Spain 1998

MSF staffing: 5

Aiding the `Fourth World`

Although the economic situation is improving, Spain has the highest unemployment rate in Europe. A large number of people are living on the margins of the welfare state

MSF has been developing a socio-medical project for the marginalised population of Barcelona known as the `Fourth World` since 1994. The target population is around 8,000 people, mainly drug-addicts, the elderly on low incomes, illegal immigrants and homeless.

The team organises and supervises out-patient consultations and treatment in a mobile clinic with fixed stops in areas of easy access for the targeted populations.

The clinic acts as a first point of contact with the ultimate aim of integrating these people into the existing health and social welfare systems.

During the winter of 1997-1998, `Operation Cold` was launched to target the homeless, a difficult group to reach as they have no base. Consultations were organised every evening at city shelters for the homeless by a MSF doctor and nurse. This strategy made is possible to follow up on the health situation of those assisted and take the necessary steps to integrate them into the health and social services.

There is a syringe exchange programme and condoms are distributed in order to prtevent the spread of STD/HIV/AIDS.

General health information is also improved.