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MSF in Ivory Coast, 2007
Field Staff: 1,098
Reason for intervention:
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2007 was a turning point for Ivory Coast. After four years of civil war and political deadlock, a peace agreement was signed in March, leading to a process of reunification between the government-controlled south and the north of the country, previously held by rebel forces. After a national union government was formed, the ‘Zone de Confiance’, a buffer zone separating the warring parties, was dismantled in April. Previously monitored by United Nations peacekeepers and French military forces, the zone is now secured by ‘Brigades Mixtes’, a police force integrating both sides. Administrative and health civil servants have now redeployed to the north and west, enabling MSF to hand over some projects to the authorities.
Improving access to healthcare in former rebel areas
Despite political change, access to health services continues to be limited for most people in Ivory Coast who cannot afford healthcare under the current cost-recovery system. While continuing to support people living in former rebel-held areas, MSF has called for a reorientation of the government’s health policy and free healthcare. Insecurity remained high until April in the district of Bangolo, in the former Zone de Confiance, where MSF treated several people with gunshot wounds. This led MSF to denounce publicly the repeated attacks, robberies, assassinations and rapes perpetrated against civilians living in the area and to release a collection of testimonies. In June, MSF upgraded the Bangolo health center to the level of district hospital. Here, MSF offers free quality secondary healthcare, including inpatient and emergency services, in the absence of adequate national health support. MSF also runs a primary health center and mobile clinics, providing basic healthcare and treatment for malnutrition in the district. About 85,000 outpatient consultations were conducted during the year.
MSF continued to manage services at Danané hospital in the west of the country at the Liberian border. These included providing secondary healthcare in inpatient services, integrated care for tuberculosis and HIV/AIDS, treatment for malnutrition and pediatric and obstetric care.
Until October, MSF supported a local hospital in Bin Houyé as well as the district hospital in Zouan Hounien, in the south of the Zone de Confiance. These projects have now been handed over to district health authorities. MSF also managed mobile clinics and a mobile nutrition program in Danané and Zouan Hounien districts. By the end of 2007, three mobile clinics and 13 ambulatory nutrition sites remained. MSF will continue to monitor malnutrition in the district until the planned withdrawal from Danané in 2008.
As public health structures started to function again, the Minister of Health expressed a willingness to take over healthcare. Where possible, MSF began to transfer projects to the authorities. This process will continue in 2008.
During an emergency in 2002, MSF had launched a project offering free healthcare in the hospital of Bouaké, a major city in the country. Following improvements in regional health capacities, MSF handed over its project to the Ministry of Health in April 2007. In the first four months of 2007, 1,243 patients were hospitalized and 6,360 consultations conducted. In June, MSF closed its project in the referral hospital of Man in the west, where it had provided free primary and secondary healthcare since 2003, including anti-retroviral treatment for HIV/AIDS patients and surgery for the wounded and women with obstetric fistulas. Between January and June, MSF carried out more than 1,200 surgical interventions and 28,000 outpatient consultations.
In September, MSF ended its activities in Guiglo in the west where it offered medical care in a primary health center and treated severely acute malnourished children under the age of five. Until September, about 26,800 outpatients consultations were carried out and 611 children under five were included in the nutritional program.
MSF has worked in Ivory Coast since 1990.