In Colombia, the civilian population is victim of a protracted conflict that tramples on their most basic human rights.There are no headline-grabbing mass movements of hundreds of thousands of people to draw international attention and condemnation. Yet people are displaced just the same, one family, one group, one community at a time. Colombia has the tragic record of having one of the largest displaced populations in the world. All are victims of a conflict that has been raging for 50 years.

MSF seeks to bring basic medical aid to civilians, in the places where they live, and in the places where they are often forced to flee. Mobile medical brigades provide primary care to people in rural areas isolated due to the conflict and to displaced and excluded people in urban areas. A medical and psychological rehabilitation program benefits young victims of urban violence.

A conflict with deep roots

Today's fighting has its roots in La Violencia, a time of civil strife, social violence, and bloodbath between political parties fighting for political supremacy. It is estimated that the conflict, which lasted from the late 1940s to the late 1950s, caused around 200,000 deaths. Nearly two million people fled the countryside between 1951 and 1964.

La Violencia and the bitterness it sowed spawned various guerrilla movements and eventually the autodefensas, also known as paramilitaries. Today, armed actors from all these groups, and the State, are engaged in an undeclared civil war that is bleeding Colombia dry. It is a merciless dispute for territorial control in a lush, mountainous country rich in oil, minerals, history and culture and, in the latest decades, coca plantations.

War in the countryside

Fighting takes place mainly in the countryside, and civilians are its principal victims. Forced displacement as a war strategy and government absence from a huge part of the country mean that the civilian population is often completely abandoned, trapped in the crossfire, vulnerable to abuse by all armed actors. The goal of weakening the social base of the "other side" leads to starvation blockades, extortion, threats, kidnappings, massacres, public executions, and indiscriminate attacks.

In many rural villages, basic services are rare. With an attack against health staff every 36 hours and a health worker killed every 15 days (according to the Red Cross), many health posts in rural areas are simply abandoned.

In such areas, MSF is often the only source of medical care. Medical brigades travel by car, boat, or donkey to reach the most isolated communities. A school or any other public house can quickly become a health post. Behind a sheet that acts as a curtain in makeshift consultation rooms, MSF teams provide primary health care and basic drugs to a population that would, otherwise, have no chance to visit a doctor.

Constantly shifting influence areas of different armed actors make life in the countryside difficult or untenable. Those that choose to stay live in fear; those that leave join two million people who have already been displaced since 1985, pushed from their homes.

Urbanization of misery

Of the country's 40 million people, 74% now live in urban areas, many pushed there by the war. In Altos de CazucÃ?¡, an "invasion slum" perched precariously in a cluster of hills just south of Bogota, overcrowding, poverty, and a lack of access to basic services such as health care erode the health of the population.

Like other such places around the country, it is a shantytown where many people live in unhealthy and subhuman conditions. Roads are dirt and marked with deep erosion ruts. Grey cinder-block shacks are mixed in with flimsier structures. Plastic water pipes, where they exist, lie on top of the dirt.

Wastewater runs into a stagnant dirty "lake" below. Whether motivated by actors in the war or resulting from economic and social exclusion, a phenomenon of violence has come to mark Colombia's cities, adding to the climate of fear. Juvenile gangs and violent behavior are ways of adapting to a hostile environment, especially when a young person lacks education, self-esteem, or a sense of roots.

What is being done to help the displaced?

Government aid to displaced people reaches only 20% of the displaced, according to Colombian NGO Human Rights and Displacement Consultancy (CODHES in its Spanish acronym). Aid is limited to a three-month period and can be extended for another three months in exceptional cases.

Law 100, passed in 1993, was designed to guarantee universal access to health care. It mandated the decentralization of health care services from federal to departmental and municipal levels. Yet, in practice, the reality in rural and urban areas is quite different from that intended by the law: many health facilities are shut, there are regular stock breaks, services are overcrowded, and the salaries of health care workers are not always paid. People, especially the displaced, have a difficult time registering for social services that allow them access to the little existing aid.

It is impossible to stop a war with doctors. But we hope that MSF's presence will serve to call attention to the plight of the population and offer civilians the possibility of regaining their human dignity. For more details on MSF programs in Colombia, click here.