In the operating theatre, a singing voice pierces through Olga Oulaï’s mask as she hands surgical tools to Martial, the MSF surgeon. Unlike many health staff in the region, Olga did not flee the violence. In addition to her invaluable help as a nurse, her singing is a much welcome boost for the rest of the team. A desperately needed boost.

Since the spike of violence hit the Duékoué area two weeks ago, the MSF surgical team has been treating 180 people bearing the marks of the hostile outbursts: wounds caused by gunshots, hunting rifles or machetes. With most surgeons having left the area, the workload for those remaining has been huge and the arrival of an MSF surgical team at Bangolo Hospital was more than welcome for the only remaining local surgeon. Only a handful of health structures are still working across the entire western part of the country.

Experienced MSF war surgeon, Dr Martial Ledecq, is about to start operating on a patient hit by a Kalashnikov bullet in the knee.

“These kinds of bullets create extensive wounds as they rotate inside the body and create huge damage when they go out on the other side,” he said. “In this case, the head of the femur has been completely shattered and the man was left with a huge hole surrounded by dead tissues: a perfect environment for microbes and infection.”

This patient’s infection got even worse as he hid in the bush for days before making his way to the hospital. After the initial influx of many patients between March 28 and April 1, there is still a constant stream of new wounded patients who have been hiding in the bush for days. Their injuries are often infected or have worsened because of the distance people have had to walk and the number of days they spent without appropriate treatment.

Just a few kilometres away from where incredible violence was unleashed just days ago, people from all communities – military and civilians – end up in the same wards spending a few days of respite at the cost of sometimes terrible injuries.

The conflict never crosses the entrance of the hospital.

As Dr Ledecq does his ward round between two operations, he spends a while with every patient. No need to pick up the clip-board as he knows their name, the status of their treatment. The pages of his notebook get filled very quickly as he schedules operations for the following days, prioritising the most urgent cases.

In the green zone, where the least urgent cases are staying, Dr Ledecq has to tell patients they will have to wait a bit longer. Four sisters, including a five-year old, will have to wait a few more days before they get the small rifle bullets removed from their legs and hips. A wink and joke later, Dr Ledecq even manages to get a smile out of them. Probably a smile of relief, a smile that means: ‘I’m safe here’.

Sitting on the floor next to them is a little girl whose foot had to be amputated after a gunshot made too much damage to consider fixing it.

“Having to amputate always feels like failure, it means everything else failed and it’s basically a last resort option,” said Dr Ledecq.

A few rooms down is a woman whose hand had to be amputated. When she and Dr Ledecq  had to make the decision, she asked him: “If you make my arm shorter, will it make my life shorter?” to which he answered “No.” She then told him to go ahead as she needed to live long for the sake of her children.

The next step in people’s lives remains a huge unknown. Some are too scared to go back to their villages, some have had their homes burned or looted. They will be bringing home visible and often permanent scars of the recent violence. The invisible ones will certainly stay with them just as long.

Following the post-election violence in Ivory Coast, MSF has been providing people with primary and secondary health care assistance by organizing mobile clinics and supporting health centres and hospitals in several locations in the western part of the country and in Abidjan. MSF teams are also assisting refugees and local populations on the other side of the border in neighbouring Liberia.

Currently, MSF has 50 international staff working together with 150 Ivorian staff in Ivory Coast. In Liberia, there are 10 international staff working with 30 Liberian staff. MSF, an impartial medical humanitarian organization, observes strict neutrality in its operations. Its activities in Ivory Coast are funded exclusively by private donors, ensuring the organization’s complete independence.