Doctors Without Borders News

DRC: Renewed Fighting Puts Thousands of Displaced Civilians in the Crossfire

Wed, 22 May 2013 16:36:00 GMT

DRC 2012 © Sven Torfinn

Displaced people at an MSF health center in Mugunga 1 camp, Goma, North Kivu Province.

GOMA, DEMOCRATIC REPUBLIC OF CONGO/PARIS, MAY 22, 2013—The resumption of heavy fighting in eastern Democratic Republic of Congo (DRC) yesterday is endangering thousands of civilians, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

The fighting broke out in areas west of Goma, the capital of North Kivu Province, between the Congolese army (FARDC) and the rebel group M23, with civilians in towns and displacement camps caught in the middle of heavy weapons fire. The Mugunga, Lac Vert, and Buhimba camps, located on the road between Goma and the town of Sake, have been caught in the middle of the shelling for the past two days. All parties should refrain from using force around displacement camps and other civilian areas, MSF said.

"The road between Goma and Sake is strategically located, but fighting in such close proximity to people's homes is endangering the lives of thousands of vulnerable people," said Thierry Goffeau, MSF head of mission in North Kivu.

The fighting and positioning of combatants so close to the camps has forced MSF to suspend its activities in Mugunga and Bulengo. An MSF team is assessing population movements and is ready to intervene if necessary. Since the shooting began, residents of Mugunga III camp fled to other nearby camps or farther into the city of Goma in search of safety.

“A quarter of the camp has emptied. People are continuing to leave, afraid they'll end up trapped. Those who remain are distraught, not knowing where to go or how to react. People are panicking," Goffeau said.

Six shells landed in the area of Mugunga on May 21, injuring at least four people. An MSF team was able to transfer them to a nearby hospital supported by the International Committee of the Red Cross (ICRC). Towns in the area were affected by heavy artillery, which injured several people. The district of Ndosho, near Goma, took the brunt of shelling, with at least three people killed and more than a dozen wounded.

Last November, M23 launched a first attack on Goma and Sake, forcing many people to flee and seek refuge in camps west of Goma. Goma fell after 10 days, leading to negotiations with the Congolese government.

Renewed fighting between the FARDC and M23 comes ahead of UN Secretary-General Ban Ki-moon's visit to the country and the establishment of a special UN intervention brigade, which for the first time has a mandate to carry out targeted offensive operations against rebel groups in eastern DRC.

MSF provides primary care and secondary medical care in the province of North Kivu, working in health centers and mobile clinics. MSF supports referral hospitals in Mweso, Pinga, Masisi, Rutshuru, Walikale, and Kitchanga.

South Sudan: MSF Hospital Severely Damaged in Intentional Attack

Thu, 16 May 2013 09:11:00 GMT

South Sudan 2013 © Vikki Stienen/MSF

Destroyed medical supplies litter the ground outside the MSF hospital in Pibor.

BRUSSELS/NEW YORK, May 16, 2013—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today strongly condemned the deliberate damage and looting of its hospital in Pibor town, in South Sudan's Jonglei State, which has left tens of thousands of people without access to essential medical care.

The hospital's infrastructure was systematically damaged May 11–12 in order to render it unusable without major repairs. Therapeutic medical food and hospital beds were looted. The MSF structure is the only hospital facility for Pibor County, with the nearest alternative more than 90 miles away. The hospital's closure leaves roughly 100,000 people cut off from health care. Many of them have fled to the bush amid conflict between the South Sudan Army (SPLA) and the David YauYau armed militia group.

"A special effort was made to destroy drug supplies by strewing them on the ground, to cut and slash the warehouse tents, to ransack the hospital wards, and even to cut electricity cables and rip them from the walls," said Richard Veerman, MSF operations coordinator for South Sudan.

From January to March, the Pibor hospital treated 3,000 people and provided surgical care to more than 100 people suffering war-related injuries, including SPLA soldiers. Prior to the attack, MSF was forced to suspend activities in Pibor on April 19 because of threats and intimidation of staff and patients.

"The rainy season has just started and we know from previous years that malaria and respiratory diseases such as pneumonia will start to claim lives if there is no health care available," Veerman said. In a report issued in November last year, South Sudan's Hidden Crisis, MSF documented the devastating health consequences when people are forced to flee to the bush.

An MSF team was preparing to return and restart medical activities when the looting and destruction took place. It was the sixth time an MSF medical facility has been looted or damaged in Jonglei State in the past two years.

"It is unthinkable that there will be no health care whatsoever for the next six months for some 100,000 frightened and vulnerable people hiding in the swamps," Veerman said. "Unless we can return to resume medical activities and have the freedom to move to wherever people need assistance, this unthinkable scenario may become the horrific reality."

MSF urges the Government of South Sudan to meet its responsibilities to ensure full respect of medical humanitarian facilities and activities. MSF also calls urgently for assurances from all parties in the Jonglei State conflict that its medical teams have unhindered freedom to return to Pibor and the ability to reach out impartially to people in need of medical assistance, on either side of the conflict. Humanitarian and medical assistance is urgently needed in Pibor County and must be resumed in the coming days or weeks.

MSF works in Akobo, Nyirol, Pibor, and Uror counties in Jonglei State. The activities in all locations, including Gumuruk Clinic in Pibor County, continue to function, with the exception of the hospital in Pibor town and the MSF clinic in the village of Lekwongole in Pibor County, which was targeted and damaged in August 2012 and where insecurity and fighting have made access impossible for MSF.

DRC: MSF Treats Survivors of Attack on Village in North Kivu

Thu, 16 May 2013 07:32:00 GMT

DRC 2008 © MSF

Patients recover from surgery in an MSF facility in Rutshuru, North Kivu Province.

GOMA, DEMOCRATIC REPUBLIC OF CONGO/NEW YORK, MAY 16, 2013—Men armed with bayonets, machetes, and wooden clubs attacked the village of Mpeti in North Kivu Province in the Democratic Republic of Congo on the morning of May 14, killing and seriously injuring civilians, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), which is treating survivors of the attack, said today.

Among the wounded under treatment at Mweso Hospital, some 25 miles from Mpeti, are two young children, one of whom was orphaned in the attack. The mother and 18-month-old baby brother of the other child under treatment were also killed.

"This was a deplorable and brutal attack in which young children were targeted and their parents killed," said Hugues Robert, MSF’s head of mission in Goma. "MSF condemns in the strongest terms attacks of this kind against civilians."

Two young children with multiple stab injuries in the chest, back, and head and one adult male with multiple stab injuries in the back and neck were admitted to the MSF facility, according to MSF Surgeon Martin Jarmin. "Currently all patients are stable and we hope they will make a good recovery," he said.

Survivors described indiscriminate violence aimed at civilians, resulting in many deaths. Corpses were apparently thrown in a river.

"I suspect that many more died in Mpeti during this attack, either directly from their injuries or because they were unable to get immediate medical attention in the hours that followed," said Robert. "I fear that the patients we have been able to treat are just the tip of the iceberg."

MSF supports a health center in Mpeti that treats roughly 300 patients per week, mostly for malaria and other common diseases. Since the beginning of the year, insecurity and fighting between armed militias in control of different parts of the area have repeatedly forced Mpeti's roughly 1,000 residents to flee their homes and at times prevented the MSF medical team from accessing patients in need. The village is fully deserted at the moment.

Pakistan: More than 110 Treated for Blast Wounds Ahead of Elections

Fri, 10 May 2013 06:10:00 GMT

Pakistan 2012 © Haroon Khan/MSF

MSF medical staff examines patient in surgical ward in Hangu Tehsil Headquarters (THQ) Hospital. MSF supports the Hangu THQ Hospital by running emergency room and providing surgical care.

ISLAMABAD/NEW YORK, MAY 10 2013—Teams from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), together with Ministry of Health staff, have treated more than 110 people for blast injuries from election-related violence in Khyber Pakhtunkhwa Province and the Federally Administered Tribal Areas over the past four days, MSF said today.

Pakistan is experiencing an increase in violence related to the general and provincial elections taking place on May 11, in the country's first democratic transition of power. MSF staff treated patients for blast injuries at facilities in Hangu and Lower Dir, Khyber Pakhtunkhwa, and Kurram Agency in the Federally Administered Tribal Areas.

"The escalation in violence has caused massive devastation over a short period of time," said Jean Guy Vataux, MSF country representative in Pakistan. "This is exacerbating an already very difficult situation for the Pakistani people who continue to bear the brunt of these violent acts on every level."

Noncombatants have been the primary victims of the recent violence, which follows several months of armed conflict in Pakistan that mainly injured members of the security forces and armed militants, according to Pakistani media reports.

MSF has been present in Pakistan since 1986, working with Pakistani communities and Afghan refugees. MSF teams have been providing primary and secondary health care in several locations across the country, where people are greatly affected by armed conflict and natural disasters or lack of access to medical care.

MSF teams are currently providing free emergency medical care in Kurram Agency, Bajaur Agency, Khyber Pakhtunkhwa, Balochistan, and Sindh provinces.

MSF relies solely on private financial contributions from individuals around the world and does not accept funding from any government, donor agency, military or politically-affiliated group, for its activities in Pakistan.

Countries Must Fix Critical Access to Medicines Flaws in Trans-Pacific Trade Pact

Wed, 08 May 2013 07:00:00 GMT

India 2013 © Sami Siva

A multi-drug resistant tuberculosis patient's drug regimen.

TAKE ACTION: Tell Members of Congress to Protect Access to Lifesaving Medicins

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LIMA/NEW YORK, MAY 14, 2013—As negotiations for the Trans-Pacific Partnership (TPP) restart in Lima, Peru, tomorrow, countries must prioritize fixing critical flaws in the agreement that could leave millions of people in developing countries with limited access to affordable generic medicines, international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

“Substantive discussions on access to medicines have languished for more than a year, with negotiating countries and many other groups, including MSF, voicing concerns about the damaging impacts of the proposed rules,” said Judit Rius Sanjuan, U.S. Manager of the MSF Access Campaign. “The Lima round offers a key opportunity for TPP negotiators to remove harmful provisions from this trade agreement before it’s too late.”

Negotiations on the TPP—a far-reaching trade agreement between 11 Pacific Rim countries—continue to be shrouded in secrecy, but leaked copies of the agreement reveal that the United States is demanding the most harmful package of intellectual property protections ever proposed for a trade agreement with developing countries.

These rules would make it extremely difficult for generic competitors to enter the market, keeping prices unaffordably high, with devastating public health consequences. The proposed provisions would, for example, lower patentability standards, making it much easier for pharmaceutical companies to obtain secondary patents and extend product monopolies for existing drugs; prohibit challenges to weak or invalid patents until after they have been granted; and grant backdoor monopolies by locking up clinical data needed to approve generic drugs.

For more information, please refer to MSF’s 2013 TPP Briefing Note, available in English and Spanish at msfaccess.org/tpp.

“The TPP threatens to constrain countries’ ability to limit abusive patenting and to ensure timely access to the affordable generic medicines that are so critically important to treatment providers like MSF,” said Dr. Jonathan Novoa Cain, president of MSF Latin America. “Alarmingly, the TPP is slated to become the ‘gold standard’ for future trade agreements across the globe, which means that unless these provisions are rejected now, they will be replicated and imposed on many more developing countries in the coming years.”

International rules require governments to grant 20-year patents on pharmaceuticals, but they also allow critical flexibilities in controlling the quality of patents, and in determining under what conditions companies can obtain additional patents on existing drugs. Companies have developed a variety of tactics to extend monopoly protection on their drugs beyond the initial 20-year period, a practice commonly referred to as ‘evergreening.’ It is up to governments to prevent evergreening by putting safeguards in place which balance commercial interests with public health needs.

One example is India’s Section 3(d) law, which aims to achieve this balance, and curb evergreening, by prohibiting the granting of secondary patents on existing drugs unless they are substantially more effective than the original drug. Pharmaceutical company Novartis recently lost a seven-year legal battle—which was taken all the way to the Indian Supreme Court—in an attempt to challenge the application of this law. If accepted in its current form, the TPP would take away governments’ ability to implement similar safeguards.

MSF urges governments involved in the TPP negotiations to reject provisions that will harm access to medicines.

DRC: Thousands Flee Violence in Pinga, North Kivu

Thu, 02 May 2013 09:02:00 GMT

DRC 2013 © MSF

The sign outside the health center in Pinga, where armed conflict has made provision of care difficult.

GOMA, DEMOCRATIC REPUBLIC OF CONGO/NEW YORK, MAY 2, 2013—Thousands of people have fled the town of Pinga in recent days amid a new wave of armed conflict in the Democratic Republic of Congo (DRC)'s North Kivu Province, making it very difficult to ensure that they receive essential medical care, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Many residents fled to the surrounding forests after attacks began on April 28, while others sought refuge at a local hospital, only to be forced out by armed men. Eleven of MSF's Congolese staff members are missing. Houses have been burned and looted, and a combatant was decapitated, further increasing the level of panic and alarm in town.

"Civilians are routinely exposed to this violence—this is the eighth time Pinga has changed hands since 2012," said Jan Peter Stellema, MSF's operations manager in Goma. "A number of patients had to be transferred for emergency surgery to Goma, among them a 70-year-old woman shot in the arm."

While over the past year MSF has been running a large clinic in Pinga and supporting the town hospital and other clinics in the area, frequent violence has made it extremely challenging for MSF to negotiate access with multiple armed actors. Health centers have been looted and medical equipment destroyed.

"Providing health care is proving a challenge when medical facilities are not respected, staff are missing, people have fled the area and those who remain fear being subjected to harsh treatment, illegal taxation, forced recruitment or worse," Stellema said.

Despite challenging conditions, MSF continues to provide high quality medical care in four reference hospitals, 12 health centers and four health posts in North Kivu province, and four reference hospitals, 19 health centers and five health posts in South Kivu. MSF also operates several cholera treatment centers, weekly mobile clinics, and emergency response activities.

Yemen: Migrants Abused, Tortured by Smugglers

Wed, 01 May 2013 14:36:00 GMT

Yemen 2013 © Anna Surinyach

Many migrants pass through Haradh town on their way to Saudi Arabia, whose border is just a few kilometers away.

SANA’A, YEMEN/NEW YORK, MAY 1, 2013—Authorities in Yemen have freed more than one thousand migrants from Somalia and Ethiopia, many suffering from torture and sexual abuse while forcibly held by human smugglers, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), which has treated the migrants, said today.

Since April 7, Yemeni authorities have freed 1,620 people held by smugglers in farms in Haradh region in the north of Yemen. Some of the migrants had been held for months and displayed signs of torture and other physical, sexual, and emotional abuse. Some had their fingernails pulled out or their tongues partially cut off. Others had been severely beaten.

“Many of the migrants are physically and mentally exhausted and are suffering from severe mental trauma due to the horrific conditions and treatment they experienced during their detention,” said Angels Mairal, an MSF psychologist in Haradh.

Many of the migrants treated by MSF were suffering from life-threatening diseases, including pneumonia, complicated malaria, and dengue. Most of the migrants referred by MSF to its hospital in Al-Mazraq, located near Haradh town, were victims of human trafficking, forced labor, and slavery. The majority of those receiving psychological support by MSF have reported being tortured. Among the migrants assisted, 62 are children and 142 are women; 71 severely ill people were admitted to the hospital.

Yemen is located along one of the main people smuggling routes from the Horn of Africa to the Gulf States. Many Ethiopian migrants fleeing extreme poverty try to enter Saudi Arabia through Haradh. They often end up in the hands of smugglers who extort money through torture and psychological abuse.

The freed migrants’ medical and humanitarian needs were extensive since some had not eaten for up to seven days before their release by Yemeni authorities. MSF provided some supplementary food rations and also improved sanitary conditions in both Haradh and Amran transit locations.

From Haradh, 800 Ethiopians have been transferred to migrant centers in the capital Sana’a, where they await repatriation; 550 Somalis were transferred to a refugee camp in Aden. However, those locations do not have the capacity and services to adequately assist the inhabitants.

“We are facing an emergency on top of this chronic situation and we are extremely worried about the future of thousands of migrants who are stranded in Yemen generally and in Haradh in particular,” said Tarek Daher, MSF’s head of mission in Yemen. “They are exhausted after so many attempts to cross the border, and without any resources. The majority of them become beggars in the street of Haradh. They try to survive without any decent shelter, sanitation, or regular access to food.”

The Yemeni government has made notable efforts to free, host, and protect the newly liberated migrants in Haradh. This support must continue, along with assistance from the international community.

MSF, together with authorities and some nongovernmental organizations, is expanding its efforts to improve living conditions for the migrants stranded in Haradh and to improve access to health care for those who are released or who are in transit and awaiting repatriation.

MSF has been working in Hajjah governorate in the north of Yemen since 2009. The organization manages the hospital near Al Mazraq, which provides local and displaced people with basic and specialist health care, surgery, and emergency services. Since last year, MSF has been providing mental health assistance for migrants in Haradh town. MSF is also carrying out medical activities in Aden, Ad-Dhale, Abyan, and Amran governorates.

Increased Mental Health Care Needed in Iraq

Tue, 30 Apr 2013 15:54:00 GMT

Iraq 2009 © Khalil Sayyad

Basra, where MSF established an international team in 2008

BAGHDAD/NEW YORK, APRIL 30, 2013—The Iraqi Ministry of Health and its supporters should improve access to mental health care services for a population still reeling from decades of conflict, political instability, and social upheaval, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said in a report released today.

The report, Healing Iraqis: The Challenges of Providing Mental Health Care in Iraq, shows how the toll of day-to-day violence has affected Iraqis, leaving people vulnerable to psychological stress, mental health disorders, and in dire need of mental health care services. It calls on the Iraqi Ministry of Health (IMoH) to improve mental health care services by integrating counseling into existing health facilities across Iraq. MSF also noted that more must be done to reduce the stigma of accessing mental health services in order to encourage more people to seek counseling

“Many Iraqis have been pushed to their absolute limit,” said Helen O’Neill, MSF’s head of mission in Iraq. “Mentally exhausted by their experiences, many people struggle to understand what is happening to them. The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental health care services that people can turn to for help,” she said.

Since 2009, MSF and the IMoH have introduced psychological counseling services in two hospitals in Baghdad and one in Fallujah. The programs focus on non-pharmaceutical approaches to address anxiety and depressive disorders commonly experienced by people exposed to violence and uncertainty. There are plans to replicate this counseling model across the country, with the IMoH starting programs in Kut, Karbala, and Sulaymaniyah hospitals.

According to patient data collected in 2012 by MSF and the IMoH, 97 percent of people who presented for counseling reported clinically significant psychological symptoms at admission. When measured on the last visit, the figure was reduced to 29 percent. Even when excluding domestic conflict, almost half of all cases seen in the program—48 percent—were violence-related. Nearly all staff and patients in the mental health program have either directly experienced or know someone close to them who has been directly affected by a violent event over recent years.

The report includes testimonies from Iraqis traumatized and struggling to rebuild lives after witnessing extreme violence.

A 36-year-old widowed mother of three describes how she began counseling sessions after her husband was killed.

“I lost my husband two years ago and the incident affected my life,” she said. “It changed my life, it turned my life upside down. I’m now the only one left responsible for raising my kids.”

One child, ten years old, describes how counseling has helped her improve her speech:

“I started attending the sessions to help improve my speech and help me overcome my fear,” she said. “I’m scared of everything. My body is always shivering. I can’t spell words correctly anymore. My teacher and my fellow classmates beat me all the time in school. I can’t study or learn anything. I’m unable to concentrate. I don’t talk to anyone. This is the first time I’ve talked to anyone about my problems.”

Chad: Urgent Need for Aid to 50,000 Displaced by Darfur Violence

Fri, 26 Apr 2013 06:03:00 GMT

Chad 2013 © MSF

Sudanese refugees in Chad.

TISSI, CHAD/NEW YORK, APRIL 26, 2013—Violent clashes in Sudan's Darfur region have driven approximately 50,000 people across the border into southeastern Chad since early March, where a lack of food, water, shelter, and basic services is developing into a humanitarian crisis, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

In addition to Sudanese refugees, the displaced population includes citizens from Chad and the Central African Republic who previously took refuge in Darfur. Humanitarian assistance is urgently needed before the looming rainy season cuts off road access to many areas, MSF said.

“We arrived in Tissi in the first week of April to respond to a measles outbreak among the local population and refugees,” said Stefano Argenziano, head of mission for MSF. “It soon became clear to us that families have other urgent needs. Most of the recently arrived refugees have no access to health care, food, or clean water. They live mostly under trees, which do not provide much shade, and they have nothing with which to protect themselves against the dust and heat during the day and the cold during the night.”

The health status of the refugees is likely to deteriorate rapidly, making them vulnerable to malaria, malnutrition, and epidemics.

Since the Tissi area has no functioning hospital, MSF teams are providing emergency and primary health care to the refugee and Chadian populations. An emergency room has been set up in the town of Tissi to treat the wounded, children under the age of five, and pregnant women. To date, MSF has treated 40 patients who suffered from bullet and knife injuries while fleeing the conflict, and an additional 24 local residents who were wounded in a road accident. Eighteen severely wounded patients were stabilized and evacuated to the town of Abeche, in cooperation with the International Committee of the Red Cross (ICRC).

In Tissi itself, MSF has improved the capacity of the town’s only source of clean water and is planning to hold mobile clinics at the surrounding sites. An emergency team has completed vaccinating 30,200 people under the age of 15 and has treated 52 patients for measles. During a measles vaccination, MSF screened 13,700 children for malnutrition and admitted 120 children into a therapeutic feeding program.

The living conditions of the displaced population, the majority of whom are women and children, are deteriorating quickly. Parents have told MSF teams that their children are increasingly falling ill. With the onset of the rainy season just two months away, time is running out, MSF said.

“Once the rainy season starts, our access to these camps will be impossible by road and the refugees will be completely cut off," Argenziano said. "With poor sanitary conditions and the lack of access to clean water, we are monitoring for an increase in malaria and respiratory infections, and also for a possible outbreak of cholera.”

None of the sites where the refugees have settled are official refugee camps. Due to the proximity of the sites to the Sudanese border and security concerns, UN agencies and most aid organizations have to-date been reluctant to provide assistance.

MSF has been working in Chad since 1983 and currently has projects in Am Timan, Abeche, Massakory, and Moissala.

Niger: Deadly Malaria and Malnutrition Season Approaching

Thu, 25 Apr 2013 05:27:00 GMT

Niger 2012 © Tanya Bindra

An MSF nurse inserts an IV drip for a malnourished child in Guidan Roumdji, where the populace is facing a peak of malaria and malnutrition.

MADRID/NEW YORK, APRIL 25, 2013—Increasing numbers of children are being treated for malaria and malnutrition in southern Niger compared to one year ago, suggesting that 2013 may see higher peaks of the two diseases than in previous years, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned in a report released today.

With the rainy season approaching, and more cases of malnutrition and malaria expected, an integrated approach to preventing and treating malaria and malnutrition together is essential in order to stave off another crisis.

“Urgent action is needed to stop children from continuing to die from these preventable causes,” said Luis Encinas, MSF’s program manager for Niger. “To tackle malnutrition and malaria, we need innovative approaches, and we need to work on two levels at the same time: prevention and cure.”

Malaria and malnutrition are closely related. The months of the "hunger gap," when malnutrition is at its peak, coincide with the rainy season, when mosquitoes breed and malaria cases increase dramatically. The diseases combine in a vicious cycle: malnourished children have weakened immunity, making them susceptible to malaria, while children sick with malaria are more likely to become dangerously malnourished.

Last year's malaria peak led to more than 3,000 deaths in Niger. A retrospective mortality survey carried out by MSF in the districts of Madaoua and Bouza showed that deaths among children under five were at three times the emergency threshold, with malaria accounting for more than half of the deaths. The peak also caused a sharp increase in the number of children admitted to hospital with severe malnutrition.

Over recent years, strategies for combating malnutrition have shifted to include prevention in addition to treatment. A similar approach can be applied toward fighting malaria. MSF plans to implement a new malaria prevention strategy known as seasonal malaria chemoprevention (SMC) in Niger's Madaoua district this year. The strategy involves pre-emptively providing a full course of antimalarial treatment to children at intervals during the peak malaria season, from July to October. MSF successfully used this strategy in Mali and Chad in 2012.

“The effort being made to treat malnutrition in Niger is tremendous, and this needs to be supported,” said José Antonio Bastos, president of MSF in Spain. “The problem in 2012 was that a massive plan for treating malnutrition was prepared and implemented, but it excluded other health needs, in particular malaria prevention and immunizations. It failed to take account that even if you provide children with appropriate nutrition, you can still lose them to malaria or a respiratory infection. There is a need for an integrated response, rather than for pushing one response to the exclusion of others.”

Malaria prevention must be integrated into basic health measures aimed at all young children in Niger, MSF said.

MSF carried out a number of activities in Niger in 2012 aimed at improving access to health care for children under five and for pregnant women. Medical teams in the regions of Zinder, Maradi, and Tahoua run outpatient feeding programs in some 37 health centers. Severely malnourished patients requiring hospital care were admitted to inpatient feeding centers in Zinder, Magaria, Madarounfa, Guidan Roumdji, Madaoua, and Bouza. In 2012, more than 90,000 children with acute malnutrition and 390,000 children with malaria were treated in medical facilities managed by MSF and its partners.

DRC: Urgent Action Needed to Prevent Malaria Deaths in Orientale Province

Thu, 25 Apr 2013 05:01:00 GMT

DRC 2012 © Aurelie Lachant/MSF

A child is tested for malaria in Orientale Province.

APRIL 25, 2013—An upsurge in malaria is likely to have serious consequences for people in Orientale Province in Democratic Republic of Congo (DRC) unless immediate action is taken, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned on World Malaria Day today.

Mosquito nets and medical supplies are urgently needed as the rainy season approaches in a region where malaria is one of the main causes of death. Tackling recurrent outbreaks demands a firm commitment from Congolese health authorities and aid organizations, MSF said.

“Too many health centers lack the supplies necessary for coping with a new outbreak, and this is completely unacceptable,” said Dr. Narcisse Wega, MSF emergency coordinator.

A measles epidemic is also forecast to hit the province, putting children under five at the most risk.

Last year, MSF took emergency action to respond to a dramatic increase in severe malaria cases in the districts north of the city of Kisangani. In the areas of Ganga-Dingila, Buta, and Aketi, MSF provided outpatient malaria treatment to almost 60,000 people and inpatient treatment to more than 3,500 people.

Two mortality surveys carried out by MSF in 2012 showed extremely high mortality figures among children under five. In Pawa region, malaria killed more than one in 10 children. This is far from a unique situation in DRC, where outbreaks also occurred in the provinces of Maniema, Equateur, and Katanga.

Major deficiencies in the health system had contributed to the 2012 outbreak’s severity. The same situation can be seen this year: mosquito nets are not being sent to vulnerable areas, and there are shortages of rapid diagnostic tests, drugs, and equipment for carrying out blood transfusions—vital for children suffering from anemia caused by malaria. These vital supplies are still not listed in the supply list drawn up by donors. The cost of health services in DRC also prevents many people from accessing the treatment they need.

MSF calls for urgent action by all those involved in the fight against malaria in DRC. Adequate treatments and rapid diagnostic testing must be available as soon as possible in the remote areas of Orientale Province, while preventive measures such as the distribution of mosquito nets must start immediately, before the peak malaria season gets underway.

MSF has been working in Democratic Republic of Congo since 1981. In 2012, MSF treated more than 500,000 people for malaria throughout the country, including large numbers of children under the age of five.

Nigeria: MSF Treats Children for Lead Poisoning After Long Delay in Clean-Up

Tue, 23 Apr 2013 16:24:00 GMT

Nigeria 2012 © Olga Overbeek

Children work at the gold processing site in Bagega.

ABUJA, NIGERIA/NEW YORK, APRIL 23, 2013—Three years after the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) responded to an unprecedented outbreak of lead poisoning in Nigeria's Zamfara state, MSF is finally able to treat children in the badly affected village of Bagega now that a long-delayed program to remediate lead contamination is underway.

However, only one of four sections of the village has been remediated, and MSF cannot effectively treat children from the remaining three sections until lead has been successfully removed from their homes.

Acute lead poisoning, often caused by unsafe mining practices, can cause severe brain damage and death in children. In March 2010, MSF responded to reports of children dying mysteriously in communities across Zamfara state, northern Nigeria. An estimated 400 children died, and thousands more were discovered to have excessive and unprecedented levels of lead in their blood. MSF has treated more than 2,500 children in the state so far.

"MSF is very happy to have finally—after three years—begun medical treatment in Bagega," said Simon Tyler, MSF country representative in Nigeria. "MSF is, however, acutely aware that this group is only the first of four needing urgent medical treatment in Bagega. The ongoing remediation must be completed before the rains come in order for us to reach all of the children in need in the village."

Remediation involves the removal of lead-contaminated soils and mining and mineral processing wastes from the village, residential compounds, homes and buildings, common areas, wells, and ponds. Remediation is an essential condition for medical treatment—otherwise children are continually re-exposed to lead toxins, rendering the treatment ineffective.

In Bagega, patients are divided into four groups according to when remediation of their houses is complete. In the remediated section of Bagega, MSF has started 34 children on specialized chelation therapy to remove the lead from their blood, and will monitor a further 126 children. In total, MSF expects to have between 600 and 800 children in Bagega under care.

Remediation can only be carried out in the dry season. Delays in the release of urgently needed funding caused remediation to start late in Bagega, and these efforts have to be tripled before the rains come.

"We have achieved more than we had hoped to in a very short time in Bagega, but our teams are under tremendous pressure to finish the remediation on a very tight schedule," said Simba Tirima, director of field operations for the TerraGraphics Foundation, which is overseeing the remediation process. "Unfortunately, ongoing procedural delays have also slowed our pace significantly. Now everything depends on the rains. We are working around the clock to ensure that all of the children of Bagega have every opportunity to receive treatment by MSF as soon as possible."

Ultimately, solving the Zamfara crisis requires a triple approach: medical treatment, remediation, and safer mining practices. MSF maintains that safer mining practices must be introduced to ensure that people involved in mining and processing ore can do so without exposing themselves or others to lead poisoning.

MSF is a medical humanitarian assistance organization that has been providing emergency medical services throughout Nigeria since 1971. MSF is not affiliated with any religion, government agency, or political party.

Kenya: Thousands Affected by Tana River Delta Flooding

Fri, 19 Apr 2013 16:33:00 GMT

NAIROBI, KENYA/NEW YORK, APRIL 19, 2013—After weeks of flooding, thousands of people in Kenya's Tana River Delta region are in urgent need of food, shelter, clean drinking water and medical services, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, calling for more concerted efforts to aid those affected.

Rising waters have destroyed latrines, contaminated water sources and left nearly 7,000 people without access to health care, which is exacerbated by shortages of medicine at local facilities.

“We are concerned about the threat of waterborne and vector-borne disease outbreaks, which are common in situations of flooding," said Martha Kihara, MSF deputy medical coordinator in Kenya. "We are monitoring the situation so that we can detect and mitigate any disease outbreaks in a timely manner."

MSF has provided medical care and non-medical supplies to the displaced since the flooding began. Because many people were unable to bring any supplies with them when they moved to higher ground, MSF has distributed items including mosquito nets and plastic sheeting to more than 900 families. However, there is an urgent need for food supplies as many people have lost their crops and livestock.

“I left Chewele a week and a half ago after losing all my things in the floods," said one 36-year-old survivor, Riziki Juma, who is now living in Molokani displacement camp. "At least I managed to move with all my five children thanks to the efforts of my community. All our goats and other cattle drowned. Now I’m here and have received utensils, but there is nothing to cook!”

In a span of two weeks, MSF has carried out consultations and treated about 700 displaced people in Bura for diseases including upper respiratory tract infections, diarrhea, gastroenteritis and parasitic diseases.

MSF is also providing basic water and sanitation services, such as helping to build latrines and distributing water purification tablets, in Bura and Garsen and in the Dalango and Molokani displacement camps.

MSF has been working in Kenya since 1987. MSF is monitoring the situation in other areas affected by floods in Nyanza and Turkana. The organization also has projects in Kibera, Mathare, Homa Bay and Daadab refugee camp. MSF responds to medical emergencies in the country.

Global Vaccines Community Must Bring Price of New Vaccines Down

Fri, 19 Apr 2013 06:30:00 GMT

The GAVI Alliance is an international public-private partnership whose stated mission is to increase access to immunization for children in poor countries. GAVI co-finances the cost of vaccines with qualifying countries. Participants include governments of developing and donor countries, the World Health Organization, UNICEF, the World Bank, the vaccine industry, research and technical agencies, the Bill & Melinda Gates Foundation and other philanthropic organizations.

ABU DHABI, APRIL 23, 2013—On the eve of the high-level Global Vaccines Summit hosted by Ban Ki-Moon, Bill Gates, and General Sheikh Mohamed bin Zayed Al Nahyan, the crown prince of Abu Dhabi, international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned that high prices for new vaccines could put developing countries in the precarious situation of not being able to afford to fully vaccinate their children in the future.

“Urgent action is needed to address the skyrocketing price to vaccinate a child, which has risen by 2,700 percent over the last decade,” said Dr. Manica Balasegaram, executive director of MSF’s Access Campaign. “Countries where we work will lose their donor support to pay for vaccines soon, and will have to decide which killer diseases they can and can’t afford to protect their children against.”

The "Decade of Vaccines," the global vaccination initiative for the next ten years, is estimated to cost US$57 billion, with more than half going to pay for the vaccines themselves. In 2001, it cost $1.37 to fully vaccinate a child against six diseases. While 11 vaccines are included in today’s vaccines package, the total price has risen to $38.80, largely because two expensive new vaccines—against pneumococcal disease and rotavirus—have been added, which make up three-quarters of that cost. They are only produced by Pfizer, GlaxoSmithKline (GSK), and Merck. Newer vaccines are significantly more expensive: vaccinating a child against measles costs $0.25, while protecting a child against pneumococcal diseases costs, at best, $21.

MSF vaccinates millions of people each year and fully supports the introduction of new vaccines in developing countries. But negotiations between companies and the largely taxpayer-funded GAVI Alliance for the newest vaccines have not resulted in deeper price cuts that would help more children benefit. The lack of transparency by companies on vaccine manufacturing costs and their focus on profits above ensuring sustainable prices for vaccines for low-income countries are at the root of the problem.

GAVI has recently announced a new deal to reduce the price of pentavalent vaccine. This is an excellent example of what GAVI can achieve, especially when there are multiple vaccine manufacturers in a market and healthy competition. GAVI should urgently prioritize further negotiations for the two newest and most expensive vaccines and pharmaceutical companies should come to the table to offer GAVI better deals.

“When you start from over-inflated prices charged in rich countries, even getting 90 percent off means paying a price that is much too high for poor countries to afford long term,” said Kate Elder, vaccines policy advisor at MSF’s Access Campaign. “The goal here is to get more children vaccinated with taxpayers’ money. To do that, we need to see prices much closer to the cost of production. GAVI should do more to speed up the entrance of manufacturers with lower costs, so that real competition can lower prices. This is particularly important for the newest vaccines which are unreasonably expensive.”

MSF is also troubled by the fact that non-governmental organizations and humanitarian actors are excluded from accessing the GAVI-negotiated price discounts. MSF is often in a position to vaccinate vulnerable groups, such as refugee children, HIV-positive children, and older unvaccinated children who fall outside of the typical age range for standard vaccination programs. However, MSF has not been able to systematically access the lowest prices negotiated by GAVI, having to resort to lengthy negotiations with Pfizer and GSK over the last four years to access the pneumococcal vaccine. While the companies have offered MSF donations, this is not a sustainable, long-term solution for MSF as we work to respond quickly to needs in the field, and wish to expand vaccination of vulnerable groups in an increasing number of countries.

“We’re asking GAVI to open up their discounted vaccine pricing to humanitarian actors that are often best placed to respond to vaccinating people in crisis,” said Dr. Balasegaram.

Hunger Strikes Malian Refugees Stranded in Mauritanian Desert

Fri, 12 Apr 2013 13:43:00 GMT

Houmou Ag Amamili arrived in the Mbera camp on November 14, 2013. As of March 11 he still had not received a tent in which to live.

NOUAKCHOTT, MAURITANIA/NEW YORK, APRIL 12, 2013—Conflict in Mali has driven nearly 70,000 refugees to Mbera camp in the Mauritanian desert, where appalling conditions and inadequate assistance are leading to severe malnutrition and deaths from preventable diseases, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said in a report released today.

Conditions in the camp worsened following an influx of 15,000 refugees in the aftermath of the joint military intervention by French and Malian forces in Mali in January. The number of consultations in MSF's clinics in the Mbera camp increased from 1,500 to 2,500 per week. The number of children admitted per week for severe malnutrition more than doubled, from 42 to 106, despite the fact very few children were malnourished when they arrived at the camp.

"These statistics show that the refugees have grown weaker while in the camp, the very place where they should have been receiving assistance, including correctly formulated food rations from aid organizations," said Henry Gray, MSF emergency coordinator.

The report, Stranded in the Desert, calls for urgent action by aid organizations to meet the refugees' basic needs. In January there was only one latrine for every 3,000 refugees, and people were receiving just 11 liters of water per day, instead of a required 20 liters. Many people have been living under makeshift shelters made of scraps of cloth and sticks. While more latrines are being built, conditions remain extremely difficult.

"There has clearly been a lack of preparation for this new influx of refugees,” said Gray. “While the situation has improved in recent weeks, it remains extremely precarious and aid organizations need to maintain their humanitarian response for as long as necessary. Shelter, clean water, latrines, and food must reach all of those in need, and be sustained at the minimum humanitarian standards."

Drawing on testimonies from over 100 refugees in Mbera, the report also reveals how open conflict, inter-communal tensions, fear of violent reprisals, food insecurity, and lack of basic services have forced people to flee, mostly from the Timbuktu area of Mali. They arrived in Mauritania only to become isolated in the middle of the desert and totally dependent on outside assistance and humanitarian aid.

"In northern Mali, entire communities are currently displaced within their country or have escaped abroad as refugees," Gray said. "Most of the refugees are from the Tuareg and Arab communities. They fled pre-emptively, often from fear of violence due to their presumed links with Islamist or separatist groups. Their home in northern Mali is still in the grip of fear and mistrust."

MSF has been working in Mauritania since the arrival of the first refugees in early 2012, and has frequently warned that the appalling conditions in Mbera are having alarming health consequences for refugees. In November 2012, MSF conducted a retrospective nutritional mortality survey that revealed death rates above emergency levels among children under two years of age.

MSF runs medical and humanitarian programs in the Malian regions of Mopti, Gao, Sikasso, and Timbuktu, as well as for Malian refugees in Burkina Faso, Mauritania, and Niger. In Mauritania, MSF supports four primary health care centers in the Mbera camp and at the Fassala border crossing post, and runs a surgical program in the town of Bassikounou. Since starting to work in Mauritania in February 2012, MSF teams have conducted 85,000 medical consultations, assisted in 200 deliveries and treated nearly 1,000 children suffering from severe malnutrition.

Central African Republic: Government Must Ensure Security

Wed, 10 Apr 2013 08:27:00 GMT

A young patient, wounded in the fighting between armed groups, is treated in an MSF facility.

BANGUI, CENTRAL AFRICAN REPUBLIC/NEW YORK, APRIL 10, 2013—Uncontrolled armed groups in the Central African Republic (CAR) are spreading chaos and leaving civilians without urgently needed medical care and humanitarian aid, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

MSF's facilities have been robbed and looted on multiple occasions, and entire communities are cut off from medical care due to insecurity. The new Seleka government must take responsibility for establishing control over lawless armed groups, in part to ensure access to health care, MSF said.

"MSF remains extremely concerned for the well-being and health of the population," said Sylvain Groulx, MSF head of mission in Bangui. “Even in times of peace, people endure daily hardships just to survive. Before the recent events, mortality rates related to preventable and treatable diseases were already above emergency thresholds in many areas of the country. The insecurity today is pushing already fragile coping mechanisms to the limit.”

MSF's medical teams were forced to evacuate the towns of Batangafo and Kabo due to robberies and other violence. MSF was the only humanitarian organization providing medical care in the area, which has a population of more than 130,000 people.

Similar incidents forced MSF's international staff to evacuate the town of Boguila, where a skeleton team of national staff continues to operate a hospital.

Insecurity is preventing MSF from reaching other areas with significant medical needs, including the town of Bossangoa, where a public hospital was looted. Hospital staff reportedly fled.

MSF's facilities in Bangui have been looted multiple times since Seleka authorities took control of the city, resulting in significant losses of equipment, medicines, cash, and vehicles.

MSF teams in Bangui are still providing medical support at Bangui Community Hospital, which suffers from shortages of water, electricity, and qualified medical staff. While violence in Bangui has reduced, people wounded in recent clashes continue to require significant medical care.

An MSF report, Central African Republic: A State of Silent Crisis, documents the appalling state of health conditions in the country, even during peacetime.

MSF has been working in CAR since 1997 and operates programs in five of the country's seven health districts. In collaboration with the Ministry of Health, MSF supports seven hospitals and at least 38 health posts. MSF projects in CAR provide malaria treatment, basic health care, HIV and tuberculosis care, treatment of neglected diseases, nutrition programs, vaccination, and surgery.

Mali: All Parties Must Respect Access to Health Care

Wed, 03 Apr 2013 05:20:00 GMT

Timbuktu, Mali

APRIL 3, 2013—Following deadly clashes in Timbuktu, Mali, on March 30–31, Doctors Without Borders/Médecins Sans Frontières (MSF) teams working in the city’s hospital treated 21 wounded people, including 11 civilians, two of whom died.

Sporadic clashes between soldiers and armed groups prevent residents from traveling within Timbuktu, and people have reportedly died from their injuries because of their inability to reach health facilities due to the fighting. MSF calls on all warring parties to respect civilian populations and to facilitate access to medical facilities.

For more than one year, MSF teams have been providing medical care, including surgery, to patients and wounded persons associated with all parties to the conflict. In recent months, MSF has admitted approximately 40 patients and performed an average of 15 operations per week at the Timbuktu hospital.

In addition to its work in Timbuktu, MSF is treating malnutrition and malaria in four district health centers and at Niafounké Hospital. To address the medical needs related to the conflict in the northern part of the country, MSF is working in Gao, Ansongo, Douentza, Konna, and Boré, and with Malian refugees in Mauritania, Niger and Burkina Faso. MSF is also providing pediatric care in a hospital and in five treatment centers in Koutiala district in the south of Mali.

Indian Supreme Court Decision on Novartis Case a Victory for Access to Medicines in Developing Countries

Mon, 01 Apr 2013 14:37:00 GMT

NEW DELHI/GENEVA/NEW YORK, APRIL 1, 2013—The landmark decision by the Indian Supreme Court in Delhi to uphold India's Patents Act in the face of a seven-year challenge by Swiss pharmaceutical company Novartis is a major victory for patients' access to affordable medicines in developing countries, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) stated today.

“This is a huge relief for the millions of patients and doctors in developing countries who depend on affordable medicines from India, and for treatment providers like MSF," said Dr. Unni Karunakara, MSF’s international president. “The Supreme Court's decision now makes patents on the medicines that we desperately need less likely. This marks the strongest possible signal to Novartis and other multinational pharmaceutical companies that they should stop seeking to attack the Indian patent law.”

India began granting patents on medicines to comply with international trade rules, but designed its law with safeguards—including a clause known as Section 3(d)—that prevent companies from abusing the patent system. Section 3(d) prevents companies from gaining patents on modifications to existing drugs, in order to gain indefinite, interminable monopolies.

Novartis first took the Indian government to court in 2006 over its 2005 Patents Act because it wanted a more extensive granting of patent protection for its products than what was offered by Indian law. In a first case before the High Court in Chennai, Novartis claimed that the act did not meet rules set down by the World Trade Organization and was in violation of the Indian constitution. Novartis lost this case in 2007, but launched a subsequent appeal before the Supreme Court in a bid to weaken the interpretation of the law and empty it of substance. All of the claims by Novartis were rejected by the Supreme Court today.

“Novartis's attacks on 3(d), one of the elements of India's patent law that protect public health, have failed,” said Leena Menghaney, India manager for MSF’s Access Campaign. “Patent offices in India should consider this a clear signal that the law should be strictly applied, and frivolous patent applications should be rejected.”

Although Novartis’s repeated legal attacks on 3(d) aimed to ensure even more patents were granted in India, including on existing medicines, the company has expressed concerns over the implications of today’s decision on the larger question of financing medical innovations.

“At the moment, medical innovation is financed through high drug prices backed up by patent monopolies, at expense of patients and governments in developing countries who cannot afford those prices,” said Dr. Karunakara. “Instead of seeking to abuse the patent system by bending the rules and claiming ever-longer patent protection on older medicines, the pharmaceutical industry should focus on real innovation, and governments should develop a framework that allows for medicines to be developed in a way that also allows for affordable access. This is a dialogue that needs to happen. We invite Novartis to be a part of the solution, instead of being part of the problem.”

Central African Republic: All Parties Must Allow Access to Health Care

Mon, 25 Mar 2013 07:03:00 GMT

A sign prohibits firearms in an MSF facility in a town outside Bangui.

BANGUI, CENTRAL AFRICAN REPUBLIC/NEW YORK, MARCH 25, 2013—As the opposition group Seleka takes charge of Bangui, all parties to the conflict in the Central African Republic must respect health facilities and guarantee the population's access to health care, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Violence and insecurity in Bangui over the last 48 hours have seriously disrupted MSF's operations and prevented critically wounded patients from being referred to surgical facilities. Displaced people throughout the country and in major cities taken by Seleka are also too fearful to access health facilities. MSF facilities in Bangui and Batangafo have been looted and robbed.

“MSF condemns the looting and robberies of our facilities and reminds all parties that medical personnel must be respected and protected and must be granted all available help in the performance of their duties,” said Serge St. Louis, MSF head of mission in Bangui.

All parties to the conflict must respect medical structures, ambulances, medical personnel, and sick and wounded patients, and guarantee access to health facilities without the risk of being targeted, MSF said.

Insecurity and violence is preventing 23 wounded patients at MSF's emergency project in Sibut from being referred to Bangui for further treatment.

MSF operations continue in Carnot, Paoua, Mboki, Zemio, Boguila, Batangafo, Kabo, Sibut, and Ndele. Once security conditions allow, MSF will assess medical needs in Bangui and other cities and undertake emergency measures to respond to medical needs.

MSF has been assisting the population of the Central African Republic since 1996. The organization has approximately 80 international staff working in five of the country’s 17 prefectures.

Bahrain: Medical Ethics Conference Canceled

Sun, 24 Mar 2013 13:02:00 GMT

MARCH 24, 2013—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has been forced to cancel a conference on medical ethics due to take place in Bahrain in April because of a lack of assurances from authorities, MSF announced today.

The conference was to be held in the Bahraini capital, Manama, April 10–11. Doctors, hospital managers, and decision makers from across the Middle East were to discuss the challenges faced by medical staff in politically unstable contexts, and explore how hospitals can remain secure havens where health workers can freely perform their duties and patients can safely receive medical assistance.

“After a year of discussions, we still do not have the support we need to go ahead with the conference,” said Dr. Bart Janssens, MSF director of operations. “As a result, we are forced to conclude that today in Bahrain it is not possible for medical professionals and international impartial participants to have a conversation about medical ethics.”

The uprisings in the Middle East and North Africa continue to present numerous challenges to medical and humanitarian organizations, and to negatively impact the delivery of care to patients.

“We strongly believe in the relevance of this topic and will be identifying other locations in the region where it is possible to have a discussion about medical ethics,” said Dr. Janssens.

MSF first provided support to victims of violence in Bahrain in March 2011 after the onset of civil unrest there. In 2011 and 2012, MSF submitted several proposals to Bahrain’s Ministry of Health to carry out medical activities, including accompanying patients to health facilities to verify that staff, patients, and security personnel were acting in compliance with universally recognized medical ethics. MSF also offered to provide mental health care and technical support in emergency preparedness.