Your donations helped Doctors Without Borders/Médecins Sans Frontières (MSF) respond to a variety of neglected emergencies.
As MSF teams ran our ongoing projects around the world, they responded to humanitarian emergencies caused by internal conflicts across South Sudan, Yemen, Central African Republic, and Syria, the latter of which resulted in refugee crises in Jordan and Iraq. These programs were made possible, in part, by support from the Emergency Relief Fund.
Thank you for your support and very generous commitment to the Emergency Relief Fund, which enables MSF to launch programs based entirely on need.
2015 Emergency Relief Fund Projects
SYRIA: THE WORLD’S WORST HUMANITARIAN DISASTER
The suffering of the Syrian people is immeasurable: as the bitter conflict continues, millions of people are enduring the direct consequences of war, as well as being forced to leave their homes and belongings. At least 220,000 people have been killed and over half the country’s population—a staggering 12 million people—have fled their homes. At least 670 Syrian medical workers have been killed, and thousands have been kidnapped or displaced by violence, leaving a massive gap in medical expertise inside Syria. As a result, hundreds of thousands of people are living in besieged areas inside the country, with extremely limited access to healthcare.
MSF has been running programs inside Syria since the war began in 2011. By 2013, we were running six hospitals in opposition-held areas. Due to an increasingly insecure environment, MSF international staff can no longer work inside most of Syria so MSF is managing its facilities in Aleppo and Idlib remotely with international teams based in neighboring countries. A small number of international staff, however, are able to work safely at our programs in northeast Syria.
The 27-bed Aleppo hospital run by MSF Syrian staff offers a wide range of services including outpatient and inpatient consultations, surgical care, an emergency room, and a maternity unit. In addition the MSF team provides mental health care, and can refer patients to other structures if they cannot be treated in the MSF hospital.
In Idlib, MSF is running the only burn unit in northern Syria where people can get the specialist care they need, such as skin grafts, dressing changes performed in an operating room under anesthesia, physiotherapy, and post-operative care. MSF’s 15-bed burn unit is staffed by Syrian medical professionals and supported by an international team in southern Turkey. In Hasakah, in northeast Syria, MSF runs several health clinics that offer primary health care services.
Inside the Kobane Canton area of northern Syria, which is administered by the interim Kurdish government, MSF has worked alongside Kobane public health staff since March 2015. We are re-establishing basic health facilities and vaccination services, providing outpatient health care, and creating mental health support programs.
In addition to these projects, MSF has been supporting a growing number of medical structures in government-held and opposition-controlled areas throughout the country, with a particular emphasis on structures in areas under siege. By October 2015, MSF was actively supporting more than 150 medical structures which vary from small rural health posts to full hospitals in urban areas. The supported structures are located throughout the country, including Idlib, Aleppo, Homs, Hama, rural Damascus, and Deraa in the south. Through all of these programs, we are reaching millions of people caught in one of the worst conflicts of our time.
Outcomes at MSF programs in Syria in 2015 include:
ASSISTING SYRIAN REFUGEES IN JORDAN AND IRAQ
MSF is caring for hundreds of thousands of refugees in Jordan, Lebanon, Turkey, and Iraq, where more than four million Syrians have sought refuge from the ongoing war. To lessen the refugee burden on health systems of Jordan and Iraq, MSF has established a number of projects that perform surgery, treat non-communicable diseases, and offer maternal, pediatric, and mental health care. Because more than three-quarters of the Syrian refugees are women and children, the majority of our programs focus on providing women and children with access to medical care.
MSF’s Reconstructive Surgery Project in Amman, Jordan’s capital city, was established in 2006 to offer orthopedic, maxillofacial and plastic surgery, as well as physiotherapy and psychosocial support to victims of violence in the region. As the conflict in neighboring Syria escalated, the number of Syrian patients increased, and today, more than 50 percent of patients are Syrian. MSF renovated a new hospital for the project in Amman and moved to the new structure in August 2015, which has allowed our teams to improve quality. Since the project began nine years ago, MSF’s Reconstructive Surgery team in Amman has conducted 8,238 surgeries.
For the past two years, MSF’s Emergency Surgical Program inside the Al Ramtha Government Hospital has been offering life-saving trauma surgery for patients injured in the Syrian conflict. Located just a few miles from the Syrian border, the project has had more than 1,850 war-wounded patients arrive from Syria. Around 75 percent of these patients were suffering from poly-trauma resulting from blast injuries.
The northern Jordanian governorate of Irbid has one of the highest concentrations of Syrian refugees. Following assessments in 2013, MSF established a maternal health and pediatrics hospital in this northern town, close to the border with Syria. The project offers free obstetric and neonatal care, prenatal and postnatal care, inpatient and outpatient pediatric care, as well as a pediatric mental health program. The urgent need for these services has increased as Jordanian authorities have decided that all Syrian refugees, whether registered or not, would have to pay for health care.
The Kurdish Region of Iraq has been hosting the vast majority of the 251,000 Syrian refugees currently in Iraq. Despite the overwhelming crisis affecting Iraq today, some international humanitarian organizations are scaling down their assistance to Syrian refugees in the country.
Since May 2012, MSF has been the main provider of health services to Syrian refugees in Domiz refugee camp, including primary and reproductive health care, chronic diseases and mental health support. MSF also offers emergency services and referrals to Dohuk hospital. MSF also provides mental health services in two refugee camps in Erbil governorate – Kawargosk camp and Darashakran camp.
Outcomes at MSF programs in Jordan and Iraq in 2015 include:
EMERGENCY PROGRAMS IN SOUTH SUDAN
MSF is committed to providing lifesaving medical care in South Sudan, offering aid to people affected by conflict, as well as to many others who lack of access to medical care. Healthcare in South Sudan was already weak before the recent waves of violence started. Now the coping mechanisms of hundreds of thousands of people are stretched to the breaking point.
Since the beginning of April 2015, clashes in Upper Nile state have displaced tens of thousands of people who have sought sanctuary at a United Nations Protection of Civilians camp in Bentiu. By the end of the year, the camp population had doubled to an estimated 110,000 people. The increasing numbers of displaced people, however, is straining the few existing resources, including the MSF hospital at the camp, which is nearing full capacity.
Teams treated a significant increase in malaria cases in the camp in Bentiu over the summer. To handle the increase, MSF opened six new health facilities in the camp, providing care to as many as 4,000 malaria patients on a weekly basis. To limit the complications of severe malaria, MSF provided immediate access to diagnostics and treatment, screening over 30,000 children under five and providing treatment to 16,000.
Rising violence against civilians in southern Unity State is depriving the population of shelter, food, and medical care. As the conflict intensified, violence against the civilian population escalated. MSF teams in southern Unity State hear daily reports of extortions, abductions, mass rapes, and killings, and have witnessed villages burnt to the ground and crops looted and destroyed. MSF has not seen this level of violence and brutality before. An MSF compound in the town of Leer was looted on October 3rd, forcing MSF's Leer hospital to close for the second time since May. MSF's staff was forced to evacuate, leaving vulnerable people in the surrounding areas without medical care, food support, or other assistance.
Outcomes at MSF programs in South Sudan in 2015 (through October) include:
WAR SPREADS TO YEMEN
The humanitarian crisis in Yemen grows more catastrophic each day. While the political struggle unfolds, civilians are caught in the crossfire and the population is suffering enormously. The conflict in Yemen currently has the country divided between the Houthi movement which controls the north of the country and an anti-Houthi coalition based mainly in the South. A coalition of mainly Gulf States led by Saudi Arabia started airstrikes against the Houthi in late March. Fighting and indiscriminate airstrikes have harmed civilians, medical facilities, and critical infrastructure, disabling the only international airport. The UN reports that in the first month of the airstrikes, at least 1,000 people were killed, over 4,350 were injured, and 150,000 fled their homes.
Huge humanitarian needs exist on the ground in Yemen, and MSF is working nonstop to meet some of these needs through a variety of new emergency programs. MSF currently works in Aden, Al-Dhale’, Taiz, Sa’ada, Amran, Hajja, Ibb, and Sana’a. A total of 790 MSF staff are currently working in the country, including 64 international staff.
MSF is running an Emergency Surgical Hospital in Sheikh Othman district, in the north of the city of Aden. MSF is also providing mental health care and physiotherapy in the hospital. Victims of landmines and unexploded ordinances have been increasing since August (more than 60 cases between mid-August and late October).
In the southern part of Aden, MSF started working at an emergency clinic in April, where MSF staff provided trauma care and treated more than 1,200 wounded patients in the emergency room. Between May and July, MSF had outpatient mobile surgical clinics in the health centers of Enma and in Al-Sha’b districts to provide outpatient care to surgical patients who could not get to the MSF hospital. More than 1,220 war wounded were provided surgical follow-up consultations and wound dressings. As movement is easier now, MSF is receiving these patients in its hospital in Aden, but is still providing drugs and dressing materials to the health centers.
Since the beginning of May 2015, MSF has been providing emergency medications and surgical supplies to five hospitals in Taiz. During this period, MSF set up and equipped three extra emergency rooms at Al-Rawdah Hospital to allow extra space for handling mass casualties, while continuing to support the hospital’s main ER with supplies and staffing. MSF has four medical doctors and one nurse working in the ER of Al-Rawdah Hospital. The team also set up a hospital-to-hospital referral system with two ambulances.
RESURGENCE OF VIOLENCE IN CENTRAL AFRICAN REPUBLIC (CAR)
Renewed outbreaks of intercommunal violence have kept the population of CAR on edge in recent months. The worsening situation also means that about 450,000 people who were displaced by violence, along with a similar number of refugees who fled to neighboring countries, have little hope of returning home due
Over the past two weeks, more than 65 war-wounded Syrian patients—most injured by barrel bombs—arrived at the emergency room of Al-Ramtha hospital in northern Jordan, marking a significant spike in the number of patients treated there by Doctors Without Borders/Médecins Sans Frontières (MSF).
In late June, 34 wounded Syrian patients arrived in just three days. Some were stabilized by MSF medical teams and referred to other hospitals. The rest continue to receive surgical and rehabilitative treatment at Al-Ramtha hospital, which sits about three miles from the Syrian border, and where MSF works in close collaboration with the Jordanian Ministry of Health to provide quality medical care to Syrian patients.
"More than 70 percent of the wounded we receive suffer from blast injuries, and their multiple wounds tell their stories," said Renate Sinke, project coordinator of MSF’s emergency surgical program in Ramtha.
MSF and many other organizations have called repeatedly for an end to the bombing of populated areas inside Syria. These calls have had no impact. Patients of all ages continue to arrive at Al-Ramtha hospital in large numbers with injuries that they say were caused by barrel bombs dropped by helicopters on residential areas and health structures in southern Syria.
There have been reports of health facilities coming under attack in Syria’s Dara'a Governorate in the past two weeks, leading more Syrian patients to risk the dangerous trip across the Jordanian border, seeking medical care that has become extremely difficult, if not impossible, to access in their home country. Many hospitals inside Syria now lack the personnel, medical expertise, or equipment to deal with highly complex injuries.
"A significant proportion of the patients we receive have suffered head injuries and other multiple injuries that cannot be treated inside southern Syria, as CT-scans and other treatment options are limited," said Dr. Muhammad Shoaib, MSF medical coordinator in Jordan.
One recent patient at Al-Ramtha Hospital was Majed, a 27-day-old baby with a head injury caused by shrapnel from a barrel bomb.
Majed's father, Murad, gave the following account:
"At 9:00 a.m., a barrel bomb hit our house in Tafas. I was not around at that time. I have to work to feed and take care of my family. When I heard the news, I dropped what I was doing and I ran to the house as fast as I could.
"I found my wife and mother both injured, but their injuries did not look too severe. Then I saw my little boy. He was quiet and his head seemed to be injured. I took him to the field hospital in Tafas. They tried to help him but couldn't, since the appropriate equipment is not available in Syria. He needed to go to Jordan for treatment.
"It took us one-and-a-half hours from the time of injury until we arrived at the border, and some more before arriving in Ramtha. Now, all I want is for my baby to be better and go back to Syria."
Since the Syrian conflict began, more than four million Syrians have sought refuge in neighboring countries, including Jordan. MSF has been present in Jordan since August 2006, running a reconstructive surgery program in Amman. Since 2013, MSF has been working to support refugees and patients through the Al-Ramtha emergency trauma surgical program, as well as a mother and child hospital and two noncommunicable disease projects in Irbid to support Syrian refugees and vulnerable Jordanians in host communities.
Many of those affected are already been displaced and living in dire conditions. In Malakal, more than 6,600 people have fled their homes to seek shelter at the United Nations Protection of Civilians (PoC) base. Meanwhile, in Melut, a town north of Malakal, more than 1,665 families have sought refuge across the Nile River since the beginning of April.
MSF has repeatedly called on all parties to the South Sudanese conflict to allow for necessary humanitarian access to all parts of the country.
The security situation in Upper Nile remains unstable. Mistrust between communities leads to clashes, with profound humanitarian consequences. People are constantly on the run, but the areas to which they flee do not offer favorable living conditions. In states like Upper Nile, some people have been forced to flee so many times that they no longer have a place to call home.
This new wave of displacement, sparked by clashes at the beginning of this month, is putting pressure on the capacity of humanitarian agencies currently working in the area. A total of 26,500 internally displaced people have sought shelter at the UN base in Malakal since the beginning of the conflict in December 2013.
The new arrivals are living in big tents, with dozens of families sharing quarters and sleeping on the floor. MSF continues to provide medical services at the UN base hospital. Other agencies are on site to ensure sufficient water supply and proper sanitation, but the increasing numbers of displaced people is straining the few existing resources.
"The rainy season is just setting in and with the congestion in the PoC, we have started to see open defecation, long queues at water points due to low water quantity and pressure," said Juan Prieto, MSF head of mission in South Sudan. "Cases of acute diarrhea are increasing, so we are reinforcing our surveillance measures to ensure that outbreaks are prevented. Last year, MSF launched a cholera intervention and vaccination campaign in the camp, and we are ready to replicate actions if needed. However, we are afraid that if fighting continues, there will be more displacement, further congestion in the PoC, and a deterioration of health and general living conditions."
In Melut, more than 1,665 families—mostly ethnic Shulluk, who were previously displaced and living in a camp—have fled to the west side of the Nile, most to the Noon area. These families are living under trees, with extremely limited access to latrines. They must travel long distances to fetch water from the Nile that, unless treated, is not safe to drink. Other families are scattered all over the west bank of the Nile in Kaka, Kuju, and Toruguang Payams, some 80 kilometers (approximately 50 miles) away from Melut. With no shelter either, the food stocks families managed to salvage when they moved are dwindling.
"The biggest problem is water," said 17-year-old Teresa, a Shilluk who recently fled to Noon. "I have to go to the Nile three to four times a day. It is a 25-minute walk each way. We are worried for our lives and for the future, if we survive."
MSF is supplying each family with water treatment kits, as well as transporting food and non-food items by speedboat and donkey to families scattered in different parts of Noon. MSF also regularly conducts mobile clinics with outpatient and emergency room services for the population in Noon, referring acute medical cases to health facilities in the towns of Melut and Kodok.
In Melut, MSF treats an average of 150 patients a day for diseases like measles, acute watery diarrhea, and respiratory tract infections. However, due to continued fighting in the area, MSF is sometimes forced to suspend its activities as a preventive measure, leaving the population in an even worse position.
"The people here have been on the move since the war started," said Joao Martins, MSF project coordinator in Melut. "They have nowhere to call home anymore, as insecurity has made them nomads, moving from one place to another in search of safe havens to stay. Whenever clashes start, they are prompted to move. Children under the age of five years and pregnant women are especially vulnerable during these times."
As more people are displaced, some to remote areas where they have hardly anything to live on, MSF calls upon all armed groups to facilitate the free movement of humanitarian assistance and personnel to all parts affected by the South Sudanese conflict.
MSF has been working in the region that today constitutes the Republic of South Sudan since 1983. MSF responds to emergencies, including large-scale displacement, refugee influxes, alarming nutrition situations, and peaks of diseases such as measles, malaria, acute watery diarrhea, and kala azar, in addition to providing basic and specialized health care services.
Since conflict began in South Sudan in December 2013, two million people have been displaced from their homes. Some live in camps, while others have fled across the border to neighboring countries of Kenya, Uganda, Ethiopia, and Sudan.
February 05, 2015
Jean Philippe Garcia de la Rosa recently returned from a mission as logistics coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF) in Central African Republic (CAR). In 2014, he witnessed the evolution of a conflict that first hit the headlines in late 2013, as renewed fighting between opposing militias launched a new chapter in a war that has left most of the country’s population in poverty and displaced thousands from their homes. Here, he describes his experience.
After the hard clashes in early 2014, has the situation in the country improved?
CAR has the same problems it had a year ago and prospects have not improved at all. No solutions have been found to the underlying problems, such as the ancestral confrontation between shepherds and farmers, and now more and more people resort to violence to solve them.
People’s daily life is still fraught with difficulty. You just have to look at the rise in the price of basic commodities. Civilians continue to suffer and that is fueling the armed conflict. The anguish and despair felt by many young people lead them to join armed groups. Many young Muslims who fled Bangui after the persecution unleashed a year ago will end up holding a weapon.
The large international presence and United Nations (UN) decision to hold crisis level three (the highest possible) in CAR are clear signs that the situation has not significantly improved.
What are the main challenges from a logistics point of view in such a difficult context?
Many problems in CAR are somehow the same as in other MSF missions, only to a higher degree. And many of these challenges are interconnected. In the last year, supply problems have grown because of the closure of some borders and the difficulty of finding local suppliers.
One factor that has complicated things even more is the fuel shortage, which has gotten worse following the deployment of the new UN contingent (started in September). This has led to an increase in fuel demand while supply has remained the same because of the limited capacity of the local provider.
Despite all the hurdles, our mission managed to improve the supply system through a joint effort of all our teams. In particular, we have responded to our priority of strengthening our performance in hygiene and sanitation in the health structures where we work. Training of our staff was key to meeting the challenges in this regard.
How has the ongoing insecurity affected the transportation of MSF supplies and teams?
The ongoing armed conflict greatly affects movements all over the Central African territory. We have to negotiate continuously with the various armed groups to facilitate access through the checkpoints, which became more and more difficult to cross by the end of last year.
The instability has even forced us to stop some airlifts of supplies and teams because of the lack of security, and that obviously affects our activities. In addition, this year there are expected to be even more fuel shortages due to the security situation in the country.
Has there been progress in rebuilding the country?
The country is small but it poses many difficulties for reconstruction. The Seleka and anti-Balaka militias have tried unsuccessfully to become political groups, in part because they are very heterogeneous, with different factions right from the origin. In addition, each region and each city have their own problems and their own leaders, making it very difficult for political groups to grow at a national level.
Moreover, the international community is too concentrated in Bangui [CAR’s capital] and cannot see well what happens in the rest of the country. The intervention could have been more determined from the start, a year ago, but maybe that would have triggered a conflict more difficult to control. Now local people are asking who is responsible for the lack of solutions and the continued insecurity. And, last but not least, if you act against one of the warring parties then you have to do it against the other, and the international community has not known how to manage this need for balance.
How far has the "religious war" discourse spread in CAR?
What we see in CAR is also found in other countries in conflict. The population is the main victim of the conflict. They have to survive with almost nothing and people end up looking for someone to blame. The easiest scapegoat is simply “the others,” whether he is a foreigner or someone with a different religion. Two years ago, after the coup by the Seleka (militia made up mostly of Muslims that forced a coup in March 2013), the idea that the villains were the Muslims grew very fast among Christian communities. Then the government fell and many Muslims had to flee Bangui, but the problems for the rest did not disappear. People saw it was not a matter of Seleka or anti-Balaka (the opposing militia), or Christian or Muslim. Many realized that the conflict had nothing to do with religious issues.
What should the focus of the humanitarian community be in this scenario?
We must focus on getting aid to people in the best possible way. In this country, if you lift a stone you immediately see lots of unaddressed needs. The problems go beyond the conflict, but we must not lose focus of what our priority is.
From MSF’s point of view, I think our work is well-recognized by all the stakeholders. One of our greatest assets is our local colleagues, who are also part of the local community and allow us a better understanding of the reality. We have to remain focused on reaching people wherever they need us, beyond the cities, anywhere.
MSF has been working in CAR since 1997. Since December 2013, in response to the crisis, MSF has doubled its medical assistance in CAR and is running additional projects for Central African refugees in neighboring countries.
Dr. Erna Rijnierse is currently working with Doctors Without Borders/Médecins Sans Frontières (MSF) in Bentiu,South Sudan, which has been the scene of heavy fighting for several days now. Here she discusses the situation on the ground.
We’ve been able to provide emergency medical care to 12 people so far since heavy fighting started several days ago, stabilizing patients with gunshot wounds and related injuries. We’ve carried out nine surgical interventions. Several patients arrived in a critical condition, including a pregnant woman, who had a gunshot injury to the chest. We inserted a chest tube, and, for the moment, she and her unborn baby are stable. One nine-year-old boy was shot in the chest and he died upon arrival at our hospital.
The last few days have been extremely chaotic. It’s difficult to move around safely inside the camp or even in the hospital, stray bullets are flying around from all directions. We’ve seen empty shell cases in our hospital. At any time the shooting and shelling can start, which means we have to run to the bunkers. We don’t really know what is happening outside or who controls what. The atmosphere is tense and very unpredictable.
It’s hard to provide meaningful medical care when you’re worrying about stray bullets and having to spend long periods of time in the bunker. As a doctor, I feel helpless, very frustrated, and even angry hearing the heavy pounding of shelling outside but being unable to reach those who are injured.
For the time being, we’ve been forced to suspend our mobile clinics outside the area under UN control. It’s simply too dangerous to go outside the camp due to heavy fighting. The primary health care clinics inside the camp have been closed for the last two days, but we hope they will be able to open again today.
The outreach team suspended activities for one day but the next morning they were there, ready to go and spread health messages in the camp. We have a positive case of hepatitis E in the camp so it’s vital that the outreach team continues to spread the message about hand washing and refers sick people to our hospital.
We’ve been able to continue staffing the hospital and aim to do so for as long as it is possible, security-wise. There are currently around 40 patients, 15 of whom are children.
MSF teams are providing health care to tens of thousands of people sheltering in the UN "protection of civilians" site near Bentiu, a town in South Sudan’s Unity state, one of the areas most affected by the ongoing conflict. MSF currently runs a hospital within the camp with maternity, pediatric, and tuberculosis wards. There’s also an emergency department and surgical care. Outside of the camp, MSF runs twice-weekly mobile clinics into Bentiu town itself.
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