MSF sends supplies to Tartus, offers increased support to all earthquake-affected areas in Syria

MSF sends supplies to Tartus, offers increased support to all earthquake-affected areas in Syria

Two Médecins Sans Frontières (MSF) trucks have reached Tartus, coming from Beirut. The trucks supplied 35 cubic metres of medical kits and around 50 cubic metres of logistics materials as donations to the Syrian Arab Red Crescent (SARC).

Surgical and trauma kits, water treatment units, shelters, and non-food items such as hygiene kits and blankets were donated to the Syrian Arab Red Crescent (SARC) logistics warehouse in Tartus to assist the population affected by the earthquakes in northern Syria.

Two weeks after devastating earthquakes struck the area, impacting thousands of lives, an urgent scale up of humanitarian assistance is needed. This will be the first MSF donation since the earthquake in areas where the organisation’s teams are not present. MSF field teams stand ready to respond directly and provide care to people impacted by the earthquakes in the affected governorates: Idlib, Latakia, Aleppo and Hama.

“Everyone affected should receive immediate humanitarian assistance wherever they are, and we remain committed to doing so, wherever access is granted”, says Ahmed Abdel-Rahman, MSF Director of Operations. “We reiterate the offer made immediately after the earthquake: to send supplies and specialist teams to all affected regions where we are not present”. 

Since 6 February, MSF has significantly scaled up its operations in northwest Syria, where we have been present for more than ten years. This support has included direct medical assistance and essential supplies to the local population, through the hospitals our teams support, as well as the provision of logistical supplies to Idlib and Aleppo. In Türkiye, we are working with local partners on distribution and relief aid assistance.

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MSF aid convoy in relief of earthquake victims enters northwest Syria

MSF aid convoy in relief of earthquake victims enters northwest Syria

The earthquakes that struck south Türkiye and northwest Syria on 6 February have wrought devastation, resulting in a shocking number of deaths and injuries, and causing untold damage to infrastructure in both countries. 

Our teams are on hand, working around the clock to respond to the emergency. Here are four things to know about the situation on the ground…  

A Médecins Sans Frontières convoy of 14 trucks entered northwestern Syria today, arriving from Türkiye through the Hammam border crossing point. This first convoy carries 1,296 tents destined to families (of 5 people or more) left homeless by the earthquake and 1,296 winter kits to insulate the tents from the cold. Other MSF convoys are planned to follow quickly to deliver medical and non-medical equipment.  

However, warns MSF, an urgent increase in the volume of supplies is needed to match the scale of the humanitarian crisis. In the ten days following the earthquake, the number of trucks that crossed the border into northwest Syria was lower than the average number for 2022. Present in the area for more than 10 years, MSF teams have been able to immediately launch an emergency response.  

“We emptied our emergency stocks in three days, donating nearly 12 tons (4,000 cubic meters) of surgical equipment, dressing and medicines to hospitals. Our teams provided support to the health facilities in the area until they were exhausted. We did not see any help from the outside. Aid is trickling in negligible amounts for the moment.”
Hakim Khaldi, head of mission for MSF in Syria

Our teams identified enormous unmet needs in terms of relief.  Access to accommodation and decent hygiene conditions are far from being granted, especially as the 180 000 people newly displaced by the 6th February earthquake add to the two-million people displaced by 12 years of war and already living in precarious conditions. MSF is currently providing relief and medical support to the people living in five reception centers in Northern Idlib (a mobile team provides health care and we distributed tents, water, bread, blankets, mattresses and fire extinguishers). Activities aimed at ensuring the continuity of access to health care for both victims of the earthquake and the general population are starting next week. 

Humanitarian aid provided to the region through the cross-border mechanism has not even matched its pre-earthquake average volume yet. According to UN data, 5 days after the earthquake, only 10 trucks had entered Syria through Bab al-Hawa, a UN-coordinated border crossing point for humanitarian aid from neighbouring Türkiye.  

As of 17 February, a total of 178 trucks loaded with aid provided by six UN agencies had crossed into northwest Syria through Bab Al-Hawa and Bab Al-Salama since the earthquakes eleven days before. In 2022, 7,566 trucks loaded with aid crossed from Türkiye into northwest Syria, which represents an average of 227 trucks for the same period of 11 days.  

Furthermore, part of the 178 trucks that reached Northwest Syria were not part of the earthquake response but rather already-planned deliveries. Even considering 3 days of border closure, the current volume of trucks is barely matching the humanitarian response before the disaster. 

The border crossing of the MSF convoy was possible thanks to the support of Al Ameen, a Syrian NGO partnering with MSF. The delivery was arranged outside of the United Nations cross-border humanitarian mechanism coordinated by the WHO, which does not cover logistical equipment. 

MSF calls for the immediate scaling up of the assistance for the people affected by the earthquake in northwest Syria, in order to address the new humanitarian needs adding to those already prevailing in the area. In particular, priority should be given to supplying shelters and water and sanitation equipment, as well as the medical supplies necessary for post-operative care and to maintain continuity of care, amongst other items which are urgently needed.  

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Four things to know about the earthquake response in Türkiye and Syria

Four things to know about the earthquake response in Türkiye and Syria

The earthquakes that struck south Türkiye and northwest Syria on 6 February have wrought devastation, resulting in a shocking number of deaths and injuries, and causing untold damage to infrastructure in both countries. 

Our teams are on hand, working around the clock to respond to the emergency. Here are four things to know about the situation on the ground…  

1. Medical and relief support remain priorities 

In the aftermath of the earthquake, both medical support and relief assistance are desperately needed in northwest Syria and Türkiye. While providing medical care to injured people and supporting health facilities remains a priority, immediate relief support is also vital. The collapse of buildings has left many people without shelter in very cold temperatures. Therefore, providing shelter, food, blankets, clothes, heating materials and hygiene kits remains a priority. 

With at least 150,000 people becoming homeless in Türkiye, the authorities have identified shelters, non-food items distribution activities and food distribution as immediate needs. 

In Syria, this disaster adds a dramatic layer for vulnerable people in  the northwest of the country, who have witnessed years of ongoing humanitarian crises including war, displacement, a pandemic and a recent outbreak of cholera. The dire consequences of the earthquakes will require an enormous response from the local and international community.

MSF team in #Syria delivered, yesterday, the first 270 kits with non-food items including hygiene items, kitchen kits, winter kits and blankets, in Jandaris area

2. Scaling up emergency response in Syria

In Syria, our teams treated more than 200 patients in the first hours following the earthquakes. We also opened a mobile clinic in Kelly’s reception centre, in Idlib governorate. MSF-supported health facilities in Aleppo and Idlib governorates have so far received 3,465 injured people and recorded 551 deaths. Our teams are offering support to ambulances to facilitate the transfer of patients in need of emergency assistance and have initiated first-aid activities in the facilities we’re supporting and across our mobile clinics. 

In northwest Syria, we have activated an immediate response to support hospitals in Idlib and Aleppo with emergency, trauma and surgical kits, and continue to support hospitals with senior staff from our teams. MSF is currently supporting seven hospitals including a burns unit, in addition to 12 general healthcare centres in the region. We have scaled up bed capacities in our medical facilities by adding tents and dressing points.

In terms of relief assistance, we’re distributing blankets, hygiene kits and food items to target 2,500 families in Jindiris area in Afrin district, Aleppo governorate.

MSF intervention in Türkiye/Syria Earthquake 2023

3. MSF ready to mobilise emergency response in Türkiye 

Our emergency teams are assessing the needs in the most affected areas of southern Türkiye. Hatay, Gaziantep and Diyarbakir appear to be the most affected by the earthquakes. 

We are ready to provide assistance in Türkiye and to mobilise our emergency capacities. We are currently holding discussions with the authorities and local partners to define the framework of our support.

MSF emergency teams are assessing the needs in the most affected areas of southern Türkiye.

4. Insecurity and limited access in Syria hamper response 

After 12 years of war, Syria remains the country with the largest number of displaced people in the world, with 6.9 million people displaced within the country, most of whom are women and children. Our teams operate in Syria where we can, but ongoing insecurity and access constraints continue to severely limit our ability to provide humanitarian assistance that matches the scale of the needs. 

Another challenge we’re facing concerns our ability to replace emergency stocks as soon as possible. This is compounded by the lack of access points to get humanitarian aid into northwest Syria. 

Bab Al-Hawa remains the only humanitarian crossing between Türkiye and northwest Syria, through which essential lifesaving medical supplies can enter the region. However, the route has been compromised as roads leading to the border have been damaged. This will potentially delay the importation of humanitarian and medical aid into Syria, as almost all organisations and actors rely on this crossing for their activities. 

Türkiye/Syria Earthquake 2023

In northwest Syria, MSF is currently supporting seven hospitals including a burns unit, in addition to 12 general healthcare centres and three ambulances for referrals. In addition, we support 11 mobile clinics serving displaced people in camps. We also run water, sanitation and hygiene activities in close to 100 camps across the northwest.

In northeast Syria, we run a general healthcare clinic, non-communicable diseases programmes, mobile wound care and a reverse osmosis plant to provide safe drinking water in Al-Hol camp. We also support a hospital, as well as an outpatient department, emergency room, nutrition programming, and currently have a team engaged in a short-term influenza B intervention in response to high child mortality.

Overwhelming needs as earthquakes hit south Turkey and northwest Syria

Overwhelming needs as earthquakes hit south Turkey and northwest Syria

Following the powerful earthquakes that hit the south of Turkey and northwest Syria on February 6th, Médecins Sans Frontières (MSF), already supporting the population of northwest Syria, has mobilized its team along with local partners to respond to the increasing needs in the area.

Unfortunately, one of our staff members was found dead under the rubbles of his house in Idlib, and others lost members of their families. “We are very shocked and saddened by the impact of this disaster on the thousands of people touched by it, including our colleagues and their families”, says Sebastien Gay, MSF Head of Mission in Syria. 

“Health facilities are impacted and overwhelmed, and the medical personnel in northern Syria is working around the clock to respond to the huge numbers of wounded arriving to the facilities. From the first hours, our teams treated around 200 wounded and we received 160 casualties in the facilities and the clinics that we run or support in northern Idlib. Our ambulances are also deployed to assist the population”
Sebastien Gay, MSF Head of Mission in Syria

MSF provided immediate support to 23 health facilities across Idlib and Aleppo governorates, by donating emergency medical kits and supporting them with medical staff to reinforce their teams.  

Moreover, our teams have donated blankets and essential life kits to the displaced populations in northwest Syria. The level of damage in the region has caused the destruction of hundreds of houses, leaving thousands homeless. It has been snowing the past three days and the population remains outside out of fear of further aftershocks that continued throughout the day. 

“The needs are very high in northwest Syria as this quake adds a dramatic layer for the vulnerable populations that are still struggling after many years of war”, adds Gay. “The massive consequences of this disaster will require an international aid effort that is up to the scale”. 

MSF remains in close contact with the local authorities in northwest Syria and with the authorities in Turkey to extend our support where it’s needed. We are currently assessing the situation and needs in Idlib, northern Aleppo and south Turkey to scale up our response accordingly, as the number of deaths and injuries is increasing by the hour.  

MSF Response to the earthquake on February 6, 2023.

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Published on February 6, 2023

Yemen: Giving birth in the face of persistent obstacles in Taiz

Yemen: Giving birth in the face of persistent obstacles in Taiz

Nogood Mohammad Ahmed Shamsan was lying under the covers of her bed, exhausted. She rested her left hand on her belly trying to provide comfort while she drew long, slow breaths. Next to Nogood was her mother sitting in a chair, making sure that her daughter was comfortable and that she tended to her needs. However, both Nogood and her mother had their heads turned to the side looking towards where the other hand of Nogood was. Under Nogood’s right arm, one-day-old Ahmed was sleeping, grabbing on the nest of blankets that surrounded him.

Nogood was admitted to the post-operative ward of after delivering Ahmed through caesarean section at the maternity unit in the Al-Jamhouri hospital, in Taiz city, Yemen. Doctors Without Borders/Médecins Sans Frontières (MSF) and the Ministry of Health (MoH) have been running the maternal and neonatal services in the hospital together since May 2021. MSF provides technical support, financial incentives to the Ministry of Health’s staff, and medical and logistical supplies to run the maternity unit including services such as caesarean sections, antenatal and postnatal care, family planning, vaccination and neonatal care.

A nearly-collapsed health system and access obstacles

More than eight years of war in Yemen is taking a devastating toll on people in many ways, including the ability to reach quality and timely healthcare, which is becoming increasingly challenging. Fewer than 50 percent of healthcare structures in Yemen are functioning.[1] Most primary healthcare centres are only partially functioning due to lack of equipment, medical supplies, or medical staff. Since 2016, healthcare workers haven’t been paid monthly salaryies on regular basis, forcing many to find alternative employment to make a living. This situation drives people to seek available and free healthcare in the closest possible area – a task that is not always easy.

Like Nogood, many women travel long distances to deliver their babies at Al Jamhouri hospital. “I come from Bani Oman, a village,” said Nogood. “My financial situation is not that good, so I came to Al Jamhouri hospital to have my caesarean section, because it is free-of-charge. There is only one health centre in the village, but it is not good. It is not qualified because of the equipment that is not available there,” Nogood said.

“It took me two hours to come here,” said Bushra Khaleed Abdualrahman*, who is eight months pregnant. Bushra’s brother brought her to the hospital for emergency medical care hospital from Sabr Al Shaqeb area. “The roads are destroyed, and our route is mountainous,” said Bushra. “We live on a mountain, so after the rain the road becomes worse and worse. I was in pain and due to the arduous journey, I became so unwell.”

After many years of fighting, Taiz is still divided in two: Taiz city—controlled by the administration of the internationally-recognized government of Yemen—and the suburb of the city Al-Houban—which is in the Ansar Allah-controlled part of Taiz governorate. The frontline runs through the city is littered with landmines and guarded by snipers. To reach Taiz city, people must take the long, perilous journey through the mountains to avoid crossing the frontlines. Prior to the conflict, it took 10 minutes to reach Taiz city from Al-Houban—now it takes between five and eight hours. This is the route many people have to take to reach free, quality healthcare at the MSF-supported Al Jamhouri hospital.

Pregnant women living in rural areas come to the hospital with high risk and/or complicated pregnancies that could have been avoided, stemming from a lack of consistent ANC antenatal and post-natal and PNC monitoring, either due to absence of the services or the necessary medical specialties and basic equipment, like ultra sound machines, to perform them. Between August 2021 and August 2022, MSF’s team in Al Jamhouri hospital assisted 6,739 deliveries, out of which 4,184 were normal deliveries; almost 29 percent required cesarean sections – an indication of the high number of complex pregnancies arriving to the hospital.

“The first time that I had pain I went to a doctor in my area and they just gave me first aid,” said Bushra.  “There is no equipment or machines and that’s the only thing they were able to do.”

It’s a challenge, some of the high risk pregnancies that come to antenatal care here in Al Jumhouri hospital are coming for the first time. Some of them are already in their eight or ninth month of pregnancy.
MSF's medical team leader in Taiz city, Mduduzi Chandawila

A lack of community health promotion

The nearly collapsed health system, compounded by access obstacles – mainly due to the insecurity and availability and affordability of health services – and the lack of community health promotion of healthy habits such antenatal and postnatal care that can be lifesaving, gravely impact the pregnancies of women and put their life and their babies’ at risk.

“Most of the women that are seen attending our services, for antenatal care for example, are presenting late or they are patients that are at high-risk pregnancies” said Chandawila. “These are women that have had some surgery before, like a cesarean section, some that have done the procedure two or three times. Others arrive with pre-conditions like eclampsia or pre-eclampsia—serious complications that need to be monitored closely and we need to carefully tend to patients that will not do normal delivery.”

MSF provides health promotion to spread awareness about the importance of antenatal and postnatal care. An MSF health promotion team shares information in the waiting areas of the maternity ward while and conducts broader community outreach.

“Through antenatal care, health conditions can be identified early in terms of way to deliver or the mode of delivery, what support they need, and what medication or treatment they need before they deliver,” said Chandawila. Postnatal care is also very important so that we can monitor the progress of the post-delivery period, we can monitor the surgical side, infections and other complications that may develop.”

The maternity unit at Al-Jamhouri hospital assists approximately 520 deliveries per month. After MSF began supporting the maternity unit, there was a sharp reduction in neonatal mortality and increase in antenatal and postnatal consultations. Between August 2021 and August 2022, neonatal mortality rate reduced from approximately 24 percent to 10 percent. Antenatal and postnatal consultations also increased, as in in August 2021, MSF in Al-Jamhouri hospital conducted 1,364 ANC consultations and 86 PNC consultations, whereas in August 2022 it remarkably rose to 1,795 ANC consultations and 527 PNC consultations.

While these numbers are encouraging, gaps remain. Timely access to primary healthcare is vital but remains a challenge, especially for pregnant women who should regularly monitor from the beginning of their pregnancies to avoid medical complications for them and their babies’ and in several cases, prevent maternal and neonatal deaths.

*name changed to protect anonymity

(1) Health Sector in Yemen – Policy Note, The World Bank, September 2021
  WHO – Yemen, HeRAMS report, 2020

MSF denounces Israeli plan to forcibly displace Palestinian residents from Masafer Yatta

MSF denounces Israeli plan to forcibly displace Palestinian residents from Masafer Yatta

Occupied Palestinian Territories, 19 January 2023 – Some 1,000 Palestinians are to be evicted from their homes in the Masafer Yatta area of the West Bank, according to a plan approved by the newly sworn-in Israeli government. The move has been strongly denounced by the international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF), whose teams provide medical care to the area’s residents.

This plan would mean the imminent forcible displacement of almost the entire population of Masafer Yatta. Where are all these families to go? This is completely unacceptable.
MSF head of mission David Cantero Pérez

In the 1980s, Israel designated Masafer Yatta, south of Hebron, as a military firing zone. In the decades since Palestinians living in 12 villages scattered across the region have seen their homes repeatedly demolished and have lived under the threat of forced displacement.

Their situation deteriorated yet further in May 2022 following a ruling by the Israeli Supreme Court which removed all legal barriers to the forced displacement of Palestinians from Masafer Yatta to make way for the military zone. Palestinian officials confirmed that, as of January 2023, most of the residents of Masafer Yatta had received demolition orders and are at imminent risk to be forcibly displaced.

Israeli authorities have put extraordinary pressure on residents of Masafer Yatta to leave the area. As well as demolishing people’s homes, they have installed checkpoints, confiscated residents’ vehicles, and enforced curfews and other movement restrictions. These measures, which have intensified in recent months, have severely impacted residents’ freedom of movement, mental health and ability to access basic services, including medical care, say MSF teams working in the area.  

Sick and elderly patients report being made to wait for hours at checkpoints and being forced to walk long distances to reach clinics. Residents’ movements are restricted even during medical emergencies. “You have to be on the point of dying to be allowed through the checkpoints,” one resident told MSF staff.   

“These measures have severely affected the residents of Masafer Yatta and made their lives unbearable,” says Cantero Pérez. “They live in constant fear. The mental health impact on residents, particularly on children, cannot be understated. In periods where more home demolitions occur, our mental health team receives more people with symptoms of depression and anxiety.”

One elderly woman described to MSF staff the moment that Israeli authorities came to demolish her home for the fourth time in two years: “I felt like I was suffocating, like I was blind, like my hands were tied. My children were in school when the demolition started, they came out to watch. They were in shock, in complete silence.”

Another resident told MSF: “They choose the winter for demolishing houses. Tonight, our family will sleep in the car, or in a tent in the cold. It’s going to be 5 degrees Celsius tonight.”

MSF teams run three clinics in the Masafer Yatta area, providing residents with basic healthcare. This includes mental health support and sexual and reproductive health services, with a focus on women, children and patients with chronic diseases. In 2022, the MSF team provided 3,066 medical consultations in the area.

MSF calls on Israeli authorities to bring an immediate halt to the eviction plan and to stop implementing restrictive measures that impede the ability of Palestinians in Masafer Yatta to access basic services, including medical care. MSF also calls on the international community to take all necessary measures to protect the population of Masafer Yatta and ensure that their human rights are upheld.

“The whole world should know what is happening to us,” one resident told MSF staff. “All we want is to live on our land, in our homes.”

All MSF staff acquitted in military tribunal in Cameroon

All MSF staff acquitted in military tribunal in Cameroon

Buea/Yaoundé (10 January 2023) – The international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF) is extremely relieved at the acquittal of five of our staff, who faced trial in Cameroon, accused of complicity with secession. Four of the staff in question had to endure incarceration for many months.

MSF has categorically denied any complicity with armed groups or parties to any violent crisis or conflict. Our staff are guided by medical ethics – these accusations were groundless from the first instance, especially as the authorities knew exactly how we were providing medical support
Sylvain Groulx, MSF coordinator in central Africa

On 26 December 2021, an MSF nurse and ambulance driver were arrested in Nguti (South-West region of Cameroon), while transporting a patient with a gunshot wound to hospital. After being detained in prison for five months, for the charge of complicity with secessionists, both aid workers were provisionally released in May 2022.

Two other colleagues, a community health worker and assistant field coordinator, were detained in January 2022 under the same charge while another was accused in absentia.

On 1 November 2022, the Buea Military Tribunal ruled “no case to answer”, regarding one of the aid workers in question, citing a lack of evidence. The MSF staff member was released soon after the ruling, having spent 10 months in prison.

Finally, on 29 December, all remaining MSF staff members who had been detained were acquitted – the last of whom was released the following day. A judgement of acquittal was also declared regarding an MSF project coordinator who had been tried in absentia.

“We are enormously satisfied with the judgement that exonerates our five staff members – and, by extension, MSF as an organisation – of any wrongdoing,” says Sylvain Groulx, MSF coordinator in central Africa.

MSF deplores the fact that our staff were forced to endure almost a year of imprisonment, which caused untold distress and anguish for them and their families. 

“Accusing medical personnel for simply doing their job – treating patients in front of them – is simply against all medical and humanitarian ethics and laws,” says Groulx.

In May 2022, following the detention of MSF’s four staff members, our teams made the difficult decision to suspend activities in the South-West region of Cameroon. We are keen to restart our much-needed lifesaving services, but basic preconditions must be met to ensure that our medical activities can be conducted in a safe and secure environment, so that patients and staff are protected.

“Despite our attempts to open a channel of dialogue with the government, to ensure our teams can continue vital activities in South-West region, the government has been unresponsive. This has made it difficult to reach an agreement that ensures working conditions guarantee the safety of our teams and patients,” says Groulx.

“This prevents us from resuming critical lifesaving medical services, which are desperately needed in the South-West,” he says.

MSF teams must be able to provide medical care to every patient in need, in line with medical ethics and following the humanitarian principles of independence, impartiality and neutrality.

“We remain ready to continue discussions with the Cameroonian authorities to analyse the feasibility of restarting medical and humanitarian activities in South-West region under such preconditions.”

In December 2020, authorities suspended MSF medical activities in the North-West region following a series of allegations accusing MSF of supporting local armed groups, which MSF has consistently denied both publicly and in meetings with authorities. This suspension was never lifted and, here as well, MSF remains open to dialogue to restart its medical support for the population.

MSF has worked in Cameroon since 1984 and in the South-West region since 2018. Since 2019, our medical teams in the South-West region have provided more than 400,000 medical consultations, and more than 68,000 consultations in health facilities that we support. In 2021, MSF-supported facilities also assisted 2,284 births. Our ambulance teams, the only emergency referral system in the South-West until activities were suspended, transported more than 8,000 patients for urgent medical care in 2021. 

Suffering and displacement in northwestern Syria

Suffering and displacement in northwestern Syria

The winter season remains a challenging period for the displaced people in northwest Syria. Every year, MSF witnesses the direct health impact of winter through its activities in the camps.

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Published on January 11, 2023

Pakistan: Flood emergency is far from over

Pakistan: Flood emergency is far from over

Médecins Sans Frontières (MSF), also known as Doctors Without Borders, is seeing alarmingly high numbers of patients with malaria and children with malnutrition among flood-affected communities it assists in Sindh and eastern Balochistan provinces, Pakistan.Catastrophic flooding began in June, and the situation remains an emergency, with critical humanitarian needs. The current response is inadequate. The basic needs of people living in the worst flood affected areas such as access to essential food assistance, healthcare and safe drinking water, remain unmet.

MSF emergency response in Sindh and eastern Balochistan

In Sindh and eastern Balochistan, MSF teams are seeing high numbers of people needing treatment for malaria. Despite the colder season, when malaria rates would be expected to decline, we continue to see malaria positivity rates of 50% during December in patients screened in our mobile medical clinics and have treated more than 42,000 patients since October.

The floods have destroyed extensive areas of crops and livestock, which represent the main source of livelihood for many communities. In our mobile medical clinics in northern Sindh and eastern Balochistan MSF are already seeing alarming numbers of acute malnutrition. Since the start of our activities in these regions, we have screened a total of 28,313 children for malnutrition in our mobile medical clinics. Of those screened, 23% (6,489) had severe acute malnutrition and 31% (8,738) had moderate acute malnutrition, comprising more than half of the children who arrived at our clinics.

“We are still in an emergency phase”

‘We are months into this response and our teams in Sindh and eastern Balochistan still see people living in tents and makeshift shelters. In these winter months, people are becoming more vulnerable. While the focus is shifting towards recovery and reconstruction, a scaled-up humanitarian response to meet people’s immediate needs is absent. In December our medical teams continued to see high rates of malaria, acute malnutrition, and skin infections. Humanitarian organisations and government agencies involved in the response must not forget that the situation remains critical,” says Edward Taylor, MSF’s emergency coordinator in northern Sindh and eastern Balochistan. “In the areas where we are working, water has yet to recede, and the emergency medical and humanitarian needs remain high. People urgently need access to food assistance, safe drinking water, healthcare and shelter. We are still very much in an emergency phase.’  

MSF emergency teams are running mobile clinics and malaria teams that visit more than 50 locations per week in the Dadu, Jacobabad, and Shahadat Kot districts of Sindh and Jaffarabad, Naseerabad, Sohbatpur, Jhal Magsi, and Usta Mohammed districts in eastern Balochistan. So far, we have provided basic medical care to more than 92,000 people, mainly for skin diseases, malaria, respiratory tract infections, and diarrhoea.

Returning to destroyed homes and contaminated water sources

Those returning to their villages are finding destroyed houses and land, still surrounded by stagnant water. The devastating loss of homes and belongings impacts people’s mental health, as well as their livelihoods. MSF teams are providing psychological first aid and group counselling sessions to support people during this extremely difficult time.

Meanwhile, those remaining in camps and informal shelters are faced with the encroaching threat of winter. MSF continues to tailor its distribution of non-food items for the season with additional blankets for winter; in the past two weeks, 6,000 households have received these relief packages.

In Sindh and eastern Balochistan, many people whose villages are now accessible found that water sources are still contaminated and they must get drinking water from far away. Crops and food stores have been destroyed, livestock have died, and fields will not be ready for the next planting season, increasing the risk of further food insecurity. MSF teams are continuing to provide safe drinking water to rural communities, with more than 20 million litres provided so far. The teams have also helped to distribute 15,973 hygiene kits to families of remote flood-affected areas.

“Ensuring adequate food, water, sanitation, health care and shelter must be a priority for the international and national response to the catastrophic flooding in Pakistan,” continues Taylor, “many people in affected areas have immediate, urgent needs that cannot wait.”

About MSF in Pakistan

MSF began working in Pakistan in 1986 and now has 1,738 locally hired staff and 53 international staff providing quality medical care to people in Punjab, Balochistan, Khyber Pakhtunkhwa and Sindh provinces. In 2022, over 50 international staff were additionally sent to support the flood response. MSF has been committed to supporting affected communities in Pakistan and has responded to natural disasters over the years. Hundreds of Pakistani staff, including medical and non-medical specialists, have been at the core of this response to emergencies, making it possible to reach those in need.

New decree obstructs lifesaving rescue efforts at sea and will cause more deaths

New decree obstructs lifesaving rescue efforts at sea and will cause more deaths

We, civil organisations engaged in search and rescue (SAR) activities in the central Mediterranean Sea, express our gravest concerns regarding the latest attempt by a European government to obstruct assistance to people in distress at sea.

A new law decree, signed by the Italian President on 2 January 2023, will reduce rescue capacities at sea and thereby make the central Mediterranean, one of the world’s deadliest migration routes, even more dangerous. The decree ostensibly targets SAR NGOs, but the real price will be paid by people fleeing across the central Mediterranean and finding themselves in situations of distress.


Since 2014, civilian rescue ships are filling the void that European States have deliberately left after discontinuing their state-led SAR operations. NGOs have played an essential role in filling this gap and preventing more lives being lost at sea, while consistently upholding applicable law.
Despite this, EU Member States – most prominently Italy – have for years attempted to obstruct civilian SAR activities through defamation, administrative harassment and criminalising NGOs and activists.

There already exists a comprehensive legal framework for SAR, namely the UN Convention on the Law of the Sea (UNCLOS) and the International Convention on Maritime Search and Rescue (SAR Convention). However, the Italian Government has introduced yet another set of rules for civilian SAR vessels, which impede rescue operations and put people who are in distress at sea further at risk.


Among other rules, the Italian Government requires civilian rescue ships to immediately head to Italy after each rescue. This delays further lifesaving operations, as ships usually carry out multiple rescues over the course of several days. Instructing SAR NGOs to proceed immediately to a port, while other people are in distress at sea, contradicts the captain’s obligation to render immediate assistance to people in distress, as enshrined in the UNCLOS.

This element of the decree is compounded by the Italian Government’s recent policy to assign ‘distant ports’ more frequently, which can be up to four days of navigation from a ship’s current location.

Both factors are designed to keep SAR vessels out of the rescue area for prolonged periods and reduce their ability to assist people in distress. NGOs are already overstretched due to the absence of a state-run SAR operation, and the decreased presence of rescue ships will inevitably result in more people tragically drowning at sea.

Another issue raised by the decree is the obligation to collect data aboard rescue vessels from survivors, which articulates their intent to apply for international protection, and to share this information with authorities. It is the duty of states to initiate this process and a private vessel is not an appropriate place for this. Asylum requests should be dealt with on dry land only, after
disembarkation to a place of safety, and only once immediate needs are covered, as recently clarified by the UN Refugee Agency (UNHCR).1

Overall, the Italian law decree contradicts international maritime, human rights and European law, and should therefore trigger a strong reaction by the European Commission, the European Parliament, European Member States and institutions.


We, civil organisations engaged in SAR operations in the central Mediterranean, urge the Italian Government to immediately withdraw its newly issued law decree. We also call on all Members of the Italian Parliament to oppose the decree, thereby preventing it from being converted into law.


What we need is not another politically motivated framework obstructing lifesaving SAR activities, but for EU Member States to finally comply with existing international and maritime laws as well as guarantee the operational space for civil SAR actors.

Signing SAR organisations:
Emergency
Iuventa Crew
Mare Liberum
Médecins Sans Frontières/Doctors Without Borders (MSF)
MEDITERRANEA Saving Humans
MISSION LIFELINE
Open Arms
r42-sailtraining
ResQ – People Saving People
RESQSHIP
Salvamento Marítimo Humanitario
SARAH-SEENOTRETTUNG
Sea Punks
Sea-Eye
Sea-Watch
SOS Humanity
United4Rescue
Watch the Med – Alarm Phone

Co-signing organisations:

Borderline-Europe, Menschenrechte ohne Grenzen e.V. Human Rights at Sea

1. UN High Commissioner for Refugees (UNHCR), Legal considerations on the roles and responsibilities of States in relation to rescue at sea, non-refoulement, and access to asylum, 1 December 2022, available at: https://www.refworld.org/docid/6389bfc84.html.