Annual report 2004 Malteser Germany Foreign Aid Division

Malteser Germany – Relief Worldwide Our mission Malteser Germany is a German Catholic relief agency of the Order of Malta (www.orderofmalta.org). Founded in 1953 and based in Cologne, it is one of the major relief organisations in Germany and exclusively pursues charitable purposes for the well-being of people. In Germany over 37,000 volunteers and approximately 13,000 full-time employees are committed to social issues such as promotion of health and social services, youth work, first aid training, disaster control and migration, supported by almost 900,000 donors. On international level, Malteser Germany’s Foreign Aid Division (www.malteser-international.org) has provided humanitarian relief since 1956. Around 35 employees in Cologne and 100 expatriates as well as several hundred local staff care for the projects worldwide. We are active in Asia, Africa, the Balkans and in Central and Eastern Europe in the sectors of emergency relief and rehabilitation. Over the last year, with a project turnover of EUR 18.6 million, we have carried out 80 projects and programmes in 34 countries. Malteser Germany was formed with the purpose to practice the Order’s basic principles and Christian charity in contemporary ways. Relief for people in need irrespective of race, creed, or political persuasion lies at the heart of our international work.

Malteser Germany Foreign Aid Division Annual report 2004

Our objectives We are especially committed to people whose lives are endangered by disasters and conflicts. The objectives of our programmes are: Emergency and disaster relief Basic medical care and setting up basic health care services ● Rehabilitation programmes following crises and disasters ● Social programmes and reduction of vulnerability and poverty ● Supporting local partner organisations ● Medical care in the context of peacekeeping missions of the United Nations ● ●

Our principles We commit ourselves to the following: To assist and help regardless creed, gender, race or nationality To respect religious and cultural tradition ● To involve all parties concerned in the planning, implementation and coordination process ● To enhance a participatory approach ● To hand over responsibilities to local partners at the earliest possible stage ● To be accountable towards all our stake-holders ● To manage financial resources cost-effectively ● ●

In order to realise effectiveness, sustainability, and accountability in humanitarian assistance, we adhere to and promote the International Humanitarian Charter Code of Conduct for NGOs in Disaster Relief ● Sphere Project ● People in Aid Code ● ●

www.malteser-international.org

English edition

Contents

Editorial

Editorial New challenges in emergency and rehabilitation aid

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Emergency aid and disaster relief Tsunami flood relief in South and South-East Asia

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Africa Our projects in Africa On the spot - Sudan and Kenya

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Asia Our projects in Asia On the spot - Iran and Thailand

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Project overview 2004

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Europe Our projects in Europe On the spot - Albania Central and Eastern Europe/ Partnership work abroad On the spot - DR Congo: Water for Ariwara

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United Nations Peacekeeping missions On the spot - Afghanistan

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Facts and Figures Experts abroad Incoming donations and project expenditure Project expenditure by countries Profit and loss account

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Working with partners People in need throughout the world benefit substantially from a community of helpers and supporters who, working together, can achieve efficient, coordinated results. Malteser Germany actively encourages these partnerships. Local partners To strengthen civil societies, safeguard cultural sensitivity and ensure local participation, Malteser Germany works whenever possible through local partners such as local Non-Governmental Organisations (NGOs) and church structures - valued partners in humanitarian aid. Non-Governmental organisations (NGOs) Whenever the coverage of humanitarian activities can be improved by working together with other national and international NonGovernmental Organisations (NGOs), Malteser Germany seeks ways for cooperation and partnership, at a strategic level or on a day-to-day basis. Public donors Through the Order of Malta’s associations and relief agencies, Malteser Germany has longstanding partnerships. Among them are the European Commission/ECHO, national governments, development banks and the organisations of the United Nations (UN).

Dear Readers, Dear Friends and Supporters of the Malteser Foreign Aid Division, At the beginning of 2004 Malteser Germany provided emergency relief for thousands of earthquake victims in the southern Iranian town of Bam. 2004 ended with one of the greatest natural disasters we have ever known. According to provisional estimates, the tsunami not only killed over 260,000 people but deprived at least as many of their livelihood. In many cases Malteser staff were there on the spot, putting programmes into operation to guarantee the provision of care to the survivors. On behalf of Malteser Germany there were soon more than 500 local aid workers in India and Thailand, making it possible for the homeless to get through the first few days after the flood with medicines, blankets, food, cooking utensils and human care. It was only a short while later that the first Malteser teams began relief operations in Sri Lanka and Indonesia. Another sphere of operation for Malteser Germany’s emergency aid and disaster relief in 2004 was aid to refugees and displaced people in Darfur/Sudan. Malteser personnel have been working since last summer in the north of the crisis region, where they are assisting health care centres with medicines, carrying out vaccination campaigns and encouraging the continuing education of midwives. In its new-look format, the 2004 Annual Report you have before you also gives details of the large number of other worldwide projects of Malteser Germany in Africa, Asia and Europe and gives account of the careful, rapid and efficient use of the funds entrusted to us. Around 35 staff in Cologne manage our projects on which, in 2004, around 100 expatriates and over 800 local employees were working. In 2004, project turnover compared with the previous year increased again by approximately EUR 600,000 to EUR 18.6 million. The 230 partnerships of our 130 German Malteser groups operating voluntarily on projects abroad also extend to Africa, Asia and Latin America as well as Europe; altogether, more than 2,400 German Malteser volunteers are collaborating with 27 countries on four continents. Our operations in Eastern Europe, the continuously growing commitment in Africa and Asia and in particular the relief efforts for the tsunami victims have contributed to the expansion and strengthening of Malteser Germany’s foreign aid work and also brought together more closely the associations and relief services of the Order of Malta on a worldwide level. In future, therefore, with Malteser International we want to utilise the international resources of the worldwide Malteser network even more intensively, form synergies and create a joint international relief service. In this way we can consolidate the manpower in humanitarian aid, safeguard the high quality of our project work and strengthen the communication and the exchange of experience among the members. Malteser International is based on the experiences and structures of Malteser Germany and its Foreign Aid Division and of ECOM (Emergency Corps Order of Malta), which was founded in 1992 as a network of the Order for worldwide emergency and disaster relief. We thank all our public and private donors and cooperation partners as well as all volunteers and full-time employees for their loyal support which ultimately makes our work possible. Please continue with us on our journey so that, with Malteser International, we can pursue our commission established over 900 years ago which is just as relevant today as it was then, namely to provide relief for people in need throughout the world. Malteser - help that reaches its destination. Worldwide. - Thanks to your support!

Johannes Freiherr Heereman Cologne, October 2005

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Theodor Wallau

Johannes Freiherr Heereman Executive President Malteser Germany

Theodor Wallau Commissioner Malteser Foreign Aid Division

New challenges in emergency and rehabilitation aid Current developments and experiences using the examples of the seaquake in South and South-East Asia and chronic crises in East Africa

Kurt Oxenius

The events following the seaquake of 26 December 2004 prompt us to examine the topic of health provision in humanitarian emergency and rehabilitation aid. Let it be said in advance that beyond the unprecedented willingness to donate and aid the victims of the natural disaster in Asia, the poverty and suffering of large numbers of people, for example in Africa, should not be allowed to fade into oblivion.

Disaster phases – emergency aid and rehabilitation The worldwide aid measures as a result of the seaquake in December 2004 showed how important it is to become aware of the phases, methods and contents of the aid. During such acute events, in natural disasters or flight movements the first objective is to secure survival and to provide those affected as quickly as possible with the bare essentials. In the first phase of emergency relief, saving and rescuing, emergency medical provision, preventive measures to contain epidemics, hygiene and the supply

of drinking water are among the priorities. In this context it is often forgotten that those affected themselves, their neighbours and fellow countrymen do a tremendous amount of relief spontaneously, before the arrival of the international aid. This also proved to be the case in the countries affected by the seaquake. Depending on the type of disaster, the emergency relief phase lasts from a number of weeks up to two months. Right from the phase of emergency aid, aspects of rehabilitation under local responsibility must be incorporated into planning. Despite

Sri Lanka: It will take years before normal everyday life returns to the regions affected by the tidal wave and the many fishermen who have lost their boats can go out to sea again.

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Indonesia: Whole sections of towns and villages were wiped out. Large expanses of rubble testify to the unimaginable energy and violence of the tidal wave.

Thailand: The supply of water tanks is an important measure of emergency relief.

Jochen Voigt

Coordination and communication Especially in the first few days and weeks after major disasters the question always arises regarding the coordination of relief measures. We should not succumb to the mistaken belief that at the level of the United Nations or elsewhere there is a supranational institution which would take on this important task. Managing this task lies clearly within the sphere of responsibility of the affected states that have to be assisted by the international organisations. The relief organisations have a duty to help to do the coordination work. Complaints about lack of coordination in the early phase are therefore addressed directly at them and are an invitation to provide this support. The aim is to provide assistance according to need, to prevent duplications on the one hand and neglect on the other. Information not only on the need but also on the offers of help must be available to all involved. The reality – particularly current experience in Indonesia –, however, also proves that in the early phase of humanitarian relief – from the best

of motives – relief items and medical emergency teams are sent randomly into the region. In many places this has made coordination considerably more difficult. No government in the world, not even the United Nations, would be in a position to prevent this humanitarian “circus” during such disasters, placed as they are in the media spotlight. We must adjust to the fact that this chaos, this lack of coordination and communication is the norm in such a situation. As an organisation we must be prepared for it and be in a position to move and act in a focussed manner within this chaotic environment. Coordination, joint planning and action by all participants is essential. In addition, all those involved – relief organisations, media, governments and politicians everywhere – must be clear about the fact that despite all the joint efforts there will always be an overtone of competition for media presence, the exertion of influence, recognition, donations and public funds. We must learn how to deal with this competitive situation appropriately in the interests of those affected. It is evident that work in the context of humanitarian assistance today constitutes an enormous challenge to the aid organisations, not only from a professional but also from an organisational and structural point of view.

Jochen Voigt

the fact that the situation during emergency relief and the early phase of rehabilitation is marked by infrastructural deficiencies, chaos and planning uncertainty, the relief organisations must act in the interests of the transition to the rehabilitation of local structures, i.e. link emergency relief with rehabilitation and development measures (“linking, relief, rehabilitation and development”, LRRD). This presupposes that, alongside skills and experience in emergency relief, they are also familiar with and apply methods and objectives of rehabilitation geared to development. Particularly important is the willingness to include local structures in the planning and implementation of the measures. It is about putting the local players and partners back in a position to exercise their responsible role in rehabilitation and reconstruction themselves. We must recognise and respect this role. Only in this way can we prevent unsuited parallel structures from being set up which may even be in competition with the local supply structures.

Thailand: In view of the large extent of the destruction, the psychosocial care of the survivors by local staff was and still is a considerable help in coping with what they have experienced.

provide sufficient drinking water. Thanks to the internationally accepted guidelines we speak a common language. At regular meetings in Banda Aceh/Indonesia, which were organised by the local health authorities and supported by WHO and UNICEF, requisitions were produced and compared with available resources and offers of aid. The decisions are based on the collection of epidemiological data on the incidence of diseases and causes of death. This information helps us to decide what assistance has to be given, where, to what extent and how urgently. It is these well-known indicators that ultimately

Sri Lanka: Clean water is vitally necessary to prevent the spread of diseases.

Forgotten disasters – “silent emergencies” Accepted standards are also suitable for analysing and describing those crises and disasters that lack media attention and publicity. Most projects of Malteser Germany and other organisations take place in this context of so-called “silent emergencies”. Examples we should mention include the Malteser projects supported by the Federal Government of Germany in southern Sudan and in the slums of Nairobi. By the end of 2004 alone Malteser staff in the south of Sudan had tested more than 100,000 people in remote villages for sleeping sickness, which is fatal without treatment, and in the process diagnosed and treated 1,500 cases. In the slums of Nairobi the infection rates for HIV/AIDS and tuberculosis have assumed proportions which, based on disease and treatment figures, can be labelled “disastrous”. This is why it is the goal of the project to improve the opportunities for diagnosis and treatment in eight slum areas. The project successfully integrates and supports local structures. For this Malteser Germany has been honoured by the Kenyan Ministry of Health. These examples show that especially in politically unstable countries, in forgotten crises and in the context of poverty, infectious diseases are spreading quickly – and this is why, there too, humanitarian action is of the utmost importance. Dr. Peter Schmitz

Kurt Oxenius

with these guidelines, initiate emergency relief programmes in terms of health care provision, supply of drinking water, accommodation and providing people affected with the bare essentials. At an early stage, however, also rehabilitation projects were planned, in close cooperation with the local population and the responsible authorities. The aim is not only to secure survival but to make it possible for people to live in dignity quickly again following the disaster. The current events in Asia, not to mention a variety of experiences elsewhere, make it clear that the existing references and guidelines, in so far as they are realistically applied, are achieving their ends and proving their worth in practice. With reference to each target group we can estimate how many patients will come into a health care centre each day. We can plan how many assistants, how many staff, how many medicines, what equipment we need, how many latrines have to be built and how many water points have to be set up to

Sven Torfinn

Kenya: Patients and a Malteser doctor in front of a centre for voluntary counselling and testing.

describe and define the disaster situation – and not the reporting in the news which then “triggers” publicity and the flow of donations (CNN effect).

Sven Torfinn

Standards and guidelines in humanitarian aid – experiences from the flood disaster Despite the perennial question, namely how the relief measures could have been better coordinated, current experience following the seaquake has shown that the existing standards and guidelines (e.g. Sphere Project, Humanitarian Charter and Minimum Standards in Humanitarian Assistance) are of considerable support in reconnaissance, demand analysis and planning of relief measures. Malteser personnel were able to react promptly to the current crises and, in accordance

Southern Sudan: Due to more than 20 years of civil war, sleeping sickness spreads like an epidemic.

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EMERGENC Y AID AND DISASTER RELIEF

Tsunami – flood relief in South and South-East Asia The seaquake and tidal wave on 26 December 2004 ravaged the coastal stretches of many countries bordering on the Indian Ocean. There were more than 200,000 fatalities. Millions of people lost their relatives, their houses and their livelihoods. Indonesia, Sri Lanka, India, Thailand and Myanmar were the most severely affected areas. Malteser Germany immediately made available an emergency relief budget of EUR 250,000 for the crisis region and concentrated the aid first on the regions and countries in which they have been active and had excellent contacts for many years.

India In South India, Malteser Germany collaborated with four local partner organisations which were immediately in a position to help the people affected.

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forces penetrated up to two kilometres into the interior, reported Binoy Acharya, who led the Unnati assessment team. “Among the fatalities are a large number of children, women and elderly people. More than 7,000 houses have been destroyed”, said the expert. Those affected were mostly simple fishermen who were only able to finance their boats and equipment with loans, and now they had lost any means of earning a living. Acharya is certain: the survivors will definitely need psychosocial support in the longer term. Surprisingly, part of the west coast of Kerala in the Kollam District was also

EMERGENCY AID AND DISASTER RELIEF

severely affected. There Malteser Germany and its partners distributed food, medicines, clothing and cooking utensils to over 1,000 families. Working with CHAI, the Catholic Health Association of India, proved to be a wise choice. Here, too, contacts have existed since the earthquake in Gujarat in 2001. CHAI consists of a network of over 3,000 Catholic health institutions and therefore has considerable social influence. It is important to know because shortly after the seaquake the Indian government refused every offer of international aid. Thanks to its dense network CHAI was also in a

Kurt Oxenius

Father Maria Arputham, head of the Christian organisation HOM (Health for One Million), reported on the day of the seaquake from his diocese Marthandam on the southern tip of India: “We have pulled bodies from the sand. The destruction here is unimaginable.” Together with over 100 voluntary helpers from congregations, youth groups and women’s networks, Arputham provided emergency relief on behalf of Malteser Germany: he distributed food and clothing, cooking utensils, blankets and mats to people who had fled from their destroyed fishing villages into the hinterland and accommodated them in schools and church buildings. The day after the quake Arputham faxed a cry for help to Germany and asked for further assistance: “We need medicines due to the imminent threat of epidemic.” The committed priest also took care of emergency accommodation: the camps were set up near the destroyed villages so that the reconstruction would be easier. Altogether HOM and its helpers looked after approximately 10,000 refugees. All of them in the Kanyakumari District. The Indian partner organisation Unnati (Development Education Organisation from Ahmedabad, Gujarat) with which Malteser Germany had been collaborating successfully since the earthquake in Gujarat in the north of India in 2001, sent an assessment team into the crisis region. It came across catastrophic devastation on the 35 kilometre-long coastal strip between Thangapatnam and Colachel, Kanyakumari District. The tidal wave with its destructive

Sri Lanka: The strong cohesion in families and villages helps to overcome the horror and despair and to jointly build a new future.

position to send well-trained staff quickly and efficiently into crisis regions. On 28 December the Malteser Foreign Aid Division received a request for assistance from the Director, Father Ousepparampil, which was promptly answered positively. On behalf of Malteser Germany, CHAI set up on the east coast not only permanent medical facilities but, with mobile medical teams - consisting of nurses and doctors also visited remote areas to look after the injured there. At the same time food and drinking water were distributed. In Trivandrum, Malteser Germany collaborated with MSSS, the Malankara Social Service Society. MSSS is the Caritas organisation of the archbishopric

of Trivandrum and for over ten years has been Malteser Germany’s project partner, especially in health education for women. The Director of MSSS, Father Joze Kizhakkedath, recognised the needs of the people and very soon initiated steps to offer psychosocial support to the population: “After the initial shock the children above all are totally apathetic. Many are only now after the chaos of the first few days realising that their parents are never coming back.” At the same time MSSS provided emergency relief on the coast of Kerala, where the southern sections were severely affected: emergency shelter was set up, cooking utensils and clothing obtained and medical care ensured for 1,000 families.

This “family kit” contains the necessary equipment, materials and food to enable a family to make a new start.

India: Emergency expert in a refugee camp in Tamil Nadu.

Crisis regions in southern India where Malteser Germany is working.

Very early, Malteser Germany learnt from its Indian partners how much the tidal wave had damaged the fishing industry, the tourism and the agriculture of the affected regions. It also became clear how much the tsunami had affected the people in India psychologically. The lethargy of the surviving fishermen became evident at an early stage.

Thailand

Furthermore, inland, at the request of the Federal Foreign Office of Germany, 34 Malteser personnel took care of the psychosocial support of those returning home. Altogether, they looked after more than 150 people affected and their relatives. After their mission, the helpers received acknowledgement for their work from the highest quarters and were invited to a reception with German President Horst Köhler. André Stülz together with the Thai Malteser staff quickly arrived in the crisis area in Thailand to provide assistance:

“The hospitals are completely overflowing and local resources are utterly inadequate”, reported the 50 year-old country coordinator for Myanmar. “Not only is the number of dead being recovered each day huge, so is the number of injured, too.“ North of Phuket and Khao Lak a scene of horror was being revealed: “We came upon around 2,000 families whose village had been completely washed away. They still had absolutely no aid”, said a female staff member. André Stülz reported from Khao Lak: “A robust fisherman told me with tears in his eyes that out of his family of ten only

Jochen Voigt

On the day the seaquake occurred, staff from the Malteser projects in the north of Thailand set out for the holiday island of Phuket in the south to begin relief work there.

Thailand: With games and handicrafts staff help children in the day care centre in Ban Muang to overcome their terrible experiences.

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two had survived and four had so far been recovered dead, scattered over 1,000 square kilometres. He still had to look for the other four and - standing beside a working shovel dredger - he reckoned he would have great difficulty in recovering the rest of his family alive.” According to Stülz, the search for the missing was the very first desire of the survivors. Many people would go into one of the four Buddhist temples which were used as collection points for the dead. New bodies were continually being transported and laid out there. On 30 December, Marie-Theres Benner, country coordinator for Thailand, arrived in Phuket. Her mission: to plan the relief measures and rehabilitation work of Malteser Germany in Thailand on a longterm basis. She was assisted by local staff and Jon Freeman. “The people are very afraid of epidemics”, said Benner, describing her first impressions. To prevent their spread, clean water, hygiene, personal protection and vaccinations were necessary. Malteser personnel were working for the people in the region of Khao Lak, Phang Nga and Phuket: “We are distributing medicines, food, blankets, drinking water, pans and crockery, so that immediate needs are covered”, said the coordinator from

Westerwald, who has been living in Thailand for nine years. Rehabilitation projects and income generating programmes are designed to improve the lives of the people affected by the tsunami in the long-term. At New Year, four surgeons and four paramedics from Malteser Germany arrived in Thailand to assist the medical team of the Federal Foreign Office of Germany. In their luggage they had 400 kgs of medical drugs, infusion and dressing materials. They were flown by helicopter mainly to German patients in hospitals. While Foreign Secretary Joschka Fischer exhorted the Germans to spend their money not on New Year’s Eve firecrackers but rather in the form of donations for the tsunami victims, Dr. Constantin von Brandenstein, President of Malteser Germany, made an initial interim assessment of the aid: “The wave of death on 26 December was followed by a wave of global willingness to help. I am pleased that we were able to be part of this wave quickly, effectively and in varied ways. We will continue to provide assistance. So that the necessary support physical, psychological and social - reaches the people who have survived the terrible tragedy.”

Areas where Malteser staff are deployed in southern Thailand.

Thailand: Jon Freeman coordinates the emergency aid in a refugee camp in the Khao Lak region.

Thanks to generous donations, Malteser Germany was able to provide around one million euros immediately for emergency relief measures in South and South-East Asia. For rehabilitation, in 2005 alone projects and relief measures with a combined turnover of a further six to seven million euros are scheduled or are already being implemented. To finance all medium and longer-term rehabilitation measures in the interests of guaranteeing lasting help for the region, Malteser Germany has launched a rehabilitation fund. This includes funds which benefit all activities in the regions affected by the seaquake and will thus facilitate structured rehabilitation in the five most severely affected regions (Indonesia, Sri Lanka, India, Thailand and Myanmar).

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EMERGENCY AID AND DISASTER RELIEF

Africa Building up and strengthening health care structures, training local personnel and combating epidemics are the main focus of attention for Malteser Germany in seven African countries at the present time. An important concern in all projects is the fight against HIV/AIDS, a disease with dramatic effects on the population.

Angola Following the end of the 27-year civil war the refugees have returned and reconstruction has begun. In the deep southeast, Malteser Germany is assisting not only in the renewal and equipping of health care centres but is also setting up a nutrition centre for children and pregnant women. The training of health personnel, education about HIV/AIDS, the construction of latrines and the distribution of household items are other major tasks. Democratic Republic of Congo Malteser Germany is helping the population to take over basic health care itself on a long-term basis. In the provinces of South Kivu and Ituri, as in past years, the local health care systems are being supported in over 240 health facilities. It is particularly important to train local personnel. Vaccinations as well as the care of women and men infected with HIV/ AIDS supplement the work in Ituri. In Bukavu, the focus is on additional food security programmes and the psychological support of women who became victims of sexual violence during the war. The local personnel are made more aware of the problem via special training sessions. Ethiopia In Gilgel Beles in the north-west, Malteser Germany is involved in communal water supply for 30,000 people. Kenya In eight Nairobi slums Malteser Germany is improving the health care of 700,000 slum dwellers: thanks to new laboratories and the training of personnel, the spread of tuberculosis and HIV/AIDS is being combated. In the slums tuberculosis can now be recognised and treated in time. In Nairobi, approximately 50% of tuberculosis patients are infected with HIV at the same

time. Our work is exemplary in nature, as there are only a few projects around the world in which tuberculosis is being successfully stemmed and AIDS combated at the same time in slum conditions. The Kenyan government honoured this work in 2004.

Mozambique In the province of Sofala, Malteser Germany is using monthly health days and vaccination programmes to care especially for mothers and children. Staff are travelling into the villages to treat the population and educate them about HIV/AIDS. DR Congo: Doctors and nurses in the hospital in the province of Kivu.

Sudan In civil war-torn Sudan, Malteser Germany is working in the south and north of the country. In Rumbek and Yei in the south, mainly tuberculosis, leprosy, sleeping sickness and malaria are being combated. Patients are identified in the health care centres and through outreach teams who travel into remote villages. In addition, in Rumbek, local lab technicians are being trained. In northern Darfur, since the middle of 2004 Malteser Germany has been providing emergency aid, supporting health care centres with medicines and equipment, carrying out vaccination campaigns and promoting the further education of midwives. Dr. Père Simarro, World Health Organisation (WHO): “In the treatment of sleeping sickness Malteser Germany has achieved a remarkable success. It is the first time such good results have been achieved. Thanks to Malteser Germany we have been able to bring the problem of sleeping sickness in Yei effectively under control. The most outstanding result of the Malteser sleeping sickness project in Yei is a death rate among treated patients of zero.” Uganda In Maracha hospital, Malteser Germany has been for many years supporting a therapeutic nutrition centre for malnourished children. In order to reduce the number of relapses and to monitor the state of health of the children on a continuous basis, staff also carry out regular house visits.

Angola: Mothers with their children in front of a health care centre.

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Sudan: Health for the people in Galab/Darfur Since the summer of 2004 Birke Herzbruch has been working for Malteser Germany in the north of the crisis region. She is coordinating vaccination campaigns against polio, distributing medicines, assisting in the reconstruction of destroyed health care centres and organising further education programmes for midwives. Here she tells of her everyday life and the small and bigger successes of her work:

us from Malteser Germany together with the refugees selected a place in the camp where we offer health care with local health personnel. Together, a tent was set up for the treatment of large and small patients, pits dug out for toilets which were then fenced round and provided with plastic canopies and a shaded area built for the people waiting. Today is the first day we have been able to give the people in Galab and the surrounding

Ralf Pahlmann

Training for local midwives.

area a little aid in their hardship. And it will be a long time yet before the camp can no longer be seen from the road because it is no longer needed. Birke Herzbruch

Oral vaccination for a refugee child in the open country.

Thilo Schmülgen

Galab - a refugee camp along the main road between El Fasher and Nyala. From the road it can barely be seen, it lies in the interior to the west, idyllically situated before a range of mountains. On closer inspection though, the camp turns out to be less idyllic. The terrain is barren, the wind blows incessantly over the plain, and it is dusty. Excrement and refuse attract swarms of flies. The plague of flies leaves the children in the camp unmoved. I wave my hands in front of my face to get at least a moment’s respite from the plague. The approximately 6,000 people who have fled the surrounding areas from the attacks of the militias have built themselves small round huts from branches and grasses, in order not to have to spend the nights in the open air. A relief organisation has distributed plastic canopies that are pulled over the small dwellings to give some protection from the wind and a little privacy. There is no clean drinking water. The only hand pump in the neighbouring village is broken. A good number of people walk miles to reach water. Others dig holes in the ground to get to it. Everyone in the camp is sick: diarrhoea because of the dirty water, eye infections because of the dust swirled up by the wind, respiratory diseases and fever because of the cold time of year. The children especially are affected. Their swollen stomachs suggest worms and malnutrition, their snotty noses and gummed-up eyes colds or conjunctivitis. Following talks with the community, the village elders and the sheikhs, the leaders of the expelled people, those of

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Birke Herzbruch.

A window into the darkness - Combating tuberculosis and HIV/AIDS in the slums of Nairobi

Sven Torfinn

them.” Together with the head of the clinic, six other nurses and a doctor, Margaret is working on the prevention, diagnosis and treatment of tuberculosis and HIV. Their work is supported by six health workers who live in the slum themselves and receive from Malteser Germany a small wage of 800 Kenyan shillings, around 8 euros, a month. They inform their neighbours, families and friends about the voluntary tests in the health care centre and explain how tuberculosis can be prevented. “Fresh air is important for tuberculosis patients”, George advised Diana’s family. Since then, windows have been put in Diana’s hut for air and light. Claudia Leipner Due to new labs and the training of staff, the spread of tuberculosis and HIV/AIDS in the slums of Nairobi is being combated and the rate of new infections significantly reduced.

Sven Torfinn

Tuberculosis (TB) and HIV are often connected: in Kenya, half of all TB patients are also infected with HIV, because immunodeficiency makes people more susceptible to the tuberculosis pathogens. Advice from Malteser staff is bearing fruit: patient numbers are growing, because more and more people are getting themselves tested and treated in the labs for tuberculosis and HIV. Many slum dwellers are dealing more openly with these diseases, previously endured in silence. The medicines are prolonging the lives of the patients and also improving their quality of life. This enables them to continue to go to work and feed their families. And: children like Diana don’t have to grow up without parents.

Nevertheless, the disease has left traces behind. Diana is very small for her age. Thanks to the antibiotics, though, she has survived the tuberculosis. “It’s very important that the patients don’t stop the treatment after a couple of weeks”, says nurse Margaret Meruga, who works in the Kangemi Health Centre. “Otherwise, the patients develop resistances to the antibiotics and we can no longer help

In eight Nairobi slums Malteser staff are improving the health care of 700,000 slum dwellers.

Sven Torfinn

The hut in Kangemi, Nairobi, has windows that let in a little light and air. In the semi-darkness stands Mary with a small girl in a red dress on her arm. The little girl’s name is Diana Nfungu, she’s six years old and lives with her three year-old brother Francis, her 18 year-old aunt Mary and her 12 year-old cousin Janet in an eight square metres small room. At weekends grandma, who works as a housemaid in Nairobi’s rich city centre, comes home to the slum. She is the only one in the family who now and then brings something to eat and some money. During the week 18 year-old Mary looks after her six year-old niece Diana on her own. Mary tells us briefly: Diana’s father had died of AIDS, the mother was a drug addict and had abandoned the family. “Little by little, Diana became so thin, so weak”, says Mary. When Diana was barely eating, Mary sought help from George Ratenu, a 25 year-old from the neighbourhood who has been working for three years as a health volunteer for Malteser Germany in Kangemi. He accompanied Mary with her niece Diana to the health centre, where the little girl was tested for tuberculosis and HIV. Both tests proved positive. If you see Diana playing outside today, you wouldn’t believe she had tuberculosis. “She has come on so much”, says Mary.

Thanks to the commitment of Kenyan health volunteer George, Diana was able to be cured of her tuberculosis.

AFRICA

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Asia Over the last few years Asia has been shaken by conflicts and natural disasters. After the wars in Afghanistan and Iraq there followed - both at Christmas time - the earthquake in Bam/Iran in 2003 and the tsunami in 2004. Helping people overcome the consequences of these wars and disasters was the focal point of Malteser Germany’s work in 2004. In countries such as India, Myanmar, Thailand, Cambodia and Vietnam the rehabilitation and development projects were successfully pursued.

Afghanistan For the population and Malteser staff, 2004 was a year of terror. Besides several kidnappings, 30 staff members belonging to relief organisations were the victims of fatal attacks, among them two from Malteser Germany. Considerable efforts were therefore devoted to safeguarding staff. We either had to withdraw completely from the most dangerous areas or, as in the case of the province of Badghis, shift parts of the programme into the neighbouring province. Schools are therefore now being built in the environs of Herat. Malteser Germany is continuing to maintain health care for 500,000 inhabitants in four districts and in the provincial hospital of Badghis. Great importance is attached to peace-building measures designed to integrate refugees back into their home villages. Cambodia With the introduction of a quality management system for health care centres in rural areas, Malteser Germany was able to conclude the programme for improving health care successfully after a period of five years. Follow-up projects will encourage self-help among communities and strengthen patients’ rights. India Even in the fourth year after the severe earthquake in Gujarat, Malteser Germany is continuing to assist its Indian partner organisations in reconstruction work. A further 600 houses for people in need have been completed. Altogether, over 1,000 houses in Gujarat have been rebuilt. Necessary knowledge about disaster prevention and disaster management is given in training sessions.

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ASIA

Iran At Christmas 2003 the southern Iranian town of Bam was almost completely destroyed. Following the deployment of the Mainz rescue dog unit to recover the earthquake victims, Malteser Germany erected 20 prefabricated school containers for 700 children as part of its emergency relief effort. Since then a permanent school building has been constructed. Local organisations give advice on the planning and execution of relief and rehabilitation projects. Siegfried Helias, a member of the German Bundestag, visited the town of Bam in October 2004 with a delegation of the Committee for Economic Cooperation and Development. “I wanted to get a picture on the spot of the current state of rehabilitation. In the process I also had an opportunity to look closely at some of Malteser Germany’s projects. In Bam, Malteser Germany is backing close cooperation with local relief organisations that are familiar with the language and the conditions of the country and in this respect can provide targeted help. From a fund, on the one hand support is being given to relief projects of the local organisations, such as care for traumatised women and children. On the other, Malteser Germany is sponsoring the further education of staff from Iranian organisations, for instance in the form of seminars on the subject of project management. With these programmes, Malteser Germany is providing exemplary help for people to help themselves and guaranteeing that long-term support will be given to the people in Bam. Because the earthquake victims must under no circumstances be left with a feeling of helplessness when the international organisations one day withdraw from Bam”.

Myanmar: On their bicycles, the local health workers can also reach patients in remote areas.

Afghanistan: Inspection of reconstruction progress in the provincial hospital in Qala-i-Nau.

Myanmar 2004 was a year of new challenges. An agreement between the Health Ministry and Malteser Germany safeguards access to Rakhine State and to the Yangon Division for a further three years. On this basis, in Rakhine State the basic health care activities were expanded and a new project started in the slum areas of Yangon: together with German Agro Action (Welthungerhilfe) Malteser Germany is improving the health and nutritional situation of the people and giving them access to drinking water and sanitary facilities. Thailand Ever since 1993 Malteser Germany has been responsible for the health care of 27,000 refugees in two camps at the border with Myanmar. Besides medical treatment, we provide the refugees with drinking water, build toilet facilities, offer health education and train health workers. In order to avoid tensions between refugees and the population, since 2002 a basic health care project has also been undertaken in the villages of the district. The focus here is on the prevention of diseases and health education as well as the support of those

IN MEMORIAM Emal Abdul Samad (19) Mohammed Idrees Sadiq (38) Malteser Germany mourns its two Afghan staff members, Emal Abdul Samad and Mohammed Idrees Sadiq, who were murdered on 3 August 2004 during an attack in the south-east of Afghanistan. They were just returning from their project area when, at around 5 p.m. local time, well-aimed shots were fired at their car from a passing vehicle. The 19 year-old driver of the car, Emal Abdul Samad, could still be flown to the hospital in Bagram but there succumbed to his severe bullet wounds. 38 year-old Mohammed Idrees Sadiq died at the scene of the accident; he leaves a wife, three daughters and two sons. As driver and project supervisor, Emal and Mohammed assisted numerous families who were returning to their destroyed home areas and facing an apparently hopeless future. They had to pay with their lives for supporting the cause of people in need. Our deep sympathy and our prayers go to their families, friends and colleagues. infected by HIV through income generating measures. In addition, support is given to orphans whose parents have died of AIDS.

Vietnam In a programme especially aimed at reducing poverty, 450 families in particularly poor areas of central Vietnam learned to improve their health and nutritional situation and to increase their income by finding new sources of earnings. In cooperation with the women’s union of this region, the programme is to be extended to further districts in 2005.

Cambodia: Health education for schoolchildren in the province of Oddar Meanchey.

Myanmar: Basic health care in remote villages in Northern Rakhine State. Jochen Voigt

Iraq Owing to the critical security situation, since February 2004 no further German Malteser staff have been working in northern Iraq. The health care centre in Karmless, however, continues to be equipped with medicines via local partners.

Vietnam: Improving the health and nutritional situation of 450 families.

ASIA

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Bam in December 2004 – One year after the earthquake Impressions of Dr. Peter Staudacher, country coordinator Iran Life in Bam is visibly getting back to normal. Gone are the times when dozens of yellow wheel loaders fought their way through the building rubble and turned everything into a dusty hell. The government has already erected a large number of emergency dwellings in the form of camps of prefabricated shelters; the rebuilding of houses has so far been tackled mainly by the international relief organisations. Until now, the reconstruction of residential buildings has only been taking place in the villages around Bam, as initially a “master plan” for the rebuilding of the city was drawn up by the government which has only now been presented - almost a year after the earthquake. This is why not a great deal of reconstruction has taken place to date in the urban area of Bam itself. Along the former main streets, shopkeepers have taken the initiative of reopening their businesses in provisional buildings that look like garages. New buildings sprang up before long and now televisions, DVD players, washing machines and bicycles are on sale again in Bam. In addition, a number of cheap restaurants have already set up their tables again on the roadside and are serving kebabs - spicy meat skewers - with rice. Fruit and vegetable sellers are offering the entire range necessary for traditional Iranian cuisine: dates, aubergines, cucumbers, pistachios, oranges, kakis and pomegranates. Life in Bam goes on, as people say. It’s true that they’re not happy with life in the temporary shelter, but the children are laughing again. One can see their cheerful

play on the playgrounds between the school containers. Hard to believe that some of these children lost their mother, their father and some of them both parents in the earthquake of 2003. The number of traumatised people - particularly among the children - is high,

Dr. Peter Staudacher with project partners in Barawat in front of the premises on which a new school is to be built.

School containers for a girls’ class in Bam.

however. In order to help them, international and also Iranian NGOs offer special support programmes. In the public arena, however, it is rather the technical aspects of reconstruction that are discussed. “Bam lives on after the earthquake”, a young tourist guide who once used to escort international tourists through the ancient castle complex of Bam told me in January 2004. The quake turned the old castle of Bam, a masterpiece of oriental architecture, into a pile of rubble. When I asked after young Mohammed on my return to Bam I was told that he had left for England two months ago. He was now studying English literature there. The earthquake left him without his castle and without his job. Bam has been living on for a year after the terrible earthquake but it still needs international assistance. For a long time now there has been no satisfactory solution for the numerous people who still have to live in the prefabs. Lessons in most schools still take place in containers. Hospitals operate in emergency accommodation. Hardly any playing grounds and sports fields exist. Traumatised children continue to wait for psychosocial support, the unemployed hope for work, women who have lost their husbands and now have to look after their families feel abandoned. One year after the earthquake Bam has recovered a little. Whether the city will really get back on its feet depends on the commitment of everyone: on the Iranian government, the relief organisations and the inhabitants of Bam. Dr. Peter Staudacher

In the past year, the Malteser Foreign Aid Division in cooperation with Diakonie Emergency Aid and with support from Malteser groups and the University of Regensburg, has begun building a school in Bam in the suburb of Barawat. Three schools were equipped with school containers where lessons are now taking place until permanent school buildings can be re-erected. Malteser Germany is committed to the strengthening of local self-help organisations in order to promote sustainable structures of civil society in Bam. By means of training and financial support they are being put in a position to pursue their important responsibilities in the social sphere, e.g. organising holiday camps and programmes for traumatised children, freeing widows from their isolation with discussion groups or supporting small income generating activities. With this form of help to self-help, Malteser Germany is shaping the rehabilitation process on a sustainable basis.

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The stream, the flight and new life Visiting a midwife in the Thai jungle Rainy season in the Thai jungle: the water’s streaming, the air’s steaming, and the red earth has turned into soft soap. The jeep is barely making progress - despite snow chains. After a four-hour journey to get 80 kilometres, hundreds of bamboo huts appear; we have finally arrived at the “Mae La U” refugee camp. Almost 15,000 people live here: “Mae La U” is one of two large refugee camps in the north-west of Thailand looked after by Malteser Germany. In the course of the last 25 years, together with refugees from Laos and Cambodia around one million people have come to Thailand. 41 year-old midwife Sunny has been living in this new camp since spring 2004 together with her husband Jonathan, her 79 year-old aunt and two of her four children. Sunny herself was twelve years old when soldiers of the military government attacked her village in Myanmar and killed her father. The mother entrusted Sunny to the aunt who fled with her over the border to Thailand. Since then Sunny has not seen her mother and her seven brothers and sisters. In 1988 she married Jonathan, who had also fled from Myanmar. When military conflict erupted again in 1994, both of them fled to the “Mae Kong Kha” refugee camp where Sunny was trained by Malteser Germany to become a midwife. Since 1993 Malteser Germany has been operating at the ThaiMyanmar border, supporting the refugees to set up their own health system. Sunny’s husband Jonathan was also trained by Malteser Germany. As a medical supervisor he directs - supported by doctors from Germany - the work of a total of 110 health workers operating in the camp. It’s not just about mother and child health care; vaccination and nutrition programmes

and extensive educational work for young people and mothers also play an important role in the camp. “The subject of HIV/ AIDS is really off-limits among refugees”, explains country coordinator Marie-Theres Benner, who has already been working in Thailand for nine years. “However, the offer of voluntary counselling and testing plays an important role in the advice we give, as it removes anxieties and the subject of AIDS is not hushed up.” Sunny has no desire to hush up her sadness at the fact that she sees her two eldest children so rarely. Both are attending secondary schools in another refugee camp and can only visit once a year. However, Sunny consoles herself with a vision: “I really hope that at last our children will be able to return again one day to their homeland when we really have peace and democracy there. That’s also why their training here is so important to us. We’ll use the opportunity we have to raise a new generation for our country”. Then Sunny goes back into the hospital to the two children who came into the world the night before. The rain has stopped. Petra Ipp

Midwife Sunny examining a girl in the refugee camp.

The hospital in the “Mae La U” refugee camp at the border with Myanmar.

ASIA

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16

PROJECT OVERVIEW

Asia

Africa

Region

Structural aid

Structural aid/health care

Structural aid Health care

Health care Rehabilitation/health care Structural aid Emergency relief

Food security

Rehabilitation/health care

Rehabilitation/health care

Rehabilitation/aid to returnees Rehabilitation/aid to returnees Health care

Rehabilitation – Gujarat earthquake Rehabilitation/disaster prevention - Gujurat earthquake Rehabilitation/development – Gujurat earthquake Health care Structural aid Emergency relief – tsunami

Emergency relief – Bam earthquake Emergency relief – Bam earthquake Emergency relief – Bam

Ethiopia

Kenya

Mozambique Sudan

Sudan Sudan Sudan Sudan

Uganda

Afghanistan

Afghanistan

Afghanistan

India

Iran

Iran

Iran

India India India

India

India

Cambodia

Afghanistan

Emergency relief Emergency relief Rehabilitation/health care

Emergency relief

Programme Focus

DR Congo DR Congo DR Congo

Angola

Country

Reconstruction of the school in Khadije

Basic health care in slums, training of female health workers Setting up a loan fund for income generating measures for women Providing tsunami victims with food, clothing, medical help in Tamil Nadu and Kerala Deployment of rescue dog unit and medical team, provision of three emergency health kits chool containers with cooling units and toilets for three schools

Reconstruction of 100 and equipping of 250 houses; development of disaster prevention measures in 20 villages Pre-school education for children of the socially disadvantaged

Reconstruction of 500 houses in Bachau

Income generating and peace-building programmes for returnees, central Afghanistan Basic health care, Oddar Meanchey province

Supporting the obstetrics department in Qala-I-Nau Hospital, Badghis province Income generating programmes for returnees, south-east Afghanistan

Rehabilitation of schools and basic health care, Badghis province

Nutrition centre, Maracha

Emergency relief and health care for displaced persons and the population in Kuando Kubango, medical provision and training, nutrition, distribution of relief items, water and hygiene measures Rehabilitation of health care structures in South Kivu Supporting over 20 nutrition centres in Bukavu/South Kivu Providing the local health workers in Ariwara/Mahagi with medicines and training Water for Gilgel Beles, Mandura, basic occupational training, support of women’s group Improving the possibilities of diagnosis and treatment of tuberculosis and HIV/AIDS; support of nursing and education in eight slum areas of Nairobi Monthly health awareness days, vaccination programme Supporting the Archangelo-Ali clinic in Rumbek and the Saint Bakhita Health Care Center in Yei Sleeping sickness control programme in Yei County Tuberculosis and leprosy control programmes in Yei and Rumbek Supporting the Rumbek laboratory school in the training of lab assistants Basic health care and vaccination campaigns in Darfur

Brief Description

EUR 175,000 Private donations

EUR 110,000 Private donations

EUR 45,000 THW

EUR 30,000 Private donations EUR 51,000 Private donations EUR 90,000 Private donations

EUR 390,000 Private donations

EUR 305,000 Private donations

EUR 373,500 Private donations

EUR 425,000 ECHO, private donations

EUR 647,400 UNHCR

EUR 531,500 UNHCR

EUR 16,156 UNICEF

EUR 6,000,000 BMZ (KfW and CIM)

BMZ, ECHO, Private donations ECHO, DAHW, Caritas Spain ECHO, DAHW AA, UNICEF, Aktion Deutschland Hilft (Action Campaign Germany Helps), Stiftung „Nachbarn in Not“ (Neighbours in Need) Foundation EUR 220,000 PMK

EUR 1,200,000 EUR 900,000 EUR 56,000 EUR 300,000

EUR 60,000 Private donations EUR 90,000 Caritas Spain, PMK

EUR 600,000 BMZ

EUR 270,000 BMZ

EUR 1,370,000 ECHO, UNICEF EUR 710,000 ECHO EUR 2,915,000 EuropeAid

Project Costs Donors/Cooperation (spread over Partners* several years) EUR 500,000 ECHO, ADH

Diocese of Yei Dioceses of Yei, Rumbek and Torit Diocese of Rumbek Municipal health centres

Sofala Provincial Health Authority Dioceses of Rumbek and Yei

EUR 175,000 Diakonie Katastrophenhilfe

EUR 110,000 Kerman NGO House

EUR 30,000 Sisters of Destitude EUR 46,000 Health for One Million Marthandam EUR 90,000 CHAI Catholic Health Association of India, MSSS Trivandrum, HOM Marthandam EUR 35,000 THW

EUR 355,000 Local health authority, village communities EUR 373,500 St. Xavier’s Non Formal Education Society/ BSC with Ekklavia Foundation EUR 305,000 Unnati Organisation for Development Education EUR 390,000

EUR 588,500 District councils and NGOs

EUR 5,800,000 Local and national health and school authority EUR 16,156 Local and national health and school authority EUR 478,800 District councils and NGOs

EUR 155,000

EUR 60,000 EUR 67,000 EUR 17,000 EUR 1,017,000 EUR 808,200 EUR 40,000 EUR 141,000

EUR 359,000 AMREF Kenya, NCC

EUR 191,000

EUR 1,330,000 EUR 710,000 EUR 2,915,000

EUR 230,000 Caritas Menongue, Kuando Kubango provincial health delegation

Amount of Do- Local Partner Organisations nations/Grants

Relief worldwide – Our projects in 2004 (extract)

1

1

2

1 1 3

1

1

1

1

1

1

1

1

1 2 1 2

1 2

1

3

2 1

2

No. of Projects

PROJECT OVERVIEW

17

Care of individuals willing to return

Health care Health care Structural aid

Structural aid

Repatriation and protection for refugees Structural aid

Structural aid/health care

Health care

Structural aid

Turkey Turkey Turkey

BosniaHerzegovina BosniaHerzegovina Kosovo/ Macedonia Kosovo

Kosovo

Serbia

Serbia

AA ADH AMREF ASHH BMZ

CIM DAHW ECHO PMK KfW NCC

THW UNAIDS UNHCR UNICEF WFP

EUR 979,158 AA GF 07

EUR 979,158 AA

1

8

2

3

1

4

2

2

4

1 1 1

2

1

1 1 1

1

1

2

2

2

2

N.B.: The difference between the amount of donations/grants provided by the donor/ cooperation partner and actual project costs is covered by private donations earmarked for Malteser foreign aid work.

EUR 469,500 Local Malteser organisations

EUR 37,800 Local Public Health Department, local NGO EUR 91,000 Dom Zdravlja, Novi Sad administration, medical and senior citizen’s welfare authorities, Novi Sad EUR 87,000 Catholic parish of Boka

EUR 504,000 Local NGOs

EUR 279,500 Local authorities

EUR 680,000 Local social institutions, BHWI and local NGOs EUR 27,150 Local NGOs

EUR 15,000 International Blue Crescent EUR 75,000 International Blue Crescent EUR 21,500 Vafki

EUR 35,000 International Blue Crescent

EUR 900,000 Karen Refugee Committee EUR 150,000 Local authorities EUR 55,000 Women’s unions at village and district level EUR 103,500 Thanh Nien newspaper

EUR 299,500 Local health authorities and inhabitants of the urban district EUR 1,001,000 Local authorities

EUR 212,000 Local health authorities, village communities EUR 253,000 Local health authorities, village communities

EUR 632,000 Local health authorities

(Social Welfare Disaster Relief) EUR 100,000 Kerman NGO House und Hamyaran

German Technical Relief Organisation United Nations AIDS Programme United Nations High Commissioner for Refugees United Nations Children’s Fund World Food Programme

EUR 469,500 Private donations

EUR 107,000 Renovabis, British Association of the Order of Malta, foundation

EUR 580,000 UNHCR, AA, archdiocese of Cologne EUR 41,300 Aktion Mensch (Action for Humanity) EUR 251,000 AA

EUR 27,150 British Association of the Order of Malta EUR 279,500 UNHCR, AA

EUR 872,000 UNHCR, AA

EUR 50,000 Private donations n.a. Private donations n.a. Private donations

n.a. Private donations

EUR 652,000 ECHO, UNAIDS, private donations EUR 260,000 ECHO, UNHCR, WFP, private donations EUR 280,000 BMZ, private funding providers, UNICEF, Japanese embassy, private donations EUR 315,000 BMZ emergency aid, private donations, (German Agro Action) EUR 1,100,000 European Commission/ EuropeAid EUR 900,000 ECHO, private donations EUR 150,000 Private donations EUR 82,000 World Child Foundation, private donations EUR 107,000 Federal Foreign Office of Germany

EUR 100,000 Private donations

Centre for International Migration and Development German Leprosy and Tuberculosis Relief Association European Commission – Humanitarian Office Papal Mission Organisation for Children Development Bank - KfW Banking Group Nairobi City Council

Medical care for UNAMA and the police academy

Federal Foreign Office of Germany Action Campaign Germany Helps African Medical Research Foundation Task Force on Humanitarian Aid, Federal Foreign Office of Germany German Federal Department of Economic Cooperation and Development

* Donors/Cooperation partners:

Health care

Afghanistan

United Nations

Extending, equipping and providing financial assistance for Boka senior citizens’ home

Health care for Romany people, infrastructural aid, training of nurse assistants

Supporting people with disabilities

Support in setting up new businesses, income generating measures

Setting-up/equipping a centre for 250 mentally-impaired children in Izmit, awareness programmes for parents Training centre for first aid Health care centre for 5,000 people in Yatzik Day care centre for children including transport bus

Setting up Malteser (organizational) structures and supporting Malteser activities in 13 countries of Central and Eastern Europe; financial assistance for the Malteser organisations in Albania, Latvia, Lithuania, Poland, Romania, Russia, Serbia and the Ukraine

Health care

Income generating measures for among others minorities, returnees, integrated women’s programme Domestic nursing, first aid training

Rehabilitation

Turkey

Central-/ Eastern Europe

Balkans

Europe

Emergency relief

Vietnam

Basic health care programme for refugees along the Thai-Myanmar border Providing tsunami victims with food, clothing, medical help Nutrition and health care programme for women and children, new business set-up courses Flood relief – central Vietnam

Health care Emergency relief - tsunami Health care/structural aid

Thailand Thailand Vietnam

Improving health care and supply of drinking water in the urban area of Yangon Improving health care and HIV/AIDS prevention

Training for local relief organisations and establishment of a small project fund Malaria and HIV/AIDS prevention, diagnosis and treatment, Wa region, Shan State Improving the health and nutritional situation of returnees with the focus on basic health care and TB control, northern Rakhine State Improving health care and supply of drinking water, prevention, diagnosis and treatment of HIV/AIDS and TB, Thongwa Township

Health care

Health care

Health care

Health care

earthquake Emergency relief – Bam earthquake Emergency relief

Myanmar (Burma) Thailand

Myanmar (Burma) Myanmar (Burma) Myanmar (Burma)

Iran

Europe Balkans

Turkey

Even ten years after Dayton and five years after the end of the Kosovo war, by no means all the war refugees have returned to their native regions. Malteser Germany is helping returnees to make a new life for themselves.

In Izmit and the surrounding area, the centre of the 1999 earthquake, Malteser Germany is working with its Turkish partner International Blue Crescent.

Bosnia-Herzegovina The “Bosnia-Herzegovina Women’s Initiative” advises and supports unemployed women in setting up new businesses. Ethnic minorities and returning displaced persons receive similar assistance. In Mostar, a domestic nursing service began its work; in Grahovo a first aid training course for nurses was run. Kosovo and Macedonia Malteser Germany assists displaced persons, mostly relatives of ethnic minorities returning to their homeland, by means of income generating measures with repayment components as well as through direct financial assistance and winterised accommodation. The often difficult situation of handicapped people is improved by offers of advice for families and measures designed to create awareness.

The programmes for a centre in Izmit, in which 240 mentally handicapped children live, are a main focus of Malteser Germany’s aid efforts in Turkey. Therapeutic procedures, the acquisition of a transport bus and a training programme that gives the parents support in dealing with the children and their environment, alleviate the children’s situation. In addition, Malteser Germany has set up a health care centre and a training centre for first aid in Izmit. Turkey: Handicapped children from the day care centre in Izmit were the proud winners of a nationwide sporting competition.

Serbia Malteser Germany is especially committed to improving infrastructure in health care services. To this end we equipped five dental practices with modern instruments, developed a training programme for nursing auxiliaries and took on the financing of a mobile medical team for the preventive and diagnostic care of Romany families. The extension of the senior citizens’ home in Boka was successfully completed.

Kosovo: By supporting carpentry businesses, Malteser Germany is helping returnees to make a new life for themselves.

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Serbia: Mobile medical team in one of the Romany camps.

MD Marku – an example of emergency aid without red tape You couldn’t imagine health care in Albania without Malteser Germany On Wednesday morning, in a small village in the mountains of northern Albania, a number of inhabitants are awaiting the arrival of the doctor. A small boy has severe stomach pains, a peasant woman has injured herself while working in the fields, an elderly woman has a high fever. MD Maranaj Marku from the Albanian Malteser Relief Service “Malteser - Ndihmon ne Shqiperi” (Malteser - Aid in Albania) knows most of them, because for years he has been holding consultation hours every week on the same day in the village and sorting out those seeking help. Malteser doctor MD Maranaj Marku, together with a physician colleague, a handful of full-time and a large number of voluntary co-workers, helps to maintain basic health care in the archdiocese of Shkoder. They hold consultation hours in individual villages and look after the sick and injured. With financial assistance from Renovabis, the Albanian Malteser Relief Service also provides information on natural family planning in order to make a contribution towards reducing the high number of abortions. For the patients, treatment in the health care centres by Malteser staff is free, just like the medicines distributed to the sick. The Albanian Malteser personnel are mainly dependent on donations and support from outside, “on every euro, in fact”, according to MD Maranaj Marku. The chairman of the Malteser Relief Organisation in Albania is especially grateful for the support from Germany, for example by the Malteser groups of the archdiocese of Cologne and Renovabis.

Top: Delivery of medicines and medical equipment.

One of the eight mountain villages where “Malteser - Ndihmon ne Shquiperi” is providing health care.

Every year the Albanian Malteser Relief Service runs summer camps with Albanian girls and boys and Romany children on the coast near Velipoja. These holiday activities are now finding a high level of acceptance in northern Albania and a further unexpected success is the fact that some Romany youths are now becoming involved as volunteers for the relief service.

“Malteser – Ndihmon ne Shquiperi” is putting a lot of energy into youth work. They are training volunteers and offering challenging leisure activities to young people who in view of the high level of unemployment often simply “live for the moment”. This makes questions about the future, which offers the youths few prospects, easier to bear. Ludwig Unger (Renovabis) In Albania – as the example of the Albanian Malteser Relief Service shows – the Catholic Church is taking on certain public tasks, for the most part of necessity. Almost two-thirds of the roughly 3.15 million-strong population of the country are Muslims; approximately 13 per cent of the people are Catholic. Without the involvement of priests, members of religious orders and lay people, many would have to wait for assistance in vain. In the south-east European country, around 40 small health care centres are being looked after jointly by Malteser and/or Caritas staff. In the “poorhouse” of Europe, as Albania is rightly called, cars are a scarce commodity, and transporting sick people to the “hospital” in the nearest town is not always without its problems.

MD Maranaj Marku en route with Renovabis visitors.

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Central and Eastern Europe/Partnership work abroad Despite the fact that some Central and Eastern European states are members of the European Union, neither there nor in other countries of the east has life actually become any easier. The aid of Malteser Germany continues to be necessary and is readily provided. The Malteser relief services in Central and Eastern Europe, however, are also increasingly taking their fate into their own hands and preparing themselves for the future. In 2003 and 2004, with “Water for Ariwara”, many German Malteser groups made an important contribution to the success of the health project in the Democratic Republic of Congo through committed fundraising.

“Relief for Ariwara” - Qualification – “CEE network” On World Water Day on 22 March 2004 the anniversary project “Water for Ariwara” was officially ended, with donations totalling almost EUR 88,000. Three representatives of the dioceses of Cologne, Berlin and Aachen travelled in spring to the Congolese project region. The aid will also continue in 2005 under the slogan “Relief for Ariwara”. In January 2004, at a pilot seminar for voluntary leaders and decision-makers in the foreign aid and partnership work sector, participants were given details of the fundamental principles of foreign aid and information on operational practice. A first regular seminar programme will follow at the end of 2005. At a conference in Prague in November 2004, the responsibles of nine Central and Eastern European Malteser relief services and representatives of the Malteser Foreign Aid Division agreed on concrete steps to consolidate the “Central and Eastern European Malteser Network”.

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Andreas Friese

Highlights from our partner organisations: ● At the beginning of 2004, the Albanian Malteser Relief Service guaranteed accommodation and food for families affected by a severe earthquake in the south of Albania. This was possible thanks to an emergency aid fund of the Malteser diocesan office of Cologne and the Malteser Foreign Aid Division. Alongside this, staff from the Albanian Malteser organisation were in action during the flood disaster in the northern Albanian district of Shkoder. ● The Romanian Malteser Relief Service has been taking part in the counselling process offered since October by the Foreign Aid Division. As only limited

●

donation funds are still available for rehabilitation aid for the Eastern European Malteser partner organisations, the latter have been trained since 2003 to be able to finance themselves to a greater extent. Through his foundation, Udo Jürgens also supports two of the children’s homes near Lemberg looked after by the Ukrainian Malteser organisation. At the TV gala broadcast on the occasion of his 70th birthday, two children from these homes as well as Paul Titko, Director of the Ukrainian Relief Service, took the opportunity to wish him many happy returns.

C E N T R A L A N D E A ST E R N E U RO P E / PA R T N E R S H I P W O R K A B ROA D

●

On the 15th anniversary of the “Day of Reception” on 14 August 1989, the Hungarian Malteser organisation invited guests from home and abroad to BudapestZugliget. On that date the site had been opened for the reception of East German refugees. In the ceremony the Hungarian President paid tribute to the remarkable commitment of Hungarian and German Malteser staff. A short time later, during his trip to Hungary, German Chancellor Schröder also thanked Malteser staff for the fact that, 15 years before, they “had helped to overcome the painful division of Europe with courage and drive”.

Birthday gala on TV: Surprise guests from the Malteser children’s homes in Ukraine congratulate Udo Jürgens on his 70th birthday. Hungary: On the occasion of the 15th anniversary, Chancellor Schröder thanks Father Imre Kozma, Director of the Hungarian Malteser organisation, for their commitment.

“Water for Ariwara” – Travelling with Malteser Germany in the Congo Impressions of a newcomer to Africa

What a country! Green and lush. Everywhere friendly, open, happy people. I find it quite impossible to escape the children’s charm. Curiously but cautiously they approach with friends, brothers and sisters, registering amazement and disbelief at our strange appearance and splitting their sides with laughter. The women set out for market first thing, on foot, often for hours. On their heads they carry brushwood or charcoal, cassava or other vegetables. In the tall grass they seem to float - despite the 20-litre water cans on their heads. Water - what a subject in this country. It’s the rainy season. On the bumpy roads, large reddish brown puddles linger in the rutted potholes. At the sources, newly walledround by Malteser Germany, there’s a lively crush. Clear water flows into bowls, kettles and cans. A woman with her child on her back fills the can with water, pauses for a moment, then lifts it high over her head and lets it down gently. It stays secure; she doesn’t have to hold on to it. What a life, here “in the bush”! By the way, that term should be taken literally. Ingo Radtke, Head of the Malteser Foreign Aid Department, has told how people even experience something like a “bushification effect”. If they’re far away from our civilisation for too long they begin, for example, to stop assessing dangers correctly. - Does the project coordinator, Dr. Alfred Kinzelbach, still assess dangers realistically? This appalling rebel leader, for example, and his warlike boys with their machine guns and reflecting sunglasses. Out of sheer frustration with a

bicycle dealer, one of them recently let off a hand grenade in the market. There were a number of dead and many injured. These characters worry me. But I do enjoy the good atmosphere in the Malteser team. Alain, the logistics specialist from France, confessed to me how glad he is that because of our visit there’s Nutella for breakfast. Yes, food in Africa! I set off with a thousand warnings ringing in my ears but nothing’s quite as bad. We eat well, but a lot here is still somewhat more immediate. The goat lying grilled on the buffet table this evening I saw just this morning still full of life - then heard its pitiful screams. After four days with the Malteser team I even know some of the many local staff. At the beginning I had great difficulty in distinguishing the black faces. Steffi Heil from Cologne, only there for barely half a year, sympathises. Things hadn’t been any different for her, she says. Steffi accompanies us to the health care centres, interprets and fixes everything on the spot so we can film - and is glad of the diversion. She loves this country and its people. I watch how the nurses press their stethoscopes onto the swollen stomachs of the pregnant women to eavesdrop on the unborn. Seven children per woman. That’s the average in the Congo. After ten days I return home healthy. Thankful. My head is full of images. And I am several valuable experiences richer. Anne Balzer (Hessian Radio, Co-author of the report “Water for Ariwara”/May 2004)

Spring enclosure in Ariwara, donated by Malteser groups of the diocese of Münster.

Dr. Constantin von Brandenstein (2nd from left) and Ingo Radtke (right) with project coordinator Dr. Alfred Kinzelbach (left) and local staff on the project.

Anne Balzer in conversation with Dr. Alfred Kinzelbach, project coordinator in Ariwara.

C E N T R A L A N D E A ST E R N E U RO P E / PA R T N E R S H I P W O R K A B ROA D

21

United Nations – Peacekeeping missions For 14 years now Malteser Germany has been charged with the medical and first aid care of peacekeeping missions of the United Nations.

UNAMA - United Nations Assistance Mission for Afghanistan In June 2004 our mission to provide medical care for the UN organisations in Kabul ended. Malteser Germany had taken charge of this task for two years on behalf of the German Federal Foreign Office. In the second half of the year the team with its seven staff members concentrated on setting up medical structures at the police academy in Kabul and in the police headquarters in the provinces. 2004 was very much a year of consolidation. From its temporary beginnings in the summer of 2002, the German Malteser Hospital has developed into a well-functioning general medical institution. Through training and further education, the Malteser team had been preparing the specialist Afghan staff to assume direct control of the hospital. In the middle of December the official handover took place to the commander of the police academy; Malteser Germany stood by in an advisory capacity until 30 June 2005. Support work in the provinces also got under way: Malteser Germany set up a police medical testing laboratory in Herat in the west and trained police and border police in first aid there. Ceremonial handover of the German Malteser Hospital to the commander of the police academy.

Taking blood under the supervision of the Head of Mission.

22

U N I T E D N AT I O N S

Treatments and medical examinations Patients/recruits Treatment of patients Physicals Laboratory analysis X-rays Dentist treatments

2004

2003

7,326 1,260 17,399 3,654 1,128

5,799 873 22,092 4,874 ./.

2004

2003

43 65

138 83

Trainings Participants First aid course First aid course “Train the trainer”

For the others – Interview with MD Kai Stietenroth, Head of Mission of the Malteser German Medical Team in Kabul Kai Stietenroth, born in 1970 in Wolfenbüttel, has been a doctor since 1999. He spent a practical year in Trinidad and wrote his doctoral thesis about a leprosy project in India. Since February 2004 he has been working as a doctor for Malteser Germany in the German Medical Team in Kabul/Afghanistan.

Why did you become a doctor? The medical profession has fascinated me right from my early childhood. Albert Schweizer especially appealed to me. Interest in the old jungle doctor was perhaps the first indication of my current occupation. How did the contact with Malteser Germany come about? I had already known about Malteser Germany’s projects for a fairly long time. A year before my deployment in Afghanistan I had applied for a project on the border between Iraq and Kuwait that was called off because of the political changes. Then, at Christmas 2003, my telephone rang: a job in Kabul had become vacant at short notice. What are your tasks during this operation in Afghanistan? As the Malteser German Medical Team we are helping to build up the Afghan police and thus contribute to greater security in the country. We assist them, for example, in the general medical care for police recruits and policemen. To this end we’ve set up a small hospital in the police academy. Until the middle of the year, in addition to this activity we were also responsible for the general medical care of the staff of the UNAMA mission and involvement in emergency operations for the United Nations.

How are you handling the aggravated security situation? The murder of the two local Malteser staff in south-eastern Afghanistan last August shocked the entire team. However, the incident won’t stop us from continuing the work. The people at whose expense these conflicts are being pursued are here, as elsewhere in the world, always the children and women, the old, the sick and the weak.

MD Kai Stietenroth, Head of Mission of the Malteser German Medical Team in Kabul.

What is your experience of the rehabilitation and how do you assess the future of the country? Kabul especially is a very dynamic city at the moment; construction work is taking place and work going on everywhere. Things look different in the province, so far only a small amount of international aid has arrived. That’s why, in addition to the project in Kabul, Malteser Germany is active in the west, in the south-east and in the central region. The Afghans are expecting stability from the outcome of the latest elections. Nevertheless, there’s no doubt that years of effort by the international community are necessary to bring health, education, the infrastructure and democracy up to an acceptable level again. The people here are trusting that the world won’t forget them again. Heike Otto and Petra Ipp conducted the interview with MD Kai Stietenroth. Reprinted by kind permission of the Niedersächsisches Ärzteblatt (Lower Saxony Medical Journal).

What is your everyday working life like in Kabul? One important task is our first aid courses for policemen and courses for paramedics and nursing assistants. We are improving organisational procedures in further and advanced vocational training and giving our Afghan colleagues the necessary knowledge to enable them to manage the hospital soon on their own account. Blood test in the lab of the German Malteser Hospital on the site of the police academy.

U N I T E D N AT I O N S

23

Facts and Figures Experts abroad Expatriate employments per region

Special projects - 15

Africa - 37

Balkans - 3

Asia - 37

Expatriates by education and occupation

trainees/ project assistants - 11

physicians - 20

paramedics - 5 nurses and orderlies - 8 others - 6

logistics specialists/ administrators - 15

project managers - 27

24

E XPERTS ABROAD

Local staff employment per region Countries

Malteser volunteers and their activities abroad 2004

2003

Africa

346

359

Angola

24

DR Congo

2004

2003

2002

Number of activities abroad

506

529

531

12

of which transports of relief items

352

385

388

98

80

Tonnage

4,265

4,404

3,504

Ethiopia

12

22

Journeys without tonnage

154

143

143

Kenya

23

20

Number of kilometres driven

1,298,460

1,351,050

1,337,701

0

8

Number of volunteers

2,430

1,727

2,019

Sudan

170

198

Uganda

19

13

Total number of volunteers (honorary/paid)

2,538

1,832

2,086

0

6

Asia

414

312

Afghanistan

251

190

20

40

2

0

Myanmar

110

52

Thailand

27

27

Vietnam

4

3

Balkans

34

39

Bosnia-Herzegovina

19

20

Kosovo

11

13

Macedonia

1

3

Serbia

3

3

Special projects

28

34

Afghanistan/Kabul

28

34

822

744

Mozambique

Zimbabwe

Cambodia Iran

Total

The 130 German Malteser subdivisions, which in 2004 were linked by a total of 230 partnerships with organisations and projects in 27 countries, have shown an undiminished level of activity.

The areas of responsibility and activities of our local staff are characterized by a large variety. They work, for example, as project supervisors, logistics specialists, secretaries, administrative staff, nurses and orderlies, physicians, lab technicians and lab assistants, translators, drivers, cleaning staff, gardeners, security personnel, engineers or mechanics.

Figures correct at: 31 December 2004

E XPERTS ABROAD

25

Incoming donation and project expenditure Development of incoming donations 3,234,585.00 €

3,045,408.00 €

2003

2004

3,000,000.00 € 2,500,000.00 €

2,466,175.00 €

2,000,000.00 € 1,500,000.00 € 1,000,000.00 € 500,000.00 €

This table includes donations for longer-term and regular programmes/projects as well as receipts following appeals for donations at the time of disasters. The tsunami donations will only be recorded in 2005 and are therefore not contained in this table. Donations received for the tsunami disaster currently amount to approximately EUR 28 millions, of which approximately EUR 15 millions were received via the “Action Campaign Germany Helps” appeal.

0 2002

Project expenditure by source of funding Caritas, PMK, Renovabis and others 1,54% UNHCR 7,59%

WFP and other UN organisations 1,43% Miscellaneous (GTZ, DAHW, ADH and others) 2,33% Donations and own resources MHD 35, 04%

EuropeAid and other EU departments 8,18%

ECOM/ Order of Malta 0,13% ECHO 23,02% Federal Foreign Office of Germany 11,03% KfW 6,0%

26

BMZ 3,69%

I N C O M I N G D O N AT I O N S A N D P ROJ E C T E X P E N D I T U R E

ADH

Aktion Deutschland Hilft (Action Campaign Germany Helps) BMZ Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung (German Federal Department of Economic Cooperation and Development) DAHW Deutsche Lepra- und Tuberkulosehilfe (German Leprosy and Tuberculosis Relief Association) ECHO Europäische Kommission – European Commission ECOM Emergency Corps of the Order of Malta GTZ Gemeinschaft für Technische Zusammenarbeit (Community for Technical Cooperation) KfW KfW Entwicklungsbank (Development Bank - KfW Banking Group) MHD Malteser Hilfsdienst (Malteser Germany) PMK Päpstliches Missionswerk der Kinder (Papal Mission Organisation for Children) UNHCR United Nations High Commissioner for Refugees

Project expenditure by relief sectors Special projects 4,95% Miscellaneous (combined relief sectors and indirect project costs) 20,36%

Emergency and disaster relief 36,17%

Structural aid 5,72%

Rehabilitation 32,8%

Direct project expenditure (rounded up) by regions/areas Special projects EUR 705,000.00

Special projects EUR 925,000.00 Latin America EUR 20,000.00

Balkans EUR 2,465,000.00 Africa EUR 6,165,000.00

Asia EUR 6,160,000.00

I N C O M I N G D O N AT I O N S A N D P ROJ E C T E X P E N D I T U R E

27

Project expenditure by countries Region

Country

Africa

Angola DR Congo

Project turnover (EUR) rounded 365,000.00 3,515,000.00

Ethiopia

315,000.00

Kenia

485,000.00

Mozambique

60,000.00

South Afrika Sudan

25,000.00 1,320,000.00

Uganda

75,000.00

Multi-country project expenditure Asia

Afghanistan

5,000.00

350,000.00 1,040,000.00

Iran

460,000.00

Iraq Myanmar

40,000.00 1,020,000.00

Sri Lanka

10,000.00

Thailand

895,000.00

Vietnam

130,000.00

Multi-country project expenditure Balkans

6,165,000.00 �

2,210,000.00

Cambodia India

Region total

5,000.00

Bosnia-Hercegovina

925,000.00

FYROM (Macedonia)

280,000.00

Kosovo

790,000.00

Serbia

320,000.00

Turkey

150,000.00

Albania Central and Eastern Europe Latvia Lithuania Poland

2,465,000.00 �

5,000.00 35,000.00 100,000.00 25,000.00

Romania

140,000.00

Russia

100,000.00

Ukraine

220,000.00

Multi-country project expenditure

6,160,000.00 �

80,000.00

705,000.00 �

*“Miscellaneous expenditure” is made up as follows: Special projects

Afghanistan

Latin America

Dominican Republic

Kuwait

Direct project expenditure Miscellaneous expenditure* Total

28

PROJECT EXPENDITURE BY COUNTRIES

920,000.00 5,000.00

925,000.00 �

20,000.00

20,000.00 � 16,440,000.00 � 2,140,000.00 � 18,580,000.00 �

Indirect project expenditure: - expenditure on project management and supervision - pro rata expenditure on recruitment, development and support of project personnel - pro rata expenditure on media and public relations activity Head office, general administrative costs: - non project-specific costs for personnel, IT, accounting, rents and similar items

Profit and Loss Account for the period from 1 January to 31 December 2004 2004 € 1. Sales 2. Other operating income

2003 €

€

90,969.51 12,658,712.48

€

59,156.37 12,749,681.99

18,625,859.17

18,685,015.54

3. Cost of materials a) Cost of raw materials, consumables and supplies b) Cost of purchased services

4,285,733.21

4,385,258.77

777,922.22

3,655,692.34

2,618,615.09

3,136,633.84

647,163.66

752,378.38

4. Personnel expenses a) Wages and salaries b) Social security and other pension costs - of which in respect of old age pensions 122,538.59 (prior year 146,502.07) Interim result

8,329.434.18

11,929,963.33

4,420.247.81

6,755,052.21

5. Income from release of payables to earmarked allocations

10,739,340.79

8,734,743.35

6. Income from release of special items including allocations for financing fixed assets

21,485. 00

26,229.00

7. Expenses for transfers to payables to earmarked allocations 8. Depreciation on intangible fixed assets and tangible assets 9. Other operating expenses

4,592,868.07 221,217.85 9,999,318.02

Interim result 10. Other interest and similar income 11. Interest and similar expenses 12. Results from ordinary activities 13. Other taxes 14. Net income for the year

6,167,957.72

9,835,986.94 205,651.15

10,220,535,87

5,487,931.78

367,669.66 168,080.74 2,006.85

-1,075,014.59

5,693,582.93 -13,545.31

247,096.42 166,073.89

10,088.84

237,007.58

533,743.55

223,462.27

29,190.74

-56,073.10

504,552.81

279,535.37

Certificate Audit opinion to Malteser Hilfsdienst e.V. We have audited the annual financial statements of the Division Generalsekretariat, Abteilung Auslandsdienst, Köln, of Malteser Hilfsdienst e.V., Cologne, for the financial year from 1 January to 31 December 2004 taking ino account the accounting records. The accounting and the preparation of the financial statements in accordance with the German generally accepted accounting principles are the responsibility of the Association’s management board. Our responsibility is to express an opinion on the financial statements, including the accounting records, on the audit performed by us. We carried out the audit of the financial statements according to § 317 HGB [Handelsgesetzbuch: German Commercial Code] in conformity with the generally accepted auditing standards stipulated by the Institut der Wirtschaftsprüfer [Institute of Auditors - IDW].According to these standards the audit has to be planned and performed

such that inaccuracies and violations materially affecting the presentation of the financial statements are revealed with reasonable accurance. Knowledge of the business activities and the economic and legal environment of the Association and the Auslandsdienst and expectations of possible misstatements are taken into account in determining the audit procedures. The effectiveness of the accounting related internal control system and the evidence supporting the disclosure in the books and records as well as the annual financial statements are mainly examined on a sample basis within the framework of the audit. The audit includes assessing the accounting principles applied and significant estimates made by the Association’s management board as well as evaluating the overall presentation of the financial statements. We believe that our audit provides a reasonable basis for our opinion.

Our audit has not led to any reservations. Cologne, 15 June 2005 KPMG Deutsche Treuhand-Gesellschaft Aktiengesellschaft Wirtschaftsprüfungsgesellschaft (Auditors)

PROFIT AND LOSS ACCOUNT

29

Notes to the Profit and Loss Account For consolidation reasons, the Profit and Loss Account of the Malteser Foreign Aid Department is prepared according to the system of accounts established by Malteser Hilfsdienst e.V. (Malteser Germany). The structure of the Profit and Loss Account (but not the audited contents) therefore differs in some respects from the presentation of data elsewhere in this Annual Report and is briefly explained in the following notes.

Income Sales revenues include all income from supplies and services provided. Allocations and grants from the public sector include project funds provided by the German Federal Foreign Office and the German Federal Department of Economic Cooperation and Development (BMZ) of EUR 2,552,108.14 (of which EUR 925,893.36 was Foreign Office funding for special projects, formerly UN missions), and by the European Union of EUR 3,265,446.86). Church contributions include project resources of EUR 73,321.14. The project funds provided by

30

PROFIT AND LOSS ACCOUNT

UNHCR of EUR 856,068.26 are contained in Contributions by third parties, as are the project funds of Caritas International, UNICEF, the German Leprosy and Tuberculosis Relief Association (DAHW) and the Order of Malta. Income from donations and internal Malteser organisation contributions amounting to a combined total of EUR 3,419,098.68 is shown under Other operating income. Grants from fund providers which cannot be used in the current financial year (e.g. for projects that last for several years or are carried over into the next year) as well as donations which cannot be used fully in the current financial year (since a large proportion of donations is received at the end of the year) are carried over to the next year and then used. The use of these funds is shown under Income from the release of payables from investment allocations/ donations and grants not yet used (the carry-over of such funds to the following year is shown under Expenses from the transfer of payables from donations and grants not yet used).

Expenditure The items Cost of materials and Personnel expenses include a part of the project costs (e.g. costs of medicines and relief items of a combined total of EUR 4,285,733.21; payments to building contractors in rehabilitation projects; costs of international and local project personnel), but also parts of the indirect project costs and administrative costs (non project-specific personnel costs). The item Other operating expenses also includes direct project costs (e.g. structural aid and direct project support for local partners in Eastern Europe of EUR 417,111.06; freight and transport charges) as well as indirect project costs (pro rata costs of media and public relations, costs of personnel recruitment and support) and administrative costs (rent, IT). In 2004, administrative costs amounted to less than 6% of our total expenditure.

Graphics/production:

Published by:

Malteser International, Kalker Hauptstr. 22-24, D- 51103 Cologne,Telephone +49 (0)221 9822-151, Fax +49 (0)221 9822-179, [email protected] Responsible for content: Ingo Radtke Editor: Petra Ipp (editor-in-chief), Janine Hammans Layout/Setting: Alexander von Lengerke Translation: Puretrans (Glees & Purer OEG) Photographs: Malteser archive, Birgit Betzelt, Andreas Friese, Claudia Leipner, Kurt Oxenius, Ralf Pahlmann, Thilo Schmülgen, Sven Torfinn, Jochen Voigt

Malteser graphic designer team, Jörg Röhrig (director)

● Deutsche Lepra- und Tuberkulosehilfe e. V. (German Leprosy and Tuberculosis Relief Association)

plus countless other local, national and international partner organisations.

● World Child Foundation

● UNICEF (United Nations Children’s Fund)

● UNHCR (United Nations High Commissioner for Refugees)

● Renovabis

Over 800 local staff take care of our projects… GE R M A N Y

stamp

affix

Please

Kalker Hauptstraße 22-24 D- 51103 Köln

Malteser International

Around 100 experts were sent on assignment around the world…

● Päpstliches Missionswerk der Kinder (Papal Mission Organisation for Children)

eMail address

Post code, town

Street, house number

Family name, Christian name

Sender

We carried out more than 80 projects and programmes in 34 countries with a total turnover of EUR 18.6 millions…

● Centrum für Internationale Migration und Entwicklung (Centre for International Migration and Development)

● Bundesministerium für Wirtschaftliche Zusammenarbeit und Entwicklung (German Federal Department of Economic Cooperation and Development)

● Malteser Hilfsdienst e.V./diocesan and municipal entities of Malteser Germany

● KfW Entwicklungsbank (Development Bank - KfW Banking Group)

● Aktion Mensch (Action for Humanity) ● Auswärtiges Amt (Federal Foreign Office of Germany)

● European Commission – Humanitarian Office

● Archbishopric of Cologne

For their support in 2004 we want to say “thank you” to all companies, foundations, societies, schools, parishes and organisations as well as all our members, donors and sponsors that with their donations have made it possible for us to help people in need around the world. We also thank all our cooperation partners for their generous support of our work, especially:

Thank you!

Malteser Archiv

Our assistance in 2004 at a glance

Around 6 million people worldwide benefit from our programmes worldwide…

More than 110,000 donors support our work financially…

2,430 male and female volunteers of Malteser Germany foster 230 partnerships with projects and groups in Central and Eastern Europe…

In 506 missions, they have distributed over 4,200 tons of relief items…

Individual donations

Use the payment form and state the name of the country as the reference so that the donation can be used for the project area you select.

very much

p

Set up a standing order with your bank society, or issue a direct debit mandate - naturally you can cancel both at any time.

quite a lot

Regular contributations

p

Legacies and foundations

Via Malteser Germany, you can dedicate part of your estate to people who live in need and poverty, or even set up your own foundation.

Imagination

There are no limits to your imagination. Whether a company wants to donate to a project instead of sending Christmas presents to its customers, whether the staff of a company collect the cents of their salaries as a donation, whether a parish wants to get involved on behalf of needy people: you can be sure that, via Malteser Germany, your help will arrive where it is needed most.

p

not at all

Malteser International Sponsor membership Donation opportunity Will donation Setting up a foundation Active membership

not so much

p p p p p p

Please send me further information on

Family celebrations and anniversaries There are many occasions on which you might want to share your happiness with others: birthdays, weddings, company anniversaries etc. Ask your guests for a donation for a Malteser project.

information p Yes p No photos p Yes p No figures p Yes p No Ideas/comments:__________________________________________________

The Annual Report should contain more…

p

I like the Annual Report…

There are many ways to help us get our job done.

Any questions about our projects? Would you like to know more about our work? Write to us or call: Telephone +49 (0)2 21 / 98 22-151.

Or visit our website:

www.malteser-international.org ●

We have committed ourselves to observe, inter alia, the following national and international codes and standards: ● The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response ● The Code of Conduct: Principles of Conduct for the International Red Cross and Red Crescent Movement and ● NGOs in Disaster Response Programmes ● Principles for the International Work of the German Caritas Association Code of Conduct to protect children and young people from abuse and sexual exploitation (Caritas Internationalis)

Malteser Germany is a member in the following networks and associations, among others: ● Aktion Deutschland Hilft (ADH) (Action Campaign Germany Helps) ● Aktionsbündnis gegen AIDS (Action Against AIDS Alliance) ● Arbeitskreis Medizinische Entwicklungshilfe (AKME) ) (Working Group on Medical Development Aid) ● Koordinierungsausschuss Humanitäre Hilfe (KAHH) (Coordinating Committee for Humanitarian Relief) ● Katholischer Arbeitskreis Not- und Katastrophenhilfe (KANK) (Catholic Working Group on Emergency and Disaster Relief) ● People in Aid ● Verband Entwicklungspolitik Deutscher Nicht-Regierungs-Organisationen (VENRO) (National Association of German Non-Governmental Organisations for Development Policy) Voluntary Organisations in Cooperation in Emergencies (VOICE) ●

Questions?