December 01, 2008

Some of the world’s leading photojournalists worked alongside our medical teams throughout 2008, documenting our work and following the lives of our patients and their communities. At the same time, some of our own staff captured unforgettable moments that we are pleased to include in this Year in Pictures issue of Alert, which brings together some of the most moving and telling photographs of the crises to which we responded in 2008.

Political Violence Displaces Hundreds of Thousands in Kenya

Kenya 2008 © Brendan Bannon

“I came here when they attacked my village and burned it. We’ve been staying in this church for 12 days. My eldest daughter is not well—she has a fever and has had a rash for days now.”

—Judith, a woman who sought refuge in the western Kenyan town of Eldoret, January 2008

Judith was among thousands of Kenyans driven from their homes when violence erupted throughout the country following the contested December 2007 presidential elections. MSF gave emergency care to those who were wounded in the worst affected slums of Nairobi and provided medical and water-and-sanitation services for thousands of people who fled to the western part of the country.


Treating Kala Azar Among India's Most Impoverished People

India 2008 © Mischa Friedman

“These people are the poorest of the poor. They work as casual laborers in the fields or tend cattle. They sleep in huts of mud and straw and are thus especially vulnerable to being bitten by sand flies.”

—Dr. Gaurab Mitra, a physician working in MSF’s kala azar program in the hospital in Hajipur, a town in India’s Bihar state, July 2008

In the impoverished state of Bihar, in northeast India, MSF expanded its use of intravenous liposomal amphotericin B to treat people with visceral leishmaniasis, or kala azar—a parasitic disease that kills 50,000 people each year around the world. This treatment can cure a patient in as little as 10 days—a marked improvement over the standard 40-day course of painful intramuscular sodium stibogluconate injections. In Bihar, where 90 percent of India’s kala azar cases occur, MSF is working at the epicenter of this disease, in a country where 80 percent of all cases of the disease worldwide are found.


Thai Government Forces Hmong Refugees Back to Lao PDR

Thailand 2008 © Francesca Di Bonito

“I don’t want to be sent back to Laos to be killed. If I think about it too much I faint. Everyone is saying we are going to be sent back.”

—H.Y., a young mother from Lao PDR living in a refugee camp in Thailand, October 2007

In February, Thai authorities began to deport to Lao PDR a small number of Hmong refugees—refugees who, like the young woman quoted above, had come to Thailand’s northern Petchabun province seeking refuge from violence in their home country. As the only aid agency working in the camp—providing water,

food, medical assistance, and mental-health counseling—MSF has repeatedly called on the Thai government to respect international law and end the forced repatriations.

Later, in June, an estimated 800 ethnic Lao Hmong refugees were forcibly returned to Lao PDR by the Thai government. MSF called once again on the governments of Thailand and Lao PDR immediately to stop the forced repatriations and to grant independent monitors access to all forced returnees in Lao PDR as well as to those believed to be held in detention centers in Thailand.


Xenophobic Violence Erupts in South Africa

South Africa 2008 © Erin Trieb

“Outside it is too cold, and that is why you can see the baby has got a chest infection. All the babies who sleep outside have chest infections…and it is not right.”

—A mother who fled to Primrose, in the East Rand section of Johannesburg, to escape the violence in the city, May 2008

On May 11, violence against foreign nationals erupted in Johannesburg and soon spread to other parts of South Africa. As more than 80,000 Zimbabweans, Angolans, Congolese, and other immigrants fled to temporary, often overcrowded shelters, MSF quickly organized mobile clinics to treat people with gunshot wounds, head traumas, lacerations, and burns. Several weeks later, when authorities relocated the displaced to unsanitary camps with inadequate protection against the cold, MSF advocated on their behalf and denounced efforts to force them to return to the volatile communities from which they had fled.


MSF Treats War-Wounded Iraqi Civilians

Jordan 2008 © Jiro Ose

“The patients who come to us usually have chronic, non-healing, war-related fractures... the consequences of which affect either their mobility, their ability to work, or, in the case of their hands or arms, their ability to feed and wash themselves....”

—Dr. Nikki Blackwell, an anesthesiologist working in an MSF surgical project for Iraqi civilians in Mehran, Iran, April 2008

MSF had to leave Iraq in 2004 due to security concerns, and is still unable to return to the most conflict-stricken areas. The Iraqi health care system has been shattered: at least half of Iraqi doctors have left the country, and many have been killed. Each month, MSF provides reconstructive surgery to Iraqi civilians injured by car bombs and other explosive devices across the border in Amman, Jordan. Many are children. MSF supplies medicines and equipment to about 12 hospitals in northern and central Iraq, and runs surgical programs in the northern provinces. In 2007 and 2008, MSF operated a related surgical program close to the border in Mehran, Iran.


Vast Numbers of Malnourished Children Struggle in Southern Ethiopia

Ethiopia 2008 © Francesco Zizola

“When my children are sick, I get very angry with myself. They are sick because I can’t feed them. I don’t have food to give them.”

—Geneme, a mother with two malnourished children at an MSF clinic in Shashemene, July 2008

Tens of thousands of hungry and malnourished people lined up every day at MSF feeding centers in southern Ethiopia when high food prices and droughts culminated in dangerous levels of malnutrition. Between May and September, MSF provided care for approximately 28,000 severely malnourished and 21,000 moderately malnourished people, primarily children, and distributed food to about 12,500 people at risk for malnutrition in both the Oromiya and Southern Nations, Nationalities, and People’s regions.


Myanmar Cyclone Wreaks Devastation; Assistance is Delayed

Myanmar 2008 © Eyal Warshawski

“I’m afraid. I don’t want to think about it again. When I think about what happened…. Wherever I can go, I will go…. I hope I will survive.”

—A woman who lost seven family members during Cyclone Nargis, living in a camp for internally displaced persons near the town of Laputa, June 2008

Cyclone Nargis completely destroyed parts of the Irrawaddy Delta in Myanmar (formerly Burma), killing an estimated 130,000 people and displacing survivors. MSF teams already in Myanmar, mainly Burmese staff, immediately began providing assistance—emergency medical care, mentalhealth care, and shelter and cooking items. Yet, many international MSF aid workers waited weeks for visas to enter the country. MSF continues to work in other areas of Myanmar, addressing extremely urgent needs—such as care for people with HIV/AIDS and malaria—that are largely ignored by the government and the international community.


Health Care Needs Ignored in Southern Sudan

Sudan 2007 © Sven Torfinn

“They need development, they need roads. But they need to be alive first to drive on those roads.”

—Chris Kielu, Sudanese MSF project coordinator, Pieri, April 2008

A degree of calm has come to southern Sudan since the 2005 peace agreement ended two decades of civil war. But access to medical care remains extremely limited. The results are malnutrition, large-scale disease outbreaks, and some of the highest maternal-mortality rates in the world. MSF is working in six states, providing primary and women’s health care, treating diseases with epidemic potential, and responding to epidemic outbreaks. MSF is one of the few humanitarian aid providers in this region, where international donors have begun funding major development projects, yet basic health needs are almost completely overlooked.


Civilians Flee For Their Lives in Somalia

Somalia 2008 © Jehad Nga

“Due to the security situation, we are unable to meet any needs other than the immediate, lifesaving needs. Our response is most certainly inadequate when taking into account the gravity of the situation.”

—Kenneth Lavelle, MSF head of mission for Somalia, October, 2008

Renewed violence in the Somali capital, Mogadishu, during 2008 sent thousands of people fleeing for their lives. By December, MSF had treated more than 2,300 war-wounded patients at Daynille Hospital on the outskirts of the city. Many patients were women and children requiring emergency surgery for head, abdomen, or chest injuries caused by mortar rounds or bullets. With one-quarter of a million displaced people already camped on the road between Mogadishu and Afgooye, the influx of the newly uprooted placed an enormous strain on the population. MSF teams provided medical care, water, and shelter materials to many of the newly displaced. MSF’s Somali staff members shoulder the risk of maintaining the organization’s emergency programs, which cannot meet the rising needs. Intensifying attacks on foreign aid workers have prevented MSF from deploying them in the country since January, when three MSF staff—foreign and Somali—were killed in Kismayo.


Major Storms in Haiti Worsen the Despair

Haiti 2008 © Klavs Bo Christensen

“The water came up to the ceiling—everyone was crying and praying. For four days we all tried to help each other on the roofs; we didn’t eat anything the entire time.”

—Sudifan, a young woman who survived the storms in Gonaïves, September 2008

Over the course of two weeks in late August and early September, Haiti was hit by Tropical Storm Fay, Hurricane Gustav, Tropical Storm Hanna, and Hurricane Ike. People took refuge on roofs and in overcrowded shelters with little or no access to clean water, food, or sanitation. Many developed skin diseases, respiratory infections, or diarrhea. MSF provided emergency medical care and water-and- sanitation assistance, mainly in the hard-hit city of Gonaïves.


Sixty Found Dead on Yemen's Shores

Yemen 2008 © Jiro Ose

“The boat was very crowded. We had no water or food. Only the smugglers did. If you move, they kick you. If someone dies on the boat, they throw them overboard. I witnessed someone being thrown into the sea.”

—A 24-year-old Ethiopian woman who crossed the Gulf of Aden from northern Somalia to Yemen in a smuggler’s boat, December 2008

Fleeing for their lives the brutal war in Somalia and hardships in Ethiopia, tens of thousands of people—like the refugee quoted above—attempted the perilous journey across the Gulf of Aden throughout 2008. Mobile MSF teams, on standby 24 hours a day, seven days a week, have provided emergency medical aid along a 165-mile coastline, often in the dark of night as refugees struggle ashore. In early November, MSF discovered the bodies of 60 Somalis and Ethiopians on the shores and subsequently called for more international attention to this escalating crisis. Another wave of more than 400 refugees and migrants arrived in early December; at least 26 people perished.


Niger Expels MSF From the Region Hardest Hit by Child Malnutrition

Niger 2008 © Laurent Chamussy/Sipa Press

“It is shocking that a government, after having allowed innovative programs to be established, would ignore the needs of thousands of children.”

—Christophe Fournier, President, MSF International Council, October 2008

In July, the government of Niger ordered MSF to close its medical and nutritional activities in the Maradi region, without providing a reason. At the time, more than 3,000 malnourished children were undergoing treatment, and an additional 500 children were being admitted each week. This region was the epicenter of the 2005 nutritional crisis and the place where MSF first demonstrated the benefits of treating severely malnourished children on a massive scale with therapeutic, ready-to-use food. While MSF is still permitted to work in other regions of the country, the organization continues to express outrage at the devastating impact of this expulsion on thousands of malnourished children.


War is Reignited in Eastern Democratic Republic of Congo

DRC 2008 © Sarah Elliott

“I was supposed to take care of (my siblings), but now, with what happened to me, I really don’t know how. I don’t even know if we can go back home.”

—J., 16, was injured when he was caught between two armed groups near Nyanzale, North Kivu province. One of his arms had to be amputated. November 2008

In August, full-scale war resumed in eastern Democratic Republic of Congo (DRC). The already terrorized, largely displaced people of the region fled yet again, to areas without adequate shelter, water, food, or security. MSF worked throughout North Kivu, providing surgery for the war-wounded, cholera treatment, clean drinking water, and other emergency assistance. Despite the huge needs, few humanitarian organizations are present in North Kivu outside of Goma, the provincial capital. In some areas, MSF is the only organization providing assistance.


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