© Anna Surinyach/MSF


We are shifting our focus in Colombia away from conflict-related projects to providing mental healthcare

Colombia is one of the most ethnically diverse countries in the world.

Situated in the northwest of South America, it is bordered by Panama, Venezuela, Brazil, Ecuador and Peru and is the fourth largest country in the region.

It has rich oil reserves and is a major producer of gold, silver, emeralds, platinum and coal.

Despite the government and Farc rebels signing a historic peace accord in 2016, ending 52 years of conflict, violence involving armed groups and drug cartels is still rife.

Médecins Sans Frontières/Doctors Without Borders (MSF) first worked in Colombia in 1985.

Our work in the country focuses on providing care for victims of  armed conflict and to those excluded from healthcare.

Colombia: The invisible wounds of Tumaco
Our team in Tumaco, Columbia, is helping residents who have been suffering the psychological effects of violence for over 50 years.

Healing the hidden wounds of Tumaco

Providing mental health services in response to urban conflict in Tumaco, Colombia

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> MSF has been working with communities ravaged by violence in Colombia for many years, caring for the psychological wounds of people living amid violence and fear.

Tumaco is a city of 200,000 people in the Nario department in south\-west Colombia, near the border with Ecuador. Its location and thriving port have made it a hot spot for the trafficking of illegal arms and drugs. For 15 years, the Colombian army, the leftist Revolutionary Armed Forces of Colombia \(FARC\) movement, paramilitary groups and drug cartels fought for control of the territory. The conflict has left the city devastated and its people traumatised.

Amidst this violence, those who suffered most were local communities. The violence has claimed more than 80,000 lives in the past 50 years. Levels of violence have dropped since the government and the FARC movement signed a peace accord in 2016. However, violence is still endemic and has become more chaotic as criminal gangs move in to fill the vacuum left by the FARC. Poverty, high unemployment and a sense that crimes can be committed with impunity fuel the continuing violence. While the conflict is mainly between armed groups, it is the people of Tumaco who have borne the brunt of the violence. The pervasive sense of fear and insecurity it creates have had a devastating impact on peoples health. They have suffered threats, extortion, displacement, injury, torture, sexual violence, forced recruitment and other abuses, and have seen family and friends lose their lives. This has led to high levels of anxiety, depression and other mental health problems.

MSF in Tumaco

MSF began providing primary healthcare services in Nario in 2010, and started offering mental health services in urban areas of Tumaco in 2014, following a surge in urban and sexual and gender\-based violence \(SGBV\). The pervasive violence in Tumaco had a brutal impact on the physical and mental health of its people.

Our primary goal is to provide comprehensive medical care, including mental healthcare, to victims of violence, in particular to survivors of sexual and gender\-based violence. Our team in Tumaco provide individual counselling and group sessions, as well as working to raise awareness about mental health issues among the local community.

By providing the community with free, high\-quality mental healthcare, MSF has helped the wider community recover from the violence of both past and current conflicts. Our team is made up of 11 psychologists, two medics and four mental health promoters.

Igniting La Negra Ardiente

MSF is there to help the people of Tumaco survive their darkest moments. With the support of an MSF psychologist, a woman known as La Negra Ardiente the Burning Black has walked through the darkness and emerged as a strong and inspirational figure.

Her history is one of conflict and trauma. La Negra Ardiente was born near Tumaco, in an area that deteriorated as conflict consumed the region. As an adult she was beaten, abused and raped. She suffered severe depression and suicidal thoughts.

> **"After the armed conflict arrived, \[life\] became very stressful. You always lived in fear. There were always grenades going, _boom_, _boom_. It became unbearable to be here."**

But through workshops and one\-to\-one counselling with an MSF psychologist, she was able to put the traumas of her past behind her. Inspired by the play of light from vigil candles, she adopted her new name, 'La Negra Ardiente' to honour this.

La Negra Ardiente is now a community leader, watching out and supporting her neighbours, who she refers to as her family. She is dedicated to helping other people.

> **"I try to contribute something good to the family. We are training young people, children, adolescents. Teaching them dance, teaching them how to sing \- to dilute, to lessen the fear."**

Rebuilding lives: Betty's story

"My emotional problems began one morning. I was at my sister\-in\-laws house and at that exact moment my brother\-in\-law was murdered in the house. From that moment, my life completely changed." Bettys husband was the one who came looking for help. After hearing about the services that MSF provided, he arrived at the clinic one morning in August 2016, extremely distressed. If MSF didnt help Betty, he said, he didnt not know what he would do. Betty began counselling sessions with Dr Yeni, an MSF psychologist, soon after.

> **Betty was diagnosed with post\-traumatic stress disorder \(PTSD\). Seeing her brother\-in\-law murdered had triggered a psychotic depression.**

When she first began to receive help from MSF, Betty didnt know where she was or what day it was. She had not left her room in days. She cried constantly and didnt eat. She was about to lose her job, and could no longer take public transport because she was afraid that people would harm her.

Through her sessions with Dr Yeni, Betty's learned to understand and control these feelings. The psychologist gave her tips on how to control her emotions and her negative thoughts. "Now I feel much better, thank God, because I am living my normal life again. I can walk alone. I feel that things have improved from that time to now."

With the community: Elva's story

As a community leader and womens rights activist, Elva Gonzalez has dedicated her life to helping others. She did this even at the expense of her own mental health, as her role exposed her to suffering as well as threats and abuse. She lost many friends and colleagues to the violence that has ravaged the streets of Tumaco for so many years.

> **Many have died working for the community. People who wanted their community to change, to have a different future, to better their knowledge.**

Elva lives in the _Once de Noviembre_ neighbourhood of Tumaco, an area previously controlled by paramilitary groups who ruled peoples lives and killed with impunity.

Those were terrible days, they were filled with sad, painful moments, where women lost their husbands and children at the same time. Some families had their children and grandchildren killed at the same time. Elvas exposure to so much suffering began to affect her own wellbeing.

> **I did not sleep at night. I thought that when I heard something like a stone fall, it was a grenade.**

Elva received counselling from MSF, which helped her come to terms with her experiences and regain her mental and physical health.

I thank God for MSF arriving. When you talk, you unload those things that pinch you inside the stomach. And when you recount your life, some of those bad energies that are in your body come out.

Mental health problems can have a profound impact on people and communities. People experiencing these conditions can feel less able to function within their families or as part of society. When treating mental health conditions, MSF teams focus on understanding the social, political, economic, spiritual, cultural and moral points of view of our patients. Our approach targets the individual and community factors that influence mental health.

[**Find out more about MSF's work with mental health around the world >**](https://www.msf.org.uk/issues/mental\-health)

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MSF’s work in Colombia: 2016

In 2016, we continued to assist victims of urban violence and sexual violence, and responded to emergency situations.

Due to the peace process, there has been a decrease in the number of clashes between armed groups, but civilians continue to be caught up in violence as criminal organisations fight for control of territory.

Colombians are exposed to murder, forced displacement, extortion, sexual violence and confinement.

“My sons still ask me what happened to their father. I tell them you need to forgive to feel good. But they are angry and ask why they did that to their father and uncle. The older one was very sad and missed him a lot. The MSF psychologist has helped us overcome the pain and she has guided me a lot because there are times when you don´t know how to explain things to children. With her you can open up.”
Angela Patricia  her brother and husband were found murdered and dismembered in 2008

In 2016, our teams focused on the urban areas of Tumaco and Buenaventura. They offered psychological support to 3,953 people affected by violence exercised in the context of organised crime and by armed groups that have arisen in the current post-conflict situation.

Teams also provided comprehensive care for 722 victims of sexual violence. In Buenaventura, where access to care is sometimes restricted, our staff provided 1,710 consultations through the ‘psychological helpline’, a confidential telephone counselling service set up in 2015 for victims of violence, including sexual violence, and people with severe mental health problems.

All users of this helpline are offered follow-up consultations.

© Lena Mucha/MSF

In Tumaco, we cared for 461 sexual violence survivors. Our teams also started activities related to voluntary termination of pregnancy for victims of sexual violence.

We continued to coordinate an emergency response team that intervenes in emergencies and monitors the health and humanitarian situation in areas most affected by armed conflict.

During the year, the team conducted 2,012 primary healthcare consultations and 2,677 mental health consultations, mainly for displaced people in the departments of Antioquia, Chocó, Córdoba and Norte de Santander.

Find out more in our International Activity Report.

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