Annual Report 2009 - Policy and financial reports - Publications - Publications - Médecins du Monde
Rapport - Annual Report 2009
13.19 MB
CONTENTS
- Our work
- 2009: key figures
- International programmes
- Scope of programmes
- Africa
- Latin America
- Asia
- Eastern Europe
- Near and Middle East
- Future programmes
- International network
- Cross-cutting projects
- Programmes in France
- Action and advocacy
- Regional delegations
- Our organisation
- Glossary
- Acknowledgements
OUR WORK
Dr OLIVIER BERNARD PRESIDENT, DOCTORS OF THE WORLD FRANCE
| Doctors of the World France has reached its thirtieth year. It has not only matured, but is confident in its achievements and strength of purpose. Always mindful of the reality we see on the ground, we have been able to adjust our course accordingly, and build an independent organisation. It is from this perspective, after my first year as president, but fully aware of our rich history, that we can make a first assessment of 2009. |
The year has been shaped by a number of developments: • Tougher policing in relation to the vulnerable groups Doctors of the World/Médecins du Monde (MdM) supports against a backdrop of economic crisis that hits the poorest and most excluded hardest. In spite of a number of plans, housing provision for those most in need has still not been addressed in any concrete fashion. On a daily basis, our teams see the lack of suitable housing for people supported by our programmes.
Profound changes in the provision of care. Although there have certainly been some improvements, such as greater representation of local-level government in the managment of services, there is increasing emphasis on financial considerations, with a new system of hospital pricing, drugs being removed from the approved reimbursement list and the introduction of medical franchise payments. There has been no notable improvement in access to care for the vulnerable people we support. As for the structures set up as a consequence of the law passed in 1999 — namely, universal health insurance (CMU), State medical aid (AME) and healthcare access offices (PASS) — with the exception of improvements in provision of home care thanks largely to our lobbying work, we have seen a net deterioration.
A new security policy targeting organisations working with vulnerable people has been put into place: MdM, having protected a group of Roma people camped out on the Quai Saint- Ouen on the outskirts of Paris, was taken to court in June 2009 for illegally occupying state-owned land. Later acquitted, MdM was recognised by the courts for its humanitarian stance.
DOCTORS OF THE WORLD HAS BEEN ABLE TO ADAPT TO THESE CHANGING NEEDS
Firstly through resistance. We chose to:
- continue to offer care through our healthcare and advice clinics (CASOs) in 22 French towns and to collect data about the barriers faced by our service users in accessing care
- maintain our outreach work, which allows us to offer care and document the difficulties faced in accessing care by those most excluded (homeless people, Roma communities, sex workers);
- denounce the appalling treatment suffered by the Roma community, and the repressive government policies aimed at migrants in Calais, Paris and Mayotte;
- join the Delinquants Solidaires group to show our ability and determination to reject the authorities’ approach of mixing up organised trafficking and humanitarian duty.
Next, through innovation. Our programmes targeting sex workers have been altered to address worrying changes introduced under the Internal Security Law. Examples include our mobile Funambus project in Nantes and the Lotus Bus in Paris.
To respond to the situation faced by psychotic patients living on the streets, and the infernal cycle of prison-streetshospital, we have set up new projects focusing on mental health in Marseille, Strasbourg and Paris.
To address the HIV and hepatitis C epidemics we continue to work on innovative new initiatives, in relation to testing for the most vulnerable and reducing risks for drug users. With a focus on prevention, we have set up a scheme to educate people on the risks associated with injecting.
In French Guiana, the introduction of rapid tests has become a necessity due to the high prevalence of HIV, particularly amongst the migrant community. In Mayotte, access to care for migrant children from the Comoros was almost impossible; we set up a programme to improve access to care and to advocate for this vulnerable group.
Moreover, MdM continues to create links between healthcare professionals, academics and humanitarian workers through the development of university qualifications dedicated to the study of health and poverty.
Finally, we should highlight the achievements of the hospital buddying scheme and its Head of Programme who recognised very early on the need to support children who were alone in hospital.
DYNAMIC INTERNATIONAL PROGRAMMES
OUR INDEPENDENCE MUST BE CLEAR
Confusion persists in the field over how so called “humanitarian workers”, working side by side with, or amongst, NGOs are perceived. These may include military personnel involved in crisis management or private security firms tasked with reconstruction, as in Iraq or Afghanistan. It also includes, of course, governments themselves, who send aid directly to the field or send civilian personnel to areas hit by crisis, and who are sometimes the main, or even only, NGO funders.
Whilst these groups may not always be acting from a humanitarian perspective, they are often confused with those who do. For our teams in conflict zones, the work is becoming increasingly complex and it is difficult to reach those in need.
Our independence from governments and political, economic or military agendas is crucial and should be reinforced to ensure that we are able to continue our work in places such as Afghanistan, Iraq, Colombia, Sudan/Darfur and Somalia. It is also important in Pakistan, where civilians suffer most from the regular clashes between government and insurgents that have led to mass displacement of an estimated two million people.
In other words, whilst dialogue remains open with representatives of the state, funders and the United Nations, we refuse to become subordinate to their respective agendas, which are often far removed from the needs of the people. On 12 January 2010 Haiti was hit by a violent earthquake, killing 200,000 people, leading to the displacement of 500,000 people, and leaving 1.1 million people without a home.
MdM, like many other NGOs, swung quickly into action, bringing in equipment, medical materials (more than 30 tons) and essential medicines that allowed us to provide surgical and medical aid and to offer psychological support. All this was made possible thanks to our presence in Haiti for the last 15 years, in Port-au-Prince and in the Grand’ Anse region, and our local partnerships. This strong community focus and our links with local partners enabled us to work quickly and efficiently to help those affected, in coordination with local authorities and other NGOs.
We will continue our work to help rebuild the healthcare system for many years to come.
KEY AREAS OF WORK
The health of mothers and children is of fundamental importance. We are supporting healthcare systems to improve the delivery of care to both mothers and children in the most vulnerable countries. In addition, we are advocating for cheaper access to care for pregnant women and children under five.
We will continue our work to fight gender-based violence and discrimination, and the medical and social consequences it entails, as we are currently doing in DRC. This work is aimed both at war torn countries and at improving access to appropriate services for women living in shantytowns and in poverty across Latin America, Asia and Africa.
As for AIDS, the epidemic is not over. Whilst real advances have been made in the fight against this pandemic, the risk of transmission amongst the most vulnerable — namely, migrants, sex workers and people who use drugs (Afghanistan, China) — must be fought with both prevention and care. This means access to rapid testing, treatment (free access to antiretrovirals), and support for our partner healthcare providers. MdM is committed to decentralising access to antiretroviral care, through providing medicines to rural clinics, in order to reach those most in need in Zimbabwe, Tanzania and Burma. We will continue to roll out this care model.
Health and the environment are ever more pressing concerns for the future. The failure of the Copenhagen Summit has done little to provide reassurance. Already in Madagascar, and perhaps tomorrow in other areas, we have set up community-led projects working on disaster risk reduction to lessen the impact on health of recurrent natural disasters. But we will also take inspiration from the example of our work on the effects of lead poisoning on children in France. The way in which our European societies treat the question of migration at the start of the 21st century will be seen, as we look back through history, as a tragedy. How can one understand silence when young Afghans who came to find refuge in Europe are sent back to their war torn country and who, having faced repressive migration policies, now face destitution and are forced to survive on the beaches or public squares of Paris or other French towns ?
As frontline humanitarian workers caring for the most vulnerable, most marginalised, and those without rights here in Europe, and also providing care in the countries where many of them come from, we see day after day how precarious their health is. Providing more support through both physical and mental health services for this population, working in partnership with key organisations in developing countries and working to document this frightening inhumanity will continue to be one of our key priorities in the years to come. MdM remains a key player in international adoption, whilst continually reevaluating its position in the face of evolving contexts, for example in Haiti and Vietnam.
DEVELOPING MORE BALANCED AND LONGERLASTING PARTNERSHIPS
Whilst of course NGOs are not completely neutral, we believe the strength of an international NGO, such as MdM, probably lies in the impartiality of our analyses of needs and responses to those needs as we understand them. Without under-estimating the importance of international or national agendas, our work is fundamentally about caring for the most vulnerable. To do this, we must continue to develop networks and to work in partnership, locally and on a regional level, to roll out an approach more firmly anchored in local cultural practices. Partnerships at home and abroad with service user representatives and local NGOs will ensure that our humanitarian action is more balanced and leads to a healthy interdependence, necessary in this complex and globalised world.
OUR OPERATIONS
After 25 years at the heart of our organisation, including 17 as General Director of Humanitarian Operations, Dr. Michel Brugière left MdM for a retirement that we hope will be very happy and militant. This is our opportunity to thank him once again for the way in which he has guided and supported us during this time. His successor will need to help us to face profound changes in the future, relating to the role and context of humanitarian action, whilst not forgetting MdM’s volunteer-led and campaigning nature. Today, Doctors of the World in France is a network of 15 regional delegations. This allows us to work as closely as we can to those we help. This year, as in previous years, we have continued our support of these offices. This policy of working together more closely grew from our need to address regional health policies, but also to ensure better consistency in our work responding to local needs.
Conscious of the influence Brussels exerts on access to care for migrants in Europe, we are working towards Europe-wide actions — care and advocacy — through the MdM international network. This is illustrated perfectly by the publication of the second European Observatory Report on Access to Healthcare and of the HUMA report on legislation relating to access to care for undocumented migrants and asylum seekers in 10 European Union countries. This is yet another clear example of the relevance of our international expansion and the need for MdM to support the development of its international network members in order to increase its operational capacity and coherence when speaking out. 2010 will be the 30th anniversary of Doctors of the World France. It is time to take stock of our past and reflect on the development of an organisation that — thanks to all those involved as volunteers, employees, members or donors — has remained radical. It is also an excellent time to take the opportunity to express our vision for the future, at home and abroad, with clarity and conviction.
June 2010