Présentation en anglais de Médecins sans Frontières.
par Vinciane Vuilleumier
Une présentation de l’ONG Médecins Sans Frontières, ses objectifs, ses méthodes, ses volontaires, ainsi qu’une petite analyse de ses résultats en terme de développement durable, autour du thème du SIDA.
Description of the NGO
The organization is known in most of the world by its French name, Médecins Sans Frontières (MSF), but in the English world (United States, Canada, Australia and Ireland) the name ’Doctors Without Borders’ is often used instead.
MSF is an international humanitarian aid organization that provides emergency medical relief to victims of war, disasters, epidemics and other catastrophes in more than 70 countries around the world. ?
It strives to provide assistance to those who need it most, regardless of ethnic origin, religion or political affiliation.
It was funded in 1971 by a group of French doctors who had worked as volunteers during the Nigerian Civil War (also called the Biafra Secession). They believed that the needs of the people supersede respect for national, religious or political borders and they wanted to emphasize the importance of victims’ rights over neutrality.
MSF has an associative structure, where operational decisions are made by 5 operational centres, in an almost independant way. These centres are situated in Amsterdam, Barcelona, Brussels, Geneva and Paris.
Common policies on core issues are coordinated by the International Council, in which each of the 19 national offices is represented. The Council meets in Geneva, Switzerland, since it is the location of the International Office, which coordinates international activities common to the operational centres.
The teams of MSF include a variety of specialized workers, such as medical professionals, logistical experts, water and sanitation engineers and administrators.
Number of volunteers
Each year about 2,000 doctors, nurses, logistics specialists and engineers of all nationalities leave on field assignments to join around 23,000 local staff in the countries of assistance. There are also hundreds of volunteers who work in the offices of MSF worldwide.
It relies on private individuals for the majority of its funding, in order to remain independent from any political or economic power.
Private donors provide about 80% of the organization’s funding, while governmental and corporate donations provide the rest, giving MSF an annual budget of approximately USD 400 million.
Objectives and way to proceed
In emergencies and their aftermath, MSF provides essential health care, rehabilitates and runs hospitals and clinics, performs surgery, battles epidemics, carries out vaccination campaigns, operates feeding centers for malnourished children, and offers mental health care. When needed, MSF also constructs wells and dispenses clean drinking water, and provides shelter materials like blankets and plastic sheeting. 
First of all, the description of a field mission team is needed.
It usually consists of a group of coordinators and a head of mission. Each coordinator has his own specific task. For example, there are physicians, surgeons, logistical experts, administrators or engineers.
The head of mission is like the « leader » of the team, and usually is the one who has the most experience in humanitarian situations. His job is to deal with the media, national governments and other humanitarian organisations.
These volunteers do not only operate the medical or nutrition components of the mission, but they are also in charge of the local medical staff and they provide training for them, in order to increase the number of skilled people in the country.
Besides the medical staff, the team also includes logisticians, who are practically the most important members, since they are responsible for providing everything that the team needs, from security and vehicle maintenance to food, water or electricity supplies. In addition to this, they help with setting up treatment centres and supervising local staff as well.
Before MSF sets up a field mission in a country, it sends an indicator team to visit the area, so as to determine the nature of the emergency, to evaluate the level of safety and to conclude what type of support is needed.
Through longer-term programs, MSF treats patients with infectious diseases such as tuberculosis, sleeping sickness, and HIV/AIDS, and provides medical and psychological care to marginalized groups such as street children. 
The objectives of MSF is providing emergency aid as well as long term development missions. Its sphere of action being very wide, we have decided to divide their actions into five categories.
1) Generally, they provide emergency aid to people affected by natural disasters or conflicts. In these situations, the medical structures of the regions are often destroyed or insufficient to help the population, thus the first task of MSF is to set up dispensaries or hospitals to admit the victims and to provide medical care to them. In this kind of situation, where the living conditions are very bad, MSF often has to face other issues such as endemic desease (cholera or measles). To prevent the spread of such water-borne deseases, MSF water engineers and volunteers must create a source of clean water. This is usually achieved by modifying an existing water well, by digging a new well and/or starting a water treatment project to obtain clean water for a population.
Hygiene and sanitation project include as well education of local medical staff in proper sterilisation techniques, wastewater treatment projects, proper waste disposal, and education of the population in personal hygiene. Water sanitation is the best way to prevent the spread of deseases such as cholera. ?The last point is the most important one : besides medical assistance, ?MSF works on providing psychological support, since the people they are assisting are having a nightmare experience.
2) Another action of MSF is to provide AIDS testing and anti-retroviral treatments in many African countries, which present the highest rate of AIDS victims. However, only 4% of African affected with AIDS has access to this treatment, thus MSF’s other preoccupation is to urge government and companies to decrease costs and increase availability. Moreover, MSF strives to educate people on how to slow transmission of this desease.
MSF volunteers frequently work in the most remote or dangerous parts of the world. 
3) Malnutrition is a major preoccupation for MSF. It operates nutritional rehabilitation centres in the countries affected (mostly in Africa) and provides the population with special ready-to-use food enriched in nutriments. In addition to this, they carry out consultations for sick children in health centres. They focus on the children under five years, since they are the most affected by malnutrition. In case of severe malnutrition, the children are admitted in the feeding centres, otherwise MSF prefers to supply mothers with food and let them care for their babies, as it produces good results.
4) Furthermore, it funds research into the development of drugs for neglected diseases, such as sleeping sickness, visceral leishmaniasis and Chagas disease.
In 2003 and in association with five public-sector research organizations (Kenya Medical Research Institute, Indian Council of Medical Research, Malaysian Ministry of Health, Oswaldo Cruz Foundation in Brazil, and France’s Institut Pasteur) MSF created Drugs for Neglected Diseases initiative (DNDi), which is an organization whose objective is to develop treatment for tropical deseases.
5) Besides its medical assistance, MSF provides education to people (see AIDS) and above all, medical training to the local staff, which is an essential task to increase the capacities of the country’s health care system and the number of skilled personnel.
This is part of MSF’s main objective, which is increasing the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff.
In other words, they aim to rebuilde health structures to acceptable levels.
In addition to its medical assistance, MSF seeks to raise awareness of crisis situations.
It acts as a witness and speaks out about the plight of populations in danger for whom it works. Whenever possible, MSF volunteers give interviews and make presentations. Their aim is to make people aware of what is happening and to appeal to the generosity of the public, in order to raise funds to be able to help at best.
Worldwide, MSF raises public awareness of the plight of people at risk. The organization sends field volunteers and staff to speak at international and national conferences, and arranges informational events and traveling exhibitions. Special public education projects have addressed the stark realities of living without access to medicines, the devastation caused by malnutrition, and the hardships of life in a refugee camp. 
In order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, MSF collects data on a number of factors during each field mission. The rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres. Various types of mortality rates are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries. By compiling data on the frequency of diseases in hospitals, MSF can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs.
In addition to epidemiology surveys, MSF also uses surveys of populations to determine the rates of violence in various regions.
By estimating the scopes of massacres, and determining the rate of kidnappings, rapes, and killings, they are able to implement psychosocial programmes to lower the suicide rate and increase the sense of security in a population. Large-scale forced migrations, excessive civilian casualties and massacres can be quantified using surveys, and MSF can use the results to put pressure on governments to provide help, or even expose genocide.
It is an essential part of MSF’s work to address any violations of basic human rights encountered by field teams, violations perpetrated or sustained by political actors. It does so by confronting the responsible actors themselves, by putting pressure on them through mobilisation of the international community and by issuing information publicly (such as the surveys mentioned above).
In order to prevent compromise or manipulation of MSF’s relief activities, MSF maintains neutrality and independance from individual governments or political/religious powers.
Dangers faced by volunteers
It happens that MSF volunteers are injured or killed by stray bullets and mines and of course they face a high risk of death in regions affected by epidemic disease.
In addition to those risks, MSF volunteers are sometimes attacked or kidnapped for political reasons. In some countries afflicted by civil war where humanitarian aid organisations have set up missions exclusively for victims on one side of the conflict, they may be viewed as helping the enemy and attacked for this reason. Arrests and abductions in politically unstable regions can also occur.
Interests in the activities
After talking about the dangers they face, we could wonder why they keep going on mission while they are aware that they might be killed or held hostage in very bad conditions. We think that the answer is quite obvious, as it is likely to be the same for any volunteer working for an humanitarian NGO : the interest is that they participate actively in the improvment of the global situation of the world. They offer their time and energy to help the people in need, to save children, to assist and give love to people left alone in their sufferings. We think that volunteers find hapiness in this kind of activity, because they use their altruism and compassion to put them at the disposal of a great and worthy cause. The interest is also to get out of our golden European cocoon and to realize what is it really like to face up to life and its torments. A humanitarian mission makes you aware of what is essential and what is not : it helps to open the eyes and to give up selfishness and vanity.
Analysis of results in terms of providing long term development
We decided to focus on one important action of MSF : AIDS.
Presentation of the AIDS issue
Since the emergence of AIDS in the early 1980s, it has become a pandemic affecting every country in the world. By end of 1999, more than 33 million people worldwide were living with HIV.
Some 95 % of HIV-infected persons live in developing countries, which are those least able to cope with the medical, social and economic consequences of the disease. The 21 countries with the highest HIV prevalence in the world are all in Africa, and in at least 10 of them the rate exceeds 10 percent of the population. Over 11-million people have died in Africa from AIDS since the first outbreak in the mid-1980’s.
Difficult access to anti-retroviral treatment
In developed countries AIDS patients have access to a range of specific antiviral drugs such as AZT that have been shown to prolong life and even postpone the transition from dormant HIV infection to full-blown AIDS.
In developing countries, however, where 95 per cent of HIV-positive persons are living, these drugs are not easily available because of their extremely high cost.
Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa and signatory of the declaration states :
The push for access to Anti-Retroviral treatment has greater momentum than ever before. For many it will mean the difference, literally, between life and death. However, if it is not free then the poor…will not benefit.
Of the 5.5 million HIV-positive people in need of treatment globally only 440,000 are receiving it. In Africa, not more than 4% of people living with HIV/AIDS are on ARV treatment. Despite decreasing market prices of the drugs, many people who have AIDS in developing countries are dying because they cannot afford the user fees asked for treatment.
The ways that HIV can be transmitted are well known and thus prevention should be simple. The difficulty, however, lies in convincing communities and individuals to apply the knowledge that is available.
The various methods used in MSF projects include :
culturally appropriate health education programmes about safe sex
educating community "gatekeepers" (that is, persons of influence whose example and precepts are likely to be followed. Such people include tribal chiefs, traditional birth attendants, school teachers, and cultural leaders such as musicians)
support of "Anti-AIDS clubs" which spread education messages
distribution of condoms or support of social marketing projects
logistic, technical and financial support of local community organisations engaged in AIDS education
education projects for commercial sex workers
treatment programmes for sexually transmitted diseases (STDs) - as it has been shown that the inflammation associated with STDs makes it easier for HIV to enter the body
ensuring that local health services do not contribute to the spread of HIV. This means educating national health workers on proper techniques of sterilisation and waste disposal and on the desirability of avoiding injectable treatments wherever possible. MSF also provides the needed equipment and supplies to ensure that immunisations, surgical procedures and blood transfusion can be carried out safely
advocacy on behalf of AIDS suffers to ensure that they can be cared for in their communities without shame or discrimination. This promotes a rational community attitude and allows prevention messages to be spread without the obstacles of fear and denial.
Gorik Ooms of Médecins Sans Frontières :
Patient fees often make it impossible to reach those who need treatment most. The families that are most affected by AIDS in many cases lose their income from labour and can simply not afford to pay for treatment. Where AIDS care is provided in clinics that are sponsored by international donors but require patients to pay part of the cost, patients that can no longer afford tests or drugs, will drop out. Some turn to our clinics where care is free, but MSF can only provide a temporary solution for a limited number of people.
MSF has provided HIV/AIDS care and ART to more than 140,000 people in approximately 30 countries. MSF treated its first patients with ART in 2000.
As a result of widespread public pressure and an eventual worldwide mobilisation of resources, HIV/AIDS care, treatment, and prevention programmes have expanded massively. Since 2000, enormous resources have been mobilised globally to address the HIV/AIDS crisis on a large scale.
The good news is that four million HIV-positive people are alive on antiretroviral therapy (ART). The scale-up of ART in developing countries has allowed individuals to live longer and enjoy a better quality of life, leading to a restoration of dignity and autonomy, and an ability to contribute to family and societal life. In some countries, ART coverage has resulted in a decline in overall mortality and other population-level impacts.
But despite scale-up successes, today at least six million HIV-positive people still need to start ART but do not have access to it.
Spotlight on Malawi
Malawi is a densely populated, mostly rural country with a population of over 13 million people. The government estimates between 800,000 and one million Malawians are HIV positive, including at least 100,000 children under 15 years of age. The national HIV prevalence is 12%.
MSF works with the Ministry of Health in two districts in Malawi, Chiradzulu and Thyolo, to provide compre- hensive HIV/AIDS services and ART in 26 health centres and three hospitals.
According to government statistics, there were more than 164,000 people alive on ART by the end of June 2009 with 18,000 people initiated on treatment between April and June 2009. Since the scale-up of ART, the country has seen a significant reduction in HIV/AIDS-related deaths between 2003 and 2008.
Moreover, in Thyolo, universal access (80% of need) was reached and has been