médecins du monde

Transcription

médecins du monde

04
MÉDECINS DU MONDE
A N N U A L
R E P O R T
2 0 0 4
02/03
…foreigners are less interested
in seeking help in the name of
the principle of universality, than
in meeting on the basis of the
principle of diversity.
”
Serge BACQUE, volunteer in the field
“Praise from the frontier”,
from “Sud/Nord – Folies et cultures” Magazine nº17 :
Humanitarian, humanitarianism
,,
> Composition of Board of Directors and Executive
Committee of Médecins du Monde
General Assembly and Board Meeting held on 8-9 May 2004
President
>
Dr Françoise JEANSON,
Deputy Treasurer
>
Dr Pierre MICHELETTI,
General Practitioner, Bordeaux
Public Health Officer, Grenoble
Vice-Presidents
International Projects Representative
(reporting to President)
>
Dr Olivier BERNARD,
Paediatrician, Marseille
>
Dr Patrick DAVID,
>
Joseph DATO,
>
Dr Bernard JUAN,
Company Director, Montpellier
Deputy General Secretary
>
Dr Frédérique DROGOUL,
Psychiatrist, Paris
Treasurer
>
Pierre KEMPF,
Deputy Hospital Administrator, Vichy
>
Dr Arnaud BOURDÉ,
Anaesthetist-Resuscitator,
Saint-Denis de la Réunion
>
Dr Laurence BOURGEOIS-GENET,
Nurse, Grenoble
Hospital Doctor, Château-Thierry
Sitting Members of the
Board of Directors
General Practitioner, Paris
Anaesthetist-Resuscitator, Reims
General Secretary
Deputy Members of the Board of
Directors, following Board Meeting
of 9 May 2004
>
Dr Thierry BRIGAUD,
General Practitioner, Paris
>
Dr Didier CANNET,
General Practitioner, Beaune
>
Dr Pascale ESTECAHANDY,
Hospital Doctor, Toulouse
>
Dr Régis GARRIGUE,
A&E Doctor, Lille
>
Dr Fabrice GIRAUX,
Honorary Presidents
>
Dr Bernard GRANJON,
Gastroenterologist, Marseille
>
Dr Jacky MAMOU,
Paediatrician, Paris
>
Dr Claude MONCORGÉ,
Anaesthetist-Resuscitator, Paris
04/05
> Table of Contents
03
04
06
WELCOME
COMPOSITION OF BOARD OF DIRECTORS
ACKNOWLEDGEMENTS
THE POLITICAL POSITION
07
OUR AIM
17
2004 IN FIGURES
TESTIMONIES
19
MÉDECINS DU MONDE IN PICTURES
PROJECTS
35
36
37
104
104
105
107
116
ATLAS OF INTERNATIONAL PROJECTS
Map of international projects
Country files
ATLAS OF FRENCH PROJECTS
Map of French projects
Introduction to French projects
Project files
Contacts
PROJECT SUPPORT
119
MdM MOBILISATION
129
130
133
THE REPRESENTATION NETWORK
REGIONAL OFFICES
INTERNATIONAL OFFICES
OPERATIONS
145
146
148
149
150
152
154
ORGANISATION
Association life
Departmental news
The Médecins du Monde international network
Sister associations and local partners
Médecins du Monde and civil society in France
Médecins du Monde International institutions
> Our thanks to:
Our private partners: A13, A2P and Associates, AIDS Fund, Aiguillon, Aladin, Alerion, Antin Résidence, APJC, Arche Promotion Groupe Arcade, Architect Xavier Bonnet,
Assurances Medic Alès, Au Coin du Feu, Aventis Pharma France, Avoda, Axalto Internationale SAS, Beat SA, Beaulieu Sports, Begon Bonneau, Herbert Bouchard SCP,
Beninvest, BHV, Bois Energie, Bretagne Enchères, Bristol Myers Squill, Busquets France, CA Winds & Hope, Capa Télévision, Carrefour DMG, Cars Berthelet, Carte et Services,
Centre Hospitalier de Châteauroux, CGMI, Charpentiers Travaux Publics, Club Avantages, Cofiroute, Colombo New Scal, Compte Correspondant Société, Comptoir des
Voyages, Computa Center, Concert Kantaldia, Consort Netcom, Construction Mécanique de l'Isère, Crédit Coopératif (and its employees), Daimler Chrysler, De la rue Cash
System, Decobat, Desmarez SA, DHL, Diager SA, Distri Club Medical, Divers et Imprévus, Eberle SA, Éditions Calmann Levy, Éditions du Seuil, Éditions Ivoires, Éditions SAEP,
Elton John Aids Foundation, Eric Bompard, Euler Hermes SFAC, Euro Information Service, Eurofeu SA, Factum Finance, Favona SA, Finaler Finance, Fondation Accenture,
Fondation Bois Brillou, Fondation Club Méditerranée, Fondation de France, Fondation de Lille, Fondation du Roi Baudouin, Fondation Florindon, Fondation GlaxoSmithKline,
Fondation Marc, Fondation Masse, Fondation Mategna Stiftung, Fondation Materra, Fondation Niarchos, Fondation Rissho Koseikai Ichijiki Heiwa Kikin, Fondation Roux,
Fondation Sancta Devota, Fondation Seviajer, Fondation Tzu Chi, Forhum, Forum Central Lille, Fracaro France, France Abonnement Entreprise, Friedrich Heilbronn Fiszer, Gérard
Rondeau, Geste, Go Voyages, Goelland Production, Grands Moulins de Strasbourg, Groupe Arcade, Groupe Impact Immo, Groupe Mornay, Groupe SNPE, Hammerson France,
Hilti, HLM France Loire, Hospices de Beaune, Hostellerie du Moulin Fouret, Hydrosystem, IFCIC, Intermed Exportation, Isica, J.P. Chaussures, J’Tkindt, Jean-Pierre Gillard, JM
Bruneau, JY Exploitation, Kahn & Associates, Keyrus, L’acoustic, La Boutik, Laboratoire Lilly France, Laboratoires Boehringer France, Le Coin du Feu, Le Pin Parasol, Leo
Pharma, L'esprit de sel, Liliane Laurence Aubry (Artist & Painter), Lions Club, LogicaCMG SAS, Lowendal Group, Macif, Magelfo Management, Marc Orian, Marsh, Matmut,
Mecaplus, Mes Éclairages, Michel Baudvin, Microsoft, Mondial Assistance, Morriss, Myriad, New Deal HCB, New Deal Trade International, Oddo, Olives Arnaud, Opéra de Paris,
Optimege, Ouest Affiche, Pac List, PC Soft, Pierson Meunier Export, Prima Solutions, Procter & Gamble, Production La Prade, Reuters, Rotary Club, RS Com SA, SACD, SAFI,
Sagone SA, Salustro, Samurge, Saveurs de France Brossard, Sebac, See Velado, Selection from Reader’s Digest, SFR, Smith and Nephew SAS, Société Centrale de Crédit
Immobilier, Société Fermod, Sodang SA Centre Edouard Leclerc, Sonia Rykiel, Sopag Maine Parking, Suzuki France, Talent, Taxis de Sorel Moussel, TBWA, TBWA France,
Techni Alarm, Tele2 France, TF1, Techno System SAS, Théâtre de la Michodière, Théâtre de la tête noire, T-Online France, Total’s former expatriate workers in Indonesia, TV5
Monde, UBS, UFG, UJARF, ULIF, UNIM, Vinci, Vivendi Universal, Voyageurs du Monde, Wargny Katz, Wegner DM, Weinman Technologies, Western Union, Yann Arthus-Bertrand.
Works council: Caisse d’Epargne Haute Normandie et d’Ile-de-France, CPAM de Sélestat et du Cantal, Crédit Agricole Centre, Crédit Coopératif, Crédit Foncier de France, Euler
Hermes, Galeries Lafayette, Fresenius Kabi France, Interdis Groupe Carrefour, Natexis Banques Populaires, Prolabo, PTC Nestlé, Temsys, SCOR, SFAC, UES CCF, Vivendi
Universal.
Public partners: For our international projects: Académie de Lille, Administration of Property for Protected Adults, Aurillac Basin Urban Area Community, Canadian Agency
for International Development (ACDI), Center for Disease Control and Prevention, Chaîne du Bonheur (Switzerland), Cities United Against Poverty, Columbia University, Cordaid,
Department For International Development, Directorate for Development and Co-operation, Dutch Ministry for Co-operation in Development, ECHO, EuropeAid, General Council
of Gironde, General Council of Charente-Maritime, General Council of Les Vosges, General Council of Doubs, Global Fund to fight AIDS, Tuberculosis & Malaria, IOM, Joint United
Nations Programme on HIV/AIDS, Ministries of Foreign Affairs of Germany, France & Japan, PACA Region, PACT, Population Services International, Rhône-Alpes Region, Rouen
Chamber of Commerce and Industry, SAFER of Île-de-France, UNDP, UNFPA, UNICEF, UNOCHA, United Nations Office on Drugs and Crime, USAID, World Bank.
Town Councils of: Aigremont, Behren-lès-Forbach, Bonnelles, Bourg-lès-Valences, Drancy, Goussainville, Le Croisty, Paray-Vieille-Poste, Petrosella, Ville de Paris, Paris 17ème,
Saint-Jean-de-Gonville, Saint-Esteve, Sucy-en-Brie, Val-d’Isère.
From our regional international projects:General Councils of: Alpes-de-Haute-Provence, Bouches-du-Rhône, Gironde, Guadeloupe Regional Prefecture, PACA, the PACA territorial collectives, Presidency of the Regions, Toulouse City Council.
From our French projects:The Army, Communal Social Action Centres (CCAS), Department of Health (DGS), Employment and Professional Training Boards (DDTEFP), Family
Benefit Offices (CAF), French Monitoring Centre for Drugs and Drug Addiction (OFDT), General Councils, General Social Action Board (DGAS), Health Cover Regional Offices
(CRAM), Health Insurance Office (CPAM), Information and Education (FNPEIS), Inter-Ministerial Committee for the Fight against Drugs and Drug Addiction (MILDT), Ministries,
National Fund for Health Prevention, National Health Prevention Fund, National Office for Waged Workers’ Health Cover (CNAM), Prefectures, Regional and Departmental Boards
for Health and Social Affairs (DRASS & DDASS), Regional Health Offices (CMR), Town Councils, Town Inter-Ministerial Delegation (DIV), Regional Union of Health Assurance Funds
(URCAM).
Our associate partners: Abbaye de Pradines, Admical, Alerte Collective, Amnesty International, Association for Communication and Action for Access to Treatment,
Association (French) for Harm Reduction, Association for Self-Support and Harm Reduction for Drug Users, Association of French Regions, ATD Quart Monde, Bam victims support collective, Brittany Football League (and the Brittany Clubs), Committee of Friends of Emmaüs, Congregation of the Augustinian Sisters, CSF, DAL, DHL Liens, Emmaüs,
Entraide Majolane, Federation of Associations for Promotion and Integration via Accommodation (FAPIL), French Co-ordination for the Right to Asylum, Gisti, IFHR, International
Harm Reduction Association (IHRA), International Prison Watch (OIP), LDH, Le Foyer, Les Mondes Solidaires, Max Havelaar, Migrants Health Rights Watch (ODSE), National Coordination of Networks (CNR), National Federation of Associations for Reception and Social Reintegration (FNARS), Passerelle La Santé sans Frontières, Rasko, Sanatatea, SOS
Drogue Internationale (SOS DI), Stade Rennais FC, Uniopss, Vialtis.
And all our other partners who have supported us in our activities in France and abroad during 2004, as well as our individual donors.
> Our project
07/16
> New enthusiasm
for service in the field
The last general assembly expressed confidence in the team, with a Board of Directors that had been entirely
replaced. We have channelled all our energy into fulfilling the mandate that you entrusted to us. This report reviews
current projects, the state of current affairs and the highlights of the past year, and our objectives for the
association. I hope that it will enable you to gauge our progress over the past year.
> Objectives reached
Model of an
association
Areas of revival
Decentralisation and
increased responsibility for
the continental and
thematic groups, an
increase in the number of
regional international
projects (MIR), regular
involvement in the Board
Meetings by regional
delegates, the reform of the
management committee,
decentralisation within the
regional offices, review of
the statutes, and
reactivation of the
international network. Other
areas still need to be
improved, especially group
independence and the
cultivation of loyalty within
the association.
First of all, our international activities. From the 31 projects planned at
the beginning of 2004, we are now involved in 90. After a financial crisis that
was resolved in 2001, Médecins du Monde has now proved itself capable of
overcoming a crisis of activity by arresting the fall in the number of projects and starting
up new ones on a regular basis. The associates’ commitment in the international sector,
with the day-to-day support of an office serving the field and the expatriates involved in
the real basics of field work, has enabled us rediscover the dynamics of activity that is
Médecins du Monde’s raison d’être.
By raising the stakes of associate commitment, Médecins du Monde has once again
proved that international solidarity need not be the preserve of “humanitarian
professionals” alone, but also that of professionals in health and other sectors, who
bring their skills and a voluntary and socially aware commitment to it.
A year ago, our analysis of the reduced number and scale of international projects
revealed, among other things, an impoverishment in the life of the association that is a
fundamental part of Médecins du Monde. Success in restoring this has been evident in
several different areas during the year. Although the work is still ongoing, its effects can
already be seen: the success of the autumn schools, increased participation in all group
08/09
and CCN meetings, a keen participation at the migrant workshops in December 2004,
and a huge increase in the number of applicants for election to be group representatives.
This new lease of life also involves fundamental thinking on certain sections
of the association and its organisation. This is our “hidden work”.
Because human beings are at the heart of our work, one of Médecins du Monde’s
aims is to provide optimum management of human resources, so that we can
become a driving force of innovation and progress, both in this sphere and in the
projects. From fund-raising to planning and epidemics, training is essential to the
Management
Human
Resources
A clear political stance was
essential, and exists now,
laying emphasis on
knowledge of the field,
maximising the value of
experience, acquisition of
skills, mobility of those
working in the various
posts, and making training
and activity compatible with
more than one post.
quality of our activities. During the next year we will put emphasis on one of the
fundamental areas defined: that of training in testimonies. Finally, in order to avoid
the financial shocks that still pose a threat to our projects, and to consolidate our
financial independence, we have set about making the association’s resources more
secure. This is essential if we are to maintain control of the places and the methods
of our activities; it is a guarantee of our freedom of intervention.
Completing this work properly will give our actions real credibility, give us
real political weight, and increase the effectiveness of the service given to
those for whom we care.
By making the association more open to initiatives and to a greater variety of
volunteers, our wish is to make Médecins du Monde more original in its role as
mediator between one society and another. This approach consolidates our ability to
be a real force of opposition in the field of state political power, whether
states fail to help the poorest or most “different” sections of the population or are
simply repressive or predatory. This choice of independence leads us to take
ethical decisions, including and in particular in the field of project funding. As a
result, we have refused to participate in the health reconstruction programme in
Afghanistan set up by the World Bank, so that we are not answerable to what appears
Security measures
Private
resources
We need to diversify our
sources of finance, by
strengthening relations with
private foundations and
business partnerships,
within the context of agreed
ethical rules.
Afghanistan
The health
system*
The reconstruction of the
Afghan health system is
based on sub-contracting all
primary health care offers to
medical NGOs. MdM, which
favours the construction
of reliable health systems
that offer health care
access for all, has decided
not to participate in this
type of privatisation.
Instead, it will maintain its
presence through other
programmes, in order to
provide assistance for those
excluded from the new
health system..
Chechnya
The violence
The violence in Chechnya
has not ceased. The
assassination of the
resistance leader
Maskhadov has confirmed
that Russia is closed to any
form of negotiation with the
Chechen resistance.
Democratic Republic
of Congo
The hope of
peace
Since the mid-1990s, the
DRC has been at the centre
of international conflict. Not
until 2004 did a fragile hope
of peace, discreetly
supported by the UN,
appear. The region vacillates
between peace and war, in a
kind of interminable
transition, keeping the
country in a state of
humanitarian emergency.
* “Reconstruction of the Afghan
health system: sub-contracting to
NGOs” – August 2004.
to us, after analysis, to be the beginning of a system of access to private health care.
This choice has led us to alter the approach to primary health care adopted by us in
that country for over 20 years, so that we will not be party to a strategy drawn up
without Afghan participation.
The way our principles, our methods of action and the origin of our
resources are articulated is born of a balance and vigilance that we have
to maintain and strengthen in the light of the complexity of the situations
in which we work.
> From one disaster to another
From the earthquake that destroyed the Iranian city of Bam on 26 December 2003, to the
tsunami that killed almost 300,000 people exactly one year later, 2004 was marked by
humanitarian disasters, more often man-made than natural. Regardless of whether the
conflicts were all over the media like Palestine or Iraq, treated with indifference like
Chechnya and Darfur, or totally forgotten like DRC, Uganda, Nepal and Colombia, they
are alike in that they all affect ordinary people, and do it with complete disregard for the
Geneva Convention.
Assistance in natural disasters….
Both in Bam and in Indonesia we were able to respond within 48 hours, bringing quick
and relevant help and follow-up supervision to the victims, in conditions made
particularly difficult both by the effects of the disaster itself and by the suspicion of
governments unwilling to open their borders. From the ruins of Bam to the devastated
villages of Aceh Province, we fulfilled our duty to provide assistance, by
conducting primary health care missions of undisputed medical quality and of a volume
adapted according to our expertise, facilitated by an effective mobilisation of
associations. We need, however, to continue to develop our tools and methods of work,
10/11
the chronically sick. We also need to think more about the role of testimony and the way
we communicate during such exceptional interventions. In the light of this
requirement, we shall continue to improve the standard of our
emergency interventions.
The tsunami, through the sheer magnitude of its impact, both geographical and human,
and the amount of aid that followed, was an unprecedented event. The whole world,
regardless of nationality, rushed to the aid of the survivors. The activities of NGOs and the
United Nations were combined with State aid and hundreds of individual or collective
initiatives, some of them with questionable objectives. In this rush of aid, Médecins du
Monde occupied a specific independent role, immediately effective as a partnership, in
both emergency aid and rehabilitation. The activities of the international delegations of
Médecins du Monde played their role by increasing our capacity for intervention and
communication..
Almost six million euros were paid to the association, by individuals, numerous
businesses, a few local collectives and the French Association of Regions. Seizing this
opportunity to create a link between the regional councils and the regional offices of MdM
was an immediate choice for logical decentralisation. Unfortunately the over-investment in
this crisis, for whatever reason (timing, number of countries affected, media coverage) is
against a background of obvious disinterest in other crises such as those affecting
Uganda or the DRC.
Many other dramas drew our attention during 2004. In these largely manmade crises, we have provided care, supported partnerships, exercised
vigilance and denounced the violation of human rights.
Darfour is the greatest humanitarian crisis of the last few years. This crisis in Western
Sudan is, however, the responsibility of individual people. When the UN resolutions
aimed at protecting populations and seeking justice for the perpetrators of the crimes
have finally been adopted, we fear that their application will be slow. Meanwhile villages
,,
by taking account of the most vulnerable sections of the population such as children or
Thank you to those who
were able, in the first few
days, to bring help, to
assess conditions for
intervening and thus define
the best way of providing
really effective long-term
activity.
”
International
regional offices
South-East Asia
MdM Cyprus, Greece and
Spain are present in Sri
Lanka and Indonesia, MdM
Portugal in Sri Lanka and
MdM Canada in Indonesia.
are burnt, cattle stolen, crops vandalised, people attacked and women raped. Having
maintained a presence in Kalma Camp for over a year, we provide care and make
testimonies daily to the agencies responsible for respecting human rights on the
atrocities committed against “displaced” people. In order to combat the impunity, we
make our communications public, so that all the forms of protection for civilians set out
Rafah
“Rainbow”
This report follows the joint
survey conducted in May
by MdM and the
International Federation for
Human Rights (IFHR) in
Rafah, in order to assess
the consequences of the
military operation
“Rainbow” in medical
terms, access to health
care for the population,
and physical and mental
health, on the basis of
testimonies and medical
reports obtained. MdM also
denounces the
consequences of the
destruction of houses,
which have left almost
3,800 people homeless, as
well as the destruction of
infrastructures, which has
exacerbated an already
very precarious social and
economic situation. MdM
has renewed its plea to all
the protagonists in the
Israeli-Palestinian conflict
to respect international
humanitarian law.
* Publication of report “Operation
Rainbow: effect on the health of
the population of Rafah”,
October 2004
in the UN resolutions are applied effectively and as quickly as possible.
In a situation greatly transformed after the death of Yasser Arafat, we have continued to
work in Palestine, providing care, testimonies and mediation between the Israeli and
Palestinian medical communities. By involving itself as an impartial third party in this
extraordinarily sensitive conflict, MdM continues to work to denounce the violation of
human rights and international humanitarian law. Mediation means dialogue and
bringing communities together. The remarkable communications exercise on the theme
of the Palestine Wall separating Israel and the West Bank, carried out jointly
with our Israeli and Palestinian partners in February 2005 and relayed by artists of both
nationalities, is a perfect expression of our vocation: not just care, but also a
partnership of civil societies working with each other, supported by committed doctors.
2004 was a particularly difficult year in Haiti, with violent political clashes and tropical
storms that brought floods of exceptional severity in both June and September. In this
country natural disasters, exacerbated by deforestation, have aggravated the
consequences of endless political transgressions. What sort of investment will help the
people get back on their feet again? With international aid coming via NGOs, how can
the new government start a reconstruction programme? We are supporting the
population in a community dynamic and through forensic medicine programmes.
12/13
> Cross-cutting themes
Analysis of the reconstruction of the Afghan health system showed clearly how much NGOs
are threatened by dependence not on States, but on funders. Funders can impose political
and economic choices on governments and therefore on populations, with the help of
NGOs, which are turning more and more into service providers. Our expertise in this case
has led us to help those actively involved in the field to adopt a stance on health service
reform and the role of donors, but also to provide testimonies and lobbying in order to
lift obstacles to health care access by exerting pressure on the decision-makers. MdM is
equally involved in international campaigns, such as World Action Against Poverty, the aim of
which is to remind politicians of their undertaking to fulfil the objectives of the Millennium
Development Goals, or the People’s Health Assembly to be held in Ecuador in July 2005.
,,
Access to care within the context of globalisation
The crises in which we
intervene are often caused
by natural elements set
against the cynical
behaviour of mankind. We
need to take account of the
many different factors and
enrich our experience of the
field through reflection on all
the themes running through
our activities.
”
The health of migrants in Europe
The opening of Europe to ten new countries has shown the need for citizens to take steps to
ensure that the most vulnerable are protected. Most member states have undertaken, within
their own territory, to provide measures leading to restricted health care access for the most
externalising the investigation of asylum claims and refusing NGOs access to detention
centres. It was against this background that the 11 European delegations and offices of
Médecins du Monde decided to create the European Observatory on access to
health care for asylum seekers and undocumented migrants, and to call for
policies on protection and equal care access for every person in Europe regardless of their
immigration status.
,,
vulnerable of people, namely migrants, the poor and the homeless. Europe is closing up,
This year, we celebrate
the 15th anniversary of the
‘First Meeting Between
Eastern and Western
Europe’, where the 300
doctors who met together
adopted the ‘Krakow
Charter’, the basis of our
individual commitment.
”
Children
At the end of the “Children and War” seminar organised in February 2005, ten proposals
arising from practical situations encountered in the field were formulated. These included the
Health
necessity to protect children against sexual violence and AIDS and to take care of victims, or
Native
populations
the need to include social and psychological needs as well as physical needs as part of
Concentration on this issue
has highlighted five points
in the approach to the
health of native populations:
long-term commitment,
direct involvement of the
population concerned,
working together with local
authorities to ensure
continuation of the
programme, demonstration
of feasibility through activity,
and the fundamental need
to transfer skills.
wartime aid programmes. The protection of children is a priority for MdM, which needs to take
greater account of it in its projects.
Health care access for native populations
2004 is the last year of the decade assigned to promote the rights of native populations by
the United Nations. On this occasion, MdM’s aim has been to capitalise on the
projects carried out with these populations over the last 25 years and to set
up an advisory group on the health of ethnic minorities. The participation in the 22nd
session of the native populations working group in Geneva showed our interest in the
topics and provided an opportunity to meet with what is a real world parliament for native
Adoption
A growing
demand
24,000 families are
currently going through an
adoption process in
France, but only 5,000
children are adopted every
year, 40% of them through
an Authorised Adoption
Body (OAA). Hence the
sudden craze after the
tsunami disaster over the
issue of taking in orphaned
children. The French
Adoption Agency, set up by
the law on adoption, should
allow an improvement in
response.
populations. Within the framework of this group, and in close association with the work
on health care access, MdM participated in the second continental summit of indigenous
Indo-Afro-Latino populations held in Quito in July.
International adoption – parents for children
Year after year, the French international adoption system has been unable to meet the
growing demands of families. 294 families adopted 322 children through MdM during
2004, making it the largest French international adoption agency. Yet of the 1,500
requests received, we were able to meet only a part. However, some children, classified
as having “special medical or surgical needs”, or groups of siblings, are unable to find
adopted families. As a medical NGO, MdM chooses to help these children as a matter
of priority, placing quality of follow-up supervision as more important than the number of
adoptions. Families still need to be found for these children…
14/15
The question of otherness in complicated situations
We need to take a step back from our work in the field and reconsider the context
against which our intervention is necessary. In 2005, the ICRC will again give us the
opportunity to prepare general statements on action and international humanitarian law,
which will raise the central issue of the question of acceptance. While death and the
denial of humanitarian aid in Afghanistan, Iraq and Chechnya marked out 2004, we can
no longer avoid the looks those whom we wish to help are giving us. Without being
complacent, but without acting hastily, we need to ask them questions so that we can
continue to act in conditions of acceptable security.
> Project France
International law
General
statements
The first edition of the
General Statements was
produced in November
2001, concentrating on the
“principle of
responsibility”. MdM was
already a member of the
steering committee for the
meetings arranged for that
time.
The beneficiaries of MdM’s 120 projects in France have suffered badly from successive
withdrawals of access to health care. For two years now, State Medical Assistance
has been the target of repeated attacks, gradually reducing the availability of health care
to those without papers. We have been protesting all year at this fundamental error. The
figures of the Mission France Observatory show how right we were to point out the
dangers of withdrawing these rights. Even though signing the form that finally allows
access to emergency care will resolve a few dramatic problems, we are still waiting
for a real step forward in policies in medical and human terms: SMA needs to
be included in CMU (Universal Health Cover), without waiting for a situation in which
nothing is left but the ragged ends that the sickening attacks saw fit to leave.
The Sarkozy Law does not deal with poverty and hardship; it pushes it out of sight
and prevents them from being prevented. It is in the squats, the dank cellars and
stealthily in the streets that the MdM teams carry out their work with ever-increasing
difficulty. In addition, by postponing for two years the obligation to create living areas for
travellers, and by evicting the Roma refugees from their tenuously established
communities in France, health is being further undermined.
France
AME (State
Medical
Assistance)
We have been followed:
160,000 individuals and
175 associations
representing altogether
almost a million people
have signed the petition
launched by MdM and
MSF together. The press
conference held on 8 June
by MSF, MdM, COMEDE
and the SAMU Social was
followed, but most
importantly was covered in
the national press in
subsequent months.
2004 is also the year of the public health law and reforms in health
,,
In Lyon’s shantytown
of Surville, where ruined
caravans reek of poverty,
where there is no access
to health care or even
education for children,
how is it conceivable that
the only solution is to boot
the people out without
offering them an acceptable
place to live?
”
insurance.
The public health law, which deals with people according to diseases, is a break with the
principle of comprehensive treatment that we cherish. There is a serious risk of seeing
the end of comprehensive, community-based health activity. With regard to health
insurance reform, this is a source of concern to us as much as to our most vulnerable
patients. After participating in the workshops, which showed a degree of dialogue, we
have since July decided to denounce the principal risks. At a time when some Mission
France centres are seeing the return of these people, too “rich” for CMU (Universal
Health Cover) and too poor to benefit from additional insurance, our community-based
activity is more legitimate than ever.
One step forward, however, is the dialogue that has been going on for over a year with
the government on the “health-stop beds”. Providing care but not necessarily
admission to hospital, these are “accessible” and “comfort” spaces for sick people living
on the streets.
Health insurance
reforms
The risks
More complicated processes,
return to a financial “residue”
for everyone, even though
we know that this measure
excludes the poorest people
from access to health care;
the road to health care
blocked by the inability to
pay more; and the obligation
of stability in the choice of a
doctor; these are just some
of the consequences of this
reform, which has chosen
financial equilibrium rather
than a public health policy
that takes account of all
the inequalities in the field
of health.
The Mission France steering committee aimed at providing practical work show a
willingness to increase our efficiency and thus facilitate the emergence of new skills
and serious commitment, in order to provide responses to the challenges that continue
to arise.
All through the year, volunteers, and employees have worked to provide access to
care for the must vulnerable, in war situations, disasters and crises, both here and
abroad. Throughout the year, we have received the support of donors and sponsors.
On behalf of the Board of Directors, and for all those to whom we bring hope, thank you
for your commitment and your confidence.
Dr Françoise Jeanson
President, Médecins du Monde
13 April 2005
2004 in figures
16/17
• MdM’s structure:
• MdM’s turnover:
283
41,6
volunteers left for the field
(up until 31 December 2004)
104 expatriates (full-time equivalent) in the field
1 146 volunteers at head office and in the provinces and in Mission
France projects
Cost distribution by
department (excluding extraordinary items):
16 regional delegations
4 international representative offices
1 611 members
153 permanent staff members (full-time equivalent) in head office10
permanent staff members in the field
13 permanent staff members in the regional delegations
73 permanent staff members in Mission France and Harm Reduction
0,8%
9,5%
21%
67,8%
0,3%
Meaning
249
permanent staff members
in total
• MdM’s international
network:
euros budget in 2004
(less than the previous year)
67 million
12
million turnover
in 2004
international
delegations
- Argentina, Belgium, Canada, Cyprus, France, Greece,
Italy, Portugal, Spain, Sweden, Switzerland, USA.
0,5%
Information and communication
costs
Management / Head Office costs
Fundraising costs
International and domestic
projects
Grant application and sponsorship
costs
Costs linked to other types of
fundraising
Origin of resources
(excluding extraordinary items):
65%
30%
2%
3%
Public generosity
Public grants
Private grants
Others
2004 in figures
• International :
• France :
90
35 651
international projects in 50
countries (excluding
launching and setting up projects
and adoptions)
Geographical distribution of MdM
programmes:
Africa
Asia
Central Asia
Eastern Europe
Latin America
Middle East
5 283
medical consultations in the Free Health
Care & Guidance Centres (CASOs), for
18 377 patients
dental consultations in 7 dental surgeries, for
2 264 patients
total number of
consultations:
almost
80
32
13
5
13
20
7
40 934
mobile proximity projects
in 23 towns and cities,
run by 626 volunteers
12 Harm Reduction programmes, more than
67 330 Harm Reduction contacts
9 400 contacts with prostitutes, through 8
different projects
Geographical distribution of
international project costs:
Africa
Asia
Central Asia
Eastern Europe
Latin America
Middle East
Cost distribution for Mission
France projects in 2004:
42
17
9
41%
39%
13
13
6
12%
7%
1%
Harm reduction
Health Care and Guidance
Centres (CASOs): 21
Projects outside the centres
Coordination of Mission France
projects
Hospital buddying
> MdM in pictures
DAVID DELAPORTE
19/34
Bolivia
The children of
Potosi
Working as an ore carrier,
shoeshine boy or bus tout, or
selling ores, sweets or ice
creams… the children of
Potosi work almost as soon
as they can walk. Although
illegal in Bolivia, this work
helps the youngest children
survive. MdM, aware of this
painful reality, makes them
aware of the risks they run
and offers them a listening
ear and a chance to express
themselves. So that they can
remember for a while that
they are still children…
Russia
ELISABETH RULL/ITEM
Two anti-HIV
buses
In St Petersburg, the number
of AIDS cases is soaring,
and the means for
combating the disease are
practically non-existent.
MdM is trying its best to fill
this gap by going out to visit
the already marginalised
drug addict and prostitute
populations.
Balkans
DAVID SEBAN
For three months, from July
to September, the
association worked in an
area of Europe where little
data is available on drug use
and unprotected sex
amongst young people in the
world of clubbing. “We didn’t
aim to replicate the method
of intervention that we’ve
been using since 1977 in the
Rave project in France”,
explained Karen Segas,
psychologist and project coordinator. Rather, it was a
question of working with the
reality as they found it and
putting together a new
network of local workers.
ISABELLE ESHRAGHI
Reducing risks in
clubs
20/21
China/Qinghai
Supporting
health workers
DAVID DELAPORTE
DAVID DELAPORTE
DAVID DELAPORTE
“This medicine is part of our
culture, we must carry on
using it”, confides Meiji, a
Tibetan nomad doctor in
Gande county. This county,
over 4,000 metres above sea
level, is part of the great
cultural mosaic that is China.
In the West of the country, a
remote, arid, mountainous
area is home to a mostly
Tibetan population. Making a
living as yak breeders, they
travel the valleys with their
herds as and when the
seasons dictate. Meiji often
travels through this unusual
terrain to provide medical
care: being both
geographically and culturally
close to the population, the
Tibetan nomad doctors are
often the first people to be
called upon. “The medical
training given by Médecins
du Monde and their material
aid makes our practices
more effective”, stresses
Meiji. “It means that we can
fill the gaps, discuss our
practices and make the best
possible use of our
medicine”.
Palestinian
Territories
Acting and
testifying
MDM
VALÉRIE DUPONT
VALÉRIE DUPONT
“The repeated incursions,
the check points, the
occupations and the
destruction of homes, are
all equally traumatic”, points
out Emmanuel Digonnet,
coordinator of the mental
health programme. This is
why the association,
present in the Palestinian
Territories since 1995, is not
content with just
responding to crisis
situations. Therefore, as
well as helping with medical
emergencies in the Gaza
Strip, it is also helping to
improve mental health care
in the West Bank and to
limit the effects of the Wall
on access to health care for
populations living nearby.
All our programmes are
developed in close
collaboration with local
associations. Médecins du
Monde aims to limit the
medical and health-related
impact of the barriers to
accessing health care
imposed on the Palestinian
population, and to testify
about the violations of
health care rights.
22/23
Women
,,
“There are,
lost places
at the ends of the earth, which without a
war or natural disaster would probably
remain unknown to anyone else. There
are places where women grow up under
the thumb of their father and then live under
the thumb of their husband. They are
valued and weighed in the balance
according to how fertile they are. They
NELLY STADERINI
marry at an age when many girls are still
playing with dolls. This year, I was in Iran
for Women’s Day. One woman came to the
clinic one morning to find out how much
her hymen could be sewn back up. This
was the first time we had to deal with a
case of sexual assault. We encouraged her
to think about it and she calmly decided not
to have herself sewn up. I had the incredible
luck to be born free in a country where
women’s rights are rarely scorned. And in
the name of these less fortunate women,
I feel proud to be able, just once a year,
to be able to testify during this day
on the situation of my sisters”.
MDM
AUDREY BOLLIER, midwife in Iran
,,
Children
BRUNO FERT/VOUS ÊTES ICI
PASCAL DELOCHE
“Paying greater attention to
children should be of
paramount importance,”
states Article 3 of the
International Convention on
the Rights of the Child.
Despite the progress made
in child protection and
health, there is still much to
do and our association is
channelling huge amounts
of energy into tackling the
isolation of abandoned and
sick children, both here and
abroad. As a result, a
training project for staff in 31
Bulgarian orphanages has
helped alter professional
childcare practices. “The
fact that all the orphans have
been adopted or placed in
families shows we are
succeeding,” states
Françoise Parrot, in charge
of the programme. Since
1988, Médecins du Monde
has favoured the adoption of
children who can legally be
adopted but, because of
their age or physical
features, have little chance
of being adopted in their
country of origin. In 2004,
322 of these children were
adopted into French
families. We also work with
children having to cope with
illness on their own. For 16
years now supporters, both
male and female, have been
visiting these children in
hospital. With true devotion,
they make themselves
available to the most
isolated children.
MDM
From words to
action
24/25
Haiti
VÉRONIQUE BURGER/PHANIE
Learning to
dream again
“Like all human beings, we
have the capacity to dream.
Those who stop dreaming
are likely to sink into
violence,” explains
Professor Toussaint, a
Haitian sociologist who
provides training for health
care organisation staff in
Port-au-Prince. Violence is
not an isolated
phenomenon linked to the
recent political situation,
and for this reason, our
teams have spent the last
ten years waging a
campaign directed against
chronic violence. Although
we provide victims with
medical, social, legal and
psychological care, our
action is now directed
exclusively at training care
staff, who are the real
intermediaries for
discussion based on an
absence of violence. This
year, Médecins du Monde
also provided help for the
victims of the floods that
struck the North of the
country in May 2004.
Iran
ELISABETH RULL/ITEM
Responding to
physical and
emotional injuries
Following the earthquake
that devastated the town of
Bam, our teams set up tents
amongst the wreckage to
provide help for the people
affected by the disaster. For
more than five months,
survivors were able to
benefit from not just
medical but psychological
care. “We owe it to every
victim to provide not just
care, but attention and a
listening ear,” explains Guy
Caussé, a doctor involved in
the assessment of needs in
Iran.
Colombia
Caring for the
most isolated
In this country, 46% of the
population finds access to
health care difficult, mainly
because of the civil war.
MdM is therefore leading
various projects with women
and children, with the
intention of improving the
health situation of the most
vulnerable people and those
in particularly remote areas.
Health care centres
STÉPHANE DENEUVILLE
Health – no
rights for the
poorest
In France, 79% of patients
received in our health care
centres had no health cover
when they first visited us,
although most of them
should have been able to
benefit from Universal Health
Cover (CMU) or State
Medical Assistance (AME).
In early 2004, the reform
aimed at removing
immediate access to health
insurance has made the
situation more precarious for
people without resources.
Chechnya
JEAN-MICHEL PAPAZIAN
A project that has been
going for ten years. Ten
years also, sadly, that a
population has been
forgotten by everyone.
Since the forced evacuation
of Chechen refugees from
Ingushetia, our teams have
been managing the activity
of local care staff from a
distance, an initiative
intended to compensate for
the lack of health care and
medicines caused by the
conflict.
ISABELLE ESHRAGHI
10 years of
being forgotten
26/27
,,
Just back from a
long project
for an NGO working amongst the Inuit, I
arrived in Angola at the height of the rainy
season in January 2004. The heat – it was
over 80 degrees – was a real shock to my
system: in just a few weeks, I lost 15 kilos!
And I didn’t escape the local scourge of
malaria either – it laid me low for three days.
But after these little setbacks, I decided to
STÉPHANE LEHR
carry on working. Being the only expatriate
in Lobito, I was able to immerse myself
more quickly in the culture of a country that
is recovering, with difficulty, from 22 years of
civil war. This is a plus in recruiting highquality local staff – I know that their
involvement is a determining factor in the
programme’s success. I’m thinking about
the six street workers who often go way
beyond the call of duty. Or about the
medical staff sent from the Angolan Health
Ministry who have shown proof of their
devotion, which is exemplary despite their
ridiculously low State salary, which isn’t
,,
always paid… From now on they will be my
STÉPHANE LEHR
little Angolan family.
PATRICK «CARIBOU» RAYMOND
(QUEBEC), 33, nurse with the street
children and teenagers project in Lobito.
Southern Sudan
A land burnt and
forgotten
KHALIL SAYYAD
KHALIL SAYYAD
KHALIL SAYYAD
On 17 July 2004, our
activities in Darfur began at
Kalma, a camp for displaced
people sheltering 80,000.
“Currently there are 150,000
people living in conditions
that we can barely imagine,”
explains Pascal Simon,
logistician with the project.
And every day, more
displaced people arrive. In
this region, our teams have
noticed a lack of staff and
medicines, especially in the
hospitals. Nothing is under
control. This is why our
temporary structure, set up in
the camp, is always full. With
its four areas – a consulting
room, a short-stay hospital
unit for the most serious
cases such as malaria or
severe dehydration, an
isolation unit for epidemic
diseases, and a delivery
room – it welcomes about
250 people every day for
consultations. Priority is given
to women, especially those
who are pregnant. Médecins
du Monde paints a dramatic
picture of a situation
punctuated regularly by
violence, with difficulties for
the civilians to gain access to
health care.
28/29
Liberia
With the
forgotten people
In the areas held by rebel
factions, the population
continues to be under
pressure. Despite the
tension, our teams have
succeeded in providing
care “where others fear to
tread”, as Head of Project
Patrick Hirtz describes it.
Algéria
Seeing people
through pain
VALÉRIE DUPONT
After the earthquake that
struck East Central Algeria
in May 2003, our teams set
up a psychosocial project,
made effective largely by
the support of the local
associations with which we
have been collaborating
since 1999.
Roma
DAVID DELAPORTE
FRANÇOIS MOURA
A never-ending
battle
Regardless of the activity
planned, be it general and
paediatric consultations or
vaccinations and guidance,
the teams start with a
traditional tour of the field.
“These ‘hellos’ are an
important stage of the
project, and are often
followed by discussion over
coffee”, explains Michèle
Mézard, the Head of
Project. “For ten years now,
we’ve been fighting a neverending battle for respect for
their rights, but as they
haven’t thrown in the towel,
we won’t either!”
South-East Asia
STÉPHANE LEHR
MDM
GÉRARD RONDEAU
An earthquake and tidal
wave have brought horror to
the Indian Ocean coasts,
especially in Sumatra and
Sri Lanka. The poor
populations of these coastal
regions, who suffered
terribly, are trying to
overcome the tragedy.
“When the deluge stopped,
I was more than a kilometre
from my home, near
Lamlhom, and I’ve stayed
there because I’ve got
nothing left – neither family
nor home.” Like thousands
of others, Aki, a 23-year-old
Indonesian, lost everything.
In the first days that
followed the catastrophe,
Médecins du Monde
intervened to bring them
help. The emergency care
was followed very quickly
by the need to develop
psychological support
activity and help with the
reconstruction of their
health system. Our teams
want to stay for the
duration, this being the only
way to help the people
envisage a future.
STÉPHANE LEHR
Scenes of
devastation
30/31
South-East Asia
,,
I arrived in Banda
Aceh, on 9 January,
nearly a fortnight after the disaster, and I
immediately realised that the emergency
was ongoing: the injured still hadn’t been
treated, and the suffering of the survivors
was intensifying. The empathy and care
provided by our teams was essential
treatment for their feelings of isolation. My
first approach was, of course, medical and
GÉRARD RONDEAU
allowed contact to be established. The
second consultation was deeper: I’m still
determined to understand the local culture. I
think that this is the best way of getting
people to express their suffering, which is all
the more important as the victims’ feeling of
guilt adds to the drama. For me,
humanitarian aid is a response to misfortune
provided with dignity and rights, as we can’t
satisfy the needs of whole populations by
simply making helpful gestures. This is why
the Médecins du Monde teams are still
spending time on accompanying the
populations. Our aim is to legitimise our
presence for the duration, so that we can
improve the living conditions of displaced
people.
,,
GUY CAUSSÉ, doctor with the Sumatra
MDM
emergency project
AIDS
MDM
MDM
There are currently over 42
million carriers of the AIDS
virus, 90% of whom are in
developing countries and
75% in sub-Saharan Africa.
More than 24 million people,
including 3 million children,
have already died. In order to
respond to this global health
emergency, Médecins du
Monde has decided to make
AIDS a matter of priority for
the next five years. In our
projects, our teams learn all
the social, cultural, economic
or political aspects of the
issue, especially when the
work is with ethnic
minorities, as in Papua.
However, it is not enough
just to prevent the illness. For
this reason, in the
Democratic Republic of
Congo, Cambodia or
Zimbabwe, the association
enables infected people
access to anti-retroviral
treatment. Our practice, in
fact, has confirmed to us that
prevention is more effective
when treatment is available
and easily accessible.
HUYEN DAO
Combining
treatment with
prevention
32/33
The homeless
Caring and
accompanying
LAURENT THEILLET
MDM
STÉPHANE LEHR
The health risks associated
with the living condition of
homeless people are legion.
Informing them and helping
them out of the spiral of
exclusion, however, is not
an easy task. In fact, rare is
the person who comes of
his or her own volition for
care in one of our care
centres. Médecins du
Monde therefore goes to
meet them by organising
street runs known as
“maraudes” (cruising).
Today the minibus in
Toulouse has located 50year-old Sergio, who is
complaining of tingling in
his feet. “It’s a common
complaint with homeless
people,” explains
Geneviève, the project
nurse, “who never take their
shoes off for fear of them
being stolen while they’re
asleep. The feet get hot and
wet, and that causes
dermatitis and sometimes
even gangrene”. In several
cities in France, the
association has also set up
medical beds reserved for
people whose state of
health needs care but not,
or no longer, admission to
hospital. “As soon as the
patient comes in, we try to
find long-term solutions but
they’re not always there
when the patient is
discharged,” explains Luis
Garcia, director of the
Toulouse organisation.
Chirurgie
LAHCÈNE ABIB
MDM
Humanitarian surgery has to
adapt itself continually to
take account of shortages
of local equipment and of
political situations that are
often changing. Although
emergency surgery, such as
we practise in the north of
Ivory Coast to save people’s
lives in conflict situations, is
our first calling, these days it
tends to be more diversified.
Therefore, more and more
programmes are aimed at
training staff in remote
hospitals in basic surgical
techniques, as is the case in
Ethiopia. “These projects
allow both theoretical and
practical knowledge to be
passed on, while addressing
the need to be suited to the
situation, the available
means and the local
culture,” says Françoise
Tandonnet, an anaesthetist
on the Northern Ethiopian
project. In fact, for 15 years
Opération Sourire has been
working with those
disfigured by war, disease or
malnutrition and has been
addressing the threefold
objective laid down by the
association: operating, of
course, but also ensuring
patient follow-up after the
operation, and training local
staff. Today, 70% of
problems are dealt with by
local practitioners.
STÉPHANE LEHR
Technical
skills and
effectiveness
>
35/118
Project Atlas
Les
missions
Médecins
duinternationales
Monde’s
1
Cuba
Haïti
Mexique
4
2
Rép. dominicaine
Salvador
3
Equateur
Crisis: situation in which the basic needs of
people are not being satisfied in the long term
(civil war, forgotten conflict, HIV pandemic).
*
x Reponse: intervention involving technical
assistance and mobilisation of local resources.
Development: support in the realisation of needs
or policies expressed by local partners,
x * communities or administrative authorities, against
a background of insufficient means.
Reponse: intervention through partnership and skills
transfer.
* X: number of projects for each country.
Polynésie française
(Mururoa)
1
1
1
Colombie
Emergency: situation in which the lives of
people are in immediate danger (natural
disaster, armed conflict etc).
x * Response: involvement through substitution.
1
2
Pérou
1
1
Brésil
Bolivie
1
Argentine
1
1
deinternational
Médecins du
Monde
projects
Russie
Moldavie
3
Géorgie
Turquie
1
Kosovo
2
1
1
Bulgarie
Serbie
2
1
Tchétchénie
Ingouchie
1
1
Afghanistan
Liban
Chine
Iran
Irak
1
1
1
Mali
1
Terr. palestiniens
Népal
4
1
Tchad
Rép. dém.
du Congo
1
2
2
Côte d’ivoire
Ouganda
Soudan
1
Vietnam
2
1
Ethiopie
Liberia
1
2
Birmanie
1
Bénin
2
1
Pakistan
Guinée
3
1
1
Egypte
Algérie
42/37
36/37
1
1
Cambodge
2
1
Sri Lanka
1
2
1
2
Tanzanie
Angola
Indonésie
3
1
1
3
Vanuatu
Madagascar
Zimbabwe
1
1
1
2
1
Afghanistan
After 23 years of war and the departure of the Taliban in late 2001, the Afghans finally
dared to believe in peace, reconstruction and progress. Despite international aid and
peace-keeping forces in the cities, the country is still far from secure. The action of NGOs
is thus limited and only one third of the country benefits from aid. The overhaul of the
Infant mortality
> unknown
Life expectancy at birth
> unknown
HDI
> unknown
Real GDP/inhabitant
($/PPA):
> unknown
International Delegation
> MdM Canada
Population benefiting from
the project as a whole
> Direct: 36,000
> Indirect: 92,000
Staff
> Local staff: 25
> Expatriate staff: 2
Co-ordinators
> Project manager: G. Causse
> Field co-ordinator: C. Buffet
> HQ: E. Martinon
Source(s) of funding
> MdM
2004 budget
> : 206,218 euros
Source: Report on human development 2004, UNDP
health system is moving towards privatisation, which excludes the most disadvantaged.
Ensuring women have access to care
Kaboul
Activities: Since 1995, MdM has supported two mother
and child welfare clinics in Kabul. Two of the four centres
have now passed to another NGO, MSF Switzerland. The
programme centres on three objectives:
• Ensuring that women have access to care (paediatrics, gynaecology
and obstetrics, vaccination campaigns, basic health and hygiene
education).
• Training of local care staff.
• Rehabilitation, supply of drugs and health care infrastructure
equipment.
The training aspect has taken on a particularly important role since
the Taliban left, with training of female doctors, nurses and midwives,
as women are now allowed to work in peace.
Progress bar at 31/12/2004
1995
2005
> Project progress
The outlook
To transfer the remaining
MCH centres to a local
NGO and invest in
populations who are at risk
and exposed to addiction
in Kabul, or work with the
nomadic Kuchi population.
38/39
Mother and Child Welfare
project as a whole
> Direct: 415,000
Hérat
Activities: Since 1992, MdM has been pursuing a mother
and child welfare programme in three clinics in Herat,
centred on three aspects:
• Direct intervention in populations (paediatrics, gynaecology,
obstetrics, malnutrition and general medicine, vaccination
campaigns, medical monitoring, basic hygiene and health
education).
• Training of local care staff.
• Rehabilitation, supply of drugs and health care infrastructure
equipment.
The training has taken on an extremely important role since
the Taliban left, as women have now been allowed to work for
two years.
Outlook
2004 allowed us to set
up a partnership for
supporting the structures
with the Ministry of
Health, so that we can
direct our programmes
towards populations at
risk from addiction and
towards nomads.
Staff
> Local project staff: 30
> MCH staff: 52
Co-ordinators
> Project co-ordinator: G. Causse
> Field co-ordinator: C. Lepoittevin
> HQ: E. Martinon
> MdM, SDC, Johanniter
2004 Budget
> 356,530 euros
1992
2005
> Project progress
Promoting primary health care
Chaghcharan
Activities:
MdM is spearheading a support project with
primary health care structures amongst the population of
Chaghcharan, centred on three objectives.
• Renovation of the Chaghcharan hospital (consulting, inpatient hospitalisation and operating rooms) and the Taiwara
Health Centre, where there is no clinic or mother and child
welfare centre.
• Training of local medical staff (doctors, surgeons, nurses and
midwives).
• Supplying medical and non-medical equipment.
• Supplying drugs.
In 2004, the logistical renovation of the hospital and the training
of staff meant that the hospital could function independently
by the end of the year.
05/04/2002
12/2004
> Project progress
Outlook
Rivalry between military
leaders and warlords have
greatly destabilised life in the
province, with armed conflict,
which means that the
expatriate team had to leave
Chaghcharan for good in late
2004. The medical and
country co-ordinator have
continued to monitor the
situation from Kabul, with a
substantial contribution from
the Afghan team.
project as a whole
> Direct: 280,000
> Indirect: 570,000
Staff
> Local project staff: 7
Co-ordinators
> Project co-ordinator: G. Causse
> Field co-ordinator: Y. Escoute
> HQ: E. Martinon
> ECHO, MdM
2004 Budget
> 472,631 euros
Angola
Since the peace treaty was signed, the country has enjoyed a relatively positive transition
towards democracy and the distribution of wealth which should accompany this is
anxiously awaited. The country is now going through an important phase of reconstruction
of civil society and national infrastructures (return of displaced people and refugees,
inclusion of ex-UNITA personnel in State structures, etc). Good progress is being made
Infant mortality
> 154‰
> 40.1
HDI
> 0.381; ranked 166/177
Real GDP / inhabitant ($)
> 857
International Delegation:
> MdM Spain
Population benefiting:
> Direct: 3,500
> Indirect: 20,000
Staff
> Local: 30
> Expatriate: 4
Co-ordinators
> Project: L. Jarrige
> General co-ordinator: O. Krins
> HQ: O. Mouzay
> DFID - ECHO
2004 budget
104,296 euros
Source: Report on Human Development 2004, UNDP
despite the delays in relation to previously set deadlines.
Dealing with moderate malnutrition
North of Huambo Province (Municipalities of Bailundo & Mungo).
Activities: In the Municipality of Mungo, the action is centred
on:
• Management, in collaboration with the WFP, of a fixed
supplementary feeding centre and two mobile units
(treatment, vaccinations, nutritional support).
• Support for primary health care centres in the
municipalities (staff management, supplies of drugs, vaccines
and consumables). All of the responsibilities in this area have been
transferred to the Ministry of Health.
In Bailundo Municipality, the project is centred on:
• support for the Bailundo Health Ministry SFC;
• staff training;
• treatment;
• management of stock.
06/2003
12/2005
> Project progress
Outlook
Transfer of the specific
supplementary feeding
structures to the Ministry of
Health, with integration into
existing health structures. The
nutritional situation should
improve in 2005 and facilitate
these progressive transfers.
Monthly evaluation of the
activity of the Mungo health
structures, through
involvement by MCW (mother
and child welfare) nurses
working in the mother and
child health programme in
Huambo Province.
40/41
Mother and child welfare
North of Huambo Province (Municipalities of Bailundo & Mungo).
Activities: Creating an integrated mother and child
welfare programme in partnership with the local network of
traditional midwives at community level, plus MCW nurses in
the peripheral structures in the North of the Province and at
the Bailundo referral hospital:
• Monitoring of MCW nurse network, which oversees all
traditional midwives.
• Supervision of paediatric check-ups and vaccination
programme.
• Training in the prevention and treatment of the main STIs.
• Family planning.
• Structural support and retraining of maternity staff at the
Bailundo referral hospital.
• Renovation of an operating unit, training of a surgical medical
team, training of doctors in emergency surgery techniques.
Outlook
To carry on the current project,
with the main aim of gradually
improving the quality of action
on the periphery and ensuring
that the improvement lasts.
Particular attention is being
paid to the training and
accompaniment of Angolan
care workers, and our joint
work with these people should
move on quickly towards
making them effective and
independent.
project as a whole:
> Direct: 80,000
> Indirect: 325,000
Staff
> Local: 15
> Expatriate: 6
Co-ordinators
> Project: L. Jarrige
> HQ: O. Mouzay
> ECHO
2004 budget
> 711,001 euros
01/12/2003
31/12/2006
> Project progress
Helping street children
Municipality of Lobito, Benguela Province.
Activities:
Opened in July 2004, the street children
project is centred on the following axes;
• In collaboration with local authorities, constructing and
equipping a health centre and supplying it with drugs.
• Agreements have been reached with local hospitals for the
care of more serious conditions, the aim being to allow the
street children to access the Angolan health system themselves;
• Six street educators are responsible for listing all the street
children, creating links with their living places and conducting
a survey during the second half of the year, allowing joint
activities to be planned with partners working in the more
specific fields of education and professional training for street
children. The possibility of family reintegration is to be reassessed with each child.
06/2004
12/2006
> Project progress
Outlook
Complete independence for
the health centre, optimum
care in all areas for street
children at the health centre
or in the hospitals.
Proposing a social
programme with several
different aspects:
reintegration into families
and into the education
system, and offers of
technical training according
to the recommendations and
conclusions of the survey.
project as a whole:
> Direct: 65,000
> Indirect: 2,000
Staff
> Local staff: 10
> Expatriate: 2
Co-ordinators
> Mission co-ordinator: L. Jarrige
> HQ: O. Mouzay
> MdM
2004 budget
> 36,579 euros
Algeria
Algeria is moving towards restructuring its health system. Access to care is becoming more
and more difficult because of lack of funds. Unemployment affects 25% of the working
population (2/3 of unemployed people are under 30). In addition, because of its strategic
Infant mortality
> 39‰
> 69.5
HDI
> 0.704; ranked 108/177
Real GNP/inhabitant ($):
> 1,785
Source: Report on human development
2004, UNDP
geographical location, Algeria is a crossroads for African immigrants.
Supporting African migrants
Tamanrasset
Activities: The aim of the project was to study the possibility
of opening a health centre in order to improve access to care
for African migrant populations en route to Europe, including:
• A STI/HIV prevention aspect;
• A human rights observatory.
04/2004
06/2004
the project as a whole:
> Direct: migrants from subSaharan Africa en route to Europe
> Direct: 100-150,000
> Indirect: 800,000
Staff
> Local staff: 2
Co-ordinators
> Project co-ordinator: D. Guerroudj
> Technical co-ordinator: P. Giraux
> Field co-ordinator: N. Seris
> Field co-ordinator: K. Baligand
> HQ: S. Beau, Emergency Desk
> HQ: RD PACA
> MdM
> PACA Regional Council
2004 budget
> 20 037 euros
> 55,557 euros
> Project progress
Outlook
This project could not be
completed for political
reasons (refusal from the
local authorities) and
logistical reasons (absence
of local contacts). MdM has
moved the project to the
border between Algeria and
Mali (Tinzaouatine).
Supporting victims of the earthquake
Zemmouri
Activities: Set up the day after the earthquake in May 2003,
the project is centred on four axes:
• Setting up of a unit in a tent, in place of the destroyed clinic
at Zemmouri;
• Supplies of drugs, consumables and medical equipment;
• Psychological aid for the populations affected by the
earthquake;
• Material support, training and creation of Algerian
psychosocial networks in partnership with an Italian NGO.
The direct aid given to the teams was halted by the exhaustion of
the teams and the rehousing of the victims in prefabricated camps.
07/2003
10/2004
> Project progress
Outlook
Strengthening of the network
of psychosocial workers. An
exploratory mission working
with women who are victims
of violence has been
confirmed.
Argentina
42/43
The Argentine population, confronted with an increasing wave of kidnappings, is
becoming more and more concerned with insecurity. The social situation is worrying
because of poverty, which is now affecting almost half of the population. Even though
unemployment is officially 13%, it actually affects nearly 50% of the active population
with workers under-employed or paid on the black market. For many Argentines,
Improved access to health care for women
and children
Abra Pampa, Puna Jujeña, Jujuy Province
Activities: The project, started by MdM in 2003, helps improve
health care access for the rural population, with particular
stress on the health of women and children.
• Care, protection and monitoring of mothers with babies;
• Monitoring of women for reduced incidence of cervical cancer
and sexually transmitted diseases;
• Strengthening of prevention and health promotion.
01/04/2003
01/03/2006
> Project progress
Outlook
During the second half of the
project, MdM will be
specifically targeting the
indigenous population through
the indigenous NGO Warmi,
and building a new maternity
unit in Abra Pampa.
especially in rural areas, access to health care remains a real problem.
Infant Mortality
> 16‰
> 74.1
HDI)
> 0.777; ranked 34/177
> 2,797
International delegations
> MdM Argentina, local projects
Population benefiting
> Direct: women and children
> Indirect: general population,
health promoters and care staff
(hospitals and health centres)
Co-ordinators
> Project B. Koepcke
> Field: M. Idiart
> HQ: F. Stea (MdM France) &
J. Foster (MdM Argentina).
> UE, MdM France, MdM Argentine
2004 Budget
> 79 257 euros
Benin
Benin’s economy is suffering from a reduction in trade with its main partner Nigeria, which
has reduced its imports since 2003. Because of this, the budgetary income of the country
has dropped sharply. At the same time, the HIV/AIDS epidemic marches on; it now affects
almost 68,000 people, including 5,700 children, who have to live with the infection. Because
Infant mortality
> 93‰
> 50.7
HDI
> 0.421, ranked 161/177
GDP / inhabitant ($)
> 411
> Direct: 421,800 (inhabitants of the
two zones), including 11,250
pregnant women and newborn
babies
> Indirect: health staff and local
NGO staff
Staff
> Expatriate: 1
Co-ordinators
> Project P. Beze Beyrie
> HQ: M.-Y. de Penanster-Rosny
> MdM
2004 Budget
> 24,266 euros
2004, UNDP
of the spread of AIDS, 34,000 children have been orphaned.
AIDS prevention and care
Ouidah and Comé
Activities: In 2004, a six-week project was conducted to
Outlook
prepare for the setting up of a future project, lasting two years
and covering two areas:
• Preventive action carried out by the American association
Africare.
• An “access to care” aspect, provided by MdM and including
screening and treatment of patients with AIDS. These actions
shall be accompanied by training to improve the skills of
Beninois care staff, together with technical support.
The two-year project
effectively began in January
2005, with substantial
preparation work with our
future partner Africare. This
project also requires political
lobbying to obtain access to
anti-retroviral medicine
locally for these areas.
11/2004
12/2004
> Project progress
Burma
44/45
Burma is suffering a severe social and economic crisis. Health expenditure (0.4% of GDP)
has been reduced to a bare minimum. The country is facing one of the worst HIV
epidemics in the whole of Asia, 687,000 people are infected with the virus and high-risk
behaviour remains widespread (drug injection and prostitution). Criminalisation of drug
users and prostitutes makes MdM’s task difficult, even though the incidence of HIV has
reached 43% in prostitutes and a staggering 90% amongst drug users.
Preventing HIV transmission
Myitkyina (Kachin) and Yangon
Activities: Since 1995, MdM has run a programme for
Outlook
preventing the transmission of HIV and STIs in Myitkyina
and Yangon, in order to:
• Reduce transmission of HIV/AIDS and STIs for the whole
population and especially those at risk, especially prostitutes and
intravenous drug users.
• Offer access to health care and treatment for opportunistic
infections.
The activities are concentrated on both male and female prostitutes
and on drug users. Prostitutes have benefited from HIV/AIDS
prevention sessions, free health care for STIs and opportunistic
diseases, workshops in drop-in centres and distribution of condoms.
Among drug addicts, harm reduction methods are promoted in
“shooting galleries”, needle distribution and prevention and
education sessions held in drop-in centres.
MdM continues to provide social support and AIDS
prevention/education in prisons, where these illegal communities
are often found in a country with the most repressive laws and
practices in the world.
Strengthening links with
vulnerable groups and
continuing to collect
testimonies. Starting the
provision of anti-retroviral
(ARV) for sex workers.
21/12/2007
> 57.2
HDI
> 0.551; ranked 132/177
Real GNP / inhabitant:
> unknown
> Direct: 4,000
> Indirect: 45,000
Staff
> Local: 70
> Expatriate: 6
Co-ordinators
> Project: F. Sivignon
> Field co-ordinator: A. de
Suremain
> HQ: V. Pardessus
> MdM, Novib, UNODC/UE,
PSI/USAID
Budget 2004
> 418,261 euros
01/01/2002
Source: Report on human
development 2004, UNDP
Infant mortality
> 77‰
> Project progress
Bolivia
Although the success of the referendum on fuel policy gave President Carlos Mesa the
electoral credibility that he needed, tension with the multi-national companies trading in
gas, the country’s principal resource, is increasing. The President is finding less and less
room for manoeuvre. Child labour is very common in this country, one of the poorest in
Latin America. MdM also cares for children working in domestic situations, less visible but
Infant mortality
> 56‰
> 63.7
HDI
> 0.681, ranked 114/177
> 886
> MdM Spain
> Direct: 1,100
> Indirect: 9,000
Staff
> Local: 5
> Expatriates: 1 until March 2004
Co-ordination
> Project: L. Liron, D. Masson
> Field: I. Tapia
> HQ: Rhône-Alpes – Burgundy RD
(S. Bret)
> Private partnerships,
Rhône-Alpes town councils, MdM
2004 Budget
> 33,933 euros
Rapport sur le développement humain 2004, UNDP
still making up a sizeable part of the work force.
Protecting child workers’ health
Potosi, San Cristobal District
Activities: MdM has been working since 2002 in Potosi, a
Outlook
mining town on the Andean Cordillera, to provide health care
access and ensure prevention of risks linked to child
labour. This activity is divided into the following parts:
• Organisation of health education workshops;
• Material aid for organisations and training of their staff in
traditional medicine, very prevalent in the district;
• Limiting the factors that lead to depression, very common
amongst adolescents;
• Awareness campaigns for organisations and the population
in general, aimed at limiting labour amongst young children
(aged 6-8 years).
Finally, MdM supports the creation of a young people’s
accompaniment network in the fulfilment of their projects. The
aim is to offer them recreational activities as an alternative to child
labour.
The health education
workshops will be
extended to three night
schools. At the same time,
to protect the health of
adults working in the mine,
MdM will offer them
training in vital moves and
the care of accident
victims.
On the social level, a
listening and guidance
centre for young people
with problems will open in
2005. Finally, once the
diagnostic stage is over,
the accompaniment of
groups of young people in
their recreational projects
will begin during the year.
2002
12/2008
> Project progress
Brazil
46/47
The social policy pursued by the Leader of the Labour Party, Luiz Inácio Lula da Silva,
since 2003, is starting to make itself felt. The pioneering “Family Purse” programme
now benefits almost 6.5 million families affected by malnutrition, but the agricultural
reforms aimed at providing land to 400,000 families between now and 2006 is taking
longer than anticipated to set up. Brazil has many impoverished and disadvantaged
Training health workers
State of Cearà
Activities: The programme is being conducted with landless
rural workers in the State of Cearà, with the aim of reducing
morbidity and mortality rates for the most common
diseases amongst this population. Not only have health care
officers been trained, but everyone living in the area has been
educated and made more aware of health, hygiene and
prevention as well as benefiting from check-ups. In addition,
the recognition of landless rural workers by the local health
care structures has progressed.
The HIV programme has been included in the training
programme, together with all the diseases endemic in the
region. The trained health care officers will be integrated
into local networks.
04/2003
03/2004
Outlook
A new project was started in
Tururu Region in December
2004, lasting for two years,
with two different aspects:
the training of health care
officers and the setting up of
a health care centre
accessible to all.
2004, UNDP
populations, including rural workers with no land.
Infant mortality
> 30‰
> 68.0
HDI
> 0.775, ranked 72/177
> 2,593
> Direct: 6,000
Staff
> Local: 3
> Expatriate: 1
Co-ordination
> Project: J. Achouline,
J. Guerrini
>
Project progress
> Field: M. Jactat
> HQ : M.-Y. de Penanster-Rosny
> MAE, MdM
2004 Budget
> 43,680 euros
Bulgaria
Bulgaria continues to establish itself on the international scene. In March 2004 it
became a member of NATO, and the discussions concerning its entry into the EU in
2007 are making good progress. The health situation, on the other hand, remains
worrying, and living conditions are still very hard for people living in specialised
Infant mortality
> 14‰
> 70.9
HDI
> 0.796, ranked 56/177
> 1,944
> Direct: Roma population in
Nadezhda District
> Indirect: Turkish population living
2004, UNDP
institutions (children, disabled people and prisoners).
Mother and child health amongst the Roma
Sliven
Activities: MdM has set up a system of mother and child
Outlook
protection in the Roma district of Nadezhda. In this former
ghetto, where more than 20,000 Roma have to endure conditions
of extreme poverty, the population is deprived of access to health
care and social rights. In partnership with the Foundation for the
Health of the Roma People, a local NGO, MdM has set up a local
health centre where mothers and children are offered medical
check-ups, vaccinations and a “school for mothers”.
The city of Sliven has
pledged to finance the
system progressively from
2005 onwards, and to
continue operating it when
MdM leaves after four years.
10/2004
12/2007
nearby
> Direct 2: 1,000 professionals
> Indirect 2: 2,500 births
Staff
> Local 1: 4
> Local 2: support from Bulgarian
Foundation
> Expatriate1: 1
Responsables
> Project 1: P. Contois
> Project 2: C. Elleau
> HQ 1: DR Corse (J.-B. Fieschi)
> HQ 2: DR Aquitaine
> Project 1: Corsica Regional
Authority, Ajaccio Town Council,
MdM
> Project 2: MdM, RD
2004 Budget
> Project 1: 37,600 euros
> Project progress
Improving initial care for newborns
Sofia
Activities: This project involves improving initial care of
Outlook
newborns through multidisciplinary training of staff in
100 Bulgarian maternity hospitals in birthing techniques
and resuscitation. The programme also involves supplying
vital equipment to the teaching hospitals to which the maternity
cases are admitted.
An initial evaluation in 2004 revealed a significant drop in
perinatal and neonatal mortality rates. The programme,
supported by the Ministry of Health, ended with a congress
on the treatment of newborns, attended by over 200 people,
in Sofia.
The programme ended in
October 2004. The practices
have been passed on to all
maternity staff. MdM has
made a point of maintaining
the professional links by
organising “neonatal
treatment days” every year
or second year.
2001
10/2004
> Project progress
48/49
Training orphanage staff
> Direct: 150 people trained
> Indirect: 3,500 children
Sofia
Activities: MdM supports the reform of institutions for children
with a training programme for 31 orphanages for children
aged 0-3. The programme, carried out in partnership with the
Bulgarian “Child and Family Development Foundation” and
with the participation of members from the Interdisciplinary
Child Centre, has a number of objectives:
• To improve initial care for children in these institutions and
their psycho-affective balance.
• To modify the way in which orphanages work and show
the need to work as a network. A contact report has been
started and several day centres for disabled children have
been opened.
Using the same model, MdM plans to develop a training
programme for staff working in establishments for
disabled children. Following an Amnesty International report
describing the horrific conditions endured by disabled children
in institutions, a number of establishments were closed in
2004. The situation is, however, still worrying in the remaining
institutions.
10/1998
06/2004
> Project progress
Outlook
MdM finished its work in
June 2004. The orphanage
staff are now, in turn, in a
position to train other
people. A project aimed at
institutions for disabled
children will be launched in
early 2005.
Staff
> Local: Child and Family
Development Foundation,
Children and Space Association
Co-ordination
> Project: F. Parrot
> HQ : DR Aquitaine
> General Council of Gironde
Region, MdM
2004 Budget
> 20,800 euros
Chad
Chad is still experiencing political instability, with military mutinies that have not
produced a putsch. In the East of the country, the huge influx of Sudanese refugees has
added to the insecurity. In addition, the country is racked with extreme poverty and very
high infant mortality. In the capital, N’djamena, children are most at risk from violence
and from the unhealthy conditions that favour the spread of diseases such as malaria.
More than 5,000 abandoned children survive by sifting through rubbish dumps.
Infant mortality
> 117‰
HDI
> 0.379; ranked 167/177
> 240
> Direct: 5,000 street children,
including 30 leaders
> Indirect: 30 social actors and 20
health care workers
Staff
> Local: 5
> Expatriate: 1
Coordinators
> Project : P. Estecahandy,
J. Boncompain
> Field : R. Lange
> HQ : DR Midi-Pyrénées
> Toulouse City Council, MdM,
FSD, private regional and local
partnerships (in N’djamena)
2004 Budget
> 68,927 euros
Primary health care for street children
> 44.7
N’djamena
Activities: MdM’s project, which ran until January 2003,
allowed social workers to be trained and children to be educated
in health and hygiene:
• 64 actors from 20 local organisations were trained;
• 2,800 children attended educational sessions.
After this programme, MdM set up an experimental primary
health care access circuit for street children in three
districts of the capital N’djamena, allowing 800 children
particularly badly affected by violence to be cared for.
In addition to the training and health care access, MdM enabled
special educational tools to be produced and made available
to the organisations in the field.
12/2001
10/2005
> Progress bar
Outlook
Definitive setting up of
the medical and social
accompaniment circuit
through the creation of a
paying third party system,
supported by local funders
and income-generating
activities by street children.
In partnership with Chad
UNICEF, ongoing peer
training / preventive activity
to reduce the incidence of
HIV/AIDS in young people.
MdM will withdraw at the
end of 2005 and ensure
that the programme will
continue through an
agreement signed with
a contact organisation
already identified.
Chechnya
50/51
Less than a year after being elected leader of Chechnya, the pro-Russian president
Akhmed Kadyrov was assassinated, being replaced by the Kremlin’s choice of Alu
Alkhanov in August 2004. The violence in the country continues and kidnapping is
very common. After the war years, the country is in ruins: infrastructures destroyed
and very limited health care. MdM has had a presence in the region since 1995,
project in Ingushetia has transferred its activities to Chechnya.
Supporting victims of the conflict
Groznyy
Activities: Present in Chechnya since 1995, in 1999 MdM
Outlook
had to adopt a system of “remote-controlling” the project from
its base in Moscow for security reasons. The programme set
up is aimed at supporting health care and surgical
organisations and covers several sections:
• supplying seven hospital organisations with heavy equipment
for resuscitation and post-operative and surgical care;
• medical training modules for Chechen health care workers;
• psychological support and monitoring of the rights of individuals;
• improvements in primary and secondary health care in the
district of Noja-Yurt;
• training and awareness on mental health issues, and
psychological consultations, within the health organisations in
Groznyy;
• socio-economic surveys on issues of health and human rights.
Since May 2004, support has been given to 17 clinics and
health care centres in the district of Noja-Yurt.
Against a difficult
background, MdM is hoping
to carry on its project
successfully.
1999
no planned end
> Progress bar
providing medical assistance for displaced persons. The team from the aborted
Infant mortality
HDI
> No data specific to Chechnya
> Indirect: +/- 300,000
Staff
> Local: 45
> Expatriate: 2
Co-ordinators
> Project: J. Dato
> Field: S. Marie-Fanon,
Z. Albastova, M. Doudaiev
> HQ: F.-D. Buquet
> ECHO
2004 Budget
> Ingushetia + Chechnya:
1,129,100 euros
Cambodia
The country’s economic situation has improved considerably since the end of the civil war in
1998. In health terms, the fight against AIDS has become a priority. The prevalence rate of
HIV in Cambodia is 2.6%, the highest in the region. The correlation between international
tourism, internal movement of populations and prostitution is a major factor in the spread of
Infant mortality
> 96‰
> 57.4
HDI
> 0.568, ranking 130/177
> 321
> Direct: 180,000
> Indirect: 400,000
Staff
> Local: 59
> Expatriate: 4
Co-ordinator
> Project co-ordinator: E. Peterman
> Field co-ordinator: P.-R. Martin
> HQ: V. Pardessus
> Global Fund, Elton John Aids
Foundation, Japanese Embassy,
MdM
2004 Budget
> 781,216 euros
2004, UNDP
HIV/AIDS in the country.
HIV priority
Phnom Penh
Activities: Since 1996, MdM has spearheaded a project to
Outlook
reduce the rate of HIV/STI transmission and provide care
for infected patients :
• Medical and social support for HIV patients in need (medical
monitoring of STIs, hospital admission service);
• Awareness raising and training for the population and for medical
staff.
In 2004, the project concentrated on:
• Specialist consultation for the treatment of patients with AIDS
(opportunistic infections and ARV);
• Training of doctors in ARV treatment and care of opportunistic
infections.
• Informing patients on the disease and the care / services
available.
• Hospital treatment of opportunist infections.
• Development of a continuum of care and support and help
networks for people living with HIV/AIDS.
The aim of treating OIs and obtaining access to ARVs is to reduce
the morbidity and mortality rates linked to AIDS and thus allow
patients a better quality of life and a longer active social life, to
fight against exclusion, to limit overloading the health system and
to reduce the economic (family and social) impact of the disease.
By September 2006,
1,500 patients will be
monitored / treated
regularly for opportunistic
infections, and 450
patients will be under ARV.
01/04/1999
30/06/2010
> Project progress
China
52/53
Despite economic growth and its inclusion in the world economic system, China still
suffers from lack of equality. In a number of remote regions, living conditions and the
health care situation are still very insecure. Donations of blood plasma, use of
injectable drugs and the high level of mobility of people continue to account for most
HIV/AIDS infections. More than a million Chinese people might have been infected
with HIV/AIDS.
Infant mortality
> 31‰
Chengdu (Sichuan)
Activities: The programme, started in late 2002 in partnership
with the Centre of Disease Control (CDC) of Chengdu, is conducted
in three voluntary detoxification centres with the raising of
awareness, information and education on prevention of
HIV/AIDS and reduction of risks amongst drug users and staff
working in the centres, as well as with medical, administrative
and political authorities.
01/12/2002
31/12/2006
> Project progress
Outlook
The current national political
climate favours projects aimed
at caring for drug addicts. The
stakes for 2005 are:
• Informing drug users
discharged from detoxification
centres on the prevention of
various methods of
transmission of HIV/AIDS and
hepatitis C.
• Creating a needle exchange
bus.
Activities: MdM has supported the health policy in
Outlook
Gande County by restoring the health structures (general
hospital, Tibetan hospital and six health centres), through
training of health staff from government organisations and
Tibetan community health workers (“nomad doctors”) and by
contributing to the meeting of Western and Tibetan medicine.
The project ended in
November 2004, but
continuation is anticipated in
Gande and Maqin Counties
for the beginning of 2006. The
continuation will be based on
the training of nomad doctors
in four or five priority diseases
and on their proper use of
Western medicine. Preventive
actions in schools and training
of relay women in health
education are also planned.
30/11/2004
> Project progress
HDI
> 0.745, ranked 94/177
> 989
> Direct 1: 500
Direct 2 : 22 000
> Indirect: 30,000
Staff
> Local 1: 1
Local 2: 26
Expatriate 2: 4
Gande County, Qinghai Province
01/04/2002
> 70.9
> Expatriate 1: 2
Facilitating health care access
Informing about the HIV epidemic
Co-ordinator
> Project co-ordinator 1: B. Luminet
> Project co-ordinator 2: C. Giboin
> Field co-ordinator 1: D. Chamla
> Field co-ordinator 2: M. Diaz
> HQ 1 and 2: V. Pardessus
> Project 1 : MdM
> Project 2 : EU, MdM
2004 Budget
Colombia
Although President Uribe’s security policy finally appears to have borne fruit, the
resumption of armed combat and kidnapping is making MdM’s work difficult.
Popular support for the President is beginning to crumble, as the population is
dissatisfied with the relegation of social policy to “second fiddle”. Despite resumed
growth, the country still suffers with high unemployment. In addition, 46% of the
Infant mortality
> 19‰
> 72.1
HDI
> 0.773, ranking 73/177
> 1,850
> MdM Spain
> Direct: women and children
under 5
> Indirect: civil population caught
up in the conflict
Staff
> Local: 5
> Expatriate: 3
Co-ordinators
> Project: C. Raggioli
> Field: C. Escobar
> HQ: F. Stea
> MAE, MdM
2004 Budget
>263,305 euros
population still does not have access to basic health care facilities. The blatant lack
of equality in health care access has led MdM to involve itself in health system
reforms in recent years.
Mother and child care
Meta Region
Activities: The military offensive that has been ongoing for
Outlook
several months in the South of the country (the Patriota Plan),
firmly supported by the United States, seems to be changing
the balance of power in the historical FARC guerrilla war regions.
The civil population caught up in these areas is suspected of
supporting the “terrorists” by one side, and of “collaborating”
by the other side.
The rural population of this region is stigmatised purely by the
fact that they live in a conflict zone, and access to health centres
is made difficult on security grounds. MdM’s aim is to facilitate
or renew access to health care for the most vulnerable
people, and provides mobile health teams for mothers and
children as well as training teachers on sexual and reproductive
health.
2005 will probably be a
strategic year in terms of the
conflict. The South of the
country is in fact the subject
of a huge government
offensive, aimed at upsetting
the balance of military
strength by penetrating the
zones historically held by the
FARC. Large-scale
movements of the
population are anticipated as
people leave the areas of
hostility. Our analysis of the
situation will determine
MdM’s capacity for providing
a health response adapted
to suit the increasing
instability.
01/01/2005
30/08/2005
> Project progress
54/55
Caring for victims of armed conflict
Rio Medio Atrato
Activities: In this strategic area, the advance of paramilitary
Outlook
forces, the ever-increasing presence of the Colombian navy
and resistance by FARC forces have compelled the black and
Indian populations, already the victims of permanent blockades,
to move again in order to avoid further repression for supposedly
collaborating with one of the armed forces. MdM provides
assistance to the indigenous Embera and Afro-Colombian
communities who, being in the heart of the armed conflict,
find access to health care difficult, especially for women and
children.
The increased conflict,
especially in Atrato, has
triggered more movements
amongst the communities
living along the various
tributaries of the Atrato River.
Control of the access routes
to the Pacific, Panama and
the interior of the country is at
stake. Our continuous
presence with these minority
people guarantees a
humanitarian response
adapted to suit them.
15/04/2004
14/04/2005
>
Project progress
> Direct: Embera indigenous
population, especially women
and children
Staff
> Local: 13
> Expatriate: 4
Co-ordinators
> terrain : V. Gavidia
> HQ: F. Stea
> ECHO, MdM
2004 Budget
> 281,181 euros
Ensuring displaced people’s return
Bajo Atrato Region (Choco and Antioquia)
Activities: As the rural population in this area suffers from
Outlook
the same problems of access to care (presence of armed
conflict), MdM provides information and medical support
in matters of reproductive health, as well as training health
professionals in delivery of babies and pre- and post-natal
care.
The project ended in March
2004 after accompanying
the people back to their
home communities.
2001
03/2004
> Project progress
> Direct: 17,549 people
Staff
> Local: 6
> Expatriate: 4
Co-ordinators
> Field: D. Chappaz
> HQ : F. Stea
> MdM, EU
2004 Budget
> 139,280 euros
Cuba
Already weakened by the American embargo, the island was hit in 2004 by a severe
shortage of electricity, which severely affected the Cuban economy, and by the
passage of two hurricanes in less than one month. Hurricane Charley alone caused
material damage estimated at 820 million euros. With a huge influx of tourists and the
return of prostitution, the island has seen an increased in HIV/AIDS cases, and the
Infant mortality
> 7‰
> 76.7
HDI
> 0.809, ranked 52/177
> unknown
International delegation
> MdM Spain
> Direct: young people aged 15-25
Staff
> Expatriate: 1
Coordinators
> Project: G. Robert
> Field co-ordinator: I. Raud
> HQ: F. Stea
> MAE, MdM, Cuban partners
2004 Budget
> 67,892 euros
District of Centro Havano remains the second worst affected area in Havana Province,
with an increase of 70% for the zone as a whole.
Café Salud – Slowing the progress of HIV
District of Centro Havano
Activities: Launched in 2001, Operation Café Salud is based
Outlook
on methods of information, education and communication by
peers to counter the spread of STIs and HIV, especially amongst
young people. With the aim of slowing the progress of
HIV/AIDS amongst people of 15-25 in Centro Havana
District, MdM is pursuing two aims:
• Recruitment, training and continuation of a group of peer
promoters from the district.
• Increasing the transmission of awareness, education and
prevention messages on STIs and HIV/AIDS amongst those
aged 15-25 in Centro Havana.
To compensate for the temporary closure of the café for structural
reasons (water seepage), outside prevention activities have been
developed with the objective of maintaining the aim of keeping
young Cubans aware and informed.
Consolidation of
information, education
and communication
activities in Café Salud.
Reproduction of the
project in other provinces
in the country, in
partnership with the
health authorities.
01/02/2002
01/02/2005
> Project progress
Dominican Republic
56/57
Leonel Fernandez, in power since August 2004, has introduced a policy of austerity
measures to overcome the disastrous economic situation that he inherited from his
predecessor Hipolito Mejia. Dominican purchasing power has still not been restored
and unemployment has reached 18%. Meanwhile, there has been a worrying increase
Promoting fundamental rights
Barohuco
Activities: MdM’s area of involvement is on the border
between the Dominican Republic and Haiti. It takes the form
of a programme for primary health care and defence of
basic civil rights for the illegal Haitian migrant population,
living in the mountainous areas that are difficult to access.
Activities include:
• improvement access to health care services;
• training proximity health care technicians;
• vaccination;
• nutritional support for children under five;
• health education and promotion of reproductive health;
• prevention of STIs and AIDS;
• active vigilance concerning the rights of this population,
through the setting up of a monitoring service with training
for human right.
2004
2006
> Progress bar
Outlook
Withdrawal from the
programme, with the
programme co-ordinator
and a logistical nurse,
over two years. After the
withdrawal, the institutions
taking over will be the
Catholic Church and
the Dominican public
health authority.
in criminal activity and a dramatic rise in illegal emigration to Puerto Rico.
Infant mortality
> 32‰
> 66.7
HDI
> 0.738; ranked 98/177
> 2,514
> MdM Spain
> Direct: 12 to 20,000
Staff
> Local: 4
Coordinators
> Project: S. Châlons
> Field: A. Nombela
> HQ: F. Stea
> Guadeloupe Co-operation Fund,
MdM
2004 Budget
> 71,467 euros
Democratic Republic of Congo
Since 1996, the Congolese population has suffered with all kinds of violence: forced
displacements of population (three million people in total), famine and malnutrition (20
million Congolese are underfed), massacres (Kivu, Kisangani and Ituri), forced
enlisting of child soldiers, use of rape as a war weapon, and a fresh upsurge in
epidemics (measles and cholera). Since 1998, 3.5 million Congolese, especially
Infant mortality
> 129‰
> 41.4
HDI
> 0.365; ranked 168/177
> 111
International delegation(s)
> MdM Belgium, MdM Canada,
MdM Greece
> Direct: 43,200
> Indirect: 480,000
Staff
> Local: 37
> Expatriate: 4
Coordinators
> Project: F. Jacquet
> Field: A. Talibo
> Country: X. Joubert
> HQ: C. Courtin
> EU (PATS), Florindon, MdM
2004 Budget
> 441,717 euros
women and children, have died of disease.
Integrated programme to combat HIV
Goma
Activities: The aim of the activity is to respond to the AIDS
epidemic in one region of the East of the Democratic Republic
of Congo that is particularly affected by war. The activities are
as follows:
• opening of three STI consultation units;
• opening of an anonymous and free screening centre;
• creating of an HIV department for taking care of HIV-positive
patients;
• carrying out an HIV prevalence study in pregnant women;
• strengthening coordination with local actors involved in the
fight against HIV (support and setting-up of “discussion table”);
• training medical and paramedical staff in respect of universal
medical precautions.
01/08/2004
31/07/2006
> Progress bar
Outlook
Continuation of the project
and commencement of ARV
treatment in the second half
of 2005.
58/59
Accompanying street children
Kinshasa
Activities: The aim of this programme is to reintegrate and
Outlook
re-socialise street children through:
• a proper welcome at a specialist centre;
• care with psychological support, educational activities,
reintegration of children into families, and primary health care.
Since 2004 the programme has been directed towards children
at risk from STIs/AIDS, especially street girls, through STI
treatment and HIV prevention. MdM is developing a network
of operations with all the child reintegration associations also
involved in the fight against HIV/AIDS. In 2004, the Pekabo
centre was completely restored to provide a high-quality service
for the children received.
Continuation of current
activities and development
of the STI/AIDS programme
with street children, and
making the Pekabo drop-in
centre independent.
Development of the
partnership with Africare
(energising the network and
designing a working tool
for providing better care
for street children in the
DRC in both health care
and reintegration).
01/01/2004
31/12/2005
> Progress bar
> Direct: 2,500
Staff
> Local: 35
> Expatriate: 1
Coordinators
> Project: D. Cannet
> Field : N. Beaulieu
> HQ: C. Courtin
> Mantegna, Florindon, Fellissimo,
UBS
2004 Budget
> 333,462 euros
Improving the health care situation
Kongolo (Northern Katanga)
Activities: Against a background of community participation,
the project aims to provide quality health care access in 25
health care centres and five advanced health posts in the
Kongolo zone. Five branches have been developed:
• setting-up of a minimum package of activity in health training,
satisfying national standards relating to primary health care;
• supplies of essential consumable medicines, and equipment;
• strengthening the capacity of the Zone Central Office;
• training of staff in health centres;
• epidemiological surveillance and combating epidemics,
including cholera.
21/12/2005
Developing the ongoing
activities through a skill
reinforcement programme
and against a background
of increased epidemic
reaction. There are also
plans to extend the action
to 28 further health centres
in the Kalémié and Niemba
Zones, covering a
population of 210,000.
Staff
> Local: 185
> Expatriate: 4
Coordinators
> Project: A. Thiriat
> Field: K. Touré
> HQ: C. Courtin
> ECHO
2004 Budget
> 758,458 euros
01/01/2005
Outlook
> Direct: 180,000
> Indirect: 350,000
> Progress bar
Egypt
Egypt is experiencing an ever-deepening social and economic crisis. The problem of
street children is increasing in Egypt. Caring for street children, who are stigmatised
and marginalised socially, is a matter of priority for MdM. The right to medical care for
street children, although written in the law, is not being exercised for social, economic
and cultural reasons. For young street girls, the situation is even more difficult:
Infant mortality
> 35‰
> 68.6
HDI
> 0.653; ranked 120/177
> 1,354
> Direct and indirect: currently
being assessed
Staff
> Expatriate 1
Coordinators
> Project: R. Heimann
> Field: I. Bruand
> HQ: S. Alary
2004, UNDP
pregnancy at a young age without monitoring or control, genital mutilation, and a
complete absence of STI prevention policy.
Welcoming young mothers and pregnant girls
Cairo
Activities: Proposed project involving support for a local
NGO working with street children (Hope Village), for:
• the creation of a permanent drop-in centre for young
mothers and pregnant girls from the streets;
• reproductive health education.
The aims of the establishment project, which started in
December 2004 for a six-month period, are:
• accreditation with the Egyptian authorities;
• compilation of the project proposal;
• a search for funders;
• setting up a partnership with Hope Village.
09/12/2004
> MdM
2004 Budget
> 6,593 euros
06/2005
> Project progress
Outlook
Once the establishment
project is completed, setting
up an effective partnership
with Hope Village.
Ecuador
60/61
Integrated development programme
Cuenca Region
Activities: Since 1999, MdM has been conducting a
community health programme with six particularly
marginalised Indian groups living near Cuenca in the South
of the country. The programme, designed at their request and
with their collaboration, has several aspects:
• Health care for the most vulnerable people (medical monitoring
of pregnant women and young children).
• Training of health staff within the communities.
• Building a network for access to running water.
• Fighting malnutrition: supplying food and introducing a more
diversified diet.
• Legal organisation of the communities within civil society:
creation of a health foundation.
To consolidate its action and make its effects last, MdM has
encouraged the creation of developmental micro-projects:
eco-tourism, restaurant, cultural centre, cheese-making etc.
1999
2004
> Project progress
Outlook
The Indian communities
have regained their
independence in matters
of health: the Jambi Runa
foundation manages the
activities of health care
officers and supplies of
drugs.
MdM’s action in the field
of food supplies has
eradicated malnutrition.
Finally, the micro-projects
are operational and should
become fully independent.
MdM France therefore
withdrew in late December
2004. The communities
will be accompanied for a
further year by MdM Italy.
Report on human development 2004, UNDP
Despite the political instability that characterises the country, Lucio Gutierrez is
hanging onto power by a thread. This unpopular president has had to reach a
compromise with the discontented Indian parties. Modernising the economy,
combating poverty and satisfying the demands of the IMF make a difficult balance
for Mr Gutierrez to achieve, especially without the benefits of a majority in
Congress. MdM is concentrating on the Indian populations, which suffer
particularly badly from poverty and exclusion.
Infant mortality
> 25‰
> 70.7
HDI
> 0.735, ranked 100/177
> 1,897
> MdM Italy
> Direct : 4,000 people
Staff
> Local: 4
Coordinators
> Project: B. Floccard, I. Lemmi
> HQ: Rhône-Alpes-Burgundy RD
(S. Bret)
> A number of towns in RhôneAlpes District, private
partnerships, MdM
2004 Budget
> 17,443 euros
Ethiopia
The HIV epidemic is growing more acute in Ethiopia. According to the United Nations, more
than three million people are infected with the virus (the fourth worst affected country in Africa
in absolute terms). The war triggered large-scale movements of the population and caused
the destruction of health infrastructures. The lack of specialised doctors and surgeons has
Infant mortality
> 114‰
> 45.5
HDI
> 0.359; ranked 170/177
PIB/habitant ($)
> 90
> Direct: 200 seropositive mother
and child pairs, 4,000 pregnant
women
> Indirect: 140,000
Staff
> Local: 6
> Expatriate: 1
Coordinators
> Project: M. Saada
> Field: F. Naureen, O. Evreux
> HQ: C. Courtin
> MAE, MdM, GSK Foundation,
Felissimo, Sternstunden
2004 Budget
> 174,678 euros
2004, UNDP
made access to health care particularly difficult in rural areas.
Preventing mother to child HIV transmission
Mekele
Activities: The project is centred on seven separate areas:
• Prevention of mother-to-child transmission (currently
with Viramune).
• Training of advisers in screening centres, passing on of skills
to care staff in Mekele (one hospital and three health centres).
• Setting up an integrated voluntary screening unit for HIV
as part of the ante-natal consultations.
• Awareness within the community on the HIV infection, MTCT,
and its prevention.
• Reconstruction of maternity services.
• The supply of drugs, consumables and equipment.
• Advice and practical assistance on infant feeding.
01/08/2003
31/07/2007
> Project progress
Outlook
Changes in Ethiopian health
policy have now cleared the
way for ARV treatments to be
used. The outlook is therefore
that mothers will be cared for
using ARV treatments, either
as part of the mother-to-child
transmission prevention
programme, or in the wider
context of an ARV access
programme for the general
population of Mekele.
62/63
Guaranteeing access to surgical care
Adwa
Activities: Working with the health authorities in Tigray Region,
Outlook
MdM is involved in a project covering, surgical training,
operations and treatment in the hospital in Adwa, in order
to guarantee health care access for the population. The areas
of activity cover:
• Treatment, preventive care and rehabilitation, with strengthening
of the surgical, gynaecological and obstetric departments among
others;
• Transfer of skills to health care professionals.
At the request of the health authorities, three surgical teams
have been put together. Two of these teams have been assigned
to peripheral health centres, while the third remains assigned
to Adwa hospital in anticipation of the transfer of MdM’s activities
to Axum hospital.
The strategy developed
from end 2004 onwards
involves strengthening
the training of complete
surgical teams, in Axum
hospital, which is close
to Adwa hospital, while
continuing to guarantee
access to surgical care
for the population of
the region.
31/12/2004
Coordinators
> Project: L. Brodi
> Field: O. Evreux
> HQ: C. Courtin
> MAE, MdM
2004 Budget
> 103 639 euros
Staff
> Local 4
> Expatriate: 5
> Project progress
Coordinators
> Project: L. Brodi
> Field: O. Evreux
> HQ : C. Courtin
Chirurgie
Tigray/Axum
Activities: Our surgical activity in Adwa started in 2000. We
left the area after training an operating theatre team: health officer
and anaesthetist nurse responsible for emergency surgery. We
are transferring our substitution and training activities to Axum,
where the activity levels and needs are greater, along three lines:
• Continuing to pass on skills in surgery and obstetrics.
• Training complete operating theatre teams to man the peripheral
health centres.
• Allowing access to health care for the poorest people.
This activity is mainly concentrated on basic surgery and Caesareans,
in order to reduce mother and child mortality and traumas caused
by childbirth.
01/10/2004
Staff
> Local: 1
> Expatriate: 4
> Direct: 179,000
> Indirect: 4,000,000
Progress bar at31/12/2004
01/04/2002
> Direct: 560,000
> Indirect: 4,000,000
30/09/2007
> Project progress
Outlook
The training of teams,
provided in co-operation
and integration with the
trainers in Tigray, should
continue for another
three years.
> UNFPA
2004 Budget
> 62,633 euros
El Salvador
Antonio Saca, on his election in March 2004, inherited a country ravaged by the long
civil war of the 1980s and natural disasters, such as Hurricane Mitch in 1998. The
anticipated economic recovery in the second half of the year was crushed by a rise in
oil prices. MdM is concentrating its action on the old conflict zone in Morazán, which is
especially poor, and has been weakened by difficulty of access to health care and poor
Infant mortality
> 33 ‰
> 70.6
HDI
> 0.720; ranked 103/177
> 2,226
> MdM Spain
> Direct: 7,000
> Indirect: 42,000
Coordinators
> project: J.-L. Pesle
> HQ: Grenoble branch
education and housing.
A community health programme
Région du Morazán
Activities: In 2003, MdM withdrew from its community
Outlook
health programme. Currently, the project involves providing
support for its local partner Doctors for the Right to
Health Care (MDS), so that the partner can implement its
programmes more effectively (basic health care, basic environmental
health improvements, a safe diet and nutrition, integrated health
care for children and training of promoters):
• management training of all MDS staff;
• development of the association’s communication system;
• computer equipment renewal and software training;
• in the context of the environmental health programmes:
disinfection, training and prevention in 20 housing areas.
Through this regional project MdM Grenoble provides financial
support, assistance with care methods and supplies of small
equipment or medicines as and when needed.
MdM is continuing to
finance the management
and computer training for
MDS staff. In 2005, the
impact of this training will
be assessed to determine
what adjustments may be
necessary. This training
should allow improved
management and
organisation within the
association. The
development of the
association’s
communication system will
enhance the value of
MDS’s activities and help
new funders to be found.
> MdM
2004 Budget
> 6,696 euros
10/2004
10/2007
> Progress bar
Georgia
64/65
The new government, appointed after the “Rose Revolution” of late 2003, needs to
respond to the population’s high hopes for improvements to economic and social
conditions in the country. The government has embarked on a series of reforms, and
mass dismissals and arrests are indicative of a wish to cleanse the system of the
corruption that poisoned it. However, the poor harvest could cause severe economic
hardship for the poorest people, and therefore hamper their access to health care for
Reproductive health aid
Mingrelia Region
Activities: The needs identified have led to the definition
Outlook
of a programme based on the theme of reproductive health
in four districts in Mingrelia Region. MdM’s task covers the
following aspects:
• Improved gynaecological and obstetric care of women and
newborn babies; support for external check-ups including antenatal and post-natal visits as well as hospital admissions.
• Restoration of health structures.
• Training of care staff (gynaecologists, obstetricians,
paediatricians, midwives, nurses etc); medical neonatal
resuscitation techniques, diseases connected with pregnancy,
antenatal monitoring etc.
• Setting up of universal measures aimed at preventing HIV/AIDS.
• Setting up of family planning systems.
• Distribution of drugs and supply of medical equipment.
Although the programme is
planned to end in July,
MdM wishes to continue
the project for a further
10 months with the
contribution from ECHO.
The programme will be
extended into the
mountainous Svanetia area,
isolated for several months
of the year, and into other
districts. Definition of an
intervention strategy for
tuberculosis, in the light
of the needs identified.
Source: Report on Human Development
2004, UNDP
financial reasons.
Infant mortality
> 24‰
> 73.5
HDI
> 0.739; ranked 97/177
> 656
> Direct: 50,000 women of
reproductive age, 1,000 patients
at the STI centre, 115 trained
medical staff members
Staff
> Local: 18
> Expatriate: 4
Coordinators
> Project: H. Lepoivre, I. Hermant
> HQ: F.-D. Buquet
> ECHO
15/09/2004
15/07/2005
> Progress bar
2004 Budget
> 114,426 euros
Guinea
General Lansana Conté, who seized power in the 1984 coup, is now seriously ill and only
able to manage the country’s affairs on an intermittent basis. Guinea, which is a country
troubled by great political uncertainty (attempted coup in January 2005), is also
experiencing increasing economic difficulties. The capital, Conakry, is regularly rocked by
Infant mortality
> 109‰
> 48.9
HDI
> 0,425; ranked 160/177
> 415
> Direct: about 200 detainees
Coordinators
> Project: P. Boucourt, T. Comte
> HQ: Rhône Alpes-Burgundy RD
(S. Bret)
> Private partnerships, MdM
2004 Budget
> 5,136 euros
Source: Report in human development
2004, UNDP
riots, especially because of the explosion in rice prices.
Improving health care for prisoners
Kindia
Activities: In 2000, MdM launched a health care
programme for prisoners in Kindia Central Prison. These
200 prisoners, mostly men but also a few women and children,
live in very difficult conditions.
MdM withdrew from Guinea in 2001 but continues to provide
financial support for a local partnership, the Kindia Prisoner Support
Group, consisting of volunteers directly involved in the life of the
prison. The activities are centred on:
• Training a prisoner in nursing care, and managing a pharmacy
in the prison itself.
• Partnership with health authorities for caring for the most
serious cases in Kindia Hospital.
• Food support for the malnourished.
• Restoration of health infrastructures.
• Literacy training for the prisoners.
Over four years, this action has reduced mortality rates in the
prison by 25%.
2000
December 2005
> Project progress
Outlook
MdM continues to support
the Kindia Prisoner Support
Group. The challenge for
2005 is to strengthen the
links with Kindia Hospital,
in order to provide better
care for the sickest
prisoners. Another challenge
is to initiate incomegenerating activities (sewing,
carpentry, brick-making,
weaving). The aim is twofold:
to favour the financial
independence of the KPSG
and make the rehabilitation
of prisoners easier.
Haiti
66/67
2004, Haiti’s bicentennial year, saw the departure of Jean-Bertrand Aristide amidst
chaos and violence. On top of the political crisis, the floods caused by the torrential
rain killed many people and caused widespread material damage. The town of
Gonaïves was devastated. Haiti is now a country in ruins, with terrible poverty and
Helping the victims of violence
Port-au-Prince
Activities: MdM is battling against the psychosocial
suffering of victims of violence (political, social and domestic)
by training staff in health establishments in Port-au-Prince,
providing multi-disciplinary care for victims of violence, and
making future health professionals and those active in the
community aware. MdM is also supporting Uramel, a Haitian
NGO, in its training of legal and medical actors in legal medical
disciplines.
01/12/2003
30/11/2005
> Project progress
Outlook
The project is continuing into
2005, and despite the political
troubles of 2004, the balance
sheet at the end of the first year
is very satisfactory. Violence is
recognised as a public health
problem and our training and
awareness action in the districts
is highly sought after.
weakened further by health issues such as access to drinking water.
Infant mortality
> 79‰
> 49.4
HDI
> 0.463; ranked 153/177
> 415
International Delegations
> MdM Canada / MdM Switzerland
> Direct: victims of violence
> Direct: the wounded of Port-auPrince
Giving aid to the victims of violence
Port-au-Prince
Activities: The aim of the project is to supply post-operative
Outlook
care for wounded people from the two health organisations in
Port-au-Prince:
• An official care organisation, where 36 people were hospitalised
and other received external care, all for bullet wounds.
• An organisation kept clandestine for security reasons, linked
to HSI.
Work has also been carried out in close association with our
network of Haitian NGOs and the few hospitals still open.
This project was
conducted in an
emergency situation
caused by the political
troubles linked to the
departure of Mr Aristide.
In mid-May, despite
continuing tension in Portau-Prince, the hospitals
reopened and people were
able to obtain health care
in complete safety.
23/02/2004
16/05/2004
> Project progress
> Indirect: 500 health professionals
Staff
> Local 1: 15
> Local 2: 20
> Expatriate 1: 3
> Expatriate 2: 2
Co-ordinators
> Project 1 and 2: A. Urtubia
> Field 1: M. Desmousseaux
> Field 2: X. Simon
> HQ 1 and 2: M.-Y. de PenansterRosny
> Project 1: MAE, MdM
> Project 2: MdM, Canadian
co-operation
2004 Budget
Haiti
> Direct: 15,000
> Indirect: 60,000
Staff
> Local: 13
> Expatriate: 2
Co-ordinators
> Project: P. Beze Beyrie followed
by J-B. André Jean
> Field: F. Levy followed by B-N.
Liehoun
> UNDP, MdM
2004 Budget
> 51,407 euros
Revitalising the health system
Grande Anse Region
Activites:
Restoring and revitalising six health
organisations (five health centres and one health post) in order
to improve the accessibility and quality of health care and management:
• Training of care staff.
• Provision of drugs and medical equipment.
• Improvements in the health information system.
• Restoration of health structures.
• Support for health authorities.
01/06/04
30/11/2005
> Project progress
Outlook
The project corresponds to a
specific need to restore and
update health centres that are
not functioning consistently.
The demand for training is
great and we must surely be
thinking about widening this
activity to include other health
centres in the area in a future
project.
Encouraging a feasible health care system
> Direct: 300
> Indirect: 166,800
Grande Anse Region
Activities: This community health care programme is
Outlook
Staff
> Local: 16
> Expatriate: 2
aimed at launching a viable peripheral health care system: technical
support for the Regional Health Department and health education
amongst the village communities.
This IEC awareness work has been carried out by voluntary
leaders from the Haitian community, and the community was
the focal point of MdM’s actions in 2004. A social and community
diagnosis has been carried out, after a lengthy survey, and has
allowed an overall “health map” of the area to be produced.
Thanks to the work carried
out and the diagnoses made
in the area during this
project, which ended in late
2004, we have been able to
do a needs assessment and
set up new projects.
Co-ordinators
> Project: P. Beze Beyrie
> Field: L. Abgahounba
> UE, MAE, MdM
2004 Budget
> 201,542 euros
01/01/2002
15/12/2004
> Project progress
68/69
Promoting health care through hygiene
Grande Anse Region
Activites: The aim is to reduce mortality and morbidity
Outlook
rates caused by diseases linked to faecal matter in the
Bonbon and Abricots zones and reach a 72% latrine distribution
target through community mobilisation and awareness, training
of families in use and maintenance, health committees, and
construction of latrines.
The success of the project
led it to develop in August
2004. The high community
participation level has
allowed the project to
continue. At the end of three
years, 99% of the latrines are
being used and maintained.
01/02/2003
31/05/2004
> Project progress
> Direct 1: 4,800
> Indirect 1: 40,000
> Indirect 2: 40,000/ 2 a : 78,000
> Indirect 3: 60,000 inhabitants of
Pilate spread over 157 km2 in
8 rural areas
Staff
> Local 1: 8
> Local 2: (2a): 10
> Expatriate 2: 3 / 2a: 4 (+ 2
occasional)
> Local 3: 31
> Expatriate 3: 7
Flood emergency
Co-ordinators
> Project 1: P. Beze Beyrie
> Project 2: A. Urtubia
Mapou (2) and Gonaïves (2a)
> Project 3: C. Castaing,
2 bis : J.-B. Pierre-Jean
Activites: MdM has brought aid to the affected areas. The
Outlook
work was concentrated on the devastated Mapou Region, with
the establishment of a small field hospital in association with the
ICRC, support for the local health centre and aid for victims. MdM
has also worked together with Fonds Verettes to supply
psychological support. The Gonaïves Region was particularly badly
hit: support for three health centres, check-ups, gifts of drugs and
medical equipment, epidemiological monitoring, and small-scale
restoration of health structures.
There are still problems in
Gonaïves, but more in the
context of the longer-term
reconstruction of the town
and development
programmes that are not
within the scope of MdM’s
priorities within the region.
Emergency 2
25/05/2004
> 1: Canadian Co-operation
> 2: General Council of Cotes
19/12/2004
>
> 2a: ECHO
> 3: MdM, Association of Friends of
Project progress
Sister Madeleine, private
donations
> Project progress
2004 Budget
> 1: 74,799 euros
> 2: 5,890 euros
> 2a: 85,590 euros
> 3: 380 euros
Training care staff
Pilate
Activites: This annual medical skills development
programme was unable to operate during 2004 because of
severe weather.
01/02/2003
C.-M. Beaudoin, later
V. Sauloup
> HQ 1, 2 and 2a:
M.-Y. de Penanster-Rosny
> HQ 3: RD Aquitaine
d’Armor
30/06/2004
Emergency 2 a
20/09/2004
M. Pardineille, P. Carbonnier
> Field 1 : Oddy Naval
> Field 2 : S. Lasserre Cordero / 2a :
31/05/2004
> Project progress
Outlook
Resumption of the
programme in 2005, with
planned extension to the
Cape.
Indonesia
When the tsunami struck Indonesia on 26 December 2004, 240,000 people died or disappeared.
Aceh Province was badly hit: medical infrastructures destroyed, lack of care staff, psychological
distress. Beyond the emergency of the first few weeks, MdM’s activity forms part of the local
health system reconstruction project, while Western Papua, home to 1% of the Indonesian
Infant mortality
> 33‰
> 66.6
HDI
> 0.692; ranked 111/177
> 817
> Direct 1: 35,000
> Direct 2: 30,000
> Indirect 1: 110,000
Staff
> Local 1: 7
> Local 2: 20
> Expatriate 1: 4
> Expatriate 2: 24
Co-ordinators
> Head of project 1: P. Gaillard
> Head of project 2: P. Foldès
> Field co-ordinator 1: A. Le Garnec
> Field co-ordinator 2: V. Cauche
> HQ 1: V. Pardessus
> HQ 2: Emergency desk
> Project 1: Cordaid, MdM
> Project 2: MdM, ECHO,
local communities
2004 Budget
2004, UNDP
population, accounts for over 42% of the AIDS cases recorded at national level.
Prevention amongst the oppressed
Mulia, Puncak Jaya District, Western Papua
Activities: This project aims to reduce the prevalence of STIs
and the incidence of HIV amongst the indigenous populations. It
involves:
• an organisational branch (strengthening the capacity of the local
health office and all the partners);
• a medical branch (care and epidemiological monitoring of STIs,
prevention, training of medical staff);
• a psychosocial branch involving prevention and social mobilisation.
01/08/2004
31/07/2008
> Project progress
Outlook
In 2004, most of the activities
were related to the first
(organisational) branch. 2005
will concentrate more on
prevention and social
mobilisation (creation of
prevention materials and
fighting against discrimination
and stigmatisation), and the
launch of the medical branch.
Aid for victims of the tsunami
Aceh Besar and Aceh Jaya Districts (Aceh Province, Sumatra)
Activities: On seven different sites in the districts of Aceh Besar
and Aceh Jaya, activities are centred on five different areas:
• restoration of access to primary health care through
the setting-up of mobile clinics: outpatient consultation, antenatal
and postnatal monitoring, nutritional surveillance, referring
patients to hospital;
• epidemiological monitoring and response to epidemics,
emergency vaccination campaigns (measles);
• reconstructing one health centre and two health clinics;
• support for the reopening of Banda Aceh provincial hospital;
training doctors and nurses in the identification and care of
psychological and psychiatric problems.
28/12/2004
31/07/2008
> Project progress
Outlook
The reorganisation,
accompaniment and support
of local health structures and
health care staff in the
resumption of their activities
in the medium term are
essential. After the buildings
are reconstructed, MdM will
be involved in the training
and accompaniment of
medical staff in order to
guarantee access to highquality primary health care.
70/71
Ingushetia
Violence has increased sharply in Ingushetia, most of it aimed at Chechen refugees.
After the camps closed in May 2004 as part of Russia’s decision to show that the
Chechen situation was being “normalised”, the project stopped suddenly as a result.
MdM is now concentrating on its activities in Chechnya, managed remotely from
Primary and mental health care for displaced people
Activities: MdM had been the only NGO present permanently
Outlook
in the region since 1995. In 1998 and 1999 the expatriate
workers withdrew for safety reasons, but the association
maintained a “remote control steering” system for the project,
managed from Moscow. The activities first centred on primary
health care, and then, from 1996 onwards, MdM implemented
mental health programmes. The activity with the Chechen
displaced people, who were in two camps, was achieved in
several phases:
• primary health care and psychological support;
• monitoring of people’s rights, with regular dispatch of observers
responsible for collecting testimonies from displaced people.
When the camps effectively closed, MdM withdrew from the territory.
The project in Ingushetia
was stopped after the
camps closed in May 2004.
1999
May 2004
Moscow since 1999.
Infant mortality
HDI
> No data specific to Ingushetia
> Direct: 18,100
> Indirect: 102,000
Staff
> Local: 45
> Expatriate: 2
Co-ordinators
> Project : J. Dato
> Field: S. Marie-Fanon,
Z. Albastova, M. Doudaiev
> Project progress
> HQ: F.-D. Buquet
> ECHO
2004 Budget
> Ingushetia and Chechnya:
1,066,530 euros
Iran
41,000 dead, 30,000 injured, 75,000 homeless – such was the toll of the earthquake that
destroyed 80% of the town of Bam on 26 December 2003. This disaster traumatised a
population already affected by high unemployment (25% of the working population) and
poverty (the official poverty rate is 18%, with 16.5 million people living below the poverty
Infant mortality
> 35‰
> 70.1
HDI
> 0.73; ranked 101/177
> 1,652
> MdM Greece
> Indirect: 150,000
Staff
> Expatriate: 12
Coordinators
> Project: B. Juan
> HQ: Emergency Desk
> ECHO, Chaîne du bonheur
2004 Budget
> 280,333 euros
line). In addition, Iran has one of the highest rates of drug use in the region.
Support for victims of the earthquake
Bam
Activities:
Following the earthquake that completely
destroyed the town of Bam, MdM set up an emergency
programme consisting of three main parts:
• access to primary health care;
• psychological support;
• development of a hygiene aspect.
A tent-based clinic, located in Zone 2 of the centre of Bam,
and a system for distributing drugs and equipment to qualified
staff were set up. This medical aspect went hand in hand with
post-traumatic stress support for earthquake victims and
provision of sanitation.
27/12/2003
03/05/2004
> Progress bar
Outlook
The programme ended
in June 2004.
Iraq
72/73
Ever since the fall of the Ba’ath regime, the Iraqi population continues to live in a
climate of insecurity, uncertainty and impunity for those responsible for the toppled
regime. The risk of civil war has not disappeared, even though “democratic” elections
have been held. The armed coalition forces and the partisans of the new democratic
Iraq are the targets of bloody guerrilla warfare. The civil population is the main victim
to the situation in which there is confusion between military and humanitarian aspects.
Finalisation of training programme
Mosul
Activities: Launched in July 2002, the programme for
Outlook
creating a post-operative care unit at the al-Khansa
paediatric hospital in Mosul was interrupted as war loomed.
Its aim was to:
• improve the surgical care available to children;
• reduce infantile operative and post-operative morbidity and
mortality.
To do this, the project developed a technical platform and a
training system for medical and paramedical staff within the
child surgery unit in the gynaecological and paediatric hospital
in Mosul. When war broke out, this programme was taken
over by a monitoring project in Northern Iraq. Resumption of
the training programme was postponed until March 2004 and
then terminated in June 2004. After an initial evacuation for
safety reasons, MdM France’s project in Iraq was suspended.
The uncertain future and
atmosphere of insecurity
suggest that access to
health care for the Iraqi civil
population will be reduced.
Médecins du Monde remains
ready to intervene again
when conditions allow.
22/04/2003
13/06/2004
> Project progress
and the humanitarian actors are gradually leaving Iraq because they are too exposed
Infant mortality
HDI
> No data specific to Iraq.
> Direct: 3,500
> Indirect: 2,2 millions
Staff
> Local: 2
> Expatriate: 3
Co-ordinators
> Project: M.-A. Silicani
> Field: J. Neerkorn
> HQ: Emergency desk
> ECHO, MdM
2004 Budget
> 32,977 euros
Ivory Coast
Despite the peace agreements signed in Marcoussis under the aegis of France in January
2003, the country remains split into two factions: the North, in the hands of the Forces
Nouvelles rebels, and the South, controlled by loyalist forces. The cease-fire signed in
May 2003 is maintained by a significant international military deployment. Since the
Europeans left in November 2004, economic activity has declined sharply, causing
serious problems of unemployment and impoverishing the population
Infant mortality
Accompanying minors
> 41.2
HDI
> 0.399, ranked 163/177
> 707
> Direct project 1: 2,500
> Direct project 2: 120,000
> Indirect project 1: 25,000
> Indirect project 2: 300,000
Staff
> Local staff 1: 31
> Local staff 2: 49
> Expatriate staff 2 : 3
Coordinators
> Project co-ordinator 1: J. Martin
> Project co-ordinator 2:
A.-J. Pocheron
> Field co-ordinator 1: K. Kouassi
> Field co-ordinator 2: L. Malingrot
> HQ 1 and 2: C. Courtin
> Project 1: MdM, UBS, EU
> Project 2: ECHO
2004 Budget
> 102‰
Abidjan
Activities: Working with minors since 1996, the current project
Outlook
has two objectives:
• access to primary health care;
• re-socialisation.
The activities involve: offering primary health care for children, both
on the streets and in the Treichville medical centre; intervention to
improve the living conditions of minors in Abidjan prison’ facilitating
their re-socialisation and improving the skills of the teaching staff;
specific HIV / STI prevention measures; a process for re-socialising
children.
The project was halted in
January 2003 and the
expatriate staff evacuated,
following the troubles. The
withdrawal process for the
programme has been under
way for several months.
MESAD, the local NGO,
currently manages all the
various aspects of the
programme.
01/01/2000
30/06/2003
> Project progress
Enabling access to health care
Seguela
Activities: This post-emergency programme provides support
for Séguéla regional hospital and for the nine primary health
care centres in the “rebel zone” cut off from the rest of the country
since the troubles of September 2002. Supplies of drugs are no
longer guaranteed and most medical executives have gone to the
South. Supplies of drugs and small-scale medical equipment, and
the sending of expatriate surgical teams (surgeons and anaesthetists)
have allowed this hospital to carry out its functions once more,
something it had been unable to do since the conflict started.
12/2002
05/2005
> Project progress
Outlook
MdM’s activity will depend on
how the crisis evolves and on
political stabilisation. These
conditions are essential for
general activity to begin
again, supplies of drugs to
resume, and medical staff to
return to their posts.
Kosovo
74/75
The issue of the future of this province in Serbia-Montenegro, administered by the UN,
remains unanswered. The non-definition of Kosovo’s status has aggravated the interethnic tension. KFOR troops and UN police forces failed in their mission during the
organised attacks staged in March by Albanian groups against the Serb, Roma and
Ashakali minorities. Almost half of the working population is unemployed, and half of
Listening to Young People
Pristina
Activities: Since 2003 MdM, together with the Kosovar Ministry
of Culture, Youth and Sport and a local NGO, Vita Kosova, has been
carrying out health prevention activities with young people
aged 13 to 24. This project has three parts:
• direct help (individual psychological support, group activities,
medical consultations and integration into a care network);
• indirect help (training youth organisations in identified health
issues, ongoing training for the Listening to Young People team);
• the setting up of a drop-in, listening, information, consultation
and guidance centre for young people.
Outlook
Since 2004, the project
has been sponsored by
“Espace Santé Jeunes”
of Salon-de-Provence.
2005 sees the beginning
of a one-third financial
contribution from the
Kosovar Ministry of
Culture, Youth and Sport.
2006
> Project progress
Gllogovsc
2004
2005
> Project progress
> Direct: +/- 250,000 young people
> Direct 2: 70-100 people per day
> Indirect: +/- 1 million young people
under 24, living in Kosovo Province
Staff
> Local 1: 8
> Local 2: 2
(L. Bouju-Malaval)
Improving oral and dental care
Activities: MdM’s project aims to improve oral and dental
health in this region, through:
• the setting up of two complete dental units in the health centre
in Gllogovsc;
• the training of local practitioners in new dental care techniques.
Infant mortality
HDI
> No data specific to Kosovo.
Coordinators
> Project 1: M. A. Chaud
> Project 2: P. Dupin
> Field 1: G. Alliu
> Monitoring: PACA RD
2003
the population as a whole lives below the poverty line.
Outlook
Oral and dental health
education in schools.
> Project 1: PACA territorial
collectives
> project 2 : MdM
2004 Budget
Lebanon
Since the end of the civil war, Lebanon has experienced an ever-deepening social and
economic crisis, while the regional geopolitical situation remains very tense (the aftereffects of war in Iraq, American threats towards Syria, and continuation of the IsraeliPalestinian conflict). Despite the recession, Lebanon takes in hundreds of thousands
of foreign workers and is a transit point for populations fleeing war and dictatorships.
Lebanon is not a signatory to the 1951 Geneva Convention on refugee status, and
> 73.5
HDI
> 0.758; ranked 80/177
> 3,894
> Direct: 10,500 migrants newly
incarcerated each year at
Roumieh Prison and the retention
centre.
> Indirect: about 5,500 Lebanese
prisoners held in Roumieh; the
medical and non-medical prison
staff at Roumieh, and local
partner teams in the project.
Staff
> Local: 5
> Expatriate : 2
Coordinators
> Project: B. Lambert
> HQ: S. Alary
> MdM
2004 Budget
> 52,293 euros
refuses to be a host country.
2004, UNDP
Infant mortality
> 28‰
Health care access for migrants in prison
Beirut
Activities: Since 2004 MdM has conducted, in partnership
Outlook
with two local organisations (Caritas-Migrants and Ajem), a
programme for health care access for migrants held in the
prison at Roumieh and in the retention centre. The first activities
set up are as follows:
• general medical consultations at Roumieh and at the retention
centre, medical screening on arrival, medical monitoring (of
chronic illnesses, supplies of essential medicines not available
in the prison, and making the prison authorities and the association
partners aware of the importance of quick diagnosis and medical
monitoring);
• training and IEC (information, education and communication)
on health (health education modules for prisoners and nonmedical prison staff, training of medical prison staff).
Continuation of the
programme in 2005, with
new activities centred on:
• health education and
training;
• improvement of care of
HIV and tuberculosis cases
in Roumieh Prison;
• information and awareness
on migrant prisoners’
access to rights, with the
Lebanese authorities and
with the general public.
01/2004
12/2004
> Progress bar
Liberia
76/77
The disarmament, demobilisation, rehabilitation and reintegration (DDRR) programme
initiated by the UN should lead to 90,000 people being disarmed. The reintegration of
the former fighting forces into civil society, and the return of refugees and displaced
Support for Monrovia clinics
Monrovia
Activities: The support project for five clinics located in
Outlook
Central Monrovia and in the suburbs was launched the day after
the civil war finished. It involved re-establishing access to health
care for the displaced population affected by the fighting that
occurred in the city of Monrovia in the summer of 2003. After
that, MdM conducted a partnership with the local NGO,
Merci, which took over direct support of these structures.
This partnership ended on
31 March 2004. MdM has
extended its activities in
Bong county, beyond the
Monrovia city zone, and
now supports nine clinics.
09/2003
no end date yet set
> Progress bar
Primary and emergency health care
Gbarnga
Activities: In Bong county, MdM is conducting the following
Outlook
activities with nine health centres:
• primary health care and reproductive health consultations,
including the prevention of infectious diseases;
• epidemiological monitoring (malaria, cholera);
• vaccinations;
• emergency transfers to reference hospital structures.
MdM is also working to develop a psychological support
initiative with women who have been associated with the
fighting forces or who have suffered sexual violence. The
association is involved in two rehabilitation centres for
demobilised children.
In 2005, MdM is planning
to carry on with providing
primary and mental health
care, as well as widening
the community health
action programme.
09/2003
09/2005
> Progress bar
Rapport sur le développement
humain 2004, UNDP
people, are major factors in the stabilisation of the country.
Infant mortality
HDI
> No data specific to Liberia.
> Direct: 108,569
> Indirect: 200,000
Staff
> Local 1: 170
> Expatriate 1: 10
> Expatriate 2: 8
Coordinators
> Project: P. Hirtz
> Field 1: B. Contamin,
C. Clavero Lopez
> Project 1: ECHO, MAE Germany,
MdM
> Project 2: ECHO, MAE Germany
Budget
Madagascar
The political crisis of 2002 and the ravages of the weather (cyclones and floods) wiped out
all the progress that had been made. In 2004, Cyclone Gafilo caused damage in 70% of
the territory and especially in the Maroentsetra Region in the North-East of the island. With
an HIV sero-prevalence rate of 1.15%, the HIV epidemic is widespread.
> 53.4
HDI
> 0.469; ranked 150/177
> 268
2004, UNDP
STI/AIDS prevention and education in Tulear
Infant mortality
> 84‰
Tulear
Activities: Sisal and MdM are working together to provide
technical support for the following activities:
• evaluating and supporting human resources, following the
development of the Tulear Centre, and providing training;
• supporting and accompanying the SISAL management;
• supporting group training;
• supporting the institutional strengthening of SISAL and its
management capacities.
> Direct 1: the NGO SISAL , 17
people
> Direct 2: groups at risk and
consultants at the SALFA
> indirecte 1 : the population of Tulear
> Indirect 2: the population of Ilakaka
Staff
> Local 1: 17
> Local 2: 6
> Expatriate 1: 1
> Expatriate 2: 1
Coordinators
> Project 1: C. Ottenwaelder,
C. Vichatzky
> project 2: C. Vichatzky
> Field: C. Dézé
> HQ 1: O. Mouzay
> HQ 2: E. Martinon
> Project 1: MdM, ICCO
> Project 2: MdM, Co-Opération
Française, La Réunion General
Council, SALFA
2004 Budget
> Project 2: 500 euros
03/2004
02/2006
> Progress bar
Outlook
The SISAL team has
managed the centre well
and completed the planned
programme satisfactorily.
This development will be
consolidated in 2005, and
MdM’s departure in 2006
remains a realistic objective.
MdM and SISAL will be
working as privileged
partners in the fight against
STIs and HIV.
Fighting STIs/HIV in partnership with SALFA
Ilakaka
Activities: After the training of the SALFA centre team
Outlook
(Malagache NGO) has been completed, the following activities
will be undertaken:
• IEC (Information, Education & Communication) and
proximity work with the populations at risk;
• prevention, screening and care of STIs;
• voluntary, anonymous and free screening for HIV and care
of people living with HIV;
• strengthening local capacities for fighting STIs and HIV.
MdM’s technical support is
planned to last for 18
months, after which MdM
should withdraw from the
project.
12/2004
05/2006
> Progress bar
78/79
Children project
> Direct: 2,000
> Indirect: families of children,
Antananarivo
Activities: Once or twice a year, the medical/surgical projects
of Action Enfance, aimed at helping children with cardiac
pathologies, enable the following to be compiled:
• a list of children to be operated on in Madagascar for closed heart
surgery during the next project;
• another list of children with more complex pathologies requiring
open heart surgery on La Réunion.
Children who do not meet the criteria for these two situations are
referred by MdM to the partner associations Terre des Hommes,
Ribambelle and Mécénat.
Outlook
MdM plans to carry on its
activity in 2005.
surgeons, paediatric cardiologists,
anaesthetist-resuscitators, nurses
(4-5 people for each
medical/surgical project)
Coordinators
> Project: J.-F. Delambre
> Field: N. Ramamonjisoa
> HQ: Indian Ocean RD
1994
end date not known
Malagache partner doctors
Staff
> Local: 4
> Expatriate: paediatric heart
> Progress bar
> La Réunion General Council,
MdM Indian Ocean donors
2004 Budget
> 56,986 euros
Emergency surgical care
Maroentsetra Gafilo
Activities: In association with the local health authorities,
MdM has provided a six-month emergency medical
programme centred on six aspects:
• supplying drugs and small and larger equipment to the 19
health centres, the hospital and the prison in Maroentsetra;
• rehabilitating the hospital;
• epidemiological monitoring, health education and distribution
of vital products to the villages, with the aim of preventing epidemic
diseases;
• supervising and training health care officers in order to allow
an improvement in care quality and deal with epidemic diseases;
• training health care officers and donating means of transport
and communication, thus allowing an improvement in the health
centre / hospital reference system;
• an anthropometric survey, to assess the increase in instances
of child malnutrition due to the cyclone;
preparing for future cyclones through workshops.
03/2004
09/2004
> Progress bar
Outlook
After the closure of the
programme, MdM assessed
the possibility of continuing it.
As a result, the authorities
and partners were satisfied
with MdM ’s activities. This
has allowed an improvement
in care quality in the region,
the incidence of potentially
epidemic diseases and the
capacity to react in the face
of the next cyclone. MdM is
confirming its partnership with
the CNS (National Help
Council) for 2005 and will be
ready to intervene the next
time a severe cyclone arrives.
> Direct: 39,800
> Indirect: about 100,000 people
(60% of the population)
Staff
> Local: 9
> Expatriate: 4
Coordinators
> Project: J.-D. Yovanovitch
> Field: C. Dézé
> HQ: O. Mouzay
> ECHO
2004 Budget
> 203,671 euros
Mali
Mali is a haven of peace and democracy in a sub-region in crisis. The troubles in Ivory
Coast however are hitting it very hard, and the effects of these troubles are exacerbated
by the recent troubles in Togo. Despite efforts by the authorities, the health care
requirements remain urgent, especially in reproductive health. The poor conditions of
confinement, and the after-effects for mothers in the form of vesico-vaginal fistulas,
Infant mortality
> 122‰
> 48.5
HDI
> 0.326; ranked 174/177
> 296
> MdM Belgium
explain the high maternal mortality rate (580‰).
Exclusion surgery
Mopti Region
Activities: MdM is conducting a programme for the prevention
and care of vesico-vaginal fistulas, centred on four areas:
• surgical treatment of women;
• training of local surgeons as well as operating theatre teams;
• broadcasting messages of prevention (local radio stations,
theatre performances);
• literacy education sessions for those ill people who want them.
> Direct: women suffering from
vesico-vaginal fistulas
Staff
> Local: 7
> Expatriate : 1
Coordinators
> Project: J.-M. Colas
> Field: J.-M. Zino
> HQ: O. Mouzay
> MdM, the Norwegian Church
2004 Budget
> 114,336 euros
12/1999
12/2005
> Progress bar
Outlook
The activity will continue
as follows:
• complete training for
two surgeons and one
gynaecologist in fistula
surgery;
• independence for Mopti
Hospital (direct financial
support). MdM has
undertaken to support it
until the new Sévaré Hospital
is built;
• setting up a national care
project for vesico-vaginal
fistulas, a project that
should include Mopti
Hospital’s activity.
Mexico
80/81
Despite enjoying a return of economic growth after three years of stagnation, Mexico
still suffers from serious social inequality. Alongside the affluent, over half the
population lives in poverty, especially the Indian communities whose exclusion makes
them very vulnerable. In Mexico, the term “d’alto grado de marginalisazion” is used to
refer to certain Indian communities in the Southern states, where the health indicators
Improving the community health care system
Chiapas Region
Activities: MdM has had a presence in Mexico since 1995.
Outlook
The current programme in Chiapas Region is aimed at improving
the state of health of the Tzotzil population. With the support
of the communities, MdM is working to train health promoters
and set up four micro-clinics in order to enable these populations
to gain access to health care. More than 250 promoters are
responsible for the health in their communities, organising their
work around three reference point micro-clinics.
Creating a health system
managed by the Indians will
help them develop their
independence. Real
negotiations between the
Government and the Zapata
movement in Southern
Chiapas would allow a longerterm solution to be found for
caring for the Indians’ health.
01/2003
12/2005
> Progress bar
Health care access for the migrant population
Tijuana
Activities: MdM has carried out a study on the health care
situation of the migrant population that passes through
the drop-in centres. An intervention strategy has been defined
for a project in partnership with a network of those involved
locally (drop-in centres, Ministry of Health, support associations
for people living with HIV/AIDS).
2003
2004
> Progress bar
Outlook
After more than six months
of setting-up, the project is
planned to start in late
April 2005.
are the worst in the whole country.
Infant mortality
> 24‰
> 73.3
HDI
> 0.802; ranked 53/177
> 6 320
> MdM Spain, MdM Switzerland,
MdM United States
> Direct 1: population indienne
> Direct 2: migrants
Staff
> Expatriate 1: 1
> Local 2: 1
> Expatriate 2: 1
Coordinators
> Project 1: T. Brigaud
> Project 2: F. Giraud
> Field 1: C. Martin
> Field 2 : M.-D. Aiguillon
> HQ: F. Stea
> Project 1: EU, MdM France,
MdM Italy
> Project 2: MdM France
2004 Budget
Moldava
Divided between the indecisive European Union and the outdated Communist
government, Moldava has been in economic and political transition since gaining
independence in 1991. With an average salary of 60 euros, the Moldavan population is
one of the poorest in Europe, and continues to emigrate in huge numbers to the
prosperous countries of the European Union. It is one of the main countries of origin for
Infant mortality
> 27‰
> 68.8
HDI
> 0.681; ranked 113/177
> 382
> Direct: young people aged 13-25
and female victims of trafficking
Staff
> Expatriate: 1
Coordinators
> Project: F. Parrot
> Field: P. Baril
> HQ: F.-D. Buquet
> MdM
2004 Budget
> 29,988 euros
2004, UNDP
victims of human trafficking.
Support for victims of human trafficking
Balti
Activities: The problem of human trafficking in Europe is a
Outlook
priority in MdM’s intervention strategies. Moldova appears to
be one of the main countries of origin for the victims. The
health care of young people at risk and of victims of
human trafficking is approached on a multidisciplinary basis
(medical, psychological, social and legal);
• medical and psychological activity: to help improve the health
of young people aged 13-25 via the setting up of a health centre
in Balti, the country’s second city, in the wider context of a
programme involving the setting up of nine youth friendly clinics
(World Bank / UNICEF);
• strengthening the work of local actors in the protection,
rehabilitation and reintegration of victims of trafficking, and
preventing all kinds of violence towards young people.
The aim is also to involve itself in the Moldavan anti-trafficking
network and to testify to the psychosocial consequences of the
phenomenon of human trafficking (prostitution).
Effective start of the
programme in April 2005.
06/2003
no planned end
> Progress bar
Nepal
82/83
The resumption of activity by Maoist guerrillas, who have been fighting the monarchy
since 1996, has hindered development in Nepal and affected a major sector, tourism. The
country did, however, benefit from good weather conditions in 2004 and agriculture
enjoyed a 3.5% growth in 2004, likely to be maintained in 2005. Known as one of the
world’s poorest countries, Nepal is weakened by tuberculosis, which affects a sizeable
Fighting tuberculosis and HIV
Western Regions
Activities: MdM has had a presence in Nepal since 1995.
The programme started in 2002 is aimed at preventing and
controlling the spread of tuberculosis and AIDS in four
districts in Western Nepal: Palpa, Syangja, Gulmi and Argha
Kanchi.
2004 was mainly dedicated to reducing the socio-economic
effects of tuberculosis and its impact on health.
The awareness and information activities have been developed
through the training of 1,909 resource staff and 2,130 health
care staff, with the aim of improving detection and monitoring
of tuberculosis through treatment. The WHO objectives have
been met: detection of 70% of potentially ill patients and
treatment of 85% of tubercular patients.
Outlook
In 2005, MdM aims to
re-centre its actions on
combating AIDS, by
concentrating solely on
the target populations:
intravenous drug users,
migrants, prisoners and
prostitutes and their clients.
part of the population.
Infant mortality
> 66‰
> 59.6
HDI
> 0.504; ranked 140/177
> 236
> MdM United States
> Direct: 1,150 and 50% of
prostitutes in Syangja District
> Indirect: 1,200,000 (population
of four districts)
01/2002
03/2006
> Progress bar
Staff
> Local: 25
> Expatriate: 2
Coordinators
> Project: P. Baguet
> Field: O. Lermet
> HQ : F.-D. Buquet
> UE, ICCO, MdM
2004 Budget
> 251,001 euros
Pakistan
Infant mortality
> 83‰
> 60.8
HDI
> 0.497; ranked 142/177
> 408
> Direct: 100 women and 30 children
> Direct 2: 35,000
> indirect 2: 160,000
Staff
> Local 1: 6
> Local 2: 17
> Expatriate 1: 2
> Expatriate 2: 3
Coordinators
> Head of projects: B. Ten Kate
> Field 1: M. Jactat
> Field 2: C. Lopez-Clavero
> HQ 1: E. Martinon
> HQ 2: S. Beau, E. Martinon
> Project 1: MdM
> Project 2: MdM, Rissho Koseikai
2004 Budget
> 1: 26,151 euros
> 2: 34,775 euros
2004, UNDP
The plight of women in Pakistan remains worrying. Violence is perpetrated on them
daily: 80% of women are victims of violence. The crime of honour is still
commonplace: over 1,000 women are killed each year in the name of honour. Each
year in the Punjab, hundreds of women are burnt by fire or by acid. 80% of women
detained are raped by police officers or prison warders.
Support for a refuge for women suffering
from domestic violence
Sargodha
Activities: In September 2004, MdM started a nine-month pilot
Outlook
project with targets to provide medical, psychological and legal
aid for women victims of domestic violence sheltering in the
Dar-ul-Aman refuge in Sargodha, Punjab. In order to increase the
duration of our activity, two branches have been developed:
• mobilisation of both civil society and government authorities;
• training of staff at Dar-ul-Aman.
The exploratory project allowed a reference project, lasting
three years, to be planned on the subject of violence against
women, in anticipation of intervention by MdM in all eight Darul-Aman centres in the Punjab.
The project has seven main
branches:
• medical aid;
• psychological support;
• legal aid;
• education, training and
socioeconomic reintegration;
• care, education and
recreational activities for
children;
• information and
mobilisation of civil society;
mobilisation, awareness and
training for staff.
2004
2008
> Progress bar
Promoting reproductive health care
Sub-district of Khanpur, Punjab
Activities: In 1997,
MdM introduced a programmed aimed
at improving the quality of reproductive health care services.
Since 2004 the partner NGO, MCWAK (Maternity and Child
Welfare Association of Khanpur), has taken over day-to-day control
of the medical and community-based activities; MdM continues
to provide periodic technical and financial support for MCWAK,
which today shows that it is capable of managing programmes
with a greater degree of autonomy.
01/1997
12/2004
> Progress bar
Outlook
The MCWAK Association
became fully independent at
the end of 2004. It is thus able
to supervise the programme
and mobilise local and
community authorities to deal
with problems of mothers’
health. As MCWAK is now
autonomous, MdM now only
provides selective technical
support.
Peru
84/85
Against a background of strikes and demonstrations, Alejandro Toledo has seen his
popularity plummet. Despite an economic upturn, unemployment is still high and
only the mining sector has truly benefited from any job creation. Half of the Peruvian
population still lives below the poverty line. MdM is making moves to facilitate
Promoting sexual and reproductive health
Lima
Activities: MdM is involved in three marginal areas in Lima
Outlook
and is concentrating on helping teenage mothers through a fourmonth implantation project. The aim is to obtain an objective and
detailed inventory of the elements missing but required for planning
a future project based on reproductive sexual health
(RSH) in young mothers.
• Analysis of the specific local situation.
• Meeting with local actors actively involved in RSH (education,
care and support services) and obtaining clinical and
epidemiological indicators.
MdM has also provided care activity in a centre already working
with teenage mothers.
2,500 teenage mothers in the five districts in the zone are involved.
The project is currently being
written up and planned on
the basis of this implantation
project. It will be submitted
for validation in 2005.
Infant mortality
> 30‰
> 69.7
HDI
> 0752; ranked 85/177
> 2,113
> MdM Spain
> Direct and indirect: currently
being evaluated
Staff
> Local: 1
> Expatriate: 1
08/2004
access to health care.
12/2004
> Progress bar
Coordinators
> Project: M. Boscaméric,
C. Batard
> Field: D. Chappaz
> MdM
2004 Budget
> 40,891 euros
Palestinian Territories
The building of the Wall in the West Bank will merely strengthen the separation of the
territories, exacerbate the isolation of the Palestinian population and still further restrict
access to health care, education and jobs. The conflict has greatly worsened living
conditions in the occupied territories: unemployment has reached 40%, with more than two
thirds of the population living below the poverty line.
Infant mortality
> 23‰
> 72.3
HDI
> 0.720; ranked 102/177
> 1,051
> MdM Cyprus, MdM Greece
> Direct 1: 189
> Direct 2: 25,000
> Indirect 1: 1,300,000
> Indirect 2: 290,000
Staff
> Local 1: 6
> Local 2: 9
> Expatriate 1: 1 permanent, plus
emergency staff for short periods
> Expatriate 2 : 2
Co-ordinators
> Project: R. Garrigue,
M. Rajablat
> Field 1: V. Miollanay
> Field 2: S. Pont-Turco
> Country : S. Laplanche
> HQ: S. Alary
> Project 1: Florindon, Felissimo
> Project 2: Villes Unies Contre la
Pauvreté (Cities United Against
Poverty) (Switzerland)
2004 Budget
Pre-hospital emergency assistance
Gaza Strip
Activities: This programme has two sections:
Outlook
• to improve knowledge of first aid and emergency
assistance among the civil population, before the arrival of
emergency services, in the Gaza Strip by the end of 2004
(training courses for trainers with the 74 paramedics in the
UNRWA health centres, then training of school students in the
UNRWA refugee camps);
• improved skills and independence for the ambulance teams
from the Palestinian Red Crescent Society (PRCS) in the Gaza
Strip between now and the end of 2004, with regard to the care
of emergencies and resuscitation outside the hospital (compilation
of standardised treatment protocols for use in ambulances,
training in materiovigilance and in the care of cardio- respiratory
arrest).
MdM will continue with its
first aid training amongst
refugee children, look to
training emergency medical
teams (EMT) with the PRCS,
and contribute to the
improvement of an
emergency admission plan
in case of large influxes of
wounded people, together
with the Palestinian Health
Ministry and other local
emergency services.
01/2004
12/2006
> Progress bar
Support for health centre
Naplouse
Activities: In May 2004, MdM completely took over the
management of the health centre in the Old City. For a token
cost of five shekels, the patients, who average 35 per day in
number, can have a medical consultation, undergo analyses
and receive medicines .Médecins du Monde has also developed
epidemiological monitoring tools and health education courses
04/2004
12/2004
> Progress bar
Outlook
Monitoring of the health
centre will be taken over
completely from January
2005 by the Municipality and
the Ministry of Health. MdM
will keep itself available to the
team and be present to
facilitate access to the health
centre if an incursion occurs.
86/87
Mental health
Nablus District
Activities: MdM has committed itself to improving the
Outlook
provision of mental health care through:
• training of mental health professionals (medical staff in hospitals,
clinics and health centres, psychologists and psychiatrists, and
social workers);
• creating a network of these actors;
• setting up a “school theatre” activity’;
• a mobile clinic and “literary café” sessions.
MdM is also working to remove the stigma that accompanies mental
health problems (information campaign through brochures and
local media in order to raise awareness amongst the general public).
MdM will continue with the
activities commenced in
2004 and work to create a
medical and psychological
community centre to be
integrated into the national
system.
12/2006
Source of funding
> French Ministry of External Affairs
(MAE)
Access to health care and the Wall
West Bank
aimed at providing medical support for populations affected by
the Wall and at testifying to its impact on health:
• together with the Palestinian Red Crescent Society, setting up an
ambulance station in the Aizaria enclave and training ambulance staff;
•care for high-risk pregnancies before and after delivery, caring for children
under five in 11 villages where access has been made difficult by the
building of the Wall;
• equipping a laboratory in the enclosed village of Rantis to the NorthEast of Ramallah;
• testimony report on ‘The ultimate barrier: the impact of the
Wall on the Palestinian health care system’;
• organising an artistic campaign on the subject of the “Wall”, in
partnership with PHR (Physicians for Human Rights - an Israeli
NGO) and the Palestinian Red Crescent Society, in order to raise
public awareness, especially in Israel.
01/04/2004
end 2006
> Progress bar
Coordinators
> Project: R. Garrigue,
M. Rajablat
> Progress bar
Activities: Since May 2004, MdM has been developing activities
Staff
> Local: 11
> Expatriate: 2
> Field: S. Pont-Turco
> Country: S. Laplanche
> HQ: S. Alary
01/2004
> Direct: 1,000
> Indirect: 3,000
Outlook
To continue the activities in
order to improve access to
health care in the zones
enclosed by the Wall,
especially around Jerusalem
and Bethlehem.
2004 Budget
> Direct: 39,000
Staff
> Local: 3
> Expatriate: 2
Coordinators
> Project: R. Garrigue, M. Rajablat
> Field: K. Peters, L. Weisgerber
pour l’advocacy
> Country: S. Laplanche
> HQ: S. Alary
> French Ministry of External Affairs
(MAE), MdM
2004 Budget
> 242,981 euros
Infant mortality
> 5‰
> 78.9
HDI
> 0.932; ranked 16/177
> 24,061
> MdM Spain
> Direct: 1,500
> Indirect: 4,500
Staff
> Local: 1
> Expatriate: 1
Coordinators
> Project: M. Brugière
> Field: A. Blancho
> HQ: M. Brugière
> MdM
2004 Budget
> 25,000 euros
French Polynesia
French Polynesia, a French Overseas Territory in the Pacific Ocean consisting of five
archipelagos and 120 separate islands and atolls, is home to 240,000 people. From 1966
to 1996, atomic weapon tests were carried out under the aegis of the AEA (Atomic Energy
Authority) and the French Ministry of Defence. To carry out the experiments on the atolls
of Moruora and Fangataufa, 4,500 Polynesians were recruited by the AEA and by private
subcontractors. Despite all the precautions taken during the tests and the setting up of
proper health surveillance, one third of the workers are complaining of sickness linked to
their activity at the sites.
Evaluating the effects of nuclear testing
Papeete
As an Overseas Territory, the French Polynesia project is linked
up with Mission France.
Activities: Since 1988, the Anglo-Saxon countries (the USA,
England, Australia and New Zealand) have passed laws
recognising a certain number of malignant conditions caused
by nuclear operations. Russia, China and France do not recognise
the risks to which they exposed the people on the sites. Given
its current level of knowledge, MdM considers that the Polynesian
workers should have the benefit of the doubt. The mission of
the doctor sent to Papeete therefore has a twofold objective:
• to examine the 1,500 former workers who have health problems;
• to determine those who fall within the scope of the American
law.
The work is being carried out in partnership with the associations
‘Moruora and Tatu’, the French Nuclear Weapons Observatory
based in Lyon, and a barrister in Paris specialising in occupational
sicknesses.
11/2003
12/2004
> Progress bar
Outlook
Legal investigation of the files.
Russia
88/89
In March 2004, Vladimir Putin was re-elected as Head of State. The Russian president
has always enjoyed a measure of popularity because of the favourable economic
circumstances that have allowed continued strong growth and an increase in domestic
consumption. The population, however, suffers because of a health system that ignores
impoverished and vulnerable people. AIDS is continuing to spread; in Russia, 70% of
Harm reduction
Saint Petersburg
Activities: This programme for drug users is operated
from a mobile bus. Activities include:
• medical consultations;
• needle exchange, screening and prevention;
• awareness campaigns and lobbying with health authorities.
In 2004, the Russian Humanitarian Action Foundation took over
MdM’s programme, which we continued to finance until the end
of the year.
Outlook
MdM stopped financing this
programme in 2004.
declared cases of people contracting HIV/AIDS are attributable to drug injection.
Infant mortality
> 18‰
> 66.7
HDI
> 0.795, ranked 57/177
> 2,405
> MdM United States
1997
2004
> Progress bar
> Direct: drug users
Staff
> Local: 15
> Expatriate: 1: 1
Coordinators
> Project: B. Stambul
> Field: A. Tsekhanovich
> HQ: F.-D. Buquet
Source of funding
> MdM
2004 Budget
> 132,380 euros
Serbia
On 27 June 2004, the Serbs finally elected their president, Boris Tadic, from the
Reformist Party. However, the country is still politically unstable, divided between
partisans in favour of opening up to Europe and nationalists such as Prime Minister
Vojislav Kostunica. Although living conditions have improved, in particular with a rise
Infant mortality
> 15‰
> 72.2
> 2,293 (figure for Yugoslavia 2000)
> Direct: 506
> Indirect: 1 500
Staff
> Local: 11
> Expatriate: 1
Coordinators
> Project : P. Beauverie
> Field : C. Debaulieu
> HQ : F.-D. Buquet
> MAE, MdM
2004 Budget
> 279,258 euros
Source: World Health Report
2004, WHO
in salaries in several sectors, 15% of the population still lives in great poverty.
Harm reduction
Belgrade
Activities: This pilot harm reduction programme was
set up in Belgrade in late 2002. The aim of the programme is
to get the Serb government to recognise harm reduction as a
public health priority. The first stage of the project is a needle
exchange programme to try and reduce the risk of infection
from HIV or hepatitis amongst drug users.
MdM is leading in several complementary areas:
• information and prevention amongst the population affected,
especially in clubs;
• proximity work on the streets with a minibus;
• lobbying with pharmacists for the free sale of injecting equipment;
• opening a centre to provide consultations and advice, and to
distribute condoms and sterile injection equipment.
10/2003
10/2005
> Progress bar
Outlook
MdM’s withdrawal in autumn
2005 will allow the local
association, Veza, created
from the current team, to
take over. The programme
will therefore continue, with
the emphasis on training
sections. Other aims are
providing support for other
local associations working in
harm reduction, creating a
dynamic to work in the clubs
with the youngest people,
and setting up a methadone
programme in Belgrade.
Sudan
90/91
In 2004, rebel forces became embroiled in a battle with the Khartoum government,
intensifying the conflict in the Darfur region and triggering an unprecedented
humanitarian crisis (huge displacements of populations, destruction des villages,
and pillaging). Thousands are dead and hundreds of thousands of displaced people
are making their way towards the camps where health and living conditions remain
very precarious.
Infant mortality
> 64‰
Darfur (Kalma, Dereij, Nyala)
Activities: In June 2004, MdM set up a primary health care
centre with a hospital unit and delivery room in Kalma camp, in
co-ordination with MSF Holland, which is caring for cases of
moderate and severe malnutrition. The centre has four treatment
rooms and antenatal and post-natal health care stations, and
offers vaccinations and rapid malaria tests. MdM is also working
in mobile clinics in Dereij Camp, with groups of displaced people
around Nyala.
11/2004
> Progress bar
Outlook
Faced with the continuous
movement of the population,
MdM is developing:
community health care,
selective support intervention
(water, diarrhoea, vaccination)
and epidemiological
surveillance, which is a priority
in this programme. MdM
remains vigilant in ensuring
that human rights are met.
Primary health care, surgery
Malakal
Activities: Improving the quality of care in the surgical
unit at Malakal General Hospital (the reference hospital for
the Upper Nile region) and for everyone, in four specific areas:
• renovating and then equipping the surgical unit;
• training staff involved in surgical care;
• setting up systems for the management of surgical consumables;
• setting up a data gathering and transmission system.
Outlook
Training to start in spring
2005.
2004, UNDP
Emergency medical care
> 55.5
HDI
> 0.505; ranked 139/177
> 412
> MdM Greece
> Direct 1: 142,000
> Direct 2: 150,000
> Indirect 1: 142,000
> Indirect 2: 300,000
Staff
> Local 1: 100
> Local 2: 1
> Expatriate 1: 17
> Expatriate 2: 1
Coordinators
> Project 1: L. Joseph
> Project 2: L. Joseph, G. Isserlis
> Field 1: M. Pomarel
> Field 2: F. Makpolo
> HQ 1: Emergency desk
> HQ 2: O. Mouzay
> Project 1 : DAH, MAE Germany,
DFID, ECHO
> Project 2 : French Embassy in
25/11/2004
indefinite
> Progress bar
Khartoum
2004 Budget
Sri Lanka
For 19 years now, the Liberation Tigers of Tamil Eelam have been locked in a civil
war with the government. The health system in the North of the country has
become isolated and faces a structural lack of health personnel, with ageing health
structures and a lack of training of hospital staff. The country was one of the worst
affected by the tsunami of 26 December 2004, which serious affected an already
Infant mortality
> 17‰
> 72.5
HDI
> 0.740; ranked 96/177
> 873
> MdM Spain, MdM Portugal, MdM
Cyprus, MdM Greece
vulnerable population.
Helping the victims of the tsunami
Kinnya Division – Trincomalee District
Activities: The hospital in Kinnya, a reference establishment
Outlook
for some 80,000 people, was destroyed by the tsunami. In
collaboration with MdM Spain, the activities have consisted of
re-establishing access to primary health care as a matter
of urgency for people living in the camp for the displaced,
through mobile consultations. More than 2,000 consultations
were carried out during the first weeks of the emergency, while
epidemiological surveillance was also re-established.
The reconstruction of the
hospital and the reestablishment of primary health
care by the Sri Lankan
authorities will lead to a gradual
withdrawal by MdM, which
anticipates completing its
project in February 2005. MdM
wishes to involve itself on a
long-term basis in support of
the Sri Lankan health system.
> Direct 1: 80 000
> Direct 2: 35 600
Staff
> Local 1: 10
> Local 2: 20
> Expatriate 1: 10
> Expatriate 2: 7
Coordinators
> Project: P. Foldès
> Field: C. Giboin
> MdM
2004 Budget
> 287,000 euros (26/12/2004 to
30/03/2004)
28/12/2004
20/02/2005
> Progress bar
Improving the quality of care
Mallavi – Mullaitivu District
Activities: The activities are centred on four main areas:
Outlook
• renovating and re-equipping Mallavi Hospital;
• reorganising and training local medical staff (especially nurses,
nursing auxiliaries and voluntary workers);
• supplying drugs and medical equipment to the hospital and the
two health centres;
• making the authorities aware of issues of financial, human and
material resources.
The work of renovating the
buildings will be completed in
2005, while the training will
require a longer-term
investment on the association’s
part. The needs will be reevaluated during 2005. Also
present and active in the North
of the country, our team will be
paying attention to any needs
that become apparent on the
North-East coast.
15/01/2005
15/07/2005*
* Project planned to last six months, at the end of
which the needs will be re-evaluated.
> Progress bar
Turkey
92/93
Although capital punishment has been abolished, torture, mistreatment of prisoners and
human rights campaigners, and non-respect for minorities are still very much a reality.
However, the recent release of 2,500 political prisoners, the fact that displaced people are
beginning to return to their villages, more lenient verdicts from the courts, and a few
tentative efforts to bring those responsible for torture and mistreatment to justice are
Support for victims of political violence
Istanbul
Activities: MdM is running a programme of medical,
psychological and social support for human rights
campaigners fighting against Turkish repression:
• assisting the human rights campaigners in three associations
(IHD, GOC’DER, TUHAD);
• assisting the human rights campaigners in proceedings;
• testimony: sending second opinions to the European Court
of Human Rights on patients whose state of health has been
judged compatible with their incarceration by doctors close
to the authorities, has led to a series of suspensions and
sanctions against corrupt doctors.
Outlook
To carry on with the activities
and adapt them as the
situation develops.
2006
Medical care for refugees
Ayasma
2004
2006
> Progress bar
> 70.4
HDI
> 0.751; ranked 88/177
> 2,638
Staff
> Local 1: involvement of members of
three human rights defence
associations.
> Expatriate 1: 6 on selective projects
> Local 2: 4 plus those involved in
training in primary health care
> Expatriate 2: 2 on selective projects
given the official illegality of
permanent aid
> Progress bar
Activities: Medical care of residents, mainly Kurds, of Ayasma
refugee camp. This care involves:
• reducing infant and maternal mortality rates;
• providing continuous medical care in this district.
In partnership with Solidarité Liberté (association from Marseille) and
Verso il Kurdistan (Italian association):
• local partnership and implementation of health project combining
care and training;
• ensuring that these people’s rights, especially the right to health, are
respected.
Infant mortality
> 39.4‰
> Direct: human rights campaigners
and prisoners who are victims of
political violence.
> Direct 2: 700 pregnant women and
very young children
> indirect 2: 4,000
2002
2004, UNDP (for the whole of Turkey)
indications that the human rights situation in this country is beginning to improve.
Outlook
- equipping a room to provide
a kindergarten;
- coordinating a proper
vaccination campaign with the
health authorities in the
country;
providing primary health care
training for women.
Coordinators
> Heads of projects B. Granjon,
G. de Castelnau
> Field coordinator: S. Gürbuz
> HQ: PACA RD
> Bouches-du-Rhône Regional
Council
2004 Budget
Tanzania
About 10% of people in Tanzania are infected with the AIDS virus. Tanzania was one
of the first African countries to be affected on a large scale by the HIV/AIDS epidemic
in the early 1990s. The latest reports by UNAIDS show that there has not been a
dramatic increase in the epidemic over the past 15 years, and that there might even
have been a slight improvement in recent years. MdM has had a presence in Bukoba
Infant mortality
> 104‰
> 43.5
HDI
> 0.407; ranked 162/177
> 267
> MdM Belgium
Source: Report on human development 2004,
UNDP
region for 15 years
Preventing mother-to-child HIV transmission
Bukoba
Activities: MdM has set up a programme for preventing
the transmission of HIV from mother to child in the Bukoba
District Hospital, with three main activities:
• training of hospital staff;
• monitoring of women during pregnancy (screening, AZT
prescription, information on transmission via milk);
• monitoring of women and their babies after delivery.
Outlook
Transferring the activities to
Bukoba Regional Hospital.
Allowing HIV-positive
mothers to benefit from ARV
treatment when they need it.
08/2002
> Direct 1: 3,350
> Direct 2: patients’ families
> Indirect 1: 510,230
> Indirect 2: educators, nurses
Staff
> Local 1: 10
> Local 2: 10
> Expatriate 1: 1
> Expatriate 2: 2
Co-ordinators
> Head of project: P. Tattevin
> General coordinator: S. Davies
> HQ: C. Courtin
> Project 1: MARC Foundation,
Aids Fund
> Project 2: Columbia University
2004 Budget
07/2005
> Progress bar
Access to anti-retrovirus
Bukoba
Activities: Since 2004, MdM’s objective has extended to
access to anti-retrovirus (ARV) in the context of the HAART
(Highly Active Antiretroviral Therapy) programme. Three
populations will benefit from this programme:
• hospital staff and their families;
• HIV-positive pregnant women and their families;
patients showing an advanced;
• HIV infection that endangers their life in the short term.
01/10/2004
2009
> Progress bar
Outlook
Continuation of the activities
in 2005.
94/95
Handling opportunistic diseases
Bukoba
Activities: In support of TADEPA (Tanzania Development
Outlook
and Prevention of AIDS), MdM is running a programme for
HIV prevention and treatment of opportunistic diseases.
There are three main branches:
• prevention (training of peers, education via peers, and
condom access);
• medical and psychological (counselling, treatment of
opportunistic diseases);
• transfer of skills.
Independence for the local
NGO, TADEPA, and
withdrawal of MdM.
08/2004
05/2005
> Progress bar
> Direct: 500
> Indirect: 510,430
Staff
> Local: 20
> Expatriate: 1
Co-ordinators
> Head of project: P. Tattevin
> General coordinator: S. Davies
> TADEPA coordinator: Dr Steve
> HQ: C. Courtin
> MAE
2004 Budget
> 160,987 euros
Uganda
Uganda, a model country in the fight against HIV/AIDS, has been conducting
prevention programmes ever since the epidemic started. It is estimated that
1,050,000 people are infected with HIV/AIDS in Uganda, with women and especially
15 to 19-year-olds most at risk. The commonest means of infection are sexual
transmission and vertical (mother-to-child) transmission. The national policy for
fighting AIDS has led to a reduction in the rate of prevalence from 30% in 1992 to
> 45.7
HDI
> 0.493; ranked 146/177
> 236
> Indirect: 172,000
Staff
> Local: 50
> Expatriate: 2
Coordinators
> Project: C. Sadorge
> Field: L. Agbahounba,
D. Sevelinge
> HQ: O. Mouzay
> MAE, MdM
2004 Budget
> 233,278 euros
6.5% in 2001. In addition to its global approach, the government has also introduced
2004, UNDP
Infant mortality
> 82‰
vertical prevention transmission programmes and access to anti-retroviruses.
Limiting the spread of HIV
Kooki County, Rakai District
Activities: The project is being carried out in accordance
with the government’s policy. It involves promoting behavioural
changes and condom usage in rural areas, improving care for
patients with AIDS, and establishing a reference system for
screening and care of HIV-positive patients. Two main
branches have been developed:
• prevention: education and awareness-raising activities aimed
at community leaders and women, training sessions on STIs
and HIV, and support for ill patients and information on their
rights. Collaboration with the local NGO, CIPA, has been set up
to ensure that prevention activities continue after April 2004;
• psycho-medical for patients living with AIDS: HIV tests,
counselling and support, and care for people infected with
opportunistic diseases. Close collaboration with the district has
allowed these activities to be strengthened, as well as being
extended into structures providing preventive care through
cotrimoxazole.
04/2001
12/2005
> Progress bar
Outlook
With the technical and
financial support of MdM
in 2005, CIPA should be
operationally and technically
independent for 2006. MdM
wishes to set up a medical
programme over three years
for improvement in the quality
of primary health care,
including medical care for
patients infected with HIV
in the basic package. The
main objective of this project
is technical support for the
local health authorities,
so that the funds made
available by the government
can be channelled into the
district and the use of these
resources optimised through
closer supervision and
monitoring of the care given
in the health care centres.
Vanuatu
96/97
The archipelago of Vanuatu is regularly a victim of its position on the Pacific Ring of Fire,
in which 70% of the world’s volcanic activity is concentrated. Earthquakes, tsunamis
and repeated volcanic eruptions damage the infrastructures, especially roads and health
systems. Despite the health development plans implemented by the authorities, the
remotest populations are still affected by a lack of drinking water, deplorable hygiene
Improving primary health care
Pentecost Region, Penama Province
Activities:
Since 1993, MdM has been working on local
health development projects and emergency renovation
projects. In 2001 the emphasis was put on health care access.
With the support of the Ministry of Health, the programme
aims to improve availability of primary health care at a
peripheral level on three islands: Pentecost, Maewo and
Santo.
The last two months of the programme successfully led to its
consolidation, which was made permanent in 2003. In partnership
with the Ministry of Health, MdM has carried out a number of
actions:
• Regular medical rounds in the three areas in question;
• Renovation of health structures (construction of sanitary
blocks, water conveyance systems and reservoirs);
• Cleaning up, especially in schools and in areas used by many
people;
• Training laboratory technicians and numerous health
professionals, and producing health education equipment.
03/2001
03/2004
> Progress bar
Outlook
Being convinced that the
activities and organisations
set up were viable, MdM
withdrew on 28 February
2004. Its action is now taken
over by the local health
authorities and professionals.
2004, UNDP
conditions and very limited health care access.
Infant mortality
> 34‰
> 68.6
HDI
> 0.570; ranked 129/177
> 1,138
> Direct: 20 000
Staff
> Local: 3
> Expatriate : 2
Coordinators
> Project : T. Fil
> HQ: E. Martinon
> MdM, UE
2004 Budget
> 43,655 euros
Vietnam
Despite recent improvements in living conditions and economic growth, the country
still has to stamp out the poverty that affects one third of the population and the
relentless progress of the HIV/AIDS epidemic, made particularly explosive by
widespread use of injectable drugs and prostitution. The repressive attitude of the
Infant mortality
> 30‰
> 69
HDI
> 0.691; ranked 112/177
> 436
> MdM Canada
government makes it difficult to work with these populations.
Developing medical services
Bac Kan and Thai Nguyen Provinces
Activities: In 2004, this programme developed the following
activities:
• mother and child health care (health education, integration
of the national programme at local level);
• strengthening the capacities of health care staff;
• access to water and drainage for homes in three
communities;
• nutrition and prevention of child illness;
• institutional development for the Hanoi Medical University (HMU).
Outlook
To continue and complete
the activities started in 2004
and to capitalise on the
partnership with Hanoi
Medical University.
> Direct 1: 10,000
> Direct 2: 6,500
> Indirect 1: 275,000
> Indirect 2: 266,000
Staff
> Local 1: 16
> Local 2: 4
> Expatriate 1: 1
> Expatriate 2: 2
Co-ordinators
> Project 1: F. Novel
> Project 2: K. Lacombe
> Field 1: A. Pinon
> Field 2: V. Trias
> HQ: V. Pardessus
> Project 1: MdM, EU
> Project 2 : MdM
2004 Budget
11/2000
11/2005
> Progress bar
Working with the homeless
Hô Chi Min City
Activities: Since 2000, MdM, in co-operation with the local
Vietnamese authorities in Ho Chi Minh City, has been running a
health care access and health education programme with
homeless or semi-homeless people, with the emphasis on
women and health education, but also with drug addicts and
prostitutes with an HIV/AIDS prevention aspect. The activities are
channelled through a day care centre and two mobile teams.
01/12/2000
31/11/2004
> Progress bar
Outlook
The start of a new phase, over
three years. This will be a
prevention and health care
access programme for street
people living with HIV, including
access to ARVs in a network
with the reference hospital. This
programme will rely on the
existing structure (day centre
and mobile teams) and be
aimed at the same population
as we have been working with
since 2000.
Zimbabwe
98/99
26% of the population of this country in the south of Africa are HIV-positive. Since
the explosion of the HIV/AIDS crisis, life expectancy has plummeted from 52 in
1990 to 34 in 2004. Amongst a total population of 12 million, there are about
800,000 AIDS orphans (that is, 23% of all children under 15). It is estimated that
20% of these orphans are HIV-positive. On top of that, more than half the children
Reducing the impact of HIV/AIDS
Chipinge
Activities: Since May 2004, MdM France, in partnership
with MdM Canada, MdM Spain and FACT (a local NGO), has
been running a pilot project to inform about, prevent and
treat HIV/AIDS amongst the population of Chipinge District.
The project has four main aspects:
• promoting health amongst the village communities;
• approaching the reception organisations for orphans and
vulnerable children;
• creating an information and screening centre;
• strengthening local capacities.
The programme has seven branches:
• information and awareness in the community;
• management of information and screening centres;
• management of home-based care services for immobilised
patients;
• psychological, social and therapeutic support for orphans
and vulnerable children;
• support for preventive and curative activity in four hospitals
and 46 health centres in the district.
05/2004
12/2007
> Progress bar
Outlook
A three-year finance
agreement has now allowed
the project to be confirmed
and consolidated across the
whole of Chipinge District.
Source: Report on human development 2004,
UNDP
suffer from malnutrition.
Infant mortality
> 76‰
> 33.9
HDI
> 0.491; ranked 147/177
> 639
> MdM Spain, MdM Canada
> Direct: 350,000 inhabitants of
Chipinge District
> Indirect: 30 community health
workers in Chipinge
Staff
> Local: 9
> Expatriate: 2
Coordinators
> Project: C. Moncorgé
> Field: S. Grieb
> HQ: E. Martinon
> MdM France, MdM Spain, MdM
Canada, Principado de Asturias,
FACT
2004 Budget
> 70,418 euros
Opération Sourire
Countries of
intervention in 2004
Benin,
Cambodia,
Chad,
Eritrea,
Ethiopia,
Madagascar,
Mali,
Mongolia,
Niger,
Rwanda,
Togo
Coordinators
> Project: F. Foussadier
> HQ: F. Lambrigot-Hervé
> Private funds, companies,
foundations
2004 Budget
> 243,180 euros
Opération Sourire’s ambition is to give back a normal face to those disfigured by
war, disease and malnutrition, and to allow people excluded by their disability to
return to a normal social life.
Plastic surgery is still a non-existent function of the health care system in many
countries, due to a lack of human resources, equipment and infrastructure. Faced
with the high demand for plastic surgery and the total absence of patient care in this
domain, the Opération Sourire doctors are busy working with this forgotten
population.
Activities and milestones in 2004:
Activities: The Opération Sourire projects are of two different
natures:
• surgical projects, carried out by expatriate surgeons (plastic,
orthopaedic and maxillo-facial), anaesthetists and nurses;
• training projects, in which the MdM teams train surgeons,
anaesthetists and theatre nurses in plastic surgery and in
optimising the functioning of the operating theatre.
2004 saw continued development of the Opération Sourire
projects launched in 2003. This development has been
facilitated by an increase to the global budget for the operation
as well as by greater zest on the part of the actors and
significant numbers of appointments. All this has led to the
launch of new projects.
In 2004, MdM teams carried out 24 projects in 11 countries
(plus 6 sites in Cambodia) and operated on 832 patients.
Almost 80 doctors left as volunteers for these projects.
Existing projects have been maintained, and two exploratory
missions have been carried out in Eritrea and Madagascar, before
succeeding in opening as Opération Sourire projects.
Outlook
For 2005, MdM is planning
to maintain the existing
projects and commence
new ones in Laos and
Pakistan.
Adoption Organisation
Since 1988, MdM has been working as an Authorised Adoption Body (OAA). As such, it
continually strives to set up more resources to make the adoption process as smooth as
possible for both children and families, from the ethical, moral, legal and financial
standpoint. The OAA’s main aim is to find places in France for children who cannot be
adopted in their own country. The OAA gives priority to the adoption of siblings, children
aged over five and children with particular needs, which may be serious or incurable.
Families for children
100/101
Countries of
intervention and associated
countries in 2004
Albania,
Brazil,
Bulgaria,
China,
Colombia,
Russia,
Vietnam.
Coordinators
> Project: A. Irazusta, M. Brugière,
Activities: The OAA teams, who always strive to accompany
Outlook
families and children as they take the necessary steps towards
adoption, are present at every stage, whether in terms of
relations established with relay countries, child selection, or
facilitating the child’s adaptation to the family or vice versa.
The work of the commission, made up of psychologists and
geographical co-ordinators, is to select the applicants who
are most suitable for adopting a foreign child.
In 2004, 322 children were adopted by 294 families, most
of the children being girls (about 80%). Most of them came
from Asia (222 adopted in 2004) and 78.9% of the children
were aged under three when they arrived in France. For children
with particular needs, either sick or with a curable disability,
there were 14 adoptions in 2004.
This year, MdM took over the Presidency of the Collective for
Adoption, created in 2001 in collaboration with two other
French OAAs, Rayons de Soleil de l’Enfant Étranger (Sunbeams
for Foreign Children) and Amis des Enfants du Monde (Friends
of the Children of the World). These three associations represent
40% of the total number of foreign child adoptions in France.
Administrative hold-ups
in Eastern Europe and
Vietnam have led to a
reduction in the number
of children coming from
these countries, meaning
that China is now
over-represented. These
situations are in the
process of being resolved
during 2005.
F. Giraud
> HQ: G. Douffet, M. Brugière
> Adopting families, MAI, MdM
2004 Budget
> 340,000 euros
Project Outlook
> New projects in 2005*
Month
JANUARY
Country
Madagascar
and Ambania
Antsiranana
• Prisons and human rights
FEBRUARY
DRC
Kaliémié
• Evaluation of health area intake
APRIL
Indonesia
Jakarta
Borneo
• Shanty town populations
• The Punan peoples
MAY
Belarus
Mali
Mexico
Kidal
Tijuana
• Radiological risk reduction: health education for pregnant women and
monitoring of children
• Migrant populations
• Migrant populations
JUNE
Burkina Faso
Morocco
Diébougou
Casablanca
• Dental care
• Physical and mental rehabilitation programme for torture victims
JULY
Nicaragua
Puerto
Cabezas
• Domestic violence
Lima
Ulan Bator
• Baby health for teenage mothers
• Alcoholism and mining populations
SEPTEMBER Peru
Mongolia
* List compiled 18 March 2005
City /Region Theme
Project Outlook
102/103
> Exploratory missions in 2005*
Month
Country
City /Region
Theme
JANUARY
Burkina Faso
Kompienga
• HIV/AIDS
FEBRUARY
Burma
China
The Moken peoples
Shanxi
• Health evaluations in the wake of the tsunami
• HIV/AIDS (2nd exploratory mission)
MARCH
Ivory Coast
Kosovo/Serbia
North Korea
APRIL
Eritrea
Uganda
Afabet
• Reproductive health (2nd exploratory mission)
• Evaluation of needs of displaced peoples in the North
MAY
Afghanistan
Burkina Faso
Russia
Kabul
Kuchi populations
Ivory Coast border
Orel
•
•
•
•
Algeria
Bolivia
Pilco Mayo
• Sexual violence
• Environmental health
Ecuador
Guamote
• Inter-cultural health project
JULY
Addict populations
Primary health care centres amongst the Kuchi nomads
Primary health care
Children in prison
* List compiled 18 March 2005
JUNE
• Identification of needs in North and South
• Evaluation of health care access for minority populations in the Balkans
• Mother and baby health
Action in France
Free Healthcase
and Guidance
Centre
Local proximity
health projects
Harm
reduction
actions
Valenciennes
Le Havre
Rouen
Metz
La Plaine-Saint-Denis
Paris
Epinal
Rennes
Nantes
Strasbourg
Nancy
Angers
Besançon
Saint-Denis
Poitiers
Lyons
Réunion
Angoulême
Grenoble
Bordeaux
Cayenne
Guyane
Montpellier
Bayonne
Aix-enProvence
Nice
Toulouse
Pau
Marseilles
Papeete
Tahiti
Ajaccio
Introduction to Mission France projects
104/105
> France: the withdrawal of health care access
A country that in the 21st century steps back from caring for the
health and social security of its weakest people is a sick country.
Mission France, the French projects created a few
years after the MdM international projects (1986),
continues to surprise with its diversity, the number
of volunteers and paid workers involved, their
reactivity, and, it must be said, their audacity, given
that they sometimes work on the fringes of the law.
Mission France, like the international projects,
works with the most vulnerable people, those
whose basic rights are denied, those who suffer and
do not have access to care.
> Access to care
In the field in 2004, we saw a withdrawal of
health
care
unprecedented
since
the
introduction of CMU (Universal Health Cover).
For the first time since 2000 we were unable to refer
certain patients to the public health care system, a
development that fundamentally altered the
direction of our action. As a direct result, it was the
suffering people who ventured most often into
MdM’s Mission France free health care and
guidance centres or drop-in centres.
The impact of the latest legislation, as of now, is
much more negative than positive.
• The successive reforms to the State Medical
Assistance system in 2002 (introduction of the ticket
modérateur or patient’s contribution to health care, and
the opening of access self-employed medical practitioner)
and in 2003 (abolition of the chance of immediate
admission, and introduction of a compulsory threemonth residence period before anyone can claim any
rights). As a direct consequence of these steps, which
we have measured in the statistics and testimonies from
2004, legitimate access to care has become contaminated
with an air of suspicion.
• The Public Health Law of August 2004 has three
direct consequences: the threatened loss of front line
harm reduction activities because of a badly-designed
administrative ’straitjacket’, the fragmentation of health
care amongst insecure people according to their medical
condition, and the reduction in the funds granted to
global activities aimed at facilitating health care.
• The Interior Security Law of 18 March 2003
makes passive soliciting on the public highway
punishable: people working in prostitution now feel
terrorised and are hiding in places where the forces
of prevention will not find them, at the risk of still
becoming victims of violence.
Introduction to Mission France projects
The unfavourable consequences of these legislative
measures, which we will continue to explain and
demonstrate, show the MPs’ and the government’s
fear of calmly assuming the fact that the world’s fifth
greatest power is able to offer all its residents the
health care access that they need. It’s worth
remembering that the diseases themselves don’t
examine rights of stay or proof of residence in
minute detail before infecting people.
• proximity medicine, closest to the needs expressed
by the patients;
• taking account of the whole person (contrary to
the principle profiled in the Public Health Law) through
the mobilisation of multi-disciplinary teams;
• having respect for patients, who are in control
of their health, our interventions are modelled on the
patient’s willingness to do or not to do at the time we
meet them – the patient’s time is our time.
> Harm reduction
> Towards European activity
Harm reduction inherent in drug use is also the
subject of hidden, but no less real, attacks. This
means that the “all cannabis” policy advocated by
the government confuses those project workers
confronted with multi-addicts, many of whom inject
intravenously, working as they do with a young and
ill-informed public. The screen of cannabis smoke is
a comfortable veil hiding a lack of commitment
towards those in an even worse situation, a situation
once more unresolved.
However, beyond our actions on French soil, our
commitment to provide access to care for the most
vulnerable people has extended to Europe through
our support for MdM offices in the United Kingdom,
the Netherlands and Germany in the putting together
of their first care access programmes for vulnerable
people in their countries, and through the European
Observatory on Access to Care.
We hope that the backward steps taken in France
can be counter-balanced by advances at European
level. We have no illusions, but we are optimistic and
ready to fight! It is the people we meet in the field,
their woes and their words, that give us the strength
each day to fight on.
> Fundamental rules
Mission France in all its aspects (drop-in centres,
mobile proximity programmes for access to care in
general or more specialised harm reduction care linked
to drug abuse) applies certain fundamental rules
based on the practice of harm reduction and sharing
of knowledge, all of which started in the AIDS years:
The homeless and poorly housed
106/107
Although measures were announced as part of the Social Cohesion Plan to allow, among
other things, the building of 500,000 housing units during the next five years, the situation is
LA RÉUNION
still worrying. The 10th report on poor housing in France estimates that over five million people
are in a very precarious housing situation in the short or medium term. 57% of patients seen
by Mission France live in insecure housing or are homeless.
Number of homeless
in France
> over 86,000 people (source:
> Housing, a fundamental right
INSEE – National Institute of
Statistics and Economic Studies)
Since 1993
Activities: Faced with the difficulties of people too marginalised
and weakened to visit the common right centres themselves,
MdM is developing mobile units to reach people living on the
streets or in squats.
The aim of this is twofold:
• to inform people of their right to care in order to refer and
accompany them wherever necessary to the common right
centres;
• to welcome to the care centres those who are not registered
with the AME and cannot, as such, access health care.
Every winter, MdM demands long-term accommodation and
housing and testifies to the adverse effects of harsh, cold
conditions on the health of people sleeping on the streets
or living in insecure housing. During the summer, a welcome,
information and prevention unit for the most excluded was set
up in Paris. Social watches are carried out all year round through
the intervention of outreach teams. In 2004, MdM was approached
by the Department of Social Action to participate in the compilation
of a magazine setting out the form of “health and care bed stops”.
Outlook
Continuing the action in the
field, working with the most
weakened people (outreach
teams and social and
medical support, medical
consultations and nursing
care in accommodation
centres, working in
partnership with the health
and accommodation
organisations, participation
in the “great cold plan”) and
political action (testimonies,
lobbying with institutions
for setting up long-term
accommodation suitable
for meeting the needs
of the homeless).
Types of intervention
> Social and medical consultations, outreach teams: Le Havre, Marseille, Metz, Nice,
Paris, Strasbourg, Toulouse, Valenciennes.
> Medical consultations with poorly-housed people visiting the “health bed stops”:
Bordeaux, Grenoble, Lyon, Strasbourg, Toulouse.
> Consultations in other associations: (Restos du Cœur, Armée du Salut, Boutiques
Abbé- Pierre, Secours Catholique, Aides, Point Ecoute Santé Jeunes …): Bordeaux,
Grenoble, Le Havre, Lyon, Nancy, Nantes, La Réunion, Valenciennes
> Consultations in emergency accommodation centres: Lyon, Metz, Nice, Toulouse
> Health and social visits to squats: Bordeaux, Paris.
Number of poorly housed
> over 3 million (source: AbbéPierre Foundation)
Main pathologies
> skin problems, trauma, mental
health problems, ENT and
respiratory infections
Number of projects
> 14
Number of volunteers
> 182
Instances of contact with
homeless
> approximately 10,000
Homeless seen in centres
> 3,451 (for the first time)
Characteristics
of homeless people visiting the
drop-in centres:
> 26% are women,
> 60% are under 35
> 10% are minors
> 71% live alone
> 75% are not entitled to any form of
health cover
> Local health authorities (DDASS),
town councils, Central Fund for Social
Activities (CCAS), general councils ...
Main partners
> he Abbé-Pierre Foundation, Secours
Catholique, Emmaüs, Red Cross,
Restos du Cœur, SAMU Social, local
associations (La Péniche, Les Amis
de la Rue, Le Fournil, GAF …),
Children of the World – Human Rights
Migrants
all the projects
(care centres and mobile
missions) receive migrant
populations in
their programme,
more than a quarter
of them asylum seekers.
The Villepin asylum law, which came into force at the start of the year, has made it more
difficult to obtain asylum seeker status. Now, the asylum seeker has to submit his claim,
in French, within 21 days (reduced to 8 days for re-examination of claims). In addition,
associations giving permanent accommodation (an address is necessary for starting an
application procedure) to asylum seekers must be given prefectural approval. The EU’s
declared wish to harmonise asylum policy (externalisation of asylum procedures, transit
Number of beneficiaries in
the programmes (drop-in
centre data)
> 89% of patients who came for
the first time are foreigners,
centres in immigration crossroads countries) has created a fear of “Sangatte relocated”.
The new European provisions on rights to asylum stipulate that any person coming from
a “safe” country will not be able to claim asylum in Europe.
> 60% of them have no right of
stay and 30% are subjects of
asylum claims
Country of origin
> Algeria, Russia/Chechnya, Congo
Brazzaville, DRC, Yugoslavia
Main pathologies
> linked to insecure living conditions
or lifestyle: osteoarticular, gastroenterological, ENT, skin problems,
cardiovascular diseases,
psychological distress
> 86% of migrants are not
registered with the health cover
yet when they first come for a
check-up at a health centre
Number of projects
> the full range of programmes (centres,
away from centres, Harm Reduction
programmes)
> 1 ,907
> Regional health authority (DRASS), Local
health authority (DDASS), general councils,
regional councils, town councils, CRAM,
Health Insurance Office (CPAM)...
Partners
> CASP, Cimade, Gisti, LDH, ANAFE
(National Association for Assistance to
Foreigners at Borders), French Coordination for the Right to Asylum, Comède,
Participation in the ODSE (Observatory on
the Right to Health for Migrants) and local
or regional association groups.
> Receiving a diverse population
Since 1986...
Activities:
Outlook
• Drop-in centres: In 2004, the 21 care centres received 89%
of migrants and carried out 35,651 medical check-ups. Among the
main obstacles to access to health care and health cover, these
people mentioned financial difficulties, unfamiliarity with rights and
systems, administrative difficulties and the language barrier. MdM
plays a bridging role and, wherever possible, refers people towards
specialised common right health or social structures.
• Co-ordination Centre for Families Seeking Asylum: MdM
has set up a welcome and health support mission for newlyarrived asylum seeker families received by CAFDA, the Coordination
Centre for Families Seeking Asylum. This centre receives and
houses over 4,000 people each year. In 2004, the MdM team,
made up of doctors and interpreters, received 3,514 people,
that is, 1,097 families.
MdM’s programmes in
France continue to work so
that every person,
regardless of his or her
administrative status, can
have immediate access to
health cover. Mission France
is continuing to develop
programmes for prevention
and detection of HIV,
hepatitis and STIs amongst
migrants.
> All the projects provide consultations, offer preventive messages and refer migrants, including asylum seekers and
undocumented migrants to common right health partnerships and systems (Universal Health Cover (CMU) for those with
regular status, State Medical Assistance (AME) for those without regular status). Case studies that we collected about the
precarious conditions linked to administrative status, long-drawn-out procedures and accommodation problems form the
basis for a determined effort to limit the social setbacks brought about by the government and parliament.
The testimonies obtained in the field, combined with an analysis of the social and medical data obtained from each care
centre, form the basis of the report on the activities of Mission France and of our observations made to the institutions.
Children
108/109
According to the 2004 report by the Council for Employment, Income and Social
Cohesion (CERC), one million children are living below the poverty line in France. In
addition to the paediatric monitoring available in care centres, two types of
programme are dedicated to children affected by exclusion, poverty or illness : the
Lead Poisoning programme, which aims to find and protect young victims of lead
poisoning, and the Buddy programme, which provides support for children isolated
through being in hospital. Particular attention is paid to isolated minors.
> Protecting isolated victims
were received at the care centres
in 2004.
Buddy Programme, 1988>…/ Lead Poisoning Programme, 1993>…
Activities:
Outlook
• Hospital buddy programmes “an energy transfusion”.
MdM volunteers give personalised emotional support (at least three
visits per week) to children suffering from isolation in hospital. The
buddy arrangements are monitored by the hospital co-ordinators,
who have a wealth of experience in such schemes. As the children
do not always recover, the training of coordinators has now been
extended to include end-of-life support. The agreement signed in
June 2002 with the Public Welfare System, which sets out the
relations between the MdM Buddying Programme and the care
teams, was also signed in 2004 with several paediatric hospitals.
• Lead poisoning: MdM’s intervention involves locating
unsuitable housing, preventing lead poisoning and protecting
child victims. MdM is calling for a policy, with real political will
behind it, to combat lead poisoning in children.
• Isolated minors: Where there is no reception policy, these
children, often foreign, are specially monitored by our centres.
• Buddy system:
Setting up the project in the
provinces: regional offices in
Marseille and Lyon. Creating
a link with hospitals in
French Guyana and
Réunion.
• Lead poisoning:
after withdrawing at the end
of 2004, Mission France in
Bordeaux maintains contact
with families that have been
monitored for 4 years.
MdM’s Suburbs Mission
aims to consolidate the
network set up to ensure
that the fight against lead
poisoning can be ongoing
without MdM activity, which
can then put its efforts into
other suburbs.
• Isolated minors:
To strengthen links with
other associations in the
field who meet with isolated
minors.
Type of intervention
> Lead Poisoning Mission: Bordeaux, seven towns in Hauts-deSeine, Poitiers. Locating, screening and protecting children, mobilising
institutions and medical bodies.
> Hospital buddy system for children: Paris and Paris Region.
Personalised monitoring of children in hospital.
> Care centres: paediatric consultations, guidance in mother-and-child
welfare (PMI)...
> All the care centres welcome children.
> Isolated minors: homeless project in Paris, all the care centres.
Beneficiaries
> 1,553 children (aged under 15)
Main pathologies
> ENT, respiratory problems
> Local health authorities
(DDASS), Health Insurance
Office (CPAM), county councils
Buddying
> Number of children buddied in
2004: 105
> Number of volunteers: 89
> Buddying partnerships: 6 Paris
hospitals, 5 long-stay centres,
Public Welfare System
Lead poisioning
> Number of children affected by
lead poisoning: 85,000 children
suffering from poisoning, only 5%
of these screened (National
Institute for Health and Medical
Research (INSERM) figures,1999)
> Number of projects: 3
> Number of volunteers: 10
> Lead poisoning partners:
Association for Families, Victims
of Lead Poisoning, PACT ARIM,
local health authorities (DDASS),
mother-and-child welfare (PMI),
doctors, hospitals ...
Roma
Although the French government’s policy aimed at encouraging Roma to return
voluntarily to Romania has failed, their situation in France is still giving cause for
concern. The regular expulsions to which they are subject, and the deplorable
standards of hygiene and living conditions to which they are exposed, makes their
situation very uncertain in terms of their health and their future. Moreover, the huge
increase in the number of shantytowns and non-authorised sites poses a health risk
that directly imperils their lives.
Main pathologies
> diseases linked to living conditions,
delays in health care access (both
in France and in country of origin)
and diseases linked to
psychological trauma caused by
repeated expulsion.
> Populations suffering from social exclusion
1992, the Suburbs Mission: the first programme to involve migrant Roma.
> 74
Activities: MdM continues to visit the Roma living quarters
with the aim of getting them access to health care and rights
(Universal Health Cover (CMU) and State Medical Assistance
(AME)). This health watch aims in particular to provide health
education and promotion, schooling for children, assistance with
access to drinking water and mother-and-child health. Having
gathered many testimonies on the disgraceful living
conditions endured by these people, MdM was greatly
upset by the death of two young girls in April 2004 when
their caravan accidentally caught fire in the Surville shanty
town in Lyon. The policy of expulsion to which the Roma are
frequently subjected further worsens their already very precarious
lives. The wandering to which they are subject forces then to
settle in shanty towns, making their access to basic rights even
worse and slowing down or hampering the work of the medical
and social teams helping them. Finally, faced with the new law
on begging, MdM denounces the ineptitude of the “neglect”
qualification for women begging with their children.
Sources of funding
> Local health authorities (DDASS),
> Prevention, health education, primary health care, assistance with
Epidemiological
characteristics
> early neonatal death (0-1 month)
nine times higher; infant mortality
(0-1 year) five times greater; life
expectancy 15-20 years lower than
that of the French population
Number of projects
>4
Number of beneficiaries
> about 3,000, over 2,000 of these
in Île de France
county councils...
Partners
> ALPIL, ASAV, ATD Quart Monde
LDH, MRAP, support groups for
Roma families, Romeurope, local
mother-and-child welfare (PMI)
services, town councils, PASS...
schooling of children, access to drinking water, implementation of
decontamination measures…
> Pre-natal activity: prevention of terminations, monitoring of
pregnancies, information on contraception, vaccination of children,
accompaniment during mother-and-child welfare (PMI) and family
planning visits.
> Testimonies on living conditions, repeated expulsions and obstacles
to health care access and rights.
> Mobilisation of Roma family support committees, health actors, town
councils and State departments.
Outlook
To continue with the
proximity health initiative
in the field, with particular
attention being paid to
children, health rights and
continued development
of mother-and-child
health activity.
Travellers
110/111
In the light of the law of 13 August concerning local liberties and responsibilities, the
government has made Parliament agree a further deadline of two years for local
authorities to fulfil their obligation to welcome and accommodate travellers. Local
authorities that have not applied the Besson Law have until the end of 2008 to do so. At
present, less than 10% of towns with over 5,000 people have created reception areas.
> Promoting access to fundamental rights
Since 1992…
Activities: The aim of the MdM mobile teams’ work is twofold:
Outlook
to meet travellers in their living places; and to help them get
their rights recognised.
There are in fact very few reception areas, and where they exist,
the living conditions are very insecure: no waste water drainage,
difficult access to running water and electricity, presence of rats,
lack of toilets. MdM works in the following areas:
• Support, a listening ear and guidance activities;
• Activities aimed at facilitating access to health care, rights
and schooling for children;
• Lobbying activity aimed at the public authorities with demands
for the creation of reception areas for travellers.
To continue the activities
designed to improve the
health and hygiene of
travellers’ living conditions,
to facilitate their access
to common law health and
social services and (more
generally) citizenship.
The expert status obtained
by the MdM team in
Bordeaux has allowed it,
in partnership with gypsy
associations and individuals
working with the travelling
community, to create
a coordination centre
aimed at contributing
to the establishment of
decent conditions for the
traveller community. MdM
teams are present in several
authorities, including the
departmental consultation
committee for the travellers’
reception scheme.
> Listening, psychological support and preventive and information
messages.
> Primary care, assistance with schooling and access to housing,
guidance towards public health and social structures.
> Lobbying town councils, health institutions and professionals for an
improvement in the health and hygiene of living conditions, and action
for the recognition of citizenship.
> Participation in the departmental consultation committees for the
travellers’ reception scheme.
> about 100 families
Main pathologies
> depression, insomnia,
cardiovascular diseases and
addiction problems, linked to
living conditions and lifestyle
Social characteristics
> isolation, dropping out of
education, marginalisation
Number of projects
>3
> 13
Sources of funding
> Health Insurance Office (CPAM),
Regional health authorities
(DRASS), Regional Union of
Health Insurance Funds
(URCAM)...
Partners
> Gironde Friends of Travellers
Association, Regional Association
of Gypsies and Gajo Friends,
Travelling People’s Welcome
Stop, Co-ordinated Action for
Travelling People, Relatives’
Social Centre, LDH, CCAS,
schools, town councils...
People working in prostitution
The Internal Security Act, introduced in 2003, continued to be applied in 2004 with a
heavy police presence in the field; this interfered with the teams’ work. Although the
message about use of condoms has got through, their use remains very much
dependent on the clients, who often have a feeling of all-powerfulness over people
working in prostitution, viewing them as lawbreakers.
Characteristics
> population mainly from Eastern
Europe, sub-Saharan Africa and
China, often holding tourist visas or
applying for asylum, or staying
illegally, sometimes the victims of
trafficking
Sex, age
> mainly women aged between 20
and 40, trans-gender people, men
and occasionally minors
Main pathologies
> gynaecological conditions linked
to street living, problems related
to stress, isolation and abuse,
addictions
Number of projects
> eight mobile teams / projects
relating to street prostitution, in
close collaboration with the care
centres
> data very difficult to obtain, but
certainly in the region of 1,000
> 90
Partners
> Cabiria, Les Amis du Bus des
Femmes, AIDES, local health
authorities, Gasprom, Platform
for the Fight Against Human
Trafficking, anonymous screening
centres (CDAG), Health Insurance
Office (CPAM), town councils,
family planning, emergency
psychiatric organisations,
SAMU Social.
> Support through prevention and information
Since 1999, as a completely different theme
Activities: Against a background of definite increases in violence
against them, people working in prostitution are very vulnerable and
find it much more difficult to gain access to associations and prevention
materials. Problems of accommodation and delays in obtaining
rights are real additional obstacles to access to care. Médecins du
Monde’s work with people working in prostitution is usually
through mobile teams, health promotion and risk reduction,
with accompanying social, medical, administrative and legal
services. The teams’ aim is to provide information, adapted and
translated wherever necessary, on the risks of STIs, HIV and hepatitis
and on rights. Going to prostitution sites, talking to people working
in prostitution, and cultivating a relationship of confidence through
exchange and regular intervention, all helps to foster an atmosphere
conducive to the social and medical progress that the people can
make with the team around.
• In Nantes, a partnership has been set up with the hospital
during the night rounds.
• In Le Havre, MdM has had to reduce the number of bus
runs, as the very heavy police presence is an obstacle to
meeting with people working in prostitution.
> All our programmes offer guidance for screening (HIV and HCV),
distribute prevention materials, listen to the people concerned and
promote their rights, and offer information and guidance (administrative
and legal) towards public structures.
> Nantes: physically accompanying people to hospital and all forms of
care, providing access to rights, helping with lodging of complaints and
in the courts during trials for soliciting. Assistance with enrolment for
literacy courses.
> Paris: information adapted and translated into Chinese,
accompaniment and guidance with interpreters.
> Metz: setting up a travelling service.
Outlook
Nantes: to develop a
day drop-in centre with
a stronger presence,
especially on the care
centre days. To improve
our knowledge of the
representations and
cultural beliefs of people
we meet, mostly
Nigerian, in relation to
health, the body, and
disease.
Concentration on
testimony activities.
Poitiers and Rennes:
exploratory projects
in progress.
Needle Exchange
112/113
The first needle exchange programme was started in 1989 as a response to the AIDS
epidemic spreading amongst drug users. For six years the Médecins du Monde
programmes were conducted in secret, as the French authorities did not pass a decree
authorising the exchange of needles in the street until 1995. This public health approach
is now widely recognised, as it allows marginalised users access to the social, health
care, information, guidance and accompaniment structures.
> Listening to a very marginalised population
1996, granting of the access prevention Kit licence to the Ministry of Health
Activities:
The distribution of sterile equipment,
fundamental in reducing the harm linked to the use of
substances, enables contact to be made with an often
marginalised population that would not have access to
information and care structures were it not for these
programmes. Activities: Once contact has been made, the teams
can then pass on prevention messages, listen and offer drug users
guidance on medical, social and legal questions: accommodation,
obtaining rights, settlement of legal matters, detox, post-drug
treatment, substitution treatments. In Paris, saliva tests for the
detection of hepatitis C are offered and provide not just opportunities
for medical care when the result is positive, but a chance to talk to
the people and provide them with more comprehensive aid. Other
tools are used in the harm reduction process, depending on the
situation: inhalation tubes for “sniffers” or nozzles for crack pipes to
prevent burning and HCV infection. The teams in the field are constantly
conducting research and surveys on tools and prevention messages
in order to make them more effective. Street work is often
complementary to the work of the mobile units.
> Four mobile structures: buses, vans and teams on foot who make
contact with drug users on the street or in squats.
> One fixed day centre in Bordeaux, fixed needle exchange centres in
Paris and Marseilles.
> Availability of sterile injecting equipment: all care centres.
> 241,788 needles given out, 35% of used needles returned in 2004.
Outlook
To favour systems that
facilitate exchange with
users, based on the saliva
test model for the detection
of hepatitis C. With more
poly drug users, new
tools need to be created,
especially linked to
crack use.
Most frequent pathologies
> infectious risks linked to
intravenous drug use (HIV, HBV,
HCV), abscesses, psychological
distress associated with
exclusion, related psychiatric
conditions, dental problems
Risk of marginalisation,
discrimination and social damage
Our programmes’ findings
> infectious risks linked to
intravenous drug use (HIV, HBV,
HCV), abscesses, psychological
distress associated with
exclusion, related psychiatric
conditions, dental problems
> Active files on almost 3,000 IDUs
for more than 10,000 visits to
mobile and fixed units.
Approximately 16,500 other
instances of contact (information,
guidance and requests other than
for injecting equipment)
> 31 within multi-disciplinary teams
Sources of funding
> mainly from the State via local
health authorities (DDASS), local
groups, Health Insurance Office
(CPAM), the National Fund for
Health Prevention, Education and
Information (FNPEIS), town
councils, CRAMIF
Partners
> Ministry of Health (Department of
Health), the Inter-Ministerial
Committee for the Fight against
Drugs and Drug Addiction (MILDT),
and the French Observatory for
Drugs and Drug Addiction (OFDT)
The Methadone Bus
Substitute treatment with methadone is aimed at limiting the harm linked to drug injection
by reducing the severity of withdrawal symptoms. The frequent marginalisation of drug
users contributes greatly to the social and health problems that they encounter. The aim
is to rebuild contact between these particularly vulnerable people and the health and
social network so that users can find their way back into health care procedures, with
relation to their addiction as much as other physical problems.
Drug users
> an estimated 200,000 injectors
Main pathologies
> HIV, HBV and HCV contamination
amongst injectors, personality
disorders and mood swings,
psychological distress associated
with exclusion
Number of projects
> Two methadone buses
> Actively registered: 830
Number of instances of contact
> An average of 100 per day in Paris
and 20 in Marseille
> 12
Sources of funding
> The Health Insurance Office (CPAM),
local health authorities (DDASS), the
Interministerial Committee for the Fight
against Drugs and Drug Addiction
(MILDT), local and regional groups,
Solidarité Sida, Sidaction
Partners
> ASUD, Tipi, Aides Provence, Sleep’in,
HAS, emergency accommodation
shelters, other occupational health
and safety commissions (CSST) in
Marseille and Paris (especially
Fernand Vidal and Marmottan),
hospitals, treatment and posttreatment establishments etc.
> Close daily community-based work
Since 1998
Activities: The programme addresses the most marginalised
Outlook
users, whom no other organisation includes, and offers services
at a low threshold of access. A dose of methadone is delivered
daily to the patients on the programme. Inclusion is at the
patient’s request, at a fixed location following a medical
consultation. The aim of the programme is to take over
the dependence on drugs by initiating and monitoring
methadone substitution treatment.
The monitoring of users is included in the programme, but the
objective is to guide patients towards other organisations: the
buses are merely a means of getting access to more longterm care structures. They park close to the places where the
drugs are taken and act as drop-in centres offering medical,
psychological and social guidance. The MdM teams also offer
HIV, HBV and HCV tests.
The creation of a harm
reduction platform in
Marseille working in
conjunction with the
Methadone Bus / Needle
Exchange Programme (PES)
to offer services and
interventions aimed at
various identified sections of
the public: redeployment of
mobile teams in squats and
festive areas, use of new
tools (flyers, testing, sniff kit),
and working together with
more specific actors (ASUD,
Tipi, Aides, MdM Rave )
In Paris, the team is
working with a philosopher
to reflect on innovative forms
of treatment; these thoughts
are to be the subject of a
written work.
> Mobile care unit offering a presence every day of the week.
> Local proximity teams.
> Fixed reception centres.
Raves
114/115
In December 2004, for the first time in its seven years of involvement, MdM was refused
access to those who attended a Teknival banned by the prefecture. Since 2002, the
organisation of raves has required prior authorisation from the prefecture. The ban on
these events hampers the actions of MdM, who provide health monitoring services and
help reduce harm, especially that connected with drug use. As some members of the
public have resorted to private or clandestine locations, access to the young people
involved has been made more difficult for the prevention and care actors.
ketamine), ecstasy, LSD,
amphetamines, cocaine, heroin
> Information on risks
Health problems
> headaches, vomiting, uneasiness,
Since 1997
Activities: Action to reduce the harm linked to use of
Outlook
psychoactive products. MdM’s rave projects are centred on
two axes:
• Health and prevention: to offer medical, listening and drop-in
areas. The teams deal both with cuts and scratches and with
emergency situations. Preventive information is offered: harm linked
to substance abuse, to cultural practices (tattoos, piercings etc)
and to the transmission of STIs, HIV, hepatitis;
• On-site and in-laboratory pharmacological analysis for
the ingredients of products in circulation, in order to adapt
the prevention message as effectively as possible. Since
1999, MdM has been involved in the SINTES project (National
System for the Identification of Toxins and Substances).
Since August 2004, the Rave Paris project has concentrated
on harm reduction in squats. The aim is to claim or restore
squatters’ social rights. The team set up harm reduction stands
and provide CCM (thin layer chromatography), a method of
substance analysis that allows analgesics, stimulants, tranquillisers
and anti-depressants to be identified.
In 2004, MdM extended its raves project to include the Balkans.
.
To adapt the project’s
method of intervention to
meet an ever more difficult
context, in which young
people have scattered and
become less and less
accessible.
To develop prevention tools
and flyers suitable for the
developing poly drug use
culture.
> All the projects provide first aid, information and product analysis.
> Interventions in clubbing locations and venues: free parties, teknivals,
discos, clubs, squat parties…
> Information sessions in schools and professional establishments.
Types of products
> anaesthetic substances (GHB,
psychological disorders, anxiety
attacks
The most frequent harm
> dehydration, bad trips,
hyperthermia, hypoglycaemia
> approximately 40,000
Sex, age
> mostly young males (average age: 22)
Nombre d’interventions
> 111
> 210 samples of synthetic drugs were
collected, documented and analysed
within the framework of the SINTES
programme co-ordinated by the French
Observatory for Drugs and Drug
Addiction (OFDT)
> 179
Sources of funding
> Department of Health (DGS), local health
authority (DDASS), Interministerial
Committee for the Fight against Drugs
and Drug Addiction (MILDT), French
Observatory for Drugs and Drug
Addiction (OFDT), and local groups
Partners
> Techno Plus, Aides, L’Orange Bleue,
ASUD, Le Tipi, Act Up, l’Acothé, Nantes
Day Centre
>
Contacts
> AIX-EN-PROVENCE
Philippe ROQUEJEOFFRE
Médecins du Monde
Maison de la Solidarité
Rue Philippe Solari
13100 AIX EN PROVENCE
Tel: 04 42 21 45 84
Fax: 04 42 21 62 48
[email protected]
> AJACCIO
François PERNIN
Médecins du Monde c/o Secours
Catholique
6 bd. Casanova
Tel: 04 95 51 28 93.
Fax: 04 95 21 17 13
All mail: F. Pernin
La Gravona
20000 AJACCIO
Work Tel: 04 95 29 90 75
Fax: 04 95 29 94 24
> ANGERS
Isabelle SALAUN - Frédéric VIE
Médecins du Monde
62, boulevard Saint-Michel
49100 Angers
Tel: 02 41 43 65 66
Fax : 02 41 43 01 49
[email protected]
> BESANÇON
Violaine LLORCA
Médecins du Monde
Appartement 168003
7, rue du Languedoc
25000 Besançon
Tel: 03 81 51 26 47
Fax: 03 81 52 70 28
[email protected]
> BORDEAUX
Christine SURAUD
Médecins du Monde
2, rue Charlevoix-de-Villers
33000 Bordeaux
Tel.: 05 56 79 13 82
Fax : 05 56 52 77 69
[email protected]
(drop-in, health care and guidance centres)
> French GUYANA
Janine KETTERLE
Médecins du Monde
Cayenne
Guyane
[email protected]
> GRENOBLE
Patrick BAGUET
Médecins du Monde
19, rue René-Thomas
38000 Grenoble
Tel: 04 76 84 17 21
Fax: 04 76 84 17 58
[email protected]
> LA PLAINE-SAINT-DENIS
Florence SUZAN
Médecins du Monde
8-10, rue des Blés
93210 La Plaine-Saint-Denis
Tel: 01 55 93 19 29
Fax: 01 55 93 19 30
[email protected]
> LYONS
Marc CUCHE
Médecins du Monde
10, rue de Sévigné
69003 Lyon
Tel: 04 78 89 99 99
Fax: 04 78 71 75 72
[email protected]
> LE HAVRE
Arlette SEIFFERT
Médecins du Monde
28, rue J.-B.-Eyriès
76000 Le Havre
Tel: 02 35 21 68 66
Fax: 02 35 22 67 33
[email protected]
> MARSEILLES
Xavier CARRARD - Georgia COUFFIN
et Florence LARMAT
Médecins du Monde
4, avenue Rostand
13003 Marseille
Tel: 04 95 04 56 00
Fax: 04 95 04 56 04
[email protected]
> MONTPELLIER
Tony DA SILVA - Marie Bernadette
CADILHAC et Margarita GONZALEZ
Médecins du Monde
18, rue Henri-Dunant
34090 Montpellier
Tel: 04 99 23 27 17
[email protected]
> NANCY
Jean-Marie GILGENKRANTZ
Médecins du Monde
5, rue de l’Armée-Patton
54000 Nancy
Tel: 03 83 27 87 84
Fax : 03 83 28 42 55
[email protected]
> NANTES
Philippe JARROUSSE
Médecins du Monde
33, rue Fouré
44000 Nantes
Tel: 02 40 47 36 99
Fax: 02 51 82 38 09
[email protected]
> NICE
Bernard AUBIN
Médecins du Monde
34, rue Rossini
06000 Nice
Tel: 04 93 16 59 60
Fax: 04 93 16 59 61
[email protected]
> PARIS
Denis HERMAN - Marc LERICHE
Médecins du Monde
62 bis, avenue Parmentier
75011 Paris
Tel: 01 43 14 81 81
Fax: 01 47 00 75 53
[email protected]
> PAU
Robert LAFOURCADE
Médecins du Monde
12 bis, place de la Monnaie
64000 Pau
Tel: 05 59 83 74 28
Fax: 05 59 27 22 32
[email protected]
> ROUEN
Michel JOLY
Médecins du Monde
5, rue d’Elbeuf
76100 Rouen
Tel: 02 35 72 56 66
Fax: 02 35 73 05 64
[email protected]
> STRASBOURG
Jean-Maurice SALEN
Médecins du Monde
24, rue du Maréchal-Foch
67000 Strasbourg
Tel: 03 88 14 01 00/01
Fax: 03 88 14 01 02
[email protected]
> TOULOUSE
Monique DREVON
Médecins du Monde
5, boulevard de Bonrepos
31000 Toulouse
Tel: 05 61 63 78 78
Fax: 05 61 62 04 15
[email protected]
> VALENCIENNES
Eliane LAMORISSE
Médecins du Monde
10-12, rue du Grand-Fossart
59300 Valenciennes
Tel: 03 27 47 40 08
Fax: 03 27 30 19 16
[email protected]
116/117
>
Contacts
(mobile action – proximity medicine)
MOBILE PROJECTS –
Street initiatives
> LYONS
Hélène GROSSHANS
et Françoise MICHAUD
Médecins du Monde
1, place du Griffon
69001 Lyon
Tel : 04 78 29 59 14
Fax: 04 78 29 55 91
[email protected]
> METZ
René MOUTIER
Médecins du Monde
11, rue Saint-Pierre
57000 Metz
Tel.: 03 87 63 55 91
Fax: 03 87 66 60 93
[email protected]
> POITIERS
La Caravane
Patrick BOUET - M.-T. RAYMOND
Médecins du Monde
Hôpital gériatrique Pasteur
Pavillon Paul-Guillon
15, pont Saint-Cyprien
86021 Poitiers Cedex
Tel: 05 49 01 77 77
Fax: 05 49 60 28 93
Back-up / Tel: 05 49 38 45 10
Fax: 05 49 38 45 11
> SAINT-DENIS DE LA RÉUNION
Philippe DE CHAZOURNE
Médecins du Monde
250 bis, rue Général-Rolland - bât. K
SHLMR Bouvet - BP 964
97479 Saint-Denis de la Réunion
Cedex
Tel.: 02 62 21 71 66
Fax: 02 62 41 19 46
medecinsdumonde.reunion
@wanadoo.fr
PROSTITUTION PREVENTION
> LE HAVRE
Arlette SEIFFERT
Médecins du Monde
28, rue J.-B.-Eyriès
76000 Le Havre
Tel.: 02 35 21 68 66
Fax: 02 35 22 67 33
[email protected]
> METZ
Frédérique CARRIE
Médecins du Monde
11, rue Saint-Pierre
57000 Metz
Tel.: 03 87 63 55 91
Fax: 03 87 66 60 93
[email protected]
> MONTPELLIER
Damien CHERET - Clélia VENTURINI
Médecins du Monde
18, rue Henri-Dunant
34090 Montpellier
Tel.: 04 99 23 27 17
Fax: 04 99 23 27 18
[email protected]
> NANTES
Funambus
Paul BOLO
Médecins du Monde
33, rue Fouré
44000 Nantes
Tel.: 02 40 47 36 99
Fax: 02 51 82 38 09
[email protected]
> PARIS
Lotus bus
Chloé CATTELAIN - Marie DEBRUS
Médecins du Monde
75011 Paris
Tel.: 01 43 14 81 61
Fax: 01 47 00 80 70
[email protected]
> ROUEN
Bus prévention
Michel JOLY
Médecins du Monde
5, rue d’Elbeuf
76100 ROUEN
Tel.: 02 35 72 56 66
Fax: 02 35 73 05 64
[email protected]
TRAVELLER PROJECT
> BORDEAUX
Bertrand FAVAREL-GARRIGUES
Médecins du Monde
33000 Bordeaux
Tel.: 05 56 79 13 82
Fax: 05 56 52 77 69
[email protected]
[email protected]
> STRASBOURG
Maryvonne LE GAC
Médecins du Monde
24, rue du Maréchal-Foch
67000 Strasbourg
Tel.: 03 88 14 01 01
Fax: 03 88 14 01 02
[email protected]
CHILDREN’S PROJECTS
Child lead poisoning
> BORDEAUX
Christophe ADAM
Médecins du Monde
33000 Bordeaux
Tel.: 05 56 79 13 82
Fax: 05 56 52 77 69
[email protected]
Claude CHAUDIERES
Mission banlieue
Médecins du Monde
8-10, rue des Blés
Tel.: 01 55 93 19 29
Fax: 01 55 93 19 30
[email protected]
NO FIXED ABODE PROJECT
> PARIS
Catherine PETERMAN
c/o coordination Mission France
Médecins du Monde
62, rue Marcadet
75018 Paris
Tel: 01 44 92 13 10
Fax: 01 44 92 99 92
[email protected]
Roma project
Michèle MEZARD
et Geneviève DURIGON
Médecins du Monde
8-10, rue des Blés
Tel: 01 55 93 19 29
Fax: 01 55 93 19 30
[email protected]
SUB-STANDARD HOUSING
PROJECT
Squats project
> TOULOUSE
Marie-Pierre BUTTIGIEG
Médecins du Monde
31000 Toulouse
Tel: 05 61 63 78 78
Fax: 05 61 62 04 15
[email protected]
NO FIXED ABODE PROJECT
> PARIS
Graciela ROBERT
Médecins du Monde
75011 Paris
Tel: (21:00-23:00 pm) 01 43 14 81 74
Tel: (for messages during day)
01 44 92 14 98
Fax: 01 43 14 81 51
[email protected]
CAFDA Project
> PARIS
Fabrice GIRAUX - Marc LERICHE
c/o coordination Mission France
Médecins du Monde
62, rue Marcadet - 75018 Paris
67, rue Vaneau - 75007 Paris
Tel. / Fax: 01 45 49 03 80
[email protected]
SOCIAL ACCOMPANIMENT
PROJECT
> BORDEAUX
Arnaud WIEHN
Médecins du Monde
2, rue Charlevoix-de-Villiers
33000 Bordeaux
Tel.: 05 56 79 13 82
Fax: 05 56 52 77 69
[email protected]
>
Contacts
(Harm reduction)
NEEDLE EXCHANGE BUS
Valérie PATRIER
> ANGOULÊME
HEALTH LISTENING BUS
Marie-Laure FERRARI
> ANGOULÊME
Médecins du Monde
22 allée du Champ Brun
16000 ANGOULEME
Tel: 05 45 65 11 82 (unit)
Tel: 05 45 65 0747 (regional office)
Fax: 05 45 61 18 85
(unit and regional office)
METHADONE BUS / HARM REDUCTION
> MARSEILLES
Médecins du Monde
4 avenue Rostand
13003 MARSEILLE
Tel: 04 95 04 56 06/08
Fax: 04 95 04 56 07
[email protected]
NEEDLE EXCHANGE BUS /
METHADONE BUS
> PARIS
Jean-Pierre LHOMME
Médecins du Monde
75011 Paris
Tel : 01 43 14 81 61
Fax: 01 47 00 80 70
secrpes.parmentier
@medecinsdumonde.net
NEEDLE EXCHANGE BUS
> BORDEAUX
Jean-Pierre DAULOUEDE
et Guy MAYER
Médecins du Monde
2, rue des Étables
33800 Bordeaux
Tel: 05 56 92 51 89
Fax: 05 56 92 03 59
[email protected]
RAVES
> BRETAGNE
Eric LE MOAL
Médecins du Monde
[email protected]
> BAYONNE
Médecins du Monde/ Bizia (centre
méthadone)
Centre Hospitalier Côte Basque
BP8
64106 BAYONNE
Tel Bizia: 05 59 44 3100
Rave mobile: 06 03 21 21 05
Rave tel: 05 59 44 3105
Fax: 05 59 44 31 03
[email protected]
> NANTES
Anne-Lise GUEGUEN
Médecins du Monde
33, rue Fouré
44000 Nantes
Tel : 02 40 47 36 99
Fax: 02 51 82 38 09
> PARIS
Camille DENIS - Valère ROGISSART
Médecins du Monde
75011 Paris
Tel / Fax: 01 43 14 81 69
[email protected]
> TOULOUSE
Olivier DROUAULT
et Elodie CHAYRIGUES
Médecins du Monde
31000 Toulouse
Tel: 05 61 63 78 78
Fax: 05 61 62 04 15
[email protected]
> NICE
Philippe de BOTTON
Médecins du Monde
34, rue Rossini
06000 NICE
Tel: 06 08 27 20 94
[email protected]
XBT PROJECT
National SINTES
co-ordination office
> PARIS
Stéphane LE VU
Médecins du Monde
75011 Paris
Tel. / fax: 01 43 14 81 69
[email protected]
> MdM mobilisation
FRANÇOIS MOURA
119/128
VALÉRIE DUPONT
VALÉRIE DUPONT
DAVID SEBAN
PASCAL DELOCHE
MDM
DAVID DELAPORTE
STÉPHANE LEHR
MDM
PATRICK CHAUVEL
120/121
January
Liberia : This country, bled dry by fourteen years of civil war, is
now struggling to recover.
MDM
VALERIE DUPONT
VALÉRIE DUPONT
>
Displaced people’s camp in Liberia, between the capital
Monrovia and the Northern city of Gbarnga.
World Social Forum in India.
> Highlights
> And also
14-15 January: 3rd International Health Forum
in Mumbai, India
As in previous years, MdM took part in the 3rd
International Health Forum (14-15 January) and
in the 4th World Social Forum (16-21 January
2004) under the "Health Care Access and
Globalisation” programme.
The analyses presented during the health forum
confirmed the relevance of the approach adopted
by MdM on changes in health systems and the
impact of reforms in this sector on access to
health care for the most vulnerable. Several
testimonies (Malaysia, India, USA and Kenya) have
quoted the privatisation of health systems as a
limiting factor in access to health care.
At the forum, MdM also represented the campaign
“World Bank: Health at a Price", which
questioned the WB on the negative impact of some
policies on access to health care for the poorest
nations. The health care access programme in
Qinghai, China, was presented as evidence of the
breakdown in the Chinese health care system.
9 January: Round Table on North Korea
with Pierre Rogoulot, Philippe Grangereau and
Valérie Gélezeau.
12 January: in the context of the draft law
relating to public health policy in France,
MdM obtained the signatures of ten leading
health professionals in a letter sent to the
Minister of Health and to MPs, demanding the
inclusion in the draft law of a guarantee of
access to health care for the poorest people.
15 January: “Post-war period in Liberia?"
forum, after 14 years of strife; MdM
interviewed representatives of Amnesty
International, Action Against Hunger and Le
Monde on peace in this country, and more
globally on destabilisation in the whole of
West Africa.
>
February
DR
> Highlights
MdM has joined in with the 1954 call anniversary
celebration to remind us that even now, 17% of French people
live on less than 700 euros per month.
>
26 February: 50th Anniversary of the Winter
’54 Appeal
On 1 February 2004, the Emmaüs Movement,
led by Abbé Pierre, launched another appeal.
Over the last half century society has altered, the
faces of poverty have changed. In answer to the
questions “what can each of us do to fight the
causes of poverty? How can we help? How can
we work together?”, MdM has been working
together with ten or so associations active in the
fight against exclusion, in an new exhibition
entitled “Poor Us!”, which was held at Musée
de l’Homme (Museum of Mankind) throughout
February.
> And also
2 February: screening of film “The Desert
of the Tartars" , in aid of the Bam earthquake
victims at the Forum des Images (Film Forum),
Paris.
22 February: 9th edition of Humanitaire
magazine, published by MdM, and dedicated
to “forgotten crises in a fragmented world”.
March
> Highlights
PATRICK CHAUVEL
11 March: Testimony on Chechnya
On the eve of the Russian elections, MdM
organised a press conference with AAH and
Handicap International to present a joint report on
“Chechnya: the Return to Hell”, on the plight
of the Chechen population in Ingushetia and
Chechnya itself. This document denounced the
forced repatriation of Chechens from Ingushetia
and false normalisation, and alerted us to the
humanitarian situation associated with the extreme
instability in Chechnya.
Chechnya : fighting against being forgotten.
24 March: Access to healthcare –
El Salvador
Following a joint project in July 2003, MdM and the
IFHR published a report that contained worrying
news on access to health care in El Salvador,
which has been complicated by the current plans
to privatise the health sector. MdM and the IFHR
have restated the need to defend a health system
based on solidarity and non-discrimination and
have stressed the importance of seeing health
as a true right held by every citizen, of which the
State is the principal guarantor. MdM and the
IFHR called on the new government in El Salvador
to follow recommendations contained in the report.
> And also
March: the first of two reports on the trial of the
former president of Techno Plus, finally fixed for
21 March 2005, for “having favoured and
encouraged the use of narcotics” by circulating
information on the attendant risks. MdM was
concerned about the calling into question of
RDR’s approach towards harm reduction and
signed the support petition for Jean-Marc Priez.
122/123
ALAIN HODOT
IBUKA
DAVID DELAPORTE
>
Roma : supporting a wounded population.
Rwanda : ten years on from the genocide.
4 April: Roma – living conditions
The death of two young girls in a fire in their
caravan in a shanty town in Surville, Lyon,
followed ten days later by police expulsions of
Roma families from their living quarters in
Bessancourt, Choisy-le-Roi and Saint-Denis,
drew attention to the difficulties experienced
by these people in France. MdM, as part of
the Romeurope coalition:
• denounced the expulsions, which carried no
offers of suitable long-term relocation;
• rcalled for a regional round table to be held, with
participation by the mayors and prefects
concerned, together with social services and
representatives from associations and Roma
communities for an emergency think tank on
access to housing.
On 30 April, during a debate and fair evening
organised by the Île de France Regional Council,
the association launched an appeal for the
Roma to have access to basic rights in
France and Europe. In May, MdM Lyon
organised a demonstration denouncing the
living conditions in Surville. In July, after the first
demonstration by the Roma in Paris against
the exclusions suffered by them, a delegation
from Romeurope was received by the Ministry
for the Interior.
> Highlights
> And also
1 April : Forum on "Access to Healthcare
for the most deprived in 2004”, inventory of
resources and essential requirements.
3 April: 10th anniversary of the Rwandan
genocide. Speech by MdM at UNESCO and
support for IBUKA for the commemoration.
15 April: Press conference organised in the
framework of Coordination SUD to denounce
the NGO subsidy crisis.
Access to care in France: what’s it like now?
April
MDM
AFFICHE TZIGART/DR
May/June
ISABELLE ESHRAGHI
>
24 free care centres in France.
Médecins du Monde’s quarterly review .
The poster for Tzigart, the organiser of the
gypsy music festival.
> Highlights
> And also
8 June: AME (State medical assistance) –
the consequences of the reform
Six months after the abolition of immediate access
to AME came into force and the introduction of a
three-month wait for treatment, the first signs
of the predicted health crisis were evident in
the field. In association with MSF, the SAMU
Social (emergency medical services) and the
Comède (medical committee for refugees), MdM
organised a press conference to present dozens
of testimonies received from carers who reported
on the damaging effects of the reforms. Access
to comprehensive health care for all was reaffirmed
as a fundamental principle of French collective
solidarity and the reforms were denounced. The
joint appeal, launched on this theme in December
2003 by MdM and MSF, received the support of
11,400 individuals and 160 associations.
22 May : 10th issue of Humanitaire magazine,
published by MdM, on the Tutsi genocide in
Rwanda, "an abjection for humanity, a failure
for the humanitarians”.
The European presidents of the MdM
international network signed an appeal to the
candidates for the June 2004 European
elections, demanding improved access to
healthcare for all European residents and an
immediate stop to the deportation of seriously ill
individuals who cannot get the care they need in
their country of origin.
9 June: MdM organised a round table on
“International rights and the fight against
terrorism: some considerations for the
NGOs”.
10-12 June: Gypsy Music Festival organised
by the Tzigart Association at the Cirque d’ Hiver,
in aid of Médecins du Monde. Exhibition of
photographs by David Delaporte.
29 June: MdM enounced the reduced access
to healthcare for the least secure in the reforms
of health insurance.
124/125
Twenty-five years of working with minorities.
Confronting insecurity, even in summer.
> Highlights
9-11 July: 22nd session of the UN working
group on native populations
2004 is the last year of the decade assigned to
promote the rights of native populations by the
United Nations. On this occasion, MdM
undertook to capitalise on the projects
carried out with these populations over the
last 25 years, and to set up an advisory
group on the health of these ethnic
minorities, within the context of a convention
being compiled by the UN announced for the end
of the decade. Participation in the 22nd session
of the working group in Geneva was an indication
of MdM’s interest in the topics and provided an
opportunity to make itself known on what is a real
world parliament of native populations. In pursuit
of this work, MdM was also present at the
2nd Continental Summit of Indigenous IndoAfro-Latino Populations held in Quito,
Ecuador on 25 July.
July
DAVID DELAPORTE
DAVID DELAPORTE
>
Solidays: theatrical presentation of AIDS prevention.
> And also
22 July – 20 August: Homeless people
Faced with the risk of another heatwave, MdM,
working in partnership with Secours Catholique
(Caritas France), has set up a plan of action for
information and referral to support vulnerable
people in Paris. A tent erected in the Place
de la République provided an accessible
access and referral to medical and social
care for people living on the streets or in
vulnerable situations.
In Toulouse, MdM joined forces with Emmaüs
to perform outreach teams which target
homeless people in order to break down their
isolation, spot people in deteriorating health,
provide water and point out places where there
are washing, food and health care facilities.
2-4 July: 40 actors from the rave drugs teams
in Nantes, Rennes and Paris travelled to the
Teknival de Scaer in Finistère as part of the
harm reduction programmes.
8 July: participation by MdM in the CRID
(Research and Information Centre for
Development) Summer School in Angers:
organisation of a health care rights workshop
by the Pays de la Loire delegation.
9-11 July: MdM participated in the 6th Solidays
Festival (AIDS solidarity group).
>
August/September
> Highlights
August: health care access – Afghanistan
Within the reconstruction of the Afghan health
care system as devised by the sponsors together
with the Ministry of Health, it was planned to
subcontract all offers of primary health care to the
medical NGOs. MdM was highly concerned
by such development, as it is mindful of
the need to construct dependable health
systems that offer health care access for
everyone. After an in-depth survey
(“Reconstruction of the Afghan Health
>
> And also
System: subcontracting to the NGOs” report),
MdM decided not to participate in this type of
privatisation but to maintain its presence through
other programmes, in order to provide aid to those
excluded in the new health care system.
21-28 August: Back from Darfur, Françoise
Jeanson, President of MdM, denounced the lack
of security in the camps and called for protection
for the local people and humanitarian aid workers.
26-29 August: Occitek Summer Teknival. MdM
were on hand to provide a health monitoring service
and reduce the risks that are especially linked to
drug abuse.
15 September : Humanitaire magazine round
table on the theme of “Eastern Europe: what fate
for the vulnerable populations, what future for
civilian society?"
October
FRANÇOIS MOURA
> Highlights
During the International Day to Eradicate World Poverty,
the street theatre company Générik Vapeur put on a show to
make everybody think.
12 October: publication of report “Operation
Rainbow: impact on the health of the
population of Rafah".
This report followed the joint survey carried out
in May by MdM and the IFHR in Rafah, on the
West Bank of Jordan, to assess the
consequences of the military operation
“Rainbow”, carried out by the Israeli army from
18-25 May. The MdM report set out the medical
consequences in terms of access to health care
for the population and physical and mental
health, based on testimonies and medical reports.
MdM also exposed the consequences of the
house destruction programme that left almost
3,800 people homeless, as well as the destruction
of infrastructures, which exacerbated an already
very precarious economic and social situation.
As in June, when an ambulance was attacked
in the camp at Balata (West Bank), MdM renewed
its plea to all the protagonists in the IsraeliPalestinian conflict to respect international
humanitarian law.
14 October: World Day for the Eradication of
Poverty
The MdM national action and testimony day
was held in Marseille and was intended to
denounce the withdrawal of health care in
France in 2004. As well as the testimonies given
to the press by carers from the MdM health
centres, a street show created by Compagnie
Generik Vapeur aimed to increase public
awareness. The "Aux petits soins" production
had musicians and actors standing around
hospital beds, representing life stories, aimed at
touching the sensibilities of passers-by via poetry
and the unusual presentation.
This action led to considerable action from
volunteers and salaried employees as well as
resulting in several features in the local press.
126/127
>
November
Siberia: capitalising on our earlier actions in order to plan
better for these local people’s future.
and representatives of international NGOs, attended
the conference. As a result of these speeches and
discussions, new perspectives marked the end
of the conference, centred on training health
technicians from the native populations. Four
regions showed an interest in working with MdM.
KHALIL SAYYAD
18-19 November: Conference held under the
aegis of MdM on “Organisation of aid to
isolated populations in Siberia and the northern
regions of Russia”, in Nadym, Siberia.
Sponsored by the WHO.
In co-operation with the health authorities in Yamal
Region, this conference summed up ten years of
work with the Nenets people. The aim was to
capitalise on this work’s positive and innovative
experiences and circulate them while adapting them
to suit other populations. Officials and representatives
of native populations from about ten regions right
across Russia, as well as ministers, specialist doctors
FRANCK DESPLANQUES
2 November: testimony – MdM draws attention
to forced relocation in Darfur and denounces
the use of rape as a war weapon.
Present in Darfur since July, working with displaced
populations in the Kalma Camp, MdM:
• Denounced the police actions that emptied
in particular the camp at Serief (South Darfur)
that was home to several hundred displaced people,
victims of war. About 500 people were forced to
move to another camp, while the police razed the
camp at Serief, destroying the shelters and tents
and firing in the air to disperse the displaced people
who were opposed to the relocation.
• Condemned the increase in the number of
rapes, after the medical teams were confronted
with an alarming rise in the number of cases
committed while women were walking in the areas
surrounding the camps to gather wood or work in
the fields. Apart from the intolerable violence of
these acts, the perpetrators resorted to methods
that grossly humiliate these women and shatter
their dignity. MdM condemned these practices and
called on the Sudanese authorities to do everything
possible to put an immediate stop to them and
ensure the security of displaced people.
FRANCK DESPLANQUES
> Highlights
> And also
20 November: 5 anniversary of the
Convention on the Rights of the Child.
Opening in Lyon of an exhibition on the Bolivia
mission (the health of child labourers) and a talk
with children in Lyon.
th
In the semi-desert provinces of Darfur, the situation of
hundreds of thousands of local residents forced from their
villages and huddled together in wretched camps continues to
get worse.
December
LAHCÈNE ABIB
>
SOPHIE BRANDSTRÖM/L’ŒIL PUBLIC
MdM is worried by the change of policy relating to the ban
on raves, which will seriously hinder the setting up of health
systems.
Since 1994, MdM has been fighting to obtain specific
measures to help poor families seriously affected by lead
poisoning.
> Highlights
> And also
16-19 December: Migrant workshops
MdM organised three days for sharing practices
and thoughts on the question of access to health
care for migrants in Europe. Volunteers, paid
and unpaid, together with representatives of the
European delegations of MdM and of the outside
partners, came together to share their
experiences. The culmination of the aim was
to create a white book, which will list health
problems faced by migrants in Europe, and
gather political recommendations calling
on European decision-makers to provide
better access to health care for migrants
in Europe.
1 December: International AIDS combat
day. The Paris drop-in centre organised an
open day on the subject of its prevention
programme amongst migrants.
6 December: harm reduction – MdM
denounced the ban imposed by the Ministry
for the Interior at the rave party in Loire Atlantique.
For the first time in seven years of intervention
by MdM in Techno festive events, the CRS (riot
police) barred the prevention teams from
entering.
14 December: the MdM lead poisoning
project called urgently on the Hauts de
Seine prefecture to rehouse two families.
Following the press release exposing their
dreadfully bad living conditions and the risks
these posed, the prefecture set up a lead
poisoning monitoring commission and provided
the families with new housing.
>
Representation network
129/142
> Alsace
Contact Details
> Regional delegation:
24 rue du Maréchal-Foch
67000 Strasbourg
Tel.: 03 88 14 01 00
Fax: 03 88 14 01 02
E-mail: [email protected]
Web site:
http://medecinsdumondealsace.org/
Board Members
> Regional Representative:
Dr Maryvonne Le Gac
> Secretary:
Dr Paul-André Befort
> Aquitaine
> Key events
Publicity initiatives and actions
• Local Internet site: introduction to the
delegation and what it does.
• Information for students in
universities, colleges and schools.
• Concert for a collection of health
products and blankets.
• Participation in 6th Association Fair in
Wacken.
• “Lay a Stone” operation at
Schoepflin primary school.
• Stand at the National Exclusion Day
and Christmas Market in Strasbourg.
• Participation in the CCFD’s “Enough
of Words – Time for Action!”
> Treasurer:
Jean Litzler
> Other members:
Aloyse Kriegel
Catherine Frapard
Dr Pierre Rosenstiel
Dr Jean-Maurice Salen
> Secretary of the Regional
delegation:
Brigitte Fanteguzzi
> Adoption Section:
Partnerships
• Association of psychiatrists and
general practitioners on exclusion from
health care.
• Grouping of associations working
in the field of prostitution.
• 115
• Town of Illkirch
• “Alerte” network.
Contact Details
2 rue Charlevoix-de-Villers
33300 Bordeaux
Tel.: 05 56 79 13 82
Fax: 05 56 52 77 69
E-mail: medecinsdumonde.
[email protected]
Board Members
Françoise Parrot
> Secretary:
Savine Baudet
> Other members:
Patrice Billecocq
François Cougoul
Jean-Pierre Daulouède
Marie-Germaine Mazeran
delegation:
Marie-Christine Chauveau
> Number of associates:
120
Colette Minard-Rosenstiel
63
Other actions
• Adoption: information shared with
ASE about couples awaiting
approval.
• Information meetings with
Friends of Children of the World
and Way of Life.
> Pau Branch:
Manager Robert Lafourcade
Tel. : 05 59 83 74 28
> Key events
• Opening of new offices.
• Concert by “Petits Chanteurs à la
Croix de Bois”.
• Participation in “International Day
for the Eradication of Poverty”, as
part of an inter-association
demonstration.
130/131
> Brittany
Contact details
19 rue Balzac
56270 Ploemeur
Tel.: 02 97 86 27 50
E-mail:
[email protected]
Board Members
Marie-Elizabeth Hochet
> Corsica
> Key events
• Presentation of MdM in the Lorient
and Vannes documentation centres.
• Participation in brainstorming days in
schools in Morbihan and Finistère.
• Participation in association forums.
• Presentation of MdM to Breton
businesses.
> Secretary:
Valérie Bergeron
> Other members:
Christophe Perron
Inès Guihaire Schubert
Marie-Françoise Le Tallec
Xavier Guillery
Contact details
Résidence “La Gravona”, bât. 1 A
Rue des Romarins
20090 Ajaccio
Tel: 04 95 10 25 49
Fax: 04 95 10 25 49
Board Members
Jean-Pierre Luciani
Partnerships
• Various associations in Rennes
working on the theme of prostitution.
• Lanester Town Council: educational
exchange programme between
mentally disabled youngsters and
children from a ghetto in Bulgaria.
40
Other actions
• Adoption: Three teams in Ile &
Vilaine and in Morbihan.
• Harm reductions: involvement in
festive occasions.
> Secretary:
François Pernin
> Treasurer:
Patrick Contois
> Other members:
Andrée Fenech
40
> Key events
• Participation in “nursing” day.
• Participation in Association Forum.
• Debate meeting on Chechnya.
• Primary school activities for
International Day for the Eradication of
Poverty.
Partnerships
• Member of a joint-NGO platform.
> Franche-Comté
Contact details
7 rue du Languedoc,
Apt. 168 003
25000 Besançon
Tel.: 03 81 51 26 47
Fax: 03 81 52 70 28
Board Members
Jacques Guitard
> Secretary:
Violaine Llorca
> Treasurer:
Bernard Badey
> Other members:
Philippe Boulhaut
Marie-Claire Tisserand
Jean-François Viel
> Key events
• Participation in international solidarity
week and International Day for the
Eradication of Poverty.
• Introducing the association in a
number of schools: activities abroad
and activities of the Mission France de
Besançon.
• Participation in meetings organised
by the Regional Council of FrancheComté in the context of co-ordinating
the associations, companies and
business schools wanting to help Asia
in the wake of the tsunami.
• Sorting of medicines for
associations in Romania and Mali.
> Ile-de-France
Contact details
62 bis avenue Parmentier
75011 Paris
Tel.: 01 43 14 81 99
Fax: 01 48 06 68 54
E-mail:
[email protected]
Board Members
Philippe Pluvinage
> Secretary:
Karen Segas
> Treasurer:
Claude Martine
> Other members:
Maria Melchior
Marie Debrus
Catherine Peterman
> Permanent Secretary of the
Regional delegation:
Anne Fontaine
400
> Key events
• Involvement in nursing and
paramedic colleges and training
schools.
• Stands at national events in Paris,
working together with the Head Office
Communications Department, and at
community events in Île de France.
• Support for the “lay a stone”
operation in a Seine-et-Marne school.
Publications
• 4 publications of the Le Fil
newsletter, with 600 copies.
Partnerships
• Vivendi Universal: fun day for
CAFDA mission children.
• MdM Nord Pas de Calais
delegation.
• Catholic Aid.
Other actions
• Tsunami: 24-hour telephone line at
MdM Head Office.
• Support during total refurbishment
of permanent offices (summer 2004).
Organising the opening of the offices.
• Management and leadership of the
recruitment of new volunteers for the
Île-de-France projects.
132/133
> Indian Ocean
Contact details
250 bis rue Général Rolland,
Bât. K, SHLMR Bouvet
BP 964, 97479 Saint-Denis
Cedex – Réunion
Tel.: 02 62 21 71 66
Fax: 02 62 41 19 46
E-mail:
medecinsdumonde.
[email protected]
Board Members
> Regional representative:
Frédéric Le Bot
> Secretary:
Claudia Vichatzky
> Treasurer::
Gilles Bourdiol
> Other members:
Philippe De Chazournes
Gilbert Potier
delegation:
Agnès
22
> Key events
• Mailshot for Cyclone Gafilo (7
March 2004): press releases,
appeals for aid.
Publications
• Journal Mission, Nos. 36 and 37.
Partnership
• CARE & Med’Air.
Other action
• 6-month post-emergency project
(funded by ECHO).
• Production of film by ECHO for its
internal communication, summarising
the various actions financed by it for
the cyclone.
> Languedoc-Roussillon
Contact details
18 rue Henri-Dunant
34090 Montpellier
Tel.: 04 99 23 27 17
Fax: 04 99 23 27 18
[email protected]
Board Members
Clélia Venturini
> Secretary:
Claude Aiguesvives
> Treasurer:
> Key events
• Participation in International Day
for the Eradication of Poverty in
Montpellier.
• Introduction to MdM and its
missions at the Nursing Preparation
College in the Red Cross School
(Grabels).
• Participation in an evening held in
support of the Bam earthquake
victims.
• Stand at the trade fair for
associations.
Françoise Jourdan
> Other members:
Antonio Da Silva
Madeleine Mercier
Delphine Peronne
Mansoureh Yaghmaie-Astruc
> Secretary to the Regional
delegation:
Magali Ibanez
100
Partnerships
• Partnership project with the
Montpellier School of Odontology,
with 5th and 6th year dental
students.
• Association APGB, with prostitutes
working in the city.
Other action
• Introduction to projects over here
and over there; training for those
going on mission, recruitment for the
IDEs for international missions, job
descriptions.
> Lorraine
Contact details
5 rue de l’Armée Patton
54000 Nancy
Tel.: 03 83 27 87 84
Fax: 03 83 28 42 55
Board Members
Anne-Marie Worms
> Secretary:
Monique Ulrich
> Trésorière :
> Nord-Pas-de-Calais
> Key events
• Televised interview held during
“Insecurity” day.
• Interview and report in
L’Est républicain magazine.
Partnerships
• University Medicine (several
meetings).
• Nancy Town Hall (reflections on
Ville Santé workshop.
• Sonacotra shelters, Nancy
(prevention).
Anne-Marie Marchetto
> Other members:
Noëlle Necker
Jean-Marie Gilgenkrantz
Lucien Gbetro
Michel Guyot
Contact details
10-12 rue du Grand Fossart
59300 Valenciennes
Tel.: 03 27 47 40 08
Fax: 03 27 30 19 16
E-mail:
[email protected]
Board Members
Guy Dehaut
> Project manager:
Eliane Lamorisse
> Secretary:
> Key events
• “Open Door” day for opening of
new offices.
• Participation in regional health
programme in Valenciennes.
• Children’s rights awareness
campaign in schools.
• Participation in “Alerte” action
group.
Publications
• “Where to Eat? Where to Find
Care? Where to Stay?” brochure.
Fabienne Ducatez
Other actions
• Setting up a Regional International
Mission (MIR) in Burkina Faso.
> Treasurer:
Christiane Ficheroulle
> Other members:
Elisabeth Dusart
Charles Lejeune
Claudine Leleu
33
Partnerships
• Emergency housing associations,
Housing and Social Rehabilitation
Centres (CHRS), drop-in centres
(AJAR , APE , Midi-Partage, POSE).
• Rimbaud Mobile Team.
• PASS (Espace Baudelaire).
• Boutique Solidarité.
• Red Cross.
• SOS Bébé.
• Future and Co-operation.
Other actions
• Aid for refugees in Calais.
• Recovery of glasses restored by an
optician.
• Recovery and sorting of medicines.
134/135
> Midi-Pyrenees
Contact details
5 boulevard de Bonrepos
31000 Toulouse
Tel: 05 61 63 78 78
Fax: 05 61 62 04 15
E-mail: mdmmidipy.
[email protected]
Board Members
Dr Florence Rigal
> Secretary:
Marie-Pierre Buttigieg
> Treasurer:
Luis Garcia
> Other members:
Dr Pascale Estecahandy
Monique Drevon
Dr Frédéric Sananes
> Project manager:
Tom Wingefeld
delegation:
Isabelle Malet
> Albi branch:
Manager: Nicole Cany
Tel. : 05 63 45 08 15
> Key events
• Activities in various schools and
colleges and the IFSI.
• Auctioning of chocolate pieces,
organised by a delta group from
ESC Toulouse.
• Participation in conference:
“Rwanda, 10 years on”.
• Organisation of an exhibition and
conference on Chad.
• Organisation of stands on
Associations Day.
• Working with Amnesty to organise
a conference: “Women in situations
of armed conflict”.
Publications
• Quarterly newsletter: Lettres et
Débats.
• Small booklet produced about
the regional delegation.
Partnerships
• Financial partnerships.
• General Council, Toulouse City
Council,
• Haute Garonne Health Insurance
Office (CPAM), Haute Garonne Local
Health Authority, Midi Pyrénées
Regional Health Authority.
Exhibitions
• Exhibition and sale of works of art in
Albi.
• Exhibition of photos of Chad and
Opération Sourire in Cambodia.
Other actions
• Various shows organised in aid of
MdM: cross, theatre, gala.
• “Five Hours for Chechnya”,
organised by the Albi Branch.
• Adoptions, every Monday from
1400 to 1800 hours.
• Sorting of medicines: 16 tonnes
of non-used medicines collected.
> Normandy
Contact details
5 rue d’Elbeuf
76100 Rouen
Tel.: 02 35 72 56 66
Fax: 02 35 73 05 64
E-mail: mdmlehavre@
wanadoo.fr
Board Members
Christian Cartier
> Secretary:
Agathe Bonmarchand
> Treasurer:
Michel Joly
> Other members:
Arlette Seiffert
Jean-Jacques Prey
Mireille Vache-Picat
delegation:
Claudie Hauduc
> PACA (Provence-Alpes-Côte d’Azur)
> Key events
• Rouen regional day –
Le Havre, 20 November.
Partnerships
• Free anonymous screening centre
at the Central University Hospital
(CUH) (for screenings carried out on
the Prostitute Bus).
• All housing associations and drop-in
centres.
• Travellers’ drop-in centre.
Other actions
• Medicines sent to Ivory Coast,
Congo and Ukraine.
Contact details
4 avenue Rostand
13003 Marseilles
Tel: 04 95 04 59 60
Fax: 04 95 04 59 61
E-mail: mdmpaca@medecins
dumonde.net
Board Members
Ariane Junca
> Secretary:
Simone Varenne Blanc
> Treasurer::
Philippe Dupin
> Other members:
Denise Clément
Marie-Agnès Chaud
Olivier Bernard
Pierre-François Pernet
> Project co-ordinator::
> Key events
• Organisation of monthly meetings
centred on MdM’s national and
international activities.
- “Migrants and vulnerable sections
of the population in Marseilles”.
- “A look at Tibet”.
- Meeting with local partners
invested in Latin America, in the
Venezuela mission.
- “Sharing about Romania”.
- “The homeless”.
• National Mission France Day: “Aux
Petits Soins” street show, for another
idea of health from the company
Générik Vapeur.
• Biennial arts exhibition in Sanarysur-Mer, on the theme of Africa.
• Meetings with gypsies.
• Regional Associate meetings.
• Cassis Christmas Market.
Isabelle Bouju Malaval
> Accountant:
Ghislaine Vincenti
> Secretaries of the
Regional delegation:
Anne-Marie Combe
Martine Semat
Daniel Imbert
190
> Le Havre Branch:
Manager: Arlette Seiffert
Tel. : 02 35 21 68 66
[email protected]
Publications
• Migrants and vulnerable sections
of the population in Marseilles, Julie
Chave (DEA).
• Study of the emotional suffering of
patients admitted to the CASO in
Marseilles, Ladislas Polski (Doctorate
Thesis).
136/137
> Pays de la Loire
Contact details
33 rue Fouré
44000 Nantes
Tel.: 02 40 47 36 99
Fax: 02 51 82 38 09
Board Members
Paul Bolo
> Secretary:
Angélique Morat
> Treasurer:
Nicole Neyrat
> Other members:
Anne-Lise Guéguen
Philippe Jarrousse
Hélène Lepoivre
delegation:
Corinne Lepert
> Key events
• Numerous publicity events and
testimonies on the subject of
prostitution.
• Training of health workers in
relation to matters of prostitution.
• Involvement with nursing colleges
and schools in the École Centrale
of Nantes and with the IFSI.
• Involvement in the Romeurope
Collective (Paris Region) and in an
evening of debate on Romanian
Roma; Groupe Alerte 44
Community; Nantes Right to
Health Group.
• Presentation at the St Malo LDH
on MdM’s actions for “Right to
Health”.
• Involvement with CRID Summer
Universities, “Rights to Health over
here and over there”.
Partnerships
• AIDES.
• SOS Women.
• Across the River.
• Gasprom.
• Le Nid movement.
• PASS, CDAG, CISIH, CHU,
CHRS.
• Planning Centre.
• Le Relais.
• Universal Sickness Cover
surveillance group.
• “Food supply and vulnerability”
group.
• Techno Plus.
• ALC Nice.
• Platform against human
trafficking.
• Metanoya.
Other action
• Participation in numerous
workshops on prostitution, human
trafficking and violence against
women, in France and elsewhere in
Europe.
> Poitou-Charentes
Contact details
22 allée du Champ Brun
16000 Angoulême
Tel.: 05 45 65 07 47
Fax: 05 45 61 18 85
Board Members
Marie-Laure Ferrari
> Secretary and Deputy
Regional Representative:
Daniel Reiss
> Treasurer:
Hubert Lacombe
> Deputy Treasurer:
Philippe Boulanger
> International Project
Co-ordinator + CCN
Patrick Bouet
(representative to CCN)
> Other members:
Myriam Massé
delegation:
Paule de Sède
> Key events
• “Musiques Métisses”, with bus
present.
• Partnership with Lycée Marguerite.
• Representation of the play “Tailleur
pour Dames” (“Ladies’ Tailor”) in aid
of MdM.
• Supper on 31/12/2004 for the
poorest people.
• Concert in aid of MdM in Poitiers.
Partnerships
In Angoulême:
• “Les Gens du Voyage” partnership.
• Omega (Town Hall / CCAS).
• Aides.
• The Red Cross.
• Le Rocher Nguyen.
In Poitiers:
• Restos du Cœur.
• Sid’Espoir.
• Delegation from Brittany.
• DDASS.
> Rhône-Alpes–Bourgogne
Contact details
1 place du Griffon
69001 Lyons
Tel.: 04 78 29 59 14
Fax: 04 78 29 55 91
Board Members
Michèle Roelens
> Secretary:
Isabelle Hermant
> Treasurer:
Pierre Micheletti
> Other members:
André-Jean Pocheron
(secrétaire adjoint)
Robert Allemand
Félicie Monneret, Edith Chabal
delegation:
Clothilde Guillerm
> Project co-ordinator:
Sophie Bret
About 200
> Angoulême branch
(mobile project):
Manager: Marie-Laure Ferrari
Tel.: 05 45 65 11 82
Needle exchange programme coordinator: Dr Jean-Michel
Gauchet
> Poitiers branch:
Manager: Patrick Bouet
Tel.: 05 49 01 77 77
> Grenoble Branch:
Manager: Jean-Pierre Vidal
Tel.: 04 76 84 17 31
[email protected]
Co-ordinator: Pierre Bourgey
> Key events
• Participation in International Day
for the Eradication of Poverty.
Production of a film on Grenoble.
• Testimonies about difficulties
encountered by people in insecure
positions seeking care.
• Conferences on projects in Bolivia,
Ecuador, Afghanistan, Chechnya and
Nepal.
• Conferences on humanitarian
action: emergency missions,
development, etc.
• Testimonies about childhood in
war, in partnership with the
Villeurbanne House of Books,
Pictures and Sound.
Partnerships
• Golf competitions, concerts, L’Isère
Press Club.
Exhibitions
• Travelling exhibition of photography
concerning the Bolivia project: “The
child labourers of Potisi”.
• Travelling exhibition of photography
on Afghanistan, Chechnya and the
“Grenoble Street People”.
138/139
> Germany
Contact details
> International Office
Aerzte der Welt
Thalkirchner Str
81/Kontorhaus 1
81371 München
Germany
Tel: 00 49 89 62 42 09 55
Fax: 00 49 89 65 30 99 72
Web site:
www.aerztederwelt.org
Contacts:
Dr Lecia Feszczak, Volker
Stapke (employees), Gertrud
Wimmer
Association governed by
German law, formed on
19 March 1999
Board of Directors
> President:
Pr Wilfried Schilli
> Vice-President:
Dr Pierre Rosenstiel
> Treasurer:
Rolf-Michael Schlegtendal
> Other members:
Dr Klaus Wieners
Dr Béatrice Stambul
Dr Francois Scheffer
Pr Albrecht Pfleiderer
Pr Norbert Schwenzer
Andreas Jungk
> Acknowledgements:
> Key events
inancial support for projects
• Sudan: financial support for
emergency surgical treatment
programme.
• Afghanistan: financial support for
primary healthcare programme.
• Liberia: financial support for
primary health care programme.
• Iraq: financial support for child
victims of war.
Cambodia: financial support for
2004 Operation Sourire Mission.
Human resources provided
for projects
Aerzte der Welt sent 13 German
expatriates on three missions:
• Cambodia: human resource
support for the two Operation
Sourire missions.
Publicity initiatives and activities
• Regular meetings with the
humanitarian aid office of
Germany’s Ministry of Foreign
Affairs and representatives of
humanitarian NGOs.
• Regular meetings with AKME
(Medical Commission for
Development Aid)
• Joint organisation of and
participation in congress on “The
theory and practice of humanitarian
aid” in Berlin, organised by the
Medical Association of Berlin, MSF
and the German Institute of
Tropical Medicine.
• Participation in the North-South
Forum in Munich.
• Three documentaries broadcast
by Bavarian television on Operation
Sourire in Cambodia and the
programme for prevention of
transmission of HIV from mother to
child in Ethiopia.
• Participation in a forum in
Munich, on the role of NGOs and
society in general in humanitarian
action.
• Participation in a form on Sudan
in Munich.
• Monthly publication of ÄDW
Online.
• Articles in regional and national
newspapers on projects in
Cambodia and Sudan.
• Setting up of an e-mail
information letter.
Projects:
• Two Operation Sourire projects in
Cambodia, in March and October.
• Preparatory project for the setting
up of a national project:
- Compilation of draft project for
improvements to a drop-in and
health care access centre for
people without medical insurance,
such as migrants and
undocumented migrants, in Munich
- Creation of partnerships for the
improvements to the drop-in and
health care access centre in
Munich. Regular meetings with the
City of Munich and the pilot
committee for the future project.
The German Ministry for Foreign Affairs, the Society for Technical Co-operation and Development (GTZ), the City of Munich, Deutscher
Spendenrat, the Munich Employment Department, the Bavarian Federal Bank, the French Consulate-General in Munich, the French Institute of Munich, the University of
Munich, the University of Freiburg, the University of Tuebingen, the Munich European Patent Office, the Materra Foundation, Martin Medizintechnik, Deutsches Aerzteblatt,
Deutscher Aerzte-Verlag, Thieme Verlag, Marburger Bund, Mibeg Verlag, Merke Kongress Via Medici, Sueddeutsche Zeitung, Muenchner Merkur, Stethosglobe, Eine-WeltZentrum of Munich, Nord-Sued-Forum of Munich, www.wordup.de, ZDF Mona Lisa, RTL-Günther Jauch, Stern TV, Bayerischer Rundfunk, Stadt München: migration and
health, Sternstunden e.V., M-Net Munich, Werner-Von Siemens-Realschule München, Sofa-lx-systems, Sonja Schultes & Hersberger, Sellier, www.helpdirect.org, www.pso.de,
www.malinet.de, www.foundandfund.com.
> Japan
Contact details
> International Office:
Médecins du Monde Japan
PMC Building 6F
1-23-5 Higashi-Azabu,
Minato-Ku, Tokyo 106, Japan
Tel: 0081 3 35 85 64 36
Fax: 0081 3 35 85 11 34
Web site:
http://www.medecinsdumonde
.org/japan/
Contacts:
Alain Wacziarg, Kehko
Takayama, Tatsuya Kishi
(employees)
Japanese law, formed on
10 October 2000
Board Members
> Board Members
President: Gaël Austin
> Other members
Dr Arnaud Bourde
Akitane KiuchiI
Dr Satoshi Yoza
Dr Francois Foussadier
Dr Patrick David
Dr Norihiko Oura
Megumi Jimbo
> Acknowledgements:
> Key events
Project funding
• Cambodia: financial support for
the Operation Sourire project in
Phnom Penh.
• Niger: financial support for the
Operation Sourire project in
Niamey.
• Rwanda: financial support for the
Operation Sourire project in Kigali.
• Ethiopia: financial support for the
programme for prevention of
transmission of HIV from mother to
child, Mekele, Tigray Province.
• Palestine: financial support for
the emergency extra-hospital
project in the Gaza Strip.
• Afghanistan: financial support for
the support programme for the
primary health care structures in
Chagcharan.
• Zimbabwe: financial support for
the AIDS prevention programme in
Harare.
• Chad: financial support for the
support programme for the street
children of N’djamena.
• Sudan: financial support for the
emergency project in Darfur
Province.
• Iraq: financial support for the
emergency project in Iraq.
• Chechnya: financial support for
the Ingushetia/Chechnya project.
• China: financial support for the
Chengu Du AIDS prevention
project.
• Indonesia: financial support for
the Papua, Mula project – AIDS
prevention.
for projects
MdM Japan has sent 10 Japanese
expatriates to work on four
projects (two projects in
Cambodia).
• Cambodia: human resources
support for an Operation Sourire
project in Phnom Penh.
• Niger: human resources support
for the Operation Sourire project in
Niamey.
• Liberia: human resources support
for primary health care and
emergency care in Gbarnga.
• Participation in the French Film
Festival in Yokohama: presentation
of the Médecins du Monde
promotional clip before the
screening of each film and
organisation of fund-raising.
• Production of a MdM Japan
promotional video, in association
with TV5.
• Presentation of MdM on the wide
screen in Carrefour de Roppongi.
• Organisation of various
photographic exhibitions: MdM’s
global activity, “Lifting the Veil for
Afghan Women”.
• Organisation of “Surrender Your
Weapons” workshop, in
association with Kids Earth Fund.
• Participation in various events for
the promotion of MdM’s projects
and activities: International Cooperation Festival, French Blue
Meeting, Career Fair Exhibition for
International Co-operation, Dandy
Four charity concert, Peace
Exhibition etc.
• Presentation of MdM’s activities
on the web site.
• Publication of a newsletter and
“Flash News” on MdM’s activities,
circulated to donors, volunteers
and partners.
• Articles in various newspapers
and magazines, on MdM’s
activities.
• Creation of greetings cards
bearing the Médecins du Monde
logo, sold through a major
greetings card company covering
the whole of Japan.
The Embassy of France in Japan, Felissimo Corporation, Sonia Rykiel, Greeting Life Inc, Global Tank, Co. Ltd., French Blue Meeting Executive
Committee, French Film Festival in Yokohama Executive Committee TV5, Nihon BS Hoso, Asahi Pretec Corp, Fuji Photo Film Co. Ltd, Maison Franco Japonaise, Sompo Japan
Insurance Inc, Alsok Co., Ltd., Sumitomo Mitsui Banking Corporation, Mitsui Sumitomo Insurance Co., Ltd, Mitsui Fudosan Co., Ltd., Mitsubishi Estate Co., Ltd, Dandy Four,
JICA, JANIC, Kids Earth Fund, The Westin Awaji Island, Hyogo International Association, French Food Culture Centre, Members of the Order of Agricultural Merit in Japan.
140/141
> The Netherlands
Contact details
Dokters van de Wereld
Rijswijkstraat 141 A
1062 ES Amsterdam
The Netherlands
Tel: 00 31 20 465 2866
Fax: 00 31 20 463 1775
E-mail:
[email protected]
Web site:
http://www.doktersvandewerel
d.org
Contacts:
Nadjehda Richardson, Reinier
Spruit, Resy Arts, Anna
Miranda Scholten, Arianne de
Jong (employees)
Dutch law, formed on
28 April 1997
Board of Directors
> President :
Dr S. Z. Alatas
> Secretary:
Dr D. J. Pot
> Treasurer::
E. F. Limburg
> Other members:
Pr Dr. W. A. M. Van der Kwast,
Dr P. Jeu, Dr. B. E. R. ten Kate
> Key events
Project funding (through direct marketing)
• Iran: financial support for emergency
programmes.
• Operation Sourire: financial support for
the programme.
• Sudan (Darfur): financial support for
emergency programmes.
• Emergencies: general financial support.
• Zimbabwe: financial support for AIDS
programmes.
Project funding (through grants)
• Burma: financial support for the drug
addiction harm reduction programme.
• Indonesia, West Papua: financial
support for the programme providing
access to health care for minority groups.
• Nepal: financial support for the AIDS
and tuberculosis prevention programme.
• Tanzania: financial support for the AZT
programme.
• Benin: financial support for the AIDS
programme (2005-2008).
• DRC (Goma): financial support for the
AIDS programme (2005-2008).
• Haiti: emergency Red Cross kit.
• Madagascar: financial support for the
HIV/AIDS prevention programme in the
field.
• Pakistan: financial support for the
mother and child health programme
(direct support to local NGO, MCWAK).
Human resources provided for projects
Six Dutch expatriates sent off to join
projects:
> Acknowledgements:
• Afghanistan: human resources support
for programmes providing aid to refugees
and access to health care for women
and children.
• Ethiopia: human resources support for
the surgical programme in Adwa.
• Surinam: human resources support for
the exploratory mission.
• Sudan (Darfur): human resources
support for the emergency project.
China: human resources support for the
STI/AIDS prevention programme.
Publicity initiatives and activities
• Interviews with Dutch volunteers by the
Dutch media (radio, newspapers,
magazines).
• Institutional communication in the Dutch
regional newspapers.
• Web site revamped
(www.doktersvandewereld.org).
• On 20 November, International
Children’s Rights Day. Organisation of
“Kids 4 Rights” event in Amsterdam, with
workshops for children aged 6-12.
• Photo exhibitions on DRC’s “street
children” project in Amsterdam.
• Publication of three newsletters on the
international activities of Dokters van de
Wereld, intended for donors, funders and
volunteers.
• Participation in NCDO campaign on
access to health care.
• Participation in a support event for
Tibet.
• Participation in “Share-Net”, a network
of organisations active in the field of
reproductive health and HIV/AIDS.
• Participation in Oneworld, a web site
promoting the activities of Dutch NGOs.
• Participation in Partos, an association of
Dutch NGOs working in development
aid.
• Participation in the National Institute of
Tropical Diseases Day.
• Development of an information service
using e-mail.
• Informal meetings and debates about
projects with volunteers.
Projects:
• Exploratory mission and preparation for
the setting up of national projects.
Identification of vulnerable population
groups in Holland: illegal immigrants and
Roma.
• Illegal residents: identification of needs.
Creation of partnerships with various
organisations. Finalisation of proposal and
search for finance for the one-year pilot
project, intended to start in early 2005 in
Amsterdam.
• Roma and Sinti: identification of needs
in the Roma and Sinti communities in the
Southern Netherlands. Creation of
partnerships with the LSRO (national
Roma and Sinti organisation) and other
organisations. Finalisation of proposal and
search for finance for the health
education project aimed at Roma and
Sinti, anticipated start date 2005.
Aids Fund, Cordaid, ICCO, Novib (Oxfam Netherlands), Dutch Ministry for Co-operation in Development, NCDO, Hivos, Nora Tol Virtual
Publishing, Stichting Lions, STOP AIDS NOW, José van den Berg, Zicht nieuwe media ontwerpers, Sandra van Noord - Bureau voor tekst en redactie, Loods 6, Coca Cola,
Hasbro, and all our volunteers and trainees and thousands of private donors.
> United Kingdom
Contact details
Médecins du Monde UK
29th Floor
One Canada Square
London E14 5AA
United Kingdom
Tel: 020 7516 9103
Fax: 020 7516 9104
E-mail:
[email protected]
Web site:
www.medecinsdumonde.co.uk
Contacts:
Karen McColl, Michelle
Hawkins, Isabelle Raymond,
Claire Loussouarn, Dorothy
Muthuri (employees).
English law, formed on 13
January 1998.
Board Members
> Board Members:
Dr David Barnes
Dr Laurence Bioteau
Janice Hughes
Robert Lion
Lord Rogers of Riverside
Roo Rogers
> Acknowledgements:
> Key events
Financial backing of projects
• Cambodia: financial backing for
the anti-retroviral programme in
Phnom Penh.
• Angola: financial backing for the
primary health care access
programme in Mungo.
• Sudan: financial backing for the
medical aid programme for
displaced persons in Darfur.
• Poland: financial support for the
“Nobody’s Children” Foundation.
for projects
Médecins du Monde UK has
increased its human resource
support by recruiting 14 volunteers.
• Tanzania: human resources
support for the care programme for
major epidemics.
• Liberia: human resources support
for the emergency surgery care
programme.
• Sudan: human resources support
for the emergency medical care
team (Darfur).
• Burma: human resources
support for care connected with
major epidemics.
• Nepal: human resources support
for care connected with major
epidemics.
• Zimbabwe: human resources
support for care connected with
major epidemics.
• Mexico: human resources
support for primary health care.
• Palestinian Territories: human
resources support for primary
health care.
• Testimonies: The 7th Luis Valtuena
exhibition, humanitarian
photography competition.
• Awareness raising: participation
in 19 forums to raise awareness
among doctors, nurses, students
and any other potential volunteers.
8 public presentations aimed at
potential volunteers and donors.
• Fund-raising evening: showing of
the Afghan film “Osama”, followed
by a reception at the Institute of
Contemporary Arts for collecting
funds to support the activities of
Médecins du Monde UK.
• Advocacy: participation in a
campaign against restrictions on
access to health care for
undocumented migrants, in
association with medical and other
organisations.
• Publication of the newsletter,
News, on the activities of the
organisation, circulated to donors,
volunteers and supporters.
• Press visits: to MdM projects in
the West Bank, which led to the
publication of articles and photos
in several medical reviews
• Articles in national and regional
newspapers on the projects in
Sudan (Darfur), Liberia, Southern
Asia (after the tsunami) and the
Palestinian Territories.
Projects
• Development of a national project
to improve access to health care
for vulnerable people in East
London.
Department For International Development (DFID), Canary Wharf Group, Caper Green, The Elton John AIDS Foundation, the Institute for
Contemporary Arts, Lonely Planet, Rufford Maurice Laing Foundation, MEDSIN, the nest, Nomad Travel Stores, SS Robin, Sylvan Technical Services, Thames Wharf Charity,
Traidcraft, Waitrose Food & Home, Young French Chamber of Commerce in Great Britain.
> The organisation
143/153
> Association life and management
of the association
The organisation of Médecins du Monde is based on a network of associates, volunteers in France and
volunteers for international operations, and a permanent team of salaried staff members. The support of
hundreds of thousands of donors ensures the association’s financial independence. Thanks to this
diversity, the association operates with a permanent combination of debate, resonance with civil society and
operational efficiency of programmes aimed at beneficiaries. The result is an original organisation that is as
strong and distinctive amongst the large NGOs.
> The Decision-Making
Procedure
The members of MdM, 1,611 in 2004,
meet once a year for the General
Assembly or GA, the highest decisionmaking body and the only one able to
modify the statutes of the association.
The GA elects the 12 members of the
Board of Directors, together with three
substitutes, for a three-year term. From
among its members, the Board elects,
for one year, the President and
Administration of the association: the
vice-presidents, the treasurer, the deputy
treasurer, the secretary-general and the
deputy secretary-general, and one overall
representative. The Board, the
association’s executive body, meets
monthly and takes all the decisions
concerning the management of the
association. To fulfil its role, the Board is
supported by:
• an associate advisory structure;
• a permanent operational structure;
• joint decision-making meetings with
• participation by the permanent and
associative structure;
• regional offices.
> The Associate advisory
structure
This includes both continental and
thematic groups.
Each of these groups, which consist of
associates involved voluntarily in various
projects, offers or issues an opinion on
the continent or theme for which it is
responsible. Their role is crucial for
analysing contexts and appropriate
action and drawing on the experience of
projects. The association has five
continental groups, eight thematic groups
and one France group, bringing together
the Mission France and Harm Reduction
steering committees. The members of the
advisory groups are elected within the
framework of the association’s internal
rules..
> The permanent
operational structure
This is led by two Directorates.
The Humanitarian Aid Directorate
includes the International Operations
144/145
Department, the Mission France Coordination Centre, Project Logistics, the
Adoption Department and the
Communications Department.
The Management Directorate
comprises the Human Resources
Department, the Development
Department, the Finance and
Information Systems Department and
the Legal Department.
Operational decisions that are not
strategic in nature are taken each week
during “project staff meetings” for
matters concerning the project, and
during the “management meetings” for
other matters.
Management of international
programmes is entrusted to the
medical co-ordinator of a programme,
under the supervision of the associative
Head of Project, who offers advice on
political issues or specific areas of
expertise, and in liaison with the desk
officer in the Head Office or the project
contract at certain regional offices. The
Head of Projects are proposed by the
different associate bodies and
approved by the Board.
> The Joint Meetings
These include the Management
Committee, which brings together the
associate managers and salaried staff every
week and thoroughly examines any
strategic decisions concerning the projects,
testimonies, political lobbying and
communication. Also held jointly, the
monthly meetings of the Human
Resources Group and Management
Group define the human resources and
management policies that are finalised and
approved by the Board.
> The Regional
delegations
In the regions, MdM has set up regional
delegations. Elected every two years,
these regional colleges represent the
regional life of the association. The
regional delegations run international
and regional projects within frameworks
established by the Board.
Heads of Projects, group coordinators,
regional representatives and members of
the Board meet three times a year, for a
National Advisory Council meeting.
> The Donor Committee
The donors are represented by the
Donor Committee. Made up of one
dozen co-opted members, this
committee is the setting for a
constructive and consensual analysis of
the association’s projects, ratios and
public relations strategy. Resources are
allocated to it to evaluate projects in
France and abroad. The President of the
Committee provides a channel of
communication to express its opinions to
the Board and the General Assembly.
This specific set-up stimulates debate at
all levels. It makes MdM a very active
association, independent both politically
and financially. It favours the voluntary
involvement of health activists for the
benefit of the most needy and vulnerable
sections of the population, concerned all
the time about the quality and
effectiveness of MdM’s international and
local projects.
> Departmental News
Every department in the MdM Head Office supports the programmes run by the association among the
most vulnerable sections of the population in France and abroad. The organisation of each department
must guarantee efficient institutional, human, logistical, financial and budgetary support for the projects,
as well as making them answerable for their activities to our sponsors and donors. In 2004, our work was
developed on three main axes: humanitarian, human resources and management.
> The humanitarian axis
> The human resources axis
• International operations management
The development of the international
has continued to develop the
projects has been accompanied by
international projects, which have
improvements in recruitment and careers
increased in both number and financial
services, along with further investment in
volume. Their volume of activity is now
the search for candidates at an
comparable to that of 2002.
international level.
• The institutional development
> The management axis
department has increased and
diversified the financial resources for
the programmes, through
representative offices and actions in the
field.
• The international logistics department
has been linked up with the deputy
emergency projects manager.
• The MdM Europe project has
increased in size, with the first stages
of putting together the European
observatory and the establishment of
communications at MdM’s European
network level.
• An invitation to tender for fund-raising
was issued, and led to a change of partner
in this activity, essential for the
association’s financial independence. At
the same time, a major test of donors’
reactions to specific requests allowed the
plan of campaign to be optimised for 2004
and the years to come.
• The international project management
axis has been strengthened in order to
respond to the diversity and complexity of
sponsors. The first stage in the setting-up
of a process for monitoring international
projects financially in the field has been
undertaken.
• The general departments have made
major improvements to the two main
project sites in the Paris region and in
Bordeaux.
> The MdM Management
on 31 December 2004
Executive Director of Humanitarian Aid:
Dr Michel Brugière
Executive Director of Management and
Human Resources: François Dupré
International Operations Manager
Dr Gilles Raguin
Coordinator of Mission France:
Nathalie Simonnot
Financial and Information Systems
Manager: Catherine Duffau
Administrative and Legal Manager:
François Rubio
Communications and Development
Manager: Isabelle Finkelstein
Adoptions Manager:
Dr Geneviève André-Trevennec.
146/147
> The Médecins du Monde
international network
The Médecins du Monde international network comprises 12 international delegations: nine in Europe
(Belgium, Cyprus, France, Greece, Italy, Portugal, Spain, Sweden and Switzerland) and three in the
Americas (Argentina, Canada and the USA).
The body that co-ordinates the
Italy: Dr Faustino Boioli
representative working in the field to
international delegations and implements
Portugal: Dr Mario de Sousa
ensure coordination of the work of the
the decisions of the international
Spain: Dr Teresa Gonzalez
different delegations and to ensure a
proceedings of the International Network
Sweden: Dr Anders Bjorkman
united representation of MdM.
Board, the International Secretariat
Switzerland: Dr Nago Humbert
(IS), is currently based in Paris.
USA: Dr Victoria L. Sharp
> Priorities in 2004
The work of the IS is currently focused
> Operational
on enhancing the quality of the
international delegations, transferring skills
coordination of network
The International Board of November
2003 confirmed two areas of priority:
AIDS and emergencies.
between delegations and developing
In November 2003, the International
The continued work of the human
shared ethics and values.
Board expressed a wish to support the
resources group was also confirmed
Zimbabwe project, a joint integrated
for 2004.
The International Board is made up
programme (France, Spain and Canada).
In addition, the European delegations
of the Presidents of each office in
The pilot programme, aimed at “reducing
of the International Network approved the
the international network:
the impact of the HIV/AIDS epidemic on
idea of putting together a coordinated
Argentina: Dr Silvana Reinoso
orphans and vulnerable children” in the
European Operational Network for access
Belgium: Dr Michel Degueldre
districts of Chipinge and Chiredzi, was
to health care for the most deprived
Canada: Dr Réjean Thomas
started in April 2004 for an initial period
people in the European Union. The aim
Cyprus: Dr Elias Papadopoulos
of three years.
was to create an access to health care
France: Dr Françoise Jeanson
The International Network has continued
observatory in the European Union,
Greece: Dr Socrates Mitsiadis
its work in the crisis situation in Iraq,
allowing communication and lobbying not
with a commissioned international
only with European political authorities,
but also national political authorities.
> Sister associations
and local partners
Médecins du Monde builds involvement with local partners in order to establish links that will ensure the
sustainability of its activities. If these partners do not already exist, MdM supports the creation of link
associations or sister associations, often formed on the initiative of, and based on, the local MdM team.
Such local teams gradually become autonomous, accompanied by MdM for one or two years. The structures
thus created remain the natural partners of MdM in the region.
> In Europe
law” programme, providing for changes
Activities: medical aid and counselling
• Bosnia-Herzegovina (Sarajevo)
in conditions under which children are
for street children and adolescents,
DUGA, drop-in and counselling
questioned.
harm reduction, prevention of HIV/AIDS
centre for children and adolescents.
• Romania, Bucharest
and STIs among intravenous drug users,
Created 1994, autonomous since 2002:
ICFF (International Child and Family
medical and social care and counselling
[email protected]
Foundation).
for young prostitutes, training and
Activities: children traumatised by
Created 1993, autonomous since 2003.
specialist centre for harm reduction.
conflict, children’s rights and the
Fax : + 40 21 311 19 15 / 23 05
appropriate education system, the fight
Activities: defending the rights of
> Latin America
against AIDS, development of a
children and the family, social integration
• El Salvador
partnership network with other NGOs.
and health promotion, fighting child
MDS (Doctors for the Right to
• Poland, Warsaw
abuse.
Health).
The “Nobody’s Children” Foundation
• Russia, Saint Petersburg
Association created 1995, autonomous
Created 1990, autonomous since 2003.
Humanitarian Action Foundation.
since 2003. www.mds.org.sv
www.fdn.pl
Created 1993, street children branch
Activities: promotion of the right to health
Activities: family and institutional
autonomous since 2003.
through community health systems
abuse, drop-in centre management, and
www.humanitarianaction.org
(consultations, prevention, training of health
the “children under the umbrella of the
workers).
148/149
> In Africa
• Mozambique, Maputo
• Ivory Coast, Abidjan
Meninos de Moçambique (Children
MESAD (Movement for Education,
of Mozambique).
Health and Development)
Association created in 2000,
Association created in 2001,
autonomous since the end of 2001.
autonomous since 2003.
Fax : + 258 30 41 16
[email protected]
Activities: assistance to children at risk.
Activities: care for street children and
• Uganda, Kyotera
help with social reintegration, health and
CIPA (Community Initiative for the
social action, AIDS prevention, care of
Prevention of HIVAIDS/STIs).
incarcerated children.
Association created as part of the
• Guinea, Kindia
HIV/AIDS and STI programme
KAD (Kindian Prisoner Assistance).
conducted by MdM from 1992 to March
Association created in 2000 as part of a
2004 in Rakai District.
prisoner assistance programme.
[email protected]
Activities: aid for prisoners (medical
Activities: AIDS prevention, fund-
assistance, literacy etc), rehabilitation of
raising activities, awareness through
infrastructures.
theatre plays.
• Madagascar, Tuléar
• Tanzania, Bukoba
SISAL association.
Tadepa (Tanzania Development and
Withdrawal of MdM and autonomy for
Prevention of Aids).
SISAL, planned for February 2006.
Withdrawal of MdM and autonomy for
Activities: AIDS prevention,
Tadepa, planned for 2005.
consultation/treatment/monitoring of
Activities: prevention of HIV/AIDS
patients, information and education,
(training of peers, education, access to
harm reduction.
condoms, treatment for opportunistic
infections).
> Médecins du Monde
and civil society in France
MdM
Activity organisation and
co-ordination groups
> Coordination SUD - HCCI - CCD
> CNVA
> Fonjep
> Charter Committee
> Unogep
> Activity organisation
and co-ordination
groups
Thematic working groups
> Health and social
• UNIOPSS – Alert Group
• CNLE
• Migrants Health Rights Watch
• Platform for the Fight Against Human
Trafficking
• French Asylum Rights Co-ordination Centre
• Romeurope
• International Harm Reduction Association
> Funding
• Afta
> Human Rights
• CNCDH
> International action
• URD
• NGO liaison committee
Geographical working groups
> Joint commissions
> Palestine Platform (as observer)
public authorities. As a board
• The Development and Co-operation
member, MdM represents the group in
Commission (CCD). A joint information
relations with:
authority for NGOs on the co-
Solidarity, Emergency, Development
• The High Commission for
operation policies of the public
Co-ordination Centre (SUD)
International Co-operation (HCCI)
authorities.
Co-ordination of the French
An independent authority linked to the
National Council for Community
humanitarian and development NGOs
Prime Minister, a place for dialogue
Life (CNVA)
that it represents in France and
between public and private figures
An independent authority linked to the
internationally. Interface with the
involved in international co-operation.
Prime Minister, serving as a point of
150/151
contact with the Prime Minster for all
policy level. MdM belongs to the
rights issues.
French associations. MdM follows all
Poverty and Exclusion Commission
International action
humanitarian issues.
for Health Groups and Europe. Link
• Development, Rehabilitation and
• Youth and People’s Education
with the Alerte Group..
Emergency Group (URD)
Co-operation Fund (FONJEP)
• The National Policy Council for the
Group of emergency associations
A jointly managed association bringing
Fight Against Exclusion (CNLE)
working through the humanitarian aid
together public services and
Monitors application by the
quality process.
associations. Helps community life by
government of measures taken in the
• Volunteer NGO liaison committee.
facilitating association employment.
fight against social exclusion.
MdM follows the issue of volunteers.
Creation, by MdM, of a global health
> Geographical working
• The Charter Committee
cover (CMU) monitoring group,
A committee comprising associations
stimulating debate on arrangements
• Joint commissions
that appeal to the generosity of the
for asylum seekers and refugees.
Joint NGO / public authority
public, in accordance with a charter
• Migrants Health Rights Watch
organisations. Exchange on methods
and previously established
• Platform for the Fight Against
of action in a country.
recommendations.
Human Trafficking
• Palestine Platform
• National Union of Organisations
• French Asylum Rights Co-ordination
A grouping of associations in which
Appealing to Public Generosity
Centre
MdM has observer status.
(UNOGEP)
• Romeurope
> Thematic working
• International Harm Reduction
groups
Association
Funding
Health and social
• French Association of Association
• National Inter-Federal Union of
Treasurers (AFTA)
Health and Social Charitable and
Human rights
Private Organisations (UNIOPSS)
• National Consultative Commission
Working with institutions for
for Human Rights (CNCDH)
recognition of the health and social
Prime Minister’s formula for advice
associations sector at European social
and recommendations on human
groups
> Médecins du Monde
International Institutions
NGOs that are active in the area of humanitarian aid cannot ignore the international institutions, which
are both important funders and front-line political authorities. Today, many decisions have moved
beyond the national context and now fall within the scope of European or global decision-making. To
gain an understanding of this complex reality, Médecins du Monde participates in various group,
facilitating access to international decision-making bodies. At the same time, the association is
developing partnerships with other international organisations and maintaining a specific status that
enables it to intervene immediately.
> European Union (EU)
countries, territories or organisations
ECHO. MdM France is a member of
• The mandate of ECHO (the European
benefit from the aid managed by this
its executive committee and regularly
Commission Humanitarian Aid Office)
Office.
participates in ECHO intervention
consists of providing assistance and
• MdM works in association with
strategy planning meetings. In past
emergency help to victims of natural
EuropeAid through Concord, a
years MdM has greatly contributed to
disasters or conflicts outside the EU.
European confederation of emergency
the revision of the ECHO partnership
Since 1982, ECHO has provided support
and development NGOs, which carries
framework agreement (CCP).
in more than 85 countries and manages
out collective lobbying of the
an annual budget of more than 500
European institutions. It is involved in
> Council of Europe
million euros.
the creation of common positions on
• The role of EuropeAid (Co-
European development policy and the
• The Council of Europe now
operation Office) is to implement the
major issues of relations between
comprises 46 European Member
external aid instruments of the
North and South.
States. It was created in 1949 with the
European Commission, one of the
• In 2004, MdM was particularly
aim of defending human rights. Since
main contributors of public aid for
active within Voice, the interface
1989 it has had the specific role of
development. More than 150
between the association sector and
helping the countries of Central and
(COE)
152/153
Eastern Europe to im plem entand
and the O ffice for the C o-ordination
> World Bank (WB)
consolidate politicalreform .The
of U N H um anitarian A ffairs
• The W orld B ank (W B )is one ofthe
internationalM dM netw ork enjoys
(O C H A).This political representationm ostim portantsources of
consultative status w ith the C ouncil
is com plem ented by an operational
developm entaid,especially in relation
ofEurope and is partofthe
partnership agreement
,m aintained
to AID S.Itis actively involved in over
internationalN G O Service,w here
by M dM w ith the H C R .O C H A and
100 clientcountries,its aim being to
N G O s w ith this status can m eet
M dM have established a partnership
help the poorestofpopulations and
togetherand organise activities.
forthe exchange ofinform ation and
countries.
operationalm onitoring via R eliefw eb.
• In 2004,M dM ’s international
• A num ber of
M dM project team s are in
netw ork w orked w ith the W B through
contact w ith theU nited N ations
the A C D E (Advice and Supporton
(EC O SO C )is the m ain co-ordinating
D evelopm ent Program m e UNDP)
(
Financing D evelopm ent)association.
body forthe econom ic and social
through operational collaboration and
This association supports N G O s
activities ofthe U N and its specialist
particularly on the them e of children
w ithin program m es financed by the
organisations and institutions.M dM ’s
caught up in conflicts.
M dM is w orking
W B and on debtrelief.
internationalnetw ork has Level 1
w ith theU nited N ations C hildren’s
Consultative Status
,w hich enables it
Fund (U N IC EF)on severalprojects.
to carry outlobbying,especially ofthe
• M dM is a m em berofthe
C om m ission on H um an R ights ,
International Council of Voluntary
w here ithas observer status
.M dM is
Agencies(IC VA),a netw ork ofN G O s
one ofthe few m edicalN G O s w ith a
w orking in the field ofhum an rights,
presence in this arena forthe public
w hich concentrates its efforts on
assessm entofhum an rights
hum anitarian issues affecting refugees.
violations.
IC VA brings togetherover80
• M dM ’s internationalnetw ork allow s
internationalN G O s.The C ouncilis in
itto be represented w ithin the H igh
active contactw ith U N authorities,
C om m ission for R efugees (H C R ),the
especially through its role as interface
W orld H ealth O rganisation (W H O )
w ith the H C R.
> United Nations (UN)
• The Econom ic and SocialC ouncil
Fighting against all illnesses.
Even injustice.
Head office: 62, rue Marcadet 75018 Paris - Tel: 01 44 92 15 15 - Fax: 01 44 92 99 99 - www.medecinsdumonde.org - Publication manager: Dr Françoise Jeanson - Chief editor: Martine
Mikolajczyk - Editorial committee: Dr Michel Brugière, François Dupré, Dominique Bloch-Berthié, Hélène Valls - Editorial staff: Elodie Abbate, Charlotte Coisne, Anne Robidel Acknowledgements: Eliane Choubrac, Dominique Ferreira, Isabelle Martija, Guillaume Plassais, Aurore Voet - Design and production:
Tel: 01 55 34 46 00 (ref. 2MDMRAP003) Copyright: any reproduction of this document is subject to a prior written request.

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