MSF is ending its commitment to support the multidrug-resistant tuberculosis (MDR-TB) programme in the penitentiary system in the self-proclaimed Donetsk People’s Republic (DPR) after its accreditation was cancelled on 19 October 2015.
The decision of the Humanitarian Committee of the self-proclaimed DPR authorities is leaving 146 patients without life-saving MDR-TB treatment and under those conditions MSF can no longer commit to resuming activities in the penitentiary facility Colony 3 where it had been working since 2011. However, MSF remains committed to resuming all the other activities in the area that were stopped after the withdrawal of its accreditation. Needs remain significant for patients suffering from chronic diseases such as diabetes, cardiac pathologies or kidney failure. It is essential for MSF to resume its work in the area to provide medical assistance to the patients in need.
"We very much regret that we had to take the decision to stop our commitment to support the MDR-TB programme", says Gabriela Das, MSF medical coordinator in Ukraine, "but the uncertain working conditions MSF was faced with in the last couple of months do not allow us to wait and hope for the chance of a continuation of the programme. From a medical and ethical point of view it is irresponsible to run a TB programme that is frequently interrupted. If patients cannot take their drugs for some time and do not get the necessary support for this burdensome and long treatment, that creates more drug resistance which is dangerous for the patient as well as posing a danger to public health." MSF is therefore stopping its negotiations with the authorities to resume activities in the penitentiary system of the self-proclaimed DPR.
In 2011, MSF started working in Donetsk in cooperation with the local authorities, providing access to treatment for patients with MDR-TB in the penitentiary system. Over the course of five years, 756 patients were enrolled, with 146 under treatment by the time of ending our activities.
Scientific data indicates that there seems to be a correlation between the success of the treatment and the number of times the patient interrupts and re-initiates treatment. It was observed that the possibility of the patients being cured decreases significantly in direct relation to the number of times that the patient stops and restarts treatment. Moreover, there are significant public health concerns as the interruption of treatment is directly linked with increasing resistance of the TB bacteria to first- and second-line TB drugs.
MSF would only restart its activities under the following conditions: uninterrupted access for at least two years allowing patients currently in the programme to finish their treatment; the continued presence of MSF national and international teams on the ground during this period to ensure direct support for the patients, assuring that the quality standards are met; and the commitment of the authorities to ensure that MSF can dispatch all necessary supplies for the functioning of the programme without intermediary chains and interferences from external actors not involved in the TB programme.
On 19 October, MSF received written notification from the Humanitarian Committee that its accreditation in the self-proclaimed DPR had been withdrawn and to immediately stop activities. The organisation was not provided with a reason for this decision. "We have spent the last weeks trying to find an agreement to resume our activities for the health of our patients, including our patients suffering from MDR-TB, but it is now already too late for our TB programme. However we remain committed to resume all our other activities as soon as possible for the health of the people in the area", adds Gabriela Das.
MSF continues to urge the DPR Humanitarian Committee to reconsider the decision of withdrawing the accreditation of the organisation without delay in order that we can resume providing much-needed healthcare. MSF is one of the few organisations providing, among other essential medicines, insulin for diabetic patients and haemodialysis to treat kidney failure. Since the beginning of the conflict in May 2014, MSF has donated medication and material to 170 medical facilities to treat war-wounded and patients with chronic diseases. MSF has also conducted more than 85,000 consultations together with the local healthcare authorities through 40 mobile clinics since March 2015, providing healthcare to people living in places from where doctors and nurses have fled or where pharmacies are empty.