International Activity Report 2014

In 2014, the largest Ebola outbreak in history struck West Africa, the number of displaced people in the world exceeded 50 million and the war in Syria entered its fourth year.

Médecins Sans Frontières (MSF) deployed teams to work in simultaneous emergency situations across the globe, from Liberia to South Sudan, from Ukraine to Iraq. The common thread this year was one of abandonment: the sheer number of Ebola sufferers meant that at the height of the epidemic, many were left to die on their own, stripped of their dignity; in conflict zones the elderly, the disabled and the sick were often unable to escape to safety; and as high-income countries turned their attention ever inward, people in desperate need found themselves largely forgotten.

Fighting Ebola in West Africa
When the Ebola outbreak was officially declared on 22 March 2014 in Guinea, no one could have foreseen the extent of the suffering that would ensue. By the end of the year, the disease had claimed almost 8,000 lives in West Africa, including those of 13 MSF employees.

MSF and Ministry of Health staff were faced with the probability that at least 50 per cent of their patients would die from the disease, and that there was no treatment available. They worked daily with the fear of contracting Ebola themselves. As the number of cases grew, the time available to spend with each patient became increasingly limited and sometimes there were not enough staff members to safely care for the sick. Impossible compromises had to be made, such as turning people away at the gates. An MSF anthropologist in Liberia, Pierre Trbovic, told of turning away a father who had brought his sick daughter in the boot of his car: “He was an educated man, and he pleaded with me to take his teenage daughter, saying that whilst he knew we couldn’t save her life, at least we could save the rest of his family from her.” People died alone, in the rain, at the side of the road, in front of the Ebola centre’s gates. The horror that those living and working in West Africa have been through in the last year cannot be adequately put into words.

The conflicts in Syria and Iraq
Another major challenge for MSF this year was gaining access to people in need of medical care. Due to bureaucratic, political or security issues – or a combination of all three – in countries such as Libya, Nigeria, Sudan, Mali and Myanmar, we were forced to reduce or even in some cases end our programmes. As a consequence, we are now re-evaluating how we work in some contexts. Syria is a good case in point. On 2 January, five MSF staff members were taken hostage by ISIS (since renamed the Islamic State (IS)) in northern Syria, despite agreements with local commanders that we would be allowed to work unhindered. Three staff members were released in April and a further two in May. The abduction led to MSF withdrawing from IS-controlled areas, and although local commanders