MSF IN 2018

Our work around the world this year

What a year this has been! 2018 may become known as the year that the humanitarian needs generated by migration and displacement reached peak politics, from a hidden humanitarian crisis on Nauru island to the very public attack on search-and-rescue efforts in the central Mediterranean.

As governments hardened their hearts and their policies against the plight of displaced communities, migrants and refugees, MSF was there to provide life-saving care to those most in need.

With our supporters behind us, we persisted in our efforts to help all those we could, in the face of unprecedented political hostility, obstruction and criminalisation of both those on the move but also those trying to assist them.

Vickie Hawkins, MSF UK Executive Director

Vickie Hawkins, MSF UK Executive Director

Vickie Hawkins, MSF UK Executive Director

In February, we marked six months into one of the largest mass movements of people in recent memory. Close to a million Rohingya have now sought refuge in Cox’s Bazar, Bangladesh, fleeing the brutal, systemic persecution they faced in Myanmar.

In a matter of weeks, a collection of small settlements was transformed into a network of chaotic mega-camps rapidly filling with traumatised, exhausted families. MSF was at the heart of the response; providing triage, clean water, primary healthcare, maternity care, counselling, and treatment for cholera, diphtheria and a variety of other ailments.

Yet there was light amid the dark, some really special milestones were reached in 2018. We celebrated the 100,000th child to be born at MSF’s maternity hospital in Khost, Afghanistan. This is one of the busiest maternity hospitals in the world.

We also saw the 100th patient enrol on to our TB PRACTECAL trial; they’ll benefit from a TB treatment that’s much shorter yet more effective. In Mali, we hit 10,000 child vaccinations.

What will 2019 bring?

As the year begins, we look towards Hodeidah, to the people still trapped there and to the port that is a lifeline for millions of Yemenis who rely on the aid that passes through it.

Our teams there have seen the terrible cost of the conflict on normal Yemenis and we will continue to call on all those involved to prioritise protecting civilians and healthcare facilities.

Our focus is also on the DRC, where an outbreak of Ebola in the east of the country threatens to take many lives in a region already suffering from conflict and insecurity.

We will continue to care for those forced from their homes, whether in camps, communities or risking their lives on dangerous journeys, seeking protection and the chance for a better future. We will provide medical care around the world, where the need is greatest, bringing some humanity into the most inhumane situations.

Vickie Hawkins
MSF UK Executive Director

We strive to keep our supporters up to date. In this article we round up some of the leading stories from our projects around the world this year. If ever as a donor you wanted to see the impact of your support then this article is a highly recommended read. Thank you.

JANUARY

New Year, new life

Photo © Sara Creta/MSF

Nurses weigh a newborn at Jahun general hospital in Jigawa State, Nigeria.

As the world celebrated the beginning of 2018, MSF teams across the globe were busy helping women and girls to safely bring their children into the world.

Baby Raihana was the first baby born in MSF’s Dascht-E-Barchi Maternity in Kabul, Afghanistan, in 2018.

Baby Raihana born in MSF’s Dascht-E-Barchi Maternity in Kabul, Afghanistan.

Baby Raihana born in MSF’s Dascht-E-Barchi Maternity in Kabul, Afghanistan.

Baby Raihana born in MSF’s Dascht-E-Barchi Maternity in Kabul, Afghanistan.

Her mother, Najia, came to the hospital at 11:00 pm on the last day of 2017 because she had heard about the high quality of care available.

When she arrived, she was told the baby was in breech presentation but safely delivered a beautiful girl weighing 3.1 kilos 15 minutes after midnight on 1 January 2018.

In the east of Afghanistan, MSF’s Khost maternity ward welcomes 60 little bundles of joy into the world each day. Khost is not only MSF’s busiest maternity, but one of the busiest maternity wards in the world.

The maternity unit was opened in 2012 to provide free quality maternal and neonatal care to women and their babies.

In 2018, we celebrated Khost’s 100,000th birth.

FEBRUARY

Battling a disease of the past

Photo © Sara Creta/MSF

A doctor provides care for patients with diphtheria at MSF’s clinic near Cox's Bazar, Bangladesh. © Sara Creta/MSF

In February, it had been six months since the outbreak of horrific violence in Myanmar which forced more than 700,000 Rohingya people to flee to Bangladesh.

In the squalid ‘megacamp’ in Cox's Bazar, which is now home to nearly one million Rohingya refugees, we were battling a dual outbreak of measles and diphtheria.

The latter is a deadly infectious disease that few British medics have had to treat back home thanks to decades of vaccination coverage.

Indeed, as British doctor Rosie Burton explained at the time: “We should not be seeing cases of diphtheria anymore.

“This highly fatal childhood disease is covered by the basic package of vaccinations, so when it appears it shows there has been a fundamental breakdown in vaccination programmes.

“In Myanmar, the Rohingya have very limited access to basic healthcare, which is why we are seeing these cases.”

So far this year we have treated more than 6,000 people for diphtheria in the Cox’s Bazar district of Bangladesh, most of them aged between five and 14 years.


Find out more about our work in Bangladesh this year on Everyday Emergency, the MSF podcast

MARCH

Up river in South Sudan

© Frederic Noy/COSMOS

MSF's mobile medical team arrives in Kier, an hour and a half by boat from Akobo on the Pibor River. © Frederic NOY/COSMOS

2018 marks five years since the outbreak of the anarchic civil war in South Sudan, which has resulted in hundreds of thousands of deaths and the flight of around one third of South Sudan’s population.

In Akobo, in the east of the country near the border with Ethiopia, people flee nearby conflict zones in search of relative safety.

It was here that we launched our newest project.

A river near Akobo, the town from which MSF organises mobile clinics across seven sites. © Frederic Noy/COSMOS

Responding to the needs of both the host community and displaced people, we began carrying out mobile clinics that travel by boat or car to provide basic healthcare where it is most needed.

“Akobo and the nearby villages are almost entirely cut-off from reliable, quality healthcare,” says Raphael Veicht, MSF’s country manager in South Sudan.

“Because medical facilities in the area have been abandoned or repurposed for other uses, this already highly vulnerable population has nowhere to turn to for basic treatment,” he adds.

Women and children make up much of the displaced community.

While some manage to settle in with family or friends, others have no other option but to stay at the nearby primary school, where they have little access to food or water.

Many are mentally traumatised after seeing their husbands, fathers, and brothers killed amid the insecurity.

Because of the ongoing conflict and resulting displacement, the medical and humanitarian needs in the region are enormous.

A mobile clinic in the remote village of Kier. © Frederic Noy/COSMOS

With mobile clinics now being held in seven different locations, our medical teams are treating over 2,000 patients per month in this part of South Sudan.

A river near Akobo, the town from which MSF organises mobile clinics across seven sites. © Frederic Noy/COSMOS

A river near Akobo, the town from which MSF organises mobile clinics across seven sites. © Frederic Noy/COSMOS

A river near Akobo, the town from which MSF organises mobile clinics across seven sites. © Frederic Noy/COSMOS

A mobile clinic in the remote village of Kier. © Frederic Noy/COSMOS

A mobile clinic in the remote village of Kier. © Frederic Noy/COSMOS

A mobile clinic in the remote village of Kier. © Frederic Noy/COSMOS

APRIL

Vaccinations in the desert

Photo © Nyani Quarmyne

Vaccines being carried towards an improvised vaccination centre in Mbera refugee camp, southeastern Mauritania. ©  Nyani Quarmyne

Being vaccinated against diseases such as diphtheria, measles and whooping cough is a commonplace event for many children.

But in the vast desert of northern Mali, where insecurity, isolation and limited health infrastructure mean many can’t access healthcare, it can prove almost impossible to protect children against these illnesses. Almost impossible, that is, until now.

In late 2017, MSF and the Mali Ministry of Health set out to vaccinate 10,000 children aged five-years and under from 11 potential life-threatening diseases including tuberculosis, measles, yellow fever, meningitis and diphtheria. By April, they’d finished the job.

A woman and her children are vaccinated in Mbera refugee camp in southeastern Mauritania. ©  Nyani Quarmyne

A woman and her children are vaccinated in Mbera refugee camp in southeast Mauritania. © Nyani Quarmyne

A woman and her children are vaccinated in Mbera refugee camp in southeast Mauritania. © Nyani Quarmyne

“A large proportion of the inhabitants in this region are nomadic, moving from one place to the next with their cattle,” says Patrick Irenge, MSF’s medical coordinator in Mali.

11 ILLNESSES COVERED
10,000 CHILDREN VACCINATED
37,280 MILES TRAVELLED
That's 1.5 times the circumference of the Earth

“This posed an additional challenge, as some of these vaccines had to be administered in three separate doses over a number of weeks.

“We had to use motorcycles and other vehicles adapted to the arid terrain. The vaccines had to be kept between two and eight degrees in the middle of a desert, where temperatures were reaching 50 degrees.”

Despite these obstacles, the teams successfully carried out the campaign, travelling over 37,000 miles; the equivalent of driving around the globe one and a half times.

“These vaccinations mean that fewer children will become ill over time,” says Irenge, “which will have a big impact on the finances of families who won’t have to spend money on healthcare. In a region like this, that really matters.”

MAY

The 'Great March of Return'

Photo © Laurence Geai

A Palestinian protestor is shot by israeli sniper. © Laurence Geai

On 11 May 2018, tens of thousands of protesters gathered along the border between Gaza and Israel in the latest stage of the "Great March of Return".

Tensions were high following more than a month of mass protests that had left 50 Palestinian protesters killed and more than 1,700 wounded.

In the image above, a Palestinian protester is carried away for medical help after being shot by an Israeli sniper. The bullet had passed through both of his legs.

Palestinians who have been wounded from Israeli live ammunition as they arrive for post-operative care at the MSF clinic in Gaza City.

Palestinians who have been wounded from Israeli live ammunition as they arrive for post-operative care at the MSF clinic in Gaza City. © Heidi Levine/Sipa Press

Palestinians who have been wounded from Israeli live ammunition as they arrive for post-operative care at the MSF clinic in Gaza City. © Heidi Levine/Sipa Press

Protests increased towards 15 May 2018, the day Palestinians mark the Yawm an-Nakba or "Day of Catastrophe", to commemorate the anniversary of their mass displacement during the 1948 war over Israel's creation.

In response to the violence, we deployed four emergency surgical teams across three hospitals, as well as established four post-operative care clinics to treat patients who had been wounded during previous demonstrations. 

Our teams also donated medical supplies to two local hospitals.

JUNE

Trapped in Mexico

Photo © Juan Carlos Tomasi

Migrants gather information at an MSF shelter in Mexico © Juan Carlos Tomasi

In June, we commemorated World Refugee Day by highlighting the situation of migrants and refugees fleeing danger in Central America.

"We are seeing a population that is increasingly trapped in Mexico," says Marc Bosch, MSF's operations manager for Latin America. 

"They can't return to the countries they escaped from for fear of violence.

"And now they can’t find safety in the US as the administration punishes those who try to cross the border with increasingly harsh and cruel measures.”

Every year more than 20,000 migrants or refugees are kidnapped in what is known as the Northern Triangle of Central America (NTCA) – Guatemala, Honduras and El Salvador.

Sixty-eight percent of the migrants and refugees interviewed by MSF in places along the transit route in Mexico had been exposed to violence. Nearly one-third of the women surveyed were sexually assaulted.

We provide medical and mental healthcare to migrants and refugees from the NTCA countries moving along the transit routes through Mexico.

We work in migrant shelters and mobile clinics along the railway lines and in three locations on the migrant routes: in Tenosique, Coatzacoalcos and Reynosa.

Ruth, right, left Honduras to escape a life of daily violence. Her husband was kidnapped and released, and her family had to flee because their lives were in danger. Their journey has been very difficult but MSF has been able to help them with medical and mental healthcare. © Arlette Blanco/MSF

We also run a comprehensive care centre for victims of extreme violence in Mexico City.

This centre opened in 2016 in response to the medical and humanitarian needs of people in transit.

Ruth, right, left Honduras to escape a life of daily violence. Her husband was kidnapped and released, and her family had to flee because their lives were in danger. Their journey has been very difficult but MSF has been able to help them with medical and mental healthcare. ©  Arlette Blanco/MSF

Ruth, right, left Honduras to escape a life of daily violence. Her husband was kidnapped and released, and her family had to flee because their lives were in danger. Their journey has been very difficult but MSF has been able to help them with medical and mental healthcare. © Arlette Blanco/MSF

Ruth, right, left Honduras to escape a life of daily violence. Her husband was kidnapped and released, and her family had to flee because their lives were in danger. Their journey has been very difficult but MSF has been able to help them with medical and mental healthcare. © Arlette Blanco/MSF

JULY

Mosul one year on

Photo © Sacha Myers/MSF

Mosul’s old town experienced intense shelling and bombing during the conflict to retake the city from the Islamic State group in 2016/17 ©  Sacha Myers/MSF

July marked one year since the battle between the Islamic State group and Iraqi forces officially ended in Mosul, Iraq.

The biggest urban battle since the Second World War left the city’s health system in ruins.

Hospitals were struggling to cope as thousands of people continued to return to Mosul.

The reconstruction of health facilities had been extremely slow.

There were still fewer than 1,000 hospital beds for a population of 1.8 million people, which is half of the internationally recognised minimum standards for health service delivery in a humanitarian context.

Our hospital in east Mosul provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. ©  Sacha Myers/MSF

Our hospital in east Mosul provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. © Sacha Myers/MSF

Our hospital in east Mosul provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. © Sacha Myers/MSF

Throughout the 12 months since the battle, MSF’s hospital in west Mosul saw a shift from war-related wounds, to mine injuries, and by July, injuries and medical issues related to poor living conditions as more people returned to the city.

Our work in the city is far from over.

AUGUST

TB treatment revolution

Photo © Lana Abramova

© Lana Abramova

This month in the Uzbek city of Nukus, something special happened: we began treating Bibizada*, our 100th patient in a groundbreaking tuberculosis (TB) study.

MSF UK doctor Bern-Thomas Nyang'wa leads the TB-PRACTECAL clinical trial. Sponsored by MSF, the study is evaluating new approaches to combat multidrug-resistant TB – a strain of the illness that does not respond to first-line antibiotics and can require an arduous two-year treatment. 

Dr Bern-Thomas Nyang'wa (second from right) at the event in Nukus marking the launch of TB PRACTECAL in February 2017. © MSF

Dr Bern-Thomas Nyang'wa (second from right) at the event in Nukus marking the launch of TB PRACTECAL in February 2017. © MSF

Dr Bern-Thomas Nyang'wa (second from right) at the event in Nukus marking the launch of TB PRACTECAL in February 2017. © MSF

“We decided to run this trial because, despite so many people currently living with multi and extremely drug resistant TB, there’s been nowhere near enough investment in finding better treatments for them,” says Bern.

“The side effects of the medicines people currently take are often described as worse than the disease itself: nausea, headaches, deafness, psychosis.

"Patients have to take up to 20 pills a day, alongside painful injections, and treatment can last more than two years.

“And after all that, only about half of patients are cured. It’s not good enough. That’s why MSF took the decision to launch TB-PRACTECAL.”

From now until the end of her treatment, Bibizada will take a combination of drugs under the expert care of our team. 

We still have lots of work to do - we’ll be recruiting 630 patients in total to the trial, and we’re expecting the final results in 2021. But we’re proud to have reached the milestone of treating our 100th patient. It’s a step on the way to improving the lives of people struggling with this disease.

The following month, we were heartened as the UN held the first-ever TB summit in New York.

*Bibizada is a false name that our patient has asked us to use

SEPTEMBER

Hard to port

Photo © Nick Owen/MSF

Aquarius search and rescue ship

© Nick Owen/MSF

© Nick Owen/MSF

In September, we received the upsetting news that the registration of our search and rescue ship, Aquarius, had been revoked.

The registration was help by the Panama Maritime Authority and was rescinded under blatant economic and political pressure from the Italian government.

Since the start of its search and rescue work in February 2016, Aquarius assisted nearly 30,000 people in international waters between Libya, Malta and Italy.

In December this year, MSF and SOS MÉDITERRANNÉE – our partner organisation on Aquarius – were forced to terminate lifesaving operations altogether due to obstruction by the Italian and other European governments.

An MSF midwife provides an ultrasound for a pregnant woman, one of the last people to be rescued in September this year. © MSF

An MSF midwife provides an ultrasound for a pregnant woman, one of the last people to be rescued in September this year. © MSF

An MSF midwife provides an ultrasound for a pregnant woman, one of the last people to be rescued in September this year. © MSF

“Just as we said when we launched our search and rescue operations in 2015 - we refuse to remain idle on shore as people continue to die at sea,” says Karline Kleijer, MSF’s head of emergencies.

“As long as people are suffering at sea and in Libya, MSF will look for ways to provide them with the vital medical and humanitarian care they desperately need.”

The unavoidable end to Aquarius’ life-saving operations is happening at a critical time.

An estimated 2,133 people have died in the Mediterranean in 2018, with departures from Libya accounting for the overwhelming majority of lives lost.

The UK and European governments have further fuelled the unnecessary suffering of thousands by enabling the Libyan coastguard to intercept more than 14,000 people at sea this year alone and forcibly return them to Libya.

This is in clear violation of international law. In 2015, Europe made a commitment to the UN Security Council that nobody rescued at sea would be forced to return to Libya.

OCTOBER

Trouble in paradise

Photo © MSF

An aerial view of a detention facility on the island of Nauru

In October, we received more bad news for our patients.

Since November 2017, we had been providing free psychological and psychiatric services on the Pacific island of Nauru to refugees, asylum seekers and Nauruan locals.

These services were put on hold on 5 October when the government of Nauru informed us that our services were “no longer required” and requested that MSF end activities within 24 hours.

Almost all 900 asylum seekers and refugees on Nauru, including 115 children, have been on the island for more than five years, with no clear process or prospect of permanent resettlement.

This is a result of the Australian government’s policy of indefinite offshore detention.

As corroborated by MSF medical analysis, refugee patients exist in a vicious cycle of deep despair with many having lost the will to live.  

Among them, at least 78 patients seen by MSF had suicidal ideations and/or engaged in self-harm or suicidal acts.

 MSF psychiatrist Patricia Schmid attends to a patient on Nauru. © MSF

MSF psychiatrist Patricia Schmid attends to a patient on Nauru. © MSF

MSF psychiatrist Patricia Schmid attends to a patient on Nauru. © MSF

Children as young as nine have told MSF staff that they would rather die than live in a state of hopelessness on Nauru.

“This policy should be stopped immediately and should not be replicated by any government,” says Paul McPhun, MSF Australia’s executive director.

“It’s not MSF’s psychiatrists and psychologists that should be leaving Nauru; it’s the hundreds of asylum seekers and refugees that Australia has trapped on the island for the past five years that should be leaving.”

NOVEMBER

City under siege

Photo © Hareth Mohammed/MSF

A boy hospitalised in Al Salakhana hospital in Hodeidah, where he was injured by shrapnel from an explosion near a petrol station.

Our teams treated more than 500 war-wounded people in the Yemeni city of Hodeidah after a new battle began this month.

The offensive was launched by Saudi and Emirati-backed forces against Ansar Allah troops on 1 November.

“Our staff can hear explosions and shootings occurring extremely close by every day around Al-Salakhana hospital,” explained Caroline Seguin, MSF operations manager for Yemen at the time.

Al-Salakhana hospital remains one of the only three open and operational public hospitals in the area. Al-Thawrah hospital, the main public health facility in the city, is still working but is threatened by fighting and rapidly moving frontlines.

“Civilians have ever fewer options to access healthcare in Hodeidah, and referral to other health facilities outside the city takes hours”, explains Seguin.

British doctor Chris Hook was in Hodeidah at the peak of the fighting.

DECEMBER

Ebola grips Congo

Photo © John Wessels

Health workers move a patient to a hospital after he was cleared of having ebola inside a MSF supported Ebola Treatment Centre on 4 November 2018 in Butembo.

The Democratic Republic of Congo was struck by two Ebola epidemics in 2018.

In December, the second outbreak – in the east of the country – became the second-worst Ebola epidemic in history. 

Since August, Ebola had been affecting the villages and towns of North Kivu and Ituri provinces. That is, until it reached Butembo, a sprawling city of one million people. 

What makes this outbreak of Ebola even harder to control is the conflict that still grips this region of Congo.  

As of 17 December, more than 490 cases of Ebola have been confirmed and it has killed more than 270 people.  

At the Congolese Ministry of Health’s request, we are part of the national group coordinating the response. We are: 

  • Caring for patients affected by the virus in five Ebola treatment centres  
  • Vaccinating frontline workers 
  • Training staff 
  • Supporting surveillance activities 
  • Providing communication and health promotion in communities 

In total, more than 100 MSF staff members are currently working in Ebola projects in North Kivu and Ituri provinces. 

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