Years of war, the destruction of the health system and social stigma associated with TB have contributed to a lack of TB diagnosis and treatment in the north Caucasus, especially for drug-resistant TB (DR-TB). MSF has worked with the Ministry of Health to implement a comprehensive TB programme in the Chechen republic. The MSF team is developing a special focus on children, as well as on HIV–TB co-infection. 

 

On another medical front, one in six people in Chechnya has heart disease but the scale and quality of medical services do not meet the needs. In Grozny, Chechnya’s capital, MSF is working to improve the cardiac unit in a local hospital. 

 

Conflict intensified across Syria in 2012. Medical attention for the direct victims of violence is not the only problem: the targeted destruction of health facilities and the collapse of the health system mean that many people cannot get the routine or emergency healthcare they need. Despite not receiving government authorisation to deliver medical assistance, MSF decided to work in the country, in opposition-held areas. 

 

Two hospitals were set up in Idlib governorate and a third was opened in Aleppo.  One of the teams in Idlib worked in a cave, and then in a converted farm, in which they set up an outpatient department, emergency department and operating theatre. They had seen more than 7,200 patients by the end of the year. The hospital in Aleppo not only treated the war-wounded but also offered obstetric and emergency care, as well as basic health services. In addition, MSF donated tons of medicines, medical supplies and relief items in different governorates and to the Syrian Arab Red Crescent in Damascus. 

 

Delays in funding and building mean the reconstruction of the health system even three years after the earthquake is far from complete. Access to healthcare was a problem for many people even before the disaster: fees were unaffordable and there were few adequately equipped public hospitals. MSF continues to fill gaps in emergency care with more than 500 beds in four hospitals, with a focus on maternal healthcare and trauma cases. 

 

Teams also treated close to 25,000 patients with cholera, which according to Haitian authorities had affected 638,000 people and killed almost 8,000 by the end of 2012.