Democratic Republic of Congo (DRC)
Violence, fear and displacement have not abated in the eastern provinces, despite a  much talk of stabilisation linked to the large peacekeeping force. In provinces of North Kivu, South Kivu, Katanga and Orientale, MSF continues to provide basic and specialist services covering outpatient and inpatient consultations, surgery, reproductive and mental healthcare, paediatric care, vaccination campaigns, treatment for malnutrition, HIV and tuberculosis (TB), and aftercare for victims of sexual violence. Teams also prevent and limit the outbreaks of malaria, cholera and measles.
 
  • Porters carry ice boxes to keep vaccines cold,during a vaccination campaign in Masisi, DRC. © Phil Moore
     
When the first Ebola cases were confirmed in August, MSF set up two treatment centres to manage and control the outbreak. Of 25 patients treated, 13 recovered. The outbreak was over by November.
 
Four Congolese MSF staff members were abducted in 2013 in North Kivu. One of them was reunited with her family this year, and started working with MSF again. Efforts are ongoing to locate the other colleagues.
 
Central African Republic (CAR)
Although a transitional government was formed, the situation in CAR remained catastrophic. Most of the Muslim population in the western half of CAR flooded out of the country. Several thousand remained living in enclaves, fearful for their lives. Yet, intercommunal violence and attacks by armed groups affected all communities. Some 430,000 people were internally displaced, and hundreds of thousands had crossed into neighbouring countries. MSF was also not spared. Three national staff members were killed by armed men at the Boguila hospital.
 
Malnutrition, malaria, diarrhoea, respiratory tract infections and measles were the main health concerns. The needs of displaced people, victims of violence, pregnant women and children were massive. MSF remained the main healthcare provider, offering comprehensive services from surgery, maternal health, basic healthcare to vaccination through long-standing programmes and emergency projects.
 
  • MSF staff at Mpoko camp, CAR, are attending to  a wounded man, who is about to be referred for emergency surgery. © William Daniels
 
Chad
Over 200,000 people fleeing violence in CAR sought refuge in southern Chad. MSF provided assistance by carrying out over 35,000 consultations and vaccinating 7,000 children against measles. Teams also ran mobile clinics on the CAR border and distributed antimalarials as a prevention strategy, as 60 percent of consultations were for malaria. 
 
In Ouddaï region, MSF started supporting emergency services at Abeché hospital in June. More than 900 major surgical procedures were carried out; one in five was related to violence.
 
In response to a measles outbreak early in the year, MSF collaborated with the health ministry at two hospitals in N’Djamena and seven health centres, with 4,500 patients treated. Teams also vaccinated nearly 70,000 children in Massakory.
 
  • An MSF staff is vaccinating a child against measles, polio and meningitis in southern Chad. © Samantha Maurin/MSF
 
Libya
Renewed fighting erupted in spring displaced thousands of people. Many health workers fled and health facilities experienced shortages of supplies and drugs. Insecurity prevented access to the east in particular, although MSF still managed to donate drugs and medical materials.
 
The crisis in Libya has funnelled people through to Europe, with the majority of them by boat from Zuwara and the surrounding area on the northern coast. But many of them did not survive the perilous trip. MSF donated hygiene materials to a local crisis committee to help cope with the number of bodies washing up on the shore.
 
The mental health project in Tripoli was closed in December due to the deterioration of the security situation. 
 
Malawi
MSF has been supporting the national health system to strengthen its HIV response. In Nsanje, MSF supervises the policy implementation of putting all HIV-positive pregnant and breastfeeding women on antiretrovirals (ARVs) to prevent virus transmission to their babies, and is developing a programme to integrate HIV and TB treatment.
 
  • In Malawi, a pregnant woman with HIV is attending a routine prenatal visit and antiviral assessment. © Marco Longari/AFP PHOTO
 
A new project started in two prisons in Lilongwe and Blantyre, screening and treating 4,400 inmates and staff for HIV, TB and sexually-transmitted infections (STIs), and providing hepatitis B vaccination. Another project offering testing for HIV and STIs to truck drivers and sex workers began near the border with Mozambique.
 
In Thyolo, MSF continues to mentor local staff in providing treatments and viral load tests. In Chiradzulu, a four-year handover process of the HIV programme began in August.
 
Sudan
Various restrictions hindered MSF’s access in conflict-affected areas of Darfur, South Kordofan and Blue Nile states, with an MSF hospital in South Kordofan being bombed. Thousands of people cut off from medical humanitarian assistance are in dire need.
 
Despite the restrictions, MSF offered outpatient and inpatient care when clashes took place in Tawila in North Darfur. In South Darfur, teams improved water supply and provided medical care for an additional 4,000 displaced people at El Sereif camp, as their villages were destroyed. MSF also began to offer basic medical care in four health centres in Kerenek locality, West Darfur. A health clinic was opened in White Nile state to provide basic healthcare to some 30,000 South Sudanese refugees. An average of 4,300 consultations were carried out each month.
 
Zimbabwe
Access to HIV treatment in Zimbabwe has improved in recent years, but remains limited for certain vulnerable groups such as children. MSF has supported the health authorities in the capital Harare and a number of other districts to develop integrated care, which includes increasing access to routine viral load monitoring of patients on treatment in government health facilities, and decentralising diagnosis and treatment to help meet people’s needs close to home.
 
MSF’s projects in Gokwe North and Harare aiming at decentralising and improving medical care for people with HIV and TB were handed over as the staff capacity was built up. The project in Tsholotsho was also handed over. More than 10,400 people were on ARVs, 85 percent of all people in need of HIV treatment in Tsholotsho.
 
  • In Tsholotsho, Zimbabwe, a health worker prescribes antiretroviral therapy to HIV-positive patient. © Pedro Ballesteros/MSF
     
South Sudan
Fighting broke out in Juba in December 2013 and spread rapidly throughout the country, with 1.5 million people internally displaced by the end of 2014. MSF responded by dispatching medical supplies and staff to critically affected locations, while striving to maintain its pre-existing programmes. The number of projects increased from 13 to more than 20 across nine states. 
 
Hundreds of thousands of people were denied lifesaving assistance as medical care came under attack. In Leer, Unity state, the MSF-supported hospital was looted and set alight. MSF staff witnessed the gruesome aftermath of armed attacks and clashes in Malakal in Upper Nile state – patients being murdered inside the teaching hospital. After fighting in Bentiu, capital of Unity state, people who had sought shelter inside the hospital were killed in the grounds.
 
Teams continued to offer basic and specialist medical care at clinics and hospitals, including surgery, maternal and child healthcare, as well as treatment for malnutrition, malaria, HIV, TB and visceral leishmaniasis (kala azar). They also launched vaccination campaigns.
 
  • An MSF doctor examines a very weak man in a clinic in Mellut, South Sudan. © Matthias Steinbach
 
In May, a cholera outbreak was declared in Juba. MSF opened and ran five treatment centres and three oral rehydration points, and provided technical assistance in Juba teaching hospital. Teams also responded to smaller outbreaks in a number of states, including Eastern Equatoria state and Upper Nile state.
 
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