a genocide with doctors" to the media, and the controversial opération turquoise followed less than one month later. this intervention directly or indirectly resulted in movements of hundreds of thousands of rwandan refugees to zaire and tanzania in what became known as the great lakes refugee crisis, and subsequent cholera epidemics, starvation and more mass killings in the large groups of civilians. msf-france returned to the area and provided medical aid to refugees in goma. at the time of the genocide, competition between the medical efforts of msf, the icrc, and other aid groups had reached an all-time high, but the conditions in rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. the code of conduct for the international red cross and red crescent movement and ngos in disaster relief programmes was created by the icrc in 1994 to provide a framework for humanitarian missions and msf is a signatory of this code. the code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments. msf has since still found it necessary to condemn the actions of governments, such as in chechnya in 1999, but has not demanded another military intervention since then. 2020 accusations of racism more than a thousand staffers accused the charity of white supremacy when they voiced their concerns in a 2020 petition. one staffer from cameroon detailed her experiences with racism from the group's leaders. many concerns involved different treatment of expatriate staff from europe and north america, who are typically white, compared to national staff. in an interview with npr, the president of the organisation acknowledged doctors without borders was founded in racism and pledged to do better. response to political changes msf issued a statement for safe abortion following dobbs v. jackson women's health organization. activities by location countries where msf had missions in 2015 in 1999, the organisation spoke out about the lack of humanitarian support in kosovo and chechnya, having set up field missions to help civilians affected by the respective political situations. although msf had worked in the kosovo region since 1993, the onset of the kosovo war prompted the movement of tens of thousands of refugees, and a decline in suitable living conditions. msf provided shelter, water and health care to civilians affected by nato's strategic bombing campaigns. a serious crisis within msf erupted in connection with the organisation's work in kosovo when the greek section of msf was expelled from the organisation. the greek msf section had gained access to serbia at the cost of accepting serb government imposed limits on where it could go and what it could see – terms that the rest of the msf movement had refused. a non-msf source alleged that the exclusion of the greek section happened because its members extended aid to both albanian and serbian civilians in pristina during nato's bombing. the rift was healed only in 2005 with the re-admission of the greek section to msf. a similar situation was found in chechnya, whose civilian population was largely forced from their homes into unhealthy conditions and subjected to the violence of the second chechen war. msf has been working in haiti since 1991, but since president jean-bertrand aristide was forced from power, the country has seen a large increase in civilian attacks and rape by armed groups. in addition to providing surgical and psychological support in existing hospitals – offering the only free surgery available in port-au-prince – field missions have been set up to rebuild water and waste management systems and treat survivors of major flooding caused by hurricane jeanne; patients with hiv/aids and malaria, both of which are widespread in the country, also receive better treatment and monitoring. as a result of 12 january 2010 haiti earthquake, reports from haiti indicated that all three of the organisation's hospitals had been severely damaged; one collapsing completely and the other two having to be abandoned. following the quake, msf sent about nine planes loaded with medical equipment and a field hospital to help treat the victims. however, the landings of some of the planes had to be delayed due to the massive number of humanitarian and military flights coming in. the kashmir conflict in northern india resulted in a more recent msf intervention (the first field mission was set up in 1999) to help civilians displaced by fighting in jammu and kashmir, as well as in manipur. psychological support is a major target of missions, but teams have also set up programmes to treat tuberculosis, hiv/aids and malaria. mental health support has been of significant importance for msf in much of southern asia since the 2004 indian ocean earthquake. msf went through a long process of self-examination and discussion in 2005–2006. many issues were debated, including the treatment of "nationals" as well as "fair employment" and self-criticism. sub-saharan africa further information: aids in africa an msf outpost in darfur (2005) msf has been active in a large number of african countries for decades, sometimes serving as the sole provider of health care, food, and water. although msf has consistently attempted to increase media coverage of the situation in africa to increase international support, long-term field missions are still necessary. treating and educating the public about hiv/aids in sub-saharan africa, which sees the most deaths and cases of the disease in the world, is a major task for volunteers. of the 14.6 million people in need of anti-retroviral treatment the who estimated that only 5.25 million people were receiving it in developing countries, and msf continues to urge governments and companies to increase research and development into hiv/aids treatments to decrease cost and increase availability. sierra leone in the late 1990s, msf missions were set up to treat tuberculosis and anaemia in residents of the aral sea area, and look after civilians affected by drug-resistant disease, famine, and epidemics of cholera and aids. they vaccinated 3 million nigerians against meningitis during an epidemic in 1996 and denounced the taliban's neglect of health care for women in 1997. arguably, the most significant country in which msf set up field missions in the late 1990s was sierra leone, which was involved in a civil war at the time. in 1998, volunteers began assisting in surgeries in freetown to help with an increasing number of amputees, and collecting statistics on civilians (men, women and children) being attacked by large groups of men claiming to represent ecomog. the groups of men were travelling between villages and systematically chopping off one or both of each resident's arms, raping women, gunning down families, razing houses, and forcing survivors to leave the area. long-term projects following the end of the civil war included psychological support and phantom limb pain management. sudan since 1979, msf has been providing medical humanitarian assistance in sudan, a nation plagued by starvation and the civil war, prevalent malnutrition and one of the highest maternal mortality rates in the world. in march 2009, it is reported that msf has employed 4,590 field staff in sudan tackling issues such as armed conflicts, epidemic diseases, health care and social exclusion. msf's continued presence and work in sudan is one of the organisation's largest interventions. msf provides a range of health care services including nutritional support, reproductive healthcare, kala-azar treatment, counselling services and surgery to the people living in sudan. common diseases prevalent in sudan include tuberculosis, kala-azar also known as visceral leishmaniasis, meningitis, measles, cholera, and malaria. kala-azar in sudan kala-azar, also known as visceral leishmaniasis, has been one of the major health problems in sudan. after the comprehensive peace agreement between north and southern sudan on 9 january 2005, the increase in stability within the region helped further efforts in healthcare delivery. médicins sans frontières tested a combination of sodium stibogluconate and paromomycin, which would reduce treatment duration (from 30 to 17 days) and cost in 2008. in march 2010, msf set up its first kala-azar treatment centre in eastern sudan, providing free treatment for this otherwise deadly disease. if left untreated, there is a fatality rate of 99% within 1–4 months of infection. since the treatment centre was set up, msf has cured more than 27,000 kala-azar patients with a success rate of approximately 90–95%. there are plans to open an additional kala-azar treatment centre in malakal, southern sudan, to cope with the overwhelming number of patients that are seeking treatment. msf has been providing necessary medical supplies to hospitals and training sudanese health professionals to help them deal with kala-azar. msf, sudanese ministry of health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of kala-azar. research on its cures and vaccines are currently being conducted. in december 2010, south sudan was hit with the worst outbreak of kala-azar in eight years. the number of patients seeking treatment increased eight-fold as compared to the year before. health care infrastructure in sudan sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between north sudan and south sudan. msf medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations. the situation of poor infrastructure in the south was aggravated by the civil war and resulted in the worsening of the region's appalling health indicators. an estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth. malnutrition and disease outbreaks are perennial concerns as well. in 2011, msf clinic in jonglei state, south sudan, was looted and attacked by raiders. hundreds, including women and children were killed. valuable items including medical equipment and drugs were lost during the raid and parts of the msf facilities were destroyed in a fire. the incident had serious repercussions as msf is the only primary health care provider in this part of jonglei state. democratic republic of the congo although active in the congo region of africa since 1985, the first and second congo war brought increased violence and instability to the area. msf has had to evacuate its teams from areas such as around bunia, in the ituri district due to extreme violence, but continues to work in other areas to provide food to tens of thousands of displaced civilians, as well as treat survivors of mass rapes and widespread fighting. the treatment and possible vaccination against diseases such as cholera, measles, polio, marburg fever, sleeping sickness, hiv/aids, and bubonic plague is also important to prevent or slow down epidemics. uganda msf has been active in uganda since 1980, and provided relief to civilians during the country's guerrilla war during the second obote period. however, the formation of the lord's resistance army saw the beginning of a long campaign of violence in northern uganda and southern sudan. civilians were subjected to mass killings and rapes, torture, and abductions of children, who would later serve as sex slaves or child soldiers. faced with more than 1.5 million people displaced from their homes, msf set up relief programmes in internally displaced person (idp) camps to provide clean water, food and sanitation. diseases such as tuberculosis, measles, polio, cholera, ebola, and hiv/aids occur in epidemics in the country, and volunteers provide vaccinations (in the cases of measles and polio) and/or treatment to the residents. mental health is also an important aspect of medical treatment for msf teams in uganda since most people refuse to leave the idp camps for constant fear of being attacked. ivory coast msf first camp set up a field mission in côte d'ivoire in 1990, but ongoing violence and the 2002 division of the country by rebel groups and the government led to several massacres, and msf teams have even begun to suspect that an ethnic cleansing is occurring. mass measles vaccinations, tuberculosis treatment and the re-opening of hospitals closed by fighting are projects run by msf, which is the only group providing aid in much of the country. msf has strongly promoted the use of contraception in africa. west african ebola outbreak a médecins sans frontières staff member adjusts dr. joel montgomery, team lead for cdc's ebola response team in liberia, goggles before montgomery