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.
Read
more about Angola
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.
More
about Colombia from the MSF 2001 Activity Report
Colombia:
The Human Face of Conflict, a Photo
Essay
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.
Read more
about DRC
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.
Read
more about North Korea
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.
Read
more about Liberia
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.
Read
more about Somalia from the MSF 2001 Activity Report
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.
Read
more about Sudan
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.
More
about Chechnya from the MSF 2001 Activity Report
More
about the abduction of MSF volunteer Arjan Erkel
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.
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.