Haut Uéle – July 2011
A female patient is waiting for her consultation in Dungu Hospital. She has a severe cut on her back.
The eastern DRC context is still volatile, marked by shifting alliances between armed groups, ongoing military operations, instability, insecurity, banditry, and violence. Attacks against civilians and aid organisations are rising, making both the population and humanitarian aid workers increasingly vulnerable.
Rape, murder, kidnapping, and random acts of violence are daily occurrences for millions of people. The ability of Médecins Sans Frontières (MSF) to provide free and lifesaving healthcare is at times limited by this instability, which continues to push people from their homes.

Jazeera, Mogadishu – August 2011
Inside an MSF inpatient therapeutic feeding center. Since July 2011, nearly 200,000 newly displaced people have arrived in Mogadishu from drought-affected central regions of Somalia. MSF has opened 4 ITFCs in the capital city to treat malnourished children and distribute ready-to-use therapeutic food to the IDPs. Measles vaccination is also undertaken to respond current epidemic outbreak.

Mogadishu – August 11, 2011
Mogadishu cathedral, in the old part of Mogadishu, which was the Italian and Indian district during the colonial period (until 1960). Between the pillars of this unroofed building, refugees who flee starvation find a shelter after several days of walking.

August 31, 2011
800-1000 migrants and refugees are living amongst boats on an abandoned military base on the outskirts of Tripoli, where they have sought refuge in fear of harassment and violence. Many have been there for the duration of the conflict, been robbed of all identity papers, money and live in constant fear, without access to healthcare or security. MSF has provided medical consultations and assistance to the community, and are calling for their protection.

Galcayo South Hospital compound, Somalia, August 2011
Hibo Osman (20) with daughter Asho (8 months) from Galcayo. She has 5 children and was married off at an early age. Her daughter is now suffering from diarrhoea and is malnourished. She is sitting outside the tents of the therapeutic feeding centre. When Hibo was pregnant from her last child her husband was shot in a firefight. Hibo is supporting herself by selling second hand cloths on the market in Galcayo. She buys them wholesale on credit, and sells them to customers who pay her in weekly rates.

Shousha Camp, Tunisia – June 2011
Abubakar, 51, Eritrea.
The last few months were very bad. I arrived in the Shousha camp in April. The living conditions here are extremely difficult. We are suffering. I am a writer. I write poems, short stories and novels and I plan to write about life here in the camp.

Some 3,000 Sub-Saharan Africans are stranded in camps at the Tunisian border with Libya. The majority remain in a deadlock situation as they cannot be repatriated due to the situation in their country of origin and face an uncertain future. Most have fled violence or repression in their own country in search for a better life. Many experienced detention in Libya and they are now stranded in Shousha, with no future in sight. This situation has repercussions on their mental health state. Tensions are building up in Shousha; many prefer to go back to Libya or cross the Mediterranean Sea rather than stay in the camp.

Juong Pajok village, South Sudan – June 18, 2011
Thousands of IPD’s (Internally Displaced People) who fled fighting in the contested border area of Abyei have sought refuge close to Juong Pajok village, Warrap State, South Sudan. Heavy clashes and bombing, in and around Abyei, between the northern SAF (Sudanese Armed Forces) and southern SPLA (Sudan People’s Liberation Army) erupted in mid May 2011, causing a massive exodus of an estimated 90,000 people towards the south. This group of displaced people first arrived on June 2, 2011, without access to food, clean water, shelter or healthcare. They tried to build basic shelters to shield themselves from the harsh sun with twigs and clothing.

Shousha camp, May 2011
A recently arrived Oromo clan (Ethiopian ethnic group) are having a meeting.
The war in Libya has forced more than 600 000 civilians – foreign workers, migrants and Libyans – to flee the country, mainly to Tunisia in the west and Egypt in the east, but also across the desert to Niger, Chad and beyond or across the Mediterranean to Lampedusa.
Assistance to Libyan refugees in southern Tunisia is mainly provided by local communities out of solidarity, while a minority is assisted by the international community. Tataouine governorate alone is hosting around 60’000 Libyan refugees.

Soglay, Liberia – May 16, 2011
A baby sleeps under an improvised malaria net.
Following the post-election violence and subsequent tension in Ivory Coast, more than a hundred thousand people fled to Liberia. The vast majority chose to stay with Liberian families and communities, particularly in Grand Gedeh and Nimba Counties. This photo was taken in Soglay, in Nimba County, where MSF runs a mobile clinic to reach the dispersed refugee population. Malaria is a key concern; numbers are rapidly rising due to the rainy season – with more than one third of consultations for malaria, including severe malaria leading to anaemia. MSF runs mobile clinics to more than 20 locations along the eastern border counties of Liberia to assist the refugees..

May 14, 2011
Cutting trees in order to expand a refugee camp in Liberia. Over 100,000 people fled post-election violence in Ivory Coast. In places like Nimba county, Liberia the majority of refugees have not travelled to camps, but seek shelter with host families in dispersed villages near the border. Out of fear, many in Ivory Coast still remain in hiding in the bush in the border region.

Shousha camp, Tunisia – May 2011
Hundreds of thousands of refugees have passed through Shousha camp since the start of the Libyan conflict, but some 4,000 people – mainly sub-Saharan Africans – cannot be repatriated due to the situation in their country of origin and face an uncertain future.
Since early March, MSF has been running a mental health programme for people who have fled the conflict in Libya, giving over 9,000 mental health consultations. Many people have had traumatic experiences, either witnessing or directly experiencing violence in the course of their escape from Libya. In addition, thousands of sub-Saharan African refugees are survivors of persecution and ill-treatment that took place in Libya prior to the conflict.

Abidjan, Ivory Coast – April 18th, 2011
A surgical team performs a c-section during a power cut in Abobo Sud Hospital in Abidjan. A week after the end of the military standoff in Abidjan, very few hospitals are open, and Abobo Sud has been handling thirty deliveries daily. MSF has been supporting Abobo Sud Hospital since the end of February. At the peak of post-election violence, MSF was treating 25-30 conflict-related wounded every day from mid-March to 11th April.

Misrata, Libya – April 2011
Médecins Sans Frontières (MSF) evacuated 99 people, including 64 war-wounded and 35 accompanying persons, by boat from 15 to 16 April from Misrata to Zarzis, Tunisia. This operation took place two weeks after a first boat evacuation of 71 injured people.
“For weeks now, health structures have been struggling to cope with the influx of patients. They have been lacking medical equipment and personnel to treat the wounded and the sick suffering from chronic diseases,” said Dr. Morten Rostrup, an MSF doctor who was on the boat.

Froley village, Nimba County – March 2011
Martine, 72 years old, arrived in Frolay with her daughter one month ago. As she is too old to walk fast and for long, she spent three days on the road to reach border crossing point of Butuo. Her daughter who was with her only kid went faster and came back to look after her mother. When people from close villages crossed their home village of Souapleu on their way to the border, Martine and her daughter decided to follow them. Here in Liberia, they stay in the house of a Liberian relative. As the situation continues to deteriorate in Ivory Coast, tens of thousands Ivorian have fled their country and sought refuge in Liberia. The vast majority are staying with host families, scattered in more than 70 villages throughout the County. This situation is more and more putting under pressure access to basic services such as clean water, food and health care.

Nimba District, Liberia – March 13, 2011
Tens of new refugees are reaching the village of Kparblee in Liberia, in the district of Nimba bordering Ivory Coast. This family just arrived from the city Toulepleu, where fighting erupted early March between pro-Outtara forces and the army loyal to disputed president Gbagbo. As the situation is deeply deteriorating in Ivocry Coast, they spent seven days in the bush, looking for places to sleep and for food. They didn’t want to go to Liberia too fast, hoping that the fighting would stop. They were exhausted when they reached the Liberian border. This family is currently staying in a school building of the village of Kparblee. They have relatives in the village, but will have to wait a few days before being able to go to their home.

Makpundu refugee camp – November 19, 2010
Widows from Lord’s Resistance Army attacks Ngbitimo 45 (left) and Letina (right) during a Medecins Sans Frontieres counselling session in Makpundu refugee camp, South Sudan.
With the world’s attention on the recent referendum determining the separation of southern and northern Sudan, the south of the country continues to face a dynamic that instils alarm and anxiety and exacerbates the situation of an already vulnerable population. MSF continues providing medical assistance to people who have been affected by the Ugandan rebel group Lord Resistance Army (LRA) violence in Yambio, Western Equatoria State in southern Sudan.

Masisi, Democratic Republic of Congo – February 2009
G. is 43 years old, she has come to the women’s clinic, part of an outreach care programme run by Médecins Sans Frontières.
“During the 1994 war, people in Masisi district were killed by machetes; others managed to escape. One day, when I was on my way to the fields with some other women – it was in 1996 – armed men stopped us, beat us and raped us. Some of the women fell in a ditch. I fell too and I am still limping today. Three of the women who were raped at the same time as me died a week later because of the injuries they had sustained.
“Since then, I have had pain in my abdomen. For all these years… I really feel weaker, I don’t go to the fields anymore. I often have headaches and I sleep badly. And when I see armed men, I am afraid and I feel sick.”
After a long consultation at the MSF clinic, G. leaves with iron tablets, pain killers and an appointment at Masisi hospital to receive psychological support.

Vavuniya, Sri Lanka – May 2010
Italian physiotherapist Valeria Maglia conducts a physio session with 22 year old patient Suvarna in Pompamadhu Hospital where MSF runs a rehabilitation programme for people with spinal injuries. Most of the patients’ injuries are a result of the war between the Sri Lankan army and the Tamil Tigers that ended in May 2009.

Ingushetia. June 2010
Residents of the ORS IDP (internally discplaced population) settlement. The situation in the three republics of the North Caucasus region of the Russian Federation remains volatile. MSF has been providing support to hospitals and through clinics and has been raising awareness of the mental health problems caused by the conflict.

India, Kashmir, August 2008
The population of Kashmir is traumatised by over 20 years of violence. New tensions arise all the time. They are living under the pressure of these tensions and have to deal with losing loved ones or get injured themselves. In one way or another everyone is affected by the situation in Kashmir. MSF has worked to increase awareness of psychosocial problems and in 2009 more than 5,800 people were treated on the mental health programme. MSF also provided support to six clinics in Kupwara, conducting more than 20,500 consultations.