Photo: An MSF vehicle enters the front gate of the MSF trauma hospital in Kunduz, northern Afghanistan, November 29, 2011. Afghanistan 2011 © Michael Goldfarb

MSF Treats Victims of Kunduz Bomb Blast

Five people were dead on arrival and two others died during surgery. Of the 17 people treated by MSF, 11 suffered life-threatening injuries and were in critical condition. Almost all of the patients sustained blast-related injuries including fractures, head trauma, and abdominal and chest injuries requiring specialized trauma surgery.

“People rushed to the hospital after the explosion, seeking information and inquiring about their families and relatives, which is understandable,” said Aurelien Marechal, MSF Field Coordinator in Kunduz. “However, the hospital grounds were crowded, so we had to temporarily close the entrance in order to give space to the medical staff to provide urgent treatment.”

By launching a “multiple casualty plan,” which classifies patients according to the severity of their injuries, the medical team was able to identify and respond to the patients requiring immediate attention.

MSF has been running the surgical hospital in Kunduz since August 2011, providing emergency surgery and follow-up treatment for people wounded in conflict and for those suffering from other life-threatening injuries. A total of 10,000 people were treated in 2012.

In all locations where MSF works in Afghanistan, a strict no-weapons policy is implemented to ensure the safety and security of patients.

“No matter what is going on outside its gates, the hospital needs to remain a safe place for doctors to work and patients to receive lifesaving treatment,” said Marechal.

Photo:A makeshift hospital in Idlib Governorate, destroyed by armed forces at the end of March 2012. Syria 2012 © MSF

In Syria’s Idlib Province, Little Medical Care For Civilians Living Under Intense Bombing

In the north of Syria’s Idlib Province, civilians are terrorized by a strategy of intense and indiscriminate bombing and the wounded face few options for emergency medical care, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

As fighting intensifies north of the road linking Aleppo and Idlib provinces, Syrian government forces are bombing towns and villages indiscriminately, endangering the lives of ordinary people.  An MSF team returned from one northern city in Idlib, which was repeatedly bombed over recent months. The only medical facility still functioning there is a secretly run clinic, staffed by local people and a few Syrian health workers.

“Since we’re prohibited from working on the side of the government forces, we’re not able to take an impartial view of the situation,” said Dr. Mego Terzian, MSF’s emergency operations manager. “But what we’re witnessing is a real strategy of terror, orchestrated by the Syrian government, against the people of this area.”

Photo: Chatuley Hospital in Léogâne. Haiti 2012 © Emilie Régnier

Health Care Lags In Haiti’s Post-Earthquake Rebuilding Efforts

Three years after a massive earthquake battered the island nation of Haiti on January 12, 2010, the Haitian health care system remains mired in a state of devastation. Doctors Without Borders/Médecins Sans Frontières (MSF), which was present in the country before the earthquake and responded with its largest-ever emergency relief effort, continues to manage four hospitals that were built to replace temporary structures the organization set up immediately after the initial disaster, which destroyed most of the existing health structures in the impact zone.

Tens of thousands of Haitians have received free, high-quality health care at these facilities, but it’s unlikely that MSF will be able to hand over the management of these hospitals to Haitian authorities any time soon. “The transition process is much too slow,” says Joan Arnan, MSF’s head of mission in Haiti. “That’s because Haitian institutions are weak, donors have not kept their promises, and the government and the international community have failed to set clear priorities.”

The inadequate response to the recurrent cholera epidemic—the other catastrophe that first struck Haiti in 2010—signifies the delays in the recovery of the country’s health system. For three years now, cholera has struck Haitians in unforgiving waves. In 2012 alone, MSF treated nearly 23,000 cholera victims in cholera treatment centers in Port-au-Prince and Léogâne. The number of cases increased after Hurricanes Isaac and Sandy hit Haiti last fall, causing sewers to overflow and spreading the bacteria that transmit the disease. The case numbers dropped somewhat last month, but MSF was still treating more than 500 cases each week.

There are deep-rooted reasons for this, which have not yet been addressed. “The majority of the population lacks access to drinking water and proper sanitation, but cholera treatment has still not been properly integrated into the few existing public health facilities,” Arnan explains. In Léogâne, for example, approximately 30 kilometers [18 miles] from Port-au-Prince, several humanitarian organizations fighting the epidemic pulled out when they ran out of funding. This led to a rise in the number of patients admitted to MSF’s treatment unit. The thing happened in Port-au-Prince, where MSF cholera treatment centers in the Delmas and Carrefour neighborhoods remain the only possibilities for patients and the number of patients has risen as other actors have closed their doors.

Léogâne, the city closest to the earthquake’s epicenter, was largely destroyed by the quake. Today, it resembles a huge construction zone. Most of the people who survived have found new housing, but the health sector has not rebounded as well. The MSF hospital is the only facility in the region offering free care available around the clock in case of emergency.

MSF arrived in Léogâne just after the earthquake and set up a tent hospital to treat quake survivors. This temporary facility was replaced by a building made of shipping containers, which opened in September 2010. In addition to maternity care, the hospital treats medical emergencies and has a surgical unit. Most of the surgeries performed involve women who require Caesarean sections and victims of road accidents. Staff conducts consultations for pregnant women and children under five years of age in another building.

There are, on average, 600 births each month at the facility, with peaks of more than 800. Other medical facilities regularly refer patients to the MSF hospital for treatments ranging from simple labor and delivery cases to complicated ones that require a Caesarean section and, thus, an operating room that functions 24 hours a day. 

Although MSF’s goal is to handover these activities to the Ministry of Public Health in Léogâne, the hospital is drawing increasing numbers of patients—some from as far away as Port-au-Prince—a clear indication of the profound lack of adequate care available.

“The hospital fills a gap that existed well before the earthquake,” Arnan says. “Most Haitians did not have access to medical care before January 12, 2010, whether this is because of the lack of available services or because they didn’t have enough money. We came in response to the catastrophe and intended to stay until reconstruction could get underway and the public health facilities could take over. Unfortunately, it’s been three years and almost nothing has changed in terms of access to care.”

Thank You, Logistics
US surgeon David Lauter’s final blog post from Central African Republic.

“Our transportation arrangements, including these last minute changes, are the responsibility of the MSF logistics crew. The ‘logs’ keep the entire project running, making sure that the hospital, clinics and the residential compounds have all our supplies, medications, transportation, food, fuel, water, electricity, etc….basically everything. Without the ‘logs’ and other non-medical personnel whose jobs include finance, HR, coordination with local and national governments and coordination with MSF headquarters, I wouldn’t have been able to do a single operation in Paoua this past month.

In the US, I show up everyday counting on finding a working hospital and OR. The same was true in Paoua. Keeping the generator running might not sound as exciting as doing surgery, but both are equally life-saving. The non-medical personnel deserve as much credit as anyone for the medical care provided here. Many people don’t realize how many non-medical people it takes to do what MSF does. Our log chief in Paoua, a 29-year-old American from Arizona, told me he had heard of MSF for a long time before ever applying with them, thinking that they only took on doctors and nurses. This is now his fourth mission with MSF.”

Photo: Ali* was injured when a discarded detonator he found exploded in his face. He was successfully treated at Doctors Without Borders’ Kunduz trauma hospital. Afghanistan 2011 © Michael Goldfarb/MSF

Martin John Jarmin III, Field Surgeon, Afghanistan

“As in any urban area, we see a lot of road accidents and civilian gunshot injuries at the new 70- bed Doctors Without Borders surgical hospital in Kunduz. Yet, while it is relatively safer here these days, remnants of war—like stray bullets or rockets— continue to put people’s lives at risk. 

One day, a family rushed in with their 14-year-old son. Ali* had been playing with friends in a field when they found something they said looked like a battery. It was probably a bomb detonator, because it exploded when they touched the two wires that were sticking out of it. Ali had shrapnel in his face and serious injuries to his hands and arms. He was lucky and will recover. The blast permanently blinded his brother. 

Prior to our arrival in August 2011, the 250,000 people living in Kunduz had no access to adequate trauma care. The Doctors Without Borders trauma center is equipped with an emergency room, two operating theaters, and an intensive care unit. Once word spread that we’re here, more and more people began coming to us for care. Many patients tell us they used to go all the way to Pakistan to get specialized care. 

Since there is not really a good hospital in this part of the country, we are filling a very real need. We always tell people that it doesn’t matter where you came from or who you are, we will treat you.”

More on our work in Afghanistan.

* Patient’s name has been changed.

Haiti Unprepared in the Face of Resurgent Cholera

Cholera cases are on the rise in Haiti following the onset of the rainy season, and the country is not adequately prepared to combat the deadly disease, the international medical humanitarian organization MSF said today.

“Too little has been done in terms of prevention to think that cholera would not surge again in 2012,” said Gaëtan Drossart, MSF head of mission in Haiti. “It is concerning that the health authorities are not better prepared and that they cling to reassuring messages that bear no resemblance to reality. There are many meetings going on between the government, the United Nations and their humanitarian partners, but there are few concrete solutions,” he said.

Photo: Patients affected by cholera receive treatment at an MSF cholera treatment center in Port-au-Prince. Haiti 2011 © Frederik Matte/MSF