Humanitarian Response of Medecins Sans Frontiers in Worldwide Public Health Emergencies Dr N Fan President of MSFHK 14/06/2009

2009 Gaza 2007 Sri Lanka 2008 Sichuan 2008 Cambodia 2005 Kenya

Medecins Sans Frontiers Formed 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 MSF has a clear intent to assist, to provoke change and reveal injustice

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 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 4,134100% Doctor1,11727% Nurse & Paramedical 1,30332% Non-Medical1,71441% Field Position 24,348100% International Staff 1,9948% National Staff 22,35492%

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 War 27/12/ /01/09 – 08/02/09

Office / House MSF Cinic Inflatable Hospital

log Pharmacy Sterilization Nursing Station 12 beds Reception OT 1 OT 2 Water bladder Water bladder M/F Guard Light Logistic stuff Washing Fuel Generator Civil Building

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 Evacuation Health - Hygiene - Food & Clean Water Infra-structure - Communication - Power supply / Electricity - Accessibility

Public Health Emergency Response by 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+ 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 ERWard s kitchen Kitchen Laundry BH C Parking Islol. Water Admin Lab 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

Undermines access to Food Clean drinking water Adequate shelter Sanitary facilities Health services  Risk of epidemics and nutritional problems is much higher  Chronic 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)

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 Funding Finance Control Health Assessment Project Planning Logistic Supply Health Personnel Health Service

Disaster Time Events 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 Rediscovery Of Clinical Sense