Of the M€24.7 used for operations in the tsunami region, 400,000 euros, or 1,6%, involve indirect operational costs. These are part of the costs incurred by MSF Operations Departments for the direct support of this emergency.

The funds redirected to other emergencies and forgotten crises were used in 21 contexts, mainly in Pakistan, Niger/Nigeria, Chad, Sudan, DRCongo and Angola for the following operations :

All 21 contexts are: Angola, Burkina Faso, Chad, China, Colombia, DRCongo, Guinea Bissau, Haiti, India, Ivory Coast, Mali, Mauritania, Mozambique, Myanmar, Niger/Nigeria, Pakistan, Peru, South-East Asia (AIDS care in Thailand; TB care and measles in Indonesia), Sudan, Uganda, Zimbabwe.

Pakistan (earthquake)

Since the devastating earthquake that struck Pakistan on October 8, MSF teams have been supporting national relief efforts and continue to work in 12 permanent sites in Kashmir and the North West Frontier Province. They run two field hospitals, perform surgical interventions, carry out over 1,000 medical consultations each day, vaccinate children against measles and injured people against tetanus and continue to distribute emergency shelter, blankets as well as cooking and hygiene kits.

Staff in this emergency (end of 2005): 120 international and 350 national.

Niger/Nigeria (malnutrition)

While malnutrition is a chronic problem in Niger, 2005 saw the emergence of a malnutrition epidemic of exceptional proportions. Despite emergency alerts launched by MSF as soon as April, the international response to the nutritional crisis in Niger was late and inadequate. Over 60,000 severely malnourished children were admitted to MSF feeding centres, 85% of whom recovered. In neighbouring Nigeria malnutrition among children was mainly the result of a measles epidemic in a country with low vaccination coverage.

Staff in this emergency (end of 2005): 86 international and 1,035 national.

Chad (Darfur refugees, malnutrition & measles)

In the last two years, an estimated 200,000 refugees from the Sudanese region of Darfur have sought refuge in neighbouring Chad where they face harsh living conditions in camps. MSF has been providing medical care, surgery, pediatric and maternal care in Adré hospital, which is accessible to the refugees, as well as food and shelter in four camps. Following an outbreak of meningitis, MSF vaccinated about 70,000 refugees and residents at the beginning of 2005. Measles outbreaks in other parts of the country, including the capital N'Djamena, led MSF to launch several vaccination campaigns as of April aimed at immunizing tens of thousands of children.

Staff in Chad (Sept. 2005): 56 international and 405 national.

Sudan (Darfur & South-Sudan)

Two years after the violence began driving people from their homes in the Darfur region of Sudan, little has improved for the two million displaced people and humanitarian assistance continues to be needed as the conflict goes on.

Faced with high rates of diarrhoea, respiratory infections, and malaria; appalling water and sanitation conditions in many areas; and outbreaks of meningitis and hepatitis, MSF has worked to provide medical care, nutritional help and safe water in 32 locations across Darfur.

Despite a peace deal for southern Sudan, humanitarian assistance continues to be needed due to recurrent medical emergencies (caused by both disease and malnutrition), sporadic fighting and a massive return of refugees to areas with little or no access to care.

MSF has been providing basic health care via hospitals, health centres and mobile clinics, has cared for malaria, sleeping sickness and kala azar (visceral leishmaniasis) patients, and provided nutritional support to malnourished children and their families in Upper Nile, Bahr el Ghazal, West Equatoria and Jonglei states.

Staff in Sudan (Sept. 2005): 348 international and 4,871 national.

DR Congo (response to conflict & emergencies, health care)

MSF has been using deristricted tsunami money to fund part of its 2005 operations in the eastern regions of the country where violence continues to flare, and to support its Congo Emergency Team. MSF carried out an emergency intervention to support tens of thousands of people who fled fighting in the Ituri District.

The temporary abduction of two MSF staff members in June 2005 unfortunately forced MSF to suspend its mobile activities outside of the town of Bunia.

In Katanga province where clashes between militias and the army continued to wreak havoc, MSF has provided a wide range of services including primary and secondary health care, treatment for malnutrition, emergency surgery, mobile health care, long-term tuberculosis treatment and care for victims of sexual violence.

The Congo Emergency Team or 'Pool d'Urgence Congo' (PUC) was created nine years ago by MSF to respond to sudden events such as disease outbreaks, displacement and natural disasters. In 2005 it responded to outbreaks of pulmonary plague, measles, bloody diarrhoea and cholera throughout the country and continued to assist 15,000 displaced people in Katanga province.

Staff Ituri, Katanga, and PUC (Sept. 2005): 71 international and 1,150 national (Total staff in DRC: 233 international and 2,133 national).

Angola (Marburg & sleeping sickness)

When an epidemic of Marburg hemorrhagic fever was confirmed in March 2005 in Angola's northern province of Uige, MSF teams arrived a few days later to assist the local health authorities. The MSF intervention included setting up and managing the isolation unit where patients were cared for, maintaining hospital infection control and reinforcing universal precautions.

MSF also assisted with case finding and contact tracing, ensuring safe burial practices, and maintaining water and sanitation systems. Teams conducted community education and epidemiological monitoring and analysis. While most cases were reported in Uige town, emergency units were also set up in the capital Luanda, in Songo and Negage (Uige province) and Camabatela (Cuanza Norte province).

Sleeping sickness or Trypanosomiasis is making a vengeful comeback in Angola where part of the tsunami funds have helped to support the sleeping sickness programme in Caxito, capital of Bengo province, in 2005. In addition to treating patients, MSF conducted active screening campaigns to identify and treat new patients, mostly in remote areas. Since the beginning of 2005, MSF screened more than 11,000 people and treated a total of 215 patients.

Staff in Angola (Sept. 2005): 80 international and 1,099 national.