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How We Work
Every year, Doctors Without Borders/Médecins Sans Frontières (MSF) provides emergency medical care to millions of people caught in crises in more than 60 countries around the world. MSF provides assistance when catastrophic events — such as armed conflict, epidemics, malnutrition, or natural disasters — overwhelm local health systems. MSF also assists people who face discrimination or neglect from their local health systems or when populations are otherwise excluded from health care.
On any given day, more than 22,000 doctors, nurses, logisticians, water-and-sanitation experts, administrators, and other qualified professionals working with MSF can be found providing medical care around the world.
In 2009, MSF medical teams carried out more than 7.5 million outpatient consultations; delivered 110,000 babies; treated 1.1 million people for malaria; treated 200,000 severely and moderately malnourished children; provided 165,000 people living with HIV/AIDS with antiretroviral therapy; vaccinated 7.9 million people against meningitis; and conducted 50,000 surgeries.
MSF is a neutral and impartial humanitarian organization that aims first and foremost to provide high-quality medical care to the people who need it the most. It does not promote the agenda of any country, political party, or religious faith, and, as such, endeavors to communicate its history, background, and capabilities to all parties in a given situation so that it may gain the necessary access to populations in need.
When MSF Responds
At its core, the purpose of humanitarian action is to save the lives and ease the suffering of people caught in acute crises, thereby restoring their ability to rebuild their lives and communities.
In the countries where MSF works, one or more of the following crises is occurring or has occurred: armed conflict, epidemics, malnutrition, natural disasters, or exclusion from health care.
Kenya 2008 © Brendan Bannon
In numerous countries, MSF is providing medical care to people caught in war zones. Some may have been injured by gunfire, knife or machete wounds, bombings, beatings, or sexual violence. Others are cut off from medical care or denied the ability to seek the treatment they need. This could be a pregnant woman who cannot reach help to deliver her baby, or someone with a chronic condition who has no way to resupply his medicines. Conflict’s consequences are manifold, and MSF has historically attempted to respond with speed, focus, and flexibility in order to deliver the necessary care to those most in need.
In 2009 and 2010, MSF provided surgical care in approximately two dozen countries, including the Democratic Republic of Congo, Haiti, Nigeria, Iraq, Somalia, and Jordan, as well as in Gaza, Sri Lanka, and elsewhere. MSF also provided medical care to refugees and internally displaced people seeking sanctuary in camps and other temporary shelters. Today, in places such as Chad, Niger, Kenya, Bangladesh, and Sudan, MSF runs vaccination campaigns and water-and-sanitation projects, provides basic medical care through clinics and mobile clinics, builds or rehabilitates hospitals, treats malnutrition and infectious diseases, and provides mental health support. Field teams also provide shelter and basic supplies—blankets, plastic sheeting, cooking pots, and more—when people have been uprooted from their homes and have nothing to help them survive.
Congo 2007 © Caroline Fernandez
Over the past decade, MSF has also become involved in the treatment of the devastating pandemics of HIV/AIDS and tuberculosis, which is the leading cause of death for people with HIV/AIDS. MSF also treats neglected diseases such as kala azar, sleeping sickness, and Chagas, diseases that largely affect the world's poorest people and for which there are, at present, few effective treatment options.
MSF believes in bringing the highest quality medical care possible to its patients. Through the Campaign for Access to Essential Medicines MSF pushes for improved diagnostics and treatments for diseases that disproportionately affect the world's poor, along with urgently needed second-line drugs for the growing numbers of patients developing resistance to first-line medicines. MSF has also called attention to the need for appropriate pediatric formulations for children with HIV/AIDS, and improved treatments and diagnostics for tuberculosis, for which there have been virtually no new advances in treatment since the 1960s.
In 1999, MSF co-founded the Drugs for Neglected Diseases initiative (DNDi) which brought together drug researchers, medical practitioners, and pharmaceutical companies to explore alternative ways of developing medicines — basing research and development priorities on need rather than profit. In 2007, DNDi and the pharmaceutical company sanofi-aventis launched ASAQ, an effective and easy-to-use treatment for malaria. More recently, MSF and DNDi worked to develop and implement the first viable new treatment for sleeping sickness in a quarter of a century, nifurtimox-eflornithine combination therapy (NECT), and they are now working to find and clinically test a new drug to treat Chagas disease.
In 2010, MSF responded to measles epidemics in several countries (particularly in Central and West Africa), a dengue fever outbreak in Honduras, kala azar outbreaks in southern Sudan and elsewhere, and a widespread outbreak of cholera in Haiti, where the organization treated more than 60 percent of all the cases that presented in the country. MSF also supported the governments of Niger and Mali as they implemented the use of a new, low-cost and longer-lasting vaccine for meningitis A.
Sudan 2008 © Anne Yzebe/MSF
An estimated 195 million children worldwide suffer from the effects of malnutrition, with 90 percent of them living in sub-Saharan Africa and South Asia. In fact, malnutrition contributes to at least one-third of the eight million annual deaths of children under five years of age.
In 2009, MSF treated approximately 200,000 severely and moderately malnourished children in a host of countries in Africa and Asia. In many cases, teams employed ready-to-use therapeutic food, or RUTF, a revolutionary product that is changing protocols for responding to malnutrition. These nutrient-dense milk- and peanut-based pastes include all the minerals, vitamins, and nutrients that rapidly growing young children need for proper development. In traditional treatment programs, severely malnourished children had to be hospitalized for several weeks to receive treatment. The fact that several weeks worth of RUTF can be given to families and then taken at home means that far more children can be treated than ever before.
In Niger in 2005 MSF pioneered the use of RUTF on a massive scale, treating 63,000 severely malnourished children on an outpatient basis with cure rates of nearly 90 percent. These results provided the impetus for MSF to begin treating moderately malnourished children in Niger with RUTF rather than providing them with the standard supplemental-enriched blended flour.
In 2007, MSF launched a pilot project using a modified RUTF to prevent malnutrition from developing in children living in one of Niger's high prevalence districts. Two years later, a study published in the Journal of American Medicine (JAMA) showed, as an MSF press release stated at the time, that “children in rural Niger who received ready-to-use food in addition to their normal diet were nearly 60 percent less likely to progress to the most life-threatening form of malnutrition than children whose diets were not supplemented.”
In 2010, MSF teamed with VII Photo Agency to launch the “Starved for Attention” multimedia campaign. The ongoing campaign has already been shown in several American, European, and African cities and featured in numerous media outlets. In pictures and video, it exposes the neglected and largely invisible crisis of childhood malnutrition and urges countries making the largest contributions to food assistance to supply the right foods and adequate resources for nutrition programs in the most-affected countries. MSF sent letters to the heads of several governments and top aid officials in the US and elsewhere to call for the reform of their food aid policies. Tens of thousands of people have already signed a petition that will be presented to leaders on the eve of the G8 Summit in France in 2011.
Pakistan 2005 © Ton Koene/MSF
Natural disasters can overwhelm a local or national health structure in a matter of minutes. There are times when the aftermath of monumental disasters requires more of a development and reconstruction focus than a medical one. This was the case after the Indian Ocean tsunami in 2005, when other organizations and government agencies had the necessary capacities to address the most pressing needs and there actually was not much for MSF to do.
In numerous instances, however, MSF played a large role in tending to the wounded and the ill who were left in a catastrophe’s wake. In several situations, MSF teams were already present in a place when disaster struck and were thus able to respond quickly. This was the case when the Kashmir region of Pakistan and India was hit by a devastating earthquake in 2005, when flooding swamped Mexico in 2007, and when cyclones thrashed Bangladesh in 2007 and Myanmar in 2008. MSF teams were able to rapidly assess where their expertise would be of most assistance and set up primary and secondary care health facilities, surgical units, and mobile clinics to reach people trapped in remote areas.
More recently, MSF launched what became the organization’s largest-ever emergency effort following the January 2010 earthquake that devastated Haiti, killing more than 200,000 people and leaving more than a million homeless. Because MSF has been working in Haiti since 1991 teams were able to respond quickly. In the first seven weeks, nearly 1,200 tons of supplies were flown, driven, and carried by boat into Haiti. Staff was increased from 800 to more than 3,300, the vast majority of them Haitian. In the three-month emergency phase that followed the earthquake, MSF treated more than 165,000 people. Through October 2010, the organization treated nearly 360,000 people.
In many parts of the world, certain groups—refugees, internally displaced people, migrants, minorities, the unemployed, prisoners, people with HIV/AIDS or tuberculosis, drug users, sex workers, street children and others—are marginalized and prevented from accessing adequate health care simply because of who they are. They may fear stigma and be reluctant to seek help, or their health care system may deliberately neglect or exclude them.
In these instances, MSF tries to bridge the gap in services and call on governments to make sure that all of the people for whom they bear responsibility can get the treatments they need. In places such as Bangladesh and Honduras, MSF medical teams provide medical, social, and mental health care to those affected by institutional neglect and advocate with local and national governments and civil society for improved access to services and increased social acceptance for their patients.
Since its inception, MSF’s work has required specialized medical and logistical support and medical departments that work together to ensure that innovations and research advances are incorporated into the organization's practices. This is an ever-evolving process, one that the organization is constantly looking to improve and expand. For instance, MSF has continually tried to upgrade its logistical networks and supply chains. And the organization now utilizes specialized medical kits and equipment that enable its teams to start saving lives immediately after they are deployed.
Uganda 2007 © MSF
Custom-designed by MSF for specific field situations, geographic conditions, and climates, these medical kits may contain everything needed to set up an entire operating room, or all of the supplies needed to treat hundreds of cholera patients as quickly as possible. In Pakistan in 2005 and in Haiti in 2010, MSF employed inflatable hospitals to give patients an actual facility in which they could be treated.
MSF has likewise demonstrated proven expertise in the field of epidemiology through repeated experiences of diagnosing and controlling outbreaks of diseases—cholera, for example, or meningitis, measles, and even lead poisoning—by conducting emergency vaccination campaigns and treating the sick.
Epicentre, MSF's epidemiological research arm, conducts assessments and studies to bolster MSF field teams’ efforts to understand the medical and nutritional needs in their area of operation, improve treatments and protocols, and develop high-quality medical care initiatives in field projects. Research from Epicentre and MSF published in 2006, in fact, showed that rapid, mass vaccinations can reduce the toll of measles epidemics in Africa, even after the epidemic has begun. The findings spurred the World Health Organization to change their protocols on responding to measles outbreaks, which had previously operated on the assumption that mass immunizations were of limited value once an outbreak was underway.
Medical data and research from MSF field operations are regularly published in peer-reviewed journals and other periodicals. MSF also publishes special reports on devastating health issues, such as sexual violence and pediatric AIDS.
As part of its founding principles, MSF stands ever ready to speak out publicly on a given issue should the situation call for it. This could mean that a certain group is being neglected, that military or political efforts are causing severe medical consequences, or that international organizations are not doing enough to respond to an emergency.
Additionally, MSF advocates in capitals and board rooms around the world in order to combat policies that might restrict access to essential medicines and health care.
These efforts could take the form of a public statement, an op-ed article, posts on MSF’s Facebook, Twitter, and Tumblr pages, or media appearances used to spread the word on a particular issue.
Since MSF is an emergency medical organization, handovers are also necessary so that resources can be allocated to the next emergency response, when and where the needs arise.
There often comes a time when the services MSF offers are no longer necessary, when, for example, an epidemic or a conflict has abated, or local organizations are able to take over the operations. There is not a rigid and specific formula for when this might occur; nor is it always an easy decision. It is a very complex process that depends on the specific project, the immediate context, the capabilities that exist on the ground, and the judgment of field and headquarters staff.
In 2009, for example, MSF handed over its HIV/AIDS programs in Cambodia to local actors. In 2010, it handed over a number of projects in Liberia, where relative stability had arrived after many years of civil war, and closed its Bon Marche hospital in the town of Bunia, in the Democratic Republic of Congo, because it was determined that the situation in the immediate area had improved and that the emergency needs were greater in other locations.
In each case, MSF does the best it can to ensure high quality continuity of care.