Thank you very much.

Doctors Without Borders, or Médecins Sans Frontières, is an international medical humanitarian organization that provides medical care to people affected by armed conflict, natural disasters, forced displacement and neglect. We carry out emergency medical interventions in more than 70 countries around the world, where access to health care has been disrupted and urgent needs cannot or will not be met by local authorities or other care providers.

Of the countries that MSF works in today, 35 are in Africa, representing more than half of MSF's activities by expenditure and totalling roughly $1.15 billion. Eight of our 10 largest country programs are in African countries.

Each of these countries, and our work in them, is complex and diverse, so I want to situate my remarks on the reality of what our teams witnessed today in two countries in particular—Sudan and the Democratic Republic of Congo.

MSF has been present in Sudan since 1979 and currently works in 11 states providing emergency medical care, surgery and outpatient primary care. Today, there are more than 10 million Sudanese people who have been displaced, because of the conflict that erupted in April 2023. Over 1.7 million people have crossed the border into neighbouring countries, including Chad, Central African Republic and South Sudan. MSF runs large emergency medical programs in each of these countries and has also scaled up there significantly.

For months, we've been sounding the alarm on the deteriorating humanitarian situation in Sudan and a response that is well below emergency standards. It's been marked by administrative obstructions from the warring parties that are denying humanitarian organizations necessary visas, travel authorizations or permissions to bring in supplies or to reach affected populations.

The consequences are very real. Last week we issued a press release highlighting the results of the malnutrition screening our teams conducted in Zamzam camp in North Darfur, Sudan. The results showed that a staggering 30% of the 46,000 children our teams screened were suffering from acute malnutrition, and 33% of the 16,000 pregnant and breastfeeding women screened were acutely malnourished.

All of this comes alongside a reality of a violent conflict, where our teams are treating hundreds of war-wounded patients, including children, as we call for an urgent scale-up in the humanitarian response; for warring parties to ensure the protection of civilians, humanitarians and health care infrastructure; and for countries like Canada to leverage their full diplomatic influence to ensure it.

In eastern Democratic Republic of Congo, we're responding to a massive humanitarian crisis, following renewed fighting in 2022, which has displaced at least 1.6 million people in a conflict that has largely been neglected, and where violence against civilians is widespread. For example, in 2023 alone, MSF clinics provided care for 20,556 survivors of sexual violence across North Kivu, which we know is only a fraction of the need.

Yet, the broader humanitarian response to this crisis has been grossly inadequate, which is why MSF has been calling repeatedly for a scaled-up humanitarian response, including a specific call for Canada to increase its humanitarian assistance and to leverage its full suite of diplomatic tools to find solutions to this crisis.

Canada is a respected humanitarian donor that operates in a principled manner that keeps humanitarian assistance and politics separate. This separation is important, but I also want to emphasize that resolving conflicts is not the work of humanitarians. It's the responsibility of states. Here, we would like to see a clearer proposal for Canadian diplomacy and engagement in fragile and conflict-affected states, including in African countries.

To close, I want to mention that, as a medical humanitarian organization, we remain extremely concerned about our teams' and our patients' access to essential medicines, which, coming out of the COVID-19 pandemic, became a significant flashpoint at the intersection of public health, human rights and international trade, and which saw many African countries deprived of timely access to vaccines and therapeutics. Unfortunately, this is not unusual for the way the market works, but there are some lessons to be learned for Canada's approach to medical research and development.

For example, from 2018 to 2020, the Democratic Republic of Congo experienced the second-largest outbreak of Ebola on record, which occurred simultaneously within a violent and protracted armed conflict. There was, at the time, only an experimental vaccine, which happens to have been developed by Canada's National Microbiology Laboratory, but it was ultimately stalled in its development when Canada licensed it to a pharmaceutical company that failed to develop it for years. There were no approved therapeutics.

Today, we have both vaccines and therapeutics for Ebola. However, the vaccines, while highly effective, are the most expensive in use in global health, and we have highlighted significant challenges in accessing the two Ebola therapeutics in a recent report.

Canada does good work in this space but needs a different approach to its innovation and licensing to ensure that access to medicines in places like several African countries are prioritized for their access and their affordability.

I will conclude by thanking the committee for this study. I'm very happy to answer your questions.