Top 10 Most Underreported Humanitarian Stories of 2003

December 31, 2003
Top 10 Most Underreported Humanitarian Stories of 2003

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Mother with child lines up to be registered at the MSF health unit in the refugee camp of Tiné Chad. Photo © Dieter Telemans

Far beyond the headlines, two of the world's most violent conflicts raged on Chad's borders in 2003. Tens of thousands of people were uprooted by brutal wars in neighboring Central African Republic (CAR) and Sudan and fled for their lives to this impoverished central African nation. From January to March, more than 40,000 people found refuge in southern Chad, especially in Goré, Maro, and Ndanamadji, when a coup in CAR plunged the area into chaos. Then in July, fighting in the Darfur region of Sudan forced more than 95,000 people to seek safety in the barren border regions of eastern Chad. These refugees fled with little or no possessions when their villages came under fire from helicopters and local militias. Many of those who reached Chad describe seeing their villages and crops burned to the ground. Assistance and protection has been slow in coming and inadequate as only a handful of aid agencies have provided sustained meaningful aid.

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Bart camp, Ingushetia. Photo © Gazelle Gaignaire

Frequently portrayed by Russia as its own "war on terrorism," the Chechen conflict continued to take a heavy toll on civilians in the North Caucasus in 2003. The war in Chechnya still rages, and reports of violence, arbitrary arrest, and disappearances are common. Throughout the year, nearly 200,000 displaced people living in tent camps and makeshift shelters in Chechnya and the neighboring Russian republics of Dagestan and Ingushetia have been victims of a concerted campaign of harassment and coercion aimed at pressing them to return to war-torn Chechnya. Authorities closed several camps in Ingushetia alone during 2003, and nearly 30,000 displaced were pushed back into a war zone. As a result, only 8,500 people live in tent camps today. In February 98 percent of nearly 3,000 families interviewed by MSF said they feared for their lives if they had to go back to Chechnya. Even so, the pressure continues. Officials claim that no one is being forced to return, but authorities block groups from providing alternative shelters and impose additional bureaucratic restrictions on aid organizations, significantly limiting their ability to improve the living conditions of the displaced Chechens. The extreme violence against civilians has extended to international aid workers, as well, with MSF Head of Mission Arjan Erkel still held hostage more than 500 days since he was kidnapped in Dagestan on August 12, 2002. This increase in security threats and violence has made effective independent humanitarian aid nearly impossible in Chechnya at a time when civilian needs are at their greatest.

Read more about Burundi

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An MSF mobile clinic providing basic health care in impoverished rural areas of Colombia. Each day, entire families arrive on foot or by horse from homes often several hours away. Photo © Juan Carlos Tomasi

The chronic conflict in Colombia has almost become invisible to the outside world. But the effects on Colombians are all too evident. Unofficial estimates put the number of displaced people at three million, many of whom live in precarious conditions without water, electricity, or other basic services in burgeoning shantytowns on the outskirts of major cities where pressure from armed groups continues. Land conflict, crop fumigations in the "war on drugs", and constant threats from paramilitary forces, government soldiers, and guerrillas displace more and more people each day, while overcrowding and acute poverty increase their exposure to health problems, sexual abuse, and exploitation. Colombia's urban centers are also plagued by a more generalized violence, which exacerbates structural inequities that exclude the poorest and the displaced from access to health care. Those who have not fled their homes try to eke out an existence in the isolated, conflict-scarred countryside. In these increasingly insecure rural areas, people find themselves cut-off from even basic health care services and more vulnerable to treatable diseases and chronic malnutrition.

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An IDP camp near Bunia. Photo © Juan Carlos Tomasi

Twenty years of neglect and near-continuous war in the Democratic Republic of Congo (DRC) have claimed the lives of millions and left the essential services of the country in ruin. In the last five years alone, some groups estimate that three million people have died in this country the size of Western Europe -mostly from disease and famine indirectly caused by the conflict. While the carnage in the eastern DRC, especially in the northeastern city of Bunia, received a fair amount of media attention this past spring, the relentless terror endured by tens of thousands of people in the surrounding areas barely registered. In these regions, rival armed groups backed by foreign interests vied for power in a war that inflamed local tensions and destabilized the country, mainly through organized violence against civilians. People trapped in this massive human catastrophe speak of a nearly unimaginable scale of suffering, with massacres, rape, assault, and looting separating families and displacing large numbers of people. Away from the daily terror and intense conflict in Ituri and other troubled areas of eastern DRC, malnutrition, disease, and the near-total absence of basic health care continue to claim thousands of lives in the rest of the country.

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Testing a child for malaria in an MSF mobile clinic in Myanmar. Photo © Laurence Hugues/MSF

Each year, malaria claims between 1-2 million lives, mainly children in Africa. In fact, a child in Africa dies from malaria every 30 seconds, nearly 3,000 every day. Resistance has rendered chloroquine useless and sulfadoxine-pyrimethamine (SP) increasingly ineffective. An effective alternative treatment exists, though: artemisinin-based combination therapy (ACT) combines artemisinin, an extract from the Chinese plant Artemisia annua, with other antimalarials to minimize the chance of resistance. Most health professionals and malaria experts agree that ACT is the best option for treating malaria today, and the World Health Organization (WHO) has recommended the treatment since 2001 especially during epidemics. Cost is the most cited reason given for why ACT is not available to the children who are dying from malaria daily. Today, ACT can cost as little as $1 per treatment, and if ACT were introduced more widely, the cost would certainly decrease. Still, international donors and governments continue buying chloroquine and SP, and offer dying patients medicines they know do not work.

Read MSF's Report: Act Now to Get a Malaria Treatment That Works to Africa
Read about the current malaria epidemic in Ethiopia

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For more than twelve years, civilians in Somalia have been punished by cycles of violence, displacement, drought, and flooding. With no recognized central government, these factors have brought agricultural development to a standstill, perpetuated extreme poverty, and forced millions of Somalis into a hand-to-mouth form of survival. Of more than 800,000 people who fled Somalia in 1991 and 1992, during the heart of the crisis that began the nation's downward spiral, almost half are still living as refugees in surrounding countries. Inside Somalia, up to 450,000 people remain displaced, with 150,000 scraping together an unstable existence in camps in the capital Mogadishu. Civilians are still routinely caught in frequent armed clashes between the myriad of clan-based militias that remain active throughout much of the country. With no working government and little outside support, the already poor health care system has ceased to function in many areas. This has hit women's health especially hard: more women die in childbirth in Somalia than almost anywhere else on earth. Low vaccination coverage and inadequate sanitary conditions result in frequent cholera and measles outbreaks in the country. Rarely is there anyone there to provide assistance. Persistent violence and a lack of international funding have hindered aid agencies from mounting an effective response to the immense needs in the country.

Read more about North Korea

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A woman in need of ARV therapy in Guatepeque who lives with a disabled sister and her little son in Guatemala. Photo © Juan Carlos Tomasi

"It's already hard enough to get treatment here," said Carmen, a soft-spoken Guatemalan woman in her 60s. "Why wouldn't the United States want to help us in this? They should not make it harder." Carmen is one of the nearly two million people living with HIV or AIDS in Latin America and the Caribbean, and one of the six million people throughout the world who are in urgent clinical need of antiretroviral therapy (ARV). But the US and its powerful pharmaceutical industry have made it harder by pushing for more stringent intellectual property requirements in regional trade agreements like the Free Trade Area of the Americas (FTAA) and the US-Central American Free Trade Agreement (CAFTA) that restrict generic competition, the only factor that has resulted in sustainable price reductions for essential medicines. Such provisions undermine the 2001 Doha Declaration, an agreement adopted by all World Trade Organization (WTO) members which reaffirmed the right of countries to make full use of existing flexibilities in international trade treaties in order to "protect public health and promote access to medicines for all." Similar agreements pursued by the US with Morocco, Thailand, five southern African states, and other countries will most likely include similar restrictions. These proposals threaten to trade away the lives of millions for commercial profit and make lifesaving treatment a luxury few people like Carmen can afford.

Read MSF's report: Trading Away Health
Read about MSF Treating HIV/AIDS
Read MSF's Access Campaign Website

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Young woman with amputated leg, one of many civilian victims of the war. The hospital in Man is the only hospital in this region of Ivory Coast where surgical interventions can be done. Photo © Peter Casaer/MSF

Civil war broke out in Ivory Coast in September 2002 causing displacement and a breakdown in health services, especially in the western regions of this West African nation. Civilians living in the war zones were exposed to extreme violence inflicted upon them by the various warring parties and conflicts between locals and outsiders over land ownership drove yet more people from their homes. Health workers fled the war zones and medical facilities in rebel-held areas were looted and cut off from supplies, dramatically reducing access to health care at a time when it was most needed by civilians. Displacement, violence, and lack of medical care led to increased malnutrition and the outbreak of preventable illnesses throughout the north and west of the country. Only a few years earlier, Ivory Coast had been the most prosperous and peaceful nation in West Africa. In 2003, civilians in the west of the country watched their homes and their villages subjected to bombardment from helicopter gunships and looting from marauding militias. Violence spilling over from the war in neighboring Liberia, coupled with flaring ethnic tensions in western Ivory Coast, pushed even more people away from whatever health care was provided. Over a year after the coup, fighting has subsided, but the country remains divided, many people are still displaced, access to health care remains difficult, and the peace remains fragile.