"The country's socio-economic reality has contributed to the failure of the health system – probably based on the model of a developed country, which does not take the specifics of the Colombian situation into account: high unemployment, social exclusion, patronage and corruption," explained Oscar Garcia, MSF's head of mission. This observation is confirmed by the 40% of individuals without social welfare benefits.

Medical and social welfare activities in the urban setting

More than 400,000 people live in Buenaventura, Colombia's largest port.  Since 2008, MSF has provided a full and varied range of health care services to individuals excluded from the Colombian health care system. Services include general medical care and specialized treatment in the areas of sexual and reproductive health, mental health, nutrition and catch-up vaccination.

MSF also runs an emergency department. In 2010, 480 patients were treated there and 40 percent of those were transferred to the hospital by ambulance. A social welfare component has been added to the medical services to help patients resolve their legal status and enter the job market.  

In addition to patient visits at the health center, MSF health care workers go into the community to reach vulnerable populations, organizing education sessions and outpatient medical activities in the "barrios", the city's low-income neighborhoods.  

The most common illnesses illustrate the precarious urban conditions - respiratory and skin infections. However, MSF's presence in this urban area is unusual. "For the most part, MSF works in rural settings over the short- and medium-term," said Gregory Montel, logistics manager for the MSF project in Buenaventura. "Working in an urban setting is much more akin to long-term development work. The services offered at the first health center and in the second one, which will open soon, will continue after we leave. These are long-term facilities."

The health care system neglects victims of violence

MSF's program focuses particularly on victims of sexual violence, who cannot obtain appropriate care in any other hospital or health care facility. MSF offers medical, psychological and social assistance, regardless of the individual's status.

In 2010, 106 people received assistance after a sexual attack, but only 26 percent of those individuals reached the clinic within 72 hours after the incident. After that deadline, treatment to prevent pregnancy, HIV/AIDS and sexually-transmitted diseases is no longer effective.

"Sexual violence remains a taboo subject in Buenaventura because it involves family members or is related to the urban conflict, a kind of war among gangs," said Pascale Bourdais, the Buenaventura project coordinator.  "In both cases, the victim may be frightened to speak out. And the national protocol urges victims to name their attacker to receive medical assistance."

To reverse that percentage, MSF will emphasize community awareness and communication in 2011.