enters the ebola treatment unit (etu), elwa 3. msf operates the elwa 3 etu, which opened on august 17. during the ebola outbreak in west africa in 2014, msf met serious medical demands largely on its own, after the organisation's early warnings were largely ignored. burundi msf-burundi has aided in attending to casualties suffered in the 2019 burundi landslides. sri lanka msf is involved in sri lanka, where a 26-year civil war ended in 2009 and msf has adapted its activities there to continue its mission. for example, it helps with physical therapy for patients with spinal cord injuries. it conducts counseling sessions, and has set up an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries". cambodia msf first provided medical help to civilians and refugees who have escaped to camps along the thai-cambodian border in 1979. due to long decades of war, a proper health care system in the country was severely lacking and msf moved inland in 1989 to help restructure basic medical facilities. in 1999, cambodia was hit with a malaria epidemic. the situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic. this has prompted efforts by msf to set up and fund a malaria outreach project and utilise village malaria workers. msf also introduced a switching of first-line treatment to a combination therapy (artesunate and mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally. cambodia is one of the hardest hit hiv/aids countries in southeast asia. in 2001, msf started introducing antiretroviral (arv) therapy to aids patients for free. this therapy prolongs the patients' lives and is a long-term treatment. in 2002, msf established chronic diseases clinics with the cambodian ministry of health in various provinces to integrate hiv/aids treatment, alongside hypertension, diabetes, and arthritis which have high prevalence rate. this aims to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic in contrast to a hiv/aids specialised treatment centre. msf also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people. msf introduced a community-based tuberculosis programme in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. in partnership with local health authorities and other ngos, msf encouraged decentralized clinics and rendered localized treatments to more rural areas from 2006. since 2007, msf has extended general health care, counselling, hiv/aids and tb treatment to prisons in phnom penh via mobile clinics. however, poor sanitation and lack of health care still prevails in most cambodian prisons as they remain as some of the world's most crowded prisons. in 2007, msf worked with the cambodian ministry of health to provide psychosocial and technical support in offering pediatric hiv/aids treatment to affected children. msf also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007, which had more than 40,000 people hospitalized, killing 407 people, primarily children. in 2010, southern and eastern provinces of cambodia were hit with a cholera epidemic and msf responded by providing medical support that were adapted for usage in the country. cambodia is one of 22 countries listed by who as having a high burden of tuberculosis. who estimates that 64% of all cambodians carry the tuberculosis mycobacterium. hence, msf has since shifted its focus away from hiv/aids to tuberculosis, handing over most hiv-related programs to local health authorities. libya the 2011 libyan civil war has prompted efforts by msf to set up a hospital and mental health services to help locals affected by the conflict. the fighting created a backlog of patients that needed surgery. with parts of the country slowly returning to livable, msf has started working with local health personnel to address the needs. the need for psychological counseling has increased and msf has set up mental health services to address the fears and stress of people living in tents without water and electricity. currently msf is the only international aid organisation with actual presence in the country. search and rescue in the mediterranean sea msf is providing maritime search and rescue (sar) services on the mediterranean sea to save the lives of migrants attempting to cross with unseaworthy boats. the mission started in 2015 after the eu ended its major sar operation mare nostrum severely diminishing much needed sar capacities in the mediterranean. throughout the mission msf has operated its own vessels like the bourbon argos (2015–2016), dignity 1 (2015–2016) and vos prudence (2016–2017). msf has also provided medical teams to support other ngos and their ships like the moas phoenix (2015) or the aquarius (2017–2018) and ocean viking (2019–2020) with sos méditerranée and mediterranea saving humans. in august 2017 msf decided to suspend the activities of the vos prudence protesting restrictions and threats by the libyan "coast guard". in december 2018 msf and sos méditerranée were forced to end operations of the aquarius, at that date the last remaining vessel supported by msf. this came after attacks by eu states that stripped the vessel of its registration and produced criminal accusations against msf. up to then 80,000 people had been rescued or assisted since the beginning of the mission. operations resumed with ocean viking in july 2019, but the ship was seized in sicily in july 2020. in may 2021, msf returned to refugee rescue operations in the mediterranean with a new vessel, the geo barents. within a month this resulted in the rescue of some 400 people. yemen msf is involved in trying to help with the humanitarian crisis caused by the yemeni civil war. the organisation operates eleven hospitals and health centres in yemen and provides support to another 18 hospitals or health centres. according to msf, since october 2015, four of its hospitals and one ambulance have been destroyed by saudi-led coalition airstrikes. in august 2016, an airstrike on abs hospital killed 19 people, including one msf staff member, and wounded 24. according to msf, the gps coordinates of the hospital were repeatedly shared with all parties to the conflict, including the saudi-led coalition, and its location was well-known. the netherlands in august and september 2022, msf provided medical care to asylum seekers staying outside the overcrowded migration centre in ter apel, the netherlands. organisation of activities before a field mission is established in a country, an msf team visits the area to determine the nature of the humanitarian emergency, the level of safety in the area and what type of aid is needed (this is called an "exploratory mission"). medical aid is the main objective of most missions, although some missions help in such areas as water purification and nutrition. field mission team msf logistician in nigeria showing plans a field mission team usually consists of a small number of coordinators to head each component of a field mission, and a "head of mission". the head of mission usually has the most experience in humanitarian situations of the members of the team, and it is their job to deal with the media, national governments and other humanitarian organisations. the head of mission does not necessarily have a medical background. medical volunteers include physicians, surgeons, nurses, and various other specialists. in addition to operating the medical and nutrition components of the field mission, these volunteers are sometimes in charge of a group of local medical staff and provide training for them. although the medical volunteers almost always receive the most media attention when the world becomes aware of an msf field mission, there are a number of non-medical volunteers who help keep the field mission functioning. logisticians are responsible for providing everything that the medical component of a mission needs, ranging from security and vehicle maintenance to food and electricity supplies. they may be engineers and/or foremen, but they usually also help with setting up treatment centres and supervising local staff. other non-medical staff are water/sanitation specialists, who are usually experienced engineers in the fields of water treatment and management and financial/administration/human resources experts who are placed with field missions. medical component doctors from msf and the american cdc put on protective gear before entering an ebola treatment ward in liberia, august 2014. vaccination campaigns are a major part of the medical care provided during msf missions. diseases such as diphtheria, measles, meningitis, tetanus, pertussis, yellow fever, polio, and cholera, all of which are uncommon in developed countries, may be prevented with vaccination. some of these diseases, such as cholera and measles, spread rapidly in large populations living in close proximity, such as in a refugee camp, and people must be immunised by the hundreds or thousands in a short period of time. for example, in beira, mozambique, in 2004, an experimental cholera vaccine was received twice by approximately 50,000 residents in about one month. an equally important part of the medical care provided during msf missions is aids treatment (with antiretroviral drugs), aids testing, and education. msf is the only source of treatment for many countries in africa, whose citizens make up the majority of people with hiv and aids worldwide. because antiretroviral drugs (arvs) are not readily available, msf usually provides treatment for opportunistic infections and educates the public on how to slow transmission of the disease. in most countries, msf increases the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff. when the local staff is overwhelmed, msf may open new specialised clinics for treatment of an endemic disease or surgery for victims of war. international staff start these clinics but msf strives to increase the local staff's ability to run the clinics themselves through training and supervision. in some countries, like nicaragua, msf provides public education to increase awareness of reproductive health care and venereal disease. since most of the areas that require field missions have been affected by a natural disaster, civil war, or endemic disease, the residents usually require psychological support as well. although the presence of an msf medical team may decrease stress somewhat among survivors, often a team of psychologists or psychiatrists help people who have depression, survivors of domestic violence and those with substance use disorder. the doctors may also train local mental health staff. such cases include palestinian refugee camps, where long-term displacement and geopolitical circumstances have left many residents without long-term purpose or clear strategies for action. humanitarian actors, like médecins sans frontières, have sometimes responded by proferring coping skills to residents as a humanitarian aim and outcome. in the late 2000s, médecins sans frontières launched a mental health program in burj al barajneh camp in lebanon, providing sexual and reproductive health services, mental health support, and health promotion activities. nutrition often in situations where an msf mission is set up, there is moderate or severe malnutrition as a result of war, drought, or government economic mismanagement. intentional starvation is also sometimes used during a war as a weapon, and msf, in addition to providing food, brings awareness to the situation and insists on foreign government intervention. infectious diseases and diarrhoea, both of which cause weight loss and weakening of a person's body (especially in children), must be treated with medication and proper nutrition to prevent further infections and weight loss. a combination of the above situations, as when a civil war is fought during times of drought and infectious disease outbreaks, can create famine. an msf health worker examines a malnourished child in ethiopia, july 2011. in emergency situations where there is a lack of nutritious food, but not to the level of a true famine, protein-energy malnutrition is most common among young children. marasmus, a form of calorie deficiency, is the most common form of childhood malnutrition and is characterised by severe wasting and often fatal weakening of the immune system. kwashiorkor, a form of calorie and protein deficiency, is a more serious type of malnutrition in young children, and can negatively affect physical and mental development. both types of malnutrition can make opportunistic infections fatal. in these situations, msf sets