Q&A on Sustainable Development Goals (SDGs) 2016-2030

Sustainable Development Goals (SDGs) 2016-2030

“Leave no one behind” Without real action, it’s just a slogan.
 

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    What are the SDGs? The Sustainable Development Goals (SDGs) is the next blueprint relating to international development. They set out a vision for the future in which a number of global issues, including health, are tackled over the next 15 years. The SDGs replace the Millennium Development Goals (MDGs) once those expire at the end of 2015. World leaders representing the 193 UN Member States will adopt the SDGs in New York at a special UN Summit (Sept. 25-27). hide

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    Why are the SDGs important, including for MSF? The SDGs are important because, for the next 15 years, governments, policy makers, international institutions, funders, NGOs, civil society groups and the private sector will set their priorities and agenda and frame their political policies and action plans based on the SDG framework. Therefore, people’s health, lives and livelihood will depend on the future approaches, funding and actions framed by the SDG goals and targets. For MSF, the SDGs are important because they impact the people we are assisting, the environment in which we work, and the response and health gaps we see. This is particularly true for the poorest, most vulnerable and the marginalised. There is a real concern that the gap between policy rhetoric and reality will increase in the post-2015 environment with a shrinking Official Development Assistance (ODA) funding envelope having to meet more, rather than fewer demands. This risks creating or exacerbating gaps in existing healthcare services and detracting from a proper appraisal of health needs to optimise access and making sure the right people are reached at the right time. Our teams in the field will feel the knock-on effect of these processes. With health staff remaining unpaid, drug stock-outs and community-based programmes closing, MSF might find itself increasingly filling gaps. hide

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    What SDG goals and targets are related to global health? Requirements SDG3, the health goal aims to “Ensure healthy lives and promote wellbeing for all at all ages.” The targets aim by 2030 to reduce mother and infant deaths; end epidemics such as HIV/AIDS, tuberculosis, malaria and other communicable diseases; reduce mortality from non-communicable diseases; guarantee broader access to healthcare, vaccines and medicines; and reinforce the capacity to tackle emergencies, to name but a few. Other SDGs have health-related targets, including: Goal 2, hunger: The target aims to end malnutrition in children and provide nutrition to adolescent girls,and pregnant and lactating mothers. Goal 5, gender equality: The target aims to ensure access to sexual and reproductive health and reproductive rights. Goal 6, water and sanitation: The target aims to provide adequate and equitable sanitation and hygiene for all. Goal 10, country inequality: The target aims to facilitate safe, regular and responsible migration. hide

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    Were the MDGs achieved? What are the shortcomings of the forthcoming SDGs? (See malaria, TB, HIV). With a major emphasis on health (three health goals out of eight), the MDGs galvanised international attention, commitment, resources and actions to save lives and alleviate suffering. New funding sources such as Global Fund, Gavi and PEPFAR raised health funding to unprecedented levels and provided additional funds to tackle the main killer diseases, by including support for health services’ recurrent costs such as medicines and remuneration of health staff, and for innovative strategies in delivering healthcare. Many civil society groups partnered with global health agencies to tackle stigma, obstructive policies and laws, rolling out necessary community-based care and monitoring effective delivery of care. This push resulted in visible progress in improving people’s health. Nevertheless, the fragile health gains of the past 15 years risk being lost unless proven approaches and flexible alternatives that accelerate progress are enhanced. Furthermore, important health gaps continue to destroy lives and cripple communities. While the aspirations of the SDGs are commendable, they lack a concrete plan to accelerate progress and address gaps. The goals stand in stark contrast to the current structural gaps and weaknesses in the global health response:   Health is rarely considered central to development policies, agendas and action plans. Governments are barely held accountable when they pledge funds to the health sector and health assistance. Structural shortfalls in human resources and health systems, with financial constraints, undermine timely reaction to emerging or recurring outbreaks. Surveillance through health facilities is hampered by patients not seeking care due to barriers to health such as user fees, or stock-outs of medicines. The lack of contingency plans and stocks causes severe delays in detection and response of outbreaks. Action to incorporate people’s health needs into core planning of development interventions, with particular attention paid to existing inequities in health access and outcomes as well as national and sub-national disease burden, is still largely absent in most countries, while it never started in others. Surveillance, preparation, alert and response to disease outbreaks must be tailored to the local needs and what is actually happening in a country. Hands-on support and presence, including in challenging contexts, to provide live- saving aid, in particular to the most vulnerable people, is also key. Development with improved and sustained health status should be a pre-requisite for human and economic development, not just an outcome of a country’s economic growth. Health is a necessity not a commodity. Concrete and swift action plans based on needs, priorities, science and best practices for people can make a difference.   hide

Reality check on some SDG health targets:

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  Malaria Considerable achievements have been made in malaria control over the past decades: some countries in Asia and Latin America have substantially reduced the malaria burden, or are working towards malaria (pre-) elimination (Cambodia, Thailand, Ecuador, Costa Rica). Despite this success, a number of high burden countries have not yet managed to bring malaria under control. In Sub-Saharan Africa (which accounts for 80% of the malaria cases and 90% of the malaria deaths worldwide; WHO 2013), MSF – whose teams treated over 2 million malaria patients in 2014 – has observed a gradual increase in the number of people suffering from malaria over the last years in some regions of the Democratic Republic of Congo, South Sudan and Central African Republic, and there have been recurrent outbreaks of the disease. In these countries, ending the malaria epidemic by 2030 seems very ambitious and maybe even unrealistic, unless there is a massive shift in the current global response. What is needed is an increase in existing, effective tools for case management (rapid diagnostic tests and artemisinin-based treatments) and prevention (long-lasting insecticide treated nets). The coverage is extremely low in some high burden countries. Sufficient funding, an uninterrupted supply of commodities and significantly reduced financial barriers to care should be secured to guarantee universal access to prevention and treatment. The increase in international funding has slowed (it was at 4% per year between 2009 and 2013, compared to an average of 43% per year between 2005 and 2009). It is estimated that about US$5.1 billion per year is needed for malaria control, whereas less than US$3 billion is available, leaving a gap of over US$2 billion (WHO 2013). In addition, new preventive and curative tools are urgently needed, such as an effective malaria vaccine and antimalarials as some lose efficacy, or the implementation of innovative preventive pharmaceutical interventions (for example, Seasonal Malaria Chemoprophylaxis –SMC- is recommended and implemented in the Sahel-region. This intervention is quite successfull, but threatened by possible decreasing efficacy of the antimalarials used). Additionally, the development of resistance to artemisinins – documented in the Greater Mekong sub-region and related to the use of monotherapies or poor quality drugs – and the possible spread to the rest of Asia and Africa, in combination with the development of resistance to insecticides, poses a serious threat to future malaria control. hide

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  Tuberculosis (TB) TB incidence and mortality rates from continue to fall, though slowly, which means that the world is on track to achieve the Millennium Development Goal to reverse the spread of TB by 2015. Yet, this success is not uniform across all countries and TB remains a leading killer. Over 95% of TB deaths occur in low- and middle-income countries. In recent years there has been a resurgence of the disease in people also infected with HIV, and 9 million people fell ill with TB in 2013 and an estimated 1.1 million HIV-negative people and 360,000 HIV-positive people died from the disease in 2013 (WHO data). The number of people suffering from the drug-resistant strains of the disease is increasing alarmingly. TB causes one fourth of all HIV-related deaths, and an estimated 480,000 people developed multi-drug resistant TB (MDR-TB) in 2013. Action to reverse course is urgent. As an organisation struggling to treat people with drug-resistant TB in more than 20 countries, MSF shared the excitement when the first new TB drug in half a century (bedaquiline) was approved for use at the end of 2012. However, three years down the line, the stark reality is that the majority of patients are still facing the same dismal outcomes that MSF has been witnessing for decades. To date, around 1,000 people worldwide have been able to access bedaquiline as well as to another new TB drug (delamanid) – just a fraction of those who desperately need them. (For more, see: https://www.msfaccess.org/content/ready-set-slow-down) Key data of concern: Certain countries report a significant increase in the spread of person to person DR-TB, with some now reporting up to 35% of new cases as MDR-TB Extensively drug-resistant TB (XDR-TB) is also on the rise within areas of the former Soviet Union, where it accounts for an estimated 20% of DR-TB cases Despite an increase in confirmed diagnoses of MDR-TB, it is estimated that globally only one in five people with MDR-TB receive proper treatment; the number of people left untreated is increasing annually If the SDG targets are to be reached, we must act now. Simple and rapid steps can be taken to progress towards these targets, including by ensuring governments have both the technical support and guidance necessary to start providing treatment to people who need it. Drug companies should also allow broad and early access to these drugs through compassionate use mechanisms, and rapidly register their products widely (especially in countries where clinical trials have been conducted and in countries where large numbers of people are living with TB). Companies should have transparent and fair policies for pricing, registration and licensing, particularly for populations with high disease burdens living in low- and middle-income countries.   hide

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  HIV/AIDS The global scale-up of access to antiretroviral (ARV) therapy over the past decade has been one of the most dramatic and successful public health interventions of the Millennium Development Goals (MDG) era, and, together with improvements in treatment efficacy, has dramatically reduced AIDS mortality rates. Important steps have been made to expand access to, and quality of, HIV treatment in resource-limited settings. As a result, record numbers of people on ARV therapy are living with HIV (PLHIV), and there were 15 million people on ARVs in March 2015. Of those, 11.1 million (or three out of every four) people receiving ARVs are living in sub-Saharan Africa, where the need is the most acute (data from UNAIDS report on MDG6, 2015). Recent years have also seen significant advances in the science of using ARVs to fight HIV. Where not long ago ARVs were used late in disease progression to prevent sick people from dying, today people living with HIV can effectively lead a healthy life and prevent transmission through early initiation of ARV therapy. Mounting evidence shows that early suppression provides major clinical benefits and prevents HIV transmission. The World Health Organization (WHO) will issue new HIV treatment guidelines later in 2015, recommending treatment for everyone living with HIV, regardless of CD4 count (the “test and treat” approach). Some of the greatest gains in global health during the last 15 years can be attributed to initiatives such as The Global Fund to fight Aids, Tuberculosis and Malaria. The Global Fund, with its well-focused goals and multi-stakeholder governance mechanisms, created results-orientated funding that prioritised effectiveness, improved health outcomes and positively influenced national and international policies. Importantly, its inclusion of civil society as a national “watch-dog” safeguarded the pertinence of health interventions in recipient countries. The Global Fund and other initiatives broke with tradition and funded critical interventions, including recurrent costs such as health staff, drugs and renewable medical commodities. These initiatives, which have stemmed from the MDGs, galvanised global attention and funding on fighting killer diseases and ill health. These important advances are now being eroded. For instance, the majority of people living with HIV/AIDS live in countries now classified as middle-income, such as Kenya, Nigeria, Swaziland and South Africa. Efforts by some key donor countries are seriously off track due to a misguided effort to remove critical investments fighting HIV, tuberculosis and malaria in such “better-off” settings, and also by introducing market-shaping strategies that may undermine the ability of the Global Fund to ensure the lowest sustainable price for new commodities needed to fight the diseases around the world. If forced to fund ARV treatment without financial help, these countries will struggle to cope with their HIV/AIDS disease burdens, and fragile health gains risk being lost, unless proven approaches and flexible alternatives that accelerate progress are enhanced. This will be truer still, once the “test and treat” approach becomes the guideline and is implemented everywhere. Other areas of concern are countries that got left behind in the HIV response revolution. A stark case in point is the West and Central Africa region, where two out of every three people who need treatment are not yet on ARVs. Despite a relatively low HIV prevalence (an average of 2.3%, with marked variations between and within countries), the region was home to about 6.2 million people living with HIV in 2013, representing 17.4% of the global HIV burden (UNAIDS 2013 estimates). Yet, there is relatively low political importance given to HIV and ARV treatment in low prevalence contexts, both by their governments and the international community. Examples of this are the Democratic Republic of Congo, Guinea or Central African Republic. Without a significant acceleration of ARV initiation and a catch-up plan to overhaul health services to support instead of hinder access and adherence, international HIV goals cannot progress. hide

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  Hepatitis C With the world now grappling with an estimated 130 to 150 million people chronically infected with the hepatitis C virus (HCV), another revolution for affordable generic life-saving medicines is needed. Hepatitis C is especially prevalent in middle-income countries, with approximately 73% of the burden in populations living in these countries. With the arrival of oral HCV drugs — direct-acting antivirals (DAAs) — the people living with hepatitis C and governments around the world have high expectations for these medicines. It is hoped that they can provide an effective, non-toxic and simplified treatment, but prices for the DAAs remain shockingly high. In the USA, sofosbuvir is sold for as much as US$1,000 per tablet. Broad treatment scale up with these drugs in developing countries can only be made possible if governments use the public health safeguards at their disposal and bring in affordable generic versions. hide

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  Maternal health/Sexual and reproductive health While the number of women dying from pregnancy-related causes has fallen worldwide over the last 15 years, it is still far short of the global goals. The aim was to ensure that between 1990 and 2015, all people were able to access comprehensive sexual and reproductive health and that the maternal mortality ratio was reduced by three quarters. The latter dropped by 45% worldwide over that period, from 380 maternal deaths per 100,000 live births to 210. The maternal mortality ratio in the developing world is 14 times higher than in the developed regions. These preventable deaths, hundreds daily, are due to pregnancy-related complications such as haemorrhage (the main cause of deaths), infections, high blood pressure during pregnancy, complications from delivery and unsafe abortion. After years of slow progress, only half of pregnant women receive the recommended amount of antenatal care, and while contraceptive use has risen unmet needs remain high in certain regions. Global averages continue to mask major inequalities in access to reproductive healthcare (MDG 2015 report). Most of MSF’s patients are women and children. Our staff see mothers walk great distances in dangerous circumstances to make sure their children get vaccinations and treatment, and risk everything, including rejection by their husbands, to prevent transmitting HIV to their unborn babies. MSF has demonstrated that simple, inexpensive interventions carried out by trained health staff can save many of these women. For more, see: https://womenshealth.msf.org/. hide

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  Under-five mortality The global under-five mortality rate declined by more than half between 1990 and 2015, from 90 to 43 deaths per 1,000 live births, and child mortality rates are falling faster than ever. However, the MDG4 goal to reduce under-five mortality by two thirds was not reached. In 2015, six million children under five will still die, predominantly from preventable causes. The objective to eradicate preventable under-five mortality will depend first and foremost on access to adequate obstetric and newborn care. Measles immunisation has saved millions of lives but progress towards eliminating measles has stalled since 2010. There have been continued outbreaks and the number of measles cases increased in 2013 (MDG 2015 report). MSF treated 33,700 patients for measles and vaccinated 1,513,700 people in response to measles outbreaks in 2014, almost exclusively in Africa (mainly the Democratic Republic of Congo, Guinea, Chad and South Sudan). According to the World Health Organization (WHO), malnutrition is the single greatest threat to the world’s public health and is a major cause of death for children under five. When children suffer from acute malnutrition, their immune systems are so impaired that the risk of death is greatly increased and they are less resistant to even common childhood diseases. This is why a common cold or a bout of diarrhoea can kill a malnourished child. Eight children die every minute because their diet lacks essential nutrients. They will continue to do so unless food aid changes. Beyond six months of age, breastfeeding alone is not sufficient to feed a child. Diets at this stage must provide the right blend of high-quality protein, essential fats and carbohydrates, vitamins, and minerals. In the Sahel, the Horn of Africa, and parts of South Asia, highly nutritious foods such as milk, meat and fish are severely lacking. For a child under the age of two, their diet will have a profound impact on their physical and mental development. According to WHO, childhood stunting is one of the most significant impediments to human development, globally affecting approximately 162 million children under the age of five who can suffer from diminished cognitive and physical development, reduced productive capacity and poor health, and an increased risk of degenerative diseases such as diabetes. Of the seven million children under five who die each year, malnutrition contributes to at least one-third of those deaths. MSF admitted 217,900 malnourished children to inpatient or outpatient feeding programmes in 2014, using ready-to-use food (RUF) to treat them. In situations where malnutrition is likely to become severe, MSF takes a preventive approach, distributing nutritional supplements to children-at-risk to stop their condition from deteriorating further. hide

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  Non-communicable diseases (NCDs) The SDGs unlike the MDGs mention NCDs specifically. NCDs now account for almost two-thirds of all deaths globally, of which approximately 80% occur in developing countries. Even in sub-Saharan Africa where communicable diseases are still the leading cause of mortality, with the current epidemiological transition, that lead is predicted to shift to NCDs by 2030. SDG3 has a specific target to improve the outcomes of those with NCDs: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” If these goals are to succeed, treatment guidelines and indicators need to be put in place, and this is largely not the case many developing countries. Improved access to medical care and medication for NCDs needs to be guaranteed, as it is for diseases such as HIV and TB. hide

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  Access to medicines and Research & Development (R&D) Committing to end the epidemics of HIV, TB and malaria is laudable, but shortly after the passage of the SDGs, world leaders will face their first test of their commitment to these aims when they complete both the development of the Global Fund’s new strategy and funding replenishment for the next five years. At present, MSF is seriously concerned that the efforts of key donor countries is seriously off track due to a misguided effort to remove critical investments fighting the three diseases where there is a high disease burden (especially in middle-income countries), and also by introducing market-shaping strategies that may undermine the ability of the Global Fund to ensure the lowest sustainable price for new commodities needed to fight the diseases around the world. Given MSF sees HIV treatment coverage levels of just 17% in the Democratic Republic of Congo, and that just one in five people with multi-drug resistant tuberculosis get treatment worldwide, funding and the right strategies for access will need to be improved. Support for research and development on behalf of developing countries is badly needed. There were no tools to treat Ebola in the nearly 10,000 people admitted to MSF Ebola Management Centres across the three West African countries, including the 5,200 people with confirmed Ebola diagnosis. At present, towards the end of the outbreak, despite encouraging clinical trials taking place, we still have no new approved tools to prevent or treat Ebola – four decades after the first outbreak and over a year after the current outbreak began. While new drugs to treat drug-resistant tuberculosis are welcome, these new combinations will still not provide patients with the outcomes they deserve, and in many countries these drugs remain unaffordable or unavailable. Ultimately support for R&D on behalf of developing countries will require not just more funding, but new approaches and in particular ones that separate the cost of research and development from the final price of the product. Such a new approach could include a new Global Fund for R&D, which combines sustainable funding with approaches to medical innovation that ensure innovation and access. Developing countries must do more to make use of the trade flexibilities created to improve access to medicines by developing countries -the Doha Declaration on TRIPS and Public Health-, nearly 15 years after it was introduced, and 20 years after the introduction of the TRIPS Agreement. Yet the ability of developing countries to use TRIPS flexibilities and promote access to medicines for all is under threat. India, the pharmacy of the developing world, is under sustained pressure by the US and other developed countries to forego these safeguards, which would result in higher prices for medicines and vaccines in India and around the world. MSF would be similarly impacted; at least 80% of the medicines MSF uses to treat over 200,000 people living with HIV are generic antiretroviral medicines from India. At the same time, leaders of 12 countries, led by the US, are finalising negotiations of the Trans Pacific Partnership Agreement, which still threatens to be the worst-ever trade agreement for access to medicines. The high prices of new vaccines remain a critical challenge. Even at the lowest global prices, the cost of the basic package of vaccines is now 68 times more expensive than it was in 2001. This makes it unavailable to many countries, or to humanitarian organisations such as MSF. With just one vaccine, the pneumococcal vaccine (PCV), accounting for nearly half of the cost of the new package, MSF sees the results in the thousands of children under age five who die from pneumonia, a preventable disease using the PCV vaccine. MSF calls on world leaders to not only back affordable vaccine prices, but to put this into practice by publishing the prices they pay for PCV, and demanding that manufacturers GSK and Pfizer reduce the price of PCV to US$5 per child for all three needed doses. Meeting any target to treat hepatitis C will require considerable efforts by governments to reduce the prices of new medicines. At the moment in the US and in EU countries treatment for hepatitis C can often cost up to US$1,000 per pill, or $84,000 per treatment course. Generic competition could bring prices down dramatically for new direct-acting antivirals, and MSF believes that governments and treatment providers should pay no more than US$500 for a full package of diagnosis and treatment; this will be critical to treating the estimated 150 million people worldwide living with the disease, including the more than 18 million people living in India, where MSF has now started treatment programmes.   hide

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  Universal Health Coverage Access and Research & Development (R&D) The target to achieve Universal Health Coverage (UHC) is laudable, but UHC remains a very vague concept, and varies greatly in its definition from region to region. UHC cannot solely be about theoretical access and country averages. Coverage is about real access to care and UHC needs to be defined as the effective utilisation of quality care, especially by the poorest, most vulnerable and socially marginalised groups. UHC is also understood as a basic benefit package, increasingly delivered by the public health sector, yet it is unclear what this package entails. UHC cannot be seen as a replacement for specific focus on diseases or alternative health service delivery models, in particular in populations where such strategies are both more relevant and will give higher impact. The recent resurgence of proven harmful mechanisms such as “”user fees”or out-of-pockets payments in the corridors of some Ministries of Health in Africa is to compensate for dwindling international aid for health, even if these are unable to raise sufficient revenues, are damaging equitable access and are further impoverishing households by increased out-of-pocket expenses for healthcare. This is totally contradictory to the concept of UHC, and a major cause for concern. Ample evidence, including by MSF, has shown that such policies lead to exclusion from care and further impoverishment. The combination of present trends such as user fees, compounded by an insistence on sustainable economic practices, increased domestic resource mobilisation and other financial mechanisms, are likely to result in people having reduced or no access to healthcare or even worse, compounding the provision of poor health services to the poor. hide

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  Emergency responses/Global health threats The Ebola crisis, which has claimed over 11,000 lives to-date, was a global wake-up call. It has been a devastating example of a collective failure to identify, respond to and control an epidemic. Not sounding the alarm on time, ineffective surveillance, slow international response, absence of leadership, and a lack of treatments, vaccines and rapid diagnostics were all part of that failure. The Ebola epidemic is only the tip of the iceberg, however, in an environment where there are regular outbreaks of measles, malaria, cholera and meningitis every year that result in nearly nine million deaths. The extremely high mortality figures observed today due to a major measles outbreak in Katanga, in the Democratic Republic of Congo, are an illustration, among many others, of decades of failure of preventive strategies. If local and national outbreaks of diseases have yet to be properly identified and responded to, how can we expect transnational outbreaks of emerging and rare diseases to be addressed properly? Many of the lessons learned from the Ebola response are not new. The weakness of current policies and practices, showing how unprepared the world is to effectively address rare, neglected or emerging diseases, has been highlighted in numerous evaluations of previous pandemics. Today, the global health system remains as unprepared as ever to respond to mass disease epidemics. Weak surveillance systems, politically-centred decision making, poor access to healthcare and limited response capacity continue to be the status quo. It is the fate and health of affected populations and not security considerations or fear of contagion that should be at the centre of any epidemic response system. Improving access to healthcare and quality of services is critical to allow for early detection of future outbreaks, as well as more effective response. We need to rethink how we approach the global health and aid system. For example, the system currently rewards countries for reaching long-term development targets but provides little incentive for them to declare outbreaks of infectious diseases for fear of harming trade and tourism. In future, incentives should be provided to countries to publicly recognise outbreaks. Meanwhile, wealthy nations should commit to deploy staff and resources to support governments that are unable to cope alone. A clear and continuous focus on emergency and pandemic preparedness is needed or there is a real risk that the world will lose what it has learned from Ebola. hide

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  Migration While MSF can agree that SDG10, target 10.7 with the objective to have “safe, responsible, and regular migration and mobility through sound and well managed migration policies” is fundamental, the reality is that current policies are more restrictive than ever, impacting the health and well-being of migrants and refugees fleeing conflict, oppression, persecution and economic hardship in their home countries at a global level. This constitutes a clear obstacle to development perspectives, but also is currently leading to a policy-made human disaster, as witnessed by our teams in their daily work with migrants, asylum seekers and refugees. Through our past and present operations MSF has witnessed significant medical and humanitarian consequences of restrictive migration policies. There has been evidence of ill treatment and abuse, and violence, including sexual violence (for example the case in Morocco, in areas close to the Melilla border fence). In particular, MSF has attested to the serious medical and mental health impact of systematic and prolonged immigration detention. Very often, living conditions in detention centres are below international standards and are themselves a source of ill-health (as seen for example in Malta, Greece, Italy, South Africa and Libya). MSF has also documented that forced returns of undocumented migrants and failed asylum seekers are often performed without due attention to health needs resulting in the rupture of necessary chronic health treatments (South Africa, Belgium). Mental health medical and protection needs have to be taken into consideration in any return processes to ensure that the person being returned will have access to adequate care and to necessary treatment during and upon return. Lastly, fences, restrictions and externalised border controls to prevent people’s movements force migrants – especially the most desperate – to take ever more dangerous routes, with disastrous impact on their health, physical wellbeing and dignity (South Africa, North Africa, Italy, Greece, the Mediterranean sea, Western Balkans, and South East Asia). The pathologies treated by MSF in its projects for migrants and refugees are the direct consequences of the dangerous migratory journey, the situation in transit countries, and substandard reception conditions. For the SDG10 target to be achieved, states will have to acknowledge the human and medical consequences of their migration policies and perform a drastic shift. –end– hide