up therapeutic feeding centres for monitoring the children and any other malnourished individuals. a therapeutic feeding centre (or therapeutic feeding programme) is designed to treat severe malnutrition through the gradual introduction of a special diet intended to promote weight gain after the individual has been treated for other health problems. the treatment programme is split between two phases: phase 1 lasts for 24 hours and involves basic health care and several small meals of low energy/protein food spaced over the day. phase 2 involves monitoring of the patient and several small meals of high energy/protein food spaced over each day until the individual's weight approaches normal. msf uses foods designed specifically for treatment of severe malnutrition. during phase 1, a type of therapeutic milk called f-75 is fed to patients. f-75 is a relatively low energy, low fat/protein milk powder that must be mixed with water and given to patients to prepare their bodies for phase 2. during phase 2, therapeutic milk called f-100, which is higher in energy/fat/protein content than f-75, is given to patients, usually along with a peanut butter mixture called plumpy'nut. f-100 and plumpy'nut are designed to quickly provide large amounts of nutrients so that patients can be treated efficiently. other special food fed to populations in danger of starvation includes enriched flour and porridge, as well as a high protein biscuit called bp5. bp5 is a popular food for treating populations because it can be distributed easily and sent home with individuals, or it can be crushed and mixed with therapeutic milk for specific treatments. dehydration, sometimes due to diarrhoea or cholera, may also be present in a population, and msf set up rehydration centres to combat this. a special solution called oral rehydration solution (ors), which contains glucose and electrolytes, is given to patients to replace fluids lost. antibiotics are also sometimes given to individuals with diarrhoea if it is known that they have cholera or dysentery. water and sanitation clean water is essential for hygiene, for consumption and for feeding programmes (for mixing with powdered therapeutic milk or porridge), as well as for preventing the spread of water-borne disease. as such, msf water engineers and volunteers must create a source of clean water. this is usually achieved by modifying an existing water well, by digging a new well and/or starting a water treatment project to obtain clean water for a population. water treatment in these situations may consist of storage sedimentation, filtration and/or chlorination depending on available resources. sanitation is an essential part of field missions, and it may include education of local medical staff in proper sterilisation techniques, sewage treatment projects, proper waste disposal, and education of the population in personal hygiene. proper wastewater treatment and water sanitation are the best way to prevent the spread of serious water-borne diseases, such as cholera. simple wastewater treatment systems can be set up by volunteers to protect drinking water from contamination. garbage disposal could include pits for normal waste and incineration for medical waste. however, the most important subject in sanitation is the education of the local population, so that proper waste and water treatment can continue once msf has left the area. statistics in order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, data on a number of factors are collected during each field mission. the rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres. various types of mortality rates are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries. by compiling data on the frequency of diseases in hospitals, msf can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs. for example, the "meningitis belt" (sub-saharan africa, which sees the most cases of meningitis in the world) has been "mapped" and the meningitis season occurs between december and june. shifts in the location of the belt and the timing of the season can be predicted using cumulative data over many years. in addition to epidemiological surveys, msf also uses population surveys to determine the rates of violence in various regions. by estimating the scopes of massacres, and determining the rate of kidnappings, rapes, and killings, psychosocial programmes can be implemented to lower the suicide rate and increase the sense of security in a population. large-scale forced migrations, excessive civilian casualties and massacres can be quantified using surveys, and msf can use the results to put pressure on governments to provide help, or even expose genocide. msf conducted the first comprehensive mortality survey in darfur in 2004. however, there may be ethical problems in collecting these statistics. innovation and use of technology in 2014 msf partnered with satellite operator ses, other ngos archemed, fondation follereau, friendship luxembourg and german doctors, and the luxembourg government in the pilot phase of satmed, a project to use satellite broadband technology to bring ehealth and telemedicine to isolated areas of developing countries. satmed was first deployed in sierra leone in support of the fight against ebola. governance and structure list of international presidents: 1991–1992 rony brauman 1992 reginald moreels 1992–1994 rony brauman 1994–1995 jacques de milliano 1995–1996 doris schopper 1996–1997 philippe biberson 1997–1998 doris schopper 1998–2000 james orbinski 2000–2003 morten rostrup 2004–2006 rowan gillies 2006–2010 christophe fournier 2010–2013 unni karunakara 2013–2019 joanne liu 2019–present christos christou in addition to the geneva global headquarters and five regional operational centers, as of 2020 msf had national offices as follows: msf australia msf austria msf belgium msf brazil msf canada msf czech republic msf denmark msf eastern africa msf finland msf france msf germany msf greece msf hong kong msf ireland msf italy msf japan msf republic of korea msf lat (spanish speaking south america) msf luxembourg msf mexico msf netherlands msf norway msf south africa msf sara (south asia regional association: india, pakistan, afghanistan, sri lanka, bangladesh) msf spain msf sweden msf switzerland msf taiwan msf united kingdom msf united states in-house organisations epicentre in 1986, msf created epicentre, an in-house research organisation, to support its activities. epicentre conducts training, publishes scientific papers and develops new techniques for msf. it performs epidemiological research, conducts clinical vaccine trials during outbreaks msf is responding to, experiments on vaccine stability, and analysis of vaccine deployment strategy. campaign for access to essential medicines main article: campaign for access to essential medicines the campaign for access to essential medicines was initiated in 1999 to increase access to essential medicines in developing countries. "essential medicines" are those drugs that are needed in sufficient supply to treat a disease common to a population. however, most diseases common to populations in developing countries are no longer common to populations in developed countries; therefore, pharmaceutical companies find that producing these drugs is no longer profitable and may raise the price per treatment, decrease development of the drug (and new treatments) or even stop production of the drug. msf often lacks effective drugs during field missions, and started the campaign to put pressure on governments and pharmaceutical companies to increase funding for essential medicines. in 2006, msf tried to use its influence to urge the drug maker novartis to drop its case against india's patent law that prevents novartis from patenting its drugs in india. a few years earlier, novartis also sued south africa to prevent it from importing cheaper aids drugs. on 1 april 2013, it was announced that the indian court invalidated novartis's patent on imatinib (gleevec). this decision makes the drug available via generics on the indian market at a considerably lower price. in march 2017, els torreele who had been leading the campaign from 1999 to 2003 returned to msf as the executive director of the access campaign. for the following three years she led a global analysis and advocacy team whose goal was to guarantee that appropriate medicines, vaccines and diagnostics are developed, available, affordable and adapted to people's needs. as of 2022, the most critical subjects of the campaign were rising antimicrobial resistance and outbreaks of epidemic diseases such as ebola and covid. still, a lot of vaccines, diagnostics and medicines were inaccessible for people in need. security risks to staff msf staff are sometimes attacked or kidnapped. in some countries, humanitarian-aid organisations are viewed as helping the enemy. if an aid mission is perceived to be exclusively set up for victims on one side of the conflict, it may come under attack. however, the war on terrorism has generated attitudes among some groups in us-occupied countries that non-governmental aid organisations such as msf are allied with or even work for the coalition forces. insecurity in cities in afghanistan and iraq rose significantly following united states operations, and msf has declared that providing aid in these countries was too dangerous. the organisation was forced to evacuate its teams from afghanistan on 28 july 2004, after five staff (afghans fasil ahmad and besmillah, belgian hélène de beir, norwegian egil tynæs, and dutchman willem kwint) were killed on 2 june in an ambush by unidentified militia near khair khāna in badghis province. in june 2007, elsa serfass, a staff member with msf-france, was killed in the central african republic and in january 2008, two expatriate staff (damien lehalle and victor okumu) and a national staff member (mohammed bidhaan ali) were killed in an organised attack in somalia resulting in the closing of the project. arrests and abductions in politically unstable regions can also occur for volunteers, and in some cases, msf field missions can be expelled entirely from a country. arjan erkel, head of mission in dagestan in the north caucasus, was kidnapped and held hostage in an unknown location by unknown abductors from 12 august 2002 until 11 april 2004. paul foreman, head of msf-holland, was arrested in sudan in may 2005 for refusing to divulge documents used in compiling a report on rapes carried out by the pro-government janjaweed militias (see darfur conflict). foreman cited the privacy of the women involved, and msf alleged that the sudanese government had arrested him because it disliked the bad publicity generated by the report. incidents below is a partial list of notable incidents of direct violence against msf staff or facilities, in chronological order: 14 august 2013: msf announced that it was closing all of its programmes in somalia due to attacks on its staff by al-shabaab militants and perceived indifference or inurement to this by the governmental authorities and wider society. 3 october 2015: fourteen staff and 28 others died when an msf hospital was bombed by american forces during the battle of kunduz. on 7 october 2015, us president barack obama issued an apology. doctors without borders was not satisfied by obama's apology. 27 october 2015: an msf hospital in sa'dah, yemen, was bombed by the saudi arabia-led military coalition. 28 november 2015: an msf-supported hospital was barrel-bombed by a syrian air force helicopter, killing seven and wounding forty-seven people near homs, syria. 10 january 2016: an msf-supported hospital in sa'dah was bombed by the saudi arabia-led military coalition, killing six people. 15 february 2016: two msf-supported hospitals in idlib district and aleppo, syria, were bombed, killing at least 20 and injuring dozens of patients and medical personnel. both russia and the united states denied responsibility or being in the area at the time. 28 april 2016: an msf hospital in aleppo was bombed, killing 50, including six staff and patients. 12 may 2020: an msf-supported hospital in dasht-e-barchi, kabul, afghanistan, was attacked by an unknown assailant. the attack left 24 people dead and at least 20 more injured. 25 june 2021: three msf employees were reported killed in tigray, ethiopia. awards 1999 nobel peace prize james orbinski speaking about msf in 2015 the then president of msf, james orbinski, gave the nobel peace prize speech on behalf of the organisation. in the opening, he discusses the conditions of the victims of the rwandan genocide and focuses on one of his woman patients: there were hundreds of women, children and men brought to the hospital that day, so many that we had to lay them out