MSF programs are run by "desks" in different headquarters offices around the world. Gwenola Francois, MSF-USA deputy program manager, talks about MSF-USA’s portfolio and the priorities for the year ahead.
In this year-end issue of Alert we highlight 2011's pictures of the year, share MSF nurse Mary Jo Frawley's remembrance of her time in Haiti, and explore MSF's history of negotiation in the new book Humanitarian Negotiations Revealed.
Despite the ostensible cessation of the fighting that wracked Ivory Coast earlier this year, violence against civilians has continued in some rural regions, particularly in the southwest. In mid-September, for instance, up to 16 people were killed and 50 homes were burned in an attack on the town of Zriglo.
In this issue of Alert, we share news and images of our response to the ongoing crisis in Somalia, where MSF has spent the summer trying to expand its services to meet the latest emergency to befall the country’s people.
A mother and child rest in the pediatric ward of MSF’s hospital in the Bicentenaire area of Port-au-Prince. Active in Haiti since 1991, MSF has opened five hospitals, including this one, and fought a widespread cholera epidemic in the country since a massive earthquake struck in January 2010.
To highlight the critical humanitarian and medical needs that exist in urban settings the world over, MSF presents "Urban Survivors," a multimedia project produced in collaboration with the NOOR photo agency and Darjeeling Productions.
Last year, a host of newspaper articles, blogs, and TV reports questioned the efficacy of the international aid system, particularly with regard to its role in the crises in Haiti and Pakistan. At Doctors Without Borders/Médecins Sans Frontières (MSF), we welcome this debate. Some of the criticisms leveled are valid, some are not. But it’s a conversation that should be had.
In the immediate aftermath of last January’s earthquake, the potential of an outbreak of disease was a major concern. Months went by without it coming to pass, though, which seemed like a rare victory for the battered population. In September, however, word came from the Artibonite region in central Haiti, , that patients were presenting with cholera-like symptoms. Cholera had not been seen in Haiti in many decades, but the signs—rapid and severe dehydration caused by excessive vomiting and diarrhea—were all too apparent.
Following the release of Doctors Without Borders/Médecins Sans Frontières (MSF)’s report, Haiti One Year After: A Review of Médecins Sans Frontières Humanitarian Aid Operations, Dr. Unni Karunakara, MSF International President; Stefano Zannini, MSF Head of Mission in Haiti; and Kate Alberti, MSF Epidemiologist discuss the issues facing Haiti and MSF one year after the earthquake. Avril Benoit, Director of Communications for MSF Canada, moderates.
MSF had already been present and active in Haiti for the past 19 years. It was therefore ready to respond when the disaster struck. And it is now prepared to do the work that will remain in the days, months, and years to come.
From January 12 to October 31, MSF treated more than 358,000 people, performed more than 16,570 surgeries, and delivered more than 15,100 babies. By December 12, MSF had treated 62,000 cholera cases in 47 treatment centers around the country.
A nurse recently back from an MSF cholera treatment center in Port-de-Paix recounts what she saw, what was accomplished, and what remains to be done in the effort to battle the cholera outbreak in Haiti.
PORT-AU-PRINCE, HAITI, November 19, 2010 — Critical shortfalls in the deployment of well-established measures to contain cholera epidemics are undermining efforts to stem the ongoing cholera outbreak in Haiti, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.
As the cholera epidemic continues in Haiti’s northern and central regions, a primary objective is to ensure treatment for affected communities dispersed throughout these areas. With Hurricane Tomas having moved past Haiti, MSF medical teams will be able to expand their support and activities.
MSF is treating more than 100 new patients with cholera-like symptoms every day in Petite Riviere, a city in the Artibonite River region north of Port-au-Prince. On October 27, 156 new patients were admitted to the center, and 177 were discharged. At the end of the day, staff were treating 179 patients.
The death toll from a cholera epidemic in Haiti topped 250 Sunday, and a handful of cases in the country's capital were confirmed, as government officials and aid groups prepared for what they call an inevitable spread of the disease.
ST. MARC, Haiti — Inside the courtyard of St. Nicholas Hospital, beyond the gate with the handwritten sign stating “Diarrhea Emergency Only,” lies a grim but unusually orderly scene at the epicenter of this country’s unexpected cholera epidemic.
Following an outbreak of cholera in Haiti's Artibonite region, MSF doctors, nurses, and logisticians rushed to the area to support the medical response and the effort to prevent the outbreak from spreading.
Among the large scope of MSF activities in Haiti, as of May 31, more than $14.6 million has been spent on surgical care for Haitians injured in the earthquake. At least $5.3 million was spent on maternal health services.
"I developed eclampsia the day before I delivered and I realize that's serious," said Crisla Florestal, 19, who was readmitted a day after giving birth at the MSF hospital Isaïe Jeanty, in Port-au-Prince.
Six months after Haiti’s January 12 earthquake, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today released a report describing the organization’s largest ever emergency response.
"Most of the patients present with physical complaints and symptoms such as loss of appetite, memory problems, sleep problems, cardiac palpitations, flashbacks of the event," says MSF psychologist Djénane Marlhen Jean Charles.
Port-au-Prince, March 11, 2010 – Two staff members of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), abducted on March 5 in Port-au-Prince, Haiti, were safely released today.
The conditions in which thousands of people are surviving today are shameful. In assembly areas, there is such overcrowding that people are literally living on top of each other. We have seen people sleeping on the ground, with only a bed sheet hanging over their head for shelter.
What follows is an overview of MSF’s current activities on the ground. MSF had projects running at three sites before the earthquake staffed by approximately 700 people. There are now 20 sites, plus 7 more mobile clinics, staffed by more than 3,000 people. The numbers below are current through the end of last week.
With conditions finally improving for the practice of surgery and medicine, three MSF staff members describe how the teams treated patients in the ruins of the Delmas district in the immediate aftermath of the January 12 earthquake in Haiti.
Dr. Philippe Touchard, an anesthetist, is head of emergencies at the Pasteur Hospital in Langon, near Bordeaux. Forty-eight hours after the January 12 earthquake, he flew to Haiti to reinforce MSF’s surgical teams in Port-au-Prince. Here are exerpts of his journal of this short mission.
Nearly two weeks after the January 12 earthquake, the most pressing needs MSF teams in Haiti face are patients who still require surgery and the growing number of patients who now require post-operative care.
We were very lucky because we found a dialysis center at General Hospital. It was broken down—there was no water, there was no electricity because of the earthquake. But with the MSF logisticians we could restart it in 36 hours.
In the immediate aftermath of the January 12 earthquake in Haiti, MSF focused on emergency surgery and life-saving interventions. Now, though, some MSF teams are seeing more patients who need care for pre-existing conditions and for infections or complications affecting wounds they couldn’t get treated properly.
While continuing to perform operations at its fixed sites, MSF has started sending mobile teams into communities in and around the capital to search for people with conditions that could deteriorate rapidly if they go untreated.
It hurts to see so many injured children and adults, some of them screaming in pain when the nurse changes the dressing on their wounds. They have suffered serious burns, broken arms, and deep cuts in the skull. They have infected wounded, gangrenous limbs—and the list goes on.
On Wednesday morning, as Doctors Without Borders/Médecins Sans Frontières (MSF) teams in Haiti continued to work through long queues of patients waiting for treatment and surgery, the country was shaken anew by a powerful aftershock.
Yesterday I visited the MSF operation at Trinite Hospital. There was a small baby, about six weeks old, lying on her side in her bed because her right arm had been amputated and was covered in bandages. The auxiliary nurse told me her story. Sad and miraculous. She had been in the hospital when the earthquake hit. The building was partially destroyed. This tiny little girl fell through concrete floors and walls. Somehow, she survived and was rescued from the rubble. No one knows where her mother is, though. Chances are she doesn't have a family anymore.
Doctors Without Borders/Médecins Sans Frontières staff in wards and operating theatres in Haiti are still working through very heavy caseloads while growing increasingly concerned about supply problems that threaten the welfare of patients. Drugs for surgical care, basic supplies for pre- and post-operative treatment, and equipment such as dialysis machines are urgently needed, but access problems for cargo shipments are causing delays in delivery.
Benoit Leduc, Doctors Without Borders/Médecins Sans Frontières (MSF) operations manager for Haiti, and Loris de Filippi, MSF operational coordinator in Port-au-Prince, participated in a teleconference with press regarding MSF's response to the January 12, 2010, earthquake.
MSF teams in Port-au-Prince are still under great pressure. While providing emergency care to as many people as possible, they are also searching for additional facilities that can serve as operating theaters and trying to get in more supplies. At the same time, MSF has been travelling to areas outside of the city and is about to extend the medical care to the people there.
Port-au-Prince/Paris /New York, 17 January 2009—Doctors Without Borders/Médecins Sans Frontières (MSF) urges that its cargo planes carrying essential medical and surgical material be allowed to land in Port-au-Prince in order to treat thousands of wounded waiting for vital surgical operations. Priority must be given immediately to planes carrying lifesaving equipment and medical personnel.
"The situation remains critical. Few aid agencies are in place. Hundreds of bodies are still stuck in buildings. In the entire city, I've only seen about four or five trucks and cranes removing pieces of collapsed buildings so they can get the people out."
Surgical units set up by MSF in Port-au-Prince are working around the clock to treat the vast numbers of patients with injuries from Tuesday’s earthquake. Experienced MSF medical staff say they have never seen so many serious injuries.
Stefano Zannini, head of mission for Doctors without Borders/Médecins Sans Frontières (MSF) in Haiti, spoke at a January 15 press teleconference about MSF's activities in Haiti following the earthquake.
Right now we still are struggling to treat patents in very rough conditions. The biggest problem is not having medical structures where we can treat them. But we have been able to find an open space big enough for the inflatable hospital that should arrive tomorrow. So we will have a 100-bed hospital with surgical capacity operation before the end of next week.
Dr. Greg Elder is the deputy operations manager for MSF in Haiti. Here he provides an update on the situation on the ground in Port-au-Prince, Haiti, 24 hours after a 7.0-magnitude earthquake struck the country leaving tens of thousands wounded and unknown number of dead.
Dr. Greg Elder comments on the possibility of infectious diarrhea and the possible spread of other diseases. Additional quote by Kathryn Dedeiu, a water and sanitation engineer with Doctors Without Borders.
"We have three general areas where we have been traditionally providing emergency care with infrastructure established to set up and provide for emergency services. All of those three centers have been severely affected in the earthquake and none of them are in a condition that we can use. One has completely collapsed and two others are so structurally damaged we cannot use them."
The first reports are now emerging from MSF teams who were already working on medical projects Haiti and have treated hundreds of people injured in the quake. "The situation is chaotic," said one senior staff. "I visited five medical centers, including a major hospital, and most of them were not functioning."
Though its own facilities were severely damaged by the massive earthquake that struck Haiti on January 12, MSF field staff have been establishing temporary clinics in order to treat injured men, women, and children. MSF was able to respond immediately because international and national staff had already been running several projects in country.
On January 12, a magnitude 7.0 quake struck about 10 miles (15 kilometers) southwest of the Haitian capital, Port-au-Prince. MSF teams on the ground have witnessed significant damage to its medical facilities, injuries to patients and staff, and an influx of wounded towards these hospitals in the capital.
As Haiti’s prime minister, the UN Secretary General, representatives from more than 30 donor countries, and multilateral agencies convene tomorrow in Washington, D.C., to fund strategies for Haiti’s future economic and social development, they must not neglect the country’s immediate public health crisis. MSF calls on the Haitian government and international donors to immediately implement concrete measures to improve access to health care for the Haitian population.
Port-au-Prince/Paris/Amsterdam/Brussels/New York, April 13, 2009 – As Haiti’s prime minister, the UN Secretary General, representatives from more than 30 donor countries, and multilateral agencies convene tomorrow in Washington, D.C., to fund strategies for Haiti’s future economic and social development, they must not neglect the country’s immediate public health crisis, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). MSF calls on the Haitian government and international donors to immediately implement concrete measures to improve access to health care for the Haitian population.
Located on one of the busiest street corners of Port-au-Prince, Haiti, the 75-bed Jude Anne Hospital has been operating well beyond its capacity since Doctors Without Borders/Médecins Sans Frontières (MSF) opened the facilities in March of 2006.
MSF's assessments of Haiti's nutritional situation have revealed small pockets of malnourished children, consistent with levels of chronic undernutrition found in the country before the recent hurricanes. However, none have shown high levels of malnutrition requiring a major scale-up of MSF’s nutritional programs.
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.
MSF medical teams are currently assessing the nutritional situation in several areas of the country. Since November 4, MSF medical doctors have been screening children in the mountain area of Baie d'Orange and Belle Anse, where authorities had reported children dead because of malnutrition in the previous weeks.
Between August 16 and September 1, Haiti was ravaged by Tropical Storm Fay, Hurricane Gustav, Tropical Storm Hanna, and Hurricane Ike. On September 4, a Doctors Without Borders/Médecins Sans Frontières (MSF) emergency team of medical staff, logisticians, and water and sanitation experts began arriving in the northwestern city of Gonaïves, which had been particularly hard-hit.
MSF teams in Port-au-Prince, the capital of Haiti, are providing emergency care and treatment to people injured in the collapse of La Promesse School in the Petionville neighborhood of the city earlier today.
Port-au-Prince, November 6, 2008 – Over the last month, hundreds of women have desperately sought emergency obstetric care at Jude-Anne hospital in Port-au-Prince. In October, hospital staff assisted a record high of 56 women giving birth in one day and received 160 women waiting for hospitalization. The hospital has been so overwhelmed by demand that mothers have given birth in the hospital’s waiting room, the staircases, and in the washrooms, essentially anywhere they could find space. For this 60-bed emergency hospital (including five delivery beds), with an average rate of 35 births per day, this is an untenable situation.
For several weeks, MSF helped support the Rabouteau Health Center in Gonaives. It reopened a hospital in another part of town while also organizing water distribution. MSF continues to witness difficult situations and documents the stories of some of the people still forgotten weeks after the last storm.
Port-au-Prince/New York, October 3, 2008 — A month after the last tropical storms and hurricanes hit Haiti, Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams have found a whole village completely submerged and its 2,400 remaining inhabitants stranded with no help.
"At the latest estimate, there were something like 60,000 people living without a house. All the bridges have collapsed around the town, and the roads are still impassable. Inside the town itself you can drive to some places, but to get to the town from outside is impossible—even big vehicles with caterpillar tracks can't get through."
While flood waters in Gonaives have mostly receded, some parts of the devastated town remain inaccessible and many people have not had access to healthcare, clean water, and food for 15 days. An MSF team continues to support the Rabouteau Health Center in Gonaives, where more than 1,000 consultations have been carried out to date.
Lionel, a 22-year-old carpenter, was at home on September 1 with his wife, who was seven months pregnant, in the Brale area in Gonaïves, Haiti. At about 11 p.m., the water started rising. As it began to spread under the bed, they knew they had to move. Within two hours, the water was four meters above ground level.
Doctors Without Borders/Médecins Sans Frontières (MSF) is responding the humanitarian needs brought about by a series of hurricanes and tropical that have struck Haiti. According to authorities, 25,000 to 30,000 houses were destroyed and up to 500 people have died nationwide. People have very little access to food and clean water, and major crops have been destroyed.
As an eerie calm settled on the center of Port-au-Prince on April 10, Doctors Without Borders/Médecins Sans Frontières (MSF) teams are continuing to receive patients suffering from trauma injuries, especially in the Martissant and Carrefour neighborhoods of the city.
Since April 7, 2008, Doctors Without Borders/Médecins Sans Frontières (MSF) teams have treated more than 31 wounded patients, including 15 people with gunshot wounds, in MSF-operated hospitals in the Haitian capital city, Port-au-Prince. Most of the patients were wounded when demonstrators in the city protested against rapidly increasing living costs, especially sharp increases in the price of basic food items.
An interview with Olivia Gayraud, a French emergency nurse, who helped open the Doctors Without Borders/Médecins Sans Frontières (MSF) 56-bed emergency medical and surgical program at St. Joseph's Hospital in Port-au-Prince in October 2004. In March 2007, she became head of mission at the project, which now inlcudes a program to treat victims of sexual violence with medical and mental health care.
Renewed clashes in the Haitian capital of Port-au-Prince involving various armed groups —including United Nations Stabilization Mission in Haiti (Minustah) forces— has brought an abrupt end to the short respite from violence in the city since elections in February. In July 2006, MSF treated more than 200 gunshot victims at three medical facilities in Port-au-Prince: St. Joseph's trauma center in the Turgeau neighborhood, St. Catherine hospital in Cité Soleil, and Jude Anne Hospital in the Delmas area. This represents a 110 percent increase from gunshot-related admissions in June.
The women of Haiti suffer from the highest maternal mortality rate in the Western hemisphere. Approximately 523 women die for every 100,000 who give birth. (In United States, 12 women die during the same number of births). To help prevent these deaths, MSF has started providing free, emergency care to women with high-risk pregnancies in Port-au-Prince, Haiti.
The intense, escalating violence endured by people throughout Port-au-Prince from November 2005 to January 2006 was suddenly replaced by a fragile quiet in the days leading up to Haiti's presidential elections.
Port-au-Prince, Haiti, 19 January 2006 - With violent attacks intensifying and spreading to many parts of Haiti's capital, Port-au-Prince, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today called on all armed groups in the city to respect the safety of civilians and allow those wounded during clashes to have immediate access to emergency medical care. The organization also called for the safety of national and international aid workers to be respected.
Until August 2005, 30-year old Renilde Kanyange was the supervising operating nurse for MSF's program providing emergency surgical care in the Haitian capital of Port-au-Prince. Originally from Bujumbura, Burundi, she helped open the trauma center in December 2004.
Port au Prince/New York, July 5, 2005 – As violent attacks intensify and spread in Haiti's capital Port au Prince, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today called on all armed groups in the city to respect the safety of civilians and allow those wounded during clashes immediate access to emergency medical care.
Pierre Salignon, General Director of MSF in France, recently returned from a visit to Haiti. He describes the extreme violence reigning in Port au Prince's poorest neighborhoods and how the United Nations Stabilization Mission in Haiti (Minustah)–far from restoring calm–has been drawn into a war against supporters of former President Aristide.
One bullet came to rest under Charles'* left jaw after ripping through the right side of his neck. Another bullet shot through Robert's chest and lodged in his ribcage next to his aorta. Yet another tore into 9-year-old Pierre's leg, exploded in fragments and broke his femur in two.
Dr. Jean-Paul Dixmeras, a surgeon from Paris and a member of the Board of Directors for the French section of MSF, recently returned from providing emergency surgical care in the Haitian capital of Port-au-Prince.
More than a month after floods killed thousands and left nearly 200,000 people homeless in Haiti's city of Gonaives, Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams are now performing over 900 consultations each day.
In response to the severe flooding that has hit the Haitian city of Gonaives, Doctors Without Borders/Médecins Sans Frontières (MSF) has begun treating people at a newly opened health center in Raboteau, a slum in the western part of the city.
Port-au-Prince, September 22, 2004 - Doctors Without Borders/Médecins Sans Frontières (MSF) has mobilized to assist people overwhelmed by severe flooding in the city of Gonaives, on Haiti's northwest coast.
Following heavy rainfalls last Sunday, villages in the border region between Haiti and the Dominican Republic were inundated. The heaviest flooding occurred early Monday morning, surprising people in their sleep. Many did not have the chance to escape.
Forty-year-old Dr. Albert Tshiula headed MSF's Emergency Response Team in DR Congo after several years as a national staff physician. He has been field coordinator for the MSF program in St. Marc, Haiti.
Port-au-Prince/New York, March 8, 2004 - Following Sunday afternoon's shooting incident during a demonstration near the National Palace in Port-au-Prince, people wounded in the crossfire were brought to hospitals throughout the capital city. At Saint-François de Salle Hospital, in the center of the city, an MSF team provided free medical care to the incoming wounded.
MSF re-launched its emergency response program in the Haitian capital Port-au-Prince after widespread reports of killings and lootings limited MSF's ability to get to Saint François de Salle Hospital safely over the weekend.
Port-au-Prince / New York, February 13, 2004 - Today, the international medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) is sending 16 tons of medical equipment to Port-au-Prince, the capital of Haiti. The supplies consist primarily of surgical and dressing kits for the MSF programs in the hospital of Saint Nicolas, in Saint-Marc, and Saint François de Salle Hospital, in Port-au-Prince. The MSF medical emergency program aims to ensure access to treatment for the people wounded during the massive demonstrations and other violent incidents that have been occurring almost daily since December 2003.
Doctors Without Borders is approved by the Internal Revenue Service as a 501 (C) (3) tax-exempt organization, and all donations are tax deductible to the extent provided by law. Doctors Without Borders Federal Identification Number (EIN) is 13-3433452.