For several years PAHO/WHO has had a special program in Colombia to give support to and reduce the public health emergencies created by the displacement of more than 3 million people (as recognized by the Presidential Agency for Social Action and International Cooperation), due to an internal armed conflict that has ravaged the country for more than 40 years.
The Organization’s efforts have concentrated mainly in the departments of Nariño, Chocó, Cauca, Valle del Cauca, Arauca, and Norte de Santander; most of them are located in border areas with difficult conditions, intensified conflict and constant violations to the medical missions. All these factors hinder the delivery of health services to the people affected by mass displacements, particularly women, children, the elderly, and indigenous and Afro-Colombians. In turn, these groups often find themselves unable to adapt and faced with disease, malnutrition, and ignorance and violations of their own health rights.
The health situation of displaced populations is characterized by indicators typical of social underdevelopment and exclusion, such as high mortality in children under five years old. They generally suffer from malnutrition, acute diarrheal disease, limited access to prenatal care, high morbidity and mortality in pregnant women and teenagers, low vaccination coverage, and low quality and access to health services. Unfortunately, this happens in a country where private companies, that do not find it profitable to work in such remote regions, are responsible for providing health services.
In this scenario, PAHO/WHO is working with national and regional authorities in the design of plans aimed at strengthening human resources to respond to the health risks of a complex emergency, which can occasionally be exacerbated by natural phenomena. Technical cooperation is focused on information management, interinstitutional, intersectoral and interagency coordination, health preparedness and response for the acute phase of mass displacements and gaps in health services.
The work being done is based on an intervention plan that characterizes the displaced population, develops tools to analyze information, and promotes advocacy with national, departmental and municipal authorities to ensure that the affected population has access to health services. Training materials with an intercultural approach have been developed, that clearly show the right to health of the population and how to access those services.
Technical cooperation is also aimed at providing psychosocial support to the affected population, generating health care models appropriate to the realities of the country, implementing healthy actions that will enable them to have healthy environments, safe water for human consumption and care of primary sources in order to prevent disease and ensure a better quality of life.
Another activity is the development of contingency plans for health mitigation and response during the acute phase of the emergency. These include working with the support of Rapid Response Teams, which are located in several areas where PAHO is present. Keeping these teams together is a real challenge, because there are problems to deal with, such as high turnout, insecurity, administrative difficulties, budgets and, sometimes, lack of political will. All these factors require that strategies are created to generate sustainable processes.
Finally, another challenge of the IDP program is the establishment of more rigorous systematic processes to facilitate the compilation of experiences and fieldwork in order to extrapolate them to other areas or communities with needs and problems similar to those experienced in Colombia.