>The regional delegations

In the regions, MdM has set up regional delegations. Elected every two years, the regional colleges represent the Association in the regions. The delegations carry out international or regional projects, within the overall framework defined by the Board. All the board members, Heads of Projects, group co-ordinators, regional and board representatives meet three times a year for a National Advisory Council meeting.

> Médecins du Monde's International Network

Twelve delegations, nine in Europe (Belgium, Cyprus, France, Greece, Italy, Portugal, Spain, Sweden and Switzerland) and three in the Americas (Argentina, Canada and the United States) were members of Médecins du Monde's international network in 2005.

• http://www.mdm-international.org/

> Sister organisations and local partners

Médecins du Monde bases its work around local partners to provide links that will ensure the work will continue. If no partners exist, MdM supports the setting up of sister organisations, which are often formed on the initiative of, and based around, MdM's local team. They gradually become autonomous and are supported for one to two years on average. The structures thus created remain MdM's natural partners in the region.

Une équipe de MdM Hollande

2011: The network took action in Haiti, Japan and Greece

The international network is made up of 13 organisations:* Argentina, Belgium, Canada, France, Germany, Greece, Japan, Netherlands, Portugal, Spain, Sweden, Switzerland and United Kingdom.

The international network management team (DRI in its French acronym) is responsible for its co-ordination and development, with guidance from the two largest organisations in the network, MdM France and MdM Spain, and the network dele­gates, Dr Françoise Sivignon and Dr Hervé Ber­tevas. DRI supports the development of network members according to their needs and means.

In 2011, the work in Haiti continued. When the teams were faced with the cholera epidemic, smooth coordination on the ground enabled a swift and efficient response.

During the year 2011, two network members were hugely affected in their own countries:

• MdM Japan responded to the 11 March 2011 earthquake, immediately sending teams to the affected areas. The team continues to provide long-term support to the poorest of those affected.

• MdM Greece sees the consequences of the financial crisis in their country on a daily basis. The number of Greek patients who no longer have access to healthcare continues to rise.

Raising funds remains a constant struggle. To further our reach, and to access new internatio­nal funds, MdM opened an office in New York in January 2012.

Overview of programmes run by international network members

In 2011, the MdM network as a whole implemented 342 programmes in 76 countries: 151 international programmes in 64 countries and 190 national projects in 13 countries. Doctors of the World network members work to re-establish, or often simply facilitate, access to care for the most vulnerable.

In Haiti, the work continues with a large scale international network presence

Faced with the massive needs in Haiti, six inter­national MdM teams are still working to support the population. The large staff numbers mean that we are able to cover several sites including Port-au-Prince, Gonaïves, Léogâne, Grand’Anse and Nippes.

In 2011, the cholera epidemic hit the population at a time when they were already very weak. Doctors of the World teams worked together to tackle the epidemic. Human resources and money, both dif­ficult to secure, were shared in order to ensure the best response possible.

Earthquake in Japan : our teams on the ground

The earthquake that hit Japan on 11 March 2011 affected the whole country. The nuclear catas­trophe that followed forced Doctors of the World to confront risks never before experienced by the network. Notably, the teams were equipped with radioprotection equipment.

Backed by its history and expertise—MdM Japan was created after the Kobe earthquake— teams responded in the affected regions in the north of Japan, in the areas surrounding Otsuchi.

Since the quake, specialists (psychiatrists, nurses, and physiotherapists) have been provi­ding care to people living in shelters and tempo­rary housing. Since the beginning of April 2011, teams have conducted medical and psychiatric consultations and rolled out relaxation and study sessions at the town’s high school. In July, Doc­tors of the World opened a consultation room for people suffering from post-traumatic stress disorder, where, working closely with the autho­rities, psychiatrists and nurses share patient care. Since the end of December, three-day relaxa­tion sessions take place twice a month, at the request of the residents.

These activities are possible thanks to the com­mitment of our Japanese volunteers.

A year on from the disaster, whilst the long-term consequences of radiation on health are diffi­cult to assess, the ongoing needs are still great. MdM Japan will continue to have a presence in the affected areas for several years.

The Greek crisis : demand for medical consultations rises

Plans to save Greece are front page news, with billions of euros promised to avoid bankruptcy and a succession of austerity plans put forward to reduce the deficit. But these plans, aimed at saving the financial system, do not take into account the real human consequences, particu­larly for the most destitute. The poorest people stop accessing care, or turn to organisations like MdM, which had previously cared predominately for migrants, including asylum seekers. Visits from Greek citizens to MdM polyclinics have doubled this year: including pregnant women who have not received any care during their pregnancy, sick children and/or children who have not been vac­cinated, retired people with no income, or public workers who have had their salaries cut.

MdM Greece reaches out to vulnerable people through its clinics and outreach teams.

International projects in 64 countries

Africa represents almost half of our projects, with 68 programmes in 24 countries. Due to the political and security situation, MdM was forced

to leave Sudan and continues to work under extreme pressure in the Sahel region.

In 2011, Doctors of the World started its first harm reduction programme on the African conti­nent, in Tanzania, working with drug users.

During the revolutions in Tunisia and Libya, teams were sent to the countries’ borders.

In the other regions, Doctors of the World’s work is divided as follows:

• Latin America—37 programmes in 14 countries;

• Asia—22 programmes in 13 countries;

• Middle East—17 programmes in eight countries;

• Europe—seven programmes in five countries.

National programmes in 13 network member countries

In the countries where the international network members are present (Argentina, Belgium, Ca­nada, France, Germany, Greece, Japan, Nether­lands, Portugal, Spain, Sweden, Switzerland and UK), 190 national programmes are run on a daily basis. These programmes, run predominately by volunteers, care for those people who, without help, could not access healthcare services.

In the majority of countries, foreign nationals without residency permits live in the greatest

difficulties, with limited, if any, rights. As a conse­quence, all our country teams work to make sure that all fundamental human rights that enshrine access to care are respected, while ensuring that the international convention on the rights of the child, and rules relating to access to care for pregnant women, are upheld.

Other programmes work with people experien­cing homelessness, who suffer a rapid deterio­ration in their health as a result of sleeping on the streets. Mobile outreach is also carried out in most of the countries, sometimes with a specific focus on homeless people suffering from mental health problems.

Roma communities experience discrimination, both in their own country and in the countries to which they travel. That is why MdM teams in France and in Greece reach out to families, travelling to where they live (often in insanitary camps), or welcome them to centres (in Ger­many and Belgium) to facilitate their access to vaccinations and care. Particular attention is paid to expectant mothers and children.

Sex workers, male and female, often migrants, are faced with multiple risks (violence from clients, harassment by police, exploitation, sexually transmitted infections from clients who insist on unprotected sex), coupled with the stigma that surrounds them. Thanks to its mobile clinics, MdM is able to work on the streets, but also in the clubs, massage parlours etc. in order to help sex workers to reduce risks that are inherent in their activity. People who use drugs often struggle to protect their health because they are forced to hide their use for fear of prosecution. MdM operates a low threshold access policy for users, providing them with sterile injection equipment, materials for other consumption methods, information on products and ways of reducing the risks related to drug use. A portfolio of other programmes are carried out by the teams (prevention of genital mutilation, child lead poisoning, support for the elderly and medical and social support in deprived areas…). The work carried out by MdM teams at home and abroad shares common themes, namely, access to care for all, prevention and care for those affected by HIV/Aids, hepatitis and tuber-culosis, the reduction of health inequalities and the right to access care, irrespective of immi-gration status. In 2011, the European members decided to join forces within the framework of a European project. This will start in 2012 and aims to chal-lenge the European Union leaders and member states on the question of access to care for the vulnerable people that MdM teams care for on a daily basis. For more information on the international network member programmes: www.mdm-international.org

THE INTERNATIONAL NETWORK MEMBERS

» Médicos del Mundo Argentina Chair: Mr Gonzalo Basile www.mdm.org.ar

» Médecins du Monde Belgium Chair: Professor Michel Degueldre www.medecinsdumonde.be

» Médecins du Monde Canada Chair: Dr Nicolas Bergeron www.medecinsdumonde.ca

» Médecins du Monde France Chair: Dr Olivier Bernard www.medecinsdumonde.org

» Aerzte der Welt Germany Chair: Professor Jochen Zenker www.aerztederwelt.org

» Doctors of the World Greece Chair: Dr Nikitas Kanakis www.mdmgreece.gr

» Doctors of the World Japan Chair: M. Gaël Austin www.mdm.or.jp

» Dokters van de Wereld Netherlands Chair: Dr Remco Van de Pas www.doktersvandewereld.org

» Medicos do Mundo Portugal Chair: Dr Abílio Antunes www.medicosdomundo.pt

» Medicos del Mundo Spain Chair: Dr Alvaro Gonzalez www.medicosdelmundo.org

» Läkare i Världen Sweden Chair: Ms Kristina Andersson www.lakareivarlden.org

» Médecins du Monde Switzerland Chair: Professor Nago Humbert www.medecinsdumonde.ch

» Doctors of the World UK Chair: Ms Janice Hughes www.doctorsoftheworld.org.uk

» Doctors of the World USAs Chair : Ms. Abby Stoddard www.doctorsoftheworld.org

_{July 2012}