Doctors Without Borders

[Press Release] Syria: Medicine as a Weapon of Persecution

Wed, 08 Feb 2012 20:42:00 GMT

Syria 2012 © MSF

A Syrian patient treated by MSF

Paris, February 8, 2012 – The Syrian regime is conducting a campaign of unrelenting repression against people wounded in demonstrations and the medical workers trying to treat them, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

While MSF cannot work directly in Syria, it has collected testimonies from wounded patients treated outside the country and from doctors inside Syria. The testimonies, collected from several people from various parts of the country, point to a crackdown on the provision of urgent medical care for people wounded in the ongoing violence in Syria.

"In Syria today, wounded patients and doctors are pursued, and risk torture and arrest at the hands of the security services," said Marie-Pierre Allié, MSF president. "Medicine is being used as a weapon of persecution."

Most of the wounded do not go to public hospitals for fear of being arrested or tortured. When a wounded person is admitted to a hospital, a false name is sometimes provided to hide his or her identity. Doctors will provide false diagnoses to help patients elude security forces, which search for patients with wounds consistent with those sustained in protests and demonstrations.

"It is critical that the Syrian authorities reestablish the neutrality of healthcare facilities," said Marie-Pierre Allié. "Hospitals must be protected areas, where wounded patients are treated without discrimination and are safe from abuse and torture, and where medical workers do not risk their lives by choosing to comply with their professional code of ethics."

The injured are largely treated in clandestine treatment facilities by doctors trying to fulfill their commitment and duty to provide medical assistance. Improvised health clinics have been established in apartments, on farms, and elsewhere. Simple rooms outfitted as makeshift operating theaters, known as "mobile hospitals," are used for surgical procedures. Hygiene and sterilization conditions are rudimentary and anesthesia is in short supply. Furthermore, the mere possession of drugs and basic medical materials, such as gauze, is considered a crime.

"The security services attack and destroy the mobile hospitals," said a doctor who requested anonymity. "They enter houses looking for drugs and medical supplies."

Security is the key concern for doctors working in the parallel underground networks. In the prevailing climate of terror, treatment must be provided rapidly since medical workers and patients must constantly change location to avoid detection.

"We are constantly being pursued by the security forces," said another physician. "Many doctors who treated wounded patients in their private hospitals have been arrested and tortured."

It is extremely difficult to treat major trauma cases and provide post-operative care. Furthermore, the clandestine health workers cannot obtain blood from the central blood bank, which is controlled by Syria’s Ministry of Defense -- the only blood supplier in the country.

Only a few wounded patients have managed to find refuge in neighboring countries, where they can receive proper—albeit delayed—medical care.

"I was wounded in the thigh and the soldiers caught me,” recounted a patient treated by MSF. “They beat me on the head and on my wound, but I managed to get away with help from people in the neighborhood. In the end, I found someone who could treat me—a nurse, not a doctor. He didn't even have anesthetic."

Under the current circumstances, MSF’s assistance to Syrians requiring medical care is limited. For months, MSF has been seeking official authorization to aid the wounded in Syria, so far without success. The organization is treating patients outside Syria and is supporting doctors' networks inside the country, through the provision of medicine, medical supplies, and surgical and transfusion kits.

[Special Report] Special Report: In Syria, Medicine as a Weapon of Persecution

Wed, 08 Feb 2012 20:42:00 GMT

Syria 2012 © MSF

A Syrian patient treated by MSF

In Syria, Medicine as a Weapon of Persecution

Download full report [1989 KB]

These 15 testimonies from injured people and doctors from across Syria were collected by Doctors Without Borders/Médecins Sans Frontières (MSF) staff between January 30 and February 6, 2012.

MSF is not authorized to operate inside Syria at present and thus is unable to fully verify the information collected here. However, given the recurring nature, consistency, and severity of the acts described in these testimonies, MSF has decided to make them public. For security reasons, names and locations have been withheld.

The testimonies reveal the following:

Casualties such as multiple fractures, gunshot wounds, and electric shocks that strongly suggest a concerted program of violence and torture;
The merciless persecution and repression of the injured and their caregivers;
The pursuit of doctors at risk of arrest and torture for treating wounded civilians;
The monitoring of hospitals by security forces, in order to arrest and torture the wounded;
The resulting need for many to seek medical care provided illegally in makeshift facilities, including private homes; and
The lack of even basic medical supplies, including drugs, anesthetics, blood bags, and sutures in places where patients do receive care.

Man, 23 years old

Date of injury: November 2011

I was in the street, and usually when there is a raid on the city, they shoot randomly and indiscriminately on all people, whether it’s an old man, a child, or a woman. Any moving person was a target. I was injured in my hand. There were other people injured, too.

“They shoot randomly and indiscriminately on all people, whether it’s an old man, a child, or a woman. Any moving person was a target. I was injured in my hand.”

No, I was not taken to a hospital, because all the hospitals were surrounded with security personnel. In the hospitals now, the security cadres are more numerous than the medical personnel, and anyone is subject to arrest and even murder inside the hospital.

They took me to a house [to get treatment]. And, god bless them, a number of doctors and nurses there bandaged my hand and told me it needs an operation in a hospital. So my family decided to send me to the capital, considering that the situation in the capital is calm. I was taken under a false name and identity, and I was operated on in the hospital under a different name because I am wanted by the security apparatus.

I stayed for one day in the hospital, but in this operation, it should not have been the case that my hand needed to be cut off. Normally, even under the worst circumstances, they might remove a finger or just bandage the wound, but in this case, they cut it off from the wrist.

A gunshot wound does not necessitate amputation. In Damascus hospital? They had everything there and they could have treated my hand. But they amputated it. That is what I find strange and surprising. I’m still upset about it today.

I decided to leave the hospital after one day. I stayed in the capital for 10 days.

Man, 29 years old

Date of injury: November 2011

I was injured November 31. There was an attack by the Syrian security forces. There were tanks and there was firing by the tanks. My mission was a media one. I was supposed to film and show the truth on free channels and Al Jazeera. It was a horrific attack.

“I was detained twice and what we saw is that some of those in prison are left to have their wounds rot. Their injuries rotted and they were not taken to hospital. Some died next to me, while others were urinating blood from the internal bleeding they were suffering from.”

There was a man who was wanted by the security and they stormed his house and broke the glass. They couldn’t find him but found his father. I was filming all of this from the bedroom of a house next door. I was moving and the snipers saw me and they were trying to hit me or shoot me in the head. There were several shots on my arm. It was an explosive bullet. It destroyed three fingers and a quarter of my hand.

I was lucky because I went into a house where there was a woman delivering. They took me into the house and put me in the place of the woman. And the security were after me.

When they arrived in that house and saw the blood, the people were shouting and saying, “Why are you coming here? There is a woman having a baby!” And that is how I was saved. The security went to other locations.

But the doctors could not do much for me. I was bleeding heavily; they were tightening [a tourniquet] around the wound to try and stop the bleeding. The pain was so bad I wished I was dead. And I call on all those who care about human rights to ensure we receive at least local anesthesia, because the pain I endured was too much.

After the security left, the guys came to move us to another location. In the situation that we have in Syria, you cannot go to a hospital, because if you do, they either amputate the limb that you are suffering from or they take you to prison. I was detained twice and what we saw is that some of those in prison are left to have their wounds rot. Their injuries rotted and they were not taken to hospital. Some died next to me, while others were urinating blood from the internal bleeding they were suffering from. And no organizations or doctors or MSF are allowed to go into prison.

The field hospital [is normally in someone’s house, moving from one house to another]. There were no ambulances; any ambulance was targeted and shot at. And the doctors who are brave enough are also watched or arrested, or they rape his wife in order to prevent him from taking any action. Or they place them under house arrest.

Man, 28 years old, laborer

Date of injury: May 2011

I was injured on May 27. The Friday that was named for protecting the homeland.

We were a group of men in the same neighborhood who went out on a demonstration to demand the fall of the regime and our freedom. We used to always face live bullets. But on the night I was injured, we did not expect that Syrian army and security apparatus would prepare an ambush for the demonstrators. So at midnight, we were surprised to be facing direct live fire.

“When I fell on the ground, two men who unfortunately were from the Syrian army came to me and started to beat me on my head and my injured leg.”

I was injured, shot in my left thigh. I suffered from a broken and crushed bone.

When I fell on the ground, two men who unfortunately were from the Syrian army came to me and started to beat me on my head and my injured leg. They started to pull me by my arms, trying to drag me back to their barrier, which was a bit far from them as they came on foot. So when they were pulling me, a woman saw what was going on from her window on the second floor.

They got scared because when the woman started shouting, I also started shouting. She gave me strength. I started calling for the people. Then the soldiers left me and ran.

The people protected me and I was taken from the neighborhood. In our neighborhoods, we can move from one house to another without going through the main roads. We kept looking for a doctor until 4:00 a.m. Finally a nurse came. I am so thankful to him because he took a major risk to come and help.

After the initial treatment I was moved to another house for safety.

We remained in the house for four days. The next day the doctor came to see me and said I needed to go to a hospital, that I could not stay here. We initially wanted to have the operation to fix my fracture in a field clinic or where we were, but he said it was impossible because the wound was infected and there was swelling. He said you need a hospital, adding that it was my choice, but I could either stay here, and they will have to amputate my leg, or I could go to the hospital.

The doctors tried their best until finally they managed to operate on me. When they took me into the OR, the hospital security also went into the operation room. The doctor told them not to and that it was a sterilized room. I was operated on and they used the external fixator and I was smuggled out of the hospital in a way that I don’t want to mention because it is still being done. I was out, but after that the doctor was detained. Thanks to god he was later released.

Also, when we went home, my situation got worse, because they were still looking for me. We were homeless for a while moving from house to house. So there was a lot of pain and difficulty and hardship. It has lasted a long time.

Man, 23 years old

Date of injury: March 2011

I was injured on March 23, 2011. The security forces shot me in the thigh.

I was taken by the guys to a mosque. And at the mosque they told me I needed a hospital for my wound, but we cannot take you to the hospital because the situation is really bad. They said the injured can be shot at the hospital. So they took me to a house I stayed in the house until the afternoon, and after that they took me to the national hospital.

“For treatment I was given a drip until the morning. I still needed an operation, but I could not get treatment for my injury for 25 days.”

At the hospital, they told us that there had been a massacre and there were a lot of wounded there already and, therefore, they cannot do the operation for me.

We stayed in the hospital until midnight and after that we were told to leave for our own safety, in order not to be targeted. For treatment I was given a drip until the morning. I still needed an operation, but I could not get treatment for my injury for 25 days.

I finally got back to the hospital after the 25 days and underwent an operation. The second day, I left the hospital and went back home.

I still needed another operation to remove the fixator and implant skewer [the metal plate that had been inserted]. I stayed like that for around two months, and after two months, when I wanted to go back to the hospital, I could not because the situation was very tense.

It was difficult for everyone to go to hospital because they started to take the patients from the hospital. It became much worse—as the number of injured increased a lot, the security also increased too. Some people donated money for the operation in the private hospital and I underwent the operation. Then I went to a doctor; the bones were healing, but the problem was with the nerve, as it was damaged. This kind of treatment is not available in Syria. So I have remained in the same condition for the last eight or nine months.

Man, 34 years old

Date of injury: December 2011

I was injured in December, and I was detained during a demonstration against the president.

I was detained and tortured for 15 days, and on the last day, day 15, they put the picture of Bashar al-Assad in front of me and told me to kneel to the photo, saying, “kneel to Allah Bashar.” I told him I only kneel to god and I tore the picture. They went crazy when I was tearing the photo, as if I was tearing out their soul. So they took me to the colonel.

“With me, they taped a detonator to my hand; it had TNT, which was tied to a long string linked to a battery. Then they put on the electric detonator and blew it up. I lost three fingers and two-thirds of the remaining two, along with most of the palm of my hand.”

They beat me badly, to the point that I was about to faint. They tied my hands behind my back and took me to the colonel and he said, “my son”—he didn’t really say “my son,” he cursed me, but I will put it like this because it was a very bad insult. He asked, “Don’t you know that whoever cuts the picture or lays a hand on the president, we will cut off their hands.”

I said, “As you wish, sir.” He kicked me, and I fell from the top of the stairs down to the last one. After that, they covered my eyes and spread my arms and tied them (like a crucifix), and they taped something to my hand. I didn’t know what it was but later found out that it was an electric detonator. They put up some sort of a shield and they blew it up.

Within less than a minute, I felt something warm on my feet. It was my blood. I was bleeding heavily and I lost consciousness. I woke up in hospital, I wasn’t totally conscious in the hospital, but my friends found out I was there. They kidnapped me from hospital and took me to a house, and they brought doctors who came and treated me in that house.

In detention: they curse and insult and were constantly beating us and they tie up people’s arms like [they’re on a] crucifix. Some guys were subject to the removal of their fingernails. Others were flogged, and there are others who had their backs broken. They put them on a certain board; they make the person lie on it and then the sides of the board are lifted and the back cracks.

They use many methods. With me, they taped a detonator to my hand; it had TNT, which was tied to a long string linked to a battery. Then they put on the electric detonator and blew it up. I lost three fingers and two-thirds of the remaining two, along with most of the palm of my hand.

Yes, they took me to hospital. They threw me there like I was a dog or something and they said they don’t want to deal with me. The treatment was bad. When the doctor saw my injuries, he said it was very bad and that my hand was completely deformed. Even the doctors later, they did not have the proper tools to treat this kind of wound.

For 25 days I could not sleep because of the pain, not even with taking sleeping pills. In the hospital, they only stopped the bleeding. After that, my friends found out that I was in hospital, so they kidnapped me from there. They took me out from the back door, because if the security saw me there, they would kill me. We are all targeted and until now they are looking for me and I am wanted.

Yes, there was a lot of torture in detention. We were 230 people kept in a small room. There were old men and doctors detained with us. There was a doctor there I met. I asked why he was there and he said, “just like you my son.”

Man, age unknown

Date of injuries: March 2011

My injury happened when a sniper shot me in my right thigh, crushing of the bones in my leg. I remember that on that date the ambulances were around, at a distance of 20 meters of less, and I was waving to them, but they did not respond. Days later we found out that the drivers of these vehicles are security people and not paramedics.

“I was given drugs and antibiotics, but they could not carry out the surgical operation because the injury was severe.”

Some of my students came and saw me injured on the ground and they insisted on taking me to the hospital, even though there was still heavy shooting.

I was moved by a taxi. The taxi driver who stopped for me was really brave. I stayed for one day in the hospital and managed to get first aid. They gave me two or three blood units and I regained consciousness. I was given antibiotics, and they told me, “This is what we can do for you, because your injury is severe.”

After that, one day later, I was referred to the Damascus hospital and I stayed there for one week. I was given drugs and antibiotics, but they could not carry out the surgical operation because the injury was severe and they sent me home and said “you need a conservative treatment.” I asked what that means and they said I should stay in bed for three or four months because the operation is semi-impossible. The bones were really crushed, but I was not convinced with what they told me.

The doctor was avoiding saying that this kind of operation was beyond their level or capacity, so he wanted to get rid of me. I went home and stayed home for 10 days. Some people mentioned the name of a famous doctor in Damascus and I was adamant to go to that doctor, and I paid for the treatment. This operation [internal fixation] cost me 150,000 Syrian liras [approximately $2,600], and the doctor was reassuring me that the success percentage was excellent. I was back to normal by 95 per cent, but now am suffering from the bullet that is still in my leg, and these metal bars hamper my ability to walk. After a while, I could not go back to hospital because security had a very tight grip on both public and private hospitals. They either terminate the injured or beat them up on their injury or arrest the injured. So I decided to come to MSF to continue my treatment.

Man, 24 years old

Date of injuries: June 2011

I was injured around eight months ago. We were in a peaceful demonstration and were demanding reforms. They started firing tear gas bombs, and shrapnel hit me in the chest. It was the Syrian security who did this. Then there was shooting with live bullets so the guys carried us and took us to a mosque. I needed an operation, but I could not go to hospital because it was filled with security people. They used basic material for treatment, like bandaging and antibiotic pills. The security was surrounding all the hospitals and anyone who goes there will be detained. Now, the impact of the shrapnel hit my chest, where there is excessive tissue, but this tissue needed to be removed according to the doctor.

“I could not go to hospital because it was filled with security people. They used basic material for treatment, like bandaging and antibiotic pills.”

I have gone without treatment for seven months. I was also detained. That happened on the twenty-seventh or twenty-eighth day of Ramadan. I went out after the Eid.

Tortured? Yes. They took me at 1:00 a.m., and they kept beating me until 4:00 a.m. We were also tied with hands apart and chained, and they used whips and kicked and insulted me.

No, there was no medical treatment in detention. We barely got food. There were 60 people in a room, some sleep standing up, others sitting down. Those who have their names called out go out, but we don’t know where to. After one or two hours they come back exhausted from the beatings and the torture. They put us in a yard and make us take off our clothes, and they spray us with water and they stand far or on top of a chair, and they electrocute the wet floor. We were all electrocuted. They also use a certain chair to crack the back of the person. Those who are injured or have broken bones are not treated. They have to endure until they are released.

Man, 29 years old

Date of injuries: Unknown

I was taking my brother’s wife to hospital. She was having a baby and my wife was also with me. And I was told not to go near that area because there are armed men there. I kept the women in that location and went to bring a car a taxi, to transport the women. As I was walking to get a car, I was shot in the calf.

“I woke up in the hospital and was told that they want to cut off my leg. Everyone in the hospital was at risk of being killed, and they even attacked the intensive care unit. I was taken outside the hospital in order not to be hurt.”

The shooting was from a tank standing behind a digging truck. The kind of bullet shot by this tank are the ones that explode in the body. I was not carrying any weapons and I had not done anything. Yes, it was the Syrian security.

I woke up in the hospital and was told that they want to cut off my leg. Everyone in the hospital was at risk of being killed, and they even attacked the intensive care unit. I was taken outside the hospital in order not to be hurt.

Security personnel were inside the hospital. The doctor talked to them and told them that even if you, the security, are injured we will treat you.

Five day later, I came back to hospital and they operated on me and put a plate in my leg, and I left the hospital. The doctors would come and see me, and they said I had an infection. The doctors were telling me if that I’m better off if I leave the country, because here the situation is worse.

I was injured the day the army stormed into the area. The whole area was full of injured and dead. It was like a massacre. Any car passing would take the injured, but the problem was with the presence of the security. There was security and a tank next to the hospital and a lot of army vehicles. The most dangerous were the snipers.

Man, 27 years old

Date of injuries: April 2011

I was injured during the demonstration. I was on a motorcycle.I saw a man who was dragging an injured person out of the crowd. They stopped me and said, "Take us with you!" There were three of us on the motorcyle with the injured person between us. They shot at us. The other guy who wasn't injured was shot. The man at the back fell off the motorcycle. It was only me and the injured man left. We fled. They kept shooting at us.

Who was shooting?

The security forces! I was pushed up against a security vehicle. We fell and they beat us up. Everybody in the vehicle got out. About fifty of them were hitting us with the butts of their guns. They were beating us, beating us . . . I had an injured leg and a bloodied face. I lost consciousness. The other guy with me, after the beating, was almost dead. He was still alive the last time I saw him. As for me, the blood was flowing from my ears, my nose, my mouth . . . they left me for dead. Some people put me in a blanket and brought me to a makeshift hospital. There, some women gave me first aid. I don't know what aid exactly . . . I stayed 13 days and then I was able to leave.

Elderly man, age unknown

Date of injuries: March 2011

We left our villages for the city. It was my first demonstration. We arrived and we were surprised. We were expecting a "normal" demonstration with water canon, tear gas, et cetera. To break us up, they fired machine guns, real bullets . . .

There were snipers also. It was indescribable. I was hit in the shoulder. I was with another demonstrator who I saved. We hid in a building waiting for it to calm down. The area was shelled for two hours. I wanted to help a wounded man but he refused. People had told him that injured people were killed at the hospital. We couldn't do anything but I bandaged his wound with a bit of fabric that a woman gave me . . . The doctor in the village is pro-regime. He refuses to treat the injured. In the hospital in my village, they just gave me first aid because nobody wants to stay at the hospital. You go in one day, and the next day "they" come and get you. You make do with what you find in
the pharmacies: medicines, disinfectants, et cetera. One scene I remember in particular was a man with his face hidden, crushing an injured person with his feet.

Who?

One of "them," security, in military gear. Judging by his uniform, he was an officer. At the end, the officer finished off the injured man. I witnessed that scene with my very own eyes.

Doctor

General surgeon who left Syria two months ago

My name was registered with the security services and I am wanted because I treated the demonstrators.

“We try to prepare these field hospitals, but they do not have the proper standards. No proper ventilation, sterilization. We are using rooms in houses. So whatever you try to have, it will not fulfill the required requirements to carry out surgical operations. But this is the utmost that we can do.”

There were three kind of cases. The first were those that could be treated in the clinic. This is mainly treatment of those injured by bullets fired by hunting rifles. This kind of rifle bullet produces a lot of shrapnel and a lot of shell wounds. Wound treatment, as well as treatment for broken bones like putting a cast on can also be done at the clinic—the simple stuff.

There are the cold cases, like a bullet lodged in someone’s leg. This, we can keep the case for two or three days before we send them to hospital. And we coordinate with the hospital to remove the foreign object from the body in a clandestine way, because if we send someone to hospital and the security finds out, they will be detained. So for the cold case, we would sustain the wound, then under a false name or medical report make arrangements for the patients to be operated on in the hospitals.

The third kind of case are the acute cases. With these, we have no other option but to take them to hospital, and it depends on luck if the patient is picked up by security or not. But all the info of the patient will be recorded by the security, like who treated him and how they were injured and all the details.

In public hospitals there is a process to go by, and through this process the patient’s name will be registered with security and those who are supporting the regime within the hospital. So you cannot really help a patient in such circumstances.

Sometimes, some doctors manage to treat simple cases and manage to let them flee without being seen or registered. But if an admission is required for the patient, then the administration of the hospital is notified, and therefore it reaches the security.

A majority of the nursing cadres in these hospitals are pro-regime. For instance, they start saying in front of a patient that they will amputate the leg because he is with the revolution. Sometimes they insult the patients and beat them, and tell them “You want freedom? This is the freedom that you want?” At other times, they decide to amputate believing that with these patients, it is not worth trying to help them or save their limbs.

In public hospitals there is equipment and drugs, but the problem is up to 95 percent of the injured do not go to the public hospitals. They are often treated in a field hospital, where the people of that neighborhood agree on a certain house to place the wounded and decide what to do with them. Of course, there is a major lack of field hospitals, but we can at least try to help or operate acute or emergency cases.

What we do is: the patient is taken to a house, then some people take the patient after they blindfold them to another location to be treated. Even the doctors do not know where these field hospitals are. They are also blindfolded and taken by the guys to treat the patients. Neither patient nor doctor knows where the field hospital is located.

We try to prepare these field hospitals, but they do not have the proper standards. No proper ventilation, sterilization. We are using rooms in houses. So whatever you try to have, it will not fulfill the required requirements to carry out surgical operations. But this is the utmost that we can do.

We need the ventilator machine, or the transport ventilator, as well as other machines to be able to use for operations in field hospitals. We have prepared ORs in houses that are sealed to be used when the situation really blows up. They are hidden rooms in houses and are covered with walls, so when there is a break-in by the security they will not find the room. [These are] to be opened for acute and major cases or when there are huge numbers of people.

Yes, violence is increasing and the number of patients is increasing as well. And the kind of weapons being used are more lethal. Now we see wounded with bullets that have exploded in the body.

I treated a young man for six bullet wounds. He was travelling with his family in the car and did not stop at the road block, so they shot at the family’s car repeatedly.

The violence varies and that is why the cases vary depending on how tense the situation is. In one case, the security went into the OR and took the patient who was under anesthesia. It was in a private hospital.

As long as I was working in a clandestine way, and nobody knew that I was helping treat the injured, there was no threat on my life. But once my name reached the security—I was not ready to jeopardize my family.

What is needed most are the echo machines, transferable operating table, mobile x-ray machine and ventilators.

Doctor

Lab doctor

For the most recent cases, I can tell you, for instance, last week we lost two patients because there was no field hospital in that area and the injuries were gunshot wounds in the chest, so we could not treat them because they needed the proper tools and specialized people.

“Some of our people were detained. Some doctors are well known who have been in detention for months. ( . . . ) [We have seen] different forms of injuries [including] bruises due to beating, electric shock, which led to the death.”

To take these patients to the public hospitals is impossible, not just because there are doctors and nurses working for the regime in these hospitals, but due to the fact that in each hospital there is a police unit and they are on the door, and they belong to the different branches of the security apparatus and they apprehend the injured.

Some of our people were detained. Some doctors are well known who have been in detention for months.

[We have seen] different forms of injuries [including] bruises due to beating, electric shock, which led to the death. One case was electrocuted in the mouth and they kept electrocuting him until he died. I saw this. I was there standing next to the mosque.

Field hospitals: we set-up three hospitals. One hospital was attacked so we had to dismantle the others, then we switched our method and we started setting up field hospitals in the countryside. But these hospitals remained unequipped and more like emergency kits. These are all in houses and changing routinely.

A doctor now is considered more dangerous than those fighting with the [rebel group, Syrian] Free Army, and anyone caught with drugs in his possession, the charges against him are more grave than being accused with possession of weapons.

The average person is normally taken for days or up to a week, but doctors are detained for months. The doctors are also targeted not just because they treat the injured but also because they are involved with the movement. In the military hospital, those who are considered renegades from the army are tortured and killed.

Some intern doctors or medical students in their last year are helping; they receive training on basic injury treatments and are helping us with the treatment of the injured

Doctor

Doctor who worked in a hospital

Certain colleagues were caught and I was advised to leave the country.

“At the beginning the security raided several areas where we had field hospitals, so
we were not able to treat as many as possible.”

In each public hospital there is a police unit, so any patient admitted for a surgical operation will be known and will be reported. We cannot work within this context. I wasn’t able to work within these hospitals. I worked in my city, going down to the street and taking my stuff to treat cases on the street.

A colleague of mine was caught with gauze in his car and he was sentenced on charges of running a field hospital. He was in prison for a month and was tortured.

At the beginning, we used to go down to the street. Those who were shot in the head by snipers or the cases we know cannot be treated, we leave them or send them to the hospitals without their families.
At the beginning, the security raided several areas where we had field hospitals, so we were not able to treat as many as possible. Other cases, like shell wounds, are taken to the field hospital and are treated. We put them in a house and we visit them and monitor their injuries.

For cold cases, we sustain the case and then send them to a hospital. With others, we try to send them to a private hospital and arrange for their treatment.

The first time there was violence, there were no ambulances. The second time, when the ambulances came, we sent them away because they can easily take all the injured and transport them to the security station, or security personnel can come out of it. So they are not safe. We would not trust any ambulance that belongs to the public hospital. One patient was shot in his leg as he was giving first aid to a patient inside an ambulance.

Doctor

I'm a Syrian doctor. I was treating the wounded in Syria.

“The risk of being arrested is big. But despite that risk, many doctors are putting their lives in danger in order to fulfill their medical oath.”

At first, when the demonstrations started, we sent the injured to public hospitals. But then we were told that injured demonstrators were being tortured or left untreated. Many were even killed.

Doctors are working in difficult security conditions and in tough medical conditions, too.

Makeshift hospitals tend to be one or two rooms somewhere near a demonstration area. In addition to that, there's all the security pressure and difficulty in reaching certain areas. Doctors who treat the wounded are also being harassed by security forces.

Security is what worries doctors most. It's difficult. The risk of being arrested is big. But despite that risk, many doctors are putting their lives in danger in order to fulfill their medical oath. It is difficult to find sterilized medical materials. Due to our limited means and the numbers of wounded, we have to resort to rudimentary medical practices.

We are forced to use medical materials and perform medical acts that are far from the safe surgical procedures we would usually carry out. Activists and protestors don't really have any medical resources. They don't have ambulances, for example. The injured are transported by their friends and fellow protestors.

When we receive serious casualties, a patient who needs to be hospitalized, we have two options: Either we let him die, or we send him to hospital not knowing what will become of him.
Many hospitals are encircled and placed under tight control when security forces are informed that a casualty is due to arrive from a demonstration area.

Doctor

The general problems that we are facing:

There are two public hospitals in X. . . . But this applies equally to the whole of Syria. The wounded do not go to public hospitals. The wounded are treated in residential houses staffed. These are emergency medical stations. There are no ambulances. The ambulances are not available. They are controlled by the authorities. We use civilian vehicles.

We are organized. In each region there is a medical team including doctors and nurses to take care of the wounded in that region. However, we cannot transport the sick from one region to another because the regions are isolated from each other. Each person is treated in his or her region, in his or her neighborhood. But serious cases are transferred to the two or three hospitals that are providing care with us in secret in X. These are not public but private hospitals.

Of course the transfers take place in an organized way far from the military checkpoints. Because anyone could be stopped at a checkpoint. If a vehicle is transporting a wounded person, that person and the driver could be stopped and the vehicle confiscated. They could also be shot at. Even the ambulances have been shot at.

I can give you an overview of the medical situation in general. The medical situation in general: we have field hospitals here in X, one field hospital. Here we perform general operations, not only small operations but also certain chest injuries. These are good operations, more or less important operations. They’re not always complex operations, but emergency operations of a good standard. That is the situation with respect to the hospitals.

In addition to the hospitals, we also have what we call emergency medical stations. There are more of these than the hospitals. Each region has one or two hospitals. There are more medical stations. They are installed in houses, in rooms inside the houses, and equipped with emergency medical equipment such as gauze, cotton, serum, the essentials.

The teams of volunteers are composed of nurses and certain doctors. The wounded person is transferred to the medical station. He is rapidly treated and released. Even the medical station is subject to searches and in danger. Actually a house which treats the wounded regularly is quickly identified by the authorities and becomes a target. This is why the medical teams are constantly transported from one house to another.

The medical stations are mobile. They are different to the field hospitals. The items of equipment in the field hospitals are also mobile. We transport them from one area to another as much as possible.

But the situation is difficult. The hospitals were searched. When the militias enter into a neighbourhood with a field hospital, they destroy it. They destroy the equipment, confiscate it, burn the medical products, such as the cotton and the gas. It was agony.

The security services search and destroy the hospitals so that we have nothing left to treat the wounded. This is why the medical stations are mobile.

We also have slightly larger medical stations in which smaller operations are performed. These stations are more or less fixed. We also have the field hospitals.

Certain [doctors] admit wounded and operate on them. These are standard operations. Today these doctors are in foreign countries. It is difficult to obtain [medical products]. They exist, they are available, either on the domestic market, or as contraband via the borders, but with difficulty.

Sometimes we suffer from a major deficiency of medical products. Other products are more available. Some organisations support us, some influential people help us to maintain supply of medical products through the border. These are the operating rooms, but they are far from perfect . . . as you know, the operating room must be sterilized. It must be maintained in a particular way.

It is installed in a room in the house. One room is sometimes open. One room in a region being bombarded. People enter and leave like in a mill. The conditions are not ideal, but it’s all that we have.

The supply of basic products was possible but we are going through difficult periods. At a time we suffered a major lack of products. In surrounded regions, the needs were far more urgent. We tried to get medical supplies by way of the internal market as much as possible.

It’s true, the security forces are present. The medical hospital here is a base for the security services. They received wounded from the army. They even receive wounded civilians. We don’t have a lot of stories that are coming through. People who come into this hospital are only injured soldiers, as wounded civilians don’t come to public hospitals.

We have got hold of the pursued people. On one of them, there’s the name of three or four doctors. One of them is being pursued for having helped an injured person. In other words, every doctor helping an injured person is accused. That’s an accusation. It’s there on the official documents in our possession. There’s the name of the doctors who have been imprisoned then came out. Others have been imprisoned and then executed.

We are people just like others. The situation is unacceptable. I got involved in this work from the first day. I can’t even imagine not being involved. I was there from the beginning with them. I was there from the first day in the demonstrations. I am one of the first to have gone into the streets, with my colleagues.

They say that people filled the streets: everybody came down to demonstrate, doctors, engineers, defavorized social classes. Everybody participated in the movement. I am part of these neighborhoods. I am not participating only because of my duty as a doctor. My role as a doctor is to heal the wounded. This is the reality. People are still dying in the streets. We can’t leave them.

Lebanon: Healing Those Deeply Affected

Wed, 08 Feb 2012 20:42:00 GMT

Lebanon 2010 © Dina Debbas

An MSF staff member in Burj el-Barajneh Palestinian refugee camp in the southern suburbs of Beirut, Lebanon

Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing mental health care in two refugee camps in Lebanon for the past three years, both to Palestinian refugees and to vulnerable Lebanese in the area. Now MSF has opened a new project in northern Lebanon, following the arrival of 4,500 Syrians fleeing the unrest in their country. Bruno Jochum, general director of MSF-Switzerland, is just back from the region.

What was the reason for your visit to Lebanon?

In 1976, MSF carried out its first wartime mission in Lebanon and became a professional medical emergency organization. This year, having recently celebrated our fortieth anniversary, we feel it is essential to share our principles of financial and medical independence, impartiality, and neutrality. We believe it is important to talk publicly about these principles—as we did in December at the Beirut launch of an Arabic-language book entitled In the Eyes of Others: Perceptions of Humanitarian Action and of MSF. My visit to Lebanon was an opportunity to restate—to the authorities and to people in the region—MSF’s readiness and commitment to provide independent, neutral, and impartial health care in situations where humanitarian needs exist.

Why is MSF working in Lebanon?

Following the 2006 war [between Israel and Hezbollah], once the immediate response to the crisis had taken place, MSF made the worrying discovery that there was little mental health care available.

MSF has put in place several mental health programs for Palestinians and Lebanese people living in and around the two largest refugee camps in Lebanon: Burj el-Barajneh in Beirut and Ein el-Hilweh in Saida. Over the past three years, more than 2,200 patients have benefited from free psychological care, provided through a multidisciplinary, community-based approach. In total, more than 15,500 free-of-charge psychological and psychiatric consultations have taken place.

Why did MSF decide to start working in north Lebanon?

Recently, with thousands of Syrians—many of whom have physical wounds—fleeing the violence in their country and seeking refuge in Lebanon, we dispatched medical teams to evaluate their health status. This resulted in our setting up a new health program in Wadi Khaled, in the north of Lebanon, in November 2011. We have been working in Lebanon for three years, and were therefore in a position to closely monitor the health situation for Syrians arriving in the country.

The support we are providing today is limited. Our first approach was to provide stocks of emergency supplies to health centers near the border with Syria. Besides mental health services, MSF is increasing its capacity in the area to respond to any further and significant influx of people from Syria by reinforcing epidemiological surveillance, vaccinations, chronic disease management, and emergency medical equipment, while assessing further medical needs. The presence of an independent international medical organization like MSF also provides a guarantee of neutrality to those arriving from Syria.

What is the humanitarian situation in northern Lebanon?

Most of the Syrians who fled their own country in need of medical care had to leave all their belongings behind. Even if the situation remains relatively stable in Lebanon, it is difficult to predict what will happen in Syria. As an emergency medical humanitarian organization, we need to be prepared in case of a massive influx of people to the area. Our purpose is to guarantee medical care in the case of the arrival of large numbers of wounded Syrians fleeing violence.

What is the humanitarian and medical situation in Syria?

It is very hard for us to get a precise picture of the humanitarian and medical situation in Syria and the magnitude of the needs to which we could respond. Based on our experiences in Libya and Bahrain, and on stories from patients and doctors in Syria, the likely pattern is that the wounded cannot be treated in the public hospitals managed by government authorities where they may be especially vulnerable. Today the Syrian population is faced with enormous difficulties in accessing necessary levels of emergency medical care. It is essential that all parties respect basic medical ethics, the impartiality of medical facilities, the day-to-day work of doctors and nurses, and the safety of patients.

MSF remains committed to responding to the humanitarian needs in Syria and providing the required assistance to the Syrian population if and when access is finally granted. MSF remains very concerned that victims of the conflict may not be able to access medical care, and reiterates the right of Syrians to flee violence in search of refuge and medical assistance.

[Voice from the Field] Somalia: "Today the Child is Completely Different Than [the] Day He Was Admitted"

Wed, 08 Feb 2012 20:42:00 GMT

Somalia 2011 © Sven Torfinn

Mothers and children wait to receive medication and supplementary food at the therapeutic feeding center in Galcayo South, one of many centers MSF runs in Somalia to help children like Khalif.

Four-year-old Khalif has been under treatment in Doctors Without Borders’s/Médecins Sans Frontières’s (MSF’s) inpatient therapeutic feeding center in the southern Somali town of Kismayo for just over two weeks when his mother, Abshiro Gedi, tells his remarkable story.

The family lives in Mayondo village, about 37 miles (60 kilometers) north of Kismayo, in an area that has been heavily affected by the ongoing crisis in Somalia. Two of Khalif’s brothers recently died from complications related to measles, and Khalif and his sister were also suffering from the disease. When one of Abshiro’s brothers, who lives in Kismayo, heard the bad news about his nephews’ deaths and illness, he hurried to Mayando to bring the two remaining sick kids to MSF’s therapeutic feeding center for malnourished children in Kismayo.

Once there, Khalif was admitted as he had signs of severe malnutrition. “Today the child is completely different than [the] day he was admitted,” explained Abdirasak Sheikh Abdiwahab, MSF project coordinator assistant in Kismayo’s center for malnourished children. “Cases like this who improve quickly are many, not only Khalif, but this is a [good example of the conditions people face here].”

With the ongoing humanitarian crisis in Somalia hitting the southern regions hardest, MSF opened a therapeutic feeding center for children under the age of five in the city of Kismayo, aiming to curb child malnutrition and mortality in the city and its surroundings. Children this age are most at risk of dying from malnutrition. Since opening this center in November 2011, MSF has treated over 300 children, with an average of 50 receiving treatment at any time.

MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions in the country. Over 1,400 Somali staff, supported by approximately 100 staff in nearby Nairobi, Kenya, supply water and relief items and provide free primary health care, surgery, treatment for malnutrition, in nine locations in south and central Somalia. MSF is also providing medical care to Somali refugees in Kenya and Ethiopia.

[Op-Eds & Articles] What Uniting to Combat Tropical Diseases Will Really Require

Wed, 08 Feb 2012 20:42:00 GMT

CAR 2011 © Anna Surinyach

An MSF staff member tests a child for sleeping sickness.

Dr. Unni Karunakara is international president of Doctors Without Borders/Médecins Sans Frontières (MSF). This article originally appeared on the Huffington Post UK.

Performing a spinal tap under field conditions is nerve-wracking. Sticking a needle into someone's spine to extract spinal fluid is painful and risky and that's just the doctor's perspective. But it's also something that our doctors have to do every day as part of routine tests for advanced stage sleeping sickness. Try too then, to imagine the experience from the patient's side. When I was in charge of Doctors Without Borders/Médecins Sans Frontières's (MSF's) sleeping sickness programs in the Republic of Congo, even the prospect of the test was sometimes too much and people took to their heels rather than undergo the procedure.

So we at MSF welcomed the commitments being made at a conference which happened in London yesterday, Monday 30 January, to attempt to eliminate this disease by 2020 along with the elimination or control of nine other so-called neglected diseases.

MSF treats sleeping sickness and several other of the life-threatening diseases under discussion in London, including Chagas disease and kala azar, and while we are glad that attention is being focused on them now, we are concerned that the conference is painting too simple a picture of how we can finally be rid once and for all of these diseases.

Continued and expanded drug donations from the pharmaceutical industry will be part of the solution to address some diseases under discussion and alleviate a great deal of human suffering. But that strategy will not meet the challenges of treating other, more challenging diseases like Chagas, kala azar or sleeping sickness. For these life-threatening diseases, drug distribution alone isn't enough—we will need to invest strongly in national screening and treatment programs, as well as the development of new and better diagnostic tests and medicines.

Regarding R&D, a 2011 survey reported a grand total of US$20.2 million investment for research and development by the pharmaceutical industry for the neglected diseases under discussion at the conference. This may sound like a lot, but Big Pharma generally claims to spend US$1.3 billion developing a single drug.

Let's return to the treatment of sleeping sickness for an example of the range of challenges that have to be overcome before we can begin to think of eliminating the disease: we have largely moved away today from the horrors of melarsoprol, an arsenic derivative injected into the patient and so caustic that it corrodes the plastic syringes. But even some of the improved drugs we now use can only be administered through a series of infusions that require specially trained staff usually in a hospital setting—a luxury in most places where sleeping sickness thrives.

To make a significant leap forward in treating this disease, patients need a medicine that can be taken orally and handed out at a simple community health post. The good news is that there are currently two promising drugs in development that could—eventually—deliver what we need, from the innovative partnership, Drugs for Neglected Diseases initiative (DNDi)—supported consistently by, among others, the British government.

New diagnostic tests and drugs will help but in their absence, the only realistic option for treating sleeping sickness today is to rely on specialized mobile medical teams that travel to affected areas to test and treat, as most patients with the disease are located in remote areas in fragile states such as the Democratic Republic of Congo (DRC), Central African Republic, and South Sudan. Even in these difficult contexts and with limited funding, mobile teams have done a great job. There were fewer than 7,200 confirmed cases recorded in 2010 as the numbers continue to decline. But treatment programs are now in jeopardy; Belgium, the main donor for DRC's sleeping sickness program, has announced that it will be withdrawing its support in 2013.

Screening activities also remain dangerously underfunded—there are probably three times as many cases of the disease than are actually reported. Past experience tells us that without adequate screening and treatment programs, we could see the number of cases skyrocket once more.

So if we are serious about eliminating this disease, we need properly funded treatment programs that include screening and surveillance; continued support for innovative partnerships such as DNDi to deliver newer and better drugs and diagnostics; and better policies to develop affordable medicines for patients in poor countries; and public authorities need to step up and take the lead on developing and maintaining these programs.

But unless people wake up to the need to commit to a broader range of challenges than those now before the conference, we won't finally see the back of these diseases for a while yet and sleeping sickness, Chagas, and kala azar will continue to debilitate thousands.

[Press Release] New Doctors Without Borders Book Reveals Perils of Negotiating Access to Crisis Zones

Wed, 08 Feb 2012 20:42:00 GMT

Angola 1999 © H.J. Burkard

Live webcast
Please join us for a live, online discussion of these issues featuring several experienced MSF aid workers.

Tuesday, January 31, 2012
8:00 PM (ET)

More information.

#AnyPrice

NEW YORK, NY, JANUARY 30, 2012 - In a new book launched in the United States today, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) takes readers behind the scenes of humanitarian action, revealing the complicated negotiations and precarious compromises required to negotiate access to populations trapped by armed conflicts and health crises.

Inspired by MSF’s fierce internal debates on the evolution of its independence as a humanitarian organization, Humanitarian Negotiations Revealed: The MSF Experience offers a candid, self-critical examination of MSF’s decision-making processes in a dozen countries, including Afghanistan, Myanmar, Somalia, Sri Lanka, and Yemen.

The book, released in conjunction with MSF’s fortieth anniversary, reflects on MSF’s medical humanitarian efforts over several decades—some successful, some less so—and aims to ignite wider discussions of humanitarian ambitions and the best ways of fulfilling them.

“Humanitarian negotiations have life-or-death consequences for people in need,” said Sophie Delaunay, executive director of MSF-USA. “As MSF weighs the risks of delivering humanitarian aid in precarious situations, such as Somalia, it seems more important than ever to lift the veil that often obscures the difficult choices our teams confront on a daily basis.”

The book consists of a series of case studies, followed by thematic essays, which examine the delicate balance between upholding MSF’s founding principles of independence, neutrality, impartiality, and speaking out; and the practical realities of delivering humanitarian aid in complex and dangerous political environments.

The authors—MSF veterans with many decades of collective field experience—chronicle MSF’s experience in 12 countries: Afghanistan, Ethiopia, France, the Gaza strip, India, Myanmar, Nigeria, Pakistan, Somalia, South Africa, Sri Lanka, and Yemen. Journalist David Rieff contributes an afterword in the book.

In conjunction with the launch, MSF will present a live, interactive webcast, “At Any Price? Negotiating Access to Crisis Zones,” free and open to the public, on Tuesday, January 31, at 8:00 p.m. EST. A panel of experienced MSF aid workers, including Michael Neuman, one of the authors and editors of the book, will discuss their experiences in conducting humanitarian negotiations in the field.

Panel discussions, featuring editors of the book and other guest speakers, will be held at the Boston Public Library on Wednesday, February 1, at 7:00 pm, and at The New School’s Tishman Auditorium in New York City on Thursday, February 9, at 7:00 pm. Both events are free and open to the public; register online a here.

Humanitarian Negotiations Revealed: The MSF Experience follows MSF’s 2004 publication In the Shadow of Just Wars, and continues the “Populations in Danger” series produced by MSF’s research center in Paris, CRASH (Centre de Reflexions sur l’Action et les Savoirs Humanitaires) (Center for Reflection on Humanitarian Action and Knowledge).

Humanitarian Negotiations Revealed: The MSF Experience (ISBN 978-0-231-70315-4) is being published by Columbia University Press. The book can be pre-ordered online from Amazon.com or Columbia University Press, and will be available in bookstores by the end of February.

Advance praise for Humanitarian Negotiations Revealed: The MSF Experience:

“With a refreshing honesty, it explores the thin line that humanitarian agencies tread between saving lives and supporting oppressors. This brave and informative book reconfirms MSF as an organization that thinks as well as acts.”

—Mark Duffield, Professor of Development Politics and Director, Global Insecurities Center, University of Bristol

“This is a very valuable book. It shows one of the world's great humanitarian organizations thinking aloud about the difficult choices it faces as it struggles to save and protect human life.”

—Dr. Hugo Slim, Oxford Institute of Ethics, Law and Armed Conflict, University of Oxford

[Press Release] As Global Fund Turns Ten, Lack of Political Support to Health Threatens Gains Against AIDS, TB, and Malaria

Wed, 08 Feb 2012 20:42:00 GMT

South Africa 2011 © Chelsea Maclachlan/Le Monde

A woman receives antiretroviral medication at an MSF clinic in Cape Town. While MSF relies solely on private donors, a loss of funding from the Global Fund will leave thousands without treatment.

NAIROBI, JANUARY 30, 2012 - As the Global Fund to Fight AIDS, Tuberculosis, and Malaria marks its tenth anniversary—and on the heels of its leadership changes—people living with HIV/AIDS and those delivering and supporting HIV and TB treatment took to the streets as they warned that the political commitment made 10 years ago to address global health is evaporating, and that drastic funding shortfalls could cause an unraveling of a decade’s progress against the three diseases. The Global Fund Board in November took the unprecedented decision to cancel its eleventh round of funding because of a dramatic resource shortfall, and will not make grants for scale-up of HIV or drug-resistant TB treatment until 2014.

“Ten years ago, there was a landmark decision to support the roll out of HIV, TB, and malaria prevention and treatment in countries that couldn’t completely support programs on their own,” said Dr. Jennifer Cohn, of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières’s (MSF) Access Campaign in East Africa. “MSF has been part of the effort over the last decade to treat patients, introduce new treatments, and develop simple ways to deliver them. We have seen the positive impact of the Global Fund and other international health initiatives on individuals and communities, with deaths and sickness plummeting.”

The progress achieved is critical: nearly half of all people in need of HIV treatment in developing countries now have access, and in sub-Saharan Africa, treatment coverage increased by 30 percent in 2010 alone. MSF provides HIV treatment in 19 developing countries, and in at least eight of them, more than 80 percent of the people on HIV medicines receive them through programs funded by the Global Fund. The Global Fund’s cancellation of its latest funding round is especially detrimental at a time when scientific research has shown that HIV treatment itself can be a decisive tool for pushing back the pandemic: a person put on treatment earlier is 96 percent less likely to transmit the virus.

In several countries affected by HIV, plans to implement treatment strategies that have the biggest impact on the epidemic are at risk because of the funding crisis. In Malawi, for example, the government is attempting to find funding to pay for a plan to provide all HIV-positive pregnant women with life-long treatment. They have also been forced to put on hold plans to switch people to a newer World Health Organization–recommended treatment that has far fewer side effects. In the Democratic Republic of Congo, where already only 15 percent of people in need have access to HIV treatment, waiting lists have grown and some clinics have had to close their doors as funding declines.

Two years ago in Uganda, a lack of funding forced serious delays in starting people on HIV treatment.

“I am gravely concerned that people living with HIV and TB in countries affected by these epidemics are being told to wait for another two years before they can get the treatment they urgently need today,” said Dr. Peter Mugyeni, in Uganda. “I don’t want to see a return of the situation we faced in Uganda two years ago, when we couldn’t give people the treatment they needed to stay alive because there wasn’t the money to pay for it. If this happens again, it will again result in unnecessary deaths.”

TB will also be impacted. Although numbers of people with TB have been slowly falling since 2006, barely 10 percent of the global annual estimate of 440,000 new patients with multidrug-resistant tuberculosis (MDR-TB) receive treatment. Just as treatment expansion for MDR-TB seemed to be gaining momentum, the evaporation of political commitment is undermining the response.Enrolment of new patients on MDR-TB treatment will slow down in countries heavily reliant on the Global Fund.

“Pledges last week for funds from Japan and the Gates Foundation should serve as a wake-up call,” said Nelson Otwoma, National Coordinator of NEPHAK, Kenya’s largest network of people with HIV. “Now that it has new leadership, the Global Fund needs to hold an emergency donor conference so it can ensure countries can apply this year for grants to provide life-saving treatment to those with HIV, TB, and malaria. A Global Fund that is downsizing is a bitter pill to swallow. We’re beginning to see light at the end of the tunnel with the HIV epidemic, so now is not the time to shift into a lower gear.”

Countries such as Belgium, Denmark, the Netherlands, and the United States need to pay their full and outstanding pledges or reverse reductions in contributions, and recipient countries must also focus on increasing funding for critical diseases such as HIV and TB. A change from ad hoc voluntary funding to a more predictable mechanism—such as the financial transaction tax currently being debated in Europe—is needed, with part of funds generated to be dedicated to global health, including the Global Fund.

Turkey: Mental Health Support Helps Earthquake Survivors Cope

Wed, 08 Feb 2012 20:42:00 GMT

Turkey 2011 © Knut Maehlumshagen

MSF is running a mental health program to help survivors of the earthquake that damaged this street and others in Van.

Three months after two earthquakes hit Van province, eastern Turkey, survivors are trying to get back to normality. Children are back at school and shops and markets are open again. But most people are still living in tents or metal containers, and it is difficult for them to recover from their traumatic experiences.

Doctors Without Borders/Médecins Sans Frontières (MSF), in collaboration with the Turkish organization Helsinki Citizens’ Assembly (hCa), is helping people cope through a mental health program.

“People have the normal stress reaction: nightmares, loss of appetite, sleep problems, or even insomnia. They feel helpless, they are afraid to die, some cannot even recognize their village,” says Maria Palha, an MSF psychologist working in Van. “First they were reluctant to come to our mental health group sessions, but little by little we won their confidence and now they speak openly about their frustrations, and come back each week,” she adds.

In December of last year MSF and hCa started a two-month psychological support program in 31 villages outside Van city center in collaboration with the Turkish Ministry of Family and Social Policy and the Center for Crisis Coordination in Van. So far, 3,000 women and 1,800 men have benefited from group sessions, and 40 people with more severe symptoms have received individual mental health support.

“In one of the villages we had a five-year-old boy who came with his mother and told us ‘I am scared and my mum is always angry. You need to help us.’ This shows how people understand now that psychological support can help them, and this is already an achievement,” says Palha.

MSF is also approaching the villages’ schoolteachers to offer support, and is offering psychological support to 91 families of refugees and asylum seekers who have been affected by the quake and live in makeshift settlements in the city of Van.

In addition to providing mental health support, MSF, in collaboration with Turkish organizations Hayata Destek and hCa and local authorities, has distributed 2,000 winterized tents and 2,000 cooking kits for 12,000 people in 37 villages in Van province.

[Press Release] Libya: Detainees Tortured and Denied Medical Care

Wed, 08 Feb 2012 20:42:00 GMT

Libya 2011 © MSF

An MSF physiotherapist works in one of Misrata's detention centers, where MSF is suspending operations.

TRIPOLI/BRUSSELS/NEW YORK, JANUARY 26, 2012 – Detainees in the Libyan city of Misrata are being tortured and denied urgent medical care, leading the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) to suspend its operations in detention centers in Misrata, MSF announced today.

MSF teams began working in Misrata’s detention centers in August, 2011, to treat war-wounded detainees. Since then, MSF doctors had been increasingly confronted with patients who suffered injuries caused by torture during interrogation sessions. The interrogations were held outside the detention centers. In total, MSF treated 115 people who had torture-related wounds. The organization reported all the cases to the relevant authorities in Misrata. Since January, several of the patients returned to interrogation centers were again tortured.

“Some officials have sought to exploit and obstruct MSF’s medical work,” said MSF general director Christopher Stokes. “Patients were brought to us in the middle of interrogation for medical care, in order to make them fit for further interrogation. This is unacceptable. Our role is to provide medical care to war casualties and sick detainees, not to repeatedly treat the same patients between torture sessions.”

MSF medical teams were also asked to treat patients inside the interrogation centers, which the organization categorically refused.

The most alarming case occurred on January 3, when MSF doctors treated a group of 14 detainees who returned to a detention facility from an interrogation center. Despite previous MSF demands for the immediate end of torture, 9 of the 14 detainees had suffered numerous injuries and displayed obvious signs of torture.

The MSF team informed the National Army Security Service—the agency responsible for interrogations—that a number of patients needed to be transferred to hospitals for urgent and specialized care. All but one of the detainees were again deprived of essential medical care and were subjected to renewed interrogations and torture outside the detention centers.

After meeting with various authorities, MSF sent an official letter on January 9 to the Misrata Military Council, the Misrata Security Committee, the National Army Security Service, and the Misrata Local Civil Council, again demanding an immediate stop to any form of ill treatment of detainees.

“No concrete action has been taken,” said Christopher Stokes. “Instead, our team received four new torture cases. We have therefore come to the decision to suspend our medical activities in the detention centers.”

MSF has been present in Misrata since April 2011, following the outbreak of conflict in Libya. Since August 2011, MSF has worked in Misrata’s detention centers, treating war-wounded, performing surgeries, and providing orthopedic follow-up care to people who had suffered bone fractures. MSF medical teams have carried out 2,600 consultations, including 311 for violent trauma.

MSF will continue its mental health activities in schools and health facilities in Misrata, and will continue to assist 3,000 African migrants, refugees, and internally displaced persons in and around Tripoli.

MSF is an international medical humanitarian organization that has worked in Libya since February, 2011. To ensure the independence of its medical work, MSF relies solely on private donations to finance its activities in Libya and does not accept any funding from governments, donor agencies, or military or political groups.

[Press Release] DRC: Majority of People Living with HIV Denied Treatment

Wed, 08 Feb 2012 20:42:00 GMT

DRC 2011 © Robin Meldrum

Michel Kongawi, head lab tech, prepares a CD4 test in the laboratory at Lubutu hospital, Maniema Province.

KINSHASA, JANUARY 25, 2012 – The vast majority of people living with the AIDS virus in the Democratic Republic of Congo (DRC) are deprived of lifesaving treatment, due to a withdrawal of international donor support and the lack of national prioritization of the crisis, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

The number of HIV-positive people in DRC is currently estimated at more than one million, 350,000 of whom could benefit from antiretroviral (ARV) treatment. However, only 44,000 people are currently receiving treatment, translating into a 15 percent ARV coverage rate, one of the lowest in the world. Of all African countries, only Somalia and Sudan have similar rates.

The conditions surrounding access to care for people living with HIV/AIDS in DRC are horrific. At the Centre Hospitalier de Kabinda (CHK) in Kinshasa, the capital, MSF has observed an excessively high number of patients arriving with serious complications resulting from lack of treatment. Their advanced illness creates unacceptable suffering.

"I have worked with HIV-positive patients in many countries in central and southern Africa, but what I'm seeing in DRC has not existed elsewhere for years," said Anja De Weggheleire, MSF's medical coordinator in DRC."The situation here reminds me of the time before any antiretroviral (ARV) treatment was available.Our doctors face serious complications every day that could be prevented if patients received early ARV treatment."

The alarming situation for HIV/AIDS patients in the Democratic Republic of Congo (DRC), coincides with the tenth anniversary of the Global Fund to Fight AIDS, Malaria, and Tuberculosis, which is struggling to meet its funding commitments.

The DRC is also one of the two lowest-ranked countries in western and central Africa in terms of prevention of mother-to-child transmission of HIV (PMTCT). Only 1 percent of pregnant women estimated to be HIV-positive in DRC have access to PMTCT treatment. Without treatment, approximately one-third of babies who are exposed to the virus will be born with HIV.

Despite these disastrous indicators, donors have not given DRC the priority it deserves. What is worse, some donors, such as the Global Fund, are withdrawing or sharply reducing their funding. While the Global Fund is the leading supplier of ARV drugs in the DRC, the countries that finance the Fund have not kept their promises. As a result, the Global Fund is having to lower its sights.

This pull-back by donors is directly threatening the lives of thousands of people in DRC.

"If nothing is done, it is highly likely that the 15,000 people currently on the waiting list and in urgent need of ARV drugs will be dead within three years,” said De Weggheleire.“As horrifying as that number is, it represents only the tip of the iceberg when you realize that most people living with HIV/AIDS in DRC do not know their HIV status. Many will die in silence and neglect."

It is crucial that Congolese authorities meet their commitment to provide free prevention services and free treatment for people living with HIV/AIDS. It is also critical that donors immediately mobilize the necessary resources to ensure that patients waiting for ARV treatment are not condemned to die.

MSF has been working in DRC for more than 30 years, operating HIV/AIDS programs since 1996. In October 2003, MSF was the first organization to provide free ARV treatment to patients in DRC. Through its healthcare support programs and its AIDS project in Kinshasa, MSF treats more than 5,000 patients in six provinces, more than 10 percent of the number receiving ARV treatment throughout the country. In Kinshasa, MSF is treating 20 percent of the total number of patients on ARV treatment in the Congolese capital.

Today, MSF is launching a communications and advocacy campaign that will continue throughout 2012 to raise public awareness of the very serious situation facing people with HIV/AIDS in DRC and to encourage all actors to expand ARV coverage.

[Voice from the Field] Somalis in Ethiopia: "It Is Not Good for People to Fear Every Day and Night"

Wed, 08 Feb 2012 20:42:00 GMT

Zaynab brought her son Ibrahim to the Hiloweyn ITFC to get treatment for his severe malnourishment.

Testimony of Zaynab, who brought her malnourished son Ibrahim to the Doctors Without Borders/Médecins Sans Frontières (MSF) Health Center after fleeing draught and war in Somalia:

Zaynab and her three-year-old son Ibrahim have been in the intensive therapeutic feeding center (ITFC) of Dolo Health Center for 17 days because Ibrahim was severely malnourished. In such cases, the child must be admitted as an inpatient and closely monitored. One relative is required to stay in the ITFC to look after the child. In most cases this is the mother.

"We are from Gedo [region, not far from Ethiopia], and for the last ten years we have had to flee to Ethiopia regularly because of war or draught," said Zaynab when asked how she came to the Dolo Health Center. "I think this is the fourth or fifth time that we are back in Ethiopia."

Back at home in Somalia, Zaynab and her husband are farmers, cultivating maize, tomatoes, beans, and tobacco. Somalia was hit frequently by draughts over the last years, and earning money from selling their products on the market became extremely difficult. The Gedo region has also seen consecutive wars, first between regional warlords, then when Ethiopia invaded Somalia in 2006–2007, and currently between the UN-backed "Transitional Federal Government" and armed opposition.

"My husband went back to Somalia in order to go and get his mother, who had remained behind. I hope that they will soon join us here in Dolo Ado," Zaynab added.

Three-year-old Ibrahim fell ill and as a consequence grew very thin. According to one MSF nurse, when they came to the health center, the boy had all the signs of progressed malnutrition. In addition to his emaciated body, he had edema and had stopped reacting to outside stimuli, his face like a death mask. "His recovery in 17 days has been remarkable. He has become lively again, getting better quickly, and when we smile at him he smiles back, which means that his neurological system is recovering."

In a few days, Zaynab and Ibrahim will be shifted to the outpatient therapeutic feeding program, where Ibrahim's treatment will be continued with daily visits to the clinic. The other household members will be given food rations too.

MSF built the Dolo Health Center buildings in 1997, and has been involved in this regional medical facility ever since. Because the renewed influx of Somali refugees into Ethiopia following the major crisis inside Somalia earlier this year has overburdened the town’s facilities, MSF is building additional wards and setting up a surgical unit to care for both local residents in the wider region and the refugee population.

Testimony of a 30-year-old woman in the ITFC in Hiloweyn camp, who walked to Ethiopia from Somalia after draught destroyed her family's harvest:

I have come here for the second time. I was staying in this hospital for over a month because my child was very ill. After some weeks we could go back to our shelter. But then after two weeks my child was sick again. He had diarrhea, chest pain, and fever, and he stopped eating the Plumpy’nut that you give us (Plumpy‘nut is special formula food that has been developed to treat malnourished children). So now I’m back in this place, I wonder what is wrong with him. He was feeling good in Somalia, but now he is just sick all the time. I think it is because we have no milk to give him. My other children are not sick like him.

I came to Dolo together with my husband and seven children. The other children are with my relatives in Somalia. Some of them have to stay there. We come from the bush. Many cattle died because of the drought. We only have some goats and donkeys left. We were suffering, there was no food in the markets, and our harvests had failed, the soil is too dry. We came walking from the village of Oforu, it took 3 days. The journey was fair, but we had to stay in the Dolo Ado Transit Center for very long. Now we have been here [in the refugee camp] for more than four months. There is a lot of fighting in Somalia, so we cannot go back. It is too dangerous. Here there is peace and the children don’t die from hunger.

Testimony of a 22-year-old woman who walked for 39 days to bring her sick child to the ITFC in Hiloweyn:

I have been here in the hospital many times. Now I came back today because my child is sick again. He has boils on his head and he doesn’t want to eat. My husband had a farm in Somalia. We had a good life there. But he died, and all our animals died so I had to leave. I came to Ethiopia together with my mother and this child. He is my only child. I think he is sick because of this environment. Where we come from in Somalia it is cold. Here it is very hot and dry. We walked for 39 days from Baardheere to Dolo. It was very hard, because it was a long walk and we had little food. The situation here in Hiloweyn is good: we get food and we go to the river to collect firewood. It is dangerous to walk to the river; men come and rape the women. I know women who have been raped. We have to go there together with men, but sometimes the men don’t have time. I got married to another man, but he is often away, and when he comes back he tells me what to do. Last time I was here in the hospital I left because my mother was sick. The doctor said I have to stay, but I could not stay longer in the hospital, and I think my son gets even sicker here. I want to go back to Somalia with my husband. My mother will stay here.

Testimony of a 45-year-old woman who fled violence in Somalia with her sick daughter:

My little girl was sick in Somalia. I thought she would recover in Ethiopia but her illness has continued here. I was here in the hospital with her for more than four weeks. Then we could leave the hospital, but after some weeks she was sick again. I don’t have enough food to give my children so the smallest one gets less food. The hospital is good, but I have other children at home and I have to take care of them, if not they will also fall sick. The biscuits that MSF gives are good for us. It keeps our children happy. When they don’t have biscuits they stop smiling. UNHCR gives us food: oil, rice, wheat flour, and sometimes sugar. Now we have not received sugar for many weeks, and we have no milk. Our children need tea; they always drink tea in Somalia so now when they don’t have it they are more vulnerable.

I come from Diinsoor. Life there is even harder than here in Hiloweyn. Here we only have problems with the food, in Diinsoor we have problem with food and there is also no peace. You cannot live without peace, it is not good for people to fear every day and night. It makes us sick. I came here with my husband and my children. My mother and some other people we know arrived to Hiloweyn after us. And more people will come. We cannot go back to Somalia, it is too dangerous. I even have nightmares about things that happened to us in Somalia, when armed men stole our cattle and beat my husband so hard I thought he would die. I will never go back. Hiloweyn is my future. Things can only improve now.

[Press Release] "Even Running Away Is Not Enough": Attacks in Jonglei, South Sudan, Perpetuate Extreme Violence

Wed, 08 Feb 2012 20:42:00 GMT

An MSF doctor examines a baby in Pibor, in Jonglei State in South Sudan, where people who went into hiding following recent attacks continue to come in for urgently needed medical care at MSF's re-opened facilities.

"Our team here in Pibor was evacuated on 23 December ..."

January 23, 2012
Listen to an interview with MSF field coordinator in Pibor, Karel Janssens, about returning to villages where MSF has been working in Pibor to find them destroyed, the MSF staff that are still missing, and the patients affected by the attacks.

Patient Testimonies

"I Don't Even Know What Happened To My Child"
Testimonies given by people who were injured or whose family members were injured, killed, or adbucted during attacks in South Sudan's Jonglei State.

JUBA, JANUARY 24, 2012 - Civilians continue to bear the brunt of extreme inter-communal violence in Jonglei state in South Sudan, with their resources and lifelines, including hospitals and water supplies, also deliberately targeted, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Wounded people are still arriving at the MSF hospital in the town of Pibor, three weeks after a violent attack on the town and outlying villages in Pibor County. Many people were injured in the bush, where thousands remain, too afraid to come out of hiding. The hospital was also targeted during the attack.

“We are seeing a cycle of attacks and reprisals throughout this area of northern Jonglei,” said MSF head of mission Jose Hulsenbek. “For the civilians in this part of South Sudan, the fear of having to flee their homes or being killed is very real.”

A recurring characteristic of the attacks in Jonglei is their extreme violence. One woman suffering from a gunshot wound and treated by MSF in Pibor said she had fled to the bush with her husband, children, and 15 other family members. After running for eleven hours, they were found by a group of men who shot at them. “We scattered. They shot me in my thigh and my baby was hanging on my back. I tried to hide in the high grass but they found me because my baby was crying. They started beating my daughter until she kept quiet. They left us behind thinking we were dead.” Her son was also treated by MSF for a bullet wound to the chest that remarkably did not kill him.

“After these attacks many women and children are coming to us shot, stabbed, and beaten,” said Colette Gadenne, MSF operations coordinator for South Sudan. “They try to keep safe by hiding in the bush, but it seems that even running away is not enough.”

A deeply worrisome pattern is emerging, where people and their scarce resources are deliberately targeted by all the armed groups involved in inter-communal violence. Hospitals, health clinics, and water sources are all targets, suggesting a tactic of depriving people of life’s basic essentials, precisely when they need them most.

The village of Lekwongole, north of Pibor town, scarcely exists today after coming under attack. All that exists of the MSF clinic there are concrete floors and walls, although medical activities resumed there on January 18.

“The people explained that during the day they dare to come out of hiding to search for food or to seek medical care,” said Karel Janssens, MSF project coordinator. “But at night they return to their hiding places in the bush where they are at risk of contracting malaria or respiratory infections.”

MSF medical teams are now treating serious wound infections, some several weeks old. Since re-launching emergency medical activities in Pibor on January 7, MSF has treated 47 patients with gunshot wounds, among them 16 women and 8 children. An additional 43 patients have been treated for stab wounds, beatings, or wounds sustained while fleeing in the bush. Since January 7, approximately half of MSF’s patient consultations in Pibor have been for malaria; people sleeping in the bush are more vulnerable to contracting the disease.

MSF is extremely concerned for the health and well-being of civilians forced to flee, either from fighting or from fear of an attack. They hide in the bush, with little to no shelter and limited access to food. If they are able to return home, they often only find ashes where their houses once stood.

In the wake of the Pibor attack, MSF has learned that Allan Rumchar, an MSF watchman, and his wife were killed. Of 156 locally recruited MSF staff members, 25 are still unaccounted for and MSF remains deeply concerned for them.

The violence in Pibor is not isolated. After a January 11 attack on the village of Wek in northern Jonglei State, MSF evacuated 13 patients by air, mostly women and children in need of urgent surgical care at MSF’s hospital in Nasir. That followed an August 2011 attack on the town of Pieri and surrounding villages, during which scores of villagers were killed. In the past six months, 185 people with serious wounds have sought care from MSF teams in Lankien, Pieri, and Yuai.

In a December 2009 report, Facing Up to Reality: Health Crisis Deepens as Violence Escalates in Southern Sudan, MSF documented the escalation of inter-communal violence in Jonglei and Upper Nile states, and its increasing impact on civilian populations. MSF treated 392 people wounded by violence that year, and estimated that 86,000 people were displaced. The situation has not improved. In the past six months, MSF has treated more than 250 people wounded in violence in Jonglei State, the majority of whom are women and children.

#MSF outpatient dept full to the brim with women & thr sick children this morn in Pibor #SouthSudan - malaria, diarrhea, respiratry infectns
— Heather Whelan (@HPWhelan) January 20, 2012

Follow Heather Whelan, UK Senior Press Officer for MSF, currently tweeting from South Sudan.

MSF has been working in South Sudan since 1983, and currently runs more than a dozen projects in eight states. MSF runs its own medical facilities and supports Ministry of Health facilities in six locations in Jonglei State, providing basic health care, therapeutic nutrition, and kala azar and tuberculosis treatment, serving a total population of some 285,000 people. In 2011 the MSF medical facilities in Lekwongole, Pibor, and Pieri were targeted and either destroyed or ransacked during inter-communal violence. MSF condemns the targeting of unarmed civilians and of medical assets by any armed group.

[Voice from the Field] South Sudan: "I Don't Even Know What Happened To My Child"

Wed, 08 Feb 2012 20:42:00 GMT

A 24-year-old woman who was shot twice and whose daughter was abducted during the December 27, 2011, attack on Lekwongole.

Patient testimony of a 24-year-old woman who was shot in the leg and the cheek during the attack on Lekwongole on December 27, 2011, when her three-year-old daughter, her only child, was abducted:

Our village was one of the first to be attacked. Three women, including me, ran with our children—my own three-year-old daughter and two of their boys 10 and 11 years old. We could only carry water with us for the children, no food, no clothes, nothing.

We ran and tried to hide in the high grass when we heard them approaching. But they heard my child crying so they found us three women and the three children. They abducted my child and slit the throats of the two boys in front of us. They told us three women to run—we ran 10 meters and they started shooting. The other two women were killed right away. I was shot in the leg so I fell down. They came over to me and shot me in the head to make sure I was dead and left me there for dead. But the bullet just went through my cheek, so I survived. I crawled to the river to take water and stayed there alone for seven days, in much pain. I didn’t know where my family was or what had happened to my daughter, my only child.

On the eighth day, I couldn’t stay there alone anymore so I used a stick to get up and walked for two hours until I came across neighbors who cared for me for seven days. They told me that my mother was missing. Then they left to inform my family where I was. I was alone again for two days. I crawled again to the river to take water. Then my husband’s brother found me and carried me for three days to Lekwongole. I couldn’t walk, I was so tired, and it was very painful.

Then MSF returned to Lekwongole and drove me to Pibor. I found out the next day that my mother was not just missing, she was dead. I felt so lonely. My mother is dead, yes, but at least if my child was still with me I would be okay. But I’m not okay. I don’t even know what happened to my child.

From my family, 10 people have been killed—four women and six men. From my husband’s family, eight people have been killed. They also abducted my sister’s son, who is six years old. It is very painful because my whole family has been killed. My only child has been taken—I feel so alone and it’s very painful.

For the future, if I get something to work with then I will, but only God knows. People are just stuck here with nothing now.

A 39-year-old man who was shot in the arm during an attack on Pibor on December 31, 2011.

Patient testimony of a man, 39, who was shot in the arm during the attack on Pibor on December 31, 2011:

When the attack happened on my village, we fled into the bush with no food, just water for the small children. I was shot in the arm and hid in the bush with my wound for eight days. So much blood was coming out. Sometimes I would just sleep without knowing it. At night it was so painful I couldn’t sleep. It took me another three days to walk to the hospital.

I was lucky. They didn’t find my family when I was shot because they ran ahead and entered the river, keeping just their mouths open out of the water to breathe, hiding the rest of themselves under the water. You might be found if you hide in the bush, but if you’re under the water they won’t find you.

In my community, some have been killed. Many are still missing. We don’t know if they are dead or not—we saw some who were killed. There are children who have been taken.

We are very happy MSF is here—we thought MSF would not operate again because everything was looted. We were afraid you would not come back. If MSF wasn’t here, I would not feel better. Maybe I would have died.

My home has been burnt to the ground, all of it, everything. I don’t know if I can go back home—because so many are missing, many are dead. We want to go back to cultivate maize and sorghum for the children, but now there is nothing there.

Those who are still alive, what do they think about all this death, the missing? Many are still crying, still looking for their missing children and wives. How can we think about our future?

Testimony of a mother whose 18-month-old daughter was severely injured during an attack on the village of Wek, in northern Jonglei State on January 11, 2012:

At 5pm, our village, [which is] called Wek, was attacked. We all began to run away. My sister was carrying my daughter who is one-and-a-half-years-old, along with another child. As I was running away, I found my daughter on the ground, crying and all alone. She was shot in the face and her mouth was cut by a knife. I picked her up and continued running through the bush. Eventually we stopped running and had to spend the night in the bush until morning.

One day later, a member of our community found us and brought us to the MSF clinic in Yuai, two hours away. We received treatment here until MSF brought us by plane to their hospital in Nasir.

At this moment, I have no information about my husband. I think he was killed.

Testimony of a neighbor of an 18-month-old child who suffered severe head trauma during the January 11 attack on Wek:

This is the child of my neighbors. Both his mother and father were shot and killed. His head was beaten against the trees. He was left for dead in the bush. He was abandoned, without any help. We, the community, came looking for people who needed help in the bush and we found him, still alive and alone. We brought him to the MSF clinic in Yuai where MSF treated him.

Patient testimony of an 18-year-old girl who suffered a gunshot wound to the leg during the attack on Wek on January 11:

It was evening when we were attacked. People all around us were being shot and cut with knives. When I heard the shooting, I tried to run away with my husband and my children, but I was shot in the leg and I fell down. One of my children and my husband were killed immediately.

I was collected by my community and they brought me to the MSF clinic in Yuai. MSF then brought me by plane to their hospital in Nasir. I expect I will be cured as I’m with MSF.

[Press Release] MSF Closes Two Large Medical Centers in Mogadishu after Killings of Staff

Wed, 08 Feb 2012 20:42:00 GMT

Houses lie in ruin in Mogadishu's Hodan district, where MSF has been forced to end activities.

January 19, 2012 - Following the tragic killings of Philippe Havet and Dr. Karel Keiluhu, staff members of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in Mogadishu, Somalia, on December 29, 2011, MSF has been forced to end all activities in the Hodan district of the capital, including the closure of two separate 120-bed medical facilities for the treatment of malnutrition, measles, and cholera.

The closure of activities in the Hodan district reduces by half the assistance MSF is providing in Mogadishu. The facilities were MSF’s largest in the city. For now, MSF projects will continue to provide medical care in other districts of the city, as well as in 10 other locations in Somalia.

However, the continuation of MSF’s assistance to Somalis in need of medical care is dependent upon the respect for personnel, patients, and medical facilities. Where these conditions prevail, MSF remains committed to continue its activities in Somalia.

“It is hard to close health services in a location where the presence of our medical teams is genuinely life-saving,” said Christopher Stokes, MSF general director. “But the brutal assassination of our colleagues in Hodan makes it impossible for us to continue working in this district of Mogadishu.”

In Hodan, MSF had been assisting 200,000 Somalis who fled to the capital in recent months. Since August 2011, MSF treated 11,787 malnourished children, 1,232 people with acute watery diarrhea, and 861 people suffering from measles. MSF teams also vaccinated 67,228 children against measles.

MSF also strongly reiterates its call to all parties, and to the leadership and people of Somalia, to facilitate the safe release of Montserrat Serra and Blanca Thiebaut, MSF aid workers abducted in the Dadaab refugee camp in Kenya on October 13, 2011 while providing emergency assistance to the Somali population.

MSF has been working in Somalia continuously since 1991 and currently operates 13 projects in the country, including medical activities related to the ongoing emergency, vaccination campaigns, and nutritional interventions. MSF also assists Somali refugees in camps in Dadaab, Kenya, and Dolo Ado, Ethiopia.

[Voice from the Field] India: Providing Health Care in Chhatisgarh

Wed, 08 Feb 2012 20:42:00 GMT

Dr. Rebecca Cuthbert leans against an MSF truck in Bijapur, Chhatisgarh state.

In the forests of central India, Maoist rebels called Naxalites are fighting government forces to control great swaths of the interior. People living in dozens of tribal villages are caught up in the conflict, unable to reach the Ministry of Health’s clinics in Chhattisgarh state. Dr. Rebecca Cuthbert describes how Doctors Without Borders/Médecins Sans Frontières (MSF) takes the clinics to them.

It takes five minutes to walk down the sandy back lane to our office, where I open the padlocks on the doors with my jailer-size ring of keys and check the whiteboard I prepared last night about the work for the day ahead.

We run five mobile clinics every week; today there will be 14 of us, which means carrying a lot of water. In the summer, when temperatures are highest, we take up to three liters of water for each person. We will also carry all our supplies, including lab equipment and drugs, health cards and registration books, plastic sheeting and privacy screens, and two cold chain boxes.

As the team starts to arrive, everyone starts in on their assigned tasks, though the cooks have been working since 5:00 a.m. to prepare our lunch. Ice packs are placed in coolers. Backpacks are stacked and ready for loading.

At the morning meeting, we get our security updates. We’ve heard that the Naxalites may impose a bandh, a travel ban, which means roads could be blocked by tree trunks or newly dug trenches. Next, we rush through a host of last-minute questions: Where is the driver? Where are the snacks? Where is my phone? Then everyone piles into two cars and we’re off.

Buffalo amble languidly along Bijapur’s main road, competing for space with bicycles and cars and children walking to school. We drive through a checkpoint and out into the country, taking care to avoid chickens, piglets, dogs, and cows, and waving to excited children who run through the fields towards us.

An hour later we park, shoulder our backpacks, and then set off single file behind a team member carrying the MSF flag. Towels, hats, and scarves protect our heads from the already burning sun. The narrow path winds though forest, around paddy fields, and across rivers that are waist-high and fast-flowing in the rainy season but little more than puddles now. Along with the occasional villager, we pass women carrying bundles of rice or loads of firewood on their heads and children on their hips, and hunters with their bows and arrows.

After walking for an hour, we arrive at the village and set up the clinic. Like clockwork, the team affixes swatches of green material between poles to make separate screened-off areas for antenatal and post natal visits, for patients waiting to be seen, for a laboratory, and for vaccinations. The drug dispensers arrange boxes of medications on an old cot. Scales for weighing children are hung and the nurses get ready to vaccinate for polio, diphtheria, tetanus, pertussis, measles, and hepatitis B. The doctor gets prepared, while the health educator begins speaking with people waiting to be seen about treatment and prevention for diarrhea, scabies, and malaria—all common in these parts.

The Basics of the Mobile Clinic

The first patients are registered. Communication takes time and patience, since information must often be translated into Hindi, which the nurses speak, English, for the expats (if necessary), and the local dialect. MSF has a translator on hand who picks up registration cards and calls patients in to see the doctor. They and their caretakers are interviewed at length about their medical histories and their most recent visits to health care facilities. After seeing the doctor, some are sent for additional tests or for medications, while others go for vaccinations or wound care (all children younger than five go to the nurses for vaccinations). Pregnant women and people seeking treatment for malnutrition are sent directly to the nurses. Anyone with a fever is immediately tested for malaria. (We see less malaria in the summer than in later months, but rapid diagnostic tests can detect both falciparum and mixed malarial infections.) Anyone with tuberculosis sees the health educator for support and counsel.

As time passes, we try to move the lab out of the heat and cool the thermometers in the cold chain. It’s very hot and very dusty, but the team remains in good spirits, focused on their work. The drug dispensers patiently explain how patients should take their medicine, using small bags with pictures of the number of tablets required at each time of day to convey the information to a population who did not have the opportunity to learn to read and write. Some children get their first dose of malaria treatment ground up and administered with water and sugar.

Most of these children are quite skinny. Illnesses decrease their body weight, especially between the age of one and two; many qualify for supplementary feeding or admission into the intensive feeding program. MSF provides mothers with nutrient-rich therapeutic food as well, using community health and outreach workers to explain how important adherence to a regular feeding schedule is and later to trace the progress the children make.

Referring Life-Threatening Emergencies

I remember a young man came to the clinic with a big cloth covering a massive, bone-deep axe wound in his forehead that he said happened five days earlier. We cleaned the wound on site, then first took him to the Bijapur district hospital and later arranged his referral to the neurosurgical department in Raipur some 10 hours drive away.

This patient’s wound eventually healed and he was able to return home, but referrals are complicated undertakings. The team leader, the counterpart (a staff member from the Ministry of Health or another relevant NGO), and the doctor evaluate all emergencies that require immediate treatment. We have to take into account the fact that many people will not feel comfortable going into town given the political climate in the area and the possibility that any patient can be stopped and questioned at checkpoints along the way. All patients need a caretaker with them as well, and a male relative has to give consent if their female family member needs an operation or a blood transfusion. If patients need to go to our Mother and Child Health Care facility in Bijapur, MSF makes sure they are able to get there.

Because the local diet involves mainly rice, vegetables, and dal, many expectant mothers arrive frighteningly anemic. This creates complications in childbirth and means we need to monitor hemoglobin levels, provide iron supplements, and occasionally carry out transfusions. MSF has been working with the Bijapur district hospital to set up a blood storage unit that can provide blood when necessary, such as in the event that obstructed labor necessitates emergency obstetric surgery. MSF also now performs C-sections when required; the alternative is referral to a hospital four hours away.

Wrapping Up and the Sun Begins to Set

The team leader and counterpart keep a close eye on the time, knowing that we need to be back in the office before 5:00 p.m. to avoid being out after dark. Since we won’t be back for a week, they make sure there is enough time to see all the remaining patients and do all the necessary tests, then dismantle the clinic, walk back to the cars, and drive back to Bijapur.

When we set off, our backpacks are lighter but everyone is still shouldering a considerable load. None of us has eaten since we arrived, so we stop along the way for a snack—small packets of spicy Indian noodles—and some water. It’s still very hot and the team is largely quiet as we walk, the song of cicadas is the only sound on an otherwise silent journey.

Upon reaching the two white MSF vehicles, we eat some more and drink cool water, then drive back down the makeshift mud roads and onto the cement roads that lead to the office. “Good clinic?” the project coordinator asks when we return. “How many patients did you see?”

It was a good clinic. This is what we are here for: the good days and the hard days, days which start early and finish late, and the feeling of doing decent work with the support of an enthusiastic and dedicated team.

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