Rapport Médecins du Monde - Annual report 2007
CONTENTS
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OUR AIM : 2007-2008 CHANGING TIMESHumanitarian action cannot escape the violence and ambiguities which characterise current global trends.For Médecins du Monde, 2007 has been a year touched by the complexity of new contexts. Beyond the ‘traditional’ conflict areas where MdM works, we provide aid to at-risk populations in these new contexts and we must also consider the risks faced by our teams on the ground. Armed with our experience, we are faced with new situations, notably increasingly frequent ethnic conflicts, which require us to adopt new strategies, to anticipate the potential risks and to come up with realistic and appropriate operational methods as part of an ongoing process of linking with networks and local leaders. Driven to support populations in need, our organisation remains committed to continuing to advocate for access to healthcare. It is difficult to find the balance between providing care and bearing witness, which can create risks for the field teams, and this balance must be evaluated on a case-by-case basis and continuously readjusted. Unfortunately, 2007 reminded us how security risks are no longer unusual for humanitarian workers. Notably, the MdM coordinator in Russia was attacked and the employees of ACF in Burundi and of MSF in Chad were murdered. For Médecins du Monde, as for other NGOs, humanitarian organisations’ operational methods are fundamental. The Zoe’s Ark affair, and the sad events which unfolded in autumn 2007, will be a lesson for future generations involved in emergency international aid. This furore prompted Médecins du Monde to reflect on the operational methods of humanitarian NGOs, by organising a forum in December 2007 involving most of the relevant protagonists. ADVOCACYPromoting access to healthcare requires us both to provide healthcare and to bear witness. In addition, we must go further to influence policymakers. The advocacy activities that we plan to develop in the coming years, are part of our ongoing work to bear witness and will focus on building our capacity to influence political decision- makers. This forum (1) reminded us of some fundamental principles and pinpointed essential requirements for any intervention, such as the need for in-depth understanding of the context in the countries where we intervene and the diversity of their cultures. The humanitarian response must react to the needs of the population, while not imposing our own ideas of what is right. The debate also underlined the ambiguity of the relationship between NGOs and the media in the exchange and the way information is processed, as well as choices on whether to give any coverage to a particular crisis. It is an important process for Médecins du Monde to question these interventions, to provoke debate around humanitarian action and geopolitical situations. We want this habit of questioning to become permanent and integral to our actions in the field. The organisation of a number of debates and regional seminars (in Latin America, the Middle East and Africa) is a concrete example of this approach. When discussing contemporary humanitarian action, it is also important to note the euro-centrism of our generation of NGOs. Thus, we must be on the look out for the emergence of partners from different continents and different cultures. These new realities affect us all. It is part of our remit to encourage the emergence of new, non-Western international solidarity actors. The opening of an office in Qatar is part of this approach. This also aims to formalise our involvement in a region where there are huge needs and which presents key challenges for international relations. Our presence in this country will enable us to develop new networks and to improve our understanding of local circumstances while, at the same time, raising our profile. As for our more long-term activities, Médecins du Monde has reaffirmed its intention to continue to improve preventive medicine and access to healthcare for all, as well as improving care for people living with HIV/AIDS, particularly by facilitating access to anti-retroviral treatment. We must reflect carefully on the sustainability of our programmes and the ability of local authorities to take things forward. Our efforts to train local staff and to support civil society and local authorities, in order to ensure the sustainability of our work, must be a permanent component of all the activities we undertake. Activities in the field also require a horizontal approach. Some health determinants, and also macro-economic and cultural factors, are impacting on circumstances in very different areas. Rather than developing vertical activities, it is more effective now to work towards capitalising on our actions. That is why we are now developing analyses on several themes: violence against women, intercultural issues, the shortage of human resources for healthcare and the strengthening of health systems. Developing cross-cutting themes, which are common across countries and continents, continues to be a priority for Médecins du Monde.IN FRANCE, THE MOBILISATION WHICH BEGAN AT THE TIME OF THE ELECTIONS, CONTINUES.The year 2007 was a poor vintage in terms of access to healthcare for the most vulnerable. The immediate consequences include a fall in attendance at frontline services because of fear of being arrested. The Roma population has not seen any environmental improvements. More than ever, they are pursued, deceived and asked to move on. We also remain firmly at the centre of a collective of organisations involved in defending those who are homeless. Our actions have had a positive impact, particularly concerning emergency accommodation in so far as the authorities have committed to increasing the number of places available and to improve the reception and security conditions. We are monitoring the situation carefully, to ensure that these promises are put into action. MdM remains vigilant in relation to the policies implemented following the presidential election. The law on immigration and, in particular, the Mariani amendment on DNA, have left us shocked, but not inactive. Once more, thanks to our local and national network, we took action and launched a petition ‘Medicine and immigration: no to dangerous liaisons’. In fact, how could we not be worried about the progressive implementation of an approach which uses medicine as a means of managing immigration? A right to defiance on ethical grounds?This petition was the opportunity to promote the idea of a right to defiance on ethical grounds for all health professionals, who could be asked to perform actions using medical science, not in the medical interest of the person concerned, but as part of the legal measures on immigration. This generated massive support from the professionals concerned, resulting in nearly 30,000 signatures. Our presence and our profile, which we want to strengthen in the academic environment, is strengthened by regular collaboration with the Political Studies Institute in Paris with a project among universities to specifically address the issue of ‘vulnerability’ in the medical curriculum. In Grenoble, Lille and Paris we have set up Post Graduate training programmes on health and vulnerability. MdM’s presence in these establishments not only does enable us to attract new field volunteers, but also enables us to influence the decision-makers and doctors of tomorrow. As part of our international adoption activities, the recent changes in European jurisprudence will contribute to the reflection begun during an MdM forum on single parent and same-sex couple adoptions. By condemning France for having refused a teacher and her partner the opportunity to adopt, the European Court of Human Rights decision in January marked a real turning point in this debate. But beyond the situation in France, it remains essential for us to continue to respect the laws in the children’s countries of origin and to put the interests of the child first. The buddying programme in hospitals has continued to be effective in responding to the needs of children separated from their families and loved ones. MÉDECINS DU MONDE AND INTERNATIONAL ADOPTIONMédecins du Monde is the only medical humanitarian organisation in France to have integrated adoption into its founding statutes and to have created an international adoption programme. The status of Approved Adoption Organisation (AAO) was granted in 1998. The objective is to stay faithful to MdM’s principles: to stand up for the most vulnerable groups, which include children, who are the first victims in crisis and conflict situations, and to protect their fundamental rights. Namely, the right to a family, the right to health and the right to grow up with an education. (see p122). FOUR BUILDING BLOCKS FOR 2010During the 2007 Annual General Meeting, I had the opportunity to announce four key areas which are central to MdM’s future and our ability to take action. The first key area relates to the situations in which we intervene, an issue described in the section on our international activities. The three other areas concern the development of our international network, the organisation’s governance and financial diversification. The international network: (2)Our network is a tool to increase the resources available for Médecins du Monde’s work. It is also a means of building international alliances to increase the weight of our advocacy work, particularly at the European level. At a time when migration represents a major international political issue, our network is working on this issue, both through our European Observatory and the Averroès project, reflecting our concerns on such trans-national phenomena. We have asked the new International Network Department (IND) to take an approach based on two main policy directions: the reform of our network must be firmly organised around issues relating to the field. The exchanges and sharing of experiences will be focused on this desire to do more and better work together, both in the field and in our advocacy activities. On the other hand, the network must adopt an approach based on concrete results in relation to development and the emergence of powerful new delegations. This means that the future of Médecins du Monde is inextricably linked to the effective growth of other delegations. Organisational governance:Last year at this time, a working group was established to look at our regional delegations and our decentralisation model. This work is bringing results and recent meetings within the association, particularly the National Consultative Committee and the Board of Directors, enabled an update on the debates which have taken place throughout the year. The contribution of the continental groups remains important for analyses, both in France and internationally, and for the organisation’s strategic decisions in different geographical areas. We are also pursuing the diversification of our funding to ensure that we have a considerable amount of private funds and a geographical and institutional diversification of our funding sources. The major private grants we have been awarded for our programmes in Liberia are the best illustration of this approach this year. On behalf of the Board of Directors, and on my own behalf, I would like to thank all those who, by participating in or supporting our work, have shown their confidence in Médecins du Monde. Volunteers, members, local partners, headquarters and field staff, and donors. It is by collaborating together, in a coherent way, that our organisation can continue its work to improve access to healthcare. Let us continue our work together with the same clarity of vision as the year gone by. Pierre Micheletti, President, MdM France
(1) FORUM: ZOE’S ARK – A ONE-OFF OR PRODUCT OF A SYSTEM?
(2) THE INTERNATIONAL NETWORK |
August 2008