Starting a Project

MSF may start a project when it identifies the existence of a humanitarian crisis, or when it has been asked by the national government or other organizations to consider establishing a project. In either case, an exploratory team of experienced MSF personnel visits the site and evaluates the medical, nutritional, and sanitary needs, the political environment, the security situation, transportation facilities, and local capabilities. This team reports its findings and recommendations to the Operations Department in one of the five operational offices. The Operations Department then makes the final decision to intervene and determines the medical priorities, the composition of the team, and the materials needed.

Upon starting a project, the following actions are taken as necessary:

An MSF aid worker vaccinates an El Salvadoran man in El Salvador in the wake of Hurricane Mitch. Photo © B. Stone/MSF

Massive vaccination campaigns:
Epidemics often develop in acute emergency situations, where a large number of weakened people live in close proximity to each other and in poor sanitary conditions. Yellow fever, cholera, measles, and meningitis are liable to spread in such conditions unless a massive vaccination campaign is launched.

Training local health workers is essential to restoring a country's health system. Photo © Remco Bohle/MSF

Training and supervision of medical personnel
MSF would be unable to function without local medical personnel. Sometimes, however, such personnel has not been adequately trained or is inexperienced. Often, well-trained doctors and nurses have fled the crisis area. In these cases, MSF provides additional training and supervision on subjects ranging from primary health care to drug prescription, diagnosis, and psycho-social care. All training is subject to fixed guidelines to ensure that the same standards are used in all programs.

A refugee collects water at a tap set up by MSF. Photo © Alain Fredaigue/MSF

Water and sanitation improvement
Clean drinking water and sanitary facilities are essential to preventing the outbreak of epidemics in any situation. MSF employs specialists who construct such sanitary facilities using existing water sources, newly dug wells, piping, plastic water tanks, tank trucks, and supplies for the construction of toilets.

Measurements of children's mid-upper arm circumferences (MUACs) provide a quick assessment of a population's malnutrition level. Photo © Alain Fredaigue/MSF

Data collection
To keep track of the health of civilians living in a crisis area and determine the most appropriate response, it is critical to register medical data, such as mortality figures, the number of patients suffering from certain diseases, degree of malnutrition, and so on.

A child has a meal in a therapeutic feeding center. Photo © Alain Fredaigue/MSF

Feeding
Lack of adequate food sources or agriculture often causes malnutrition among refugees or war victims. MSF regularly monitors the food situation in the areas where it works. Seriously malnourished children must be administered food under medical supervision. For this purpose, MSF sets up therapeutic feeding centers (TFCs), where children can stay with their mothers. Children whose condition is less critical, pregnant women, and breast feeding mothers visit the supplementary feeding centers (SFCs) a few times a day to receive vitamin- and mineral-fortified food.

A young member of a Zambian family gets a checkup from an MSF doctor. Photo © MSF

Patient care
Diagnosing and treating people in need of medical care the MSF organization's primary activity. Experienced MSF international and national staff coordinate the work, provide support and training where necessary, and ensure that there is a sufficient supply of drugs and medical materials. When necessary, MSF has set up special programs to address particular diseases, such as kala azar, tuberculosis, sleeping sickness, and malaria. If fighting produces casualties that exceed the capacity of local hospitals, MSF will offer surgical assistance.

A group of mothers review health information distributed by MSF volunteers. Photo © Alain Fredaigue/MSF

Maternal and pediatric care
Women and children are often the most vulnerable groups in the emergency situations in which MSF is involved. Pregnancy check-ups, neonatal care, special feeding programs, vaccination campaigns, birth control, treatment of venereal diseases, and health education are therefore important parts of the organization's work.

Two national staff members deliver medical supplies to an MSF clinic. Photo © Gael Turine/MSF

Distribution of drugs and medical supplies
The supply of drugs and medical materials can be cut off by fighting, dangerous conditions, road destruction, lack of transport vehicles or lack of funds. If that happens, MSF can come to the rescue and take over the supply until local supply lines are re-established.

This drawing by a Bosnian child illustrates the effects war has on mental health. Visit MSF's online exhibit Childhoods Interrupted by War. Photo © MSF

Mental health care
The death of loved ones, terror, witnessing massacres, and suffering from hunger, thirst, and cold are but a few of the traumatic events that give rise to serious mental and physical difficulties in victims of conflicts and emergency situations. If help is not forthcoming, trauma victims can suffer protracted insomnia, aggression, headaches, listlessness, and other physiological and psychosocial symptoms. As a result, they neglect themselves and their families and have a great deal of trouble starting their lives over. MSF started its first mental health program in 1991 and psychosocial care has become a component of many MSF emergency and long-term projects.

If hospitals have been destroyed or are inaccessible, MSF relies on mobile clincs like this one. Photo © MSF

Rehabilitation of hospitals and clinics
In acute and chronic conflict situations, hospitals and clinics are often devastated through destruction, wear and tear, or looting. Where necessary, MSF assumes the task of rehabilitating and re-equipping these buildings.

A Thai AIDS patient receives counseling from an MSF staff member. Photo © MSF

AIDS care and prevention
Providing general health information is part of nearly all MSF programs. In more and more countries, this means addressing the HIV/AIDS epidemic. MSF has launched HIV/AIDS treatment programs in 27 countries to provide comprehensive care for 25,000 people living with HIV/AIDS.

Project Management

Field operations are managed by a country manager and a coordination team (often including a medical coordinator, a logistical coordinator, and a financial coordinator) typically in the capital city of each country where MSF works. These individuals oversee the execution of the project and act as liaison between MSF, local authorities, partners, and other nongovernmental organizations. They report regularly to the Operations Departments at their headquarters. In countries where there are several projects, each project team is led by a field coordinator.

Each of MSF's field missions is initiated and coordinated by one of the organization's five operational sections located in Paris, Brussels, Amsterdam, Geneva, and Barcelona. The Operations Departments of these offices are responsible for the field operations.

The Project Team

An average field project team has 4 to 12 international volunteers working in collaboration with up to 200 local staff members. Expatriates generally supervise the work of local staff and provide training on medical techniques. Local staff assist expatriate volunteers by helping them to better understand the needs of the patients and the overall social and cultural context. The team is managed by a field coordinator and supported by the operating section headquarters staff who visit the projects regularly and provide advice in program planning and management.

Terminating a Project

Once the acute emergency phase of a health project is over and the local health care infrastructure has been restored to an acceptable level, MSF begins to phase out its presence. Often, an entire program or part of it is handed over to other organizations which concentrate on reconstruction and long-term aid. In addition, MSF will terminate a project if risks in an area become too great to ensure the safety of the staff.

How Does MSF Respond So Quickly and Effectively?

MSF has developed and produced pre-packaged disaster kits ready for transport within hours, including a complete surgical theater the size of a small conference table and an obstetrics kit the size of a two-drawer file. These kits are used as models by emergency relief organizations worldwide. To maximize its responsiveness to emergency situations, MSF maintains four logistical centers based in Europe and East Africa and stocks of emergency materials stored in Central America and East Asia. The logistical centers purchase, test, and store equipment including vehicles, communications material, power supplies, water-processing facilities, and nutritional supplements. Logistical centers ensure that, within 24 hours, planes can be loaded with essential equipment and flown into crisis areas.

In addition, the organization has developed handbooks for use in the field covering many aspects of relief work, from essential drugs to water and sanitation. These guidelines have been translated into several languages and are used by many other relief organizations. They are available in the Bookstore in the Publications & Speeches section of this website.

Specialized training of field volunteers is an essential part of the organization's efficacy. New volunteers are trained in skills that they will need in the field by a cadre of emergency experts. MSF offers training programs to an estimated 1,000 participants every year.

When Does MSF Speak Out?

In accordance with universal medical ethics and the right to humanitarian assistance, MSF observes strict neutrality and impartiality, and demands full and unhindered freedom in performing its functions. When medical assistance is not enough to save lives, MSF will speak out against human rights abuses and violations of humanitarian law its teams witness while providing medical relief.