International staff: 32
National staff: 206
Nicaragua, like many other countries in the region, has experienced intense urban migration over the last decade. About 60% of the population now lives in and around cities. This puts undue pressure on a public health system already suffering from infrastructure deterioration, a shortage of medical material and medical staff often unmotivated because of very low wages. In the overcrowded cities, many people fall through the cracks.
The capital, Managua, is home to about 30,000 children and adolescents living on the streets. MSF has a medical, psycho-social and legal assistance program that reaches about 4,000 young people, who often flee home because of ill-treatment or violence.
The goal of the program is to improve the street children's family relationships and their access to health care, facilitate social reintegration and encourage area people and institutions to treat these young people like ordinary citizens - as stipulated in Nicaragua's National Code for Children and Adolescents.
"Street children are in a very vulnerable situation," explains Chus Alonso, coordinator of the program. "They are seen as undesirable and are the victims of all kinds of abuse and violence."
MSF visits the areas of the city where street children live. A doctor, nurse, psychologist and lawyer provide health care, psychological support and legal aid both on the streets and at a recently opened drop-in center. In addition, MSF contacts any institution that has not respected the National Code.
Lobbying efforts lead to results
On several occasions, MSF has publicly denounced violence against street children. In November 1999, MSF bought advertising space in two newspapers to condemn the murder of a street child who had stolen a hat. More ad space was bought again the following January, after a security guard shot and wounded a child who was trying to steal a chair. After both of these public denunciations, the General Prosecutor contacted MSF for more information and committed himself to investigating the cases. The investigations were ongoing through summer 2000.
A focus on women's rights in Quilali
Since late 1998, MSF has been working at the Casa Materna in Quilali, a small city in northern Nicaragua. At its core a place to care for women with difficult pregnancies, MSF hopes the center will also become a base for working with the local community to promote women's rights. Beginning in April 2000, MSF began to set up a prevention and response network for women in the community. A separate "Women's Commission" - to accompany victims, push for the training of a female police officer, and rehabilitate facilities - was also launched.
Tourism and shipping increase the rate of HIV/AIDS
Although Nicaragua has one of the lowest HIV/AIDS rates in Central America, certain parts of the country have been particularly touched by the disease. In the southeastern coastal city of Bluefields and on Corn Island, in the Caribbean, adults regularly leave for work in the tourism industry or on commercial boats, a pattern that has resulted in an STD/AIDS rate much higher than the national average. MSF runs STD/AIDS prevention and awareness programs in both of these areas.
In the aftermath of Hurricane Mitch, MSF helped rehabilitate medical buildings and water and sanitation systems. This program, in the departments of Managua, Leon, Chinandega and Nueva Segovia, ended in June 2000.
MSF first intervened in Nicaragua in 1972, following an earthquake that devastated Managua.