Setting the Scene: The collapse of healthcare

Malnutrition, violence and displacement in western Côte d'Ivoire

"I am P. and I come from a village near Ity. One day, soldiers speaking French and English came to our village and started killing the men. I managed to flee into the bush with my husband and child. The next day we returned and I saw the corpses of my brothers. They had been tied up and had their throats slit. We were hiding in the bush for two weeks. We would keep moving all the time and gave our child whatever we found to eat, in order to keep her quiet. We were scared that her crying would attract attention and that we would be attacked again."

- Woman, currently living as an IDP in Ganleu, western Côte d'Ivoire

Côte d'Ivoire was once a model for African development. However, its recent descent into violence, the humanitarian crisis that has developed and the terror experienced by the civilian population makes this historical claim begin to sound like an unfortunate cliché. What is more, the present conflict tends to obscure years of economic decline, the rise of political and communal violence as a function of the government-legislated concept of Ivoirité. It has contributed to widespread resentment towards the country's five million foreigners.

The current phase of the conflict began with a rebellion that exploded on 19 September 2002. Members of the military staged an uprising that soon evolved into a new rebel movement, le Mouvement Patriotique de Côte d'Ivoire (MPCI) and before long, they controlled the northern half of the country. The rebellion was largely a response to the broadening of Ivoirité, which the rebels interpreted as a way to exclude Northerners, from the political franchise.

On 28th November, two more rebel groups emerged from West and joined the fray: the Mouvement pour la Justice et la Paix (MJP) and the Mouvement Populaire Ivoirien du Grand-Ouest (MPIGO). With the support of fellow West African fighters, mainly Liberians, these new groups fought government troops in various and shifting combinations for control of what earned the region the title "the Wild West". This new aspect effectively linked the country's homegrown political crisis to an overarching regional conflict. More recently, these groups appear to have collapsed into the MPCI and into the more generically termed "Forces Nouvelles."

January 2003's round of negotiations in Linas-Marcoussis, France produced the closest thing thus far to a tangible peace accord, despite its controversial nature. At the time of this writing, French armed forces and ECOWAS peacekeepers deploy in more and more areas and in greater numbers. The last remnants of Liberian mercenaries have been rounded up, garrisoned, and (most) deported. Yet, intransigence from uncompromising elements on all sides continues to raise concerns regarding the sustainability of the peace accord, which has yet to be implemented fully.

Most importantly, the humanitarian crisis provoked by the conduct of this conflict (in addition to recent violence in Liberia) has yet to be addressed. After several years of conflict, nearly a year of war, and several months of falling victim to violence and displacement, civilians in western Côte d'Ivoire have all but been crushed under the weight of violence-driven social and economic upheaval and decline. Outright war and widespread predatory behaviour have generated tens of thousands of displaced, many of whom suffered or witnessed grisly human rights abuses and watched their villages being looted and burned. These people remain profoundly in need of humanitarian intervention and protection.

MSF operates in the West since March 2003 using mobile clinics and supporting health centres to address the overwhelming health needs in the region. Specifically, these health interventions have been in the towns and villages of Man, Mahapleu, Danané, Ganleu, Yapleu, Logoualé, Zouan-Hounien, Bin-Houyé, Toulepleu, Duékoué, Ifa and Diboké. Closely linked, MSF manages Therapeutic Feeding Centres (TFC) in Man and Guiglo. The following report is a synopsis of what we have witnessed during our brief encounter with this population in crisis, as we treated their wounds and diseases and listened to their harrowing stories.