New York, July 27, 2010—Victims of the on-going conflict in Colombia not only suffer from the direct consequences of violence caused by the conflict but also from social and institutional stigma and neglect, according to a report released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). In the report, titled “Three Time Victims,” MSF documents how violence, stigma, and neglect impact the mental health of people living in Caquetá Department of southern Colombia, and calls for mental health services to be adapted to the needs of this vulnerable population.

“Our teams witness the appalling reality endured by most of the population in Caquetá,” said Teresa Sancristóval, head of MSF operations in Colombia. “On the one hand, people are exposed to the violence perpetrated by the different armed groups, and on the other hand authorities and society fail to provide them with the attention they deserve. The consequences of this situation for mental health include severe psychological suffering that should be addressed by authorities.”

Between March 2005 and September 2009, MSF saw 5,064 patients in its mental health project in Caquetá. Of these patients, 49.2 percent had been directly exposed to the conflict, caught in the fighting between armed groups, as well as violent incidents involving threats, injuries, forced recruitment, displacement, movement restrictions, or killings of family members.

The victims of the conflict not only endure the consequences of direct violence, but also face social stigma. “In Colombia, the stigma surrounding those affected by the conflict forces them to keep silent about their condition and suffering, which prevents their social integration and recognition and sense of belonging,” said María Cristóbal, MSF mental health officer in Colombia. This prevents people’s access to employment, housing, education, and health.

In addition to direct violence and social stigma, victims are often excluded from receiving state support through social services. This institutional neglect can be clearly seen through the scant recognition of the forced displacement phenomenon in Colombia.

“The Colombian government should live up to its responsibility in terms of tending to the needs of these people,” said Sancristóval. “Based on our experience in Caquetá, we can say that offering mental health care with limited resources in conflict contexts is possible and that this care can effectively improve patients’ conditions.”

Doctors Without Borders/Médecins Sans Frontières has been working in Colombia since 1985, offering medical and psychological care, as well as guidance and support to thousands of people affected by the conflict. Since 1999, MSF has worked in Caquetá Department; since 2005, the organization has been carrying out specific mental health activities there.

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HIV/AIDS: The Stories Behind the Science

• MSF at the International AIDS Conference
• HIV Facts Sheet

July 19, 2010, Vienna/New York — International donors are disregarding scientific evidence of the benefits of earlier and expanded HIV/AIDS treatment in order to achieve short-term cost savings, at the expense of the ten million people in need of treatment, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) at the International AIDS Conference in Vienna on Monday.

“Today international donors expect doctors to tell patients to come back for treatment when they’re at death’s door,” said Dr. Eric Goemaere, MSF medical coordinator in South Africa. “This is bad medicine. As a doctor I’d much rather give a patient pills today and send her home, than delay treatment and see her in six months at the hospital with complicated tuberculosis.”

With data from its project in the southern African country of Lesotho, MSF will present “late-breaker” evidence at the international AIDS conference this Thursday that shows how earlier treatment reduced the mortality rate and hospitalization of HIV patients by more than 60 percent.

But this type of research is being ignored by international donors, particularly the United States—the world’s primary HIV treatment donor—which is now advising countries to restrict treatment to those in the more advanced stages of HIV disease.

In addition to medical and financial benefits of earlier treatment initiation, studies are also showing that making treatment widely available at the community level is one of the most effective ways to prevent people from getting HIV.

Despite this evidence, there is a general trend toward backtracking on HIV funding, which will increasingly mean treatment delays, deferral, or denials. The Global Fund—the world’s principal funding mechanism for HIV treatment—faces a major financing gap. The US is proposing both continued PEPFAR program flat-funding and a decrease in its contribution to the Global Fund.

Just this week, the German media reported top-level discussions surrounding a three-fold cut of its contribution to the Fund. Austria, the International AIDS Conference host country, has not contributed a single dollar to the Fund since 2001.

This retreat comes after a decade of progress—more than 5.2 million people are alive on treatment today—made possible by the emergence of affordable generic drugs and the commitment of donor countries. With 1.2 million people starting treatment in 2009, progress has been rapid. Yet there are still 10 million people waiting to start treatment and the current climate suggests a decreased commitment to fund treatment for those waiting in line.

“Donors repeatedly promised millions of people a lifeline to treatment,” said Goemaere. “It is a matter of choice: will donors help pay for treatment or let people die?”
 

Geneva, July 20, 2010 — Five weeks after violent clashes erupted in the south of Kyrgyzstan, and despite an apparent return to a more peaceful situation, doctors, psychologists, and nurses working with the international humanitarian medical organization, Doctors Without Borders/Médecins Sans Frontières (MSF) continue to deal with cases of violence on a daily basis. More concerning still is that the capacity of victims to receive adequate health care differs according to the community they belong to.

“Every day, in our mobile clinics and health facilities with which we collaborate, our medical teams treat patients who recently suffered heavy beatings or who even show signs of torture,” said Andrei Slavuckij, MSF program manager for Kyrgyzstan. “Many people, especially from the Uzbek community in Osh, told us they are not going to a public medical structure as they are afraid of being arrested.”

Amid a climate of fear and deep mistrust between Uzbek and Kyrgyz communities, access to health care is still a major concern due to the presence of armed personnel in and around some health structures in Osh. The fear of not receiving adequate and impartial medical services deters many persons requiring urgent medical attention from seeking adequate care.

“In such a tense and volatile context, we call on all responsible authorities to preserve the neutrality of medical facilities. It is essential that any patient who needs care can receive adequate treatment, regardless of their origin,” said Bruno Jochum, director of operations for MSF.

Since the start of the current crisis, MSF has provided more than 1,400 medical consultations through four mobile teams in and around Osh and Jalal-Abad. MSF has also been supporting 25 health structures with donations of drugs and medical equipment. Today, thousands of people are still in a state of deep shock after the extremely violent and traumatizing events that took place in June. Mental health needs are immense and MSF is increasingly focusing its action on psychological support.

MSF has worked in Kyrgyzstan since 2006, providing medical treatment to tuberculosis patients in the penitentiary system, including those suffering from the most resistant forms of the disease. Today, 45 MSF employees, including 19 international and 26 national staff, are running the current emergency operation.

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Port-au-Prince, July 8, 2010 – Six months after Haiti’s January 12 earthquake, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today released a report describing the organization’s largest ever emergency response. The report also describes the dire living conditions of Haitians today and provides an explanation of MSF’s commitment for the coming years.

MSF’s medical work in Haiti has evolved during the past six months, from an emergency response to a wider range of medical and relief activities.

View the report:
Emergency Response after the Haiti Earthquake [1.29 MB]

“Haitians were the first to respond to this disaster, and we have reinforced their effort with a massive aid intervention,” said MSF Head of Mission Stefano Zannini, who was in Port-au-Prince when the earthquake struck, killing and injuring hundreds of thousands of people and leaving more than a million people without shelter. “Today, medical provisions for Haitians have improved, and are certainly more accessible than before the earthquake, allowing poor people to receive proper health care.”

The situation for many Haitians is still hugely precarious, with frustration growing among people who are disappointed with the pace of rehabilitation.

“There is a staggering gap between the enthusiasm and promises for aiding the victims of the earthquake in the early weeks, and the dire reality on the ground after half a year,” adds Zannini.

MSF’s report publishes figures on the scale of its relief intervention. As of May 31, in the first 138 days following the disaster, MSF staff treated more than 173,000 people and performed more than 11,000 surgical procedures. More than 81,000 Haitians received support to cope with psychological trauma. MSF brought in almost 27,000 tents and distributed more than 35,000 relief kits.

In the report, MSF describes some of the choices which had to be made in the first few weeks following the earthquake. For example, the extremely high number of injuries forced teams to focus almost exclusively on the stabilization of patients and emergency surgery, at the expense of other crucial activities. Finding locations for temporary medical facilities was done in haste as there was little time for more in-depth assessments.

An extraordinary number of foreign aid workers had to be brought into the country quickly – two months after the earthquake MSF had more than 350 international staff on the ground –as many Haitian health workers themselves were also victims of the earthquake. This put a huge strain on MSF’s human resources and management capacity. MSF was eventually able to reduce the number of foreign workers, as more Haitians were hired to work in MSF facilities. By the end of May, 93 percent of MSF staff on the ground was Haitian.

MSF also reports that as of May 31, approximately $122 million was received in public donations earmarked for Haiti relief. The organization spent $71.5 million by that same date, including more than $14.8 million on surgery, $5.4 million on maternal health (MSF helped deliver 3,700 babies) and over $11 million providing shelter. MSF foresees that, by the end of the year, it will have spent around $120 million on assistance to the Haitian population. (Note: Figures are converted from Euros based on an average of currency exchange rates from January 12 to May 31.)

Although there are uncertainties around the speed of reconstruction and the extent to which other organizations will still provide health care, MSF commits to continue working for the victims of the earthquake in the years to come.

“Health care was already fragile in Haiti before January 12,” says Dr Unni Karunakara, the International President of MSF. “The earthquake destroyed much of the medical services that were available. It will take many years before the country is back on its feet. MSF is determined to play our part in rebuilding health care for Haitians and will dedicate our staff and means to this task as required.”
 

Geneva, June 29, 2010 – The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today announced the election of its new international president, Dr. Unni Karunakara.

Dr. Karunakara was formally installed during MSF’s International Council meeting in in Amsterdam over the weekend. He takes over from Dr. Christophe Fournier, and will head MSF’s worldwide movement, which includes 19 national associations and branch offices in other countries, for the next three years.
 
“I am honoured to be elected for such an important role in the MSF movement and to contribute to strategic choices that face our organization,” said Dr. Karunakara. “We are confronted with many challenges in the provision of crucial medical assistance to people who are trapped by conflict or suffer the consequences of disasters, disease outbreaks, or neglect. MSF will remain relevant for the survival of large numbers of people, if we manage to constantly adapt our organisation to new realities. The members of MSF’s associative platforms, including the International Council, are important for setting out the organisation’s general directions. I look forward to making my contribution.”

Dr. Unni Krishnan Karunakara first became involved with MSF in 1995 when he was tasked with setting up a tuberculosis control program in Jijiga, Ethiopia. He went on to become medical coordinator of MSF activities in Azerbaijan, providing basic health care services to forced migrants from Nagorno-Karabakh, in Brazil, running a health care program for the indigenous population in Amazonas Province, and in the Republic of Congo, operating a sleeping sickness program. In 2002, Dr. Karunakara joined the public health department of MSF in the organization’s Amsterdam office, advising country programs in the Middle East, southern Africa, and south and central America.  Three years later, he became medical director of MSF’s Campaign for Access to Essential Medicines.  In 2007, he was part of the medical emergency response team that treated victims of cyclone Sidr in Mathbaria, Bangladesh.

Dr. Karunakara received his medical degree from Kasturba Medical College in India and degrees in public health from Yale and Johns Hopkins Universities in the United States. He has held various academic and research fellowships at universities in South Africa, Zimbabwe, Uganda, Germany, and the United Kingdom, focusing on the demography of forced migration and the delivery of health care to neglected populations affected by conflict, disasters, and epidemics.  Since 2008, Dr. Karunakara had been working at Columbia University in New York as Deputy Director of Health for the Millennium Villages Project at the Earth Institute, where he was also Assistant Clinical Professor at the Mailman School of Public Health.

As President, Dr. Karunakara will be based at MSF’s international office in Geneva, Switzerland, where he will work alongside the organization’s secretary general, Kris Torgeson.

Monrovia, Liberia, June 25, 2010 — After providing 20 years of emergency medical aid in Liberia, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today officially stopped running its remaining two hospitals in the country and the Liberian Ministry of Health and Social Welfare (MoH&SW) has taken responsibility for the services previous provided by MSF.

Following the end of civil war in 2003 and elections in 2005, MSF began to progressively hand over its emergency projects and hospitals in many of Liberia’s 15 counties. At the start of this year, MSF was still operating two free hospitals in the capital, Monrovia—Benson Hospital in Paynesville, and Island Hospital in Bushrod Island—treating more than 20,000 women and children, per year.

“Liberia was devastated by 14 years of brutal civil war, with its health system left in ruins by its end,” said Dr. Dhammika Perera, MSF head of mission for Liberia. “Recovery is always slow, but today the Ministry of Health takes over MSF’s last hospital services. However, we remain in the country providing care to victims of sexual violence -- but after two decades, it is an important milestone for us and symbolic of how far Liberia has come in providing healthcare to its people again.”

“As an emergency organization, MSF provides medical aid to people in extreme crisis,” said Dr. Perera. “As Liberia moves steadily towards stability, our role greatly diminishes and the government’s further increases. However, major challenges remain to ensure that the most vulnerable – women and children – continue to receive much needed free care. There are no cheap solutions; as Liberia reconstructs, the international community must step up and provide increased support.”

To minimize gaps that could be created by the closure of its last two hospitals, MSF constructed the James N. Davies Junior Memorial Hospital in Jacob Town Neezoe in Monrovia, transferred its services there, and donated it to the MoH&SW. MSF also added 80 pediatric beds and increased the pediatric services available in Monrovia’s main public hospital, Redemption Hospital.

Longer term support rather than emergency aid is now needed. There are currently less than 100 doctors in a country of 3.6 million, and just over 250 children’s hospital beds in Monrovia, a city of more than one million people. In addition to increasing the pediatric care available, Liberia also needs greater free emergency obstetric and gynecological capacity and better access to free women’s health services.

“We came a long way since the war, but there is a great deal of work ahead,” said Dr. Walter Gwenigale, Liberia’s minister of health and social welfare. “We face difficult obstacles to making our promise of free care a reality for people who cannot even afford their daily bread. To overcome these we will need continued commitment from international donors to increase the numbers of hospitals beds, guarantee staff salaries, ensure drug supply in hospitals, and train new medical staff.”

From July 2010, MSF will work in collaboration with the MoH&SW to provide much needed free medical and psychological care to survivors of sexual violence in up to three MoH&SW health structures.

MSF has provided medical humanitarian aid in Liberia since 1990. The handover of its last hospital services is the most significant reduction of activities during the organization’s two decade presence in the country. MSF remains in Liberia to support the MoH&SW to address sexual violence. During Liberia’s civil war, rape was extremely widespread. Incidence of rape and domestic violence remained high in the period directly following the conflict, and in 2009 it was the second most frequently reported serious crimes in Liberia, after armed robbery. In 2005-2006, out of 1,600 women interviewed for a government survey, 92% had experienced some form of sexual violence. In 2007, 46% of reported rape cases to the Liberian National Police involved children under the age of 18. MSF has been treating survivors of sexual violence in Liberia since 2003. Last year, MSF provided comprehensive medical and psychological care to 1,655 sexual violence survivors.

Toronto/Geneva, June 22, 2010: World leaders meeting at the G8 and G20 summits will not succeed in improving mother and child health in the developing world unless they fundamentally change how they address malnutrition and establish new sustainable funding sources to combat this treatable and preventable condition, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Malnutrition affects 195 million children worldwide and is the underlying cause of at least one-third of the eight million annual deaths of children under five years of age. It can cause stunting, cognitive impairment, and lead to greater susceptibility to disease. The problem is inextricably linked with mother and child health, as malnourished mothers give birth to underweight children, perpetuating a vicious cycle. Many mothers living in areas of high food insecurity do not have access to foods like milk and eggs that contain the high-quality protein and other essential nutrients that their children need. Currently, most international food aid consists of nutritionally inadequate fortified corn-soy flours, which do not provide the nutrients young children need most.

“Foods we would never give our own children to eat are being sent overseas as food aid to the most vulnerable children in malnutrition hotspots in sub-Saharan Africa and parts of Asia,” said MSF International President Dr. Christophe Fournier. “This double standard must stop. As the world’s leading food aid donors, G8 countries are uniquely positioned to have a major impact on reducing malnutrition. If world leaders in Muskoka and Toronto want to truly roll back mother and child mortality, it is imperative they commit to reforming key parts of the global food aid system. We know what works and what children need – let’s simply get it to them.”

In addition to improving the quality of food aid provided to young children, an effective overall nutrition response will require substantial financial resources. The World Bank estimates it will cost $12 billion per year to address malnutrition in the most-affected countries. In a time of global economic austerity, current funding from donors is insufficient, volatile, and unpredictable. Sustainable sources of funding through innovative financial mechanisms are required, such as the financial transaction tax currently promoted by the European Union. A share of the funds raised by such means must be earmarked to global health issues such as nutrition, HIV/AIDS treatment, and tuberculosis research.

In 2009, MSF treated 208,000 children affected by severe acute malnutrition in its programs. Although this is barely one percent of the 20 million children estimated to be affected, this represents more than 15 percent of the 1,200,000 children who received treatment.

“Nongovernmental agencies should not be expected to carry such a huge burden in fighting malnutrition,” said Dr. Fournier. “Donor governments need to step up to fill the gap and help the most-affected countries follow lifesaving nutrition programs that have been successfully implemented in countries like Mexico, Thailand, and Brazil. We need sustainable sources of funding, like the proposed financial transaction levy, that dedicate a share to global health - not the one-shot pledges that G8 summits are prone to deliver.”

The G8 gathering coincides with the onset of a particularly harsh “hunger gap” season in Africa’s Sahel region, the period when staple food crops are exhausted before the next harvest. Most countries in the region are already experiencing increasing rates of childhood malnutrition. MSF is operating emergency nutrition programs—and reinforcing existing ones—in Burkina Faso, Chad, Niger, Mali, and Sudan.

MSF recently launched “Starved for Attention,” a global multimedia campaign to highlight the crisis of childhood malnutrition and how increased childhood sickness and death can be prevented with effective nutrition interventions: www.starvedforattention.org

Athens, June 17, 2010 - Ahead of World Refugee Day on June 20, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today released a report documenting the impact of detention on the wellbeing and mental health of migrants and asylum seekers in detention centers in Greece. MSF urges Greek authorities to ensure humane living conditions for detained migrants, and to consider alternatives to their detention.

MSF’s report, “Migrants in detention: Lives on hold,” documents the unacceptable living conditions in the three detention centers of Pagani on Lesvos Island, Filakio in Evros and Venna in Rodopi,  where MSF provided psychosocial support to detained migrants from August 2009 to June 2010.

“The report shows that detention can exacerbate existing symptoms and contribute to new traumas and psychological distress,” said Ioanna Kotsioni, deputy head of mission of MSF’s project for migrants in Greece. “Most of the migrants supported by MSF described detention as a painful and inhumane experience. Detention was the single most important reason for distress and anxiety.”

Most of the detainees have fled war-torn or unstable countries, such as Afghanistan or Iraq, seeking security. They endure a long and dangerous journey to reach Europe and upon arrival are arrested and detained in degrading conditions. According to the report, almost one third of MSF patients mentioned that they experienced or witnessed violence in their country of origin or that their life was threatened. MSF psychologists observed symptoms of post-traumatic stress disorder in 9.5 percent of the patients. During individual sessions, 39 percent of patients presented symptoms of anxiety, while 31 percent presented symptoms of depression.

The report also reveals that conditions in the detention centers are below national and international standards. Inappropriate facilities are often used and overcrowding is a persistent problem in some detention centers. Sanitary conditions are usually very poor. Detained migrants are not allowed to go out of their cells on a regular basis and family members are separated.  No provisions are in place for vulnerable groups, such as pregnant women, minors, and people with disabilities. Migrants and asylum seekers receive inadequate information about their legal status and the detention system and there are no interpreters present.

Moreover, migrants systematically complained to MSF teams that they were receiving insufficient medical care and had difficulties in communicating with the doctors. Migrants and asylum seekers detained in all three detention centers often said they were being treated “like animals”. As one detained migrant told MSF: “How can I live here? This place is for animals. I am looking at everyone's faces and I see only death”.

During its interventions in the three detention centers, MSF witnessed the negative impact of detention on the wellbeing and mental health of migrants and asylum seekers and raised its concerns with the authorities, urging them to improve living conditions and seek alternatives to detention.

MSF urges Greek authorities to carefully measure the impact of detention on the well being of migrants and asylum seekers and to consider alternatives, especially for vulnerable groups. The Greek government’s plan to establish reception/screening centers for new arrivals is a positive first step and should be implemented. The government should ensure that conditions and services in these centers are in accordance with international standards and pay particular attention to providing appropriate medical and mental health care. Detained migrants and asylum seekers should be treated in a humane and dignified manner and those who wish to do so should be given the possibility to seek asylum.     
MSF has been providing psychosocial support to migrants and asylum seekers in three detention centers, Pagani on Lesvos Island, Filakio in Evros and Venna in Rodopi, since August 2009. MSF teams comprised of psychologists, social workers and interpreters and regularly visited the detention centers. Psychosocial support was offered through individual and group counselling sessions. MSF psychologists saw 305 patients in 381 first and follow-up individual consultations. In addition, 79 group sessions and 258 play therapy sessions were held. MSF ceased its activities in the detention centers at the end of May 2010.