Doctors Without Borders News

Efforts to Combat Global Childhood Malnutrition Woefully Underfunded

Wed, 11 Nov 2009 17:48:00 GMT

Rome/New York, November 11, 2009 – Funding by rich countries to combat malnutrition has remained flat for seven years, according to a report released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). This barely accounts for three percent of the funds needed to reduce the 3.5 to 5 million annual deaths of children under five attributed to malnutrition.

The report also reveals the enormous waste built into the food aid system. According to MSF, much of the nutrition funding gap could be filled by re-allocating existing funds towards the most vulnerable group, children under five.

The report, released in advance of the World Food Summit in Rome, analyzes how a global effort to prevent childhood malnutrition – which can lead to life-long handicaps, if not death – has simply not been funded. Rich countries only spend an annual US$350 million out of US $12.5 billion the World Bank estimates is required to adequately combat malnutrition in 36 high-burden and 32 high-prevalence countries.

“At the World Food Summit it would be a colossal mistake not to finally commit to improve and scale-up nutrition programs alongside efforts to boost local food production,” said MSF nutrition team leader Stéphane Doyon and co-author of the report. “This report documents the fact that nutrition interventions that have been proven to reduce deaths remain catastrophically underfunded.”

MSF used data from the OECD, European Commission, World Bank, Gates Foundation and UNITAID to analyze the funding flows of the main international donors. Although billions of dollars of international assistance are labelled “development food aid and food security” or “emergency food aid,” less than two percent is being spent on interventions targeted specifically at reducing childhood malnutrition. Moreover, existing funds are being wasted through inefficient practices, such as the US government policy of shipping in-kind food aid overseas, which costs an estimated US$600 million more than purchasing food aid locally.

“The lack of targeted efforts means that young children receive inappropriate food that does not have the key nutrients they need to avoid becoming dangerously malnourished,” said Doyon. “There are opportunities to partly scale-up nutrition funding simply by improving the efficiency of the existing donor government policies.”

Today the authors of the report said that governments can also improve food aid by introducing and paying for newer, more expensive, but nutritionally appropriate food for young children. International organizations, including MSF, have proven that severe malnutrition can be prevented and cured on a very large scale.

Over the past two years MSF has treated more than 300,000 malnourished children in 22 countries. Malnutrition weakens resistance and increases the risk of dying from pneumonia, diarrhoea, malaria, measles or AIDS.

The World Food Summit will be held on November 16th-18th in Rome.

DR Congo: MSF Vaccination Used as Bait in Unacceptable Attack on Civilians

Fri, 06 Nov 2009 15:24:00 GMT

Kinshasa, November 6, 2009 – Last month, seven vaccination sites operated by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) came under fire during attacks by the Congolese army against the Forces Démocratiques de Libération du Rwanda (FDLR) in North Kivu, Democratic Republic of Congo (DRC). Thousands of civilians had gathered at the sites. MSF denounces this clearly unacceptable abuse of humanitarian aid for military purposes.

MSF launched a mass vaccination campaign in Masisi district to support the Congolese ministry of health in its response to a measles epidemic. On October 17, MSF medical teams were vaccinating thousands of children in seven different sites in Ngomashi and Kimua Zones, controlled at the time by the FDLR.

All parties to the conflict had given security guarantees to MSF to vaccinate at these locations at those times. However, the Congolese national army launched attacks on each of the vaccination sites. All the people who had come to get their children vaccinated were forced to flee the heavy fighting. Scattering everywhere, they are now in unknown locations and thus cannot be vaccinated. MSF had to stop its activities in the zones and evacuate its teams to Goma, the regional capital of North Kivu.

“We feel we were used as bait,” said Luis Encinas, head of MSF programs in Central Africa. “The attacks coincided with the beginning of our vaccination and put the lives of civilians in extreme risk. Thousands of people, and the MSF teams, were trapped in the gunfire. The attack was an unacceptable abuse of humanitarian action to fulfil military objectives. How will MSF be perceived by the population now? Will our patients still feel safe enough to access medical care? We are compelled to strongly denounce this situation as such actions seriously compromise our neutrality.”

MSF is an independent medical, humanitarian organisation that delivers impartial medical aid according to the strictest principles of neutrality. It is this neutrality that makes it possible for MSF teams to vaccinate in such FDLR-controlled zones, which, until that point, had been inaccessible to Ministry of Health staff.

In addition, the last few months have seen a worrying increase in attacks against humanitarian organisations by various armed groups in North and South Kivu.

“MSF demands that all parties to a conflict respect the work of humanitarian organisations,” added Meinie Nicolai, MSF director of operations. “If not, it is the populations who pay the price. Those already overwhelmed by extreme violence and endless displacement are the ones who may end up cut off from humanitarian assistance.”

A total of 165,000 children, aged from six months to 15 years, were vaccinated against measles during the campaign in the Masisi region before and following the attacks. In Masisi town, MSF supports a hospital, a health center, runs mobile clinics, and provides vaccinations. The organization operates clinics and supports hospitals in other parts of Masisi District. MSF also brings medical care to people in Walikale, Rutshuru, and Lubero Districts, as well as in South Kivu Province. MSF has worked in North Kivu since 1992.

Punishing Success in Tackling AIDS

Thu, 05 Nov 2009 14:25:00 GMT

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Johannesburg/New York, November 5, 2009 — A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

International support to combat HIV/AIDS is faltering, as reflected in significant shortfalls among two of the world’s main funding mechanisms for HIV/AIDS. The board of directors of the Global Fund, a key financer of AIDS programs in poor countries, is unable to respond to countries’ needs. The board will vote next week in Addis Ababa whether or not to suspend all new funding proposals in 2010. The US President's Emergency Plan for Aids Relief (PEPFAR), the American government’s AIDS program, is capping funding for two more years. This means that new patients will be turned away for treatment.

Report: Punishing Success: Early Signs of a Retreat from Commitment to HIV Care and Treatment.

The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people living with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years.

In Malawi and South Africa, MSF observed significant decreases in overall mortality in areas with high antiretroviral therapy (ART) coverage. Increased treatment coverage has also had an impact on the burden of other diseases. For example, tuberculosis cases have been significantly reduced in Thyolo, Malawi and Western Cape Province, South Africa.

“After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health,” said Dr. Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign. "Recent funding cuts mean doctors and nurses are being forced to turn HIV patients away from clinics, as if we were back in the 1990s before treatment was available.”

“The Global Fund must not cover up the deficit caused by its funders,” said von Schoen-Angerer. “The proposed cancellation of the 2010 funding round and other measures to slow the pace of treatment scale-up are punishing the successes of the past years and preventing countries from saving more lives.”

PEPFAR has had a huge impact on increasing the number of people on AIDS care and treatment in poor countries since 2003, supporting more than two million people on treatment with a commitment to increase treatment to at least three million by 2013. But U.S. government HIV/AIDS funding has remained the same for 2009 and 2010 and early signs indicate there will be no increase in funds for 2011 either. The proportion of PEPFAR’s budged dedicated to treatment has actually decreased. Only a handful of countries will be able to increase the number of new patients at a pace similar to what PEPFAR has supported in the past.

In 2005, world leaders promised to support universal AIDS coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programs.

"What about the promise made to people with AIDS?” said Olesi Ellemani Pasulani, MSF clinical officer in Thyolo District Hospital in Malawi. “We gave them hope and life. We have to be there for them. We all knew from the beginning that this treatment was for life. Passing on the bill for treating AIDS to very poor countries would be a colossal betrayal.”

Reducing funding at this time will leave people in urgent need of treatment to die prematurely, and can lead to dangerous interruption of treatment.

In Uganda, cuts have already begun to hit home, with some facilities forced to stop treating new patients with HIV. Other countries are backing away from their earlier treatment coverage targets. In Free State, South Africa, past funding problems—since resolved—led to disruption of treatment and a moratorium on treating new patients, which resulted in an estimated 3,000 deaths.

The report provides evidence that treating AIDS, particularly in high prevalence settings, has a positive impact on other important health goals, in particular maternal and child health.

“A stronger commitment to other health priorities must happen, but this should be in addition to, not instead of, continued, increased commitment to HIV/AIDS,” said von Schoen-Angerer.

At present, over four million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated six million people who are in need of life-saving treatment are still waiting for access. MSF operates HIV/AIDS programs in approximately 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children.

Improved Treatment for Sleeping Sickness Now Available

Mon, 26 Oct 2009 08:02:00 GMT

Geneva/Kampala, September 22, 2009 - NECT (Nifurtimox-Eflornithine Combination Therapy), the first new treatment in 25 years against Human African trypanosomiasis (HAT) or sleeping sickness, is now available. Endemic countries have now begun the process of ordering the new combination treatment and kits through the World Health Organization (WHO). Developed by DNDi and its partners, NECT cuts the cost of treatment by half and significantly reduces the burden on health workers. The announcement was made today at the International Scientific Council for Trypanosomiasi Research and Control (ISCTRC), in Kampala, Uganda.

“Thanks to an innovative partnership and the hard work of health workers, researchers, and specialists from endemic countries, industry and academia, a new treatment is now available to treat one of the most neglected disease in Africa. Not only is this new therapy more adapted to patient needs in remote areas, but it also cuts the cost of drugs, hospitalization and transport,” said Dr Bernard Pécoul, Executive Director of Drugs for Neglected Diseases (DNDi).

Sleeping sickness threatens 60 million people in 36 countries across sub-Saharan Africa. Transmitted to humans by the tsetse fly, this neglected tropical disease is fatal without treatment. NECT is a new, combination treatment option for the advanced stage (stage 2) of HAT or sleeping sickness. This stage affects the patient’s central nervous system and causes neuropsychiatric problems, convulsions, and serious sleep disturbance—leading to coma and death.

In May 2009, NECT was added to the WHO list of Essential Medicines for the treatment of sleeping sickness.

NECT combination therapy consists of a simplified co-administration of oral nifurtimox, and injectible eflornithine. It reduces the total number of intravenous infusions of eflornithine from 56 to 14 and shortens hospitalization from 14 days to ten, which makes treatment more convenient for patients. Because NECT only requires two infusions a day, administered during the daytime, this is easier for health workers and makes treatment far more suitable for remote and resource-poor settings where HAT is being treated.

Until now, health workers and patients had two main treatment options: 1) widely used ‘melarsoprol’, which is painful to inject, arsenic-based and toxic, and kills an estimated five percent of patients, and 2) the newer Eflornithine monotherapy, which requires one hour infusions, to be given every six hours for two weeks. Eflornithine monotherapy is better tolerated and more effective than Melarsoprol, but due to the high burden on health workers and the high cost of the medical equipment required to correctly administer it night and day, too many patients throughout Africa still continue to be treated with toxic Melarsoprol.

“As a doctor, you don’t treat someone to see them die, you treat them to see them go home,” said Dr. Constantin Miaka Bilenge, National Health Advisor, for DRC. “This new combination treatment is easier to use than eflornithine in monotherapy and brings hope for the patient and for the clinician, especially in countries like ours where the infrastructure has broken down.”
Treating patients with the new combination therapy now costs half as much as the existing, eflornithine monotherapy. With the NECT kits, the cost per patient of medicines, medical treatment and transport is halved to US$330 from US$665 for ‘eflornithine monotherapy’. Because the new treatment reduces the number of daily intravenous infusions and the length of treatment, it also reduces the cost of hospitalization and the burden on health staff in country.

“The availability of NECT improves the treatment of sleeping sickness and makes a big difference in terms of logistics, hospitalization, and cost,” said Dr Pere Simarro, Head of WHO sleeping sickness control and surveillance program."To support countries, WHO will make available, free of charge, kits which include the new treatment and all the medical equipment needed to treat patients in remote areas.”
WHO has made preparations for the arrival of NECT and is working to ensure health workers receive appropriate training. WHO has designed a kit in collaboration with Médecins Sans Frontières-Logistique that contains the medicine and all the equipment needed to correctly administer the treatment.

The kits are provided to countries free of charge through WHO1. It is hoped this will also help national control programs to switch from toxic and painful Melarsoprol to better tolerated NECT.

Jacqueline Tong, senior advocacy officer for Doctors Without Borders/Médecins Sans Frontières (MSF) added: “Until now, we have been losing patients because of toxic old drugs such as Melarsoprol, so we welcome and urgently need this new, safer and less complicated treatment to save lives from this fatal disease.”

Each 36 kg NECT kit contains four full treatments instead of two treatments with the eflornithine monotherapy. The volume per treatment is also reduced from three cubic feet to 1.3. Less volume and less weight makes transport much easier and cheaper, especially to remote areas in places such as the DRC.
The development of NECT is the result of a six year collaborative partnership, coordinated by DNDi. Partners include, MSF, Epicentre, HAT platform, the Swiss Tropical Institute, the national control programs from Democratic Republic of the Congo (DRC) and Republic of Congo, with the support of the WHO. The drugs were donated by sanofi-aventis and Bayer Schering Pharma AG.

The Drugs for Neglected Diseases initiative (DNDi) is an independent, not-for-profit product development partnership working to research and develop new and improved treatments for neglected diseases such as malaria, leishmaniasis, human African trypanosomiasis, and Chagas disease. With the objective to address unmet patient needs for these diseases, DNDi was established in 2003 by Institut Pasteur and Médecins Sans Frontières along with four publicly-funded research organizations in neglected disease-endemic countries. Working in partnership with industry and academia, DNDi has the largest ever R&D portfolio for the kinetoplastid diseases and currently has 3 post-registration, 9 clinical, and 4 preclinical projects, along with a wide variety of discovery activities. In 2007 and 2008, DNDi has delivered its first two products, fixed-dose antimalarial “ASAQ” and “ASMQ”. This year, the safe and effective treatment for the advanced stage of sleeping sickness NECT (nifurtimox-eflornithine combination therapy), has been added to the Essential Medicines List (EML) of the World Health Organization. For further information, please consult www.dndi.org.

Since the beginning of the 20th century, medicines and treatment for sleeping sickness, TB and leprosy have traditionally always been provided for free to patients throughout Africa. Because sleeping sickness affects the poorest of the poor and requires hospitalization, treatment cannot be purchased over the counter and is managed through specialized national control programmes.

European Countries Dramatically Underfunding TB Research

Wed, 21 Oct 2009 07:09:00 GMT

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Stockholm, October 21, 2009 – The largest European countries are lagging far behind the United States in funding of tuberculosis (TB) research and development. As such they bear a responsibility for the painfully slow progress in finding new TB tests and treatments, according to a report released today by the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). The report shows that all European countries in the analysis—with the exception of Sweden-- have failed to prioritize TB and are contributing to huge global underfunding at a time when 1.7 million people die every year from the disease.

“We are committed to treating people with multidrug-resistant tuberculosis today and we are even piloting new community approaches,” said Dr. Christophe Fournier, President of MSF’s International Council. “But we’re also facing up to the hard facts that we can’t treat TB properly with the drugs and diagnostics at our disposal and that means losing significant numbers of patients. That is why there is such an urgent need for European countries to mobilize more research activity on TB.”

According to the report, France and the UK are paying only 52 and 50 percent of their fair share, respectively, while Germany and Italy are doing much worse at 23 and 11 percent. With an average contribution of just over a third of their fair share, the European contribution is dwarfed by the US which is contributing two thirds of its fair share. Of the estimated 1.45 billion Euro required to fully scale-up TB research, only 350 million Euro (or 24 percent) is currently invested worldwide.

MSF is championing this cause because it faces increasing numbers of difficult-to-treat cases of TB in its programs in Eastern Europe, Asia and sub-Saharan Africa. TB also poses a direct threat to Europe more widely. Within the World Health Organization’s European region, including the former Soviet Union, there are 55 new cases of TB every hour meaning that more than half a million people develop TB each year.

The chronic funding neglect has led to the situation, for instance, where in developing countries, inadequate and outdated diagnostic tests fail to detect TB in about half of all patients who are in fact suffering from TB. For the treatment of multidrug-resistant TB (MDR-TB) drugs that had been abandoned because of side effects have been brought back into use because there are no other alternatives. Even with the best treatment available, MDR-TB treatment is only successful in less than two thirds of patients.

Under the Swedish presidency, the European Union (EU) has targeted antimicrobial resistance as a major health priority to be addressed. Unfortunately, TB and other neglected diseases are grossly underrepresented in this program. The MSF report - released just ahead of the EU’s European Development Days - demonstrates the urgent need for the EU to include TB as a priority in this program.

“When we ask the question are we doing everything we can, clearly the answer in Europe is no,” said Dr. Nils Billo, Executive Director, International Union Against Tuberculosis and Lung Disease. “There is an ambitious plan to improve MDR-TB treatment by testing new and existing drugs in clinical trials, but so far funding requests have come up empty. Changing the current reality will take political commitment for sustaining funding over many years. Europe needs to prioritize TB.”

The new report also highlights a highly promising and innovative financial mechanism that could speed up the development of a new point-of-care test for TB. Prize funds can eliminate the need to recover research and development costs through high final product prices. With approximately 50 million Euro, it would be possible to set up a prize that companies and research consortiums could compete for. Prizes like this have successfully been used by companies and governments to solve scientific or commercial problems. But so far no donors have stepped forward to fund this type of prize.

MSF treats around 30,000 people with tuberculosis in more than 80 projects worldwide.

Yemen: Razeh Hospital Hit by Rocket Fire

Tue, 20 Oct 2009 16:04:00 GMT

Sanaa/Paris, October 20, 2009 — Two months into the war in Northern Yemen, one of the last functioning hospitals in the Saada governorate was directly hit by rocket fire last week and forced to close. It is urgent that a hospital be set up in a safe area allowing patients to access health care, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) on Tuesday. MSF is ready to restart medical activities in the governorate as soon as possible.

The night between Thursday, October 15 and Friday October 16, Razeh hospital, in the Saada governorate, was hit by rocket fire. Staff and patients were forced to evacuate the premises the following day despite the many wounded in need of continued medical attention. Just the day before, 10 war-wounded patients, including six children and two women, had been hospitalized in the facility.

MSF reiterates its call to warring parties to guarantee respect for medical facilities and to facilitate patients’ access to care.

MSF has been working in collaboration with the Ministry of Health in two hospitals in Al Talh and Razeh, in the Saada governorate, since late 2007, providing medical and surgical care free of charge. Despite difficulties, activities had continued uninterrupted until now, thanks to an agreement between both parties to the conflict. But medical work is no longer possible given that even the minimum security conditions are no longer met.

Since fighting broke out and work stopped in Al Talh, on September 27, and Razeh, on October 16, MSF and Yemeni Ministry of Health’s medical teams have carried out some 2,000 emergency consultations and performed 195 surgical interventions (70 percent involving war wounds), 330 hospitalizations, and over 130 deliveries. These were the last two secondary healthcare facilities still operating in the governorate, outside the town of Saada, making their suspension of care of particular concern.

“After more than two months of non-stop intensive fighting, the medical and surgical needs in the Saada region are running high, but most of the population can no longer reach any medical facilities,” said Dr. Isabelle Defourny, program manager for MSF operations in Yemen. “There is an urgent need to set up a hospital in an area where safety conditions will allow patients to safely access medical care.”

Such safety conditions currently exist in Mandabah (district of Baqim), located to the north of the governorate, where a number of people have gathered fleeing the fighting. MSF teams have been conducting assessments in this area since late August, and consider it a priority to set up a hospital there right away.

Our medical and surgical teams are ready to provide assistance. MSF is waiting for the authorization of the authorities to begin providing secondary health care in Mandabah as soon as possible.

The MSF teams have carried out 30,000 consultations between January and July 2009, 8,000 of which were emergencies, and 1,450 hospitalizations. MSF has also performed 720 surgical interventions, including some 100 on the war-wounded.

Violence Expands in Northern Congo, Population in Urgent Need of Assistance

Wed, 14 Oct 2009 13:37:00 GMT

Kinshasa, DRC, October 14, 2009 – One year after violence erupted in Haut-Uélé district, in northern Democratic Republic of Congo (DRC), attacks and clashes have now expanded to new areas, forcing hundreds of thousands of people to flee. Humanitarian organizations have failed to meet the massive needs that have resulted and an urgent response with greater presence in the rural areas of Haut-Uélé and Bas-Uélé is imperative, said the international humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

Since late 2008, the civilian population of Haut-Uélé and Bas-Uélé has been caught in a dramatic cycle of violence linked to attacks perpetrated by the Ugandan rebel group the Lord's Resistance Army (LRA), and the Ugandan and Congolese offensive against the LRA. As the situation deteriorates, civilians also find themselves facing increasing banditry.

"The local population is the target of violence: murder, kidnapping and sexual abuse," said Luis Encinas, coordinator of MSF operations in Central Africa. "We are talking about tactics of violence aimed at instilling fear in the people. Our patients have told us the most brutal stories – about children who are forced to kill their parents and people burnt alive inside their homes."

The violence and armed confrontations have gradually expanded, now stretching from Haut-Uélé into Bas-Uélé in northeastern DRC, as well as in the neighboring regions of southern Sudan and eastern Central African Republic.

Hundreds of thousands of people have been displaced over the last year. Ongoing attacks continue to send thousands fleeing to seek shelter and greater security in towns. The population of Doruma city has tripled. The towns of Gangala and Banda are each hosting more than 20,000 displaced without assistance. These locations have become enclaves with outlying fields and villages left deserted.

In several places like Dingila or Niangara, MSF remains the only humanitarian organization present. "New people are being displaced every day in the region," said Pierre Kernen, MSF coordinator in Niangara, a town located in western Haut-Uélé. "They have been forced to flee one time, two times, three times. They have sought shelter with local families or in empty buildings but they still don’t feel safe there. MSF is providing medical and psychological care, but we have our limits. These people also urgently need food, clean water, shelter and proper living conditions."

Due to insecurity and the absence of roads in these very isolated areas, MSF has had to use airplanes to bring supplies, drugs and staff to most of its project locations. "Delivering humanitarian aid to the people of this region is of course a challenge, but we believe much more can and must be done to address the consequences of this war on the population," said Encinas. "Humanitarian organizations should urgently address people’s needs in areas that are most affected by the fighting and have so far been neglected."

MSF is currently working in Dingila, Doruma, Dungu, Duru, Faradje, and Niangara, providing over 9,000 medical consultations a month in hospitals and health centers. MSF has also distributed relief items to some 16,000 people displaced by violence, as well as vaccinations and mental health support. Twenty-seven international staff work alongside 140 Congolese colleagues in MSF projects in Haut-Uélé and Bas-Uélé.

Drug Companies Called On to Pool HIV Patents

Wed, 30 Sep 2009 13:21:00 GMT

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to drug companies asking them to put their drug patents in the pool.

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Why We Need a Patent Pool

New York/London, September 30, 2009 – The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today called on nine of the world's largest pharmaceutical companies to help accelerate the availability of new treatments for millions of people living with HIV/AIDS, by pooling their patents on a list of key HIV medicines.

A patent pool is a mechanism in which a number of patents held by different parties are brought together and made available to others for production or further development. Patent holders receive royalties paid by those using the patents. The mechanism has been instrumental in promoting innovations in the aeronautics and digital telecommunications industries, for example.

Make It Happen – Help Us Get HIV Drugs in the Pool

"It’s a simple idea: companies share their knowledge in return for fair royalty payments,” said Michelle Childs, director of policy and advocacy at MSF’s Campaign for Access to Essential Medicines. "But it has the potential to transform companies’ approaches to access to HIV medicines and foster innovation in a way that marks an alternative to the confrontation and litigation of the past.”

UNITAID, the international drug purchasing agency, is currently establishing a medicines patent pool for HIV drugs. Critical to its success will be the willingness of patent owners to participate, by including their patent rights in the pool.

"The scheme is voluntary, so companies have a choice -- and today we’re asking them to make that choice,” said Childs. “This is an opportunity for these drug companies to demonstrate that they are genuinely committed to effective measures that allow access to life-saving medicines for people with HIV in developing countries. Some companies have expressed interest in the idea, but we need them to go further and put key patents in the pool.”

For people living with HIV/AIDS, the impact could be considerable. A patent pool could speed up the availability of more affordable versions of new medicines, as generic production could begin well before the 20-year patent terms expire. Currently, patent barriers can also prevent innovation such as new pediatric formulations or much-needed fixed-dose combinations.

“This opportunity comes at a crucial time,” said Dr. Eric Goemaere, medical coordinator for MSF in South Africa. “Many patients in our programs have developed resistance to their medicines and need to switch to newer, more effective drugs now. Because these are either unavailable or unaffordable, patients face a return to AIDS death row as treatment options dry up.”

Some of the drugs identified by MSF to be essential for the pool, based on its field experience, are recommended by the World Health Organization for use in developing countries.

MSF is launching an e-mail writing campaign calling on Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Johnson & Johnson, Gilead Sciences, GlaxoSmithKline, Merck & Co, Pfizer, and Sequoia Pharmaceuticals to meet the promise afforded by this mechanism and put their HIV drug patents in the pool.

Click here for the list of drugs that MSF is calling for to be included in the UNITAID patent pool, and to learn more about each medicine.

MSF currently treats over 140,000 people living with HIV/AIDS in 30 countries.

Nutrition Emergency in Central African Republic

Tue, 22 Sep 2009 14:57:00 GMT

Barcelona/Paris/New York, September 22, 2009 – The southwestern area of Central African Republic (CAR) is facing a severe nutritional emergency, with more than 1,000 children at grave risk, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

After being alerted by local authorities, MSF medical teams have opened four feeding centers in the past month in Carnot, Boda, Nola, and Gamboula. MSF has also implemented a number of outpatient treatment programs. Initial assessments in some areas have revealed severe malnutrition rates over the emergency threshold of two percent. In barely six weeks, more than 1,300 children, mostly suffering from severe malnutrition, have been admitted to MSF treatment programs.

A large number of patients who suffered from malnutrition also suffered from medical complications and required admission to hospital. “In Boda and Nola, for instance, it is difficult to find patients only suffering from malnutrition, as many of them arrive here suffering from other diseases and their condition is very severe,” said Clara Delacre, MSF coordinator in Nola. “There are many cases of malaria, diarrhoea, tuberculosis, or AIDS, which further complicates children’s already delicate condition.”

The economic crisis that has unfolded in the area’s mining industry was the final straw for an already highly vulnerable population. Yet it is only one of the many causes of this nutrition emergency.

“Several elements can explain this situation, one of them is the crisis affecting the gold and diamond sector, the main means of sustenance for most of the people in the area,” said Delacre.

The crisis has left many men working in the mines unemployed and without income. In addition, many of the diamond and gold buying-and-selling businesses have been forced to close down over the past few months. The economic crisis, however, is only one more factor compounding the chronic difficulties in the region. A very poor cassava-based diet, lack of access to healthcare for most of the population, and the malaria-generating rainy season increases risks for the population.

Other basic foods, including meat, are hard to find. According to the area’s inhabitants, the problem started some years ago when groups of bandits began threatening cattle farmers, who fled to Cameroon. Moreover, most people cannot afford healthcare. This has been compounded by the recent loss of income in many families and the closure of many health centers.

“MSF has come here to respond to the emergency, treating the most severe cases,” said Delacre. “Yet there are background problems requiring a broader response.”

MSF has been working in CAR since 1997. Currently, the organization is implementing projects to provide care to people affected by violence in north-eastern areas of the country, in Kabo, Batangafo, Boguila, Markounda, Maïtikoulou, Paoua and Bocaranga.

Iraq: MSF Supplies Mosul Hospital With Emergency Material in Wake of Bomb Attack

Fri, 07 Aug 2009 07:33:00 GMT

Amman, August 7, 2009—More than 100 wounded patients have been assisted in the aftermath of a large bomb blast on the outskirts of the city of Mosul in northern Iraq today, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

More wounded are expected to arrive in the coming hours to the Jumury Hospital in the center of the city. The hospital, which has been assisted by local MSF volunteers since 2007, immediately requested supplies and materials from MSF to cover the increased emergency needs.

“The hospital has exhausted much of its available medical and surgical supplies due to the enormous number of critically wounded patients,” said Gustavo Fernandez, Amman-based head of mission for MSF’s Iraq program. “MSF regrets the deaths and suffering of civilians who have been caught in this indiscriminate and terrible violence.”

MSF is sending surgical materials, catheters, tubes, drains, iodine bottles, as well as bandages and compresses, to Jumury Hospital to cover the needs of approximately 100 wounded patients. In addition, MSF is supplying kits to treat 100 burn victims.

MSF has been supporting Jumury Hospital since 2007. In addition to providing medical materials, local volunteers in the hospital’s emergency unit have been trained to respond to mass casualty events.

Despite the ongoing conflict in Iraq, which has made it difficult for humanitarian organizations to be present in the country, MSF is striving to provide medical care to the Iraqi people. Since 2006, MSF has implemented programs in different parts of Iraq, such as Anbar, Basra, and in the Northern governorates of Tameem and Ninewa, mostly supporting hospitals by supplying medical materials and training. In Suleimanyah, in the north of the country, MSF has taken over the provision of services at a hospital specializing in treating burn victims. MSF is also operating a reconstructive surgical program in Jordan.

Sub-Optimal Treatment Threatening Survival of HIV/AIDS Patients

Mon, 20 Jul 2009 13:59:00 GMT

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Cape Town, July 20, 2009 – Stagnation in HIV/AIDS funding and the high cost of new medicines are putting the lives of thousands of poor patients at risk, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned today at the 2009 International AIDS Society Conference in South Africa. Patients needing new drug regimens will return to AIDS “death row.” While the lack of access to antiretroviral treatment for seven million people remains unaddressed, inadequate financing now further threatens treatment scale-up.

In one of the longest running public sector AIDS treatment programs in Africa, a partnership between MSF and the Department of Health in Khayelitsha, South Africa, 16 percent of patients experienced treatment failure on their first-line regimen within five years. A quarter of those patients who were switched to a second-line regimen failed on this alternative treatment line within two years. With no third-line regimen available in South Africa—as is the case in many other developing countries—these patients are now at risk of dying.

View the new report HIV/AIDS treatment in developing countries – The battle for long-term survival has just begun.

“What we are seeing in Khayelitsha is what we will soon see throughout Africa if there is not a focused push for urgent change,” said Dr Eric Goemaere, medical co-ordinator for MSF in South Africa. “We need to provide the most robust first-line treatment possible, to detect treatment failure through monitoring HIV levels in the body before patients show symptoms, and to provide access to affordable second and third-line treatment combinations. None of this is happening now, which means that thousands of patients are back on AIDS death row.”

Unlike older first-line drugs, most second- and third-line drugs are patented and priced out of reach for patients in developing countries. In some of these countries, switching from a first- to second-line regimen increases treatment costs as much as 17-fold.

To stop spiraling costs, countries will have to routinely use measures such as compulsory licenses, which allow the generic manufacture of drugs under patent to ensure affordable treatments. MSF is recommending that drug companies put their AIDS drug patents in the “patent pool” that the international drug financing agency UNITAID is creating to allow poor countries to access critically needed drugs at affordable prices. The patent pool will provide generic producers or researchers with drug licenses in exchange for a fee paid to the originator company.

“It is a question of choice for national and donor governments,” said Dr. Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign. “Will they give poor people just a few extra years of life, or the same chance for long-term survival as people with HIV/AIDS in rich countries?”

At present, over three million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated seven million people who are in need of treatment are still waiting for access. MSF operates HIV/AIDS programs in approximately 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adult and child patients.

Disruptions in HIV Drug Supplies and Funding Endangering Patients' Lives

Fri, 17 Jul 2009 15:20:00 GMT

Cape Town, July 17, 2009 - Recent disruptions in the supply of anti-retroviral (ARV) drugs and other essential medical items in at least six African countries are putting HIV patients’ lives at risk, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today, in advance of the International AIDS Society Conference in Cape Town, South Africa.

Funding gaps and supply management problems have led to the delay, suspension—or risk of suspension—of the supply of life-saving HIV drugs in recent months. The inaction of national governments, donors, and their partners must end and they must take urgent and concrete measures, said MSF.

The consequences of disruptions in funding and supplies are potentially catastrophic: if the start of new patients on treatment has to be suspended or delayed, then the lives of many in urgent need of drugs are at risk. For people already on treatment, the interruptions or lowering of dosages will lead to treatment failure and a higher risk of developing drug-resistance. Disruptions are having a direct impact on MSF’s HIV programs.

In South Africa, the government budget for health was cut due to the global financial crisis; finding alternative funding seems difficult in the short term.

“All around us, clinics stop enrolling patients because there are just not enough ARV supplies,” said Eric Goemaere, MSF head of mission in South Africa. “The waiting lists are growing by the day, risking that patients die before they start ARVs. It’s unbelievable that a relatively well-functioning ARV program has been allowed to be crippled in the space of just a few weeks. MSF will not be able to fill the gaps, and we seriously question why we should have to do so, in view of declared international commitments.”

In Malawi, delays in funding disbursements from the Global Fund for AIDS, Tuberculosis and Malaria have already caused worrying shortages in ARV supplies. As a result, ARV stocks are running dangerously low in several health facilities. In order to avoid further ruptures, the Ministry of Health, with the help of MSF and other NGOs, is currently re-distributing ARV supplies to different districts. MSF has also had to buy additional backup stocks, to ensure a steady supply for patients in its projects. For now, MSF is able to start new patients on treatment, but there is a real risk that this will have to slow down.

MSF teams in Uganda, the Democratic Republic of Congo, Zimbabwe, and Guinea are also seeing stock-outs and disruptions.

Disruptions are a result of a shortage of in-country funding and delays by donor governments in fulfilling their commitments. Major international funding institutions such as the Global Fund for AIDS, tuberculosis and malaria and PEPFAR face budget caps or uncertainty in the replenishment of funding. Country level supply management and procurement issues compound the problem, as any delays in funding place the supply chain in danger.

“MSF is extremely concerned about the lack of effective action from governments, their partners, and international donors in assuring the continued funding and supply of ARVs and other medical items for treatment,” said Meinie Nicolai, MSF director of operations. “They are playing with fire: no ARVs means no HIV/AIDS treatment. Governments and donors must respond to funding and supply problems urgently and effectively.”

MSF Calls For Humane Treatment, Medical Assistance to Migrants Displaced in Greece

Mon, 13 Jul 2009 08:05:00 GMT

Athens, July 13, 2009 — Following yesterday’s police operation at a makeshift camp for migrants in Patras and the subsequent fire that broke out, Doctors Without Borders/Médecins Sans Frontières (MSF) expresses concern for the medical and humanitarian condition of the migrants and asylum seekers who were left homeless, as well as those who were arrested. MSF urges authorities to ensure humane living conditions and the provision of medical assistance to this population.

“Many of the people who are left without shelter and the ones who were arrested have been our patients for a long period of time,” said Micky Van Gerven, Head of Mission of the MSF project for migrants, asylum seekers and refugees in Greece. “We are deeply concerned about their condition and request guarantees from the authorities that they will be treated with dignity and receive medical and mental health support if needed.”

MSF was informed about the police operation early in the morning and rushed immediately to the camp, said Christos Papaioannou, the MSF field coordinator in Patras. Bulldozers began to demolish the makeshift construction and a fire broke out, he said. Several migrants without official documents have been arrested, while many others left the camp by themselves.

“We don’t know yet where they are and what has happened to them,” he said. “Most of them have been forced to leave their country because of conflict or extreme poverty and are now faced with an uncertain future and possible detention for an unclear period of time. This may have a negative impact on their medical and mental health condition.”

MSF calls on the authorities to assume full responsibility for the provision of medical assistance and psychosocial support to these people, ensure humane living conditions for the detainees, and pay special attention to vulnerable groups, such as minors, patients with chronic diseases and people with special medical needs.

The majority of the people living in the camp were from Afghanistan and have fled conflict and war. Among them are a number of minors, who are extremely vulnerable and in need of special protection. It is important that all migrants and asylum seekers are treated with dignity and that the authorities adhere to the relevant international and European conventions as well as the EU Council directive which established minimum standards for the reception of asylum seekers

Today’s police operation is part of a broader response targeting migrants, refugees and asylum seekers in Patras and other parts of the country. MSF will closely monitor the situation in Patras and continue to respond to the needs of migrants, asylum seekers and refugees in the country.

MSF has been working in the migrants’ makeshift camp in Patras since May 2008 providing primary health care and psychosocial support and improving the living conditions of the population inside the camp. So far the organization has carried out more than 8,500 consultations, treating mostly respiratory infections and dermatological diseases, and referring more than 350 patients to the local hospitals. During this period, more than 400 refugees have received individual psychosocial support and more than 450 group sessions, including psycho education and health promotion sessions. Finally, sleeping bags and hygiene kits have been distributed to the refugees and migrants living inside or outside the Patras makeshift camp.

The Fight Against Chagas: Time to Focus on Patients

Thu, 09 Jul 2009 08:59:00 GMT

View Chagas Special Report

Madrid, July 9, 2009 — The international medical humanitarian organization Doctors Without Borders/Medecins Sans Frontieres (MSF) today launched a campaign to raise awareness of the parasitic disease Chagas. MSF is calling on countries where the disease is endemic to stop neglecting the disease by moving beyond prevention activities to increased diagnosis and treatment.

The campaign, “Chagas: It’s Time to Break the Silence,” coincides with the 100th anniversary of the discovery of one of the world’s most neglected diseases.

Approximately 10-15 million people in Latin America are infected with Chagas every year. It is estimated that 14,000 people die of the disease annually. Most Chagas patients are asymptomatic and the disease often goes undiagnosed, so the true scope of Chagas-related deaths is unknown. MSF is also calling for more research and development toward new and more effective treatments, rapid diagnostic tests for use in remote settings, and better methods for determining treatment success.

Additional background information on Chagas is available online:
http://doctorswithoutborders.org/publications/article.cfm?id=3696

Also visit MSF's Chagas website:
www.chagas-break-the-silence.com

Chagas disease is caused by the Trypanosoma cruzi parasite. In most Latin American countries, the disease is transmitted by the bite of the vinchuca insect although transmission is also possible from mother to child, through blood transfusions, organ transplants, and contaminated food. Chagas patients can be asymptomatic for years, but during the chronic phase of the disease one third develop serious health problems—mainly heart and intestinal complications—that can lead to death.

“One of the main problems we have is that for years patients have no symptoms, so they do not know they are sick and they receive no treatment,” said Dr. Nines Lima, MSF’s tropical medicine advisor. “Active case detection is essential to find and treat infected people.”

Chagas is endemic in several Latin American countries but worldwide migration means that more and more cases are being reported in the United States, Europe, Australia, and Japan. Chagas is a potential killer, but so far governments have focused on prevention and vector control rather than on the treatment of patients. Integrating Chagas care into primary health care facilities would greatly improve patient access to treatment.

The sooner the disease is detected, the more effective the treatment. The only two existing drugs—benznidazol and nifurtimox—were developed over 35 years ago through research not specifically focusing on Chagas. Although these medicines are very effective in newborn and breastfeeding children, only about 60 to 70 percent of adolescents and adults are successfully treated. The older the patients, the greater likelihood they will experience side effects from the drugs.

“Doctors do not treat children, let alone adults, for fear of side effects,” said Dr. Tom Ellman, MSF head of mission in Bolivia, where the organization runs a Chagas treatment program. “We are showing that these effects are manageable in both cases. Leaving patients untreated is no longer ethical.”

However there is still an urgent need for better drugs for the treatment of Chagas. The disease is one of poverty.and therefore has been absent from research, development and political agendas for years. A recent Global Funding of Innovation for Neglected Diseases (G-Finder) survey, revealed that in 2007 only $10.1 million was spent on research and development of new drugs to treat Chagas.

Research and development must be boosted in order to develop new rapid diagnostic tests, better medicines, and new cure tests to address this disease more effectively.

“The lack of commercial incentives has pushed Chagas into oblivion,” said Gemma Ortiz, head of the MSF Chagas campaign. “New ways to boost research and development and better tools to care for patients need to be found.”

In the coming months, MSF will campaign for greater awareness and commitment to the fight against Chagas. For more information on Chagas disease and the enormous gap between the number of people living with Chagas and those who receive treatment, go to: www.chagas-break-the-silence.com. Visitors can participate in the MSF campaign and “break the silence” by sending information about this silent disease to their friends.

Doctors Without Borders/Médecins Sans Frontières has been working in projects fighting Chagas disease since 1999. Currently, the organization is working in three districts on the outskirts of Cochabamba, in Bolivia, the country with the highest prevalence of Chagas in the world. Activities are carried out in collaboration with the Bolivian Ministry of Health and integrated into five primary health care centers, where children and adults up to 50 years of age are diagnosed and treated. Using the same approach, the organization is currently setting up a new project in the rural zone of Cochabamba region, where it is working to involve the community in all aspects of the strategy (prevention, diagnosis and treatment), in an area where the vector is much more prevalent.

At the end of 2008, MSF had tested over 60,000 people for Chagas, treating 3,100 patients, of whom 2,800 successfully completed their treatment. This shows that, even though the current means are not ideal, diagnosing and treating Chagas in limited resource settings and remote areas is feasible.

Somalia: Majority of North Mogadishu Population Flees as Fighting Escalates

Tue, 07 Jul 2009 13:32:00 GMT

Nairobi/New York, July 7, 2009—The resumption of fighting in Mogadishu, Somalia’s capital, has forced the majority of people living in the Yaqshid, Karan, and Abdul Azziz districts in the north of the city to flee, according to the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). Continuous shelling, explosions, and open combat among various armed groups have claimed the lives of dozens of civilians and plunged the city into chaos. As a consequence, MSF has been forced to close its medical centers in the area.

Last week, MSF closed a pediatric hospital and three health clinics in the north of Mogadishu. MSF staff—like the rest of the population—have had to flee to safeguard their own lives and those of their families. This is the first time in the 17 years that MSF staff working in north Mogadishu have had to flee for their lives.

The MSF teams were performing an average of 2,500 outpatient consultations per week, and were treating nearly 400 malnourished children when they were forced to cease operations. In Daynile Hospital, located on the western edge of Mogadishu, MSF medical teams have treated 869 wounded people and performed 49 operations since the beginning of May. Among those receiving emergency treatment, 162 were children under the age of 14, and 156 were women. Twelve patients have died from their wounds.

"In the past two months, an estimated 200,000 people have had to flee towards Afgooye and Jowhar,” said Monica Camacho, general coordinator of the MSF mission in Somalia, based in Nairobi. “The population is terrorized, and in the past two weeks the number of dead and wounded has drastically increased. It has become impossible to provide medical and humanitarian assistance to those in need,” added Camacho.

Along the road to Afgooye, west of Mogadishu, half a million people are living in temporary shelters made from sticks and plastic sheeting and there is very limited access to health care. There is a desperate shortage of food and water, and settlements of internally displaced people are overcrowded, posing a serious risk for epidemics, such as measles and cholera.

MSF calls on all parties to the conflict to respect the organization’s medical structures and the work of Somali staff—health professionals who have managed to provide vital medical and humanitarian aid in some of the worst conditions imaginable.

"Some of the medical structures in the north of Mogadishu had been taken over by armed men,” said Alfonso Verdu, operations manager for MSF in Somalia. “All the patients who were being treated in MSF medical structures over the past two weeks have fled or have had to be evacuated. Many of them have had to interrupt their treatment, which is extremely worrying. Practically no one remains on the streets of North Mogadishu”.

In the past three months, MSF has experienced numerous security incidents. In April, two staff members were kidnapped in Huddur, in the Bakool region. On June 18, an MSF employee died in an explosion which killed 30 other people. Later in June, an MSF vehicle in North Galcayo was attacked, resulting in the death of the mother of a patient. These recent incidents, and the general deteriorating security environment of the past two years, have made the work of MSF in Somalia increasingly difficult.

"Despite all that has happened, we want to continue working in the country,” said Benoit Leduc, head of operations for MSF in Somalia. “The needs are huge and the main victims of this conflict are civilians. We can see it in our hospital in Daynile, where most of the patients are women and children. We are again calling on all the parties to the conflict to respect the safety of civilians and guarantee the humanitarian space necessary to treat the wounded.”

MSF has worked continuously in Somalia for more than 17 years and is providing medical care in nine regions in the country. In 2008 alone, MSF teams provided 727,428 outpatient consultations, including 267,168 for children under five. Over 55,000 women received antenatal care consultations and more than 24,000 people were admitted as inpatients to MSF-supported hospitals and health clinics. There were 3,878 surgeries, 1,249 of which were injuries due to violence. Medical teams treated 1,036 people suffering from the deadly neglected disease kala azar, more than 4,000 for malaria, and started 1,556 people on tuberculosis treatment. Nearly 35,000 people suffering from malnutrition were provided with food and medical care and 82,174 vaccinations were given.

Long-Suffering Rohingya in Bangladesh Face Unacceptable Abuse

Thu, 18 Jun 2009 14:11:00 GMT

Kutupalong, Bangladesh, June 18, 2009—Thousands of unregistered Rohingya refugees living in the Kutupalong makeshift camp, Bangladesh, are being forcibly displaced from their homes, in an act of intimidation and abuse by the local authorities. The international medical organization Doctors Without Border/Médecins Sans Frontières (MSF) has treated numerous people for injuries, of which the majority were women and children. Furthermore, MSF has witnessed countless destroyed homes and heard many reports of people being warned to remove their own shelters or face the consequences.

“I was working. When I went back to my shelter I found it totally destroyed,” said a camp resident. “An inspector was there with nine or 10 people. I asked why they destroyed my house. They showed me a fish cutter and said, ‘If you say anything, I’ll cut you.’ ”

The Rohingya, a Muslim ethnic minority originating from Myanmar, are denied citizenship and suffer persecution and discrimination in Myanmar. Hundreds of thousands have fled to Bangladesh and Thailand.

To date, an estimated 25,000 people have flocked to the Kutupalong makeshift camp hoping for recognition and assistance. Instead of finding help, they have been told that they cannot live next to the official camp, supported by the Bangladesh Government and the United Nations High Commissioner for Refugees. Nor can they legally live on adjacent Forestry Department land. They have nowhere to go and no way to meet their basic needs.

“I cannot move,” said another camp resident. “If we go to collect wood we will be arrested. If we collect water we will be beaten. If we move our house, where should we go?”

In March, 2009, MSF was alerted to fast-rising numbers in the makeshift camp and conducted an assessment. There were 20,000 people living in dire humanitarian conditions with global acute malnutrition rates above the emergency threshold, 90 percent food insecurity, poor water and sanitation, and no assistance.

“To forcibly displace this group when they are already so vulnerable is outrageous,” said Gemma Davies, MSF project coordinator for the Kutupalong makeshift camp.

MSF responded immediately by treating the severely malnourished children, offering basic health care and improving water sources and waste facilities.

“Within four weeks of opening, we had almost 1,000 children in our feeding program,” said Davies. “The rainy season has begun and the appalling water and sanitation situation is further deteriorating, increasing the risk of communicable diseases. These people have little to no access to even the most basic of services and they are being forced to flee in fear, with nowhere to turn. The situation is deplorable.”

Denied citizenship in Myanmar, hundreds of thousands of Rohingya have fled their homes to seek refuge abroad. Few have been granted refugee status. The majority struggle to survive, unrecognized and unassisted in countries such as Bangladesh and Thailand.

A fundamental solution for the Rohingya, not only in countries where they seek asylum but at their origin, is crucial to restoring the health and dignity of these long suffering people.

MSF has assisted people in Bangladesh since 1992, most recently setting up a basic healthcare program in the Chittagong Hill Tracts, assisting victims of Cyclone Aila and implementing an emergency intervention to assist unregistered Rohingya in Kutupalong makeshift camp, with services also open to the host community.

Growing Insecurity Forces MSF to Leave its Largest Health Center in Somalia

Wed, 17 Jun 2009 06:51:00 GMT

Nairobi/Brussels, June 17, 2009 — After nine years of providing health care for the population in Bakool region, Doctors Without Borders/Médecins Sans Frontières (MSF) has reached the regrettable conclusion that it does not have sufficient security to continue its work. This decision was MSF’s alone and the organization was not expelled by the authorities. MSF medical activities elsewhere in Somalia continue.

Somalia is a very difficult place to provide humanitarian assistance as was underlined by the abduction of two MSF medical staff in Bakool in April 2009. MSF is grateful that the incident was resolved positively with the help of the community.

However, following the abduction and other serious incidents over the past year, MSF can no longer safely provide quality medical care to the people living in Bakool.

For the past several months, MSF has run the project from a distance, complemented by short visits of international technical support staff. With the abduction, the possibility of even this approach has eroded.

“Given the immense needs in Bakool and beyond we have continued to work under difficult circumstances, but unfortunately we now have to concede that the risks there have reached unacceptable levels,” said Jerome Oberreit, Director of Operations at MSF.

MSF hopes that despite our departure the population of Bakool will find ways to mitigate the loss of services provided by MSF and that they will recognize the efforts by our Somali staff for the past nine years.

MSF activities in Bakool include the Health Center in Huddur – the largest in-patient facility in South and Central Somalia - and four outlying health posts in Labatan Jerow, El Garas, El Berde and Rabdure.

During the nine years of the program, the Huddur Health Center expanded from a single feeding center for malnourished to a fully functional Health Center with a capacity of 278 beds and 157 staff receiving continuous training.

Since 2002 the Huddur Health Center and the health posts have provided 272,700 outpatient consultations, while 11,075 have been admitted to the Health Center. Of these, 3,314 were treated for Kala Azar and 945 for Tuberculosis. Additionally, 1,913 children have been treated for severe malnutrition.

In the past 14 months, MSF has been forced to close four projects due to increasing insecurity including abductions and fatal attacks on our staff in Somalia. The continued free medical activities that MSF provides in the regions of Banadir, Bay, Galgaduud, Hiraan, Lower Juba, Middle Shabelle, Lower Shabelle and Mudug will depend on the communities and authorities providing conditions that prevent such incidents toward our staff and health facilities.

The international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) has worked in Somalia since 1991.

Since January 2008, MSF's projects in South and Central Somalia have been run by dedicated Somali staff, supported by international staff based in Nairobi who visit whenever security allows. The commitment, hard work and bravery of these Somali staff meant that MSF was able to continue providing health care to hundreds of thousands of Somalis throughout 2008.

In 2008 MSF teams provided 727,428 outpatient consultations, including 267,168 for children under five. Over 55,000 women received antenatal care consultations and more than 24,000 people were admitted as inpatients to MSF supported hospitals and health clinics. There was a total of 3,878 surgeries performed, 1,249 of which were injuries caused by violence. Medical teams treated 1,036 people suffering from the deadly neglected disease kala azar, more than 4,000 for malaria and started 1,556 people on tuberculosis treatment. Nearly 35,000 people suffering from malnutrition were provided with food and medical care and 82,174 vaccinations were given.

Zimbabwean Nightmare Of Neglect Continues In South Africa

Tue, 02 Jun 2009 06:40:00 GMT

Special Report

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Johannesburg/Brussels/New York, June 2, 2009 – Violence, sexual abuse, harassment, appalling living conditions, and a serious lack of access to essential healthcare define the desperate lives of thousands of Zimbabweans in South Africa today, warned the international medical humanitarian aid organization, Doctors Without Borders/Médecins Sans Frontières (MSF).

Recent developments in Zimbabwe and South Africa have done little to alter the fact that scores of Zimbabweans continue to flee to South Africa as a matter of survival. Once they cross the border, their living conditions hardly improve. MSF is calling on the government of South Africa and United Nations (UN) agencies to urgently address the specific humanitarian needs of vulnerable Zimbabweans falling through the cracks of South African society.

Click here to read a new MSF report:
“No Refuge, Access Denied: Medical and Humanitarian Needs of Zimbabweans in South Africa.”

“Every day, despite claims that Zimbabwe is ‘normalizing’, thousands of Zimbabweans continue to cross the border into South Africa, fleeing economic meltdown, food insecurity, political turmoil, and the total collapse of their health system,” said Rachel Cohen, head of mission for MSF in South Africa. “Instead of finding the refuge they so desperately need, they endure intolerable suffering on their journey to and within South Africa.”

Since 2007, MSF has been providing basic primary health care, referral to secondary and specialized care services, emergency medical treatment for victims of violence and epidemic outbreaks, and specific services for survivors of sexual violence, as well as unaccompanied minors. Each month, MSF medical teams perform between 4,000-5,000 consultations for Zimbabweans in the South African border town of Musina and at a clinic at the Central Methodist Church in inner-city Johannesburg, a ‘safe haven’ for thousands of Zimbabweans.

“We see thousands of sick, wounded, psychologically scarred and marginalized Zimbabweans in both Johannesburg and Musina every month,” said Dr Eric Goemaere, medical coordinator for MSF in South Africa. “They come to us because they have nowhere else to turn. Many of those who reach us have chronic diseases, such as HIV and TB, and severe violence-related injuries, most often from rape and sexual assault experienced while crossing the border from Zimbabwe, but also in South Africa itself. Consultations in our Johannesburg clinic have almost tripled in the last year, a telling sign of the extent to which Zimbabweans are consistently denied access to even the most basic health services necessary for their survival.”

South Africa’s constitution guarantees access to health care and other essential services to all who live in the country—including refugees, asylum-seekers, and migrants—regardless of legal status. But in reality Zimbabwean patients are rejected outright, or are often charged exorbitant fees and subjected to long delays, inappropriate treatment, or premature discharge, thus placing health care out of reach for many.

“The stories of our patients are truly shocking,” said Bianca Tolboom, MSF nurse and project coordinator in Johannesburg. “I’m talking about pregnant women, unconscious or critically ill patients, even a six-year-old girl who had been raped, who were all refused the medical care they urgently required. It’s deplorable, it’s a breach of medical ethics and it’s a violation of their rights under the South African Constitution. This nightmare of neglect must end.”

MSF has been treating an increasing number of victims of sexual violence in Musina. In April, more than half of those treated had survived gang rape and 70 percent had been raped under threat of a gun, knife, or other weapon. Another worrying trend is the number of unaccompanied children crossing the border alone. They make their way to the Central Methodist Church, a journey of more than 500 kilometers, where as many as 4,000 Zimbabweans seek shelter each night - either dangerously packed into all available space inside the building, or sleeping on the pavement outside the church. Currently, there are more than 150 unaccompanied children between the ages of seven and 18 years crammed into the church. These children are extremely vulnerable and exposed to many forms of abuse in South Africa, yet no viable solution has been found to ensure they are properly assisted or protected.

“Each day, MSF teams witness the failure of the South African government primarily, but also of UN agencies, to meet the basic medical and humanitarian needs of vulnerable Zimbabweans,” said Rachel Cohen. “The recent announcement by the South African Department of Home Affairs that a new system will be put in place to regularize the legal status of Zimbabweans in South Africa, and to stop their systematic deportation, is a welcome departure from the government’s previous policy of aggressive harassment, arrest, and deportation. However, these measures have yet to translate into tangible improvements in the lives of most Zimbabweans. Their only places of safety are under attack and they remain relegated to the shadows of society, forced to live in squalor and denied access to adequate assistance and protection.”

MSF has been working in South Africa since 1999 providing HIV/AIDS and TB treatment, as well as care to survivors of sexual violence. In 2007, MSF began providing medical and humanitarian assistance to Zimbabweans seeking refuge in South Africa and presently carries out between 4,000-5,000 consultations each month through mobile clinics along the border in Musina and at a fixed MSF clinic at the Central Methodist Church in Johannesburg. MSF also has a large presence in Zimbabwe, treating more than 25,000 people on antiretroviral therapy in the country and, most recently, deploying a major emergency intervention and treating more than 50,000 patients in response to a cholera epidemic.

Thailand: Forced Repatriation of Hmong Refugees to Laos Denounced

Wed, 20 May 2009 09:07:00 GMT

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Bangkok/Paris, 20 May 2009—Doctors Without Borders/Médecins Sans Frontières (MSF) denounces the growing pressure applied by Thailand’s army to force the 5,000 Hmong refugees living in Huai Nam Khao camp, in northern Thailand, to return to Laos. Increasingly restrictive measures have forced MSF to put a stop to its assistance activities after some four years of presence in the camp.

The Thai and Laotian governments effectively reasserted last March that they aim to repatriate all the Hmong back to Laos before the year is out, and without any external supervision. The number of refugees being repatriated has picked up since December 2008, reaching 500 last March.

During the last four months, the Thai army, present in the camp, has introduced increasingly restrictive measures with the aim of pressuring the Hmong into dropping their demands for refugee status and returning “voluntarily” to Laos. The refugees talk of arbitrary arrests and cases of forced repatriation.

Moreover, MSF denounces the methods employed by the Thai authorities, who have stamped out any possibility of offering independent humanitarian assistance to the camp’s refugee population: restrictions on the population’s freedom of access to MSF's assistance, the multiplication of military checks on the Hmong and MSF’s staff. In the light of these conditions, MSF has decided to stop its activities in the camp.

“We can no longer work in a camp where the military uses arbitrary imprisonment of influential leaders to pressure refugees into a “voluntary” return to Laos, and forces our patients to pass through military checkpoints to access our medical clinic,” says Gilles Isard, MSF head of mission in Thailand.

MSF once again calls on the governments of Thailand and Laos:

• To stop the forced repatriation of the Hmong refugees in Huai Nam Khao and allow an independent third party to review the refugee status determinations.

• To allow an independent third party to assess the areas of return and the adequacy of assistance offered, monitor all repatriations, verify the voluntary nature of returns, and ensure the continued safety of returnees.

Furthermore, MSF requests any States that have already resettled Hmong, or could be ready to do so, to offer them an alternative in accordance with international law in terms of protection of people fleeing persecution.

MSF has been providing medical and sanitation assistance to some 7,500 refugees in the Petchabun camp since 2005. Less than 5,000 still remain. It has been the only international organisation present, and could provide firsthand accounts of events in the camp. MSF also works in Maesot, on the Myanmar border, offering care for patients with tuberculosis and infected with HIV/AIDS. Other teams work in Phang Nga, providing access to health care for Myanmar migrants, and in Sangklaburi, where they run a cross-border malaria project supporting ethnic Mon living inside Mon State (Myanmar).

Chagas Disease Not Addressed by World Health Assembly

Tue, 19 May 2009 09:24:00 GMT

Barcelona/Geneva, New York, May, 19, 2009 – The World Health Organization (WHO) has cut short its annual health ministers meeting because of influenza A (H1N1) preparations and has postponed discussions about Chagas disease. Much needed progress in diagnosing and treating people for this neglected disease must not be further delayed, warned the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

This week’s World Health Assembly (WHA), the annual gathering of health ministers in Geneva, was an opportunity for countries to commit collectively to stepping up the fight against Chagas, a largely neglected tropical disease endemic in many Latin American countries, which affects an estimated 14 million people and kills about 15,000 people every year.

“At the 100th anniversary of the discovery of Chagas we had expected that the WHA would adopt a resolution where all affected countries agree to integrate care of acute and chronic Chagas patients into their primary healthcare systems, and to invest more in research,” said Roger Teck, MSF director of operations. “People affected by this neglected disease are once again neglected. However, even though Chagas is now off the WHA agenda, this should not be used as an excuse for inaction. Governments of endemic countries should step up through developing and implementing better national and international protocols to fight Chagas.”

Chagas programs have traditionally focused on preventing the disease by controlling the "kissing bugs," the blood-sucking insects that transmit the disease. But MSF's experience in Honduras, Nicaragua, Guatemala, and Bolivia since 1999 has shown that prevention is far from enough.

“The focus on prevention ignores the needs of those who are already infected and are suffering in silence. In endemic countries, governments should actively screen, diagnose, and treat many more patients,” said Gemma Ortiz, senior advocacy officer for Chagas at MSF. “Access to diagnostics and treatment must be made a priority.”

MSF also urges WHO member states to review a range of alternative financing mechanisms, such as prize funds, to stimulate research and development for better tools to diagnose and treat Chagas patients in all stages of the disease. The lack of commercial incentives to invest in research and development has meant that Chagas has been neglected for decades.

Chagas is an infectious disease caused by the trypanosoma cruzi parasite. Originating in Latin America, more and more cases are appearing in the U.S., Europe, Australia, and Japan as a result of migration and mobility. In its chronic form, Chagas causes heart and gastrointestinal tract disease, leading to disability and death.