Humanitarian Response of Medecins Sans Frontiers in Worldwide Public Health Emergencies

1. Humanitarian Response ofMedecins Sans Frontiersin WorldwidePublic Health Emergencies Dr N Fan President of MSFHK 14/06/2009

2. 2009 Gaza 2008 Sichuan 2007 Sri Lanka 2008 Cambodia 2005 Kenya

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

4. Humanitarian act is to seek to relieve suffering, to restore autonomy, to witness to the truth of injustice and to insist on political responsibility As such humanitarian action is more than simple generosity, simple charity - In addition to cover needs, we aim to enable individuals to regain their rights and dignity as human beings MSF provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict; irrespective of race, religion, creed or political convictions. MSF observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions. Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic, or religious powers. As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them MSF Charter MSF has a clear intent to assist, to provoke change and reveal injustice

5. What are the biggest challenges MSF is facing nowadays? • 無國界記者 Reporters sans frontières • 無國界工程師 Engineers Without Borders • 無國界義工 Volunteer Space • 無國界教育 Education without Frontier • 網路無國界 • 愛心無國界

6. Top 10 Humanitarian Crises of 2008 • HIV/TB co-infections poses health battle on two fronts • Iraq - civilians in urgent need of assistance • Sudan - No end in sight to violence and suffering • North-West Pakistan - Civilians killed and forced to flee as fighting intensifies • Ethiopia’s Somalia Region - Critical need of assistance • Millions of malnourished children left untreated despite advances in lifesaving nutritional therapies • DRC - Civilians trapped in war rages • Zimbabwe - Health crisis sweeps as violence and economic collapse spread • Myanmar - Beyond the international spotlight critical health needs remain unmet • Somalia - humanitarian catastrophe worsens

9. Gaza Mission 2009(18/01/09 – 08/02/09) Dr Ning, Fan 11/02/09

10. aza Today G

11. al-Shifa - “the cure” The largest hospital in Gaza strip • Internal medicine (100 beds) • Pediatrics (70 beds) • Surgery (50 beds) • Ophthalmology (20 beds) • Gynecology (10 beds)

12. Palestinian internal political fragmentation VULNERABLE • Socioeconomic decline • Military actions • Physical, psychological and economic isolation • Health decline

13. Gaza War27/12/200818/01/09 – 08/02/09

14. MSF Cinic Inflatable Hospital Office / House

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

19. DisastersPublic Health Emergencies

20. Public Health Emergency Response How do you feel? What’s the first thing you are going to do? Whitehead & Dahlgren 1991

21. A medical team, which composes of one surgeon, one physician, 3 nurses, will arrive 2 days later • Shelter • Food & Clean Water • Hygiene • Medical Service Provision • Physical • Acute • Chronic • Psychological • Stress • Depression

22. Security - Personnel safety - Working environment - Shelter EvacuationHealth - Hygiene - Food & Clean WaterInfra-structure - Communication - Power supply / Electricity - Accessibility

23. Public Health Emergency Responseby MSF • Fast action • Flexibility • Professionalism • Advocacy Whitehead & Dahlgren 1991

24. 50% of the world’s population lives on less than US$2 / day (2007) Health Equity • 2 / 100,000 Tanzania • 170 / 100,000 H.K. • 256 / 100,000 U.S.

25. Need Assessment Emergency response Disaster Time Events 0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+ Need Assessment by local authority Deaths and Burial Deaths SAR & FA Evacuation Serious Injuries Treated Epidemics. If Any Long term Care Number of Homeless Shelter Chronic Illness and Other Injuries Local Services and Response 0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+

26. Field hospital

27. Mobile Hospital

28. Islol. Enter. Staff kitchen OT Admin Lab Parking ER Xray Wards Stores Kitchen Cars Laundry Water Refugees BHC

29. Disaster Medical Response • Search & Rescue (SAR) • Triage & initial stabilization • Definitive medical care • Evacuation • Medics could not work alone • Security & crowd control • Firemen • Specialty SAR team • Transport • Communication

30. Essence of Medical Service Planning

31. Earthquake Tsunami War Primary Health Surgical Problems Undermines access to • Food • Clean drinking water • Adequate shelter • Sanitary facilities • Health services • Risk of epidemics and nutritional problems is much higher • Chronic health diseases care Injuries

32. Temoinage / Advocacy

33. In an ideal world, volunteer outreach pursuits would consist of true partnerships working toward sustainable solutions to identified problems, which ultimately would obviate the need for the volunteer effort. • In the real world, of course, political, social, economic, religious, and practical issues intervene • Kathleen M. Casey. Global Impact of Surgical Volunteerism. Surgical Clinic NA 87 (2007) 949-960

35. Disaster is Nothing but… . • Disaster is not remote • Disaster is medic & non-medical • Variation in nature but there is a formula in medical response

36. Communication • Authority • Public • Beneficiaries • Funding • Finance Control Health Assessment Project Planning Logistic Supply Health Personnel Health Service Disaster Medical Response • Shelter • Food & Clean Water • Hygiene • Medical Service Provision • Physical Health • Acute • Chronic • Psychological • Stress • Depression

37. Need Assessment Emergency response Disaster Time Events 0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+ Need Assessment by local authority Deaths and Burial Deaths SAR & FA Long term Care Evacuation Serious Injuries Treated Epidemics. If Any Number of Homeless Shelter Chronic Illness and Other Injuries Local Services and Response 0Hr…12…24…36…48…72…Day 4…5…6…7…8…9…10…Week 4…5…6+

38. We don’t need Heroes We want Professionals

40. Cultural sensitivity Mutual respect Working with beneficiaries Medical Diplomacy Mutual expectation Rediscovery Of Clinical Sense Resource management Stress & Risk Management