Appendix A Program Information

Appendix A
Staying in the know . . .

Program information for Volunteers
AFGHANISTAN PROGRAMME - Medical and Surgical Centre, Anabah
Uzbekistan Cina Update Sheet - March 2009
Tagikistan
Turkmenistan In the summer of 2008, for the third year running, a team of ophtalmologists went to the Centre in
Anabah in order to diagnose patients, then prescribe and provide free glasses to the local population.
Thanks to the donations of sanitary materials and personal bio-medical material collected by the team
Anabah
themselves, it has been possible to completely equip an ophthalmic OPD. 900 patients have been visited
Kabul in the hospital, in the network of First Aid Posts and Primary Health Clinics in the Panshir Valley.
Afganistan
Afghanistan is considered as one of the least developed countries in the world. According to the
Lashkar-gah
2005 UNPD Human Development Index Afghanistan was ranked 173rd out 178 countries. The
Iran Pakistan country has been the scene of decades of fighting, which has left the infrastructure in the country
in tatters. EMERGENCY has been present in Afghanistan since 1999.
The EMERGENCY Medical and Surgical Centre in Anabah opened on 15th December 1999. Anabah
is a village in the Panjshir valley in the northern mountainous region of the country; the entire area
is riddled with landmines. Initially the Centre offered surgery to victims of war and landmines.
In 2002, EMERGENCY decided to extend its admissions criteria to the Centre; it now offers general
surgery, internal medicine and paediatrics. The Medical and Surgical Centre is a reference point in
a vast area with a population of approximately 250,000 people.
The complete lack of well equipped free medical facilities in the area prompted EMERGENCY to
further extend its services. In June 2003 a Maternity Centre was opened next to the EMERGENCY
Medical and Surgical Centre. EMERGENCY now runs a Paediatric Programme providing paediatric
treatment at the Medical Centre’s OPD. The programme sees an average of 230 patients a month.
The more severe cases are admitted in the medical paediatric ward at the Centre, while the children
requiring surgical procedures are admitted to the adult surgical ward.
Following requests from both the local community and the Afghan Ministry of Health, EMERGENCY
established a network of Primary Health Clinics (PHC) and First Aid Posts (FAP) to offer medical
assistance to the most isolated villages in the region. These PHCs and FAPs transfer severely
ill patients in need of further treatment via ambulance to the EMERGENCY Medical and Surgical
Centre, in Anabah. At present, there are 18 FAPs and PHCs in Panjshir and Salang regions.
The annual operating costs for the Centre are approximately €1,000,000.
January – March 2009: Structure: emergency department; an outpatients’

Patients seen at the OPD: 6,806 department (OPD), 2 operating theatres, a sterilisation
- Surgical consultations: 2,522 room, an intensive care unit, 4 wards, a physiotherapy
- Medical consultations: 2,526 department, an x-ray department, a laboratory and
- Paediatric consultations: 1,758 blood bank, a pharmacy, classrooms, a children’s play
Total number of Admissions: 504 room, a canteen, domestic services and a maintenance
- surgical admissions: 490 department.
- of which: 24 were war surgeries, 167
Capacity: 70 beds
emergency surgeries and 206 elective surgeries
- admissions to the paediatric ward: 214
International Staff: 1 surgeon; 1 paediatrician; 2 nurses
Surgeries: 553
Data from June 2003 to March 2009: National staff: 179 doctors, nurses, clinical staff,
OPD consultations: 92,643 administrative and service staff
Admissions: 17,676
Surgeries: 12,444
EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

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AFGHANISTAN PROGRAMME - Maternity Centre, Anabah
Update Sheet - March 2009
Uzbekistan China
Tajikistan In the first three months of 2009, more than 780 women have been visited through the prenatal
Turkmenistan assistance programme provided by a team of midwives in EMERGENCY ’s Primary Health
Clinics (PHC) and First Aid Posts (FAP) located in the Panshir Valley.
Anabah
Kabul
Afghanistan is considered as one of the least developed countries in the world. According to the 2005
Afghanistan UNPD Human Development Index, Afghanistan was ranked 173rd out of 178 countries. For decades, the
Lashkar-gah country has been the scene of fighting which has left the infrastructure in tatters. EMERGENCY has been
present in Afghanistan since 1999.
Iran Pakistan
In 1999, after the successful opening of the Anabah EMERGENCY Surgical and Medical Centre in the
mountainous Panjshir Region, the need for a maternity hospital was immediately evident. In Afghanistan, a
woman dies every half an hour as a result of complications related to pregnancy. This is 60 times higher
than the mortality rate of women in developed countries. Women’s access to healthcare in Afghanistan is
limited due to the marginalization of women in Afghan society.
EMERGENCY’s Maternity Centre began clinical activities on 3rd June 2003. It offers free of charge obstetric
and gynaecological care to the women of the Panjshir Valley as well as neonatal care for the babies
who are born at the Centre. Furthermore, mothers are offered prenatal care at the Centre’s outpatients
department (OPD), in order to monitor pregnancies and prevent future complications related to deliveries
and pregnancies.
The Maternity Centre is linked to a network of 18 first aid posts (FAPs) and primary health clinics (PHCs) located in
the most remote areas of Panjshir and Salang regions. These FAPs and PHCs offer screening and follow-up visits
to expectant mothers. Medical assistance is also available to new mothers. Should an expectant mother need
further testing or urgent treatment, she is transported, via the EMERGENCY ambulance, to the Maternity Centre
in Anabah. A team from the Centre composed of an expatriate midwife and an Afghan midwife periodically visits
the FAPs and PHCs for the screening of patients and to provide on-the-job training to local staff who work there.
The all-female national medical team at the Centre is supported by a team of expatriate staff, who have
developed the protocols and clinical procedures required to run the Maternity Centre. A training programme
was also created to ensure that the national staff acquires the necessary skills and knowledge to handle
the rigors of the Centre. Prior to EMERGENCY’s intervention, there were no qualified personnel or maternity
facilities in the entire region, which has approximately 250,000 inhabitants.
The annual operating costs of the Maternity Centre are approximately €500,000.
January – March 2009: Structure: an obstetrics ward and an internal medicine

OPD consultations: 2,892 ward (combined 17-bed capacity), an outpatients’
- obstetric consultations: 2,115 department (OPD), an operating theatre, a 5-bed intensive
- gynaecology consultations: 777 care unit (ICU), a 3-bed isolation ward, a maternity ward,
Admissions: 719 a nursery, an ultrasound room, a delivery room, and
Surgeries: 186 diagnostic, technical and auxiliary services shared with the
- caesarean sections: 65 EMERGENCY Medical and Surgical Centre.
Deliveries: 505
Babies born: 514 Capacity: 25 beds
International Staff: 1 gynaecologist, 2 midwives

Data from June 2003 to March 2009:
OPD consultations: 38,181 National staff: 24 nurses and midwives, 8 service staff
Total Number of Admissions: 8,478
Surgeries: 1,691
Babies born: 5,612

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AFGHANISTAN PROGRAMME - Surgical Centre, Kabul
Update Sheet - December 2008
Uzbekistan China In December the Centre admitted around 50 patients, transferred from the FAP in Charikar, who were
Tajikistan wounded due to an explosion of a mine during a wedding party. To manage the great number of patients,
Turkmenistan the hospital staff started a mass casualty procedure. The activity in the emergency tent in the garden has
been intense and the Operating Room worked for more than 20 hours in a row.
Shebergan
Anabah
Kabul Afghanistan is considered as one of the least developed countries in the world. According to the 2005
Afghanistan UNPD Human Development Index Afghanistan was ranked 173rd out 178 countries. The country has been
the scene of decades of fighting, which has left the infrastructure in the country in tatters. EMERGENCY has
Lashkar-gah been present in Afghanistan since 1999.
Iran Pakistan
Inaugurated on 25 April 2001, the EMERGENCY Surgical Centre is the second medical facility EMERGENCY
has opened in Afghanistan. The activity of the 95-bed centre has continued to grow in the successive years,
resulting in the broadening of its admission criteria.
The centre now also admits emergency trauma patients. To guarantee adequate treatment for seriously ill
patients, EMERGENCY built a new 6-bed, state-of-the-art resuscitation and intensive care unit (ICU) in the
summer of 2003. The ICU has a life support system, as well as a defibrillator, and is consequently the
leading centre for trauma surgery in the entire country, making it unique. Furthermore, EMERGENCY is the
only organisation to offer treatment in the area that is completely free-of-charge.
EMERGENCY also equipped the centre with a computed tomography (CT) scan to handle the alarming
increase in road traffic accidents (RTAs). On average 5 children per day are killed as result of RTAs in
Kabul and its surrounding area, many more are those seriously injured. This is the first and only centre in
Afghanistan to have a CT scan that is accessible free of charge to the general population. The CT scan
allows for non-invasive examinations of patients suffering from cranial and abdominal injuries (by and large
sustained from RTAs).
EMERGENCY created a network of 12 FAPs, PHCs and clinics, some of which are run in the main prisons
around Kabul, which refer patients in need of further treatment to the Centre. Seriously ill patients seen at the
first aid posts (FAPs) and primary health care centres (PHCs) are referred to the Centre for further treatment.
In 2005, EMERGENCY embarked on a joint working relationship with the Afghan National Institute of Nursing.
Third year nursing students are now able to gain work experience at the Centre three days a week under the
supervision of EMERGENCY clinical staff.
The annual running costs of the Centre are approximately €2,000,000.
January – December 2008: Structure: a casualty department, an out patient

OPD Consultations: 8,612 department (OPD), 2 operating theatres, a sterilization
- patients with war injuries: 3,816 room, an intensive care unit, a patient ward, a physical
Admissions: 2,642 therapy department, an X-ray department, a CT scan, a
- female patients: 9% laboratory and blood bank, a pharmacy, classrooms,
- paediatric patients: 27% housekeeping services, a maintenance department and a
- admissions for war-related injuries: 1,151 children’s playroom.
- RTA related admissions: 524
Surgeries: 3,830 Capacity: 95 beds
- surgeries for war injuries: 2,219
Expatriate Staff: 1 general surgeon; 1 orthopaedic
Data from April 2001 to December 2008: surgeon; 2 anaesthetists; 1 radiologist; 1 x-ray technician;
OPD Consultations: 55,449 4 nurses; 1 physiotherapist; 1 administrator; 1 logistician;
Admissions: 18,337 1 biomedical technician.
Surgeries: 22,083
National staff: 97 doctors, nurses and clinical staff, 104
service staff.

AFGHANISTAN PROGRAMME - Surgical Centre, Lashkar-gah
Uzbekistan China At the end of August dozens of patients arrived to the Surgical Centre in Lashkar-gah, including
Tajikistan
a baby, four children, a young girl and four women, one of whom was pregnant. All of them were
Turkmenistan
celebrating a wedding party in a house nearby Lashkar-gah, men on one side, women and children
on the other, according to the local tradition, when they were hit by shells because of a bombing.
Shebergan
Anabah
Kabul
Afghanistan The 2005 UNPD Human Development Index Afghanistan was ranked 173rd out 178 countries. The country
has been the scene of decades of fighting, which has left the infrastructure in the country in tatters.
Lashkar-gah
EMERGENCY has been present in Afghanistan since 1999.
Iran Pakistan
The Tiziano Terzani Surgical Centre for War Victims is located in southern Afghanistan, in the city of Lashkar-gah.
The estimated 100,000 inhabitants of the city are mainly Pashtun (40% of the Afghan population). The city
is still in a Taliban stronghold, and is also at the heart of the country’s opium and hashish production – it
is estimated that 40% of heroin in circulation comes from this region. Consequently, its control is of great
strategic importance. The struggles to secure Lashkar-gah mainly affect the civilians attempting to go
about their daily lives. 2005 witnessed the emergence of yet another phase of violence. The conflict and
its ensuing security issues have led to the departure of the few international humanitarian organizations
working in the region.
The Centre began clinical activities in September 2004, and it is named after Italian journalist Tiziano
Terzani, a peace advocate and a dear friend and supporter of EMERGENCY, who died in July 2004. It is
EMERGENCY’s most recently opened medical facility in Afghanistan that offers free high quality medical care
to victims of war. Patients come from as far as the border with Iran to receive treatment.
Similar to other EMERGENCY medical facilities, this Centre works in collaboration with a first aid post (FAP) located
in Grishk, by receiving patients who, requiring further treatment, are referred to the Centre. The Centre is located
on a large 4,000 sq m plot. This 70-bed Centre is equipped to meet EMERGENCY’s high standards and criteria.
Approximately a third of all patients treated at the hospital are under the age of 14 and a paediatric and
female patient ward was created to accommodate them.
The annual operating costs for the Tiziano Terzani Surgical Centre are approximately €1,400,000.
January – December 2008: Structure: 3 male wards, a female ward, a paediatric

OPD: 7,177 ward, an intensive care unit (ICU), a surgical outpatient
department (OPD), an X-ray department, a sterilization
Admissions: 2,018 room, a pharmacy, a physical therapy room, housekeeping
- women: 8% services, a classroom, and a children’s playroom.
- children: 39%
- patients admitted for war-related injuries: 1,040 Capacity: 70 beds
Surgeries: 2,577
Expatriate Staff: 4 nurses, 2 surgeons, 1 anaesthetist, 1
- war-injured: 1,752
logistician
Data from September 2004 to December 2008:
Total number of patients seen at the OPD: 44,724 National staff: 71 doctors, nurses and clinical staff, 99
Admissions: 7,706 service staff.
Surgeries: 8,643

CAMBODIA PROGRAMME - Ilaria Alpi Surgical Centre, Battambang
Srey Mao is a young girl who stepped on a mine while she was cultivating her field. She
lost both her legs beneath the knees and her left eye. Luckily her knee joints were undamaged
therefore she will be able to make good use of the prosthesis. Srey Mao also underwent plastic
Tailandia
Laos
surgery to fix her eye socket and to restore the bones and the muscle of the face.
Battambang
Samlot Cambogia
The EMERGENCY Surgical Centre in Cambodia is located in an extremely poor area, in the north west of the
country near the border with Thailand. The zone is densely mined, estimates suggest that there are between 8 to
Phnom Penh
Vietnam 10 million landmines in Cambodia and that 1 in 236 people have been injured by a landmine. The national health
system in Cambodia is one of the worst in Asia; this a result of Pol Pot’s Khmer Rouge Regime, which persecuted
Golfo della Tailandia and executed professionals. Today only 17% of the population have access to healthcare and there are only 16
doctors per 100,000 people.
Public hospitals in Cambodia are not free. An average Cambodian family has an annual income of between 800
– 1000 Euros and spends approximately 10-12.5% of this on healthcare.
The Ilaria Alpi Surgical Centre, in Battambang (the second largest city in Cambodia), began clinical activities on
25th July 1998. The Centre provides free-of-charge high quality surgical care and rehabilitation for the victims of
war, landmines and poverty. The Centre is named after Ilaria Alpi, an Italian journalist killed in Somalia in 1994.
The Centre is now considered as being a referral centre for emergency and trauma surgery in the province. Since
2001, in agreement with the Cambodian Ministry of Health, the Centre extended its admission criteria to carry out
orthopaedic and reconstructive surgery for victims of war, as well as for people who have developed deformities
resulting from polio. The Centre also provides treatment for clubfoot.
EMERGENCY is progressively broadening its admission criteria. In 2002, in agreement with the national Ministry
of Health, patients with facial deformities such as cleft lip, as well as clubfoot or burn victims began undergoing
treatment at the Centre. The national surgical staff receives on-the-job training from the team of expatriate surgical
staff, and now are able to autonomously carry out some of the reconstructive surgery. In 2005, the Centre’s
services were further extended to include emergency and trauma surgery. This was in direct response to the
growing number of road traffic accident (RTA) victims.
The Centre plays a fundamental role in offering on-the-job training to the national staff, as training facilities are
largely inadequate. As well as English classes, the Centre offers basic reading and writing classes for staff which
give them a chance to better their skills.
Two hours away from the hospital there is EMERGENCY’s FAP – First Aid Post in O’Tatiek, in the District of Samlot,
near the border with Thailand. This FAP, established in 1999, is open 24 hours a day and carries out the tasks
of the Emergency Room in a hospital: the FAP screens and transfers the patients needing hospital admissions
and treats the other ones in the OPD. To face the lack in health structures the activity of the FAP broadened
from treatment of war and mine victims, to the care of many pathologies affecting mainly children (such as
malaria, infections and diphtheria). Emergency opened another 4 FAP’s in this area (Tasanh, Chamlong Kouy,
Kamponglopov, O’Rotkros) which were transferred to the local health authorities in 2003.
The annual operating costs for the Ilaria Alpi Surgical Centre are approximately €1,000,000; the annual operating
costs of the FAP in O’Tatiek is over €5,000.
Data from July 1998 to December 2008: Surgical Centre:

OPD appointments in Surgical Centre: 80,154 Structure: an emergency department, 3 outpatients’
Admissions in Surgical Centre: 22,345 department (OPD), 3 operating theatres, a sterilization
Surgeries in Surgical Centre: 23,807 room, an intensive care unit, a patient wards, a physical
therapy department, an X-ray department, a laboratory
Total OPD appointments in the FAP’s: 229.452 and blood bank, a pharmacy, a maintenance department,
Patients transferred in hospital: 4.295 classrooms, a guesthouse and a children’s playroom.
Capacity: 107 beds
Surgical Centre, data from January to December 2008:
OPD appointments: 13,722 Expatriate Staff: 1 medical coordinator, 1 surgeon,
Admissions: 3,436 2 orthopaedic surgeons, 3 nurses, 1 anaesthetist, 1
- Females: 23% physiotherapist.
- Under 14 years old: 17%
- Victims of RTA: 1,573 National Staff: 177 doctors, nurses and service staff
- War injured: 120 FAP in O’Tatiek, data from January to December 2008:
- Plastic Surgery: 136 OPD appointments in the FAP: 2,539
- Reconstructive Surgery: 103 - Malaria 212
Surgeries: 3,477 Patients transferred in hospital: 38
National Staff: 4 nurses; 1 midwife

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REGIONAL HEALTH PROGRAMME - Paediatric Centre, Bangui, The Central African Republic
Update Sheet - March 2009
On March 3rd 2009 clinical activities started in the Pediatric Centre of Bangui, in the
Central African Republic: the name of the first patient was Christofer, 3 and a half years
old. A few days later, on March 6th, the official inauguration ceremony was celebrated, being
Chad present the local authorities.
Sudan
The Central African Republic (CAR) is among the least developed countries in the world. It is ranked 171
THE CENTRAL
AFRICAN REPUBLIC out of 177 countries in the UNDP Human Development Index (HDI). Life expectancy at birth in CAR is
Bangui 43.7 years. Access to basic healthcare services is minimal, and there is a true lack of skilled personnel
Democratic Republic to run the existing medical facilities in the country.
of the Congo
EMERGENCY started construction on the paediatric centre in Bangui in March 2008. It will be part of
the EMERGENCY Regional Health Programme for Africa consisting of a network of centres providing
paediatric healthcare in the region. The centres will also undertake cardiac screening and follow-up clinics
for patients with acquired and congenital heart conditions. Patients screened at the centre, and requiring
cardiac treatment will be transferred completely free-of-charge to the Salam Centre for Cardiac Surgery.
The Salam Centre for Cardiac Surgery, is a state-of-the-art cardiac surgery facility that EMERGENCY
constructed in Sudan. Clinical activities at the Salam Centre began in April 2007.
The centre in Bangui will be open 24 hours/day, and will offer primary and emergency healthcare,
free-of-charge to all children under the age of 14. EMERGENCY estimates that the new paediatric centre
will be able to examine and treat approximately 40 patients/day, amounting to approximately 1,000
patients/month. The centre will host regular cardiac screening clinics for children and adults. In addition
it is envisaged that the centre will be able to admit approximately 100 patients/month. The centre
started activities on March 2009.
The main goal of the EMERGENCY Regional Health Programme for Africa is to build high quality in terms
of infrastructure, as well as to provide on-the-job training to locally recruited staff at the Salam Centre,
and each subsequent paediatric centres that will make up the network. The centre in Bangui will also
provide on-the-job-training by a team of expatriate staff whose mandate will be to transfer professional
knowledge and skills to the local staff. The ultimate aim of the programme is to enable the national staff
to function autonomously to the highest of standards.
EMERGENCY estimates that the average annual cost of running the Paediatric centre in Bangui will be
approximately €500,000.
Data on CAR Patients:

CAR patients treated at the Salam Centre: 25
Structure:
two consultation rooms, an echocardiograph room, and electrocardiograph
room, a stress testroom, a laboratory, an x-ray room, a pharmacy and an 8-bed ward.
Proposed Expatriate Staff:

1 paediatrician, 2 nurses a logistician and a cardiologist who will be at the centre on a regular
basis.
Proposed National Staff:

approximately 40 staff members in total composed of doctors, nurses and service staff.

IRAQ PROGRAMME - Rehabilitation Centre and Social Reintegration Programme
Update Sheet - September 2008
Turkey
Early in October 2008, the Rehabilitation Centre in Sulaimaniya celebrated
its 23rd graduation ceremony for the participants of the vocational training
Choman
Erbil held at the centre. 17 trainees graduated on that day, 4 of whom were female.
Sulaimaniya
Syria Iran
Iraq
EMERGENCY ’s Rehabilitation Centre and Social Reintegration Programme in Sulaimaniya is in
Baghdad
Jordan Iraqi Kurdistan, the region bordering both Turkey and Iran. It an area with the highest amount
of landmines in the world, and over the last three decades has been the scene of renewed
national and international conflict. The Kurdish population have suffered, and continues to
Saudi Arabia Kuwait suffer, the consequences of war, even many years after the official end of the war. According
to a 2005 World Bank report, disability and mental health are the biggest factors affecting
Iraq’s economic development.
The Rehabilitation Centre is the only structure in the area that offers a rehabilitation programme
and has in fact become a reference point for the entire region; patients come to the centre
from as far as Syria and Iran. Moreover, in southern Iraq, many other similar organisations
have closed down their operations due to security fears.
EMERGENCY has been in Iraq since 1995, it has already handed over 2 rehabilitation
centres to the local authorities in Diana and Dohuk in 2002 and 2003 respectively and 2
surgical centres for war victims in Erbil and Sulaimaniya which were transferred to the local
authorities in April 2005 along with a network of 22 first aid posts. The Rehabilitation Centre
in Sulaimaniya is the only structure that EMERGENCY is still managing in Iraq.
EMERGENCY’s decision to open the Rehabilitation Centre in Sulaimaniya in 1998 was taken
as a result of the high prevalence of amputees in Kurdistan who did not even have the
necessary assistance or equipment to enable them to work and thus maintain themselves
and their families. The Rehabilitation Centre was established to meet the needs of amputees
and disabled people in the area. During the physical rehabilitation programme patients are
fitted with prostheses and are given the necessary physiotherapy to ensure that they use
their artificial limbs and/or walking aids correctly.
The annual operating cost for this Centre is approximately €600,000.
January – December 2008: Structure: an orthopaedic laboratory (including 5 sections:

Patients treated: 379 casting, modifications, kiln, machines and a laboratory where
OPD Consultations: 3,162 5 lab technicians, 4 assistants and a work coordinator),
Physiotherapy Sessions: 1,858 physiotherapy (with 2 physiotherapists), a covered swimming
Fittings for prostheses: 402 pool, 5 laboratories for professional training courses
Crutches and other walking aids: 163 (tailoring, leatherwork, iron work, carpentry and shoe
Wheel chairs: 11 production), classrooms, offices and storage houses.
Upper limb prostheses: 30
Lower limb prosteses: 367 Capacity: 41 beds
Orthoses: 40
Data from February 1998 to December 2008:
Graduate Apprentices: 34
Patients treated: 5.139
Cooperatives Initiated: 46
Upper limb prostheses: 672
National staff: Approximately 100 people, of whom Lower limb prosteses: 4,590
approximately 30% are considered physically disabled. Orthoses: 680
Vocational training Courses: 24
Graduate Apprentices: 596
Cooperatives Initiated: 202

Italy
Serious violations of human rights affect the daily lives
of migrants coming to Italy. In April 2006, EMERGENCY
opened a medical facility which offers social and health
care services to any patient, regardless of immigration
status, seeking treatment in the following departments:
general medicine, paediatrics, dermatology, dentistry,
ophthalmology and otolaryngology, obstetrics
and gynecology, cardiology, psychiatry and psychology.
The volunteer medical staff at the clinic is comprised

of 25 dentists, 4 optometrist, 12 internists,
1 otolaryngologist, 1 dermatologist, 2 paediatricians,
3 nurses, 4 gynecologists, 4 cardiologists, 1 psychiatrist
and 1 psychologist.
The free of charge services are intended for immigrants,

but are available to anyone in need. The health care
treatment is made possible thanks to the collaboration
of a volunteer corps of medical personnel committed
to integrating national health care and to ensuring
the right of free high standard health care to all.
As of December 31, 2008, 4,474 patients from 62

different countries have been registered for treatment
at the clinic.
Palermo
Programme for Migrants
Outpatient Clinic
Opened: April 2006
Activities:
Cardiology Obstetrics and Gynaecology
Dermatology Otolaryngology
Infectious Diseases Paediatrics
Basic Health Care Psychiatry and Psychology
Dentistry Radiology
Ophtalmology
Facilities:
Dental, General Medicine, Eye Surgery, Outpatient,
OB-GYN, Outpatient Radiology, Infectious Disease,
Services.
Local staff: 6
As of December 2008:
Outpatient consultations: 21,272
EMERGENCY
www.emergency.it
SIERRA LEONE PROGRAMME - Surgical and Paediatric Centre, Goderich
Guinea Each month in the paediatric ward of the hospital around 60 patients are admitted and treated for malaria.
Unfortunatly, too often the children arrive to the hospital after two or three days since the early symptoms and
after the outbreak of a serious brain disease. The lack in health services and the cost of transportation, in fact, make
it difficult to receive medical care and they contribute to cause the high rate of infant mortality due to malaria.
Sierra Leone
Freetown
Goderich
Sierra Leone was ravaged by a civil war that lasted over ten years. Child soldiers were forcefully recruited
during this brutal war that wounded thousands of victims. Many were the victims of the atrocious practice
of amputating healthy limbs (3,000 victimised in the Freetown area alone).
Atlantic Ocean
Liberia Infant mortality rates here are amongst the highest in the world. Life expectancy at birth is 41.8 years
(UNDP 2007). The principal diseases that afflict the population (estimated 6 million) derive from poor
sanitary and hygienic conditions, malnutrition, and limited access to drinkable water- all optimal conditions
for the breeding of malaria which claims the lives of hundreds of people every year, particularly children.
The public health infrastructure was completely devastated as a result of the civil war in Sierra Leone. Only
private healthcare exists, and its costs are inaccessible to the vast majority of the population. The war also
completely disrupted the country’s vaccination program, resulting in a resurgence of polio in the country.
EMERGENCY’s Surgical and Medical Centre in Goderich began clinical activities in November 2001, and the
paediatric outpatients’ department (OPD) opened in 2002. It is the only facility in the country that offers free
healthcare. The Centre primarily offers emergency trauma surgery to road traffic and work related injury
patients. Reconstructive, orthopaedic and abdominal surgical procedures are the main treatments provided
at the Centre, as well as treatment of malformations, such as those resulting from polio.
Children in the paediatric OPD (comprised of two consultations rooms and a storage room) are mainly
treated for malaria, respiratory tract and other infections, as well as anaemia. More severe cases are
admitted to the medical paediatric ward of the hospital.
The training programme that the local anaesthetic nursing staff undergoes at the Centre is fully recognized
by the national Ministry of Health. In fact, the Centre is recognized by the government as a professional
teaching hospital for the training of anaesthetic nurses.
The annual operating costs are approximately €1,800,000, for the Surgical Centre and €160,000 for the
Paediatric Centre.
January – December 2008: Structure: 6 wards (3 male wards, a female ward, a

Surgical OPD consultations: 22,828 surgical paediatric ward and a medical paediatric ward),
Surgical Admissions: 2.499 a Laboratory and Blood Bank, an X-ray Department,
- patients under 14 years old: 45% Casualty Department, a surgical Outpatients’ Department
- women: 18% (OPD), 2 Operating Theatres, an Intensive Care Unit, a
Surgeries: 3,331 Physical Therapy Department, a Pharmacy, Storage
- dilatation of the oesophagus: 295 Rooms, a Maintenance Department, a Sterilization Room,
a Canteen, Classrooms, and a Children’s Play Room.
Paediatric consultations: 9,989
Paediatric admissions: 1,379 Capacity: 100 beds.
Data from November 2001 to December 2008: Expatriate Staff: 1 programme coordinator; 2 surgeons; 1
Surgical OPD consultations: 137,610 physiotherapist; 2 anaesthetists, 5 nurses; 1 logistician;
Surgical Admissions: 15,922 1 paediatrician.
Surgeries: 14,115
National staff: approx. 250 doctors, nurses and service staff.
Paediatric consultations: 82,835
Paediatric admissions: 6,296

Via Meravigli 12/14 , 20123 Milan Via dell’ Arco del Monte 99/a, 00186 Rome PO Box 62437, London, E14 1GA T +1 888 501 EUSA
SUDAN PROGRAMME - Mayo PAEDIATRIC CENTRE, Khartoum
Egypt The Paediatric Centre in The Mayo IDP Camp in Khartoum, Sudan, celebrated its 3rd anniversary
Libya
on December 3rd 2008. Since its beginning, the Centre has treated more than 56.000 children,
mainly for acute respiratory infections, diarrhoea, viral infections, skin and eyes infections, otitis,
Khartoum Eritrea
malaria and other patoligies wich, treated incorrectly could have fatal consequencies.
Chad
SUDAN
Ethiopia
Central African
Republic Sudan has been at the heart of a conflict for over twenty years, resulting in hundreds of thousands of
Democratic Republic Uganda people being displaced. Many of these people end up living in appalling conditions in Internally Displaced
of the Congo Kenya
Persons’ (IDP) camps such as Mayo. On 3rd December 2005, EMERGENCY began clinical activities at its
Paediatric Centre at the Mayo IDP Camp, located in the suburbs of Khartoum. Approximately 200,000
people live in the area called ‘Angola’. More than half of the camp’s inhabitants are children under the age
of 14. The bleak living conditions are barely above the minimum standards required for survival. The lack
of infrastructure and potable water, the dreadful sanitary conditions and malnutrition are the root cause
for the rampant spread of diseases. There are no adequate medical facilities in the area, other than the
EMERGENCY Paediatric Centre.
The Centre offers free-of-charge, high quality, paediatric treatment to children who live in the camp, but
also to those who come from further away. In 2007, following the opening of the Salam Centre for Cardiac
Surgery in Khartoum, the Centre became part of the Regional Health Programme for Paediatric Healthcare
and Cardiac Surgery, in Africa.
The most serious cases seen at the Centre are either treated in the clinic’s day observation ward, or
transferred, via EMERGENCY’s ambulance, to the Bashair Public Hospital in Khartoum. Just months after
the Centre’s opening, the Governatorate of Khartoum state allocated increased funds in its public healthcare
budget to ensure that all children under the age of fourteen can have access to free basic paediatric
treatment at public hospitald. Prior to EMERGENCY’s intervention in the area, only the first 24 hours of
treatment were free of charge to paediatric patients.
The annual operating costs of the Mayo Paediatric Centre are approximately €190,000.
Data from January to December 2008: Data from December 2005 to December 2008:
OPD Consultations: 15,212 OPD Consultations: 56,147

Principal presenting pathologies: - Patients seen by the CHP: 4,304
- acute respiratory infections (4,710 cases) Patients transferred to hospital: 1,039
- diarrhoea (2,208) Patients treated on the observation ward: 2,092
- viral infections (1,669)
- skin infections (833) Structure: 2 consultation rooms, a laboratory, a pharmacy,
- otitis (1.338) a six-bed observation ward, and a veranda that serves as a
- eye infections (608) waiting area.
- malaria (354)
- mouth infections (302) Expatriate Staff: An international paediatrician and
- malnutrition (414 di cui grave 197) paediatric nurse.
- anaemia (213)
National Staff: 2 doctors; 3 nurses; 1 lab technician; 1
Children under 5 years old: 7,141 pharmacist; 1 CHP; 1 logistician; 1 ambulance driver; 3
- 5,001 of whom were under 1 cleaners and 8 security guards.
Patients seen by the CHP: 1,660
Patients transferred to hospital: 492
Patients treated in the observation ward: 706

Via Meravigli 12/14 - 20123 Milan Via dell’ Arco del Monte 99/a - 00186 Rome PO Box 62437, London, E14 1GA T +1 1 888 501 EUSA
REGIONAL HEALTH PROGRAMME - Salam Centre for Cardiac Surgery, Khartoum
Egitto
Libia The health authorities of Iraq invited Emergency to screen Iraqi citizens affected by cardiac diseases. In
October 2008 Emergency’s team reached the Rehabilitation Center in Sulaimaniya, Iraqi Kurdistan,
where they screened 131 patients. A 20 months old child, whose conditions revealed to be very serious,
Khartoum was immediately transferred to the Salam Centre and operated. Other 10 Iraqi patients, aged
Eritrea
Ciad between 3 and 20, were transferred to the Salam Centre in November.
Mayo
SUDAN
Etiopia Sudan is the biggest country in Africa with a population of approximately 40 million living on 2,500,000 km² of
Repubblica Centro land. The average life expectancy in Sudan is 57 years. A third of the population lacks permanent access to
Africana
potable water. 41% of children under the age of 5 are underweight. Only 34% of the population has access to
healthcare assistance, and 26% are under nourished (figures from 2005). The infant and maternal mortality rates
Repubblica Democratica
del Congo
Uganda are very high (90/1000 live births – HDI 2007). Although there is a lack of basic healthcare, there is also an
Kenya increasing need for specialised medical and surgical facilities.
According to the World Health Organization, in Africa, there are only 0.4 cardiologists per 100,000 patients.
Moreover, there are only 13 primary healthcare doctors and 98 nurses per 100,000 inhabitants who are trained to deal
with non-communicable diseases. There is a severe lack of human capacity as well as infrastructure on the continent,
particularly in sub-Saharan Africa. To redress this situation, EMERGENCY launched a Regional Health Programme for
Paediatrics and Cardiac Surgery in Africa, which is based in Sudan and the region.
EMERGENCY’s Salam Centre for Cardiac Surgery, in the suburbs of the Sudanese capital, Khartoum,
began clinical activities in March 2007. Salam means peace in Arabic. The centre is equipped with state-of-the-
art biomedical and technological equipment. One of the world’s largest thermal solar panel plants supports the
hospital’s internal cooling system, allowing for a vast reduction of the centre’s energy consumption.
The Salam Centre offers free-of-charge cardiac surgery and interventional cardiology to patients affected by
both congenital and acquired heart disease. Acquired heart disease usually originates from rheumatic fever - an
infection that predominantly affects children and adolescents. Today it represents one of the main causes of
cardiovascular disease in Africa.
The centre will also admit patients from a network of paediatric centres that will be built and run by EMERGENCY in
the region. Each centre will be open 24 hours/day, and will offer free-of-charge primary and emergency healthcare
to all children under the age of 14. EMERGENCY estimates that the paediatric centre will have the capacity to see
approximately 40 patients/day and 1,000 patients/month. The centre will host regular cardiac screening clinics
for both adults and children. Patients requiring further treatment will be transferred completely free-of-charge to the
Salam Centre. Each centre will employ an expatriate paediatrician and paediatric nurse and approximately 40 national
staff. In March 2008, construction started on the first paediatric centre in Bangui, the Central African Republic, which
is expected to be operational within the end of February 2009. The second paediatric centre will be realised in Nyala,
Sud Darfur, Sudan, beginning in spring 2009.
In December 2006, in anticipation of the opening of the Paediatric Centres, and in order to identify patients
ready for transfer to the Salam Centre for treatment, EMERGENCY’s team of international staff began screening
consultations in hospitals in Uganda and the Democratic Republic of Congo. In spring 2007, consultations began
in Eritrea and the Central African Republic.
The annual running costs of the Salam Centre are approximately €8,000,000. EMERGENCY estimates that the
construction and operational set up of each paediatric centre will be approximately €750,000.
Data from March 2007 to December 2008: Structure: 3 operating theatres, a sterilisation room; a
Triage Consultations: 12,107 15-bed intensive care unit (ICU), a 16-bed sub-intensive
Specialist Cardiological Consultations 6,526 care unit, a 32-bed surgical ward, 2 consultation
Total Number of patients admitted: 1,324 rooms, a radiology and ultrasound department,
- Paediatric patients: 283 a laboratory and blood bank; a catheterization
- Female patients: 608 laboratory, a physiotherapy department, a pharmacy,
offices, warehouses, auxiliary services and a 50-bed
Patient’s distribution by countries: Sudan 1,214; Eritrea 38; Ethiopia 20; guesthouse for patients’ relatives.
Central African Republic 19; Iraq 11; Sierra Leone 6; Democratic Republic of
Congo 5; Rwanda 4; Kenya 3; Nigeria 1; Tanzania 1; Uganda 1; Zambia 1. Capacity: 63 Beds
Principal pathologies treated: Expatriate Staff: 1 medical coordinator; 6 cardiac

- valvular (886 cases) surgeons; 6 cardiologists; 6 anaesthetists;
- congenital (248) 3 perfusionists; 28 nurses; 1 pharmacist; 1
- ischemic (184) programme coordinator; 8 logisticians, technicians
and IT support staff.
Number of Patients operated: 983
Interventional Cardiology Procedures: 99 National Staff: 12 doctors; 54 nurses and auxiliary
Diagnostic Cath Lab Procedures: 277 staff; 179 administrative and general staff.


Appendix A Program Information

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Appendix A Program Information

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Appendix A

Staying in the know . . .

January – March 2009: Structure: emergency department; an outpatients’

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

January – March 2009: Structure: an obstetrics ward and an internal medicine

International Staff: 1 gynaecologist, 2 midwives

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

The annual running costs of the Centre are approximately €2,000,000.

January – December 2008: Structure: a casualty department, an out patient

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

January – December 2008: Structure: 3 male wards, a female ward, a paediatric

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

Data from July 1998 to December 2008: Surgical Centre:

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

Update Sheet - March 2009

Data on CAR Patients:

Proposed Expatriate Staff:

Proposed National Staff:

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

The annual operating cost for this Centre is approximately €600,000.

January – December 2008: Structure: an orthopaedic laboratory (including 5 sections:

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

The volunteer medical staff at the clinic is comprised

The free of charge services are intended for immigrants,

As of December 31, 2008, 4,474 patients from 62

January – December 2008: Structure: 6 wards (3 male wards, a female ward, a

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

OPD Consultations: 15,212 OPD Consultations: 56,147

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

Principal pathologies treated: Expatriate Staff: 1 medical coordinator; 6 cardiac

EMERGENCY MILAN EMERGENCY ROME EMERGENCY UK EMERGENCY USA

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