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We believe in the principal of témoignage - or 'bearing witness' - which means being willing to speak out about what we see happening in front of us.
In MSF, this means willingness to speak on behalf of the people we assist: to bring abuses and intolerable situations to the public eye.
We also believe in openness, honesty and self-reflection as a way to improve our work and world of humanitarian action.
These reports are available to download, please feel free to read, share and let us know what you think.
Emergency now: a call for action beyond summits
MSF’s reflections on the World Humanitarian Summit
In early May 2016, MSF announced its decision to pull out of the World Humanitarian Summit (WHS). The statement published expressed MSF’s lack of hope that the WHS will address the weaknesses in humanitarian action and emergency response, particularly in conflict areas or epidemic situations.
Instead, the WHS’s focus would seem to be an incorporation of humanitarian assistance into a broader development and resilience agenda. Further, the summit neglects to reinforce the obligations of states to uphold and implement the humanitarian and refugee laws which they have signed up to.
MSF has been significantly engaged in the WHS process over the past 18 months, and this report summarises our reflections on some of the key themes in the ‘Agenda for Humanity’ put out by the UN Secretary General.
Our observations highlight the urgent need to overcome the current status quo and develop an adapted fast-track action framework for the countries in West and Central Africa.
Concrete proposals for a catch-up plan to close the treatment gap in West and Central Africa are included in this report, including the call to triple ART initiations by 2020 in countries with less than 50 percent HIV treatment coverage, and to transfer knowledge and experience from places that have effectively rolled-out ART provision.
Return to abuser
'Return to Abuser' uncovers the gaps in services and systems in Papua New Guinea, trapping women and children in cycles of severe family and sexual violence.
The report details how a dire lack of protection mechanisms, a weak justice system and a culture of impunity endanger the health and lives of patients in Papua New Guinea even if they manage to reach medical care.
MSF denounces the European Union’s catastrophic failure to respond to the humanitarian needs of refugees, asylum seekers and migrants in Europe in 2015.
Five years of unrelenting violence in Syria has left thousands of ordinary men, women and children with devastating injuries, yet unable to get the specialist medical care they need in Syria’s overwhelmed field hospitals. In this report, MSF describes the challenges and successes of providing medical care in Jordan to victims of the Syrian war, while MSF’s patients tell their own, often heartbreaking, stories.
According to the Office for the United Nations High Commissioner for Refugees (UNHCR), by 29 October 2015, 705,251 people had arrived by sea to Europe, a huge increase on the 216,054 new arrivals by sea for the whole of 2014.
The crisis comes on top of another crisis, one in part created by the European Union (EU) and its member states’ ever-increasing efforts to "seal off" the continent – i.e. the constant, often silent and sometimes violent pushing-back of people considered to be irregularly entering Europe.
Epidemics: Neglected emergencies?
The Ebola outbreak that hit West Africa in 2014 dominated the headlines for months, eclipsing coverage of other medical emergencies.
It was an enormously important crisis, with many lessons learned during the response phase and with much work remaining to be done. But if we focus too intently on any single disease, we risk overlooking less spectacular but far more common outbreaks of measles, malaria, cholera, and meningitis that take place every year, with profound consequences and loss of life.
On 22 March 2014, an Ebola epidemic was officially declared in Guinea. Over the course of the next year, the virus would infect more than 25,000 people in nine countries and claim more than 10,000 lives, dwarfing all previous Ebola outbreaks. For comparison, the biggest previous outbreak had a total of 425 cases.
This is our accountability report.
A year into the outbreak, many questions abound. How did the epidemic spiral so spectacularly out of control? Why was the world so slow to wake up to its severity and respond? Was it due to fear, lack of political will, lack of expertise, or a perfect storm of all three?
Did MSF make the right choices? How could MSF have done more and saved more lives? What have we learned from this outbreak and what must be done differently in future? There are many questions and few simple answers.
The way in which the Syria war has been fought - and the regional geo-political dynamics that frame it - has resulted in a polarised aid environment.
At the core of the challenges facing MSF institutionally in Syria is the reality that the aid landscape has drastically shifted, and MSF is no longer an insider to the aid system, able to criticise the failings of the system from within, while relying on certain operational alliances with NGOs that essentially have the same ‘principles’.
Philippines Typhoon Haiyan response
Typhoon Haiyan was a major natural disaster that overwhelmed the capacities of the national and local governments in the Philippines. The international humanitarian system mounted a massive response, and, due to the Government’s openness to receive aid, a wide range of actors responded. Despite this MSF’s interaction with them was entirely pragmatic, based on operational need.
This paper attempts to shed light, on the one hand, on the changing landscape of aid actors in Mali with a special attention to the “new” actors; and, on the other hand, to MSF’s relationships (or lack of thereof) with these actors and the factors that shape these relationships.
Pushing the envelope
The Global Fund is by far the biggest contributor to the fight against the three largest killer diseases: HIV, TB and malaria. It gets its funding by donor countries who pool their resources into the Global Fund. It has introduced recently a new model to fund those diseases which is having very concrete impact on the ground, which is what this brief examines.
Considering the Global Fund has a budget of 16 billion dollars in the next four years its new funding model has a direct impact on the 12 million people currently on HIV treatment (it directly finances care for half of the total, six million people), and to the 16 million people who are HIV positive and don’t have access to treatment yet.
Working at the frontline of delivering humanitarian aid, we at MSF are acutely aware of the limitations and deficiencies of the international aid response to crises. Some good work is taking place, and lives are being saved, but much more can, and should be done, to reach those people most in need.
In 2016 the World Humanitarian Summit brought together global experts in aid to consider the structure and funding of humanitarian work in the future. In parallel to this important meeting, MSF is publishing Where is everyone?, a report which diagnoses some of the key issues inherent in the international response to humanitarian crises.
Central to the work of MSF are its patients – the people affected by distress and conflict whom MSF seeks to treat. MSF’s medical and operational staff, both international and national, choose to bring their humanitarian imperative and medical ethics as close to their patients as a medical humanitarian organisation should.
But while MSF ensures proximity to its patients and their communities, it is acutely conscious that crossing the geographic and cultural barriers to be with its patients in times of crisis demands more than medical skill and logistical know-how. Providing optimal medical care to its patients requires detailed understanding of their political and cultural context, their needs and habits, and the impact on them of the crises that MSF is there to address.
2014 is another crucial year for Afghanistan: after 12 years the US-led NATO military intervention in the country has entered its final phase, and presidential and provincial elections are scheduled for April. As the bulk of international troops withdraw before the end of the year, the world's attention is rapidly turning elsewhere.
What interest remains in Afghanistan is firmly fixed on military drawdown, security transition and pre-electoral wrangling. Conspicuously lacking is a focus on the daily reality for Afghans, trapped in an escalating conflict - indeed 2013 was reportedly the second most violent year for civilians since 2001.
Improving paediatric TB care in Tajikistan
Children are, globally, the most vulnerable patient group in tuberculosis treatment and have been neglected for too long.
Estimates for paediatric TB indicate that it accounts for 10-15 percent of all tuberculosis cases in the 22 highest-burden countries and worldwide kills at least 130,000 children each year.
The illness of migration
In this report, Médecins Sans Frontières/Doctors Without Borders (MSF) looks back at 10 years of medical humanitarian assistance for migrants in the European Union and in transit countries.
Our experience shows that restrictive immigration policies make it harder and much more dangerous for people to seek safety and a better life for themselves and their families.
Over the last ten years, as the European Union (EU) has tightened its border controls and increasingly externalised its migration policies, Morocco has changed from being just a transit country for migrants en route to Europe to being both a transit and destination country by default. MSF’s experience demonstrates that the longer sub-Saharan migrants stay in Morocco the more vulnerable they become.
After two years of an extremely violent conflict which has resulted in more than 70,000 dead according to the UN, the Syrian people are faced with a humanitarian catastrophe. Despite repeated requests, MSF has not received permission from the government to work in the country, but has been able to open three hospitals in the opposition-held areas in the north where assistance remains well below the level of the needs.
Violence, displacement and food shortages are salient features of Somalia’s humanitarian landscape. The report draws on the testimonies of more than 800 Somali patients attending MSF medical facilities in Somalia and in Ethiopian refugee camps.
The ongoing crisis in Syria is forcing ever more Syrians to flee their homeland in search of safety.The humanitarian needs of this growing population are immense and continue to grow. Half of the refugees are not receiving required medical care. MSf is calling for immediate steps to be taken to improve shelter and provide aid to new arrivals.
DR-TB drugs under the microscope
Yet the response to the epidemic remains inadequate. With 94 percent of patients at risk of MDR-TB (those previously treated) not having access to tests capable of diagnosing MDR-TB, and only 19 percent of people with MDR-TB having been enrolled on treatment in 2011, the full extent of the burden is unknown and undertreated.
Older people in crisis
There is emerging evidence that the needs of older people in crises have not been properly addressed by emergency aid. There are often very high death rates amongst elderly populations in emergencies, partly due to their inherent vulnerability and partly due to services that inadequately deal with their needs.
Progress under threat
While significant gains made in the fight against HIV/AIDS in the past decade are encouraging, countries most affected by the pandemic continue to struggle to place enough people on treatment and to implement the best science and strategies to fight the disease. The current situation in these five affected countries reminds us that the HIV epidemic is still an emergency in many African countries.
Dadaab: shadows of lives
Dadaab: Shadows of Lives describes the plight of half a million refugees living in increasingly insecure conditions with nowhere else to go, and argues that there is an urgent need to explore alternatives.
Charting MSF's 25 years of experience in diagnosing and treating Chagas disease, sleeping sickness, and kala azar in Latin America, Sub-Saharan Africa, South Asia and the Caucasus, the report examines past, present, and future management of the diseases and discusses the access to quality life-saving treatment.
The forgotten population of Jebel Si in North Darfur is left without healthcare as MSF struggles to continue its medical activities in the region
Lack of information on both the price and the different product characteristics of vaccines has been limiting countries’ ability to operate affordable and effective immunisation programmes.
This publication serves as a resource for immunisation stakeholders, such as donors, implementing partners, and developing countries, which are ultimately responsible for their national immunisation programmes.
The data presented, though being provisional, account for MSF’s medical activities and financial income and expenditures in this region, whereas the narrative sketches how MSF as a medical aid organisation responded to this evolving crisis.
In this report, MSF calls on all key stakeholders to assure quality rapid TB diagnosis, treatment and care, and argues that a scale-up of the decentralised and community-based approach, including access to second-line TB drugs at district level, is the most feasible method of averting Uganada's impending TB crisis.
Maternal death: the avoidable crisis
Around the world women continue to die needless deaths due to medical complications that are preventable or treatable.
This report highlights how limited access to skilled staff, drugs and medical equipment means that a thousand women a day are denied the chance to become mothers.
Urgent funding and assistance must be made available by the international donor community to help Myanmar close the devastating gap between people’s need and people’s access to treatment for HIV and TB.
Central African Republic: state of silent crisis
The Central African Republic (CAR) today finds itself in a state of chronic medical emergency. Five separate retrospective mortality surveys, carried out by MSF and other researchers, in prefectures accounting for the majority of the population, show excess mortality above what is considered to be the “emergency threshold.”
Treating drug-resistant TB: what does it take?
Tuberculosis (TB) is a curable disease that kills nearly 1.45 million people across the globe each year and is the main cause of death for people living with HIV/AIDs. Of the 8.8 million new tuberculosis cases each year, 440,000 are forms of the disease that are multidrug-resistant, meaning they cannot be treated with the two primary antibiotics used to treat TB.
During 2009 and 2010 there were regional outbreaks of measles in central and southern Africa. The measles outbreaks were all distinct in nature, but similar in terms of the burden they represented on health services, and in their ability to cause fatalities. This report aims to highlight the main challenges of dealing with such outbreaks and the ways in which the responses deviated from optimal response strategies, in preparation for developing advocacy strategies for outbreaks of similar scope within the region.
The southern African kingdom of Swaziland is being devastated by a dual epidemic of tuberculosis (TB) and HIV. MSF highlights measures that urgently need to be expanded nationwide, including improved infection control measures and the implementation of new diagnostic techniques.
MSF and Oxfam show how access to newer vaccines and the development of products for developing countries is faltering and failing to provide life-saving vaccines to children in developing countries.
Turkmenistan's opaque health system
The people of Turkmenistan are being failed by their healthcare system, by their government, and by the international community. The system that is supposed to ensure their health is instead designed to conceal problems. This is not a case of individual practitioners failing to do their jobs but one that is far more systematic.
Sexual violence and migration
This briefing paper highlights the problem of sexual violence against Sub-Saharan migrant women, who arrive in Morocco on their way to Europe. Through the data and testimonies gathered in its medical-humanitarian projects, Médecins Sans Frontières hopes to contribute to finding a comprehensive answer to this problem, which increasingly affects more, and younger, women.
Over three million people living with HIV/AIDS in the developing world receive antiretroviral treatment. However, the medicines and diagnostic tools available are inadequate to respond fully to their needs. It is now time to invest in improving the public health approach.
Through this report MSF shares its experience in providing medical care, counseling and other forms of support to thousands of victims of sexual violence in many countries around the world. MSF hopes it will inform and inspire health officials, aid workers and others who should be involved in providing such support.
Chagas: it's time to break the silence
One hundred years since its discovery, many of those infected with Chagas disease are still unaware that they are sick. For one hundred years, Chagas disease has been a silent illness. The time has come to break the silence.
This report highlights the plight of Zimbabweans seeking refuge in South Africa, the appalling conditions in which they live and their ongoing lack of adequate protection, shelter and basic services, particularly healthcare, in South Africa.
Over the past four months, the Thai military has used heightened restrictions and coercive tactics to pressure some 4,700 ethnic Lao Hmong refugees to renounce their claims for protection and accept a forced return to Laos.
Tuberculosis: new faces of an old disease
TB is a deadly killer, responsible for 1.7 million deaths in 2006. The vast majority of cases occur in developing countries. Worse, this ‘disease of the past’ has returned with new faces that are stretching our capacities to breaking point.
Based on observations from our work in Guéckédou and beyond, MSF concludes that the appalling conditions observed in Guéckédou prison are unfortunately not an isolated case.
Beyond cholera: Zimbabwe’s worsening crisis
This report discusses the worsening health crisis emerging in Zimbabwe in the wake of the country's political and economic breakdown.
This report looks at what has been achieved since the establishment in April 2008 of a Task Force on the Global Food Security Crisis, composed of the heads of the UN specialised agencies, funds and programmes, the IMF and World Bank.
Starved for attention: wake up to the crisis of malnutrition
Without access to a wide range of essential nutrients, nine children will continue to die every minute of causes related to malnutrition. MSF calls for food aid to change and for a nutrient rich diet to be made available to children to save millions of lives.
A preventable fate: the failure of art scale-up in Myanmar
Thousands of people are needlessly dying due to a severe lack of lifesaving HIV/AIDS treatment in Myanmar. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the government of Myanmar and other international organisations urgently and rapidly scale-up the provision of antiretroviral therapy.
In a new report launched today, MSF said many more lives can be saved if newer effective strategies to tackle malaria are more widely implemented. The report describes the organisation’s work in Sierra Leone, Chad and Mali, and shows that unnecessary deaths can be avoided with simple, affordable treatment and diagnostic tools available today.
HIV/AIDS treatment and management are essential components of many MSF programs worldwide. Currently MSF provides antiretroviral therapy (ART) for over 140,000 patients in 27 countries, with about 10,000 of those patients being children. In conjunction with this year’s International AIDS Conference in Mexico City, this document presents MSF’s current “state of play” in providing quality care to people living with HIV/AIDS (PLWHA) in resource-limited settings.
Thousands of people risk their lives every year to cross the Gulf of Aden to escape from conflict, violence, drought and poverty.