Aiding Civilians
Caught in Ivory Coast
Violence
In early November, Doctors Without Borders/Médecins Sans
Frontières (MSF) medical teams responded to emergencies in
northern and southern Ivory Coast in the wake of a government
offensive on the rebel-held cities of Bouaké, in north-central
Ivory Coast, and Korohgo, on the northern border with Mali. MSF
works in both government- and rebel-controlled areas.
On November 4, 2004, MSF treated 39 people who were
injured during an air strike on Bouaké. The wounded were
referred to Bouaké’s public hospital, where an MSF medical
and surgical team has been working since October 2002, the
start of the country’s civil war. The same air strike killed
several French peacekeepers and was followed by retaliatory
attacks by the French military, which precipitated riots and
mob violence in the capital, Abdijan.
MSF donated medical and surgical equipment, including
antibiotics, analgesics, sterile bandages, and gloves, to three
hospitals in Abidjan to assist the staff in providing emergency
medical care for those wounded during the week of violence.
In addition, MSF airlifted eight tons of emergency relief
materials to the Ivory Coast. Some international volunteers
were evacuated when mobs began targeting foreigners.
Prior to the recent violence, MSF’s aid work in Abdijan had
focused on providing medical assistance to the prisoners in
the city’s main prison, the Maison d’Arrêt et de Correction
d’Abidjan. Recently, MSF teams provided medical assistance
in the aftermath of a riot in the prison that resulted in more
than 45 injuries and at least 10 deaths.
TABLE OF CONTENTS
AIDING CIVILIANS CAUGHT IN IVORY COAST VIOLENCE
UNENDING SUFFERING IN NORTHERN UGANDA
FIGHTING MEASLES IN DARFUR
THE HIDDEN SCARS OF WAR: PROVIDING MENTAL
HEALTH CARE IN TIMES OF CONFLICT
ON THE FRONTLINES OF HIV/AIDS TREATMENT
RESPONDING TO EMERGENCIES IN CONGO
NEWS&EVENTS
MSF STOPS ACTIVITIES IN IRAQ
FIELD UPDATES
SNAPSHOTS
COVER PHOTO: MSF mobile clinic in Lira, Uganda. 2004 © Francesco Zizola
IVORY COAST VIOLENCE
An MSF surgical team operates on a patient at a public hospital in the north-central
city of Bouaké, where MSF has been working since the start of the civil war in
October 2002. 2004 © Jacques Kahn/MSF
Throughout the fighting, MSF has continued to support the
160-bed main hospital in Bouaké. In addition to running
pediatric, maternity, and other wards, medical teams have
run two 24-hour operating rooms in the hospital. In Korohgo,
an MSF medical team operated two health centers and a
maternity department, with 250 deliveries per month, until
December 2004.
Medical teams also performed surgery, provided health care,
and ran a therapeutic feeding center in Man Hospital in
western Ivory Coast. In Danané, an MSF-supported hospital
treated approximately 70 patients each day. An MSF medical
team continues to provide consultations and emergency care
at Bin Houyé Hospital, which is on the country’s western border
with Liberia. In Guiglo, in the south, MSF assists vulnerable
and internally displaced people at an outpatient clinic, and
attends to malnourished children in a feeding center.
2
3
4-5
6-7
8-9
10-11
12
13
14-15 MSF IN IVORY COAST
16 PRESENT SINCE 1991
INTERNATIONAL STAFF: 60
NATIONAL STAFF: 850
2

Unending Suffering in
Northern Uganda
A recent study conducted by Doctors Without Borders/Médecins
Sans Frontières (MSF) in northern Uganda found alarming daily
mortality rates. People in the region continue to suffer the con-
sequences of the country’s 18-year civil war, and reports of torture,
abductions of children, and killings are commonplace.
The retrospective mortality study was conducted in six camps
for internally displaced people in Lira and Pader Districts. The
teams found a crude mortality rate of 2.8 deaths per 10,000
people per day for the general population, and an even more
alarming rate of 5.4 deaths per 10,000 children a day among
those under five years of age. The rate climbed to 10.5 deaths
per 10,000 children a day in one location.
“The extent of suffering is overwhelming, and the situation
remains critical,” said Monica de Castellarnau, MSF head of
mission in Uganda. “Not only do people live under constant
threat, they lack basic resources and safe access to water,
food, and health care. We are doing what we can, but more
assistance is needed immediately.”
Traumatized People
A mental health survey in Pader revealed that almost all of
the residents surveyed had been exposed to severe traumatic
events since 2002.
MSF IN UGANDA
PRESENT SINCE 1986
INTERNATIONAL STAFF: 67
NATIONAL STAFF: 510
3 SUFFERING IN NORTHERN UGANDA
An MSF nurse examines a child at a mobile clinic in a displaced-persons camp
outside the northern Ugandan town of Lira. 2004 © Francesco Zizola
— 63 percent reported the disappearance or abduction of a
family member;
— 58 percent reported the death of a family member due
to the insurgency;
— 79 percent had witnessed torture;
— 40 percent had witnessed a killing; and
— 5 percent had been forced to physically harm someone
Responding to Growing Needs
MSF has been expanding its emergency programs throughout
northern Uganda. In Lira District, MSF runs a 350-bed thera-
peutic feeding center and a supplementary feeding program,
and operates clinics in four camps for internally displaced
people. MSF mobile clinics serve two additional camps every
week, and teams conduct water-and-sanitation activities in
eight rural camps for displaced people.
In Pader District, MSF runs water-and-sanitation and medical
activities as well as a mobile clinic that visits a camp outside
the main town. A little farther north, MSF medical teams
recently found tens of thousands of people living in squalid
conditions with little access to health care.
MSF runs a night shelter for the nearly 4,000 children who
seek a safe place to sleep each night on the grounds of Lacor
Hospital in the town of Gulu. The children fear abduction
and forced conscription by the Lord’s Resistance Army, the
rebel group that has been fighting the Ugandan government
for more than a decade.
Also in Gulu District, MSF supports a clinic in Pabbo camp for
internally displaced persons, and treated nearly 100 people
for cholera following a recent outbreak.
Early in the morning, MSF staff and local health workers prepare the vaccines for the campaign. Measles vaccines require the maintenance of a
“cold chain”—dependable refrigerators and coolers that keep the vaccines at a constant temperature—a difficult task in a town where generators
are the only source of electricity. At one of the vaccination sites, an MSF nurse and local health-care worker maintain the “cold chain” by placing
vaccines in smaller coolers to be used by each vaccinator.

A vaccinator fills syringes with the appropriate Children line up to be vaccinated at one of the sites. Some come alone, and others are accompanied
amount of vaccine so that many children can by a parent or older sibling.
be immunized quickly.

Each child receives an immunization card to show that he or she has been vaccinated against measles. MSF staff tally the numbers of children
being vaccinated, and each child’s sex and age, to calculate the success of the vaccination campaign.

FIGHTING MEASLES IN DARFUR 4

 Recognizing that many parents are unable to bring their children to the vaccination points, MSF A community leader walks through the market in
deploys a mobile vaccination team to the local market to reach children there. Kebkabiya announcing the measles-vaccination
campaign and urging parents to bring their
children to be vaccinated.

Children are vaccinated.

All photos: 2004 © Kris Torgeson/MSF

FIGHTING MEASLES IN DARFUR

Measles kills 500,000 children in sub-Saharan Africa each year. The
disease can spread quickly, especially in crowded, unhygienic
conditions, which are often found in conflict zones and in places
where poverty and lack of health care has prevented children
from being vaccinated.
When Doctors Without Borders/Médecins Sans Frontières (MSF)
arrived this past spring in Kebkabiya in North Darfur, Sudan, local
leaders, parents, and health-care workers told of children dying
of measles despite a vaccination campaign that had been carried
out by the ministry of health. Kebkabiya’s population swelled from
12,000 to 60,000 over the past year as people fleeing fighting
in the region settled in and around the town. MSF surveys found
that merely 63.2 percent of the people had been vaccinated against
measles. MSF proposed a mass vaccination campaign for all children
between six months and 15 years old living in Kebkabiya and the
nearby town of Serif Umra—a total of more than 35,000 children.
MSF worked with local community leaders to identify the best sites
in the towns for the vaccination campaign and enlisted locally
hired staff to get the word out to Kebkabiya residents and dis-
placed people. After overcoming difficulties securing permis-
sions for the campaign and getting the vaccines and medical
staff in place, MSF launched its measles-vaccination program in
late September. Over a 12-day period, nearly 27,000 children
were vaccinated in Kebkabiya alone. The campaign continues
in three MSF clinics and in the local hospital for new arrivals
and those not previously vaccinated.

5 FIGHTING MEASLES IN DARFUR

THE HIDDEN SCARS OF WAR: PROVIDING
MENTAL HEALTH CARE IN TIMES OF CONFLICT
Doctors Without Borders/Médecins Sans
Frontières (MSF) has for more than 30 years
responded to wars, famines, epidemics, and
natural disasters by providing emergency
medical care to people in crisis. However,
it was on the killing fields of Bosnia in
the 1990s that MSF volunteers recognized
that it was not enough to meet the physical
needs of people caught up in conflict. The
psychological and emotional scars of war
—wounds that may continue in people’s
minds long after the fighting has ended—
were being neglected.
“What do you do if there is enough food,
but no one wants to eat?” asks Kaz de Jong,
MSF’s mental health advisor. “Sometimes
people are unable to eat because they
photo: A Bosnian woman attends a funeral for victims
of the war. 1992 © Tom Stoddart
THE HIDDEN SCARS OF WAR
no longer want to live. They may have
witnessed the killing of their family.”
From 1993 to 1997, MSF implemented
a comprehensive program to address
the emotional trauma of thousands of
people, including children, affected by
the Bosnian war.
“I would like a new house like a castle and
I would like the people who destroyed it
to be punished by making them rebuild a
castle,” said Matja, a 7-year-old Bosnian
girl who lived in Croatia during the war,
in response to a question from an MSF
psychologist. “I also want them to give
me back the boat they stole. I want the
little brook next to my house, the water-
falls, and the things I had in the house.
I want my grandmother to come back
alive from Bosnia.”
The Bosnia program was a departure, in
both size and scope, from earlier mental
health interventions MSF had undertaken
in the Gaza Strip, Uganda, and India. Under
de Jong’s coordination, MSF established
10 counseling centers in Sarajevo and
trained 70 local counselors to help bridge
the cultural divide between MSF volunteers
and the Bosnians they aimed to assist.
Training local counselors, which is at the
heart of MSF’s mental health approach, was
also crucial to building up the community’s
capacity to deal with the ongoing conflict.
Through a mix of individual and group
counseling the program aimed to help
Bosnians restore the bonds among family,
friends, community, and society.
MSF used radio programs to teach Bosnians
about emotional reactions to traumatic
6
events. “The stigma of weakness, the
acknowledgment of suffering, and the
shame that so often surrounds traumatized
people became a collective experience,”
says de Jong. The program reached more
than 10,000 people.
From Bosnia to Gaza to Sudan
Since the Bosnian war, MSF has conducted
mental health interventions in more than
40 countries. Generally, MSF’s mental health
volunteers provide psychological education
and train local counselors to assist their
neighbors. They also bring home-based care
to people too traumatized to leave their
homes and establish walk-in clinics.
With mental health programs operating
from Colombia to Nepal, MSF volunteers
design their interventions to account
for cultural differences. In Sierra Leone,
for example, MSF volunteers found the
greatest success using group therapy for
people affected by the country’s civil
war. But in Chechnya, people were
reluctant to speak within groups and
favored one-on-one sessions in formal
health structures, according to MSF’s
Kaz de Jong.
“We made it less formal in Sierra Leone,”
says de Jong. “The sessions often took
place sitting under a tree. People would
walk by and join the group.”
Since 2000, MSF psychologists have con-
ducted counseling sessions for families
trapped amid the ongoing conflict in
the Palestinian Territories. During an
Israeli offensive into the Gaza Strip in
October 2004, MSF mental health teams
were denied access for several weeks to
the families they had been treating.
Indeed, one of the greatest challenges
of treating emotional and psychological
trauma in conflict zones is the risk
that patients will become separated from
their therapists. For this reason, the
counselors and therapists focus their
intervention on enhancing psychological
self-help mechanisms.
7 PROVIDING MENTAL HEALTH CARE
Integrating Mental Health Care
In most cases, mental health specialists
work within MSF’s existing emergency
medical programs. In Darfur, western
Sudan, MSF psychologists are training
community health workers to identify
and support survivors of sexual violence.
“Women are afraid to tell their husbands
they have been raped since they don’t
want them to go and fight,” a 20-year-
old displaced woman in West Darfur told
MSF. “They only say they have been
beaten. But men are fully aware that their
wives have been raped.”
“WHAT DO YOU DO IF THERE
IS ENOUGH FOOD, BUT NO
ONE WANTS TO EAT?”
The health workers tell the people living
in displaced-persons camps about the
opportunities for psychosocial care and
refer women for medical treatment.
In therapeutic and supplementary feeding
centers, volunteers are trained not only
to focus on the malnourished children but
also to look for signs of emotional trauma
in mothers. The most telling signs are
mothers who no longer care for their
children—who do not hold them anymore
and hardly interact while feeding them.
Volunteers try to rebuild the mother-
child bond by addressing the mother’s
psychosocial needs through counseling
groups or helping the women get back
to their daily routine from before their
displacement, like making clothes or
cooking meals.
Supporting AIDS Patients
Mental health care is an integral part
of MSF’s HIV/AIDS-treatment programs.
All of the 23,000 patients receiving
antiretroviral therapy in MSF clinics
and hospitals have access to psycho-
social support.
“But we need to improve this support
for people living with AIDS,” says de
Jong. “The incidence of depression is
very high among this group. All end-stage
HIV/AIDS patients suffer from dementia
or conditions seen in much older people.
We need to develop strategies to help
our patients cope with these conditions.”
Coping with Natural Disasters
MSF sends mental health teams to help
people cope with the traumatic stress
of natural disasters. Currently, teams are
working with families that have been
left homeless by the flooding in Gonaives,
Haiti, and with the government workers
who have buried the dead. In late 2003,
MSF sent psychologists to Bam, Iran,
following the severe earthquake there.
Care for the Neglected
MSF operates mental health programs
not only in response to conflicts and
natural disasters, but also for the most
vulnerable groups in relatively stable
societies. MSF has worked with institu-
tionalized people, for example, in
Armenia, Tajikistan, Albania, and in other,
less-stable countries like Sierra Leone
and Kashmir. In the town of Baoji,
China, MSF offers psychosocial support
to orphaned and abandoned children,
many of whom have been abused.
“Eighty percent of the children have
been mistreated or beaten—often by
the ‘adoptive’ families who took them
in—before being abandoned on the
streets of Baoji,” says Francoise Oppenot,
an MSF volunteer and child psychiatrist
who has treated children there. “They
wander the streets, collecting empty
bottles that they sell by weight, and
have to beg to stay alive.”
The goal of the program is to offer a
stable environment for the children and
the right conditions for their recovery,
which includes temporary housing and
access to medical and psychosocial care,
as well as access to schooling.
The program has reached more than 300
children since 2001.
 ON THE FRONTLINES OF
HIV/AIDS TREATMENT
Doctors Without Borders/Médecins Sans Frontières (MSF) has been caring for people living
with HIV/AIDS in developing countries since the mid-1990s, and first launched treatment
programs in 2000 in Thailand and South Africa. MSF currently provides antiretroviral
(ARV) treatment to more than 23,000 people in 27 countries—a 150 percent increase
from December 2003. But there are more than six million people living with HIV/AIDS
worldwide who are desperately in need of ARV treatment today while fewer than 500,000
people have access to it.

A week’s worth of ARV medicines for an HIV/

AIDS patient in Siem Reap Provincial Hospital
in Cambodia. The boxes are color-coded to
With the counseling and guidance of an MSF medical team, an 11-year-old, HIV-positive Thai girl is able to prepare her ARV distinguish pills to be taken at different
medicines without help from her mother. 2004 © Joanne Wong times in the day. 2004 © Espen Rasmussen

Two MSF national staff members operate a bicycle-ambulance service to transport an HIV/AIDS patient to the MSF clinic in
Malawi’s Thyolo province. A relative accompanies the patient to the clinic. MSF provides ARVs to more than 4,000 people —
more than 90 percent of the people receiving treatment for HIV/AIDS in Malawi. 2004 © Gael Turine

ON THE FRONTLINES OF HIV/AIDS TREATMENT

Eric Goemaere, MD, MSF head of mission in South Africa, exam-
ines an HIV/AIDS patient in an MSF clinic in the town of
Khayelitsha. MSF treats more than 2,000 South Africans living with
HIV/AIDS. 2003 © Francesco Zizola
Esther, a five-year-old girl, is examined at
the MSF HIV/AIDS clinic in the Mathare
slums of Nairobi, Kenya. A neighbor who
receives ARV treatment at the clinic has
brought Esther here.
2003 © David Levene
A nurse at Odessa City Hospital in Ukraine, where MSF supports a comprehensive HIV/AIDS treatment pro-
gram, brings food to eight-year-old Maxim. Maxim is HIV-positive and was abandoned by his parents. Some
1,000 mother-child pairs participate in MSF’s program to prevent mother-to-child transmission of the virus,
and 120 adults and approximately 30 children now receive ARV treatment. 2003 © Alexander Glyadelov
A young woman waits with her daughter to receive ARV treatment at an MSF clinic in Mozambique. MSF
provides ARVs to more than 2,800 people—more than 60 percent of those receiving HIV/AIDS treatment in
this country. “Before, only treatment for opportunistic diseases existed,” says Dominique Arthur Delley,
coordinator of MSF’s AIDS program. “We were trying to delay death. Now we are supporting a life project.”
2004 © Martin Beaulieu
ON THE FRONTLINES OF HIV/AIDS TREATMENT
RESPONDING TO EMERGENCIES IN CONGO
A delicate peace agreement has been reached in the Democratic
Republic of Congo (DRC), but many people are still in a state of
crisis. Among them are at least 9,000 Congolese who fled their
villages after violence broke out in the Mitwaba region of south-
east Katanga Province.
“It is hard to say how many people have been forced to leave
their villages due to continuing violence between the Congolese
army and local militia groups because many are still hiding in
the forest,” says Doctors Without Borders/Médecins Sans Frontières
(MSF) head of mission Alain Decoux. “The people are caught
in the crossfire. Both sides prey on the villages for their survival.
When it is suspected that a village is backing the other side,
the result is often that the village is razed to the ground and
the people are forced to flee into the bush.”
In November 2004, MSF dispatched one of its DRC emergency
teams to assist the displaced people in Katanga. MSF set up
four health centers in and around Mitwaba, providing 1,500
consultations in the first week alone.
Currently, each health center is receiving 60 to 120 patients
every day, with the most common ailments being bloody diarrhea,
malaria, and acute respiratory infections. On the day that one
of the health centers opened, 45 of the 54 patients were
found to be malnourished.
“Being forced to flee means that people can’t tend to their crops,”
says Decoux. “Although even if cultivation were possible, the
harvest is vulnerable to pillaging by any one of the numerous
armed forces. It has reached the point that people prefer to
eat seeds than to risk attempting to cultivate.”
RAPID RESPONSE
The situation in Katanga is just one of more than 40 emergencies
to which the MSF emergency teams in the DRC have responded
this year. From addressing outbreaks of measles and cholera, to
aiding abused Congolese diamond miners who were expelled into
the jungles of southwestern DRC by the Angolan government,
the emergency teams try to intervene within five days of
receiving a call for assistance. This is no easy task in a country
the size of Western Europe, many of whose communities are
only accessible by boat or motorcycle.
“Our team is capable of carrying out three simultaneous inter-
ventions. But two is more reasonable,” says Charles Kisamba, MD, a
member of the Kisangani-based MSF emergency team. The teams
are based in Kinshasa, Mbandaka, Lubumbashi, and Kisangani.
RESPONDING TO EMERGENCIES IN CONGO
One of the MSF emergency teams intervened in a measles epidemic
in the Yahuma region of Eastern Province. “This started right
at the beginning of August when we received an alert from
our mobile team in Lobutu, verified by village chiefs and nurses
from the local health centers,” says Dr. Kisamba. “So we were
off to investigate and intervene.”
With 326 measles cases in two weeks across four villages, the
team had to work fast to stop the spread. “We quickly set up
four diagnostic and treatment centers,” says Dr. Kisamba, “first
treating the infected cases and creating isolation facilities to
cut the transmission chain. Then, we began a public-awareness
campaign to inform parents of the need to separate healthy
from ill children.”
Measles is one of the biggest health threats in the region
because vaccination coverage is very low, malnutrition is rife,
and the health system has been ruined by the war. Says Dr.
Kisamba, “These factors help the rapid spread of disease, and
children are just not protected.” The MSF emergency teams
treated more than 12,000 people for measles in 2004.
BATTLING 13 DISEASES
Measles is only one of the 13 diseases covered by the emergency
team. Others include common killers such as cholera, malaria,
and diarrhea-related diseases, as well as rare diseases like
Ebola and bubonic plague.
An MSF emergency team was recently sent to Dingila in Eastern
Province to deal with monkeypox, a disease that kills 15 percent
of the people it infects. It is virtually unknown to the medical
profession and therefore extremely difficult to treat.
“This animal pox can be transmitted to humans,” says Dr.
Kisamba. “Hunters often get infected, as do those who’ve been
in contact with dead animals.”
Monkeypox causes eruptions on the skin, which are entry
points for other microbes. By isolating the patient and raising
public awareness, the transmission chain can be broken, but
without MSF’s assistance the local hospitals would not have
the means to treat patients effectively.
But Dr. Kisamba’s greatest fear is an outbreak of viral hemorrhagic
fever, more commonly known as Ebola, a highly contagious
virus that can kill 90 percent of all people who have clinical
signs of the disease. “We do rehearsals before going to the
field because if you commit the smallest error, there is no safety
Maintaining the cold chain, an MSF volunteer removes
net,” says Dr. Kisamba.
vaccines from a refrigerator. © Frederic Sautereau
10
 MSF IN THE DEMOCRATIC
REPUBLIC OF CONGO
PRESENT SINCE 1981 An MSF emergency team unloads its motorcycles along the banks
INTERNATIONAL STAFF: 217 of the Tshuapa, a tributary of the Congo River. The team still has
to travel more than 20 miles before reaching the health center in
NATIONAL STAFF: 1,829 Equateur Province. 2003 © Carl De Keyzer

DEMOCRATIC REPUBLIC OF CONGO

POPULATION: 53.6 MILLION
INTERNALLY DISPLACED PEOPLE: 3 MILLION
LIFE EXPECTANCY 1970-75 VS. 2000-05: 45.8 YEARS VS. 41.8 YEARS
PROBABILITY AT BIRTH OF NOT SURVIVING TO AGE 40: 47.2%
UNDER-FIVE CHILD MORTALITY RATE PER 1,000 LIVE BIRTHS: 205
CHILDREN UNDER WEIGHT FOR AGE: 31%
MATERNAL MORTALITY RATIO PER 100,000 LIVE BIRTHS: 990
PHYSICIANS PER 100,000 PEOPLE: 7
Source: Human Development Report 2004

11 RESPONDING TO EMERGENCIES IN CONGO


Sudan. 2004 © Ton Koene
SPEAKING OUT ON DARFUR
Doctors Without Borders/Médecins Sans Frontières (MSF) held
a number of public events this fall in New York and Los Angeles.
In September, NBC’s Ann Curry moderated a discussion on the
catastrophe in Darfur, Sudan, which was hosted by the New
School University in New York City and attended by 500 people.
Curry was joined by MSF-USA Executive Director Nicolas de
Torrenté; MSF field volunteer Jonathan Spector, MD; Salih
Booker of Africa Action; and journalist Scott Anderson.
Afghanistan 2002 ©Sebastian Bolesch
PHOTOGRAPHS FROM AFGHANISTAN
In October, the 92nd Street Y in New York City opened “Doctors
Without Borders: Photographs from Afghanistan,” an exhibit
documenting MSF’s long history in this war-torn country.
Speakers at the opening reception included writer Sebastian
Junger, MSF Operations Director Kenny Gluck, and photojournalist
Didier Lefevre. Lefevre traveled with MSF medical teams in
the 1980s as they undertook clandestine cross-border operations
from Pakistan to reach Afghans stranded in areas that were
most affected by the Soviet occupation.
NEWS & EVENTS
After its six-week run at the 92nd Street Y, the exhibit moves
to Los Angeles, where it will appear at the 14th International
LA Photographic Art Exposition from January 20-23, 2005. The
photographs are also viewable online at:
www.doctorswithoutborders.org/afghanphotos
THE HIDDEN SCARS OF WAR
In November, broadcast journalist and MSF-USA Board of Advisors
member Garrick Utley hosted a discussion of MSF’s mental health
programs at an event hosted by NYU Medical Center and attended
by more than 150 mental health professionals and others.
Malawi 2004 © Gael Turine
AIDS TREATMENT FILM SCREENING
To mark World AIDS Day on December 1, a documentary featuring
MSF AIDS-treatment programs in Guatemala, Malawi, and
Thailand, was screened at the University of California at Los
Angeles. The documentary, “AIDS Treatment: Reaching the
People?” was screened again that evening at the Laemmle
Theatre in Santa Monica, followed by a discussion hosted by
KPCC radio’s Kitty Felde, with MSF doctors Gildon Beall,
Rick Hamner, and Deborah Milligan.
“HUMANITARIAN AID IS AN
APOLITICAL ACT”
On November 11, 2004, King Abdullah of Jordan presented
Doctors Without Borders/Médecins Sans Frontières (MSF) with
the King Hussein Humanitarian Leadership Prize.
The $50,000 prize came into existence in 2000 and was award-
ed by the King Hussein Foundation, named for the late king
of Jordan.
“In these times of renewed fighting in Ivory Coast, with
great needs in the Darfur region of Sudan, and in many
less-known contexts such as northern Uganda or Chechnya,
this recognition from civil society makes us realize our work
is supported and not forgotten,” said MSF International
President Rowan Gillies, MD.
12
MSF STOPS ACTIVITIES IN IRAQ
In November 2004, Doctors Without
Borders/Médecins Sans Frontières (MSF)
closed its humanitarian aid programs in
Iraq after nearly two years of working
there. MSF made the decision because of
the extreme risk that aid workers are
currently facing in the country.

Escalating violence in Iraq forced MSF to

conclude that it was no longer acceptable
to expose its staff to the serious risks that
have become an apparent part of being
associated with an international human-
itarian organization.

“It has become impossible for MSF as an

organization to guarantee an acceptable
level of security for our staff, be they
foreign or Iraqi,” says Gorik Ooms, MSF
general director. “We deeply regret the
fact that we will no longer be able to
provide much-needed medical help to
the Iraqi people.”

MSF has always adhered strictly to its

principle of providing assistance on the
basis of human needs. MSF strives never
to allow political, military, or other motives
to interfere with its objective of assisting
those who urgently need medical aid. In
Iraq, however, the warring parties have
repeatedly shown their disrespect for
independent humanitarian assistance.

MSF has worked in Iraq since December

2002. During the bombing of Baghdad, a
small team of international aid workers
stayed in the city to assist in the hospi-
tals. Soon after, MSF set up three clinics
in Sadr City and began supporting a
referral hospital.
The clinics provided some 100,000 medical
consultations from January to November
2004. During the course of the year, MSF
assessed needs in cities that had endured
heavy fighting—Fallujah, Najaf, and
Karbala—and supported health workers
there. The organization also added an
ambulance service to its activities in Sadr
City and had only recently begun caring
for people displaced from Fallujah.
From top to bottom:
A women on her way to work walks past a wall riddled
with bulletholes in Baghdad.
2003 © Geert van Kesteren
A boy receiving first aid from an MSF volunteer in
June 2003 at the primary health clinic in Sadr City,
north Baghdad.
2003 © Andrew Stern
The former MSF health clinic in Sadr City.
2003 © Andrew Stern

13 MSF STOPS ACTIVITIES IN IRAQ

 GUATEMALA REPEALS LAW
RESTRICTING ACCESS TO MEDICINES
In November 2004, the Guatemalan Congress
repealed a law that could have severely restricted
people’s access to affordable essential medicines.
MSF has recommended that the government take
advantage of this decision to ensure treatment for
greater numbers of Guatemalans living with HIV/
AIDS and other infectious diseases. MSF also has
warned that this step forward could be reversed
by similar intellectual-property provisions found in
the recently signed United States-Central America
Free Trade Agreement (CAFTA). MSF has been
treating people living with HIV/AIDS in Guatemala
since 2001. The organization treats more than
RESPONDING TO FLOODS IN HAITI 1,600 patients with antiretroviral (ARV) therapy in
In response to the hurricane and floods that killed
a hospital and clinic in Guatemala City and in health
thousands and left nearly 200,000 people homeless
centers in Coatepeque and Puerto Barrios.
in the Haitian city of Gonaives, Doctors Without
Borders/Médecins Sans Frontières (MSF) medical
teams established in September 2004 a health
center in Raboteau, a slum in the western part of
the city. “The center existed before the disaster but
was not operational at all,” says Silvien Auerbach,
MSF head of mission in Haiti. “Thanks to people
in the community who helped us remove the mud
and clean the building, we were able to use it for
consultations.” MSF volunteers performed more
than 900 medical examinations a day in the clinic
in the weeks following the floods. Today, a mental
health team is also offering psychosocial therapy
to people receiving care in the Raboteau center,
to local government staff who were charged with
recovering the dead, and to rural populations out-
side the city. Another MSF team has supported the
hospital in Port de Paix, north of Gonaives, since
October, and has organized mobile clinics in the
village of Chansolme, also hit by the hurricane.
2004 © Dieter Telemans

FIELD UPDATES
 DOCTORS WITHOUT BORDERS/
MÉDECINS SANS FRONTIÈRES USA
TREATING AIDS IN KENYA Executive Director
In October, MSF and the Kenyan Ministry of Health Nicolas de Torrenté, Ph.D
opened a health center and HIV/AIDS-treatment Board of Directors & Officers
Darin Portnoy, MD, MPH
program for the people living in the Kibera slum of
President
Nairobi. Kibera is one of the largest slums in Africa Martha Carey
with a population of more than 600,000. Those living Vice President
in Kibera will have access to outpatient consultations, David A. Shevlin, Esq.
mother-and-child health care, treatment for victims Secretary
Jean-Hervé Bradol, MD
of sexual violence, and comprehensive HIV/AIDS William Conk
treatment. “Disease is rife, with the biggest killer Roshan Kumarasamy
in the slum being HIV/AIDS-related diseases,” says Bruce Mahin
MSF head of mission Christine Jamet. MSF has been Christine Nadori, RN
John E. Plum
working in Kibera since 1997. Currently, 150 people
Treasurer
living with HIV/AIDS are receiving antiretroviral Myles Spar, MD, MPH
treatment through MSF. MSF runs similar programs Board of Advisors
in other areas of Nairobi, as well as in Busia and Richard Rockefeller, MD
Homa Bay. Chairman of the Board
Robert Bookman
Chairman, West Coast Council
Creative Artists Agency
Donald Mark Berwick, MD, MPP
Institute for Healthcare Improvement
Victoria B. Bjorklund, Esq., Ph.D
Simpson Thacher & Bartlett
A. Bruce Brackenridge
J.P. Morgan & Co., Inc. (Ret.)
Marek T. Fludzinski, Ph.D
Thales Fund Management, LLC
Peter Grose
Kennedy School of Government, Harvard
Jean Karoubi
The LongChamp Group
Susan Liautaud
James Ottaway, Jr.
Dow Jones & Co. (Ret.)
Ottaway Newspapers, Inc.
Kevin Patrick Ryan
DoubleClick, Inc.
Garrick Utley
Neil D. Levin Graduate Institute, SUNY
AID TO SUDANESE REFUGEES IN CHAD Robert W. van Zwieten
Lehman Brothers, Inc.
MSF continues to work near the Chad-Sudan border,
Marsha Williams
assisting some 200,000 refugees who have fled Blue Wolf Productions
violence in the Darfur region of western Sudan. More New York Office
than 1.5 million Sudanese have been displaced in 333 Seventh Avenue, 2nd Floor
New York, NY 10001-5004
Darfur since fighting broke out there in 2003. In
Tel: 212-679-6800
September, MSF medical teams provided con- Fax: 212-679-7016
sultations to nearly 5,600 refugees living in two main Email: doctors@newyork.msf.org
camps, Iridimi and Toulum. Consultations increased Web: www.doctorswithoutborders.org
to more than 6,800 people in October. The nutritional West Coast Office
2525 Main Street, Suite 110
situation is improving: in the MSF therapeutic
Santa Monica, CA 90405
feeding center for severely malnourished children Tel: 310-399-0049
in one of the camps, the number of children en- Fax: 310-399-8177
rolled dropped by 75 percent from August to October. Alert is a quarterly newsletter sent to friends and
In the supplementary feeding program for the supporters of Doctors Without Borders/Médecins Sans
moderately malnourished, the number of children Frontières. As a private, international, nonprofit
enrolled dropped from 2,042 in August, to 1,965 in organization, MSF delivers emergency medical relief
to victims of war and disaster, regardless of poli-
September, to 1,658 in October. However, the
tics, race, religion, or ethnicity.
refugees are still entirely dependent on food
Editor: Jason Cone
assistance, and any interruption in aid could result
Editorial Advisor: Kevin Phelan
in drastically increased malnutrition among the Design: CoDe, Jenny 8 del Corte Hirschfeld
people in the camps. MSF is also working in Iriba
Doctors Without Borders is recognized as a nonprofit,
Hospital, which acts as a referral hospital for the
charitable organization under Section 501(c)(3) of
most serious cases from Iridimi and Toulum. the Internal Revenue Code. All contributions are
2004 © Gael Turine tax-deductible to the fullest extent allowed by law.

FIELD UPDATES
2004 © Patricia Rincon Mautner

Ana Milena, the mother of a 3-year-old girl, was
stabbed in the stomach and back by her ex-husband.
The attack left her paralyzed. Milena was brought
to the Doctors Without Borders/Médecins Sans
Frontières (MSF) rehabilitation center in Cali, Colombia,
where she was one of more than 2,700 survivors of
urban violence who have received free, comprehensive
rehabilitative care since 1998. MSF recently handed
the project over to the local government.
“I think the MSF rehabilitation center is great
because I was able to learn how to walk again,”
says Milena. “The staff helped me to learn on a chair,
then on crutches. Now, I only need a stick to go up
stairs or cross the street.” Milena has also been
able to go back to work as a toymaker. “I see life in
a different way now—I love it more. I value myself
more, and I enjoy each day as a gift.”

333 Seventh Avenue, 2nd Floor

New York, NY 10001-5004
Tel: 212-679-6800
Fax: 212-679-7016
www.doctorswithoutborders.org