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Colombia: health-care workers under pressure

05-08-2011 Feature

Mirta Nubia Rosero is the only health worker in a remote village in the Nariño department of south-western Colombia. Here, the Andean mountain range enters Colombia. It is also a place where, after five decades of conflict, unexploded landmines and remnants of war lie hidden in the ground.

Various armed groups are active in this area and recently, armed forces have increased their presence. Frequent clashes block the community's access to firewood, water and other basic essentials. People cannot work their land when explosive remnants of war threaten life and limb. For Mirta, simply doing her job is dangerous.

"Red Zone"

"This is a "red zone" where there's a lot of conflict with many armed groups on the edge of the law who every now and then clash," explains Mirta. "There’s never been any de-mining. What we say here is: everyone walks at their own risk. If it is there, it is there. If it hits me, it hits me."

In the last decade, the Colombian government estimates over 8,300 people were injured or died from abandoned weapons of war such as landmines and unexploded ordinance. For Mirta, getting to a patient in an emergency is risky, even carrying out a simple vaccination programme could be deadly.

Over the last few years, there has been a rise in the number of armed groups, fuelled by the drug trade, fighting each other for control of towns and villages. Under international humanitarian law, health-care workers must treat everyone and anyone without distinction, yet many find themselves under pressure over who they treat and how they treat them.

Under pressure

"It makes you afraid," says Mirta. "One day, one group is in control, tomorrow another one arrives, so you never know. I treat every patient that arrives here, no matter from which group he is, I treat him but often an armed group comes to me and says: 'Do this for me!' or 'Give me an intravenous fluid!' And you have to do it. Even if this patient doesn't need this treatment, you have to do it."

Mirta is the auxiliary nurse for Santa Cruz and seven other neighbouring villages.  When she travels to the other villages, she fears getting stuck, unable to get back home.

"When one armed group is in control, the fear is that another armed group will turn up and suddenly there'll be a clash and I can get stuck in another village and be unable to return to Santa Cruz."  

In a bid to make Mirta and other health workers operating in weapon contaminated areas safer, the ICRC has trained nearly 600 health workers in the area on what they can do to be safer while working in danger zones.

Mirta feels she has learnt a lot through the Safe Behaviour workshop provided by the ICRC: "When there is an accident, you must not go to the exact spot where the accident happened, because there might be more mines or explosive devices there. Instead, see if the patient can get out on his own and tell him to come out the same way he went in."

For health-care workers like Mirta, the pressure is increasing. The ICRC registered 29 cases of violence against medical staff and health facilities between January and May 2011 in Colombia alone. This represents not just an increase in attacks but also a rise in the intensity of violence. As a consequence, medical workers often flee dangerous areas, leaving whole communities without any health care.


Colombian army engineers walk along a road cleared of landmines. 

Colombian army engineers walk along a road cleared of landmines.
© AFP Photo / Raul Arboleda