MSF may start a project when it identifies the existence of a humanitarian crisis, or when it has been invited by the national government or a UN agency to establish a project.
In either case, an exploratory team of experienced MSF personnel visits the site and evaluates the medical, nutritional, and sanitary needs, the political environment, the security situation, transportation facilities and local capabilities. This team reports its findings and recommendations to the operations department in one of our operational offices. The operations department then makes the final decision to intervene and determines the medical priorities, the composition of the team and the materials needed.
Upon starting a project, the following actions are often necessary:
Massive vaccination campaigns
Epidemics often develop in acute emergency situations where a large number of weakened people live in close proximity to each other and in poor sanitary conditions. Yellow fever, cholera, measles, and meningitis are liable to spread in such conditions unless a massive vaccination campaign is launched.
Training and supervision of medical personnel
MSF would be unable to function without local medical personnel. Sometimes, however, well-trained doctors and nurses have fled the crisis area, and those left behind lack adequate training or experience. In these cases, MSF provides additional training and supervision on subjects ranging from primary healthcare to drug prescription, diagnosis and psychosocial care. All training is subject to fixed guidelines to ensure that the same standards are used in all programmes.
Improving water and sanitation
Clean drinking water and sanitary facilities are essential to preventing the outbreak of epidemics in any situation. MSF employs specialists who construct such sanitary facilities using existing water sources, newly dug wells, piping, plastic water tanks, tank trucks and supplies for the construction of toilets.
To keep track of the health of people living in a crisis area, it is important to register medical data, such as mortality figures, the number of patients suffering from certain diseases, degree of malnutrition and so on. These data are generally registered during consultations given at hospitals or outpatient clinics, or during house calls. Sometimes, special surveys are carried out to catalogue certain medical facts.
Therapeutic food for malnutrition crises
Lack of adequate food sources or agriculture often causes malnutrition among refugees or victims of armed conflict. MSF regularly monitors the food situation in the areas where it works. Seriously malnourished children must be administered food under medical supervision. For this purpose, MSF sets up therapeutic feeding centres where children can stay with their mothers. Children whose condition is less critical, pregnant women, and breast-feeding mothers visit the supplementary feeding centres to receive vitamin and mineral fortified food.
Diagnosing and treating ill people is a medical aid organisation’s primary activity. This is mostly done by local medical personnel recruited by MSF and international workers. Experienced staff coordinate the work, provide support and training where necessary, and ensure there is a sufficient supply of drugs and medical materials. When necessary, MSF has set up special programmes to address particular diseases, such as kala azar, tuberculosis, sleeping sickness and malaria. If fighting produces casualties that exceed the capacity of local hospitals, MSF will offer surgical assistance.
Maternal and paediatric care
Women and children are often the most vulnerable groups in the emergency situations in which MSF is involved. Pregnancy check-ups, prenatal care, special feeding programmes, vaccination campaigns, birth control, treatment of venereal diseases, and health education are therefore important parts of the organisation's work.
Distribution of drugs and medical supplies
The supply of drugs and medical materials can be cut off by fighting, dangerous conditions, road destruction, lack of transport vehicles or lack of funds. If that happens, MSF assists in re-establishing the supply chain.
Mental health care
The death of loved ones, terror, witnessing massacres, and suffering from hunger, thirst and cold are but a few of the traumatic events that give rise to serious mental and physical difficulties for victims of conflicts and emergency situations. If help is not forthcoming, trauma victims can suffer protracted insomnia, aggression, headaches, listlessness and other physiological and psychosocial symptoms. As a result, they neglect themselves and their families and have a great deal of trouble starting their lives again. MSF started its first mental health programme in 1991 and psychosocial care has become a component of many MSF emergency and long-term projects.
Rehabilitation of hospitals and clinics
In acute and chronic conflict situations, hospitals and clinics are often devastated through destruction, wear and tear or looting. Where necessary, MSF assumes the task of rehabilitating and re-equipping these buildings.
HIV/AIDS care and prevention
Providing general health information is part of nearly all MSF programmes. In more and more countries, this means addressing the HIV/AIDS epidemic. Poverty, tourism, prostitution, lack of knowledge, lack of money and unwillingness to use condoms have led to an increase in the number of HIV infections. Providing adequate information to dispel local prejudices, pride, and fears, and explaining the use of condoms are challenges that MSF is facing in many of its projects. In addition, MSF has launched pilot HIV/AIDS treatment programmes in several countries to care for HIV positive patients with anti-retrovirals and to prevent mother-to-child transmission of HIV.
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