MSF2003

USAnnual Report 2003 Médecins Sans FrontièresDoctors Without Borders

MSF's decision to be present in any country is not based on political or military objectives, but on an assessment of human need made in an independent and neutral manner.

Doctors Without Borders/Médecins Sans Frontières (MSF) delivers emergency medical aid to victims of armed conflict, epidemics, and natural or man-made disasters, and to others who lack essential health care due to geographical isolation or discrimination. ■ MSF unites direct medical care with a commitment to bear witness and speak out against the underlying causes of suffering. ■ In the United States, MSF has its headquarters in New York with a second office in Los Angeles. The US organization was started in 1990. It contributes to the international MSF network by: > Raising funds to support projects conducted by the international MSF network, wherever in the world medical, public health, or other humanitarian crises exist. >> Recruiting volunteer medical and other professionals in the United States to participate in these projects. > Carrying out public education projects to increase awareness of populations at risk. > Advocating on behalf of vulnerable populations by informing the public, the media, the United Nations, US government agencies, and other nongovernmental organizations of the latest news and developments in the field.

Recipient of the 1999 Nobel Peace Prize

COVER PHOTO © FRANCESCO ZIZOL A, 2002 (INSET) © TIM DIRVEN, 2004 IFC © JODI BIEBER, 2003 (INSET) © ATSUSHI SHIBUYA, 2002 PAGE 1 PHOTO © H.J. BURKARD, 1999

"Independent humanitarianism is a daily struggle to assist and protect. In the vast majority of our projects it is played out away from the media spotlight, and

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away from the attention of the politically powerful. It is lived most deeply, most intimately in the daily grind of the forgotten war and forgotten crisis." (FROM THE NOBEL PEACE PRIZE SPEECH GIVEN BY THE FORMER MSF INTERNATIONAL PRESIDENT)

PRESIDENT AND EXECUTIVE DIRECTOR

Dear Friends, As we present the 2003 Annual Report of the US section of Doctors Without Borders/Médecins Sans Frontières (MSF), nearly one million people have been displaced by violence and are on the brink of starvation in the Darfur region of western Sudan. Because of your support, MSF is one of the only humanitarian organizations in Darfur providing aid directly to the most vulnerable people. MSF’s decision to intervene in Darfur or any other crisis is based solely on our independent assessment of people’s needs—not political, economic, or religious interests. MSF does not take sides or intervene where governments or warring parties tell us to—we go where the needs are greatest. Private donations are essential to our ability to operate independently, and allow MSF to respond at a moment’s notice to the most urgent emergencies, often in countries and regions that are otherwise forgotten.

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When the world neglected the crisis unfolding in Liberia as the country’s civil war intensified, your increased support enabled MSF to put tremendous resources into aiding the hundreds of thousands of Liberians affected by the conflict. In Iraq, MSF observed in practice the value of our independence. While many other aid organizations accepted US government funds and waited for clearance before entering Iraq, MSF was able to put a six-person team into Baghdad ahead of the fighting. MSF conducted an independent assessment of the situation and concluded that, while human need certainly existed, a huge humanitarian emergency did not. As governments focused their aid funding on Iraq, often at the expense of underreported and less strategic crises, MSF’s financial independence empowered us to sustain assistance for people in war-torn Democratic Republic of Congo (DRC) and Sudan, where we identified massive unmet needs. Preserving MSF’s independence is crucial to bearing witness to the underlying causes of human suffering.

A Hazara horseman passes an MSF vehicle on its way to the MSF mobile clinic in the Bamiyan Province of Afghanistan.

The importance of independence In 2003, MSF spoke out against the expulsion of Chechen refugees who had sought shelter in the neighboring Russian republic of Dagestan—even when the international community chose to turn a blind-eye. Because MSF sustains our malaria programs with private donations, MSF was able to switch to more effective treatments and to call on the US Agency for International Development and other donor agencies to stop supporting cheaper, but failing, malaria drugs that are linked to the rising death toll from the disease. In Iraq, Afghanistan, and elsewhere, however, the independence of humanitarian action is under threat. In 2003, Western governments put humanitarian assistance to work for broader political objectives at the expense of aid for those who need it most. Meanwhile, attacks against aid workers reached unprecedented levels— jeopardizing access to the most vulnerable people.

With emergencies mounting around the world, your continued support is crucial to maintaining MSF’s independence and to providing urgent medical care to people most affected by war, famine, and disease. On behalf of all MSF staff, volunteers and, most importantly, the people whom we assist, we extend our deep appreciation for your belief in our mission and your ongoing support in making it a reality. Thank you.

Carol Etherington President

Nicolas de Torrenté Executive Director

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Thanks to your generosity in 2003—a year in which we raised $53.1 million, an impressive 19 percent increase from 2002—MSF-USA was able to maintain our independence and to support the growing medical activities

of our field teams worldwide. By keeping operating and fundraising costs low, we were able to direct 86 percent of this revenue to our program activities. Furthermore, 157 international volunteers recruited by MSF-USA provided services valued at more than $9 million in 2003.

© JEAN-MARC GIBOUX, 2003

© TEUN VOETEN, 2003

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Independence in action 03 LIBERIA

As Liberia’s Civil War Escalates, MSF Responds with Medical Care for Thousands

A man wounded by a mortar attack in Monrovia arrives at an MSF clinic with his son.

the spring and summer of 2003, Liberia’s decade-long civil war intensified as rebel and government forces clashed throughout the country—causing tens of thousands of Liberians to flood into the capital, Monrovia, and into camps in nearby Bong County. Although a significant portion of the country was cut off from all humanitarian aid, MSF was one of the only international humanitarian aid organizations to provide assistance throughout the worst of the fighting. During the crisis, more than a dozen international and 900 national MSF staff worked tirelessly in the midst of a war zone to provide medical care and humanitarian assistance in both Monrovia and the countryside. The teams treated hundreds of war-wounded people, set up cholera treatment centers, and, after Monrovia’s Redemption Hospital had to be evacuated, established two field hospitals in the compound where MSF volunteers lived. Outside the capital, MSF provided medical care for 50,000 displaced people in Bong County as well as for 44,000 displaced people in the cities of Tubmanburg and Buchanan. JUNE 6 “Last night we saw thousands of 05 displaced people—mainly children under five, women, and elderly—wandering Monrovia, looking for a place to sleep. Some of them found shelter with relatives, but many spent the night in churches, empty buildings, the market, and on the streets. It is raining heavily, and these people are already vulnerable due to insecurity and lack of assistance, so we are looking at a humanitarian catastrophe in the making.”—ALAIN KASSA, MSF HEAD OF MISSION IN MONROVIA

During

© KRIS TORGESON, 2003

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Evacuating Redemption Hospital With rebel and government forces fighting in the streets of Monrovia, MSF was forced to halt its medical services and to evacuate patients from the 130-bed Redemption Hospital, the only public hospital for the more than two million residents and displaced people inhabiting the city. Redemption would be re-opened and evacuated two times during the summer—requiring the teams to move patients, including children, in the midst of a war zone. JUNE 11 “There is no public hospital anymore that civilians can turn to. Many people are getting close to exhaustion and risk dying in the streets of Monrovia. And the risk of epidemics is very real.”—DR. NATALIE CIVET, MSF MEDICAL COORDINATOR IN MONROVIA

US ANNUAL REPORT 2003

A wounded civilian awaits treatment at an MSF clinic in Monrovia.

INDEPENDENCE IN ACTION Liberia

Setting Up Mamba Point Hospitals Faced with hundreds of displaced patients, the MSF

teams turned two of their living quarters at Mamba Point in central Monrovia into two inpatient hospitals with emergency rooms, operating rooms, obstetrics and pediatric wards, pharmacies, and labs. The teams also established an outpatient hospital there. The Mamba Point hospitals provided some of the only medical care available in all of Monrovia during the months of intense fighting. JUNE 25 “In order to build the hospitals, we had to go under-cover to get materials. Everyone had their shops closed. We had to go to our suppliers in Monrovia and say, ‘Guys, we need your help, we need this material.’ So we were able to set up beds. We were able to set up tents as soon as possible.” —ANDRA WROBEH, MSF LOGISTICIAN IN MONROVIA

Treating War Wounded at Mamba Point Hospitals From June to August 2003, during the height of the civil war, the MSF team treated 300 to 400 patients every day at the Mamba Point hospitals, including some 800 war-wounded patients. They were forced to cover the windows of the hospitals with sandbags to protect themselves and their patients from stray bullets. During the worst of the fighting, a 06 wheelbarrow ambulance brigade transported wounded people from the frontlines to the Mamba Point hospitals and carried medical supplies, food, and drinking water back to small clinics. MSF also treated more than 100 severely malnourished children. JULY 30 “A 15-year-old boy arrived with a gunshot wound to the chest. After we tried resuscitation it was obvious that he would not survive. I took the decision to take him to the operating room and ‘crack his chest.’ While operating by the light of a desk lamp, performing cardiac massage and injecting epinephrine into his heart, somehow I was able to repair the injury. His heart started beating and he developed a blood pressure. After an hour he began to wake up.”—DR. GARY MYERS, MSF SURGEON Dr. Natalie Civet, MSF Medical Coordinator, examines a girl who was severely wounded by a mortar attack.

© CHRIS HONDROS, 2003

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AT MAMBA POINT HOSPITALS

JULY 31 “Patients were pouring in with severe wounds from the rocket attack. We just had to keep

cleaning up the blood. There was no time to rest.”—ARTHUR NARMAH, MSF MAINTENANCE WORKER AT MAMBA POINT HOSPITALS

operations

OFTEN STAYING AWAKE FOR 2 DAYS AT A TIME, MSF TEAMS CARRIED OUT OVER 200 EMERGENCY OPERATIONS. 1/4 OF THE CASES INVOLVED WAR SURGERY.

ALL PHOTOS © KRIS TORGESON, 2003

Responding to an Outbreak of Cholera By mid-

Going Back to Redemption In late August fighting finally subsided in Monrovia. For the first time in nearly two months, Redemption Hospital was reopened. MSF’s logistics staff installed new generators, repaired the roof, restocked the pharmacy, and painted the patients wards. AUGUST 21 “After working so hard for so many days and nights at the Mamba Point hospitals, everyone is excited to return to Redemption. Reopening Redemption gives everyone hope that a sense of normalcy will return to Monrovia again soon.” —DR. JUANITA ANGULO BONILLA, MSF SURGEON AT MAMBA POINT HOSPITALS

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MONROVIA CHOLERA TREATMENT PROGRAM

Tom Quinn, MSF nurse, helps transport a woman to the Mamba Point hospitals.

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July, a cholera epidemic had broken out in Monrovia. MSF responded by coordinating cholera surveillance and establishing a 110-bed cholera treatment unit in JFK Hospital, two additional centers on Randall Street with 60 beds each, a 270-bed unit on UN Drive in central Monrovia, and a 50-bed unit in Samuel K. Doe Stadium. When fighting broke out near three of the centers, MSF moved the patients to the Mamba Point compound, setting up a temporary emergency isolation and treatment center. MSF staff sanitized dozens of homes and nine displaced persons camps in the city where cholera cases had been identified. The teams trucked 70,000 liters of clean drinking water per day to distribution centers throughout the city. JULY 30 “Some patients who recovered left or were picked up, but it was difficult to tell them to go. How can you say, ‘O.K., you survived cholera, now please go out on the street where you might be killed by a bullet or mortar.”—MATHIAS FORMELIUS, MSF NURSE,

Dr. Juanita Angulo Bonilla, MSF Surgeon, treats a war-wounded boy.

Dr. Christophe Sereau treats a patient at MSF’s cholera unit in Monrovia.

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Independence in decision-making Escalating conflicts around the world and increasing insecurity for aid workers made 2003 one of the most challenging years for Doctors Without Borders/Médecins Sans Frontières (MSF).

© JEAN-MARC GIBOUX, 2003

WarinIRAQ

PROJECT SUPPORT IN 2003

YEAR IN REVIEW 2003

Through

US Private The generous contributions of US donors Contributions to Doctors Without Borders/Médecins Sans Frontières (MSF) helped to make possible the projects described in this section. Amounts awarded by MSF-USA follow the names of each country listed. Additional funds for these projects were raised by other MSF offices. To learn more about these projects and others, please visit our website, www.doctorswithoutborders.org.

AFRICA ALGERIA $10,000 Aiding earthquake survivors MSF provided medical and psychological care to people affected by an earthquake in northern Algeria that killed more than 2,700 people, injured 7,000, and left tens of thousands homeless. ANGOLA $3,537,265 Fighting malnutrition and disease after years of war As the country emerged from decades of war, MSF teams provided essential medical care and monitored and treated diseases, such as malaria and measles, in Cuimba Hospital in northwest Angola. MSF supported hospitals and health posts in Chicomba and Kuvango in the southwestern Huila province and in Quimbele in the northwestern Uige province. In the northeastern town of Saurimo, in Lunda Sul province, MSF provided medical care in a pediatric hospital and established a therapeutic feeding center that admitted an average of 40 children each month. MSF performed consultations through mobile clinics in six districts. MSF launched an HIV/AIDS program in the northern town of Malange, which operated from within the town hospital and two clinics. In Caala, MSF provided medical assistance to displaced people living in camps, provided the local hospital with medical supplies, treated malaria and tuberculosis, and cared for more than 1,200 children in a therapeutic feeding center.

US ANNUAL REPORT 2003

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BURUNDI $1,400,000 Providing care amid conflict MSF made available highly effective artemisinin-based combination therapy to the country’s many malaria patients. MSF supported or ran clinics and hospitals in several provinces. In the capital, Bujumbura, MSF operated a specialized treatment and rehabilitation center for war-wounded civilians from areas around the capital; managed a health center that treated 150 to 200 patients a day; and ran a surgery program in one of the city’s hospitals. In Cankuzo, a province in northern Burundi, MSF supported three health centers and performed patient consultations through mobile clinics.

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When the United States began its attack on Iraq in March 2003, a six-person MSF team was already in Baghdad to provide medical support to the staff of the 250-bed al Kindi General Hospital. As the fighting intensified, however, MSF was forced to suspend its Baghdad operations for nine days when two MSF staff were detained by the Iraqi authorities. They were released several days after the government of Saddam Hussein was toppled, amid looting and chaos that left Baghdad’s hospitals in ruins and without adequate materials or medical staff. MSF spoke out in the United States and at the United Nations about the failure of the United States, as an Occupying Power, to provide protection to hospitals so that people could receive needed medical attention. Despite the chaos, MSF teams witnessed none of the characteristics of a major humanitarian crisis, such as massive displacements of people, severe food shortages, or widespread epidemics. There were, however, pockets of urgent medical need as Iraq’s centralized medical system was severely disrupted. More than 40 international MSF aid workers based in Iraq and its neighboring countries assessed conditions around the country and assisted civilians affected by the conflict. MSF provided medical care in three health centers in Sadr City (a marginalized area of Baghdad) and, until August, distributed drugs and supplies to clinics and hospitals in Basra and Missan. Lack of security for civilians and aid workers quickly became a significant problem. With

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MSF Activities in 2003

In 2003, MSF worked in nearly 80 countries. MSF-USA funded projects in the countries colored white on the map. These projects are described in the Project Support in 2003 section. MSF also operated projects in the countries colored red on the map. Countries with an * received MSF-USA funds, but are not described in this report.

AFRICA

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Algeria Angola Benin Burkina Faso Burundi Cameroon Central African Republic Chad Democratic Republic of Congo Ethiopia Guinea Ivory Coast Kenya Republic of Congo (Brazzaville) Liberia Madagascar Malawi Mali Mauritania Morocco Mozambique Niger Nigeria Rwanda* Sierra Leone Somalia South Africa Sudan Tanzania* Uganda Zambia Zimbabwe

THE AMERICAS Argentina Bolivia Brazil* Colombia Ecuador El Salvador Guatemala Haiti Honduras Mexico Nicaragua Peru

ASIA AND THE PACIFIC Afghanistan Bangladesh* Myanmar (Burma) Cambodia China India Indonesia Iran Iraq Laos Nepal North Korea Pakistan Philippines Sri Lanka Thailand

THE CAUCASUS AND CENTRAL ASIA Armenia Georgia Caucasus/Chechnya Russian Federation Tajikistan Turkmenistan Uzbekistan

EUROPE Belgium Bulgaria France* Italy Luxembourg Romania* Serbia Spain Ukraine*

MIDDLE EAST Kuwait/Qatar* Palestinian Territories Yemen

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PHOTOS FROM LEFT TO RIGHT (TOP) © FRIDA L AGERHOLM, 2004 © SVEN TORFINN, 2002 © SERGE SIBERT, 2001 (BOTTOM) © KRIS TORGESON, 2003 © ERIC MILLER, 2002 © JUAN CARLOS TOMASI, 2003

PROJECT SUPPORT IN 2003 Through US Private Contributions

CENTRAL AFRICAN REPUBLIC $280,000 Assisting civilians trapped by war After a civil war began in late 2002, MSF supplied medicines and material to one hospital and several health centers in the capital, Bangui, and in the surrounding province; supported a therapeutic feeding center in Bangui’s pediatric hospital; and treated sick and injured people in the south of the country through the use of mobile clinics. MSF also assisted those who had fled across the border to Chad. MSF set up an epidemiological surveillance system to monitor disease outbreaks throughout the country and responded to epidemics of meningitis, hemorrhagic viral fever, measles, and hepatitis. MSF assisted more than 300 victims of sexual violence in Bangui. >

CONGO REPUBLIC $800,000 Raising awareness of sexual violence In Brazzaville, the capital, MSF assisted people who had been displaced by fighting in the southern Pool region. MSF later gained access to displaced people within the Pool region itself. MSF provided victims of sexual violence with comprehensive treatment, including psychological counseling and post-exposure prophylaxis to prevent HIV infection. MSF also launched a publicawareness campaign on sexual violence.

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DEMOCRATIC REPUBLIC OF CONGO $3,767,000 Assisting a country in distress With conflict continuing and the health care system still in ruins, MSF worked in 8 of the country’s 10 provinces and in the capital, Kinshasa, responding to epidemics and emergencies, providing health care, and running rural hospital facilities. MSF set up emergency medical services for people displaced by fighting in the Ituri region in the eastern part of the country. In a report describing the violence against civilians in Ituri, MSF published testimony from Congolese civilians and medical data gathered from the field, and stressed the urgent need for combatants and governments to do more to protect civilians. ETHIOPIA $900,000 Treating infectious diseases MSF continued to provide tuberculosis treatment in 4 hospitals and 11 health centers in the Somali region, as well as in a center for nomadic people in Galaha. In the capital, Addis Ababa, MSF provided reproductive health care and care for people living with HIV/AIDS. MSF also ran a reproductive health project for commercial sex workers in the Tigray region in the north. In Humera, MSF treated people living with HIV/AIDS and those suffering from the parasitic disease kala azar. MSF

25 percent

NON-MEDICAL VOLUNTEERS ACCOUNTED FOR 25 PERCENT OF ALL VOLUNTEERS SENT TO THE FIELD BY MSF-USA IN 2003.

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suicide bombers targeting the UN headquarters in Baghdad in August and the International Committee of the Red Cross compound in Baghdad in October, Iraq became one of the most dangerous places for aid workers to provide assistance. Many organizations withdrew entirely from the country while others, like MSF, scaled back their programs and temporarily withdrew international staff. Such attacks are war crimes. Still, the US government, in Iraq as in Afghanistan, has made aid workers more vulnerable by seeking to bring humanitarian aid efforts under its control and claiming that all assistance supports its political and military objectives. When aid becomes a partisan effort, controlled by a belligerent that itself commits violations of international humanitarian law, it is more difficult and dangerous for independent humanitarian organizations to respond on the basis of need alone.

AFGHANISTAN forgotten Media attention shifted away from Afghanistan once the war in Iraq became imminent, but the needs in this war-torn country remained great and largely unmet. During 2003, MSF ran projects in 16 of the country’s 32 provinces. More than 100 international volunteers and in excess of 1,300 national staff operated therapeutic and supplemental feeding centers, vaccination campaigns, basic health care clinics, mother-and-child health care programs, mobile clinics in remote areas,

YEAR IN REVIEW 2003

responded to a malaria epidemic by conducting 15,000 patient consultations. MSF spoke out against both the government’s refusal to approve the use of artemisininbased combination therapy and international donor agencies’ funding of ineffective medicines to treat people with malaria. MSF also conducted a retrospective study of mortality associated with the malaria epidemic. GUINEA $900,000 Helping war refugees MSF worked in several camps, providing care to Liberian refugees in Macenta, Guéckédou, Kissidougou, Nzérékoré, and Boreah. After war broke out in neighboring Ivory Coast, MSF provided assistance to refugees through health centers in rural districts and hospitals. MSF also trained traditional birth attendants, provided psychosocial support for street children, and assisted the national tuberculosis program. In March, MSF began an HIV/AIDS program in the capital, Conakry.

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KENYA $1,873,524 Combating AIDS and assisting refugees In Homa Bay, Busia, and Nairobi, MSF operated voluntary counseling and testing centers for people at risk for HIV/AIDS, treated secondary infections including tuberculosis, worked to prevent mother-to-child transmission of HIV, and provided psychosocial care and antiretroviral (ARV) therapy. More than 900 people were receiving ARV therapy by the end of 2003. MSF ran three hospitals and nine health centers in camps for Somali refugees in Dadaab.

© SEBASTIAN BOLESCH, 2002

An Afghan boy receives a vaccination from an MSF national staff member.

LIBERIA $2,864,000 Working in a war zone MSF’s work in Liberia shifted to an emergency response when the country’s civil war intensified in 2002-2003. In the capital, Monrovia, MSF assisted thousands of displaced people gathered in schools and stadiums, supported public hospitals until the advancing frontline made it impossible, and then created clinics in the two MSF compounds to treat war wounds and critical illnesses. MSF set up several cholera treatment centers for displaced persons during an outbreak in Monrovia at the peak of the conflict. >

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IVORY COAST $2,454,000 Medical support to civilians near the frontline Following the onset of civil war in 2002, MSF’s work expanded beyond its programs at MACA prison in the capital, Abidjan, to include emergency responses on both sides of the frontline. MSF worked at the hospital in Man, near the Liberian border in the western part of the country, and in hospitals in Korhogo and Bouaké, in the rebel-controlled north, providing surgical care and responding to disease outbreaks. Mobile clinics reached isolated people in the west.

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water and sanitation projects, and specialized treatment programs for diseases such as tuberculosis and leishmaniasis. By the end of the year, however, security had deteriorated significantly and humanitarian agencies were increasingly the targets of attacks against the Western presence in the country. In December, following several deliberate and lethal attacks on aid workers, MSF was forced to suspend activities in Zhare Dasht camp near the city of Kandahar in southeastern Afghanistan, where MSF teams had been providing basic health care to a population of 40,000 displaced persons. In a country where an untreated chest infection can quickly become life threatening, the reduction of MSF’s presence in the southeast came with severe repercussions for the most vulnerable Afghans.

PROJECT SUPPORT IN 2003 Through US Private Contributions

MADAGASCAR $300,000 Supporting children at risk Three socio-medical centers in the capital, Antananarivo, provided comprehensive medical care and social and legal support to more than 3,500 street children, mothers, and pregnant women. MSF also helped to improve health and sanitation conditions in three juvenile correction centers and in the juvenile section of Antanimur prison in the capital. MSF continued to run a therapeutic nutrition unit to treat severely malnourished children in the Befelatana Hospital in Tana. >

MALAWI $1,300,000 Focusing on HIV/AIDS treatment and care In the Thyolo and Chiradzulu districts, MSF’s HIV/AIDS programs included voluntary counseling and testing, training of local personnel, treatment of opportunistic infections, prevention of mother-to-child transmission of HIV, control of sexually transmitted diseases, and community HIV-prevention education. In addition, by the end of 2003, more than 1,800 people were receiving antiretroviral therapy.

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NIGER $300,000 Vaccinating against measles and meningitis In response to simultaneous outbreaks of measles and meningitis in the Maradi and Zinder regions, MSF vaccinated more than 125,000 children against measles and 290,000 children and adults against meningitis. MSF also provided 300,000 measles vaccines, 450,000 meningitis vaccines, and 10,000 curative treatments to the Ministry of Health for a massive rural vaccination campaign. MSF ran a therapeutic feeding program in Maradi for children under 5 years of age, treating children both in feeding centers and in their homes. NIGERIA $250,000 Introducing a new malaria treatment MSF provided basic health care in three health centers in Bayelsa State. Because of high levels of resistance to the malaria drugs chloroquine and sulfadoxinepyrimethamine, MSF introduced artemisinin-based combination therapy as the first-line treatment for malaria patients. MSF began an HIV/AIDS treatment and support project at Lagos General Hospital. SIERRA LEONE $859,000 Medical care in the aftermath of war Ensuring quality care at health centers and hospitals remained the cornerstone of MSF’s work in Sierra Leone. During 2003, thousands of Liberian refugees fled to the country, straining the already damaged health system. In many areas, MSF provided care for both local residents and refugees. MSF conducted studies of resistance to common antimalarials and worked to convince the national authorities of the need to change to artemisinin-based combination therapy.

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World ignores horror in Another war raged on, largely unnoCONGO ticed, in the Democratic Republic of Congo (DRC). Decades of neglect and violence have scarred the country and left an estimated three million people dead. MSF’s programs in the DRC constitute one of MSF’s largest interventions in the world today, with more than 100 international volunteers and thousands of national staff working throughout the country. In the spring and summer of 2003, MSF brought medical care to those attempting to flee massacres near the eastern city of Bunia. At the height of the terror, medical teams performed nearly 1,300 consultations each week in a temporary hospital that was set up in a former supermarket. MSF teams treated victims of gunshot and machete wounds—half of them children under five years old—but were frustrated by knowing that thousands more remained beyond their reach, hiding in the forests outside the “protected” area of the city. Having witnessed the brutal violence against civilians and the inadequate response by the international community, MSF released a report in August describing the horror. The report included testimony from Congolese civilians and medical data gathered from the field, and it urged the belligerents and other governments to do more to protect the civilian population. To date, that call remains largely unanswered. But MSF continues to provide medical assistance to people affected by the conflict itself and by inadequate public health services in many parts of the country.

YEAR IN REVIEW 2003

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million

TODAY MORE THAN 42 MILLION PEOPLE ARE LIVING WITH HIV/AIDS. IN 2003, MSF PROVIDED ANTIRETROVIRAL THERAPY TO MORE THAN 9,000 HIVPOSITIVE PEOPLE.

SOUTH AFRICA $150,000 Increasing access to care for HIV/AIDS patients At MSF’s AIDS program in Khayelitsha, a township of Cape Town, more than 600 people received antiretroviral therapy and many thousands more obtained care for opportunistic infections and medication to prevent mother-to-child transmission of HIV. In Lusikisiki, a rural town in the former Transkei, MSF ran a program to implement comprehensive AIDS services in remote rural areas.

© JODI BIEBER, 2003

A victim of sexual violence in DR Congo at an MSF clinic in Baraka.

ers around the world continued to work together to raise international awareness of the abduction of Arjan Erkel, MSF head of mission in the Russian republic of Dagestan. Thousands of people worldwide signed the petition in support of Arjan’s release that was delivered in May 2003 to the Russian government. In September, during an address to UN delegates by Russian President Vladimir Putin, MSF-USA held a demonstration outside the United Nations building in New York, urging all UN member states to hold the Russian leader accountable for the resolution of this case. Under international humanitarian law, host governments are responsible for the safety of humanitarian aid workers on their soil, and other

UGANDA $1,750,000 Responding to victims of conflict and disease Beginning in July 2003 MSF teams provided medical care in the northeast of the country for people who were displaced by fighting and living in camps in and around the town of Soroti. MSF also worked to meet the medical and nutritional needs of displaced people in the districts of Lira and Gulu. In more stable parts of the country MSF ran treatment programs for kala azar and HIV/AIDS. At the MSF HIV/AIDS clinic in Arua, MSF provided antiretroviral therapy to nearly 700 people and worked to prevent mother-to-child transmission. At Amudat Hospital in northeastern Uganda, MSF treated kala azar. > ➔

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Drawing attention to plight of CHECHEN refugees During 2003, MSF volunteers, staff, and support-

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SUDAN $5,300,000 Providing crucial relief for war-affected civilians A new civil war broke out in the Darfur region of western Sudan causing thousands of civilian deaths and forcing hundreds of thousands to seek refuge in nearby Chad. Beginning in September, MSF provided medical care, nutritional support, and vaccinations to more than 30,000 refugees living along the border with Chad. At the end of the year, MSF gained access to the Darfur region and assisted people displaced or otherwise affected by the violence. In Bahr el Ghazal in southern Sudan, MSF provided medical care and monitored and treated endemic diseases, such as malaria and kala azar. In the Marial Lou Rural Hospital in southern Sudan, MSF continued to run a 60-bed sleeping sickness treatment unit and operated mobile clinics that screened people for the disease. MSF provided health care and treated kala azar and tuberculosis in the town of Malakal in northern Sudan and in the Jonglei and Upper Nile regions. MSF offered basic health care to the displaced population settled in the periphery of the capital, Khartoum.

PROJECT SUPPORT IN 2003 Through US Private Contributions

ZAMBIA $100,000 Providing refugee health services and AIDS care In Maheba refugee camp near Solwezi, which accommodates 50,000 people, most of them Angolan refugees, MSF supported a health post and a government-run clinic that serves as the camp’s emergency referral facility. An integrated HIV/AIDS-care project in Nchelenge offered education, voluntary counseling and testing, treatment for opportunistic infections, and prevention of mother-to-child transmission. >

ZIMBABWE $114,776 Alleviating malnutrition and expanding AIDS treatment In Bulawayo, MSF ran a program to prevent transmission of HIV from mothers to children and provided antiretroviral therapy to mothers and other HIV-positive family members. MSF set up therapeutic feeding centers for children with severe malnutrition in five hospitals in Masvingo province. In Manicaland province, MSF continued to treat malnutrition at Murambinda Hospital.

ASIA AND THE PACIFIC

CAMBODIA $800,000 Expanding HIV/AIDS care and treatment In the Sotnikum district of Siem Riep province and in Takeo province, MSF provided antiretroviral therapy to more than 1,200 people living with HIV/AIDS. Many thousands more received consultations, treatment for opportunistic infections, and other care and support. At clinics in Siem Reap and Takeo, MSF also treated people living with diabetes, hypertension, and AIDS. CHINA $200,000 Introducing AIDS treatment and battling SARS MSF opened an AIDS clinic in Xiangfan city of Hubei province to treat AIDS-related opportunistic infections,

60 percent

MORE THAN 60 PERCENT OF MSF-USA VOLUNTEERS SENT TO THE FIELD IN 2003 HAD PREVIOUS EXPERIENCE.

governments must ensure that these obligations are met. After more than 20 months, MSF was greatly relieved on April 11, 2004, when Arjan was released and able to return to his family in Holland. Arjan’s abduction came with severe repercussions for civilians affected by the ongoing conflict in Chechnya. One of the few independent humanitarian organizations still working in the region at the time of Arjan’s abduction, MSF had to suspend its humanitarian activities in Dagestan and considerably limit operations in Chechnya and the neighboring republic of Ingushetia as a result of his kidnapping. Throughout 2003, nearly 200,000 displaced people living in tent camps and makeshift shelters in Chechnya, Dagestan, and Ingushetia were victims of a concerted campaign of harassment aimed at coercing them to return to war-torn Chechnya. Authorities closed several camps in Chechen refugees living in camps in the neighboring Russian republic of Ingushetia.

© EDDY VAN WESSEL, 2003

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

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AFGHANISTAN $1,650,000 Assisting civilians despite increasing insecurity As armed clashes—whether between rival warlords or Coalition forces and remnants of the Taliban— continued, MSF operated projects in 16 of the country’s 32 provinces. Working with both displaced people and those living in their own communities, MSF operated therapeutic and supplementary feeding centers, vaccination programs, basic health care services, mother-and-child health care programs, mobile clinics in remote areas, water and sanitation programs, and specialized programs to treat diseases such as tuberculosis and leishmaniasis.

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YEAR IN REVIEW 2003

Ingushetia during the year, and nearly 30,000 displaced people were pushed back into a war zone. In testimony to the US Congress Helsinki Commission, MSF urged the US government to pressure Russian authorities to stop all forced and coerced relocations of displaced people to Chechnya. Unfortunately, governments continue to ignore the plight of Chechen civilians who, day after day, remain victims of abuse and violence and are increasingly left with little or no assistance.

‘‘Without ongoing political pressure from people living with AIDS, access to treatment will never be a reality for the poor. In the meantime, we will continue to support our South African colleagues as they demand to be treated with dignity, and with urgency.’’ —ERIC GOEMAERE, MD, MSF HEAD OF MISSION IN SOUTH AFRICA and began providing antiretroviral therapy. A second HIV/AIDS project was begun in Nanning, Guangxi Autonomous Region. After the outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong, MSF provided protection and training in Hong Kong and in two hospitals in Zhangjiakou city in Hebei province. MSF continued to provide medical and psychosocial care, housing, and food to marginalized children in Baoji city in Shaanxi province.

ScalingupAIDStreatment More than 20 years after the first AIDS-related

LAOS $200,000 Spearheading efforts to treat HIV/AIDS MSF provided medical care for people living with HIV/ AIDS in the southern province of Savannakhet. MSF supported the provincial hospital there by delivering care to AIDS patients, supplying needed medicines, providing technical assistance and training for local physicians and nurses, and treating opportunistic infections. Approximately 40 patients began receiving antiretroviral therapy in September. > ➔

US ANNUAL REPORT 2003

Indonesia $100,000 Reorienting assistance MSF launched an HIV/AIDS project in the eastern city of Merauke and began providing antiretroviral therapy. In the capital, Jakarta, MSF offered social support and free treatment for sexually transmitted diseases to commercial sex workers. MSF responded to malaria outbreaks in Jayawijaya, a district of Irian Jaya, and South Halmahera, in the Maluku Islands, by introducing effective artemisinin-based combination therapy.

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death was reported, there remains no cure for the disease. However, the arrival of antiretroviral (ARV) therapy in the mid-1990s revolutionized HIV/AIDS treatment. During 2003, MSF increased the scope of its HIV/AIDS treatment programs and provided evidence that treating AIDS in developing countries is possible and that scaling up treatment is feasible, even when health systems are severely limited. MSF’s HIV/AIDS programs provide voluntary testing and counseling, treatment of opportunistic infections, and prevention of motherto-child transmission of HIV. By the end of 2003, MSF medical teams were providing ARV therapy to more than 9,000 people living with the disease in 19 countries and that number continues to increase each month. MSF has been able to scale up treatment programs in large part because of the development of simplified treatment regimens utilizing fixed-dose combinations (FDCs) of

INDIA $50,000 Refocusing TB care on patients After having provided technical support to India’s national tuberculosis (TB) program for four years, MSF began to provide direct patient treatment, TB-prevention services, training, and technical assistance in a Mumbai health post and dispensary. In Assam, MSF focused on early diagnosis and treatment of malaria, especially in pregnant women and children, aiming to help some 200,000 displaced people in the area.

PROJECT SUPPORT IN 2003

NORTH KOREA $5,000 Support to fleeing civilians MSF continued to assist North Korean refugees who had managed to escape to neighboring countries and collected their accounts to raise awareness of their situation. MSF spoke out against China’s repression of North Korean refugees and the humanitarian aid workers assisting them, and protested the government’s forced repatriation of refugees. >

SRI LANKA $200,000 Slowly withdrawing after war After the 2002 ceasefire ended 19 years of civil war, MSF closed projects that had provided medical care and surgery for war-wounded civilians. MSF teams continued to support the gynecology department at the hospital in Puthukkudiyiruppu and performed clinical monitoring of health staff and patients in area mother-and-child health clinics. In Vavuniya, MSF provided community-based psychosocial support for displaced people. MSF also improved living conditions in camps for the displaced.

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THAILAND $820,000 Promoting HIV/AIDS and TB care MSF worked in the capital, Bangkok, and in Surin, Rayong, Non Thaburi, Pethburi, and Kalacin to provide antiretroviral therapy to approximately 1,000 people living with HIV/AIDS. MSF programs included home visits, clinical care, treatment of opportunistic infections, and technical assistance to district and provincial hospitals. MSF also made available treatment for both tuberculosis and HIV/AIDS to 44,000 Karen refugees from Myanmar living in camps in Maesot and Ratchaburi, and for about 7,000 Mon people across the ThailandMyanmar border.

THE CAUCASUS AND CENTRAL ASIA ARMENIA $450,000 Providing access to care MSF ran an outpatient mental health center and offered occupational therapy at a day center in Sevan. MSF provided treatment for sexually transmitted diseases and voluntary HIV counseling and testing in a clinic in Bagratashen (a town on the border between Armenia and Georgia). MSF also offered health education for sex workers in northern Armenia. GEORGIA $1,100,000 Caring for the most vulnerable MSF provided health care for people in the Pankisi Valley, the capital Tbilisi, and Abkhazia, a separatist Georgian republic devastated by civil war. In Tbilisi, MSF provided more than 1,000 medical consultations each month and visited homebound patients. In Sukhumi, Abkhazia, MSF screened for and treated tuberculosis, including multidrug-resistant cases, and provided general medical care and surgery at

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ARVs—pills containing two or three AIDS drugs in one tablet—and because medical teams are decentralizing and adapting treatment to meet the needs of people with HIV/AIDS even in the poorest and most remote settings. Years of activism and the introduction of generic competition have pushed down the prices of triple therapy, including FDCs, to as little as $140 per person per year compared with $10,000 to $15,000 just three years ago. This has also enabled more and more people to be treated and made it difficult for national governments and international institutions to justify inaction in the face of the AIDS treatment emergency. Affordability and accessibility of medicines— not just for AIDS but for all diseases that threaten the lives of people in poor countries—were threatened in 2003 when the US and its powerful © RACHEL CORNER, 2002

Through US Private Contributions

YEAR IN REVIEW 2003

pharmaceutical industry pushed for more stringent intellectual property rules in bilateral and regional free trade agreements than are required in international agreements. These rules would significantly restrict generic competition. In response, MSF published a report in November on the impact of the Free Trade Area of the Americas agreement on access to essential medicines and called on governments to reject draconian intellectual property requirements in all trade agreements. The US is pursuing trade agreements that could have similar consequences in southeast Asia, southern Africa, and across the globe. These proposals threaten to trade away the lives of people with HIV/AIDS and other life-threatening illnesses for commercial profit, and to make lifesaving treatment a luxury few people can afford.

30 seconds

A CHILD IN AFRICA DIES FROM MALARIA EVERY 30 SECONDS—MANY BECAUSE OLD DRUGS ARE INEFFECTIVE. MSF IS NOW SWITCHING THERAPIES TO COMBAT THIS PROBLEM.

several clinics. In Akhmeta in the Pankisi Valley, MSF’s surgical assistance at the local hospital benefited area residents as well as refugees from Chechnya. RUSSIAN FEDERATION $350,000 Ending projects for people with TB and the homeless In Siberia, MSF’s tuberculosis (TB) program was halted after many years when Russian medical authorities demanded that MSF use an inappropriate treatment for multidrug-resistant TB. MSF handed over its Moscowbased program for the homeless to local authorities, although MSF will continue to promote the social integration of this vulnerable group. During the project’s 11-year history, MSF provided more than 200,000 medical and 65,000 social-welfare consultations.

THE AMERICAS

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An HIV-positive woman with her two daughters in the MSF-rebuilt Thmar Pouk Hospital in Cambodia.

GUATEMALA $1,250,000 Providing AIDS care and social support In Guatemala City and in the city of Coatepeque, MSF provided voluntary testing and counseling, care and treatment of opportunistic infections, nutritional support, and home care for people living with HIV/AIDS. More than 600 people were receiving antiretroviral therapy through MSF by the end of 2003, and MSF continued to support efforts to increase access to affordable medicines for AIDS and other diseases. In Guatemala City, MSF offered care for children and young adults living on the street. MSF supported mothers and their at-risk children through a therapeutic daycare center in one of the city’s slums. >

US ANNUAL REPORT 2003

EL SALVADOR $12,500 Assisting people living with HIV/AIDS In the capital, San Salvador, MSF worked with the Ministry of Health to run a program to prevent motherto-child transmission of HIV, treating nearly 300 mother-child pairs. An MSF project promoted safe sex and HIV/AIDS prevention to approximately 500 commercial sex workers in four areas including the capital.

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COLOMBIA $265,000 Support to victims of war MSF’s mobile medical teams brought primary care, prenatal care, and vaccinations to people in rural areas caught up on all sides of the country’s civil war. In urban zones including Bogotá and Quibdó, MSF gave medical attention to displaced people. In Cali, MSF offered psychological care and physical rehabilitation to young victims of violence.

PROJECT SUPPORT IN 2003 Through US Private Contributions

HAITI $200,000 Health care for the most vulnerable In the communes of St. Marc, Desdunes, Grand Saline, and Petite Rivière, MSF teams trained national medical staff, provided equipment and supplies, and rehabilitated health centers and hospitals. Project activities focused on reproductive and maternal health. >

MEXICO $215,000 Assisting marginalized people Since March 2000, MSF has provided humanitarian assistance to marginalized people in self-declared Zapatista autonomous communities in the state of Chiapas. In remote areas, MSF ran mobile clinics offering basic health services including mother-andchild health care and vaccinations. PERU $100,000 Assisting socially excluded groups In Peru, MSF cared for people living with HIV/AIDS in the slums of Lima and in the city’s overcrowded Lurigancho prison. MSF continued to address the problem of violence against children and adolescents in Lima’s Villa El Salvador district. In addition, MSF responded with material assistance and aid to health facilities when extreme cold affected thousands in July.

MIDDLE EAST

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IRAQ $352,000 Providing care for civilians MSF entered Baghdad in March 2003 just before the US-led Coalition overthrew the regime of Saddam Hussein. After the heaviest fighting ended, MSF assessed needs in more than 70 health structures and found that the most urgent problems were related to the collapse of leadership in the highly centralized health system, resulting in the disruption of supply chains and services. MSF provided basic medical care in three health centers in Sadr City, a slum area of Baghdad, and until August distributed drugs and supplies to clinics and hospitals in Basra and Missan. In the wake of the looting of Baghdad’s hospitals, MSF called on the US-led coalition to uphold its obligation to ensure the protection of medical structures and provide for the needs, including health care, of the Iraqi people. PALESTINIAN TERRITORIES $100,000 Aiding traumatized civilians Since 2000, when the conflict in the Palestinian Territories intensified, MSF has worked in Gaza, Hebron, and Jenin to ease the psychological and physical suffering of Palestinian families who have had little access to health care and whose movement is restricted.

40 countries

MSF TREATS MORE THAN ONE MILLION PEOPLE FOR MALARIA IN NEARLY 40 COUNTRIES EVERY YEAR.

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MALARIA death count While HIV/AIDS gained increased soars political and media attention in 2003, malaria continued to claim between one and two million lives—mainly children in Africa. In fact, a child in Africa dies from malaria every 30 seconds, nearly 3,000 every day. With drug-resistant strains of malaria rendering classic antimalarials such as chloroquine and sulfadoxine pyrimethamine useless in most Africa countries, MSF continued to switch to artemisisin-based combination therapy (ACT) in all programs. ACT, derived from the Chinese Artemisia plant, quickly rids patients of the parasite that causes malaria. MSF has urged many African ministries of health to convert to ACT and has called on donor governments to stop supporting cheap, but failing, malaria treatments in Africa that are linked to the rising death toll from the disease.

Access to essential In May, MSF concluded its nationMEDICINES EXPO wide tour of the Access to Essential Medicines EXPO, a traveling exhibit staffed by returned field volunteers and highlighting the urgent need for effective treatments for infectious diseases such as kala azar, sleeping sickness, tuberculosis, HIV/AIDS, and malaria. With a final stop on the National Mall in Washington, DC, MSF delivered petitions to the US government and the Pharmaceutical Research and Manufacturers of America

YEAR IN REVIEW 2003

calling for an increase in the research and development of drugs for neglected diseases. Prominent names on the petition included 30 deans of US medical and public health schools, former Surgeon General Dr. David Satcher, and former FDA Commissioner Dr. David Kessler. An educational magazine and curriculum were developed to accompany the EXPO in the final leg of its tour, and are still being used today. These materials are accessible on the campaign and educational tools section of our website, www.doctorswithoutborders.org.

MSFdocumentary MSF’s field work was highlighted in a 13-part

ADVOCACY, COORDINATION, AND RESEARCH MSF International Office $450,000 Supporting advocacy and network coordination As part of the MSF network, MSF-USA helped to support the MSF International Office, which coordinates policies and carries out common projects on behalf of MSF’s 18 sections worldwide. It also supported MSF’s advocacy on medical and humanitarian issues with the United Nations and other international bodies. International Campaign for Access to Essential Medicines $250,000 Confronting barriers to treatment MSF-USA supported this campaign, which draws on MSF’s field experience to promote international and national policy changes to achieve greater access to affordable and effective medicines and diagnostics.

Epicentre $310,000 Carrying out operational research MSF supported the operational research efforts of Epicentre, which in turn assists MSF in improving treatments and developing high-quality health care initiatives in its field projects. Other donor-designated funds (Bangladesh, Brazil, France, Honduras, Kuwait/Qatar, Nicaragua, The Philippines, Romania, Rwanda, Tajikistan, Tanzania, and Ukraine)$13,300

TOTAL PROJECT SUPPORT THROUGH US PRIVATE FUNDING At year end 2003: $38,823,720 ■

Africa $ 29,210,565

■

Asia and the Pacific $ 4,028,000

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Caucasus and Central Asia $ 1,906,300

■

Americas $ 2,045,000

■

Middle East $ 452,500

■

Other $ 1,181,355

21 US ANNUAL REPORT 2003

Drugs for Neglected Diseases Initiative (DNDi) $171,355 Developing medicines for forgotten diseases This new partnership involving MSF, the World Health Organization, and key public research institutes was launched in July 2003 to research and develop new drugs and new formulations of drugs to treat neglected diseases such as sleeping sickness, kala azar, and Chagas.

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National Geographic television series, “Doctors Without Borders: Life in the Field.” The documentary series featured 30 MSF projects in more than 20 countries and profiled more than 45 MSF volunteers as they provided assistance to people affected by violence, famine, and disease. Viewers saw MSF volunteers organize feeding centers to aid Angola’s young famine victims, go door-to-door in villages in Siberia to test for tuberculosis, and operate on war wounded near the frontlines in Burundi, among other projects.

Through mobile clinics, MSF teams brought medical and psychological care to these areas. Home visits and counseling by psychologists or psychiatrists helped traumatized individuals (half of them under 15 years of age). In Hebron and Jenin, the MSF team also carried out emergency interventions such as escorting pregnant women and gunshot victims to nearby hospitals.

VOLUNTEERS

An MSF volunteer performs consultations with a family left homeless by an earthquake in Bam, Iran.

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

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Independence in movement

© TIM DIRVEN, 2004

Doctors Without Borders/Médecins Sans Frontières’ (MSF) activities depend on the dedicated and talented work carried out by thousands of volunteers in field projects around the world. In 2003, MSF sent physicians, surgeons, nurses, psychologists, midwives, logisticians, and administrators to work in nearly 80 countries. Among these volunteers were 157 individuals recruited and dispatched by MSF-USA—the highest number ever. Of these volunteers, 60 percent had prior experience working with MSF in the field. At each project location, international volunteers worked alongside national staff members to provide urgently needed medical assistance.

MSF VOLUNTEERS SENT ON FIELD MISSIONS IN 2003 Nabil Al-Tikriti, LA, Exploratory Team Member, Iraq > Martha Anderson, NM, Nurse, Angola > Mauricio Arellano-Osorio, Venezuela, Logistician/Administrator, Sudan >

Mark Ashey, IN, Logistician/Construction, Kenya > Voiteck Asztabski, NC, Logistician/Construction, Sudan > Severine Autesserre, NY, Program Coordinator/Manager,

Democratic Republic of Congo > Barbara Bauer, MO, Mental Health Officer, Nepal > Gildon Beall, CA, Physician, China > Candice Becker, CA, Midwife, Burundi > Tania

Bernath, NY, Humanitarian Affairs Officer, Ethiopia > Jane Boggini, CT, Nurse, Ivory Coast, Democratic Republic of Congo; Field Coordinator/Nurse, Liberia > Laura Brav, France, Head of Mission, Sudan > Barbara Burke, AL, Physician, Sierra Leone > Jeanne Cabeza, CA, Physician, Thailand > Patricia Campbell, NY, Physician, Ivory Coast, Republic of Congo > Jonathan Caplan, MA, Field Coordinator, Sudan > Sonia Cheng, PA, Physician, Sudan > James Chu, CA, Administrator/Financial Coordinator, Nigeria >

Manita Coggins, MT, Nurse, Angola > Sharon Connor, PA, Coordinator, Campaign for Access to Essential Medicines, Ethiopia > Jordy Cox, TX, Surgeon, Ivory Coast >

Ian Cree, Zambia, Surgeon, Haiti > Ioana Cretescu-Kornett, WA, Physician, Ethiopia > Larry Crook, OR, Physician, Thailand > Andrew Cunningham, MI, Head of Mission, Zimbabwe, Russia; Emergency Coordinator, Pakistan > Deborah Cunningham, MI, Medical Coordinator, Russia, Democratic Republic of Congo, Zimbabwe > Christopher

Day, SC, Field Coordinator, Ivory Coast

>

Henry Debusmann, OH, Logistician, Georgia

>

Pascal Delamaire, France, Logistician/Construction, Democratic Republic of

Congo > Terufat Deneke, VA, Logistician/Administrator, Ivory Coast > John Duwel, WV, Surgeon, Sri Lanka > Kodjo Delali Edoh, NY, Physician, Burundi > Greg Elder, NY, Medical Coordinator, Sudan > Rosamond Everard, MA, Physician, Thailand > Nagib Fares, FL, Physician, Kenya > Ingrid Ford, France, Field Coordinator/Nurse, Ivory Coast >

Bruce Frank, MO, Surgeon, Liberia > Mary Jo Frawley, CA, Nurse, Mexico, Liberia > Mary Annette Friala, NY, Nurse, Liberia > Rhian Gastineau, TX, Field Coordinator,

Republic of Congo > Carlos Eduardo Giraldo, NY, Physician, Afghanistan > Katherine Gnauck, NM, Physician, Sudan > Rebecca Golden, LA, Head of Mission, Democratic Republic of Congo > Camilo Gomez, Colombia, Physician, Nepal > Jorge Arturo Gonzales-Duran, Colombia, Physician, Guatemala > Jim Goodson, MD, Nurse, Sudan >

Debra Guss, MD, Nurse, Zimbabwe > Katherine Hagerty, OR, Nurse, Sudan > Lauren Heidbrink, IL, Administrator/Financial Coordinator, Angola > Nils Hennig, NY, Medical Coordinator, Ethiopia > George Holloway, WY, Administrator/Financial Coordinator, Uzbekistan > Cindy Huang, CA, Administrator/Financial Coordinator, Sudan >

Catherine Husa-Husseini, NY, Physician, Burundi > Benjamin Ip, NV, Exploratory Team Member, Bangladesh > Rosa-Elisa Jaramillo, GA, Physician, Mexico > Deborah Elaine Jenkins, ID, Anesthesiologist, Sri Lanka, Democratic Republic of Congo > Don Johnston, CO, Logistician, Zimbabwe, Iraq > Joan Kauffman, CA, Nurse, Guatemala >

Michelle Kelly, CA, Field Coordinator/Nurse, Jordan, Nigeria > Anne Marie Kilmartin, MA, Nurse, Nigeria > Eamonn Kilmartin, CT, Logistics Coordinator, Kenya > Pierre

Labranche, NH, Logistician, Sri Lanka > David Lanier, NC, Physician, Thailand > Robert Levin, MN, Physician, Uganda > Ya-Ching Lin, AZ, Epidemiologist, Republic of Congo > Kathryn MacLaughlin, MA, Logistician/Water and Sanitation Expert, Sudan > Marcia Mayer, FL, Nurse, Angola > Margaret McChesney, AZ, Nurse, Mozambique >

Stephen McElroy, MA, Exploratory Team Member, Turkmenistan; Physician, Liberia

>

Michael Michalik, IL, Mental Health Officer, Palestinian Territories

>

Piotr

Michalowski, WA, Anesthesiologist, Sri Lanka > Max Morel, CO, Logistician/Administrator, Ivory Coast > Esther Moring, Holland/AL, Medical Coordinator, Republic of Congo, Liberia; Emergency Coordinator, Chad, Uganda > Patrick Murphy, CA, Nurse, Ivory Coast > Gary Myers, OK, Surgeon, Liberia > Sally Najera, LA, Nurse, Angola >

Lulu Oguda, MA, Physician, Zambia

>

David Olson, NM, Medical Coordinator, Burundi

>

Peter Orr, NY, Head of Mission, Ivory Coast; Field Coordinator, Palestinian

>

Paul Radway, CO, Surgeon, Georgia > Laurence Ravat, CA, Administrator/Financial Coordinator, Sierra

Leone > Sylvie Renaudin, MA, Administrator/Financial Coordinator, Guinea > Christopher Richardson, PA, Logistician, Sudan > Christina Roberts, MA, Nurse, Angola >

Paul Roddy, NM, Epidemiologist, Tajikistan, Sierra Leone > Marie Elena Rosales, Venezuela, Head of Mission, Zambia > John Ryan, CA, Physician, Sudan > Heather Schlott, VT, Physician, Ethiopia > Bettina Schunter, WA, Program Manager, South Africa > Amy Segal, CA, Logistician, Sierra Leone; Logistician/Administrator, Uganda > John Shepherd, CO, Physician, Sierra Leone > Susan Shepherd, MT, Physician, Uganda > Todd Graham Smith, NY, Logistician, China > Stephen Sokol, ME, Physician, Sierra Leone > Lindsay Spainhour, NC, Nurse, Sudan > Per-Erik Stafanson, CA, Logistician, Kenya > Yoko Sugawara, SD, Nurse, Georgia > Margaret Sweeney, AZ, Nurse, Sierra Leone

>

Ahmed Taha, NY, Administrator/Financial Coordinator, Guatemala

>

Aurora Teixeira, WI, Medical Coordinator, Palestinian Territories

>

Steven

Untracht, PA, Surgeon, Democratic Republic of Congo, Burundi > Deepa Upadhyaya, CA, Midwife, Afghanistan > Deborah van Dyke, VT, Field Coordinator/Nurse, India >

Diana Vartan, NY, Mental Health Officer, Palestinian Territories > Thor Wagner, NY, Physician, Sudan > Moira Walsh, MN, Health Educator/Trainer, Turkmenistan >

Benjamin Wan, NY, Physician, Liberia > Margo White, OH, Physician, Bangladesh > Annie Whitehouse, CO, Nurse, Sierra Leone > Margaret Wideau, ID, Nurse, Zambia >

John Willow, NM, Logistician/Administrator, Sierra Leone > Ian Wilson, FL, Surgeon, Ivory Coast > Thomas Witschi, NY, Surgeon, Democratic Republic of Congo >

Allison Wolff, CA, Nurse, Sudan > Jason Wong, WA, Physician, Ivory Coast > Chloe Wurr, HI, Medical Coordinator, Sudan > Julie Wynne, MD, Surgeon, Sri Lanka > James Yoon, CA, Physician, China > Myriam Zech, CA, Logistician/Water and Sanitation Expert, Afghanistan > Stuart Zimble, Greece, Head of Mission, India; Field Coordinator, Liberia > Ahmed Zouiten, NC, Physician, Laos

INTERESTED IN BECOMING AN MSF VOLUNTEER?

MSF is always looking for both medical and non-medical volunteers to take part in its missions, which last six months or longer. Volunteers are required to have at least two years of experience in their professional fields. For more information, contact our Human Resources Department at 212-655-3768 or visit our website. MSF-USA also needs volunteers and interns to work in its offices in New York and Los Angeles. For more information, please visit our website or call 212-679-6800.

US ANNUAL REPORT 2003

CO, Field Coordinator, Sudan > Michael Pate, CA, Nurse, Angola

23 ➔

Territories > Robyn Osrow, NY, Mental Health Officer, China > Hansel Otero, TX, Physician, Liberia > Jennifer Pahl, AK, Field Coordinator/Nurse, Sudan > Joseph Pale,

DONORS

An MSF volunteer examines a child admitted to a therapeutic feeding center in Monrovia, Liberia.

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

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Independence in funding

© KRIS TORGESON, 2003

Doctors Without Borders/ Médecins Sans Frontières (MSF) is extremely grateful for the financial support it receives from individuals, foundations, corporations, and other organizations. Your generous contributions in 2003 gave us the opportunity to carry out programs and respond to emergency situations in almost 80 countries.

$1 MILLION +

Anonymous (1) Dixie Chicks $500,000-$999,000

Seth D. Neiman $250,000-$499,000

Anonymous (4) Simpson Thacher & Bartlett* $100,000-$249,000

Anonymous (14) Estate of Ella Poe Burling The Capital Group Companies Charitable Foundation The Fludzinski Foundation Clifton A. Gaskill Kwok Charitable Trust The Lawrence Foundation, in honor of Hubert and Elizabeth Troth Lloyd A. Fry Foundation Lopatin Family Foundation Payden & Rygel The Starr Foundation The Tides Foundation, advised by Mr. John Gaguine Thomas & Ancella Toldrian United Airlines* VERITAS Software Foundation* Weiler-Arnow Family

$50,000-$99,999

Anonymous (127) Abraham Fuchsberg Family Foundation Albert & Turkan Adriani Meena & Liaquat Ahamed Albert & Doris Pitt Charitable Trust * In-kind contribution

>

Evelyn V. Fielden Mark & Donna Flowers Mr. John Franklin Fort, III Fox Point Limited The Franklin Fund Tom Freston Fullbloom Baking Company E. Marianne Gabel & Don Lateiner Dr. & Mrs. Woodrow Gandy Jim & Yukiko Gatheral GDS Legacy Foundation GE Employers Reinsurance George L. Shields Foundation, Inc. Richard Gilfillan, MD & Carmen Caneda Martha Taft Golden Daniel Goldring Orlando Gonzalez, MD Grace Jones Richardson Trust Benjamin Krischer Greene Nicholas P. Greville Neal C. & Olivia B. Hansen Jan M. Hayden Mr. Rick Hayman Henry & Joan Wheeler Charitable Fund Nancy Hoagland Dot Hogue The Howard & Barbara Farkas Foundation Robert G. Huber Andrew & Caroline Huddart The Hunter-White Foundation International Monetary Fund, Civic Program Irving Berlin Charitable Fund The J.P. Morgan Chase Foundation James and Norma Smith Foundation Jane & Worth B. Daniels Jr. Fund of the Baltimore Community Foundation Janus Matching Gifts Program Jim & Yvonne Sexton Foundation John A. Sellon Charitable Residual Trust Charles & Marion Johnson The Jorgensen Charitable Trust

Names appearing in red indicate membership in our Field Partner program and a commitment to make a monthly donation.

76 000 ,

new

IN 2003, MSF-USA HAD ALMOST 76,000 FIRST-TIME DONORS.

25 US ANNUAL REPORT 2003

$10,000-$49,999

Many Thanks to Our Field Partners More than 10,000 people are members of our monthly giving program, providing MSF with more than $2.5 million in regular and predictable income in 2003. These ongoing contributions allow us to respond immediately to emergencies, and to make solid commitments to new and current projects. Field Partners who contribute more than $5,000 throughout the course of the year are recognized throughout the following report and are highlighted in red. We are truly grateful for the generous commitment of all of our Field Partners.

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Anonymous (13) Bridge of Allen Foundation The C.E. and S. Foundation The Charles Engelhard Foundation Coventry Health Care The Dibner Fund Edward & Janet Howle Wendy Keys & Donald A. Pels Paul Newman Estate of Allis Peaker Peierls Foundation, Inc. The Pumpkin Foundation James Rushton David & Beth Sawi Seafood Supply Company Stavros S. Niarchos Foundation T. Peter Thomas Colin T. Watmough Wellington Management Company, LLP White Wave, Inc. Working Assets

George & Herawati Alvarez-Correa The April Fund Alex & Louise Armstrong Astec America, Inc. The Baobab Fund Norman L. Barnett Baron & Baron, Inc. Mrs. Eleanor Close Barzin Anson & Jean Beard, Jr. & Family Kaya Beeley Mrs. W. H. Beim Benjamin & Sophie Scher Charitable Foundation Richard L. Bennett, MD Richard Bernstein Mr. & Mrs. Dennis Berryman Bicycle Fund of The Greater Cincinnati Foundation The Briarcliff Trust, on behalf of Brad Pitt Mr. C. David Bromwell The Brown Foundation, Inc. of Houston Daniel G. & Nalini Brown Dr. David Louis Brown The Brownington Foundation Bruce Ford Brown Charitable Trust Bunting Family Foundation Audrey Steele Burnand Christine Campbell & Christopher Lochhead Christopher Campbell Jennifer Corn Carter CDC IXIS North America, Inc. The Ceil & Michael E. Pulitzer Foundation Laurence J. Chang L. Chase Virginia S. Chase Joel D. Coen Ms. Mary Virginia W. Coffman & Mr. Peter D. Coffman Cogan Family Foundation Collegiate Church Corporation Patrick & Amy Collins John R. & Kathleen Corbet Barbara & Raymond Dalio The Danielson Foundation Tom & Linda Daschle The David Geffen Foundation Mr. Simon Davis Hester Diamond Directions for Rural Action Fund Dr. & Mrs. Emmett J. Doerr, Jr. Doll Family Foundation Donald F. Donahue & Jeanmarie Anderer, MD Robert Lee Douglas, Jr. & Elizabeth Strode Mrs. Allen Early Edward T. Cone Foundation Edwin W. and Catherine M. Davis Foundation The Emanuel & Anna Weinstein Foundation The Emerald Foundation Mr. & Mrs. Robert M. English Epitaph & The Kids Alan Fehsenfeld Mr. Lincoln P. Field

© CARL DE KEYZER, 2004

DONORS

An MSF vaccination team at work in Maymaneh region of Afghanistan.

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

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26

Joseph and Sally Handleman Charitable Trust The Karma Foundation Mr. & Mrs. Michael Keiser Keith S. and Marcelle M. Henley Foundation Flora & Farhad Khosravi Walter S. Kimball Sue Klapholz Edwin J. Krane The Kurr Foundation David & Jennifer Kurtz Mr. & Mrs. Conrad Kuzma Peter & Deborah Lamm Diane D. & Robert J. Lang Lillian & Ira N. Langsan Foundation, Inc. Renato Y. Lee Ms. Elizabeth Lees Leibowitz & Greenway Foundation Yoko Ono Lennon Mary & Charles Liebman Litterman Family Foundation The Louis and Harold Price Foundation, Inc. The Louise & Gerald Kaiser Foundation, Inc. Eric J. Lunger Liz & Greg Lutz The Lynn R. & Karl E. Prickett Fund Jane C. MacElree Scott & Jan MacGregor Malcolm Hewitt Wiener Foundation Carole Marcus The Margaret H. and James E. Kelley Foundation Hugh & Moira Martin MBIA, Inc. Mark McGauley Russell & Ellen McManus Estate of Rosalyn M. Mervis Maurice R. Meslans & Margaret E. Holyfield Fred & Marie-Noelle Meyer David & Rosemary Miller ML In Memory of Her Father Ms. Anne Modarressi

* In-kind contribution

>

Moriah Fund Mushett Family Foundation Ravi & Padma Nangunoori Naomi and Nehemiah Cohen Foundation Babak Noorian The Norman & Rosita Winston Foundation, Inc. Gilbert Mudiwa Nyamuswa, MD Oak Lodge Foundation The Oak Tree Philanthropic Foundation O’Brien Family Fund Mary M. O’Hern G. Olerich ORCA Design & Manufacturing Corporation The Orinoco Trust The Overbrook Foundation Overmire Fund The Parker Family Foundation Nicholas & Anne Patterson Jorge Pellegrini, MD Perls Foundation Sarah M. & Michael Peterson Theodore Petroulas & Nasimeh Ali Khani Philancon Fund of the Boston Foundation Robert & Anne P. Pinchuk Porter Braden Endowment Fund William Presseau & Family M. Virginia Procter The Radiator Doctor The Rapoport Family Foundation Red Tettemer Adrianne B. Reilly Renee B. Fisher Foundation Maggie Renzi Richard & Rhoda Goldman Fund Mr. & Mrs. Andrew D. Richard Elizabeth Richmond Frank Ritchey Richard Rockefeller, MD Sascha M. Rockefeller Irene Rogers

Ruth & David Levine Foundation Meg Ryan Harriet W. Rylaarsdam Jeff & Laurel Sakihara Donald & Laura Sanders Sandpiper Fund Val & Min-Myn Schaffner Ellen M. Schiffman Arthur L. Schrepple Mrs. Guenter H. Schulenberg Noralee & Jon Sedmak Seeley Charitable Foundation Serine Bonnist SG Cowen Susan & Jeremy Shamos Edward & Barbara Shapiro The Shifting Foundation Silhouette Optical Ltd. Randy A. Siltanen, MD Jacqueline Albert Simon James M. Smith Gladys & Everett Spector Spruce Fund Jolie Stahl & Robert Dannin Mrs. Lawrence E. Stahl Mark & Sarah Stegemoeller George Stout & Margaret Ellis Owen Connolly & Harold Sundberg Memorial Fund Sy Syms Foundation Charlotte L. Taylor Ben Tench Richard Thorpe Drs. Angelo Tomedi & Margaret M. Wolak John & Louisa Troubh Bob & Dee Turner Elsie P. Van Buren Edgar Villchur Lalita & Vish Viswanathan Marc Waldor & Nancy Long, PhD The Warwick Foundation of Bucks County The Wasily Family Foundation The Watkins Family Watson Family Fund of the Minneapolis Foundation Mrs. Nell V. Weidenhammer Sam Weisman & Nancy Crown David R. & Isabel Welland Wendy & Barry Meyer Charitable Foundation Douglas & Melinda Weston WestWind Foundation Steve & Peg Wilcox Howard E. Wille William H. Prusoff Foundation Nina-Dawne Williams, Esq. Endowment Nina J. Williams, Esq. Mr. & Mrs. John H.T. Wilson Wishing Well Fund Working Assets Grantmaking Fund of the Tides Foundation The Worster Foundation Anne & Dick Young Christian & Sarah Zimmerman

Names appearing in red indicate membership in our Field Partner program and a commitment to make a monthly donation.

$5,000-$9,999

MSF is pleased to announce that we are now offering a charitable gift annuity program. Linda P. Dotson Nancy Shuford Dowdy Jean Driscoll & Peter Calthorpe Kingston & Liz Schwere Duffie Eileen Duggan Tim Dunn Eaglemere Foundation, Inc. East Bay Community Foundation Easy Partnership Mr. & Mrs. Paul C. Edmunds, II Edward H. & Frieda Davis Jr. Fund David & Lynne Eggert Jeanne Eisenstadt Debra Poretsky Ekman Cami & Peter Elbow Gary Elden Elder Family Foundation Elizabeth Hebert & Donald Guthrie Foundation Elliot & Roslyn Jaffe Family Foundation Daniel & Pamela Elliot Allen & Lois Evans Mark Everett F. Forrest Living Trust Nastaran Fathi, MD Ferguson Foundation Janet Ficke Fidelity Cares Fort Dearborn Company Fraenkel Gallery Matt Frankel & Sally Salisbury Fred & Ruthann Prifty Fund Robert Friedman & Jane Grenadier Charles A. & Margaretha Fritz, III Cheryl Furey Nancy Lawton & Steve Fury Treacy & Todd Gaffney Galewitz Family Foundation GAP Incorporated Giving Campaign Beverly Gee Gemi, LLC Michele Gillett Mr. Raymond P. Ginther The Glickenhaus Foundation Glynton Handkerchief Company, LLC GMW Associates

2003 SOURCES OF INCOME Individuals Corporations

81% 4% 11%

Foundations Organizations

REVENUE

4%

Total MSF is thankful for the continued support of our longtime donors as well as the almost 76,000 first-time contributors in 2003.

$ 42,825,371 $

2,142,284

$

5,887,919

$ 2,246,987 $ 53,102,563

27 US ANNUAL REPORT 2003

Ed & Amy Brakeman Mark Brazill Bridgeway Charitable Foundation Jim & Lynn Briody Mr. Larry Broderick Nico Brooks & Polly Dawkins Patrick Brown & Sue Klapholz Buck Henry Charitable Fund of the California Community Foundation William & Mary Buckley Clifford Burnstein C. Cretors & Co. Ms. Bonnie Campbell Martha Campbell Alexander E. Carles Mr. Charles W. Carson Mary Case The Cawley Family CB & Anita Branch Trust Cendent Mobility Sandy Chalstrom Charles S. Chapin Charles A. Mastronardi Foundation Charles A. Rini Charitable Trust Charles Allen Ward Fund of the Saint Paul Foundation Anna Chavez & Eugene Eidenberg Ying Chen Chubb’s Matching Gift Program Church of St. Joan of Arc The Church Without Walls, Episcopal Diocese of Pennsylvania Dr. Robert W. Clausen Computer Associates’ Matching Gift Program John A. & Paige Contreras Caroline A. & James W. Cooley, III Cora Corliss Countess Moira Charitable Foundation Cross Family Fund CRT Capital Group, LLC Da Capo Fund The David Butler Family Foundation David Woods Kemper Memorial Foundation Jo De Lorenzo Luc & Rieve De Wulf Grace Dembitz Douglas Derwin William & Donna DeSeta Deutsche Bank Americas Foundation Dickler Family Foundation, Inc. Dion Peterson Foundation Doctors Hospital of Jackson

➔

Anonymous (177) A Corporation for Art & Commerce A & J Saks Foundation Janet & Gregory Abels AE Charitable Foundation A.E. & Martha Michelbacher Fund of the Marin Community Foundation Al Fatiha Foundation for Lesbian, Gay, Bisexual, Transgendered, Queer & Questioning Muslims Allegro International Services, Inc. S.W. Almy Amazescape.com America’s Charities Julian & Sylvia Ander Franklin J. Arcella Richard & Ruth Armold Arthur & Eve Fastenberg Philanthropic Fund Paul Asente Atkins Family Foundation Mr. & Mrs. Marshall Ausburn Frederic M. & Diane L. Ayres Varian Ayers Andrew Balber Ken & Ginger Baldwin Jeffrey B. Barden Richard Barna Joanna & Simon Barouch Robert A. Barr David R. Barry Ivan & Pamela Rand Barzakov Ms. Margaret L. Bates Anne Beckett Ralph J. & Elizabeth Begley Pete & Elizabeth Beglin Teri Roudabush Bennett Karl Berger & Maribeth Visco Harold Berliner Martin Bickman Glen R. Birrell Victoria & Hank Bjorklund Mark A. & Nancy Briggs Blaser Elizabeth Block Lori Boardman Boggess Family 1990 Rev Trust Victoria Boisen, DO Robert Bookman Nicholas & Lise Borg Timothy Boudreau Bruce & Barbara Brackenridge Thomas M. & Diane Brady Ms. Sally Braid

DONORS

‘‘If MSF were a person, you would say they have high energy, absolute integrity, vision, effectiveness, and the broad reach which comes from undeniable commitment and selflessness.’’ —CHARLES HIRSCHLER AND MARIANNE ROSENBERG

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

➔

28

James Dean Gould, MD Helen Anne Greeley Andre Gregory Ward & Marlene Greenberg Groundspring.org Frank & Carol Gruen Mr. Manuel Guerr Roger Gural Mr. Robert D. Gwin Reggie Hahn Charles & Susan Hairston Robert & Ruth Halperin Lynn Hanna Lawrence Harrigan Harris and Eliza Kempner Fund Norman Harvey Francis W. & Serena Hatch George & Cheryl Haywood Ms. Teresa Healy Susan & Albie Hecht Roslyn Hees David William Helgren Mr. & Mrs. George Sutherland Herscher Highview Management Charles Hirschler & Marianne Rosenberg Michel Hoessly, MD The Holborn Foundation Ruth M. Holland Robin & Brad Holmgren Daniel & Kellie Holoski The Howard Bayne Fund Neil & Nancy Humphreys Gianfranco & Rita Iavarone Independent Realty Capital Corporation International Transport Solutions, Inc. Stephen Ippolito The Irving Foundation Gary Isaac & Toni Gilpin Nina Jacobson The Jaquith Family Foundation Shamala & Rangarajan Jayaraman Peter Jennings * In-kind contribution

>

Jerome & Ilene Cole Foundation, Inc. Jerome Medical The JKW Foundation The Joan Leidy Foundation John Michael Associates Ms. Brown Johnson Eric Johnson/Spectrum Finishes The Johnson Family Foundation Ms. Jean T. Johnson Lance Jones Thomas P. & Elisabeth M. Jones, III Joseph C. & Esther Foster Foundation, Inc. Sten Jostrand Naomi M. Kane, MD The Philip Kaplan Glass Works, LLC Karen & Christopher Payne Family Foundation Pamela & Andrew Kaufmann Keare/Hodge Family Foundation Susan Petersen Kennedy Christian E. & Linda Kimball Barbara Kirchheimer John & Cornelia Kittredge Philip & Rhonda Gale Klein Mr. & Mrs. Lorenz F. Koerber, Jr. Dr. Claudia A. Komer Florence Koplow Mr. Douglas Kreeger Ehren Kruger Michael & Tess Kunesh Laura & Edward M. LaFond Lanza Family Foundation Dr. Joel Lebowitz Lemaire Family Fund Leon Foundation Martin & Carol Levin Lewis-Bakker CLAT Marjorie R. Lewis Susan & Bernard Liautaud Lionbridge Technologies, Inc. Gregory Lipper David & Amy Lippitt Sheng C. Lo Lucille M. Loginon, MD Louis & Anne Abrons Foundation M9 Charitable Fund Leslie M. Mack John Maher Shigeki & Kay Makino The Malcolm Gibbs Foundation Wai Man & Grace Yeung Mandile Family Foundation Ms. Carolyn Mangeng Annie Manuel & Bill Mascioli Susan Margolin Gabriel Marshank Maurice Mandell & Rebekah Gisnet Trust Patricia McBride The McCaffrey Family Foundation

Brian McCaffrey & Sylvia Yee Mr. Martin McConnell Mr. & Mrs. Paul McCulley Mr. Anthony J. McEwan Daniel & Teresa McGovern The McGraw-Hill Companies, Inc. Dr. & Mrs. Bradley McIver Ruth E. McNally Steve & Suzi McVoy Merrill-Hughes Family Fund The Miller Family Fund Helen Knox Miller Walter E. D. Miller Greg Minshall MKM Foundation Peter W. & Vicki R. Morgan Morris M. Goldberg Trust, MD Peter Muller Wilma Tucker Muse Mary Newman Norma Kline Tiefel Foundation Mr. Edward H. Norton The Oberod Foundation Dan O’Keefe Lorna E. Oleck David Oswald OTA Limited Partnership The Page & Otto Marx, Jr. Foundation Palmer Foundation Marjorie Tooker Patton Paul & Diana Margolis Charitable Trust Margarette Paz Peachtree House Foundation Christine Pendzich Danielle & M. Hardy Penzer Richard Perez Roland Pesch Tuan V. Phan, MD The City of Philadelphia Philip W. Riskin Charitable Foundation Timothy & Katherine Philip Pinnacle Entertainment, Inc. Mr. & Mrs. John & Ethel Piper R.M. Ellis Foundation Craig & Maja Ramsey Gita Rao T.R. & Susan Rao Eric Reeves Kay Gunderson Reeves Andrew Reich The Renaissance Foundation, Irving J. Levin & Stephanie J. Fowler, Trustees Lynnette Rhodes The Rice Family Foundation James & Jean Richardson Rienzi & Rienzi Communications, Inc. B.C. Rimbeaux

Names appearing in red indicate membership in our Field Partner program and a commitment to make a monthly donation.

90 000 ,

more

IN 2003, MSF-USA RECEIVED ALMOST 265,000 PRIVATE CONTRIBUTIONS, 90,000 MORE THAN IN 2002.

Make a Planned Gift By providing for MSF in your financial planning, you will help ensure our ability to respond to the challenges we will face now and in the future while at the same time meeting your personal financial objectives. MSF’s Legacy Society Each year, many of our loyal supporters join our Legacy Society by naming MSF in a will or trust, as a beneficiary of a life insurance policy, financial account, Individual Retirement Account (IRA), or other qualified retirement programs.

LEGACY SOCIETY

Allen E. Armstrong John Ballentine Thomas & Johanna Baruch Richard & Marilyn Batchelder Mr. Bergman Ms. Anne C. Bush Ms. Alice Byers James & Charlotte Caldwell Greg & Suzanne Carlock Diane Lewis Chaney, PhD, MPH Clara Coen Allen Coulter Jill Donna Delman Bernard L. Desroches Robert Egan Allen & Lois Evans Joyce Fierro Alice Fischer Florence & William Fisher Gary L. Gaubatz B.J. Giacobello Mr. Ken Hadley The Harlow Family Trust Robert Hofreiter Marcia Jasiulko Gloria M. Kardong, MD George Karnoutsos Dr. Robert & Elaine Kirk Robert Knudson Mrs. Reti Kornfeld Elmira C. Lake Helen Craig Lappé Shiela S. Lyman Marion Mayer Richard J. McGonagle Sol D. Pickard, MD Albert Podell Ms. Lisa Shea Stephen & Josephine Spear Gladys & Everett Spector In Memory of Delmar Euin Thomason & Brian Keith McCann Dina von Zweck Sara E. Yeagy

29 US ANNUAL REPORT 2003

Dave & Laura Thompson Paul & Leigh Tischler Cheryl & Stan Tomchin Ms. Mitsuhiro Tomoko TravelSmith Outfitters Robert & Karen Trenner Samuel Tripp Maud Trismen Tucker Ray & Rita Utterback Paul & Maryjolyn Van Der Wel Beatrice F. Van Roijen Anna Marie & Robert D. Vernot The Virginia & Leonard Marx Foundation Betsy A. & Paul E. Von Kuster, III Anna & Michael Vranos Ms. Deborah Wagman The Wallack Family Foundation Walter & Laurie Parkes Charitable Fund Yuet Wei Wan Judith Watson & Daniel Finnegan Sam J. & Veronica Watters Brenda Webster & Ira M. Lapidus Barbara J. Weedon Lucille Werlinich Marissa Wesely & Fred Hamerman Whispering Bells Foundation Searle Whitney Robert & Raidza Wick Mr. Ross G. Williams Mr. & Mrs. Thomas L. Williams Dr. Clyde H. & Kathleen M. Wilson Mike & Kelly Windsor WINGS Enterprises Kirk Wise Ms. Vikki Wolff James A. Womack Robinson Woolson, PA WorldClinic, Inc. Anne K. Yeager, MD & Alan B. Segal, MD Janet M. Young Donald Zack Siegfried Zerweckh The Zients Family Foundation

Charitable Trust and Gift Annuities Planned giving through Charitable Trusts and Gift Annuities offers an opportunity to leverage your commitment to MSF while also receiving substantial individual tax benefits. For information about MSF’s planned giving programs, please call 212-679-6800.

➔

Robbins Family Fund Robert & Catherine Miller Foundation Dwight & Margaret Robinson David Rockefeller Rocker Family Foundation Joseph Roda Walter Rohloff Sheldon Rose Molly Rowan Dean Rubine & Ruth Sample Ruth & Peter Metz Family Foundation Ruth McLean Bowman Bowers Foundation Ruth Turner Fund, Inc. Dorothy Rutledge Lennart A. Saaf Michael & Sally Sachs The Sani Family Foundation Sargent Management Company Dr. Mary K. L. Sartwell Sayer Charitable Foundation Mark E. & Barbara A. J. Schaffer Richard L. Schiffman J.L. Schiffman & Company, Inc. Barton Schmitt Dustin Schneider Jonathan & Marika S. Schoolar The Schreiber Family Foundation Andrea Schulze David H. Schulze Bruce & Sara Schundler Elizabeth Seaborn The Seattle Foundation Nancy & David Seeman The Seinfeld Family Foundation Thom & Ann Serafin Shaker Family Foundation Trond Skramstad Jane & Don Slack Sloman Foundation Small Dog Electronics, Inc. Harry Smith Peter & Betsy Snow Mr. & Mrs. Michael Sormani Andrew I. Soye, MD James & Joyce Spain Warren J. Spector Aruna & David Spencer Robert E. Spohn Sprague Educational & Charitable Foundation Joseph H. Stanley The Staple Family Fund Benno Stebler Mr. & Mrs. Daniel Steiner Drs. Paul & Tyra Stephens Nancy Ruh Stevens Sudler & Hennessey Sulica Fund SunGard Trading & Risk SuNova Capital, LP Debbie Sweeney St. Andrew’s Episcopal Church Sylvan & Ann Oestreicher Foundation Tcom International, Inc. Arthur L. Thiele

FINANCIAL REPORT

© JUAN CARLOS TOMASI, 2003

MSF mobile clinics provide medical care to people living in remote villages in Colombia.

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

➔

30

STATEMENT OF ACTIVITIES AND CHANGES IN NET ASSETS The following summary was extracted from MSF-USA's audited financial statements. 2003 Revenues Contributions Other Revenue Investment Income Unrealized and Realized Gain (Loss) on Investments US Government Grants Other Revenue Grants from Affiliates Total Other Revenue Total Revenues Excluding Gifts in Kind

Expenses Program Services Emergency and medical programs Program Support and development Public Education Total Program Services Supporting Services Management and General Fundraising Total Supporting Services Total Expenses Excluding Gifts in Kind

$

53,102,563

$ $

174,161 51,252 67,785 17,435 128,246 438,879 53,541,442

$ $

2002

$

43,227,720

$ $

276,861 (232,455) 1,262,508 51,994 233,640 1,592,548 44,820,268

38,891,505 1,711,539 1,555,111 42,158,155

36,659,880 1,816,791 1,965,451 40,442,122

947,196 6,105,222 7,052,418 49,210,573

751,437 6,227,985 6,979,422 47,421,544

$ $

Net Assets Net Assets at beginning of year Increase/(Decrease) in Net Assets In-Kind Asset contribution (note 1) Net Assets at End of Year

$

8,148,087 4,330,869 9,025 12,487,981

$

10,740,945 (2,601,276) 8,418 8,148,087

note 1 - Represents fair market value of software donation

2003 Gifts In Kind (expensed in 2003) In-kind Program gifts represent the estimated fair market value of field volunteers' services, and in-kind management gifts include the estimated fair market value of donated legal services.

$

Program Management Total Gifts in Kind

$

9,289,226 328,563 9,617,789

$ $

9,914,143 414,556 10,328,699

STATEMENT OF FINANCIAL POSITION 2003 Assets Cash and equivalent Receivables Other assets Total Assets

$

$

Liabilities and Net Assets Grants payable (Note 2) Other payable Other liabilities Total Liabilities

$

10,634,024 1,749,653 2,837,500 15,221,177

$

12,271,523 216,458 12,487,981 15,221,177

$

$

19,884,759 3,384,803 1,756,146 25,025,708

$

15,971,416 675,337 230,868 16,877,621

$

7,900,133 247,954 8,148,087 25,025,708

Note 2: Grants Payable reflects unpaid grants as of December 31, 2002 and December 31, 2003 subsequently paid prior to April 2003 and April 2004 respectively

2003 EXPENSES

excluding in-kind expenses

2003 EXPENSES

including in-kind expenses

■

Program Services 85.67%

■

Program Services 87.45%

■

Management and General 1.92%

■

Management and General 2.17%

■

Fundraising 12.41%

■

Fundraising 10.38%

MSF-USA is recognized as tax-exempt under section 501 (c) (3) of the Internal Revenue Code. A copy of the most recent annual report filed by MSF-USA with the New York State Attorney General may be obtained, upon request, by contacting MSF-USA at 333 Seventh Avenue 2nd Floor, New York, NY 10001-5004, or the Attorney General's Charities Bureau at 120 Broadway, New York, NY 10271. A list of all of the MSF offices that received funds from MSF-USA is also available upon request. A copy of our most recent filing with the IRS is available on our website, www.doctorswithoutborders.org/donate/info.shtml

31 US ANNUAL REPORT 2003

$

2,014,800 521,616 196,780 2,733,196

$

➔

Unrestricted net assets Temporarily restricted Total Net Assets Total Liabilities and Net Assets

2002

BOARD OF DIRECTORS

ADVISORY BOARD

IN MEMORY

Carol Etherington, MSN, RN

Richard Rockefeller, MD

President

Chairman of the Board

Darin Portnoy, MD

Robert Bookman

Vice President

Creative Artists Agency

David A. Shevlin, Esq.

Victoria B. Bjorklund, Esq, PhD

During 2003, Doctors Without Borders/Médecins Sans Frontières (MSF) lost valued colleagues who died while carrying out their duties in the field and at home.

Secretary

Simpson Thacher & Bartlett

Jennifer White

A. Bruce Brackenridge

Treasurer

J.P. Morgan & Co., Inc. (Ret.)

Jean-Hervé Bradol, MD

Peter Grose

Martha Carey William Conk

Foreign Affairs

Jean Karoubi The LongChamp Group

Roshan Kumarasamy

Susan Liautaud

Bruce Mahin

James Ottaway, Jr.

Bart Meijman, MD Christine Nadori, RN

Carlo Urbani, MD, a specialist in infectious diseases, died in March from Severe Acute Respiratory Syndrome (SARS) after working tirelessly to prevent its spread in Vietnam. Urbani once headed MSF-Italy. In Liberia, Thomas Neaway, a national staff member, died in July after a mortar hit his home in Monrovia. Aderito Augusto, a driver in Luanda, Angola, was killed by a mob following a car accident. Ulugbek Makhmudov, an Uzbek physician, was killed in a car crash outside Nukus, Uzbekistan. In December, Bashir Yusuf Ali, a national staff logistician, was killed in Marere, Somalia, during a robbery. Fabien Ngenzebuhoro, national staff member in Kigali, Rwanda, died of an unknown disease. Godefroy Gedibere Wuluwulu, MD, a national staff member, died in Bangui, Central African Republic.

Dow Jones & Co. Ottaway Newspapers, Inc.

Kevin Patrick Ryan DoubleClick, Inc.

Garrick Utley Neil D. Levin Graduate School, SUNY

Marsha Williams Blue Wolf Productions

32

Robert W. van Zwieten Lehman Brothers Inc.

DOCTORS WITHOUT BORDERS/MÉDECINS SANS FRONTIÈRES (MSF)

➔

MSF-USA mourns the loss of Lucas van den Broeck, the husband of our colleague Cerue. He worked for MSF for 12 years, in Burundi, Iraq, Liberia (two missions), Somalia, Sudan, and Zaire, as well as in the Amsterdam office of MSF-Holland and the Brussels office of MSF-Belgium. Another former volunteer, Ann Graham, RN, from Massachusetts, died at 68. She had worked with MSF in 2001 in Abkhazia. Rob Boom, MD, a surgeon, chairman of MSFHolland from 1986 to 1992, and one of its first volunteers, died in 2003.

A boy receives medical treatment from an MSF volunteer working in a clinic in Sadr City in Baghdad, Iraq.

© ANDREW STERN, 2003

An MSF physician performs surgery on a war-wounded child in Burundi.

Your donations help us save lives WHAT IS THE IMPACT OF YOUR SUPPORT? Your donations ensure that when disaster strikes, our medical volunteers will arrive quickly with emergency supplies and be able to provide care immediately. Our pre-assembled medical kits give teams everything they need to start battling health emergencies without delay. Your gift provides:

$ 5,000

$ 10,000

$ 25,000

$ 50,000

Emergency Health Kit Contains medicines, dressings, and equipment enabling medical teams to care for 10,000 refugees for three months in an isolated area.

Vaccination Kit Holds cold-chain equipment, syringes, vaccine cards, and other materials needed to immunize 10,000 children.

Cholera Kit Delivers medicine, laboratory, testing supplies, and material to allow MSF teams to treat 1,000 people during an epidemic.

Hospital Kit Designed to set up medical, surgical, and outpatient activities in a 30-bed bush hospital for 3-months.

Malaria Treatment Purchases the most effective course of treatment, known as artemisinin-based combination therapy, for 6,000 people infected with the deadliest form of malaria.

Therapeutic Feeding Kit Contains everything needed, including high-energy biscuits, milk powder, vitamins, and other essential equipment to treat 700 acutely malnourished children in a country such as Angola.

HIV/AIDS Medecines Purchases a one-year supply of first-line antiretroviral medicines for approximately 200 people living with HIV/AIDS.

High-Frequency Radio Kit Includes complete equipment for long-range voice and modem data transmissions allowing teams to communicate in the field.

WE NEED YOUR HELP IN 2004 To make a donation:

By phone > 1-800-392-0392 On-line > www.doctorswithoutborders.org By mail > Doctors Without Borders, 333 Seventh Avenue, 2nd Floor, New York, NY 10001-5004 For more information about our programs or ways to make a donation, please call our Donor Services team at 212.655.3757. On behalf of our volunteers and the people we serve worldwide, thank you.

© KRIS TORGESON, LIBERIA, 2003

The Médecins Sans Frontières Charter

Doctors Without Borders/ Médecins Sans Frontières (MSF) is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honor the following principles: MSF provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. They do so irrespective of race, religion, creed or political convictions. MSF observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions. Members undertake to respect their professional code of ethics and to maintain complete independence from all political, economic, or religious powers. As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the association might be able to afford them.

US Headquarters: 333 Seventh Avenue, 2nd Floor, New York, NY 10001-5004 Tel: 212-679-6800 Fax: 212-679-7016 West Coast Office: 2525 Main Street, Suite 110, Santa Monica, CA 90405 Tel: 310-399-0049 Fax: 310-399-8177 Web site: www.doctorswithoutborders.org Email: [email protected]

ART DIRECTION & DESIGN © EMERSON, WAJDOWICZ STUDIOS / NYC / WWW.DESIGNEWS.COM