Humanitarian Response ofMedecins Sans Frontiers

in WorldwidePublic Health Emergencies

Dr N FanPresident of MSFHK

14/06/2009

2009 Gaza

2007Sri Lanka

2008Sichuan

2008Cambodia

2005Kenya

Medecins Sans FrontiersFormed in 1971 by a group of doctors and journalists after the Biafra war in Nigeria (1 million dead). Providing medical assistance in the name of universal medical ethics to victims of natural or man-made disasters regardless of race, religion, creed or political affiliations while bearing witness. To go where others will not & to be the first in the field.

MSF Charter

Humanitarian act is to seek to relieve suffering, to restore autonomy, to witness to the truth of injustice and to insist on political responsibility

As such humanitarian action is more than simple generosity, simple charity - In addition to cover needs, we aim to enable individuals to regain their rights and dignity as human beings

• MSF provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict; irrespective of race, religion, creed or political convictions.

• MSF observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions.

• Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic, or religious powers.

• As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them

What are the biggest challenges MSF is facing nowadays?

• 無國界記者 Reporters sans frontières

• 無國界工程師 Engineers Without Borders

• 無國界義工 Volunteer Space

• 無國界教育 Education without Frontier

• 網路無國界• 愛心無國界

Top 10 Humanitarian Crises of 20081. HIV/TB co-infections poses health battle on two fronts

2. Iraq - civilians in urgent need of assistance

3. Sudan - No end in sight to violence and suffering

4. North-West Pakistan - Civilians killed and forced to flee as fighting intensifies

5. Ethiopia’s Somalia Region - Critical need of assistance

6. Millions of malnourished children left untreated despite advances in lifesaving nutritional therapies

7. DRC - Civilians trapped in war rages

8. Zimbabwe - Health crisis sweeps as violence and economic collapse spread

9. Myanmar - Beyond the international spotlight critical health needs remain unmet

10.Somalia - humanitarian catastrophe worsens

International

Departure

4,134 100%

Doctor 1,117 27%

Nurse & Paramedical

1,303 32%

Non-Medical 1,714 41%

Field Position

24,348 100%

International Staff

1,994 8%

National

Staff

22,354 92%

Gaza Mission 2009(18/01/09 – 08/02/09)

Dr Ning, Fan

11/02/09

aza Today

al-Shifa - “the cure”

The largest hospital in Gaza strip– Internal medicine (100 beds)– Pediatrics (70 beds)– Surgery (50 beds)– Ophthalmology (20 beds)– Gynecology (10 beds)

Physical, psychological and economic isolation

Military actions

Socioeconomic decline

Palestinian internal political fragmentation

Health decline

Gaza War27/12/2008

18/01/09 – 08/02/09

Office / House

MSF Cinic

Inflatable Hospital

log

Pharm

acy

Sterilization

NursingStation

12 beds

Reception

OT 1

OT 2

WaterbladderWater

bladder

M/F

Guard

Light

Logistic stuff

Washing

Fuel

Generator CivilBuilding

Disasters

Public Health Emergencies

How do you feel?

What’s the first thing you are going to do?

Public Health Emergency Response

Whitehead & Dahlgren 1991

• Shelter• Food & Clean Water• Hygiene• Medical Service Provision

– Physical• Acute• Chronic

– Psychological• Stress• Depression

A medical team, which composes of one surgeon, one physician, 3 nurses,will arrive 2 days later

Security - Personnel safety - Working environment - Shelter

EvacuationHealth - Hygiene - Food & Clean Water

Infra-structure - Communication - Power supply / Electricity - Accessibility

Public Health Emergency Responseby MSF

• Fast action• Flexibility• Professionalism

• Advocacy

Whitehead & Dahlgren 1991

• 50% of the world’s population lives on less than US$2 / day (2007)

Health Equity• 2 / 100,000 Tanzania• 170 / 100,000 H.K.• 256 / 100,000 U.S.

Disaster Time Events

0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+

0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+

Deaths and Burial

Epidemics. If Any

Chronic Illness and Other Injuries

Serious Injuries Treated

Number of Homeless

SAR & FA

Evacuation

Local Services and Response

Need Assessment by local authority

Deaths

Shelter Long term Care

Need Assessment

Emergency response

Field hospital

Mobile Hospital

Staff

Stores

OT

ER Wards

kitchen

Kitchen

Laundry

BHC

Parking

Islol.

Water

AdminLab

Xray

Enter.

Cars

Refugees

Disaster Medical Response

• Search & Rescue (SAR)

• Triage & initial stabilization

• Definitive medical care

• Evacuation Medics could not work alone• Security & crowd control• Firemen• Specialty SAR team• Transport• Communication

Essence of Medical Service Planning

Authorities

Flow

Topography Ownership

Expandability

Access

Security

Site Selection

Undermines access to• Food • Clean drinking water• Adequate shelter• Sanitary facilities• Health services

Risk of epidemics and nutritional problems is much higherChronic health diseases care

Primary Health Surgical Problems

Injuries

Earthquake Tsunami War

Temoinage / Advocacy

• In an ideal world, volunteer outreach pursuits would consist of true partnerships working toward sustainable solutions to identified problems, which ultimately would obviate the need for the volunteer effort.

• In the real world, of course, political, social, economic, religious, and practical issues intervene

– Kathleen M. Casey. Global Impact of Surgical Volunteerism. Surgical Clinic NA 87 (2007) 949-960

Disaster is Nothing but… .

• Disaster is not remote

• Disaster is medic & non-medical

• Variation in nature but there is a formula in medical response

Disaster Medical Response

• Shelter• Food & Clean Water• Hygiene• Medical Service Provision

– Physical Health• Acute• Chronic

– Psychological• Stress• Depression

Communication•Authority•Public•Beneficiaries

FundingFinance Control

HealthAssessment

ProjectPlanning

LogisticSupply

HealthPersonnel

Health Service

Disaster Time Events

0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+

0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+

Deaths and Burial

Epidemics. If Any

Chronic Illness and Other Injuries

Serious Injuries Treated

Number of Homeless

Long term Care

SAR & FA

Evacuation

Local Services and Response

Need Assessment by local authority

Deaths

Shelter

Need Assessment

Emergency response

We don’t need Heroes

We want Professionals

Mutual respect

Mutual expectation

Resource management

Stress & Risk

Management

Cultural sensitivity

Working with beneficiaries

Medical Diplomacy

RediscoveryOf

Clinical Sense