South Sudan 2013 © Vikki Stienen/MSF

Destroyed medical supplies litter the ground outside the MSF hospital in Pibor.

BRUSSELS/NEW YORK, May 16, 2013—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today strongly condemned the deliberate damage and looting of its hospital in Pibor town, in South Sudan's Jonglei State, which has left tens of thousands of people without access to essential medical care.

The hospital's infrastructure was systematically damaged May 11–12 in order to render it unusable without major repairs. Therapeutic medical food and hospital beds were looted. The MSF structure is the only hospital facility for Pibor County, with the nearest alternative more than 90 miles away. The hospital's closure leaves roughly 100,000 people cut off from health care. Many of them have fled to the bush amid conflict between the South Sudan Army (SPLA) and the David YauYau armed militia group.

"A special effort was made to destroy drug supplies by strewing them on the ground, to cut and slash the warehouse tents, to ransack the hospital wards, and even to cut electricity cables and rip them from the walls," said Richard Veerman, MSF operations coordinator for South Sudan.

From January to March, the Pibor hospital treated 3,000 people and provided surgical care to more than 100 people suffering war-related injuries, including SPLA soldiers. Prior to the attack, MSF was forced to suspend activities in Pibor on April 19 because of threats and intimidation of staff and patients.

"The rainy season has just started and we know from previous years that malaria and respiratory diseases such as pneumonia will start to claim lives if there is no health care available," Veerman said. In a report issued in November last year, South Sudan's Hidden Crisis, MSF documented the devastating health consequences when people are forced to flee to the bush.

An MSF team was preparing to return and restart medical activities when the looting and destruction took place. It was the sixth time an MSF medical facility has been looted or damaged in Jonglei State in the past two years.

"It is unthinkable that there will be no health care whatsoever for the next six months for some 100,000 frightened and vulnerable people hiding in the swamps," Veerman said. "Unless we can return to resume medical activities and have the freedom to move to wherever people need assistance, this unthinkable scenario may become the horrific reality."

MSF urges the Government of South Sudan to meet its responsibilities to ensure full respect of medical humanitarian facilities and activities. MSF also calls urgently for assurances from all parties in the Jonglei State conflict that its medical teams have unhindered freedom to return to Pibor and the ability to reach out impartially to people in need of medical assistance, on either side of the conflict. Humanitarian and medical assistance is urgently needed in Pibor County and must be resumed in the coming days or weeks.

MSF works in Akobo, Nyirol, Pibor, and Uror counties in Jonglei State. The activities in all locations, including Gumuruk Clinic in Pibor County, continue to function, with the exception of the hospital in Pibor town and the MSF clinic in the village of Lekwongole in Pibor County, which was targeted and damaged in August 2012 and where insecurity and fighting have made access impossible for MSF.

DRC 2008 © MSF

Patients recover from surgery in an MSF facility in Rutshuru, North Kivu Province.

GOMA, DEMOCRATIC REPUBLIC OF CONGO/NEW YORK, MAY 16, 2013—Men armed with bayonets, machetes, and wooden clubs attacked the village of Mpeti in North Kivu Province in the Democratic Republic of Congo on the morning of May 14, killing and seriously injuring civilians, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), which is treating survivors of the attack, said today.

Among the wounded under treatment at Mweso Hospital, some 25 miles from Mpeti, are two young children, one of whom was orphaned in the attack. The mother and 18-month-old baby brother of the other child under treatment were also killed.

"This was a deplorable and brutal attack in which young children were targeted and their parents killed," said Hugues Robert, MSF’s head of mission in Goma. "MSF condemns in the strongest terms attacks of this kind against civilians."

Two young children with multiple stab injuries in the chest, back, and head and one adult male with multiple stab injuries in the back and neck were admitted to the MSF facility, according to MSF Surgeon Martin Jarmin. "Currently all patients are stable and we hope they will make a good recovery," he said.

Survivors described indiscriminate violence aimed at civilians, resulting in many deaths. Corpses were apparently thrown in a river.

"I suspect that many more died in Mpeti during this attack, either directly from their injuries or because they were unable to get immediate medical attention in the hours that followed," said Robert. "I fear that the patients we have been able to treat are just the tip of the iceberg."

MSF supports a health center in Mpeti that treats roughly 300 patients per week, mostly for malaria and other common diseases. Since the beginning of the year, insecurity and fighting between armed militias in control of different parts of the area have repeatedly forced Mpeti's roughly 1,000 residents to flee their homes and at times prevented the MSF medical team from accessing patients in need. The village is fully deserted at the moment.

Pakistan 2012 © Haroon Khan/MSF

MSF medical staff examines patient in surgical ward in Hangu Tehsil Headquarters (THQ) Hospital. MSF supports the Hangu THQ Hospital by running emergency room and providing surgical care.

ISLAMABAD/NEW YORK, MAY 10 2013—Teams from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), together with Ministry of Health staff, have treated more than 110 people for blast injuries from election-related violence in Khyber Pakhtunkhwa Province and the Federally Administered Tribal Areas over the past four days, MSF said today.

Pakistan is experiencing an increase in violence related to the general and provincial elections taking place on May 11, in the country's first democratic transition of power. MSF staff treated patients for blast injuries at facilities in Hangu and Lower Dir, Khyber Pakhtunkhwa, and Kurram Agency in the Federally Administered Tribal Areas.

"The escalation in violence has caused massive devastation over a short period of time," said Jean Guy Vataux, MSF country representative in Pakistan. "This is exacerbating an already very difficult situation for the Pakistani people who continue to bear the brunt of these violent acts on every level."

Noncombatants have been the primary victims of the recent violence, which follows several months of armed conflict in Pakistan that mainly injured members of the security forces and armed militants, according to Pakistani media reports.

MSF has been present in Pakistan since 1986, working with Pakistani communities and Afghan refugees. MSF teams have been providing primary and secondary health care in several locations across the country, where people are greatly affected by armed conflict and natural disasters or lack of access to medical care.

MSF teams are currently providing free emergency medical care in Kurram Agency, Bajaur Agency, Khyber Pakhtunkhwa, Balochistan, and Sindh provinces.

MSF relies solely on private financial contributions from individuals around the world and does not accept funding from any government, donor agency, military or politically-affiliated group, for its activities in Pakistan.

India 2013 © Sami Siva

A multi-drug resistant tuberculosis patient's drug regimen.

TAKE ACTION: Tell Members of Congress to Protect Access to Lifesaving Medicins

LIMA/NEW YORK, MAY 14, 2013—As negotiations for the Trans-Pacific Partnership (TPP) restart in Lima, Peru, tomorrow, countries must prioritize fixing critical flaws in the agreement that could leave millions of people in developing countries with limited access to affordable generic medicines, international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

“Substantive discussions on access to medicines have languished for more than a year, with negotiating countries and many other groups, including MSF, voicing concerns about the damaging impacts of the proposed rules,” said Judit Rius Sanjuan, U.S. Manager of the MSF Access Campaign. “The Lima round offers a key opportunity for TPP negotiators to remove harmful provisions from this trade agreement before it’s too late.”

Negotiations on the TPP—a far-reaching trade agreement between 11 Pacific Rim countries—continue to be shrouded in secrecy, but leaked copies of the agreement reveal that the United States is demanding the most harmful package of intellectual property protections ever proposed for a trade agreement with developing countries.

These rules would make it extremely difficult for generic competitors to enter the market, keeping prices unaffordably high, with devastating public health consequences. The proposed provisions would, for example, lower patentability standards, making it much easier for pharmaceutical companies to obtain secondary patents and extend product monopolies for existing drugs; prohibit challenges to weak or invalid patents until after they have been granted; and grant backdoor monopolies by locking up clinical data needed to approve generic drugs.

For more information, please refer to MSF’s 2013 TPP Briefing Note, available in English and Spanish at msfaccess.org/tpp.

“The TPP threatens to constrain countries’ ability to limit abusive patenting and to ensure timely access to the affordable generic medicines that are so critically important to treatment providers like MSF,” said Dr. Jonathan Novoa Cain, president of MSF Latin America. “Alarmingly, the TPP is slated to become the ‘gold standard’ for future trade agreements across the globe, which means that unless these provisions are rejected now, they will be replicated and imposed on many more developing countries in the coming years.”

International rules require governments to grant 20-year patents on pharmaceuticals, but they also allow critical flexibilities in controlling the quality of patents, and in determining under what conditions companies can obtain additional patents on existing drugs. Companies have developed a variety of tactics to extend monopoly protection on their drugs beyond the initial 20-year period, a practice commonly referred to as ‘evergreening.’ It is up to governments to prevent evergreening by putting safeguards in place which balance commercial interests with public health needs.

One example is India’s Section 3(d) law, which aims to achieve this balance, and curb evergreening, by prohibiting the granting of secondary patents on existing drugs unless they are substantially more effective than the original drug. Pharmaceutical company Novartis recently lost a seven-year legal battle—which was taken all the way to the Indian Supreme Court—in an attempt to challenge the application of this law. If accepted in its current form, the TPP would take away governments’ ability to implement similar safeguards.

MSF urges governments involved in the TPP negotiations to reject provisions that will harm access to medicines.

DRC 2013 © MSF

The sign outside the health center in Pinga, where armed conflict has made provision of care difficult.

GOMA, DEMOCRATIC REPUBLIC OF CONGO/NEW YORK, MAY 2, 2013—Thousands of people have fled the town of Pinga in recent days amid a new wave of armed conflict in the Democratic Republic of Congo (DRC)'s North Kivu Province, making it very difficult to ensure that they receive essential medical care, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Many residents fled to the surrounding forests after attacks began on April 28, while others sought refuge at a local hospital, only to be forced out by armed men. Eleven of MSF's Congolese staff members are missing. Houses have been burned and looted, and a combatant was decapitated, further increasing the level of panic and alarm in town.

"Civilians are routinely exposed to this violence—this is the eighth time Pinga has changed hands since 2012," said Jan Peter Stellema, MSF's operations manager in Goma. "A number of patients had to be transferred for emergency surgery to Goma, among them a 70-year-old woman shot in the arm."

While over the past year MSF has been running a large clinic in Pinga and supporting the town hospital and other clinics in the area, frequent violence has made it extremely challenging for MSF to negotiate access with multiple armed actors. Health centers have been looted and medical equipment destroyed.

"Providing health care is proving a challenge when medical facilities are not respected, staff are missing, people have fled the area and those who remain fear being subjected to harsh treatment, illegal taxation, forced recruitment or worse," Stellema said.

Despite challenging conditions, MSF continues to provide high quality medical care in four reference hospitals, 12 health centers and four health posts in North Kivu province, and four reference hospitals, 19 health centers and five health posts in South Kivu. MSF also operates several cholera treatment centers, weekly mobile clinics, and emergency response activities.

Yemen 2013 © Anna Surinyach

Many migrants pass through Haradh town on their way to Saudi Arabia, whose border is just a few kilometers away.

SANA’A, YEMEN/NEW YORK, MAY 1, 2013—Authorities in Yemen have freed more than one thousand migrants from Somalia and Ethiopia, many suffering from torture and sexual abuse while forcibly held by human smugglers, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), which has treated the migrants, said today.

Since April 7, Yemeni authorities have freed 1,620 people held by smugglers in farms in Haradh region in the north of Yemen. Some of the migrants had been held for months and displayed signs of torture and other physical, sexual, and emotional abuse. Some had their fingernails pulled out or their tongues partially cut off. Others had been severely beaten.

“Many of the migrants are physically and mentally exhausted and are suffering from severe mental trauma due to the horrific conditions and treatment they experienced during their detention,” said Angels Mairal, an MSF psychologist in Haradh.

Many of the migrants treated by MSF were suffering from life-threatening diseases, including pneumonia, complicated malaria, and dengue. Most of the migrants referred by MSF to its hospital in Al-Mazraq, located near Haradh town, were victims of human trafficking, forced labor, and slavery. The majority of those receiving psychological support by MSF have reported being tortured. Among the migrants assisted, 62 are children and 142 are women; 71 severely ill people were admitted to the hospital.

Yemen is located along one of the main people smuggling routes from the Horn of Africa to the Gulf States. Many Ethiopian migrants fleeing extreme poverty try to enter Saudi Arabia through Haradh. They often end up in the hands of smugglers who extort money through torture and psychological abuse.

The freed migrants’ medical and humanitarian needs were extensive since some had not eaten for up to seven days before their release by Yemeni authorities. MSF provided some supplementary food rations and also improved sanitary conditions in both Haradh and Amran transit locations.

From Haradh, 800 Ethiopians have been transferred to migrant centers in the capital Sana’a, where they await repatriation; 550 Somalis were transferred to a refugee camp in Aden. However, those locations do not have the capacity and services to adequately assist the inhabitants.

“We are facing an emergency on top of this chronic situation and we are extremely worried about the future of thousands of migrants who are stranded in Yemen generally and in Haradh in particular,” said Tarek Daher, MSF’s head of mission in Yemen. “They are exhausted after so many attempts to cross the border, and without any resources. The majority of them become beggars in the street of Haradh. They try to survive without any decent shelter, sanitation, or regular access to food.”

The Yemeni government has made notable efforts to free, host, and protect the newly liberated migrants in Haradh. This support must continue, along with assistance from the international community.

MSF, together with authorities and some nongovernmental organizations, is expanding its efforts to improve living conditions for the migrants stranded in Haradh and to improve access to health care for those who are released or who are in transit and awaiting repatriation.

MSF has been working in Hajjah governorate in the north of Yemen since 2009. The organization manages the hospital near Al Mazraq, which provides local and displaced people with basic and specialist health care, surgery, and emergency services. Since last year, MSF has been providing mental health assistance for migrants in Haradh town. MSF is also carrying out medical activities in Aden, Ad-Dhale, Abyan, and Amran governorates.

Iraq 2009 © Khalil Sayyad

Basra, where MSF established an international team in 2008

BAGHDAD/NEW YORK, APRIL 30, 2013—The Iraqi Ministry of Health and its supporters should improve access to mental health care services for a population still reeling from decades of conflict, political instability, and social upheaval, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said in a report released today.

The report, Healing Iraqis: The Challenges of Providing Mental Health Care in Iraq, shows how the toll of day-to-day violence has affected Iraqis, leaving people vulnerable to psychological stress, mental health disorders, and in dire need of mental health care services. It calls on the Iraqi Ministry of Health (IMoH) to improve mental health care services by integrating counseling into existing health facilities across Iraq. MSF also noted that more must be done to reduce the stigma of accessing mental health services in order to encourage more people to seek counseling

“Many Iraqis have been pushed to their absolute limit,” said Helen O’Neill, MSF’s head of mission in Iraq. “Mentally exhausted by their experiences, many people struggle to understand what is happening to them. The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental health care services that people can turn to for help,” she said.

Since 2009, MSF and the IMoH have introduced psychological counseling services in two hospitals in Baghdad and one in Fallujah. The programs focus on non-pharmaceutical approaches to address anxiety and depressive disorders commonly experienced by people exposed to violence and uncertainty. There are plans to replicate this counseling model across the country, with the IMoH starting programs in Kut, Karbala, and Sulaymaniyah hospitals.

According to patient data collected in 2012 by MSF and the IMoH, 97 percent of people who presented for counseling reported clinically significant psychological symptoms at admission. When measured on the last visit, the figure was reduced to 29 percent. Even when excluding domestic conflict, almost half of all cases seen in the program—48 percent—were violence-related. Nearly all staff and patients in the mental health program have either directly experienced or know someone close to them who has been directly affected by a violent event over recent years.

The report includes testimonies from Iraqis traumatized and struggling to rebuild lives after witnessing extreme violence.

A 36-year-old widowed mother of three describes how she began counseling sessions after her husband was killed.

“I lost my husband two years ago and the incident affected my life,” she said. “It changed my life, it turned my life upside down. I’m now the only one left responsible for raising my kids.”

One child, ten years old, describes how counseling has helped her improve her speech:

“I started attending the sessions to help improve my speech and help me overcome my fear,” she said. “I’m scared of everything. My body is always shivering. I can’t spell words correctly anymore. My teacher and my fellow classmates beat me all the time in school. I can’t study or learn anything. I’m unable to concentrate. I don’t talk to anyone. This is the first time I’ve talked to anyone about my problems.”

Chad 2013 © MSF

Sudanese refugees in Chad.

TISSI, CHAD/NEW YORK, APRIL 26, 2013—Violent clashes in Sudan's Darfur region have driven approximately 50,000 people across the border into southeastern Chad since early March, where a lack of food, water, shelter, and basic services is developing into a humanitarian crisis, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

In addition to Sudanese refugees, the displaced population includes citizens from Chad and the Central African Republic who previously took refuge in Darfur. Humanitarian assistance is urgently needed before the looming rainy season cuts off road access to many areas, MSF said.

“We arrived in Tissi in the first week of April to respond to a measles outbreak among the local population and refugees,” said Stefano Argenziano, head of mission for MSF. “It soon became clear to us that families have other urgent needs. Most of the recently arrived refugees have no access to health care, food, or clean water. They live mostly under trees, which do not provide much shade, and they have nothing with which to protect themselves against the dust and heat during the day and the cold during the night.”

The health status of the refugees is likely to deteriorate rapidly, making them vulnerable to malaria, malnutrition, and epidemics.

Since the Tissi area has no functioning hospital, MSF teams are providing emergency and primary health care to the refugee and Chadian populations. An emergency room has been set up in the town of Tissi to treat the wounded, children under the age of five, and pregnant women. To date, MSF has treated 40 patients who suffered from bullet and knife injuries while fleeing the conflict, and an additional 24 local residents who were wounded in a road accident. Eighteen severely wounded patients were stabilized and evacuated to the town of Abeche, in cooperation with the International Committee of the Red Cross (ICRC).

In Tissi itself, MSF has improved the capacity of the town’s only source of clean water and is planning to hold mobile clinics at the surrounding sites. An emergency team has completed vaccinating 30,200 people under the age of 15 and has treated 52 patients for measles. During a measles vaccination, MSF screened 13,700 children for malnutrition and admitted 120 children into a therapeutic feeding program.

The living conditions of the displaced population, the majority of whom are women and children, are deteriorating quickly. Parents have told MSF teams that their children are increasingly falling ill. With the onset of the rainy season just two months away, time is running out, MSF said.

“Once the rainy season starts, our access to these camps will be impossible by road and the refugees will be completely cut off," Argenziano said. "With poor sanitary conditions and the lack of access to clean water, we are monitoring for an increase in malaria and respiratory infections, and also for a possible outbreak of cholera.”

None of the sites where the refugees have settled are official refugee camps. Due to the proximity of the sites to the Sudanese border and security concerns, UN agencies and most aid organizations have to-date been reluctant to provide assistance.

MSF has been working in Chad since 1983 and currently has projects in Am Timan, Abeche, Massakory, and Moissala.