Colombia has been ravaged by decades of conflict, in which hundreds of thousands of people have been displaced. Thomas Prochnow has just returned from working as a nurse for MSF in Colombia, during which he coordinated mobile clinics in the Norte de Santander region of the country.
Thomas Prochnow.
Photo by Barbara Sigge
What does it mean to be displaced in Colombia?
Internally displaced people (IDPs) in Colombia often describe themselves as being “refugees for life.” This stigmatises them. The conflict has also penetrated deeply into the social fabric of society. Inhabitants of the same village become extremely mistrustful of one another; no one knows who to trust, as past experience has shown that acquaintances or neighbours can unexpectedly turn into perpetrators of violence. Many live from day-to-day without any hope for the future – what's the point of building anything if you can never be sure that you won't have to go on the run again at a moment's notice? These people are struggling for survival on a daily basis, and no one takes the trouble even to ask how they are.
Some are attracted by the idea of life in the city, but city life deprives them of even the limited opportunity of growing rice or vegetables. Therefore, IDPs in cities often end up in even greater poverty.
Why are people on the run?
Fighting between rebel groups, government forces and paramilitary organisations has led to massive waves of displacement, in the course of which whole regions have been abandoned. People are also often forced to flee by direct death threats or blackmail. Nearly all of them have stories to tell of relatives or friends who have been murdered or abducted, or have themselves fallen victim to, or witnessed, acts of violence. Added to the mix are social problems, domestic violence, rape and abuse. A ten-year-old patient who was brought to the clinic by his grandmother because he was acting very aggressively told us: “When I grow up I’m going to shoot the ones who shot my parents.”
How does MSF assist such patients?
Many patients initially come to the clinic suffering from physical conditions, such as insomnia, headaches or pains in the joints or stomach. The medical staff are trained to pick up on potential psychological problems, however. In many cases they suggest a further discussion with the psychologist. Sometimes the discussion is as far as we get. More recently, women have been coming because they have heard from friends that it can help to talk to a psychologist, to get things off their chests.
What happens to IDPs who return to their homes?
Those villagers who do go home are often re-confronted with the trauma that caused them to flee in the first place. Four years after a massacre in a town called Saiza, the villagers returned. Yet, they found their village had been reclaimed by the jungle. It took months to make it habitable again. And even after years of living again with their former neighbours, there is no real evidence of the emergence of any genuine social structures.
What progress has MSF made in Norte de Santander?
The presence of MSF helps create a positive sense of security. We are always being told that people feel they get the support and the attention that they need in their isolation when the teams are around. In individual and group therapy sessions we look together with those affected for the causes of their problems; our primary focus, however, is on finding solutions and new perspectives for the future. Sometimes it is enough just to create a space in which someone can unburden themselves through talking. This can be a very liberating and helpful experience. The teams also conduct workshops in schools and kindergartens, including providing information to help prevent sexual abuse.