Throughout 2009, 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. Guerrilla 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.

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 in provincial capitals. Afghans in need of 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.

In 2009, Somalia experienced 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 are thwarting the efforts of humanitarian organizations to respond, and the public health-care system remains in near-total collapse.

A series of 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.

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.

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.

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.

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. This 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.

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. Pakistan also ranks among the highest infant and maternal mortality rates in the region.

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. Patient populations are often stuck in remote or insecure areas with little or no access to health care.