IAR 2007 Executive Summary

The International Activity Report 2007 aims to highlight some of the key activities and challenges undertaken by Médecins Sans Frontières (MSF) during 2007. The year in brief
In 2007, MSF carried out 8,447,106 outpatient consultations and dealt with 340,689 inpatient admissions in 63 countries worldwide. Our interventions spanned four continents with the majority of projects taking place in Africa, and smaller numbers in Asia, the Americas and Europe and the Middle East. Armed conflict was the most common cause of humanitarian and medical crises followed by epidemic or endemic disease outbreaks. MSF treated many patients affected by the world's most deadly diseases:
  • 2.5 million people vaccinated against meningitis and more than 10,800 cases treated
  • 1.3 million cases of malaria treated
  • 430,000 measles vaccinations carried out
  • 112,000 people received anti-retroviral therapy (ART) for HIV/AIDS
  • 43,000 people treated for cholera
  • 29,000 people treated for tuberculosis, including 640 for the severest form, MDR-TB (multidrug-resistant tuberculosis)
  • 4,200 treated for Leishmaniasis, a disease which attacks the immune system
  • 1,700 patients treated for Human African Trypanosomiasis, or sleeping sickness
  • 685 people treated for Chagas Year in Review
    Christophe Fornier, President of MSF International, in his essay ‘Year in Review' outlines that in 2007 MSF provided emergency medical and humanitarian assistance to some of the most vulnerable and neglected people in the world. He explains that although MSF works with many displaced and disadvantaged groups wherever there is acute need, our emphasis is increasingly on women and children, as they occupy the majority of our consultations. His observations are summarised below: Women and children
    As well as being exposed to infectious and communicable diseases, women are particularly vulnerable during pregnancy and childbirth and traditionally have less access to healthcare and so are less able to express their concerns. Children, if they survive birth and the first few days of life, are prone to disease, abuse and malnutrition in many countries. We are currently focusing our efforts on addressing some of the main pathologies affecting the morbidity and mortality of these two critical groups, including pneumococcus, rotavirus, measles, meningitis, malaria and HIV. As well as using existing vaccines, treatments and therapies, we are starting to introduce new vaccines such as the conjugate vaccine for meningitis, which will available for use in 2009. Maternal mortality
    During 2007, MSF carried out more than 500,000 antenatal care consultations and almost 100,000 deliveries. However, maternal mortality continues to cause major concern with pregnancy and childbirth accounting for a quarter of female deaths in the majority of the countries we work in. Reaching these women is problematic as few attend clinics for antenatal or postnatal care and even less for delivery, unless there are complications, by which time it may be too late. We are currently looking at ways to increase awareness of care before, during and after birth and exploring the possibilities for extending surgical care to those affected by vesico-vaginal fistulas, one of the most disabling and stigmatising chronic post delivery complications. Family planning
    Increasing access to family planning is another area of focus for MSF. We are looking to reinforce and extend this activity to include post delivery care, nutrition programmes and HIV/AIDS activities so that all women can access these services. Pre-requisites to progress
    Sourcing good quality, affordable medicines remains a priority for MSF. In 2007, the positive outcome of the judicial ruling, regarding the laboratory Novartis challenging the Indian Patent Law, ensured that we could continue considering India as a source of drugs for our patients. MSF has also been involved in discussions at World Health Organisation (WHO) level aimed at changing the way research into essential health needs that affect poorer countries is funded, by de-linking the cost of research and development from the price of a drug. Our access challenge
    Access to civilian victims in areas of conflict remains one of MSF's major challenges. The reality is that we are rarely welcomed by warring governments or factions and our operations are often obstructed and our staff threatened. Both international and national MSF colleagues have been kidnapped, injured or even killed carrying out their duties. We have faced continued difficulties intervening in several conflict areas during 2007, including: Somalia - our work to support people fleeing violence was deliberately targeted resulting in a kidnapping and the murder of three staff. Darfur - convoys were attacked and stocks looted. Ethiopia - repeated attempts to intervene to help displaced local populations were refused. Afghanistan - we left in 2004 after the deaths of five staff but may consider returning to help the most vulnerable. ‘'We will persevere because this is the mandate we have given ourselves but the reality of our working environment means we will never assume that our action, the perception of it and its legitimacy are clearly and universally accepted''. Dr Christophe Fournier, President, MSF International Council. Accountability: An MSF Perspective
    The International Activity Report 2007 also details MSF's efforts to become more accountable as an organisation. As Secretary General of MSF International, Christopher Stokes, points out in his essay, that MSF welcomes the increasing drive to make humanitarian organisations accountable and answerable for their actions. However, he advocates taking a cautious and realistic approach to ensure that any measures introduced are appropriate and relevant to each organisation. MSF mainly sees accountability in terms of assessing the results of our action so that we can improve operations in the future. For example, publishing the results of some of MSF's pioneering malaria and HIV interventions led to some national health priorities and protocols being changed to benefit previously neglected patients. We believe we should be assessed on three key criteria: relevance, effectiveness and efficiency of our actions, as well as their broader impact on society. However, any efforts to be more accountable need to recognise the volatile and insecure contexts in which we work. Engaging in real-time responses to acute needs necessarily involves risk-taking and we need to acknowledge the limits, challenges and dilemmas inherent in our work. Ultimately, we see assessment as an ongoing learning process to change and improve our response. This was acutely demonstrated during the cholera outbreak in Angola in 2006. Several factors contributed to our late response to this emergency and we were only able to carry out curative activities, as opposed to the combination of preventative and curative measures we usually strive for. Despite treating 80 per cent of all cases, amounting to 40,000 people, we carried out a full evaluation of the programme to ensure lessons could be learned for the future. When we intervene...
    This essay outlines why MSF intervenes to save lives and alleviate suffering in countries where one or more of the following events has happened: armed conflict, endemic/epidemic disease, social violence/healthcare exclusion or natural disaster. We recognise the limits in delivering aid and use our experience and judgement to assess whether our presence is required in any situation. Armed conflict - MSF works in health structures and hospitals to cover the range of medical crises inherent in conflict such as malnutrition and mental health problems. Example: During 2007, 90,000 people fleeing from violence in Central Africa Republic received medical and humanitarian aid at a refugee camp in Chad. Endemic/epidemic disease - MSF works with vulnerable populations, particularly women and children, to treat and prevent diseases such as cholera, measles and malaria. We work in collaboration with local governments and authorities to respond quickly to outbreaks. Example: During 2007, 100,000 cases of malaria were treated in Sierra Leone. Social violence/healthcare exclusion - Many groups in society, from ethnic minorities to asylum seekers to people living with HIV/AIDS or TB, are exposed to regular violence or have inadequate access to healthcare. MSF works to alleviate daily suffering with medical, psychological and social activities. Example: During 2007, 400 street children received medical help and support at a centre in Honduras. Natural disasters - Such crises often require an immediate medical and humanitarian response. MSF offers medical support such as surgery, psychological and nutritional programmes and preventative actions to address risks of epidemics. Example: During 2007, we provided 5,110 medical consultations, 43,600 blankets and 22,000 hygiene kits as part of an emergency response to the earthquake that hit West Sumatra, Indonesia. And deciding when to leave...
    The decision to leave or hand over a project is never taken lightly. It is based on a thorough analysis of whether our presence and operations are still required and relevant, and how safe our staff are in any given situation. Ending activities in a country reflects our specific mandate as an emergency medical-humanitarian actor that exists to help the most vulnerable at times of extreme crisis. It acknowledges that our actions and presence are limited and replaceable and are not meant to substitute more permanent solutions. In 2007 MSF closed all programmes in Angola, Benin, Ecuador, Japan, Malaysia and Rwanda. Most under-reported crises of 2007
    While some emergency situations receive significant attention from the media, and subsequently the public, many more examples of conflict, violence and desperate human need go largely unreported or continue long after initial interest has faded. The International Activity Report 2007 highlights last year's ten most under-reported crises and how MSF responded to them. Somalia, Zimbabwe, TB treatments, Ready to use food (RUFs), Sri Lanka, Democratic Republic of Congo, Colombia, Myanmar, Central African Republic, Chechnya Key facts and figures Project locations
    Africa: 67.2%, Asia: 21%, America:7.5%, Europe: 4.3% Context of interventions Stable: 44%, Armed conflict: 29%, Internal instability: 17%, Post conflict: 10% Event triggering intervention
    Armed conflict: 43%, Epidemic, Endemic disease: 34%, Social violence, healthcare exclusion: 15%, Natural disaster: 6% Programme activity highlights
    Total outpatient consultations: 8,447,106
    Total inpatient admissions: 340,689
    Total treated for malaria: 1,201,358
    Total number of HIV patients registered: 166,481
    Total number of measles vaccinations: 429,996
    Total number of meningitis vaccinations: 2,498,241
    Total number treated for TB: 29,000 MSF programme countries
    Armenia, Bangladesh, Belgium, Bolivia, Brazil, Burkino Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, China, Colombia, Democratic Republic of Congo, Ethiopia, France, Georgia, Guatemala, Guinea, Haiti, Honduras, India, Indonesia, Iran, Iraq, Italy, Ivory Coast, Kenya, Kyrgystan, Laos, Lesotho, Liberia, Malawi, Mali, Moldova, Morocco, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Palestinian Territories, Papua New Guinea, Peru, Republic of Congo (Congo Brazzaville), Russian Federation, Rwanda, Sierra Leone, Somalia, South Africa, Sri Lanka, Sudan (including Darfur), Swaziland, Switzerland, Thailand, Turkmenistan, Uganda, Uzbekistan, Yemen, Zambia and Zimbabwe. Key financial figures (in millions, Euros) Income (in millions, Euros)
    Private income: 518.7
    Public institutional: 54.2
    Other income: 19.8
    Total income: 592.7 Expenditure (in millions, Euros)
    Operations: 439.1
    Temoinage: 19.4
    Other humanitarian activities: 9.1
    Total social mission: 467.6
    Fundraising: 76.9
    Management, general and administration: 32.9
    Total expenditure: 577.4
    Surplus: 12.1 Programme expenses by country
    Africa: 72%
    Americas: 7%
    Europe and Middle East: 3%
    Unallocated: 1%