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MédecinsSansFrontières (Doctors Without Borders)

Médecins Sans Frontières (Doctors Without Borders)

Introduction

History and Scientific Foundations

Applications and Research

Impacts and Issues

Primary Source Connection

BIBLIOGRAPHY

Introduction

Médecins Sans Frontières (MSF), known in English as Doctors Without Borders, is an international, independent humanitarian organization designed to provide assistance in emergency situations caused by war, drought, famine, epidemics, disasters (either natural or manmade), or lack of available healthcare. It was established in 1971. Among the characteristics that distinguish MSF from other charitable organizations are its independence from government funding (it relies on primarily private donations and is very successful at fundraising) and its ability and willingness to make public opinion statements. Currently, MSF has branches in nearly twenty countries around the world. Roughly 80% of its funding comes from public and private donations; the remaining 20% is received from governmental and international humanitarian agencies.

Médecins Sans Frontières was awarded the Nobel Peace Prize in 1999.

History and Scientific Foundations

Because MSF is an independent international organization, it has no political ties or limitations to prevent it from responding to any situation thought likely to benefit from its assistance. It was not designed to become involved in international governmental affairs. For those involved in the local response of MSF, the effort is a humanitarian one. Traveling staff are primarily volunteers (although their personal expenses are paid and they may receive a small stipend) who are willing to make themselves available with very little notice; they are typically deployed in an area for six to twelve months. Assigned locations may be remote and dangerous. MSF hires local staff and provides them with training and materials, and all personnel (MSF core and local staff) work in cooperation with other local and international emergency and relief organizations.

MSF is staffed by physicians, nurses, healthcare providers, logisticians, technicians, technical and non-medical personnel, sanitation and water experts, and administrative workers. There is a small core of paid staff, a large number of volunteer workers, and a significant number of local staffers hired at each major site. MSF participates in an average of nearly 4,000 medically related missions each year.

Applications and Research

MSF's primary tasks are the provision of basic and emergency physical and mental health care on-site at hospitals and clinics (either existent or created locally by MSF staff); the performance of surgery; the provision of vaccinations and immunizations; and the operation of feeding centers, primarily for children and mothers of babies. MSF also employs experts who are able to dig and construct wells or bring in potable (safe to drink) water, in order to establish a means of supplying clean drinking water. When necessary, MSF also assists in creating temporary shelters and can supply blankets and plastic sheeting materials.

In addition to their emergency operations, MSF operates longer-term projects to treat infectious and communicable diseases such as HIV/AIDS, tuberculosis, and sleeping sickness, and to provide physical and mental health treatment for marginalized groups and street children. MSF also has an expert epidemiology section, and it has been utilized around the world to diagnose, treat, monitor, and contain epidemics of cholera, meningitis, and measles, among other diseases.

Impacts and Issues

By traveling in small teams and enlisting local resources, MSF teams have penetrated war zones and reached refugee groups and epidemic epicenters. The photograph below shows a makeshift refugee camp in the Democratic Republic of Congo set up by MSF in January 2006 after over 18,000 people fled conflict between the Congolese Army and Mai Mai rebels.

Because of its size, well-trained staff, and ability to hire significant numbers of local people in order to meet personnel needs, MSF is generally able to respond extremely quickly to emergencies. They utilize highly specialized kits and equipment packs that enable them to carry all needed supplies with them when they mobilize, so they are literally able to “hit the ground running,” with no delay before they are able to begin emergency operations.

Their field kits are tailored to be an exact match for the type of emergency situation, geographic conditions, terrain, environmental conditions, and estimated patient population size. They can set up portable operating theatres, clinics, and hospitals immediately upon arrival in an affected area. They have created myriad treatment and response protocols that are customized to fit any necessary situation; their kits and protocols have been adopted by emergency and relief organizations worldwide.

One of the unique aspects of MSF, in contrast to nearly all other relief and aid organizations, is its commitment to combining humanitarian medical care with outspoken opinion on the causes of worldwide suffering. It is equally vocal on perceived impediments to the provision of effective medical care. For example, MSF has spoken publicly against pharmaceutical companies that refuse to manufacture pediatric dosages of AIDS related drugs or to provide affordable and appropriate medications to African countries hardest hit by the AIDS pandemic. MSF has sought (and received) audiences with the United Nations, various international and governmental organizations, and the worldwide media, in an effort to communicate both the needs of their various patient groups and to educate the world on violations of international humanitarian doctrines that they have witnessed or that they argue have been perpetrated across the globe. Researchers, academics, and scientists associated with MSF publish scholarly articles, create media campaigns, engage in public education programs, and offer presentations and exhibits at local and international conferences, in an effort to create public awareness of medical and living conditions in underserved, impoverished, and war-torn areas of the world. MSF has launched a major initiative called the Campaign for Access to Essential Medicines, through which they are trying to help underserved or marginalized populations obtain safe, effective, affordable treatments for such diseases as HIV/AIDS, tuberculosis, and malaria.

Primary Source Connection

Médecins Sans Frontières (MSF), or Doctors Without Borders, is an international humanitarian organization that provides emergency medical assistance in over seventy nations. MSF's mission is to provide medical care in to the world's neediest populations, often those touched by war, conflict, epidemic disease, natural disaster, and famine. In the following article, an MSF worker describes the organization's work in Somalia. The story of one patient, Isaac, evidences the significant health threats facing the war-torn region, including tuberculosis, leishmaniasis, and widespread malnourishment.

WORDS TO KNOW

EPIDEMIOLOGY: Epidemiology is the study of various factors that influence the occurrence, distribution, prevention, and control of disease, injury, and other health-related events in a defined human population. By the application of various analytical techniques including mathematical analysis of the data, the probable cause of an infectious outbreak can be pinpointed.

NOBEL PEACE PRIZE: An annual prize bequeathed by Swedish inventor Alfred Nobel (1833–1896) and awarded by the Norwegian Nobel Committee to an individual or organization that has “done the most or the best work for fraternity between the nations, for the abolition or reduction of standing armies and for the holding and promotion of peace congresses.”

NON-GOVERNMENTAL ORGANIZATIONS (NGOS): A voluntary organization that is not part of any government; often organized to address a specific issue or perform a humanitarian function.

POTABLE: Water that can is clean enough to drink safely is potable water.

Isaac

“…WHEN HE FIRST ARRIVED HE WAS TOO WEAK TO STANDANDS OTO SEE HIM WALKING GIVES EVERYONE HOPE.” BY JAKE MCKNIGHT, MARCH 2006

Isaac is seven but he looks much younger. His weak legs barely support the top half of his meagre frame, forcing him to press his hands into his knees to hold himself upright. His movements are further restricted by the horrific damage inflicted by tuberculosis of the spine, which has caused him to effect the hunch of an old man. In his ragged t-shirt and near useless flip-flops, I often see Isaac walking the thirty or so metres from the tuberculosis ward to paediatrics with his head down, concentrating his efforts against the hot winds that almost carry enough dust to hide his cheerful smile. It would seem that Somalis don't make very good victims.

I have been working for MSF for about a year now, first in Angola and now in Huddur, the small town in central Somalia where I have been for the last six weeks.

On reading a little about Somalia I had felt compelled to come here. For the last century, the country has been at war: firstly with the colonial powers of Italy, France and Britain; secondly with Ethiopia; thirdly with Siad Barre, the dictator who was deposed in 1991. Finally—in the power vacuum that resulted—Somalia has been at war with itself.

Hundreds of clans and sub-clans have split the country into an immensely complex framework of allegiances and ties. All efforts to bring this system under control have failed, earning Somalia the dubious title of being the only country in the world without a government. In addition to this long history of woes, the southern regions—including Huddur—are currently suffering the terrible results of the drought, which is spreading across the horn of Africa.

In such an environment, it would be fair to assume that the Somalis might be quite a bitter people. However, in the late afternoons, when the sun is less fierce and the winds die down, I regularly have the chance to walk around the hospital wards. Despite the cramped conditions and lack of amenities, the patients and their carers sit sometimes in groups, sometimes nursing children and almost always content and peaceful.

Part of the reason for both the lack of space and the happy faces is that MSF is achieving a lot in Somalia. One of the most prevalent serious diseases we treat here is kala azar (leishmaniasis), a condition that mostly affects children. If not treated, kala azar is almost always fatal. When patients arrive in the health centre they are often desperately sick and sometimes malnourished. After careful treatment of the disease and admission into our Therapeutic Feeding Programme for the severely malnourished, it generally takes about five weeks for kala azar patients to be discharged: fat, happy and cured. Word has spread to the surrounding areas and we have noted a month on month increase in patients for over a year.

It will be a while before Isaac leaves the hospital. His condition is serious and unfortunately, although his spine will not become any worse, he will not recover completely. However, when he first arrived he was too weak to stand and so to see him walking gives everyone hope. Doubtless, like the country itself, he has many problems ahead of him. There are no schools, very few hospitals and many of the charities and agencies that would usually be willing to help improve the situation are absent due to the high level of insecurity. Given these factors, the future looks as grim as ever for Somalia but, watching Isaac walk, head down against the wind, I feel not pity but hope and admiration for these uniquely brave people.

Jake McKnight

MCKNIGHT, JAKE. MEDECINS SANS FRONTIERES. “ISAAC.” JUNE 13, 2007. <HTTP://WWW.UK2.MSF.ORG/UKNEWS/LETTERS/JAKEMCKNIGHTISAAC.HTM> (ACCESSED JUNE 11, 2007).

See AlsoCDC (Centers for Disease Control and Prevention); Developing Nations and Drug Delivery; United Nations Millennium Goals and Infectious Disease; World Health Organization (WHO).

BIBLIOGRAPHY

Books

Bertolotti, Dan. Hope in Hell: Inside the World of Doctors Without Borders. Tonawanda, NY: Firefly Books, 2004.

Médecins Sans Frontières, eds. In the Shadow of Just Wars: Violence, Politics, and Humanitarian Action. Translated by Fabrice Weissman and Doctors Without Borders. Ithaca, NY: Cornell University Press, 2004.

Web Sites

Campaign for Access to Essential Medecines. “Companies Not Selling New AIDS Drugs in Africa.” <http://www.accessmed-msf.org/index.asp> (accessed May 15, 2007).

Médecins Sans Frontières/Doctors Without Borders. “About Us.” <http://www.doctorswithoutborders.org/aboutus/index.cfm> (accessed May 15, 2007).

Network for Good. “Doctors Without Borders USA.” <http://partners.guidestar.org/controller/searchResults.gs?action_gsReport=1partner=networkforgood&ein=13-3433452> (accessed May 20, 2007).

Nobelprize.org. “The Nobel Peace Prize 1999: Médecins Sans Frontières.” <http://nobelprize.org/peace/laureates/1999/index.html> (accessed May 20, 2007).

Paul Davies

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