Medicine and public health

Four hepatitis E epidemics have occurred in the areas in which we operate since 2000, prompting a reflection on the quality of the water produced and distributed to their populations by humanitarian organisations.

Using Niger as an example, this text seeks to explore the dilemmas involved in medical responses to child malnutrition when such malnutrition is endemic (strong, permanent presence) and gives rise to seasonal peaks (epidemics) each year.

Four years after the Nigerian crisis, many things have changed in the nutrition field. This Cahier du Crash aims at considering this evolution and explore new possibilities for action for MSF.

Pharmaceutical companies produce drugs and are increasing involved in the clinical trials of these products. This conflict of interest is incompatible with the expectations  of Public Health. Rony Brauman suggests that the industry no longer be responsible for therapeutic trials.

Based on MSF's experience in responding to epidemics, Jean-Hervé Bradol describes the risks of spending precious time and energy on trying to delay the spread of the epidemic rather than on the case management of large numbers of sick people.

In 2008, Southern Ethiopia was the epicentre of a vast nutritional intervention: more than 100,000 malnourished children received assistance from a mix of actors including both international actors and local health facilities.

Influenza A H1N1 is turning into a pandemic. What will the number of cases be, what groups will be the most affected, how virulent will the virus be, and how long will it last?

Humanitarian medicine is intented for marginalized people, hit by a crisis or deprived of access to medical care. This book helps us understand how the specificity of humanitarian medicine stems from real-life situations, more than from the medical act in itself.

Dr. Jean-Hervé Bradol, Former President of MSF-France presented data based on MSF's experience in Niger that showed the implementation of the UN recommendation for the treatment of severe acute malnutrition was not possible in a high burden setting.

Twenty years after the charity concerts for the Sahel Nigerien politicians, institutional donors, aid agencies and humanitarian organisations clashed on the nature and substance of the crisis affecting Niger in 2005. Identifying the causes of, and adequate responses to, the situation also gave rise to profound disagreements. Having set up their most ambitious emergency nutrition programme to date, Médecins Sans Frontières found itself at the forefront of these controversies.

Rony Brauman questions the link between public health decisions and the right to health care. 

« Never again »: in the wake of the second World War, the terror caused by the Holocaust led the community of states to condemn genocide as a crime and to create a new international organization, the United Nations. And yet, half a century later, the international community did nothing to prevent the first undeniable genocide since that of the Jews: it let the massacre of the Rwandan Tutsis and merely sent humanitarian aid, even though it was nearly over.