Central African Republic (CAR)
MSF has been responding to the chronic medical crisis in the country where the mortality rates in some regions were up to five times the emergency threshold. Following the coup by the rebel group Séléka in March, extreme violence escalated, resulting in a massive, acute humanitarian crisis. Despite the arrival of international forces in the capital, there were daily clashes, attacks, lynchings and reprisals. By year’s end it was estimated that over 700,000 Central Africans were displaced and 750,000 had crossed into neighbouring countries.
In response, MSF gave free medical care such as emergency surgery to the wounded and the displaced, launched mobile clinics and teams supported government healthcare facilities. Teams regularly treated patients for malaria, respiratory and skin infections, diarrhoea and malnutrition. Additional activities were started to ensure access to clean drinking water and improve hygiene for the displaced.
MSF also repeatedly spoke out, calling for an end to violence against civilians, patients and staff in healthcare facilities, and the deployment of more aid from the UN and other aid organisations to respond to the extensive human needs.
As of December, MSF had more than 250 international and 2,500 Central African staff providing free medical care to approximately 600,000 people in seven hospitals, two health centres and 40 health posts.
The Centre for Obstetric Emergencies in Kabezi hospital offered free, high-quality emergency and surgical obstetric services to an average of 250 women per month in 2013, reducing maternal deaths by 74 per cent. The team trained and coached Burundian medical staff and handed over the programme to local authorities.
An MSF team continued to provide obstetric fistula treatment at the Urumuri health centre in Gitega. Fistulas, a consequence of birth complications, cause not only pain but incontinence, which in turn often leads to social exclusion and sometimes rejection by friends and family. The package of care at Urumuri includes surgery, physiotherapy and social support.
Malaria is one of the main causes of death for children under five. MSF has focused on preventing and treating malaria in different regions in Chad. In Mandoul region, a distribution of antimalarials as a prevention strategy was organised and teams recorded an overall reduction in malaria of 60%.
The routine vaccination coverage in Chad is low and hence puts children at greater risk of infection. Thus MSF was involved in delivering nearly 440,000 measles doses and further campaigns against yellow fever and meningitis. Besides, MSF provided assistance to refugees displaced by conflicts in Sudan and Central African Republic.
Democratic Republic of Congo (DRC)
Decades of conflict, lack of investment in the healthcare system and ongoing violence cause extreme hardship for people across DRC. MSF has sustained its substantial presence in the country, particularly in the unsettled eastern provinces. The teams provided medical assistance people affected by conflicts, as well as outbreaks of malaria, measles, rabies and cholera in provinces of North Kivu, South Kivu, Katanga and Orientale. In South Kivu alone, more than 565,000 outpatient consultations were completed.
The medical work stretches across a range of urgent needs, including surgery, infectious disease prevention and treatment, mother and child healthcare, and support for victims of sexual violence.
In 2013, measles epidemics continued to proliferate. Some health zones were overwhelmed by the number of cases, and MSF launched emergency campaigns, vaccinating more than 1.2 million children aged between six months and 15 years.
At Abu Elian clinic, on the outskirts of Cairo, MSF offers healthcare to mothers and children under five. 70 per cent of patients were young children suffering from respiratory tract infections, intestinal parasites, skin diseases and diarrhoea. MSF also provides transport and covers hospital costs for pregnant women in the clinic’s 24-hour emergency referral system.
MSF also trained a number of volunteer Egyptian doctors in Cairo, including some Egyptian Ministry of Health personnel, so that they could respond quickly and effectively to medical needs on the spot during demonstrations. Training included how to deal with large numbers of wounded.
Libya’s health system is gradually recovering from the 2011 conflict, but the violence has had a lasting effect on many people’s mental health. The prevalence of severe post-traumatic stress disorder was estimated at 12.4% and severe depression at 19.8% in 2012.
In August 2013, MSF opened a mental health centre in Tripoli, the country’s capital, to treat people who have been affected by any form of violence, be it physical, psychological, sexual or conflict-related. The team also trained doctors from the Ministry of Health and has established a referral system from basic healthcare facilities and from Libyan and international NGOs.
Although Zimbabwe has made significant progress, gaps in treatment for HIV/AIDS and tuberculosis (TB), including drug-resistant TB (DR-TB), remain. The needs of children and teenagers are particularly overlooked. MSF supported HIV and TB projects throughout the country in 2013 and is striving to implement modern technology including routine yearly viral load monitoring and new diagnostic techniques.
A team of MSF mental health professionals continued to provide psychiatric support to inmates in 10 prisons, including Harare maximum security prison. They treated 1,880 patients in individual and group counselling sessions. Also, free medical care, counselling and referrals for psychosocial and legal support were provided to sexual violence victims in suburb of Harare.
Escalating violence in South Sudan increased the need for emergency medical aid in 2013. During clashes between the government and militia in Jonglei in May the MSF hospital in Pibor was looted and severely damaged. The fighting caused people to flee into the bush or hide in malaria-infested swamps without access to safe water or food. As the MSF hospital was the only one in the county, 100,000 people were deprived of healthcare.
Over the six-month emergency period, MSF ran two clinics and a surgical unit in Gumuruk and Dorein. More than 26,500 consultations were provided across Pibor.
In December, fighting broke out in Juba between different army factions and violence spread quickly through several states causing displacement. MSF has been struggling to respond to the huge and urgent needs created by the new conflicts.
Throughout the country, MSF teams continued to offer a full range of services at clinics and hospitals, including surgery, maternal and child healthcare, vaccinations, emergency obstetric services, and treatment for malnutrition, kala azar, HIV and TB. They also responded to outbreaks of diseases.