 Eleven-year-old Lydia lives with her mother and three sisters and brothers in the shantytown Obrero located on the outskirts of Quibdo. The father has left them. Their home is a shed. Lydia cares for the other children while her mother works as a maid. None of the children has an identity card that entitles them to health care. Photo © Pieter ten Hoopen/MOMENT |
Inescapable violence
In Colombia, violence is the major public health hazard and the leading cause of death. For decades, government
military forces, paramilitary groups and armed guerrillas have fought one another against the
backdrop of an illicit narcotics trade and conflict over natural resources, terrorizing and targeting civilians
in both rural and urban areas.
It is no wonder that three million people
have fled their homes, many gathering in
shantytowns outside major cities, where
they seek safety and anonymity among the
masses. Estimates suggest Colombia now
has the third highest number of internally
displaced people in the world, after Sudan
and the Democratic Republic of the Congo.
In an effort to alleviate some of the suffering,
MSF brings essential medical services
to vulnerable and displaced civilians in
Colombia, while advocating for improved
services and medical care for those who
have been displaced. MSF teams are currently
at work in the departments of
Caqueta, Chocó, Cordoba, Sucre, Bolivar,
Nariño, Norte de Santander, Tolima,
Cundinamarca and in the Bogotá capital
district.
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"We are here without work. We
don't know what we are going
to do when we are told to
leave. Our children don't go to
school. But how can I even
think of going back? It would
be like a death sentence."
— A displaced man living in Soacha with
his family |
| Millions outside the system
Since 1999, MSF has been working in Altos
de Cazucá-Soacha, in the Cundinamarca
department, aiding the displaced population Soacha is a one-hour drive southeast
of Bogotá. Each day, the MSF team brings
medical equipment and supplies to this
shantytown where they operate a clinic.
Though Colombian law provides for health
benefits for the displaced, in reality a lack
of information is one of the leading causes
for people to remain outside of the health care system. Others are worried that entering
the system could make them vulnerable.
Participation in government programs
requires registration and detailed
personal information that could be misused.
As a result of these factors, MSF estimates
that about two-thirds of the displaced
population remain unregistered
and therefore without access to medical
help from the government.
In Soacha, as in many shantytowns, the
most common health problems are respiratory
complaints and diarrheal diseases
caused by crowded living conditions, poor
sanitation and a lack of clean water. In
addition to offering medical care, MSF staff
inform internally displaced people about
their rights and provide mental health support.
Home visits play an important role.
While visiting families, the team often
detects medical or family problems that need to be addressed.
More than 100,000 people live in the western
city of Quibdó, in Chocó department,
Colombia's poorest region. The city is surrounded
by tropical jungle, and half of its
inhabitants fall outside of the health care
system. MSF teams support two health
centers in the shantytowns of Porvenir and
Reposo as well as large hospital center,
Ismael Roldan. In November 2004, an MSF
team expanded the program by beginning
to offer assistance in the maternity ward of
San Francisco Regional Hospital in the city
center. For those who live in the jungle,
medical care can be days away, and health
conditions can worsen or become fatal,
before people ever reach a health facility.
In 2004, MSF staff treated more than 16,000
people through six health posts in Quibdó.
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"One day some men arrived. They accused us of supporting the guerrillas. They
threatened my husband with a weapon in front of the children, and told us to leave
by dawn. My children cried a lot. We were all very scared and so we did not take anything
with us, concentrating only on leaving as fast as we could. That is why we are here."
— An internally displaced woman living in Soacha, Colombia | |
Reaching isolated populations
In many parts of Colombia, MSF staff use
mobile clinics to reach isolated populations
that have almost no other way to
obtain health services. To limit risk and
help ensure the safety of the team and
patients, MSF is always completely transparent
about the mobile clinics' travel
plans. Mobile-clinic teams mostly treat respiratory,
skin and parasitic infections and
provide vaccinations, psychosocial care for
victims of trauma and some dental care.
The mobile-team doctors are sometimes
the first caregivers communities have seen
in more than a year.
In the department of Tolima, home to more
than a million people, MSF mobile teams
bring medical and psychological assistance
to those living in conflict zones. This
department and the western part of
Cundinamarca department comprise a
strategically important area because the
main roads leading from Cali and Medellin
to Bogotá pass through them, and all
armed groups are active in the region. In
2004, MSF carried out an average of 2,000 consultations, including more than 100
mental health visits, each month in Tolima.
MSF is also working to bring health care to
people in the Norte de Santander and
Cordoba departments in northern
Colombia. Communities are visited by
mobile teams every six to eight weeks,
depending on both needs and accessibility
of the area. To reach these isolated communities,
MSF teams travel by four-wheel
drive vehicle, on foot, on mules or by
canoe. Spending two to three days in each
site, MSF staff see an average of 90 patients
a day. MSF has also established a fixed
health clinic in Saiza within the conflict
zone to provide more consistent quality
care than is possible through mobile clinics.
MSF has also started working in the
town of Sincelejo in Sucre department,
opening a primary care clinic within the
vast urban slums of this town.
Mental and reproductive health
MSF teams counsel patients about stress,
trauma, insomnia, fear and grief as part of
their work in Colombia. According to MSF
mental health experts, many patients who
seek care from the mobile clinics report
generalized body pain or headaches. Some
have also travelled long distances to
request common medicines that could be
obtained elsewhere. These are indications
that people are suffering from fear of the
continuous violence. Moreover, domestic
violence, sexual assault and child abuse are
so common that many people have come
to accept them as inevitable. Although
mental health services are included in all of
MSF's work in Colombia, in some places,
such as the south-central city of Florencia
in Caqueta department, they are the primary
focus.
Sexual and reproductive health care are
also important parts of the work being done in Colombia. For adolescent girls, sexual
and reproductive health problems are
the primary medical issues for which they
seek care. Most of MSF's patients are single
mothers with numerous children. Maternal
and child mortality remain huge problems,
exacerbated by domestic violence.
Emergencies
MSF also responds to emergencies in
Colombia. In October 2004, after floods
enveloped the west coast city of Monteria,
displacing more than 20,000 people, MSF
teams assisted with basic health care,
water and water-container distribution,
provision of hygienic supplies and referral
services. Most of the displaced had been
living in shantytowns at the time of the
floods, which occurred during the peak of
the rainy season. MSF also provides emergency
assistance in the wake of war-related
displacement. This year MSF staff in
Cordoba and Norte de Santander offered
emergency health and psychosocial care as
well as water and sanitation services following
two massacres and subsequent
population displacements.
MSF advocates for better living conditions
for vulnerable and displaced people in
Colombia. In February 2005, MSF submitted
an open letter to the governments and
organizations participating in a donor's
table for Colombia. MSF called for an end
to the practice of displacement of civilians
as a war strategy and sought aid and care
for the millions of displaced people who
require and are entitled to it.
MSF has worked in Colombia since 1985. |
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