1. Without BordersMédecins Sans Frontières/Doctors Without Borders | msf.org.uk
The outbreak of Ebola that
began in March this year is
wreaking havoc across a swathe
of west Africa as the number
of cases surges. Here five MSF
volunteers talk about their
experiences of the arduous and
dangerous battle to halt the
virus – and the euphoria that
the teams feel when a patient
recovers and returns home.
HANNAH SPENCER
A DOCTOR FROM SURREY
“When I heard about the Ebola outbreak in
west Africa, I contacted MSF and asked if I
could help. When I told my mum, she said,
‘As if I could stop you from going!’ Naturally
my family were concerned. Ebola is highly
infectious, and while you can never say there’s
no risk, if you follow all the procedures, the
risk of catching it is low.”
TIM JAGATIC
A DOCTOR FROM CANADA
“When I’m dressed up in my full personal
protective equipment, I know I’m not
exposed to the virus. Before we go back to
our compound, we go through multiple
decontaminations – there are all these
checkpoints to make sure we’re washing our
hands. There is a very strong sense of safety.”
BENJAMIN BLACK
AN OBSTETRICIAN FROM SUSSEX
“Trying to work in the heat is unbearable.
Coupled with the stress of the environment,
the high stakes of getting it right and of not
exposing oneself to the disease make the work
incredibly intense.
Once inside the isolation ward, you have to
rely on yourself and your ‘buddy’ – you never
go inside alone.”
COKIE VAN DER VELDE
A SANITATION SPECIALIST FROM YORKSHIRE
“This morning I woke with a sore throat – it’s
almost certainly due to inhaling chlorine, but
paranoia has set in and I take my temperature
for the tenth time this morning. Not sure this
is a healthy obsession.”
ANE BJØRU FJELDSÆTER
A PSYCHOLOGIST FROM NORWAY
“Dealing with the dead bodies is disturbing.
The hygienists experience feelings of sadness
and fear, and also disgust. With Ebola,
patients can die in a disgraceful manner –
there’s bleeding, vomiting and diarrhoea. The
cleaners tell me they experience flashbacks
Fighting Ebola
Moments of joy amid the outbreak
MSF staff at our Ebola treatment
centres give their all to treat
hundreds of patients each month.
But they can’t operate without
donations. Please support our
medical teams working around
the world today.
Phone: 0800 408 3894
Visit: www.msf.org.uk/support
Or use the form on page 3
INSIDE:
4-6 SYRIA – THE REACH OF WAR
7 SOUTH SUDAN
8 THROUGH THE LENS
Sida Bentou says goodbye to staff at MSF’s treatment centre in Guéckédou, Guinea, having survived Ebola.
Credit: Sylvain Cherkaoui/Cosmos
Médecins Sans Frontières/Doctors Without Borders (MSF) is the world’s leading emergency medical humanitarian aid organisation. We help people affected by armed conflict,
epidemics and natural or man-made disasters, without discrimination and irrespective of race, religion, creed or political affiliation. We work in over 70 countries and go to places
where others cannot or choose not to go. We can do this because we are independently funded, with 90 percent of our funding coming from individual or private donors, like you.
continued on page 2
Sierra Leone
Guinea
Mali
Senegal
Côte d’Ivoire
Liberia
Guinea Bissau
Burkina
Faso
Ghana

2. EBOLA CRISIS
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/msf.English @msf_uk
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– of things they have seen and of things they
have smelt. Even wearing a mask, you can’t
shut out all the smells.
The stigma also makes it hard for the
hygienists and cleaners – who are all locals
– to maintain their image of what they are
doing. We tell them, ‘You are heroes, you’re
doing a very important service for your
community – it’s absolutely vital that someone
is doing this job.’ But although we see them as
heroes, this isn’t always how they are perceived
by their families, their friends or their villages.”
TIM JAGATIC
“The isolation unit is in a tent and the barriers
are made of plastic fencing, so family members
can sit on chairs outside and talk normally
with the patients, who sit inside. I’d say there
are a good 10 to 15 patients in there who will
survive. Social bonds form among many of
the patients. There’s a group of women sitting
there over lunchtime, and because it’s kind of
boring in these isolation units, they become
friends, they’re gossiping.”
COKIE VAN DER VELDE
“I’ve been working ridiculous hours. At night
we go back to the house for a team meeting
to discuss what’s happened during the day. At
the end of our meetings, we always say, has
anybody got any good news? That’s my cue to
tell a really rude joke.”
BENJAMIN BLACK
“An expert in Ebola recently told me, ‘This
disease kills those you love the most, the
people closest to you and those that you are
most likely to care for’. Wise and poignant
words, true to the cruel nature of transmission
in this disease.”
ANE BJØRU FJELDSÆTER
“Last week a very little girl came out of the
isolation ward. Her name was Bintu, and
she was 21 months old. Both her parents had
tested positive for Ebola, but she had tested
negative, so we had to take her out of the
ward because the risk of contamination was
too high. That was a horrible day. The nurses
told me she didn’t know how to speak. For
the two days she’d been in the ward, she’d
been so shocked that she hadn’t uttered a
word. This can happen to children – it’s called
elective mutism. When she came out, she
didn’t make eye contact, she didn’t speak to
anyone. We put her in a chair and she turned
around, with her back to the world. It must
have been a terribly disturbing experience for
a child: to see someone come into the ward
in a spacesuit; to hear them speaking to your
mother in words you don’t understand; to
see your mother start crying; and then to be
handed over to the stranger in the spacesuit
and carried off. I sat with her for four hours,
trying to talk to her in a calm voice and
singing her songs, to see if the shock would
pass. By the end, she had turned around and
was facing me. She made eye contact, she put
her hand out for me to touch her, she started
a conversation. You could see that she was
warming up to me, and that she wasn’t in
the same condition. Both of Bintu’s parents
died that day. Now she is in the care of a child
protection organisation which is trying to
locate other family members who can take
care of her. I just hope she’ll be ok.”
BENJAMIN BLACK
“Occasionally everyone stops what they are
doing – doctors, nurses, cleaners, everyone. All
attention is directed at the exit from the high-
risk zone. A patient is being discharged. Like
a celebrity, the survivor is surrounded by an
excitable crowd, whooping and clapping. The
beaming faces of the crowd are reflected in the
broad smile and shining eyes of the survivor. It
is an intensely emotional moment.”
ANE BJØRU FJELDSÆTER
“When we discharge a patient who has survived
Ebola, it makes an enormous difference.
Yesterday, three people who had been cured
were discharged from the isolation ward, and
all the cleaners were dancing around the ward,
deliriously happy and taking photographs.”
HANNAH SPENCER
“One 15-year-old girl was inside the isolation
ward for over a week, along with her seven-
year old sister and her mother, who was
very unwell at first – I really thought she
was going to die. But then they all started
to get better. When, finally, the girl’s test
came back negative, she had a shower in
chlorine, changed into new clothes and was
discharged from the ward. Her family were
all there to meet her at the gate and she was
crying because she was so happy. That was a
wonderful moment – to see that and to know
that her mother and sister would soon be well
enough to join her.”
BENJAMIN BLACK
“Everyone feels a huge sense of achievement
when a cured patient leaves the centre.
But MSF doesn’t cure Ebola – only an
individual’s own body can win the fight. But
I sense that the emotional and psychological
impact of seeing that you are not alone, and
of witnessing the euphoric moment when
others are discharged, has an important
restorative effect.”
TIM JAGATIC
“My family are not the happiest, but they
understand why I’m here. There’s a need,
plain and simple. I have the training to help
bring an end to this problem, so I’ll give
everything I can.”
COKIE VAN DER VELDE
“Tomorrow’s my last day in Liberia. Once us
tired ones have left, new people will come
in. I’m going home to Yorkshire, to see my
grandchildren and to have a jolly nice cup of
English tea. But in a month’s time, I’ll be ready
to come back with MSF to west Africa, to
wherever I’m needed.”
HANNAH SPENCER
“I’m back in the UK now, and a bit tired.
Working in an Ebola epidemic isn’t easy,
but it’s exactly the kind of work MSF should
be doing.”
MSF staff in protective clothing bring a girl with suspected Ebola into the treatment centre in Kailahun, Sierra Leone.
Credit: Sylvain Cherkaoui/Cosmos
continued from front page
Hannah Spencer Tim Jagatic Benjamin Black Cokie van der Velde Ane Bjøru Fjeldsæter
WHAT IS MSF DOING?i
The outbreak of Ebola in West Africa is the
largest Ebola epidemic ever recorded. The
virus has already infected more than 8,000
people and the outbreak is far from over.
MSF has been combatting the outbreak
since the first cases were reported and have
admitted 5,065 patients, among whom
3,264 were confirmed cases of Ebola. 1,173
have recovered.
We are operating six treatment centres in
affected areas, but more needs to be done.
We are stretched to the limit of our capacity.
MSF has 3,408 staff on the ground and
has brought in more than 807 tonnes of
equipment and supplies to help fight the
epidemic. It’s the financial support of
individuals like you that enables us to do
this. Thank you.
For the latest news and information,
visit msf.org.uk/ebola

3. SUPPORTING MSF
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Your support makes our work possible – thank you!
£10 a month – or 33p
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£20 a month
can buy medicine to
treat 200 people for
malaria: a treatable
disease that kills one
child every 30 seconds.
Credit: Seb Geo Credit: Marcell Nimfuehr/MSF
The one thing we can’t do without is your
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Giving monthly is easy for you too. No hassle. No
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4. SYRIA
4
SSSUPPORT MAKES OUR WORK POSSIBLE + WE CAN’T OPERATE WITHOUT YOU + YOUR SUPPORT SAVES LIVES + YOUR
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Syria: The reach
Now into its fourth year, the war in Syria has killed
more than 150,000 people and driven upwards of
nine million people from their homes, nearly a third
of whom have fled the country.
MSF has been working in Syria and in the
surrounding countries since the start of the conflict,
providing emergency medical care and support to
many thousands of people.
These photographs — all taken on one day in MSF
projects in Iraq, Jordan and Lebanon — reveal the
very personal dimensions of the conflict, as lived by
Syrian patients and the MSF staff members treating
them.
“The war is so overwhelming that it’s easy to lose
sight of what it means for individual Syrians,” said
Dr Joanne Liu, MSF’s international president.
“Working in Syria late last year, I saw children
suffering from blast wounds, families without
proper shelter and women who had nowhere safe
to give birth to their babies. These photographs
bear witness to the personal toll of a brutal,
relentless conflict.”
“We are trying to help as many Syrians as we can
in neighbouring countries as well as people inside
Syria itself.”
We can’t do it without your support.
Fourteen-year-old Malik plays chess with British anaesthetist Ben Gupta in Ramtha hospital, Jordan. Malik
party at his family’s home in Syria. Credit: Ton Koene
A Syrian child is checked for malnutrition at MSF’s clinic in Arsal, in Lebanon’s Bekaa valley. The
refugees’ poor living conditions can be particularly hard on the young, many of whom arrive in
Lebanon already traumatised by their experience of the war in Syria. Credit: Moises Saman/
Magnum
Eight-year-old Maria, from Sana in Syria, was badly burned when her bed caught on fire. She is
being treated by MSF doctors at Ramtha hospital in Jordan, which provides surgical and post-
operative care that is unavailable in much of Syria. Credit: Kate Brooks

5. SYRIA
5
SUPPORT MAKES OUR WORK POSSIBLE + WE CAN’T OPERATE WITHOUT YOU + YOUR SUPPORT SAVES LIVES + YOUR
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h of war
Malik lost one leg and sustained severe injuries to his arm and other leg when a bomb fell on a wedding
Syrians who have crossed into Iraq for safety wait to see a doctor at MSF’s clinic in Domiz refugee
camp. “People have suffered a lot,” says MSF psychologist Henrike Zellman. “If somebody could
tell them, ‘You have to stay here for another two months, and then you can go back home,’ people
would cope easily. But nobody can tell them when they’ll actually be able to leave.” Credit: Yuri
Kozyrev/Noor
Dr Haydar Alwash, an Iraqi surgeon who was once a refugee himself and now works for MSF,
operates on a young man in Ramtha, Jordan. “All our patients are newly injured in this conflict,
usually by bombs or gunshots,” he says. “We concentrate on surgical procedures that can save
lives or save limbs. You can really see the vital importance of the services you are providing.”
Credit: Ton Koene
Fourteen-year-old Rukaya lost both her legs when her hometown in Syria was bombed. “My
mother and I were going to another neighbourhood,” says Rukaya. “As we were about to leave,
we were hit by a rocket. My mother died, and I was wounded. I felt that I had no legs. Then I fell
unconscious.” Brought to hospital in Ramtha, Jordan, Rukaya has been operated on seven times
by MSF surgeons, and will soon be fitted with prosthetic legs. Credit: Ton Koene

6. SYRIA
6
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YOUR SUPPORT
£10.76 pays for a box of
300 surgical gloves
£17.26 pays for a surgical gown
£30.20 pays for a box of
300 surgical masks
£161.41 pays for a basic surgery
set of 27 instruments
£
Syria: The reach of war
*UN statistics July 2014
Community healthcare worker Falak Saadoun demonstrates handwashing techniques to Syrian refugee children in their family’s tent
in Domiz camp in northeast Iraq. At the camp’s clinic, MSF teams provide healthcare to some 60,000 refugees who have fled the war
in neighbouring Syria. Credit: Yuri Kozyrev/Noo
SYRIA 6.4M people displaced in Syria*
10,151 surgical acts by MSF teams
63,440 Emergency Room consultations
109,214 out-patient and mobile clinic
consultations
90,214 children vaccinated against measles
2,373 babies delivered
100+ MSF clinics
IRAQ 217,192 refugees*
4 MSF clinics
285,082 medical
consultations
6,963 mental health
consultations
JORDAN 607,878 refugees*
6 MSF clinics
30,205 medical consultations
2,123 surgical acts by MSF teams
1,008 babies delivered
813 mental health consultations
TURKEY 808,600 refugees*
LEBANON
1,138,043 refugees*
9 MSF clinics
272,564 medical
consultations
3,846 mental health
consultations
Amman
Damascus
Beirut
“I am a surgeon but
I am also a human
being. I feel pain
when I am face-to-
face with innocent
children and older
men and women
whose lives have
been forever changed
by conflict. But as a
surgeon, I am in a
position to treat these
vulnerable people,
to make them smile
and enjoy a sense of
independence again.”
Dr Ali Al-Ani, surgeon
at MSF’s reconstructive
surgery project in
Amman, Jordan
WHAT IS MSF DOING?i
MSF is running 25 health clinics and
hospitals in Lebanon, Jordan, Iraq and
Syria, and is providing remote support
to other clinics within Syria.
Is MSF taking sides in this conflict?
No, MSF never takes sides. We offer
medical assistance to anyone who needs it,
irrespective of their race, religion or politics.
Thank you.
It’s the financial support of individuals
like you that has enabled us to perform
760,505 medical consultations and 12,274
surgeries in and around Syria since the
crisis began. We couldn’t do it without you.
For more information, visit msf.org.uk/
syria and reachofwar.msf.org
During morning rounds, MSF’s Dr Haydar Alwash and his team in Ramtha, Jordan, visit patient Mohammed Jamus, who was wounded in the arm,
chest and leg in the war in Syria. “Most of our patients have a story other than their actual injury – they come with two or three tragedies,” says Dr
Alwash. “What we are trying to do is to give hope for these patients by trying to alleviate their pain.” Credit: Ton Koene

7. When I arrived in early July, there
were about 40,000 people living
in this camp, situated in one of the largest
swamps in the world. At first glance, it
looked like your average refugee camp, with
ramshackle dwellings made out of plastic
sheeting and twigs, and a lot of grass, mud
and people. It looked bad, but not too terrible.
But as soon as you looked beneath the surface
and examined what was happening to the people
here, the results were absolutely shocking. The
crude mortality rate – the number of deaths per
10,000 people per day – was 1.5. The emergency
threshold is one per 10,000 per day. What does
that mean in human terms? If you can picture
an average school with 1,000 students, that’s one
student dying every 10 days. That’s a staggering
level of death.
Three children dying every day
It was even worse for the under-fives, who were
dying at the rate of three children a day. You’d
go into a tent and see emaciated children with
protruding bellies as if they were in a famine, and
this was happening in a camp with enough food.
Why were people caught in this cycle of death?
It was because of water. Each person had just
four to five litres of water every day – for cooking,
drinking and washing. And when you’ve got such
a small amount of water, you’re basically not
washing. And if you are washing, it’s in muddy
water contaminated with sewage, because in the
camp there is only one latrine per 300 people.
There is faeces everywhere, and even if you want
to keep clean, you can’t. As a result, people are
constantly exposed to parasites and bacteria and
viruses, which means that people are constantly
suffering from diarrhoea, vomiting and fever.
Having diarrhoea means that you’re not gaining
weight, and that’s a big problem if you’re a
child under five. It means your immune system
is suppressed, and you’re more vulnerable to
infections. Before you know it, you’ve got dozens
of kids with severe acute malnutrition in a camp
with plenty of food, alongside adults dying from
diarrhoea.
We know what to do
So what do we do? This is where it’s an absolute
pleasure and privilege to be part of MSF, because
we know what to do in these situations. On
the front end, you start providing more water.
You dig more wells, and you encourage other
organisations working there to dig more wells.
We have water and sanitation experts who can
take muddy, contaminated water, pump it into a
tank, treat it, and turn it into clear drinking water.
Within a short amount of time, we’ve boosted
water availability to 10.6 litres per person per day.
Not enough, but better than before.
We also start building latrines – it goes from one
latrine for every 300 people to one for every 70
people. Then we set up nutritional care teams
and go out into the camp. Twenty percent of the
children are malnourished; seven percent of the
children – around 700 kids – have severe acute
malnutrition. We bring these children into our
inpatient centre and start treating them with
medicalised food and therapeutic milks.
Anchoring all this is our hospital. Nobody is
going to come to your clinic if they think the
traditional healer is going to do just as good a
job. But if people see that emaciated children
and people close to death go into your hospital,
and a week or two later come out looking fat and
sassy, then they know you’re offering something
real. Word spreads fast.
So we implement this package of water and
sanitation and feeding and medical care, and
within a decent period of time, we’ve pushed the
crude mortality rate down from 1.5 to 0.6, and
from 3 to 1 for the under-fives. That means that,
every single day, there are two more children
walking and talking and looking at the possibility
of a lifespan because of what we are doing.
Then the rains come...
But then the rains come. Initially, there is 50 cm
of water in the camp, and then suddenly there
is more, and then the latrines have flooded. We
are in a situation where most of the inhabitants
of the camp are unable to lie down and sleep
MSF.ORG.UK/SOUTH-SUDAN
7
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YOUR SUPPORT
Conflict, hunger, disease, disaster.
MSF tries to go where we are needed
most. But our staff can only help if they
have training and resources. We can
only provide these if people give to us.
Please support us today.
Phone 0800 408 3894
Visit: www.msf.org.uk/support
Or use the form on page 3
£
Living in filthy conditions, children can quickly become
caught in a cycle of sickness and malnutrition.
Credit: Jean-Pierre Amigo/MSF
People wade through floodwater to their shelters in Bentiu camp, South Sudan, situated in one of the world’s largest swamps.
Credit: MSF
‘
because of the water. Women are standing in
water at night with their children in their arms
trying to keep them dry. These are conditions
not compatible with human dignity, and barely
compatible with life.
People in the camp have been given dry rations
to eat, but these can’t be eaten unless they’re
cooked, and there’s no dry firewood in the
camp. There’s still a civil war going on, and
if men leave the camp, there’s a risk they’ll
be shot, while for the women, there’s a risk
they’ll be raped. But what choice do they have?
Women start to leave the camp to collect
firewood, and before long, we are treating
victims of rape.
People are alive because MSF
is there
What do we do in a situation like this? We speak
out on behalf of our patients. The United Nations
is responsible for this camp and for protecting
these people, so we called on them to improve
conditions, to start assisting with drainage and to
provide protection for people leaving the camp to
collect firewood. We got them to act, and things
have improved in the camp, although there’s still
room for improvement.
It was hard for me to leave at the beginning of
August, because you feel there’s still so much
to be done. But at MSF, we have three aims:
to save lives, alleviate suffering, and restore
dignity. I think we have gone some way to
achieving those aims at Bentiu. It is a small
drop in a large ocean, but it is something,
and people are alive because we are there.
In South Sudan,
40,000 people have
taken refuge from
the civil war in an
overcrowded camp
in Bentiu. MSF’s emergency
coordinator, Ivan Gayton,
talks about the practical steps
MSF takes to save lives in such
desperate environments.
‘
Saving lives in a swamp

8. Médecins Sans Frontières/Doctors Without Borders (MSF) Charity Registration Number 1026588
67-74 Saffron Hill London EC1N 8QX Tel: 44 (0)207 404 6600 Web: www.msf.org.uk 24620_ON2
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SUPPORT MAKES OUR WORK POSSIBLE + WE CAN’T OPERATE WITHOUT YOU + YOUR SUPPORT SAVES LIVES + YOUR
Mexico, May 2014 – Young men ride a cargo train known as ‘the
Beast’ as they head for the US. MSF teams provide medical care
to the migrants, many of whom are fleeing violent gang culture in
El Salvador and Honduras. Credit: MSF
Burundi, May 2014 – Nurse Annalisa Baldi, from Italy, helps a woman give birth in a field after she went into premature labour.
Credit: Matteo Bianchi Fasani
Iraq, August 2014 – Following their escape from the Sinjar mountains, after days under siege by Islamic State
militants, Iraqi families receive bottled water and biscuits from MSF teams. Credit: Favila Escobio/MSF
Around the world with MSF
South Sudan, July 2014 – MSF’s team in Agok bandage the leg of a
two-year-old girl hit by a bullet during fighting between rival forces.
Credit: Valérie Batselaere/MSF
Gaza, July 2014 – MSF anaesthetist Kelly Dilworth cares for one of two
brothers injured when a missile fell on their house during the Israeli
offensive on the Gaza Strip. Credit: Samantha Maurin/MSF
South Sudan, June 2014 – Two-year-old Gatluok is treated
for malnutrition at MSF’s hospital in Leer, after his home
was looted and burnt and his family was forced to hide in
the bush. Credit: Nick Owen/MSF
Ukraine, September 2014 – MSF teams deliver
urgently needed medical supplies to a hospital
in Donetsk. Credit: MSF