Colombia: Poor access to health care and violations against medical personnel and services

10-07-2013 Feature

In conflict areas, access to health care can mean the difference between life and death. Very often, there is no way of getting sick and injured people to a medical facility to receive the treatment they need. Violations committed against medical services complicate the situation further.

A state-run health post in Guayabal, in a rural area of San Vicente del Caguán municipality, Caquetá. It bears the emblem used to designate health-care facilities and personnel. 

A state-run health post in Guayabal, in a rural area of San Vicente del Caguán municipality, Caquetá. It bears the emblem used to designate health-care facilities and personnel.
© CICR / M. Méndez

For people living in remote areas who are injured as a result of the armed conflict or become seriously ill, seeking medical attention can be a nightmare. There are health facilities that provide the services they need, but they are often unable to get to them.

In spite of the efforts of the national health system to improve health service delivery, over the last year the ICRC observed first-hand that logistical and administrative difficulties persist, preventing and limiting access to health care, particularly in conflict areas.

In some cases, the problem was that there was no ambulance available to pick up or transfer the patient. In other cases, the doctor who saw the patient did not have the training to deal with such a serious case. In still others, the patient did not have the authorization needed to get a bed in a higher level hospital. These deficiencies are not confined to conflict zones, although they are more acute in such areas and can mean the difference between life and death.

Violations against medical services still on the rise

The problem of poor access to health-care services is compounded by difficulties faced by medical personnel in carrying out their work. Reports of threats and attacks against health-care personnel and facilities, known in Colombia as the “Medical Mission”, continued to rise in 2012. The ICRC documented 75 violations and 13 incidents which hindered health-care activities.

They included the destruction of health posts, the abduction of medical personnel and death threats and physical assaults against them, the theft of medicines and vehicles and even the removal of patients from ambulances on the way to hospital. The department registering the most cases was Cauca, followed by Antioquia, Nariño, Norte de Santander and Chocó.

The gravity of these attacks is increased by the impact they have on communities. Violations and incidents against medical personnel and facilities reduce access to health-care services for thousands of people, leading to an increased risk of injured and sick people dying and the spread of disease.

The ICRC’s humanitarian response

Medical attention for the injured and sick

.Activities carried out to overcome difficulties encountered in the transportation of patients to health-care facilities included the evacuation of 14 injured civilians and combatants by the ICRC, sometimes in collaboration with the Colombian Red Cross. Some of these people had been injured in the fighting or by improvised explosive devices and explosive remnants of war.

In addition, 490 injured or sick people received financial assistance to cover travel expenses, accommodation and medical bills. The ICRC also arranged medical appointments for them. A further 769 people were given advice about how to access health-care services and were referred to the institutions responsible for providing the services they required.

Mobile health units

In emergency situations and when communities do not have permanent health-care facilities, mobile health units provide medical services. In 2012, the ICRC, in some cases in conjunction with the Colombian Red Cross, accompanied 11 such units formed by personnel from State institutions to ensure their safe access to remote areas or areas where armed actors were present. Over 80,000 people benefitted from these services.

On one occasion, when the State institution’s mobile health units were unable to provide health-care services, the ICRC took its own medical personnel to the community in question in Cartagena del Chairá, Caquetá. Medical consultations and vaccinations were provided for 5,000 people.


In addition to helping people living in conflict areas obtain access to health-care services, the ICRC also took measures to strengthen the capacities of health-care personnel in such areas to deliver medical services in the community. In association with the National University, 345 civilian doctors and nurses received instruction in dealing with war injuries, and 38 doctors and specialists attended a similar seminar organized with the University of Antioquia. Another 330 health promoters and health-care assistants attended first-aid workshops given by the Colombian Red Cross.

The communities themselves also received first-aid training through workshops run by the ICRC and the Colombian Red Cross. The purpose of these courses is to teach the civilian population how to deal with medical emergencies, for example, if a neighbour or family member is injured in an armed attack (see p. 63). A total of 1,080 civilians received this first-aid training.

Additionally, 183 members of the armed forces medical services participated in two war-surgery seminars, and 15 armed group members received training in treating injuries.

Lastly, with guidance from the ICRC, the University of Antioquia and the National University created a Chair of War Surgery in their post-graduate degrees in medicine. The addition of these subjects aims to promote the exchange of knowledge among the country’s surgeons on the treatment of people injured in armed conflict and other forms of violence.
Medical duties

With a view to informing health-care personnel about their rights and duties and providing them with advice on protective measures, the ICRC carried out 213 training events for 3,394 professionals, 279 health facilities and 1,868 employees from related institutions. It also marked 161 hospitals and health posts in remote areas with the distinctive emblem to facilitate the recognition and protection of health-care facilities and personnel, which must not be attacked under any circumstances.

The ICRC and the Colombian Red Cross also supported eight department working groups on the situation of health care in the different regions, with the participation of local, department and central government authorities. Based on the outcomes of these discussion group meetings, action plans were implemented.

Eleven workshops were also held for armed forces and national police personnel on the protection of health-care personnel, facilities and duties and the importance of ensuring respect for the protective emblems.

In December 2012 the Ministry of Health issued decision 4481, adopting the Medical Services Manual produced with the support of the ICRC, the Colombian Red Cross, the Vice-President of the Republic, the Ministry of Employment and external consultants. This tool defines medical duties in other situations of violence, ratifies the concept of violations against medical services, defines the term “incident”, establishes regulations on the use of the emblem by medical services and puts forward safety recommendations for health-care personnel.


A training manikin helps to teach life-saving tips

All the travelling along dusty roads from village to village has taken its toll on ‘Rita’, a training manikin used in community first-aid workshops held by the ICRC in Arauca. More noticeable, though, are the wounds that have been inflicted on her to teach local people how to deal with the typical injuries and illnesses affecting people in conflict areas... Read more



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