Sunday, December 30, 2007

10 humanitarian crises forgotten (but not gone)

10 humanitarian crises forgotten (but not gone)
If doctors edited newspapers... The frontline physicians at Médecins Sans Frontières have chosen the 10 humanitarian crises that should have been given more coverage in 2007. By Claire Soares and Daniel Howden
Published: 20 December 2007


While the cocaine trade regularly features in the headlines, little attention is devoted to the scale of the internal refugee crisis. After four decades of civil conflict that has evolved from a war of political ideologies to a struggle for territory and control over the narcotics trade, large numbers of Colombians live in areas controlled by militia or guerrillas. With basic human rights under threat and unpredictable violence endemic in many rural areas, millions have fled to the shantytowns – or barrios – that ring every major town. Nearly four million people live in these insecure settlements cut off from basic state services such as mains electricity, water and health care. In the endless slums that now choke the capital, Bogota, areas are divided up and fought over by the same paramilitaries and left-wing rebels that blight and dominate the countryside.

Sri Lanka

After a quarter of a century of fighting, this year will be remembered among the bloodiest in Sri Lankan history. The civil war between the government forces and the separatist Tamil Tigers flared back into life last year and has kept worsening. International efforts to resolve the conflict have made no headway as key figures on both sides appear to have decided that a military solution is possible. Targeted bombings, mine attacks, suicide bombings, abductions, recruitment of child soldiers have all followed. The civilian toll in a country already flattened by the 2004 tsunami has been horrendous. Hundreds of thousands of people in need of humanitarian aid have been forced to flee to makeshift camps and the situation has been compounded by a climate of hostility and suspicion towards aid agencies. MSF is among the few agencies still operating in frontline areas, such as Point Pedro and Vavuniya, where doctors are desperately needed.


Violence in Somalia hit some of the worst levels in more than 15 years in 2007, prompting UN officials to declare it the worst humanitarian crisis in Africa, surpassing even Darfur in its horror and hopelessness. Ethiopia invaded Somalia on Christmas Day last year and easily overpowered the Union of Islamic Courts, but ever since insurgents have been staging increasingly ferocious guerrilla style attacks, particularly in the capital, Mogadishu. Aid workers say one million people have fled their homes, including 60 per cent of Mogadishu's population. This week mortar shells slammed into a crowded market in the capital, killing a dozen people including a mother and her three children, and a foreign journalist was kidnapped. This precarious security situation means reaching those in need is increasingly difficult. Just yesterday, the UN called for the creation of "safe zones" so that aid could get through to the most vulnerable, particularly children.


The extraordinary democracy protests by the Buddhist monks in one of the most repressive countries on earth put Burma back atop the news agenda this year. But the nature of ordinary life under the military junta has remained a dim part of the picture. High levels of malaria and HIV are made unimaginably worse by the negligence of a regime that spent only 1.4 per cent of its budget on health care. Despite the overwhelming need, there are few humanitarian groups able to work within the country and those that do so have to operate under severe restrictions. Comparatively few donors are willing to fund operations in the country for fear of indirectly supporting the regime. Further complicating the situation is the absence of any clear statistics on the health situation. The UN says that as many as 360,000 Burmese, out of 50 million, are living with HIV.


There may not have been a headline-catching food crisis in 2007 on a similar scale as the one that beset Niger last year, but malnutrition is still a disturbing way of life for many in west and east Africa and south Asia, and is associated with the deaths of five million children under the age of five. MSF is campaigning for international donors to scale up their funding for ready-to-use foods, milk and peanut-based pastes that do not need to be kept in a refrigerator, so can be sent out into the rural mud-hut villages where mothers can feed them to their babies at home, rather than being forced to trek miles to the nearest clinic. In Maradi, Niger aid workers are using these pastes to boost the diets of 62,000 children during the seasonal lean period and stop them becoming malnourished in the first place.


Ninety-nine per cent of the electorate here turned out to vote for Vladimir Putin in the recent Russian presidential election. Such a result defies belief in the breakaway Muslim republic crushed by Mr Putin's forces in the second Chechen war. The Putin-installed strongman who rules the republic, Ramzan Kadyrov, made sure that his boss would not be disappointed. Under his authoritarian rule, Mr Kadyrov has cowed the separatists and terrified their families through torture and abduction. The capital, Grozny, flattened by Russian bombs, has been rebuilt, and the airport reopened. But two wars have left psychological and physical scars on the civilian population with large numbers of people suffering from high levels of anxiety, insomnia and depression. As the military conflict with Russia fades into the background with only sporadic clashes now reported, and western leaders no longer openly challenge Russia on its human rights abuses in the republic, humanitarian needs remain critical.


With each new headline warning of economic meltdown in Zimbabwe the litany of impossible statistics has grown this year: inflation at 12,000 per cent, three million fleeing the country, 85 per cent unemployment. Under this extraordinary strain, what had been among the best healthcare systems in Africa has collapsed. As many as 3,000 people are dying every week from HIV/Aids and the chronic absence of life-extending antiretroviral drugs is accelerating this death march.

As many as four million people are in danger of starvation according the World Food Programme and the fuel crisis means that rural clinics are treating patients who have sometimes walked for days in search of medical treatment. The fate of the 83-year-old President, Robert Mugabe, continues to dominate coverage of the country that was once seen as the poster boy of post-colonialism, but it is the impoverished people of this beautiful southern African country paying the price of a man-made crisis.

Central African Republic

While neighbouring Chad and the western Sudan region of Darfur have made their way into global media coverage, the tiny landlocked Central African Republic finds itself starved of attention. This "phantom state" in the middle of Africa has no government institutions functioning outside the capital, in the north bandits and warring factions constitute the law of the land. Rights groups say hundreds of civilians have been executed and at least 100,000 people caught in the crossfire of rival armed groups have fled their villages and are hiding in forests and bush. Complicating a perilous internal situation are the CAR's unpredictable neighbours. The potential for the whole region to tip over into chaos is immense. A small contingent of EU peacekeepers is due to be deployed in the New Year.

Democratic Republic of Congo

With the country's first democratic elections in decades successfully completed in 2006, the Congolese might have been forgiven for expecting an easier time in 2007. But those out in the east, in the North Kivu region, have seen little sign of the stability that re-elected President Joseph Kabila promised. Instead, fighting between armed groups has raged for much of the year and the government is in open combat with rebel leader Laurent Nkunda. Hundreds of thousands of homeless people are hiding in the forest because their villages are no longer safe. They are scavenging food to stay alive and trying to dodge the cholera that is rampant throughout much of the region. And for the women living in this area, there is another nightmare to face: sexual violence is alarmingly high. A peace conference has been scheduled for next week to try to calm the troubled region, but few are optimistic of a rapid solution.


Kairat, from Uzbekistan, on the right, was among the 500,000 people to be diagnosed with multi-drug-resistant tuberculosis this year. But he was one of the lucky ones, moving to one of the few hospitals in the region to get specialist care. But even those who do get treatment have to rely on a highly toxic and expensive cocktail of drugs that often trigger violent side-effects and has to be taken for two years. Amazingly, there have been no major advances in treatment of the disease since the 1960s, and the most commonly used test to diagnose TB was developed at the end of the 19th century and detects only half the cases. An estimated $900m is needed every year for research and development but only $206m has been made available.

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