. o c i d e m
: o t o h P
. h s e d a l g n a B n i a r d n e K a y a t s a h s o n o G r e n t r a P s ’ o c i d e m y b d l o h s e s s a l c l a t a Annual Report 2011 n e r P
> Financial Report > Summary of Projects > Project Countries > Overall Result medic o international > Organisational Structure medico international 2011 Financial Report
Current status and trends
edico's total budget for 2011 was ness-raising work. In 2011 operational expen - € 20,234,329.46. This is a further diture totalled € 9,915,243.17, or 91.89% of M slight increase on the previous year, total expenditure. This breaks down into due primarily to extensive reserves for pro - € 8,228,932.95 (76.26%) spent on project fun - jects for which funds were provided in 2010 ding, € 911,435.56 (8.45%) on project but could not be spent until 2011. A carry-for - management and € 774,874.66 (7.18%) on ward to the following year is essential where – campaigning and awareness-raising work. We as in the case of the disasters in Haiti and funded a total of 90 projects in 2011, including Pakistan – donations received immediately large programmes such as humanitarian mine are also intended for use in carefully planned clearance in Afghanistan, continuing recon - reconstruction projects with long-term effect. struction aid for Pakistan and Haiti, work on the West Bank and aid for the victims of the famine in East Africa. We also gladly funded Income small and often highly labour-intensive aid programmes in 2011, e.g. direct medical assi - Medico's total donations for 2011 were stance to people on Cairo’s Tahrir Square, in € 4,944,543.19, including € 1,755,000.00 in cooperation with our Egyptian partners. Ex- donations forwarded from the ‘Development penditure on advertising and administration Works Alliance’ (BEH), which extensively was € 875,490.76, 8.11% of total expenditure. benefited victims of the famine in East Africa. (DZI regards a share of less than 10% for Excluding the BEH donations, income from administrative costs as low.) donations was € 3,189,543.19. This was a slight decrease, although only in comparison with 2010, when donations were unusually Risks and opportunities high at € 3,727,098.89 as a result of the two major disasters. Government grants increased The annual result for 2011 again confirmed the (€ 5,011,074.51, compared with solid financial basis of medico’s work. While € 4,243,319.61 in 2010), primarily due to the the 2011 budget was still dominated by the two expansion of our work in Palestine. Grants major disasters in 2010, it maintained the from the medico international foundation slight rise in donations in previous years, increased from € 44,857.66 in 2010 to excluding the donations received in 2010 for € 80,000.00 in 2011, not least as a result of Haiti and Pakistan. The goal is to stabilise this increased endowments. The continued increa - trend while at the same time seizing other se in donor membership is gratifying, rising opportunities. medico’s specific approach of from 1,985 in 2010 to 2,205. This enables us working with local partners instead of sending to work in a long-term and stable manner with its own staff is also proving justified in view of our partners in the global South. the negative consequences of globalisation. Where other organisations are taking greater and greater risks from growing violence by Expenditure assigning aid workers, medico is able to main - tain and intensify its solidarity with and support In 2011 medico again received the Seal of for partners who are often all the more depen - Approval of the German Central Institute for dent on this in the face of great hardships and Social Issues (DZI). The income statement on risks. the following pages is based on the DZI’s expenditure categories, which distinguish bet - Conclusion: Two good reasons give opportu - ween operational expenditure and expenditure nities the edge over risks. First, the financial on advertising and administration. Operational and organisational solidity of medico as an expenditure includes project funding, project organisation, and second the ongoing interest management and campaigning and aware - in medico’s work on the part of a critical public. Summary of Projects by Region
Project Countries 2011
• Afghanistan • Bangladesh • Brazil • Guatemala • Lebanon • Palestine • Cambodia • Ha iti • Mali • Sierra Leone • Chile • India • Mauretania • Sri Lanka • Colombia • Israel • Mexico • South Africa • Egypt • Kenya • Nicaragua • Western Sahara • El Salvador • Kurdistan/Iraq • Pakistan • Zimbabwe
Africa
Mali East Africa • Contribution to AME annual budget for 2011 and 2012, Association • Emergency aid in the Garissa District – access to health services and Malienne des Expulsés (AME) advocacy work, PHM Kenya Circle • Support to deported migrants in Mali and improvement of reception con- • Emergency aid to East Africa, cofinancing famine crisis, Deutsche ditions, Association des Refoulés d´Afrique Centrale au Mali (ARACEM) Welthungerhilfe (DWHH) € 55,000.00 € 562,553.39
Mauretania • 20 years of AMDH – review and strategy development, Association Sierra Leone Mauritanienne des Droits de l'Homme (AMDH) • Strengthening the poor population in the diamond region of Kono, Network • Improvement of health services to migrants in Nouadhibou, Mission Movement for Justice and Development (NMJD) Catholique de Nouadhibou € 24,886.00 € 9,610.60 Zimbabwe Migration, West Africa • Right to health in the constitution and in practice – campaigning and • Contribution to the Counter-Summit of Civil Society Actors from Africa and strengthening PHC structures in local communities, Community Working Europe in parallel with the 3rd Euro-African Ministerial Conference on Group on Health (CWGH) Migration and Development in Dakar, 22.11.2011, CONGAD Senegal € 180,946.86 (incl. support from the German Federal Ministry for Economic € 2,000.00 Cooperation and Development (BMZ)) Summary of Projects by Region
South Africa Chile • Institutional promotion of the self-help organisation for apartheid victims, • Human rights work, Corporación de Promoción y Defensa de los Khulumani Support Group Derechos del Pueblo (CODEPU) • Support for children in families and communities affected by HIV/AIDS, € 5,500.00 Sinani-KwaZulu Natal Programme for Survivors of Violence • Legal advice for refugees and migrants and xenophobia prevent in South El Salvador Africa, Zimbabwe Exiles Forum (ZEF) • Strengthening the National Health Forum, Alianza Ciudadana contra la • Conceptual and organisational capacity development for local develop- Privatización de la Salud (ACCPS) ment actors in peace and development work phase 3, Sinani • Contribution to social fund for people with artificial limbs in El Salvador, € 191,643.61 (incl. support from ifa zivik) Promotora de la Organización de Discapacitados de El Salvador (PODES) • Awareness raising for schoolchildren on the effects of migration, Museo de Western Sahara la Palabra y la Imagen (MUPI) • German subtitles for the film ‘El Problema’, MundoDoc Film • Capital fund for buying materials to make artificial limbs, PODES • Western Sahara ECHO MdMGR 2011 evaluation • Support for the International People´s Health University in El Salvador, • Provision of medication and medical supplies to Saharan refugees PHM & ALAMES € 54,869.32 (incl. support from ECHO) • Emergency aid in 11 districts of the provinces of San Salvador and La Libertad, Asociación de Promotores Comunales Salvadoreños (APROCSAL) • Expenditure on the Central America project office Asia € 101,575.19 Guatemala Afghanistan • Empowerment of young persons and children in indigenous communities • Humanitarian mine clearing in Afghanistan: Promoting the mine clearing in northern Guatemala, Asociación Coordinadora Comunitaria de Servicios programme of the Mine Detection and Dog Centers (MDC) para la Salud (ACCSS) • Mine awareness for women and children in Central Afghanistan, • Psychosocial work and investigations in the context of the search for the Organisation for Mine Clearance and Afghan Rehabilitation (OMAR) ‘disappeared’ and executed and exhumations, Equipo de Estudios • Supporting the MDC polyclinic: promoting the physical therapy and psy- Comunitarios y Acción Psicosocial (ECAP) chology components, MDC • Forestation project (CO2 capture), Fundación Centro de Servicios € 3,094,342.35 (incl. support from German Federal Foreign Office) Cristianos (FUNCEDESCRI) • III. International Film Festival, Guatemala 2012, Internationale Solidarität Bangladesh und Kulturaustausch e.V. (ISKA) • Rural health programme in Bhatshala, Sherpur District, Gonoshasthaya • Struggle against impunity and strengthening democratisation of the justice Kendra (GK) system, Central American Section of the International Commission of € 18,491.74 Jurists • Emergency relief for tropical depression 12-E, ACCSS Pakistan • Social and legal support for the right to integral restitution and justice, • Campaign work for structural reforms in the reconstruction process, Asociación Campesina para el Desarrollo Integral Nebajense Pakistan Institute for Labour Education & Research (PILER) (ASOCDENEB) • Reconstruction of 20 villages in the Jocababad and Jamshoro Districts, • Expenditure on the Central America project office Health & Nutrition Development Society (HANDS) € 300,654.49 (incl. support from the German Federal Ministry for Economic • Emergency aid for victims of the 2011 monsoon in the Badin District, Cooperation and Development (BMZ)) HANDS € 459,505.00 Haiti • Strengthening the primary health services of the Service Oecuménique Sri Lanka D'Entraide (SOE) in Artibonite • Flood aid for returnees from Kanakarayankulan, Social Economical & • Construction of a bridge in Carrefour Feuilles, Comité de Gestion de Environmental Developers (SEED) Cité 9 (COGEC9) • Provision of land for a centre for people with special needs, SEED • Construction of Centre for Women and Children, promotion, advisory ser- • Medical support for workers in free trade zones, Free Trade Zones and vices and vocational training, Movimiento de Mujeres Dominico-Haitianas General Services Employees Union (FTZGSEU) (MUDHA) & Association des Femmes pour le Développement communau- • Resettlement of internal exiles in North Sri Lanka, SEED taire (AFDC) € 270,718.26 (incl. support from the German Federal Ministry for Economic • Construction of 50 family and ten public toilets, Asosy Asyon Peyizan pou Cooperation and Development (BMZ)) Devlopman Kolora (APDK) • Construction of cisterns, Tét Kole Ti Peyizan Ayisyen (Tét Kole) • Equipment (cameras, toys) for partner organisations for orphans • Participation of SOE representatives in an IPHU course and the World Social Forum in Dakar Latin America • Transport costs for portable water treatment plants for project partners (GEDDH, SOE, AFDC) Brazil • Drawing up a community development plan in Aquin, Centre de • Training Waiapi health promotors, Instituto de Pesquisa e Formação Recherche et de Formation Economique et sociale pour le Développement Indigena (IEPE) (CRESFED) • Patent law, improving public health policy and access to essential drugs, • Pilot project for integrated rural development in the Commune Léogâne, Associaçao Brasileira Interdisciplinar de Aids (ABIA) Groupe Ecologique pour un Dévelopement Durable en Haiti (GEDDH) € 25,920.00 (incl. support from Climate Alliance) • Reafforestation and planting of fruit trees in Carnifice, Mouvement pour le Développement Rural de Gros-Morne (MODERUG) • Construction and operation of a health station in Fauché, Organisation des Paysans Progressistes de Fauché (OPPF) • Expansion of organisational capability and production capacity at CESCAL, Centre de formation, éducation civique, d´assistance commu- nautaire et aux cooperatives (CEFECACC) • Accommodation for young Haitian activists at MST federal training centre, Lebanon Escola Nacional Florestan Fernandes (ENFF) • Empowering Palestinain Youth and enhancing their capacities (Ein el • Establishment of chicken farming and political training for organisation Hilweh Camp), Nashet Association members, Tét Kole • Support for reproductive health clinic, Marsa Sexual Health Center • Defending human rights and implementing the rule of law, Réseau • Assistance with rental costs for nursing school, Chouah Al Nour National Defense des Droits Humains (RNDDH) Educational Professional Association (CENEP) • Integrated reafforestation programme in Roy Sec, APDK • Strengthening political and social human rights of children, youths and • Third dental brigade for Haiti, Asociación Coordinadora Comunitaria de women in Palestinian communities, Popular Aid for Relief and Servicios para la Salud (ACCSS) Development (PARD) • Expenditure on the Haiti project office € 106,551.44 (including support from German Federal Ministry for Economic € 1,044,151.48 Cooperation and Development (BMZ)
Colombia Palestine/Israel • Support for a community-based mine awareness programme, Mines • Health services for chronically ill and community-oriented emergency aid Advisory Group (MAG) in Gaza & Westbank, Palestinian Medical Relief Society (PMRS) • Mine awareness and assistance to victims of armed conflict, Fundación • Improving basic health services for marginalised communities and repairs Tierra de Paz (TdP) to health centre in the Gaza Strip, PMRS € 38,636.04 • Training and campaign for early diagnosis of breast cancer and medical and psychological counselling for breast cancer victims in Gaza, Culture Mexico and Free Thought Association (CFTA) • Community health and herbal medicine in Chiapas, Salud y Desarrollo • Erecting wind and solar installations to assist the population of the Comunitario A.C. (SADEC) southern West Bank, Community Energy Technology in the Middle East • Caravan for relatives of disappeared migrants from Honduras and (COMET-ME) Nicaragua, Movimiento Migrante Mesoamericano (MMM) • Human rights work in the Gaza Strip, Al Mezan Center for Human Rights • Expenditure on the Central America project office (5.9%) • Mobile clinics along the wall, basic health services and first-aid courses in € 36,368.01 marginalised communities in the occupied regions, PMRS Nicaragua • Awareness raising on aspects of a potential return of Palestinian refugees • Construction and equipment of preschool and library/multipurpose room to Israel, Zochrot and promotion of reading circles in La Palmerita, Moviemento de Mujeres • Refuge for young women in emergency situations, Women against Maria Elena Cuadra (MEC León) Violence (WAV) • Health awareness raising for children and adolescents, Centro de • Mobile clinics in marginalised communities in the West Bank, Physicians Información y Servicios de Asesoría en Salud (CISAS) for Human Rights-Israel (PHR-IL) • Integral community development in La Palmerita, MEC León • Health work in East Jerusalem, Medical Relief Society • Support for self-organisation in the area of the production fund in La • International advocacy and institution building, PHR-IL Palmerita by Coopcove • Playback Theatre, psychodrama & trauma training programme, The • Strengthening children and youths as actors for a healthier environment, Freedom Theatre, Jenin CISAS (incl. support from the German Federal Ministry for Economic • Support for school for female health workers, PMRS Cooperation and Development (BMZ)) • Legal costs after raids and attacks by Israeli military, The Freedom • Chronic renal insufficiency aid fund for drugs and laboratory supplies, Theatre, Jenin Nicaragua Forum Heidelberg • Expenditure on Ramallah project office • Expenditure on the Central American project office € 1,179,877.62 (incl. support from German Federal Foreign Office, DETA € 175,335.24 (incl. support from Initiative Eine Welt Köngen) from the German Federal Ministry for Economic Cooperation and Development (BMZ), medico international Switzerland)
Near East/Middle East Thematic health programmes
Egypt • Understanding and resisting pharmaceutical advertising – a learning • Emergency aid for victims of political violence, PHM Global, Cairo Office programme of Health Action International (HAI) • Defending the right to adequate housing in Ezbet El Haggana Slum, • Feasibility study for drug supplies in Jharkhand, India, Community Al Shehab Foundation for Comprehensive Development Development Medicinal Unit (CDMU) € 23,931.61 • Democratisation of global health policies, People's Health Movement (PHM) Kurdistan • Support to Urban Health Initiative in KG Halli, Bangalore, India, Institute • Support for assistance to juvenile detainees at the detention facility, for Public Health Bangalore (IPH) Sulaimania, Khanzad, Haukari FFM • Strengthening regional PHM groups and network building in Subsaharan • Prevention of and information on domestic violence against women and Africa (PHM) children through a preventive health programme in Qadir-Qaram and • Health policy meeting of civil society actors, New Delhi, India Doloy Jafatee, Kurdistan Health Foundation, Haukari FFM € 139,434.70 (including support from German Federal Ministry for Economic • Support for juvenile detainees in Sulaimania and support for public educa- Cooperation and Development (BMZ)) tion in the rural region of Doloy Jafatee, Khanzad, KHF, Haukari FFM € 48,430.00 Other
• Salud Mental – study on trauma intervention and research into violence in war and crisis areas, Katrin Groninger, INA FU Berlin – € 2,000.00 • Mine victims – humanitarian mine clearing as a prerequisite for community development in Cambodia, Mines Advisory Group (MAG) – € 20,000.00 • Refugee assistance project in North Rhine Westphalia, Interkulturelles Solidaritätszentrum e.V., Essen – € 56,000.00 Financial Report 2011 - Overall Result
InCome 2011 2010
Monetary donations € 3,189,543.19 € 3,727,098.89 Third-party donations € 1,755,000.00 € 8,466,803.34 Grants – public funding € 5,011,074.51 € 4,243,319.61 Grants – non-public funding € 164,087.05 € 253,274.03 Contributions of the medico international foundation € 80,000.00 € 44,857.66 Bequests € 166,900.73 € 45,753.56 Fines € 446.90 € 6,600.00 Third-party fines € 0.00 € 1,770.00 Interest and other income € 78,888.65 € 26,403.83 Member fees € 6,387.08 € 6,487.08 Other revenues € 13,869.05 € 14,217.89
Total Income € 10,466,197.16 € 16,836,585.89
Reserves According to § 58 No. 6 of the German fiscal code As at 01.01.2011 € 7,480,944.81 € 1,340,891.51 For projects that were scheduled in 2010 but whose issuing of funds could not or could only partially be completed by 31.12.2010, and for earmarked remaining funds
Free Reserves according to § 58 No. 7a of the German fiscal code € 2,073,000.00 € 800,000.00
Association Capital As at 01.01.2011 € 214,187.49 € 263,595.58
BudgeT 2011 € 20,234,329.46 € 19,241,072.98
Evolution of Income (in million euros)
9 –
8 – Direct donations to medico 7 –
6 – Third-party donations 5 –
4 – Grants
3 – Other income 2 –
1 –
0 – | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | expendITuRes 2011 2010
Project funding € 8,228,932.95 € 6,835,115.89 Project management € 911,435.56 € 1,133,396.75 Campaigning and education work and awareness raising € 774,874.66 € 756,099.94 in line with statutes Advertising and general public relations work € 296,222.54 € 225,742.76 Administration € 579,268.22 € 522,585.34
Total expenditures € 10,790,733.93 € 9,472,940.68
Reserves According to § 58 No. 6 of the German fiscal code As at 31.12.2011 € 7,322,279.55 € 7,480,944.81 For projects that were scheduled in 2011 but whose issuing of funds could not or could only partially be completed by 31.12.2011, and for earmarked remaining funds
Free Reserves according to § 58 No. 7a of the German fiscal code € 1,911,000.00 € 2,073,000.00
Association Capital As at 31.12.2011 € 210,315.98 € 214,187.49
BudgeT 2011 € 20,234,329.46 € 19,241,072.98
Project Expenditures by Region
Others Southern and
Central Asia
Caribbean, Central and South America
Africa Near and Middle East medico international Association Organisational Structure (as at April 2012)
Annual General Meeting
Supervisory Board
Brigitte Kühn, Chair Internal Audit Committee Prof. Dr.-Ing. Alexander Wittkowsky, Deputy Chair Lars Grothe Prof. Dr. Joachim Hirsch, Deputy Chair Horst Pfander Dr. med. Anne Blum, Rainer Burkert, Stephan Hebel, Board Members Michael Rumpf
NN Thomas Gebauer Assistant to the Executive Director Management Executive Director
Katja Maurer Karin Urschel Johannes Reinhard Head of Public Relations and Press, Head of Projects Head of Administration & Finance Spokeswoman
Projects Department Administration & Finance Public Relations Department Department Dr. med. Andreas Wulf, Martin Glasenapp, Deputy Head of Department, Project Jens-Alexander von Bargen, Deputy Head of Department, Coordination Medicine, Lebanon Deputy Head of Department, Texts, Advertising Eva Bitterlich, Controlling, Finance and Accounts, Marek Arlt, Project Coordination Afghanistan Bookkeeping Head Office, Event Organisation, Sabine Eckart, Anna Huber, Proofing Project Coordination Migration, Human Resources, Association and Tsafrir Cohen, West Africa, Zimbabwe Foundation Administration Coordination Palestine & Israel Dr. Annelie Koschella Jan Krabbe Bernd Eichner, Project Coordination, West Sahara Donations Administration and Support, Press Relations, Online Editor Usche Merk, Legacies, Field Offices Anne Jung, Project Cordination Africa, Bernadette Leidinger-Beierle, Campaigns Psychosocial Work Donations administration, accountancy Gudrun Kortas, Riad Othman, Uwe Schäfer, Donations and Legacy Fund Raising Project Coordination Emergency EDP & IT Dr. Ramona Lenz, Relief Donation Fund Raising, Texts Doris Pfeiffer-Götze Financial Project Coordination Claire Schäfer, Project Coordination Haiti Cofinancing and Donations Office Management, Head Office Maarg Semere, Kirsten Schubert, Office Management Anita Heiliger Health Advocacy Officer Dr. Sönke Widderich Till Küster Dr. Thomas Seibert, Project Coordination Southern and Elena Mera Project Public Relations and Southeast Asia/ Mine Action Nicole Renner Networking, Themes Rita Velásquez Jürgen Wälther, Medico Office Central America Website Dieter Müller, Office Director Herlon Vallejos, Project Finances
Medico Office Palestine & Israel Luke McBain, Office Director Maisa Alnatsheh Project Finances Nizar Qabaha, Project Assistent
Medico Office Haiti Anne Hamdorf, Office Director Morris Viertel, Project Finances
Project Office Western Sahara (in Algeria) medico Office Central America & Mexico: Sonia Diverres, Project Coordination [email protected] Amokrane Taguett, Project Finances Arezki Sahmoun, Logistics, Technical medico Office Palestine & Israel: Operations [email protected]
Project Support and Coordination medico Office Haiti: Afghanistan [email protected] Mohammad Hamayun The Work of medico international
> Emergency Relief > Health > Psychosocial Work > Human Rights medic o international > Acting in Networks For more than 40 years medico international has been promoting the human right to health. In 1997 medico and other members of the International Campaign to Ban Landmines were awarded the Nobel Peace Prize.
Table of Contents:
3 Introduction
4 Emergency Relief – Haiti, Pakistan, Nicaragua
6 Health – Guatemala, Zimbabwe, Sri Lanka
8 Psychosocial Work – Nicaragua, South Africa, Palestine
10 medico Projects in Brief – Bangladesh, Chile, Guatemala, Egypt
12 Human Rights – Migration /Mali
14 medico’s Work with Partners
16 Campaign to Ban Lanmines
18 medico in Alliances
20 Global Health Networking
Information and Acknowledgements: medico international Burgstraße 106 D-60389 Frankfurt am Main
Tel. +49(0)69 944 38-0, Fax +49(0)69 436002 [email protected], www.medico.de
Donations account: 1800, Frankfurter Sparkasse, Bank code 500 502 01
For donations from abroad: IBAN : DE21 5005 0201 0000 0018 00 BI/SWIFT: HELADEF1822
Editors: Katja Maurer, Usche Merk, Thomas Seibert
Report authors: Martin Glasenapp, Ramona Lenz, Andreas Wulf
Translation: transparent Language Solutions GmbH
Layout: ostpol
October 2011
Photographic credits: Cover front: Young woman in Afghanistan, photo: www.one-step-beyond.de Cover back: Rehabilitation in Pakistan - project partner HANDS, photo: medico The medico team in Frankfurt, photo: Christoph Boeckheler
Introduction Solidarity among Equals medico international is struggling for the right to health medico international has been campaigning for health to be recognised as a human right for more than 40 years. In 2010 alone, the Frankfurt-based aid and human rights organisation provided funding for over 100 projects run by its partner organisations in Africa, Asia and Latin America.Defending aid, questioning aid and overcoming aid are the guidelines of medico international’s work. By supporting partner organisations, raising public awareness in Germany and Europe, and networking with health initiatives globally, we are contributing to the struggle to change the causes of poverty and adversity. In practical terms this might mean direct emergency aid to survivors of the earthquake in Haiti, for example, which was provided within a few days of the tragedy by our Dominican Republic partners, the health organisation Cosalup, and funding for the International People’s Health University in Kisumu. Both actions have seen the emergence of a new concept of solidarity: one forged between equals in this one world. Haitians do not need the expertise of ‘white’ aid workers to overcome their marginalised situation. It needs their own expertise and support for their resources for self-help and recovery. By strengthening solidarity from below rather than sending own staff, we are making a stand against paternalistic approaches to aid that all too often increase dependence of marginalised people rather than addressing it. Our support for the IPHU is also an attempt to retain, develop and pass on alternative expertise, to go against the ever more mainstream assumption that people’s access to health is subject to market forces. The IPHU convenes regularly in various locations throughout the global south (and also in Brooklyn, New York in 2011) and promotes the exchange of knowledge and specific practical experiences.
Since the banking crisis of 2008 we are experiencing a global renaissance of the idea of social justice. Whether in Cairo, Santiago, Madrid or Tel Aviv, people are going out on to the streets and are demanding democracy infused with the notion that ensures everyone participates. ‘Another world is possible’ is the slogan of the global social forums. For many years this slogan faced criticism from politicians across the world who claimed there was no alter - native to a global economic order based on rising inequality. Now we are experiencing an – albeit fragile – return of political thinking. Inherent therein is the idea that all human beings are citizens of this world and thus have rights. The work that medico international carries out is dedicated to ensuring that these rights take shape. We do this as equals among equals in association with our partners across the world and our supporters and donors in Germany.
3 Haiti South to South
How emergency aid from neighbouring countries turned into a long-term programme
hen the earthquake to political training, learning struck Haiti on 12 Emergency Relief practical ways of advocating W January 2010 the for their rights and political capital Port-au-Prince was At medico international action. The aim is to streng - almost totally destroyed and ‘critical emergency then Haitian grassroots orga - over 250,000 people lost nisations and civil society relief’ means more than their lives. In the midst of structures in order to provide disaster management. such an apocalyptic night - support not only for rebuilding mare, emergency aid provi - Our approach involves infrastructure but also for poli - ded by Haiti's neighbours providing victims the tical and social (re-)construc- provided a ray of hope. In support they need to tion. These include the rural addition to the solidarity help themselves, under - community-based organisati - Haitians showed through nu- stand the underlying on APDK, which is attempting merous examples of self- political and economic to stave off the next disaster help, neighbouring Domini- causes and deal with through an environmentally- can Republic also provided the psychological and friendly reforestation program - assistance. One of the orga - social trauma they have me; the NGO CRESFED, nisations supported by medi - suffered as a result of which is setting up a participa - co international using funds tive community development the disaster. raised in Germany was the scheme with the help of advi - Dominican health associati - sers from Benin; the Haitian- on Cosalup. As part of the Dominican Women’s Organi- ‘Ayuda Haiti’ network it was sation (AFDC), which has its in charge of basic healthcare at emergency shelters in origins in emergency aid but has also begun developing Léogâne, where volunteer doctors and care workers a long-term operational programme to support women’s maintained a health supply chain for several weeks. rights in Haiti; and finally the Haitian human rights orga - medico has known Cosalup for many years through the nisation RNDDH, whose aim is to monitor transparency health activist networks in Latin America. Like medico, it and the rule of law during the national reconstruction and is a member of the People’s Health Movement. pursue abuses through the courts.
This was the first project funded by medico in Haiti and This approach arises directly from medico’s experience the approach adopted in it remains an important feature of humanitarian aid over a number of decades and its of medico’s programming to this day. medico funded often ambivalent consequences for the victims, of which Guatemalan dental health promoters to undertake two Haiti is a classic example. On the one hand, the pre - missions to Léogâne, only to find that even this was not sence of many NGOs – whose number has tripled since enough to cover basic needs. This gave us the idea of the earthquake – is needed to ensure the population’s learning from other partners’ positive experiences in basic humanitarian needs are met. On the other hand, similar situations of exclusion and poverty. Aid was also they present a serious problem as they undermine the provided by a grassroots organisation in a rather more Haitian’s own capacities to recover and move on from distant neighbour – Brazil. The Landless People’s Move- the disaster. medico is attempting to address this dilem - ment in Haiti has links with the Landless People’s Move- ma by actively encouraging public debate about the ment in Brazil (MST) through the Via Campesina net - limits and responsibilities of international aid organisati - work and medico has been working with the Brazilians ons and by strengthening South-South cooperation. This for several years. We are now providing funding to train is something we have already had success with in other Haitian peasant activists at MST’s training centre in contexts. Brazil. They attend courses ranging from organic farming
4 Nicaragua
Integrated Community Development
An emergency relief project with long-term results
Rebuilding houses for flood victims – HANDS, Pakistan, photo: HANDS
t can often take many years to assess the long- Pakistan term effects, if any, of humanitarian aid in post- I disaster situations. One example is the situation in Nicaragua following Hurricane Mitch in 1998. There, medico international had been supporting partners and Strengthening projects since the mid-1970s and responded with huma - nitarian aid immediately after the hurricane. The emer - gency relief programme brought us into contact with sur - Self-Help viving campesino families who had been forced to flee from their villages and land by a mudslide. Returning medico’s partner HANDS was home was not an option. Most of them had lost many of ready to act immediately their relatives during the mudslide and were in a state of severe shock at the total collapse of their normal living conditions. Despite this, they managed to establish a vil - lage at a new site, set up an agricultural cooperative, hen Pakistan was overwhelmed by floods restore their own livelihoods and even develop pro - along the Indus and other regions in August spects for their children’s futures. Since then the village, W 2010, medico’s partner HANDS (Health and called El Tanque, has become a symbol of a viable alter - Nutrition Development Society) was one of the first civil native to neoliberal approaches to development. society organisations on the scene. In the Sindh region HANDS evacuated tens of thousands of people trapped Farming in El Tanque Nicaragua, photo: medico by the floods, quickly set up camps to ensure their survi - val and is now supporting the return of the refugees. This was possible because HANDS had been working in the poor regions affected by the disaster for decades and was able to mobilise thousands of volunteers rapidly. HANDS was just one of many other civil society organi - sations in Pakistan that demonstrated their capacity to act during disasters. medico was able to provide consi - derable amounts of money for HANDS due to the overw - helming generosity and solidarity shown by German donors. It had previously had contacts with health and community-based organisations over many years via the People’s Health Movement. HANDS’ approach to emer - gency relief is based on both providing basic health care and supporting flood victims to organise themselves. As a result of this shared approach and the shared under - standing that health is a basic human right, the work car - ried out by medico and HANDS to deal with the dis - astrous flood in Pakistan has become a paradigm for a critical understanding of emergency relief work. Guatemala A Long Common History medico’s support for the health association ACCSS
edico’s cooperati - involved in community work on with the acti - Health for All as youth; while Juana joined M vists of the Guate- later. Santos talks about how malan health and community The concept of primary he once operated on a young organization ACCSS began girl with a tumour under her health care is the during the fight against the tongue. Her father had per - guiding principle for military dictatorship in the suaded him to operate after 1980s. medico supported medico when supporting failing to get help from the indigenous refugees who direct healthcare proj - poorly equipped public health - sought protection from the ects. Health outreach care system. Like the other junta’s policy of extermina- teams, cooperation with promoters Santos has recei - tion in camps in Mexico and, local institutions, ved further training in dental in so called ‘resistance villa - training of health pro - care, traditional herbal medici - ges’ in the forests of the nort - moters, the democratic ne and acupuncture. For ma- hern border region. medico participation of local ny years he also learned supported the refugees with communities in develo- much from experts from the medicines and training for ping these structures – city and from abroad. Sebas- health and dental care pro - tián, who has completed a these are just some of moters. After the end of the three-step dental training pro - the cornerstones of the civil war medico continued gramme and a course in ac- this support as they organi - concept, which focuses counting, not only provides his zed the refugees’ return. The primarily on people’s fellow villagers with dental aim was to transfer the expe - health needs rather treatment but also looks after rience of autonomy and than on market needs. the cooperative’s accounts. emancipatory health con - ACCSS has trained around cepts into the new, post war 100 dental promoters in this Guatemalan context and to way in recent years. develop them further. This has proved successful in many aspects. One example is the health and training Results of the work in the region of Ixcán give evidence centre that ACCSS has built on the outskirts of the pro - that the Primary Health Care concept – understood vincial town Playa Grande in the north of Guatemala, co- holistically in its full political dimension – can impact funded with a subsidy from to the German Ministry for much more than basic health care. Since 2009 ACCSS Economic Cooperation and Development. The single- works in 28 villages with children and youth in schools floor building is full of air and light. The doors to the and youth committees to strengthen their self organisati - offices are kept open. There are rooms for training and on and participation. While focusing on health interests professional development of health promoters; a work - and problems of children and youth, groups also discuss shop where young people can attend basic vocational other social and political developments in the villages: courses; a recycling system that clears waste water into the displacement of peasants in the interest of big plan - drinking water quality; and a tropical medicinal plant gar - tations, the return of the military, which is justified in den that is a riot of colour. But even more importantly, the terms of the fight against drugs, and human rights abu - centre is seen as an oasis or Noah’s ark for a different ses by the state and the drug syndicates. Hugo Rosetti, future mainly because of the way that all those involved a professor from Argentina specialising on Primary interact with each other and with the project itself. Health Care, evaluated the work of ACCSS in 2011. His conclusion: “I have seldom visited health projects like Among them are Santos Chen, Sebastián Bartolo, ACCSS which not only focus on certain health indicators Viviano Matias and Juana Perez. The three men come but works as comprehensively on health.” from the hidden resistance villages and were already
6 Sri Lanka
Between Strike and Cookery
A trade union in the legal vacuum of Sri Lanka’s global Health committee members of CWGH, Zimbabwe, photo:medico market factories
Zimbabwe atunayake Free Trade Zone is 30 kilometres from the capital Colombo. ‘Eighty per cent of K those employed here are women,’ says Anton Small Marcus from medico’s partner the Free Trade Zone and General Services Employees Union (FTZ&GSEU). The women live in cramped boarding houses, three to a Victories room, with an open fire for cooking outside and a couple of showers. Working conditions are tough, the supervi - medico’s partners in Zimbabwe sors are ruthless and the wages are so low that most of fight for the right to health the women ‘volunteer’ to do overtime. Following years of operating illegally, FTZ&GSEU is now the strongest union in Sri Lanka’s free trade zones. It is he devastating cholera epidemic of 2008 in concerned not only about wages and employment law, Zimbabwe, in which thousands of people died, but also its members’ health. The workers simply do not T was the worst consequence of the dramatic have the time to go to the state hospitals – and a visit to situation facing health in that country. This disaster is pri - a private doctor would easily cost an entire month’s sala - marily a political one: Since the collapse of the healthca - ry. The union provides assistance twice a week, suppor - re system in the 1990s the situation has continued to ted by medico, at its own offices and after the end of the deteriorate and diseases that could be prevented by working day. One doctor and one assistant doctor attend clean water supply are spreading. around twenty women per session and a small pharma - cy provides the most important medicines. The service The crisis has inspired a committed health movement even includes a cookery course for which the union whose members include medico’s partner Community recruited a popular TV chef. How and what can the Working Group on Health. As its name implies, civil women cook when they only have half an hour in the society is a key focus. The CWGH is closely linked to the evening to prepare meals in the flickering light of the local community through its grassroots structures: 25 kerosene cooker? The TV maestro’s main message is regional health committees provide the community with that the women need to share the shopping and cooking expertise and tools they can use to work together to im- and – just as with the fight for wages and employment prove their own situation. The committees were also acti - rights – you can’t do it alone. ve during the cholera epidemic. Through their health centres they provided information on prevention measu - Union cooking course with the TV chef, Sri Lanka, photo: medico res and distributed sanitary products to prevent the disease from spreading further. The CWGH combines its action on health with criticism of the government: ‘The crisis in healthcare is partly to blame on the increasing number of people with no access to education, transport or water;’ says Itai Rusike.
CWGH is therefore attempting to raise the profile of basic health care on the political agenda and is current - ly campaigning for the right to health to be adopted in Zimbabwe’s new constitution. Nicaragua Moving on – Looking Back
Organisational development for social change – the Centro Antonio Valdivieso (CEAV)
edico has been express the pain, mourning supporting Nicara- Psychosocial Work and other emotions accumula - M guan civil society ted over the many years of in its attempts to implement Psychosocial work has sacrifice and struggle, in order social and political changes been at the core of to come to terms with the in the country since the meaning of their experiences medico’s work for struggles against the So- over that period. decades. It started moza dictatorship. The new beginning, marked by the with support for vic - Many people, as they spoke of revolution in the 1980s, was tims of political vio - what they had lost, started to followed by disenchantment lence, and today it has touch on other problems that over neoliberal policies in extended its activities had previously been hidden, the ‘90s and a discussion to the consequences of such as a woman from León, about misjudgements, global political, economic and who told us: ‘I am very sorry power relations and the role social exclusion and that I have lost my home but of psychosocial dynamics. violence. There are what is far worse is that I can - ‘In order to understand and many facets of this not sleep at night because I come to terms with our own work from individual am frightened that my hus - history, we also need to ana - band will lie in my daughter’s therapeutic support, lyse the history of our coun - bed and abuse her.’ CEAV psychosocial community try,’ explains Marta Cabrera, decided to develop a multi- head of the ecumenical cen - work to political dimensional approach to tre CEAV founded in 1979 interventions and lob - strengthening social organisa - that offers a ‘psychosocial bying to establish tions and the issues they dealt training programme for soci - human rights standards. with: ‘We wanted to bring issu - al change’ in a number of re- es to the table that no-one gions of Nicaragua. The trai - was addressing: subjective, ning courses are attended psychological, spiritual.’ Star- by local grassroots organisations and disseminators ting from the complexity of the realities of life and fully committed to social change. CEAV’s one year training recognising the multilayered nature of what people have process, which is divided into several workshops, is the experienced, this is a holistic approach that does not result of a decade’s experience of psychosocial work. It equate development with economic growth and does not was prompted by the observation that all the community view society as something external and independent workshops and local development projects on self-deter - from individuals. Institutional structures also needed to mination, gender issues or ecological sustainability in be examined. ‘In Nicaragua many organisations want to Nicaragua had only had a limited positive impact. As use a machete to carry out a heart operation,’ says they tried to identify the reasons why many people Martha Cabrera. ‘They want to change the world whilst lacked the initiative to take a pro-active approach to reproducing an outdated style of leadership inside orga - changing their life and the social situation, they came to nisations that makes any change impossible.’ The work - the conclusion that Nicaragua as a country had been shops gave them an opportunity to analyse and discuss ‘wounded’ in many ways by the succession of social the consequences of the revolution as well as the rapid upheavals and natural disasters over the last decades. social change resulting from the globalisation process of Many people fought in different ways to bring about the the last twenty years. They also helped them to under - Sandinista revolution and social change. When the de- stand why it is necessary to acknowledge the past ‘so we feat came they were left to deal with it on their own, as can go forward on a firm footing’. there was no collective space in which to publicly
8 Palestine
At the Edge of the World
Community workers training Sinani South Africa, photo: medico The Freedom Theatre in Jenin
South Africa uliano Mer Khamis was an extremely paradoxi - cal phenomenon. Son of a Jewish Israeli mother J and a Palestinian father, he embodied the bor - Transforming der. He did not allow himself to be confined to one camp or the other, but preferred to sit on the fence: an unpro - tected place. He was murdered on April 4, 2011 outside Poverty his Freedom Theatre. He journeyed to Jenin in the occu - pied West Bank in the footsteps of his mother Arna, arri - and Violence ving in a town where the people knew Israelis only as soldiers. He continued her work with the children’s and youth theatre that she had founded there. The theatre The work of Sinani KwaZulu- represented a protected space in which young people Natal Programme for Survivors could process the violence and feelings of powerless - of Violence ness they experienced in their everyday lives. To the theatre the first Palestinian drama school was added, and their productions were among the best that the Palestinian theatre had to offer. In the glare of the thea - inani, which has been one of medico’s project tre’s spotlights, a battle was fought on two fronts: against partners for many years, grew out of a group of the Occupation that made prisoners of Jenin’s populati - S committed psychologists who provide thera - on; and against the development of reactionary type of peutic support to prisoners and torture victims of the attitudes and opinions growing up as a consequence of apartheid regime. SINANI’s work in marginalised, exclu - isolation and occupation. Juliano’s companions are da- ded and violence-ridden communities in KwaZulu Natal ring to continue with the venture. This dual struggle cli - is driven by the conviction that help for transformation maxed in the scandal-rocked production of George Or- processes must cover all needs and be organised on a well’s parable ‘Animal Farm’, in which young Palestini- holistic basis. Since 1995 SINANI has been working in ans are robbed of their life chances by occupation (the around 20 communities prone to systemic violence humans) and their own authorities (the pigs). Juliano’s where political, social and domestic violence are closely murder should not be allowed to be the final act of the intertwined. These communities are also dominated by Freedom Theatre. His associates are hoping that the extreme poverty and high HIV infection rates. SINANI’s theatre will continue to shine out, even after his violent work combines empowering individuals by restoring rela - death. Their next project is the Playback Theatre, an tionships and connections within the communities and interactive theatre experience for Jenin and the surroun - with public institutions. The aim is to increase the self- ding area. It will allow the public to tell their own stories, empowerment of political and social actors in communi - which will then be improvised on stage by actors and ties through training and developing social and econo - musicians – a powerful way of articulating the common mic programmes, to promote conflict resolution in an struggle and the strength of resistance. attempts to transform the causes of poverty and violen - ce in a constructive way. Freedom Theatre performance, Palestine, photo: Bärbel Högner
SINANI’s success over many years in providing assi - stance to communities designed around their needs is reflected in the fact that SINANI is now being requested by government agencies to provide training and compile a curriculum for training community workers who will work in areas of extreme poverty and violence. medico in brief
Bangladesh Solidarity from Below
Rickshaw pullers establish a healthcare insurance cooperative
t every intersection in the 15-million-strong hours. They rest after their shifts at the ‘garage’ belon - metropolis of Dhaka armies of tricycle rick - ging to their ‘rickshaw lord’, where they all roll out their A shaws jostle through the inevitable traffic jam, sleeping mats. The lord deducts the rent directly from even mounting the pavements if necessary. It’s serious - their daily wage of just 8 Euro. Since this gives them ly hard work: the drivers stand up on the pedals, pedal slightly more room for manoeuvre than many other poor three, four, five times, gain momentum, sit down, then people, medico’s partner Gonoshastaya Kendra (GK) have to brake and start all over again all day for up to ten wants to try out a specific experiment with them: the Gonoshastaya Rickshawpullers Health Cooperative. This is a mutual health in- surance fund that costs the drivers 1 Euro per year. GK provides mobile clinics and basic (primary) healthcare with drugs and comprehensive health awareness-raising in the garages. More comprehensive examinations and treat - ments are offered to the insured mem - bers in the high-rise Gonoshasthaya Nagar Hospital in the city centre. In Bangladesh, however, this is certainly not a step towards privatising healthca - re provision: it is a grassroots initiative in the fight for statutory health insuran - ce. medico also supports the project in memory of the history of the German workers’ movement which started out with similar mutual associations. Rickshaw puller ‘garage’ in Dhaka, Bangladesh, photo: medico
Egypt Democracy Is the Cure!
Urban health in Cairo
he pharaoh had to go, and nothing will ever be also at work in Cairo’s Ezbet Al Haggana district. This the same again. Still in February 2011, medico slum has grown up without planning and without a sani - T was helping our Egyptian partners in the tation, educational or health infrastructure. Al Shehab People’s Health Movement, donating €10,000 as a rapid supports its residents – locals and immigrants – in their response to meet the needs of the injured in Tahrir campaign for the right to adequate living conditions: the Square. A mobile team of doctors and nurses cared for aim is to forge a civil society alliance, bolster the activi - the wounded; colleagues from the Al Shehab Foundation ties of the local community and educate people about gave legal advice; and work has begun on documenting their rights. In this way democracy is taking root in the the events of the uprising. medico’s partner Al Shehab is community.
10 Guatemala An Archive of Crime
Guatemala’s Police Archive makes the civil war crimes publicly available
Filing the National Police Archives, Guatemala, photo: Ulrich Stelzner n a windowless hall young women and I men with facemasks and gloves sit in long rows sif - ting through yellowing, dusty books of files. The staff treat the material with the greatest care. For these files hold pri - celess information about a grisly chapter in Guatemala’s recent history: this is the his - torical archive of Guatemala’s National Police. Discovered almost by chance in 2005, it comprises 80 million files go- ing back over 100 years and also documents the period of the civil war that lasted que. medico funds the psychological support of the from 1960 to 1996. During that period the military, the Police Archive staff who are regularly faced with trauma - police and death squads murdered 200,000 people. tic histories as they inspect the files. medico is also invol - Another 45,000 disappeared. The archive is now in the ved in funding screenings of the film ‘La Isla’ by the hands of the victims and their families. In Latin America, German documentary film-maker Ulrich Stelzner, who is with its history of brutal military dictatorships, this is uni - documenting the work of the archive.
Chile Providing Emergency Relief
CODEPU supports indigenous victims of the earthquake
he coastal village of Tirúa was particularly badly assistance with reconstruction. With medico’s support, hit by the severe earthquake that devastated twenty destroyed houses had been rebuilt by the start of T Southern Chile in February 2010. Many Ma- 2011. But CODEPU’s core aims are actually rather differ - puche Indians live here, who were persecuted during the ent: for many years the organisation has been working Pinochet dictatorship and also have little voice in socie - alongside victims and survivors of the Pinochet dictator - ty under the neoliberal economic model. Poverty rates ship, providing legal assistance and psychotherapy. In are well above the average for the country. Since little Tirúa CODEPU had recently begun an oral history pro- was to be expected from the state, medico’s partner of ject to write down the history of the Mapuche. medico will many years, Corporación de Promoción y Defensa de continue to support colleagues at CODEPU on this and los Derechos del Pueblo (CODEPU), quickly decided other projects. after the earthquake to provide emergency relief and
11 Mali What We Mean by Freedom
Migration and cross border networks
he West African Because Mali is not only the country of Mali is a Human Rights homeland but also a transit T migration hub with country for many migrants from traditional routes within medico’s work involves the southern part of West Af- Africa to Arabic countries an equal mix of defend - rica, European foreign policy that stretch back to antiqui - has selected the country for an ing and implementing ty. This is partly a result of experiment in migration ma- political, social and the weakness of the econo - nagement. It shares the atti- my but also an expression economic human rights. tude of the former colonial of societal traditions of a We always connect our power, France, that treats fran - culture of mobility entirely human rights work with cophone West Africa and Mali separate from the nation the daily struggle for in particular as a Special Eco- state. As in many West social justice, educa - nomic Zone. Since European African countries, people tion and health and demand for cheap African la- are generally free to travel particularly when sup - bour has dwindled and the in Mali, state borders or porting people in 1990 Schengen Agreement en- passports have had little migration or flight. ded the visa waiver for Europe, significance since post- Mali is now treated as a peri - colonial independence. pheral dumping ground to which unwanted, ‘undocumen - Mali is one of the poorest ted’ people are deported from countries in the world. The minimum salary is approxi - Europe. For some time now, not only deported migrant mately 12,300 CFA francs (35 Euro) for an unskilled wor - workers from Mali land at Bamako airport – those from ker and approximately 50,000 CFA francs per month for its West African neighbours do as well. a skilled worker. Many of the unofficial convoys of refu - gees that cross the Sahara in pick-ups to reach hidden The Office for Migration Management (Centre d’Infor- harbours on the North African coast start out from the mation et de Gestion des Migrations au Mali) in the capi - desert regions in North-Eastern Mali. tal Bamako is currently drafting models for a selective migration procedure on African soil designed to keep the
12 Detained ‘illegal’ migrants at the Mali-Algerian border, photo: Reuters
majority of prospective migrants in Africa and restrict in sub-Saharan West Africa, which was formerly entirely access to the EU labour market to just a few. The EU is exempt from EU visa requirements with a cross-border targeting existing self-help associations of deportees to solidarity. Working jointly with another of medico’s part - make use of their local and regional support networks ners, the Mauritanian human rights organisation and to appear to be embedded in the local community. Association Mauritanienne des Droits de l’Homme Solidarity networks such as the Association Malienne (AMDH) in conjunction with human rights defenders in des Expulsés (AME), an association of deported per - North-Eastern Morocco, AME is attempting to build up a sons, has so far resisted these attempts to promote stop - transnational solidarity network. The concern is not limi - ping migration. AME is a partner of medico international. ted to emergency assistance for deportees or direct It provides direct assistance to deportees at the Mali cooperation, such as in the Mauritanian-Malian border desert borders and Bamako airport and is also directly area where people are found half-dying of thirst every engaged in Mali’s internal politics as an organisation of day and cared for, but also with creating a public opposi - affected people. tion movement defending migrants’ rights through trans - national workshops and demonstrations. In Bamako the Ousmane Diarra, AME’s president, described in Mali’s AME is also providing a particular type of development parliament the 21st-century odyssey undertaken by assistance: with its advice and support, the Association migrants and the exposure of hundreds of thousands of des Refoulés d’Afrique Centrale au Mali (ARACEM) was people caught between structural poverty and forced founded, a self-help group of deportees from Central immobility in the following terms: ‘After arriving in our African countries (Cameroon, both Congolese republics, homeland and completing border formalities we are left the Central African Republic, Chad, Gabon), that at- to fend entirely for ourselves. After so many years spent tempts to provide hundreds of stranded migrants with elsewhere, we deportees are left completely alone. Most essential supplies (medicines, water, food). of us had to leave our wives, children and property behind. Destitution has become part of our life. Now we Our partner network in West Africa is starting to organi - are back in Mali we think of our other life far away that se itself. Its staffing and financial resources are still far lies in tatters. So many of our young brothers and sisters too small to be able to care for even a fraction of those have migrated from rural areas and then emigrated, only who are flown out by aeroplane, detained at desert bor - to end up on the desert roads. If they don’t drown in the ders between African countries or captured in the boats sea these migrants return as deportees after suffering along Europe’s southern coastline. But an important step long periods of imprisonment, harassment, violence and has been taken: the ‘voiceless’ people have started to hunger. They are passed from border to border only to find their voice and are increasingly demanding their be abandoned in Northern Mali. They are left alone to rights from their own authorities, who are all too ready to live in the wild. It is a living hell.’ defer to Europe. In doing so, they criticise not only the inhumanity of the European border regime, but also the There are many aspects to the work of the West African neoliberal European economic reality which allows the Network for Migrants’ Rights. AME is also responding to free movement of goods but restricts the movement of the increasingly visible European migration policy in the human beings. They demand that they too should have region by opposing the tightening up of border controls freedom of residence and movement to Europe.
13 How to cooperate Reflective Dialogue
Matching aims and objectives
edico does not imple - and anti-globalisation net - ment development medico’s Work works and encourages the M projects itself but sup - with Partners deportees and expellees to ports the work of partner orga - help themselves and to be- nisations in Africa, Asia and come involved in shaping medico works with peo - Latin America. In many cases their political reality. This cooperation lasts for many ple and organisations comprehensive approach years and we develop a close in Africa, Asia and closely matches medico’s relationship with our partners. Latin America who want objectives and way of wor - However medico is also ente - to see short- and long- king and AME’s first applica - ring into cooperation with new term political and tion in 2008 was approved. partners. Before agreeing to social change. Working Since then medico and AME become partners, both sides together includes con - have been working together. need to check whether their tinuously learning from Cooperation based on mu- respective aims and objectives and for each other. tual respect is the basis of coincide. The partner organi - Planning, monitoring every partnership for medi - sations then submit specific co. This also includes re- and evaluation (PME) funding applications. During a cognising our partners’ au- methods also help us in cooperation programme we tonomy and their specific consult with our partners on our critical and features since they work whether we are on track to- reflective dialogue. under a wide range of con - wards achieving our common ditions. A standardised PME objectives and reflect on what process would be too rigid improvements we can make. to cover all this diversity. We At the end of a project we also check what went well and therefore apply PME tools flexibly, for example tailoring what we should do differently next time. This process is them to the size and capacities of the partner organisa - often referred to as planning, monitoring and evaluation, tion. We use them primarily as a means of communicati - or PME for short, but we prefer the terms reflective on at the various stages of cooperation. By maintaining practice and partner dialogue. a constant dialogue both sides can reflect on their own work and learn from each other. This allows a relations - hip of trust to be built up which also makes it easier to Finding partners overcome difficulties and conflicts.
When medico decided some years ago to become more active in the field of migration we wanted to find partners Joint evaluation whose politics and programming matched medico’s visi - on. While researching on the internet and discussing this In December 2010 AME and medico staff met to evalua - with colleagues from other non-governmental organisati - te the cooperation so far and to discuss future plans. ons, one of medico’s staff came across the Association Two colleagues from La Cimade, one of AME’s French Malienne des Expulsés (AME), a self-help group of partner organisations, also attended, since AME, like deported migrants in Mali. A visit to Mali confirmed that many other organisations, is not only funded by medico. medico should cooperate with AME. The organisation This means its work needs to be coordinated and agreed not only provides emergency relief for individuals who with a wide range of stakeholders. The interim evaluati - have been deported or expelled immediately following on report stated that: ‘AME has made impressive pro - their return, but also carries out public awareness cam - gress since 2007: its political position is sounder and the paigns and is politically active. It is a committed member organisational structure has improved.’ But it was also of national, regional and international migration policy clear that AME had taken on too much and that it was
14 Team members of AME, Mali, photo: medico losing sight of its core tasks. The joint report stated: ‘It is ment was made following the joint evaluation that all important for AME to remain true to its mandate and to partners should pay into a pooled budget in future and set priorities to avoid weakening the organisation.’ use this to fund the organisational infrastructure as well However the joint evaluation was not only used to as projects. For AME, this means not only that funding assess AME’s work, but also to reflect on how the diffe - for their infrastructure is more secure, it also relieves the rent organisations were cooperating with each other. For burden by standardising administrative procedures. The example, the report states: ‘The relationship between pooled budget was also approved over a longer term, AME, La Cimade and medico is very good; we speak which also reduces the administrative burden for all “the same language” and our organisations complement sides. each other.’ As so often, here too, we saw that other donors wanted to tie their funding to specific activities; The joint interim evaluation of AME, La Cimade and whereas, medico also finances the organisational infra - medico in December 2010 was thus not merely a chan - structure such as office space, staff costs, etc. medico is ce to consult and plan future cooperation. Agreements bucking the trend of funding publicly visible projects at were made on very specific improvement measures the expense of expanding and maintaining local organi - affecting all the organisations involved. At the next eva - sational infrastructure. luation we will need to check the extent to which the agreed changes have been implemented and whether This is as unsatisfactory for medico as it is for our part - they have had the expected impact. Until then, however, ners: the constant need to apply and bill for individual we will still consult frequently with our AME colleagues, projects to different donors places a huge administrative remaining open to any changes and maintain our part - burden on them. Therefore, in AME’s case, an agree - nership.
15 Global Networking A Successful Global Initiative
The International Campaign to Ban Landmines
he International due to a network of institutions Campaign to Ban Global Networking set up since then to ensure the T Landmines was implementation of the Ottawa founded in 1991 by medico medico supports the Treaty in all countries. The international in cooperation realisation of social pressure brought to bear by with the Vietnam Veterans of and political human the ICBL in the last two de- War Foundation. cades has not just lead to the rights within global establishment of a new inter - networks. States and In 1997 the International national standard, a ban on Campaign to Ban Land- other global actors can landmines under international mines was awarded the only be forced to abide law, but to an institutional Nobel Peace Prize. The idea by laws and ensure structure which is essential developed into a movement human rights through a to reduce the danger posed for a global ban. Without global agreement. by landmines as well. The global support, the cam - institutions that have emerged paign would never have be- since the signing of the Treaty come so significant. The include regular conferences ‘most successful civil society held by the Treaty signatories initiative in the world’ (as Kofi Annan, then UN Secre- concerned with the political implementation of the provi - tary-General, then called it) succeeded in forcing the sions of the Treaty; civil society monitoring programmes military in many countries of the world to ban these such as the ‘Landmine Monitor’ that watch over compli - weapons. The Ottawa Treaty came into force in 1999, ance with the resolutions; the UN Mines Action Service banning the production, stockpiling, transfer and use of (UNMAS) that coordinates the mine awareness and anti-personnel mines as well as stipulating that financial mine clearance programmes enforced around the world; resources be provided for mine clearance and mine the Swiss-based Intergovernmental Geneva Internatio- victim assistance programmes. Finally, for the first time, nal Centre for Humanitarian Demining (GICHD) provides the number of mines being cleared is exceeding the essential materials and has developed appropriate mine number of new mines being laid. clearance processes, compiling the standard operating procedures for mine removal. This might sound like too There are many reasons for the success of the cam - much bureaucracy, but these quality standards are final - paign. One of the most important is that the International ly crucial life or death decisions. Campaign to Ban Landmines (ICBL) succeeded in buil - ding up an independent ‘international public’ that enab - It took a lot of work to convince people – a form of ‘citi - led it to turn a military issue into a public one. At its height zen diplomacy’ – and to persuade the individual Treaty the ICBL consisted of a global network of more than 60 signatories including Germany to fulfill multilateral mine national campaigns. clearance and victim assistance duties. The continuing need to keep up this type of multilateral commitment on Much has changed since the landmine campaign started these issues is evident in Afghanistan today, where the back in 1991. The number of people killed or maimed by successes of the past years risk being superseded by a mines has been drastically reduced. That large areas number of military strategies, whether these are called ‘a around the world are now being cleared of mines is also comprehensive approach’ or ‘networked security’.
16 Mine awareness with children, Tierra de Paz Colombia, photo: medico
Examples of mine clearance and victim rehabilitation projects funded by medico:
Colombia
Landmine War on a Daily Basis
The violent conflict in Colombia is far from over. The mines and explosives in the world. medico’s partner government’s military strategy to take the fight directly to Tierra de Paz focuses on protecting children: schools are the midst of populated areas is having fatal consequen - declared conflict-free zones and teachers become mine ces. Colombia has the highest accident rates from land - awareness-raisers.
Afghanistan
Anti-Landmine Sniffer Dogs
Millions of mines and unexploded devices have been left tions must be removed from zones used by the popula - behind by the conflict in Afghanistan and now present a tion. MDC has 1,500 Afghan employees and is training huge danger to the population. Before fields, schools landmine sniffer dogs to detect mines. and roads can be repaired and used to the full, the muni -
Sri Lanka
Mine Awareness Protects the Civil Population
In Vanni, an area previously under the control of the Ta- they have no free access to their fields and have not mil Tigers (LTTE), there was severe fighting shortly be- been made aware of the danger posed by landmines. To fore the end of the conflict. Large areas are riddled with prevent further accidents, CTF raises awareness of ex- landmines and unexploded devices. Returning refugees plosive remnants of war and trains up community acti - are in great danger: already in a precarious situation, vists to disseminate knowledge as broadly as possible.
El Salvador
Artificial Limbs on the Principle of Solidarity
PODES is Spanish for ‘You Can’. This organisation supports and spare parts to international standards and employs mostly people injured by mines laid during earn enough to support their entire families. Another suc - the war as artificial limb technicians and managers. They cess story due to a long-term cooperation partnership have been injured and traumatised by the long years with medico. of fighting. But at PODES they make artificial limbs,
17 Global Networking The Alliance Development Works
Acting fast and sustainable
ive years ago medico, Brot für die Welt, Mise- home. The spontaneous, widespread civic solidarity, the reor, terre des hommes and Welthungerhilfe high standing of the organisations in the alliance and the F formed the Alliance Development Works (Bünd- support of the German ARD TV network led to an extra - nis Entwicklung Hilft or BEH in German): It has since ordinarily high level of donations. been joined by other German partners including Kinder- nothilfe, Christoffel-Blindenmission, Eirene and Welt- The alliance ensured that it was reported in a trans- friedensdienst. parent way with several press conferences and com- prehensive documen- Their joint aim is to provi - tation of the wide vari- de immediate and long- ety of aid acivities at term assistance in emer - www.entwicklung-hilft.de. gency situations and dis - The Alliance’s director asters simultaneously by Peter Mucke empha- supporting experienced sized what the member indigenous partners. In organisations had in addition the public should common despite the diffi - be informed in a profes - culties that are unavoi- sional and engaged man - dable in countries like ner of the background to Haiti and Pakistan: ‘With the emergency and the opportunities for overcoming our approach of interlinking emergency relief, preventive poverty and misery. During the disasters in Haiti and measures and development we aim to strengthen stand- Pakistan, this tried and tested method of cooperation alone civil society structures over the long term. That is again proved successful both in the field and back at not something you can do in one year.’
photo: medico
18 Sri Lanka Advocacy
Joint lobbying in Berlin, Brussels and Geneva
lthough the war in Sri Lanka ended in 2009, the in a precarious position: any statement about Sri Lanka country’s Tamil-populated north is not at peace. endangers the work of our partners on the ground, which A Quite the reverse: their land is completely occu - is all the more important in the uncertain post-war period. pied, tens of thousands live in internment camps and To protect them and safeguard their mutual assistance thousands are in prison. Lawlessness is also increasing and support, the network ‘Sri Lanka Advocacy’ was for - in the south, with journalists ‘disappearing’, trade union med at the start of 2010 as a means for a number of activists being arbitrarily detained, any opposition gag - NGOs, including medico, to coordinate lobbying activi - ged. This is also placing the work of medico and other ties in Berlin, Brussels and Geneva and run a joint web - development non-governmental organisations (NGOs) site at www.lanka-advocacy.org.
The People’s Health Movement
A worldwide network for the right to health
he People’s Health Movement (PHM) was found new partners: for example in Egypt, where a team founded in December 2000 in Savar, of doctors and nurses connected to the PHM provided T Bangladesh. 1600 people from 93 countries assistance to those wounded on Tahrir Square. Their came together at the premises of medico’s partner joint activities range from projects in the field to demon - Gonoshasthaya Kendra: activists, professionals and strations and lobbying against the neoliberal erosion of academics who in their various activities are committed healthcare systems, the exclusion of minorities and to the concept of primary health care (PHC). medico refugees, punitive drug patents, protectionism and world came across many old partners at the PHM, from market prices and strives for a comprehensive democ - Central America, South Africa, India and Palestine – and ratisation of the World Health Organisation.
Challenging the War
Development and peace organisations discuss Afghanistan
he bloodiest year of the war in Afghanistan was position to the policy of ‘networked security’ under which 2010, with the civil population the hardest hit by aid and development NGOs are expected to cooperate T the violence. For development aid organisations more closely with the German Bundeswehr (army) as it working in the country this was a reason to intensify co- begins to move into ‘out-of-area’ interventions. By estab - operation with one another and increase their contacts lishing regular communication with the peace move - with the peace movement. VENRO, an umbrella organi - ment, the NGOs are looking for an ally through which the sation of non-governmental development organisations voice of the partners in Afghanistan can also be heard. in Germany, also has an Afghanistan Working Group, In 2010 development NGOs and peace activists had se- whose members include medico, Caritas International, veral meetings towards preparing a conference in 2011 Deutsche Welthungerhilfe, Misereor, medica mondiale to present their shared objective jointly to a wider public. and Oxfam. They are united by an uncompromising op-
19 Global networking
Health activists of CWGH and TARSC, Zimbabwe, photo: medico Health as a Common Good
The Delhi Statement on democratising Global Health
In early May 2011 representatives of organisations a human right and to introduce that idea into and institutions campaigning for health and current debates, particularly on the role and work social justice came to a meeting in New Delhi of the World Health Organisation (WHO). This organised by the Indian health organisation led to the Delhi Statement which caused a stir Prayas, the Community Health Cell Bangalore, at the WHO’s World Health Congress held a few the People’s Health Movement, the Public Health weeks later. Some excerpts are given here. Foundation India and medico international. The full text can be accessed at www.medico.de The aim of the meeting was to develop a shared and also on the website of the initiative vision of how health could achieve the status of www.democratisingglobalhealth.org.
ealth is an essential condition for human and relatively high on the international policy agenda, and social development. That is why the right to governments are launching directs assaults on poverty H health is enshrined in the Constitution of the through various programmes, health inequalities within World Health Organization, in the International Covenant and between countries are on the rise. Persistent pover - on Economic, Social and Cultural Rights (CESRC) and ty and growing inequalities, these intractable foes, are in over 130 national constitutions worldwide. (…) stark reminders that economic globalization and market liberalization have not created an environment conduci - Even now, when global health and poverty reduction are ve to sustainable and equitable social development. (…)
20 Listening to the Grassroot Voices
medico’s health campaigning
Global Health Policy has no shortage of initiatives ened its critical campaigning in Germany, organising and experts, but the voice of the stakeholders them - an alternative event at the first ‘World Health Summit’ selves is often ignored; medico fights to make their in 2009. While the summit was aimed exclusively voices heard. Working through international civil so- at technical solutions for the issues of health and ciety networks, we strive to prevent the right to health disease, ignoring their social dimension, medico from being sacrificed to commercial interests or sub - organised a conference in Berlin in 2010 that brought jected to a narrowly technocratic interpretation. together international speakers and a national net - work for global health. The network is not only made Since 1981 medico international has been campai - up of international initiatives but local public health gning within the global network Health Action Inter- campaigners, trade unions and migrant groups are national so that access to essential medicines is not involved. We are convinced that ‘Global Health starts subordinated to profits for the Big Pharma lobby. at home’. This joint approach is designed to provide constructive criticism of German policy on global In 2000 the People’s Health Movement was launched health issues. as a strong voice for everyone’s right to health. One of its key demands is that people should be involved The most recent step in this direction is the emer- in decisions that affect their health. The fact that so gence of a distinctive, single voice of civil society many activists and groups from the People’s Health amid current debates on ‘Global Governance for Movement were involved in the work of the World Health’. Before now, the sheer number of separate Health Organisation’s Commission for the Social initiatives on Global Health have made coordination Determinants of Health in 2005–2008 attests to the difficult and reduced the movement’s capacity to global achievement of this initiative. counter the influence of the many actors who focus on their own commercial self-interest rather than Against this backdrop of success, medico strength- health as a public good.
Health is a common good that demands collective As the UN health agency, the WHO remains in today’s responsibility. Instead, structural violations of the right to globalised world the “directing and coordinating authori - health are produced by the dominant market dynamics ty” for the realization of the right to health and universal and the uncontrolled influence of profit-driven transnatio - coverage. Its role as the sole global legal authority nal corporations, supported by the policies of internatio - in health is embedded in its constitution, and needs to be nal financial and trade institutions – the International strongly supported. The last few decades, however, Monetary Fund, the World Bank and the World Trade have witnessed the rapid emergence of new actors who Organization. Such violations are often unmonitored, have highlighted health as a priority and largely shaped unmeasured, and are too numerous to quantify. As they the global agenda, but who have also contributed to form part of a process of systematic violations of other much fragmentation in health governance. Their increa - rights – to gender equality, to water and food, to work sing prominence has produced a shift in institutional cul - and income, to housing and education – any commit - ture, favouring the penetration of market values into ment to the right to health cannot be conceived in isola - areas where they do not traditionally belong and resul - tion from a broader approach of universal social protecti - ting in a new sphere of influence in health policies. (…) on as a key policy to human development.
21 The topics of global health governance and the WHO actors as well as develop and implement measures to reform agenda were prominently featured during the avoid and properly manage conflict of interest situations. WHO Executive Board debate in January 2011, a deve - These go beyond transparency and include a clear defi - lopment we welcome. Fire has been lit and WHO, nition of institutional conflict of interest, clear entry crite - through its Member States, needs to take responsibility ria and sunset clauses; (…) for the policy dialogue opportunity it has opened up. It is a collective responsibility, too. 5. Urge Member States to focus on taxation as one of the key policy instruments to enhance revenue capacity (…) We are convinced that WHO needs to rediscover to advance human welfare, and in particular to finance a its fundamental multilateral identity. Drawing on its home-grown health agenda. (…) The world is awash in strengths, the organisation has to take advantage of money and time has come to focus on wealth as a way its reform process to rethink and reassert itself as the to reconnect redistribution and social policy with econo - leading actor in a broader governance for health that mic and fiscal policymaking. (…) is coherent with the need for solid public policy respon - ses to the neoliberal prescriptions, so that globalization 6. Recall that international solidarity is essential in many be shaped around the core values of equality and social countries with insufficient financial potential to ensure justice. the necessary human and material resources to guaran - tee the right to health. Today’s non binding provisions need to be turned into mandatory arrangements if we are We, the participants in the New Delhi consultation to make such support predictable and long term.
1. Call on Member States to strengthen the enforceabili - 7. Strongly encourage Member States to increase their ty of the right to health, and the other economic, social financial contributions to WHO and enhance their impact and cultural rights. (…) in the organisation. (…)
2. Are convinced that the primary responsibility to enfor - ce the right to health lies with national governments. (…) Signed by: Without people’s mobilization, human rights cannot be Salud y Desarollo, Bolivia; Wemos – Health for All, met. The right to health is no exception. (…) Belgium; Prayas, India; medicus mundi, Switzerland; Geneva Health Forum, Community Working Group on 3. Favourably consider the proposal by WHO for innova - Health, Zimbabwe; Partners in Health, USA; Training tive consultation mechanisms that allow meaningful par - and Research Support Centre, Zimbabwe; Section 27, ticipation of the multiple actors involved in global health South Africa; O’Neill Institute for National and Global and require that the WHO consult with public interest Health Law, USA; Southern and Eastern African Trade, groups to this end. (…) Information and Negotiations Institute, Zimbabwe/ Uganda; World Social Forum, Brazil; Tax Justice Net- 4. Strongly challenge the increasingly disproportionate work, Kenya; Community Health Cell, India; Equinet, participation of the corporate private sector in WHO pro - Southern Africa; World Council of Churches, Geneva; cesses without a robust mechanism to address conflict Action Group for Health, Human Rights and HIV/AIDS, of interests. WHO needs to develop a comprehensive Uganda; Diverse Women for Diversity, India; medico framework that would guide interaction with commercial international, Germany, People’s Health Movement.
22 Afghanistan. photo: www.one-step-beyond.de Health – Social Support – Human Rights
medico works... with partners
The assistance provided by medico is more than the supply of relief goods in emergency situations. We see our work as an element within comprehensive social action that aims at the implementation of the right to health. Our concern is to cooperate in a spirit of solidarity and trust with people who are autonomous partners and anything but mere recipients of aid. Our common point of departure is marked by the political and social aims that we share with our partner organizations in the South.
medico works... in context
Wars and affliction are never a bolt out of the blue. They have under- lying reasons that must be challenged. Those who through avoidance of important political and cultural linkages do not understand the root causes of human distress will not be able to react adequately to such distress.The aim of our efforts is not simply targeted at alleviating hu- manitarian crises, but at overcoming them permanently.
medico works... for change
Any assistance granted to people leaves traces that will remain long after the original intervention. Therefore, assistance aimed at overcom - ing the status quo presupposes a socio-political vision of a different and more just world. It must develop strategies that can serve as a roadmap. There are no humanitarian solutions to humanitarian crises. We believe that assistance is an element within social action that fights for democracy, social justice and respect for human rights – together with the victims of destitution and despotism.
medico international Tel. +49(0)69 944 38-0 Burgstraße 106 Fax +49(0)69 436002 D-60389 Frankfurt am Main E-Mail: [email protected] Internet: www.medico.de medico international