The medical consequences of neglect - Colombia's cycle of violence

My kids live in constant fear. When shooting starts, the girl holds her aunt's leg and both kids start screaming, they go crazy. The thing is that the bullets pierce through the house, there are holes everywhere. My boy has nightmares and I don't know what to do. — Displaced mother living in an urban slum
Waterborne illnesses such as diarrhoea, parasitic diseases, and hepatitis A represent 14% of the 5,294 consultations done by MSF in Sincelejo over the last six months of 2005. The high incidence of respiratory infections relates to overcrowded and inadequate living conditions. In the MSF clinic, these types of illness represent 63% of the standard medical consultations. According to statistics from the Sincelejo water company (Aguas de la Sabana) approximately 77% of Sincelejo's residents have running water and sanitation facilities. However the same statistics also show that only half of the 22 slums from which most of MSF's patients originate have these essential services. MSF's patients consistently report that those living in the slums are unable to get needed medical care in cases of minor emergencies at public hospitals. They also say they can only see a doctor or nurse when their condition becomes more severe. As a consequence, illnesses that are usually not life threatening can become serious. Normal life events, including pregnancy, can develop into complicated conditions, especially due to the early age at which many girls become pregnant. Thirty-five out of every 100 displaced adolescent girls (15-19 years of age) were already the mothers of at least one child. The average number of children born by the displaced is also significantly higher than among the general population.6 MSF has found extremely low levels of immunisation among the patients visiting its health care clinics in slum areas. Estimates on coverage amongst displaced populations by the health authorities in Sincelejo confirm MSF data, and show a bleak 8.9% coverage for polio, 14.6% for BCG, MMR (measles, mumps, rubella) 9.5%, DPT (diphtheria, pertussin and tetanus) 8.9%, hepatitis B 8.9%, haemophilus influenzae 8.9%. The rates are far below national averages reported by the Colombian Ministry of Health. These figures highlight the poor levels of basic care among those displaced by violence, and are a source of concern due to the increased vulnerability to outbreaks. However, the most alarming impact of the ongoing conflict can be seen in the way in which victims of violence struggle to cope with the events that led to their forced displacement. Firstly, they have problems coming to terms with the consequences of the violent incidents that forced them to leave their homes, mourning the loss of their loved ones and their past life, and adapting to the adversity of their circumstances in the slums. Secondly, violence reproduces itself in urban settings and comes back in different forms. The increase of problems such as alcohol and substance abuse and domestic and sexual violence can be directly linked to the breakdown of the social fabric associated with violence and displacement. MSF addresses some of these problems through its mental health programme.