2008 was a year of achievement as well as frustration for MSF. While advances in malnutrition treatment allowed more children to be helped, teams trying to reach victims of some of the most acute conflicts in the world faced considerable obstacles.

Throughout the year, MSF aid workers carried out 8.8 million consultations and 47,500 surgical interventions in over 65 countries. They provided treatment for more than one million people with malaria, and nutritional care for more than 200,000 malnourished children.

When post-election violence broke out in Kenya, a cyclone devastated Myanmar’s Irrawaddy Delta, and a cholera epidemic swept Zimbabwe, MSF medical teams were already in place and ready to offer urgently needed assistance. In Kenya, MSF reinforced its teams on the ground with extra surgeons, emergency physicians, nurses, and logistical specialists in response to the escalating violence

When post-election violence broke out in Kenya, a cyclone devastated Myanmar’s Irrawaddy Delta, and a cholera epidemic swept Zimbabwe, MSF medical teams were already in place and ready to offer urgently needed assistance. In Kenya, MSF reinforced its teams on the ground with extra surgeons, emergency physicians, nurses, and logistical specialists in response to the escalating violence

In the Democratic Republic of Congo (DRC), MSF provided critical medical care in towns affected by fighting in the eastern part of the country. Throughout the region, teams treated war-wounded in surgical programs, set up cholera treatment facilities, and provided other basic essentials such as clean water and relief items to displaced people and local residents.

These emergencies made the world news in 2008, if only briefly. But most of what MSF teams accomplished during the year – and even more disturbingly, what they were unable to accomplish – did not make it into the headlines and is difficult to summarize in statistics or brief reports.

Accessing the victims of armed conflicts in countries such as Somalia, Iraq, Pakistan, Sudan, and the Palestinian Territories posed a tremendous challenge throughout the year. Insecurity and administrative barriers – sometimes raised intentionally – contributed to these challenges. MSF relied heavily on national staff to help provide independent humanitarian assistance to those most in need in these conflict zones.

In Somalia, the kidnapping and release of two members of staff over the 2008 New Year, and then the brutal killing of three colleagues in January, forced MSF to close programs and reassess how to deliver assistance in this highly violent conflict. MSF Somali staff kept working: they treated 2,300 people wounded by gunshots or mortar rounds and cared for 10,000 children suffering from acute malnutrition in camps for people displaced by the violence. In Iraq, MSF continued to provide medical assistance at the periphery of the conflict through reconstructive surgical programs and by providing training and supplies to hospitals in the country.

After more than two decades working in Afghanistan, MSF was forced to leave in 2004 following the deliberate slaughter of five colleagues. In 2008, teams began exploring the possibility of returning to provide medical assistance again to those affected by escalating insecurity. In neighboring Pakistan, where 600,000 people fled due to fighting in the North West Frontier Province, MSF teams helped people to access healthcare by offering ambulance services. But ensuring that all parties to the conflict recognize and respect independent humanitarian assistance continued to prove difficult. In early 2009 MSF was forced to suspend this service after two members of staff traveling in a clearly identified MSF ambulance were killed.

In Sudan, increasing administrative obstacles and insecurity hindered MSF’s response to those most in need in Darfur and other regions. For example, in August, after a series of attacks against staff, teams were forced to leave projects in Tawila, North Darfur, where 35,000 displaced people had gathered, and in Shangil Tobaya, where MSF had provided medical care for 28,000 displaced people. Leaving so many people without access to medical care, even if only temporarily, was extremely hard, but without a guarantee of minimum security for humanitarian workers, MSF had no option but to suspend activities for several weeks. Despite this, 70,000 consultations where carried out in these two areas in 2008.

In December, Israel launched the ‘Hard Lead’ offensive in the Gaza Strip. During the fighting, MSF struggled to send in additional medical teams due to Israeli restrictions on the movement of people and aid. However, teams already in Gaza were able to respond immediately by supporting the local hospitals overwhelmed by the influx of wounded. Only once the Israeli forces had declared a ceasefire in January were a surgical team and 21 tons of supplies (including two inflatable hospital tents) able to reach Gaza City. MSF then concentrated its activities on specialized surgery and on postoperative and physiotherapy treatment.

Another key objective in 2008 was to find new ways to fight malnutrition and neglected diseases. Throughout the year, MSF lobbied to improve the standards of international food aid so that young children would receive the nutrients they need. In the areas most chronically devastated by malnutrition, such as South Asia, the Sahel, and the Horn of Africa, many families cannot afford nutritious food. However, food aid provided by international agencies and donors is mainly cereal- based and does not include animal-source foods, such as milk, which contain essential nutrients. In 2008, MSF committed to treating undernourished children with the animal-source food they need and lobbying for wider availability of appropriate food aid for children around the world.

In Ethiopia, between May and August, MSF conducted a large program treating more than 28,000 people for acute and moderate malnutrition. In Niger, work was threatened in July when local authorities suspended MSF projects in some regions. This decision was based largely on the authorities’ desire to re-integrate activities into the national healthcare system and to avoid independent action and public awareness campaigns. MSF believed this decision was taken prematurely, considering the number of children affected, and after two months of discussions, teams were able to partially restart some nutritional activities. In 2008, MSF treated 97,600 children under five who were moderately or severely malnourished.

In Southern Africa, where TB/HIV coinfection is endemic, MSF stepped up efforts to increase access to diagnosis and treatment. In recent years, the number of people with TB alone has more than tripled in countries where HIV prevalence is high. Worldwide, an estimated one third of all HIV sufferers have TB, but only one per cent receive treatment. Most people are not tested for TB and even if they are, the standard diagnostic method is a century old and ineffective for most people living with HIV. In addition, the current treatment protocols are difficult for people on antiretroviral therapy (ART) to use. MSF repeatedly called on governments and donors to invest in TB research and the development of new diagnostic and therapeutic tools, estimating that current investment falls at least four times below what is needed to combat the resurgence of this deadly, but treatable, disease.

HIV also affects an estimated 1.9 million children worldwide, but only around 200,000 of those who need it receive ART, meaning that nine out of ten children do not have access to the lifesaving medicines they need. In response to this, MSF called on governments and donors to make existing tests more widely available and to increase considerably the use of a pediatric version of a standard fixed-dose combination drug. A combined effort by governments and aid agencies is needed, and MSF will continue to provide comprehensive treatment, including the prevention of mother-to-child transmission of HIV.

MSF also continues to support the search for new treatments for neglected diseases and in 2008 an important step towards improving treatment options for sleeping sickness was taken. The Drugs for Neglected Diseases Initiative (DNDi), together with MSF and Epicentre, pioneered a new, less toxic and easier-to administer treatment for sleeping sickness, called NECT (Nifurtimox-Eflornithine Combination Therapy). This ten-day treatment is of particular interest to MSF since most of the 50,000 patients currently needing treatment are in remote and unstable areas.

Challenging the deliberate exclusion from healthcare that many people experience remained a focus of MSF’s work in 2008 and teams in Europe, the Middle East and Africa sought to help refugees and migrants in need of medical assistance. Restrictive entry policies in Europe have not stopped people from arriving in search of refuge, protection, or better living conditions. In response to their health needs, MSF is running emergency medical programs in a number of countries including Malta, Italy and Greece. In South Africa, too, teams provided these services to a mostly Zimbabwean migrant population. It is clear that migration and displacement is a global challenge – MSF assisted displaced people in 37 countries in 2008.

In July 2008, MSF was shocked by a judgment made by Switzerland’s highest judicial body, the Federal Tribunal. The case concerned the repayment of a ransom paid by the Dutch authorities to obtain the release of Arjan Erkel, a Dutch civilian and MSF head of mission, who was held hostage in the North Caucasus region for 20 months having been abducted in August 2002. Following four years of proceedings, and in spite of two previous rulings in favor of MSF, the Federal Tribunal found partly in favor of the Dutch government by ruling that the financial burden should be shared between MSF and the Dutch government. This decision sets a grave precedent for independent humanitarian action. By agreeing to downgrade the consequences of the abduction to a mere commercial dispute, as requested by the Dutch government, the Federal Tribunal’s ruling is contributing to making unpunished crimes against humanitarian workers part of everyday life.

There is no doubt that, in 2009, MSF will continue to challenge barriers to the provision of independent, emergency medical care to those affected by conflict or excluded from healthcare. MSF will seek new, innovative ways to treat malnutrition and infectious diseases, will ensure that medical tools are effective and field-adapted, and will work to increase preparedness to respond to natural disasters. But this vital work can be done only with the continued support of the millions of donors – including 3.7 million individuals worldwide – and the tens of thousands of MSF staff who make it possible every day.

Related News & Publications

Be part of MSF

Our supporters, donors and fundraisers are a vital part of the MSF movement.

Find out how you can support MSF's lifesaving work.

Learn more

News and stories from around the world