South Africa 2011 © Chelsea Maclachlan/Le Monde

A woman receives antiretroviral medication at an MSF clinic in Cape Town. While MSF relies solely on private donors, a loss of funding from the Global Fund will leave thousands without treatment.

NAIROBI, JANUARY 30, 2012 - As the Global Fund to Fight AIDS, Tuberculosis, and Malaria marks its tenth anniversary—and on the heels of its leadership changes—people living with HIV/AIDS and those delivering and supporting HIV and TB treatment took to the streets as they warned that the political commitment made 10 years ago to address global health is evaporating, and that drastic funding shortfalls could cause an unraveling of a decade’s progress against the three diseases. The Global Fund Board in November took the unprecedented decision to cancel its eleventh round of funding because of a dramatic resource shortfall, and will not make grants for scale-up of HIV or drug-resistant TB treatment until 2014.

“Ten years ago, there was a landmark decision to support the roll out of HIV, TB, and malaria prevention and treatment in countries that couldn’t completely support programs on their own,” said Dr. Jennifer Cohn, of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières’s (MSF) Access Campaign in East Africa. “MSF has been part of the effort over the last decade to treat patients, introduce new treatments, and develop simple ways to deliver them. We have seen the positive impact of the Global Fund and other international health initiatives on individuals and communities, with deaths and sickness plummeting.” 

The progress achieved is critical: nearly half of all people in need of HIV treatment in developing countries now have access, and in sub-Saharan Africa, treatment coverage increased by 30 percent in 2010 alone. MSF provides HIV treatment in 19 developing countries, and in at least eight of them, more than 80 percent of the people on HIV medicines receive them through programs funded by the Global Fund. The Global Fund’s cancellation of its latest funding round is especially detrimental at a time when scientific research has shown that HIV treatment itself can be a decisive tool for pushing back the pandemic: a person put on treatment earlier is 96 percent less likely to transmit the virus.

In several countries affected by HIV, plans to implement treatment strategies that have the biggest impact on the epidemic are at risk because of the funding crisis. In Malawi, for example, the government is attempting to find funding to pay for a plan to provide all HIV-positive pregnant women with life-long treatment. They have also been forced to put on hold plans to switch people to a newer World Health Organization–recommended treatment that has far fewer side effects.  In the Democratic Republic of Congo, where already only 15 percent of people in need have access to HIV treatment, waiting lists have grown and some clinics have had to close their doors as funding declines. 

Two years ago in Uganda, a lack of funding forced serious delays in starting people on HIV treatment.

“I am gravely concerned that people living with HIV and TB in countries affected by these epidemics are being told to wait for another two years before they can get the treatment they urgently need today,” said Dr. Peter Mugyeni, in Uganda. “I don’t want to see a return of the situation we faced in Uganda two years ago, when we couldn’t give people the treatment they needed to stay alive because there wasn’t the money to pay for it.  If this happens again, it will again result in unnecessary deaths.”

TB will also be impacted. Although numbers of people with TB have been slowly falling since 2006, barely 10 percent of the global annual estimate of 440,000 new patients with multidrug-resistant tuberculosis (MDR-TB) receive treatment. Just as treatment expansion for MDR-TB seemed to be gaining momentum, the evaporation of political commitment is undermining the response.Enrolment of new patients on MDR-TB treatment will slow down in countries heavily reliant on the Global Fund.

“Pledges last week for funds from Japan and the Gates Foundation should serve as a wake-up call,” said Nelson Otwoma, National Coordinator of NEPHAK, Kenya’s largest network of people with HIV. “Now that it has new leadership, the Global Fund needs to hold an emergency donor conference so it can ensure countries can apply this year for grants to provide life-saving treatment to those with HIV, TB, and malaria. A Global Fund that is downsizing is a bitter pill to swallow. We’re beginning to see light at the end of the tunnel with the HIV epidemic, so now is not the time to shift into a lower gear.”

Countries such as Belgium, Denmark, the Netherlands, and the United States need to pay their full and outstanding pledges or reverse reductions in contributions, and recipient countries must also focus on increasing funding for critical diseases such as HIV and TB. A change from ad hoc voluntary funding to a more predictable mechanism—such as the financial transaction tax currently being debated in Europe—is needed, with part of funds generated to be dedicated to global health, including the Global Fund. 

DRC 2011 © Robin Meldrum

Michel Kongawi, head lab tech, prepares a CD4 test in the laboratory at Lubutu hospital, Maniema Province.

KINSHASA, JANUARY 25, 2012 – The vast majority of people living with the AIDS virus in the Democratic Republic of Congo (DRC) are deprived of lifesaving treatment, due to a withdrawal of international donor support and the lack of national prioritization of the crisis, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

The number of HIV-positive people in DRC is currently estimated at more than one million, 350,000 of whom could benefit from antiretroviral (ARV) treatment. However, only 44,000 people are currently receiving treatment, translating into a 15 percent ARV coverage rate, one of the lowest in the world. Of all African countries, only Somalia and Sudan have similar rates.

The conditions surrounding access to care for people living with HIV/AIDS in DRC are horrific. At the Centre Hospitalier de Kabinda (CHK) in Kinshasa, the capital, MSF has observed an excessively high number of patients arriving with serious complications resulting from lack of treatment. Their advanced illness creates unacceptable suffering.

"I have worked with HIV-positive patients in many countries in central and southern Africa, but what I'm seeing in DRC has not existed elsewhere for years," said Anja De Weggheleire, MSF's medical coordinator in DRC."The situation here reminds me of the time before any antiretroviral (ARV) treatment was available.Our doctors face serious complications every day that could be prevented if patients received early ARV treatment."

The alarming situation for HIV/AIDS patients in the Democratic Republic of Congo (DRC), coincides with the tenth anniversary of the Global Fund to Fight AIDS, Malaria, and Tuberculosis, which is struggling to meet its funding commitments.

The DRC is also one of the two lowest-ranked countries in western and central Africa in terms of prevention of mother-to-child transmission of HIV (PMTCT). Only 1 percent of pregnant women estimated to be HIV-positive in DRC have access to PMTCT treatment. Without treatment, approximately one-third of babies who are exposed to the virus will be born with HIV.

Despite these disastrous indicators, donors have not given DRC the priority it deserves. What is worse, some donors, such as the Global Fund, are withdrawing or sharply reducing their funding. While the Global Fund is the leading supplier of ARV drugs in the DRC, the countries that finance the Fund have not kept their promises. As a result, the Global Fund is having to lower its sights.

This pull-back by donors is directly threatening the lives of thousands of people in DRC.

"If nothing is done, it is highly likely that the 15,000 people currently on the waiting list and in urgent need of ARV drugs will be dead within three years,” said De Weggheleire.“As horrifying as that number is, it represents only the tip of the iceberg when you realize that most people living with HIV/AIDS in DRC do not know their HIV status. Many will die in silence and neglect."

It is crucial that Congolese authorities meet their commitment to provide free prevention services and free treatment for people living with HIV/AIDS. It is also critical that donors immediately mobilize the necessary resources to ensure that patients waiting for ARV treatment are not condemned to die.

MSF has been working in DRC for more than 30 years, operating HIV/AIDS programs since 1996. In October 2003, MSF was the first organization to provide free ARV treatment to patients in DRC. Through its healthcare support programs and its AIDS project in Kinshasa, MSF treats more than 5,000 patients in six provinces, more than 10 percent of the number receiving ARV treatment throughout the country. In Kinshasa, MSF is treating 20 percent of the total number of patients on ARV treatment in the Congolese capital.

Today, MSF is launching a communications and advocacy campaign that will continue throughout 2012 to raise public awareness of the very serious situation facing people with HIV/AIDS in DRC and to encourage all actors to expand ARV coverage.

South Sudan 2012 © Heather Whelan/MSF

An MSF doctor examines a baby in Pibor, in Jonglei State in South Sudan, where people who went into hiding following recent attacks continue to come in for urgently needed medical care at MSF's re-opened facilities.

JUBA, JANUARY 24, 2012 - Civilians continue to bear the brunt of extreme inter-communal violence in Jonglei state in South Sudan, with their resources and lifelines, including hospitals and water supplies, also deliberately targeted, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Wounded people are still arriving at the MSF hospital in the town of Pibor, three weeks after a violent attack on the town and outlying villages in Pibor County. Many people were injured in the bush, where thousands remain, too afraid to come out of hiding. The hospital was also targeted during the attack. 

“We are seeing a cycle of attacks and reprisals throughout this area of northern Jonglei,” said MSF head of mission Jose Hulsenbek. “For the civilians in this part of South Sudan, the fear of having to flee their homes or being killed is very real.”

A recurring characteristic of the attacks in Jonglei is their extreme violence. One woman suffering from a gunshot wound and treated by MSF in Pibor said she had fled to the bush with her husband, children, and 15 other family members. After running for eleven hours, they were found by a group of men who shot at them. “We scattered. They shot me in my thigh and my baby was hanging on my back. I tried to hide in the high grass but they found me because my baby was crying. They started beating my daughter until she kept quiet. They left us behind thinking we were dead.” Her son was also treated by MSF for a bullet wound to the chest that remarkably did not kill him.

“After these attacks many women and children are coming to us shot, stabbed, and beaten,” said Colette Gadenne, MSF operations coordinator for South Sudan. “They try to keep safe by hiding in the bush, but it seems that even running away is not enough.”

A deeply worrisome pattern is emerging, where people and their scarce resources are deliberately targeted by all the armed groups involved in inter-communal violence. Hospitals, health clinics, and water sources are all targets, suggesting a tactic of depriving people of life’s basic essentials, precisely when they need them most.

The village of Lekwongole, north of Pibor town, scarcely exists today after coming under attack.  All that exists of the MSF clinic there are concrete floors and walls, although medical activities resumed there on January 18.

“The people explained that during the day they dare to come out of hiding to search for food or to seek medical care,” said Karel Janssens, MSF project coordinator. “But at night they return to their hiding places in the bush where they are at risk of contracting malaria or respiratory infections.”

MSF medical teams are now treating serious wound infections, some several weeks old. Since re-launching emergency medical activities in Pibor on January 7, MSF has treated 47 patients with gunshot wounds, among them 16 women and 8 children. An additional 43 patients have been treated for stab wounds, beatings, or wounds sustained while fleeing in the bush. Since January 7, approximately half of MSF’s patient consultations in Pibor have been for malaria; people sleeping in the bush are more vulnerable to contracting the disease.

MSF is extremely concerned for the health and well-being of civilians forced to flee, either from fighting or from fear of an attack. They hide in the bush, with little to no shelter and limited access to food. If they are able to return home, they often only find ashes where their houses once stood.

In the wake of the Pibor attack, MSF has learned that Allan Rumchar, an MSF watchman, and his wife were killed. Of 156 locally recruited MSF staff members, 25 are still unaccounted for and MSF remains deeply concerned for them.

The violence in Pibor is not isolated. After a January 11 attack on the village of Wek in northern Jonglei State, MSF evacuated 13 patients by air, mostly women and children in need of urgent surgical care at MSF’s hospital in Nasir. That followed an August 2011 attack on the town of Pieri and surrounding villages, during which scores of villagers were killed.  In the past six months, 185 people with serious wounds have sought care from MSF teams in Lankien, Pieri, and Yuai.

In a December 2009 report, Facing Up to Reality: Health Crisis Deepens as Violence Escalates in Southern Sudan, MSF documented the escalation of inter-communal violence in Jonglei and Upper Nile states, and its increasing impact on civilian populations. MSF treated 392 people wounded by violence that year, and estimated that 86,000 people were displaced. The situation has not improved. In the past six months, MSF has treated more than 250 people wounded in violence in Jonglei State, the majority of whom are women and children.

#MSF outpatient dept full to the brim with women & thr sick children this morn in Pibor #SouthSudan - malaria, diarrhea, respiratry infectns

— Heather Whelan (@HPWhelan) January 20, 2012

Follow Heather Whelan, UK Senior Press Officer for MSF, currently tweeting from South Sudan.

MSF has been working in South Sudan since 1983, and currently runs more than a dozen projects in eight states. MSF runs its own medical facilities and supports Ministry of Health facilities in six locations in Jonglei State, providing basic health care, therapeutic nutrition, and kala azar and tuberculosis treatment, serving a total population of some 285,000 people. In 2011 the MSF medical facilities in Lekwongole, Pibor, and Pieri were targeted and either destroyed or ransacked during inter-communal violence. MSF condemns the targeting of unarmed civilians and of medical assets by any armed group.

Somalia 2011 © Martina Bacigalupo

Houses lie in ruin in Mogadishu's Hodan district, where MSF has been forced to end activities.

January 19, 2012 - Following the tragic killings of Philippe Havet and Dr. Karel Keiluhu, staff members of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in Mogadishu, Somalia, on December 29, 2011, MSF has been forced to end all activities in the Hodan district of the capital, including the closure of two separate 120-bed medical facilities for the treatment of malnutrition, measles, and cholera.

South Sudan 2012 © Parthesarathy Rajendran/MSF

The pharmacy at the MSF-run hosptail in Pibor, Jonglei state, lies in ruin after it was ransacked in inter-communal violence.

JUBA, SOUTH SUDAN/NEW YORK, JANUARY 13, 2012—Following inter-communal violence on January 11 in northern Jonglei State, South Sudan, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is treating several people with serious wounds, including women and children.

Thirteen severely wounded people were medically evacuated by air from the MSF clinic in Yuai, Jonglei State, to the MSF hospital in Nasir, Upper Nile State, where they have received urgent surgical care. Five adult women and two adult men suffered gunshot wounds. The remaining patients are children under five, who suffered beatings or gunshot wounds.

“We are very concerned that the majority of the wounded in this latest wave of violence are women and children,” said MSF head of mission Jose Hulsenbek. “The 13 patients have survived the night, but some of the children are still in critical condition with severe head trauma ” she said.  

MSF supports a small outreach clinic in Yuai, about two hours outside of Wek, Uror County, where the latest violence took place. MSF is continuing to monitor the situation; if more severely wounded people arrive at the Yuai clinic they will be referred to the MSF-run hospital in Nasir.

This latest round of inter-communal violence follows attacks in late December and early January in Pibor County, where the MSF-run hospital in Pibor town was looted and ransacked.  MSF emergency teams resumed medical activities in Pibor town on Sunday, January 8.

MSF has demonstrated its complete impartiality and neutrality over the years, working in many different communities in South Sudan.  In 2011, three MSF medical facilities were targeted in Jonglei State. MSF condemns the targeting of medical facilities by any armed group. The organization remains committed to providing humanitarian aid and medical assistance to the population of Jonglei State.

January 7, 2012 – One week ago, a gunman killed Phillipe Havet and Andrias Karel Keiluhuo, two Doctors Without Borders/Médecins Sans Frontières (MSF) aid workers, while they were implementing emergency assistance projects in Somalia’s capital, Mogadishu. Three months ago, MSF staff members Montserrat Serra and Blanca Thiebaut were abducted in the Dadaab refugee camp in northern Kenya while providing emergency assistance for the Somali population there.

These attacks on aid workers must be condemned in the strongest terms, MSF said today. They jeopardize life-saving medical projects that are already far from adequate in addressing the vast medical needs of the Somali population.

MSF is confronting the difficult dilemma of working in a context like Somalia, where the needs are not only extremely great, but the risks are exceptionally high for the safety and security of all staff. As we consider this dilemma, MSF is requesting that all people—especially the authorities in control of areas in Somalia where our kidnapped colleagues are being detained—do everything possible to facilitate the safe release of Blanca and Montserrat.

MSF has been working in Somalia continuously since 1991, assisting Somalis in need on all sides of ongoing conflict. Over the last six months, MSF has treated 225,000 patients in Somalia, vaccinated 110,000 children and cared for 30,000 malnourished children in 14 projects. Additionally, MSF provides assistance to Somali refugees in nine projects in Kenya and Ethiopia, where finding the balance between the massive medical needs of the population and the risks that MSF teams are forced to endure is increasingly challenging. The net result is that the Somali population—extremely vulnerable after 20 years of civil war, international interventions, and institutional collapse—receives less assistance than it needs.

“To effectively continue our medical humanitarian work for populations affected by violence in Somalia, MSF needs all parties to the conflict, the leadership as well as the people of Somalia, to support us in this work and help ensure the safety and security of humanitarian workers,” said Dr.Unni Karunakara, international president of MSF. “For our colleagues Philippe and Kace, this failed tragically. For Blanca and Mone, the leadership and people of Somalia have the responsibility to facilitate the safe and prompt resolution of their abduction.”