End of war reveals nutritional emergency in Angola

An April ceasefire brought an end to Angola's brutal 27-year civil war, but not to the extreme suffering of the Angolan people. Peace revealed one of the worst nutritional emergencies seen in Africa in a decade. Civilians emerged from formerly inaccessible regions of the country desperately seeking food and relief only to find a government largely indifferent to their plight and a slow ineffectual response from the international aid community. Having barely survived years of violence deliberately perpetrated against civilians by both the UNITA rebels and the Angolan government, including forced displacements, rape, and summary executions, Angolans now perished from starvation and disease in this enormous man-made catastrophe.

In government-controlled Chipindo, for example, traditional leaders reported that in the first half of the year, nearly 4,000 people had died from an initial population of roughly 18,000. A May survey in MSF's therapeutic feeding center in Malange, revealed that 6 out of 10 women had lost a child to hunger in the past four months. By the end of 2002, the nutritional situation had improved, but with an estimated four million people displaced, a destroyed infrastructure, a landscape littered with millions of land mines (7 aid workers and patients, including 4 MSF staff, were killed in a landmine accident in December), inadequate mine-clearing activities, and continuing government intransigence, the desperate struggle for Angolans is far from over.

Civilians caught in increasing violence in Colombia

2002 saw a dramatic escalation of the conflict in Colombia following the collapse of peace negotiations between the government and FARC rebels. Against a background of widespread poverty and weakened public services, the war is affecting civilians in both urban and rural areas. Throughout the country, some 25,000 people are murdered and another 3,000 kidnapped every year. Since 1985, an estimated 2 million Colombians have been displaced - nearly half within the past two years - flooding urban centers to escape the escalating violence in the countryside. For those left behind, extreme isolation has intensified. Rural health posts have been abandoned, hospital services have become sporadic, and many rural residents forego seeking medical treatment out of a well-founded fear of traveling. As a result, preventable diseases such as measles have made a comeback, and outbreaks of malaria have been recorded. As right-wing paramilitaries, left-wing rebels and government forces become further entrenched, the situation for civilians will continue its downward spiral.
 

War and lack of health care in the Democratic Republic of Congo

Despite a peace deal and the withdrawal of some foreign armies, war continues to wreak havoc on the Democratic Republic of Congo (DRC). The consequences are particularly devastating along the ceasefire line and in the east, where an estimated one in four children dies before reaching the age of five. For the survivors, the conflict exacts a chilling and steep price. An estimated 2.5 million people have been displaced from their homes, and, for years, civilians throughout the country have been subjected to indiscriminate violence, rape, abduction, and killings. Meningitis, measles, malaria, and tuberculosis needlessly kill hundreds of thousands of people every year; alarming levels of malnutrition have been recorded in North Kivu province; and a cholera outbreak in Katanga province, where 25,000 cases have been counted since September 2001, has only added to the death toll. The country's ravaged infrastructure cannot begin to address these soaring health needs. In many parts of DRC, hospitals have ceased to function, while some districts have only one or two doctors serving hundreds of thousands of people.

Food aid and refugee protection in North Korea

Although North Korea remains one of the largest recipients of food aid in the world, its people continue to suffer from a severe lack of access to adequate food supplies. As a result, many North Koreans, mainly from the northern provinces, continue to risk arrest and imprisonment attempting to cross the border into China in search of a means to survive. Even population groups such as children, pregnant women, and the elderly, who are specifically targeted for assistance by the United Nations World Food Program, are being denied food aid. In February 2002, an MSF team met with 12 North Korean children between the ages of 6 and 15 who had recently arrived in China. None of them had ever received food at primary school and they were often too weak and hungry to attend school. Delivery of food aid to the most vulnerable populations is not independently monitored. Those North Koreans desperate enough to seek food, medicine, or refuge in China face enormous obstacles. Considered illegal migrants, they live in hiding and risk fines, arrest, and forceful repatriation - in contravention of the 1951 Refugee Convention that China has ratified - as well as severe repercussions upon their return to North Korea. Despite its mandate to protect refugees, the United Nations High Commissioner for Refugees has done little to stop forced repatriations of North Korean refugees in China or to provide adequate humanitarian assistance or protection to them.

Hundreds of thousands displaced by civil war in Liberia

Throughout 2002, civil war raged between Charles Taylor's government troops and rebels from the Liberians United for Reconciliation and Democracy (LURD) in Liberia's northern Lofa region. Fighting has forced as many as 250,000 civilians to flee Liberia and seek refuge in neighboring Guinea, Sierra Leone, and Ivory Coast - almost 90,000 fled during 2002 alone. In addition, there are at least 80,000 internally displaced persons living in camps in Liberia and an unknown number of civilians still trapped in conflict-riddled Lofa County. Many Liberians have been uprooted multiple times in the past decade and have suffered at the hands of the LURD and government forces, both of which have perpetrated violations of international humanitarian and refugee law with virtual impunity in front of an indifferent international community. Refugees and displaced persons throughout the region have described enduring extortion, rape, forced conscription, labor, and repatriation to war zones, beatings, and imprisonment as they have sought assistance. Many displaced persons and residents struggle to survive in rural areas, particulary in the Lofa County region, where insecurity makes access to humanitarian assistance next to impossible. In Liberia's capital Monrovia, most of the buildings destroyed by civil war in the early 90s still lie in ruins. Public hospitals and health services have all but stopped functioning, except for where assisted by international agencies, and there is a severe lack of potable water, a situation that is not likely to improve as long as a significant portion of the national budget is diverted to the conflict rather than to improving the living conditions of the population.

War, disease, hunger and lack of healthcare contribute to mortality in Somalia

Twelve years of near continuous warfare have brutalized the civilian population of Somalia, exposing them to injury, disease, displacement, and hunger. War-related injuries and deaths, including those caused by the millions of landmines in the country, have remained consistently high throughout the past decade. In Galcayo Hospital alone, MSF treats approximately 500 war injury cases per month. Regular outbreaks of epidemic diseases such as cholera, tuberculosis, malaria, and kala azar, plus a chronic food shortage, contribute to, according to the UN, the death of nearly a quarter of all children before their fifth year and an average life expectancy of only 46 years. Despite the enormous needs, the public health care system is in a shambles and trained staff, medicines, and equipment are severely lacking. MSF estimates that there are less than 15 qualified doctors per million people in the country and existing health facilities serve hundreds of thousands of people. Constant insecurity has displaced approximately 2 million Somalis and forced 440,000 to seek refuge in neighboring countries. Attacks on humanitarian workers and health facilities and limited recognition by warring parties of the principle of access for humanitarian organizations to people in need, compounded by a decline in interest from the international donor community and a politicization of aid, have left some of the most vulnerable Somali populations without assistance. In October of 2002, for example, gunmen fired on patients and visitors in an MSF health structure in Aden Yabal in the Middle Shabelle region of the country, killing one and wounding three and resulting in the suspension of aid programs.

Violence, health and access to aid in Sudan

Although peace talks between the government of Sudan and rebel forces controlling much of the southern part of Sudan have promoted "a sustainable peace based on justice, equality, democracy, and freedom," leading to "meaningful development and progress," the people of the western Upper Nile region in southern Sudan have experienced the polar opposite - they have seen perpetual violence and an accompanying deterioration of all life-sustaining systems and infrastructures. In the past few years, a number of factors have forced the displacement of civilian populations. The escalation of violence between the government of Sudan and shifting coalitions of ethnically-based militias have forced residents of the impoverished region to flee their homes, leaving their meager possessions behind to be burned and looted. To make matters worse, the government of Sudan has repeatedly used military aircraft to bomb and strafe civilians living in the path of a road under construction to serve foreign oil companies, forcing thousands to relocate or be killed. Throughout the most recent stage of conflict in southern Sudan, malnutrition and disease have taken over where violence has left off. Forced displacement has led to a vicious cycle of food insecurity and lack of access to health care, as well as an increase in deadly epidemic diseases such as kala azar, malaria, and sleeping sickness.

Pressure rises on civilians escaping war in Chechnya

Ongoing violence and insecurity in Chechnya throughout 2002 continued to threaten the safety of Chechen civilians caught in the conflict and impede the delivery of humanitarian aid to those most in need. On numerous occasions since the spring, authorities in the region have taken measures to pressure displaced Chechens, particularly in the neighboring republic of Ingushetia, to return to Chechnya, where continued fighting and inadequate basic services make living conditions intolerable.

In July, the closure of a camp housing some 2,200 displaced persons in Znamenskoye, in northern Chechnya, was accomplished through an organized campaign of harassment and coercion that left people with no option but to move out. International organizations active in the region, including MSF, condemned the involuntary return of refugees and displaced persons to Chechnya. Nevertheless, in December, a camp near Aki Yurt in southern Russia was sealed off, and some 1,700 residents were evicted. The authorities have warned that they intend to close all camps for displaced Chechens in the Caucasus by the end of the year 2002.

An estimated 110,000 persons are currently seeking refuge in camps, private homes, and collective centers in the region. Moreover, assistance provided to those who have returned to Chechnya is largely insufficient, and their safety is not guaranteed. Administrative pressure, kidnappings, and violence in the region have continued to hamper the delivery of much-needed humanitarian aid in the region. In July, Nina Davydovich, the head of Druzhba, a Russian non-governmental organization, was kidnapped, followed by the abduction of Arjan Erkel, head of mission for MSF's projects in Dagestan, on August 12, 2002. Despite repeated calls for their safe release, both have remained in captivity more than four months.

World's poor still die for lack of access to medicines

Despite public fanfare over announcements of price reductions of AIDS drugs by the pharmaceutical industry, scientific advances such as the discovery of the mapping of the malaria parasite genome, and the establishment of the largest funding mechanism in history to fight infectious diseases, the vast majority of people suffering from HIV/AIDS, malaria, tuberculosis (TB), and other infectious diseases continued to die with no access to lifesaving medicines. The gap between the rhetoric of governments, multilateral agencies, and pharmaceutical companies and the reality faced by millions of people suffering from these treatable diseases has never been as serious as in 2002.

Ninety-five percent of the 42 million people with HIV/AIDS live in poor countries and at least 6 million of them require immediate treatment with life-extending anti-retroviral therapy. Although a growing number of programs are proving that such therapy is possible in resource-poor settings, the high cost of medicines and lack of political will to take action, continue to deprive millions of people with AIDS in the developing world of treatment. As a result, six people die from AIDS each minute. Wealthy countries have contributed only a small fraction of the estimated $7-10 billion needed annually to fight AIDS alone.

The United States' pledge to the Global Fund to Fight AIDS, TB and Malaria, for example, is paltry. In addition, the United States and the European Union have been using trade negotiations to roll back important gains made on access to medicines during the World Trade Organization ministerial meeting in Doha, Qatar, in 2001. Meanwhile, research and development into new treatments for killer infectious diseases such as malaria, TB, kala azar, and sleeping sickness remains woefully inadequate. More people die today from malaria than they did 40 years ago and TB cases are soaring to the point that, if left unchecked, 35 million people will die of the disease over the next decade, according to World Health Organization estimates.

Disregard for humanitarian law erodes protection for war-affected people

Legal protections shielding civilians from violence during war, as set down in International Humanitarian Law (IHL), have been dangerously undermined during the past year. Terrorist groups like al-Qaeda have shown in word and deed little regard for IHL as they unleash direct attacks on civilians in various countries. In response, the US-led coalition has given worrisome signs that the "war on terror" may require deviating from these fundamental legal guarantees. During the Afghanistan campaign, Pakistan, a close US ally, as well as Iran, faced little protest when they shut their borders to people fleeing the conflict, effectively trapping people in the violence they were trying to escape. Although there is evidence that prisoners of war were suffocated after they had surrendered to the US-supported Northern Alliance, calls for inquiries into the responsibilities for this breach of IHL have been ignored.

Devastating aerial bombardments, like the one unleashed on Tora Bora a year ago, have killed an unknown number of civilians in the conflict, but the absence of independent observers has made it difficult, if not impossible, to assess whether all appropriate precautions were taken to limit civilian casualties to a minimum. These actions have had profound global repercussions, especially by legitimizing the idea that there may be exceptions to the application of IHL.

Military forces in Colombia, Chechnya, Israel, Pakistan, China, and Liberia, for example, have used the rhetoric of a global "anti-terror" campaign to cover up mounting abuses. Restraints on the conduct of war have been a hard-earned, often threatened, advance in human relations. Western countries, including the US, played a key role in bringing them about particularly in the consolidation of IHL in the Geneva Conventions following World War II. For the millions affected by war around the globe today, it is critical that all countries respect and defend these fundamental rights.