Doctors Without Borders News

Nine Out of Ten Children are Denied Livesaving HIV/AIDS Treatment

Mon, 01 Dec 2008 14:44:00 GMT

Geneva, November 28, 2008 – Nine out of ten children with HIV do not have access to life-saving antiretroviral drugs. Governments and donors need to be more ambitious in bringing existing pediatric HIV tests and drugs to the children who need them, said the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). This is particularly threatening for babies who are born with the virus as half of them will die before their second birthday if untreated.

An estimated 1.9 million children are in need of antiretroviral treatment but only around 200,000 are able to get the medicines they need. MSF calls on governments and donors to roll out existing tests faster and to considerably increase the use of a pediatric version of a standard fixed-dose combination (FDC) drug – a pill that combines all needed drugs in one tablet.

“It was when we introduced this easy-to-use pill that we were able to boost the number of children on antiretroviral treatment in our projects,” said Dr Tido von Schoen-Angerer, Director of MSF's Campaign for Access to Essential Medicines. “We are showing that HIV care for children is possible. We challenge governments and donors to set ambitious goals and stop abandoning the majority of children with HIV to their fate."

In wealthy countries, pediatric HIV infection has nearly been eliminated through successful prevention of mother-to-child transmission which is why HIV in children is almost entirely a problem of poor countries. Companies see little financial incentives in developing easier tests and newer drugs for children with HIV.

“We can treat today but we also need more child-friendly drugs and diagnostics,” said Dr von Schoen-Angerer. “Most of the life-saving medicines exist only in adult versions. This needs to change. Drug companies should pledge to come up with and test easy-to-use pediatric versions of all their HIV medicines or governments will need to pressure them to do this.”

The lack of a simple HIV test hampers children’s access to HIV care, as the detection of the infection is a pre-condition to start treatment. Currently a complicated DNA-based test requiring transport of blood samples to advanced laboratories remains the only option for diagnosing infants.

The vast majority of children become infected with HIV through transmission from the mother during pregnancy, childbirth or breastfeeding. Greater efforts to prevent mother-to-child transmission are crucial. Meanwhile, the two million children already infected need care.

During the last five years, nearly 10,000 children under the age of 15 were started on antiretroviral therapy in MSF’s programs worldwide, 4,000 are children under five years of age.

Fractional Dose of Scarce Meningitis Vaccine May Be Effective in Outbreak Control

Mon, 01 Dec 2008 12:53:00 GMT

New York, New York, December 1, 2008—A partial dose of a commonly used vaccine against meningitis may be as effective as a full dose, according to newly published research in PLoS Neglected Tropical Diseases. Fractional dosing would enable large-scale vaccination campaigns during epidemics, especially at a time of global vaccine shortages.

In a study by Epicentre (the research arm of Doctors Without Borders/Médecins Sans Frontières), the Norwegian Institute of Public Health, and Mbarara University of Science and Technology in Uganda, immune responses in patients receiving smaller doses of a meningitis vaccine were comparable to a full dose.

The study’s findings contributed to a 2007 WHO recommendation that a fractional dosing strategy be utilized in the context of severe vaccine shortages during a meningitis epidemic.

Meningitis epidemics occur nearly every year across a wide swath of sub-Saharan Africa, dubbed the “Meningitis Belt”. Outbreaks are caused by specific bacterial strains (primarily Neisseria meningitidis serogroups A and W135), which current vaccines target. Because of global shortages of meningococcal vaccines, the researchers investigated the use of lower doses.

In a 2004 randomized clinical trial of 750 healthy volunteers (2-19 years old) in Uganda, immune response, assessed by serum bactericidal activity (SBA), was measured for 1/5 and 1/10 doses against a full dose. SBA response and safety/tolerability using 1/5 dose were comparable to full dose for three serogroups (A, Y, W135), though not a fourth (C).

Although another measure of immune response, IgG level, was lower for fractional doses, the aim of mass vaccination during epidemics is short-term protection, which is best measured by SBA.

Because of the lack of vaccine producers and publicly financed vaccine stock, current supplies will likely be insufficient in the case of a large-scale epidemic. Efforts are under way to increase production, but this will not be soon enough if a massive epidemic occurs in the coming months as meningitis season nears. If a large-scale outbreak occurs, WHO will need to quickly advise countries on the fractionate strategy before vaccine supplies run out.

“In view of the current shortage of meningococcal vaccines for Africa, the use of 1/5 fractional doses should be considered as an alternative in mass vaccination campaigns,” the authors say.

Read full paper here: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000342

Myanmar: Urgent Lack of HIV/AIDS Treatment Threatens Thousands

Tue, 25 Nov 2008 10:51:00 GMT

Special Report

A Preventable Fate: The Failure of ART scale-up in Myanmar

Slideshow

A Preventable Fate: The Failure of HIV/AIDS Treatment in Myanmar

Geneva, Amsterdam, Yangon, November 25, 2008—Thousands of people are needlessly dying due to a severe lack of lifesaving HIV/AIDS treatment in Myanmar, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in a report released today. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the government of Myanmar and international organizations urgently and rapidly scale-up the provision of antiretroviral therapy (ART).

An estimated 240,000 people are thought to be living with HIV/AIDS in Myanmar. Among them, 76,000 are in urgent need of antiretroviral treatment, yet less than 20 percent of them are currently able to access it.

“Last year, around 25,000 people died of AIDS related illnesses,” said MSF Operations Manager Joe Belliveau. “A similar number of people could suffer the same fate in 2008 unless there is a significant increase in accessible antiretroviral treatment.”

With more than 11,000 people in treatment for HIV in the country, MSF is providing the majority of ART in the country. The government of Myanmar and other non-governmental organizations (NGOs) provide relatively little.

“It is unacceptable that a single NGO is treating the vast majority of HIV patients in a crisis of this magnitude,” said Belliveau. “It is unacceptable because it is wholly inadequate. We cannot meet the needs, and we therefore call upon those who can to take up this responsibility.”

Pushed to its limit, MSF has recently been forced to make the painful decision to drastically reduce the number of new patients it will treat. With so few other actors providing ART, there is little option to refer new patients for treatment elsewhere. “With so many needs still unmet, we strongly urge all actors, led by the government, to scale-up the provision of ART,” said Belliveau.

The urgent need for increased treatment is evident, yet investment from both inside and outside of the country remains grossly insufficient. In 2007, the Government of Myanmar spent just $0.70 USD per person on health care, with a paltry $200,000 USD allocated for HIV/AIDS in 2008. This sum is hugely disproportionate when compared to the extent of the needs and availability of resources. The government of Myanmar has proven its ability to treat HIV/AIDS patients in the public sector, but must commit the necessary resources to scale-up.

Likewise, the level of international humanitarian aid is strikingly low, around $3 USD per person, one of the lowest rates worldwide. This is significantly less than the far greater amounts received by nearby countries facing similar epidemics. Few of the big international donors provide resources out of concern over the appropriate and effective use of aid in the country, yet it is the people of Myanmar who suffer as a result. A 29 year-old male ART patient in Myanmar best explains why more should be done. “It is everyone’s responsibility to fight against this disease. All people must have a spirit of humanity in helping HIV patients regardless of nation, organization, and government.”

MSF’s work has shown that even though working in Myanmar can be challenging, providing lifesaving HIV/AIDS care and treatment directly to patients is possible. It is long overdue that the government of Myanmar and other international organizations step-up their efforts and make ART rapidly and widely available. It is crucial that they act now, in order to prevent the suffering and needless death of thousands of people.

MSF has provided essential healthcare services in Myanmar since 1993 and began an integrated program to support people living with HIV/AIDS in 2003. Since then, MSF staff has assisted thousands of HIV patients, working from 23 clinics, in five areas throughout the country. Services include counseling, testing, treatment of opportunistic infections, nutritional support, health education and most importantly antiretroviral treatment.

Condition: Critical

Thu, 20 Nov 2008 15:08:00 GMT

Condition: Critical
Voices From the War in Eastern Congo

Fact Sheet

MSF Activities In North Kivu, Democratic Republic Of Congo

New York, November 20, 2008 — The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today launched “Condition:Critical,” a multimedia initiative aiming to bring global attention to the humanitarian consequences of the intensifying war in eastern Democratic Republic of Congo.

Through testimonies, photos, and video, Condition: Critical goes beyond headlines and news reports to document how civilians are struggling to survive in Congo’s North and South Kivu provinces, the front lines of a long-running war, where violence, displacement, and sexual violence are mainstays of daily life.

The video feature is built around photographs taken by World Press Photo laureate Cédric Gerbehaye, who worked with MSF in the region for close to a year.

Condition: Critical is online at: http://www.condition-critical.org
The website will be regularly updated to provide fresh news and material in an effort to keep the crisis in the spotlight.

MSF has been working in North and South Kivu since 1992, and in the Democratic Republic of Congo since 1981. MSF medical teams carry out emergency surgery, treat injuries including gunshot wounds and burns, run mobile clinics to reach those who have fled to safer, more remote areas, provide health care in hospitals and health centers, treat diseases such as cholera, provide medical care to victims of sexual violence, and provide psychological support to those traumatized by what they have experienced.

MSF has increased its emergency response in the region to cope with the deteriorating situation. It is currently working in Goma and other parts of North and South Kivu including Rutshuru, Kibati, Kirotshe, Kiwanja, Buhimba, Masisi, Kitchanga, Mweso, Nyanzale, Kayna, Bukavu, Minova, and Kalonge.

MSF remains extremely concerned for the hundreds of thousands of people still on the move who are continuously fleeing ongoing fighting. Many of the displaced and local residents continue to be in urgent need of food, clean water, health care, and basic items such as blankets, hygiene kits, and shelter materials.

In addition, the recent fighting has led to an increase in the number of cholera patients, with cases now being documented in places where cholera is not normally a major health threat. Risk factors for contracting cholera include poor sanitation, lack of clean water, the constant movement of populations, and crowded conditions in displaced camps.

Pregnant Women Desperate for Free Emergency Care in Haiti

Thu, 06 Nov 2008 17:24:00 GMT

Haiti 2007 © Julie Rémy

The prepartum ward at Jude Anne Hospital in Port-au-Prince, Haiti.

Port-au-Prince, November 6, 2008 – Teams from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières’ (MSF) are struggling to provide free, quality emergency care to pregnant women and their babies in Port-au-Prince, the capital of Haiti.

Over the last month, hundreds of women have desperately sought emergency obstetric care at Jude-Anne hospital in Port-au-Prince. In October, hospital staff assisted a record high of 56 women giving birth in one day and received 160 women waiting for hospitalization. The hospital has been so overwhelmed by demand that mothers have given birth in the hospital’s waiting room, the staircases, and in the washrooms, essentially anywhere they could find space. For this 60-bed emergency hospital (including five delivery beds), with an average rate of 35 births per day, this is an untenable situation.

Haiti 2007 © Julie Rémy

A patient waits for an available bed five hours after being admitted to the hospital.

The overwhelming number of patients at Jude-Anne Hospital is the result of several factors, the most critical being repeated hospital strikes in the capital. For example, the government’s central hospital in Port-au-Prince, an important referral center for pregnant women who do not have complications in their pregnancies, has been on strike for the past three weeks, with no end in sight.

“If the situation continues I am afraid women and children will die as a result,” said MSF Head of Mission Hans van Dillen. “Hospitals must accept patients and give free maternal care immediately or the situation will become catastrophic. I urge the government and its donors to reinforce the implementation of free obstetric services without delay.”

Haiti has the highest maternal mortality rate in the Western Hemisphere. Despite the Ministry of Health receiving funding in February 2008 to implement a free obstetric care program in the country, a system of cost recovery continues. Babies and mothers are dying unnecessarily, partially because authorities are too slow to apply the free program and some hospitals are too reluctant to implement it.

MSF is extremely worried by the impact of the strikes on access to care for pregnant women, and urges the Ministry of Health to immediately implement the promised free obstetric care program to help save the lives of mothers and babies.

In Port-au-Prince, MSF provides emergency obstetric care in Jude Anne hospital, organizes mobile clinics in the slums of Martissant, Pelé Simon, La Saline, and Solino, offers emergency and stabilization care in Martissant hospital, and provides trauma care and physiotherapy in La Trinité and Pacot hospitals, including counseling for victims of sexual violence. In response to the destruction caused by tropical storms and hurricanes north of the capital, in Gonaives, MSF has set up a water and sanitation program, conducts mobile clinics, and manages an 80-bed hospital to provide emergency, maternity, and pediatric care.

Armed Aid Convoys an Inadequate Bandage for Congo's Deep Wounds

Thu, 06 Nov 2008 14:52:00 GMT

Goma, DRC - November 6, 2008 – Relief convoys under armed escort by MONUC, the United Nations peacekeeping mission in the Democratic Republic of Congo, are creating confusion between independent humanitarian assistance and military action in the North Kivu region of the country. Keeping the two separate is crucial, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

The widely publicized armed convoys escorted by MONUC to Goma and Rutshuru are an inadequate response to the humanitarian crisis facing the Democratic Republic of Congo’s troubled North Kivu region.

“Armed aid convoys may aim to improve access for humanitarian aid groups, but they actually risk reducing access to the populations,” said Anne Taylor, MSF head of mission in Goma. “There is a risk of aid being manipulated by political or military actors and of humanitarian actors being seen as parties to the conflict.”

Military-escorted aid convoys also risk blurring the line between humanitarian assistance and political-military action. MSF stresses the need to maintain this crucial distinction in the volatile Kivu region.

“MSF provides healthcare to all patients without discrimination,” said Taylor. “Thanks to our neutrality, MSF teams can go where people need our assistance and not where we are instructed to go. MSF provides assistance without armed escorts.”

Not only are the armed convoys risky, but their limited assistance is failing to reach large areas affected by conflict and displacement. Ample and widespread aid is urgently needed.

The recent escalation of violence in North Kivu has brought DRC back to the world’s attention, but the suffering there is not new. For years, MSF teams have witnessed widespread and repeated displacements of people throughout North Kivu.

The ceasefire agreement signed in January did not end their suffering. Hostilities that broke out at the end of August only exacerbated a conflict that had been going on for some time.

The conflict in the Kivu region goes far beyond Goma and Rutshuru. Over the past weeks, hundreds of thousands of people have fled in different directions. MSF is particularly worried about the people in the areas around Rutshuru, Kayna, Nyanzale, and Masisi, who are in urgent need of water, food, healthcare, and basic supplies.

Both a political solution and an adequate humanitarian response are needed. One cannot be substituted for the other, nor should politics and humanitarian action be mixed. Doing so jeopardizes the neutrality of aid organizations and compromises their ability to operate in locations controlled by parties to the conflict.

Despite ongoing insecurity, MSF continues to work in towns affected by fighting, like Rutshuru, Kayna, Masisi, Kitchanga, and Mweso. Throughout the region, the organization is treating war wounded and cholera patients, and providing other healthcare as well as clean water and basic relief items to displaced people and local residents.

Sixty Refugees Found Dead on Yemen Coast

Sat, 01 Nov 2008 07:26:00 GMT

UPDATE: Twenty-One More Bodies Found on November 2
Doctors Without Borders Teams find a total of 60 bodies on Yemeni shores between Friday, October 31 and Sunday, November 2.

MSF Report

View online
Download Report [2.2 MB]

Video

PBS WorldFocus: Somalia struggles with famine, fear and flight

Slideshow

Somalis and Ethiopians Flee Across Gulf of Aden

November, 1, 2008, Awhar, Yemen -- A team from Doctors Without Borders/Médecins Sans Frontières (MSF) assisting refugees in the south of Yemen found 39 dead bodies on the shore between Friday, October 31 and Saturday, November 1.

The refugees said they were coming from the port city of Bosasso in Somalia, fleeing from war and extreme poverty. They made the trip on smugglers’ boats in extremely harsh conditions during a two-day trip across the Gulf of Aden.

One of the survivors described the incident to the MSF team:

"While approaching the shore at 8:00 PM, the smugglers noticed some lights on the land. Being afraid to be spotted by the coast guard, they forced us into the sea, even if the water was too deep. Several people did not know how to swim and they drowned." An eight-months pregnant woman was severely wounded by the boat’s propeller after being forced overboard. She suffered four fractures in her leg and was in a critical condition when the MSF team found her.

In another incident a few hours later, the team discovered a group of Somalis and Ethiopians that had been on the shore for several hours trying to recover after their boat capsized. They said they had to immediately bury 23 of their dead co-passengers. When the MSF team arrived there were still survivors in the capsized boat.

Saïd, a local MSF staff member, described the scene: "The boat was stuck almost upside down in the sand, not far from the beach. The fishermen were trying to find survivors underneath but they could not. So I had to dive under. I managed to get in the hull and with god’s help we got two women and a man out safe. Unfortunately, two others were already dead."

After being given first aid, food, and relief items on the beach, the refugees were taken to the Ahwar Reception Center, where MSF provides medical assistance and counselling to new arrivals.

Such stories are common on the southern coast of Yemen. More than 32,000 people have attempted the trip since the beginning of 2008, according to the United Nations High Commission for Refugees. Somalis and Ethiopians are fleeing from war and extreme poverty, having no choice but to risk their lives in the sea journey. The conditions of the trip are extremely harsh and the death toll is high; since the beginning of September 2008, at least 114 people were found dead in the region of Abyan. The figure does not include dead bodies washed ashore and buried unannounced by fishermen.

"A lot of attention has been paid lately to tackling the issue of piracy in the waters off the Horn of Africa," said MSF Head of Mission in Yemen, Francis Coteur. "Unfortunately, little attention is paid to the drama of the refugees crossing the same waters in horrific conditions. Much more needs to be done to address this issue."

MSF began its project in southern Yemen in September 2007, providing medical and humanitarian assistance to refugees and migrants arriving on the beaches in the Abyan and Shabwa Governorates. During 2008, MSF has provided assistance to over 7,000 people.

In June 2008, MSF released a report, titled "No Choice," which documents the conditions of the perilous journey to Yemen and calls for increased assistance for the thousands of refugees, asylum seekers, and migrants fleeing their home countries.

French Section of Doctors Without Borders Forced to Leave Niger

Thu, 30 Oct 2008 17:00:00 GMT

Press Teleconference

MSF Calls on President of Niger to Lift Ban on Organization’s Nutritional Programs Immediately
October 21, 2008

Video

Government Suspension Leaves Thousands of Malnourished Children in Niger Without Treatment

Paris/Niamey, Niger October 30, 2008 – On July 18, 2008, the Niger government, suddenly and without explanation, terminated the medical and nutritional activities of the French section of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in the Maradi region of Niger. This decision has had grave consequences on mortality among young children.

Over the last three months, MSF has made every effort to determine the reasons for this suspension, clarify its medical work, and redefine with the Niger authorities the modes of its intervention in Maradi. On October 21 in the capital, Niamey, in the face of the government’s refusal to authorize MSF to resume its activities, MSF called on the President of the Republic to arbitrate. We have received only silence in response. The French section of MSF has thus chosen to take formal note of the government’s position that “MSF leave.”

The cessation of MSF’s activities has occurred at the most difficult time of year for young children—between the harvests, when malnutrition rises, and at the height of the malaria season. On the suspension date, more than 3,000 children were undergoing treatment and 500 new children were admitted into the program weekly. In addition, the latest nutritional survey, conducted in June 2008 by the government and UNICEF, estimated the number of children in the Maradi region suffering from acute malnutrition at between 35,000 and 67,000. These official statistics contradict the Nigerien government’s publicly stated reasons for its decision to suspend the organization’s activities in Maradi.

“Maradi is one of the regions in Niger most affected by malnutrition,” said Dr. Christophe Fournier, president of the international board of MSF. "Since MSF’s activities in southern Maradi were halted, and despite an increase in admissions into other health centers and MSF projects in the surrounding areas, thousands of children are not receiving treatment. Given significant advances in the field of malnutrition that now allows childhood malnutrition to be prevented and treated on a large scale, it is shocking that a government, after having allowed innovative programs to be established, would ignore the needs of thousands of children," he said.

The departure of the French section of MSF comes at a time when efforts to make progress in the fight against malnutrition are more possible—and necessary—than ever. Malnutrition is a preventable and treatable condition that must be recognized as a public health priority.

Countries affected by malnutrition, like Niger, and international organizations have been slow to acknowledge the real possibilities offered by new, ready-to-use nutritional products. The United Nations does not recommend a specific approach for the major areas affected by malnutrition and mortality, such as Maradi, and limits the use of effective foods to the most severely undernourished children. Last, international funding for malnutrition remains sorely inadequate.

MSF calls on the government of Niger, UNICEF, and the World Food Program to take swift action in Maradi so that malnourished children receive treatment. It also calls on donors to establish an international policy and treatment approaches adapted to the major areas affected by malnutrition.

MSF has been working in Niger since 2001 and operates malnutrition treatment programs in the Zinder, Maradi, and Tahoua regions. Between early 2008 and mid-September, a total of 61,051 children suffering from acute malnutrition were admitted into MSF feeding centers. In collaboration with health authorities, MSF also provides epidemic response in Niger, treating patients and carrying out vaccination campaigns. In 2008, it responded to measles, meningitis and cholera epidemics. The MSF teams in Niger total 1,537 staff, including 1,468 Nigeriens.

Press Teleconference: MSF Calls on President of Niger to Lift Ban on Organizations Nutritional Programs Immediately

Tue, 21 Oct 2008 16:00:00 GMT

Niger 2008 © MSF

Nicolas de Torrenté, executive director of MSF-USA and Marie Pierre Allié, president of the French section of MSF, discussed the organization’s suspension from treating malnutrition in the Maradi region of Niger.

The suspension endangers the lives of thousands of children vulnerable to malnutrition in Niger. For the sake of these children, MSF has called for an immediate resumption of its nutritional programs.

Listen:

Download: Audio | Transcript

Transcript

Sandra Murillo:
Good morning, everyone. And thank you for joining us today. As you know we will be discussing the suspension of Doctors Without Borders/Médecins Sans Frontières malnutrition treatment programs in the Maradi region of Niger. On the call this morning are Doctors Without Borders/Médecins Sans Frontières USA Executive Director, Nicolas de Torrente, and Dr. Marie-Pierre Allié, President of the French section of Doctors Without Borders/Médecins Sans Frontières. Dr. Allié is speaking from Niamey, the capital of Niger, where she recently returned from meetings with health care staff and hospitals and health centers who are unable to cope with growing needs of malnourished children in this region of Niger. At this point, I'd like to hand the conversation over to Nicolas deTorrente and after the two brief presentations we will open this call up to your questions. Thank you.

Nicolas de Torrenté:
Good morning, everybody. Thank you for being with us today. Thank you for your interest in this situation. As you know, malnutrition is a medical emergency accounting for about 11 percent of the global burden of disease. It contributes to between 3.5 to 5 million deaths estimated in children under five every year. The WHO, the World Health Organization, estimates that there are 178 million children who are malnourished across the globe and at any given moment, about 20 million of those are suffering from the most severe form of malnutrition, the most life threatening one.

According to our estimates, only 3 percent of the 20 million children suffering from severe acute malnutrition receive the UN recommended treatment that they need. Now Niger is one of the malnutrition hotspots around the world where areas that concentrate the highest burden of malnutrition. And Doctors Without Borders or MSF, our medical teams have been treating malnutrition in that country since 2001. They carry out programs in various parts of the country, in the Zinder, Maradi, and Tahoua regions. So these are the areas of the country with the highest incidence of childhood malnutrition in Niger. Between early 2008 and mid September, our teams had admitted a total of 61,051 children, so that's 61,051 children in feeding programs in Niger, children suffering from acute malnutrition.

This is a recurrent situation. Year after year we've treated tens of thousands of acutely malnourished children with therapeutic, ready-to-use foods. These are pastes, innovative pastes that do not require refrigeration or cooking. We're in a chronic emergency in which children, young children in these regions of Niger, are not getting access to food with vitamins, minerals and proteins, and other nutrients that they need to grow and survive. They require complementary feeding, they require therapeutic feeding when they are acutely malnourished.

It’s in Niger where a lot of progress has been made. With the support of the government, MSF has been able to pioneer a new approach to treat malnutrition. We are doing it on an outpatient basis using these ready-to-use foods. This strategy has helped us reach many more children than ever before. And starting in 2006, we've also been able to try new strategies that try to prevent children from developing this life threatening condition, the most severe forms of malnutrition, in the first place.

Our blanket distribution of ready-to-use foods to all children from six months to three years of age in the Maradi region dramatically reduced the seasonal peak in severe malnutrition just before the harvest. So this is this preventative, early treatment approach. It's an approach that we know is reducing child mortality and morbidity. This approach also costs less in terms of hospitalizing children who have fallen into the most severe forms of malnutrition. We recognize the need to find a long term solution to this problem of malnutrition rather than conducting emergency responses every year to the seasonal outbreaks of acute malnutrition that occur, particularly between the harvests. And we recognize the need to partner with the Government of Niger and the Minister of Health that have the long term responsibility for the care and welfare and health of the children in Niger.

And that's why it's so incredibly frustrating for us to be forced to cease this important lifesaving work and we are calling upon the government in Niger to let us immediately resume our nutritional programs in Maradi. At this point, the lives of tens of thousands of children are at stake. This whole crisis in Niger is revealing how difficult it is for governments to acknowledge malnutrition as a public health problem and hence as a public health priority that needs to be tackled by effective and efficient policies supported by international donors.

And at a time when government's own agencies, donors, and international aid organizations should be expanding such effective strategies for the treatment and increasingly for the prevention of malnutrition in the world’s most affected regions, the Sahel, the Horn of Africa, Southeast Asia, the current stance of the government of Niger is really a setback.

So I'm going to turn it over to Dr. Marie-Pierre Allié. She is the president of the French section of Doctors Without Borders responsible for the programs in the Maradi region of Niger. And she will speak about the needs we continue to see on the ground and also our desire to continue working in the country to help the government of Niger, the children of Niger, and the people of Niger address childhood malnutrition. So I'll turn it over to you, Marie-Pierre.

Marie-Pierre Allié:
Thank you, Nicolas. Hello, good morning to everyone. As Nicolas just told you now, childhood malnutrition is a regular challenge in Niger requiring long term and sustained action to combat. And we have been, together with the government in Niger, trying to address this issue for a number of years now. But right now we are facing a life-threatening emergency for thousands of children in the country’s Maradi region. On July 22, the government of Niger suspended our malnutrition treatment program in the Maradi region. At the time of the suspension, our nutrition program was admitting an average of 500 new patients every week. We are estimating, that there are as many as 8,000 children with severe malnutrition who have not been treated since this time because we were not able to protect them. Of course their fates remain unknown now.

So I came to Niger to try to come to a solution and to resume—for as long as possible—the program, for the sake of the children in Maradi. And I've been visiting the Maradi region where I saw-- I visited health structures, I met with staff, I met with mothers. I was really impressed by the situation and by [speaking with] health care staff especially because they basically are unable to cope with the influx of malnutrition [cases] coming into hospitals and health centers. And this is in sharp contrast with the declaration, with the statements, made by government officials a few days ago denying any problem in the area and denying the existence of the malnutrition in this area.

So to be more precise about what I saw, I visited the regional hospital in Maradi. I visited some health centers, I visited some villages where I [spoke with] with mothers. The number of children I saw myself in the health structures is much different from what I have been hearing from official statements. In the hospital of Maradi at the time I visited there were at least 150 kids waiting for care and the staff was trying to help. It's just there is not enough [health staff] to cycle the number of children coming to them. The centers were really overcrowded. Then in the village where we’ve been meeting with mothers, they all report the usual number of children dead in the past few weeks.

So the situation I've been seeing there, it's quite critical. And it's a bit upsetting to see the situation, to see the health centers overwhelmed, to see the staff in need of help and at the same time we are seeing the MSF structures empty and their adequate staff not able to give a hand. We know from the experience of our medical teams this year in the region that childhood malnutrition remains hidden unless effective treatment is made easily accessible. Since working there since 2001, we have seen tens of thousands of mothers bringing their malnourished children to our therapeutic feeding centers. Working in collaboration with the Minister of Health in the past, we have been able to implement effective, life saving treatments to help these children in the area. So today as a medical humanitarian organization we are urging the government of Niger to let us continue to practice this medicine. From what I'm seeing today, I can say these children cannot afford to wait any longer for the suspension to be lifted. Thank you.

Sandra Murillo:
Thank you, Marie-Pierre. We can answer any questions that you might have about the situation or if Nicolas wants to add some points at this time.

Nicolas deTorrente
I think we can open it up to questions, either to Marie-Pierre or myself.

Question:
Can you give me a little background on why the government of Niger would suspend your efforts?

Marie-Pierre Allié:
It is quite unclear why this very drastic decision was taken in the middle of July. There have been a variety of reasons that have been given, but the most frequent and the most worrying for us is that MSF is creating malnutrition, that if MSF is not present, there is no malnutrition in the area. And it is something that we can't accept. We know that when treatment is provided, mothers come. That's why we are treating malnourished kids. Of course if there is no effective treatment, mothers may stop coming and then of course we will not see them. But that [does not mean] that MSF is creating the problem of malnutrition. It's something that we cannot accept. This is the main argument and it's a situation where there’s a tendency to diminish the visibility of the problem of malnutrition.

Question:
And why would they want to diminish the visibility of the problem of malnutrition?

Marie-Pierre Allié:
When you speak about malnutrition, you speak about lack of food, money, etc. And that is something that is not really acceptable. But I think the main reason is that it’s difficult for the government to tackle these issues. They need means, they need money. And today because malnutrition is not recognized as a public health problem internationally, it's also difficult for them to get access to sufficient funds to finance these kinds of solutions. And this is an issue that we're talking about in Niger today. The fight against malnutrition needs to be considered a priority on an international [level] and donors need to invest more in this area. Then I think the governments of different countries would be able to tackle this problem.

Question:
I may be misinterpreting this, but are you saying that the government said malnutrition did not exist in the Maradi region before MSF got there?

Marie-Pierre Allié:
What the government has been saying to us in public declaration and also when we met them was that the problem of malnutrition exists, yes, but with not such big numbers than the ones we are treating now. And even in their latest declaration, by the Minister of Health, the Minister was saying that in the hospital of Maradi there were 46 kids hospitalized for malnutrition when that’s not what I saw when I was there. So this [shows that] there is no recognition of the problem. The government is just saying that malnutrition in the area of Maradi is not so important and the success is declining.

Question:
So just to confirm, the government is saying malnutrition did exist there, but basically your figures are exaggerating the problem?

Marie-Pierre Allié:
Yes, that's what the government is saying. But as we said, this is a question of offering care. If you offer an effective treatment, they keep coming and then we treat them.

Question:
Are there other NGOs that are working in Niger that have had this problem? Or WFP, are they doing emergency feeding now and have they run up against opposition from the government?

Marie-Pierre Allié:
Yes, as we speak there is another NGO facing the same kind of problem, suspension from activity. It's Action Contre La Faim (ACF) and their activities have been stopped since the beginning of August. So they are in the same situation as MSF. You can make a link to what is happening to us because it’s another organization working on malnutrition. And if two organizations treating malnutrition are not working there anymore, of course the number of children treated is going to diminish.

Question:
And is this the same government in power that was there in 2005 and that was concerned about when you were calling for international assistance then?

Marie-Pierre Allié:
Yes, President Mamadou Tandja was the president at the time. I think that what has been happening since 2005, putting Niger on the spot, speaking about the malnutrition crisis, the food crisis, etc., is something now affecting the government and the President in particular. But also during this time, Niger has been really, really taking new steps to fight malnutrition. After 2005, the National protocol has been modified, ambulatory care has been established, production of ready to use food has been established in Niamey. So there have been really, really good things done by the government, by the Minister of Health, in Niger to tackle malnutrition. So as a consequence of the 2005 crisis, I think there have been huge steps that have been taken by the government in Niger. That's why today what's happening to us is really quite a drawback from what has happened in past several years. And I really hope that we can [be reinstated] in order to get back on this positive track.

Question:
Rising food prices of the last year all over the globe, how much did they make the situation, the malnutrition situation in Niger worse? Did it throw a lot more people into hunger?

Marie-Pierre Allié:
No, I won't say that. To us what's important in this kind of situation is really to address the needs of the patients who are the most vulnerable. In this kind of situation, when there are food shortage everywhere, it’s the small kids who are the most vulnerable and we try to address these cases. So that's what we have been doing in the past several years, this year and the year before, is offering a supplementary food with minerals, nutrients, to these kids. And as we have been following it, it has been quite effective in terms of malnutrition affecting these young children. So before our suspension we didn't see the rise in food prices have an impact in the area.

Question:
Isn't it possible -- or is it possible that the government of Niger could take on this work itself? Reading the AFP article from yesterday, they said, the government can do it, we don't need Doctors Without Borders to take on the malnutrition problem.

Marie-Pierre Allié:
Yes, it's a real issue. I think what Doctors Without Borders/Medecins Sans Frontieres want to do, is really not to stay indefinitely in the region. And this is the kind of discussion that we were having with the Minister of Health. What we are expecting is to work hand in hand with the Minister of Health and staff in the health care system in order to implement new strategies making treatment simpler and more possible to run. But this is something that we need to build in the coming years and it's something for which we need more support, more finance than what exists today. I'm saying that without appropriate funding from international donors, it's going to be very difficult for countries like Niger to tackle the issue. But what we are speaking about today and what the Minister of Health is saying is that today the infrastructure [can handle the extent of the malnutrition problem in Niger].

What I've been seeing on the ground is that the health structures in Maradi are crying for help, the staff says, “we cannot manage with the number of people who are coming today for treatment.” The mothers are [used to knowing that when] their kids are malnourished, their kids can be treated, so they come to the health structures. Not all of them, but a lot of them continue to come. And it's creating a lot of pressure on health centers because today they don't have the means. You need some human resources, you need some ready-to-use foods, you need treatment. And today the health centers are not ready to handle such a big influx. But really, my discussion with the Minister of Health was to say, ‘Okay, let's try to work together to establish the possibility that in two or three years time MSF can withdraw and the existing health centers can take over.

Question:
Do you foresee a problem on the same scale as what happened in 2005?

Marie-Pierre Allié:
No, the situation we are describing today is not the one of 2005. The situation we are seeing today is created by the fact that the care that we [normally provide for the] children is absent. And that's also what's making the situation so sad. We have the means. We have our staff, who are quite well trained, able to treat malnutrition; our national staff is really very well trained. We have the staff, we have the structures, we have the equipment, we have the food, and we really want to treat the children. And this has been impossible for the past 13 weeks now and this is what is making the situation critical now. It’s mainly because there has been no treatment for the past month. [Now] children are not treated so they are still sick. We used to do prevention by distributing supplementary food to all kids from six months to three years and this [approach] was really showing good results in reducing malnutrition. Another worrying factor this year, the number of malaria cases is quite high, it's higher than it was last year. And of course when children get malaria, there is increased risk for them to become malnourished. So all of that makes the situation today more critical. But no, I'm not comparing today’s situation with what happened in 2005. I'm just saying that today in Maradi they have been waiting too long and really it is going to be quite important to intervene now.

MSF France Calls On President of Niger to Lift Ban on Its Nutritional Programs Immediately

Tue, 21 Oct 2008 13:04:00 GMT

Press Teleconference

Listen: MSF press teleconference on the ban on its nutritional programs in the Maradi region of Niger

Paris/Niamey, October 21, 2008 — Three months after Nigerien authorities suspended the activities of the French section of Doctors Without Borders/Médecins Sans Frontières (MSF), the international medical humanitarian organization is calling for an immediate resumption of its nutritional operations in the Maradi region.

"The situation in the field is very troubling," said Dr. Marie-Pierre Allié, MSF’s president. "Despite all their efforts, the health care staff in the hospitals and health centers I visited cannot respond to the influx of malnourished children."

When MSF’s work was suspended, nearly 3,400 malnourished children were under treatment and 500 new children were being admitted weekly. This interruption occurred during the most critical time of year – the lean period. MSF estimates that nearly 8,000 severely malnourished children should have been treated in feeding centers in the Madarounfa and Guidan Roumdji districts during those three months.

Many children currently require treatment, yet so far, no one has been able to offer an adequate alternative to the medical treatment that MSF provided in the Maradi region. Despite the urgency of the situation, MSF France has still not been authorized to resume its activities.

This prohibition against treating malnourished children contrasts strongly with the Nigerien government’s policy of fighting malnutrition in recent years. Considerable progress has been made, including the adoption of a new protocol increasing the number of children treated and the development of local production of ready-to-use therapeutic foods. These advances contradict the attitude of certain Nigerien decision makers today who tend to minimize—if not deny—the existence of malnutrition hotspots in the country.

Effective treatment does exist and has been used in Niger for several years, resulting in a sharp reduction of mortality related to childhood malnutrition. Today, many malnourished children in urgent need in the Maradi region are unable to benefit from such treatment.

"Over the last few years, we have carried out innovative and effective programs in collaboration with Nigerien authorities," Dr. Allié noted. "Given the seriousness of the situation today, we are asking them to allow us to resume our activities in Maradi immediately so that we can treat malnourished children."

Doctors Without Borders/Médecins Sans Frontières (MSF) has been working in Niger since 2001 and carries out malnutrition treatment programs in the Zinder, Maradi and Tahoua regions. Between early 2008 and mid-September, a total of 61,051 children suffering from acute malnutrition were admitted into MSF feeding centers. In collaboration with health authorities, MSF also provides epidemic response in Niger, treating patients and carrying out vaccination campaigns. In 2008, it responded to measles, meningitis and cholera epidemics. The MSF teams in Niger total 1,537 staff, including 1,468 Nigeriens.

Haiti's Hurricane Victims Facing Homelessness and Food Shortages

Mon, 13 Oct 2008 15:02:00 GMT

Haiti 2008 © Gregory Vandendaelen /MSF

GONAÏVES, October 13, 2008 – Five weeks after a series of hurricanes struck Haiti, people in the city of Gonaïves are still deprived of essential services, the international medical humanitarian organization Doctors Without Borders/ Médecins Sans Frontières (MSF) said today. Since early October, families have been evicted from schools and churches where they had sought refuge after the storms destroyed their homes.

With no alternative housing available, MSF estimates that approximately 10,000 people—out of a total population of 200,000—are living on roofs, in tents, or in fragile shacks made of wood debris and bed sheets. Other families are crammed into abandoned buildings by the dozens, or staying temporarily with relatives in overcrowded conditions that increase the risk of poor sanitation and domestic violence. In addition to this, electricity and running water have yet to be re-established.

While it has not rained in more than ten days, many roads are still flooded. Mud is more than three feet deep in some parts of the city, making it extremely difficult to get around. “It’s as if a cyclone passed through here just a couple of days ago,” said Vikki Stienen, MSF project coordinator in Gonaïves. “The coordination of relief efforts is extremely chaotic.”

“Usually after natural disasters MSF can reduce it activities after the first month,” Stienen said. “Here, it’s the opposite; we’ve had to reinforce our teams and our intervention.”

So far in Gonaïves, MSF has distributed 3,000 family kits (including plastic sheeting, soap, and jerry cans) and is distributing 2,000 more beginning today. Moreover, MSF is planning to distribute another 5,000 kits to cover the needs of as many people as possible in the city. Additionally, MSF is providing the majority of clean drinking water distributed in Gonaïves, a total of one million liters per day.

MSF is also witnessing an increase in the number of malnourished children admitted to its hospital. MSF re-opened the hospital in Gonaïves only 10 days ago and seven severely malnourished children have already been admitted. This number is expected to grow as people hear about the re-opening of the hospital. Haitians already face chronic food crises and nutritional deficits. The recent hurricanes destroyed crops and killed significant numbers of livestock, making people all the more vulnerable.

Haiti 2008 © Gregory Vandendaelen /MSF

International food aid reaching the community is clearly insufficient in quantity, unsuitable for the nutritional needs of young children, and is being distributed in a way that excludes single mothers. There is still no clear strategy to identify the needs, nor implement a proper nutrition response.

Despite the significant presence of international organizations, the people of Gonaïves have yet to see much benefit. Hurricane season ends in late November. If another storm were to strike the region with more heavy rains, inhabitants here would once again pay a heavy price.

MSF urges international organizations and the Haitian government to immediately re-examine their emergency aid response, and to prioritize housing and nutritional support for the youngest of the flood victims.

Doctors Without Borders Protests Comments by Bernard Kouchner in Jerusalem

Wed, 08 Oct 2008 13:35:00 GMT

Paris/Jerusalem, October 7, 2008—During an October 5, 2008 press conference at the French consulate in Jerusalem, French Foreign Minister Bernard Kouchner made the following statement: “Officially, we have no contact with Hamas, but unofficially, international organizations working in the Gaza Strip—in particular, French NGOs—provide us information.”

Doctors Without Borders/Médecins Sans Frontières (MSF) is one of the organizations working in the Palestinian territories and, specifically, in the Gaza Strip. MSF confirms that it has never transmitted political information—officially or unofficially—regarding Hamas or any other Palestinian political group to the French Ministry of Foreign Affairs.

Once again, Mr. Kouchner’s statements create confusion and harm MSF’s work in the field and with Palestinian civilians who have suffered greatly from years of conflict. Confusing political activity and humanitarian work is profoundly damaging to MSF’s efforts, the security of our teams, and the deployment of impartial and independent aid in crisis areas.

MSF wishes to emphasize that independence from all governments and interests (political, religious, economic, and military) is central to its definition of humanitarian action. Since its founding in 1971, MSF has provided aid on an independent, impartial, and neutral basis. These principles, spelled out in the MSF charter, guarantee freedom of action in the field. Similarly, MSF has chosen a policy of financial independence, refusing any funding from the French government.

Mr. Kouchner left MSF in 1979. Since that time, he has had no involvement in or responsibility towards the organization.

MSF has been working in the Palestinian territories (the West Bank and Gaza) since 1989. In Nablus, on the West Bank, MSF provides mental health care, medical care and social services to families exposed to violence. In Gaza, MSF provides a mental health-medical-social services program, pediatric activities, post-operative and outpatient treatment, and physical therapy for the hundreds of people wounded in inter-Palestinian and Israeli-Palestinian confrontations.

International Community Failing Civilians in North Kivu, Congo

Mon, 06 Oct 2008 13:51:00 GMT

Goma, DRC, October 6, 2008 – In the most volatile parts of North Kivu Province in the Democratic Republic of Congo (DRC), violence has reached its highest levels in years while assistance is hardly reaching those most in need, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today. Hundreds of thousands of people have been forced to flee their homes since full-scale war resumed at the end of August and are living in fear, without the means to meet their most basic needs.

The international community has failed to address the ongoing conflict in the region as a priority. Even though one of the largest peacekeeping forces in the world is currently deployed in DRC, the United Nations peacekeeping mission (MONUC) is clearly failing to fulfil its mandate to protect the civilian population in North Kivu.

Most United Nations agencies and nongovernmental organizations are also failing to provide an adequate response as an already disastrous humanitarian situation further deteriorates. Despite the presence of a large number of humanitarian organizations in Goma, the province’s capital, few are active in the areas most affected by the war.

Many people who now need assistance have been forced to flee several times. They have repeatedly lost their homes and belongings—often as a result of looting—and are losing their capacity to cope. In addition to the extensive needs of the population—food, shelter, access to water, medical care, and protection—the risk of epidemics is high, and many health clinics have been looted.

Some of the people who flee reach relatively established camps, while others gather in isolated pockets of calm or with host families. Still, others have become ‘invisible’ – hiding in the bush, trapped between armed groups.

"We were assisting over 100,000 displaced persons in Nyanzale and Kabizo,” said Anne Taylor, MSF head of mission in Goma. “We have no idea where they have fled in the past few weeks. Only 25,000 people arrived in Kayna and Kanyabayonga. Where are the others? We are extremely worried about their fate."

In other areas, MSF found groups of newly displaced people. In Ngungu, thousands are living in terrible conditions, without any health care. Thousands of people also arrived in Kitchanga during the last weeks.

“Reaching these people is extremely difficult because of the volatile security context and because they are constantly on the move,” said Taylor. “But it is not impossible. We just keep trying and trying until we can find them and provide some vital assistance. But we are aware that we are only dealing with a small part of this humanitarian catastrophe. Hundreds of thousands are out of reach.”

In North Kivu, MSF teams are currently working in and around Rutshuru, Nyanzale, Kayna, Kanyabayonga, Kitchanga, Mweso, and Masisi. Mobile teams are doing assessments and providing medical assistance in new areas, including Ngungu in North Kivu and Minova, in South Kivu. MSF has 62 international staff and 716 national staff working in North Kivu.

WHO Experts Raise Antiquated Nutrition Standards

Mon, 06 Oct 2008 13:49:00 GMT

Geneva, October 6, 2008 — After decades of neglect and poor standards for nutrition programs, the international nutrition community has put forth a clear set of principles to reduce deaths in moderately malnourished children. These new standards could positively impact 55 million moderately malnourished children worldwide, but only if they are translated into more effective food programs.

After a week-long meeting, World Health Organisation (WHO) experts have just agreed that animal source foods such as dairy products are the first and most effective choice to treat moderately malnourished children. According to the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), this new standard can significantly reduce child deaths. But the impact of these new rules will depend on the creation of new initiatives to support and fund programs.

Currently, food programs targeted at moderately malnourished children are mainly cereal-based and lack many of the nutrients young children need.

"Fortified blended flours based on wheat or corn plus soy that are so widely used no longer meet the new minimum criteria that the WHO experts have just set for young kids," said Christophe Fournier, President of the MSF International Council. "With everyone now agreeing that malnutrition in children needs to be treated with animal source food, this should be the beginning of the end of providing poor quality diet to malnourished, vulnerable children."

In the areas most devastated by malnutrition, such as South Asia, the Sahel, and the Horn of Africa no other condition contributes more to death and illness in children.

The newly recommended animal source foods will make nutrition programs for children much more expensive. MSF estimates that it will cost 3.5 billion euros annually to adequately address moderate malnutrition worldwide.

“National governments and donors need to urgently put new policies and funding in place to implement these new standards," said Fournier. "Not doing so would be endorsing double standards in which we would continue to give food aid that we would not feed to our own children."

MSF has recently made it a policy to treat all malnourished children with at least some animal source food and has begun to implement this strategy in all its nutrition programs worldwide. In 2006 and 2007, the organization treated over 150,000 malnourished children in 22 countries with therapeutic and supplemental food.

The WHO experts meeting for "The Dietary Management of Moderate Malnutrition" was held in Geneva from September 30-October 3, 2008.

Somalia: Surge in Wounded and Displaced as Violence Increases in Mogadishu

Thu, 02 Oct 2008 14:26:00 GMT

Nairobi/Geneva/New York, October 2, 2008 — The recent escalation in fighting in one of Mogadishu’s most populated residential areas has resulted in a surge of wounded civilians and has once again displaced thousands of people. The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is treating some of the wounded and is providing basic relief supplies to newly displaced people.

As of last week, MSF had treated more than 100 wounded people in the Dayniile hospital, located on the outskirts of the capital. The wounded, many of whom are women and children under 16 years-of-age, had suffered head, abdomen, and chest injuries caused by mortar rounds or bullets, with many of them requiring emergency surgery.

On the road from Mogadishu to Afgooye, where more than 250,000 displaced people are living in appalling conditions, MSF has seen the arrival of at least 9,000 more people since last Wednesday. Teams are trying to provide them with essential supplies including soap, plastic sheeting, and blankets. However, these basic items will only meet initial emergency needs. People are completely dependent on external food aid to survive, but assistance is provided intermittently. Families who just fled the violence in Mogadishu are met with a lack of shelter, food, and health care.

The situation is appalling," said Kenneth Lavelle, MSF head of mission based in Nairobi who is in daily contact with MSF field teams. Because of the constant flow of people fleeing Mogadishu, the camps are getting more and more crowded and already atrocious living conditions are rapidly deteriorating. Families of five have less than a few square meters to settle in, without proper shelter," he said.

MSF has been working in health centers in Hawa Abdi and Afgooye since 2007 and has treated more than 1,000 children suffering from acute malnutrition every month since April 2008. Working conditions—primarily the lack of security for the population and for aid workers—prevent any significant increase in this vital aid.

"Despite all of the insecurity, MSF has still been able to respond thanks to our Somali colleagues, who are taking tremendous risks to provide immediate assistance," said Lavelle. "Due to the security situation, we are unable to meet any needs other than the immediate, life-saving needs. This includes medical care, nutrition, and sanitation. Our response is most certainly inadequate when taking into account the gravity of the situation."

MSF staff in Dayniile hospital have treated 3,700 people suffering from trauma injuries since the beginning of 2008. More than half of these are women and children under 14, with half of the patients treated for injuries sustained during fighting.

MSF has carried out 32,982 medical consultations and cared for 6,937 children suffering from acute malnutrition in its Hawa Abdi and Afgooye health centers since April 2008.

Haiti: Survivors in Flooded Village Stranded with No Help

Thu, 02 Oct 2008 08:15:00 GMT

The area of Mamont, in the Artibonite region, remains partially submerged under water.

Reuters Video: Submerged Village in Haiti

Port-au-Prince/New York, October 3, 2008 — A month after the last tropical storms and hurricanes hit Haiti, Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams have found a whole village partially submerged and its 2,400 remaining inhabitants stranded with no help.

On Tuesday, September 30, MSF teams managed to reach Mamont, a town southeast of Gonaïves in the Artibonite region, which was heavily affected by the series of storms that struck Haiti in late August and last month. The town, with an original population of roughly 17,000 people, had been totally isolated for the last four weeks. The teams found the village partially submerged with water spilling over from a lake formed by the storm. The remaining population is cut off from all major towns since the road is also submerged. The survivors have been without clean water, sufficient food, or medical care for weeks.

The MSF teams are currently providing assistance to those who remained in Mamont and is calling on other organizations to assist as quickly as possible. Although international attention has largely moved on from the emergency in Haiti, the example of Mamont shows that emergency assistance remains critical for some parts of the country.

In the Gonaïves area, concrete measures for getting the victims of the storms back on their feet are slow to materialize; there remains a lack of access to clean water, problems with sanitation, and a shortage of the most basic goods.

There is the risk of disease spreading and MSF is worried about the repeated expulsions of displaced people from places where they found temporary shelter. For several days the authorities have been pushing for the evacuation of classrooms before the start of the new school term on Monday, October 6. The situation is similar in churches, where congregations want to resume their worship and are pushing those sheltering inside to leave.

A man shovels mud from a house in Parc Vincent.

The cathedral in Gonaïves, where more then 200 people found refuge, was emptied two weeks ago; some of the displaced moved to a camp of 65 tents in Praville, where conditions are unacceptable. In the area of K-Soleil, more than 800 people were evicted from their shelter and had no option than to camp in their ravaged houses or sleep under a piece of cardboard. People who were asked to leave the Church of the Christian Union, numbering some 500 following the floods, had to relocate to the university, where now over 200 of them remain without even minimal hygiene facilities. And while the Parc Vincent area, heavily affected by the disaster, is gradually being cleaned up, large numbers of families there find themselves with no choice but to sleep in the street after being forced out of shelters.

Today, hundreds of families are left without a place to stay and without any means to rebuild their lives, as neither the authorities nor international organizations present in Gonaïves have provided alternative shelter.

MSF Emergency Intervention in Haiti

MSF has recently opened an 80-bed hospital in the north of Gonaïves in collaboration with the Health and Population Ministry. This structure is the only one in the region that can respond to emergencies and provide obstetric and pediatric services in this town of 300,000 inhabitants, devastated by the recent hurricanes and tropical storms.

During the first five days, this structure has already received 108 patients in the emergency room and performed 19 deliveries as well as eight minor and one major surgery interventions. In total, 40 people have been hospitalized

In parallel with its activities in the hospital, MSF continues to provide drinking water to the population, but the situation remains precarious in Gonaïves. Every three days, the team chlorinates 1 million liters of water, and, together with other organizations, they truck 350,000 liters daily for distribution to the communities. In total, since September 8, MSF has distributed more than 3.3 million liters of water. This represents the largest percentage of the water that has so far been distributed. MSF aims at having a capacity of 1 million liters of water per day.

Mobile medical teams continue to travel by car around Gonaïves and by helicopter to its environs to provide assistance to the most vulnerable people in temporary shelters or in nearby isolated villages. Since September 12, MSF teams have performed more than 1,150 consultations in mobile clinics.

After performing 2,326 consultations in 20 days, MSF teams left the health center of Rabouteau in Gonaives last week; it is now fully managed by the Health and Population Ministry.

MSF teams have also assessed needs in the northwest of Haiti, in the central Artibonite region, and in the south of the country. While interventions are not currently required in the areas visited, the teams have provided some health structures with drugs and materials and have carried out medical consultations. A nutritional surveillance system has also been established in the northwest region and assessments have been carried out in the northeast and southeast areas of the country in relation to food insecurity.

MSF Still Blocked in Maradi Despite a New Memorandum of Understanding

Wed, 01 Oct 2008 13:50:00 GMT

Niamey, Niger, October 1, 2008 — Ten weeks after Doctors Without Borders/Médecins Sans Frontières' (MSF) authorization to treat malnutrition in the Maradi region was suspended, the French section of MSF is no longer providing any medical-nutritional treatment on site there. A new memorandum of understanding was drafted between the Ministry of Public Health and MSF, but the authorities of Niger have yet to sign it.

"In recent weeks, many contacts raised our hopes that the suspension would be lifted soon," said Christophe Fournier, international president of MSF. "Unfortunately, these favorable indications have been slow to materialize. However, we still hope that a positive outcome is possible."

Since July 18, the date its authorization was suspended, MSF has taken a variety of steps in an effort to resume its activities. On August 7, Marie-Pierre Allié, president of the French section of MSF, went to Niamey to meet with the Minister of Public Health. Following that meeting, a joint delegation of Ministry of Health representatives and MSF operational managers went to Maradi to draw up a new memorandum of understanding between the organization and Niger’s health authorities. It was submitted to the Minister of Public Health and then transmitted, officially, to the Prime Minister on August 15. In addition, in early September, MSF submitted requests to meet with Niger’s president and the Health and Interior ministries.

In accordance with the Nigerien authorities’ decision, MSF halted admission of new children into its program when the suspension was announced and gradually closed its 13 treatment centers in Maradi and surrounding areas. In addition, 2½ months after the suspension, given that it could not treat children in Maradi, MSF had to start the process of terminating the employment contracts of its Maradi staff.

Considerable progress has been made on nutritional issues in recent years. In 2005, Niger was the first country in the sub-region to adopt a national treatment protocol for severe malnutrition. A national malnutrition agency was created within the Ministry of Public Health. Based on surveys conducted by Niger’s own Ministry of Public Health and UNICEF, the prevalence of malnutrition in the Maradi region dropped sharply between 2005 and 2008.

"Since early 2008, our program has treated more than 14,000 malnourished children in the Maradi region," stated Marie-Pierre Allié, president of MSF France."At the time our work authorization suspension was announced, nearly 3,400 children were being treated in our centers, 180 of whom were hospitalized. It is very disturbing not to be able to treat malnutrition in the midst of the dry period, the most sensitive time of year."

Lifting the suspension quickly is more critical than ever so that MSF can resume its activities in Maradi and continue working with authorities to improve treatment of malnutrition in Niger.

Doctors Without Borders/Médecins Sans Frontières (MSF) has been operating malnutrition treatment programs in Niger since 2001. The organization is currently working in the Zinder, Maradi and Tahoua regions. Between early 2008 and mid-September, a total of 61,051 children suffering from acute malnutrition were admitted into MSF feeding centers. In collaboration with health authorities, MSF also provides epidemic response in Niger, treating patients and carrying out vaccination campaigns. In 2008, more than 700,000 children were vaccinated against measles, and MSF was involved in responding to meningitis and cholera epidemics. The MSF teams in Niger total 1,537 staff, including 1,468 Nigeriens.

Malaria: From Good Intentions to Effective Action

Tue, 30 Sep 2008 13:53:00 GMT

MSF Report

Download Report [988 KB]

Johannesburg/Brussels, September 30, 2008 — In a new report launched today, the international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) said many more lives can be saved if newer effective strategies to tackle malaria are more widely implemented. The report, titled "Full Prescription; better malaria treatment for more people, MSF’s experience,"describes the organization’s work in Sierra Leone, Chad and Mali, and shows that unnecessary deaths can be avoided with simple, affordable treatment and diagnostic tools available today.

"Although still insufficient, increased funding is available for malaria," said Meinie Nicolai, General Director of MSF in Brussels. "Newer and more effective drugs have started to arrive on the shelves, rapid tests exist that can confirm the diagnosis in fifteen minutes. But many efforts are failing at the last hurdle and scores of sick people, mainly children, still do not get the treatment they need."

In large parts of sub-Saharan Africa, people do not go to health structures because they are too expensive and too far away. In Sierra Leone, for example, only 12 percent of children suspected of having malaria received efficient treatment in the health services. MSF’s experience and research show that the fees patients are requested to pay are a huge deterrent to seeking care in most of the poor settings where MSF works.

A second barrier to providing malaria care effectively is geographical. Some rural communities are very remote from health structures, or isolated by water during the rainy season. Strategies involving malaria village workers have proved to be highly efficient in reaching and treating malaria patients where they live. By combining free care at health center level and in the communities that were geographically isolated, MSF’s project in Mali succeeded in tripling the number of malaria cases detected and treated over a year’s time.

This has been possible without jeopardizing the quality of care through user-friendly rapid tests, which allow lay-people with basic training to confirm if the patient’s fever is indeed caused by malaria. When cases are identified, the malaria village worker dispenses drugs to the patient or the caretaker free of charge.

"Malaria village workers are not the silver bullet," explained Christine Jamet, Head of Mission for MSF in Chad. "But they allow to efficiently bridge the gap where health structures are not accessible. They should not exempt the authorities from extending access to care, especially as people who test negative for malaria must be treated for whatever causes their fever and complex cases need to be referred to a health structure. To ensure appropriate medical treatment, malaria cases should be systematically confirmed by using a test."

At the moment, the World Health Organisation (WHO) recommends to treat all children with fever, in highly endemic regions, with anti-malarial drugs. But in a Sierra Leone for example, a high-transmission area, systematic use of rapid tests in our project in Bo showed that 30 to 40 percent of the suspected cases under five are actually negative. Not using the tests - as recommended by WHO - means that many will receive treatment for the wrong disease and no further examination will be performed to check what actually causes the fever.

Until more successful prevention and eradication measures bear their fruit, patients will continue to die needlessly if available efficient treatment and diagnostic tools do not reach them. Shipping tests and drugs to the country is not enough; measures to actually ensure their delivery to patients need to be implemented urgently.

WHO Experts Meeting Has Potential to Impact Millions of Malnourished Children

Mon, 29 Sep 2008 13:45:00 GMT

September 29, 2008, Geneva — A World Health Organization meeting to develop new recommendations for the treatment of malnutrition will have a far-reaching impact on the quality of food aid and nutrition programs for infants and young children, according to the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

MSF called on WHO experts to take this opportunity to raise the standards of food aid and malnutrition programs.

In the areas most chronically devastated by malnutrition, such as South Asia, the Sahel, and the Horn of Africa, many families cannot afford access to nutritious food and must survive on cereal porridges that are missing many essential nutrients. However, food aid provided today by international agencies or donors is also mainly cereal-based. These do not include animal source foods such as milk, which contain many of the nutrients young children need.

"We would not provide our own children only cereal porridge, why do we accept a double standard in food aid?" asked Dr. Tido von Schoen-Angerer, Executive Director of MSF’s Access to Essential Medicines Campaign. "It would be a tragedy not to seize on this opportunity to raise the nutritional standards of food aid and national programming to include animal source food."

No other condition contributes more to death and illness in children than malnutrition, the underlying cause of death of more than 3.5 million children under five every year in developing countries. Yet programs to prevent children from falling into the most terminal stages of malnutrition have barely changed for the last 30 years.

"MSF has made it a policy to treat malnourished children with at least some animal source food and we are now working toward more comprehensive implementation," said Dr. von Schoen-Angerer. "Hopefully a clear recommendation from these experts will lead to a change to dramatically reduce unnecessary deaths from malnutrition."

The United Nations already has clear recommendations for treating severe acute malnutrition, but only 5% of children in need receive treatment. MSF believes the challenge is to reach young children with high-value, nutritious food before they become dangerously ill.

The WHO experts meeting for "The Dietary Management of Moderate Malnutrition" takes place in Geneva from September 30 – October 3.

MSF has treated over 150,000 malnourished children in 2006 and 2007 in 22 countries with therapeutic and supplemental food.

Need to Fix Food Aid to Tackle the Crisis of Childhood Malnutrition

Thu, 11 Sep 2008 15:31:00 GMT

New York, NY, September 11, 2008—Hundreds of international food aid and nutrition experts, representatives from donor institutions and aid organizations, and political leaders gathered in New York today to try to better tackle the scourge of global childhood malnutrition—a neglected crisis that contributes to the unnecessary deaths of 3.5 to five million children under five every year and leaves millions more with life-long disabilities.

The two-day symposium, titled "Starved for Attention: The Neglected Crisis of Childhood Malnutrition," is being hosted by Doctors Without Borders/Médecins Sans Frontières (MSF) and Columbia University's Institute of Human Nutrition (IHN). Participants will examine why, despite domestic and international efforts, including billions of dollars in donated food aid every year, current nutrition programs do not adequately target childhood malnutrition. They will discuss ways to overcome barriers to improving diet quality and nutrition programming, particularly in malnutrition hotspots such as Southeast Asia, the Sahel and Horn of Africa.

"It is unacceptable that current food aid is not providing adequate, nutrient-rich food for the most vulnerable children,” said Dr. Susan Shepherd, nutrition advisor for MSF's Access to Essential Medicines Campaign. "It is a double standard that we send food aid to children in low-income countries that we would never feed to our own children. If we are serious about preventing the deaths, illnesses, and disabilities caused by childhood malnutrition, it's time we fix a broken food aid system. Making food aid more effective will mean changing what we provide."

For infants and young children, good nutrition depends on breast feeding and nutrient-rich complementary food. It is an issue of diet quality—nutrients and energy density—as much as quantity. But for poor families living in regions devastated by malnutrition, attaining nutrient-rich foods on a daily basis, particularly animal-source foods, is not possible. Yet at the international policy level, nutrition programs have not paid sufficient attention to addressing deficits in diet quality for infants and young children.

Current food aid for children consists largely of corn or wheat/soy-blended porridge, the ingredients of which can inhibit absorption of essential minerals, such as zinc, which are vital to childhood development and survival. These enriched flours also have no animal-source content, which is important for rapidly developing children. The milk component of fortified flours in U.S. overseas food aid targeted at young children was actually eliminated in the late 1980s for economic reasons.

"As we saw with HIV/AIDS, only when assistance is driven by desperate needs and not by economic interests do we mobilize sufficient resources to even begin to address a crisis of this magnitude,” said Stephen Lewis, co-director of AIDS Free World, and keynote speaker for the first day of the symposium.

Arguably the most important innovation in recent years has been an outpatient strategy based on milk-based, nutrient fortified, energy dense therapeutic foods to treat severely malnourished children in the most resource-limited settings. While strategies need to be adapted to local contexts in places where infrastructure and resources are limited, a strategy this simple, affordable, and direct can reach children in areas where malnutrition is chronically at crisis levels.

“There is no one solution to overcoming malnutrition, but there must be the political will and commitment to act," said Dr. Richard Deckelbaum, director of Columbia University's Institute of Human Nutrition. "We have to ask ourselves: what is the cost of doing nothing?"

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