Dear Friends,
Médecins Sans Frontières (MSF) was faced with exceptionally difficult decisions and compromises in 2013. In many of the places where we work, we were prevented from delivering all of the help we should have done by various kinds of violence. At the same time, we have witnessed the striking failure of the global humanitarian aid system to respond in some of the most pressing crises.
The issue of incidents targeting MSF and other humanitarian organisations is of significant concern, not only because of security, but also because of the ultimate impact of these events on the health and survival of the people we aim to help. In Somalia, the situation became untenable in 2013 and finally led to our withdrawal from the country with heavy hearts. Our patients have often been targets and staff members were also threatened, attacked, abducted and even killed during our time in Somalia. However, when it became apparent that the parties we had to talk to about security agreements were actively involved in violence directed against MSF, we had no choice but to draw the line. 
In Syria, where the civil war has come to its third year, nine million people are internally displaced or have fled abroad. The collapsed healthcare system has left countless Syrians in desperate need of basic medical treatment, but the opportunities to reach people and to respond to their needs remained extremely limited because of the insecurity. MSF is struggling to maintain its presence in the country and provide aid to Syrian refugees in Lebanon, Iraq, Turkey and Jordan.
The situation is equally bad in the Central African Republic, if not worse. Over one million people fled their homes after the coup in March and the subsequent political clashes which inflamed religious divisions. The violence has been affecting healthcare facilities in which our staff were threatened and intimidated. Even so, by the end of the year, nine MSF emergency projects were delivering healthcare in CAR alongside seven ongoing programmes, and over 800,000 medical consultations had been provided to people throughout the country. But the needs are still overwhelming. 
In South Sudan, violence in Jonglei early in the year caused displacement, and in December, fighting between different factions of the army quickly spread throughout five states, causing people to flee their homes. It was only the beginning of what has become a horrible civil war creating intense human suffering in South Sudan. In response, MSF opened emergency programmes while maintaining our regular projects in nine states. 
Violence, epidemics and natural disasters did not spare the Asian region either.  In Myanmar, MSF continued to face challenges when delivering aid. Tens of thousands of vulnerable people in Rakhine state were dependent on outside medical care, but our work there has been suspended since February 2014. We are looking forward to further dialogues with the Union Government to ensure life-saving services reach those in need.
In November 2013, typhoon Haiyan swept across the Philippines causing extensive destruction and injuring many. MSF-Hong Kong took a major role by deploying staff in the first few days to assess and respond to the needs in affected areas, and to lay the groundwork for the massive response. We provided medical care and relief supplies in the Visayas Islands and rebuilt healthcare capacity there. In the first two weeks, MSF had a fast-growing team of international and local staff in four hospitals and eight health centres, and was running mobile clinics in 37 locations, despite the numerous logistical challenges encountered.
On the disease front, the spread of drug-resistant malaria in the Southeast Asian region is worrying. MSF has carried out a survey to look at the level of artemisinin resistance in northeastern Cambodia. A project will then be developed focusing on eliminating artemisinin-resistant malaria. At the same time, the dual epidemics of tuberculosis (TB) and HIV are of growing concern in Asia. MSF continues to treat those who are in need of life-saving treatments in India and Myanmar.  
MSF is a medical organisation but our work does not stop at the delivery of care; it is also about bearing witness in extreme situations and pushing for access to essential treatments for our patients. MSF’s Access Campaign advocated tirelessly for patients whose interests could be affected by the Transpacific Partnership Agreement (TPP) negotiations between the USA and 11 Pacific Rim nations including Singapore and Malaysia. The trade agreement includes proposals to extend drug patents and block access to affordable generic drugs used to treat HIV patients. 
In 2014, MSF Hong Kong marks the 20th Anniversary of its establishment in 1994. We sincerely thank you and all the other supporters who have made our work possible over the past two decades. In the coming years we are still counting on you as we extend our reach in the region, particularly in Taiwan and Singapore. I hope you can continue to be part of the team, and help us to assist those most in need of medical care.
Thank you very much for your support.
Dr. Fan Ning
President, MSF-Hong Kong
Rémi Carrier
Executive Director, MSF-Hong Kong


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