DispatchesM S F C A N A D A N E W S L E T T E R

Vol.9, Ed.1

IN THIS ISSUE

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1999 Nobel Peace Prize Laureate

Living in fear:Colombia’s cycle of violence

First day in Habilah

Upholding impartialhumanitarian action

Emergency responseand creative solutions

Not a single pill

Eyes in the field: Providing care andbearing witness

Knowing Marilyn ... Introducing MSF Canada’s new general director

COLOMBIALIVING IN FEAR

Colombia is a thriving country with alively culture and growing level of

progress. It has modern cities, flourishingscientific and education centres, and theglobal aspirations of a decidedly developedcountry. Behind this upbeat image, anextremely violent internal conflict has car-ried on unabated for four decades. Fuelledby drug trafficking and foreign militaryassistance, the struggle by guerrillas, para-military groups, and government forces tocontrol territory and resources continues totake a high toll on the civilian population.The human cost is immense.

Massacres, executions, intimidation andthe massive consequent fear have becomean inescapable part of everyday life forColombians living in conflict-affectedareas. The homicide rate for malesbetween the ages of 15 and 44 stands ata startling 221 per 100,000. Violence isnow also the leading cause of death forwomen between 15 and 39 years old (17per 100,000), overtaking complicationsfrom pregnancy and childbirth.

However, the impact of violence cannot bereduced to a simple body count. For everyperson killed a family is left behind: chil-

dren without parents; parents withoutchildren; a wife without a husband; fami-lies without an income or a home. Forevery person who dies as a result of vio-lence, many more struggle to survive it,often burdened by a range of physical andmental health problems.

“It is difficult for MSF [Médecins SansFrontières] to speak out about the situa-tion in Colombia because we must takeinto account the safety and potentialthreats to our staff, or worse yet, to thepeople we’re trying to help,” says PaulMcPhun, former head of mission withMSF in Colombia and now operationaldirector for MSF in Canada.

Arguably, the most worrisome feature ofthis conflict is the way in which violencehas become entrenched in every aspect ofsocial life, normalized in daily existence.The weight of this burden and its negativeimpact on people’s well-being and qualityof life cannot be overestimated.

People who live in conflict zones in ruralColombia are often perceived as support-ers of the armed actors who operate local-ly. In this way, ordinary citizens become

stigmatized and identified with armedactors on all sides of the conflict. This sit-uation creates not only a direct threat totheir lives but also limits their ability totravel safely, even in cases of a medicalemergency. Due to the conflict, healthservices barely exist in these isolated com-munities. Immunization programmes failto extend vaccination coverage into ruralColombia, with coverage rates for somediseases such as polio as low as one percent. The resulting risk of infection or out-break constitutes a severe public healthrisk to populations in some of these areas.

People forced by violence to flee their ruralhome areas typically settle in urban slums.There they must struggle against the harshconditions, lack of opportunity and ram-pant violent criminality of the urban slumenvironment. Their displacement sadlycreates another form of stigma, a mark forlife, to the point where many displaced areunwilling to register for assistance pro-grammes out of fear of the stigma. In theseslums, provision of health services for dis-placed persons is inadequate. Vaccinationcoverage among displaced populations isdisproportionately lower than nationalaverages. Even so, the far greater risk of an

Dispatches Vol.9, Ed.1

LIVING IN FEARCOLOMBIA’S CYCLE OF VIOLENCE

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outbreak of infectious diseases comesfrom the appalling living conditions.

Physical health is already one seriousissue. Yet the greatest health impact of theconflict among the displaced is upon theirmental well-being, and consequently upontheir ability to adjust and cope with the for-midable challenges of flight, displace-ment, and return. Ironically, men-tal healthcare receives woefullylow priority in these places ofgreatest need, and someprovinces have few psychologistsavailable to provide clinical care.

The return of internally dis-placed people to their homeareas is often perceived as apositive development, an escapefrom displacement and a returnto “normality” for the familiesinvolved. Although this may be the casefor some, return is often a traumatic expe-rience, one presenting new threats andcontinued instability, with a demonstrableimpact on people’s mental state. In theend, Colombia’s cycle of violence oftentransforms the salvation of return into yetanother phase of temporary displace-ment. Programmes promoting return bythe government and independent agen-cies should be scrutinized to ensure theyrespond effectively to the complexity ofthe problem.

MSF has worked in Colombia since 1985,providing medical care to civilian popula-tions isolated by the conflict, and morerecently to those internally displaced inurban settings. More than 40 internation-al staff and 150 Colombian staff provideassistance to thousands of people affect-ed by the ongoing conflict in various partsof the country.

It is hard for the MSF workers to deal withthe volume of violence their patients aredealing with, says McPhun. Even staffhave counselling and debriefing every fewmonths to help them cope with what theysee and hear.

In the northeastern province of Norte deSantander, MSF conducts medical out-reach activities in isolated rural areas, pro-viding general consultations, vaccinations,reproductive health care, psychosocial careand dentistry.

In Cordoba province on the northwesterncoast, MSF staff use mobile clinics toprovide healthcare to people living inremote rural villages. The teams offerbasic healthcare, prenatal care, maternaland child healthcare, dentistry, and psy-cho-social support. In addition, the teamsalso treat people with malaria and cuta-neous leishmaniasis.

In northeastern Sucre province,MSF has set up a clinic in theurban slums of the city of Sincelejoto provide urgently needed care tothe local population. MSF teamsare also working in rural and urbanareas in the provinces of Caqueta,Choco, Narino, Tolima, Huila, andin Bogota.

MSF is trying very hard throughits work to monitor the health

of Colombians affected by the violence,says McPhun. “We must not let this be asilent conflict.”

MSF reportLiving in fear: Colombia’s cycle of violence

Go to www.msf.ca to read the full MSF report, which includes photos as well as stories of Colombians affected by the conflict.

We’ve been here for a year and still we’re notwell. When the dogs bark my husband getsup and sits out on the patio to see if some-one is coming. There are more nights that wedon’t sleep than we do. How are you going toforget the things you saw, the people theykilled? I only sleep when I go somewhereelse. It’s a nightmare here. People says thatthose people will come back.

— A woman living in a community of return

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Dispatches Vol.9, Ed.1

L e t t e r f r o m t h e f i e l d

Iarrived yesterday by helicopter and hadmy first small tour of Habilah while flying,

while landing, then once on the ground.The village is surreal, with an earthly beau-ty in spite of its history and its poverty. Thelandscape and all structures upon it areshades of brown and red, caked with thedust that permeates the entire atmosphere.

The people, however, dress in brilliant,vibrant colours that show an incredible con-trast with the setting. Men in white hats

and long, white robes sit on the sides of theroad in the shade, mostly telling the chil-dren who are following us to leave us alone.The women walk down the “roads” carryinghuge bundles of wood or pots on theirheads and babies strapped to their backs.The children run around barefoot sportingtorn, filthy clothes. These children don’t fitthe criteria for being malnourished, butthey certainly aren’t anywhere close tobeing considered well-nourished. This is indanger of changing when the UN World

Food Program cuts the food rations in halfdue to a lack of funding. There has alreadybeen a big increase in the number of chil-dren being admitted to the Médecins SansFrontières (MSF) therapeutic feeding cen-tre at the hospital.

Each dwelling is set apart by a fence ofsorts, some of them made with wovenstraw, some with brick, others with dried,spiky brush. Each fence encloses a perfectsquare, and within that square compound

FIRST DAY IN

HABILAH Photography by Amy Osborne(pictured here, top left) and MSF

are the tukuls (huts) of the people. Someare fairly well built, while others lookthrown together with whatever materialhappens to have blown by. The village ofHabilah, once home to around 5,000 peo-ple, has swelled to around 25,000 with theinflux of internally displaced people (IDPs).However, rather than living separately fromthe villagers, the IDPs here are integratedinto the village, making it hard to know whois displaced and who isn’t. Over the pasttwo and a half years, the people have start-ed to try to make a life for themselves here.

MSF hospitalOur little hospital is adorable. I got to meetour staff, and see the different sections ofthe hospital, getting a small idea as to whatit is that we’re doing here in Habilah.

There are examination rooms for the outpa-tients who come in daily for the moreminor illnesses and injuries. The inpatientward is where the patients who have to beadmitted stay. One of the patients in theward is a beautiful 10-year-old boy whosehand was blown off when he picked up andplayed with a random grenade — the thirdvictim from his village in the last littlewhile. He lay in his bed with one stumpand his three remaining limbs wrapped inwhite gauze and he still managed to giveus a blinding smile.

When we got to the women’s centre, thewomen I’m going to be working with cameout dancing and singing, while one of thememitted what sounded like a high pitchedwar-cry. One of them came running to hugme and they started to show me the small,handwritten signs on their clothes that read,“well come mrs Amy.” There’s a little roomwith two beds for the women in labour, anda small adjoining room for deliveries.Behind the two rooms is a private courtyardwhere the labouring women can walkaround, rinse off or use a private latrine.

We went to the TFC next, which is the ther-apeutic feeding centre. One large tent con-tained 10 small, malnourished children,each with a mother or older sister to care forthem. They stay all day so the families canbe taught how to care for them (and so themother doesn’t divide the food between her

other hungry children) and at 5 p.m. theygo home with a bag of food for the night.Once the child reaches a level of “moder-ate” malnutrition, they graduate to the SFC(supplementary feeding centre), where thefamily comes to pick up two weeks worth offood at a time.

Next we saw the small room that has beenconverted to an operating theatre. Surgicalcases are referred to El Geneina, WestDarfur’s provincial capital, unless it’s nightand travel is forbidden, or it’s a life or deathemergency. The last surgery was a C-sectionon a woman who had an obstructed labourfor two days. When she went into shock theteam set up an impromptu operating tableand performed the surgery. My first real con-versation with Andi, the logistician, was himtelling me about standing over the table, try-ing to hang a light so they could see what

they were doing, and looking down andmaking eye contact with the patient, andhow it felt when they delivered her of a deadbaby, then lost her as well three hours later.Not something that a former businessmandeals with in Austria very often.

My team here consists, thus far, of myself,Carmenza, Milena and Andi. Carmenza is adoctor from Colombia, Milena is a nursefrom Switzerland, and Andi is the formerbusinessman from Austria.

Amy OsborneMidwife

Habilah, Darfur, Sudan

Amy Osborne is a midwife from Vancouver, British Columbia. She spent five months working with MSF in Darfur in 2006.

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Dispatches Vol.9, Ed.1

The desire and ability to make impartialchoices are at the core of humanitari-

an action. What does impartiality mean?Like triage, impartiality focuses on thegreatest human suffering. Impartial deci-sions are based on the level of need ratherthan factors such as ethnicity, religion,political affiliation, economic status ornationality. Impartiality is an integral ele-ment of both medical ethics and the prin-ciples of humanitarianism.

Within the context of humanitarian emer-gencies, the desire to make impartialchoices is increasingly being underminedin various ways.

First, long-term objectives such as recon-struction, peace, good governance, democ-racy and stability can be compromised byimmediate impartial choices to alleviatehuman suffering. During the civil war inSierra Leone, for example, there was mas-sive suffering and unmet needs in therebel-controlled zone. Many aid agencies,as well as the UN, refused to operate in the

rebel zone, fearing their operations wouldprop up the notorious rebel group.Médecins Sans Frontières (MSF) chose tohave part of its operations in the rebel areadue to the magnitude of human sufferingwe witnessed there. We disregarded thepolitical pressure not to do so. It can be dif-ficult to establish peace and democracy orlong-term protection without sacrifice.Impartial humanitarian action, by its defini-tion, seeks those that are sacrificed.

Second, strategic objectives relating tonational political interests make it difficultfor states and their military to make impar-tial choices. Western governments increas-ingly speak about a three-pronged approachin failed states where states engage simul-taneously in three activities: provision ofassistance to civilians (sometimes referredto as humanitarian action); diplomacy toencourage stabilization; and military com-bat or peace operations. This kind of policytries to align various aspects of government(diplomacy, development, defense) behindthe general strategic objectives. Within this

mind-set, addressing immediate humansuffering will not be prioritized unless doingso helps achieve the original objectives.

Third, the desire to make impartial choic-es can be clouded by the increasinglycomplex working environments in whichhumanitarians do their jobs. It is easy tolose sight of priorities. The MSF team inKatanga, Democratic Republic of Congo,launched a nutritional survey in 2006after alarming observations of malnutri-tion in the province. The UN health coor-dination group decided to block and boy-cott the results of the survey on the pro-cedural bureaucratic grounds that MSFhad not asked the coordination group forpermission to proceed. If actors at thefield level spend most of the time attend-ing coordination meetings and writingreports, obvious priorities such as the pro-vision of life-saving food and medical carewould take a back seat.

The ability of humanitarians to carry outimpartial action is also being undermined.

UPHOLDING IMPARTIAL

H u m a n i t a r i a n a c t i o n

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Security concerns can quickly underminethe ability of MSF to access populationswith the greatest needs. Neutrality, bothreal and perceived, is crucial. Localarmed actors must accept the presence ofMSF. This acceptance is easily compro-mised, however, if one side in a conflictlays claim to all humanitarian work. Bydoing so, the opposing armed group mayfeel justified in targeting humanitarians.Early in the war in Afghanistan, for exam-ple, coalition forces dropped leaflets onTaliban areas in the south. The leafletsstated: “The attacks on allied forces arean obstacle to delivering humanitarianaid to your area.” The message was that iflocals cooperated with coalition forces,they would receive aid. Aid cannot beseen as impartial when it hinges on coop-eration with military forces. This type ofblurring of lines not only kills humanitar-ians, it also kills the ability to impartiallyalleviate suffering.

The difficulty humanitarian groups expe-rience in carrying out impartial assistance

is also exemplified in the ongoing conflictin Darfur, Sudan. The UN SecurityCouncil called for a UN peacekeepingforce (Aug. 31, 2006, resolution 1706)to assist or replace African Union forcesin Darfur. The Sudanese governmentrejected the UN force. The resulting ten-sions have transferred to the field level,with some armed groups supporting theUN mission and others rejecting it. MSFand other humanitarian organisations onthe ground are caught in the middle andunfortunately have experienced increasedtargeted attacks and a decreased abilityto assist populations in need.

Financial restraints can also hinder impar-tial action. Nongovernmental organisa-tions that rely on governments (or evenmilitaries) to carry out their action caneasily find their work controlled or influ-enced. Thankfully, MSF has a strong pri-vate donor support and can make inde-pendent, impartial choices with minimalexternal influences. In India-controlledKashmir in 2004, MSF received institu-

tional funds from the humanitarian branchof the European Union (EU). The EU wasperceived as a neutral player in the con-flict. When the EU began taking politicalstatements regarding the situation in theKashmir, MSF decided to suspend thatfunding. This action allowed MSF teamsto continue a transparent dialogue withthe various players in the conflict withoutthe negative impact of perceived bias.

Now more than ever MSF must upholdimpartial humanitarian action. To do so,MSF must continue to operate inde-pendent of all economic, political andreligious affiliations.

Humanitarian action is and must remainmotivated by the unacceptability ofhuman suffering, and the desire to dosomething about that suffering.

Kevin CoppockProgramme officer

HUMANITARIAN ACTIONS

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On July 12, 2006 war broke out betweenIsraeli military and armed Hizbollah forces

from Lebanon. Retaliatory air strikes andground offensives against Lebanon destroyedinfrastructure, effectively cutting it off from theoutside world. Assistance was offered on theIsraeli side dealing with civilian deaths andinjured from rocket attacks; however the natureof the conflict was such that there were greaterneeds and less available assistance in Lebanon.

Médecins Sans Frontières (MSF) was nolonger present in Lebanon and restartingoperations from zero was no easy challenge.“At the beginning of the war it was not clearhow it could evolve,” says Jean de Cambry,

head of the MSF emergency response teamfor Lebanon.

Israel imposed a sea and air blockade at the start of the month-long war. At the same time, air strikes hit several bridgesand important roads, trucks, vans, ambu-lances and cars were targeted several times,making any land transportation for Lebanonextremely difficult and dangerous.

“The international airport of Beirut had beenbombed several times and wasn’t function-ing anymore,” says de Cambry. “To find agood and safe point to cross the Syrian bor-der was not that easy; and sea checkpointsmade it very long and sometimes impossibleto reach Lebanon from Cyprus.”

While the first difficulty, how to get peopleinside Lebanon, was partially and temporarilyovercome, the bringing in of humanitarian aidand organising internal transportation provedto be extremely problematic throughout thewar. The first major problem was getting hugequantities of medical and logistical materialsinto the country. The only way to do so was byboat from Cyprus. But by the end of July morethan 100 tonnes of material were stacked onthe island because there were no civilian boats

linking the two countries anymore. At thatpoint, by accepting the Greenpeace offer touse the Rainbow Warrior to transport the mate-rial, MSF was able to get around this furtherobstacle.

The problems of internal transportationrequired another creative solution. Sincetrucks and vans were targeted and it wasimpossible to find anybody willing to drivethem to the south, MSF set up a system oftaxis. Small convoys composed of three carswere organised to transport materials on aregular basis from Beirut to other placeswhere MSF teams were working.

During the conflict bombing completelydestroyed bridges on the Litani River, a geo-graphic division separating north and southLebanon. This posed yet another challenge fordelivering aid to some of those in need.

“One day, when there was a lull in the bomb-ing for 24 hours, my driver George and I drovewest along the river looking for a crossing. Wedrove for five hours, going down every majorand minor road only to find a crater in the roador a blown up bridge. In the end, we got as faras the coast without seeing a person or anextant crossing of the river. At the coast themain bridge had been blown up days beforeand a temporary sandbridge had been erect-ed,” remembers Adam Childs, MSF head ofmission in Lebanon.

On Aug. 7, 2006 MSF set up a human chainacross the Litani River, and from hand to handto hand moved three trucks worth of medicalsupplies to MSF teams on the other side.

Throughout the conflict more than 60,000people displaced in Lebanon and 3,500refugees in Syria received relief items such ascooking and hygiene kits, mattresses, blan-kets, bed sheets, baby formulas and tents.More than 300 tonnes of material were sent toBeirut, including relief items, medical supplies(material for dialysis, medicines, surgical kits)and logistical materials (sanitation equipment,water bladders).

Sergio CecchiniEmergency press officer

All MSF activities in Lebanon werefinanced through private funds.

Emergency responseand creative solutions

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A c c e s s t o e s s e n t i a l m e d i c i n e

As reported previously in Dispatches(Summer 2005), Médecins Sans

Frontières (MSF) in Canada has beeninvolved in trying to ensure that Canadianinitiatives to allow the export of genericversions of patented essential drugs wouldlead to drugs for patients in developingcountries. This would happen under a so-called compulsory licence to developingcountries, part of the JCPA. Once theCanadian framework was in place in mid2004, MSF committed to placing an orderunder the legislation. Despite optimismthat this legislation could deliver, the pastfew years of effort have not borne fruit.

International rules unworkable in practiceApotex, a Canadian generic company,developed a combination AIDS treatmenturgently needed in developing countriesin April 2005. However, we have still notmanaged to get this drug out of Canada.The reasons stem from the complexity of

the legislation and bureaucracy. TheCanadian rules are based on a tortuousinternational decision. In particular, thisdecision (referred to as the August 30thDecision) requires a series of negotiationsbetween the generic manufacturer andthe pharmaceutical company holding therights to the drugs. In practice, this hasmeant interminable discussions mired inlegalistic squabbling stretching overmonths. Meanwhile, patients who couldbe saved by Apotex’s formulation contin-ue to die.

Negotiations combined with potential expo-sure to lawsuits and overly stringent meas-ures to prevent the diversion of drugs backinto developed markets (which is irrelevantas these drugs hold no appeal for developedmarkets) have eroded away the interest and confidence of Apotex. In turn this dis-courages the already lukewarm Canadiangeneric companies from participating.

The Canadian compromiseAs if the international framework were not already complicated enough, theCanadian rules have added additionalhurdles. They restrict which medicinescan be exported under the legislation,they require drugs to be approved byHealth Canada — something not requiredby international trade rules — and theylimit the quantity and export of drugseven further.

The Canadian legislation was a compro-mise legislation from the start. It attempt-ed to find middle ground where no middleground can exist. Trying to balance theinterests of a for-profit pharmaceuticalindustry with the interests of patients inpoor countries dying at catastrophic rates— one child dies every 30 seconds ofmalaria; 8,000 people die every day fromAIDS, and the list goes on — is untenablefrom the start.

NOT A SINGLE PILLNot a single pill. So ran the headlines in Canada during the XVI International AIDS Conference in Toronto inAugust 2006. Since coming into force in 2004, not one drug has been exported under Canada’s Jean ChrétienPledge to Africa (JCPA). This fact became a major Canadian media story during the AIDS conference and led toa commitment from the Conservative government to “immediately” review the legislation.

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Hope for change at IACBy May 2006, it was clear to MSF thatthe legislation was an ineffective andinadequate solution to the global accessto medicines crisis. The InternationalAIDS Conference in Toronto was to be theideal time for MSF and other Canadiannongovernmental organisations to provethe impotence of the Canadian and inter-national access to medicines rules.

During the conference, MSF released areport entitled, Neither expeditious nor asolution: The WTO August 30th Decisionis Unworkable, with its two-fold message:

• The August 30th Decision was a fail-ure and had to be urgently reviewed bythe WTO member states on the basisof the Canadian attempt to implementit domestically.

• The Canadian government had tourgently revise the Canadian legisla-tion to ensure medicines could beexported to developing countries.

New promise by Canadian government?By the third day of the AIDS conference,the Canadian Minister of Health, TonyClement, announced that he would “launchan immediate review of why Canada has

failed to deliver on its pledge to get low-costAIDS drugs to countries in need.” (TorontoStar, 16 Aug 2006, front page).

At the time this publication went to print,four months after that statement, nothinghas happened. A consultation paper, prom-ised to kick off the “immediate” review, hasyet to be issued. Such a consultation risksbecoming another untenable compromiseputting patients lives into the balance withcorporate profits.

What next?It is clear that the Canadian governmenthad to revise the JCPA (also known now as the Canadian Access to MedicinesRegime). But this should mean more thanmerely tinkering with a few clauses hereand there. The legislation must be funda-mentally overhauled, this time keeping theurgent needs of patients in developingcountries at the heart of the legislation.This means seeking innovative solutionsthat go beyond the text of the internationalrules which we know to be unworkable. Italso means not making compromises on theobjectives by kowtowing to the corporateinterests of the pharmaceutical industry.

The international economic community,which so publicly committed to “ensuringaccess to medicines for all” in its DohaDeclaration in 2001, has to take notice ofwhat happened in Canada, of the factthat despite the implementation of thelegislation in five countries, not a singlepill has gone out under these provisions.It has a responsibility to remedy the situ-ation, urgently.

Meanwhile MSF will continue to try andmake the drug order a reality and push theCanadian government and internationalactors to make the international rulesmeaningful for patients in poor countries.But the time for compromise is past. Newsolutions have to be found. Everybodyrecognises and acknowledges the problem.Government and pharmaceuticals have thepower to change the situation. It is time forthem to do just that.

Rachel Kiddell-MonroeAccess campaign coordinator

Dispatches Vol.9, Ed.1

© Spencer Platt/Getty Images

© Kenneth Tong

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C h a d

Irecently spent nine months working inChad as a logistician with Médecins

Sans Frontières (MSF). During that time Iprovided support to refugee camps, aswell as aid to some local and outlying pop-ulations. I spent time at MSF’s Hadjer-Hadid project in eastern Chad, includingrefugee camps in Breijing and Farchana.

MSF's Hadjer-Hadid project providesassistance to two main groups: Sudaneserefugees who have fled the tragic ongoingevents in Darfur, and internally displacedChadians in the unstable Chad/Darfur bor-der area fleeing violence and attacks fromarmed forces in the conflict in Darfur.

What this actually means is that basichealthcare is provided for two largerefugee camps, Breijing and Farchana, inclinics run by MSF. As well, mobile clinicsand other outreach activities such as vac-cination campaigns to the border area arealso carried out. At the time I was there,there were approximately 27,000 peopleliving in Breijing camp, and roughly17,000 people in Farchana.

One of the most shocking things for anewcomer like me was the normalcy ofthe camps and the very humbleresilience of the refugees. It's not allcrushed defeat and desperate horror,

although that exists. But people also gethappy, sad, confused, married, angryand hopeful.

I found humanitarian work to be asmuch about the simple gesture of soli-darity being made as it is about actualprogramme objectives. Even for a med-ical organisation like MSF, for instance,the act of really and sincerely “beingthere” and establishing proximity (mucheasier said than done) is just as impor-tant as offering health services.

Text and photography by Omar Odeh

EYES IN THE FIELDPROVIDING CARE AND BEARING WITNESS

BELOW LEFT: A local staff nurse gives a shot to a patient seen in the observation unit at the Breijing refugee camp

health centre. BELOW RIGHT: A mother and her child at the foot of a water reservoir in Breijing camp.

Dispatches Vol.9, Ed.1

TOP LEFT: Nurse Benoit Wullens treats a three-day-old gunshot wound in a village about 15 minutes from Alacha.

TOP RIGHT: Local MSF nurse Brigitte (white tshirt) conducts triage at a mobile clinic in Alacha. BOTTOM: A child

with acute conjunctivitis awaiting treatment at a mobile clinic in Borota village.

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TOP: MSF driver Abakar translates followup care instructions to a patient recovering from a bullet wound to his leg.

BOTTOM LEFT: South-looking view of a section of Farchana camp. BOTTOM RIGHT: A mother and child during

supervised feeding at the nutrition centre in Breijing camp.

Dispatches Vol.9, Ed.1

“They knew what they were gettingwhen they hired me.”

That’s the kind of line Marilyn McHargdelivers with a mirthful smile. There’s

no question McHarg comes to the generaldirectorship of Médecins Sans Frontières(MSF) in Canada with a global reputation.Nine years of field experience coupled withseveral years of MSF leadership positions inEuropean capitals have earned her a certainrenown. Time and again, her colleaguesthroughout MSF openly share their admira-tion for McHarg. Clear. Quietly authorita-tive. Compassionate.

McHarg was among the founders of MSF inCanada back in 1990 when Dr. RichardHeinzl succeeded in bringing the thenEurope-based organisation closer to home.She was working as an intensive care unitnurse in Toronto at the time.

Being a Canadian section founder, howev-er, was not enough to win the confidenceof recruiters at MSF in Holland. Theyrejected her first application to work in thefield on the grounds that she lacked expe-rience in a developing country. McHarg got

herself a backpack and a plane ticket. Shetravelled solo throughout Africa for sixmonths, stopping by MSF missions as shewent. It worked.

In May 1991 McHarg began an overseasjourney that would last 15 years. She start-ed as a field nurse in Soroti, Uganda. Shethen went to Sudan, a country that capti-vated her heart. She spent time in NorthernSudan, including Darfur – training othernurses and working as MSF’s medical coor-dinator in Khartoum. She went on to be amedical coordinator in south Sudan. Shewas medical coordinator and head of mis-sion in Liberia, as well.

McHarg returned to south Sudan for sever-al more years, most notably as head of mis-sion overseeing nine clinical sites acrosstwo factional lines in the conflict. Thatlongevity went a long way toward establish-ing her credibility in the MSF headquartersin Amsterdam and in Geneva, whereMcHarg has held leadership posts since theyear 2000. Most recently, as director ofoperations for MSF in Switzerland, she wasresponsible for missions in 20 countriesand a budget of $50 million.

Now she’s home again. The new generaldirector commutes to the national office inToronto from her house near Hamilton.There are many demands on her time, bothfrom her counterparts in other MSF sec-tions around the world and from the teamshe is leading in Toronto, Montreal, Ottawaand Vancouver.

Being a known quantity ought to make iteasier. McHarg has been earning respectsince her first MSF mission in Uganda,when armed gunmen barged into the com-pound for a looting. The gunmen made itclear they were not happy with the results.They wanted more. “Will you take the med-icines?” she offered. They expressed shockat her suggestion. “We can’t take your pills.You are treating our own families!”

With Marilyn McHarg, MSF Canada getsthe sang froid of a field veteran, thecompassion of a nurse, the pluck of abackpacker, and the experience of a CEO– all in one.

Avril BenoîtMSF director of communications

M S F i n C a n a d a

Knowing Marilyn…INTRODUCING MSF CANADA’S NEW GENERAL DIRECTOR

© Kenneth Tong

© MSF© MSF

DispatchesMédecins Sans Frontières/

Doctors Without Borders

720 Spadina Avenue, Suite 402 Toronto, Ontario, M5S 2T9

Tel: 416.964.0619Fax: 416.963.8707

Toll free: 1.800.982.7903Email: msfcan@msf.ca

www.msf.ca

Editor:linda o. nagy

Editorial director:Avril Benoît

Copy editors:Corinne Cécilia

Daniel IvorraGregory Vandendaelen

Contributors:Avril Benoît, Sarah Burdeniuk,

Sergio Cecchini, Kevin Coppock, Rachel Kiddell-Monroe,

Omar Odeh, Amy Osborne

Circulation: 80,000Layout: Artshouse Communications Inc.

Printing: Warren's Imaging and Dryography

Winter 2007

Cover photo: Stephan Vanfleteren

ISSN 1484-9372

page 15

CANADIANS ON MISSIONAANNGGOOLLAAFrank Boyce

AARRMMEENNIIAARobert Parker

BBUURRUUNNDDIIFanny Morel

CCAAMMBBOODDIIAACarlo Testa

CCEENNTTRRAALL AAFFRRIICCAANNRREEPPUUBBLLIICCMarie-Claude AllyLaura ArcherAnnie DesiletsSylvain DeslippesBenoît ÉmondIvan GaytonSherri GradySylvain GroulxJean-François HarveyMélanie Marcotte

CCHHAADDIsabelle ChotardGeneviève CôtéMarise DenaultLori HuberClaudine MaariDavid PonkaJames SquierGrace Tang

CCHHIINNAAMichelle Chouinard

CCOOLLOOMMBBIIAATyler Fainstat

DDEEMMOOCCRRAATTIICC RREEPPUUBBLLIICCOOFF CCOONNGGOOLindsay BrysonMatthew CalvertErwan ChenevalMario FortinGisèle FournierDolores LadouceurWendy LaiJoanne LiuFrédéric ManseauDaniel NashMarlene PowerIsabelle RiouxLeslie Shanks

EETTHHIIOOPPIIAAJaroslava BelavaIvan Zenar

IINNDDIIAAIndu GambhirGordon Hutton

IINNDDOONNEESSIIAAJacques CaronDiane Rachiele

IIVVOORRYY CCOOAASSTTPenny BayfieldAndrea BoysenSteve DennisBeverly Winder

JJOORRDDAANNLouisa Zebic

KKEENNYYAADavid MichalskiOmar Odeh

LLIIBBEERRIIAADon ChambersAlanna Shwetz

MMAALLAAWWIIEva LamChantal St-Arnaud

MMAALLAAYYSSIIAAAdrienne Carter

MMYYAANNMMAARRNadine CrosslandFrédéric Dubé

NNIIGGEERRMarisa Cutrone

NNIIGGEERRIIAAMichel LacharitéLuke Shankland

PPAAKKIISSTTAANNJustin ArmstrongFahreen DossaDawn Keim

PPEERRUUYanik Delvigne

RREEPPUUBBLLIICC OOFF CCOONNGGOOAhmed AlasBrenda HoloboffJudy MacConneryNicolas Verdy

SSIIEERRRRAA LLEEOONNEEConcetta BuonaiutoLara SergovichJennifer Yeo

SSOOMMAALLIIAAReshma AdatiaJosé GodboutAudrey St-ArnaudDarryl Stellmach

SSOOUUTTHH AAFFRRIICCAACheryl McDermid

SSRRII LLAANNKKAAAdam Childs

SSUUDDAANNLori BeaulieuSteffen (Tom) De KokJulia PaysonJoli Shoker

TTAANNZZAANNIIAAMireille Roy

UUGGAANNDDAAAndré FortinMathieu Léonard

ZZAAMMBBIIAAIan AdairChris Warren

ZZIIMMBBAABBWWEEJoe BelliveauDavid CroftCara Kosack

© P

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Cas

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MS

F

MAKING AN IMPACT

Thanks to loyal supporters likeyou, in 2006 Médecins Sans

Frontières (MSF) provided inde-pendent medical care to more than13 million people in 71 countries.With your help, we treated650,000 children for malnutritionand provided hospital care to morethan half a million people. One ofthe most rewarding aspects of myrole at MSF is knowing that peoplelike you have a positive impact onthe lives of some of the most vul-nerable people in the world.

What we also know at MSF, however,is that the medical needs our volun-teers address every day in the fieldare interminable. Armed conflicts,natural disasters, epidemics, andnutritional crises will continue tothreaten peoples’ health. And MSFwill continue to strive to addresssuch needs.

The long-term commitment of oursupporters ensures our teams willbe able to provide shelter and basicmaterials to victims of the next

earthquake, establish a therapeuticfeeding centre to address the nextnutritional crisis, and provideimproved medicine for childrenwith HIV/AIDS.

If and when the time is right for youto include MSF in your will, pleasebe in touch. I would love to discusshow you can help MSF be where weare needed most.

Nancy Forgrave Director of fundraising

Nancy ForgraveDirector of fundraising

(416) 642-3466 / 1 800 982-7903nforgrave@msf.ca

Just a few wordsin your will...

For information about making a giftin your will to Médecins Sans Frontières,

please use the enclosed envelope or contact:

www.msf.ca402 - 720 Spadina AveToronto ON M5S 2T9

© Espen Rasmussen

Charitable registration number: 13527 5857 RR0001

Create a legacy to providelife-saving medical care for populations

in need around the world.