INTERNATIONAL ACTIVITY REPORT 2019 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 2019. Staffing figures represent the total full-time equivalent employees per country across the 12 months, for the purposes of comparisons. 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. This activity report serves as a performance report and was produced in accordance with the recommendations of Swiss GAAP FER/RPC 21 on accounting for charitable non-profit organisations. CONTENTS FOREWORD THE YEAR IN REVIEW MSF PROGRAMMES 2 AROUND THE WORLD 4 5 OVERVIEW OF THE EBOLA RESPONSE THE SAHEL: CIVILIANS ACTIVITIES IN THE DEMOCRATIC TRAPPED IN A REPUBLIC OF CONGO DEADLY SPIRAL OF VIOLENCE 8 10 12 LESS THAN HUMAN: ACCESS CAMPAIGN: ACTIVITIES HOW EUROPE’S POLICIES 20 YEARS OF BY COUNTRY HARM REFUGEES, MIGRANTS ADVOCACY AND ASYLUM SEEKERS IN ACTION 14 16 20 FACTS AND GLOSSARY OF CONTACT FIGURES DISEASES AND MSF ACTIVITIES 92 96 100 International Activity Report 2019 1 MSF PROGRAMMES AROUND THE WORLD MSF PROGRAMMES AROUND THE WORLD BELARUS BELGIUM UKRAINE BOSNIA- FRANCE HERZEGOVINA SERBIA UZBEKISTAN ITALY GEORGIA ARMENIA GREECE TURKEY SYRIA LEBANON AFGHANISTAN IRAQ IRAN PALESTINE JORDAN PAKISTAN LIBYA EGYPT MEXICO MALI HAITI NIGER HONDURAS CHAD SUDAN YEMEN EL SALVADOR NICARAGUA GUINEA-BISSAU BURKINA GUINEA FASO NIGERIA CÔTE VENEZUELA SIERRA LEONE CENTRAL ETHIOPIA D’IVOIRE SOUTH AFRICAN LIBERIA SUDAN REPUBLIC COLOMBIA CAMEROON SOMALIA AND UGANDA SOMALILAND KENYA DEMOCRATIC REPUBLIC OF BURUNDI CONGO TANZANIA BRAZIL MALAWI BOLIVIA ZIMBABWE MOZAMBIQUE ESWATINI SOUTH AFRICA 2 Médecins Sans Frontières 21 ARMENIA 53 KYRGYZSTAN 21 BALKANS 54 KENYA 22 AFGHANISTAN 56 JORDAN 24 BANGLADESH 57 LEBANON 25 BELARUS 58 LIBERIA 25 BELGIUM 58 NICARAGUA 26 BOLIVIA 59 LIBYA 26 BRAZIL 60 MALAWI 27 BURKINA 61 MALAYSIA FASO 62 MALI 27 BURUNDI 63 MOZAMBIQUE 28 CAMBODIA 64 MEXICO 28 CÔTE 66 NIGER D’IVOIRE 68 NIGERIA 29 CAMEROON 70 MYANMAR 30 CENTRAL RUSSIA AFRICAN 71 PAKISTAN REPUBLIC 72 PALESTINE 32 COLOMBIA 73 PAPUA NEW 34 CHAD GUINEA 35 DEMOCRATIC 73 PHILIPPINES PEOPLE’S 74 RUSSIA REPUBLIC 74 TAJIKISTAN KYRGYZSTAN OF KOREA DPR KOREA 75 SEARCH TAJIKISTAN 35 EGYPT AND RESCUE 36 DEMOCRATIC AFGHANISTAN OPERATIONS REPUBLIC 76 SIERRA LEONE OF CONGO PAKISTAN 77 SOMALIA AND 40 ETHIOPIA BANGLADESH SOMALILAND INDIA 42 EL SALVADOR MYANMAR 78 SOUTH 43 ESWATINI AFRICA THAILAND 43 FRANCE 79 SUDAN CAMBODIA PHILIPPINES 44 GREECE 80 SOUTH 45 GEORGIA SUDAN 82 SYRIA MALAYSIA 45 GUINEA 46 GUINEA- 84 TANZANIA INDONESIA BISSAU 84 THAILAND PAPUA 46 HONDURAS 85 TURKEY NEW GUINEA 47 HAITI 85 UGANDA 48 INDIA 86 UKRAINE 50 IRAQ 86 UZBEKISTAN 52 INDONESIA 87 VENEZUELA 52 IRAN 88 YEMEN 53 ITALY 90 ZIMBABWE Countries in which MSF only carried out assessments or small-scale cross-border activities in 2019 do not feature on this map. FOREWORD In 2019, tens of thousands of MSF staff undertook lifesaving work that impacted millions of people in more than 70 countries around the world. We begin this report by thanking them for their commitment and dedication. This is also an opportunity to raise two issues of growing concern to MSF. Over the past two decades, governments have implemented Monitoring and assessing how these restrictive measures threaten increasingly restrictive legislation to fight radical armed groups. the security of our staff and impede our work is a priority for us, as In certain situations, these restrictive measures conflict with the is mitigating the way in which humanitarian action and principles provisions of international humanitarian law and have direct are impacted. Security and humanitarian frameworks should be consequences on MSF’s ability to provide medical and humanitarian able to coexist so that people affected by conflict and violence are assistance to those in need. Our work is sometimes perceived not denied the assistance they are entitled to. as material support and collusion with criminal groups, rather Climate change, a human-induced reality, is also of great concern to than impartial and neutral medical humanitarian assistance to us, as it may well alter the dynamics of conflict and the incidence of the wounded, the sick and other very vulnerable people. In some disease, impacting communities already at risk. Following a motion places, this is compounding an already very difficult situation where passed by our International General Assembly in 2019, we are humanitarian aid is significantly curtailed as a result of the abduction evaluating how we can address environmental issues most effectively. and killing of humanitarian workers by armed groups. On the basis of scientific reports outlining what can be expected in the future, it is vital that we prepare to assist the people who will In Nigeria and Syria, for example, we have for years been confronted be affected. At the same time, we need to assess our own carbon with reduced access to people in dire need, living in highly insecure footprint and take steps to incorporate environmentally responsible regions where states have criminalised some humanitarian and working methods, products and equipment into our projects. medical activities and personnel. Our staff have been arrested in Adapting the way we operate could greatly impact the communities Syria, military investigations into our activities have taken place in we serve, which is why we must define and adopt a strategy as a Nigeria and non-state armed groups have attacked and kidnapped matter of urgency. humanitarian workers. International sanction regimes and restrictive state measures also affect the financial transactions of aid The following pages present an overview of MSF’s work in 2019. organisations by, for example, placing restrictions on where funds We extend our deepest gratitude to our donors, whose trust and can be transferred. We have experienced this first-hand, notably generosity allow our organisation to continue to provide vital when we endeavoured to transfer money to pay our staff in Somalia. humanitarian and medical assistance wherever we can. Dr Christos Christou Christopher Lockyear INTERNATIONAL PRESIDENT SECRETARY GENERAL 4 Médecins Sans Frontières Syrian Kurdish refugees who fled their homes in northeast Syria gather to receive winter clothes during a distribution in Bardarash camp. Iraq, October 2019. © Moises Saman/Magnum Photos THE YEAR IN REVIEW By Oliver Behn, Dr Marc Biot, Dr Isabelle Defourny, Kenneth Lavelle, Bertrand Perrochet and Teresa Sancristoval, MSF Directors of Operations In 2019, the Ebola outbreak declared in northeastern Democratic Republic of Congo (DRC) in August 2018 continued to rage, alongside the worst-ever measles epidemic, while further east, two cyclones and severe flooding devastated parts of Mozambique, Sudan, and South Sudan. There was an upsurge in conflict across the Sahel and in Yemen, and thousands of migrants, refugees and asylum seekers remained trapped in Libya, Greece and Mexico, exposed to violence and disease. Médecins Sans Frontières (MSF) teams responded to all these crises, worrying levels of malnutrition and malaria, particularly among and other emergencies around the world, during the year, with a children. However, intense violence and the ever-present threat of workforce of approximately 65,000 people – around 80 per cent of abductions meant that it was no longer safe for our teams to work whom were hired in the countries where we work. in some areas. We worked where it was safe to do so, although the precarious context requires a lot of time and staff resources to Deteriorating situation for people and relief providers manage the risks, restricting who and where we are able to help. Living conditions, including access to medical care, significantly deteriorated for many people in countries across the Sahel region In northwest and southwest Cameroon, where violence between – especially Mali, Niger and Burkina Faso – during 2019. Armed government forces and separatist armed groups escalated sharply, groups and intercommunity