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MSF in Ivory Coast, 2005
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The conflict that started in 2002 has resulted in thousands of civilian deaths and has forced hundreds of thousands of desperate residents to flee their homes. Renewed violence broke out in November 2004, causing more casualties and forcing civilians to flee again. The ongoing violence has left many without basic health care or sufficient food. MSF is the only provider of basic primary and secondary health care in many of the areas where its teams work.
MSF works on both side of the conflict's frontlines, providing medical personnel for health facilities and urgently needed care. At hospitals in Bouaké, Man and Danané, MSF staff provide essential medical care including pediatric consultations, emergency medicine, obstetric and gynecological care and surgery. Mobile clinics are also used in the west to bring care to those living in more isolated areas. A team in the town of Guiglo provides more than 2,500 medical consultations each month (many of them for children with malaria), assists malnourished children and gives aid to those displaced by violence.
Because malaria is the largest threat to children's health in Côte d'Ivoire, MSF treated more than 70,000 malaria patients in the last year, using artemisinin-based combination therapy (ACT), the most effective treatment available. MSF also carried out a mass measles-vaccination campaign for almost 10,000 children in the Bangolo area south of Man, in 2004.
More violence rocks the country
The eruption of violence in November 2004 posed a challenge to MSF's work in the country. Government and rebel forces clashed, resulting in the intervention of French troops who, together with UN troops, guarded the demilitarized zone in the center of the country. The unrest caused such strong anti-French sentiment that more than 8,000 foreigners were evacuated from the country. Despite the tense situation, MSF managed to keep its projects running with skeleton teams of international and national staff.
In the western town of Danané, hospital services continued throughout the crisis, providing up to 70 consultations a day. Airstrikes on a military base in Bouaké injured many civilians, and on 4 November, 39 people were urgently referred to the town's public hospital where an MSF medical and surgical team were prepared to treat them. MSF also responded to the needs of those who had been displaced by the fighting. In other parts of the country, basic medical assistance was given to wounded civilians caught in the crossfire.
Tons of medical and surgical material including medicines, dressings, bandages, compresses and gloves were distributed to several hospitals throughout the country. At the end of February 2005, an attack on the rebel-controlled village of Logoualé, south of Man, created new tensions in the "demilitarized zone". Since that incident, MSF teams have witnessed a pattern of attacks on villages followed by population movements that raise concerns that a form of ethnic cleansing could be under way.
MSF teams also provided assistance during a week-long riot that began on 2 November in the MACA prison, formally known as the Maison d'ArrÃªt et de Correction d'Abidjan. MACA prison holds about 5,000 inmates, although it was built to house only 1,500. The growing political tension in November permeated the prison, and inmates began a mutiny to demand better living conditions. These conditions — overcrowding, poor hygiene and insufficient food — give rise to frequent cholera epidemics, high levels of tuberculosis (TB) and malnutrition. The riot injured 75 people and resulted in 24 deaths. The MSF team transferred 12 seriously wounded patients to the university hospital in Yopougon.
MSF conducts more than 1,200 medical consultations with prisoners each month. In 2004, the organization extended its activities in the prison's TB ward in collaboration with the country's national TB program and began treating six people who had multidrug-resistant strains of the disease. An estimated 150 detainees benefit from a supplemental nutrition program established by MSF.
Since its teams began working in the prison, MSF has been able to improve health care and increase the number of medical staff on duty. In addition, the prison's budget has been increased. Because of these positive developments, MSF is now decreasing its support in the prison and plans to close most of its projects there, except for the multidrugresistant TB program, by the end of 2005.
A silent crisis
A patient arrives semiconscious at the Danané Hospital in northwestern Côte d'Ivoire. She has abdominal pain and no blood pressure can be detected. The concerned midwife finds that the patient's vaginal walls are encrusted with a thick, solid discharge. This is one of the worst cases of sexually transmitted infection (STI) that the midwife has seen in her 20 years of experience. Despite immediate treatment by the hospital staff, the patient goes into cardiac arrest and dies of septic shock. She is 13 years old.
A 14-year-old girl comes to a mobile clinic complaining of general pain in her head and stomach. She does not know whether she is pregnant, but the nurse examining her discovers that she is carrying both a baby and an STI. The young girl tells MSF that she is unmarried but often has sex with a boy in the military. She explains that, in exchange for sex, she receives money, clothes and protection for herself, her brothers and sister.
The civil war and subsequent collapse of the country's health care system have provoked a medical crisis in parts of Côte d'Ivoire. MSF teams in the western part of the country have encountered alarmingly high rates of STIs. These infections can lead to horrible complications in reproductive health.
While drastic in its own right, the high level of STIs is also a clear indicator that HIV/ AIDS is spreading in the region, making prevention and treatment efforts all the more urgent. Family separations and the influx of soldiers have left many women and young girls vulnerable to sexual violence, prostitution, unwanted pregnancy and STIs.
MSF teams diagnose STIs in about 20 percent of the adults visiting their clinics in some towns. The teams are convinced that the actual prevalence is higher, and that many STIs, including HIV/AIDS, often go undiagnosed and untreated.
The teams are frustrated by these alarmingly high numbers of STIs and the lack of effort to prevent the spread of these diseases, including HIV/AIDS. Despite an estimated 10 percent prevalence rate for HIV in Cte d'Ivoire, little is being done to combat it outside of the major city centers. In addition to boosting education, prevention and treatment of STIs, MSF is advocating for increased prevention of mother-to-child transmission of HIV, treatment of opportunistic infections and treatment of AIDS with effective medication.
MSF has worked in Ivory Coast since 1990.