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doctorswithoutborders:

Photo: An MSF surgeon operates on a patient in northern Syria. Syria 2012 © MSF
Syria: “A War Against Health Workers and Services”This article originally appeared in French in Le Monde.
In June, Doctors Without Borders/Médecins Sans Frontières-France (MSF) opened a hospital in the Idlib region in northern Syria, an area under rebel control. Located behind the front lines, the hospital has 15 beds and a staff of approximately 50, including 10 international MSF workers. Designed to perform war surgery, the facility also offers medical and surgical emergency care as the front moves further away. MSF’s Belgian and Spanish sections managed two other hospitals in Syria.
Fabrice Weissman, MSF’s operations advisor, returned from a mission in Syria in early December. He was particularly struck by the breadth of the needs and the lack of international response.
What are the conditions facing MSF’s medical staff in the Idlib region? 
As soon as you cross the border, you are vulnerable to aerial bombing by the Syrian air force, even behind battle lines. Hospitals are at particular risk, as they have become one of the government’s preferred targets. As a result, public hospitals are deserted. Temporary field hospitals that do perform surgery tend to be hidden in individual houses and abandoned public facilities or are buried underground. When they are spotted, the doctors change location. 
This makes it difficult to organize medical treatment. Some Syrian medical professionals have gone into exile and dentists and pharmacists are providing emergency medical care. Their skills are improving but they are rarely trained in war surgery, which presents specific complications such as bone infections, and in triaging victims during mass influx of wounded. Even so, they are managing quite well given the conditions and increasing stock-outs of medical supplies such as anesthetics. Syrian doctors from the diasporas are coming to help out, too. 
What struck me most profoundly about this conflict is the way health facilities have became part of the war zone. The Syrian army is waging a war against health workers and services operating in opposition-controlled areas. Using health care denial as a weapon of oppression, the government has de facto transformed health care provision as a weapon of resistance.Do international humanitarian aid organizations like MSF have a significant presence in Syria?
You don’t see the traditional aid actors—such as the United Nations agencies and the major humanitarian NGOs—in Syria. Acting officially in support of the Syrian government, the UN does not have Damascus’ authorization to provide cross-border assistance into rebel-held areas, which have significantly expanded over the past six months. However, precedents do exist, as in South Sudan in the 1980s, where the UN intervened in areas that were not under the legal government’s control, based on a Security Council resolution or following direct negotiations with the parties. 
With regard to nongovernmental organizations, very limited funds are allocated to those that want to work in rebel-held areas. There’s a paradox here because the European Union and the US support the opposition, but are providing minimal financial and diplomatic support to humanitarian organizations ready to operate in rebel territory. Most international aid is allocated to the government-held areas, through the ICRC, the World Food Program, the UNHCR, all working with the Syrian Arab Red Crescent Society. The needs in the rebel-held areas are not being met. 
However, there is an aid network organized by Syrians in the country and in the diasporas, with the help of neighboring countries and Gulf nations. But it’s not enough. Traditional international aid would be more than welcome to support the efforts of this local network. That would require diplomatic courage on the part of the UN agencies and the states that support them—whether the European Union, the US, Russia, China, and others. 
What needs did you observe on site? 
There are extensive treatment needs in the area of chronic illnesses, which are the primary cause of mortality (specifically diabetes, kidney failure, hypertension and heart problems, and cancer). The organization of medical care has virtually collapsed and there are shortages of specialized medicine, as 90 percent of drugs were produced previously in Syria. Fatal respiratory illnesses are also a source of concern, given winter conditions. Children and the elderly are of course the most vulnerable. The weakest members of the population are experiencing mortality rates and suffering that could be prevented. 
The number of wounded has increased significantly over the last six months as a result of the intensification of fighting (among the 60,000 deaths counted by the UN Human Rights Commission, more than 40,000 occurred since June alone). At the same time, the types of wounds are changing, with growing numbers of people injured by ammunition fragments during aerial and artillery bombing. Among the 500 wounded treated in MSF facilities so far, 70 percent presented extensive soft tissue and bone damage due to shrapnel. Some need major reconstructive surgery that requires hospitalization abroad, in Jordan, Lebanon, or Turkey, where 700 hospital beds are currently dedicated to Syrian patients. On the other hand, we have not seen any illnesses related to the use of combat gas.Beyond medical assistance, there are other major needs. Daily life has become very difficult. There is a housing crisis resulting from the internal population displacement. The Office for the Coordination of Humanitarian Affairs (OCHA) estimates that some two million people are displaced. Most are living with relatives living further away from the frontlines or in tent camps, most located close to the Turkish border. The conditions in those camps are very precarious, particularly given the arrival of winter, with freezing temperatures at night. There is also an energy crisis. Diesel, which was subsidized before the war, is hard to find and of poor quality. Its price has increased twenty- or thirty-fold, triggering a dramatic increase in transport and food prices. There is an acute shortage of baby formula, milk, and flour. Bread is becoming scarce in several towns. The situation calls for large-scale food assistance by the World Food Program and other humanitarian agencies. 
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doctorswithoutborders:

Photo: An MSF surgeon operates on a patient in northern Syria. Syria 2012 © MSF

Syria: “A War Against Health Workers and Services”
This article originally appeared in French in Le Monde.

In June, Doctors Without Borders/Médecins Sans Frontières-France (MSF) opened a hospital in the Idlib region in northern Syria, an area under rebel control. Located behind the front lines, the hospital has 15 beds and a staff of approximately 50, including 10 international MSF workers. Designed to perform war surgery, the facility also offers medical and surgical emergency care as the front moves further away. MSF’s Belgian and Spanish sections managed two other hospitals in Syria.

Fabrice Weissman, MSF’s operations advisor, returned from a mission in Syria in early December. He was particularly struck by the breadth of the needs and the lack of international response.

What are the conditions facing MSF’s medical staff in the Idlib region? 

As soon as you cross the border, you are vulnerable to aerial bombing by the Syrian air force, even behind battle lines. Hospitals are at particular risk, as they have become one of the government’s preferred targets. As a result, public hospitals are deserted. Temporary field hospitals that do perform surgery tend to be hidden in individual houses and abandoned public facilities or are buried underground. When they are spotted, the doctors change location. 

This makes it difficult to organize medical treatment. Some Syrian medical professionals have gone into exile and dentists and pharmacists are providing emergency medical care. Their skills are improving but they are rarely trained in war surgery, which presents specific complications such as bone infections, and in triaging victims during mass influx of wounded. Even so, they are managing quite well given the conditions and increasing stock-outs of medical supplies such as anesthetics. Syrian doctors from the diasporas are coming to help out, too. 

What struck me most profoundly about this conflict is the way health facilities have became part of the war zone. The Syrian army is waging a war against health workers and services operating in opposition-controlled areas. Using health care denial as a weapon of oppression, the government has de facto transformed health care provision as a weapon of resistance.

Do international humanitarian aid organizations like MSF have a significant presence in Syria?

You don’t see the traditional aid actors—such as the United Nations agencies and the major humanitarian NGOs—in Syria. Acting officially in support of the Syrian government, the UN does not have Damascus’ authorization to provide cross-border assistance into rebel-held areas, which have significantly expanded over the past six months. However, precedents do exist, as in South Sudan in the 1980s, where the UN intervened in areas that were not under the legal government’s control, based on a Security Council resolution or following direct negotiations with the parties. 

With regard to nongovernmental organizations, very limited funds are allocated to those that want to work in rebel-held areas. There’s a paradox here because the European Union and the US support the opposition, but are providing minimal financial and diplomatic support to humanitarian organizations ready to operate in rebel territory. Most international aid is allocated to the government-held areas, through the ICRC, the World Food Program, the UNHCR, all working with the Syrian Arab Red Crescent Society. The needs in the rebel-held areas are not being met. 

However, there is an aid network organized by Syrians in the country and in the diasporas, with the help of neighboring countries and Gulf nations. But it’s not enough. Traditional international aid would be more than welcome to support the efforts of this local network. That would require diplomatic courage on the part of the UN agencies and the states that support them—whether the European Union, the US, Russia, China, and others. 

What needs did you observe on site? 

There are extensive treatment needs in the area of chronic illnesses, which are the primary cause of mortality (specifically diabetes, kidney failure, hypertension and heart problems, and cancer). The organization of medical care has virtually collapsed and there are shortages of specialized medicine, as 90 percent of drugs were produced previously in Syria. Fatal respiratory illnesses are also a source of concern, given winter conditions. Children and the elderly are of course the most vulnerable. The weakest members of the population are experiencing mortality rates and suffering that could be prevented. 

The number of wounded has increased significantly over the last six months as a result of the intensification of fighting (among the 60,000 deaths counted by the UN Human Rights Commission, more than 40,000 occurred since June alone). At the same time, the types of wounds are changing, with growing numbers of people injured by ammunition fragments during aerial and artillery bombing. Among the 500 wounded treated in MSF facilities so far, 70 percent presented extensive soft tissue and bone damage due to shrapnel. Some need major reconstructive surgery that requires hospitalization abroad, in Jordan, Lebanon, or Turkey, where 700 hospital beds are currently dedicated to Syrian patients. On the other hand, we have not seen any illnesses related to the use of combat gas.

Beyond medical assistance, there are other major needs. Daily life has become very difficult. There is a housing crisis resulting from the internal population displacement. The Office for the Coordination of Humanitarian Affairs (OCHA) estimates that some two million people are displaced. Most are living with relatives living further away from the frontlines or in tent camps, most located close to the Turkish border. The conditions in those camps are very precarious, particularly given the arrival of winter, with freezing temperatures at night. There is also an energy crisis. Diesel, which was subsidized before the war, is hard to find and of poor quality. Its price has increased twenty- or thirty-fold, triggering a dramatic increase in transport and food prices. There is an acute shortage of baby formula, milk, and flour. Bread is becoming scarce in several towns. The situation calls for large-scale food assistance by the World Food Program and other humanitarian agencies. 

doctorswithoutborders:

Photo: Greece and the island of Lesvos 2012 © Google
Deadly Voyage Highlights Risks to Migrants and Refugees Arriving in Greece
The sinking of a boat believed to be carrying 28 people near the Greek island of Lesvos on December 14 highlights the dangers of a recent increase in maritime crossings to the Aegean Islands.
The death toll from the latest incident stands at 21, with six other people missing and only one confirmed survivor, an 18-year-old man. The majority of new arrivals over the last few months are Afghan and Syrian nationals, including many families with young children, pregnant women, and other vulnerable people. MSF teams providing medical assistance in the Aegean Islands report that migrants arrive in a state of extreme fatigue and are very frightened because of the difficult conditions they experienced on the voyage.
“The experience of the journey and of the arrival to a new unfamiliar environment seems to be an especially traumatic experience, particularly for children,” said Marianthi Papagianni, a medical doctor and a member of the MSF team in Lesvos. “In addition to obvious health risks—primarily upper respiratory tract infections, hypothermia, lack of appropriate food—the impact on children’s mental health is something which should not be underestimated.”
Children may lose a parent on the trip, fall into the water or witness a drowning, Papagianni said. “Upon their arrival, they are scared, silent, ready to attach themselves to the first person that will give them a smile,” she said.
In cooperation with local health services and authorities, MSF has been responding to the urgent medical and humanitarian needs of migrants and refugees arriving in Greece’s Aegean Islands and in the Evros region since 2008. In August, when Greek authorities enhanced border control measures in Evros, MSF teams noticed a dramatic decline in the arrivals of migrants and refugees there, and a considerable increase in arrivals in the Aegean Islands.The MSF team in Lesvos consists of one doctor, two interpreters and one administrator. MSF is also providing medical supplies and basic relief items to people arriving on other islands through a network of local actors.
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doctorswithoutborders:

Photo: Greece and the island of Lesvos 2012 © Google

Deadly Voyage Highlights Risks to Migrants and Refugees Arriving in Greece

The sinking of a boat believed to be carrying 28 people near the Greek island of Lesvos on December 14 highlights the dangers of a recent increase in maritime crossings to the Aegean Islands.

The death toll from the latest incident stands at 21, with six other people missing and only one confirmed survivor, an 18-year-old man. The majority of new arrivals over the last few months are Afghan and Syrian nationals, including many families with young children, pregnant women, and other vulnerable people. MSF teams providing medical assistance in the Aegean Islands report that migrants arrive in a state of extreme fatigue and are very frightened because of the difficult conditions they experienced on the voyage.

“The experience of the journey and of the arrival to a new unfamiliar environment seems to be an especially traumatic experience, particularly for children,” said Marianthi Papagianni, a medical doctor and a member of the MSF team in Lesvos. “In addition to obvious health risks—primarily upper respiratory tract infections, hypothermia, lack of appropriate food—the impact on children’s mental health is something which should not be underestimated.”

Children may lose a parent on the trip, fall into the water or witness a drowning, Papagianni said. “Upon their arrival, they are scared, silent, ready to attach themselves to the first person that will give them a smile,” she said.

In cooperation with local health services and authorities, MSF has been responding to the urgent medical and humanitarian needs of migrants and refugees arriving in Greece’s Aegean Islands and in the Evros region since 2008. In August, when Greek authorities enhanced border control measures in Evros, MSF teams noticed a dramatic decline in the arrivals of migrants and refugees there, and a considerable increase in arrivals in the Aegean Islands.

The MSF team in Lesvos consists of one doctor, two interpreters and one administrator. MSF is also providing medical supplies and basic relief items to people arriving on other islands through a network of local actors.

doctorswithoutborders:

Easier-to-Use Vaccines Are Needed for Hard-to-Reach Children
“Unless vaccines are simplified so that they’re better adapted to real-life conditions, we will never get on top of these killer diseases and will always need to respond to outbreaks that we haven’t managed to prevent through effective immunization programs.”—Florence Fermon, MSF Vaccines Adviser
Immunization is one of the most effective ways of saving young lives, yet every year one in five children born—22 million—is left without this basic protection from disease. Why?
It’s because existing vaccines are hard to use in the places where many of these children live. The problem with the vaccines currently available—both basic and newer vaccines—is that they have been developed for use in wealthy countries, with strong health systems, good transport and other functioning infrastructure. In trying to use these vaccines in countries which don’t have the advantages of good roads, reliable power supplies, and adequate numbers of trained staff, it becomes clear why so many children in developing countries fall through the immunization net.
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doctorswithoutborders:

Easier-to-Use Vaccines Are Needed for Hard-to-Reach Children

“Unless vaccines are simplified so that they’re better adapted to real-life conditions, we will never get on top of these killer diseases and will always need to respond to outbreaks that we haven’t managed to prevent through effective immunization programs.”—Florence Fermon, MSF Vaccines Adviser

Immunization is one of the most effective ways of saving young lives, yet every year one in five children born—22 million—is left without this basic protection from disease. Why?

It’s because existing vaccines are hard to use in the places where many of these children live. The problem with the vaccines currently available—both basic and newer vaccines—is that they have been developed for use in wealthy countries, with strong health systems, good transport and other functioning infrastructure. In trying to use these vaccines in countries which don’t have the advantages of good roads, reliable power supplies, and adequate numbers of trained staff, it becomes clear why so many children in developing countries fall through the immunization net.

doctorswithoutborders:

Photo: One-and-a-half-year-old Husseini and his twin brother are both on chelation therapy for lead poisoning. Nigeria 2012 © Olga Overbeek/MSF
Time Running Out for Nigeria Lead Poisoning Victims
The Nigerian government has failed to promptly release funds needed to remove lead from homes in a northern area of Nigeria, worsening a health crisis in which hundreds of children have fallen ill or died from lead poisoning since 2010. 
Funds to tackle an ongoing lead poisoning crisis in Zamfara District—with a specific focus on the remediation of Bagega village—were promised by the president in May 2012, but have still not been released by the secretary of the government of the federation. The remediation process removes lead from the environment. Without it, children are continually re-exposed to lead toxins, rendering medical treatment useless. MSF has been treating victims of lead poisoning in Zamfara district since it was discovered in 2010.
“Bagega is reaching a crisis point,” said Michael White, acting head of mission for Nigeria. “More than two and a half years after the lead poisoning disaster was first discovered, hundreds of children are still awaiting critical medical treatment. MSF is ready and willing to treat these children, but cannot do so until their homes have been environmentally remediated. It’s time to get the lead out of Bagega.”
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doctorswithoutborders:

Photo: One-and-a-half-year-old Husseini and his twin brother are both on chelation therapy for lead poisoning. Nigeria 2012 © Olga Overbeek/MSF


Time Running Out for Nigeria Lead Poisoning Victims

The Nigerian government has failed to promptly release funds needed to remove lead from homes in a northern area of Nigeria, worsening a health crisis in which hundreds of children have fallen ill or died from lead poisoning since 2010. 

Funds to tackle an ongoing lead poisoning crisis in Zamfara District—with a specific focus on the remediation of Bagega village—were promised by the president in May 2012, but have still not been released by the secretary of the government of the federation. The remediation process removes lead from the environment. Without it, children are continually re-exposed to lead toxins, rendering medical treatment useless. MSF has been treating victims of lead poisoning in Zamfara district since it was discovered in 2010.

“Bagega is reaching a crisis point,” said Michael White, acting head of mission for Nigeria. “More than two and a half years after the lead poisoning disaster was first discovered, hundreds of children are still awaiting critical medical treatment. MSF is ready and willing to treat these children, but cannot do so until their homes have been environmentally remediated. It’s time to get the lead out of Bagega.”

doctorswithoutborders:

Photo: Ali* was injured when a discarded detonator he found exploded in his face. He was successfully treated at Doctors Without Borders’ Kunduz trauma hospital.
Martin John Jarmin III, Field Surgeon, Afghanistan
“As in any urban area, we see a lot of road accidents and civilian gunshot injuries at the new 70- bed Doctors Without Borders surgical hospital in Kunduz. Yet, while it is relatively safer here these days, remnants of war—like stray bullets or rockets— continue to put people’s lives at risk. 
One day, a family rushed in with their 14-year-old son. Ali* had been playing with friends in a field when they found something they said looked like a battery. It was probably a bomb detonator, because it exploded when they touched the two wires that were sticking out of it. Ali had shrapnel in his face and serious injuries to his hands and arms. He was lucky and will recover. The blast permanently blinded his brother. 
Prior to our arrival in August 2011, the 250,000 people living in Kunduz had no access to adequate trauma care. The Doctors Without Borders trauma center is equipped with an emergency room, two operating theaters, and an intensive care unit. Once word spread that we’re here, more and more people began coming to us for care. Many patients tell us they used to go all the way to Pakistan to get specialized care. 
Since there is not really a good hospital in this part of the country, we are filling a very real need. We always tell people that it doesn’t matter where you came from or who you are, we will treat you.”
More on our work in Afghanistan.
* Patient’s name has been changed.
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doctorswithoutborders:

Photo: Ali* was injured when a discarded detonator he found exploded in his face. He was successfully treated at Doctors Without Borders’ Kunduz trauma hospital.

Martin John Jarmin III, Field Surgeon, Afghanistan

“As in any urban area, we see a lot of road accidents and civilian gunshot injuries at the new 70- bed Doctors Without Borders surgical hospital in Kunduz. Yet, while it is relatively safer here these days, remnants of war—like stray bullets or rockets— continue to put people’s lives at risk. 

One day, a family rushed in with their 14-year-old son. Ali* had been playing with friends in a field when they found something they said looked like a battery. It was probably a bomb detonator, because it exploded when they touched the two wires that were sticking out of it. Ali had shrapnel in his face and serious injuries to his hands and arms. He was lucky and will recover. The blast permanently blinded his brother. 

Prior to our arrival in August 2011, the 250,000 people living in Kunduz had no access to adequate trauma care. The Doctors Without Borders trauma center is equipped with an emergency room, two operating theaters, and an intensive care unit. Once word spread that we’re here, more and more people began coming to us for care. Many patients tell us they used to go all the way to Pakistan to get specialized care. 

Since there is not really a good hospital in this part of the country, we are filling a very real need. We always tell people that it doesn’t matter where you came from or who you are, we will treat you.

More on our work in Afghanistan.

* Patient’s name has been changed.