Médecins Sans Frontières Australia ANNUAL REPORT 2017
OUR CHARTER
Médecins Sans Frontières is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principals:
Médecins Sans Frontières offers assistance to Médecins Sans Frontières volunteers undertake populations in distress, to victims of natural or to respect their professional code of ethics and to man-made disasters and to victims of armed maintain complete independence from all political, conflict, without discrimination and irrespective economic or religious powers. of race, religion, creed or political affiliation. As volunteers, members are aware of the risks and Médecins Sans Frontières observes neutrality and the dangers of the mission they undertake, and impartiality in the name of universal medical have no right to compensation for themselves or ethics and the right to humanitarian assistance their beneficiaries other than that which Médecins and demands full and unhindered freedom in the Sans Frontières is able to afford them. exercise of its functions.
CONTENTS
3. Médecins Sans Frontières charter 4. Message from the President 6. 2017: Our Year in Review 8. Australian and New Zealand field staff 10. Message from the Medical Unit 12. Médecins Sans Frontières Australia 2017 highlights 14. Médecins Sans Frontières projects funded by Australian and New Zealand donors 56. Financial report
Front cover: Australian doctor Roslyn Brooks assesses a young patient in Lankien, South Sudan, October 2017. © Kati Romics Left: Dr Andrew Dimitri (R) from Australia cares for a baby with pneumonia in Qayyarah hospital, Iraq. © Javier Rius Trigueros/MSF
Médecins Sans Frontières Australia Annual Report 2017 – 3 MESSAGE FROM THE PRESIDENT
In 2017, we witnessed continuing emergency team. We had received written authorisation from PNG authorities to destructive conflicts, major crises assess the medical conditions of refugees of displacement and unacceptable and asylum seekers inside the officially- attacks on healthcare facilities. closed regional processing centre on Manus. Despite this, we were not able to Globally, millions of people remain access the centre before the 328 remaining disproportionally affected by the impacts men were removed and sent to alternative of violence, disease and natural disasters. transit centres. We spoke out against Unfortunately, the critical situation and the denial of access, as an independent needs of these people, from refugees with humanitarian actor with the means to an uncertain future to civilians trapped provide much needed medical assistance in conflict zones, are often overlooked or to these people. Our team was eventually dismissed by the rest of the world. In this able to treat some men on the island, and context, independent humanitarian action we continue to monitor the situation. remains more essential than ever. All people should have equal access to medical Forgotten crisis in the Stewart Condon aid – regardless of their racial, religious, Central African Republic President political or economic status – and the right Médecins Sans Frontières Australia to be treated with dignity. While not a priority of the media in © Sarah Norton Australia, the conflict in the Central Revolutionising TB treatment African Republic (CAR) heightened in in Papua New Guinea 2017 and continues to take an extreme toll (see pages 22-23 for more details). Brutal In November, I travelled to one of our violence against civilians has led to mass projects in a nation close to home: displacement. Many people are extremely Papua New Guinea (PNG). There, in vulnerable and in desperate need of Gulf Province and the National Capital medical care. In 2017, Médecins Sans District, our teams are diagnosing and Frontières ran 17 projects in CAR, but treating the world’s deadliest infectious several attacks on our staff and hospitals disease, tuberculosis (TB), of which PNG forced us to cease work in some areas, a bears a heavy burden. I was struck by painful decision when this meant leaving the complexity of treating this disease patients without access to medical care in this setting, where geography makes that they clearly depend upon. accessibility extremely difficult. Devastating conflict in Yemen Moreover, the cultural barriers to treatment are high. In areas where Attacks on health facilities continued to education is limited, health literacy is low define another conflict in 2017, in Yemen. and patients often don’t understand how Dubbed “the forgotten war”, the conflict to limit the spread of TB. Many people in Yemen has claimed over 100,000 lives still believe TB is the result of sorcery. in three years. Providing emergency Médecins Sans Frontières runs mobile medical aid in this country continued to clinics and home visits to reach patients be a priority for Médecins Sans Frontières in remote areas and improve adherence Australia. In 2017 we directed the highest to treatment, together with counselling proportion of funding there with a and education programs. The use of a contribution of $4.1 million. Tragically, GeneXpert machine allows our teams to civilians, medical personnel and health quickly diagnose drug-resistant TB, and structures continued to be affected by individualise management. Medication fighting, and Médecins Sans Frontières for serious conditions like TB should be hospitals were hit by airstrikes and shelling available to all, and we have adapted our several times. These attacks leave both response in an effort to achieve this for the healthcare workers and people in need people of PNG. of medical treatment fearful to enter healthcare facilities. Civilians were further Immediately following this visit, I flew deprived of medical aid by the blockade on to another area of PNG, Manus Island, humanitarian assistance in 2017. as part of a Médecins Sans Frontières Dr Stewart Condon sits with a tuberculosis patient at her home on the outskirts of Port Moresby in Papua New Guinea. © Sophie McNamara/MSF
An uncertain future for the Rohingya governed organisation, but I believe our board offers good and reasonable this to be the case. Our board of oversight of the organisation, while In late 2017 a wave of Rohingya refugees directors, almost entirely comprised of continuing to challenge ourselves in the from Rakhine state, Myanmar, fled over returned field workers or others who work that we do. the border into Bangladesh, seeking have experience working in Médecins safety from horrific systematic violence Sans Frontières offices, takes the task of The lifesaving medical care provided by targeting this ethnic group. These governance seriously. This year we have Médecins Sans Frontières would not be displaced Rohingya quickly formed the worked together with management on possible without the generosity of our largest refugee camp in the world. Even market entry into New Zealand, allowing field partners and donors. To you, our in Bangladesh, they remain extremely our Kiwi donors the opportunity to have supporters, I express my sincere gratitude vulnerable, at the mercy of disease tax deductible donations. for making our mission a reality. related to poor living conditions and overcrowding, the enduring physical Our board committees, particularly the Stewart Condon and mental effects of violence, and the Governance and Association Committee President upcoming rainy season. Médecins Sans and the Finance, Audit and Risk Médecins Sans Frontières Australia Frontières has been treating conditions Committee have reviewed multiple issues including respiratory tract infections and over the year, and assisted the board in diphtheria as well as providing mental guiding our strategy. In 2017 we were healthcare and water and sanitation able to remit more funds to the field as support. The situation remains critical for well as maintain the ratios which guide the Rohingya, who continue to face an our work, so that we continue to spend uncertain future. reasonable amounts on administration. Our patients remain our focus, while we Governance in 2017 continue to prioritise our duty of care to our field staff – whether they responding It would be clichéd to say that Médecins to conflict in Yemen or an epidemic Sans Frontières Australia is a well- outbreak. Most importantly, I believe,
Médecins Sans Frontières Australia Annual Report 2017 – 5 2017: OUR YEAR IN REVIEW
In 2017, Médecins Sans Frontières the Philippines, Pakistan, Nigeria, South scaled up its response in emergency Sudan, Haiti, Liberia and Lebanon. contexts around the world, Raising the voice of our patients delivering medical aid to those who Throughout 2017, we participated in need it most with the support of our 70 speaking engagements, produced Australian executive team. approximately 100 pieces of original content, facilitated 149 external media With millions of people displaced globally interviews and had more than 763,000 after being forced to flee conflict or visits to our website. With 65.6 million persecution, continued violence against people forcibly displaced from their homes civilians and outbreaks of infectious around the world, we highlighted their disease, Médecins Sans Frontières perilous journeys and precarious living increased its capacity to deliver quality conditions with a communications project medical assistance. In the Message from during Refugee Week. Across the year the President (page 4), Dr Stewart Condon we placed a communications spotlight discusses the critical role for medical Paul McPhun on the crises affecting millions in Yemen humanitarian aid to address the needs Executive Director and Nigeria. My visit to Maiduguri, Borno of people caught in crises. In 2017, our Médecins Sans Frontières Australia state, allowed me to document the stories Sydney office team continued to work Médecins Sans Frontières New Zealand of some of our patients first hand and give diligently to support our operations in the © Meredith Schofield media interviews from our clinics. We also field and make our work assisting these prioritised coverage of the refugee crisis in people possible. the Mediterranean Sea and the desperate Our field staff situation of thousands trapped in Libya. We supported our operations with a long-term Through the efforts of our Field Human placement of our Media Coordinator on Resources department, Australian and the rescue ship Aquarius. Closer to home, New Zealand field workers filled a total we denounced our lack of access to refugees of 233 field positions in 37 countries. This and asylum seekers on Manus Island. exceptional number of placements was in direct response to a significant growth To allow New Zealanders to invest in in our emergency activities worldwide. Médecins Sans Frontières and become The countries most supported were Iraq, engaged and aware of our work, we South Sudan, Nigeria, Syria, Yemen, launched www.msf.org.nz and supported Bangladesh, Afghanistan, Uganda, our returning field workers to share their Tanzania and the Democratic Republic stories with the media and the public in of Congo. This list comprises some of New Zealand. the world’s most severe humanitarian Deepening operational support for forced emergencies and indicates the essential contribution made by our field staff. migration projects Delivering patient-centred care The Advocacy and Public Affairs team continued to offer services in political Our staff continued to deliver high quality, and sectoral analysis and networking patient-centred medical care to our in support of our field operations. In patients. In the Sydney Medical Unit (see 2017 field teams in Indonesia and Nauru message, page 10), our medical advisors were directly supported to improve worked to support our field projects in understanding of the political and sectoral improving paediatric, women’s health context of their operations, which focus on and sexual violence care. The Medical mental health for local populations as well Unit works in close collaboration with as forced migrants. In addition, we engaged colleagues of the Operational Centre with the Australian government and their Paris group, as well as in direct contact allies in the Bali Process and ASEAN with individual field projects. In 2017, to ensure our operational experience the Unit conducted 16 field visits to and perspectives on the situation of the provide technical expertise in Jordan, Rohingya fleeing Myanmar were well understood when those states’ actions influence their fate.
Following on from our work in 2016 addressing attacks on patients, staff, and facilities in war zones, our Advocacy staff led a successful engagement with the Australian Defence Force and other key sector actors to discuss matters including targeting, protection and International Law. Facilitating growth
The Finance and Administration team continued to improve internal controls, essential systems and drive efficiencies. The finance team has itself expanded to better support the overall growth of the office. One of the key areas of growth was the launch of our fundraising activities in New Zealand in 2017. This exciting step allows New Zealand supporters to make tax deductible donations to support medical humanitarian action.
The two-year information technology Paul McPhun meets with women in Bolori, Borno state, Nigeria in May 2017. © Jean-Christophe Nougaret/MSF strategy is being implemented, providing many direct benefits in online tools and Médecins Sans Frontières spoke out on To our supporters systems across the office and ensuring a behalf of its patients when confronted high level of data security. Following the by dramatic events. This valuable In 2017, our fundraising activities review and restructure of the Supporter research will support internal and generated a total of $88,039,735 mostly Relations team we are seeing improved external training and reflection in the through the generous donations of our one-on-one relationships with our field humanitarian sector. field partners and major donors. partners and growing supporter base. Our partnership with the Operational I would like to thank you, our supporters, Domestic Human Resources maintained Centre Paris continues to be our main for the trust you have placed in Médecins two priorities throughout 2017: a international engagement. A shared Sans Frontières. It is this trust that allows review of leadership within Médecins strategy is now under implementation our medical teams to set priorities based Sans Frontières, focusing on how we with specific contributions from on what they know best and are directly develop both current and emerging Australia to our field operations such confronted with. It is this trust that allows leaders to increase effectiveness across as our women’s and children’s health us to mobilise worldwide to respond the organisation, and an increased expertise, advocacy capacity and support quickly to emergencies, while maintaining investment in the health and wellbeing of in the development of field personnel. our independence and impartiality to act staff. As an extension to these priorities, on behalf of those often least visible. we have committed to an assessment of An assessment across the region of diversity and inclusion, ensuring that Southeast Asia has been undertaken In 2018 I will step down as Executive we cultivate a diverse workforce with in collaboration with our regional Director after eight fulfilling years in the the associated benefits of increased Médecins Sans Frontières partners in role, during which time the commitment productivity and innovation. Hong Kong and Japan. This highlighted and loyalty of our long-term supporters significant investment opportunities has continued to overwhelm and impress. International that will be further explored in 2018 Over these years I have met and formed in the countries of Malaysia, the a strong relationship with many of you, Médecins Sans Frontières Australia Philippines, Thailand and Indonesia. with goodwill, collaboration and a joint was active within the international determination to provide the best possible movement, positioning ourselves We were also finally able to support outcomes for the patients Médecins Sans strongly on priority setting for the launch of a new Médecins Sans Frontières serves. I am sincerely grateful operations, and leading or supporting Frontières program addressing the for what we have been able to achieve projects that benefit our operations significant gap in mental health services together and I trust that the strong worldwide. Médecins Sans Frontières in Nauru. The Sydney office plays a role collaboration will continue. Australia has taken responsibility for in directly supporting the operations of the international Speaking Out Case this new team in the region. Paul McPhun Studies project, which researches and Executive Director documents historical periods where Médecins Sans Frontières Australia Médecins Sans Frontières New Zealand
Médecins Sans Frontières Australia Annual Report 2017 – 7 AUSTRALIAN AND NEW ZEALAND FIELD STAFF IN 2017
Field workers from Australia and New Zealand filled 233 field roles in 2017, contributing to an international workforce of more than 45,000 people.
AFGHANISTAN Rosanna Sanderson INDIA Kyla Ulmer KYRGYZSTAN Anne Hoddle logistics team leader Parul Kashyap nurse Graham Baker paediatrician Sam Templeman HR officer Louise Timbs general logistician Carmel Morsi medical coordinator Stobdan Kalon nurse Vivegan Jayaretnam nurse Sandra Downing medical coordinator Malcolm Hugo logistics team leader epidemiologist mental health coordinator Heather Loane IRAQ LEBANON anaesthetist Tanya Coombes Aiesha Ali Mathew Zacharias Mohamad-Ali Trad Janet Coleman HR officer - regional pharmacist anaesthetist medical doctor midwife CAMBODIA Cath Deacon Melissa Hozjan medical doctor LIBERIA Jessica Chua Helen Tindall medical doctor anaesthetist Natalie Schulz Frederick Cutts nurse Daron Cunningham logistician-electrician Judith Forbes surgeon administration-finance anaesthetist CENTRAL AFRICAN REPUBLIC coordinator Peter Sheridan Eugen Salahoru David Danby logistics team leader Loren Shirley logistician-electrician Natalie Thurtle pharmacist medical doctor medical doctor William Johnson Diane Hanna logistician-electrician Megan Graham Heidi Woods Lehnen Neil Thompson nurse mental health coordinator administration-finance logistician-electrician LIBYA coordinator Hugo De Vries Elisha Swift midwife Neville Kelly Neil Thompson Miho Saito general logistician logistics team leader logistician-electrician midwife Katie Treble Emer McCarthy nurse Philippa Collins Nicole Campbell medical doctor nurse MALAYSIA nurse Emma Clark Corrinne Kong DEMOCRATIC REPUBLIC OF medical doctor Rachel Tullet administration-finance Rachael Auty CONGO medical doctor coordinator nurse Felicity Heath Ann Thompson nurse Raewyn Turner Rodney Miller midwife nurse MEXICO field coordinator Georgina Woolveridge Adelle Springer John Swinnen medical doctor Sacha Myers surgeon communications officer epidemiologist BANGLADESH Geri Dyer Andrew Dimitri Kaheba Clement Honda psychiatrist Shanti Hegde MYANMAR medical doctor obstetrician-gynaecologist medical doctor Grace Yoo Adelene Hilbig Arunn Jegatheeswaran Louisa Cormack pharmacist Sivapalan Namasivayam medical doctor logistics team leader anaesthetist field coordinator Graham Baker Jennifer Duncombe Ben Collard Rose Burns logistics team leader Stephanie Sarta field coordinator medical doctor logistics team leader logistics team leader Helmut Schoengen NAURU Eva Capa Corrales anaesthetist Suzel Wiegert ETHIOPIA nurse Beth O’Connor humanitarian affairs officer Andrew Dimitri Ivan Thompson psychiatrist Evan O’Neill medical doctor surgeon Vino Ramasamy HR officer - regional Carol Nagy medical doctor Prudence Wheelwright Jessa Pontevedra field coordinator Jacqui Jones midwife medical doctor ITALY Chandri Nambiar midwife Erica Spry cultural mediator GREECE Jessica Chua Jai Defranciscis anaesthetist psychologist nurse Trudy Rosenwald NIGER mental health coordinator Kevin Baker Lauren King communications officer Kaheba Clement Honda Jessie Watson anaesthetist nurse HR officer - regional HAITI Kiera Sargeant Shaun Cornelius Matthew Gosney Alex Rutherford medical doctor general logistician surgeon HR officer - regional Kimberley Hikaka Jordan Nastaran Rafiei Melissa Hozjan logistics team leader medical doctor medical doctor NIGERIA PAPUA NEW GUINEA Maurice Scott Sivapalan Namasivayam Claire Manera Allen Murphy Anna Haskovec logistics team leader anaesthetist field coordinator field coordinator logistics team leader Miho Saito Susan Bucknell David McGuinness Anne Taylor Jeff Fischer midwife logistics team leader nurse head of mission general logistician Petra van Beek Suzel Wiegert Diana Wellby Chatu Yapa Rachel Sun HR officer - regional nurse obstetrician-gynaecologist epidemiologist pharmacist Rachel Lister Toby Gwynne Haydar Alwash medical doctor nurse surgeon Corrinne Kong PHILIPPINES administration-finance Rosanna Sanderson Vanessa Cramond Helle Poulsen-Dobbyns coordinator Kaye Bentley administration-finance water and sanitation logistician medical coordinator medical coordinator Eileen Goersdorf coordinator Roslyn Brooks Virginia Lee Hugo De Vries nurse medical doctor mental health coordinator logistician-construction Erica Spry SERBIA Susan Bucknell TANZANIA Liam Hannon mental health coordinator Simone Silberberg logistics team leader medical doctor mental health coordinator Elisha Swift Frederick Cutts Susan Crabtree midwife Lisa Altmann logistician-electrician SIERRA LEONE midwife nurse Jennifer Craig Jacqui Jones Anita Williams Tien Dinh logistics team leader Melissa McRae midwife epidemiologist pharmacist medical coordinator Kristi Payten Janine Evans Annie Whybourne Tria Rooney medical coordinator Natasha Davies nurse medical doctor medical doctor nurse Morne Ferreira Jared Watts Bethany Lansom Ursula Alwash logistician-electrician Richard Lees obstetrician-gynaecologist nurse nurse anaesthetist Natasha Davies Jessica Paterson Daniel Baschiera SWAZILAND nurse Sita Cacioppe administration-finance general logistician field coordinator coordinator Nick O’Halloran Saschveen Singh Stella Smith administration-finance medical doctor Steven Purbrick Josiah Park field coordinator coordinator field coordinator logistics team leader UGANDA SOUTH SUDAN Tamaris Hoffman Keith Cavalli SYRIA Amy Le Compte surgeon logistics team leader Alan Hughes Aiesha Ali midwife obstetrician-gynaecologist pharmacist Tiffany Button Kelly Wilcox Anna Haskovec nurse field coordinator Alison Moebus Amy Neilson general logistician nurse Kerrie-Lee Robertson medical doctor Anthea Fisher VARIOUS administration-finance Ben Collard Annie Chesson logistics team leader Kylie Gaudin logistics coordinator logistics team leader coordinator midwife Hannah Hassell Kerry Atkins Brian Moller David MacFarlane midwife Robert Onus field coordinator field coordinator HR officer - regional obstetrician-gynaecologist Irina Petrova Liam Correy Brigid Buick Eric Boon psychologist Rose Stephens health promotion nurse nurse logistics team leader Janthimala Price Maurice Scott Catherine Flanigan Haydar Alwash field coordinator nurse general logistician surgeon Kaheba Clement Honda Natalie Thurtle Dwayne Minch Jane Davies nurse logistics team leader medical doctor nurse Khang Hoong Foong Sarah Scott Edith Torricke-Barton Jessica Chua pharmacist nurse medical doctor anaesthetist Kimberley Hikaka Shanti Hegde Evan O’Neill Jessica Vanderwal logistics team leader medical doctor obstetrician-gynaecologist nurse Lisa Mazlin Simon Black Freya Hogarth John Cooper nurse nurse logistician-electrician general logistician Stephanie Sarta Grace Yoo Kamal Heer general logistician PAKISTAN pharmacist surgeon Vanessa Cramond Kate Edmonds Hannah Rice midwife Kevin Baker medical coordinator midwife anaesthetist Lisa Yu Jai Defranciscis UKRAINE paediatrician Kriya Saraswati nurse general logistician Zen Patel Sarah Dina Jairam Kamala administration-finance mental health coordinator Peter Mathew coordinator Ramakrishnan surgeon Simon Roberts psychiatrist anaesthetist Rachel Tullet UZBEKISTAN Jezra Goeldi medical doctor Jemma Taylor logistics coordinator medical doctor PALESTINE Raewyn Turner Carol Nagy Malcolm Hugo nurse medical coordinator mental health coordinator YEMEN Ranya Samaan Caterina Schneider-King Carol Nagy Martin Sosa logistician-construction HR officer - regional field coordinator medical coordinator
This list of field workers comprises only those recruited by Médecins Sans Frontières Australia. We also wish to recognise other Australians and New Zealanders who have contributed to Médecins Sans Frontières programs worldwide but are not listed here because they joined the organisation directly overseas.
Médecins Sans Frontières Australia Annual Report 2017 – 9 MESSAGE FROM THE MEDICAL UNIT
Providing patient-centred, high quality care across paediatric, women’s health and sexual violence care projects was the focus for the Médecins Sans Frontières Australia Medical Unit in 2017. In 2017 the Medical Unit continued organisation and from local Ministries of to strive to deliver a high standard Health in countries where we work. of healthcare across Médecins Sans Frontières’ projects globally. In women’s Along with safe delivery care, and as an Dr Myrto Schaefer health we prioritised the development essential part of lifesaving healthcare Head of Medical Unit of quality obstetric support to deliver for women, we continued to offer safe Médecins Sans Frontières Australia babies safely, together with quality care for abortion care in our projects. We are © Meredith Schofield newborns from the start of life. providing emergency care for unsafe abortion, family planning and termination We fulfilled our primary responsibility of pregnancy on request, with sustained KEY MEDICAL FIGURES 2017 of supporting patient care in many ways, efforts to increase training and support for In projects supported by the Médecins Sans including through disease screening our teams. Frontières Australia Medical Unit and prevention, innovative treatment, providing better access to medical care for Cervical cancer prevention and treatment highly vulnerable patients, and increasing 16,000 our understanding of the contexts in Across our two projects providing cervical BIRTHS which we work. cancer prevention, in the Philippines assisted in Kabul, and Malawi, 4,807 women were screened Afghanistan Beyond the hospital walls: for cervical cancer. In the second year of obstetric and newborn care our project in the Tondo slum area of Manila, Philippines, we vaccinated more 4,807 WOMEN A key priority for the Medical Unit in than 23,000 girls against the human screened for cervical 2017 was further improving women’s papillomavirus (HPV) responsible cancer in the access to quality delivery care. We shifted for cervical cancer, and we increased Philippines and Marawi our focus to outside of the hospital, screening for cervical cancer by visual aiming to improve care and awareness inspection with acetic acid (VIA) by in communities. In Jahun, Nigeria, we over 500 per cent. This type of screening focused on delivery care in health centres allows for immediate recognition of 45,817 to enable women to safely deliver babies suspicious lesions and their treatment CHILDREN closer to home, aiming to reduce the on the same day. The implementation of admitted to therapeutic high rate of complicated deliveries and a mobile clinic in the form of a van set feeding programs reduce risk of consequences such as up to screen and treat patients provided fistula, foetal death and maternal death. more accessible care for women. In terms of higher level obstetric and 70,350 newborn care, the maternity hospital Treating malnutrition in young babies children in Kabul, Afghanistan, remained our hospitalised largest maternity program: in 2017, our Our treatment of paediatric malnutrition medical teams helped with the deliveries required context-adapted responses. In of some 16,000 babies, a quarter of all the 2017 we were involved at a larger scale 262 MEDICAL births assisted in Medical Unit-supported than ever before in providing treatment for STAFF TRAINED projects worldwide. malnutrition in infants under the age of six in emergency paediatric care months, in Qayyarah in Iraq, following the Across all our projects offering maternal evacuation of Mosul, and in Kobane/Ain healthcare, we also deliver quality care Al Arab in northern Syria. We provided 6,244 for newborns. In 2017 the Medical Unit formula milk for malnourished babies PATIENTS piloted a neonatal training program, of mothers who could not lactate and came for initial care linked to our neonatal guidelines, aimed at initiated activities aiming at re-establishing for sexual violence staff not experienced in newborn care. This lactation and breastfeeding support. received a good response both across the Globally, we admitted 45,817 children MESSAGE FROM THE MEDICAL UNIT
A young girl from Tondo, in Manila, the Philippines, receives a human papillomavirus vaccination in a clinic run by Médecins Sans Frontières and local organisation Likhaan, September 2017. © Hannah Reyes Morales
to our therapeutic feeding programs. In Syrian refugee population. In 2018 we reduce barriers to access care. In 2017 we 2017 we continued to work on simplified will continue to develop the provision of implemented sexual violence care in an strategies of treatment. The measure of a intensive care to critically sick children emergency context in Yumbe, Uganda, child’s middle upper arm circumference in this project. In Monrovia, Liberia we serving mainly South Sudanese refugees. (MUAC) was scaled up as an admission developed our first project to focus on This project saw 786 cases in the year. criterion to feeding programs in addition paediatric surgery. We plan to raise the As well as providing ongoing training to to being a screening tool, allowing faster level of care through training local staff in our international and national staff, the and more efficient identification of paediatric surgery, paediatric anaesthesia Medical Unit supported field operations children in need of therapeutic feeding. and high level paediatric care. In 2017 by developing the role of Sexual Violence a total of 262 medical staff were trained Mobile Implementation Officer. The High level paediatric care in emergency paediatric care across 14 Officer will, in 2018, provide face-to-face courses worldwide. In 2017, 70,350 children under 15 years of support in our projects to ensure a high age were hospitalised across our projects Care for victims of sexual violence quality of care is delivered to victims of and 788,257 children were treated in sexual violence. Médecins Sans Frontières health centres. Sexual violence care is increasingly a We opened a paediatric intensive care priority for the Medical Unit. In 2017, 2017 proved to be a challenging but unit (PICU) service in our project in 6,244 patients came for initial care, productive year for the Medical Unit. Zahle, Lebanon, close to the border with almost 50 per cent more than in 2016. In 2018, we will continue to work in Syria. The project encompasses a PICU The increase reflects the opening of new innovative ways to improve the care linked to a paediatric ward and chronic clinics providing sexual violence care, as we deliver. disease service to treat conditions such well as indicating that established clinics Dr Myrto Schaefer as epilepsy, asthma and thalassemia (a are seeing more patients. Our Mathare Head of Medical Unit hereditary blood disease), with the aim sexual violence project in Nairobi, Kenya, Médecins Sans Frontières Australia of providing specialised paediatric care running for over eight years, has added which otherwise is not accessible to the two decentralised clinics to continue to
Médecins Sans Frontières Australia Annual Report 2017 – 11 MEDECINS SANS FRONTIERES AUSTRALIA 2017 HIGHLIGHTS
Field Human Resources
Medical 27% 27% Non medical support staff 32%
Paramedical 41% 41%
* ‘Paramedical’ includes all health professionals who are not doctors. 32% In 2017, Australians and New Zealanders filled 233 field positions in 37 countries.
0.4% Income AUD
Field Partners 55.2% 52,559,910 11.2%
Other Donations 15.5% 14,737,178 10.6%
Bequests 11.2% 10,688,166 6.3% 55.2% 1% Major Donor Income 10.6% 10,054,481 15.5% Income from other Médecins Sans Frontières sections 6.3% 5,961,608
Other Income 1% 914,350
Gifts in Kind 0.4% 370,291
100% 95,285,984
*Due to rounding, percentages shown do not total 100%.
The 2017 income of Médecins Sans Frontières Australia totalled AUD$95.3 million. Of this AUD$88 million was income generated from fundraising activities. This is consistent with the 2016 level of fundraising income and represents continuing support from the Australian public. More than 129,000 Australians participate in the field partner program, contributing on a monthly basis to Médecins Sans Frontières Australia, and another 42,000 provide occasional gifts. 1% 1% Spending on Social Mission 3%
Africa 58%
Asia and the Middle east 37%
Americas 3% 37% 58%
Oceania 1%
Europe 1%
Spending on social mission was 80% of total expenditure, which is in line with 2016 spending. Consistent with previous years, this is split between Operational Centre Paris and Operational Centre Geneva.
Finance
2017 2016 Donation Income 88.04 88.31 Total Income 95.28 94.27 Social Mission Costs 83.1 74.16 Total Costs 102.3 90.17 Surplus/(Deficit) -7.02 4.099 Cash Reserves 22.25 34.66 ($m) ($m)
Our investment policy within Australia remains consistent with previous years. Short term deposits are used to maximise interest, minimise risk and ensure flexibility and accessibility of funds when required.
Médecins Sans Frontières continues to rely on the support of volunteers both in the field and in the office. The estimated total salaries forgone by field staff for 2017 is $4,866,479 (compared with $4,336,000 in 2016) and for office volunteers is $158,800 ($154,000 in 2016).
Médecins Sans Frontières Australia Annual Report 2017 – 13 MEDECINS SANS FRONTIERES PROJECTS FUNDED BY AUSTRALIAN AND NEW ZEALAND DONORS
36
2
17 33 13 1 27 12 14 19
10 21 24 11 7 30 37
25 8 6 31 18 5 35 15 9 34
20 22
32
Médecins Sans Frontières field projects are run by five operational centres (Amsterdam, Barcelona, Brussels, Geneva and Paris). The Australian section is an official partner of the Paris operational centre, and Australian and New Zealand donors contribute to funding projects run by both the Paris and Geneva operational centres. Australians and New Zealanders also fill field roles in projects run by all operational centres. “All people should have equal access to medical aid and the right to be treated with dignity.” - Stewart Condon, President, Médecins Sans Frontières Australia
Country MSF Paris MSF Geneva 1. Afghanistan 1,402,033 2. Armenia 150,761 3. Bangladesh 280,407 4. Cambodia 926,579 5. Cameroon 2,150,000 6. Central African Republic 2,562,942 400,000 7. Chad 1,206,091 1,000,000 8. Cote D’Ivoire 2,329,964 9. Democratic Republic of Congo 2,261,420 1,295,000 16 10. Haiti 1,402,033 11. Honduras 500,000
26 12. Iran 1,490,091 13. Iraq 1,249,239 2,000,000
3 14. Jordan 4,191,696 23 15. Kenya 3,430,204 1,200,000 29 16. Kyrgyzstan 150,000
4 17. Lebanon 1,491,026 18. Liberia 588,235 19. Libya 1,569,518 20. Malawi 753,807
28 21. Mali 2,980,182 22. Mozambique 100,000 23. Myanmar 94,744 24. Niger 1,507,613 2,000,000 25. Nigeria 4,672,354 26. Pakistan 1,490,091 27. Palestine 1,507,613 28. Papua New Guinea 1,040,519 29. Philippines 926,579 30. Sudan 2,000,000 31. South Sudan 2,087,295 2,000,000 32. Swaziland 1,355,000 33. Syria 753,807 3,281,956 34. Tanzania 200,000 35. Uganda 1,507,613 36. Ukraine 1,000,000 37. Yemen 4,275,268 716,863 TOTAL 50,034,979 21,443,563 OVERALL TOTAL: 71,478,542 *All figures are in Australian dollars
Médecins Sans Frontières Australia Annual Report 2017 – 15 PROJECTS FUNDED BY AUSTRALIAN AND NEW ZEALAND DONORS
This section describes those projects supported by the generous donations made to Médecins Sans Frontières Australia and Médecins Sans Frontières New Zealand in 2017. It also includes stories from people treated in these projects, and stories from field workers recruited by Médecins Sans Frontières Australia. For a complete record of Médecins Sans Frontières’ work in 2017, including projects funded through other Médecins Sans Frontières sections, please go to www.msf.org.
KEY:
TOTAL FUNDING
refers to the total cost of the projects described in the country description for 2017 (projects run by Operational Centre Paris and/or Operational Centre Geneva). All amounts are in Australian dollars.
MSFA FUNDING
refers to Médecins Sans Frontières Australia’s contribution to the country’s projects in 2017. All amounts are in Australian dollars.
MSFNZ FUNDING refers to Médecins Sans Frontières New Zealand’s contribution to the country’s projects in 2017. All amounts are in Australian dollars.
FIELD STAFF
refers to the total number of field staff in projects run by Operational Centre Paris and Operational Centre Geneva in 2017.
A Médecins Sans Frontières midwife with her son, who is examined by staff for symptoms of malaria in a clinic in Aweil, South Sudan. © Peter Bauza AFGHANISTAN
TURKMENISTAN AFGHANISTAN
KABUL Médecins Sans Frontières focuses on providing maternal healthcare in Afghanistan, which has some of the highest maternal and neonatal mortality rates in the world. The conflict in Afghanistan continued the facility’s capacity to provide non- PAKISTAN to intensify in 2017, exacerbating complicated maternity services. the already immense medical needs. Working at full capacity, the IRAN In Kabul, Médecins Sans Frontières newborn unit admitted 1,342 babies supports the Ministry of Public Health Project locations funded by Australian donors with complications such as sepsis, to provide 24-hour maternal care hypoglycemia and birth asphyxia [loss at Dasht-e-Barchi hospital, the only KEY ACTIVITIES: of oxygen around the time of birth]. Maternal healthcare, facility for emergency and complicated newborn care deliveries in a neighbourhood of more than one million people. Médecins Sans Frontières runs the labour and FUNDING: delivery rooms, an operating theatre TOTAL MSFA for caesarean sections and other complicated deliveries, a recovery room, $ 5,253,740 $1,402,033 a 30-bed maternity unit and a 20-bed neonatal unit. FIELD STAFF: In 2017, the Médecins Sans Frontières 278 team assisted almost 16,000 deliveries, a third of which were complicated KEY MEDICAL FIGURE: cases. At the end of the year, we started 16,000 babies delivered in to support another Ministry of Public Dasht-e-Barchi Health hospital in the area with staff, A mother and her child, who is receiving care in the Dasht-e- training and essential drugs to increase Barchi public district hospital, Kabul. © Aurelie Baumel/MSF, 2016 ARMENIA ARMENIA
Médecins Sans Frontières supports the Armenian health authorities in AZERBAIJAN treating patients with drug-resistant tuberculosis (DR-TB). Tuberculosis remains a significant public endTB partnership, a project that aims YEREVAN health concern in Armenia, with an to accelerate the use of bedaquiline estimated incidence of 44 new cases and delamanid, and to document their per 100,000 people in 2016. DR-TB safety and effectiveness in routine use. TURKEY prevalence is 47 per cent among patients At the end of 2017, 142 DR-TB patients who have already been treated for TB. started a regimen that included one of the two new drugs. To help patients cope Project locations funded by Australian donors Médecins Sans Frontières has supported with the constraints of the treatment, the Armenian health authorities in which lasts up to two years and involves KEY ACTIVITIES: providing treatment to DR-TB patients taking thousands of pills under medical Tuberculosis care since 2005 and has progressively observation, Médecins Sans Frontières expanded its activities. Since June 2016, has introduced a system enabling these have covered the whole country. FUNDING: patients to take some drugs at home, In 2013, with Médecins Sans Frontières’ with a medical staff member remotely TOTAL MSFA support, Armenia was among the connected by video. In 2017, 65 patients $2,522,361 $150,761 first countries in the world to use benefited from this system. bedaquiline, the first new drug to Since 2016, Médecins Sans Frontières be developed to treat TB in 50 years. FIELD STAFF: has also been offering treatment to The Armenian Ministry of Health 43 DR-TB patients co-infected with and Médecins Sans Frontières have hepatitis C, using direct-acting since collaborated to provide access antivirals, a new, effective and less KEY MEDICAL FIGURE: to delamanid, another new TB drug. toxic class of drugs. In 2017, 26 142 patients receiving innovative Since 2015, both drugs have been co-infected patients started treatment. DR-TB treatment prescribed in the framework of the
Médecins Sans Frontières Australia Annual Report 2017 – 17 BANGLADESH
INDIA
COX’S BAZAR DISTRICT
Project locations funded by Australian donors KEY ACTIVITIES: Paediatrics, primary healthcare, sexual and reproductive healthcare, water and sanitation activities
FUNDING: TOTAL MSFA $2,522,361 $280,407
FIELD STAFF: 278 A mother with her 18-month-old daughter in a Médecins Sans Frontières clinic in Bangladesh, where KEY MEDICAL FIGURE: the baby is being treated for a fever, cough and severe 400 patients treated per day breathlessness. The family crossed the border from in Tasnimarkhola Myanmar in September. © Mohammad Ghannam BANGLADESH In 2017, Médecins Sans Frontières dramatically scaled up its activities to encompassing a maternity department respond to a massive influx of Rohingya refugees from Myanmar. with a neonatal care unit, an intensive care unit, an isolation unit and an A concerted campaign of violence child malnutrition, which directly intensive therapeutic feeding centre. unleashed by the Myanmar military correlate with the abject living Médecins Sans Frontières also undertook against the Rohingya in Rakhine state, conditions in the settlements. In water and sanitation activities, Myanmar, from 25 August prompted 2017, teams established two health which in 2017 included providing the more than 660,000 people to flee across centres in Balukhali informal refugee health facilities with water, hygiene the border into Cox’s Bazar district, camp, and one health centre with and sanitation support through the Bangladesh, by the end of 2017, bringing a sexual and reproductive health construction of wells, latrines, greywater the total Rohingya refugee population service in Tasnimarkhola camp. The management and a waste zone; as well in the country to over 830,000. Most Tasnimarkhola centre treated an average as a deep drilling campaign to increase Rohingya are living under precarious of 400 patients per day, 30 per cent of access to clean water in the camps. shelters in heavily congested settlements who were children under five years prone to mudslides and flooding, where old. The centre also received victims To manage outbreaks of infectious the hygiene and sanitation conditions of sexual violence. A 50-bed hospital disease, Médecins Sans Frontières are dire, and there is a shortage of clean with an isolation room for people with established an active surveillance drinking water. infectious diseases was constructed system alongside a volunteer-based in Tasnimarkhola camp, dedicated outreach program to identify and refer In response to the huge growth in to children under 15 years of age. cases of diphtheria and measles in the needs, Médecins Sans Frontières The facility was the only one offering community. Our team also worked with massively scaled up operations in Cox’s inpatient care in the area. other Médecins Sans Frontières sections Bazar. The main conditions treated to support a Ministry of Health measles by the teams were respiratory tract Plans were made to open a second vaccination campaign in late November. infections, diarrhoeal diseases and hospital in Balukhali camp in 2018, A field worker story from Bangladesh
In December, Médecins Sans Frontières © MSF published results from six surveys it In addition to a clinic, we also have an outpost deeper in the conducted in refugee settlements in camp where we provide medical advice and essential medicines Bangladesh, which revealed that at least to patients unable to traverse the tricky path to our crowded 9,000 Rohingya died in Myanmar, in clinic. It also gives us extra eyes, as we monitor for potential Rakhine state, between 25 August and 24 outbreaks – cholera, measles, polio – all possible. September 2017. As 71.7 per cent of the reported deaths were caused by violence, Children account for more than the fair share of smiles I see, and at least 6,700 Rohingya, in the most in my mind each smile is defiance in the face of the statistical conservative estimations, were estimated peril facing paediatric patients. Or maybe it’s just a good to have been killed, including at least NAME: distraction. Children don’t know the numbers, but they know 730 children under the age of five years. Evan O’Neill hunger. We are seeing more children wasted to the point of Médecins Sans Frontières has routinely severe acute malnutrition (SAM). It is said that if you are a child collected accounts by refugees who FROM: arrived in Bangladesh after 25 August to with malnutrition, you are 10 times more likely to die from better understand the circumstances of Melbourne, VIC common camp afflictions, like diarrhoea or respiratory infections. their flight and the patterns of violence This worries me as I think about the spectre of malnutrition to which they have been exposed. At the FIELD ROLE: looming larger by the day. We are monitoring it and referring end of 2017, Rohingya continued to seek Medical Activity Manager, the ones we identify as SAM to the ambulatory malnutrition refuge in Bangladesh and a significant increase in humanitarian aid is needed Bangladesh, September to treatment centres in the camp and, eventually, referring the in 2018. November 2017 more severe cases to the intensive inpatient treatment centre Médecins Sans Frontières has a few kilometres north.
Médecins Sans Frontières Australia Annual Report 2017 – 19 CAMBODIA
PHNOM PENH
VIETNAM
Project locations funded by Australian donors
KEY ACTIVITIES: Hepatitis C care
FUNDING: TOTAL MSFA $5,299,315 $926,579
FIELD STAFF: 54
KEY MEDICAL FIGURE: 2,926 patients treated with Savorn is given a shot by a technician at the direct-acting antivirals clinic run by Médecins Sans Frontières in Phnom Penh, Cambodia. © Todd Brown
CAMBODIA A PATIENT’S STORY: Savorn is a father of three young children who lives and works in Phnom Penh. Like many In 2017, Médecins Sans Frontières people with hepatitis C in Cambodia, Savorn knew he was sick with the virus many years ago projects in Cambodia focused on and struggled to find any effective and affordable treatment. In early 2017, Savorn started on tackling hepatitis C. treatment, and in May he heard the good news that he was cured. In May 2016, Médecins Sans Frontières “Before I started this treatment, I felt launched a program offering free diagnosis hopeless. I couldn’t afford the new and treatment for hepatitis C. Although treatment and was waiting to die. its prevalence is unknown, an estimated If I wanted to have the treatment, I two to five per cent of the Cambodian needed to sell my house. If I sold my population is infected. Treatment for house, my kids would not have any this blood-borne virus, once considered a lifelong and deadly disease, has been shelter. Then someone told me about revolutionised in recent years with the a post on Facebook that Médecins arrival of new – and expensive – drugs, Sans Frontières was offering this new called direct-acting antivirals. treatment for free at Preah Kossamak The project is based at Preah Kossamak Hospital. I went straight to the clinic and hospital in the capital, Phnom Penh. One registered myself. This morning when of its goals is to simplify diagnosis and the doctor showed me the result, I was treatment, to show its cost-effectiveness overwhelmed with relief. I was really and make it replicable in other countries. happy and on the edge of crying.” In 2017 Médecins Sans Frontières treated A Médecins Sans Frontières volunteer nurse performs a 2,926 patients with direct-acting antivirals, fibroscan at the Preah Kossamak clinic in Phnom Penh, which cure more than 95 per cent of people Cambodia. © Todd Brown who complete the treatment. CAMEROON CAMEROON MORA Médecins Sans Frontières increased activities in north Cameroon to INDIA MAROUA provide emergency care for victims of violence. Since 2011, the conflict between armed referral service at the local hospital. The opposition groups and the Nigerian team stabilised patients and transferred army has forced hundreds of thousands those in need of specialised surgical care of people from northeast Nigeria to seek to Maroua hospital. refuge in Cameroon, Chad and Niger. Médecins Sans Frontières also During the past three years, violence has rehabilitated the operating theatre and Project locations funded by Australian donors increasingly spilled over from Nigeria post-operative ward at Maroua hospital into the three neighbouring countries, in 2016 and now manages its surgical KEY ACTIVITIES: causing further displacement. By the end department. During 2017 our teams Primary healthcare, secondary of the year, there were around 88,000 carried out 3,136 surgical interventions in healthcare, surgery, vaccinations refugees and 240,000 internally displaced Maroua. In Mora, our staff worked in two people in Cameroon. health centres serving displaced people FUNDING: Since the first suicide attacks on and local residents, and vaccinated 28,748 Cameroonian soil in Maroua in 2015, children against diseases including polio, TOTAL MSFA there have been frequent bombings in the diphtheria, tetanus, whooping cough, $9,335,530 $2,150,000 Far North region. In 2017 alone, Médecins measles and hepatitis B. Médecins Sans Sans Frontières recorded over 58 such Frontières also trained Ministry of Health attacks in the region – more than one staff in the management of large influxes FIELD STAFF: each week. In response, Médecins Sans of wounded patients and donated mass 378 Frontières scaled up emergency surgical casualty kits to local hospitals. activities and boosted capacity to treat KEY MEDICAL FIGURE: mass casualties following attacks. In the town of Mora, close to the Nigerian border, 3,136 surgical interventions Médecins Sans Frontières rehabilitated the in Maroua operating theatre and set up an ambulance
A young boy returns to his bed in the postoperative care unit of a regional hospital in Cameroon. © Alexis Huguet/MSF
Médecins Sans Frontières Australia Annual Report 2017 – 21 CENTRAL AFRICAN REPUBLIC
INDIA CENTRAL AFRICAN OUHAM-PENDÉ HAUTE-KOTTO REPUBLIC
BANGUI In the Central African Republic (CAR), renewed conflict and extreme levels of violence against civilians led to mass displacement and acute humanitarian needs. MAMBÉRÉ-KADÉÏ In 2017, non-state armed groups prefectures and the capital. In Paoua Project locations funded by Australian donors controlled 14 of the 16 prefectures in this (Ouham-Pendé), Carnot and Berbérati country of 4.5 million people. Thousands (Mambéré-Kadéï), Bria (Haute-Kotto) KEY ACTIVITIES: of civilians fled their homes because of and Bangui, the team provided basic, HIV/AIDS care, maternal fighting and violent attacks against them, specialised and emergency care, as well healthcare, nutrition, paediatrics, taking the number of people displaced in as maternity and paediatric services. sexual violence care, surgery recent years to 688,000 – around 15 per cent of the population. In neighbouring Responding to violence countries, the number of refugees from In 2017, Médecins Sans Frontières FUNDING: CAR rose to 545,000. adapted its projects in Bria and Paoua to respond to the urgent needs of those TOTAL MSFA The conflict directly affected the directly affected by the spiralling conflict. $27,774,259 $2,962,942 population’s access to medical care, food, In Bria, a surgical team was deployed water, shelter and education, and left them between January and April to support the in a state of extreme vulnerability. Brutal hospital’s regular paediatric activities, and FIELD STAFF: murders took place, including summary to treat the hundreds of patients wounded executions, some of which were witnessed 1,146 in the ongoing clashes in the region. by Médecins Sans Frontières staff. As Bria came under repeated attack, In 2017, Médecins Sans Frontières civilians who did not flee were trapped KEY MEDICAL FIGURE: continued to offer outpatient and in their homes, prompting Médecins 5,500 births assisted in Berbérati inpatient care to local communities Sans Frontières to set up mobile clinics and internally displaced people in three Thousands of civilians A field worker story from CAR fled their homes because of fighting and violent © MSF Even though I have been a doctor for nearly eight years and I thought I’d seen my fair share of sick kids, it turns out I attacks against them. hadn’t seen anything ‘til I got here. CAR is one of the poorest, hungriest countries in the world, with one of the highest infant mortality rates. The majority of kids who come through my emergency department are much sicker than any child I’ve ever seen in the west, and have diseases I’ve only read about in textbooks. Many are malnourished and weak before they even get sick, and live far away in camps for displaced people where they are visited occasionally by our mobile outreach clinics, so they’re usually desperately unwell by the time they reach us. A NAME: 19-year-old mother cycled 100km with her 3-week-old baby to Katie Treble get to us the other day. It’s a beautiful country but a brutal place to be a child, with FROM: tetanus, pneumonia, TB, starvation, diarrhoea and malaria all Byron Bay, NSW on the cards. The children survive through a pervasive resilience and cheerfulness, and for every death there are dozens who FIELD ROLE: pull through who I’d never have imagined could recover. They show me that being here and trying to swim against the Medical doctor, Bria, overwhelming tide of childhood disease isn’t always a completely February to June 2017 pointless, thankless task after all. A young girl is vaccinated in a health centre supported by Médecins Sans Frontières in Paoua, Central African Republic. © Alexis Huguet in a number of locations such as the PK3 prefectures. Teams treated victims of children from diseases such as diphtheria, displacement site. sexual violence and performed 4,128 hepatitis B, measles and pneumonia in surgical interventions. Carnot. In Berbérati, 22,400 women of The security situation in Paoua childbearing age were vaccinated against deteriorated considerably at the end of In Carnot, teams admitted 4,074 tetanus, which will also help protect their December. Fighting on the outskirts children to hospital and provided newborns in the future. of the city displaced more than 65,000 59,540 consultations in health facilities people and forced Médecins Sans supported by Médecins Sans Frontières. Project closures Frontières to end its support to seven HIV care After three years working in the hospital health centres. Until then, the team had in the prefectural capital, Berbérati, Teams continued to provide treatment for been running a primary and secondary and surrounding health centres, HIV/AIDS in CAR. The HIV programs healthcare program, and had treated Médecins Sans Frontières handed over in Paoua and Carnot focused on more than 1,000 patients for snakebites. its activities to the Ministry of Health in decentralising antiretroviral treatment at Overall in 2017, the team conducted September. Since the beginning of the primary healthcare level in challenging 78,782 outpatient consultations. project, Médecins Sans Frontières had and low-resource settings. In Bangui’s first district hospital admitted 20,700 children to the hospital’s Médecins Sans Frontières provided care, Vaccination campaigns paediatric unit, treated more than 4,570 including surgery, to victims of violence Médecins Sans Frontières carried children under five years of age for severe from the city and the surrounding out vaccination campaigns to protect acute malnutrition and assisted more than 5,500 births.
Médecins Sans Frontières Australia Annual Report 2017 – 23 CHAD LIBYA CHAD In 2017, violent clashes between armed opposition groups and military forces in the Lake Chad region, near the border with Nigeria and Niger,
LIWA forced people to flee inland.
BAGA SOLA Médecins Sans Frontières continued its mothers to detect malnutrition in their projects in Baga Sola and Liwa health children as early as possible, and also districts, in the Lake Chad region, where vaccinated malnourished children against MOISSALA access to healthcare is extremely limited common diseases. Project locations funded by Australian donors for local residents as well as refugees and displaced people. Teams run frequent Fighting malaria in Moissala KEY ACTIVITIES: mobile clinics providing primary Since 2010 in the health district of healthcare, including psychological Moissala, in southern Chad, Médecins Malaria care, maternal healthcare, support and treatment for victims Sans Frontières has focused on the nutrition, primary healthcare of sexual violence. Médecins Sans prevention and treatment of malaria Frontières also launched a preventive in children under the age of five and FUNDING: malaria treatment campaign (seasonal pregnant women. In 2017, four preventive TOTAL MSFA malaria chemoprevention) for children treatment campaigns against malaria under the age of five. During the year, reached a total of 111,757 children. $11,523,224 $2,206,091 teams carried out 79,363 outpatient Médecins Sans Frontières also supports consultations and 6,598 antenatal 22 health centres to manage simple cases FIELD STAFF: consultations, vaccinated 12,684 of malaria, and to refer other patients to people and screened 11,108 children for Moissala hospital where our teams run an 282 malnutrition. Médecins Sans Frontières antimalarial unit for complicated cases. is constantly developing and applying KEY MEDICAL FIGURE: new strategies to improve its response to 111,757 children protected emergencies, including malnutrition. For against malaria example, in this region, teams trained
A Médecins Sans Frontières nurse assesses a patient in a mobile clinic for local and displaced people in the Lake Chad region. © Sara Creta/MSF CÔTE D’IVOIRE CÔTE D’IVOIRE GUINEA Médecins Sans Frontières supports maternal and child health in the HAMBOL Hambol region of Côte d’Ivoire. The political and military crises of 2002 neonatal emergencies in this rural GHANA KATIOLA to 2010 have taken a severe toll on the setting by supporting Katiola referral LIBERIA Ivorian health system: according to the hospital and six primary health centres World Health Organization, it is one in the region. In 2017 Médecins Sans ABIDJAN of the weakest in Africa, with only one Frontières also started to rehabilitate medical doctor and five midwives per parts of Dabakala hospital, including the Project locations funded by Australian donors 10,000 inhabitants. As the maternal operating theatre, in order to improve mortality rate is very high, the Ministry of the management of caesarean sections. KEY ACTIVITIES: Health has made maternal healthcare one Médecins Sans Frontières supports all Maternal healthcare, of its main priorities, offering it free of these facilities with medical supplies newborn healthcare charge to all pregnant women. However, and personnel and operates an efficient budgetary restrictions, drug stockouts referral system for complicated deliveries. FUNDING: and a lack of trained health personnel, Training, coaching and supervision among other factors, continue to hamper of Ministry of Health staff also form a TOTAL MSFA access to good quality medical services for significant part of the program. women and young children. $6,952,601 $2,329,964 Every month in 2017, on average 415 In Hambol region the mortality rate deliveries were assisted in Médecins Sans FIELD STAFF: is estimated at 661 per 100,000 live Frontières supported facilities, including 198 births, according to a 2015 survey by over 40 caesarean sections; and 64 Epicentre, Médecins Sans Frontières’ newborns were admitted to the neonatal epidemiological research group. The ward at Katiola hospital. KEY MEDICAL FIGURE: Médecins Sans Frontières team, in 415 births assisted each month conjunction with the Ministry of Health, aims to improve care for obstetric and
A PATIENT’S STORY: Albertine cares for her baby in Koutiala hospital, Côte D’Ivoire, two days after her complicated delivery. Albertine was referred from Dabakala, more than 80 km away. Obstetrician-gynaecologist Dr Rasha Khoury explains Albertine’s case before getting ready to operate. “She needs to have her baby delivered by caesarean section because her baby is bigger than her pelvis. This is a potentially life-saving intervention, because if her labour prolongs she risks a uterine rupture or dystocia [obstructed labour], and both could cause serious, future complications for her. She has already had a caesarean for her first baby, and she took traditional medicine to accelerate the birth this time. In fact, this combination has already caused a partial uterine rupture.” One hour after surgery began, Albertine is out of trouble. Her newborn has survived but had to be resuscitated by a paediatrician and midwife, because his small lungs were filled with meconium [a baby’s first faeces]. He is under care in the neonatal intensive care unit. Says Rasha, “Without the quick referral from Dabakala, the emergency obstetric services here in Koutiala hospital, the trained staff, the blood bank and the newborn unit, mother and baby would probably have not survived.”
© Jean-Christophe Nougaret/MSF
Médecins Sans Frontières Australia Annual Report 2017 – 25 DEMOCRATIC REPUBLIC OF CONGO DEMOCRATIC REPUBLIC ITURI
NORTH KIVU OF CONGO Millions of people were displaced in the Democratic Republic of Congo (DRC) TANGANYIKA in 2017 as new waves of violence erupted. KASAI HAUT-LOMAMI In Goma, North Kivu province, Médecins Response to outbreaks Sans Frontières supports the Ministry of In the Upper Lomami region, teams Health to provide HIV/AIDS screening Project locations funded by Australian donors responded to an outbreak of cholera in in five health facilities. In 2017, 9,380 May which affected people in the areas KEY ACTIVITIES: people were screened. At the end of 2017, along the lakes of Kabamba and Kibala, Médecins Sans Frontières transferred HIV/AIDS care, maternal and the Lulaba River. Médecins Sans its activities in the hospital in Rutshuru, Frontières opened a cholera treatment healthcare, paediatrics, primary North Kivu, to the Ministry of Health. healthcare, outbreak response, centre, in which teams were treating 1,568 Teams had been supporting the hospital patients at the end of 2017. secondary healthcare, vaccinations since 2009, and in 2017 performed 6,582 surgical procedures and treated 4,606 Our team continued to work to bring FUNDING: people in emergency for malaria. an outbreak of measles under control in Nyunzu, Tanganyika province. Staff TOTAL MSFA After 11 years working in Gety in Ituri, vaccinated 78,467 children against the Médecins Sans Frontières handed over the $24,172,926 $3,556,420 disease in 2017. The region also remains last of its activities there to the Ministry affected by violence, with around 30,000 of Health. Since 2015, our teams had been people displaced from their homes. FIELD STAFF: gradually handing over responsibility Médecins Sans Frontières worked to for various departments to the ministry 428 provide primary and secondary healthcare and, with over 650 training sessions, had to refugees and the local community, ensured staff have the required knowledge including management of severe measles KEY MEDICAL FIGURE: and skills. From 2007, teams conducted cases and the opening of a 21-bed 78,467 children vaccinated 573,200 outpatient consultations, 16,900 paediatric department. Teams also carried against measles in Nyunzu postnatal consultations, admitted 42,900 out epidemiological surveillance for patients to hospital and assisted almost measles and cholera. 13,500 deliveries. As well as supporting paediatrics, women’s health, neonatology, Assistance to victims of violence emergencies and intensive care, our staff In July, Médecins Sans Frontières sent worked to prevent epidemics through a team to the Kasai region, based A Médecins Sans Frontières health promoter explains vaccination campaigns. Médecins Sans on reports of extreme violence and the importance of malaria testing and treatment, Frontières also helped to rebuild and displacement of people related to the at the health centre in Gety, Democratic Republic of renovate the regional hospital. Congo. © Caroline Frechard/MSF conflict between the Congolese armed forces and a new armed group. The team were the first representatives of an international organisation to assess the health zones of Dibaya and Thsimbulu. Staff conducted mobile clinics and screening for malnutrition in several health centres run by the Ministry of Health, and donated medical and food items to these health centres. Bwito, in Rutshuru territory, has seen a resurgence of intercommunal violence since 2016, with clashes between armed groups and with the Congolese army. Civilians continue to be subjected to brutal violence, resulting in forced displacement and a phenomenon of “mono-ethnicity” of certain areas. In the village of Bambu, Médecins Sans Frontières provided 23,058 primary healthcare consultations and supported the paediatric ward and an intensive therapeutic feeding unit in Bambu hospital. HAITI HAITI In Haiti, where quality healthcare is unaffordable for the majority, Médecins Sans Frontières provides free, specialised medical care to burns patients. In the capital Port-au-Prince, Médecins and infection control. In one innovative Sans Frontières is working in Drouillard technique, patients were treated with hospital, close to Cité Soleil slum. grafts of artificial skin. Most patients PORT-AU-PRINCE Drouillard is the only specialised came from the Port-au-Prince area, but Project locations funded by Australian donors centre in the country to focus on the some were referred from other regions by treatment of severe burns – a widespread air ambulance. Médecins Sans Frontières KEY ACTIVITIES: problem mostly linked to the dire living also trained medical staff and started Burns care conditions of destitute Haitians. Around constructing a new 40-bed hospital to half the patients are children under the replace the existing temporary facility age of five who have been injured in in 2018. FUNDING: domestic accidents. In 2017, the team conducted more than 1,300 emergency TOTAL MSFA room consultations and admitted almost $8,760,681 $1,402,033 700 patients. Treatment included surgery, dressings and pain management, as well FIELD STAFF: as physiotherapy, psychological care 314
KEY MEDICAL FIGURE: Droulliard is the only specialised centre in Haiti to 1,300 emergency room consultations focus on the treatment of severe burns.
A Médecins Sans Frontières nurse at Drouillard hospital, Haiti treats a patient who suffered severe burns in an explosion. © Spencer Platt/Getty
Médecins Sans Frontières Australia Annual Report 2017 – 27 HONDURAS HONDURAS Honduras continues to experience high levels of political, economic and CHOLOMA social instability, and has one of the world’s highest rates of violence. Women are among the worst affected by the medical, psychological and social consequences. In March 2017, Médecins Sans Frontières Médecins Sans Frontières teams in started working at a mother and child Choloma provide family planning, clinic in Choloma, a rapidly expanding ante- and postnatal consultations, assist Project locations funded by Australian donors industrial city in northern Honduras births, and offer psychosocial support that is notorious for its high levels of to victims of violence, including victims KEY ACTIVITIES: violence. Until Médecins Sans Frontières of sexual violence. In collaboration Sexual and reproductive opened the project, there were few health with the Ministry of Health staff, 19,271 healthcare, sexual violence care facilities catering for the needs of women outpatient consultations were carried out. in the area. Many pregnant women In October, Médecins Sans Frontières were not receiving antenatal care and began implementing its strategy for the FUNDING: delivery services remained extremely prevention of unsafe abortion practices TOTAL MSFA limited. The result was a high rate of through activities such as family medical complications among women of planning, counselling, contraceptive $1,549,544 $500,000 reproductive age. services and sexual violence prevention.
FIELD STAFF: 30 Our teams in Choloma provide family planning, KEY MEDICAL FIGURE: ante- and postnatal consultations, assist births, and 415 deliveries assisted each month offer psychological support to victims of violence.
A mental healthcare worker comforts a patient who has come to a Médecins Sans Frontières clinic in Honduras for medical and mental healthcare after suffering domestic violence. © Christina Simons/MSF IRAN
TEHRAN
IRAQ
SAUDI ARABIA
Project locations funded by Australian donors
KEY ACTIVITIES: Hepatitis C care, HIV/AIDS care, mental healthcare, sexual and reproductive healthcare
FUNDING: TOTAL MSFA $2,541,219 $1,490,091
FIELD STAFF: 40
KEY MEDICAL FIGURE: 19,575 outpatient consultations
A baby receives care in the primary healthcare centre in Tehran, Iran. © Samantha Maurin /MSF, 2013 IRAN Since 2012, Médecins Sans Frontières has been providing free healthcare treatment for hepatitis C. Iranian to excluded and marginalised groups in south Tehran, including drug authorities accepted a proposal for a new project to address drug issues users, sex workers, street children and the ghorbat ethnic minority. among the Afghan community in Although the prevalence of infectious and treatment for sexually transmitted Mashhad, which will be launched in diseases is relatively low in Iran (less infections. Patients can also be tested early 2018. than one per cent for HIV), it is much for communicable diseases such higher in these vulnerable groups. as HIV, tuberculosis and hepatitis According to the Iranian Ministry of C. Médecins Sans Frontières treats Health, more than 60 per cent of the hepatitis C patients with direct-acting Médecins Sans Frontières 160,000 HIV patients in the country are antivirals, which are effective and well- drug users, and an estimated 50 to 75 tolerated drugs, with a course of only per cent of injectable-drug users have three months. The team also operates offers medical services hepatitis C. a referral system, and runs mobile clinics in partnership with Society for designed for high-risk In Darvazeh Ghar district, Médecins Recovery Support, a local organisation Sans Frontières runs a clinic offering which specialises in support for addicts patients who experience a comprehensive package of medical and provides psychosocial assistance, services designed for high-risk patients harm reduction and shelter. In 2017, who experience stigma, or need more stigma, or need more teams conducted 19,575 outpatient help to follow their treatment. Services consultations and 3,495 individual include counselling and support from help to follow their mental health consultations in fixed and peer workers, psychosocial aid, medical mobile clinics. A total of 218 patients and mental health consultations, ante- treatment. were referred for care, and 45 started and postnatal care, family planning
Médecins Sans Frontières Australia Annual Report 2017 – 29 IRAQ A consultation in a mobile clinic near Zummar, Iraq. © Louise Annaud/MSF TURKEY MOSUL
ERBIL SYRIA NINEWA IRAN
BAGHDAD
SAUDI ARABIA
Project locations funded by Australian donors A consultation in a mobile clinic near Zummar, Iraq. © Louise Annaud/MSF KEY ACTIVITIES: Mental healthcare, paediatrics, primary healthcare, secondary healthcare, sexual and reproductive healthcare, surgery
FUNDING: TOTAL MSFA $33,674,538 $3,249,239
FIELD STAFF: 654
KEY MEDICAL FIGURE: 26,770 mental health consultations in refugee camps
In displacement IRAQ settlements teams The conflict in Iraq continued to take its toll in 2017, killing, injuring and provided primary displacing thousands of civilians. Many health facilities were destroyed, healthcare, treatment leaving the sick and wounded with no access to care. Although the conflict subsided in late assistance to people living in displacement for non-communicable 2017, humanitarian needs in Iraq remain settlements after having fled the violence. extremely high. More than 2.9 million Teams provided primary healthcare, people have still not been able to return to treatment for non-communicable diseases and mental their homes. diseases (NCDs) such as diabetes and hypertension, and mental health support, In the battle to recapture Mosul, many health support. including psychosocial counselling and civilians were killed and wounded in child therapy. Overall, teams carried the city or while trying to flee, due to out 25,168 primary health and non- explosions, bombings and shooting. communicable disease consultations and People fled east of Mosul, settling in 26,770 mental health consultations. camps in the governorates of Erbil and Ninewa where access to healthcare was Qayyarah extremely limited. Médecins Sans Frontières’ field hospital Camps for displaced people in Qayyarah operated at full capacity, providing surgery, emergency and Médecins Sans Frontières operated inpatient care, paediatric medicine, in 16 locations in Erbil and Ninewa nutrition and mental health support. governorates, delivering medical A field worker story from Iraq
©Alice Martins
NAME: Our health facilities in Iraq are remarkable, with all the required Kevin Baker surgical and anaesthetic equipment. There’s one operating theatre in a shipping container on the back of a truck, a second operating FROM: theatre in a tent, and a recovery room with an intensive care unit, Sydney, NSW where we maintain patients before transferring them. The injuries we were seeing were predominantly gunshot wounds. There was a shocking number of children under 15. Many of these kids weren’t FIELD ROLE: hit by a stray piece of shrapnel, but appeared to suffer sniper Anaesthetist, Mosul/ wounds – it seemed they had been intentionally hit. That was the Hammam Al Allil, most dramatic thing about this field placement: kids being shot, March to April 2017 even toddlers being shot. That was an emotional experience for the team, and there were plenty of tears shed, including my own.
Teams treated more than 1,000 people injured by explosions and Zummar emergencies in the first month, artillery fire. Teams established a 17- In Zummar, north of Mosul, Médecins carrying out over 90 surgeries. bed maternity hospital in Karama, a Sans Frontières continued to run a Following the end of the offensive on region deprived of access to maternal maternity clinic, an emergency room Mosul, the number of war-wounded and newborn healthcare. Staff assisted and a paediatric inpatient department patients decreased, and teams mainly 482 deliveries before the closure of the at Tal Maraq Hospital. The team offered received paediatric and burns cases project in mid-July. Médecins Sans sexual and reproductive healthcare referred from other health facilities in Frontières also supported Al Taheel and referrals for complicated cases. In the region. In 2017, our teams provided Hospital from March to August, where addition, mobile clinics were deployed to 14,306 emergency consultations, teams undertook 1,403 emergency neglected communities in Tal Afar district carried out 2,854 surgeries and consultations, mainly related to trauma, to provide primary healthcare, including admitted 1,421 patients to hospital. In and performed 1,827 dressings and 489 treatment for non-communicable February, Médecins Sans Frontières surgical interventions. diseases. After the Kurdish referendum managed the emergency department of in September and the subsequent border a trauma stabilisation post in Hammam Baghdad changes in that region, communities Al-Alil, 30 kilometres south of Mosul. In August, Médecins Sans Frontières previously cut off from medical care In that month, teams received a total of opened a rehabilitation centre with suddenly had access to the Zummar clinic. 1,895 patients. a 20-bed inpatient department in This resulted in a sharp increase in the Baghdad, to provide physiotherapy, number of people seeking help, and the East Mosul pain management and psychological team conducted a total of 10,600 sexual At Gogjali trauma stabilisation post, support to civilian war victims. Teams and reproductive health consultations and our teams received 1,077 emergency carried out 714 outpatient and 520 assisted 2,881 deliveries. cases in three months, including inpatient physiotherapy sessions.
Médecins Sans Frontières Australia Annual Report 2017 – 31 JORDAN JORDAN Médecins Sans Frontières runs healthcare programs to assist Syrian IRBID refugees and vulnerable Jordanians. AMMAN There are almost 650,000 registered Médecins Sans Frontières also
SAUDI ARABIA Syrian refugees in Jordan, the majority continued to support medical facilities of whom rely on humanitarian in southern Syria from Jordan through assistance to meet their basic needs. The medical donations, technical support huge growth in the number of people and distance training. has placed increased pressure on the Project locations funded by Australian donors health system. Reconstructive surgery in Amman The Amman reconstructive surgery KEY ACTIVITIES: Médecins Sans Frontières is the main hospital continues to treat war-wounded Mental healthcare, neonatal provider of reproductive healthcare for patients and indirect victims of violence care, sexual and reproductive Syrian refugees in Irbid governorate, from neighbouring countries. The healthcare, surgery where we run a 22-bed maternity hospital provides comprehensive care department and a neonatal intensive for patients requiring orthopaedic, care unit. This year, the teams assisted FUNDING: reconstructive and maxillofacial 4,120 deliveries, admitted 664 newborns surgery, including physiotherapy and TOTAL MSFA and carried out some 16,000 antenatal mental health support. In 2017, 1,150 consultations. We also increased our $27,155,062 $4,191,696 surgical procedures were performed, focus on mental healthcare, offering and an average of 188 patients were support to Syrian children and being treated in the hospital at any their parents in a project based in one time. FIELD STAFF: Mafraq, as well as through outreach 238 consultations and sessions held at the non-communicable disease clinics and KEY MEDICAL FIGURE: primary healthcare centre in Irbid. The various teams provided individual and 16,000 antenatal consultations group counselling, psychosocial support and health education sessions.
A PATIENT’S STORY: Manal was injured in 2015 when a missile exploded in the northern Iraqi city of Kirkuk. She was left with burns and muscle tightening which restricted movement in her forehead, neck, right ear, eyelid, right elbow and wrist. Before coming to Jordan, Manal had had no surgery. She had difficulty closing her right eye, which stayed slightly open while she slept, disturbing her rest. In Médecins Sans Frontières’ hospital in Amman, the physiotherapists massage her eye and teach her how to do it on her own. Since having surgery and intensive physiotherapy, Manal is able to close her eyes and sleep properly, as well as use her hands to pick out tunes on the guitar.
© Alessio Mamo KENYA ETHIOPIA KENYA SOMALIA In 2017, Médecins Sans Frontières continued to provide much-needed UGANDA medical care in Kenya’s refugee camps and slums, while also responding HOMA BAY to public health challenges including infectious disease outbreaks across
NDHIWA the country. NAIROBI Many public health facilities were number of incidents, this could be a result TANZANIA closed and thousands of people were left of outreach campaigns by our teams and MOMBASA without access to essential healthcare the local community, making people more Project locations funded by Australian donors for a large part of the year due to strikes willing to come forward. by health workers – doctors for the first HIV care in Homa Bay KEY ACTIVITIES: three months of the year, followed by HIV/AIDS care, maternal nurses from June until November. This More than 24 per cent of the population healthcare, sexual violence care, had a knock-on effect on Médecins Sans of Homa Bay county is HIV positive tuberculosis care Frontières’ activities, increasing the – the highest rate of HIV infection in number of patients presenting at our the country. Médecins Sans Frontières facilities and putting a strain on resources. supports both inpatient and outpatient FUNDING: In response, Médecins Sans Frontières set services in 33 facilities in Ndhiwa TOTAL MSFA up additional medical facilities and offered subcounty, in addition to two wards financial assistance for patients needing for patients with advanced HIV- $18,980,927 $4,630,204 specialised care in private clinics, which related diseases. Our teams work they could not otherwise have afforded. with the Ministry of Health and local communities to run outreach services, FIELD STAFF: Nairobi including door-to-door visits, testing 188 Médecins Sans Frontières continues and counselling, to reduce the spread to offer treatment to victims of sexual of HIV and the number of deaths from violence in the capital through its project HIV-related diseases. Médecins Sans KEY MEDICAL FIGURE: in Eastlands. In recent years, the team Frontières also supports the TB ward 7,864 births assisted in Likoni has recorded an increase in the number at Homa Bay county referral hospital, of people treated; rather than a rise in the treating patients with both drug- sensitive and drug-resistant strains of the disease. Obstetric care in Likoni In 2017, Médecins Sans Frontières implemented sexual and reproductive healthcare services and comprehensive emergency obstetric and neonatal care at the Mrima health facility in Likoni sub-county. A temporary container village was set up to accommodate the inpatient department, the laboratory and an operating theatre. A total of 7,864 deliveries were assisted in this structure, as well as 1,656 caesarean sections. Previously, pregnant women had to take a ferry across a channel to reach medical services in Mombasa. The ferry often experienced delays, putting the lives of women and their babies at risk. Construction and extension of the existing permanent health facility began in January 2017, and continued throughout the year. The project also has an important outreach component including health promotion activities and support for peripheral health facilities. A blood sample collection in Ndhiwa hospital, Homa Bay, Kenya. © Patrick Meinhardt
Médecins Sans Frontières Australia Annual Report 2017 – 33 KYRGYZSTAN KYRGYZSTAN KAZAKHSTAN In 2017, Médecins Sans Frontières continued to focus on the health effects of environmental pollution in the south-west of Kyrgyzstan.
AIDARKEN In the city of Aidarken, Batken district, child healthcare through mobile clinics. Médecins Sans Frontières is supporting In parallel, our teams are assessing the CHINA the Ministry of Health to deliver care possible impact of heavy metal pollution BATKEN for non-communicable diseases such as on public health. In 2017 teams supported anaemia and hypertension. The project, a total of 1,438 consultations, including 673 launched in December 2016, aims to non-communicable disease consultations Project locations funded by Australian donors provide better diagnosis and management and 765 obstetric consultations. of disease as well as improve mother and KEY ACTIVITIES: Primary healthcare A consultation in the Aidarken hospital, Kyrgyzstan. FUNDING: © Maxime Fossat TOTAL MSFA $2,039,385 $150,000
FIELD STAFF: 23
KEY MEDICAL FIGURE: Six primary healthcare centres supported
LEBANON LEBANON As neighbouring conflicts continue to spiral, more than one-quarter of Lebanon’s population is now composed of refugees, including over one million from Syria. ZAHLE This huge influx of people has put an in March. In total we are now providing SYRIA immense strain on the country’s services, secondary and tertiary healthcare, general such as education, healthcare, housing, paediatrics and paediatric intensive care, as BEKAA water and electricity. well as elective surgery. Teams are treating chronic diseases including epilepsy, asthma In the Bekaa Valley, where the majority of Project locations funded by Australian donors and thalassemia, a hereditary blood Syrian refugees has settled, Médecins Sans disease. From March, teams conducted Frontières opened a paediatric intensive KEY ACTIVITIES: 1,400 emergency room consultations. care unit in a government hospital in Zahle Paediatrics, secondary healthcare, surgery A PATIENT’S STORY: FUNDING: Sobhiya holds her seven-month-old grandson, Mohamed. TOTAL MSFA “My daughter, Amera, delivered her son Mohamed at home and not in a hospital, due to the difficult $5,976,659 $1,491,026 financial situation faced by her family. The size of the baby was very small, and the midwife told the family that Mohamed is not in a good condition.” Mohamed was born in a refugee camp in the Bekaa FIELD STAFF: Valley, where his parents and brother live. Since the baby’s birth, Mohamed’s family hasn’t stopped 82 visiting hospitals. They were relying on money from relatives to pay for each visit, until they heard about the free healthcare offered in the paediatric department run by Médecins Sans Frontières in KEY MEDICAL FIGURE: Zahle. Sobhiya comes to see her grandson in the hospital regularly. 1,400 paediatric emergency room consultations Sobhiya feeds her young grandson in a paediatric intensive care unit run by Médecins Sans Frontières in Lebanon. © Florian Seriex/MSF
LIBERIA LIBERIA In 2017, Médecins Sans Frontières prioritised paediatric care and mental health treatment in Liberia. CÔTE D’IVOIRE Médecins Sans Frontières set up In September 2017, Médecins Sans Bardnesville Junction hospital in Frontières started to support mental MONROVIA Monrovia in 2015 to support Liberia’s health and epilepsy care at four primary health services during the Ebola crisis. healthcare centres in and around Originally serving children under Monrovia. A Médecins Sans Frontières the age of five, in 2017 the admission psychiatrist and two mental health criteria were broadened to include clinicians offer guidance on diagnosis Project locations funded by Australian donors patients up to the age of 15. During and treatment to Ministry of Health 2017, staff attended to 7,040 children personnel at the health centres, and KEY ACTIVITIES: in the emergency room and admitted psychosocial workers train volunteers Malaria care, mental healthcare, almost 6,000 patients, mainly for to identify people in the community nutrition, paediatric care, surgery malaria, severe acute malnutrition who need treatment. Médecins Sans and respiratory tract infections. Frontières also provides psychiatric FUNDING: and anti-seizure medications. With Bardnesville Junction hospital Médecins Sans Frontières’ support, the TOTAL MSFA continued to serve as a teaching health centres carried out 2,446 mental $8,978,347 $588,235 hospital, providing placements for health and epilepsy consultations. nursing students. The team conducted operational research on paediatric FIELD STAFF: health issues, including paracetamol 290 intoxication. In late 2017, an operating theatre was constructed for a paediatric KEY MEDICAL FIGURE: surgery program that opened 7,040 children received in January 2018. emergency care
Médecins Sans Frontières Australia Annual Report 2017 – 35 LIBYA KHOMS ZLITEN LIBYA
MISRATA BENGHAZI In 2017, widespread violence and insecurity in Libya meant that BANI WALID Médecins Sans Frontières was one of the few international organisations working in the country. Despite the instability and ongoing exploitative. Médecins Sans Frontières conflict, Libya remained a destination also denounced European governments’ NIGER for migrant workers from across migration policies to seal off the coast CHAD the African continent and a transit of Libya and ‘contain’ migrants, asylum Project locations funded by Australian donors country for migrants, asylum seekers seekers and refugees in a country where and refugees attempting to cross the they are exposed to extreme, widespread KEY ACTIVITIES: Mediterranean and reach Europe. violence and exploitation. Mental healthcare, paediatrics, In 2017, Médecins Sans Frontières In Misrata, Khoms and Zliten, medical primary healthcare, sexual and provided medical assistance to migrants teams started working in five detention reproductive care and refugees arbitrarily held in centres, carrying out a total of 1,351 detention centres that are nominally consultations and referring 49 patients FUNDING: under the control of the Ministry of for further treatment. The majority the Interior. Most medical complaints of migrants and refugees in Libya TOTAL MSFA were related to the conditions in live outside detention centres, and $7,182,049 $1,569,518 which people were detained, with like the local communities, they are overcrowding, inadequate food and affected by the deterioration in public drinking water and insufficient health facilities, which face drug and FIELD STAFF: latrines resulting in respiratory tract staff shortages. In Misrata, Médecins 53 infections, musculoskeletal pain, skin Sans Frontières opened an outpatient diseases such as scabies infestations, clinic offering primary healthcare and KEY MEDICAL FIGURE: and diarrhoeal diseases. Médecins Sans referrals to patients of all ages and 1,351 consultations in migrant Frontières publicly called for an end to nationalities. Médecins Sans Frontières detention centres the arbitrary detention of migrants and supported the main hospital to improve refugees in Libya, calling it harmful and infection control and also scaled up its response to the needs of migrants and refugees in the area. In mid-2017, teams also started to work in Bani Walid, reportedly a major transit hub for smugglers and traffickers. In partnership with a local organisation, Médecins Sans Frontières assisted people who had been held captive by criminal networks in the area but had managed to escape. Many had survived kidnapping for ransom, extortion and torture. The team provided 479 medical consultations to survivors and referred 24 patients to hospitals in Misrata and Tripoli. In the east of the country, Médecins Sans Frontières ran a clinic in Benghazi in collaboration with a Libyan non-governmental organisation, offering paediatric and gynaecology consultations to displaced and vulnerable women and children. In 2017, teams held 12,501 paediatric consultations, and saw 8,798 gynaecology and obstetric cases. Teams also provided mental health support to children and families affected by trauma and violence.
A consultation with female migrants in a detention centre outside of Misrata, Libya. © Tankred Stoebe/MSF MALAWI
TANZANIA MALAWI ZAMBIA The main focus of activities for Médecins Sans Frontières in Malawi continues to be improving care for HIV patients, particularly adolescents and other vulnerable groups. Since the 1990s, when the HIV epidemic aimed at improving management of these was at its peak in the country, the situation patients and their adherence to treatment. BLANTYRE CHIRADZULU in Malawi has improved greatly but there They include setting up comprehensive, remains work to be done. By mid-2017, multidisciplinary services for adolescents, Project locations funded by Australian donors 714,691 people living with HIV were taking patients facing difficulties staying on lifelong antiretroviral treatment. treatment or those not responding to treatment. KEY ACTIVITIES: Yet HIV remains the leading cause of Cervical cancer care, HIV/AIDS death among adults in Malawi, and there Prevention and early treatment of care, sexual and reproductive are still around 28,000 new cases each cervical cancer healthcare year. The progress made relies heavily Malawi has the highest incidence of on international funding, and there is a cervical cancer in the world, with an critical lack of qualified health staff. FUNDING: estimated 75 of every 100,000 women TOTAL MSFA Care for adolescents in Chiradzulu newly affected each year. Yet only 10 to 20 per cent of women in the country $4,420,810 $753,807 In Chiradzulu, Médecins Sans Frontières is completing the four-year handover receive early screenings, while preventive of its HIV activities to the Ministry of vaccination is not implemented. FIELD STAFF: Health. However, in 2016, Médecins Médecins Sans Frontières is developing 138 Sans Frontières studies showed gaps in a comprehensive project in Blantyre the detection and timely management city and Chiradzulu district, including screening and treatment for pre- KEY MEDICAL FIGURE: of patients failing first- and second-line HIV treatment and revealed that only cancerous lesions, vaccination against 2,912 patients younger 30 per cent of adolescents were under human papillomavirus (the main cause than 20 years receiving effective treatment. Médecins Sans of cervical cancer), treatment for cervical antiretroviral treatment Frontières is developing specific activities cancer and palliative care.
Alfred, 18 years old, is receiving treatment for HIV in Chiradzulu, Malawi, where Médecins Sans Frontières is working to improve adherence to antiretroviral treatment for adolescents. © Luca Sola
© Luca Sola A PATIENT’S STORY: Debora, 18, is HIV-positive. She is receiving care from Médecins Sans Frontières at Mbulumbuzi Health Centre in Chiradzulu. “I feel ok, because I have accepted that I am HIV-positive. With the counselling I received I realised that being HIV-positive is not the end of everything. The main constraint for me is not being able to study at boarding school because I always think how I will be taking my drugs, and how my friends will think of me if they know I am taking ARVs (antiretrovirals). I know that one day I will achieve my dream of becoming a journalist. With proper medication the future is bright.”
Médecins Sans Frontières Australia Annual Report 2017 – 37 MALI MALI Persistent insecurity, particularly in northern and central regions, has MAURITANIA resulted in an overall deterioration of the national health system and TIMBUKTU basic social services in Mali. TENENKOU NIGER In Koutiala, in the south of the country, In Ténenkou, teams provide primary Médecins Sans Frontières runs a and secondary healthcare for women BURKINA FASO comprehensive paediatric program and adolescents. Staff support the KOUTIALA aimed at reducing the morbidity and maternity ward, operating theatre Project locations funded by Australian donors mortality of children under the age and the outpatient department at the of five, many of them vulnerable to referral health centre. In 2017, teams KEY ACTIVITIES: malaria and malnutrition. As part of conducted 5,597 consultations with Malaria care, nutrition, sexual and the program, which links community women of childbearing age and 2,068 reproductive care, paediatrics and hospital-level care in collaboration prenatal consultations. Médecins Sans with the Ministry of Health, the Frontières also supports malaria health team supports nutrition services in workers to manage malaria cases in FUNDING: Koutiala’s main referral hospital and in five health centres during the peak TOTAL MSFA 15 community health centres. In 2017, malaria months, and runs mobile 2,644 children were hospitalised for clinics offering basic healthcare to hard $12,737,530 $2,980,182 treatment of severe acute malnutrition. to reach communities. A total of 5,373 In the peak malaria season, from people were treated for malaria. FIELD STAFF: August to November, Médecins Sans Médecins Sans Frontières’ project in the Frontières dispatches extra community 489 regional referral hospital of Timbuktu, workers in the health district to identify, which opened in 2012, was handed over manage and refer cases. Our teams are KEY MEDICAL FIGURE: to local authorities in April. currently constructing a new, 185-bed 2,644 children treated for severe paediatric care unit to improve facilities acute malnutrition in the hospital. MOZAMBIQUE MOZAMBIQUE Médecins Sans Frontières provides specialised care in Mozambique, ZAMBIA where the frail health system is struggling to curb a dual epidemic of HIV and tuberculosis (TB). Mozambique has one of the highest rates treatment for injectable drug users, focusing of HIV prevalence in the world. Around 13 on developing a model of care that SOUTH per cent of people aged 15-49 are infected includes comprehensive harm reduction. AFRICA MAPUTO and 34,000 people co-infected with HIV Of the 27 patients with hepatitis C who and TB die each year. received treatment, 10 were cured – the Project locations funded by Australian donors first in the country as treatment was In Maputo, Médecins Sans Frontières cares previously unavailable. for patients needing second- or third-line KEY ACTIVITIES: antiretroviral treatment and for those with Hepatitis C care, HIV/AIDS care, co-morbidities such as Kaposi’s sarcoma, tuberculosis care drug-resistant tuberculosis (DR-TB) and In Maputo, Médecins hepatitis. Kaposi’s sarcoma is a cancer FUNDING: that particularly affects patients with Sans Frontières cares for poor immune function. Médecins Sans TOTAL MSFA Frontières has provided these patients patients needing second- $5,954,159 $100,000 with a new, improved treatment allowing quicker recovery. A total of 1,498 patients or third-line antiretroviral were taking this new drug in 2017. Our FIELD STAFF: teams also provide comprehensive care for treatment and for those 129 multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis with co-morbidities such KEY MEDICAL FIGURE: (XDR-TB). A hepatitis C treatment program 1,498 people received new treatment was scaled up during the year to include as Kaposi’s sarcoma. for HIV and co-morbidities Médecins Sans Frontières supplies in a health centre in Mozambique. © Morgana Wingard/NAMUH/MSF, 2016
MYANMAR MYANMAR In 2017 in Myanmar, armed conflict, displacement, intercommunal SHAN tensions and statelessness led to a significant crisis. Meanwhile, provision of medical care diminished further as aid organisations were refused access. In August, attacks on police posts in In eastern Myanmar, in Wa Special Rakhine state prompted government Region 2, Médecins Sans Frontières ran forces to respond with grossly clinics to provide primary healthcare disproportionate security operations. in an area where access to medical Project locations funded by Australian This caused a catastrophic humanitarian treatment is severely limited. and New Zealand donors. situation in the state, prompting over Due to a worsening political situation 660,000 people – mostly Rohingya – to and the inability to secure access for KEY ACTIVITIES: flee to Bangladesh by the end of the year. international staff, Médecins Sans Primary healthcare At the end of 2017, Médecins Sans Frontières activities in Wa ended in Frontières was still still waiting for official mid-2017. Until this point, teams FUNDING: permits to carry out medical activities, conducted over 2,438 outpatient Rohingya continued to flee across the consultations through fixed and TOTAL MSFA MSFNZ border into Bangladesh, and very few mobile clinics. $1,654,149 $33,138 $61,606 humanitarian actors were allowed to respond in Rakhine. FIELD STAFF: 9 In Wa, Médecins Sans Frontières ran clinics in an area KEY MEDICAL FIGURE: where access to medical treatment is severely limited. 2,438 outpatient consultations
Médecins Sans Frontières Australia Annual Report 2017 – 39 NIGER NIGER ALGERIA In Niger, Médecins Sans Frontières focused on reducing child mortality, particularly during the peak malnutrition and malaria season, and MALI DIFFA continued providing healthcare to refugees and displaced people in Diffa. CHAD ZINDER Every year, people in Niger face the Diffa TILLABÉRI MARADI MAGARIA annual ‘hunger gap’ between June People living in Diffa region, on the NIAMEY and September, when the number MADAROUNFA of malaria and malnutrition cases border with Nigeria, continue to suffer the consequences of the violent clashes Project locations funded by Australian donors increases dramatically. Without early treatment, severe cases can result in between armed opposition groups in medical complications. Médecins Sans Nigeria and the different military forces KEY ACTIVITIES: in the region. In 2017, Médecins Sans Malaria care, nutrition, Frontières has worked in Magaria, in Zinder region, since 2005, and in 2017 Frontières started supporting Mainé- outbreak response, Soroa district, providing primary and paediatrics, vaccinations continued to boost the capacity of the paediatric unit in Magaria district secondary healthcare to cross-border and hospital by providing staff and training. mobile populations living between Niger FUNDING: Between June and December, when the and Yunusari Local Government Area number of admissions for malnutrition in Yobe state, Nigeria. Teams ran mobile TOTAL MSFA and malaria increased, the paediatric unit clinics and supported the referral of $17,889,000 $3,507,613 had a peak capacity of 600 beds. More surgical, paediatric and internal medicine than 14,849 children under the age of cases to Mainé-Soroa hospital. In total, staff carried out 46,569 consultations in FIELD STAFF: five were treated in the paediatric unit of Magaria hospital in 2017. In addition, Mainé-Soroa and in Kanama, Yunusari. 759 Médecins Sans Frontières staff worked in Maradi six health centres and one health post to In Madarounfa district, Maradi region, KEY MEDICAL FIGURE: support primary healthcare for children Médecins Sans Frontières continues to 14,486 children treated for and hospital referrals for the most severe run its paediatric program focusing on severe malnutrition cases. Observation rooms were set up in the management of the main causes of the busy health centres of Dantchiao and childhood death, notably malnutrition Magaria, where patients were stabilised and malaria. Mothers also come over the before being transferred, if necessary, to border from Nigeria to seek treatment the paediatric unit in Magaria. Médecins for their children. The program, which Sans Frontières teams also led awareness- opened in 2001, today comprises inpatient raising sessions in Magaria. A child is treated for malaria by a nurse in a community health care for severe malnutrition and its centre in Magaria, Niger. © Sarah Pierre/MSF complications, malaria and other diseases affecting children under the age of five in the district hospital, and outpatient treatment for severe malnutrition without complications in five Madarounfa health zones. Médecins Sans Frontières- supported community health workers are active in 34 villages during the peak malaria season to ensure early detection and treatment of simple malaria and screening for malnutrition. Our teams have scaled up health promotion and community-based healthcare activities. A total of 14,486 children in Madarounfa district received outpatient care for severe malnutrition in 2017. Meningitis outbreak Cases of meningitis were detected in Niamey in February and March 2017. The epidemic threshold was crossed in Boukoki, Lazaret and Foulan Koira health areas. Our teams conducted a vaccination campaign in coordination with the Ministry of Health, to immunise 320,000 people in the regions of Niamey, Dosso and Tahoua. NIGERIA JIGAWA BORNO NIGERIA In Nigeria, assisting people caught up in the conflict between armed MAIDUGURI opposition groups and the military remained a priority for Médecins Sans Frontières in 2017. Civilians are bearing the brunt of the emergency care and intensive care, conflict, which entered its eighth year in outpatient therapeutic nutritional centres, CAMEROON 2017. According to the United Nations, and basic obstetric and neonatal care. RIVERS more than 1.7 million people are internally The Borno Emergency Support Team displaced in the northeast of Nigeria. Project locations funded by Australian donors works to reduce the mortality and Of these, some 80 per cent are in Borno. morbidity of vulnerable people in the Thousands have been killed in the fighting KEY ACTIVITIES: region, and to respond to emergency needs. and many more by the deadly combination Nutrition, paediatrics, outbreak In 2017, the team focused on surveillance, of malnutrition, measles and malaria. In response, sexual and reproductive vaccinations, screening for malnutrition, 2017, Médecins Sans Frontières continued healthcare, sexual violence care therapeutic food distribution, and water to expand its programs focusing on women and sanitation activities. The emergency and children. It is estimated that 58,000 team also responded to a cholera outbreak FUNDING: women die from complications during in Monguno and Maiduguri. In total, staff pregnancy and childbirth every year and vaccinated 75,676 children in Borno. In TOTAL MSFA one in eight children dies before the age Monguno, also in Borno state, Médecins $29,803,148 $4,672,354 of five. Sans Frontières admitted 2,280 people Responding to armed conflict for hospital care. Our team also assisted FIELD STAFF: in the northeast the development of water and sanitation 1,044 activities in camps for displaced people. Médecins Sans Frontières has scaled up its assistance in Borno state over the past two Providing healthcare for KEY MEDICAL FIGURE: years, but access to areas held by armed women and their newborns 75,676 children vaccinated opposition groups, or contested by the In the Médecins Sans Frontières-run in Borno two sides, has been restricted, and little is maternity and neonatal departments known about the needs of people in these of Jahun general hospital, in Jigawa locations. Although the nutrition situation state in the north, a high proportion of has generally stabilised in Maiduguri, the 1,000 women admitted per month capital of Borno state, due to a massive in 2017 were suffering from obstetric deployment of aid, vulnerable pockets still complications such as eclampsia. Our remain. In some enclaves controlled by the team also treated 325 women for vesico- military, people are unable to farm or fish vaginal fistula, a condition resulting from due to restrictions on their movements, prolonged obstructed labour that requires making them heavily dependent on complex surgery. To reduce pregnancy humanitarian assistance. Our teams complications, teams also support basic continued to deliver health services obstetric care in health centres. for women and children in Maiduguri, A doctor checks a patient’s blood pressure in the Jahun providing paediatric consultations, In the southern Rivers state, in partnership general hospital, Nigeria. © Maro Verli with the Ministry of Health, Médecins Sans Frontières opened a second clinic in Port Harcourt offering comprehensive care to victims of sexual violence. In 2017, the team received 950 new cases. Outreach and community-based awareness activities were also organised in schools, police stations and through the media. Emergency response The Emergency team ‘EPrep’, based in Abuja, was created in 2006 to enable Médecins Sans Frontières to react to natural and man-made disasters and epidemics. In 2017, the team responded to the meningitis outbreak in Katsina state, supported the Monguno team in responding to the cholera epidemic, and performed consultations and referrals in mobile clinics in Yobe state.
Médecins Sans Frontières Australia Annual Report 2017 – 41 PAKISTAN KHYBER PAKHTUNKHWA PAKISTAN FATA AFGHANISTAN Access to healthcare remains a challenge in Pakistan, especially for women and children: women die from preventable complications during pregnancy and delivery, and newborn care is unavailable in many parts of the country. INDIA Médecins Sans Frontières continues certificate required for carrying out to fill gaps in healthcare, particularly medical activities in FATA would not in isolated rural communities, urban be renewed, but gave no explanation for slums and areas affected by conflict. this decision. It is likely that the closure Project locations funded by Australian donors of these medical facilities delivering Emergency, maternal and newborn care free, high-quality healthcare will have KEY ACTIVITIES: in Khyber Pakhtunkhwa serious negative implications for people Emergency care, maternal In Peshawar Women’s Hospital who rely on them. Médecins Sans Frontières operates a healthcare, neonatal care, Médecins Sans Frontières had been comprehensive 24-hour emergency paediatrics, primary healthcare providing medical services in Kurram obstetric care service for patients for 14 years at the time of the closure. referred from surrounding districts In Sadda, Médecins Sans Frontières was FUNDING: and the Federally Administered Tribal responsible for the paediatric outpatient Areas (FATA). The hospital has 24 TOTAL MSFA and inpatient departments. Teams obstetric beds and an 18-bed unit for also ran the newborn unit, and treated $7,028,036 $1,490,091 premature and severely ill newborns patients with the parasitic skin disease requiring specialised care. In 2017, cutaneous leishmaniasis. In Alizai, our 3,687 deliveries were assisted, including FIELD STAFF: teams ran the paediatric outpatient 489 caesareans. 300 department and observation room. In Forced closure of projects in FATA 2017, up until closure, Médecins Sans Frontières carried out a total of 26,567 KEY MEDICAL FIGURE: In September and November outpatient consultations in Sadda 3,687 births assisted in Peshawar respectively, the authorities informed and Alizai. Médecins Sans Frontières that the
A newborn receiving respiratory assistance in Médecins Sans Frontières’ maternity hospital in Peshawar, Pakistan. © Shaista Aziz/MSF PALESTINE PALESTINE NABLUS In Palestine, Médecins Sans Frontières provides psychological assistance in the West Bank and specialist medical care to burns and trauma patients in the Gaza Strip. GAZA STRIP Médecins Sans Frontières runs mental Overall, staff performed 2,238 GAZA CITY health programs offering confidential psychological consultations in Nablus support in Nablus governorate, where in 2017. the ongoing occupation and internal Gaza Strip Project locations funded by Australian donors violence continue to have a serious impact on the physical and psychological A number of factors have contributed KEY ACTIVITIES: health of the people. They are exposed to the deterioration in the general Burns care, mental healthcare to both direct and indirect trauma, socioeconomic situation in Gaza, including violence, raids on their homes including the 10-year blockade imposed and arrests of family members. by Israel and the fighting between FUNDING: Teams also continued to provide mental the various Palestinian authorities. More than half of the population is TOTAL MSFA health awareness sessions in villages in Nablus. The sessions included unemployed, electricity is restricted $6,716,866 $1,507,613 psychoeducation on stress management to a few hours per day and there is a as well as mental health stigma and lack of clean drinking water. People’s awareness, and individual consultations movements in and out of the Gaza Strip FIELD STAFF: are extremely limited, preventing them 114 were offered for those in need. In 2017, Médecins Sans Frontières strengthened from seeking specialised healthcare. its partnership with Nablus Rafidia Médecins Sans Frontières staff work in KEY MEDICAL FIGURE: hospital, providing psychological support three clinics in Gaza, providing specialist 4,900 people treated for burns to patients admitted to the burns unit and care for burns and trauma patients, and trauma the paediatric ward, to their caretakers, such as dressings, physiotherapy and and to supervising medical staff. occupational therapy. In 2017, 4,900 patients were treated, mostly for burns sustained in domestic accidents; 62 per cent of these patients were under 15 years old. Despite the technical experience of our nurses and physiotherapists, their work is complicated by the limited access to essential painkillers in Gaza. To alleviate the suffering of burns patients during the most painful medical procedures, our teams introduced a sedation technique using nitrous oxide mixed with oxygen, known as EMONO. Médecins Sans Frontières continued to run reconstructive surgical programs in conjunction with the Ministry of Health for patients with burns, trauma or congenital malformations and in 2017 performed a total of 411 interventions on 197 patients, 75 per cent of whom were under 18 years of age. The most complex cases that cannot be handled in Gaza are referred to Médecins Sans Frontières’ reconstructive surgery hospital in Jordan (see page 32). However, due to administrative restrictions, only six out of 19 patients could be referred in 2017. Our teams continued to run sessions on burns awareness for schools and women’s associations, giving advice on preventing accidents and lessons in first aid. Mohammed was shot by an Israeli soldier in May 2017, while stopping at the border on his motorbike. He was operated on four times by Médecins Sans Frontières surgeons and received physiotherapy at our clinic in Gaza. © Laurie Bonnaud/MSF
Médecins Sans Frontières Australia Annual Report 2017 – 43 PAPUA NEW GUINEA PAPUA NEW GUINEA In Papua New Guinea, Médecins Sans Frontières focused on expanding access to care and improving adherence to treatment for patients with tuberculosis (TB). PORT MORESBY TB was declared a major public health to support two health centres as well KEREMA emergency in Papua New Guinea, with as Kerema general hospital. Difficult almost 30,000 new cases in 2016. It access to remote areas and the lack of is the fourth-biggest cause of death an effective follow-up system result in a among hospital admissions, and the high number of patients not completing Project locations funded by Australian donors principal cause of mortality among their treatment. In collaboration with KEY ACTIVITIES: HIV/AIDS patients. the provincial authorities, Médecins Sans Frontières continues to develop a Tuberculosis care In collaboration with the national TB decentralised model of care facilitating program, Médecins Sans Frontières access to diagnosis, treatment and focuses on improving screening, follow-up closer to patients’ homes. FUNDING: diagnosis, treatment initiation and TOTAL MSFA follow-up at Gerehu hospital, in the By the end of 2017, Médecins Sans capital Port Moresby. Mobile teams Frontières had initiated treatment $6,639,859 $1,040,519 also work in the community to improve for more than 2,100 patients with patient adherence to treatment. drug-sensitive TB, and 53 with drug-resistant TB. FIELD STAFF: In Gulf Province, Médecins Sans 152 Frontières expanded its TB program
KEY MEDICAL FIGURE: More than 2,150 people receiving TB treatment in 2017
“Losing a child was very hard, and I really wanted to know what was going on with me. So we came to Gerehu clinic and they advised me that I had TB.” © Sophie McNamara/MSF
A PATIENT’S STORY: Giakila was five months’ pregnant when she became seriously ill, and ended up losing her baby. “Losing a child was very hard, and I really wanted to know what was going on with me. So we came to Gerehu clinic and they advised me that I had TB.” Giakila was diagnosed with multidrug-resistant TB, which involves two years of treatment including daily injections in the early stages. “I was scared at first, because there were too many medicines that I was taking. But then it started helping me to recover some of the loss that I encountered, so I was happy taking these medicines.” PHILIPPINES PHILIPPINES MANILLA In the Philippines, Médecins Sans Frontières focused on improving access to sexual and reproductive healthcare in slums in the capital Manila, and responded to violent clashes in the south. Since 2016, Médecins Sans Frontières pro-Islamic State factions, in Marawi city, MARAWI has partnered with a local organisation, Mindanao region. More than 370,000 Likhaan, to offer sexual and reproductive people were displaced. Teams provided health services in two densely populated psychological first aid to more than 11,500 and impoverished Manila districts, people, and distributed 1,500 hygiene kits Project locations funded by Australian donors Tondo and San Andres. In 2017, Médecins and 1,150 jerry cans. When the siege of Sans Frontières and Likhaan moved to a the city was declared over in late October, KEY ACTIVITIES: larger clinic in Tondo and carried out an teams remained in the area to support Sexual and reproductive healthcare, average of 1,380 consultations a month internally displaced people and returnees. sexual violence care, water between the two clinics. The Tondo clinic offers family planning services and care A young girl from Tondo FUNDING: for victims of sexual violence, as well as receives her free HPV screening and treatment for cervical cancer. vaccination in a Médecins TOTAL MSFA In conjunction with Likhaan and Manila Sans Frontières and $2,860,247 $926,579 City Health our teams also vaccinated Likhaan clinic in Manila, more than 23,000 girls against the human the Philippines. © Hannah Reyes Morales papillomavirus (HPV) responsible for FIELD STAFF: cervical cancer. 29 From June 2017, Médecins Sans Frontières offered psychological first aid and ran KEY MEDICAL FIGURE: water, sanitation and hygiene activities for More than 23,000 girls vaccinated people displaced by the conflict between against HPV in Manila the Philippine armed forces and two SUDAN SUDAN At the end of 2017, there were nearly 3.3 million internally displaced people and 772,000 registered South Sudanese refugees in Sudan, as well as many other migrants in transit to Europe. Sudan has the highest rate of kala azar, a level not seen since 2011. More than or visceral leishmaniasis (a disease 1,300 patients were treated for visceral spread by sandfly bites), in East Africa, leishmaniasis in 2017. AL-GEDAREF and Al-Gedaref in eastern Sudan Also in Al-Gedaref, Médecins Sans accounts for nearly 70 per cent of the Project locations funded by Australian donors Frontières treated 336 cases of suspected national caseload. Médecins Sans acute watery diarrhoea. Our teams Frontières provides free diagnosis KEY ACTIVITIES: trained staff from partner organisations and case management support to two Outbreak response, visceral in case management and prevention, and hospitals in this region and organises leishmaniasis care conducted community education sessions. awareness-raising activities in the community. From the end of 2016 to FUNDING: April 2017, the number of cases rose to TOTAL MSFA $3,010,188 $2,000,000 Médecins Sans Frontières provides diagnosis of FIELD STAFF: visceral leishmaniasis and case management 40 support, and organises awareness-raising activities KEY MEDICAL FIGURE: 1,300 people treated for in the community. visceral leishmaniasis
Médecins Sans Frontières Australia Annual Report 2017 – 45 SOUTH SUDAN
SOUTH SUDAN YIDA
AGOK Throughout 2017, Médecins Sans Frontières responded to emergency
AWEIL OLD FANGAK medical needs arising from conflict and epidemics, while striving to NEW FANGAK maintain its existing healthcare programs in South Sudan. WAU Tens of thousands of people in South remains the main cause of admission; Sudan have died and roughly one in in 2017, 5,767 people were admitted JUBA three people have been forced from for treatment of the disease. Teams their homes since renewed conflict also support five health facilities with Project locations funded by Australian donors broke out in December 2013. Two testing and treatment for the disease million people have fled to neighbouring throughout the rainy season. In March, KEY ACTIVITIES: countries, while another two million are Médecins Sans Frontières closed the Malaria care, maternal healthcare, displaced within South Sudan. Security mobile clinics we had been operating in nutrition, paediatric care, surgery, also remained a major challenge for Wau and the surrounding countryside vaccinations humanitarians in 2017, as facilities came as other organisations began medical under attack and it became increasingly activities in this conflict-affected area. dangerous to work in some areas. FUNDING: Abyei Special Administrative Area In South Sudan, Médecins Sans In Agok, Médecins Sans Frontières TOTAL MSFA Frontières operates primary and runs the only referral hospital in the $45,211,600 $4,087,295 secondary healthcare programs in area providing primary and secondary hospitals and clinics, runs outreach healthcare, including surgery for a activities for displaced people and FIELD STAFF: population of more than 140,000 people. remote communities, responds to Due to the increased need for specialist 688 emergencies and outbreaks as they healthcare, teams started to rehabilitate occur and carries out preventive and extend the hospital in 2017. The KEY MEDICAL FIGURE: activities such as vaccination campaigns. new inpatient department, due to be 101,831 people treated for Fangak completed in mid-2018, will provide malaria in remote villages room for more than 140 inpatients. In Fangak, a remote, opposition-held Overall, 9,806 patients were admitted area, Médecins Sans Frontières manages to the hospital, including 2,162 for the emergency room, operating theatre treatment in the therapeutic feeding and inpatient feeding centre, as well centre. Teams ran a malaria test-and- as the paediatric, adult and maternity treat program in remote villages and wards at Old Fangak hospital. In treated over 101,831 patients with the late 2017, the team restarted surgical help of community workers. In Agok, Médecins Sans services, performing 184 surgical procedures in December. The team also Sudanese refugees Frontières runs the only opened an outpatient clinic in nearby Médecins Sans Frontières continues to Phom, where they provided 18,148 work in Yida camp for refugees from referral hospital in the consultations, and deployed mobile South Kordofan, Sudan. There, teams clinics along the Zeraf River. manage an inpatient department, an Greater Bahr el Ghazal region inpatient feeding centre, a neonatal unit area providing primary and the treatment of HIV and TB. Our Médecins Sans Frontières staff teams also work in the Nuba Mountains, manage the paediatric and maternity and secondary healthcare, South Kordofan, where in 2017 we departments in Aweil state hospital, provided 151,895 consultations and the only facility providing secondary including surgery. vaccinated 36,709 children. healthcare in the region. Malaria
A PATIENT’S STORY: Dr Rosyln Brooks, from Cooma, NSW, recounts a patient she treated in Lankien, South Sudan. “Here in Lankien, I have seen many conditions that are rare or non-existent in Australia. One morning, I was called to see a four-year-old boy in the emergency room. He was sitting up, mouth half open, drooling and spitting saliva, and struggling to breathe. His throat and upper airway were almost completely obstructed and he had spasms of barking, seal-like cough. This is the typical picture of acute epiglottitis, a life-threatening medical emergency in which there is fever and massive swelling of the throat that can completely block the airway. The boy’s father was wonderful – he sat up supporting his child for several days and nights, while we treated with intravenous antibiotics, corticosteroids and fluids. After about a week, this little boy recovered well and went home, still with a barking seal-like cough, but breathing and eating easily.” Patients arrive at the Médecins Sans Frontières hospital in Agok, South Sudan, having been transported by special chain vehicle from Mayom. © Peter Bauza SWAZILAND SWAZILAND In 2017, Médecins Sans Frontières continued to focus on reducing HIV transmission and improving access to decentralised care for people with HIV, tuberculosis (TB) and drug-resistant TB (DR-TB) in Swaziland. SOUTH AFRICA Swaziland has one of the world’s highest risk of contracting HIV, pre-exposure rates of HIV, affecting roughly one in prophylaxis is offered as an additional three adults. The country also has one means of HIV prevention. Overall, SHISELWENI of the highest TB notification rates, 5,886 patients received antiretroviral and 70 per cent of people who contract therapy in 2017. In May, oral HIV Project locations funded by Australian donors TB are also HIV-positive. The HIV self-testing was also implemented in epidemic is showing signs of stabilising Nhlangano, with a total of 1,328 self- KEY ACTIVITIES: and in recent years the number of testing kits distributed by the end of HIV/AIDS care, tuberculosis care AIDS-related deaths has reduced. Based the year. on a 2017 HIV incidence survey, the rate of new infections has almost halved FUNDING: within five years. To help patients stick TOTAL MSFA Médecins Sans Frontières’ project in $8,412,733 $1,355,000 Nhlangano, Shiselweni region, aims to to their treatment, improve the quality of comprehensive HIV and TB care in health facilities Médecins Sans Frontières FIELD STAFF: and at community level, and provide 147 better management of DR-TB. To has set up community help patients stick to their treatment, Médecins Sans Frontières has set up adherence clubs for KEY MEDICAL FIGURE: community adherence clubs for adults 1,328 oral HIV self-testing kits and children. For people particularly at adults and children. distributed
Médecins Sans Frontières Australia Annual Report 2017 – 47 SYRIA
RAQQA ALEPPO
HASSAKEH
IDLIB
IRAQ
Project locations funded by Australian donors KEY ACTIVITIES: Burns care, mental healthcare, outbreak response, primary healthcare, physiotherapy, surgery
FUNDING: TOTAL MSFA $21,397,028 $4,035,763
FIELD STAFF: 250
KEY MEDICAL FIGURE: 13,100 physiotherapy sessions in Atmeh
SYRIA The conflict in Syria continued into its seventh year, entering new depths international support to take control of of violence and leaving millions of people in desperate need of assistance. Raqqa city. As the frontlines approached the city, civilians became trapped Civilians, civilian areas and civilian In areas where staff could not be deployed and high levels of insecurity made it infrastructure continued to come under or permanently present, Médecins Sans extremely difficult to reach those in need. direct fire in Syria in 2017. Thousands Frontières maintained its distance support Ain Issa displacement camp, to the north of people were killed and wounded in of medical facilities. Mostly run from of Raqqa, became an official transit camp military offensives around the country neighbouring countries, this consisted for people fleeing the conflict. As arrivals and hundreds of thousands more were of donations of medicines, medical to the camp increased, teams distributed forced from their homes by the conflict. material and relief items; remote training relief items such as mattresses, blankets of medics inside Syria; and technical and hygiene kits, set up water and Our teams continue to provide medical medical advice and financial support sanitation services, and responded to a and humanitarian assistance in Syria to cover facility running costs. In 2017, measles outbreak, as well as conducting but our activities are severely limited Médecins Sans Frontières supported 23 routine vaccinations. In September, as by insecurity and constraints on access. health facilities, reduced to 14 in June. the camp reached a population of 9,000 Médecins Sans Frontières always Up to August, these facilities provided people, teams performed an average of negotiates access with the authorities 278,177 outpatient consultations and 200 consultations each day. The camp – official or de facto – in control of an treatment for 58,187 people with reached a population of some 15,000 area; but the Islamic State group has not chronic disease. people by the end of 2017. Médecins given any assurances since it abducted Sans Frontières also built a medical and Médecins Sans Frontières staff in 2014 Raqqa governorate mental health clinic and supported a and the Syrian government has not In June, the Syrian Democratic Forces volunteer-run primary healthcare centre. granted authorisation to work despite launched an offensive with US-led repeated requests. A physiotherapist treats a man who lost both his legs after activating an explosive device while fleeing Raqqa, Syria. © Agnes Varraine-Leca
In July, Médecins Sans Frontières provided 10,575 emergency team saw a sharp increase in the number rehabilitated a primary healthcare consultations and admitted 1,151 of patients wounded by explosive devices centre in Tabqa and started offering children to the hospital. that had been left or placed in homes, on medical consultations, mental agricultural land and along roadsides. In healthcare and physiotherapy to Idlib governorate 2017, Médecins Sans Frontières treated displaced people. To the north of Tabqa, Médecins Sans Frontières continued to nearly 3,800 people in the emergency room a team in Twaheenah displacement offer specialist care for burns patients and performed 563 surgical procedures. camp conducted measles vaccinations at Atmeh hospital, including surgery, Médecins Sans Frontières also ran and provided primary healthcare. skin grafts, dressings, physiotherapy and psychological support. In 2017, staff mobile and fixed clinics in camps for Aleppo governorate performed 13,100 physiotherapy sessions displaced people, focusing on mental In Kobanê/Ain Al Arab, Médecins Sans and 602 major surgery interventions. healthcare, reproductive healthcare Frontières is working with the local and treatment for non-communicable health authorities to re-establish basic Hassakeh governorate diseases such as hypertension and health facilities, providing outpatient Intense fighting in northeast Syria resulted diabetes. Teams carried out a total of consultations, vaccinations and in massive displacement, thousands of 15,219 consultations in 2017. psychological support. This year, the casualties and severe damage to health team built an outpatient department and facilities. Many injured patients were supported the emergency room, intensive treated in the emergency room that care unit, maternity ward, operating Médecins Sans Frontières rehabilitated in theatre and nursing activities at Kobanê the main referral hospital in Hassakeh. general hospital with supervision, As in Raqqa, when the violence subsided training and drug supplies. The team and people began to return home, the
Médecins Sans Frontières Australia Annual Report 2017 – 49 TANZANIA KENYA TANZANIA NDUTA Throughout 2017, thousands of people fleeing unrest in Burundi continued NYARUGUSU to cross the border to seek refuge in Tanzania. In January, the Tanzanian government outpatient consultations in 2017. Despite revoked the prima facie status of the comprehensive malaria prevention Burundian refugees, meaning that and control activities in the camp, ZAMBIA automatic refugee status was not granted including rapid access to diagnosis and to new arrivals in the country, and each treatment, the infection rate remained person had to have their refugee status very high during the rainy season. In Project locations funded by Australian donors determined individually. December, Médecins Sans Frontières distributed thousands of mosquito nets KEY ACTIVITIES: Although the number of arrivals from in areas identified as being high risk due Burundi decreased over the course of Malaria care, maternal to the concentration of mosquitos and the year, there were still over 315,000 healthcare, mental healthcare, incidence of malaria. nutrition, paediatrics, primary refugees from the Democratic Republic healthcare, secondary healthcare, of Congo and Burundi living in three The number of patients with diarrhoea sexual violence care main camps in the Kigoma district. and skin diseases also remained high due to poor living conditions and hygiene in In Nduta camp, which was at double its certain areas of the camp. FUNDING: intended capacity with 118,635 refugees at the end of the year, Médecins Sans As a consequence of protracted TOTAL MSFA Frontières was the main healthcare encampment and a general sense of $10,554,082 $200,000 provider. Teams ran a 175-bed hospital, insecurity and helplessness about the six outpatient health posts and health future, mental health needs among promotion activities. Hospital services the refugees grew significantly in 2017. FIELD STAFF: included maternal healthcare, nutritional The main diagnoses were depression, 194 support, paediatric and adult inpatient anxiety and psychosomatic disorders. departments and an emergency room. In addition, the number of patients KEY MEDICAL FIGURE: In 2017, 18,002 patients were admitted presenting with acute psychiatric 8,888 individual psychological to the hospital and 6,365 births were conditions at the Médecins Sans consultations assisted. Specialised outpatient services, Frontières hospital increased throughout such as treatment for HIV, malaria and the year. Teams performed 8,888 tuberculosis, were also provided. individual psychological consultations throughout the year. Care was also Malaria remained the most common provided for a total of 540 victims of medical problem in the camp, sexual violence. accounting for around one-third of all
A field worker story from Tanzania
NAME: Among the chaos that is a refugee camp, and despite all the limitations and Saschveen Singh restrictions, there is an incredible sense of teamwork that permeates our activities at our hospital and in the community health posts. The work of the FROM: 600-plus staff on the ground here in Nduta is no mean feat, and it never ceases Perth, WA to amaze me how it somehow all comes together each day and keeps an incredible momentum, charged with the collective energies of the people here. FIELD ROLE: Many people are of the misconception that Médecins Sans Frontières is Medical comprised only of doctors and nurses, however the reality is that the medical teams would have no way of reaching the population or administering doctor, Nduta, care without the support of a huge number of other professionals making Tanzania, April to it happen; no one department could exist or function without the support November 2017 of another. I’ve been inspired by so many of the people I work with here, in particular our refugee colleagues who have to deal with the reality of living in a tent, but who still come to work every day and give it their all. ©MSF The Médecins Sans Frontières hospital in Nduta refugee camp, Tanzania, where children are recovering from severe acute malnutrition. © Erwan Rogard/MSF
Médecins Sans Frontières Australia Annual Report 2017 – 51 UGANDA YUMBE UGANDA ADJUMANI ARUA In Uganda, Médecins Sans Frontières focuses on responding to the medical KWEEN needs of refugees and improving access to care for HIV and sexual and
KAPCHORWA reproductive health. KASESE Huge numbers of refugees from the Expanding access to HIV care southern belt of South Sudan (Greater An estimated 1.2 million people live Equatoria region) continued to arrive with HIV in Uganda. Despite significant in Uganda in 2017. By August, one improvements, HIV detection and Project locations funded by Australian donors million people – 85 per cent of whom care remain a public health concern were women and children – had fled in specific groups of people, such as KEY ACTIVITIES: across the border into northern Uganda, adolescents. Médecins Sans Frontières HIV/AIDS care, malaria according to UNHCR, the United offers quick and reliable viral load care, mental healthcare, Nations refugee agency. Despite the monitoring through its point-of-care outbreak response, sexual and efforts of the Ugandan authorities and testing facility at Arua regional referral reproductive healthcare, sexual other organisations, the provision of aid hospital, allowing patients to be switched violence care, vaccinations, was insufficient to meet the urgent needs to second-line antiretroviral treatment if water and sanitation of so many people. necessary. By the end of 2017, 739 people Médecins Sans Frontières developed were on second-line ARVs in Arua. FUNDING: and adapted a wide range of activities to In 2017, the team also provided drug- assist refugees. In Bidi Bidi, Imvepi and resistance tests and an alternative drug TOTAL MSFA Adjumani settlements, teams conducted regimen which enabled 10 new patients $14,252,518 $1,507,613 96,814 outpatient consultations, cared for to access third-line treatment. Médecins 50,701 cases of malaria, admitted 1,802 Sans Frontières reinforced clinical and patients to Médecins Sans Frontières- psychosocial support for HIV patients, FIELD STAFF: managed facilities, assisted 477 deliveries especially for adolescents, to help them 517 and offered mental healthcare for 3,089 comply with their life-long treatment. people. In addition, staff provided Sexual and reproductive vaccinations and ran health surveillance KEY MEDICAL FIGURE: activities. The logistics team worked to care for adolescents 50,701 cases of malaria treated improve access to drinking water and the Adolescents are particularly vulnerable construction of latrines. to the life-threatening health risks related to unwanted pregnancies, HIV/AIDS and sexually transmitted infections, due to a lack of awareness about these risks, and the shortage of youth-friendly sexual health and counselling services. Médecins Sans Frontières opened the Kasese adolescent centre in Kasese town in 2015, which offers sexual and reproductive healthcare, as well as community awareness-raising and recreational activities that encourage adolescents to come for consultations. In 2017, 30,852 adolescents had consultations and 20 victims of sexual violence received care. Response to a Marburg fever outbreak Between the end of October and beginning of December, Médecins Sans Frontières addressed an outbreak of Marburg fever in Kween and Kapchorwa districts, in the east of Uganda. Teams set up two 10-bed treatment centres, trained healthcare staff and assisted local health authorities with epidemiological surveillance, community health promotion and mapping activities.
A child receives an oral vaccine against polio in Imvepi refugee camp, Uganda. © Judith Kormann A pregnant woman receives a consultation in the health centre of Bidi Bidi refugee camp, Uganda. © Frederic Noy/ COSMOS/ MSF UKRAINE UKRAINE RUSSIA In Mykolaiv district, southern Ukraine, Médecins Sans Frontières started a new project for the treatment of hepatitis C. MYKOLAIV When left untreated, hepatitis C can in order to improve adherence to lead to liver failure and liver cancer. treatment and help manage social
The program, which is conducted in issues resulting from their disease. ROMANIA collaboration with the Ministry of The project became operational in Health and the Mykolaiv Regional November and by the end of the year Centre of Palliative Care and 328 hepatitis C consultations had been Integrated Services, is aimed at around carried out. Médecins Sans Frontières Project locations funded by Australian donors 1,000 patients with hepatitis C. Some has also provided state-of-the-art of the patients are coinfected with diagnostic equipment and medical KEY ACTIVITIES: HIV or on opioid substitution therapy, items to the centre in Mykolaiv. Hepatitis C care while others are healthcare workers infected with the virus. Patients receive FUNDING: free treatment with direct-acting antivirals and are also supported with TOTAL MSFA counselling and health education $2,102,305 $1,000,000
FIELD STAFF: Médecins Sans Frontières provided state-of-the-art 14 diagnostic equipment and medical items to the centre KEY MEDICAL FIGURE: in Mykolaiv. 328 hepatitis C consultations
Médecins Sans Frontières Australia Annual Report 2017 – 53 YEMEN In the recovery tent of a cholera treatment centre in Yemen, patients are taught hand washing practices to avoid infection. © MSF SAUDI ARABIA SA’ADA
AMRAN
IBB
ADEN
Project locations funded by Australian and New Zealand donors. KEY ACTIVITIES: Emergency medicine, outbreak response, surgery
FUNDING: TOTAL MSFA MSFNZ $32,111,841 $4,848,384 $143,747
FIELD STAFF: 655
KEY MEDICAL FIGURE: 12,674 people treated for cholera in Amran
YEMEN A full-scale war has been raging in Yemen since 2015. In 2017, donations, and water and sanitation a cholera outbreak and an upsurge in fighting exacerbated the support in cholera treatment centres (CTCs) set up by the Ministry of Health. already dire humanitarian situation. At Médecins Sans Frontières’ emergency Much of the public infrastructure, to go to them. This means they are surgical hospital in Aden, the team saw including health facilities, has been unable to seek timely care, and easily an increase in the number of patients destroyed by the warring parties. Import curable health conditions are turning admitted for surgery this year, not restrictions due to the imposition of deadly when left untreated. only from the frontlines, but also from a blockade by the Saudi-led coalition within the city, due to an upsurge in In 2017, Yemen experienced its worst in 2015, coupled with high inflation, violence. Staff performed 4,881 surgical cholera epidemic, with an estimated have crippled Yemenis’ access to interventions in Aden in 2017. one million people affected. The healthcare and other essential services. conflict exacerbated the challenges Amran Furthermore, many of the country’s for Yemeni people in accessing clean 50,000 health workers have not been paid Teams treated 12,674 people with water, disposing of waste and obtaining since August 2016 and have consequently cholera in Amran governorate in 2017. medical care. left the public health system, forced to Médecins Sans Frontières also worked in look for other sources of income. All Aden Khamir and Huth hospitals, where teams provided maternal healthcare, paediatric these factors have led to the collapse In Aden governorate, Médecins Sans of the health system and outbreaks of care and nutrition care, and performed Frontières dispatched an emergency 2,210 caesarean sections. diseases. Even where medical facilities team to respond to the second wave are operational, most people are no of cholera, providing training of staff, longer able to afford the transport costs A field worker story from Mediterranean
NAME: FROM: Lauren King Sydney, NSW
FIELD ROLE: Field Communications Manager on the MV Aquarius, search and rescue ship operated by Médecins Sans Frontières and SOS Mediterranée, July to December 2017 © Lauren King/MSF
I coordinate all communications for Médecins Sans Frontières from the Aquarius. There are often independent journalists on board the ship, so I set up interviews for them and organise the logistics of their visit. I respond to interview requests, write stories, and make videos for social media. But of course, when there are rescues, all plans go out the window! Quite often we’re woken up at 4am by the Maritime Rescue Coordination Centre informing us of boats in distress. I grab my tools – for doctors, it’s the medical kits, for communications, it’s your phone and camera. I wake up the journalists on board, and then I head up to the deck to take photos of the team in action and update Twitter. After that, I help with the rescue. I hand out rescue kits and assist the midwife in the women’s shelter. My scheduled deck watch is a great time to hear the stories of the people we have rescued. The hardest time on board is disembarkation. Watching people leave after two days hearing of their extraordinary journeys from Africa and the Middle East, and not knowing what their future holds, is incredibly difficult to do. Once they disembark we can’t do much for them. The team would identify the most vulnerable cases and link them to other humanitarian organisations in Italy. Apart from this, we can only provide humanity and dignity in the short time we are with them.
Sa’ada Challenges to our programs In 2017, Médecins Sans Frontières Respect for humanitarian in Yemen going forward returned to the hospital in Haydan, in The respect for humanitarian the governorate of Sa’ada. Teams had principles and the safety of principles and the safety of medical left after the hospital was destroyed facilities and staff remain key concerns by airstrikes in 2015. Throughout the medical facilities and staff for Médecins Sans Frontières, as year, staff provided 11,894 emergency well as import limitations due to consultations and 3,889 ante- and post- remain key concerns for the blockade and their effects on the natal consultations. Further east, our Yemeni healthcare system. Authorities teams also support the health centres of Médecins Sans Frontières. in Sana’a and Aden continue to Nushor and Yesnim. In response to the impose new and often arbitrary cholera outbreak, we ran a CTC of 20 requirements and restrictions on aid beds in Sa’ada city. incident preparedness and supported operations across the country. In Ibb the maternity unit, laboratory and X-ray November 2017, the Saudi-led coalition department with logistics and supplies. imposed a complete blockade on In Kilo, a city located between Ibb As more people became aware of our humanitarian staff and cargo at the and Taiz, Médecins Sans Frontières activities at this hospital, the number ports and airports under its control, continued to work on improving of patients increased. Médecins Sans thereby hampering Médecins Sans the surgical capacity, intensive care Frontières teams provided 3,886 surgical Frontières’ capacity to assist vulnerable unit, emergency ward and inpatient interventions and 3,644 emergency communities in need. department of one of the main hospitals. consultations, and admitted 7,737 The team trained staff in mass casualty patients for treatment in 2017.
Médecins Sans Frontières Australia Annual Report 2017 – 55
Ernst & Young Services Pty Limited Tel: +61 2 9248 5555 200 George Street Fax: +61 2 9248 5959 Sydney NSW 2000 Australia ey.com/au GPO Box 2646 Sydney NSW 2001
Auditor’s Independence Declaration to the Directors of decins ans ronti res Australia i ited
In relation to our audit of the financial report of Médecins Sans Frontières Australia Limited for the financial year ended 31 December 2017, and in accordance with the requirements of Subdivision 60-C of the Australian Charities and Not-for profits Commission Act 2012, to the best of my knowledge and belief, there have been no contraventions of the auditor independence requirements of the Australian Charities and Not-for profits Commission Act 2012 or any applicable code of professional conduct.
Ernst & Young
Loretta Di Mento Partner 2 May 2018
A member firm of Ernst & Young Global Limited Liability limited by a scheme approved under Professional Standards Legislation ACN 004 860 860
Ernst & Young Services Pty Limited Tel: +61 2 9248 5555 200 George Street Fax: +61 2 9248 5959 Sydney NSW 2000 Australia ey.com/au GPO Box 2646 Sydney NSW 2001
Independent Auditor's Report to the Members of Médecins Sans Frontières Australia Limited
Report on the Financial Report
Opinion
We have audited the financial report of Médecins Sans Frontières Australia Limited (the Company) and its subsidiaries (collectively the Group), which comprises the consolidated statement of financial position as at 31 December 2017 , the consolidated statement of comprehensive income, consolidated statement of changes in equity and consolidated statement of cash flows for the year then ended, notes to the financial statements, including a summary of significant accounting policies, and the directors' declaration.
In our opinion, the accompanying financial report of the Group is in accordance with the Australian Charities and Not- for-Profits Commission Act 2012, including: a) giving a true and fair view of the consolidated financial position of the Group as at 31 December 2017 and of its consolidated financial performance for the year ended on that date; and b) complying with Australian Accounting Standards – Reduced Disclosure Requirements and the Australian Charities and Not-for-Profits Commission Regulation 2013.
Basis for Opinion
We conducted our audit in accordance with Australian Auditing Standards. Our responsibilities under those standards are further described in the Auditor’s Responsibilities for the Audit of the Financial Report section of our report. We are independent of the Group in accordance with the ethical requirements of the Accounting Professional and Ethical Standards Board’s APES 110 Code of Ethics for Professional Accountants (the Code) that are relevant to our audit of the financial report in Australia. We have also fulfilled our other ethical responsibilities in accordance with the Code.
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.
Information Other than the Financial Report and Auditor’s Report Thereon
The directors are responsible for the other information. The other information is the directors’ report accompanying the financial report.
Our opinion on the financial report does not cover the other information and accordingly we do not express any form of assurance conclusion thereon.
In connection with our audit of the financial report, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial report or our knowledge obtained in the audit or otherwise appears to be materially misstated.
If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard.
A member firm of Ernst & Young Global Limited Liability limited by a scheme approved under Professional Standards Legislation
ACN 004 860 860
1
Responsi ilities of the irectors for the Financial Report
The directors of the ompany are responsible for the preparation of the financial report that gi es a tr e and fair ie in accordance ith A stralian Acco nting Standards – ed ced isclos re e irements and the Australian harities and ot for rofits o ission Act and for s ch internal control as the directors determine is necessary to enable the preparation of the financial report that gi es a tr e and fair ie and is free from material misstatement hether d e to fra d or error.
n preparing the financial report the directors are responsible for assessing the ro p’s ability to continue as a going concern disclosing as applicable matters relating to going concern and sing the going concern basis of acco nting nless the directors either intend to li idate the ro p or to cease operations or ha e no realistic alternati e b t to do so.
Auditor s Responsi ilities for the Audit of the Financial Report
r ob ecti es are to obtain reasonable ass rance abo t hether the financial report as a hole is free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable ass rance is a high le el of ass rance b t is not a g arantee that an a dit cond cted in accordance ith the A stralian A diting Standards ill al ays detect a material misstatement hen it e ists. isstatements can arise from fra d or error and are considered material if indi id ally or in the aggregate they co ld reasonably be e pected to infl ence the economic decisions of sers ta en on the basis of this financial report.
As part of an a dit in accordance ith the A stralian A diting Standards e e ercise professional dgment and maintain professional scepticism thro gho t the a dit. e also
dentify and assess the ris s of material misstatement of the financial report hether d e to fra d or error design and perform a dit proced res responsi e to those ris s and obtain a dit e idence that is s fficient and appropriate to pro ide a basis for o r opinion. The ris of not detecting a material misstatement res lting from fra d is higher than for one res lting from error as fra d may in ol e coll sion forgery intentional omissions misrepresentations or the o erride of internal control.
btain an nderstanding of internal control rele ant to the a dit in order to design a dit proced res that are appropriate in the circ mstances b t not for the p rpose of e pressing an opinion on the effecti eness of the ro p’s internal control.
E al ate the appropriateness of acco nting policies sed and the reasonableness of acco nting estimates and related disclos res made by the directors.
Conclude on the appropriateness of the directors’ use of the going concern basis of accounting and, based on the a dit e idence obtained hether a material ncertainty e ists related to e ents or conditions that may cast significant do bt on the ro p’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclos res in the financial report or if s ch disclos res are inade ate to modify o r opinion. r concl sions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may ca se the ro p to cease to contin e as a going concern.
E al ate the o erall presentation str ct re and content of the financial report incl ding the disclos res and hether the financial report represents the nderlying transactions and e ents in a manner that achie es fair presentation.
btain s fficient appropriate a dit e idence regarding the financial information of the entities or b siness acti ities ithin the ro p to e press an opinion on the financial report. e are responsible for the direction s per ision and performance of the ro p a dit. e remain solely responsible for o r a dit opinion.
e comm nicate ith the directors regarding among other matters the planned scope and timing of the a dit and significant a dit findings incl ding any significant deficiencies in internal control that e identify d ring o r a dit.
A member firm of Ernst & Young Global Limited Liability limited by a scheme approved under Professional Standards Legislation ACN 004 860 860
Report on the re uirements of the NSW Charitable Fundraising Act 1991 and the NSW Charitable Fundraising Regulations 2015 and the re uirements of the WA Charitable Collections Act (1946) and the WA Charitable Collections Regulations (1947)
e have audited the financial report as required by ection of the haritable Fundraisin Act and the A haritable ollections Act . ur procedures included obtaining an understanding of the internal control structure for fundraising appeal activities and examination, on a test basis, of evidence supporting compliance with the accounting and associated record eeping requirements for fundraising appeal activities pursuant to the haritable Fundraisin Act and the haritable Fundraisin Re ulations and the A haritable ollections Act and the A haritable ollections Re ulations .
ecause of the inherent limitations of any assurance engagement, it is possible that fraud, error or non compliance may occur and not be detected. n audit is not designed to detect all instances of non compliance with the requirements described in the above mentioned ct s and Regulations as an audit is not performed continuously throughout the period and the audit procedures performed in respect of compliance with these requirements are underta en on a test basis. he audit opinion expressed in this report has been formed on the above basis.
Opinion In our opinion a the financial report of the Company has been properly drawn up and associated records have been properly kept during the financial year ended 31 December 2017, in all material respects, in accordance with:
i. sections 20(1), 22(1-2), 24(1-3) of the NSW Charitable Fundraising Act 1991;
ii. sections 10(6) and 11 of the NSW Charitable Fundraising Regulations 2015;
iii. the WA Charitable Collections Act (1946); and
iv. the WA Charitable Collections Regulations (1947). b the money received as a result of fundraising appeals conducted by the Company during the financial year ended 31 December 2017 has been properly accounted for and applied, in all material respects, in accordance with the above mentioned Act(s) and Regulations.
rnst oung
oretta i ento artner ydney ay
A member firm of Ernst & Young Global Limited Liability limited by a scheme approved under Professional Standards Legislation ACN 004 860 860
Médecins Sans Frontières Australia
ABN 74 068 758 654 PO Box 847, Broadway NSW 2007, Australia Phone: +61 2 8570 2600 1300 136 061 Fax: +61 2 8570 2699 Email: [email protected]
© 2017 Médecins Sans Frontières Australia www.msf.org.au