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INTERNATIONAL ACTIVITY REPORT 2013 www.msf.org THE MÉDECINS SANS FRONTIÈRES 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 principles: Médecins Sans Frontières provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. They do so irrespective of race, religion, creed or political convictions. Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions. Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic or religious powers. As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them. The country texts in this report provide descriptive overviews of MSF’s operational activities throughout the world between January and December 2013. Staffing figures represent the total full-time equivalent positions per country at the end of 2013. Country summaries are representational and, owing to space considerations, may not be comprehensive. For more information on our activities in other languages, please visit one of the websites listed on p.100. The place names and boundaries used in this report do not reflect any position by MSF on their legal status. Some patients’ names have been changed for reasons of confidentiality. CONTENTS 2 MSF PROGRAmmES AROUND THE WORLD 4 THE YEAR IN REVIEW Dr Joanne Liu, International President Jérôme Oberreit, Secretary General 4 The year in review 8 OVERVIEW Of ACTIVITIES 10 GLOSSARY OF DiSEASES AND ACTIVITIES 14 SOUTH SUDAN: A COUNTRY GRIPPED BY VIOLENCE 16 ADDRESSING WOMEN’S HEALTH NEEDS 18 CENTRAL AFRICAN REPUBLIC: DESCENT INTO CHAOS 14 South Sudan: A country gripped by violence 22 A DAY IN THE LifE: méDECINS SANS FRONTIÈRES (MSF) CLINIC AT DERA MURAD JAMALI, BALOCHISTAN, PAKISTAN 24 OVERCOmiNG CHALLENGES TO MEET MSF’S VACCINATION AMBITIONS 27 ACTIVITIES BY COUNTRY 95 SPECIAL REPORTS 2013 16 Addressing women’s health needs 96 FACTS AND fiGURES 100 CONTACT MSF 18 CAR: Descent into chaos 27 Activities by country CONTENTS 1 MSF PROGRAmmES AROUND THE WORLD 2 MSF PROGRAmmES AROUND THE WORLD 28 AfGHANISTAN 58 KENYA 30 ARMENIA 60 LEBANON 30 BOLIVIA 62 LESOTHO 31 BANGLADESH 63 LiBYA 32 BULGARIA 63 MADAGASCAR 32 BURKINA FASO 64 MALAwi 33 BURUNDI 65 MALI 33 CAMEROON 66 MAURITANIA 34 CAMBODIA 66 MOROCCO 34 CHINA 67 MEXICO 35 COLOMBIA 68 MOZAMBiqUE 36 CENTRAL 69 MYANMAR AfRICAN REPUBLIC 70 NiGER 38 CHAD 72 NiGERIA 40 CONGO 73 PALESTINE 40 CÔTE D’IVOIRE 73 PAPUA NEW GUINEA 41 DEMOCRATIC 74 PAKISTAN PEOPLE’S REPUBLIC 76 PHILIPPINES OF KOREA 78 PARAGUAY 41 EGYPT 78 RUSSIAN 42 DEMOCRATIC FEDERATION REPUBLIC OF CONGO 79 SOUTH AfRICA 44 ETHIOPIA 80 SOMALIA 46 FRANCE 82 SOUTH SUDAN 46 GEORGIA 84 SUDAN 47 GREECE 85 SwAZILAND 47 GUINEA 86 SYRIA 48 HAITI 88 SiERRA LEONE 50 HONDURAS 88 TAjiKISTAN 50 IRAN 89 TURKEY 51 ITALY 89 UKRAINE 51 LAOS 90 UGANDA 52 INDIA 91 UZBEKISTAN 54 IRAQ 91 ZAMBIA 56 JORDAN 92 ZimBABWE 57 KYRGYZSTAN 94 YEMEN MSF PROGRAmmES AROUND THE WORLD 3 MÉDECINS SANS FRONTIÈRES THE YEAR IN REVIEW Dr Joanne Liu, International President Jérôme Oberreit, Secretary General In August 2013, Médecins as Central African Republic (CAR) and our time in Somalia, but it was when it South Sudan. Sans Frontières (MSF) pulled became apparent that the parties with whom we were negotiating were in some Since its founding, MSF has faced different out of Somalia after working cases actively involved in, or complacent forms of violence against its patients, staff, towards, violent actions directed against in the country continuously health facilities and medical vehicles, and MSF that we had no choice but to draw for 22 years. has also witnessed targeting of health systems in general. The situation in Somalia, the line. A lack of respect and deliberate The last year has been one of exceptional however, became untenable in 2013 as the violations of medical humanitarianism for circumstances, decisions and compromises, balance could no longer be found between political and financial profit were putting particularly with regards to Somalia and the risks involved, the compromises we the lives of our patients and staff at risk. Syria. We have again seen profiteering from had to make – such as hiring armed guards We withdrew with heavy hearts. humanitarian organisations, in the form and implementing remote management to of robberies and the looting of medical support national staff – and our ability to In Syria, the civil war continued into its third structures, but the most striking thing we provide medical care to the Somali people. year and it is estimated at present that nine have witnessed is the failure of the global Staff members had been threatened, million people are internally displaced in the humanitarian aid system in countries such attacked, kidnapped and even killed during country or have fled abroad as a result of © Giulio Di Sturco A staff member surveys what remains of the MSF office in Kitchanga, Democratic Republic of Congo, after a wave of violence engulfed the town. 4 THE YEAR IN REVIEW INTERNATIONAL ACTIVITY REPORT 2013 © Jodi Hilton A young Syrian refugee is examined by an MSF paediatrician at the mobile clinic in Voenna Rampa camp in Sofia. Thousands of Syrians have fled to neighbouring countries to escape the conflict. the violence. This means that over 40 per provide healthcare for Syrians inside and In South Sudan, where people have come cent of Syrians have been forced from their outside the refugee camps. to rely in large part on MSF for healthcare, homes. Those remaining in Syria have had violence in Jonglei early in the year caused to endure ongoing and incessant violence, The year was punctuated by numerous acute displacement, and in December, fighting and entire cities have been decimated. crises that left entire communities vulnerable, between different factions of the army The healthcare system has collapsed, with little skilled medical help. In some cases, quickly spread throughout five states, resulting in outbreaks of preventable external assistance was their only lifeline and causing people to flee their homes and diseases such as measles and polio. yet MSF often found itself alone tackling destroying hopes of stability for the nascent Countless Syrians are desperate to access not just the medical but also the other country. More than 3,000 MSF staff medical treatment, and are without services continued to operate 16 programmes in humanitarian needs of the people affected. for everyday requirements like antenatal nine states, and three emergency projects care, immunisations and the management Political events marked a descent into were opened to care for the displaced of infections or chronic diseases. MSF and war-wounded; further emergency instability and brutal violence in both South operated aid programmes where working programmes opened in neighbouring Sudan and CAR, displacing thousands. In agreements could be negotiated, namely in countries such as Uganda to provide aid CAR, there was a presidential coup in March opposition-held areas where instability was to the refugees. December was only the and subsequent political clashes spread a constant challenge, and support was given beginning of what was to become a grave to Syrian medical networks. Inpatient wards, throughout the country and inflamed crisis of violence, civil war and human outpatient consultations, surgery, and religious divisions. By January 2014, it was suffering in South Sudan. maternal and obstetric care were provided estimated that over one million people had by MSF and vaccinations were undertaken. fled their homes, 245,000 of them crossing Once again this year, MSF’s largest However, in a country where we should the border into neighbouring countries programme expenditure was a response have been running some of our largest such as Chad and Cameroon. Hundreds to the repeated displacement of people medical programmes, the opportunities to and the appalling lack of healthcare in of thousands of people were sheltering reach people and to respond in a timely Democratic Republic of Congo (DRC). in the bush and others were living in manner to the enormous needs remained While there is a large aid community in displacement sites. By the end of 2013, nine extremely limited; a forceful reminder of DRC, much of it is focused in Goma and how access to medical care was by and large MSF emergency projects were delivering areas of the country considered stable, the not respected and in many cases directly healthcare in CAR alongside seven ongoing more remote areas of eastern DRC, where targeted by those involved in the conflict programmes, and over 800,000 medical people are subjected to increasing conflict, and used for political purposes. In Lebanon, consultations had been provided to people banditry, widespread abuse and sexual Iraq, Turkey and Jordan, MSF continued to throughout the country. violence, are largely neglected. In 2013, THE YEAR IN REVIEW 5 MÉDECINS SANS FRONTIÈRES heavy fighting caused massive displacement local staff in four hospitals and eight health On 12 December, MSF published an open and inadequate living conditions meant centres, and was running mobile clinics in letter to Valerie Amos, UN Under-Secretary- diseases such as malaria, cholera and 37 locations. General, about the situation in CAR and measles were rampant. MSF undertook the UN humanitarian system’s failure to a number of emergency projects and Speaking out for access to healthcare respond adequately to the emergency vaccination campaigns in the country and MSF is a medical organisation but our work or ensure minimum requirements for in total, more than 1.2 million children does not stop at the delivery of care; it human life.

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