December 31, 2014

Dear friends,

We think it’s fair to say that 2014 was one of the most challenging years in the history of Doctors Without Borders/Médecins Sans Frontières (MSF), a year marked by uncommonly complex crises that demanded rapid, sustained, and effective responses on many different fronts.

As you know, our teams were pushed into new territory—and to their limits—by the Ebola outbreak in West Africa, which required us to mobilize personnel and resources on a vast scale in order to treat victims and slow the spread of the disease across Liberia, Guinea, and Sierra Leone. We first sounded the alarm in March, long before others started paying attention, and struggled to keep pace as the disease gained momentum, killing thousands and terrifying communities. As teams in the field treated as many patients as they could, our leadership repeatedly exhorted other bodies to bolster their responses, and headquarters and field staff offered training in Ebola treatment for other agencies—from local NGOs to international organizations to governments.

The outbreak forced us to make difficult operational decisions, not least how to balance the urgent needs of patients with the need to keep our staff as safe as we could in highly infectious environments. And now we must remember not only those we helped save, but also those we lost, which, tragically, includes 13 of our own staff members, who quite literally gave their lives in the effort to beat back this lethal disease.

As is always the case, however, the intensity of one crisis did not diminish the needs elsewhere. Throughout the year, MSF continued to provide emergency care in massive humanitarian emergencies in South Sudan, Central African Republic (CAR), Syria, and beyond, work that brought with it similar levels of pride in what we were able to accomplish, anguish about those we could not reach, and mourning for members of our own teams who died in the effort.

The dangerous nature of our work was again brought into fine focus. We had 13 staff members abducted in Syria, five of whom were held for several months. Three others were killed when a project in Boguila, in CAR, was attacked by gunmen. We also had numerous facilities ransacked and robbed, staff members harassed and intimidated, even patients killed in their beds when a facility in South Sudan was overrun by militants.

This is part of the world in which we operate, where instability often reigns and our best efforts to establish a safe space in which we can provide care can fall short. It is a stark calculus. When millions of people are cut off from humanitarian aid, trapped in a war zone or a displacement scenario or some other crisis, our humanitarian spirit propels us to be at their side, providing care and bearing witness. At the same time, our responsibility toward our staff requires us to be vigilant as we make assessments that help us gauge whether it is reasonable to run programs in a given area, knowing that should we leave, there would be no assistance for the population at all.

In the face of these limitations, however, MSF was able to provide meaningful care to millions of people caught in crisis. We ran six health facilities in northern Syria, for instance, and provided support to 100 medical centers in places it was not safe for us to go. We ran 20 medical projects across CAR and nearly as many in South Sudan, serving, in most cases, people with no other options for medical care.

In addition to responding to emergencies and raising awareness about the suffering we witness, MSF also remained wary of developments that could affect our ability to deliver aid in the future. The Trans-Pacific Partnership Agreement (TPP) is one such measure. A pan-Pacific trade agreement negotiated in secret, its working draft contained stipulations that would severely undermine access to affordable medicines. We advocated for changes in these clauses throughout 2014, and we have continued this work in 2015.

It is the generosity of our donors, who came through for MSF in amazing force in 2014, that allows us to proceed with this work. We far surpassed projections and raised more than $330 million in 2014, putting us in a strong financial position to tackle the web of continuing emergencies and the new ones that will inevitably arise (because they always do). We are ever grateful to those who supported us in the response to the Ebola crisis and also those who provided unrestricted funding that allows us to respond to simultaneous crises based first and foremost on the medical needs on the ground, now and into the future.

We are deeply grateful for your humanitarian spirit, your dedication, your commitment. We emerged from 2014 stronger, thanks to you, and ready for what the coming days bring.

Sincerely Yours,

Sophie Delaunay, MSF-USA Executive Director

Deane Marchbein, President, MSF-USA Board of Directors