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Our Conditions For Returning Home?

Forced to flee their village in Sinjar, Ismael and Zere sought refuge in Chamesku camp, the largest IDP (Internally Displaced Persons) camp in Northern Iraq, which provides refuge for over 27, 000 displaced civilians. It is mostly inhabited by the Yezidi community, who have been particularly targeted by ISIS (Islamic State of Iraq and the Levant/ al-Sham).

Zere recounts, “We have been living in Chamesku camp since 2014. We had no choice but to flee when ISIS invaded our village [in Sinjar]. I remember when we fled, leaving in the morning before they entered the village at 2 pm. They were not as lucky as we were, they did not escape. We were able to reach Iraq and ended up in this camp. It is not the first time that we have had to leave behind our homes, we have suffered persecution and forced displacement ever since 1975, but never have we experienced anything like what we went through 4 years ago. It is beyond description”.

 “We haven’t heard from our former neighbors and friends since our arrival here, as they are scattered all over the place [among different IDP sites and over great distances]; this worries us. Life in the camp and as a displaced person is far from easy, we face daily challenges related to the lack of electricity and food; we are very much uncertain about the future”, she continues.

For both Ismael and Zere, returning to their homes in Sinjar is not an option, at least not until it is completely safe2. Ismael further explains, “I suffer from a chronic disease and as such need continuous access to medical treatment and a proper hospital. So long as this is not possible in Sinjar it is impossible for me to return”.

If you would like to help people like Sinjar, Ismael and Zere, donate to our Refugee Fund here.

World Mental Health Day An invisible crisis prevails in Syria and Iraq

An invisible crisis is happening in the countries affected by the Syrian and Iraqi crises. Doctors of the World (Médecins du Monde) releases a booklet to mark World Mental Health Day (October 10^th) in order to shed light on the important mental health and psychosocial needs of people who have been plagued by the protracted Syrian and Iraqi crises. This publication calls upon international and regional decision-makers to consider a response to mental health needs as a priority.

Armed conflict and natural disasters pose significant challenges to the long-term mental health and psychosocial wellbeing of affected populations. The Middle East has long been plagued by war and conflict, resulting in mass loss of life, displacement, and cross-generational changes to traditional familial and societal structures. The results can be devastating to the emotional wellbeing of affected populations throughout the region with notable increases in the prevalence of common mental disorders such as anxiety and depression. According to the 2018 Humanitarian Response Plan for Syria, one in five Syrians are at risk of developing moderate mental health issues, and one in 30 is at risk of developing severe or acute mental health problems.[1] There is a pressing need for high-quality mental health and psychosocial support services provision.

 

Doctors of the World is responding to this need by implementing programs enabling access to essential mental health care and psychosocial support.

The MdM publication: “An Invisible Crisis: Exploring Mental Health Needs in the Syrian and Iraqi Crises” highlights the numerous challenges to quality service provision, along with the organisation’s response to mental health needs, and recommendations for international and regional decision-makers.

The booklet can be downloaded as PDF here.

[1] https://reliefweb.int/sites/reliefweb.int/files/resources/2018_2018_hrp_syria.pdf. Page 60

Doctor Mukwege wins Nobel Peace Prize

“It’s with great joy and pride that Doctors of the World received the news that the Nobel Peace Prize has been awarded to Doctor Mukwege and Nadia Murad. This award recognizes the horrendous agony of countless victims of sexual violence in Congo. Doctors of the World has been working together with Dr. Mukwege in Bukavu since 2015, coordinating the medical aspects of the Sexual Survivors Project in Mukwege’s Panzi Hospital. Throughout this partnership, an average of 170 women a month receive medical treatment and surgery.

“Dr. Denis Mukwege was in the surgery block when the news came in, operating victim of sexual violence”, says Eric Wijnants, Coordinator of Doctors of the World, based in Bukavu.” This anecdote says everything about him – even winning a Nobel prize doesn’t stop him from doing his number one priority in life – healing and protecting survivors of sexual violence.

“All of us – his partners, other NGOs, the doctors, the midwives, psychologists and lawyers – are one big team with Dr. Mukwege in the center, mobilizing all of us in his fight against sexual violence. As a partner, we are extremely proud to be working on his side on the field.”, says Pierre Verbeeren, Director of Doctors of the World Belgium.

After founding the Panzi Hospital in 1999, Mukwege was increasingly being confronted with the horrors of the sexual violence that were being used as a weapon of war in the region: countless of women, genitally and sexually mutilated by armed militia seeked his help. Dr Mukwege, profoundly touched and agonized of what he witnessed, decided at that point to dedicate his life to the recovery of the survivors of rape in Bukavu. Almost 20 years later, the Panzi hospital has become a reference for the physical, psychological and social recovery of women and girls who have been sexually mutilated.

Doctors of the World Launch Global Clinic

Update: Urgent Crowdfunder

Doctors of the World is preparing to deploy the first Global Clinic this summer where it will support refugees access mental health care.

Support it today!

 

The Global Clinic was launched today at the Wellcome Collection. The Global Clinic is an innovative mobile centre designed by Roger Stirk Harbour + Partners, BuroHappold Engineering and ChapmanBDSP. First in its kind, it demonstrates how architecture can respond to worldwide issues in health.

Today, Doctors of the World operates in over 80 countries. Our medical professionals face a variety of challenges. They work in all corners of the globe, from Palestine to Nepal, in different climates, in emergencies, and in protracted situations. The Global Clinic was designed by asking doctors and healthcare professionals what would work best in the field.

The response was found in a clinic made of plywood and constructed by a CNC (computer numerical control) machine. The Global Clinic can then be easily transported and built, constituting an adaptable and strong structure. Simple and economically built, it upholds the focus on privacy, accessibility, and sustainability.

Ellen Waters, Director of Development at Doctors of the World UK, contributed to its design and ideation. “Refugees fleeing their homes, and survivors of natural disasters will have often suffered severe loss, separation, physical pain and witnessed unimaginable suffering. We love this innovative Global Clinic, which can be quickly deployed anywhere to provide the safe, sanitary and private space in which our doctors can discuss health concerns and, most importantly, give psychosocial support for mental health, exacerbated by the trauma they have experienced.”

The Global Clinic is currently displayed as part of Living with Buildings exhibition at the Wellcome Collection. Living with Buildings examines the positive and negative influences of buildings on health and wellbeing. The Global Clinic will be presented to the public until early March, and will later be sent to one of our teams in the field.

If you would like to visit our Global Clinic, please find further information on the exhibition here.

 

 

The Hidden Refugee Crisis in Bosnia and Croatia

Migrants crossing to Croatia from Bosnia are being pushed back and harassed by the Croatian police. With over 13,000 migrants arriving in Bosnia last year (a 15-fold increase from the previous year) a new refugee crisis along the Balkan route is developing.

Following a number of reports from civil society and international newspapers, reports of violence by the Croatian police are quickly spreading. Migrants crossing over from Bosnia have been pushed back, beaten and their possessions have been stolen. The beatings targeted men, women and young children. Some were hit with police batons, others were kicked and punched. Men and women were rounded up, made to undress, forcefully searched, and then beaten. They have been physically scarred, cannot access the medical care they need, and have suffered severe mental abuse.

People depart every night from Velika Kladusa, a small city on the Bosnian border. They are making their way through the forest towards Croatia. The situation in the town was described by Peter Van der Auweraert, IOM’s representative in Bosnia and Herzegovina, as “a human catastrophe”. The border corresponds to the last European frontier, and returning refugees across the border to Bosnia constitutes a breach of the non-refoulement principle, according to which EU states cannot return refugees to a state where they face a threat to life or liberty. The Croatian police have been breaching international and European law every day. According to UNHCR, over 2,500 people have been pushed back. Countless more have been beaten and harassed.

Here are some of their stories:

Rahim, 38, from Afghanistan*
“Every country we have been in we have had problems with police, but nothing like Croatian police. I don’t mind which country we end up in. My daughter is sick, I just want to take her somewhere with good doctors. We don’t have any money so we can’t pay smugglers.

“We are just walking, walking, walking every time in the night. Last time, we were five days in the forest, but then the police stopped us at the end. They took €180 from me and sent us back. This time they didn’t hit me. They have beaten me twice out of five attempts.‘‘

Leila, 45, from Iran*

“I have tried five or six times to cross into Croatia, every time they have caught me. Once they lied to me, they said I could stay for 21 days if I signed some papers at the police station, so I did. Then they took my photograph, drove me back to the border, and let me out. They stole my last €150 and my telephone. I have paid thousands of euros and I have been travelling for two years. I have two daughters here with me and I don’t know what to do.‘‘

Please donate to our Croatia Emergency Appeal so we can provide medical care and supplies to these desperate refugees.

 

*Case studies from The Guardian

Protect human rights before it is too late

We, the presidents and directors of DOTW’s 15 chapters, are extremely concerned about the increasing tendencies of isolationism, far-right populism and exclusion in many countries. It is part of DOTW’s identity to bear witness to human rights abuses. We therefore cannot remain silent as walls and fences are going up, men, women and children are forced to live in camps under deplorable conditions – not only in the global South but also in Europe, Asia and North and South America – political leaders are engaging in dehumanizing, sometimes outright racist, rhetoric, and civil society is increasingly under threat.

The hateful language and fear mongering we are observing across the globe are reminiscent of the darkest times in our history and only distract from the important challenges our world is facing today: The protracted crises in countries such as Syria, Yemen, the Central African Republic, the exodus of Rohingya refugees from Myanmar, increasingly precarious living conditions for large parts of the population, even in advanced economies, as well as other obstacles preventing billions of people from accessing necessary health care.

With more people displaced than any time since the Second World War, we are facing a historical global crisis. But more than a refugee crisis, it is a crisis of solidarity, a crisis of human rights.

“No more excuses – Advocating for Human Dignity in Times of Crisis” is the motto of this year’s Humanitarian Congress, on the occasion of which the annual meeting of all 15 chapters of the DOTW International Network in Berlin is taking place. As today they are routinely undermined, we re-affirm very clearly that human rights are a binding commitment, and that human dignity is non-negotiable.

International actors must provide aid to those in need on the basis of solidarity and human rights, instead of furthering militarization and by engaging in harmful geopolitical interventions under the guise of “humanitarianism.”

We are calling on leaders to do everything in their power to allow everyone on this planet to lead a life in dignity. We need to take action now!

Doctors of the World and partner NGOs decry failure of Oslo Accords

Doctors of the World joined with more than 80 NGOs to publish a report highlighting the failures of the Oslo Peace Process and urging new negotiations. The report marks the 25^th anniversary of the Oslo Accords this month.

The report boldly criticizes the Oslo Process, noting that it was initially a “beacon of hope to end conflict between Israel and the Palestinians”. But 25 years later, it “has manifestly failed to deliver the ‘just, lasting and comprehensive’ peace it promised”.

The report, entitled 25 Years after the Oslo Accords – Time for a New Narrative, traces the Accords’ unravelling, and emphasizes how a lack of accountability and sustained pressure from the international community contributed to it. Life for Palestinians has devolved into cycles of poverty, violence, and human rights violations under Israeli occupation.

Especially in Gaza, a blockade since 2007 has made life abysmal. Daily power outages plague the territory, 96% of tap water is unsafe to drink, and nearly three-quarters of the shoreline is polluted by raw sewage.

But peace between the two peoples could dramatically change this situation. The report urges Israel, the Palestinians, and the international community to start fresh with negotiations based on six principles, including human rights and accountability under international law.

Read the full report Oslo_25+_final-WEB_PAGES.

European Patent Office maintain patent on hepatitis C drug sofosbuvir

This week, Doctors of the World together with Médecins Sans Frontières and other organisations* from 17 countries challenged a patent on the hepatitis C drug sofosbuvir at the European Patent Office (EPO). EPO decided to maintain this key patent on a pharmaceutical component, despite the fact that this component is inactive.

This unmerited patent contributes to Gilead’s monopoly and prevents hundreds of thousands of patients from receiving affordable treatment.

The verdict shows how pharmaceutical companies abuse the patent system by using patents for their own interests instead of for their original purpose. Patents were devised to improve the well-being of society, preventing access to affordable treatment is in direct contradiction to this purpose.

Unmerited patents create monopoly positions, allowing companies to pressure governments into paying exorbitant prices for life-saving drugs. For this reason, Gilead can charge up to €43,000 for the twelve-week sofosbuvir based treatment in some European countries. The massive financial burden on the health systems caused by the excessive prices place a burden on the tax payer, who have paid more than €8.5 billion into Gilead’s pockets. This drives the health systems to the brink of collapse.

As a result, the treatment based on sofosbuvir, which is currently the most effective one, has been rationed in many countries.

“We are very concerned by this decision of the European Patent Office. It demonstrates that the patent system is broken in Europe. We are extremely worried what this will mean for the many new cancer drugs that are currently coming on the market. Their price is tenfold higher than the price of sofosbuvir”, says Oliver Maguet of Doctors of the World drug pricing campaign.

Doctors of the World urges European government to take serious action regarding EPO and the European Patent System. Pharmaceutical companies must comply with European patent convention requirements signed by the 38 member states.

By filing the opposition, Doctors of the World and its allies forced Gilead to itself amend its patent prior to the public hearing. “It is vital for civil society organizations to challenge the patent system in Europe. This is the only way to provide evidence on patent abuse and the lack of scrutiny by the EPO”, says Olivier Maguet.

*The additional organizations who were part of the patent opposition include: European Public Health Alliance (EU-wide); Salud Por Derecho (Spain); AIDES (France); Praksis (Greece); and Access to Medicines Ireland

Civil Society Groups Call for End to Gilead’s Hepatitis C Drug Monopoly in Europe

This week in Munich, the European Patent Office is hearing a legal challenge filed by groups in 17 countries in March 2017 against an unmerited patent that allows US pharmaceutical corporation Gilead Sciences to charge exorbitant prices in Europe for the key hepatitis C drug sofosbuvir. The organizations Doctors of the World, Médecins Sans Frontières (MSF) and Just Treatment are among the patient and treatment provider organizations* that challenged the validity of a Gilead patent on sofosbuvir on the grounds that it does not fulfill the requirements to be a patentable invention from a legal or scientific perspective. The groups today urged the European Patent Office (EPO) to rethink its decision that gives Gilead this monopoly. The EPO will hold a public hearing on 13 and 14 September to make a decision on the case.

If the patent challenge is successful, a major step will have been taken toward allowing the production and importation of affordable generic versions of sofosbuvir in Europe, thereby protecting health systems across Europe from illegitimate financial burden due to excessive corporate pricing of this drug. The extremely high prices in Europe of newer hepatitis C medicines—called direct-acting antivirals, or DAAs—has led civil society organisations to investigate and subsequently challenge the monopoly status and legitimacy of such patents.

“I have been through an extremely agonizing wait for three long years to get access to the critical oral hepatitis C medicine sofosbuvir,” said Clare Groves, Just Treatment patient leader who was treated and cured of hepatitis C through the NHS, which was forced to ration supply of the medicine due to its high price. “I was repeatedly told by my doctor that I am sick, but not sick enough to qualify for the treatment under the public health program. I don’t want other people to be denied sofosbuvir because its price is exorbitant, so I will continue to fight for their access to this hepatitis C cure.”

The World Health Organization estimates that 15 million people in the European region—approximately one in 50 people—are chronically infected with hepatitis C, leading to approximately 112,500 deaths per year from related liver cancer and cirrhosis. The advent of DAA drugs, which offer a safer, shorter and more effective cure compared to older treatments, has marked a major breakthrough in the treatment of the disease, with cure rates higher than 90%, compared to around 50% previously. Sofosbuvir forms the backbone of most hepatitis C combination treatments, yet access to these newer treatments remains very limited globally because of high prices, with governments and treatment providers in many countries forced to ration treatment and limit access only to people with advanced forms of the disease

Gilead charges as much as €43,000 for one person’s 12-week treatment of sofosbuvir in Europe. Meanwhile, in countries where the drug is not patented, competition among generic producers has driven the price of sofosbuvir to just €52 for the same treatment course. Studies have shown that it costs about €0.50 per daily pill to manufacture the drug.

Financial barriers in access to medicines and healthcare have become a challenge for high-income countries in Europe, … it’s time to challenge unmerited patents in Europe

“Financial barriers in access to medicines and healthcare have become a challenge for high-income countries in Europe, and because unmerited patents are the key driver for these excessive prices, it’s time to challenge unmerited patents in Europe,” said Olivier Maguet, of Doctors of the World’s drug pricing campaign.

While the high prices charged for medicines are a well-known problem in many parts of the world, the recent excessive pricing of DAAs has for the first time brought Europe’s attention to the impact that monopolies have both on health budgets and on people’s access to many other essential medicines. Legal challenges against patents on sofosbuvir and other DAAs have been filed in several countries, and key patents on sofosbuvir have already been rejected in Egypt, China and Ukraine. Decisions are pending in other countries, including Argentina, Brazil, India, Russia and Thailand.

*The additional organizations who were part of the patent opposition include: European Public Health Alliance (EU-wide); Salud Por Derecho (Spain); AIDES (France); Praksis (Greece); and Access to Medicines Ireland

Forgetting The Atrocities We Experienced Is Impossible

Shames and Shirin have been living in Chamesku camp, Northern Iraq, for four years. They are part of the Yezidi (or Yazidi) community who were forced to flee the atrocities perpetrated by ISIS (Islamic State of Iraq and the Levant/ al-Sham) in 2014.

Shames recounts, “My husband and I were captured by members of ISIS when they stormed our village [in Sinjar, Northern Iraq]. We were lucky enough that their car broke down and saw this as a chance to escape while they were repairing it. Our children were able to escape before ISIS captured the village. Today, most of them live in Germany and I hope that we can join them in the near future. There is nothing left in our village; our house [like many others] is completely destroyed”. When asked if she plans to return home, Shames replies “Of course, I wish I could return to my village someday, but only if it is safe, if my home is rehabilitated and if we receive financial assistance to help us rebuild our lives, but those conditions are far from being met right now”.

In Chamesku camp, Shames lives in a tent near her former neighbours, and when they meet, they cannot help but remember the terror they witnessed first-hand. Perhaps it is only by sharing with each other that they are able to find solace and the strength to carry-on, knowing that only they can truly understand the depth of each other’s sufferings, or perhaps by seeing each other every day they are inevitably reminded of the life they once had and the remnants of those lives now.

‘We cannot return because we simply have nothing left”, Shirin adds. “My family and I fled the day before ISIS came to our village. We had no other choice but to remain in hiding for ten days in the mountains, without food supplies and other necessities. My husband had to carry my son all the way, as he is disabled and cannot walk. It was a very difficult journey and what we witnessed along the way left us emotionally drained. We saw many dead children, whose mothers were forced to leave them behind. We will never forget what has happened to us and so many others like us”. She continues, “Today, we live in this camp, but our living conditions are very harsh. We only have two hours of electricity per day, from 12pm to 2pm, and five hours in the evening. We sleep in the afternoon because of the excessively high temperatures during the day (reaching over 40 degrees Celsius in June, July and August)”. Such high temperatures often cause dehydration, which in turn leads to general fatigue.

If you would like to help people like Shames and Shirin, donate to our Refugee Fund here.

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Inside View from a Safe Surgery: “Our concern is more with the patients we aren’t seeing”

In May, the Clapham Park Group Practice in London became the first practice to declare itself a Safe Surgery. Since then, the Safe Surgeries community, launched by Doctors of the World UK, has grown across the country and now counts members across London, Manchester, Birmingham, Norwich and Leeds.

As GP practices that commit to providing safe and welcoming care to everyone in their community, in line with NHS guidelines, Safe Surgeries combat discrimination in healthcare by tackling the barriers faced by migrants in vulnerable circumstances.

Dr. Jenny Akhurst and her colleagues at Clapham Park had already emphasized the importance of inclusive and equitable healthcare. They hoped that joining Safe Surgeries would allow them to learn from others’ experiences and that using the resources would make their ‘welcome’ more visible. Dr. Akhurst explained:

“From a practice point of view, one doesn’t always know if certain patients are facing barriers [to healthcare] because you only see them in a clinical context. We need to make sure that as a practice, we aren’t contributing to any of these barriers. Our concern is more with the patients that we aren’t seeing and Safe Surgeries practices help us reach them.”

Like many practices, they find language barriers at patient registration a challenge, especially when reception is unable to get a hold of interpreters. In consultations, Dr Akhurst always opts for face-to-face interpreters when possible – even if it takes extra coordination.

Patient education is also important, as many patients don’t know that they are entitled to free healthcare and some might be fearful of approaching a GP.

So what makes Safe Surgery policies work for them? Training and shared understanding of what is best practice in terms of patient registration – and the reasons why this is important – are key. For example, if a patient can’t give a stable contact address, maintaining other kinds of contact information becomes even more important for receptionists.

“Training is especially important. GPs and receptionists should not need to ask about a patient’s immigration status. And a patient does not necessarily need to give their home address. We simply want to know that they are currently living within the catchment area.”

Having a Safe Surgeries ‘lead’ in the practice has also been helpful, to advise colleagues who are in doubt and reach out for support from Doctors of the World UK where needed.

Looking ahead, Dr. Akhurst notes that improving understanding of healthcare entitlement and charging among healthcare workers needs to be a priority.

“Most people do not know that everyone is eligible for free primary care. There is huge confusion around charging in hospitals, too, and these questions are more and more ending up with GPs who are frustrated by the lack of patient-centred support for those left vulnerable and without the healthcare they need.”

Along with the other ongoing efforts to challenge these policies, she hopes that Safe Surgeries can help shift the narrative.