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The Humanitarian Situation in Liberia
Statement by Morten Rostrup, MD, President, International Council of Médecins Sans Frontières (MSF) to the United Nations Security Council "Arria Formula" Meeting
September 9, 2003
Members of the Security Council,
Médecins Sans Frontières is grateful for this opportunity to again address members of the Security Council about our current concerns regarding the humanitarian situation in Liberia.
Before I begin, I would like to take a moment to remind the Council that Arjan Erkel, an MSF volunteer who was kidnapped in the Russian Republic of Dagestan on August 12, 2002, is beginning his second winter in captivity. MSF remains dismayed at the Russian government's failure to vigorously investigate the case and secure Arjan's freedom. During the General Assembly next week, we urge all members to put the newly passed Resolution 1502 on the safety and security of humanitarian workers into action by holding President Putin accountable for making Arjan's immediate and safe release a matter of the highest priority.
I would like to turn now to Liberia, where I have worked in 2000 and returned last month to set up a health clinic in LURD-held Tubmanburg north of Monrovia and carrying out assessment missions in Bong and Margibi Counties. Fighting may have ceased momentarily in Monrovia, but I can assure you that Liberia is not a country at peace. The country is divided into two: on the one hand Monrovia with improved security and overwhelming humanitarian needs, but where we are able to provide direct, yet insufficient assistance. On the other hand the countryside, where there is ongoing fighting between armed groups, brutal violence exercised against the civilian population, and where it is extremely difficult to provide essential assistance in the face of massive needs because of the widespread insecurity. Despite claims that the nightmare is now over, Liberia remains a humanitarian emergency that deserves an emergency response.
Violence and Displacement in Bong County
A very clear and urgent example of this is the situation in Bong County, north of Monrovia. Active fighting just 25 kilometers from camps for displaced people in Bong County is threatening tens of thousands who are currently on the move in search of safety. It is not just the fighting between different armed groups that these civilians fear. Looting, indiscriminate violence, rape, and forced conscription committed by all the warring parties have sent thousands in search of safe havens throughout the war. The massive displacement of civilians in Bong County that is currently going on is symptomatic of the vicious cycle of violence against civilians that has been continuing since 1999.
The Totota and Maimu camps in Bong County were nearly completely emptied last week, with fifty-five severely malnourished children and tens of patients treated for cholera still unaccounted for as a result of the chaotic escape. In hours, Salala camp, which was already overcrowded with displaced people, has doubled in size to an estimated 50,000 people. Tens of thousands of others are on the move to Kakata, where fighting occurred today, Careysburg, and Monrovia. Many of these Liberians have already fled fighting several times in the past two years alone. People have lost everything and now they are being forced to move again. They are traumatized and exhausted and fearful of being trapped behind the frontlines once again, but there are very few places left for them to flee to and assistance is seriously inadequate.
With the rainy season at its peak, the displaced of Bong are left without proper shelter, food, or health care. The newly displaced are taking refuge in schools, transit camps, and abandoned buildings. Food has not been regularly distributed in the camps in Bong since May and MSF medical teams working in Bong are seeing a rise in malnutrition. MSF has treated over 250 severely malnourished children in our therapeutic feeding center in Salala camp in the past month. MSF will open a clinic in Careysburg to provide assistance to displaced people currently moving from Bong.
Other Areas outside of Monrovia
The situation in Bong County is only the most visible example of the dire conditions outside of Monrovia. Since fighting subsided in Monrovia on August 10, MSF assessment teams have traveled beyond the city to assess health needs in parts of the country that have been cut off from humanitarian aid for months, and in some cases, years. MSF has now undertaken assessment trips to Grand Cape Mount, Bomi, Gbarpolu, Grand Bassa, Margibi, and Grand Gedeh counties and reopened clinics in three displaced camps in Montserrado County. Living conditions in the camps, villages, and cities everywhere in Liberia remain horrible. There is a severe lack of adequate food and water, and access to primary medical care is practically nonexistent. For example in Tubmanburg where I was working up until last week, an estimated 14,000 displaced people are living with little or no assistance. Most of the 200 patients we are treating each day in our mobile clinic are women and children who have fled fighting numerous times, and are suffering from malaria, respiratory infections, and malnutrition. In Buchanan, MSF found an estimated 30,000 displaced people who fled the fighting areas are living in a dozen makeshift shelters in need of urgent medical and nutritional assistance.
In all sites visited recently, the Liberian population is desperately asking to be protected from the effects of the fighting and from the violence perpetrated by armed groups. Yet insecurity and fighting continues, forcing the people to leave their homes and the camps for displaced persons. The population living in most of the county's territory beyond Monrovia remains unaccounted for, left without any protection, and cut off from medical care and adequate food, shelter, and water. As an example, Lofa County has been cut off since mid-2000 and Nimba, where fighting is currently ongoing, is also out of reach.
MSF is extremely worried that the population outside of Monrovia continues to be exposed to fighting and targeted violence which is also making it extremely difficult, if not impossible, to provide them with appropriate humanitarian assistance. Neighboring Guinea, Cote d'Ivoire, and Sierra Leone must open their borders to allow humanitarian aid workers to reach people in need inside Liberia and to allow civilians to exercise their right to flee areas at war and seek safe refuge.
During the three rounds of attacks on Monrovia this past summer, over a dozen international and 900 MSF national staff worked under extremely dangerous and difficult conditions to provide some of the only medical care available in the city. Throughout the summer, MSF teams ran two field hospitals in Monrovia with emergency, surgical, and in- and out-patient facilities that treated over 800 war wounded civilians and, between attacks, when patients were able to access our clinics, MSF treated thousands of people, primarily for malaria, acute respiratory infections, cholera, and malnutrition. Unfortunately, we can only guess how many people suffered or died due to cholera, complicated births, war-related wounds, and other illnesses due to lack of access to medical care during the fighting.
Despite improvements in the security environment since the deployment of the ECOMIL troops, Monrovia itself continues to remain a city of squatters living without electricity, running water, proper shelter, sanitation, or adequate food. The public health system and basic infrastructures in a city of 1.5 million that is hosting several hundreds of thousands of displaced persons, are in shambles. More displaced people might arrive in Monrovia in the coming days due to the fighting in Bong County. The needs are overwhelming. Every new clinic we open is flooded with people seeking treatment, food and water. MSF teams in Monrovia are running the only two free full-service hospitals in the city - that means only 230-hospital beds, in addition to the surgical facility for war wounded in JFK Hospital managed by the ICRC. MSF in Monrovia is also running 11 out-patient clinics treating 1500-2000 patients a day, 2 therapeutic feeding centers for over 75 malnourished children, and 3 cholera treatment units (CTUs).
Cholera remains of grave concern to MSF teams, as well as the alarming increase of cases of malaria. The number of people treated for cholera increased when fighting in the city subsided and by August 24, MSF had treated 8132 cases of suspected cholera, among them 2992 severe cases, in its CTUs in Monrovia in 2003. The cholera outbreak began two months earlier than usual this year and our CTUs in Monrovia and Bong county continue to receive patients suffering from suspected cholera cases every day. Although we are now stepping up our efforts to treat and monitor the outbreak, with cases continuing to appear all over the city and the hygiene conditions remaining so poor, we have certainly not seen the end of this epidemic yet.