Médecins Sans Frontières (MSF) in the Middle East and North Africa

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Médecins Sans Frontières (MSF) in the Middle East and North Africa

As an international medical humanitarian organisation, MSF strives to provide free medical assistance to communities affected by natural disasters, armed conflicts and disease outbreaks, as well as those suffering from a lack of access to healthcare. MSF offers neutral and impartial assistance regardless of race, religion, gender or political affiliation. MSF is an independent, non-profit organisation founded in 1971. Today, it is a worldwide movement working in 65 countries around the world.

In order to ensure its independence, MSF does not accept funding from any government, religious committee or international agency for its programmes in the Middle East, relying solely on private donations from the general public around the world to carry out its work.

Jordan

© J.B. Russell

Since August 2006, MSF has been providing medical health care to Iraqi victims of violence through its reconstructive surgery programme in Jordan. In 2010, MSF treated over 1450 Iraqi victims of violence in its surgical projects in Amman, Iraq and Iran. MSF offers surgical interventions in maxillofacial and orthopaedic injuries, and severe burns.

In 2008, the first round of patients from the Gaza strip were taken in.

2010 saw a further expansion in outreach with the acceptance of Yemeni patients injured during the unrest. In 2011 and in view of the extensive needs that resulted from the Arab spring, the project was again broadened to encompass victims from Libya and Syria, which in turn prompted the organization to allocate a higher budget for the project and turn into a regional medical facility.

Occupied Palestinian Territories

© Frederic Sautereau

MSF has been present in the Palestinian Territories since 1989. In the West Bank, in Hebron and Nablus, MSF provides medical, psychological and social assistance to populations suffering from the consequences of trauma related to the Israeli-Palestinian and inter-Palestinian conflicts.

Since 2000, MSF has been catering to the needs of populations in the Gaza Strip suffering from the consequences of trauma related to conflict, including rehabilitation care to the wounded and burns victims in its two health centres in Gaza. In 2010, more than 180 surgical operations were performed and mental health staff held almost 3,400 consultations. And most recently MSF opened its first unit dedicated to hand therapy to treat all patients in the Gaza Strip who require this specialized care.

Bahrain

© Google Maps

Early 2011, an MSF assessment team made contact with medical organisations in the country. The team visited Salmaniya hospital, in the capital Manama, several times and offered support. At a later date, training was provided to the hospital on mass casualty management of the emergency room.

Following the escalation in violence, the MSF team has been treating patients at their homes. Negotiations are ongoing with the Bahraini authorities to allow MSF staff to accompany injured protestors to health facilities.

Tunisia

© Mattia Insolera

In January 2011 MSF donated medical equipment, including orthopaedic materials to hospitals in Kasserine and Sidi Bouzid, where health staff had seen their stocks depleted during the demonstrations.

Since the conflict in Libya began, MSF teams have been providing psychological support to people fleeing the conflict on the coastal border of Ras Ajdir. In the southern border town of Dehiba more than 50,000 Libyan families have reportedly crossed into Tunisia since April. MSF has deployed mobile clinics, providing medical and mental health care to Libyan families. Approximately 150 consultations take place each week in the villages of Omziguarr, Ouni and Nekrif.

About 40,000 Libyan refugees are believed to be present in Tataouine. MSF is also working in the local hospital and supporting health centres in 15 locations to absorb the increasing demand in medical care.

Djibouti

© MSF

MSF has been working in Djibouti since 2008. Drought, rising food prices and increased numbers of migrants passing through the country have had a profound impact on Djibouti. Levels of malnutrition exceeded emergency thresholds in a number of locations in 2010. MSF has concentrated its efforts on reducing malnutrition among children in the slums of Djibouti City.

Syria

© Enass Abu Khalaf-Tuffaha

MSF response to Syrian crisis

Three years of extremely violent war have ripped apart towns, villages, hospitals, clinics – everything that Syrians relied on for their existence. Throughout the country, families that can are fleeing from one place of refuge to the next, each time with fewer belongings and more fear. The entire country is in a state of medical crisis, with the worst-affected areas experiencing extreme suffering. And the crisis extends beyond Syria to the surrounding countries where more than two million refugees are struggling to survive.

Gunshot wounds, bomb blasts and shrapnel injuries make for a long medical case list in Syria. But maternal health, vaccinations, burns, chronic diseases that turn deadly if medication is neglected – all these add to the waiting list of urgent requirements that are not being met. Millions of Syrians are reliant on the limited medical assistance that can be provided at makeshift facilities in basements and private houses.

=> Inside Syria

Since June 2012 MSF has been providing healthcare in parts of northern Syria where needs were identified and where it was possible to set up makeshift hospitals and clinics. To date the medical teams have provided more than 140,000 consultations, many of them for trauma wounds and life-threatening chronic diseases. Nearly 7,000 surgical procedures have been performed and more than 1,900 women have been assisted with safe deliveries.

But the war makes providing assistance extremely challenging. The intensity and volatility of the conflict is a huge obstacle to reaching the people in need. On the evening of 2 January 2014, while on assignment to provide medical care to Syrians suffering from the war, five staff members were taken from an MSF house in northern Syria. MSF continues to put all its efforts towards securing their safe return.

The hospital and the two clinics in the area of the incident are currently suspended. However, because the needs are so overwhelming, we continue to maintain medical activities in five makeshift hospitals and clinics in Syria. Our programme of supporting Syrian medical networks also continues. We are providing medical supplies and technical support to 50 hospitals and 80 health centres across seven governorates, covering opposition-controlled, government-controlled and contested areas. Because we are working in an intense war environment, we constantly reevaluate our projects and activities in the light of the security challenges. 

Syria statistics (to end January 2014):

Emergency room consultations – 49,083

Outpatient consultations – 94,389

Surgical procedures – 6,895

Maternity deliveries – 1,962

Emergency measles vaccination campaign – 75,000 children (April to June 2013)

=> Syrian refugees

More than two million Syrian refugees are registered or awaiting registration in countries neighbouring Syria, but the actual number could be much higher. Compared to Syria, there is much better access and security in the surrounding countries, but the resources of these countries are stretched to the limit, and gaps in health services continue to expand while the needs of refugees show no signs of diminishing.

In Iraq there are more than 210,000 Syrian refugees. MSF is providing outpatient health services, mental health consultations and water and sanitation services in several locations for refugees in Iraq, notably in Domeez and Kawargosk camps, and also in transit and refugee camps located in Dohuk and Erbil governorates. On average, MSF teams provide around 3,000 consultations per week in Iraq.

In Jordan there are more than 575,000 Syrian refugees, the majority living outside the refugee camps. MSF’s project in Zaatari camp closed in 2013 as other organisations had the capacity to manage the health needs. Meanwhile an MSF assessment showed that needs for mother and child healthcare were a major concern for refugees living outside the refugee camps, particularly in Irbid governorate in the north of the country. In November 2013, MSF started a new programme providing maternal health, neonatology and paediatric services; by the end of January the team had provided 1,753 antenatal consultations and assisted 303 safe deliveries.

MSF’s emergency surgical project inside the Ministry of Health hospital in Ramtha, next to the Syrian border, continues to be extremely busy – more than 540 lifesaving surgeries have been provided for war-wounded patients coming from Syria. Often patients arrive with severe abdominal, chest and orthopaedic injuries, and require multiple amputations. 

In Amman, MSF operates a reconstructive surgery project providing complex orthopaedic, maxillofacial and plastic surgery for victims of violence. While some patients come from elsewhere in the region, most are from Syria. Physiotherapy, psychosocial support and postoperative care are also provided as necessary.

In Lebanon there are more than 990,000 Syrian refugees. Growing medical gaps for refugees include access to secondary healthcare, safe deliveries in a hospital environment, and medication for chronic diseases. MSF is assisting refugees through general medical consultations including treatment of acute and chronic diseases, immunisations, reproductive healthcare and mental healthcare, as well as distributing relief items. MSF’s main activities are in the Bekaa valley, where the organisation runs four clinics; in Tripoli, northern Lebanon, where MSF supports two hospitals and two clinics; and in Saida and Shatila, where the majority of Palestinians from Syria have gathered.

Syrian refugee statistics (to end January 2014):

Iraq total consultations (including mental health) – 173,030

Jordan emergency room, maternal health and outpatient consultations – 22,914

Jordan surgical procedures – 956

Lebanon total consultations (including mental health and reproductive health) – 119,813

ENDS

Sudan

© Hayato Oguchi

MSF has been woring in Sudan since 1978. MSF activities include responding to several medical emergencies including the biggest Kala Azar outbreak and treating victims of violence in Darfur as well as providing reproductive healthcare. Kala Azar (visceral leishmaniasis) is endemic in Sudan. MSF treated 2,600 people for the disease in Upper Nile, Unity and Jonglei states in 2010. In the North of the country MSF opened a Kala Azar treatment centre in Al Gedaref state and treated 1,100 patients.

In the city of Port Sudan, in north-eastern Sudan, MSF provided reproductive healthcare in the Tagadum hospital. Staff provided a range of services including antenatal and postnatal care, delivery services, family planning, treatment for sexually transmitted infections and counselling. Staff conducted over 14,000 antenatal consultations, helped deliver 2,000 babies in 2010.

Somalia

© Michael Tsegaye

MSF has been working in Somalia since 1991. With the deterioration of the security situation in Somalia in 2010, basic medical services also deteriorated and the needs grew. MSF provides free emergency surgery and care for the war-wounded in Daynile hospital, nine kilometres northwest of Mogadishu as well as in six other areas inckuding the Shabelle region in central Somalia, where the staff offer maternal and paediatric care, general medical care and treatment for malnutrition.

In Somaliland MSF staff supported the emergency surgery department, the paediatric and maternity wards in Ceerigabo hospital (the main referral centre for Sanaag region). MSF also established links with health centres in the area to encourage referrals. In 2010, MSF carried out a measles immunisation campaign for children under 15 and a tetanus vaccination campaign for adults aged between 15 and 49. The campaign focused particularly on increasing the number of women protected against tetanus, as they are more susceptible to infection. Almost 6,400 children were immmunised against measles and almost 6,300 women were vaccinated against tetanus.

In 2011, two MSF employees were abducted in the Dadaab refugee camp in northern Kenya while providing emergency assistance for the Somali population there and two other were killed while implementing emergency assistance projects in Mogadishu. MSF has condemned the attacks on aid workers saying they jeopardize life-saving medical projects that are already far from adequate in addressing the vast medical needs of the Somali population.

Iraq

© Andrew Stern

MSF has worked intermittently in Iraq since 1982. In 2006, MSF began implementing programmes in Najaf, Anbar, Basra, Baghdad, Kirkuk and Ninewa in the fields of surgery, dialysis, mental health, maternity, paediatrics and emergency medicine.

In Northern Iraq, an MSF surgical team composed of Iraqi doctors is working in the General Hospital in Hawijah, near Kirkuk while another team supports a dialysis unit in the city where it provides treatment for 80 patients with renal failure. MSF also donates medical supplies to four hospitals in Kirkuk and Ninewa province where it has implemented triage systems in the emergency departments.

In September 2009, MSF opened a mental health counselling unit in Baghdad's Imam Ali Hospital, followed by similar units in Yarmouk Hospital and Fallujah General Hospital. Staff seconded from the Ministry of Health have been selected and trained to provide counselling. In 2010, the teams treated 2,371 patients in 5,062 counselling sessions.

In Najaf, MSF has established a new medical programme to improve the quality of obstetric and perinatal healthcare in Al Zahra District Hospital. In Basra, MSF is supporting the emergency services of Basra General Hospital, where as many as 20,000 people a month seek emergency medical care. After supporting the rehabilitation of the emergency room's operating theatre, where over 300 surgeries are carried out each month, MSF is also training hospital staff in peri and post- operative care.

Lebanon

© REUTERS

MSF first worked in Lebanon in 1976 to respond to the Lebanese Civil War and during the Israeli offensive in 1978, operating in the South and Beirut areas in what represents the organisation's first intervention in a conflict area. During the July 2006 war, MSF assisted the population by providing emergency aid, including medical care, fresh water and sanitation facilities to hundreds of thousands of displaced persons seeking refuge in Beirut, Saida, Sour, Jezzine, Nabatiye and the Aley region. Assistance was also given to Lebanese refugees who had crossed into Syria.

MSF has been running community-based mental health programmes in the area of Burj el-Barajneh in the southern suburbs of Beirut and Ein el-Hilweh Refugee Camp in the southern city of Saida, providing psychological and psychiatric support for the most vulnerable Palestinian and Lebanese living in the refugee camps and the surrounding neighbourhoods. Over the past three years, more than 2,200 people have benefited from this programme. In total, more than 15,500 free-of-charge psychological and psychiatric consultations have taken place. Recently, with thousands of Syrians—many of whom have physical wounds—fleeing the violence in their country and seeking refuge in Lebanon, we dispatched medical teams to evaluate their health status. This resulted in our setting up a new health program in Wadi Khaled, in the north of Lebanon, in November 2011.

Libya

© Tristan Pfund / MSF

MSF has been operating in Libya since 24 February 2011. In the city of Misrata, MSF has been providing medical and surgical care in two hospitals and one clinic. A surgical team provides support to Abbad hospital and another MSF team focuses on emergency obstetrics and gynaecology, paediatric, and neonatal care at Tubah clinic. A psychologist is providing support to Libyan medical staff under stress.

In the eastern city of Benghazi, MSF provides technical support to the central pharmacy in waste management and stock organization. In Al Jalaa hospital, MSF medical teams are supporting the hospital staff with nursing care management. Over 44 tons of medicine and medical materials were also sent to Benghazi within the first three months of intervention.

In Zintan, an MSF team has been supporting the emergency department and intensive care unit, in addition to providing training to medical staff.

MSF has also organised two medical evacuations by boat from Misrata to Tunisia. The first evacuation on 3 April carried 71 patients affected by violence in Misrata while the second evacuation carried 64 people. MSF teams are currently working in Tripoli and Misrata providing basic healthcare and psychological support for victims of violence.

Egypt

© MSF

During the protests in Tahrir Square in Cairo early 2011, MSF supplied medical materials to Egyptian doctors in three hospitals and to an improvised clinic in a mosque. The team also provided training on how to manage a high number of injured people coming in over a short period of time, and helped set up additional emergency preparedness systems.

Morocco

© EPA

Morocco is a country of transit and forced stay for migrants from sub-Saharan Africa. Many face extremely poor living conditions and violence. MSF has teams based in Rabat and Oujda. There are two components to MSF's work with migrants: provision of direct curative and preventive medical care; and facilitating access to the Moroccan health system. Sexual and reproductive health is a priority for MSF. In 2010, MSF teams provided medical care to 145 survivors of sexual violence. MSF medical staff carried out 2,568 medical consultations and provided psychosocial help to migrants through 182 individual mental health consultations and 48 group sessions that year.

Yemen

© Paul Cabrera

MSF has been working in Yemen since 2007. In the northern governorates of Saada, Amran and Hajjah, MSF provides medical care to those most in need including internally displaced people. In the southern governorate of Lahj, MSF works with local authorities in Radfan, one of the poorest districts of the governorate. MSF teams are also working in Al-Daleh hospital and Abyan governorate as well as a clinic in the city of Aden. In the first six months of 2011, MSF conducted more than 12,000 emergency room consultations and performed 600 surgical procedures in these programs.

In late September 2011, MSF had to suspend its activities in the governorate of Saada, following the introduction of new working conditions by the de facto authorities in the region.

Since the start of widespread demonstrations in January 2011, MSF teams have been donating medical material and performed training to medical staff in health care structures, including health centres run by demonstrators' committees in Sana'a, Aden and Ta'ezz. Meanwhile, the organisation is actively involved in medical evacuation and referral of severely wounded patients to hospitals. In the region of Abyan, east of Aden, where intense fighting has been ongoing since May, MSF is providing basic medical care to the wounded before they are transfered to medical centres in Aden. By the end of Octopber 2011, 162 pateints were transfered to access free surgical care and hospitalization.

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