Why are so many people still dying and suffering from snakebite?

Why are so many people still dying and suffering from snakebite?

Up to 5.4 million people are bitten by snakes a year, up to 2.7 million develop clinical illness, and 81,000-138,000 die preventable deaths.  Why are so many people still dying and suffering from snakebite?

Snakebite envenoming affects the world’s poorest, usually those living in remote rural areas, with a direct correlation between snakebite deaths and poverty. It kills more people than any other disease on the Neglected Tropical Diseases list of World Health Organization (WHO).

One of the key issues is people’s access to antivenom for urgent treatment of snakebite. Production, price and demand all play a role in antivenom access.

Snakebites are a neglected health crisis. Urgent change is needed to ensure that fewer people have to face the consequences of it: 

  • Better access to quality antivenom
  • Increased community awareness
  • Investment in first aid and preventing bites in the first place.

 

 

Pakistan underwater: Responding to the emergency on the front line

Pakistan underwater: Responding to the emergency on the front line

“In June and July, we received normal rainfall and daily life was going fine. I used to visit my family on weekends in my village which is 4 to 5 kilometres from Dera Murad Jamali where I work with MSF’s outreach team. We used to visit the communities and help raise awareness about mother and child health and different diseases. It was the month of August and oddly we were receiving more continuous rains than normal years. On the 17th of August, the water started coming towards our village and we were asked to leave immediately.

In the rush, my parents and younger siblings left the village and thankfully we had our uncle’s home in Dera Murad Jamali, so they shifted there, whereas one brother and one sister were left behind to take care of our cattle as my family had a herd of cows and goats. They took the cattle to higher ground but when they saw the flood water start to cover the village, they had to flee. My siblings took shelter and climbed up the rooftop of a nearby house. They watched as the water started to increase, and our cattle, houses, and farm, all washed away. The water came up to 8 or 9 feet high. It was so heartbreaking to see our house and village underwater.

I initially took leave for a week to support my family but when I saw that so many people needed help, and I received a call from MSF requesting support for the emergency response, I couldn’t stop myself from saying ‘yes’. Within two days, I was on duty conducting assessments in flood-affected villages. We reached faraway villages, and found families were living in the open without shelter. I saw some people using two wooden beds (charpai) pushed together with plastic covers as shade on the side of the road because their houses were under water, and they did not have a home or enough food or clean drinking water. Still, the rain continued, on and off.

After the assessments, our emergency teams were formed, and I was part of Team B. The first village we visited was Rabi Pull and Uch power plant camp where we set up a mobile clinic and provided clean drinking water. The water was sourced from MSF’s gravity fed water treatment plant in Dera Murad Jamali, Balochistan. It’s one of the few water treatment plants available in the region. In our mobile clinics, we are seeing patients with respiratory infections, diarrhea cases, malaria cases and skin infections. The people here are drinking and using the flood water, which is contaminated, and it is spreading several diseases.  Our doctors are completing check-ups, providing medications and referring pregnant women and people who require specialist care to an MSF facility in District Headquarters Hospital, Dera Murad Jamali.

We have also distributed 236 hygiene kits to people near Uch Power plant where internally displaced people are taking shelter. We have so far also provided 70,000 litres of clean drinking water to displaced families and medical consultations to around 2,575 patients at different locations in Naseerabad, Jaffarabad and Dera Murad Jamali, Balochistan province.

During our response, we set up a mobile clinic in my flood-affected village Mir Gul Hassan Manju Shori Barun Naseerabad, also called ‘tanki wala’. As we were moving towards my village, I felt a sense of contentment. The people of my village know my work with MSF well as I also visited them many times during our outreach activities. I was part of MSF’s emergency team providing support to the communities and my community was one of them. All the houses in my village, including my house, are still in the water and they will take up to a month to completely dry out.

In one of our medical camps, there were some people on one side, a few families on the other side of the flood water and there was a family with three children, all of whom had a high fever. I watched as the parents, on seeing our medical camp, crossed the flood water seeking treatment for their children. But many people in other more remote villages are still waiting for help to arrive.  I can feel their pain as many have left their houses and are living in camps without help. Some of them are also cut off from the cities and access is difficult.

They are a reminder of why we continue our daily mobile clinics and to provide clean drinking water to the displaced families.”

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Akeela, an Outreach Counsellor with MSF since 2020, lived in the village of Mir Gul Hassan Manju Shori Barun Naseerabad which is around 5 kilometres from Dera Murad Jamali (DMJ) in Balochistan, one of the areas hardest hit by monsoon rains and extreme flooding that left one third of Pakistan underwater. After losing her home, she is now responding to the emergency on the front line.

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MSF International Financial Report: Funding and Spending Rules

MSF International Financial Report: Funding and Spending Rules

Every for-profit organization has its own financial sources to continue its activities that generate a financial return that enables it to continue in the market, but this is not the case for international non-governmental organizations, especially those working in the humanitarian field and depend mainly on the donations of individuals and private institutions such as Médecins Sans Frontières (MSF) the international medical charity founded in 1971 and currently has more than 65,000 people among health workers, logistics and administrators working in more than 70 countries around the world.

The organization relies on 5 main principles, including transparency and accountability, that drives it to issue an annual financial report that includes its revenues from donors and its expenditures, such as the one recently issued for its activity for the year 2021.

Funding rules

To ensure its independence and impartiality, which constitute two of its five principles, the organization relies for most of its funding on the donations of individuals who give small sums of money, while the rest that comes from some governments “less than 2%” and the private sector have special rules. At the level of governments, the organization has refused since 2016 to receive any funding from the European Union or EU member states as well as Norway in refusal of its immigration policies to keep migrants from its shores.

As for the private sector, the organization rejects any contributions from a company whose activities conflict with the continuation of MSF in its charitable medical work, such as pharmaceutical companies, extractive industries, tobacco and arms manufacturers.

Spending Rules

MSF allocates the largest part of its budget to fund medical and humanitarian missions, health awareness projects, the Essential Medicines Campaign and the Neglected Diseases Drug Initiative, followed by the necessary fundraising expenses and the expenses associated with running the organization.

2021 budget

According to last year financial report, the organization’s operating income increased by 2% to more than 1.93 billion euros ($2 billion) compared to 1.90 billion euros ($1.99 billion) in 2020.

With regard to funding sources, the number of individual donors has stabilized at 7 million people around the world, and they provided, along with some private institutions, 97.4% of their total budget, while the income coming from countries and public and multilateral organizations represented 1.5%, or about 29 million euros (30.5 million dollars), while sales of relief items to other organizations and the benefits of financial investments accounted for the remainder (1.4%).

On the other hand, operating expenses in general increased by 6.1% to reach more than 1.78 billion euros ($1.87 billion) compared to 2020, when it amounted to 1.680 billion euros ($1.76 billion).

In detail, expenditures for social tasks increased by 81 million euros ($85.2 million) to 1.43 billion euros ($1.5 billion) compared to 1.35 billion euros ($1.42 billion) in 2020, representing 80.4 percent of total operating expenses. Public administration, which received 4.4% of the total expenditures, an increase of one million euros ($1.05 million) compared to 2020, and the expenditures for financing “donations” amounted to 270 million euros ($284 million), representing 15.1% of the total budget.

The number of individual donors has stabilized at 7 million people around the world, and they provided, along with some private institutions, 97.4% of their total budget.
International Financial Report 2021

In order to increase transparency, the organization announced in its financial report the provision of a surplus in its budget estimated at about 169 million euros ($ 177.8 million), which allowed the operational management to increase the proportion of expenditures on social tasks during 2022.

Spending in the Middle East

MSF allocated 228 million euros ($239.8 million) of its budget in 2021 to support its operations in the Middle East, including 5 Arab countries (Yemen, Sudan, Syria, Iraq and Lebanon) were among the countries to which the organization allocates about 25 million euros ($26.3 million) for each of them, where MSF teams are present to provide their medical and humanitarian services.

To view the financial reports and the financial policy of the organization, you can click on the following link: https://www.msf.org/reports-and-finances

Discriminatory and cruel migration practices compounding people’s suffering in Lithuania

Discriminatory and cruel migration practices compounding people’s suffering in Lithuania

Vulnerable migrants and people seeking asylum who are held in prolonged detention in Lithuania are consequently experiencing an alarming deterioration in their mental health. The Lithuanian authorities’ flawed migration practices and legal processes are further discriminating against certain nationalities, and contributing to the continued detention of these people, the international medical humanitarian organisation Doctors Without Borders/Médecins Sans Frontières (MSF) said today. MSF denounces the prolonged detention and systemic discrimination in Lithuania, and is calling for the immediate implementation of humane alternatives that equitably meet the needs of vulnerable and traumatised people. 

“Many of the people detained have survived deeply traumatic experiences,” says Georgina Brown, MSF Country Manager in Lithuania. “But, instead of responding to their needs, the Lithuanian authorities are worsening their mental suffering by detaining them and holding them in limbo. These men, women, and children are uncertain of their future, terrified of being forcibly returned to the danger they have fled, and imprisoned without freedom, autonomy, or adequate protection. People’s resilience will diminish, and their suffering will only grow exponentially. Appallingly, we know that some nationalities are more likely to have this detention extended than others, creating a hierarchy of suffering that the Lithuanian authorities should be deeply ashamed of.”

Approximately 700 people are detained in Kybartai, Pabrade and Rukla and Naujininkai Foreigner Registration Centres (FRCs) in Lithuania, after having crossed the border from Belarus in 2021.  Many of these men, women, and children have grave vulnerabilities and have undergone highly traumatising events. Detention is only exasperating these people’s suffering, and some nationalities are experiencing discriminatory higher rates of distressing extensions to their detention.

Since January 2022, MSF has been providing primary healthcare (until May 2022) and mental health support to the people held in Lithuania. However, MSF remains painfully aware that this work cannot address detention as the root cause of people’s suffering. Of the patients who MSF provided mental healthcare for between January and March 2022, over 70% highlighted detention as being the main cause of their need for support.

I am so desperate, I tried to hurt myself because I want to go out from this prison
a man detained in an FRC in Lithuania

“I am so desperate, I tried to hurt myself because I want to go out from this prison,” a man detained in an FRC in Lithuania told MSF. “Many times I really decided to be ready to kill myself. You are hurting, you are embarrassed, you are abused. And so, this is prison. I was desperate. I was so depressed. But I can’t because we need more courage. I am not too broken.”

MSF has seen that some nationalities are significantly more likely to have this detention extended, remain detained after their detention order has expired, or have the limited freedom of movement they may have been granted revoked. For example, out of 184 people being held in Kybartai FRC during August 2022, most individuals come from two nationality groups which are present in almost identical numbers, making up 18% and 16% of the total population respectively. Nigerians make up 16% of this population, yet nearly 28% of the people are enduring extensions to their detention. The largest nationality group makes up 18% of the population, but under 2% of the extensions to detention.

Indians are only 6% of the people in this population, but make up over 15% of the current extensions. Additionally, Russian and Belarusian asylum seekers who recently arrived in the FRC were not subject to detention at all, and 100% of them have been granted limited freedom of movement.

MSF sees this pattern echoed in other FRCs across Lithuania, including places where precise data is almost impossible to gather. We are receiving numerous reports from some of the FRCs that some nationalities, including Nigerians and Congolese, are more likely than others to be subject to discriminatory migration practices. These include continued detention after the expiration of their detention order without receiving a legislatively mandated court-issued extension, and having their limited freedom of movement revoked (returning them to detention).

Across the world, MSF has seen how hostile migration policies and practices, such as arbitrary and prolonged detention, serve no purpose except to deny people their rights, and compound the misery of those subject to them. When authorities treat people in this cruel way; depriving them of their liberty, hope, and autonomy, it has severe consequences. It can destroy lives.

That the cruelty of detention is compounded in Lithuania by discriminatory practices and flawed legal processes, resulting in the further abuse of certain nationalities, underscores the inhumanity of the country’s approach to migration. It is the antithesis of the dignified and humane treatment, as well as the basic human rights, that these people are entitled to while in search of international protection.

In light of the suffering of the people who remain detained in Lithuania, and the Lithuanian authorities’ shameful contribution to the collective global degradation of the human rights of refugees, migrants, and asylum seekers, MSF is calling for prolonged detention to be immediately ended, and for the implementation of an equitable asylum system that respects the dignity, health, and human rights of the men, women, and children seeking safety in Lithuania.  

“Us Africans are still here,” says a man detained in a Lithuanian FRC told MSF. “Other nationalities were the majority. And now all of them have left, and us Africans remain. There are so many things which were not equal treatment. They treat us differently. I don’t feel bad about this, because it’s not strange to me. You just need to accept how life is. You just need to keep breathing. If you kept breathing for 12 months, you can keep breathing.”

MSF to provide medical care for stranded asylum-seekers in the Netherlands

MSF to provide medical care for stranded asylum-seekers in the Netherlands

Amsterdam, 25 August 2022 – Starting today, Médecins Sans Frontières (MSF) will provide medical care to hundreds of people stranded outside the main Dutch reception centre for asylum-seekers in Ter Apel. The international humanitarian organisation calls on the Dutch government to urgently provide access to medical care and improve conditions for people forced to sleep outside the overcrowded centre. 

Last Friday, an MSF team carried out an assessment of the situation outside the reception centre in Ter Apel which is the first entry point for refugees in the Netherlands. The centre is completely overwhelmed and unable to meet the most basic needs of new arrivals. Among those living in a field outside the facility in inhumane and undignified conditions were pregnant women, children and people with chronic diseases (such as diabetes), some of whom had run out of medication. There are no showers on site and the very few toilets available are not sufficiently maintained. Tents and makeshift shelters had been removed and people were sleeping on the ground, exposed to the elements. MSF saw people suffering from skin disease, upper respiratory tract infections, urinary tract infections, diarrhoea and vomiting, mental health problems, dental problems and injuries in various states of healing. The very real concern is that if this situation is allowed to continue, it may lead to serious medical emergencies. 

This is the first time that MSF has ever provided medical assistance in the Netherlands. We cannot stand back and do nothing with this increasingly inhumane and unacceptable situation on our doorstep
Judith Sargentini, director for MSF Netherlands

Provision of basic healthcare 

Following consultation with the relevant authorities and the Red Cross, MSF has dispatched a medical team with immediate effect to provide basic healthcare to people in Ter Apel who are seeking asylum in the Netherlands. A medical team will be present on site outside the centre to treat illness and injury, ensure that those with chronic disease can continue with their medications, triage cases that need to be referred to hospital or seen at a health centre, as well as providing psychological first aid to adults and children.  

Structural solution needed

 “However, our intervention is a stop gap measure. The Dutch government and local municipalities must urgently improve living conditions and take on the responsibility of providing vulnerable people with medical care. Furthermore, there must be a structural solution, such as creating multiple, and more humane reception locations. This is something that the Dutch government has been called upon to do for years.”  said Judith Sargentini.

Five Years Since Rohingya Killings, One Million People Remain in Dire Conditions

Five Years Since Rohingya Killings, One Million People Remain in Dire Conditions

Today marks five years since horrific events unfolded in Rakhine state, Myanmar. Thousands of Rohingya people were killed by the Myanmar military. MSF alone documented 6,700 violent deaths.

More than 700,000 people fled for their lives to Bangladesh. They joined others who had already sought refuge from previous cycles of violence and together now make up one million people stranded in Cox’s Bazar area of Bangladesh.

Below we share some testimonies from Rohingya people living in refugee camps in Cox’s Bazar, whose health, water, sanitation, and protection needs remain immense. At the same time, the roots cause of Rohingya suffering – statelessness – is no closer to being addressed.

Tayeba Begum, fled Myanmar in 2017 with her children.

“My twin girls, Nur Ankis and Nur Bahar, were only six-month-old babies when we escaped from our homeland in Myanmar. After the killings began, we couldn’t stay in Myanmar any longer – the military were brutally murdering Rohingya and burning their houses.

When I fled with my babies, we crossed jungles and muddy roads in the soaking rain to get to Bangladesh.  After reaching the border, people were resting wherever they could, but there was nowhere to shelter. We ate whatever we could find to survive. My daughters became weak and vomited whenever I tried to feed them. They suffered for a long time as it was difficult to find medicine when we arrived.

“I long for peace. If we can ever live peacefully again in Myanmar, we will return. But how can we return if our rights are not ensured? How can we go back if our children could be taken away and murdered?”

A few days after our arrival [to Cox’s Bazar], shelters were built for us out of cloth and bamboo. Now, we live here in the refugee camps. It has been five years of living in distress.

We depend on food assistance and worry about what to feed the children and if it’s enough. We worry about how to clothe them and how to educate them. 

I long for peace. If we can ever live peacefully again in Myanmar, we will return. Why wouldn’t we return if justice is served to us and we are given citizenship? Is it not our homeland also? But how can we return if our rights are not ensured? Where will we live, since our houses have been destroyed? How can we go back if our children could be taken away and murdered? 

You can keep us here or transfer us to another country, we will not refuse, but I would not go back to Myanmar without justice being served.”

Anwar, 15 years old, fled violence in Myanmar

“My name is Anwar. I am a student from Myanmar. We escaped our neighbourhood in Myanmar and now live in the Jamtoli refugee camp in Bangladesh. 

I remember when I ran away from Myanmar with my family. It was one afternoon, when the army attacked our neighbourhood and we had to run to a nearby area. When they torched our houses, we had to run further. We survived but many of relatives and neighbours were murdered.

We travelled a long way to seek safety. I remember it was almost 12 days of running and walking before we reached Bangladesh. It was dangerous: we walked unfamiliar roads, climbed hills and even crossed water. We saw a lot of dead bodies on the way.

“Our life in the camp is not easy. I would like to address young people like me around the world. Please use the opportunity you have and learn as much as you can. My fellow Rohingya refugees and I do not have such an opportunity.”

I was a student at school when we escaped, so when I came here my education was interrupted. I was a good student with high grades. I like learning, but now, I can’t study or get the books I need.

My dream was to become a doctor, to be useful to the community. Since my childhood, I have seen doctors helping people and doing their best. I understand now that the dream might never come true. Still, I feel happy when I go to classes and meet my friends. We try to be happy while studying and playing.

 

Our life in the camp is not easy. The incentive my father earns is not enough to support my family. And sometimes when I come back from school at night, I feel unsafe.

I would like to address young people like me around the world. Please use the opportunity you have and learn as much as you can. My fellow Rohingya refugees and I do not have such an opportunity.”

Mohamed Hussein, 65, fled Myanmar five years ago

“One morning [in 2017], we heard gunshots. It was a Thursday night that actual shots were fired from the military post close to our home. The next morning, we heard some Rohingya people had been killed.

We were terrified, as the military were arresting and killing people everywhere. Running for our lives, we arrived here to Bangladesh. We were fortunate that we made it here alive. Bangladesh is doing a lot for us and standing by us.

When we first arrived here, we were very hopeful. But now, we feel stuck. Life has become difficult. I feel anxious about our future because our children are not being educated properly. Whether they stay here or return to Myanmar, what will they do without education? We have many sleepless nights thinking about this.

“My heart longs for our repatriation to Myanmar. The world is made for everyone to live. Today, we have no country of our own despite being human. We are requesting the world to help us live as humans. My wish is to have rights, and peace.”

I receive medical care for my diabetes and high blood pressure at an MSF facility inside the camp, but treatment for my kidney disease is not available in the camp. I am old now and will die soon. I wonder if I will see my motherland before I die. My wish is to breathe my last breath in Myanmar. I am not sure if that wish will be fulfilled.

My heart longs for our repatriation to Myanmar, with the guarantee that our rights will be protected and that we will not be persecuted further. I am scared about the possibility of facing persecution again in Myanmar and since our families are there, we need to think of their safety.

We should be able to study, lead our lives and move around like any other citizen of Myanmar. We should be able to vote, participate in elections and raise our voices in Parliament.

Now that all our rights have been taken away, we are nothing but a walking corpse. The world is made for everyone to live. Today, we have no country of our own despite being human. 

I am saying to the world, we are just as human as you are. As we were born as humans, we wish to live a dignified life. We are requesting the world to help us live as humans. My wish is to have rights, and peace.”

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Gaza: Caught in a Cycle of Destruction

Gaza: Caught in a Cycle of Destruction

Sakhar was asleep when a bomb hit his family home in Gaza City, and even then, he knew exactly what was happening. That was before he lost consciousness, before being transported to the hospital, before coming to and realizing that once again, he and his family had survived.

Sitting in an MSF Gaza clinic on 10 August, five days after the bombing and two days after a ceasefire was announced, he swipes through photos on his phone, sent by his neighbours. They show him and his brothers unconscious on the ground, faces covered in blood and cement dust. He marvels at the fact that here they are, still alive.

Not only did Sakhar, who is thirty years-old and a father of four, survive this August 2022 bombing, he also survived another bombing during the 2014 war in Gaza, in which he needed skin grafts. Today, his back is covered in fresh, open cuts, and he has come to the clinic, with his two younger brothers, both of whom sustained severe fractures and abrasions, to have their dressings changed.

Their family are among the approximately 350 Gazans who sustained severe injuries during this round of escalation, joining the several thousand others who have been injured or disabled by one of the five wars on Gaza that have taken place in a 15-year span of time. This time around, according to the United Nations, 49 Gazans were killed, including 17 children.

Sakhar’s brothers, who are 22 and 13 recall how their lives have been shaped by their close proximity to the trauma of war despite repeatedly moving neighbourhoods to escape the destruction.

Mahmoud, who is 22, says “During the 2008 war, I was in 4th grade, I remember as children we used to hear the explosions and see the (dead bodies).”

“In 2012, again we saw many injured and (dead people), and I lost many of my friends at the time. Then in (the 2014 war) our house was damaged.”

Over the years, he reflects, “We saw bad and horrible sights, but not like this one.”

For Gazans like Sakhar and his brothers, the cycle of repeated wars has led to compounded physical and mental health traumas. For healthcare workers too, the scenes in the emergency rooms have become all too familiar.

Dr. Osama Tawfiq Hamad, an anaesthesiologist was working on Friday night when the bombs began to hit Gaza. As a doctor for MSF since 2019, he has provided care for patients through two wars. He describes how the emergency room at Al-Awda hospital filled up within minutes, receiving over 15 patients including six children. He treated one young child who had been hit with shrapnel to the skull, and another with a hematoma in the chest, both requiring urgent surgery.

“In Gaza, (in the past 15 years) we’ve had five wars, and every time there’s an airstrike we have a huge amount of (injured people) that all come to the hospital at one time. You could have 50 or more patients at a time. In these moments, we have very bad emotions, anger and mixed emotions, but you must be strong to deal with the cases.”

Dr. Osama points to the fact that over time, for those patients that survive, returning to the hospital for follow-up surgeries, physiotherapy, and support following the mental and physical injuries of war becomes part of their daily lives.

His colleague Shadi Al-Najjar, who manages the physiotherapy department at Al-Awda Hospital with MSF is familiar with the revolving door of patients that come in waves after each war.

“I am still seeing patients from the May escalation in 2021, getting rehabilitation and physiotherapy. In our department we have a high load of patients as well from the Great March of Return. We are now preparing the department, both in and out-patient, to receive the injured from this escalation.”

Shadi has returned to work, managing existing and new caseloads, despite his own experience over the weekend. His home was partially destroyed on the second day of the war, as his neighbours house was hit. His family didn’t have a chance to evacuate before his 9-month old son’s room was damaged – he found him in his crib surrounded by glass and shrapnel, but without injury. He says his youngest daughter has been traumatized, too.

“She is not able to sleep, crying all the time, I am trying to be as supportive as I can for them.”

Like Shadi, Sakher also emphasized that one of the worst parts of coping with the aftermath is in trying to support his children emotionally; “My eldest is now 5 years old. And after this escalation my son has been asking me to stop the war, and he always screams at night, he has not slept for 3 nights and when he is asleep he wakes up from nightmares and starts running and I don’t know what to do or how to help him.”

The trauma of repeated violence in Gaza has made a discernible impact on children and parent’s mental health. According to the WHO in 2021, 82 per cent of adolescents in Gaza reported overall poor to very poor levels of mental wellbeing. The United Nations’ 2022 Humanitarian Needs Overview states that more than half (53 per cent) of all children in Gaza are in need of child protection and mental health services. Additionally, 137,000 caregivers in Gaza are in need of mental health services.

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In the days following the escalation, MSF staff members and patients frequently expressed their concern for their children and other young people in Gaza who have grown up or will grow up in an environment where escalations take place with disturbing regularity.

After his wound dressings were changed, Wael, the 13-year old brother of Sakhar and Mahmoud was asked by an MSF support worker what he wants for the future.

“I hope that there will be no wars in the future, and the calm (in Gaza) stays, without any bombings.”

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“Returning to Haiti means death”

“Returning to Haiti means death”

Haitians seeking asylum in the United States continue to be at risk of being expelled and sent back to a country in crisis, where the capital, Port-au-Prince, has become a battleground between armed groups, causing thousands of people to flee their homes and leaving many residents with extremely limited access to health care or basic services.

More than 26,000 Haitians were expelled from the United States between September 2021 and June 2022. In May alone, the US government expelled nearly 4,000 Haitians.  Most Haitians have been expelled under Title 42, a health order invoked at the start of the COVID-19 pandemic that allows for the blocking and rapid expulsion of migrants, including people seeking protection at the US border. This devastating policy has effectively shut down asylum at the US southern border and has been used to authorize over two million expulsions from the US.

While deportation flights to Haiti have been paused since June, without a change in US policy, Haitians who arrive at the US border could still be expelled to what has effectively become a conflict zone, as armed groups have taken over large areas of the capital. More than half of the patients arriving at the Doctors Without Borders/Médecins Sans Frontières (MSF) hospital in Tabarre, Port-au-Prince, have suffered life-threatening wounds, often from high-powered firearms. Armed clashes in two neighborhoods, Martissant and Cité Soleil, forced us to move longstanding medical programs in 2021.

The United Nations has documented a sharp increase in violence this year, with 934 killings, 684 injuries and 680 kidnappings in Port-au-Prince from January to the end of June. Many people who have fled the violence are living in informal displacement sites within the city in appalling conditions. In recent months, armed clashes have again destroyed water networks and disrupted water truck deliveries in Bel Air and other neighborhoods. MSF teams are adapting to the current rise in violence and insecurity, operating mobile medical teams and providing water and sanitation facilities.

“We see an increase in kidnappings and killings and people telling us they don’t feel safe in their homes, and it’s not safe to leave the house either,” said Cédric Chapon, project coordinator for MSF’s urban violence program in Port-au-Prince. “Access to water is also a big challenge. Since the beginning of the year, we have seen an epidemic of scabies, which is not usual in Haiti. And this is directly linked to the lack of water. People can afford small quantities of drinking water, but they can’t access clean water in quantities needed for hygiene.”

The situation is also dangerous for MSF staff, some of whom are trapped by the violence, unable to leave their homes to come to work. In some areas, MSF staff must work in basements and windowless rooms to avoid the risk of stray bullets.

Haitian migrants face dangers crossing Latin America

MSF also provides medical and mental health care along the migration route in the Americas, where for the past several years our teams have seen an increasing number of Haitians trying to reach the United States.

Haitian migrants often have family and support networks in the US, but Title 42 forces them to take increasingly hazardous routes to get there, from South America through the extremely dangerous Darién jungle in Panama. From April 2021 to early May 2022, MSF teams working in Panama with patients who had crossed the Darién jungle treated 417 women for sexual violence. 

The border between Mexico and the US is the final leg of their journey. In border cities such as Nuevo Laredo and Reynosa, they join other migrants who are also waiting to cross, in many cases to seek asylum in the US. Migrants are often forced to sleep on the street, in abandoned structures, or in makeshift camps because there is not enough space at local shelters to accommodate the high number of people. Access to health care, food and basic services is limited and these cities are extremely dangerous, particularly for migrants, who are vulnerable to violence, including kidnapping and sexual assault.

“I’m here with my family, I have two children and times are tough,” said Wisly, 36, a Haitian man who had arrived in Reynosa, Mexico, in April, after a long journey through South and Central America from Chile. “We’re going through difficult times because of the heat, we’re sleeping in the street where anything can happen to you and I’m told we’re in a dangerous area. Anything can happen.”

Most of the migrants our teams are seeing along the migration route fled violence and general instability in Haiti many years ago. They initially found work in Chile and Brazil, but several factors, including an economic downturn, an inability to access documentation to legally work, and growing anti-migrant sentiment, have led thousands of Haitians to leave these countries in an attempt to reach the United States in recent years.  

Antogama Honoraí, 23, left Haiti for Brazil in 2019, but there wasn’t work for him there. So he set out for the US, traversing Colombia and Central America before reaching Mexico, where he has stayed for five months so far.

“I’m here because I want to go to the United States and help my family,” he said. “In the United States I have family. Here I’m alone. Here there’s nowhere to sleep. Yesterday it rained all day and I slept in dirty water. I don’t want to go back to Haiti. There’s no school there, there’s no food there, there’s no work….  Returning to Haiti means death.”

Risking everything to seek safety, then being treated like a criminal

“In that jungle you will die if you don’t have a good strategy,” said Louckensia Paul, 28, recalling her journey through the Darién jungle in Panama. “It’s a dangerous place. There are wild animals and routes that are not accessible and difficult crossings. There’s a point where you run out of food and you have to use all your strength to try to get out of there.”

Paul was interviewed in Nuevo Laredo in May, attempting to reach the United States a second time. She had left Haiti years ago and had been living in Chile and then decided to try to reach the United States. In December 2021, after traversing nine countries and risking her life crossing the Darién jungle, she reached the US, spent seven days in US detention and was quickly expelled back to Haiti.

“In Texas, I was put on a bus in chains—around my waist, on my ankles and hands,” she said. “I thought about the entire trip, and the sacrifices I made, for them to do that to me and treat me like a criminal.”

Back in Haiti, her family urged to try to reach the US again.

“It was a pleasure to see them, but it was also sad,” said Paul. “It felt like I was at someone’s funeral because the situation in Haiti is so bad. Everyone told me don’t stay here, do something and go back quickly because here there’s nothing. I’m just thinking about how terrible it is to go back to my country and not be able to feel happy to be with my family because the situation is so bad.”

MSF has repeatedly called for an end to Title 42 and an end to expulsion flights to Haiti on humanitarian grounds. Haiti is in the middle of a humanitarian, economic and political crisis. There is open fighting in the streets of the capital with increasing numbers of people wounded and killed, including by stray bullets, while many are unable to reach medical care or basic needs such as clean water.

No country should be sending people back to Haiti. The US must permanently end all deportation flights and further facilitate access to asylum processes for Haitians.

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The people of Gaza: An Ongoing Suffer

The people of Gaza: An Ongoing Suffer

MSF teams on the ground in Gaza are assessing the impact of Israeli airstrikes on the health system and have donated pharmaceuticals for the operating theaters and emergency rooms of Gaza hospitals.

The closure of the border crossings since 2 August has compromised the entrance of essential medicines and medical supplies. In addition, the closure has led to a severe fuel shortage, which may impact clean water supplies, access to essential services, and the functioning of Gaza’s healthcare infrastructure.

Médecine donations following airstrike

It is essential that the healthcare system has access to fuel and medicine in order for hospitals to function at this critical moment. MSF welcomes any tangible actions that will prioritize the protection of civilian lives, open the border to essential supplies, and in particular lead to a lasting ceasefire. We will continue to work with our partners in the Ministry of Health to provide care to injured people in Gaza, as needed.

In this 4 mini-series, Abdullah, Aseel, Nermin, Shams and Yasmin describe their daily lives as teenagers under blockade and occupation.
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What is Hepatitis C?

What is Hepatitis C?

An estimated 58 million people around the world live with the Hepatitis C virus (HCV). Although HCV is a curable disease, millions don't have access to proper treatment due to high prices, which leads to the death of hundreds of thousands each year as a result of liver complications. Pakistan suffers from the second highest rate of HCV infections in the world. Since 2015, MSF has been running a Hepatitis C programme in its clinic in Karachi’s Machar Colony informal settlement.

Published on August 10, 2022
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