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MSF in Colombia, 2003
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Soacha just doesn't stop growing. Every day families arrive, coming from all over the country to start a new life up in the hills of this township attached to Bogotá. Soacha is one of the main reception sites for displaced people in Colombia. Despite the precarious conditions (water, electricity or other services are almost non-existent), people keep coming. The land conflict, economic interests, crop fumigations in the war on drugs and threats from paramilitary forces, government soldiers and guerrillas force farmers and indigenous people to leave their homes and their land, displacing them to the ever-growing misery of the outskirts of the main cities. Unofficial estimates put the number of displaced people in Colombia at 3 million. MSF, active in Colombia since 1985, provides medical care to people isolated by conflict in rural regions and displaced by con. ict to the country's urban areas. MSF also cares for people who have become victims of the more generalized violence that plagues Colombia's cities.
Basic care in conflict-scarred rural areas
The conflict is most visible in rural areas and on the periphery of the cities. In the rural areas the war continues to exact a staggering toll. Civilians are the victims of a constantly-shifting division of territories between the warring parties. Human rights violations, assassinations and threats occur in silence, almost without denunciation, almost without ceasing. The cruelty and the extension of the conflict have left large parts of Colombia isolated; people can easily fall prey to diseases such as malaria, leishmaniasis, tuberculosis, tropical diseases and parasitosis, or chronic malnutrition. Combined with distance from medical care, difficulty traveling because of the con. ict and a health system which excludes many people, the result is great difficulty getting access to health care in Colombia.
The geographic dispersal of the conflict and the number of actors in a small area mean that it's difficult to move around; there is a great danger of being blocked or caught in the middle of an "operation." In many areas, warring parties block roads and rivers and prevent transport of medicines and food. The few existing health posts can be situated in territory held by the "other" side. Many are only partially functioning, some are simply abandoned. Hospitals often cannot organize mobile clinics because of insecurity. Threats to medical missions are frequent and made by all actors involved. MSF has been a witness to flagrant violations of international humanitarian law through non-respect of health facilities and medical personnel.
In this context, MSF's mobile clinics in rural zones are of special relevance. MSF has created a space to enter zones controlled by the different actors and can provide neutral, impartial and independent assistance to people in Bolivar, Caquetá, Córdoba, Cundinamarca, Narino, Norte de Santander, Sucre and Tolima, delivering what in some places is the only available medical care. A typical mobile clinic might operate like the one in Tolima: MSF provides services in five different districts. Every six weeks, villages and hamlets receive a visit from a team made up of medical personnel from MSF and the hospital of that district. The team provides basic care and vaccinations; people with severe health problems are referred to the hospital. In Tolima, teams carried out 15,000 consultations in 2002. Similar brigades are ongoing in the Costa Atlantica area and in Caquetá, Cundinamarca, Nariño, and Norte de Santander departments.
In the Magdalena Medio region, MSF was able to end its mobile clinics when the larger communities regained regular access to health care. In the last months before closure, focus was therefore shifted from curative care to training local health personnel. In August 2002, with the end of peace talks between the government and the guerillas, MSF concentrated its efforts in the northern part of Caquetá department, including San Vicente del Caguán. However, because the situation has become more stable there, mobile clinics have restarted in southern Caquetá.
Access to care is difficult for people remaining in Colombia's fractured rural areas; it can be equally difficult for those who manage to escape this and end up in the cities. Although emergency assistance to the displaced is stipulated by law, claiming that they are displaced rarely brings people the promised aid. As a result, they become almost invisible.
Since late 1999, MSF has assisted some of the 40,000 people, many of them displaced, living in Soacha, near Bogota. In March 2003 MSF began medical aid to people in Quibdo, which, with a population estimated at 140,000, is one of the largest towns in the province of Chocó and a magnet for rural people fleeing conflict in that region. Daily reality dictates that the people who come to live in places like Soacha and Quibdo have no right to become sick, because nobody will provide services for them. In theory, the government has foreseen their inclusion in the public health system, but in reality the process is so complicated and so far behind the social and economical reality of the country that the most vulnerable have no access. To become integrated into the system, these people – who already live in dire conditions, having to carry the burden of atrocities they have experienced or witnessed, who often have little education, who are frightened and unaware of their rights – have to orient themselves toward a circus of letters, passes, ID-cards and socioeconomic classifications. It can take months or even years to get registered, if it happens at all. Furthermore, new rules complicate access to services. At the same time, the privatization process currently underway in Colombia is having a negative impact on the delivery of quality health services. All this means that displaced people are isolated, living in conditions (such as overcrowding and poverty) that make them more vulnerable to health problems, sexual abuse and exploitation. MSF runs two health centers and a mobile clinic in Soacha to attend those who are excluded from the system or cannot reach health centers in the city. In Quibdo, MSF works at a health center and reference hospital, and focuses on primary care for mothers and children in order to combat the high infant and maternal mortality rates in the area. In both places, MSF helps people obtain the medical coverage that is their right.
MSF deals with the medical consequences of extreme violence in the Aguablanca neighborhood of Cali, providing physical rehabilitation and psychological care to young victims of violence.
MSF has worked in Colombia since 1985.