This weeks featured project : Médecins Sans Frontières Australia

1 Nov 2005

Cote d'Ivoire in crisis: the challenges for MSF

The West African nation of Côte d’Ivoire is bracing itself for further civil unrest following the postponement of presidential elections last Sunday (30 October). While the African Union and United Nations have asked President Gbagbo to stay on for 12 more months, opposition and rebels are refusing to recognise Mr Gbagbo as president. It is against this volatile and unstable backdrop that Médecins Sans Frontières (MSF) works hard to maintain its health services in hospitals and clinics throughout the country.

The following interview with Australian volunteer, Lauren Cooney, Medical Coordinator for MSF-Holland in Côte d’Ivoire, depicts a country in political turmoil which poses serious threats to continuity of the medical aid organisation’s programs.

What sort of projects does MSF conduct in Côte d’Ivoire?

We have two projects, one team based in Bin Houyé, one team in Danané. (MSF employs almost 300 national staff, 18 expatriate staff, including the coordination team in Abidjan). The projects provide primary and secondary health care to the population of Danané and Zouan Hounien Districts (formerly Danané District), covering a population of approximately 370,000 people. The districts are in the west of the country, joining the borders of Liberia and Guinea, and were heavily affected during the war that started in 2002. They cover the government controlled zone, the Forces Nouvelles zone, and the ‘zone de confiance’ [or demilitarised zone guarded by French and UN troops in the centre of the country separating the north and south parties to the conflict].

The Danané project consists of a hospital, providing In-patient department (IPD) services (approximately 90 beds), including adults, paediatrics, maternity and surgical services. Tuberculosis (TB) services are provided as part of the national program, but are run by MSF. HIV services, including voluntary counselling and testing (VCT) and provision of anti-retroviral drugs (ARVs) expect to be fully functioning by the end of 2005. Out-patient department (OPD) services, sexually-transmitted infection (STI) clinic, routine vaccination and 24-hour laboratory services also operate from the hospital.

Two mobile clinics visit ten sites each week to provide basic health care services in the area. Services from the mobile clinics include general consultations, ante-natal and post-natal care, dressing room, routine vaccination, STI clinic, nutritional screening and referral; and referral of urgent cases to Danané hospital.

Bin Houyé project operates two mobile clinics, to 12 different sites weekly or bi-weekly, with the same services as the Danané mobile clinics.

What is currently the most challenging aspect of operating in Côte d’Ivoire?

Planning for the future and developing program activities, with continuing political/ security instability, combined with the challenge of how best to collaborate with the Ministry of Health, who are trying to restart government services in the areas our projects currently operate in. Other obstacles exist too: lack of staff – both in quality and quantity, drug supply and the national cost recovery system.

Has this year's violence hampered MSF's programs? If so, how?

Violence in and around Dueoke did not hamper our activities. In June, one of our cars from the Bin Houyé project was taken by mutinous government troops, which stopped project activities for three to four days. Other than that, we have generally operated without major difficulties, although there are roadblocks for multiple authorities (government, UN and Forces Nouvelles). We are well known however, and our neutrality and independence are generally understood.

What are the main pathologies and health issues confronting Ivorians now?

Writing?? here for our project area the major morbidity is malaria (>95% falciparum). Other major morbidities, especially in children, include respiratory infections and intestinal parasites. Sexually Transmitted Infections (including HIV/AIDS) are a key cause of morbidity in the adult population. Reported figures vary, but the prevalence rate for STI's in general is estimated to be over 20% (see MSF Holland report September 2005 on STI's in Côte d'Ivoire). Vaccine coverage in population is low, so childhood diseases, such as measles and whooping cough remain a risk. Recent mass measles immunisations were conducted throughout Côte d’Ivoire by the Ministry of Health in conjunction with the World Health Organisation (WHO) and the United Nation’s Children Fund (UNICEF). And while water is available in most areas, the quality remains an issue. Lack of health knowledge and lack of health services also remain as ongoing and stifling issues for the people of Côte d’Ivoire.

Do you have a picture of how the current context of a de-stabilised political and military process is affecting the overall humanitarian situation?

Many schools and health services have not restarted in our project area since the war (especially in the North). Ongoing instability has led to continued economic difficulties and threatens food security. And though it has received little attention, another key area of concern is the level of sexual violence – even against children under twelve – which is related to the prevalence of STIs, including HIV/AIDS. We’re also seeing internally displaced persons (IDPs) throughout the north and the zone de confiance in particular. Faced with this kind of uncertainty, life for the people of Côte d’Ivoire is difficult to deal with.

Keep an eye out for a late-November issue of Good Weekend in the Sydney Morning Herald and The Age, in which MSF International President Rowan Gillies talks about MSF’s work in Côte d’Ivoire.

» Read about other featured projects

Overseas Field Work - Recruitment info evenings