Roger Micolta, MSF physiotherapist, explains to Ramon Mancilla, a taxi driver who was shot, about his recuperation in MSF's program for rehabilitation and prevention of violence. Photo © Patricia Rincon Mautner

At the age of 17, Edilson was a gang member in Cali, Colombia. Constantly at "war" to defend his "territory," he was caught one night by a rival gang. They shot him in the back and in the skull. At the hospital, doctors couldn't operate and he was told he would never walk anymore.

Two years later, after seeking treatment at the Doctors Without Borders/Médecins Sans Frontières (MSF) rehabilitation center in the heart of one of the most difficult areas of Cali, the Aguablanca district, Edilson is walking again on his own.

Edilson remembers the night his life changed. "The guy who shot me belongs to a gang that operates where I used to steal," says Edilson. "We steal from neighboring suburbs; we go there and they come here. We try to make others respect our territory... it's like everything... isn't it?" On that particular night, Edilson ran into his enemies who then surrounded him and threatened him with a gun and a chupasangre (a home-made weapon, literally meaning "blood-sucker"), and they demanded he hand over his running shoes. "I heard them say, 'Kill him!' 'Finish him off!' said Edilson. "I heard the shot and then everything turned black."

Like Edilson, since 1998, more than 2,700 patients have received free, comprehensive physiotherapy, psychological, nursing, transportation, and social services at the MSF center in Cali. "This unique model of intervention in Colombia for victims of urban violence and their families has demonstrated that the health sector has a very important role in reducing the physical, psychological, and social effects of violence in the cities," states Antonio da Silva, MSF Head of Mission in Colombia.

In Colombia, urban violence is the first cause of death for men between 14 and 44 years of age. In Cali, the third largest Colombian city, an incredible 1,225 assassinations were registered in the first six months of 2004. These figures do not include deaths related to the Colombian armed conflict. In the outskirts of most cities, many young people belong to organized gangs who define territories with invisible borders known only among themselves and their "enemies." For them, the rules are clear, and to venture beyond these invisible safety zones could have fatal consequences.

MSF staff talk to an injured patient in the Hospital Universitario del Valle about the what help he can receive from MSF's program for rehabilitation and prevention of violence. Photo © Patricia Rincon Mautner

“Most of our beneficiaries are male between 14 and 25 years of age. All present either a knife or a gunshot wound and most frequently they are recidivists. Approximately 18 percent of them present a permanent disability as a consequence of their injury: paraplegics or quadriplegics,” explains Justine Simons, coordinator of the Aguablanca project. “This astonishing situation should be of concern to public health authorities. If the rate of urban violence injuries continues in the manner it has been during the past six years, the city of Cali could become one of the cities of the world with the highest rate of disability.”

The MSF rehabilitation program was set up to respond to lack of integrated care for people injured in urban violence events after they have received emergency medical treatment. Once people have been discharged from the emergency departments of hospitals, there is no follow-up. Lack of interest in the well-being of this particular population is an underlying problem. MSF beneficiaries have frequently complained of hospital staff attitude and have heard comments such as, "Oh, he must be a gang member or something of the sort, so when you clean his wound, make sure you rub it hard so it hurts him bad." Stigmatization, lack of education on wound care, and lack of follow-up are just some of the issues faced by victims of urban violence at the doors of a public health service.