July 2, 2007
Colombia is now in its fifth decade of conflict and more than three million people have been displaced by the violence fueled by the narcotics trade. People in conflict zones where government military forces, paramilitary groups, and armed guerrillas from ELN and FARC fight for control are often cut off from basic health care services. Even in medical emergencies, it is often too dangerous for them to seek care outside their villages. So, many have sought safety in the shantytowns springing up outside of Colombia's major cities. Once there, they endure poverty, appalling living conditions, limited access to medical and counseling services, and an ever-present risk of disease outbreaks. Doctors Without Borders/Médecins Sans Frontières (MSF) provides basic health care, mental health, and sexual and reproductive health services to those who have been marginalized. Tony Tomasouw, interim Head of Mission for Colombia, gives an update on the activities of MSF in the northern parts of Colombia.
Can you describe the work of MSF in the northern parts of Colombia today?
"Currently, MSF has three projects: the Norte de Santander project in the northeastern part of the country bordering Venezuela; the Bolivar and Sucre project in the northwestern part of the country bordering the Caribbean Sea; and the Uraba project in the west.
In Norte de Santander, MSF works in rural areas of the Catatumbo region. This is a dense jungle region heavily affected by the conflict. The population often does not have access to basic health care. We reach these populations through our mobile clinics where we travel for hours by car and by canoe, guided by indigenous people. We also have an urban component in La Gabarra and will soon have one in El Tarra. These urban settings often have limited Ministry of Health facilities, and our projects address gaps in essential care, such as mental health and sexual and reproductive health. Our presence and patient contact in these urban areas give us the legitimacy and experience to advocate for better health care on a local level.
MSF also manages a basic health care clinic in Sincelejo, the capital of Sucre department in northwestern Colombia. This project specifically addresses critical gaps in the provision of health care for displaced people and vulnerable people in urban slums and rural areas. Sincelejo has about 270,000 inhabitants, about 100,000 of whom are displaced people. The local health system is unable to cope with the needs of this population, which is why we are there. In the last few months, MSF has managed to re-enter the Montes de Maria mountainous region with mobile clinics after three years of no access due to insecurity. The situation is still very fragile in terms of security, but we are making progress, bit by bit. This project also includes an urban component in the city of Ovejas and in Carmen de Bolivar, where we provide complementary services like mental health and sexual and reproductive health.
In the western region of Colombia, the Urabá project's target population and geographical focus was redefined in 2006. In March of this year, we opened a mental health and sexual and reproductive health clinic in Riosucio, a small town that serves as a jump-off point to the rural areas northwest of Chocó. In the near future, MSF would like to start medical mobile clinics in these areas. In the rural town of Saiza, in Córdoba department, MSF continues to offer basic health care services in the absence of any other health services."
What is the current situation of displaced people in these regions?
"After Sudan and the Democratic Republic of Congo, Colombia ranks third in the world in terms of the volume of people who have been internally displaced. The government has officially registered about 1.5 million displaced people, but it is widely recognized that the actual figure is more than 3 million.
The Catatumbo region in Norte de Santander is a natural resource-rich area with a violent history. Its original habitants, the Bari, have struggled for decades to maintain their territory. Because of economic interests (oil and carbon), the government has reduced their territory to some 10 percent of what they originally occupied. The armed groups use displacement as a strategy to gain control over territories and expand their economic interests.
People flee the rural areas for the overcrowded city slums (Cúcuta, for example), where the conflict continues. Organized crime, social cleansing, selective killings, and forced recruitment are issues displaced people must deal with and these are often the very same issues that made them flee their homes in the first place.
Sometimes, people return to their homes, but here again they may encounter a situation which is not much different, or it is even worse than when they left. Their house is destroyed, their land gone, there is a weak state presence with no guarantees for security and almost no support. Various armed groups claim control over the territory and the population must adapt to every new group that passes by. They are often intimidated, accused of being collaborators or spies, and at times even recruited by force. Families can't build homes for fear they may have to flee again and leave their homes behind. This on-going instability is often the root cause for mental health and physical health issues that affect the displaced population."
As a way of dealing with this pervasive issue, MSF has been advocating for the government of Colombia to prioritize the provision of free comprehensive health care to these populations, while also trying to raise awareness about their endless predicament. MSF has worked in Colombia since 1985.
Organized crime, social cleansing, selective killings, and forced recruitment are issues displaced people must deal with and these are often the very same issues that made them flee their homes in the first place.
– Tony Tomasouw
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)