More than 90 per cent of the western Central African Republic’s Muslim inhabitants have fled violence in the past few months. Armed international forces are protecting the last Muslims in a few enclaves under very precarious conditions.
Inside the Church compound, nearly one thousand people of different ethnicities, but all Muslim, are crammed in very precarious conditions on an area the size of half a football field.
These internally displaced persons (IDPs) were brought here by the MISCA (French acronym for the African mission supporting Central African Republic) troops in order to ensure their protection.
Since 2001, June 20th has been the day when the world considers the plight of refugees and internally displaced people by commemorating World Refugee Day . This year’s theme is a continuation of the “1” campaign, in which the world is asked to take 1 minute to consider the situation for a family forced to flee, many of whom may have just 1 minute to get ready . Keeping with the time theme, the UN High Commissioner for Refugees (UNHCR) estimates that world-wide, one person is forced to flee to become a refugee or internally displaced person every 4.1 seconds .
One of the main drivers of displacement is armed conflict, which is the disruptive force responsible for most of the world’s 45.2 million displaced people . Providing health care to displaced people is challenging, even to those in relatively stable settings, such as camps. For example, earlier this month, PLOS Medicine published an article by Joshua Mendelsohn from the London School of Hygiene & Tropical Medicine and colleagues from the UNHCR calling for equity in antiretroviral therapy provision for refugees and internally displaced people with HIV. The authors focused on stable settings and proposed several recommendations mostly targeted at host countries . Previously, PLOS Medicine published an article from Unni Karunakara from Médecines Sans Frontières and Frances Stevenson from HelpAge International highlighting the particular challenge of meeting the health needs of older people caught in conflict and other emergency settings .
The devastating effects of armed conflict on the health of populations is in no doubt, with both the direct effects of violence and the indirect effects, such as disruption to health services, having a huge toll on mortality and morbidity. For example, a study by Amy Hagopian and colleagues published in PLOS Medicine last year showed that, between 2003 and 2011, the majority of deaths in Iraq during the war and occupation were caused by the direct effects of violence and a third were due to indirect effects of health system disruption, resulting in a total of approximately half a million deaths attributable to the conflict .
To further add to the destruction and chaos of conflict, the past few years have brought mounting concern over the deliberate attacks on health care facilities and health workers, perpetrated to cause maximum damage to the health of populations. In 2011, the International Committee of the Red Cross (ICRC) published a landmark report that documented attacks on health care in 16 countries affected by conflict . As the ICRC says: “Statistics represent only the tip of the iceberg: they do not capture the compounded cost of violence–health-care staff leaving their posts, hospitals running out of supplies, and vaccination campaigns coming to a halt” . These knock-on effects of attacks dramatically limit access to health care for entire communities. Furthermore, such attacks are an insult to the Geneva Conventions, and the international community has responded with several initiatives and activities. For example, the ICRC launched the Health Care in Danger campaign, with the slogan “Violence against health care must end” . And several organizations worldwide have recently joined forces to form the Safeguarding Health in Conflict Coalition, with the aim of promoting respect for international humanitarian and human rights laws for the safety of health facilities, health workers, ambulances, and patients during conflict .
What is the current situation in Iraq?
Escalating violence in Iraq’s Anbar governorate over the past six months, and more recently in the city of Mosul, is having enormous consequences for hundreds of thousands of Iraqis. More than 400,000 people who fled Anbar governorate in the past six months are in need of assistance and emergency medical care. In addition, an estimated 500,000 people have reportedly fled Mosul since armed opposition groups took control of the city on 12 June. People have reportedly fled from the west to the east of the city, to other parts of Ninewah governorate, and to the Kurdish Region of Iraq (KRG), while fighting is ongoing in several areas of the country.
The humanitarian situation is extremely concerning. The displaced people are faced with difficult living conditions. They are staying in schools, mosques, unfinished buildings or with relatives. They need water, shelter, food and emergency healthcare. Hospitals and health facilities are increasingly short of medical and paramedical staff, who are fleeing the conflict areas en masse. There are severe shortages of drugs and medical supplies, as it is a struggle to bring supplies into the region.
The extremely volatile security situation in Iraq today makes it very difficult for humanitarian organisations to gain access to the conflict areas.
Providing the most basic assistance and medical care to the displaced population is extremely challenging for humanitarian organisations on the ground, given the security situation and the fact that people are scattered over a large area. The fact that international staff – who hold a position of neutrality in a conflict which is becoming increasingly sectarian – cannot be deployed in most areas for security reasons makes the provision of impartial aid more complicated.
Following severe damage of its clinic in Tikrit as a result of the shelling of the city on 13 June, preventing the provision of medical care to approximately 40,000 people displaced by the recent surge in conflict in Iraq, Médecins Sans Frontières (MSF) is calling on all warring factions to immediately respect medical staff and facilities, and to spare the lives of civiliansProviding the most basic assistance and medical care is extremely challenging in such an environment where the medical activities themselves are under attack.Urgent need for water, food, shelter, emergency health care.
As bombs struck the village of Farandalla on June 16,
Share depriving civilians of critical medical care, the organization said today.
Amidst Bombing of South Kordofan Village, MSF Facility Attacked
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Médecins Sans Frontières (MSF) confirms that its five staff held in Syria have been safely released. The organisation strongly condemns this abduction, which has forced MSF to permanently close one hospital and two health centres in the Jabal Akkrad region in northwestern Syria.
On January 2, 2014, five MSF staff were taken by an armed group in northern Syria, where they were working in an MSF-run hospital to provide essential healthcare to people affected by the conflict. Three of our colleagues were released on April 4, and two returned on May 14 and are on their way to be reunited with their friends and families.
Some 150,000 people in the Jabal Akkrad region are now deprived of MSF’s medical care, while living in a war zone.”