In February 2001, flames engulf several dwellings in the Katkama refugee camp, in Guinea. Local residents, opposed to the presence of the refugees, set the buildings on fire. (© Robert Knoth/MSF)

 

People suffering because of war, violence, exclusion, displacement, famine, and neglected diseases have been at the center of the work of MSF since the beginning. In December 2001, MSF marks 30 years providing medical aid that is matched by a commitment to witness, debate, and reflect critically on our action and the political failures we confront: weak protection for those in need, especially refugees and the displaced; inability to reach people in danger; lack of medicines for the diseases of the poorest; the dangerous advance of the military into the field of humanitarian aid; and the list goes on...

This year marks the 50th anniversary of the 1951 Refugee Convention, which was created to define protection and rights of those who flee their countries because of insecurity and persecution. In 2001, the plight of refugees and displaced people has animated debate in many international forums. However, the talk hardly disguises the fact that practical action on the refugee "problem" has never been weaker. In a year when people talk of reaffirming the Refugee Convention, never has it been so ignored.

In West Africa, tens of thousands of refugees were trapped in a particularly exposed and dangerous situation in late 2000 and early 2001. In Pakistan, Afghans linger in squalor in overcrowded camps. In Italy, would-be asylum seekers are turned away before setting foot on Italian soil.

The political responses reflect not the obligation to offer sanctuary and protection but rather a desire to contain would-be refugees where they are—no matter how dangerous that place is. Instead of taking responsibility for protecting those who feel forced to flee their homelands, many western countries are protecting themselves. These policies of containment and non-asylum threaten the basic right of people to flee and be given refuge.

As people are being denied refuge, aid organizations are finding it increasingly difficult, if not impossible in some cases, to reach people in distress. This lack of access is strangling humanitarian action.

The reality for many displaced people is far from the picture of masses of people grouped in camps. Displaced people are increasingly seeking refuge outside of camps, for example in Ingushetia, where many dwell in homes or collective centers; in Colombia, where the population is displaced, one person, one family, one village at a time; in Angola, where many people live in areas beyond the provincial cities, where no organization can go. Our operational challenge is reaching these people, understanding their circumstances, assisting them.


This woman is crying as she trudges past Boudou camp, in Guinea. Because of insecurity and fighting in the area, she and her husband are trying to get away from the Kolomba refugee camp on the Sierra Leonean border and make their way to Massakoundou, further inside Guinea. (© Robert Knoth/MSF)

 

Other challenges are also rooted in the field, in daily encounters with patients. As doctors, we can't tell our patients "Go home. We don't have medicine to give you." Yet the reality is that drugs people need often don't exist, or are too expensive, or don't work.

MSF has struggled to make access to medicines a reality. Working within a broader coalition of concerned organizations, we gathered nearly 300,000 signatures from ordinary people worldwide on a petition to press a group of pharmaceutical companies to withdraw a lawsuit against the South African government. The lawsuit would have restricted the country's options for obtaining necessary medicines. The companies dropped the case.

We were part of a global push to lower the cost of antiretrovirals (ARVs) for treating AIDS. Prices have dropped dramatically over the last year. As of October 2001, MSF was able to introduce life-prolonging ARV treatment programs in a number of developing countries. Nevertheless, there is still a lot to be done.

ARV treatment can be effective in developing countries and is essential in the battle against AIDS. It must be given the same support as prevention.

We want to see the successes already underway in the fight for AIDS drugs echoed for other neglected diseases. The human cost of the market and public policy failure to provide lifesaving drugs is etched on the faces of the millions of mostly poor people who are suffering from sleeping sickness, Chagas disease, malaria, and leishmaniasis—diseases for which effective new treatments are not even being developed. We will not stand by and see the ranks of the sick condemned to death by "unprofitable" diseases.

One of these "unprofitable" diseases, malaria, caused one of the largest emergencies we faced over the last year. The disease devastated Burundi, with several million cases counted among a population of 6.5 million people. But we also faced other disasters, outbreaks, and catastrophes, such as earthquakes in El Salvador, India, and Peru. Ebola resurfaced in Uganda. Malnutrition was ever-present in many countries. Alongside the emergencies, in over 80 countries in Africa, Asia, Europe, and Latin America we continued ongoing projects devoted to primary care, mother and child health, hospital support, and staff training.

Assistance is often not enough, or our access is prevented. When people are threatened and the space for providing aid disappears, we must speak out. Our report "The Politics of Terror," issued in November 2000, used firsthand testimony to expose the ongoing climate of fear in Chechnya and the consequences of that war on the lives of ordinary people. Also in November 2000, we released a report entitled "Angola: Behind the Façade of Normalization—Manipulation, Violence, and Abandoned Populations." Excerpts of both documents are included in this report. Meanwhile, the difficulties of providing aid were brought home to us with the kidnapping of two volunteers, in Chechnya and Colombia. Even if both were safely and unconditionally released, these incidents reflect a climate of increasing threats to independent aid in many places.

As we go to press, the brutal attack on civilians in the United States is fresh in our minds. Politicians and their military advisors are now defining new forms of war, which will affect the way aid is carried out in times of difficulty.

As events unfold, the fate of millions of Afghans in and around Afghanistan continues to concern us deeply. Like other aid organizations, we were forced to evacuate our international staff from areas of the country under Taleban control in mid-September 2001; work continued under local staff. International teams began to return to those areas in mid-November. Our first priority was always to return to the people in need.

We have emphatically denounced any kind of military intervention that calls itself "humanitarian." It can be regarded by opponents as an act of war, and aid workers can be denied access to people in need. The needs of the people, and not political objectives, should shape the aid that is given. As a humanitarian organization, we can and must push for this because we see independent assistance as vital for Afghans, and millions of others, in distress. We are militants for independence.

In this sense, our work would not have been possible without the support of the 2.5 million private funders and individual donors around the world who placed their confidence in us in 2000, helping ensure that 79% of our income came from private sources. This matters particularly to MSF, because financial independence from governments and institutions is essential to our freedom to act and to speak. But our responsibility is not only financial. For those who support us, and for the people we try to help, we are also committed to maintaining independence in analysis, spirit, and action.

Rafael Vilasanjuan, MSF Secretary General
Dr. Morten Rostrup, President, MSF International Council

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