People often have to travel long distances, across insecure areas, to reach public medical facilities. A lack of trained medical staff, particularly female doctors and nurses, further restricts access for many. 
The trauma centre run by MSF in Kunduz is unique in northern Afghanistan, providing free, high-quality surgical care to victims of the conflict and of traffic accidents. 2012 saw a new emergency room and a larger outpatient clinic. Over the year, surgeons carried out 1,500 operations. 
In eastern Kabul, MSF continues to support the Ahmad Shah Baba hospital. In 2012, emergency obstetric care was extended to offer services round the clock. Mental health and health promotion services were also developed. In the South, Boost hospital in Lashkargah had 2,000 people admitted each month, a 15-fold increase in patients since MSF started working in this hospital in 2009. 
In the East, MSF opened a maternity hospital in Khost. Though a targeted bomb attack at the hospital forced a suspension of activities for several months, MSF reopened it at the end of December following the assurance of support and safety for its activities by the community leaders and relevant parties. 


Around 30,000 registered refugees were living in Kutupalong camp, in Cox’s Bazaar, some fleeing violence in Myanmar. MSF runs a clinic there but has been challenged by the government. In Dhaka’s slum district of Kamrangirchar, MSF runs two health centres offering basic medical care and child and maternal health services. Girls aged between 10 and 15 often get married and become pregnant soon afterwards, so there is a real need for specialist services to these young women. 
Another project in the country is to treat the deadly tropical disease transmitted by sandflies called kala azar. Some 90 per cent of cases occur in just six countries, and Bangladesh is one of them. 


Drug-resistant tuberculosis (DR-TB) is a major health problem and the national response remains underdeveloped. DR-TB is much more difficult to treat, requiring at least two years of medication with serious side effects. MSF has HIV and TB clinics in Manipur and Mumbai. The Mumbai project has a team specialised in treating co-infection of HIV and DR-TB or hepatitis B or C. Research into treatment options and models of care is an important component . 
In Chhattisgarh, MSF provides basic healthcare to people caught up in conflict between the government and Maoist opposition groups through mobile clinics and a mother and child health centre. In the disputed region of Kashmir, mental healthcare continues to be the focus for MSF. MSF also treats kala azar and manages feeding centres in Bihar, and supports a district hospital in Nagaland.


Deadly intercommunal clashes in Rakhine triggered an official state of emergency. Over 100,000 people were displaced and living in makeshift camps. MSF provided basic medical care in 15 of the largest ones, treating patients with skin infections, worms, chronic coughs and diarrhoea. Insecurity, delayed authorisation and repeated threats from a small group of Rakhine people have hindered MSF’s work, particularly with the Rohingyas. 
Elsewhere in the country, thousands of people still have no access to medical services. Coverage for antiretroviral treatment for people with HIV is very low: barely one in three of those needing it receives it. MSF, the leading provider in the country, has to make difficult choices about whom to treat.


MSF programmes focus mainly on meeting urgent needs among communities affected by insecurity. In the northwest, where many Afghan refugees and displaced people have settled, MSF works in emergency departments and operating theatres in hospitals in Hangu and Timergara, and provides support on maternity services. In Peshawar, MSF runs a hospital specialising in obstetrics and gynaecology.
In Balochistan, MSF focuses on the needs of pregnant women and children. The teams also responded to the severe flooding in eastern Balochistan in September, by providing basic health services, safe drinking water and relief items. In October, in partnership with a local organisation, MSF opened a clinic in Karachi, providing basic healthcare and emergency services. 

Papua New Guinea

There are high levels of domestic, sexual, social and tribal violence in Papua New Guinea, yet medical care remains inadequate. MSF provides comprehensive treatment and psychosocial care, with a particular emphasis on victims of domestic and sexual violence, through family support centres in Lae and Tari. The team also offers emergency surgery at Tari hospital. 
Decades of conflict have weakened the health system in the Autonomous Region of Bougainville and MSF is now helping refurbish several healthcare facilities. A maternity waiting home provides accommodation for women in their final weeks of pregnancy, so they do not have to travel for long periods on poor roads during an emergency. 


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