As 2009 comes to a close, we bring you some of the most striking photos from some of the most urgent crises Doctors Without Borders/Médecins Sans Frontières (MSF) responded to over the last 12 months.
Haiti: Urgent Action Needed on Public Health
Haiti © Espen Rasmussen
MSF's free hospitals in Haiti's capital, Port-au-Prince, have been a lifeline for patients who can't afford to pay for treatment: providing crucial care to thousands; handling 40 percent of the capital's emergency obstetric cases, and running Haiti's only adequate burn unit. In 2009, MSF relocated its 75-bed Jude Anne Hospital, which was providing maternity care well beyond capacity. The five-bed delivery room was overflowing: with an average of 35 deliveries a day and 50 during peak times, women were
giving birth on the floor and in stairwells. Haiti has the highest maternal mortality rate in the Western Hemisphere, and many women die before making their way to a hospital. The new facility enabled MSF to provide a higher standard of patient care. But MSF cannot act as Haiti's primary public health provider and in 2009 the organization called on the government and international donors to prioritize essential health needs, even as Haiti sought outside assistance for hurricane reconstruction.
Pakistan: Displacement Creates Massive Health Needs
Pakistan © Eymeric Laurent-Gascoin/MSF
Fighting between Taliban factions and the government during the spring in Pakistan's North West Frontier Province displaced 2.1 million people, according to official figures. As warfare intensified in 2009, curfews, roadblocks, and fierce fighting blocked humanitarian aid. This only exacerbated an already desperate situation for sick and injured civilians. MSF provided extensive aid in the displaced persons' camp in Mardan, northwest of the capital, Islamabad. To help meet the profound needs of the larger group of displaced- those who stayed with host families or in makeshift
shelters-MSF distributed supplies, in some cases assisting households sheltering 50 people to a room. In Mardan, Peshawar, and Lower Dir, MSF helped strained hospitals cope with war injuries and large patient loads. The entire MSF community was devastated in February when two medical staff members, Riaz Ahmad and Nasar Ali, were killed in the Swat Valley as the clearly marked MSF ambulance they rode in came under fire during an emergency response.
Dadaab, Kenya: Somali Refugees Only Find More Suffering in Camps
Kenya © Spencer Platt/Getty Images
In the border town of Dadaab, in northeastern Kenya, more than 270,000 Somali refugees were living in camps where conditions were so poor that some said they were considering a return to war-torn Somalia. The three camps, which have been plagued by severe shortages of food, water, and shelter, are operated by the office of the UN High Commissioner for Refugees (UNHCR). The photo above shows some of the hundreds of desperate people who waited to be tranfered to a less crowded camp while a security officer kept order.
MSF surveys found extremely high rates of global acute malnutrition–in more than 22 percent of the population at one camp–while rations from the World Food Program were being cut by 30 percent. Many of the people in Dadaab were already suffering from war-related injuries, crammed into spaces holding three times as many people as they were designed for, with inadequate water, sanitation, or health care. MSF works in the camps, along with other aid groups, providing primary health care, nutritional support, and vaccinations.
Democratic Republic of Congo: Brutal Attacks, Far-Reaching Consequences
DRC © Michael Goldfarb/MSF
Life in northeastern Democratic Republic of Congo (DRC) became even more difficult in 2009 as Ugandan rebel group the Lord's Resistance Army (LRA) unleashed merciless brutality on civilians in Haut-Uélé and Bas-Uélé provinces, following military attacks by the Ugandan and Congolese armies on the LRA. Villages were burned, people attacked with machetes and clubs, and children abducted. People fled by the hundreds of thousands, with many crossing into camps in Uganda and in Southern Sudan, where existing MSF teams set up emergency medical care. In addition to performing surgical interventions on those wounded in the fighting, MSF teams in northeastern DRC also provide more than 9,000 medical consultations per month in hospitals and health centers; this includes obstetric care, treatment for malnourished children, and vaccinations. In the Dungu area of Haut-Uélé, MSF vaccinated 20,000 children against measles in August. About 16,000 displaced people received relief items from MSF between January and October. Teams also offer mental health services and run a program for
children who were abducted by armed groups in Faradje, Haut-Uélé. Civilians were directly targeted as violence between the DRC military and the Democratic Forces for the Liberation of Rwanda (FDLR) rebel group continued in North and South Kivu provinces, also in the northeast, in 2009. People fled their homes as they received word of nearby attacks, but many were killed or injured, or became victims of sexual violence. In the Kivus, MSF carried out nearly 300,000 medical consultations in the first half of the year, and treated 2,800 victims of sexual violence. The only international humanitarian organization performing surgery in North Kivu, in Rutshuru hospital, MSF performs an average of 12 emergency surgeries per day. During a mass vaccination campaign for measles in Masisi district in October, seven sites operated by MSF came under fire by the DRC military. Some 165,000 children were vaccinated, but the thousands of people gathered at the sites with their children had to flee the fighting.
Bangladesh: Expulsion Adds to Misery for Rohingya Refugees
Bangladesh © Giles Duley
The Rohingya refugees living in the Kutupalong camp in Cox's Bazaar, Bangladesh, endure some of the world's most dire poverty. In this unofficial camp, some 25,000 refugees-members of a Muslim minority group that fled repression and persecution in Myanmar-cope with appalling sanitary conditions and lack even basic cooking supplies. They live in limbo, stateless people with no recognized citizenship in Myanmar and no recognized status in Bangladesh. In June police and local authorities began a
violent campaign to expel residents of the camp by destroying homes, looting possessions, and brutalizing refugees. MSF began an emergency intervention in its camp-based clinic, which has treated malnutrition among children under five years old. MSF's clinic became a haven for exhausted refugees, some of whom had fled multiple times and had nowhere left to go. MSF has continually called for these refugees to be granted official status and to receive assistance.
Gaza: Aiding Those Wounded in Fighting
Palestinian Territories © Bruno Stevens/Cosmos
In the Gaza Strip, an MSF international team struggled to reach thousands of wounded civilians trapped during three weeks of intense fighting in December 2008 and January 2009. The Israeli army's incursion into Gaza was in response to longstanding and indiscriminate rocket attacks launched by Hamas from the Strip into Israel. When the surgical team finally gained access, the impact of delayed medical treatment was evident. Children and adults injured in bomb blasts were in critical need of treatment for broken bones and infected tissue, as well as skin grafts for severe burns. For many injured and sick people making their way to a medical facility was prohibitively dangerous, so MSF's
Palestinian medical staff members risked their own lives traveling to treat hundreds of patients at home. After the ceasefire on January 18, MSF increased post-operative activities, treating more than 750 patients at three clinics while seven mobile teams treated people at home. Teams also set up two operating rooms in inflatable hospital tents in central Gaza, and between January and June they performed more than 300 surgeries and 1,300 consultations. Teams also focused on providing mental health services, including for aid workers exposed to the fighting.
Chagas: Breaking the Silence
Bolivia © Anna Surinyach
People who have Chagas disease-a parasitic illness affecting up to 15 million people, primarily in Latin America-may show no symptoms for many years. But one-third will develop heart and intestinal complications leading to death. In July MSF launched an international campaign to raise awareness of this neglected disease, which was discovered 100 years ago. The campaign, "Chagas: It's Time to Break the Silence," sounded the alarm for recognition and treatment of patients with the disease. In October MSF held a one-day symposium in Los
Angeles where Chagas experts shared current evidence and explored the potential for collaboration in Latin America and the US for increased advocacy, and for research and development of more effective treatments and diagnostic tests. Through its two projects in Bolivia, MSF is promoting the integration of treatment into primary care facilities and raising awareness that the side effects of the available medication can be managed; some doctors in Bolivia hesitate to treat patients, especially adults, for fear of these effects.
TB: A Double Medical Crisis in the Developing World
India © Cristina De Middel
Millions of people in developing countries, and the health care providers working to assist them, face a double medical crisis right now: an increase in the cases of drug-resistant strains of tuberculosis (TB); and the rapid spread of TB among people who are infected with HIV. The World Health Organization estimates there are currently two million cases of multidrug-resistant (MDR) TB worldwide. In 2008, MSF treated about 900 such patients in 18 projects, from Chad to Kyrgyzstan to Thailand. Treating these patients presents enormous challenges- the available drugs can trigger severely toxic side effects and require a two-year regimen that includes a six-month course of daily painful injections. The cure rates are dramatically lower than for standard TB treatment-only 60 percent. For people with extensively drug-resistant (XDR) TB, there are
virtually no effective treatment options. In southern Africa, HIV-TB co-infection is the highest cause of death. In Swaziland, where MSF works in 20 health facilities, about 83 percent of the tens of thousands of people who have TB are co-infected with HIV. People with HIV are at a much greater risk of developing TB and its resistant forms than other people, and co-infection makes TB more complicated to diagnose and treat. In March, MSF held a meeting of doctors, lab workers, and TB activists from around the world to decide on exactly what a new TB diagnostic test should look like. And in October, MSF took part in a workshop in Swaziland that produced a list of recommendations on improving and stepping up the response to HIV-TB co-infection throughout southern Africa.