Brazil

Local armed groups have for years controlled slum areas in Rio de Janeiro called favelas, where they recruit young men as soldiers and impose social rules that include harsh punishment for those who do not obey. Clashes between armed groups for territorial control, as well as fighting between police forces and the ruling groups, leave thousands of people trapped by violence. People risk being caught up in the fighting as they go about their everyday business.

In one of these favelas, Complexo do Alemão, Doctors Without Borders/Médecins Sans Frontières (MSF) runs a medical structure that provides emergency care and psychosocial support. The complex, a conglomerate of 11 communities on the outskirts of Rio, has a population estimated at 150,000. At the MSF emergency unit, people affected by fighting receive immediate assistance, improving their chances of survival and recovery. Once stabilized, patients are referred to a government hospital outside the community. MSF ambulances can also reach patients inside their homes. Due to checkpoints and blockages set up by the armed groups, no other ambulance can enter the area. Patients presenting with other medical emergencies, such as the hemorrhagic form of dengue fever, a seasonal disease in Rio, were also seen at the MSF center. In 2008 MSF provided 11,315 consultations in Complexo do Alemão. Nearly one third of all patients were under five years old.

Living permanently surrounded by violence has a serious impact on people’s mental health. In 2008 MSF provided psychological support to approximately 900 people. Most of them had been caught up in fighting or had directly witnessed acts of violence. One in ten has had a family member murdered. To promote the services available at the center, a team of four community health workers liaises with schools, churches, and other local institutions; organizes activities in the streets; and conducts home visits.

MSF has worked in Brazil since 1991.

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