Gisela Díaz, a young mother who was raped by a local militia member and fled to Buenaventura for safety, said she still feels at risk. “They hardly show any of the violence against women and children in the news,” she said. “But the armed groups are still here.”
After being assaulted again after moving to the city, Díaz felt deeply depressed and tried to harm herself. Fortunately, she saw a phone number for MSF and called for help. “You feel good when you release all this repressed pain,” she said. “Because when you don’t talk to anyone, you start having crazy thoughts, like taking your own life.” Díaz is now a local leader supporting other survivors of sexual violence.
In a report published last August, MSF provided evidence that exposure to violent events or the risk of violence has led to intense mental suffering among people living in certain urban areas of Colombia affected by both the conflict and the drug war.
The report, based on data drawn from mental health consultations with 6,000 patients in the port cities of Buenaventura and Tumaco in 2015 and 2016, showed that patients suffered from a range of conditions, including depression (25 percent), anxiety (13 percent), and post-traumatic stress disorder (8 percent).
Despite the immense needs, comprehensive mental health services are generally not available at local health centers, except in the major cities. There is not a single psychiatrist in Buenaventura.
"Violence isn’t only something out there, it also exists within the home, within the family... Violence is contagious."
MSF began its program for victims of violence in Buenaventura in 2015. The team, comprising 11 clinical psychologists and one social psychologist, conducts outreach activities in the community and has three health centers across town. Often the first point of care is through MSF’s telephone hotline and counseling service, established last year. Counselors listen, triage calls, give basic psychological first aid if needed, and help callers make follow-up appointments for counseling or medical care at one of our health centers.
In the last year, the team in Buenaventura has counseled more than 500 women and men who have been victims of sexual violence, including rape. (In Colombia, 89 percent of sexual violence survivors treated by MSF are women.) If a woman comes to a health center soon after a rape, MSF counselors try to ensure that she receives treatment to help prevent pregnancy and sexually transmitted diseases, including HIV. Emergency contraception and post-exposure prophylaxis treatment must be provided within 72 hours of an assault, but often survivors of sexual violence seek care months or even years after an attack.
Increasingly, women in Buenaventura are asking how to access safe abortion services. Abortion is legal in almost all cases in Colombia, but access to services can be limited, causing delays and health complications. In 2018, the MSF team has already seen five women who came in with complications after failed or incomplete abortions. “We provide a safe place to talk to someone in the event of an unplanned pregnancy,” said Andrade.
