Colombia: Surviving in a culture of violence

  • International staff: 36
  • National staff: 90 The well-being of most Colombians has been adversely affected by one thing: violence. Colombia is one of the most violent countries in the world. Conflicting political aspirations are often expressed in deadly ways: Armed groups launch attacks on those they suspect of collaborating with the powers that be, and others use equally brutal methods to defend what they see as the country's established economic and industrial order. The government and the military seek to redress the balance through force of their own. But it is the civilians who suffer. In conflict areas, small groups of people live in partially abandoned villages with little or no access to health care. Many health posts have no staff or lack medicine and equipment. To help these people, MSF has organized medical brigades to assist those in the isolated areas of Cordoba, Uraba, Magdalena Medio and Montes de Maria in northern Colombia, the area most hit by violence. In addition to treating common health problems (including malaria, dengue fever, pneumonia and skin problems), teams do vaccinations and work on prevention and health education. MSF also engages in advocacy. The focus is on the most vulnerable people: children, women and internally displaced persons (IDPs). MSF recently began work in the Pacific province of ChocÃ?³. At the hospital in the town of TadÃ?³, MSF works side by side with Colombian health workers. The treatment of malaria, mother and child care and vaccination have been identified as priorities in this region where an estimated five out of six people do not have access to adequate care, and where about 40,000 people (out of a population of 500,000) have been displaced by violence. Caring for those who flee to the cities Many of the country's 1.5 million IDPs flee to urban areas. They settle down in slums and mushrooming shantytowns, where they live in deplorable conditions. Basic services such as water and sanitation are very poor, and access to health care is difficult. MSF offers IDPs and other vulnerable people in the cities medical care and health education. "IDPs often don't know how the health care system works, or what their rights are. They are distressed, trying to find ways to survive in a hostile environment, and they experience a lot of difficulties getting integrated into the public health system," says one of the MSF coordinators in Colombia. In Soacha, a suburb of Bogota, MSF carries out health education, vaccinations and mother and child health care programs targeted at the area's many IDPs. Urban violence touches young men Poverty, unemployment, easy access to firearms and minimal access to education have spectacularly increased the homicide rate in Colombia - the murder rate is 77 killings for every 100,000 people. Urban violence, and in particular fighting between gangs, has left a ghastly legacy in its wake: physically handicapped young people with little access to medical care. Gunshot wounds leave many boys between the ages of 15 and 21 paralyzed from spinal cord injuries. Many of the victims are paraplegic patients who require special care. They need physical and psychological rehabilitation, yet they often lack the economic resources to get the care they need. In a community-based project in Cali, MSF works with these victims of violence and their families, through a rehabilitation program that includes medical care, physiotherapy, psychological support and social work, as well as prevention activities. There is a reference system for specialized consultations. Another problem targeted by MSF is that of early pregnancies and sexual violence. In Agua Blanca, a neighborhood of Cali, MSF has been working since 1996 to provide pre- and postnatal medical care, family planning services, psycho-social support and counseling. Education about sexual health and the detection and treatment of STDs are also part of the program. In little-populated rural southern Colombia, MSF makes rotating visits to small villages in the area of Solita. Teams carry out vaccinations, offer preventive and curative care and train local medical workers.