This month sees the arrival of the first batches of a brand new vaccine against meningococcal meningitis in three African countries that could revolutionise the battle against a disease that claims so many lives each year in the so-called meningitis belt.

Year after year, Médecins Sans Frontières vaccination teams launch vast reactive campaigns against this bacterial disease that kills up to half of those infected if not treated. Millions have been vaccinated but because the present vaccine is not highly effective, vaccination teams have to return each time a new epidemic threatens.

Now, there may be a brighter future with the arrival of a more effective, longer lasting vaccine. Médecins Sans Frontières is taking part in the first pilot programmes in Niger, Mali and Burkina Faso. Laura McCullagh asks Australian Médecins Sans Frontières Medical Advisor Dr. Cathy Hewison, about the limitations of the current vaccine, the benefits of the new vaccine and her vision of a meningitis-free future in the region.

CH The current vaccine has served a purpose, however it’s not an ideal vaccine. The limits are that the length of its action is very short - protection lasts only up to three years. But its protection goes down with time from the very first year on, especially in small children who are not protected for a long time at all.

LM So what are the benefits of the new vaccine?

CH The big benefit is that the protection can last for 10 years which means that we vaccinate people before epidemics hit. This means that we can actually prevent epidemics. The other benefits are that it is more effective, more people are better protected and with just one vaccination. And an additional major benefit is that it can stop the transmission of the epidemic. The previous vaccine could protect an individual person but couldn’t prevent the transmission of the meningitis epidemic.

LM Does this mean an end to meningitis epidemics in this region then?

CH It could mean an end to epidemics of meningitis in this sero group and that is sero group A. There are other sero groups of meningitis that can trigger epidemics and other bacteria as well and this vaccine will not cover them.

LM How will this affect the activities Médecins Sans Frontières has been involved in with regards to vaccination for meningitis?

CH We will probably be involved now in the prevention of epidemics in terms of vaccinating an entire target population of a geographical region in advance of epidemics instead of running after epidemics wherever they may pop up during the epidemic season. But we should take on board that the roll-out of this new vaccine will take several years so we still have several years of combating the epidemics with the existing vaccines.  

LM What will the next steps be in terms of rolling this out?

CH The first three countries to be targeted are Burkina Faso, Niger and Mali and they will start the vaccination there on a small scale in September this year. Then after the roll-out, those three countries will be fully covered by the end of 2011. For the rest of the countries in the meningitis belt, there’s no plan as such in what order that will go. It will depend on the epidemiological situation in each country and the country readiness for a large immunisation campaign.

LM: What are the finances looking like right now?

CH  For the first three countries about 80 percent of the costs are covered but there’s a still a shortfall of about US$10 million for those first three countries. For the rest of the countries in the meningitis belt, it’s up to each country to find their own finance.

LM Evidently it’s a fantastic medical breakthrough that will have enormous impact on the communities involved?

CH  Yes, it’s going to have a massive impact. Every meningitis season -  which is the dry season going from January to about May -  the countries are on tenterhooks; they don’t know if there will be an epidemic or not. If there is one, it takes up a massive amount of resources, human and medical. And people are scared because both adults and children die of meningitis so it has a major economic as well as psychological impact on people.

LM As a medical doctor, how do you respond to this breakthrough?

CH It’s a miracle, a revolution, and I think that the project that developed this vaccine, tailored to the needs of the meningitis belt in Africa and at a price they could pay, is a breakthrough and should be used as an example for other problems of this sort.

For more information, visit http://www.msfaccess.org/main/vaccines/

On Thursday 26th August, Médecins Sans Frontières was alerted to a brutal attack in a small village 20 kilometres from Mweso.

“At 22:30, 25th August, 8 men entered the village armed with hammers and attacked more than twenty people”, explains Médecins Sans Frontières Medical coordinator Martins Dada, “As soon as we heard the next morning, we immediately drove to the village to provide emergency medical care. Once there, the seriousness of the situation became clear. We quickly took care of the wounded, putting in intra venous (IVs). One of the victims died on the scene. Another person had passed away before we arrived”.

15 people were admitted to the Médecins Sans Frontières hospital in Mweso, 7 of who were in a coma having suffered severe skull fractures and 8 others who were severely wounded. The first patient died on Friday evening: a 15 year old boy. Since then, another patient passed away, while the rest remain in a serious condition, including a pregnant woman. All patients are extremely traumatised.

“We were stitching head injuries all day”, continues Martins Dada, “Everyone is in shock. The villagers are too shattered to speak. One man is totally confused and is constantly terrified, he calls and cries and kicks and beats until we calm him down and he returns to his coma. Then he wakes and relives the entire story again”.

Just days before, Médecins Sans Frontières tended to patients wounded during the burning and looting of a camp for internally displaced persons. “170 shacks burned to the ground, and another 80 homes were looted”, tells Médecins Sans Frontières Mental Health worker Joelle Depeyrot.

Médecins Sans Frontières does not know who the perpetrators of these horrific attacks are, but is shocked by the brutality of the incidents and the ongoing level of violence suffered by the people caught up in the conflict in eastern Congo. Since May 2010, the number of rape victims being treated at Médecins Sans Frontières’ hospital in Mweso has gone up nearly two fold, with more than 40 patients being provided with treatment in August. Likewise, the average case load of victims of physical violence has doubled in August, to more than 20 cases, compared to previous months.   

“Since these incidents, other patients have come to us in a state of agitation and fear”, continues Joelle Depeyrot, “they were not there. But they have lived through other horrific events. And they have heard the stories. They report being scared, scared all the time. They spend their time wondering when they will be tortured and killed”.

Médecins Sans Frontières continues to provide much needed emergency healthcare to people in the places most affected by the conflict in eastern Congo, including emergency assistance, healthcare, treating victims of sexual violence, providing psychosocial care, running vaccination campaigns, and responding to disease outbreaks.

Fleeing Jacobabad, Kashmore, Shikarpur, Shadadkot- more than 500,000 people have arrived to Sukkur- this city of rivers and canals, in the North of Sindh province is now home for those displaced by water. Reportedly, one out of every three people in Sukkur is a newcomer, seeking dry shelter anywhere: empty school buildings, streets, and even old railway lines are full of people who need food, medicine and safe water.

Mohssen Ali, 54, and his family of ten were among the first to settle in a land plot in Sukkur town where Médecins Sans Frontières has distributed tents to 150 families. “It took me years to make a house for my family, and now it’s just a pile of mud.” he said. “The water drove us out of Kashmore so quickly; I couldn’t even get my wife her medicine. She has a chronic heart problem and I don’t know how long she will last without her pills. I can’t even buy food for my children. I’m their father, I have to take care of them, but I can’t. What are we going to do?”

Medical Care on the Move

Improving access to essential healthcare services is one of the priorities of Médecins Sans Frontières teams working in Sukkur today. “The influx of people has stretched the capacity of the 13 hospitals in this area to the limit. At least half of the people being seen in hospitals now are from the displaced population. I’ve seen 3 or 4 patients on the same bed.” recalled nurse Anja Braune, who is in charge of Médecins Sans Frontières medical activities in Sukkur.

To reach those who cannot even get to the health centers, Médecins Sans Frontières teams are now conducting mobile clinics in various locations around the area. Screening for malnutrition is also one of the main components of the mobile clinics. By measuring the middle upper arm circumference (MUAC), health workers are able to identify moderate to severely malnourished children who need extra support, and refer them to the recently opened Médecins Sans Frontières run Intensive Therapeutic Feeding Center ITFC in Railway hospital.

To prevent dehydration, setting up oral rehydration salt (ORS) points is another one of the essential activities of teams working in the area. Established in camps and schools and staffed by two health workers, these sites provide ready rehydrating solution for anyone who needs it. Médecins Sans Frontières nurse Petra Frankuizen is in charge of setting up more than 9 ORS points and training the 15 health workers who all come from Sukkur. “The heat is unbearable, and the water is contaminated.  The combination of the two means that a lot of people, especially children are thirsty and dangerously dehydrated” said Petra.

The poor living conditions, including bad hygiene and sanitation are quickly transforming the schools and makeshift camps into sites where waterborne diseases, like Acute Watery Diarrhea, can flourish. Epidemiologist Todd Swarthout has been working to get a better picture of the health needs of the displaced in Sukkur, “one of the main challenges is the size of the area and the overwhelming number of people” he said, “I’ve visited schools where hundreds are using the same toilet. Cramped spaces, with poor sanitation and too many people is simply a breeding ground for disease”.

Low Quantity, Poor Quality Water

In Sukkur, there are three main treatment plants drawing water from the Indus River, which is the main source of water. However, the river has a very high turbidity- a measure of cloudiness- this means that an efficient filtration system is essential for the water to be useable. Although some people can afford to purchase drinking water from private vendors, for the remaining majority the only water that is available is low in quantity and poor in quality.

For this reason, the provision of safe water is another main priority for Médecins Sans Frontières staff working in Sukkur. Teams have installed two 5000 liters refillable containers in an Internally Displaced People’s camp, as well as put in place a purification system that treats water directly from one of the town’s water plants.

“We are targeting the health structure so that at least sick people are not given the same bad water that made them ill in the first place, ” explained Imran Ali, Médecins Sans Frontières water-sanitation technician.

By putting in place an Assisted Direct Pressure (ADP) filtration system, up to 80,000 liters of safe water is now being provided daily to health structures around Sukkur, but still more needs to be done.

“The situation is very  precarious here, because there is no chlorination happening anywhere.  If there is any contamination that enters the river, it’s going to wind up directly in people’s homes, boreholes and wells, making everybody ill”, he continued.

Nowhere to Go

Clearly, the relief efforts of national and international organizations working in Sukkur must scale up and continue in order to match the various needs of the displaced there.  In a few weeks the schools are due to reopen, which means that most of the people huddled in the, for now, empty school buildings will need to find another place to go.  Children like 12 years old Yasmeen Haj, will bear the consequences of the floods long after the water recedes. “Maybe it is weeks or months from now, but everybody is praying to go home eventually”, she said, “Baba died last year, and we lost our mother in the floods. My brother is only five, so I’m his mother now. We have nowhere to go back to”. 

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Since 1988, Médecins Sans Frontières has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters in KPK, FATA, Balochistan, Sindh, Punjab, and Kashmir.

Since the start of the floods in Pakistan Médecins Sans Frontières has distributed 24,834 non-food item kits and 6,801 tents; performed 27,151 medical consultations; set up 7 Diarrhoea Treatment Centres; continuously conducts 12 mobile clinics; distributes 718,000 litres of clean, safe water per day; built 258 latrines and installed 11 Oral Rehydration Salt points.

152 international staff are working alongside 1,279 Pakistani staff in Médecins Sans Frontières’ existing and flood response programs  in Pakistan.

Médecins Sans Frontières does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations.

Her severely malnourished daughter Suha is currently being treated at Médecins Sans Frontières’ recently established Intensive Therapeutic Feeding Centre (ITFC) in the paediatric ward of Railway Hospital in Sukkur, a town in the North of Sindh province.

The floods still ravaging Pakistan have left people without access to life’s basic necessities like food, water, shelter and basic healthcare. Hundreds of thousands of displaced have recently fled to Sukkur and children like one year old Soha, are among the most vulnerable.

To provide essential nutritional support, Médecins Sans Frontières medical teams have set up an Intensive Therapeutic Feeding centre (ITFC) to treat severely malnourished children. Most of the patients are referred through Médecins Sans Frontières’ mobile clinics in various locations around Sukkur, where a rapid screening test called the Middle Upper Arm Circumference or ‘MUAC’ helps determine the nutritional status of children under the age of five.

“Displacement has only exacerbated existing health problems, and children become malnourished or even severely malnourished due to the lack of food, clean water, and a place to stay,” explained Médecins Sans Frontières Nurse Abdul Wasay, as he proceeded with the morning round, checking on every patient.

The ITFC is run by four doctors; eight nurses and four health educators, and it is open around the clock. The therapeutic feeding programme includes the provision of high calorie nutritious food like fortified milk, ready-to-use food supplements rich in micronutrients and protein and biscuits.

“It is important that the ITFC stays open all day and night”, emphasized nurse Abdul Wassay: “Each child has to be fed every two hours, and we need to be able to monitor their appetite, digestion, and weaning diet closely,” he continued.

In an isolated room, eight year old Kubra’s head rests in her mother’s lap, “We need water, food, and accommodation,” said her mother Noor. “We need everything.” Kubra is isolated from the other patients, because in addition to being malnourished, she also has tuberculosis which is highly contagious.

“The reality is that most of the patients we are treating today were admitted with another associated disease such as acute watery diarrhoea, skin infection, pneumonia or tuberculosis. It is important that they are correctly diagnosed and treated. Our health workers help the mothers understand the treatment process, and raise awareness about nutrition, hygiene and disease prevention measures”, explained nurse Abdul Wasay.

Since it opened on the 28th August, the ITFC has already treated around 100 severely malnourished children.

The floods have left people with little to be optimistic about, but still Nabila is hopeful that her daughter’s condition will improve: “I can’t tell when my daughter will be discharged but I can tell that she is getting better. I am very happy that her diarrhoea has stopped; she is more active and is starting to eat little by little, and I hope she will gain weight soon.”

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Since 1988, Médecins Sans Frontières has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters in KPK, FATA, Balochistan, Sindh, Punjab, and Kashmir.

Since the start of the floods in Pakistan Médecins Sans Frontières has distributed 24,834 non-food item kits and 6,801 tents; performed 27,151 medical consultations; set up 7 Diarrhoea Treatment Centres; continuously conducts 12 mobile clinics; distributes 718,000 litres of clean, safe water per day; built 258 latrines and installed 11 Oral Rehydration Salt points.

152 international staff are working alongside 1,279 Pakistani staff in Médecins Sans Frontières’ existing and flood response programs in Pakistan
Médecins Sans Frontières does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations.

Since the beginning of August, intense fighting has broken out in the northern part of South Kivu province. More than 20 villages have been burned and looted, and more than 25,000 people have been forced to abandon their homes, in fear of their lives, seeking refuge in the towns of Shabunda and Katshungu and in the surrounding bush.

Médecins Sans Frontières teams were already at work in the south Shabunda area, where they had been providing medical care since late-June to 20,000 displaced people. When this second wave of displaced people reached the Katshungu and Shabunda regions in early August, Médecins Sans Frontières was quick to respond, setting up two health centres in Mbangayo and Lupinbi, in the town of Shabunda, and another one close to the hospital in Katshungu. “Since we opened these health centres, our teams have been seeing large numbers of patients every day. They are carrying out around 200 consultations per day in each health centre,” says Patrick Wieland, Médecins Sans Frontières’ head of operations for DRC. “Mainly we are seeing respiratory tract infections, sexually transmitted infections and worms, related to the displaced people’s bad living conditions.”

Cholera has also broken out in the town of Shabunda, due to a lack of clean water and the poor conditions in which the displaced people are living. Médecins Sans Frontières teams responded to the outbreak, which began on 17 August, by immediately setting up a cholera treatment centre in Shabunda’s hospital, where they are seeing more than 30 new patients each day. Up until 29 August, Médecins Sans Frontières teams provided medical care to 290 cholera patients. Two people have died from the disease. Most of the cholera patients are displaced people living with host families in the town, though some come from surrounding areas.

With the number of cholera cases continuing to increase steadily, Médecins Sans Frontières plans to scale up its activities, despite some major challenges. “The biggest challenge that we are facing is logistical,” says Patrick Wieland. “Shabunda is a very isolated area, and the only way to get our staff and medical supplies there is by cargo plane. Because of the cholera outbreak, we have already sent three planes with around 8,200 kg of supplies, and we plan to send one more plane carrying two tons of supplies, and probably a car too.” He adds: ”There are no cars in Shabunda, and the roads are in a very bad condition, so our teams move around on motorbikes or bicycles.”

Médecins Sans Frontières is currently the only humanitarian organisation providing emergency medical care in the Shabunda region. Mostly due to the logistical challenges, humanitarian aid is difficult to reach this isolated area. “The medical needs of the displaced people in the Shabunda area are enormous. More needs to be done to respond to this emergency,” says Patrick Wieland.       

Médecins Sans Frontières provides emergency medical care throughout North and South Kivu, running hospitals, mobile clinics, vaccination campaigns and cholera programmes, and providing treatment and psychosocial care to victims of sexual violence.

Major concerns about waterborne diseases, malnutrition, shelter and clean, safe water prevail as teams rush to establish new bases in Hyderabad and Sukkur in a bid to access flood affected communities on either side of the Indus River. Priorities for Médecins Sans Frontières include water supply, medical care for dehydration, acute watery diarrhoea and distribution of essential non-food items and shelter.

More than a year and a half after the Israeli military operation ‘Cast Lead’ (January 2009), the health situation in the Gaza Strip remains fragile. Despite the opening of crossing points and aid sent by international NGOs, there are still chronic shortages of certain medical supplies and drugs. Some one hundred items remain totally unavailable at the Department of Health’s central pharmacy.

Health consequences of the embargo. Since the war, only one power station remains operational - the lack of adequate fuel supplies, however, means that it cannot run at full capacity and power shortages are a daily occurrence. In health facilities, the running of emergency generators is also affected by the unpredictable fuel entry permits and they are forced, at times, to reduce the healthcare services they provide. Likewise, travel for health workers, patients and ambulances is also difficult… Another health consequence of the embargo is that people have no choice but to use electric generators and low-quality, contraband bottled gas, which are a source of serious domestic accidents.    

Those injured receive treatment in our postoperative care programme (opened in 2007) or in Ministry of Health facilities. Their condition requires reconstructive surgery, but Gaza lacks services of this type. Only two hospitals can provide such treatment: the Al Shifa and Nasser hospitals, as well as a few private clinics and surgeons. Over 500 patients are due to wait between 12 and 18 months for surgery. Médecins Sans Frontières has therefore decided to open a reconstructive surgery project to treat its patients and reduce the Ministry of Health’s waiting list.

In May, a Médecins Sans Frontières team -consisting of Dr. Remy Zilliox, a plastic surgeon who works in the burns unit in Lyon, Dr Mathilde Berthelot, G.P., and Olivier Munnier, a logistics officer specialised in biomedical equipment- led assessments at Nasser Hospital, in order to set up this programme and define the terms of our collaboration with the health authorities in Gaza.

Médecins Sans Frontières will work with part of the hospital surgical team, to which it will add an expatriate surgeon, anaesthetist and theatre nurse. The aim is to share skills, both in surgery and anaesthesia and also postoperative care. Three days a week will be dedicated to surgery, the other two will be devoted to pre-operative examinations and medical monitoring.

Final preparations. Nasser hospital already has most of the necessary equipment. The surgical equipment will be supplied by Médecins Sans Frontières. The Médecins Sans Frontières operating theatre, sterilisation room and laundry room (where we will ensure sterilisation and washing of our surgical materials), have been upgraded and our pharmacy has been supplied with specialised equipment.

In June, the Memorandum of Understanding was signed. Our theatre nurse is on site to supervise the setting up of the programme. The triage of 70 patients on the Médecins Sans Frontières waiting list and their pre-operative examinations are underway. The first surgeries were carried out at the beginning of August.

The articles and commentaries allege anti-Israel sentiment expressed by Médecins Sans Frontières staff and the staff’s refusal to work with their Israeli counterparts. Médecins Sans Frontières has carried out a thorough internal investigation with its team in DRC and has found no basis for the allegations made against it in the various publications.

Any accusation that Médecins Sans Frontières places politics above the best interests of our patients is vehemently rejected.

The fact is that during the intervention in DRC, both the Médecins Sans Frontières and Israeli teams on the ground collaborated extremely well and appreciated each other’s contributions to assist patients. Both medical teams shared - and worked together toward - the common goal of providing the best possible treatment to those most in need. Cooperation continues with the exchange of medical data on the 64 remaining burn patients in our care.

Both Dr. Eyal Winkler, who led the Israeli team from the Sheba Medical Center, and Gila Garaway, who escorted the team, have reassured Médecins Sans Frontières that there was good collaboration and co-operation throughout the five-day intervention and they have rejected any suggestion that this was not the case. Media reports and commentaries alleging otherwise are unfounded and irresponsible.

Médecins Sans Frontières’ humanitarian action is guided by the principles of alleviating the suffering of victims of violence, epidemics, and natural disasters through the provision of impartial and neutral medical assistance that is independent of political, religious, or other interests. All Médecins Sans Frontières staff members are obliged to respect medical ethics and international humanitarian law, as well as to display a general attitude and conduct characterised by neutrality, impartiality, and non-discrimination. Any deviation from these principles by a Médecins Sans Frontières staff member is deemed unacceptable.

Regarding references in some of the coverage to Médecins Sans Frontières’ work in the Palestinian Territories: Médecins Sans Frontières routinely describes publicly the humanitarian impact of hostilities on civilians, as witnessed by our medical teams on the ground. Operating under the rubric of international humanitarian law and the Geneva Conventions, Médecins Sans Frontières pays particular attention in conflict situations to the measures taken by belligerents to spare civilians during the conduct of hostilities.

These principles were the basis for Médecins Sans Frontières speaking out in January 2009 during “Operation Cast Lead,” the Israeli military response to rocket attacks against Israel. Médecins Sans Frontières teams working in Gaza indeed observed a significantly high number of civilians wounded and killed in a very short period of time. Contrary to references in some coverage, however, Médecins Sans Frontières representatives never stated that the consequences of the Israeli military offensive in January 2009 resulted in a greater overall toll than the violence in Sudan’s Darfur region.

Médecins Sans Frontières also has a track record of speaking out when its teams have witnessed civilians injured or killed as a result of internecine Palestinian violence in Gaza, as it did in June 2007, for example.

When working in conflict areas, Médecins Sans Frontières assesses the level of needs and local response capacities on each conflicting side. Israel has a comprehensive and advanced emergency response capability and medical infrastructure. While Médecins Sans Frontières has offered its services within Israel, including during the 2006 conflict between Israel and Hezbollah, to date the organisation’s assistance has not been required there.

FURTHER READING

The floods that first struck Pakistan on 22nd July 2010 and subsequently devastated villages and communities across all provinces of Pakistan are leaving hundreds of thousands displaced and vulnerable. Affected communities and community-based organisations are responding quickly to the crisis. However, the needs are so high, that more than one month after the floods first arrived, too many people have received too little assistance.
 
The response to date has taken place in a highly political environment and has been influenced by national and international political agendas. Some donor countries have openly mobilised support for this crisis based on their own national security interests. US Senator John Kerry has stated that “obviously there is a national security interest” in providing assistance to Pakistan.  

“Humanitarian assistance in any conflict environment must be based on principles of independence and neutrality. Warring parties, governments, and political parties, cannot claim these principles” said Thomas Conan, Médecins Sans Frontières representative in Pakistan. “We therefore do not accept any funds from donor governments for our work in Pakistan and Afghanistan. Our reliance on private funds that are gathered from the general public worldwide ensures that we remain strictly independent from any government or military and allows us to be responsive to the needs that we identify”.

Since the beginning of the crisis, Médecins Sans Frontières has conducted more than 16,664, consultations, delivered over 540,000 litres of clean water per day and distributed 14,675 packages of relief items, in addition to 4,855 tents.

An increase in the emergency response, particularly with regards to safe water and access to health facilities, is what is needed to ensure that those who have been left vulnerable from the floods are able to recover, and to prevent a deterioration of the medical situation. “Considering the conditions people are living in now, in particular the lack of access to safe drinking water and adequate sanitation, the risk of gastroenteritis or waterborne diseases such as cholera is a real concern,” said Dr Ahmed Mukhtar, Médecins Sans Frontières Medical Coordinator in Pakistan. As a result, Médecins Sans Frontières is scaling up its activities in the treatment of diarrhoea by putting in place 6 diarrhoea treatment centres, and focussing on the provision of safe drinking water. However, “more needs to be done” continued Dr Mukhtar, “and it should be done based on these very real medical needs – not political agendas”.

Médecins Sans Frontières is an international medical humanitarian organisation providing emergency medical assistance to people in need, independent of any military or political groups and irrespective of race, religion, ideology, or politics.

Since 1988 Médecins Sans Frontières has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters.

Médecins Sans Frontières volunteers currently conduct medical activities in more than 15 locations in Khyber Pakhtunkhwa, Federally Administered Tribal Areas, Punjab, Balochistan and Sindh provinces. With more than 1,200 national and 100 international staff in Pakistan,  Médecins Sans Frontières is currently  scaling up its rapid response to the flood disaster.

To ensure the independence of our medical work, Médecins Sans Frontières relies solely on private financial donations to fund its activities in Pakistan and does not accept funding from any government, donor agency, nor from any military or politically affiliated group.

For the past 39 years Médecins Sans Frontières medical teams have been providing medical treatment to populations  affected by armed conflict, epidemics, natural catastrophes or a lack of general healthcare in over 60 countries around the world including in Pakistan, Sri Lanka,  Afghanistan, Somalia, Iraq, Colombia, Uganda and Sudan among many others. For more information, visit www.msf.org