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MSF in Colombia, 2005
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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.
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.
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.
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.