Credit: Claire Magone/MSF

Several days ago I returned from Borno state in northeast Nigeria, where a catastrophic humanitarian emergency is quietly unfolding.

I was there to assess the situation and help set up Médecins Sans Frontières’ aid activities in one of those towns—Bama, approximately 70 kilometers southeast of Maiduguri, the state capital. On arrival, we found high numbers of people on the brink of death and in urgent need of food and medical care.

Until recently, Bama and the surrounding area had been under control of Boko Haram and completely inaccessible. For close to two years, people in the region had extremely limited access to medical care and food. more…

The day was hot and quiet. Ward rounds had finished and the local midwife and I were waiting on a woman’s seventh baby. The other midwife had just examined our labouring patient and told me she was dilating well at seven centimetres. Generally, when a person is giving birth to their seventh baby things can happen quite fast, so we were prepared for the woman to tell us when she needed to push.

Women labour next to each other in the maternity department, and mostly prefer to lay down while they do. I attempt to encourage women to walk about, as this can help with labour, but my pantomime actions are apparently hilarious, and usually not considered seriously. more…

How strong is the evidence base underlying humanitarian medical assistance? How do you innovate safely to overcome the obstacles inherent in delivering care in conflict settings or to regions where no direct access to the population is possible, such as the besieged areas of Syria? Every year, Médecins Sans Frontières (MSF) attempts to answer some of these questions in a round of conferences, the MSF Scientific Days, held in London (20th May—medical research, 21st May—innovation), South Asia (28 May), and Southern Africa (9 June). These conferences, livestreamed (except Southern Africa) and free to attend and access, were watched last year by over 5200 people in 115 countries. The events are intended to catalyse debate on the state of humanitarian medical aid, to challenge MSF and other organisations to improve the quality of their work, and to ensure that discussion of humanitarian research and innovation in new models of care and technology is accessible for anyone with an internet-enabled device. more…

Recent treatment regimens for drug-resistant tuberculosis (DR-TB) have resulted in patients enduring a gruelling two-year treatment journey, which necessitates taking up to 20 tablets every day with months of daily painful injections. The side-effects associated with the treatment results in many suffering from permanent hearing loss and some developing suicidal depression and psychosis. For those able to tolerate this miserable treatment, only around half of those suffering with multi-drug resistant tuberculosis (MDR-TB), and one quarter suffering with extensively drug resistant TB (XDR-TB) will be cured. more…

Late on Wednesday night two barrel bombs fell on buildings surrounding the hospital of Al Quds hospital in Aleppo, Northern Syria. As tens of wounded were being rushed to the emergency room (ER) for treatment, a third barrel bomb fell directly at the entrance to the ER, killing and injuring staff and patients. The building was immediately reduced to rubble while surviving patients, staff, and volunteers began to search desperately for those caught in the ruins.

At least 14 people lost their lives, including two doctors, two nurses, a guard and a maintenance officer. The remaining eight were patients. more…

World Malaria Day 2016

Since the early 2000s the world has seen considerable success in the fight against malaria, with a significant decrease in overall numbers of cases and deaths. But this success is uneven: there are still contexts where the toll of malaria is worsening and seasonal spikes in patient numbers are getting higher. Teams at projects run by Médecins Sans Frontières (MSF) saw particularly high peaks in 2012, 2014, and 2015—largely in the most difficult to reach areas of Democratic Republic of Congo (DRC), Central African Republic (CAR), and South Sudan, but also in countries like Uganda and Mali, which have stronger health systems. more…

In 2015 the world woke up to the idea that the spread of antimicrobial resistance (AMR) will ultimately lead to a post-antibiotic era in which even simple medical treatments will cease to be possible.

Over the past decade the infectious disease medical community has looked on in horror as NDM-1 (New Delhi metallo-beta-lactamase-1—an enzyme rendering bacteria resistant to many antibiotics) has spread across the globe, causing havoc wherever it is detected. Furthermore, last year the first plasmid-meditated resistance mechanism to the antibiotic colistin, active against gram-negative bacteria, was identified in Chinese animals and humans. Since plasmids are efficient vehicles for the rapid transfer of resistance between bacteria, this is a huge threat to the last line of defence against gram-negative infections. more…

Grania Brigden discusses the findings of the Out of Step report on national tuberculosis (TB) policies. The report is being launched on 2 December at the 46th Union World Conference on Lung Health, Cape Town, South Africa.

TB is winning a deadly race—this year it overtook HIV as the world’s deadliest infectious disease, killing 1.5 million people annually. How has a curable disease won such a title? One reason is the gaps that exist in the TB response. more…

On World AIDS Day and with the ICASA conference ongoing, Helen Bygrave discusses the implications of the recently announced World Health Organization (WHO) “treat all” policy.

On the back of the headline studies Temprano, START, and new data from HPTN 052, the WHO recently announced the “treat all” policy: everyone diagnosed with HIV should start antiretroviral therapy (ART), regardless of their immunological status. So no more hanging around waiting for people to get sick and transmit the virus, we now crack right on and start the right medication for the right disease. Great news, we all say, as pre-ART follow-up was an undeniable disaster and the new policy may further simplify how we get treatment to those in need, especially in low coverage or unstable settings. But what are the implications of a policy that increases the number of people now eligible for ART to 37 million? more…

MSF nurse Lajos Zoltan Jecs was in Kunduz trauma hospital when the facility was struck by a series of aerial bombing raids in the early hours of Saturday morning. He describes his experience.

“It was absolutely terrifying.

I was sleeping in our safe room in the hospital. At around 2am I was woken up by the sound of a big explosion nearby. At first I didn’t know what was going on. Over the past week we’d heard bombings and explosions before, but always further away. This one was different—close and loud. more…