International Activity Report 2004
Colombia

International staff: 40
National Staff: 133

Caring for those isolated by war

In Colombia, decades of protracted violence have made conflict a daily reality for civilians. Each day, people are killed, wounded or forced to flee their homes, or they simply "disappear". Trapped amid this unending war, many rural dwellers face restrictions on their movement caused by nearby violence or the fear that they will be seen as sympathetic to one of the armed groups. At the same time, many health professionals are reluctant to provide care in isolated areas for fear that military groups might target them.

MSF attempts to break through this isolation by running mobile clinics that provide medical and mental health care to people who desperately need it. MSF's presence in such harsh locations, rarely visited by authorities or other international organizations, also brings some psychological relief to those forced to live amid chronic violence. MSF's mobile-clinic teams provide basic medical consultations, deliver essential drugs, treat mothers and children, give individual and group counseling and even perform dentistry. MSF also addresses water and sanitation needs. The mobileclinic teams are composed of international and local doctors and nurses, a psychologist, a dentist, logisticians and drivers.

They visit sites in the departments of Norte de Santander, Tolima, Sucre, Bolivar, Córdoba, Caquetá and Nariño. Their rounds – made by car, boat, mule or on foot – enable tens of thousands of people to obtain basic health care. For many, MSF is the sole health care provider.

In some areas of the country, where health facilities do exist, the profit-based health system excludes displaced or vulnerable people. In addition, fierce political tensions make it dangerous for some people to register for health care. Because being associated with particular territories imply loyalty to certain armed groups, some people fear that by providing detailed personal data they could be inviting the armed group from which they fled right to their door. Therefore, in a country where no one is outside of the conflict, many displaced civilians remain reluctant to use the health system.

In urban areas such as Quibdó, MSF has persuaded local authorities to stop charging consultation fees for civilians not yet registered with the public health system. The team also helps people navigate the bureaucratic registration process, which must be completed before an individual can obtain medical care. Since 2000, MSF has been working near Bogotá, the capital, in the Soacha district, which is home to one of the country's largest reception centers for displaced people. Each week newly displaced families arrive from all over the country. To assist them, MSF operates a health post that provides medical care, nutrition for malnourished children, and sexual and reproductive health care. The team also refers victims of domestic violence to other care givers.

After six years of activity in Cali, Colombia's third largest city, MSF is handing over its violence-prevention project to local health authorities. The project assists victims of urban violence in the Aguablanca district. Since its creation in 1998, MSF has carried out 34,000 consultations and treated 2,700 victims of urban violence and members of their families.

MSF has worked in Colombia since 1985.