL STAFF: 60 unable to gather data in the south of guaranteeing universal access to At international level, complications during the country for safety reasons); only treatment. Free health and transport AS OF 31 DECEMBER 2014: pregnancy and childbirth are the second 16% have at least 4 antenatal check-ups are the cornerstones of an accessible Admissions: 38,264 cause of death for women of child-bearing (the minimum established by the World healthcare system, able to give 50% of Outpatient consultations: 28,643 age (15-49): in 2010, 289,000 women Health Organisation***); only 1 woman female population the chance to give birth Surgical operations: 7,399 died and 99% of those deaths occurred in in 3 is assisted during birth by qualified safely. Babies born: 26,892 developing countries*. operators; only 1 woman in 3 gives birth Another strong point of this model is the The midwives and gynaecologists at the Anabah Maternity Centre help more than 10 women a day to give in a medical facility. Most women give training of local personnel: international birth – a result not to be taken for granted. The project has come up against many difficulties since it began in There are many reasons for these figures: birth at home, assisted by either friends, staff, working on the front line, train local 2003, mainly because of the traditional culture. It was only after extensive work in the area involving the local illnesses occurring during pregnancy or relatives or "traditional" helpers with no doctors, midwives and nurses by setting communities that it was possible to develop the activities at the Centre, which, 11 years after opening, is still the existing beforehand, often not recognised professional training. According to the up care protocols and giving on-the-job only specialist facility offering free treatment in an area with a population of about 250,000. or not treated due to the logistic, economic survey, 50% of the Afghan women who training and theory lessons. or social difficulties most of the population choose not to give birth in healthcare The training also conveys our “vision” of Our Maternity Centre offers antenatal care, gynaecology, obstetrics and neonatal services to women in the have in getting treatment (when they centres do this either because they have healthcare, based on the centrality of the Panjshir Valley and provinces of Kapisa and Parwan; once a month, staff at the Centre head out to our Health are recognised as being entitled); the no money or because the centre is too far patient, the universal right to treatment Centres in the valley to monitor pregnant women and make sure there are no patients at risk. If necessary, the greater number of pregnancies in a away or there is no transport. and the undertaking to provide the highest women are transferred to the Maternity Centre where they're kept under observation or hospitalised. woman's lifetime, often close together, The Maternity Centre opened by possible quality standards. putting her at risk of complications (foetal EMERGENCY in Anabah, Afghanistan, Out of respect for Afghan culture, only female staff work at the Centre. The midwives and gynaecologists are malpositions, placenta previa and post- in 2003, is a hospital that provides trained by international staff, to give them greater expertise and autonomy. partum haemorrhaging); management of assistance to mothers and newborn The training is officially recognised by the Ministry of Health. The Maternity Centre now runs a four-year the pregnancy and birth at a domestic babies in line with CemonC specialisation course for gynaecologists and, thanks to an agreement made several years ago with the nursing event, for cultural reasons and because of (Comprehensive Emergency Obstetric and school in Kapisa, the Centre has been recognised as a training centre for midwives. the difficulty of finding a midwife with a Neonatal Care standards: the “complete” Specialist care, training, work and emancipation: these are the results of the Centre's 11 years of work in the area. minimum level of qualification. assistance model, according to the WHO). *: World Health Organization, Saving Mothers’ lives, 2013; **: Afghanistan Mortality Survey 2010, USAID et al; ***: “Women’s health” Fact sheet n° 334 - WHO Update Sept 2013; World Health statistics 2013 - WHO
26 — Report 2014 Report 2014 — 27 PAEDRIATRICS Guinea SIERRA LEONE Freetown Goderich
Golf of Guinea Liberia
Goderich Paediatric Centre
OPENED: April 2002
ACTIVITIES: Paediatrics, paediatric first aid.
FACILITIES: 2 outpatient departments, ward, waiting area, technical and auxiliary services shared with the Surgical Centre.
NUMBER OF BEDS: 14
LOCAL STAFF: 33
AS OF 31 DECEMBER 2014: EMERGENCY opened its first Paediatric resource for many thousands of people. Admissions: 14,969 Centre in Goderich, in Sierra Leone, in In 2005, in Sudan, EMERGENCY opened Outpatient consultations: 204,735 Manuela Valenti 2002. The Ebola epidemic that broke a Paediatric Centre in the Mayo refugee Paediatrician out in 2014 further involved the Centre's camp, providing first aid and primary locally recruited and international staff, healthcare free of charge. The Centre has a who normally examine more than 130 6-bed unit for short-term observation and children a day. The main reasons for an ambulance to transfer urgent cases to More than 90% of the victims of modern hospitalisation are malnutrition, airway hospital. A second centre that was opened According to the World Health Organisation, in Sierra Leone 21% of children below the age of 5 are underweight conflicts are civilians, and one out of infections, typhoid fever and malaria in 2010 in Nyala, Darfur, was closed due and, of 1000 babies born alive, 185 won’t reach their 5th birthday. three of these is a child. War means (often with severe complications such to serious safety problems. A third centre Since 2010, children under the age of 5 and pregnant or breast-feeding women have had the right to free much more than deaths and injuries as convulsions, septicaemia and serious was opened in 2011 in Port Sudan in the healthcare. In reality however, the precarious nature of the health system means that few people can really take on the battlefield. For years to come, it anaemia). In 2003 EMERGENCY opened a Red Sea State for the treatment of children advantage of this right. also means a devastated social fabric, Maternity Centre at Anabah, in Northern under 14 and the provision of healthcare, This very serious healthcare situation got dramatically worse with the spread of the Ebola virus last May. poverty, a destroyed education system, Afghanistan, the only centre in the area – hygiene and education services. In 2009, a lack of resources for ensuring people’s which has a population of about 250,000 a Paediatric Centre was opened in Bangui, By 31 December more than 1,600 children had contracted Ebola – but the virus also had its indirect victims. fundamental rights – including the right – specialising in obstetrics, gynaecology the capital of the Central African Republic, Hundreds of children no longer had access to treatment. Hospitals remained closed for months because health to healthcare. That's why our commitment and neonatology. The neonatal intensive where malaria and typhoid fever mortality workers, afraid of contracting the virus, were refusing to work. to war victims continues long after the care ward guarantees assistance for rates are still very high. Freetown's public paediatric hospital, the Ola During Children's Hospital, was closed for more than two months. end of the fightings, to offer medical and premature babies or those suffering from EMERGENCY's Paediatric Centres are part The children, mostly affected by malaria, gastrointestinal infections and airway infections – the leading causes of surgical assistance in countries where infections, respiratory distress or jaundice. of its regional cardiac surgery programme death in Sierra Leone – could get treatment only at our Paediatric Centre in Goderich, the only healthcare facility the chances of receiving good, free There is also a 12-bed paediatric ward. In - a network of facilities where international to remain open and fully operational in the capital even at the height of the epidemic. treatment are few. Amongst the first to Afghanistan, EMERGENCY guarantees first cardiologists single out heart patients pay the price of the conflicts, there are aid and basic treatment for children via its (both children and adults) to be operated To cope with the emergency in these months, the hospital accommodation block was converted into a ward to the children: malnutrition, often due to network of health centres located in small on at the Salam Centre in Khartoum, and obtain more beds for the patients. extreme poverty, and endemic diseases isolated villages and on mountain passes carry out all necessary post-op check-ups. like malaria, typhoid, infection of the – areas still strewn with unexploded airways and dehydration are the main landmines. The locally recruited nurses threats to survival under the age of 5. in these centres are the only healthcare
28 — Report 2014 Report 2014 — 29 China Uzbekistan Egypt Tagikistan Libya Turkmenistan
Khartoum Anabah Chad Mayo Eritrea DARFURR Kabul SUDAN AFGHANISTAN Ethiopia South Sudan Central African Republic Iran Pakistan Uganda Democratic Kenya Repubblic of Congo
Anabah Mayo, Khartoum Paediatric Department Paediatric Centre
OPENED: December 2003 OPENED: December 2005
ACTIVITIES: Paediatrics ACTIVITIES: Paediatrics, preventive medicine, antenatal care. FACILITIES: Outpatient department, patient observation ward. FACILITIES: 2 outpatient departments, NUMBER OF BEDS: 12 patient observation ward, pharmacy, laboratory, auxiliary and technical LOCAL STAFF: 14 services, reception area and outdoor play area. AS OF 31 DECEMBER 2014: NUMBER OF BEDS: 6 (day hospital) Admissions: 8,035 Outpatient consultations: 58,595 LOCAL STAFF: 35
AS OF 31 DECEMBER 2014: Admissions (day hospital): 13,348 Outpatient consultations: 169,956 Patients referred to hospital: 8,067 Beneficiaries of integrated outreach activities: 32,441 In 2003, EMERGENCY opened a Paediatric Department in the hospital of Anabah to provide free treatment to Antenatal care consultations: 7,841 The Mayo refugee camp, on the outskirts of Khartoum, was opened twenty years ago for refugees of the war children from the Panjshir Valley and surrounding provinces. between Sudan and South Sudan. Over the years, with the arrival of refugees from Darfur, the camp has expanded Children either come directly to the Outpatient Department or are sent to the hospital from one of EMERGENCY’s and is now home to 400,000 people who live in conditions of basic survival. Health Centres dotted around the area, which act as a filter for the hospital: years of work throughout the region The only health facility providing free treatment for the population is EMERGENCY's Paediatric Centre, opened in have produced a network that guarantees on-the-spot assistance for less serious patients and transfer to December 2005 in the Angola area. hospital for the more critical ones. Every day, around a hundred mothers and children come to the Centre: the EMERGENCY staff perform a triage to The most frequent illnesses are gastroenteritis and dehydration, pneumonia, asthma, malaria, meningitis and understand which patients need to be examined first. Children in a critical condition are hospitalised for daily MAYO PAEDIATRIC CENTRE CO-FUNDED BY septicaemia. THE EUROPEAN UNION (EUROPEAID). observation in a 6-bed ward. The most serious are transferred by ambulance to public hospitals, where we continue to monitor their conditions until they are discharged. Malnutrition too is a serious problem, caused not only by poverty but also by wrong choices such as bottle- At the Centre, we provide antenatal care, while workers from the local Ministry of Health perform the necessary feeding, now becoming widespread in the valley. vaccinations. Healthy babies born in the Maternity Centre are discharged after just a few hours, while premature babies, To help as many children as possible, our doctors, nurses and health promoters organise health education those suffering delivery distress, twins, cases of jaundice or neonatal sepsis and risk conditions are kept in the courses, screening sessions for malnutrition, monitoring for pregnant women and vaccination programmes in neonatal intensive care unit where there are neonatal incubators and a new cPap – a device that helps premature different areas of the camp. EMERGENCY extended its preventive medicine work with the project "Community babies with respiratory distress syndrome to breathe more easily. European Union participation to strengthen basic maternal and paediatric health services in Mayo IDP camp", co-financed by the The paediatric staff play a key role in neonatal resuscitation on delivery. A paediatrician is always on hand during European Union in partnership with the Ministry of Health of the state of Khartoum. The project concluded in 2014. risky deliveries for neonatal resuscitation manoeuvres, and to intervene in normal deliveries where, albeit rarely, Our staff trained 47 camp inhabitants to be "village volunteers" for the identification of the sick children in their the baby may have trouble breathing. communities. 50,065 children have been treated at the Paediatric Centre, 20,590 have been vaccinated at the clinic and directly in the field and 11,745 have been screened for malnutrition.
30 — Report 2014 Report 2014 — 31 Egypt Libya
Sudan Port Sudan Chad Khartoum Nigeria Chad Eritrea DARFURR SUDAN CENTRAL AFRICAN South Sudan REPUBLIC Ethiopia Cameroon Bangui South Sudan Central African Republic Democratic Republic of Congo Congo Uganda Uganda Democratic Kenya Repubblic of Congo
Bangui Port Sudan Paediatric Centre Paediatric Centre
OPENED: March 2009 OPENED: December 2011
ACTIVITIES: Paediatrics, ACTIVITIES: Paediatrics, Paediatric paediatric emergency unit, emergency unit, preventive medicine. antenatal care. FACILITIES: 2 paediatric outpatient FACILITIES: 3 paediatric outpatient departments, radiology, laboratory, departments, obstetrics outpatient pharmacy, ward, sub-intensive care unit, department, radiology, laboratory, warehouse, offices, external waiting area pharmacy, ward, warehouse, offices, and playground, auxiliary facilities. waiting area and playground, auxiliary facilities. NUMBER OF BEDS: 18
NUMBER OF BEDS: 17 LOCAL STAFF: 90
LOCAL STAFF: 90 AS OF 31 DECEMBER 2014: Admissions: 2,938 AS OF 31 DECEMBER 2014: Outpatient consultations: 64,477 Admissions: 8,709 Preventive medicine programme Outpatient consultations: 120,814 examinations: 3,331 Antenatal care: 21,749 When we opened the Paediatric Centre in Bangui, in 2009, the Central African Republic was one of Africa's We arrived in Port Sudan in 2011 to provide paediatric care in a very poor area, where there are no healthcare BLOOD BANK: poorest countries. Out of 1,000 live births, 129 babies die from easily treatable illnesses, and malaria is the facilities for a population of around 800,000 people. Number of blood bags distributed: 5,959 leading cause of death among the under 5's. A programme of vaccinations, carried out in collaboration with the local Ministry of Health, allows the children to In the last few years, the situation has got drastically worse. The outbreak of war in December 2012 resulted in complete the series of vaccinations envisaged by the international protocols. thousands of deaths and approximately 1 million displaced people out of a population of 5 million. During the most critical stage of the conflict, after the coup d'état in March 2013, EMERGENCY's Paediatric Centre In 2014 we opened a new paediatric outpatient department. stayed open and our staff intensified their work, visiting the main refugee camps that had sprung up near the Also in 2014, we launched a preventive medicine programme, co-funded by the Italian Ministry for Foreign Affairs capital. and International Cooperation. BANGUI PAEDIATRIC CENTRE CO-FUNDED BY PORT SUDAN PAEDIATRIC CENTRE CO- THE EUROPEAN UNION (EUROPEAID). Today, the situation in the capital Bangui is more stable, but the apparent calm is often interrupted by riots, FUNDED BY ITALIAN COOPERATION AGENCY Each week, our doctors and nurses go out to the various communities and meeting points in the area to provide armed street fights and common crime, keeping the city in a tense state of alert. hygiene/health education and teach people about preventive measures for their children and their families. Even now, more than 100 children come to our Paediatric Centre every day. The outpatient departments and They give advice about vaccinations, how to minimise the risk of getting malaria and other infectious diseases wards are always full, as is the tent that was pitched in the hospital garden at the height of the conflict to provide and how to have a healthy diet. They also monitor the conditions of sick children receiving treatment; all these extra beds. activities are helping to improve the general health of children in the communities. Illnesses such as malaria, infections and typhoid fever were widespread even before the start of the war, but food shortages and harsher living conditions have made it even easier to fall ill, with the lack of safety convincing The Port Sudan Paediatric Centre, built with contribution of the MAXXI 2per100 promoted by MAXXI – the National European Union many mothers to put off the journey to the hospital as long as possible. Museum of XXI Century Arts in Rome – has won a prestigious architecture award: the Giancarlo Ius Gold Medal Our staff have started working with a local organisation that runs small health centres, helping to train their staff 2013, for the architectural project considered most innovative and sustainable in terms of energy savings and the in the treatment and transfer of emergency paediatric cases. use of renewable energy sources.
32 — Report 2014 Report 2014 — 33 Egypt Libya
Khartoum CARDIOLOGY AND HEART SURGERY Eritrea Chad DARFURR SUDAN
Ethiopia South Sudan Central African Republic
Uganda Democratic Kenya Repubblic of Congo
Khartoum Salam Centre for Cardiac Surgery
OPENED: April 2007
ACTIVITIES: Paediatric cardiac surgery, adult cardiac surgery, interventional cardiology.
FACILITIES: 3 operating theatres, sterilisation, 15-bed intensive care unit, sub-intensive care unit, surgical wards, outpatient department, catheterization laboratory, radiology, ultrasound, TC, laboratory and blood bank, physiotherapy, pharmacy, technical and auxiliary facilities, guesthouse for foreign patients. of developing rheumatic disease - an patients, who are so young (average age NUMBER OF BEDS: 63 inflammatory illness that causes the 25) and so ill that we often have to get deformation of the cardiac valves. them into the operating theatre as soon as LOCAL STAFF: 356 Mimmo Risica Rheumatic disease thrives in conditions they arrive. If the Salam Centre didn't exist, Cardiologist of underdevelopment: it's enough just to they'd have no alternative but death: no AS OF 31 DECEMBER 2014: improve people's living conditions in order other hospital in the whole of the continent The Salam Centre is the only cardiac surgery hospital in the whole of Africa providing highly specialised, free Admissions: 6,669 Cardiologists and heart surgeons in Africa? to drastically reduce it. provides free cardiological treatment and treatment to patients suffering from acquired and congenital cardiovascular diseases. Outpatient consultations: 54,582 Since we opened the Salam Centre of In so-called developed countries in fact, it heart surgery. And the number of patients In October 2014, the underground zones of the Salam Centre were damaged in a fire: luckily, no-one was involved Cardiological examinations: 46,952 cardiac Surgery, we've been asked this has practically disappeared, while in Africa is so high. In the coming years, heart in the incident, but because of renovation work, we had to stop operating until the end of the year. Surgical operations: 5,766 question so often. Every time, we think more than 18 million people are affected, disease will hold the sad record of being Cath Lab diagnostic and surgical about the crowded waiting rooms at the two thirds of them children between the the first cause of death in Africa. Our staff continued to provide cardiological examinations for follow-up patients that had already been operated procedures: 1,253 Salam Centre. Every time, we try to explain ages of 5 and 15. It's calculated that about on. Foreign patients: 922 that marriages between blood relatives one million young people need heart The Salam Centre is linked to a network of EMERGENCY Paediatric Centres where our cardiologists screen children (not rare in Africa), or the contraction of surgery (WHO data, 2005). and adults with heart conditions, identifying those who need to be operated on in Khartoum and providing all the certain illnesses during a pregnancy, Finally, poor hygiene conditions and necessary post-op care. Where there is no EMERGENCY facility, we organise screening sessions in local hospitals increase the risk of foetal malformations limited access to treatment (because in collaboration with the health authorities of the host country. like congenital heart disease. Congenital it costs, and so it's the prerogative of a heart diseases are alterations in the reduced portion of the population) make So far, the Salam Centre has treated patients from 25 different countries – not only African countries. Guest rooms anatomy of the heart that prevent the it easier for infections to set in, and provide free accommodation for foreign patients and their relatives throughout their convalescence. normal flow of blood, inhibiting growth these attack the heart. Bacteria flourish and making it extremely difficult to live a on the valves, destroying the tissue and The Salam Centre has won numerous architecture awards, including the prestigious Aga Khan Award for normal life, even to breathe. maybe even becoming detached and Architecture, for innovative buildings that combine architectural excellence with a positive impact on the quality Even a mundane bout of tonsillitis can spreading throughout the body with of life of the surrounding communities. lead to a heart condition: if it’s not treated dramatic consequences, such as bacterial with antibiotics, type A beta-hemolytic endocarditis. streptococcus can increase the risk These are the illnesses that affect our
34 — Report 2014 Report 2014 — 35
Manifesto a for Human Rights Based Medicine Following the international "Building Medicine in Africa. Principles and Strategies" seminar, held on the island of San Servolo, Venice, Italy, Regional heart surgery programme from 14 to 15 May 2008, and in accordance with the spirit and principles of the Universal Declaration of Human Rights which states
“All human beings are born free and equal in dignity and rights” (art.1) “Everyone has the right to… medical care” (art.25) “Recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world” (Preamble)
Syria Lebanon Afghanistan WE DECLARE Tunisia Morocco Israel Iraq Jordan that the “right to be treated” is a fundamental and inalienable right of every member of the human community.
Kuwait
Libya Algeria Egypt WE THEREFORE ADVOCATE Saudi Arabia United Arab Emirates Oman the implementation of health systems and projects devoted exclusively to preserving, extending and improving the life of patients in
Mauritania need and based on the following principles: Mali Niger Chad SUDAN Eritrea Senegal DARFUR Yemen The Gambia Burkina Equality Faso Djibouti Guinea Nigeria Somalia Every human being has the right to receive medical treatment regardless of their economic Sierra Leone Cóte Ethiopia d’Ivoire Ghana Central African South Sudan and social condition, gender, ethnic group, language, religion and opinions. Liberia Republic Togo Cameroon The best treatment made possible by progress and medical science must be provided impartially and without discrimination to all patients. Benin Equatorial Guinea Uganda Kenya Congo Gabon Rwanda Democratic Republic Quality of Congo Burundi High quality health systems must be based on the needs of everyone and must be adapted to progress in medical science. Tanzania They cannot be guided, organised or determined by lobbies and corporations involved in the health industry.
Angola Mozambique Malawi Zambia Social responsibility
Madagascar Governments must consider the health and well-being of their citizens as priorities, and must allocate the necessary human and Zimbabwe
Namibia Home countries of Salam Centre patients financial resources to achieving this purpose. The Salam Centre is the core of our Botswana heart surgery programme: international The Services provided by national health systems and humanitarian projects in the health field must be free of charge and accessible cardiologists carry out screening sessions Swaziland Countries where EMERGENCY has permanent facilities by everyone. at the Paediatric Centres in Sudan, the Lesotho Central African Republic and Sierra Leone, South Africa at the Rehabilitation Centre in Iraq, and As Health Authorities and Humanitarian Organisations in the Surgical Centres in Afghanistan, identifying patients who need to be The Salam Centre is also a highly right to good-quality, free healthcare. WE RECOGNISE transferred to Sudan for heart surgery and innovative model of humanitarian The conclusions of the seminar formed health systems and projects based on EQS (Equality, Quality and Social Responsibility) principles that observe human rights, permit guaranteeing the necessary follow-up for intervention. The aim of the project is, the "Manifesto for a Human Rights based patients who've already been operated on. in fact, to bring high quality healthcare medicine", in which the signatories the development of medical science and are effective in promoting health, strengthening and generating human, scientific and Where there is no EMERGENCY facility, to Africa, at the same time asserting the recognise the "right to be treated" as a material resources. screening is carried out in cooperation right of every human being to receive "fundamental and inalienable right of every with the authorities of the host country. good, free treatment. To discuss this member of the human community", and WE UNDERTAKE The Salam Centre has become the model, EMERGENCY invited delegations ask for a health service based on equality, point of reference for thousands of sick of the Health Ministries of eight African quality and social responsibility. These to set up and develop policies, health systems and projects based on EQS principles; people from no less than 25 countries: countries in May 2008 to the island of principles were subsequently developed, to cooperate with each other to identify shared needs in the health sector and plan joint projects. Afghanistan, Burkina Faso, Burundi, San Servolo in the Venice lagoon, for the leading to the definition of the ANME Cameroon, Chad, Eritrea, Ethiopia, Djibouti, international "Building Medicine in Africa" (African Network of Medical Excellence) WE APPEAL Jordan, Iraq, Kenya, Liberia, Nigeria, the seminar. Together with EMERGENCY, the in 2010 - a project involving 11 countries Central African Republic, the Democratic representatives of the Central African in the building of top quality medical to other health authorities and humanitarian organisation to sign this Manifesto and join us in promoting medicine based on EQS Republic of Congo, Rwanda, Senegal, Republic, the Democratic Republic of centres, with the aim of strengthening principles; to donors and the international community to support, finance and take part in the planning and creation of programmes Sierra Leone, Somalia, Sudan, South Congo, Egypt, Eritrea, Rwanda, Sierra the healthcare system on the African based on EQS principles. Sudan, Tanzania, Uganda, Zambia and Leone, Sudan and Uganda talked about continent. Zimbabwe. how to guarantee African citizens the
36 — Report 2014 Report 2014 — 37 Trentino Alto Adige
Friuli Venezia Giulia Valle d’Aosta Lombardia Austria Veneto Marghera Hungary Switzerland Piemonte Francia Slovenia Liguria Emilia Romagna Marghera Croazia
Bosnia and Toscana Marche Herzegovina Mar Adriatico PROGRAMME IN ITALY Serbia Umbria Abruzzo Lazio Montenegro Roma ITALY Kosovo Molise Puglia Sassari Spagna Campania Rome Adriatic Sea Macedonia Basilicata Albania Sardegna
Calabria Tyrrhenian Sea Grecia Mar Tirreno Polistena Palermo
Palermo Sicilia Mar Ionio
Mediterranean Sea Mar Mediterraneo Ionian Sea
Palermo/Marghera/Polistena Outpatient Clinics
OPENED: April 2006
FACILITIES: General medicine, cardiology, dermatology, infectious diseases, dentistry, obstetrics and gynaecology, ophthalmology, paediatrics, socio- medical assistance and counselling.
EMPLOYEES IN THE FACILITIES: 25
VOLUNTEER STAFF IN THE FACILITIES: 156
AS OF 31 DECEMBER 2014: PALERMO outpatient consultations: 85,003 MARGHERA outpatient consultations: 27,571 POLISTENA outpatient consultations: 5,777 EMERGENCY opened the Outpatient Clinic in Palermo in 2006 together with Palermo Provincial Health Authority 6, spending are threatening the fundamental we've provided health care for immigrants which provided and renovated the premises. Andrea Bellardinelli rights of increasing numbers of Italians. arriving at Siracusa after gruelling sea The idea behind the creation of the Palermo Outpatient Clinic was to offer basic and specialist medical care to Coordinator of the When we opened our Outpatient Clinic voyages. immigrants and people in difficulty, both independently and in collaboration with the reference health authority. Italy Programme in Palermo in 2006, we never imagined Based on this experience, in December 2010, we opened a second Outpatient 38 — Report 2014 Report 2014 — 39 Trentino Trentino Alto Adige Alto Adige Friuli Venezia Giulia Friuli Venezia Giulia Valle d’Aosta Valle d’Aosta Lombardia Lombardia Austria Veneto Marghera Austria Veneto Marghera Hungary Hungary Switzerland Piemonte Switzerland Piemonte Francia Slovenia Francia Slovenia Liguria Emilia Romagna Liguria Emilia Romagna Marghera Croazia Marghera Croazia Bosnia and Toscana Marche Bosnia and Toscana Marche Herzegovina Mar Adriatico Herzegovina Mar Adriatico Serbia Umbria Serbia Umbria Abruzzo Abruzzo Lazio Lazio Montenegro Roma Montenegro Roma ITALY Kosovo Molise ITALY Kosovo Molise Puglia Puglia Sassari Spagna Campania Sassari Spagna Campania Rome Adriatic Sea Macedonia Basilicata Rome Adriatic Sea Macedonia Basilicata Albania Albania Sardegna Sardegna Calabria Calabria Tyrrhenian Sea Grecia Tyrrhenian Sea Grecia Mar Tirreno Mar Tirreno Polistena Polistena Palermo Palermo Palermo Sicilia Mar Ionio Palermo Sicilia Mar Ionio Mediterranean Sea Mar Mediterraneo Mediterranean Sea Mar Mediterraneo Ionian Sea Ionian Sea Italy Sassari Mobile clinics Information desk for social and health orientation OPENED: April 2011 OPENED: December 2012 FACILITIES: General medicine, FACILITIES: Social-medical medications, social-medical assistance and counselling. assistance and couselling. EMPLOYEES: 1 EMPLOYEES: 27 VOLUNTEER STAFF: 12 VOLUNTEER STAFF: 11 AS OF 31 DECEMBER 2014: AS OF 31 DECEMBER 2014: services provided: 3,249 Outpatient consultations: 41,917 PLACES OF INTERVENTION: Ragusa/Catania/Messina Apulia, Emilia Romagna, Sicily, Campania, Basilicata, Calabria. Information desk for social and health orientation for the project for Development of health and integration courses EMERGENCY has transformed two buses into mobile clinics so it can take its medical assistance where it's most OPENED: October 2013 A right, even when guaranteed by law, can never be taken for granted. needed. The Polibuses operate in areas of extreme social hardship, where access to public healthcare facilities is COMPLETED: June 2014 Language difficulties, inadequate knowledge of your rights (or the inability to demand them) and the complexity difficult due to logistic problems: farming areas, refugee camps, camps and various emergency situations. of the national health service - these are the main obstacles preventing Italian and foreign citizens from getting ACTIVITIES: the treatment they need. In June 2013, two new mobile clinics were added to the fleet: these minivans, fitted out in collaboration with the Social-medical and counselling. Apulia region, bring medical care to farm labourers working on the tomato and olive harvests. To overcome these problems, we opened an information desk for social-medical assistance in Sassari in 2012. In 2013, at the request of the provincial health authority and the Municipality and Prefecture of Siracusa, one EMPLOYEES: 9 Here, mediators inform patients about their rights, deal with the paperwork to obtain the STP code (Straniero of our mobile clinics began providing healthcare services to immigrants living in the former Umberto I school, Temporaneamente Presente - "Temporary Foreigner", guaranteeing access to the public health service even for which houses roughly 250 people who landed on the shores of the province. Over the past 3 years, the number of AS OF 30 JUNE 2014: illegal immigrants), accompany them if necessary during check-ups or examinations in public facilities and immigrants arriving in the province of Siracusa has tripled to over 170 thousand in 2014. Many are unaccompanied FEI Help Desks - monitor the area to identify pockets of particular hardship or places where rights are being denied. minors, the most vulnerable of all. Our staff have started providing assistance in the reception centres of Priolo, Beneficiaries: 2,467 Augusta and Caltagirone. In 2013, we also opened information desks in the provinces of Ragusa, Catania and Messina with funding from the European Fund for the Integration of country Nationals. The project ended in June 2014. In 2014, we launched two new projects. A lorry has been converted into a new mobile clinic known as the Project co-funded by the Politruck, and another mobile clinic has been fitted up to provide preventive health advice and guidance to During the course of the project, we trained 113 local health authority workers on assistance issues and prostitutes working in the Caserta area. organised information and awareness-raising courses on healthcare issues for immigrants. The courses were The doctors and nurses in the mobile clinics are accompanied at all times by cultural mediators who receive the attended by 610 people. patients, inform them of their rights, help them gain access to public health services and, if they have problems European Union with the language, accompany them for specialist examinations and tests at public healthcare facilities. European Fund for the Integration of Third- Party Nationals 40 — Report 2014 Report 2014 — 41 Completed Programmes CULTURE OF PEACE 1994 - Renovation and reopening of the surgical 2001 - Setting up of an aid programme for war representatives of the local community and to ward in Kigali hospital, Rwanda. During a widows, distributing livestock for breeding to the local hospital. 4-month long mission, a team of surgeons 400 families in the Panjshir Valley, Afghanistan. operated on 600 war casualties. At the same 2004/05 - Renovation and equipment of the time EMERGENCY also reopened the obstetrics 2003 - Supply of medicines, consumables and emergency surgery ward of the Al Fashir and gynaecology department where over fuel for generators to the Al-Kindi hospital in Teaching hospital, in North Darfur, Sudan. The 2,500 women received medical and surgical Baghdad, Iraq. facilities included a surgical block and a ward assistance. In the same period, medicines and healthcare with 20 beds. The ward was handed over to the materials were donated to the hospital in Ministry of Health in August 2005. 1996/2005 - Construction of a Surgical Centre Karbala, south of Baghdad. in Sulaimaniya, Northern Iraq, to offer treatment 2005 - Donation of surgical equipment and for landmine casualties. 2003/04 - Setting up of a Rehabilitation consumables supplied to the general hospital The facilities include units for treatment of and Prosthetics Centre in Medea, Algeria. in Kalutara, in Sri-Lanka, to enhance clinical burns and spine injuries. In 2005, the Centre EMERGENCY refurbished and equipped a activity after the tsunami. and the 22 First Aid Posts connected to it were building inside the public hospital complex, and handed over to the local health authorities. also trained the local personnel. The Centre, 2005 - Following the tsunami in 2004, the “Back known as Amal, the Arabic word for “hope”, was to the sea” project involving the distribution 1998/2005 - Setting up of a Surgical Centre in handed over to the local health authorities in of motor boats, canoes and fishing nets to the Erbil, Northern Iraq, to treat landmine victims. 2004. fishermen in the village of Punochchimunai in The facilities include a burns unit, and one for Sri-Lanka was completed. Also, school kits were the treatment of spinal cord injuries. In 2005, 2003 - Building of a Rehabilitation and donated to students to further encourage the the Centre was handed over to the local health Prosthetics Centre in Dohuk, Northern Iraq. return to everyday life. authorities. The Centre is now run by the local health authorities. 2005/07 - Courses on hygiene, prevention and 1998/2012 - Construction and running of a first aid were organised for the inmates of the Surgical Centre in Battambang, Cambodia. The 2003/04 - Operation in Angola, in the province Rebibbia New Complex prison in Rome. Centre was handed over to local authorities in of Benguela, invited by a congregation of EMERGENCY also organised TB screening in 2012. Angolan nuns. the prison. Furthermore, EMERGENCY provided Two health centres were renovated, equipped specialist medical assistance in several other 1999 - Support for the Jova Jovanovic Zmaj and run for over a year by EMERGENCY, who also prisons in the Lazio region. orphanage in Belgrade, Serbia. trained the local personnel. 2005/08 - Reconstruction of 91 brick houses for 1999/2009 - Five First Aid posts (FAPs) set up 2003/04 - A surgical team was sent to the the families in the village of Punochchimunai, in the Samlot district, Cambodia, to provide orthopaedic unit at the public hospital in Jenin, in Sri-Lanka, destroyed by the tsunami in treatment for landmine casualties. In 2003, the Palestine. 2004. The delivery of the houses could only O’Rotkroh, Chamlong Kouy, Tasanh and O’Chom In addition to performing clinical services and be completed in September 2008, due to the FAPs were handed over to the local health training medical personnel, EMERGENCY set up resumption of hostilities between government authorities. In 2009, the local health authorities a new physiotherapy department and a new troops and local rebels, which halted all work took over the running of the O’Tatiak First Aid orthopaedic ward. for months. Post. 2003/04 - Supply of medicines to the Casa 2011 - War surgery programme in Libya, in the 2000 - A team of surgeons was sent, at the de la mujer, a community network giving under-sieged city of Misrata. request of Cooperazione Italiana, to Eritrea. assistance to women affected by cancer and EMERGENCY staff worked for two months at diabetes in Nicaragua. the Mekane Hiwet hospital, in Asmara, treating casualties of the war between Ethiopia and 2003/07 - Opening of a workshop for the Eritrea. production of rugs aimed at promoting the economic independence of women in the 2001/2002 - Building of a Rehabilitation and Panjshir Valley, Afghanistan. Prosthetics Centre in Diana, Northern Iraq. The Centre has been handed over to the local 2004 - Support for the population of Fallujah, in health authorities. Iraq, during the siege of the city, in May. Relief items, water and medicines were distributed to Afghanistan, Kabul - Surgical Centre for war victims 42 — Report 2014 Report 2014 — 43 In 1995, one year after its foundation, For many it was a revelation: up to then President in the summer of 1996. The EMERGENCY reopened the hospital in there had been little media coverage international appeal for the banning Choman, a village in Iraqi Kurdistan near on this issue in Italy, a country which, of anti-personnel mines was signed in the border with Iran. at the time, was one of the leading December of the same year by ten Nobel 1995 CAMPAIGN AGAINST LANDMINES Choman was in an area infested with manufacturers and exporters of landmines. prize winners: Rita Levi Montalcini, Adolfo landmines, most of them manufactured After an intensive information campaign Pérez Esquivel, Joseph Rotblat, Elie Wiesel, in Italy: one of the most common models involving newspaper articles, meetings Jean Dausset, Christian de Duve, Frank was the Valmara 69, a fragmentation in schools, debates and exhibitions, Sherwood Rowlands, Steven Weinberg, mine made in Brescia which can kill landmines became a question of public Kenneth J. Arrow and James M. Buchanan. within a radius of 25 metres and seriously interest. injure within a radius of 200 metres from Finally, in response to pressure from the explosion. Initially at the hospital EMERGENCY publicly asked the Minister of an increasingly well-informed body of in Choman, and later in those that Defence to take concrete action against public opinion, on 29 October 1997, the EMERGENCY built in Erbil and Sulaimaniya, landmines. On 2 August 1994, the Italian Italian Parliament approved Law no. 374 our doctors treated men, women and parliament passed a resolution calling prohibiting not only the manufacture, children who had stepped on landmines for a moratorium on the production and stockpiling, sale, export and possession while taking their animals out to pasture, export of anti-personnel mines. “Keakaws of landmines, components, patents getting water or playing. They were not Amin Ahmed, aged 30, was hunting, left and technologies but also the holding fighters: they were just people trying to leg amputated; Wahid Karim, aged 32, of financial interests in any foreign live their lives normally. In Iraqi Kurdistan, was gathering metal, right leg amputated; companies connected with the production EMERGENCY's doctors had to deal with one Saeed Majeed, aged 43, was gathering and sale of landmines. On 3 December of the worst legacies of war: it is estimated metal, multiple injuries...”: an excerpt from 1997, Italy signed the Anti-Personnel Mine that there are 100 million unexploded the admissions register of the EMERGENCY Ban Convention in Ottawa, which prohibits landmines scattered over seventy or so hospital in Sulaimaniya became the the use of these weapons, mandates the countries. wording on a postcard that was sent to dismantlement of arsenals and – a new the President of the Italian Republic Oscar development with respect to the Italian law EMERGENCY's surgeons decided to start Luigi Scalfaro, demanding the “rapid - calls for the instigation of mine clearing telling people about the things they had debate and approval of a bill or draft law” operations and aid for victims. The Ottawa seen on their hospital operating tables. to prohibit the production, trade and use Treaty came into force on 1 March 1999, In Italy, their work attracted a great deal of landmines by Italy, together with the although many countries have not yet of attention on the Maurizio Costanzo commitment to support a total ban at signed it. These include China, Russia and TV Show, when Gino Strada, the surgeon international level plus the launching of the United States of America. who founded EMERGENCY, talked about humanitarian aid initiatives for casualties the devastating effects of anti-personnel and mine clearing operations. Over mines. one million postcards were sent to the Cambodia 44 — Report 2014 Report 2014 — 45 2001 A SHRED OF PEACE 2002 ITALY OUT OF THE WAR It was the autumn of 2002. Once again, “We want a world based on justice and Stop war, sign for peace war seemed inevitable: Iraq was the solidarity. number one enemy, the non-existent We reject violence, terrorism and war as The rejection of war is a fundamental weapons of mass destruction were being means of resolving disputes between men, principle of the Italian Constitution and is presented as a threat to the safety of peoples and states. We demand that Italy, stated in article 11. the West and the West was preparing for with regard to the threat of military action To give more power to the demand for another military campaign in the region. against Iraq, does not take part in any act peace, in the same period EMERGENCY of war, in compliance with its Constitution. asked three legal experts – Luigi “Italy out of the war”: this was the We do not want to be jointly responsible for Ferrajoli, Domenico Gallo and Danilo demand that EMERGENCY put to the Italian more deaths, and nor do we want to fuel Zolo – a bill of popular initiative “Rules government and people by means of a the spiral of terror. No more wars, no more for the implementation of the principle of huge campaign and mass mobilisation, deaths, no more victims.” repudiation of war decreed by art.11 of the which reached its peak on 10 December Constitution and of the UN Charter”. 2002. EMERGENCY handed over the text of the On the same day as the anniversary of the appeal and the collected signatures The draft bill calls for a series of Universal Declaration of Human Rights, to the Presidents of the Republic, the guarantees about making article 11 more than 250 torch-lit processions and government, as well as to the Speaker operative, ensuring its effective application 500 thousand people poured onto the of the Chamber of Deputies and the and providing for strict sanctions if it was streets all over Italy, with strips of white President of the Senate and the different breached. cloth and rainbow flags fluttering at the parliamentary groups. Going against windows. the wishes of such a large section of EMERGENCY collected 137,319 signatures There were also hundreds of meetings the population, on 15 April 2003, the (far more than the 50,000 required by law) in schools, declarations of support for government obtained parliamentary and presented the appeal to the legal office the campaign from dozens of municipal, approval for the “emergency humanitarian of the Italian Parliament on 17 June 2003. “War has broken out and is continuing, On 11 September 2001, the attacks on the boarding naval ships at the port of Taranto. provincial and regional councils and 500 mission” to Iraq, even before the UN it has killed and will continue to kill. It United States shocked international public The propaganda told us that war was an thousand signatures to the Italy out of the Security Council had passed resolution will persist even when the soldiers and opinion. inevitable step in the legitimate defence of war appeal on the EMERGENCY website: 1483. strategists consider it finished, from their The reaction was swift: less than a month a country under attack. point of view. It will persist in the grief after the attack, on 7 October, United EMERGENCY knew that war would not of the survivors, in the mutilated bodies States bombers attacked Afghanistan. bring justice for the victims of the attack, of many of them. It will persist in the This was the Enduring Freedom operation, or eliminate the threat of terrorism. It explosive devices that remain active in the the first act of the global war on terror the would merely be the umpteenth act of ground. We know that many of you are in Taliban regime governing Afghanistan was violence against a country laid prostrate favour of this war. But we want those of accused of backing the Al-Qaeda terrorist by decades of conflicts, causing the death you who are against it to have a voice too. group, considered responsible for the of thousands of innocent civilians. Many To show your dissent, take a shred of white attack on the Twin Towers. people shared this view, and supported cloth: tie it to your handbag or briefcase, the work of EMERGENCY. attached it to the front door or balcony The military attack on Afghanistan was To make everybody's dissent on the of your of home, tie it to dog leashes, car supported by much of the international war and the decisions of the Italian aerials, pushchairs, satchels … community. Parliament clearer, EMERGENCY asked A shred of peace. people to express it with a shred of peace. Many of us will display it. So that no Italy fell into line too: on 7 November 2001, These little strips of white cloth tied to one will be able to say that the whole of the Italian Parliament approved military people's wrists or bags or hung up in Italy has chosen war as the way to solve participation in the international operation their cars were to become the symbol of conflicts. with 92% of its members in favour, in those “wishing to find new ways of living EMERGENCY asks the support not only clear disregard of article 11 of the Italian together, new ways of solving problems of individual citizens but also of local Constitution. other than by violence, terrorism and war.” councils, parishes, associations, schools With the “most bipartisan vote in the and all those who agree with what we are history of the Italian Republic” – as Gino saying. Spreading this message is a way Strada defined it – eleven days later, 600 to begin.” Italian soldiers sailed for Afghanistan, 46 — Report 2014 Report 2014 — 47 “The citizens of the world are no longer spiral of violence that seemed destined to editor of the magazine Tikkun; Sari Hanafi, able to weep over the tragedies of terror: spread endlessly. director of the Palestinian Diaspora and another bomb follows a car bomb, EMERGENCY launched an appeal Refugee Centre; Peretz Kidron, journalist another vendetta follows every death, demanding that governments and armed and writer; Yesh Gvul, of the Israeli soldiers 2003 CEASE FIRE thus generating more deaths and more groups should cease fire, before hatred against occupation movement; Sylvie vendettas. The different names for it – war, and violence became the only language Coyaud, journalist; Farid Adly, journalist; terrorism, violence – all mean the same used between human beings. Hebe de Bonafini, President of the Madri thing: human bodies torn to pieces and di Plaza de Mayo association; Don Luigi pieces of humanity lost for ever. We no The appeal was immediately signed Ciotti, President of the Libera association; longer want to see atrocities: humans by Noam Chomsky, professor at the Carlyle Vilarinho, Head of the Cabinet of continuing to kill each other is inhuman. Massachusetts Institute of Technology; the Brazilian government; José Graziano da We have to stop this spiral or in the end Ignacio Ramonet, editor of Le Monde Silva, Minister of the Brazilian governments nothing will remain. There will be right or Diplomatique; Oscar Luigi Scalfaro, Zero Hunger programme; Amos Oz, writer; wrong, just an unending chain of death President of the Italian Republic 1992- Andrea Camilleri, writer; Monsignor and destruction. We ask all those who are 1999; Rigoberta Menchù, 1992 Winner Raffaele Nogaro, Bishop of Caserta; Tiziano making or planning attacks and acts of of the Nobel Prize for Peace; Rita Levi Terzani, writer. war to stop. Montalcini, 1986 Winner of the Nobel Prize One of the first to sign was Hans von We ask for time to think. We cannot just for Medicine; Dario Fo, 1997 Winner of the Sponeck, the former director of the UN stand by, powerless, while this murderous Nobel Prize for Literature; Jack Steinberger, humanitarian programme in Iraq, who madness rages. 1988 Winner of the Nobel Prize for Physics; resigned in protest against the embargo To all those advocating violence, all those Leonard Boff, philosopher and theologian; ordered by the USA. Numerous Italian secret organisers of massacres and very Tavola Valdese, Union of Waldensian and international local councils and visible dictators or presidents, we, the and Methodist churches in Italy; Inge associations subscribed to the appeal, people, implore you to: “Cease fire!”». Schoental Feltrinelli, editor; Ermanno Olmi, including the association of the families film director; Riccardo Muti, orchestra of the victims of 11 September. Over 76,000 In the autumn of 2003, the escalation of conductor; Pietro Ingrao, politician and citizens subscribed to the appeal on the war in Iraq and in Afghanistan and the author; Carlo Ossola, professor at the EMERGENCY's website. attacks in Turkey, Palestine and Chechnya Collège de France; Padre Alex Zanotelli, followed on, one after the other, in a Comboni missionary; Rabbi Michael Lerner, Afghanistan, Kabul - Surgical Centre for war victims 48 — Report 2014 Report 2014 — 49 2010 THE WORLD WE WANT 2011 “IT CAN ONLY BE ABOLISHED” In February 2011, the international And our country chose war “against “This then is the question we ask you, a community and, subsequently, Italy, Gaddafi”. It was presented to us, yet again, clear and terrible question that cannot be declared war on Libya. EMERGENCY once as humanitarian, inevitable and necessary. avoided: shall we put an end to the human again spoke out against war: the decision No war can be humanitarian. War has race; or shall mankind renounce war?” to strike at a dictator, who up to a few always been the destruction of fragments (from the Manifesto of Russell-Einstein, months before was backed by many of humanity, the killing of our fellow men. 1955). western governments, was a decision to Every “humanitarian war” is, in reality, a For this utopia to become real, we must attack a whole country in breach of the crime against humanity. first of all learn to think in a different way, Italian Constitution. EMERGENCY launched If we want to defend human rights, the removing war from our cultural and political an appeal inspired by the famous words of only way is to get all parties concerned horizon. Together with all the citizens who Einstein: “War can't be humanised. It can to cease fire and to put a stop to war, are victims of war, violence and repression, only be abolished.” In just a few days the violence and repression. who struggle for their rights and for appeal had been signed by over 50,000 No war is inevitable. Wars at a certain democracy. people; amongst the first to sign were point appear to be inevitable only when “War can't be humanised, it can only be Gino Strada, Carlo Rubbia, Don Luigi Ciotti, nothing has been done to prevent them. abolished.” Albert Einstein. Renzo Piano, Maurizio Landini and Alex They appear to be inevitable to those who Zanotelli. for years have ignored rights, those who The mobilisation reached its peak on 2 have grown rich by arms trafficking, those April in Piazza Navona, in Rome. Just a few who have denied the dignity of peoples days later, EMERGENCY sent a war surgery and social justice. They appear inevitable team to Misrata, the city hardest hit by to those who have prepared them. “We believe in the equality of all human their own citizens by building up a system Fazio, asks for a world without wars, where the war. No war is necessary. War is always a beings regardless of their opinions, of privileges, based on exclusion and the basic rights of every human being choice, not a necessity. gender, race, ethnic, political and religious discrimination, a system of arrogant abuse – health, education, information … – are “Once again the governors chose war. Killing is an absurd choice, exalting background, and of their social status and of power, of habitual corruption. In the guaranteed and where fundamental values Gaddafi chose war against his own violence, spreading it, amplifying it, financial condition. name “security”, the Italian political class such peace, democracy rights and equality citizens and the migrants crossing Libya. generating “culture of war”. We reject violence, terrorism and war as has chosen war against those who have are upheld. means of resolving disputes between men, come to Italy to survive, instigating hatred peoples and states. We want a world based and racism. The Manifesto is not a revolutionary on social justice, solidarity, reciprocal Is this a democracy? Just because document: it was written with an eye to respect, dialogue and fair distribution of it involves representative electoral the Italian Constitution and the Declaration resources. processes? Is the fact that people vote of Human Rights, drafted over sixty years We want a world in which governments in a country sufficient for it to be called ago when the world was emerging from guarantee the basic equality of all democratic? two wars that had overturned every human members of society, the right to high We consider a political system to be principle and ideal. quality and free medical care; the right democratic only when it works for the to state education that develops each common good, ensuring that its actions EMERGENCY felt the urgent need to bring person as a human being and expands are addressed to the needs of the less these words back to the centre of public their knowledge; the right to freedom of wealthy and the weaker social groups, in debate, to ensure that the basic rights of information. order to improve their living conditions so everyone do not become the privileges of In our country, on the contrary, for many that we can become a "society of citizens". a few. years we have been witnessing the This is the world that we want. For And it was written with an eye to the progressive and systematic demolition ourselves, for all of us. A world of equality.” organisation's history: from EMERGENCY's of every principle of social harmony. A first mission to Rwanda to the mobile very serious shift towards barbarism is “The world we want” is the title of the clinics in Italy, EMERGENCY has provided unfolding before our very eyes. Manifesto that EMERGENCY presented assistance to anyone needing it, because In the name of “international alliances”, in September 2010 at the ninth National it has always believed that peace, the Italian political class has chosen war Meeting of its volunteers. democracy, rights and equality are the only and aggression against other countries. The Manifesto, discussed during the event possible forms of coexistence between In the name of “freedom”, the Italian by Gino Strada, Antonio Tabucchi, Roberto human beings. political class has chosen war against Saviano, Vauro, Andrea Camilleri and Fabio 50 — Report 2014 Report 2014 — 51 Work with us Support EMERGENCY with a donation WORK WITH US EMERGENCY uses over 90% of the contributions received to achieve its statutory aims: providing free medical care to whoever needs it and promoting a culture Working with EMERGENCY is an amazing of peace and respect for human rights. professional and humane experience. We ask for consolidated professional experience, a good knowledge of English (French for the Central African Republic), and at least 6 months of availabilty. We provide suitable remuneration and 8.76% cover the cost of insurance, travel, board Administrative costs and lodging. For more information, go to www.emergency.it and take a look at the Work with us section. 91.24% Funds committed to institutional activity The work of EMERGENCY is made possible by contributions from private citizens, companies, foundations, international bodies and some of the governments of the Countries where we work, who have decided to support our operations. Over the years, EMERGENCY has also grown thanks to the support of hundreds of thousands of people. You can help us with: • EMERGENCY italian post office account no. 28426203 • EMERGENCY bank current account - at the Banca Etica, Milan Branch IBAN IT 02 X 05018 01600 000000130130 - at the Banca Popolare dell’Emilia Romagna IBAN IT 41 V 05387 01600 000000713558 • CartaSi Freephone number 800-667788 for donations via CartaSi, Visa and MasterCard • credit card (online) and PayPal on the website www.emergency.it All donations are tax-deductible. Central African Republic, Bangui - Complexe pédiatrique Afghanistan, Anabah - Maternity Centre 52 — Report 2014 Report 2014 — 53 Afghanistan, Lashkar-gah - Surgical Centre for war victims 54 — Report 2014 Report 2014 — 55 «All human beings are born free and equal in dignity and rights». The acknowledgment of this principle «is the foundation of freedom, justice and peace in the world». Universal Declaration of Human Rights Paris, December 10, 1948, Article 1 and Preamble EMERGENCY BELGIUM www.emergencybe.org EMERGENCY HONG KONG EMERGENCY www.emergencyhkg.org www.emergency.it EMERGENCY JAPAN www.emergency-japan.org EMERGENCY SWITZERLAND FOUNDATION via Gerolamo Vida 11 via dell'Arco del Monte 99/A Isola della Giudecca 212 www.emergency.ch 20127 Milan, ITALY 00186 Rome, ITALY 30133 Venice , ITALY EMERGENCY UK T +39 02 881881 T +39 06 688151 [email protected] www.emergencyuk.org F +39 02 86316336 F +39 06 68815230 EMERGENCY USA [email protected] [email protected] www.emergencyusa.org