This Year’s Top Ten

(noon. – promoted by ek hornbeck)

This is not the Top Ten you might think. These are the Top Ten Humanitarian Crises from around the world that are selected by Doctors Without Borders at the end of each year.

  Aid Blocked and Diseases Neglected

New York, December 21, 2009 – Civilians attacked, bombed, and cut off from aid in Pakistan, Somalia, Yemen, Sri Lanka, Afghanistan, and the Democratic Republic of Congo (DRC), along with stagnant funding for treating HIV/AIDS and ongoing neglect of other diseases, were among the worst emergencies in 2009, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) reported today in its annual list of the “Top Ten” humanitarian crises.

Continuing crises in north and south Sudan, along with the failure of the international community to finally combat childhood malnutrition were also included on this year’s list.  The list is drawn from MSF’s operational activities in close to 70 countries, where the organization’s medical teams witnessed some of the worst humanitarian conditions.

 1. Unrelenting Violence Stalks Civilians Throughout Eastern DR Congo

Throughout 2009, the civilians suffered continuous violence from different armed groups in eastern Congo. Hundreds of people were killed, thousands of women, children, and, sometimes, men were raped and hundreds of thousands of people fled their homes. Guerilla warfare has replaced armed clashes in North Kivu where combatants spread terror by looting and burning houses in reprisals against the perceived support of communities to different factions.

In 2008, the fighting occurred mainly between the Congolese army (FARDC) and the National Congress for the People’s Defense (CNDP) rebel group. This past year saw the conflict change when the Congolese and Rwandan armies started an offensive in both North and South Kivu to wipe out Rwandan rebels of the Democratic Forces for the Liberation of Rwanda (FDLR). The Congolese military received logistical support from the UN peacekeeping mission in DRC, known as MONUC.

2. Somalis Endure Violence And Lack Of Access To Health Care

In 2009, the Somali population continued to fall victim to indiscriminate violence, while severe drought plagued parts of the country. Millions of people urgently require health care, yet the enormous gap between the needs of Somalis and the humanitarian response on the ground continues to widen. Ongoing abductions and killings of international and Somali aid workers is thwarting the efforts of humanitarian organizations to respond, and the public health-care system remains in near total collapse.

This occurred despite a new political momentum at the beginning of the year with the election of a new president Sheikh Sharif Sheikh Ahmed. In the capital, Mogadishu, fighting raged between the African Union- and UN-backed Transitional Federal Government forces and opposition groups. It remains impossible to verify the precise human toll of the conflict, but human rights groups and United Nations agencies have estimated that between 20,000 and 25,000 people have been killed from the fighting and countless others wounded since 2007, along with the displacement of more than 1.5 million people who have fled renewed, heavy fighting in Mogadishu and other parts of South Central Somalia in the last twelve months.

3. Precarious Situation for People in Southern Sudan and Darfur

Medical humanitarian emergencies persisted throughout 2009 in several parts of Sudan. In addition to the ongoing crisis in Darfur, people in southern Sudan faced a deteriorating situation marked by escalating violence, disease outbreaks, and little or no access to health care.

Nearly five years after the Comprehensive Peace Agreement (CPA) ended a brutal, decades-long civil war, medical needs throughout southern Sudan remain at urgent levels, and escalating tensions are creating a precarious security situation. Violent inter-communal clashes in Jonglei, Upper Nile, Warrap and Lakes states throughout the year have left hundreds dead and thousands displaced. Sporadic attacks on villages by the Ugandan rebel group, the Lord’s Resistance Army (LRA), near the Congolese border and also in Democratic Republic of the Congo (DRC) itself, caused thousands of Sudanese people to flee their homes and Congolese refugees to cross the border and seek refuge in Western Equatoria state.nd Darfur

4. Hundreds Injured during the Final Stage of Sri Lanka’s Decades-long War

As fighting raged earlier this year between the Sri Lankan military and the Liberation Tigers of Tamil Eelam in northeastern Sri Lanka, tens of thousands of civilians were trapped for months in a war zone reduced to a narrow strip of jungle and beach, with no aid and limited medical care. A few months before the final phase of the country’s decades-long civil war, humanitarian aid agencies, including MSF, had to leave the areas most affected by the fighting, at the request of the government. Only the International Committee of Red Cross (ICRC) could continue some crucial medical assistance, evacuating some of the wounded to Ministry of Health hospitals. An MSF surgical team worked since February 2009 in one of these hospitals, in nearby Vavuniya.

5. Civilians Suffer from Violence & Neglect in Pakistan

Pakistan was convulsed by intense violence throughout 2009. Conflict between the Pakistani army and armed opposition groups in the North-West Frontier Province (NWFP) and in the Federally Administered Tribal Areas (FATA) displaced more than two million people, while numerous bombings in major Pakistani cities killed hundreds and injured thousands. In the province of Balochistan, a long-running conflict continued beyond the media’s glare. Across the country, people suffer from a general lack of health care, and Pakistan features one of the highest infant and maternal mortality rates in the region.

Difficult living conditions in Pakistan’s more remote regions were made even worse by the violence, which has escalated over the last two years. Insecurity and travel restrictions limit the provision of medical services to people most in need. MSF was unable to provide medical support during fighting in Kurram, Swat, and South Waziristan.

6. Politics of Aid leaves many Afghanistans Cut Off from Humanitarian Assistance

As the war in Afghanistan escalated in 2009, Afghan civilians endured increasing levels of violence throughout the country. The insecurity has damaged an already beleaguered health-care system, leaving only a few poorly functioning hospitals and clinics in provincial capitals. Afghans in need of any health care must now make an impossible choice: risk traveling hundreds of miles through a war zone to seek a medical care or allow a condition to worsen until it becomes life-threatening only to arrive at a health structure where services are greatly diminished.

MSF has returned to Afghanistan after nearly five years of absence following the murders of five of our colleagues in June 2004. At that time, many had hoped that Afghanistan was in a post-conflict situation. Today that hope has been crushed and the need for emergency medical assistance remains acute.

7. Civilians Trapped in Violect War in North Yemen

Five prior unsettled wars in Yemen’s northern Saada Governorate led to a sixth in 2009, the most intense so far. The Yemeni army ratcheted up its offensive against a rebel group drawn from the dominant community in the region, and the humanitarian fallout was unprecedented. Civilians and non-military targets such as hospitals were heavily affected by fighting. Hundreds of thousands were displaced and humanitarian assistance came to a virtual halt. A malnutrition emergency was discovered among children uprooted from their homes. For the first time, a foreign neighbour, Saudi Arabia, was drawn into the conflict, further complicating the plight of civilians.

8. Woefully Inadequate Funding Undermines Gains In Childhood Malnutrition Treatment

An estimated 3.5 to 5 million children die each year from malnutrition-related causes-one death every six seconds. Yet childhood malnutrition is a medical condition that is easy to prevent with the right mix of nutritious foods and is effectively treated with therapeutic products available today. Recent years have seen great improvements in our understanding of childhood malnutrition and an international consensus has emerged around the provision of therapeutic ready-to-use foods-rich in protein, vitamins, and minerals-to treat its most severe form in children under five. So why do 55 million children continue to suffer from this devastating condition?

9. Funding for AIDS Treatment Stagnating Despite Millions Still in Need

In 2005, world leaders at the G8 summit in Scotland pledged support for universal AIDS treatment coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programs and that helped to expand coverage to more than 4 million people in developing countries. And now those same leaders are retreating from the pledges made, leaving governments and millions of people with HIV/AIDS at a dangerous loss.

10. Lack of R&D and Scale Up Treatment Plagues Patients with Neglected Diseases

More than 400 million people are at risk for the neglected tropical diseases (NTDs) visceral leishmaniasis (kala azar), sleeping sickness, Chagas disease, and Buruli ulcer. The first three are among the deadliest of all the NTDs, and all four have been highlighted by the World Health Organization (WHO) as especially troublesome due to treatment and diagnostic tools that are old, ineffective, or worst, simply non-existent, and with patient populations stuck in remote or insecure areas with little or no access to health care. Even worse, research and development (R&D) of new medicines and diagnostics is woefully under funded. Unless there is a substantial increase in resources available for national control programs for active diagnosis and treatment of patients, investment in prevention initiatives, as well as dedicated R&D for new tools, victims of these will remain neglected.


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    • TMC on December 22, 2009 at 10:47
  1. Well, I think we can take adequate credit for the worsening conditions in Afghanistan, Pakistan, and Yemen.  (Strange, Iraq was not mentioned!)  Other countries are those that do not, unfortunately, command enough of the world’s attention — a lack of concern, I fear.

    All this, as we continue to “war” here and there, at the costs of billions, and prey on the already strife-ridden communities that we seek out to further impoverish in an effort to acquire their resources.  


    Climate swindle ought to be number one though.

    • Diane G on December 23, 2009 at 19:25

    Ok, this made me almost bawl….

    and I’m supposed to believe there’s a God?

  3. Where the fuck is Gaza?

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