http://www.msf.org/
19.01.2005
Beyond the headlines: "Top 10" most underreported
humanitarian stories from 2004
Uganda | Democratic Republic of Congo | Colombia |
Tuberculosis | Somalia | Chechnya | Burundi | North Korea |
Ethiopia | Liberia
Intense grief and fear in Northern Uganda
For 18 years, people in northern Uganda have endured a
brutal conflict with consequences that are nearly invisible
to the outside world. More than 1.6 million people – 80
percent of northern Uganda's entire population – have been
displaced and now live in squalid conditions. Civilians have
been attacked and killed by the Lord's Resistance Army (LRA)
in their villages, as well as in the camps where they have
sought refuge.
The LRA has abducted tens of thousands of children, forcing
them into combat and sexual slavery, a fear that causes up
to 50,000 children to stream into city or camp centers
across the north every night from as far as 10 miles away in
search of a safe place to sleep. The Ugandan army has moved
hundreds of thousands of civilians against their will into
"protected villages" that offer little security and hardly
any assistance, and has victimized ordinary people with
brutal raids against suspected LRA militants.
While the death toll from direct violence reaches into the
tens of thousands, chronic food and water shortages in the
200 makeshift settlements throughout the north have also
exacted a heavy price.
In November 2004 alone, MSF recorded staggering death rates
in six camps in Lira and Pader districts, with many dying
from preventable diseases like malaria, respiratory disease,
and diarrhea. Recent peace overtures from both the LRA and
the government have not led to a noticeable improvement of
the situation for people living in deplorable conditions and
in constant fear.
No end in sight to devastating conflict in Democratic
Republic of Congo (DRC)
Civilians were once again besieged in the eastern DRC when
fighting erupted in North Kivu this past December.
Nearly 150,000 people fled for their lives from Kayna,
Kanyabayonga, and Kirumba just a few weeks after thousands
of others fled fighting in the Mitwaba region.
These were just the latest chapters in a decade-long war
that has cost an estimated three million people their lives
and reduced an already impoverished country's limited
infrastructure to ruins. Towns like Bunia, in Ituri
province, still bear scars from last year's fighting, and
rape is widespread.
Political divisions often erupt along ethnic lines,
affecting entire areas of a country the size of western
Europe, where many Congolese cannot meet even their most
basic needs.
Local militias and government troops prey on civilians
throughout the east. In Katanga province, armed groups have
burnt down health structures, and unpaid militaries harass,
loot, and exploit people. Medical services are woefully
inadequate in the entire country, if they exist at all.
Measles vaccination coverage in the country is barely above
50 percent, while MSF responds to frequent outbreaks of
cholera and typhoid fever because of poor sanitation and
lack of potable water.
A peace accord signed by seven warring factions in December
2002 led to a transition government and a UN peacekeeping
force in the east, but the situation remains grim.
Even with elections scheduled for June 2005, much remains to
be done before any sense of security or hope is restored to
people ravaged by a war with no end in sight.
Civilians caught in Colombia's crossfire
Forgotten by much of the world, Colombia's enduring conflict
continues to inflict great misery on civilians.
More than three million people have been displaced within
the country, usually to vast shantytowns on the outskirts of
major cities, and violence is still the leading cause of
death. While control over coca, oil, timber, and other
resources fuels the decades-long conflict, half of
Colombians live in extreme poverty.
In many areas, it is nearly impossible for people to stay
outside the conflict, as both government and anti-government
forces consider everyone a potential informer or collaborator.
In areas where control changes hands, civilians caught in
the middle can be threatened, attacked, or killed.
Various armed factions fight for control inside the shanty
towns, making violence and intimidation a part of people's
daily lives.
Medical personnel are threatened, patients have been
forcibly removed from ambulances and executed, and health
structures are repeatedly looted.
Even medical supplies have become a strategic objective.
Diagnostic tools and treatments for cutaneous leishmaniasis
are heavily controlled because the disease, which primarily
affects people in rural areas, is viewed as a marker for
possible rebels or their supporters. Living in a state of
continuous fear has taken a predictable toll on people's
mental health, as well.
Some patients walk for hours to a clinic seeking treatment
for headaches, when medicines are available in their villages.
Subsequent consultations often lead to discussions with
mental health personnel that reveal the terrifying
conditions of life in Colombia.
Tuberculosis spiraling out of control
Tuberculosis (TB) kills one person every 15 seconds, thus
claiming millions of lives every year even though it is a
curable disease. While the risk of TB is relatively low in
wealthy countries, the disease is making a comeback
throughout the developing world: one-third of the world's
population is infected with the TB bacilli and eight million
people annually develop active TB.
Unfortunately, most TB is diagnosed by sputum microscopy, a
diagnostic test developed in 1882, and the only available
medicines for treatment were invented up to 60 years ago.
TB treatment takes a minimum of 6 months and nearly two
years for multi-drug resistant (MDR-TB) strains. The AIDS
pandemic has lead to an explosion of HIV/TB co-infection, as
TB is the most common opportunistic infection for those
living with HIV/AIDS.
This further increases TB's appalling human toll. There is
an urgent need for serious improvements in the way TB is
tackled globally, from research and development of new
medicines and diagnostic tests that detect all forms of TB
in all patients, especially children and people living with
HIV/AIDS, to innovative treatment programs that go beyond
Directly Observed Therapy – Short-course (DOTS).
"It's time to openly admit we'll never be able to 'control
TB' by prescribing more of the same," said Dr. Francine
Matthys, TB advisor for MSF's Campaign for Access to
Essential Medicines, at the 35th Union World Conference on
Lung Health in October 2004. "Massive investment is needed
now, so that we can effectively diagnose and treat all those
with TB in the shortest possible time."
Somalia shattered by anarchy and chaos
Fourteen years of violence have dramatically affected
Somalia's population of nine million, with approximately two
million people displaced or killed since civil war erupted
in 1990 and close to five million people estimated to be
without access to clean water or health care.
The collapse of the health-care system, along with most
other state services, have hit women and children
particularly hard: one in sixteen women dies during
childbirth; one in seven children dies before their first
birthday; and one in five children dies before the age of five.
Natural disasters like flooding in the lower Juba and
Shabelle valleys have only worsened the human catastrophe,
causing high rates of chronic malnutrition and preventable
disease. Even though a recently selected central government
offers a glimmer of hope, violence still shatters people's
lives as predatory militias and warlords wield power for
financial profit.
From January to November in Galcayo, in one of the more
stable parts of Somalia, MSF treated nearly 1,000 people for
violence-related traumas, including 262 gunshot victims.
The continuing insecurity in many areas and a lack of
international attention has resulted in a dearth of
meaningful emergency assistance, leaving many desperate
segments of society abandoned and all but forgotten.
The trauma of ongoing war in Chechnya
A decade of intense conflict continues to devastate people
in and around Chechnya.
Despite repeated claims from officials that the situation is
'normalizing,' Chechnya is far from peaceful and stable.
Even so, since 2003, Russian and Ingush authorities have put
considerable pressure on internally displaced people (IDPs)
in Ingushetia to return to the war-wreaked region. By the
end of 2004, only 45,000 people who fled the conflict, out
of an original 260,000, remain in Ingushetia and are living
in terrible conditions, while those pressured to return to
Chechnya have been placed in "Temporary Accommodation
Centers," where conditions are not much better.
Almost all of the 539 people interviewed for a study by MSF
in 2004 had been exposed to crossfire, aerial bombardments,
and mortar fire.
More than one in five had seen killings, and nearly half had
seen family members assaulted.
About 90 percent of people in the Chechen camps and 80
percent in Ingushetia had had someone close to them die from
war-related violence, while more than a third of people in
Ingushetia and two-thirds in Chechnya felt unsafe.
It is common for friends and neighbors to be arrested or
simply "disappear" on both sides of the border.
As authorities look poised to continue their policy of
moving people against their will, from one inadequate and
insecure location to another, the plight of people trapped
in this nightmare remains largely ignored.
User-fee system excludes Burundi's poorest from basic health
care
In Burundi, a country struggling to emerge from a
decade-long civil war, a user-fee, or cost-recovery, system
has become the cornerstone of health-care financing.
As a result, the country's most impoverished are paying a
catastrophic price.
A recent medical survey by MSF found mortality rates double
the emergency threshold, and little or no health care for
those who could not pay.
In regions covered by the user-fee system, malaria deaths
were twice as high as in areas adopting a low flat fee.
One in five people interviewed said they didn't visit health
centers even when there are sick because they couldn't
afford it – not surprising in a country where nearly 99
percent of the people live on $1 a day and a staggering
85-90 percent survive on $1 a week.
For many, even a simple consultation costs an average of 12
days' worth of income.
To access lifesaving care, the sick risk further
impoverishment by selling off all of their tools and
livestock or by borrowing sums of money that can take years
to repay.
Hospitals have even held patients in confinement until the
family finds money for treatment.
Deficient state funding and international donor priorities
only reinforce the system, even though there is no evidence
that cost-recovery contributes to either the sustainability
or efficiency of health-care delivery.
In the end, it is the health of the war-affected country's
poorest citizens that suffers most from the failed policy.
North Koreans endure massive deprivation and repression
A man-made cataclysm continues to rage in North Korea, where
people struggle against violent repression and massive
deprivation in a country that is almost entirely sealed-off
from the outside world. In the late 1990s, an estimated two
to three million people starved, and recent stories from
refugees reveal that the food and health situation is still
dire.
Even though huge amounts of international assistance pours
into the country, there is no way of knowing if it reaches
those most in need and many suspect that the bulk of aid is
simply diverted by the military regime.
Economic reforms, introduced in July 2002, have exacerbated
problems, resulting in runaway inflation that undermines
people's ability to afford basic food items.
For many desperate North Koreans, even fleeing the country
does not end their anguish.
Considered economic immigrants by Chinese authorities, most
live in hiding because they fear arrest and forced
repatriation to North Korea where they are subject to
imprisonment and brutal treatment.
Humanitarian aid workers who try to assist refugees face
reprisals from Chinese authorities, who deem such assistance
a criminal offense.
The UN High Commission for Refugees (UNHCR) has not visited
the border region for years even though China is a signatory
to the 1951 Refugee Convention.
While most international interest continues to focus on
North Korea's nuclear weapons program, little attention is
paid to the intense suffering endured by North Koreans, both
inside and outside the country, who have little access to
the basic services and security they need to survive.
Constant threat of hunger and disease in Ethiopia
More than 10 percent of children do not survive their first
year of life in Ethiopia.
Scarce farmland in the overpopulated arid highlands leave an
estimated five million of Ethiopia's 69 million people to
face chronic food shortages.
Severe droughts in 1999 and 2001 compounded the situation.
While some recent rains have provided a little respite, the
lack of substantial rainfall since early 2003 has led to the
deaths of an estimated 50 percent of people's livestock.
To address this persistent food insecurity, the government
is in the process of a multi-year effort to voluntarily
resettle more than 2 million people to the country's more
fertile lowlands.
Actual assistance in the program has fallen short of
government promises, while resettlement has proven deadly
for some communities by exposing people to malaria-endemic
regions for the first time.
Ethiopian doctors struggle with few resources to fight
infectious diseases like HIV/AIDS, malaria, TB, and kala
azar for which treatment is expensive and often inaccessible.
Malaria has become particularly deadly because drug
resistance has rendered the most common anti-malarial
treatment practically useless. The government has changed
its national malaria protocol to use the more effective
artemisinin-based combination therapy (ACT), but
international supplies of ACT are facing a huge shortfall.
Ethiopia is considered an important partner in the US-led
"war on terror," and the US military has carried out some
assistance activities alongside its intelligence and
training missions in regions bordering Somalia.
MSF has already warned against a possible confusion between
soldiers trying to win "hearts and minds" and humanitarian
aid workers providing needs-based assistance, and raised
concerns that the security of its teams could deteriorate.
The war is over, but Liberians still live in crisis
Intense fighting during the summer of 2003 in Liberia's
capital, Monrovia, cost more than 2,000 people their lives.
More than a year after this debilitating 15-year civil war
ended, though, Liberians are still living in a state of crisis.
Little of the country's demolished infrastructure remains,
leaving most people without basic services like water and
sanitation.
More than 300,000 people are still displaced within the
country while 300,000 refugees wait to return from
neighboring countries.
Health care, already scarce in the main cities, hardly
exists at all in remote areas of the country.
Today, there are only 30 Liberian physicians working in a
country with more than 3 million people.
In Bong County, MSF provides 7,000 consultations a month for
60,000 displaced people.
Some families are returning to Lofa County, but virtually
nothing by way of essential services has been prepared for them.
The return of refugees to Nimba County, where MSF provides
5,600 consultations a month, could exacerbate ethnic
tensions. Women continue to be victimized by sexual
violence, as well – from October 2003 to July 2004 alone,
more than 800 people came to MSF for treatment from camps
housing 35,000 displaced people north of Monrovia.
Against this awful backdrop, instability in neighboring
countries, an incomplete disarmament process, and general
discontent threatens Liberia's fragile peace.
During three days of riots in Monrovia in October 2004,
nearly 400 people were wounded and 15 killed.
