Médecins Sans Frontières

Médecins Sans Frontières

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, or Doctors Without Borders, is a secular
Secularism
Secularism is the principle of separation between government institutions and the persons mandated to represent the State from religious institutions and religious dignitaries...

 humanitarian-aid
Humanitarian aid
Humanitarian aid is material or logistical assistance provided for humanitarian purposes, typically in response to humanitarian crises including natural disaster and man-made disaster. The primary objective of humanitarian aid is to save lives, alleviate suffering, and maintain human dignity...

 non-governmental organization best known for its projects in war-torn regions and developing countries
Developing country
A developing country, also known as a less-developed country, is a nation with a low level of material well-being. Since no single definition of the term developing country is recognized internationally, the levels of development may vary widely within so-called developing countries...

 facing endemic disease
Endemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...

s. Its headquarters are in Geneva
Geneva
Geneva In the national languages of Switzerland the city is known as Genf , Ginevra and Genevra is the second-most-populous city in Switzerland and is the most populous city of Romandie, the French-speaking part of Switzerland...

, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....

. The organization is known in most of the world by its French name or simply as MSF, but in Canada and the United States the name Doctors Without Borders is commonly used. In 2007 over 26,000, mostly local, doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers and administrators provided medical aid in over 60 countries. Private donors provide about 80% of the organization's funding, while governmental and corporate donations provide the rest, giving MSF an annual budget of approximately US$400 million.

was created in 1971 by a small group of French doctors and journalists in the aftermath of the Biafra secession
Nigerian Civil War
The Nigerian Civil War, also known as the Nigerian-Biafran War, 6 July 1967–15 January 1970, was a political conflict caused by the attempted secession of the southeastern provinces of Nigeria as the self-proclaimed Republic of Biafra...

, who believed that all people have the right to medical care regardless of race, religion
Religion
Religion is a collection of cultural systems, belief systems, and worldviews that establishes symbols that relate humanity to spirituality and, sometimes, to moral values. Many religions have narratives, symbols, traditions and sacred histories that are intended to give meaning to life or to...

, creed or political affiliation, and that the needs of these people outweigh respect for national borders.

Core documents outlining MSF's principles are the Charter and the Chantilly Principles, along with the later La Mancha Agreement, which in Rules, Section 2 addresses governance. MSF has an associative structure, where operational decisions are made, largely independently, by the 5 operational centres (Amsterdam
Amsterdam
Amsterdam is the largest city and the capital of the Netherlands. The current position of Amsterdam as capital city of the Kingdom of the Netherlands is governed by the constitution of August 24, 1815 and its successors. Amsterdam has a population of 783,364 within city limits, an urban population...

, Barcelona-Athens
Athens
Athens , is the capital and largest city of Greece. Athens dominates the Attica region and is one of the world's oldest cities, as its recorded history spans around 3,400 years. Classical Athens was a powerful city-state...

, Brussels, Geneva
Geneva
Geneva In the national languages of Switzerland the city is known as Genf , Ginevra and Genevra is the second-most-populous city in Switzerland and is the most populous city of Romandie, the French-speaking part of Switzerland...

 and Paris). Common policies on core issues are coordinated by the International Council, in which each of the 19 sections (national offices) is represented. The International Council meets in Geneva
Geneva
Geneva In the national languages of Switzerland the city is known as Genf , Ginevra and Genevra is the second-most-populous city in Switzerland and is the most populous city of Romandie, the French-speaking part of Switzerland...

, Switzerland, where the International Office, which coordinates international activities common to the operational centres, is also based.

The organization actively provides health care and medical training to populations in about 70 countries, and frequently insists on political responsibility in conflict zones such as Chechnya
Chechnya
The Chechen Republic , commonly referred to as Chechnya , also spelled Chechnia or Chechenia, sometimes referred to as Ichkeria , is a federal subject of Russia . It is located in the southeastern part of Europe in the Northern Caucasus mountains. The capital of the republic is the city of Grozny...

 and Kosovo. Only once in its history, during the 1994 genocide in Rwanda
Rwandan Genocide
The Rwandan Genocide was the 1994 mass murder of an estimated 800,000 people in the small East African nation of Rwanda. Over the course of approximately 100 days through mid-July, over 500,000 people were killed, according to a Human Rights Watch estimate...

, has the organisation called for military intervention. In order to be able to speak and act freely, MSF remains independent of any political, religious or economic powers. The majority of MSF activities are paid for with private donations.

MSF received the 1999 Nobel Peace Prize
Nobel Peace Prize
The Nobel Peace Prize is one of the five Nobel Prizes bequeathed by the Swedish industrialist and inventor Alfred Nobel.-Background:According to Nobel's will, the Peace Prize shall be awarded to the person who...

 in recognition of its members' continuous effort to provide medical care in acute crises, as well as raising international awareness of potential humanitarian disasters. Dr. James Orbinski
James Orbinski
James Jude Orbinski, OC, OOnt, MSC is a Canadian physician, writer, and humanitarian activist. He is an associate professor of Medicine at the University of Toronto and a Fellow at the Munk School of Global Affairs. In January 2011, he also assumed the Chair of Global Health at the Dalla Lana...

, who was the president of the organization at the time, accepted the prize on behalf of MSF. Prior to this, MSF also received the 1996 Seoul Peace Prize
Seoul Peace Prize
The Seoul Peace Prize was established in 1990 as a biennial recognition with monetary award to commemorate the success of the 24th Summer Olympic Games held in Seoul, Korea, an event in which 160 nations from across the world took part, creating harmony and friendship...

. The current president of MSF is Dr. Unni Karunakara.

MSF should not be confused with Médecins du Monde
Médecins du Monde
Médecins du Monde or Doctors of the World, is a non-governmental humanitarian aid organisation created in March 1980 by 15 French doctors, including Bernard Kouchner after he had left Médecins Sans Frontières , the aid society which he had co-founded earlier in 1971...

 (Doctors of the World, in English). The latter organization was formed in part by members of the former organization, but it is an entirely independent non-governmental organization with no links to MSF today.

Biafra


During the Nigerian Civil War
Nigerian Civil War
The Nigerian Civil War, also known as the Nigerian-Biafran War, 6 July 1967–15 January 1970, was a political conflict caused by the attempted secession of the southeastern provinces of Nigeria as the self-proclaimed Republic of Biafra...

 of 1967 to 1970, the Nigerian military formed a blockade
Blockade
A blockade is an effort to cut off food, supplies, war material or communications from a particular area by force, either in part or totally. A blockade should not be confused with an embargo or sanctions, which are legal barriers to trade, and is distinct from a siege in that a blockade is usually...

 around the nation's newly independent
Secession
Secession is the act of withdrawing from an organization, union, or especially a political entity. Threats of secession also can be a strategy for achieving more limited goals.-Secession theory:...

 south-eastern region, Biafra
Biafra
Biafra, officially the Republic of Biafra, was a secessionist state in south-eastern Nigeria that existed from 30 May 1967 to 15 January 1970, taking its name from the Bight of Biafra . The inhabitants were mostly the Igbo people who led the secession due to economic, ethnic, cultural and religious...

. At this time, France was the only major country supportive of the Biafrans (the United Kingdom, the Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....

 and the United States sided with the Nigerian government), and the conditions within the blockade were unknown to the world. A number of French doctors volunteered with the French Red Cross
International Red Cross and Red Crescent Movement
The International Red Cross and Red Crescent Movement is an international humanitarian movement with approximately 97 million volunteers, members and staff worldwide which was founded to protect human life and health, to ensure respect for all human beings, and to prevent and alleviate human...

 to work in hospitals and feeding centres in besieged Biafra. One of the co-founders of the organisation was Bernard Kouchner
Bernard Kouchner
Bernard Kouchner is a French politician, diplomat, and doctor. He is co-founder of Médecins Sans Frontières and Médecins du Monde...

 who is now a French diplomat.

After entering the country, the volunteers, in addition to Biafran health workers and hospitals, were subjected to attacks by the Nigerian army, and witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticized the Nigerian government and the Red Cross for their seemingly complicit behaviour. These doctors concluded that a new aid organization was needed that would ignore political/religious boundaries and prioritize the welfare of victims.

1971 establishment


The Groupe d'Intervention Médicale et Chirurgicale en Urgence ("Emergency Medical and Surgical Intervention Group") was formed in 1970 by French doctors who had worked in Biafra, to provide aid and to emphasize the importance of victims' rights over neutrality. At the same time, Raymond Borel
Raymond Borel
Raymond Borel is a French doctor, editor of the medical journal TONUS and one of the founders of Médecins Sans Frontières.Borel had founded an aid organization called Secours Médical Français in response to the 1970 Bhola cyclone...

, the editor of the French medical journal
Medical journal
A public health journal is a scientific journal devoted to the field of public health, including epidemiology, biostatistics, and health care . Public health journals, like most scientific journals, are peer-reviewed...

 TONUS, had started a group called Secours Médical Français ("French Medical Relief") in response to the 1970 Bhola cyclone
1970 Bhola cyclone
The 1970 Bhola cyclone was a devastating tropical cyclone that struck East Pakistan and India's West Bengal on November 12, 1970. It was the deadliest tropical cyclone ever recorded, and one of the deadliest natural disasters in modern times...

, which killed at least 625,000 in East Pakistan
East Pakistan
East Pakistan was a provincial state of Pakistan established in 14 August 1947. The provincial state existed until its declaration of independence on 26 March 1971 as the independent nation of Bangladesh. Pakistan recognized the new nation on 16 December 1971. East Pakistan was created from Bengal...

 (now Bangladesh). Borel had intended to recruit doctors to provide aid to victims of natural disasters. On 20 December 1971, the two groups of colleagues merged to form Médecins Sans Frontières.

MSF’s first mission was to the Nicaraguan capital, Managua
Managua
Managua is the capital city of Nicaragua as well as the department and municipality by the same name. It is the largest city in Nicaragua in terms of population and geographic size. Located on the southwestern shore of Lake Xolotlán or Lake Managua, the city was declared the national capital in...

, where a 1972 earthquake
1972 Nicaragua earthquake
The 1972 Nicaragua earthquake was an earthquake that occurred at 12:29 a.m. local time on Saturday, December 23, 1972 near Managua, the capital of Nicaragua. It had a magnitude of 6.2 and occurred at a depth of about 5 kilometers beneath the centre of the city. Within an hour after the main...

 had destroyed most of the city and killed between 10,000 and 30,000 people. The organization, today known for its quick response in an emergency, arrived three days after the Red Cross had set up a relief mission. On 18 and 19 September 1974, Hurricane Fifi
Hurricane Fifi
Hurricane Fifi was a catastrophic tropical cyclone that killed between 3,000 and 10,000 people in Honduras in September 1974, ranking it as the fourth deadliest Atlantic hurricane on record. Originating from a strong tropical wave on September 14, the system steadily tracked...

 caused major flooding in Honduras and killed thousands of people (estimates vary), and MSF set up its first long-term medical relief mission.

Between 1975 and 1979, after South Vietnam
South Vietnam
South Vietnam was a state which governed southern Vietnam until 1975. It received international recognition in 1950 as the "State of Vietnam" and later as the "Republic of Vietnam" . Its capital was Saigon...

 had fallen to North Vietnam
North Vietnam
The Democratic Republic of Vietnam , was a communist state that ruled the northern half of Vietnam from 1954 until 1976 following the Geneva Conference and laid claim to all of Vietnam from 1945 to 1954 during the First Indochina War, during which they controlled pockets of territory throughout...

, millions of Cambodians emigrated to Thailand to avoid the Khmer Rouge
Khmer Rouge
The Khmer Rouge literally translated as Red Cambodians was the name given to the followers of the Communist Party of Kampuchea, who were the ruling party in Cambodia from 1975 to 1979, led by Pol Pot, Nuon Chea, Ieng Sary, Son Sen and Khieu Samphan...

. In response MSF set up its first refugee camp
Refugee camp
A refugee camp is a temporary settlement built to receive refugees. Hundreds of thousands of people may live in any one single camp. Usually they are built and run by a government, the United Nations, or international organizations, or NGOs.Refugee camps are generally set up in an impromptu...

 missions in Thailand. When Vietnam withdrew from Cambodia in 1989, MSF started long-term relief missions to help survivors of the mass killings
The Killing Fields
The Killing Fields are a number of sites in Cambodia where large numbers of people were killed and buried by the Khmer Rouge regime, during its rule of the country from 1975 to 1979, immediately after the end of the Cambodian Civil War ....

 and reconstruct the country’s health care system. Although its missions to Thailand to help victims of war in Southeast Asia could arguably be seen as its first war-time mission, MSF saw its first mission to a true war zone, including exposure to hostile fire, in 1976. MSF spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in Lebanon, during the Lebanese Civil War
Lebanese Civil War
The Lebanese Civil War was a multifaceted civil war in Lebanon. The war lasted from 1975 to 1990 and resulted in an estimated 150,000 to 230,000 civilian fatalities. Another one million people were wounded, and today approximately 350,000 people remain displaced. There was also a mass exodus of...

, and established a reputation for its neutrality and willingness to work under fire. Throughout the war, MSF helped both Christian and Muslim soldiers alike, helping whichever group required the most medical aid at the time. In 1984, as the situation in Lebanon deteriorated further and security for aid groups was minimized, MSF withdrew its volunteers.

New leadership


Claude Malhuret
Claude Malhuret
Claude Malhuret is the mayor of Vichy, France.He was born on 8 March 1950 in Vichy. After completing his doctorate in medicine at the University of Paris, he worked as a hospital intern...

 was elected as the new president of MSF in 1977, and soon after debates began over the future of the organization. In particular, the concept of témoignage ("witnessing"), which refers to speaking out about the suffering that one sees as opposed to remaining silent, was being opposed or played down by Malhuret and his supporters. Malhuret thought MSF should avoid criticism of the governments of countries in which they were working, while Kouchner believed that documenting and broadcasting the suffering in a country was the most effective way to solve a problem. Nevertheless over the years, MSF routinely criticized the government of the U.S.A. for inactivity or inadequate response.

In 1979, after four years of refugee movement from South Vietnam and the surrounding countries by foot and by boat, French intellectuals made an appeal in Le Monde
Le Monde
Le Monde is a French daily evening newspaper owned by La Vie-Le Monde Group and edited in Paris. It is one of two French newspapers of record, and has generally been well respected since its first edition under founder Hubert Beuve-Méry on 19 December 1944...

for "A Boat for Vietnam", a project intended to provide medical aid to the refugees. Although the project did not receive support from the majority of MSF, some, including later Minister Bernard Kouchner
Bernard Kouchner
Bernard Kouchner is a French politician, diplomat, and doctor. He is co-founder of Médecins Sans Frontières and Médecins du Monde...

, chartered a ship called L’Île de Lumière ("The Island of Light"), and, along with doctors, journalists and photographers, sailed to the South China Sea
South China Sea
The South China Sea is a marginal sea that is part of the Pacific Ocean, encompassing an area from the Singapore and Malacca Straits to the Strait of Taiwan of around...

 and provided some medical aid to the boat people. The splinter organization that undertook this, Médecins du Monde
Médecins du Monde
Médecins du Monde or Doctors of the World, is a non-governmental humanitarian aid organisation created in March 1980 by 15 French doctors, including Bernard Kouchner after he had left Médecins Sans Frontières , the aid society which he had co-founded earlier in 1971...

, later developed the idea of humanitarian intervention
Humanitarian intervention
Humanitarian intervention "refers to a state using military force against another state when the chief publicly declared aim of that military action is ending human-rights violations being perpetrated by the state against which it is directed."...

 as a duty, in particular on the part of Western nations such as France. In 2007 MSF clarified that for nearly 30 years MSF and Kouchner have had public disagreements on such issues as the right to intervene and the use of armed force for humanitarian reasons. Kouchner is in favor of the latter, whereas MSF stands up for an impartial humanitarian action, independent from all political, economic and religious powers.

MSF development


In 1982, Malhuret and Rony Brauman (who became the organisation's president in 1982), brought increased financial independence to MSF by introducing fundraising-by-mail to better collect donations. The 1980s also saw the establishment of the other operational sections from MSF-France (1971): MSF-Belgium (1980), MSF-Switzerland (1981), MSF-Holland (1984), and MSF-Spain (1986). MSF-Luxembourg was the first support section, created in 1986. The early 1990s saw the establishment of the majority of the support sections: MSF-Greece (1990), MSF-USA (1990), MSF-Canada (1991), MSF-Japan (1992), MSF-UK (1993), MSF-Italy (1993), MSF-Australia (1994), as well as Germany, Austria, Denmark, Sweden, Norway, and Hong Kong (MSF-UAE was formed later).
Malhuret and Brauman were instrumental in professionalising MSF. In December 1979, after the Soviet army had invaded Afghanistan
Soviet war in Afghanistan
The Soviet war in Afghanistan was a nine-year conflict involving the Soviet Union, supporting the Marxist-Leninist government of the Democratic Republic of Afghanistan against the Afghan Mujahideen and foreign "Arab–Afghan" volunteers...

, field missions were immediately set up to provide medical aid to the mujahideen
Mujahideen
Mujahideen are Muslims who struggle in the path of God. The word is from the same Arabic triliteral as jihad .Mujahideen is also transliterated from Arabic as mujahedin, mujahedeen, mudžahedin, mudžahidin, mujahidīn, mujaheddīn and more.-Origin of the concept:The beginnings of Jihad are traced...

, and in February 1980, MSF publicly denounced the Khmer Rouge
Khmer Rouge
The Khmer Rouge literally translated as Red Cambodians was the name given to the followers of the Communist Party of Kampuchea, who were the ruling party in Cambodia from 1975 to 1979, led by Pol Pot, Nuon Chea, Ieng Sary, Son Sen and Khieu Samphan...

. During the 1984 - 1985 famine in Ethiopia
1984 - 1985 famine in Ethiopia
A widespread famine affected the inhabitants of today's Eritrea and Ethiopia from 1983 to 1985. In northern Ethiopia, famine led to more than 400,000 deaths; over half this mortality can be attributed to human rights abuses that caused the famine to come earlier, strike harder, and extend further...

, MSF set up nutrition programmes in the country in 1984, but was expelled in 1985 after denouncing the abuse of international aid and the forced resettlements. MSF's explicit attacks on the Ethiopian government led to other NGOs criticizing their abandonment of their supposed neutrality. The group also set up equipment to produce clean drinking water
Drinking water
Drinking water or potable water is water pure enough to be consumed or used with low risk of immediate or long term harm. In most developed countries, the water supplied to households, commerce and industry is all of drinking water standard, even though only a very small proportion is actually...

 for the population of San Salvador
San Salvador
The city of San Salvador the capital and largest city of El Salvador, which has been designated a Gamma World City. Its complete name is La Ciudad de Gran San Salvador...

, capital of El Salvador, after the 10 October 1986 earthquake that struck the city.

Sudan


SInce 1979, MSF has been providing medical humanitarian assistance in Sudan
Sudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

, a nation plagued by starvation and the ongoing civil war
Second Sudanese Civil War
The Second Sudanese Civil War started in 1983, although it was largely a continuation of the First Sudanese Civil War of 1955 to 1972. Although it originated in southern Sudan, the civil war spread to the Nuba mountains and Blue Nile by the end of the 1980s....

, prevalent malnutrition and one of the highest maternal mortality rates in the world. In March 2009, it is reported that MSF has employed 4590 field staff in Sudan tackling issues such as armed conflicts, epidemic diseases, health care and social exclusion. MSF’s continued presence and work in Sudan
Sudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

 is one of the organization’s largest interventions. MSF provides a range of health care services including nutritional support, reproductive healthcare, Kala-Azar treatment, counselling services and surgery to the people living in Sudan
Sudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

. Common diseases prevalent in Sudan
Sudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

 include tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

, kala-azar also known as visceral leishmaniasis
Visceral leishmaniasis
Visceral leishmaniasis , also known as kala-azar, black fever, and Dumdum fever, is the most severe form of leishmaniasis. Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus. This disease is the second-largest parasitic killer in the world , responsible for an...

 meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...

, measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...

, cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

, and malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

.

Kala-Azar in Sudan


Kala-azar, also known as visceral leishmaniasis
Visceral leishmaniasis
Visceral leishmaniasis , also known as kala-azar, black fever, and Dumdum fever, is the most severe form of leishmaniasis. Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus. This disease is the second-largest parasitic killer in the world , responsible for an...

, has been one of the major health problems in Sudan
Sudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

. In March 2010, MSF set up its first Kala-Azar treatment centre in Eastern Sudan, providing free treatment for this otherwise deadly disease. If left untreated, there is a fatality rate of 99% within 1-4 months of infection. Since the treatment centre was set up, MSF has cured more than 27,000 Kala-Azar patients with a success rate of approximately 90-95%. There are plans to open an additional Kala-Azar treatment centre in Malakal
Malakal
-Location:The city of Malakal is located in Malakal County, Upper Nile State, in the northeast of South Sudan, close to the International borders with the Republic of Sudan and with Ethiopia...

, Southern Sudan to cope with the overwhelming number of patients that are seeking treatment. MSF has been providing necessary medical supplies to hospitals and training Sudanese health professionals to help them deal with Kala-Azar. MSF, Sudanese Ministry of Health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of Kala-Azar. Research on its cures and vaccines are currently being conducted. In December 2010, South Sudan is hit with the worst outbreak of Kala-Azar in eight years.
The number of patients seeking treatment increased eight-fold as compared to the year before.

Health care infrastructure in Sudan


Sudan’s latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between North Sudan and South Sudan
South Sudan
South Sudan , officially the Republic of South Sudan, is a landlocked country located in the Sahel region of northeastern Africa. It is also part of the North Africa UN sub-region. Its current capital is Juba, which is also its largest city; the capital city is planned to be moved to the more...

. MSF medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations. The situation of poor infrastructure in the South was aggravated by the civil war and resulted in the worsening of the region’s appalling health indicators. An estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth. Malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....

 and disease outbreaks are perennial concerns as well.
In 2011, MSF clinic in Jonglei State, South Sudan
South Sudan
South Sudan , officially the Republic of South Sudan, is a landlocked country located in the Sahel region of northeastern Africa. It is also part of the North Africa UN sub-region. Its current capital is Juba, which is also its largest city; the capital city is planned to be moved to the more...

 was looted and attacked by raiders. Hundreds, including women and children were killed. Valuable items including medical equipment and drugs were lost during the raid and parts of the MSF facilities were destroyed in a fire. The incident had serious repercussions as MSF is the only primary health care provider in this part of Jonglei State.

Early 1990s


The early 1990s saw MSF open a number of new national sections, and at the same time, set up field missions in some of the most dangerous and distressing situations it had ever encountered.

In 1990, MSF first entered Liberia to help civilians and refugees affected by the Liberian Civil War. Constant fighting throughout the 1990s and the Second Liberian Civil War
Second Liberian Civil War
The Second Liberian Civil War began in 1999 when a rebel group backed by the government of neighbouring Guinea, the Liberians United for Reconciliation and Democracy , emerged in northern Liberia. In early 2003, a second rebel group, the Movement for Democracy in Liberia, emerged in the south, and...

 have kept MSF volunteers actively providing nutrition, basic health care, and mass vaccinations, and speaking out against attacks on hospitals and feeding stations, especially in Monrovia
Monrovia
Monrovia is the capital city of the West African nation of Liberia. Located on the Atlantic Coast at Cape Mesurado, it lies geographically within Montserrado County, but is administered separately...

.
Field missions were set up to provide relief to Kurd
Kürd
Kürd or Kyurd or Kyurt may refer to:*Kürd Eldarbəyli, Azerbaijan*Kürd Mahrızlı, Azerbaijan*Kürd, Goychay, Azerbaijan*Kürd, Jalilabad, Azerbaijan*Kürd, Qabala, Azerbaijan*Qurdbayram, Azerbaijan...

ish refugees who had survived the al-Anfal Campaign
Al-Anfal Campaign
The al-Anfal Campaign , also known as Operation Anfal or simply Anfal, was a genocidal campaign against the Kurdish people in Northern Iraq, led by the Iraqi regime of Saddam Hussein and headed by Ali Hassan al-Majid in the final stages of Iran-Iraq War...

, for which evidence of atrocities was being collected in 1991. 1991 also saw the beginning of the Somali Civil War, and widespread famine and disease, for which MSF set up field missions in 1992. Failed United Nations interventions led to greater violence, and MSF denounced the organisation's operation in 1993, but volunteers continued to provide health care and food. Since the United Nations left, violence in Somalia has been unhindered, and MSF is one of the few organisations helping affected civilians by running clinics and hospitals.

MSF first began work in Srebrenica
Srebrenica
Srebrenica is a town and municipality in the east of Bosnia and Herzegovina, in the Bosnian Serb entity of Republika Srpska. Srebrenica is a small mountain town, its main industry being salt mining and a nearby spa. During the Bosnian War, the town was the site of the July 1995 massacre,...

 (in Bosnia and Herzegovina) as part of a UN convoy in 1993, one year after the Bosnian War
Bosnian War
The Bosnian War or the War in Bosnia and Herzegovina was an international armed conflict that took place in Bosnia and Herzegovina between April 1992 and December 1995. The war involved several sides...

 had begun. The city had become surrounded by the Bosnian Serb Army and, containing about 60,000 Bosniaks
Bosniaks
The Bosniaks or Bosniacs are a South Slavic ethnic group, living mainly in Bosnia and Herzegovina, with a smaller minority also present in other lands of the Balkan Peninsula especially in Serbia, Montenegro and Croatia...

, had become an enclave guarded by a United Nations Protection Force
United Nations Protection Force
The United Nations Protection Force ', was the first United Nations peacekeeping force in Croatia and in Bosnia and Herzegovina during the Yugoslav wars. It existed between the beginning of UN involvement in February 1992, and its restructuring into other forces in March 1995...

. MSF was the only organisation providing medical care to the surrounded civilians, and as such, did not denounce the genocide for fear of being expelled from the country (it did, however, denounce the lack of access for other organisations). MSF was forced to leave the area in 1995, when the Bosnian Serb Army captured the town. 40,000 Bosniak civilian inhabitants were deported, and approximately 7,000 were killed in mass executions.
Srebrenica massacre
The Srebrenica massacre, also known as the Srebrenica genocide, refers to the July 1995 killing, during the Bosnian War, of more than 8,000 Bosniaks , mainly men and boys, in and around the town of Srebrenica in Bosnia and Herzegovina, by units of the Army of Republika Srpska under the command of...


Rwanda


When the genocide in Rwanda began in April 1994, some delegates of MSF working in the country were incorporated into the International Committee of the Red Cross
International Committee of the Red Cross
The International Committee of the Red Cross is a private humanitarian institution based in Geneva, Switzerland. States parties to the four Geneva Conventions of 1949 and their Additional Protocols of 1977 and 2005, have given the ICRC a mandate to protect the victims of international and...

 (ICRC) medical team for protection. Both groups succeeded in keeping all main hospitals in Rwanda's capital Kigali
Kigali
Kigali, population 965,398 , is the capital and largest city of Rwanda. It is situated near the geographic centre of the nation, and has been the economic, cultural, and transport hub of Rwanda since it became capital at independence in 1962. The main residence and offices of the President of...

 operational throughout the main period of the genocide. MSF, together with several other aid organisations, had to leave the country in 1995, although many MSF and ICRC volunteers worked together under the ICRC's rules of engagement, which held that neutrality was of the utmost importance. These events led to a debate within the organisation about the concept of balancing neutrality of humanitarian aid workers against their witnessing role. As a result of its Rwanda mission, the position of MSF with respect to neutrality moved closer to that of the ICRC, a remarkable development in the light of the origin of the organisation.

The ICRC lost 56 and MSF lost almost one hundred of their respective local staff in Rwanda, and MSF-France, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a French military
Military of France
The French Armed Forces encompass the French Army, the French Navy, the French Air Force and the National Gendarmerie. The President of the Republic heads the armed forces, with the title "chef des armées" . The President is the supreme authority for military matters and is the sole official who...

 intervention stop the genocide. MSF-France introduced the slogan "One cannot stop a genocide with doctors" to the media, and the controversial Opération Turquoise
Opération Turquoise
Opération Turquoise was a French-led military operation in Rwanda in 1994 under the mandate of the United Nations.- Background :On 6 April 1994 Rwandan President Juvénal Habyarimana and Burundian President Cyprien Ntaryamira were assassinated, sparking the 1994 Rwandan Genocide...

 followed less than one month later. This intervention directly or indirectly resulted in movements of hundreds of thousands of Rwandan refugees to Zaire
Zaire
The Republic of Zaire was the name of the present Democratic Republic of the Congo between 27 October 1971 and 17 May 1997. The name of Zaire derives from the , itself an adaptation of the Kongo word nzere or nzadi, or "the river that swallows all rivers".-Self-proclaimed Father of the Nation:In...

 and Tanzania in what become known as the Great Lakes refugee crisis
Great Lakes refugee crisis
The Great Lakes refugee crisis is the common name for the situation beginning with the exodus in April 1994 of over two million Rwandans to neighboring countries of the Great Lakes region of Africa in the aftermath of the Rwandan Genocide...

, and subsequent cholera epidemics, starvation and more mass killings in the large groups of civilians. MSF-France returned to the area and provided medical aid to refugees in Goma
Goma
Goma is a city in the eastern Democratic Republic of the Congo, on the northern shore of Lake Kivu, next to the Rwandan city of Gisenyi. The lake and the two cities are in the western branch of the Great Rift Valley, and Goma lies only 13 to 18 km due south of the crater of the active...

.

At the time of the genocide, competition between the medical efforts of MSF, the ICRC, and other aid groups had reached an all time high, but the conditions in Rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes was created by the ICRC in 1994 to provide a framework for humanitarian missions and MSF is a signatory of this code. The code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments. MSF has since still found it necessary to condemn the actions of governments, such as in Chechnya
Chechnya
The Chechen Republic , commonly referred to as Chechnya , also spelled Chechnia or Chechenia, sometimes referred to as Ichkeria , is a federal subject of Russia . It is located in the southeastern part of Europe in the Northern Caucasus mountains. The capital of the republic is the city of Grozny...

 in 1999, but has not demanded another military intervention since then.

Sierra Leone


In the late 1990s, MSF missions were set up to treat tuberculosis and anaemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...

 in residents of the Aral Sea
Aral Sea
The Aral Sea was a lake that lay between Kazakhstan in the north and Karakalpakstan, an autonomous region of Uzbekistan, in the south...

 area, and look after civilians affected by drug-resistant disease, famine, and epidemics of cholera and AIDS. They vaccinated 3 million Nigerians against meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...

 during an epidemic in 1996 and denounced the Taliban’s neglect of health care for women
Taliban treatment of women
While in power in Afghanistan, the Taliban became notorious internationally for their treatment of women. Their stated aim was to create "secure environments where the chasteness and dignity of women may once again be sacrosanct," reportedly based on Pashtunwali beliefs about living in purdah.Women...

 in 1997. Arguably, the most significant country in which MSF set up field missions in the late 1990s was Sierra Leone, which was involved in a civil war
Sierra Leone Civil War
The Sierra Leone Civil War began on 23 March 1991 when the Revolutionary United Front , with support from the special forces of Charles Taylor’s National Patriotic Front of Liberia , intervened in Sierra Leone in an attempt to overthrow the Joseph Momoh government...

 at the time. In 1998, volunteers began assisting in surgeries in Freetown
Freetown
Freetown is the capital and largest city of Sierra Leone, a country in West Africa. It is a major port city on the Atlantic Ocean located in the Western Area of the country, and had a city proper population of 772,873 at the 2004 census. The city is the economic, financial, and cultural center of...

 to help with an increasing number of amputee
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

s, and collecting statistics on civilians (men, women and children) being attacked by large groups of men claiming to represent ECOMOG. The groups of men were travelling between villages and systematically chopping off one or both of each resident’s arms, raping women, gunning down families, razing houses, and forcing survivors to leave the area. Long-term projects following the end of the civil war included psychological support and phantom limb
Phantom limb
A phantom limb is the sensation that an amputated or missing limb is still attached to the body and is moving appropriately with other body parts. 2 out of 3 combat veterans report this feeling. Approximately 60 to 80% of individuals with an amputation experience phantom sensations in their...

 pain management.

Ongoing missions


The Campaign for Access to Essential Medicines was created in late 1999, providing MSF with a new voice with which to bring awareness to the lack of effective treatments and vaccine
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...

s available in developing countries. In 1999, the organisation also spoke out about the lack of humanitarian support in Kosovo and Chechnya, having set up field missions to help civilians affected by the respective political situations. Although MSF had worked in the Kosovo region since 1993, the onset of the Kosovo War
Kosovo War
The term Kosovo War or Kosovo conflict was two sequential, and at times parallel, armed conflicts in Kosovo province, then part of FR Yugoslav Republic of Serbia; from early 1998 to 1999, there was an armed conflict initiated by the ethnic Albanian "Kosovo Liberation Army" , who sought independence...

 prompted the movement of tens of thousands of refugees, and a decline in suitable living conditions. MSF provided shelter, water and health care to civilians affected by NATO’s strategic bombing campaigns
Operation Allied Force
The NATO bombing of Yugoslavia was NATO's military operation against the Federal Republic of Yugoslavia during the Kosovo War. The strikes lasted from March 24, 1999 to June 10, 1999...

.

A serious crisis within MSF erupted in connection with the organization's work in Kosovo when the Greek section of MSF was expelled from the organization. The Greek MSF section had gained access to Serbia at the cost of accepting Serb government imposed limits on where it could go and what it could see – terms that the rest of the MSF movement had refused. A non-MSF source alleged that the exclusion of the Greek section happened because its members extended aid to both Albanian and Serbian civilians in Pristina during NATO's bombing,
The rift was healed only in 2005 with the re-admission of the Greek section to MSF.

A similar situation was found in Chechnya, whose civilian population was largely forced from their homes into unhealthy conditions and subjected to the violence of the Second Chechen War
Second Chechen War
The Second Chechen War, in a later phase better known as the War in the North Caucasus, was launched by the Russian Federation starting 26 August 1999, in response to the Invasion of Dagestan by the Islamic International Peacekeeping Brigade ....

.

MSF has been working in Haiti since 1991, but since President Jean-Bertrand Aristide
Jean-Bertrand Aristide
Jean-Bertrand Aristide is a Haitian former Catholic priest and politician who served as Haiti's first democratically elected president. A proponent of liberation theology, Aristide was appointed to a parish in Port-au-Prince in 1982 after completing his studies...

 was forced from power, the country has seen a large increase in civilian attacks and rape by armed groups. In addition to providing surgical and psychological support in existing hospitals – offering the only free surgery available in Port-au-Prince
Port-au-Prince
Port-au-Prince is the capital and largest city of the Caribbean nation of Haiti. The city's population was 704,776 as of the 2003 census, and was officially estimated to have reached 897,859 in 2009....

 – field missions have been set up to rebuild water and waste management systems and treat survivors of major flooding caused by Hurricane Jeanne
Hurricane Jeanne
Hurricane Jeanne was the deadliest hurricane in the 2004 Atlantic hurricane season. It was the tenth named storm, the seventh hurricane, and the fifth major hurricane of the season, as well as the third hurricane and fourth named storm of the season to make landfall in Florida...

; patients with HIV/AIDS and malaria, both of which are widespread in the country, also receive better treatment and monitoring. As a result of the 2010 Haiti earthquake
2010 Haiti earthquake
The 2010 Haiti earthquake was a catastrophic magnitude 7.0 Mw earthquake, with an epicentre near the town of Léogâne, approximately west of Port-au-Prince, Haiti's capital. The earthquake occurred at 16:53 local time on Tuesday, 12 January 2010.By 24 January, at least 52 aftershocks...

, 12 January 2010, reports from Haiti indicated that all three of the organization's hospitals had been severely damaged; one collapsing completely and the other two having to be abandoned. Following the quake, MSF sent about nine planes loaded with medical equipment and a field hospital to help treat the victims. However, the landings of some of the planes had to be delayed due to the massive number of humanitarian and military flights coming in.

The Kashmir Conflict
Kashmir conflict
The Kashmir conflict is a territorial dispute between India and Pakistan over the Kashmir region, the northwesternmost region of South Asia....

 in northern India resulted in a more recent MSF intervention (the first field mission was set up in 1999) to help civilians displaced by fighting in Jammu and Kashmir
Jammu and Kashmir
Jammu and Kashmir is the northernmost state of India. It is situated mostly in the Himalayan mountains. Jammu and Kashmir shares a border with the states of Himachal Pradesh and Punjab to the south and internationally with the People's Republic of China to the north and east and the...

, as well as in Manipur
Manipur
Manipur is a state in northeastern India, with the city of Imphal as its capital. Manipur is bounded by the Indian states of Nagaland to the north, Mizoram to the south and Assam to the west; it also borders Burma to the east. It covers an area of...

. Psychological support is a major target of missions, but teams have also set up programmes to treat tuberculosis, HIV/AIDS and malaria. Mental health support has been of significant importance for MSF in much of southern Asia since the 2004 Indian Ocean earthquake
Countries affected by the 2004 Indian Ocean earthquake
This article lists the countries affected by the 2004 Indian Ocean earthquake and the resulting tsunami in alphabetical order – for detailed information about each country see their individual articles...

.

MSF went through a long process of self-examination and discussion in 2005–2006. Many issues were debated, including the treatment "nationals" as well as "fair employment" and self criticism.

Africa


MSF has been active in a large number of African countries for decades, sometimes serving as the sole provider of health care, food, and water. Although MSF has consistently attempted to increase media coverage of the situation in Africa to increase international support, long-term field missions are still necessary. Treating and educating the public about HIV/AIDS in sub-Saharan Africa
Sub-Saharan Africa
Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...

, which sees the most deaths and cases of the disease in the world, is a major task for volunteers. Of the 14.6 million people in need of anti-retroviral treatment the WHO estimated that only 5.25 million people where receiving it in developing countries, and MSF continues to urge governments and companies to increase research and development into HIV/AIDS treatments to decrease cost and increase availability. (See AIDS in Africa for more information)

Although active in the Congo region of Africa since 1985, the First
First Congo War
The First Congo War was a revolution in Zaire that replaced President Mobutu Sésé Seko, a decades-long dictator, with rebel leader Laurent-Désiré Kabila. Destabilization in eastern Zaire that resulted from the Rwandan genocide was the final factor that caused numerous internal and external actors...

 and Second Congo War
Second Congo War
The Second Congo War, also known as Coltan War and the Great War of Africa, began in August 1998 in the Democratic Republic of the Congo , and officially ended in July 2003 when the Transitional Government of the Democratic Republic of the Congo took power; however, hostilities continue to this...

 brought increased violence and instability to the area. MSF has had to evacuate its teams from areas such as around Bunia
Bunia
Bunia is a city in Democratic Republic of the Congo and is the headquarters of Ituri Interim Administration in the Ituri region of Orientale Province....

, in the Ituri district due to extreme violence, but continues to work in other areas to provide food to tens of thousands of displaced civilians, as well as treat survivors of mass rapes and widespread fighting. The treatment and possible vaccination against diseases such as cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

, measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...

, polio, Marburg fever, sleeping sickness, HIV/AIDS, and Bubonic plague
Bubonic plague
Plague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...

 is also important to prevent or slow down epidemics.

MSF has been active in Uganda since 1980, and provided relief to civilians during the country’s guerrilla war during the Second Obote Period. However, the formation of the Lord's Resistance Army
Lord's Resistance Army
The Lord's Resistance Army insurgency is an ongoing guerrilla campaign waged since 1987 by the Lord's Resistance Army rebel group, operating mainly in northern Uganda, but also in South Sudan and eastern Democratic Republic of the Congo...

 saw the beginning of a long campaign of violence in northern Uganda and southern Sudan. Civilians were subjected to mass killings and rapes, torture, and abductions of children, who would later serve as sex slaves or child soldiers. Faced with more than 1.5 million people displaced from their homes, MSF set up relief programmes in internally displaced person
Internally displaced person
An internally displaced person is someone who is forced to flee his or her home but who remains within his or her country's borders. They are often referred to as refugees, although they do not fall within the current legal definition of a refugee. At the end of 2006 it was estimated there were...

 (IDP) camps to provide clean water, food and sanitation. Diseases such as tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

, measles, polio, cholera, ebola
Ebola
Ebola virus disease is the name for the human disease which may be caused by any of the four known ebolaviruses. These four viruses are: Bundibugyo virus , Ebola virus , Sudan virus , and Taï Forest virus...

, and HIV/AIDS occur in epidemics in the country, and volunteers provide vaccinations (in the cases of measles and polio) and/or treatment to the residents. Mental health is also an important aspect of medical treatment for MSF teams in Uganda, since most people refuse to leave the IDP camps for constant fear of being attacked.

MSF first set up a field mission in Côte d'Ivoire in 1990, but ongoing violence and the 2002 division
History of Côte d'Ivoire
The date of the first human presence in Côte d'Ivoire has been difficult to determine because human remains have not been well-preserved in the country's humid climate...

 of the country by rebel groups and the government led to several massacres, and MSF teams have even begun to suspect that an ethnic cleansing is occurring. Mass measles vaccinations, tuberculosis treatment and the re-opening of hospitals closed by fighting are projects run by MSF, which is the only group providing aid in much of the country.

MSF has strongly promoted the use of contraception
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...

 in Africa.

Libya


The 2011 Libyan civil war
2011 Libyan civil war
The 2011 Libyan civil war was an armed conflict in the North African state of Libya, fought between forces loyal to Colonel Muammar Gaddafi and those seeking to oust his government. The war was preceded by protests in Benghazi beginning on 15 February 2011, which led to clashes with security...

 has prompted efforts by MSF to setup a hospital and mental health services to help locals affected by the conflict. The fighting created a backlog of patients that needed surgery. With parts of the country slowly returning to livable, MSF has started working with local health personnel to address the needs. The need for psychological counseling has increased and MSF has setup mental health services to address the fears and stress of people living in tents without water and electricity.

Sri Lanka


MSF is involved in Sri Lanka, where a 26 year civil war
Sri Lankan civil war
The Sri Lankan Civil War was a conflict fought on the island of Sri Lanka. Beginning on July 23, 1983, there was an on-and-off insurgency against the government by the Liberation Tigers of Tamil Eelam , a separatist militant organization which fought to create an independent Tamil state named Tamil...

 ended in 2009 and DWB has adopted its activities there to continue its mission. For example, it helps with physical therapy for patients with spinal cord injuries. It conducts counseling sessions, and has setup an “operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries.”International Activity Report 2010

Field mission structure


Before a field mission is established in a country, an MSF team visits the area to determine the nature of the humanitarian emergency, the level of safety in the area and what type of aid is needed. Medical aid is the main objective of most missions, although some missions help in such areas as water purification
Water purification
Water purification is the process of removing undesirable chemicals, materials, and biological contaminants from contaminated water. The goal is to produce water fit for a specific purpose...

 and nutrition.

Field mission team


A field mission team usually consists of a small number of coordinators to head each component of a field mission, and a "head of mission." The head of mission usually has the most experience in humanitarian situations of the members of the team, and it is his/her job to deal with the media, national governments and other humanitarian organisations.

Medical volunteers include physicians, surgeons, nurses, and various other specialists. In addition to operating the medical and nutrition components of the field mission, these volunteers are sometimes in charge of a group of local medical staff and provide training for them.

Although the medical volunteers almost always receive the most media attention when the world becomes aware of an MSF field mission, there are a number of non-medical volunteers who help keep the field mission functioning. Logisticians are often the most important members of a team. They are responsible for providing everything that the medical component of a mission needs, ranging from security and vehicle maintenance to food and electricity supplies. They may be engineers and/or foremen
Construction foreman
A construction foreman is the worker or tradesman who is in charge of a construction crew. While traditionally this role has been assumed by a senior male worker, the title in the modern sense is gender non-specific in intent...

, but they usually also help with setting up treatment centres and supervising local staff. Other non-medical staff are water/sanitation specialists, who are usually experienced engineers in the fields of water treatment and management and financial/administration experts who are placed with field missions.

Medical component


Vaccination campaigns are a major part of the medical care provided during MSF missions. Diseases such as diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...

, measles, meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...

, tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...

, pertussis
Pertussis
Pertussis, also known as whooping cough , is a highly contagious bacterial disease caused by Bordetella pertussis. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air...

, yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....

, polio, and cholera, all of which are uncommon in developed countries, may be prevented with vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...

. Some of these diseases, such as cholera and measles, spread rapidly in large populations living in close proximity, such as in a refugee camp, and people must be immunised by the hundreds or thousands in a short period of time. For example in Beira, Mozambique
Beira, Mozambique
Beira is the second largest city in Mozambique. It lies in the central region of the country in Sofala Province, where the Pungue River meets the Indian Ocean. Beira had a population of 412,588 in 1997, which grew to an estimated 546,000 in 2006...

 in 2004, an experimental cholera vaccine was received twice by approximately 50,000 residents in about one month.

An equally important part of the medical care provided during MSF missions is AIDS treatment (with antiretroviral drug
Antiretroviral drug
Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...

s), AIDS testing, and education. MSF is the only source of treatment for many countries in Africa, whose citizens make up the majority of people with HIV and AIDS worldwide. Because antiretroviral drugs (ARVs) are not readily available, MSF usually provides treatment for opportunistic infection
Opportunistic infection
An opportunistic infection is an infection caused by pathogens, particularly opportunistic pathogens—those that take advantage of certain situations—such as bacterial, viral, fungal or protozoan infections that usually do not cause disease in a healthy host, one with a healthy immune system...

s and educates the public on how to slow transmission of the disease.

In most countries, MSF increases the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff. When the local staff is overwhelmed, MSF may open new specialised clinics for treatment of an endemic disease or surgery for victims of war. International staff start these clinics but MSF strives to increase the local staff's ability to run the clinics themselves through training and supervision. In some countries, like Nicaragua, MSF provides public education to increase awareness of reproductive health care and venereal disease.

Since most of the areas that require field missions have been affected by a natural disaster, civil war, or endemic disease, the residents usually require psychological support as well. Although the presence of an MSF medical team may decrease stress somewhat among victims, often a team of psychologists or psychiatrists work with victims of depression, domestic violence
Domestic violence
Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...

 and substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...

. The doctors may also train local mental health staff.

Nutrition


Often in situations where an MSF mission is set up, there is moderate or severe malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....

 as a result of war, drought, or government economic mismanagement. Intentional starvation is also sometimes used during a war as a weapon, and MSF, in addition to providing food, brings awareness to the situation and insists on foreign government intervention. Infectious diseases and diarrhoea, both of which cause weight loss and weakening of a person's body (especially in children), must be treated with medication and proper nutrition to prevent further infections and weight loss. A combination of the above situations, as when a civil war is fought during times of drought and infectious disease outbreaks, can create famine.

In emergency situations where there is a lack of nutritious food, but not to the level of a true famine, protein-energy malnutrition
Protein-energy malnutrition
Protein-energy malnutrition refers to a form of malnutrition where there is inadequate protein intake.Types include:* Kwashiorkor...

 is most common among young children. Marasmus
Marasmus
Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency.A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight that corresponds to the height . Marasmus occurrence increases prior to age 1, whereas kwashiorkor...

, a form of calorie deficiency, is the most common form of childhood malnutrition and is characterised by severe wasting and often fatal weakening of the immune system. Kwashiorkor
Kwashiorkor
Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. The presence of edema caused by poor nutrition defines kwashiorkor...

, a form of calorie and protein deficiency, is a more serious type of malnutrition in young children, and can negatively affect physical
Human development (biology)
Human development is the process of growing to maturity. In biological terms, this entails growth from a one-celled zygote to an adult human being.- Biological development:...

 and mental development
Developmental psychology
Developmental psychology, also known as human development, is the scientific study of systematic psychological changes, emotional changes, and perception changes that occur in human beings over the course of their life span. Originally concerned with infants and children, the field has expanded to...

. Both types of malnutrition can make opportunistic infections fatal. In these situations, MSF sets up Therapeutic Feeding Centres for monitoring the children and any other malnourished individuals.

A Therapeutic Feeding Centre (or Therapeutic Feeding Programme) is designed to treat severe malnutrition through the gradual introduction of a special diet intended to promote weight gain after the individual has been treated for other health problems. The treatment programme is split between two phases:
  • Phase 1 lasts for 24 hours and involves basic health care and several small meals of low energy/protein food spaced over the day.
  • Phase 2 involves monitoring of the patient and several small meals of high energy/protein food spaced over each day until the individual’s weight approaches normal.


MSF uses foods designed specifically for treatment of severe malnutrition. During phase 1, a type of therapeutic milk called F-75 is fed to patients. F-75 is a relatively low energy, low fat/protein milk powder that must be mixed with water and given to patients to prepare their bodies for phase 2. During phase 2, therapeutic milk called F-100
F-100 (food)
F-100 and F-75 are therapeutic milk products designed to treat severe malnutrition. In 1994 Action Against Hunger / Action Contre la Faim pioneered the use of milk formula F-100 for the treatment of severe acute malnutrition...

, which is higher in energy/fat/protein content than F-75, is given to patients, usually along with a peanut butter mixture called Plumpy'nut
Plumpy'nut
Plumpy'nut is a peanut-based paste in a plastic wrapper for treatment of severe acute malnutrition manufactured by a French company, Nutriset...

. F-100 and Plumpy'nut are designed to quickly provide large amounts of nutrients so that patients can be treated efficiently. Other special food fed to populations in danger of starvation includes enriched flour
Enriched flour
Enriched flour is flour with specific nutrients returned to it that have been lost while it was prepared. These restored nutrients include iron and B vitamins . Calcium may also be supplemented. The purpose of enriching flour is to replenish the nutrients in the flour to match the nutritional...

 and porridge
Porridge
Porridge is a dish made by boiling oats or other cereal meals in water, milk, or both. It is usually served hot in a bowl or dish...

, as well as a high protein biscuit called BP5
BP-5 Compact Food
BP-5 Compact Food is a high-calorie, vitamin fortified, compact, compressed and dry food, often used by relief agencies for the emergency feeding of refugees and internally displaced persons.-Description:...

. BP5 is a popular food for treating populations because it can be distributed easily and sent home with individuals, or it can be crushed and mixed with therapeutic milk for specific treatments.

Dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...

, sometimes due to diarrhoea or cholera, may also be present in a population, and MSF set up rehydration centres to combat this. A special solution called Oral Rehydration Solution (ORS), which contains glucose and electrolytes, is given to patients to replace fluids lost. Antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...

s are also sometimes given to individuals with diarrhoea if it is known that they have cholera or dysentery
Dysentery
Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the faeces with fever and abdominal pain. If left untreated, dysentery can be fatal.There are differences between dysentery and normal bloody diarrhoea...

.

Water and sanitation


Clean water is essential for hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...

, for consumption and for feeding programmes (for mixing with powdered therapeutic milk or porridge), as well as for preventing the spread of water-borne disease. As such, MSF water engineers and volunteers must create a source of clean water. This is usually achieved by modifying an existing water well
Water well
A water well is an excavation or structure created in the ground by digging, driving, boring or drilling to access groundwater in underground aquifers. The well water is drawn by an electric submersible pump, a trash pump, a vertical turbine pump, a handpump or a mechanical pump...

, by digging a new well and/or starting a water treatment project to obtain clean water for a population. Water treatment in these situations may consist of storage sedimentation, filtration and/or chlorination
Chlorination
Chlorination is the process of adding the element chlorine to water as a method of water purification to make it fit for human consumption as drinking water...

 depending on available resources.

Sanitation is an essential part of field missions, and it may include education of local medical staff in proper sterilisation
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...

 techniques, wastewater treatment
Wastewater Treatment
Wastewater treatment may refer to:* Sewage treatment* Industrial wastewater treatment...

 projects, proper waste disposal
Waste management
Waste management is the collection, transport, processing or disposal,managing and monitoring of waste materials. The term usually relates to materials produced by human activity, and the process is generally undertaken to reduce their effect on health, the environment or aesthetics...

, and education of the population in personal hygiene. Proper wastewater treatment and water sanitation are the best way to prevent the spread of serious water-borne diseases, such as cholera. Simple wastewater treatment systems can be set up by volunteers to protect drinking water from contamination. Garbage disposal could include pits for normal waste and incineration for medical waste. However, the most important subject in sanitation is the education of the local population, so that proper waste and water treatment can continue once MSF has left the area.

Statistics


In order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, data on a number of factors are collected during each field mission. The rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres. Various types of mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

s are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries. By compiling data on the frequency of diseases in hospitals, MSF can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs. For example, the "Meningitis Belt" (sub-Saharan Africa, which sees the most cases of meningitis in the world) has been "mapped" and the meningitis season occurs between December and June. Shifts in the location of the Belt and the timing of the season can be predicted using cumulative data over many years.

In addition to epidemiology surveys, MSF also uses survey
Statistical survey
Survey methodology is the field that studies surveys, that is, the sample of individuals from a population with a view towards making statistical inferences about the population using the sample. Polls about public opinion, such as political beliefs, are reported in the news media in democracies....

s of populations to determine the rates of violence in various regions. By estimating the scopes of massacres, and determining the rate of kidnappings, rapes, and killings, psychosocial programmes can be implemented to lower the suicide rate
Epidemiology and methodology of suicide
Incidence of suicide is under-reported due to both religious and social pressures, and possibly completely unreported in some areas. Nevertheless, from reported cases, certain trends are apparent. Since the data is skewed, comparing suicide rates between nations is statistically unsound...

 and increase the sense of security in a population. Large-scale forced migrations
Population transfer
Population transfer is the movement of a large group of people from one region to another by state policy or international authority, most frequently on the basis of ethnicity or religion...

, excessive civilian casualties and massacres can be quantified using surveys, and MSF can use the results to put pressure on governments to provide help, or even expose genocide. MSF conducted the first comprehensive mortality survey in Darfur
Darfur
Darfur is a region in western Sudan. An independent sultanate for several hundred years, it was incorporated into Sudan by Anglo-Egyptian forces in 1916. The region is divided into three federal states: West Darfur, South Darfur, and North Darfur...

 in 2004.
However, there may be ethical problems in collecting these statistics.

Campaign for Access to Essential Medicines


The Campaign for Access to Essential Medicines was initiated in 1999 to increase access to essential medicines
Essential medicines
Essential medicines, as defined by the World Health Organization are "those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford."The WHO...

 in developing countries. "Essential medicines" are those drugs that are needed in sufficient supply to treat a disease common to a population. However, most diseases common to populations in developing countries are no longer common to populations in developed countries; therefore, pharmaceutical companies
Pharmaceutical company
The pharmaceutical industry develops, produces, and markets drugs licensed for use as medications. Pharmaceutical companies are allowed to deal in generic and/or brand medications and medical devices...

 find that producing these drugs is no longer profitable and may raise the price per treatment, decrease development of the drug (and new treatments) or even stop production of the drug. MSF often lacks effective drugs during field missions, and started the campaign to put pressure on governments and pharmaceutical companies to increase funding for essential medicines.

In recent years, it has tried to use its influence to urge the drug maker Novartis
Novartis
Novartis International AG is a multinational pharmaceutical company based in Basel, Switzerland, ranking number three in sales among the world-wide industry...

 to drop its case against India’s patent law that prevents Novartis from patenting its drugs in India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

. A few years earlier, Novartis also sued South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

 to prevent it from importing cheaper AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

 drugs. While MSF is generally impartial, the statements by MSF representatives suggest they are taking a somewhat political position. Dr. Tido von Schoen-Angerer, director of DWB's Campaign for Access to Essential Medicines, he says the following: "Just like five years ago, Novartis, with its legal actions, is trying to stand in the way of people's right to access the medicines they need." MSF launched a petition drive on its website to make Novartis drop the case. The case is an example of how MSF goes beyond being a healthcare provider to being an advocate for human welfare.

Dangers faced by volunteers


Aside from injuries and death associated with stray bullets, mines and epidemic disease, MSF volunteers are sometimes attacked or kidnapped for political reasons. In some countries afflicted by civil war, humanitarian aid organizations are viewed as helping the enemy, if an aid mission has been set up exclusively for victims on one side of the conflict, and attacked for that reason. However, the War on Terrorism
War on Terrorism
The War on Terror is a term commonly applied to an international military campaign led by the United States and the United Kingdom with the support of other North Atlantic Treaty Organisation as well as non-NATO countries...

 has generated attitudes among some groups in US-occupied countries that non-governmental aid organizations such as MSF are allied with or even work for the Coalition forces
Multinational force in Iraq
The Multi-National Force – Iraq was a military command, led by the United States, which was responsible for Operation Iraqi Freedom. Multi-National Force – Iraq replaced the previous force, Combined Joint Task Force 7, on 15 May 2004, and was later itself reorganized into its successor, United...

. Since the United States has labelled its operations "humanitarian actions" independent aid organizations have been forced to defend their positions, or even evacuate their teams. Insecurity in cities in Afghanistan and Iraq rose significantly following United States operations, and MSF has declared that providing aid in the countries was too dangerous. The organization was forced to evacuate its teams from Afghanistan on 28 July 2004, after five volunteers (Afghans Fasil Ahmad and Besmillah, Belgian Hélène de Beir, Norwegian Egil Tynæs
Egil Tynæs
Egil Kristian Tynæs born August 12, 1941 was a Norwegian doctor. On June 2, 2004 in Badghis, Afghanistan Tynæs and four others were killed in an ambush whilst working for the humanitarian organization Médecins Sans Frontières.Tynæs worked in his everyday life as a senior doctor at the Municipal...

, and Dutchman Willem Kwint) were killed on 2 June in an ambush by unidentified militia near Khair Khana in Badghis province
Badghis Province
Bādghīs is one of the thirty-four provinces of Afghanistan. It is located in northwestern Afghanistan, between the Murghab and Hari rivers, extending as far northward as the edge of the desert of Sarakhs. It includes the Chul formations through which the Turkmen-Afghan boundary runs...

. In June 2007, Elsa Serfass, a volunteer with MSF-France, was killed in the Central African Republic and in January 2008, two expatriate staff (Damien Lehalle and Victor Okumu) and a national staff member (Mohammed Bidhaan Ali) were killed in an organized attack in Somalia resulting in the closing of the project.

Arrests and abductions in politically unstable regions can also occur for volunteers, and in some cases, MSF field missions can be expelled entirely from a country. Arjan Erkel
Arjan Erkel
Peter-Arjan Erkel is a Dutch medical aid worker and was head of the relief mission for Médecins Sans Frontières in Dagestan, a constituent republic of Russia....

, Head of Mission in Dagestan
Dagestan
The Republic of Dagestan is a federal subject of Russia, located in the North Caucasus region. Its capital and the largest city is Makhachkala, located at the center of Dagestan on the Caspian Sea...

 in the North Caucasus
North Caucasus
The North Caucasus is the northern part of the Caucasus region between the Black and Caspian Seas and within European Russia. The term is also used as a synonym for the North Caucasus economic region of Russia....

, was kidnapped and held hostage in an unknown location by unknown abductors from 12 August 2002 until 11 April 2004. Paul Foreman, head of MSF-Holland, was arrested in Sudan in May 2005 for refusing to divulge documents used in compiling a report on rapes carried out by the pro-government Janjaweed
Janjaweed
The Janjaweed is a blanket term used to describe mostly gunmen in Darfur, western Sudan, and now eastern Chad...

 militias (see Darfur conflict
Darfur conflict
The Darfur Conflict was a guerrilla conflict or civil war centered on the Darfur region of Sudan. It began in February 2003 when the Sudan Liberation Movement/Army and Justice and Equality Movement groups in Darfur took up arms, accusing the Sudanese government of oppressing non-Arab Sudanese in...

). Foreman cited the privacy of the women involved, and MSF alleged that the Sudanese government had arrested him because it disliked the bad publicity generated by the report.

Documentary


Living in Emergency
Living in Emergency: Stories of Doctors Without Borders
Living in Emergency: Stories of Doctors Without Borders was among the 15 documentaries shortlisted for the Best Documentary Oscar by the Academy of Motion Picture Arts and Sciences for the 82nd Academy Awards....

is an award-winning documentary film that tells the story of four MSF volunteer doctors confronting the challenges of medical work in war-torn areas of Liberia and Congo. It premiered at the 2008 Venice Film Festival
Venice Film Festival
The Venice International Film Festival is the oldest international film festival in the world. Founded by Count Giuseppe Volpi in 1932 as the "Esposizione Internazionale d'Arte Cinematografica", the festival has since taken place every year in late August or early September on the island of the...

 and was theatrically released in the United States in 2010.

Namesakes

  • A number of other Non-governmental organizations (NGO) have adopted the Without Borders
    Without Borders
    The following is a partial list of international non-governmental organizations that have names and objectives inspired by Médecins Sans Frontières :* Action Without Borders...

     tag, inspired by the Doctors without Borders name.

See also


  • Attacks on humanitarian workers
    Attacks on humanitarian workers
    Humanitarian aid workers belonging to United Nations organisations, PVOs / NGOs or the Red Cross / Red Crescent have traditionally enjoyed both international legal protection, and de facto immunity from attack by belligerent parties. However, attacks on humanitarian workers have occasionally...

  • Farmers Without Borders
    Farmers Without Borders
    Farmers Without Borders is a non-governmental organization which defines itself as a farmer-led organization with a mission to support struggling agricultural communities in developing regions and strengthen regenerative agriculture around the globe.- Overview :FWB defines its vision of the future...

     (FWB)
  • Living in Emergency: Stories of Doctors Without Borders
    Living in Emergency: Stories of Doctors Without Borders
    Living in Emergency: Stories of Doctors Without Borders was among the 15 documentaries shortlisted for the Best Documentary Oscar by the Academy of Motion Picture Arts and Sciences for the 82nd Academy Awards....

     (2008 documentary film)
  • The Photographer: Into War-torn Afghanistan with Doctors Without Borders
    The Photographer (graphic novel)
    The Photographer: Into War-torn Afghanistan with Doctors Without Borders is a graphic novel by Emmanuel Guibert, Didier Lefèvre and Frederic Lemercier....

  • Timeline of events in humanitarian relief and development
    Timeline of events in humanitarian relief and development
    The following is a timeline of selected notable events in the history of humanitarian aid, international relief and development.* 1705 – Bhai Kanhaiya Ji , founder of the Sewa Panthi or Addenshahi sect of the Sikhs. He established a Dharamsala at Kavha village in the Attock district of...

  • Avocats Sans Frontières
    Avocats Sans Frontières
    Avocats Sans Frontières , also known as Advocaten Zonder Grenzen is an international non-governmental organization contributing to the creation of fair and equitable societies, in which the law and its institutions serve the most vulnerable groups and individuals...


External links