Health: a bridge to peace in Colombia

Citation

(2001), "Health: a bridge to peace in Colombia", Disaster Prevention and Management, Vol. 10 No. 2. https://doi.org/10.1108/dpm.2001.07310bab.001

Health: a bridge to peace in Colombia

Health: a bridge to peace in Colombia

Violence has displaced much of the rural population of Colombia's 40 million inhabitants. In its search for safer places to live, the internally displaced population (IDP) has lost its income and compromised access to health services. In the last four years, the number of displaced persons has grown at an alarming rate and each day affects a much broader geographical area. In Colombia, the size of the IDP increased from 89,000 in 1995 to as many as 288,000 by the end of 1999 (figures from CODHES, Consultoria para los Derechos Humanos y el Desplazamiento). Equity is a major issue in the debate over access to health services. Depending on the source of information, between 500,000 and 2 million persons have been deprived of access to health care, a benefit that the remainder of Colombia's population has been able to maintain. This number includes those displaced by violence. By mid-1999, the situation had deteriorated to the point that forced migration had overwhelmed approximately 100 of the 1,090 Colombian municipalities. The number also includes those who may not have been displaced, but who live in such an insecure environment that health care providers have evacuated the area, resulting in the further disruption of health services. Other difficulties arise when IDPs resettle in areas that were already plagued with problems – lack of access to potable water or inadequate shelter. The health services, which were not designed to suddenly absorb such an increase in demand, are taxed beyond their limit. And although the Colombian Health System offers access to health care for all of its population, it requires each person to be properly identified. This is one of the reasons that only a limited number of displaced persons benefits from health care – fear of further becoming a target for armed groups has made anonymity the best means of protection. Inequities are further exacerbated when NGOs (local and international), religious groups, universities, private associations, armed groups and international organisations are all providing some type of health care, using significantly different criteria. It can happen that one particular segment of the displaced population has been targeted to receive assistance, while the surrounding population, living in similar conditions but falling beyond the scope of a particular project, does not benefit from the same attention. Up to now, the areas where the greatest inequities existed were well within the borders of Colombia. However, this is now an issue along the borders of the five surrounding countries: Venezuela, Ecuador, Peru, Brazil and Panama where Colombians are looking for a safer place to live. This is fuelling passions and anger at all levels, and making the peace process even more cumbersome. Should we be able to reverse that situation, health would be a definite bridge to peace. This is not an impossible task but requires a significant reorientation in the approach to improving access to health services, for example.

The government, NGOs and international agencies have taken a number of steps to reduce inequities. One approach involves improving conditions for health care workers in these circumstances, in accordance with ICRC guidelines. Another is to ensure that all health partners work along the same lines so that, for example, a mayor of a small municipality facing one of the above-described situations could count on a minimum of human resources to provide the minimum acceptable health standards for the entire population. The need to exchange information more readily, whether over the Internet, at face-to-face meetings, or through other means, is not only one way to provide access to health care more equitably, it is also a vital part of the peace process, since it forces opposing parties to find solutions to the essential and common needs of human beings.

It is unacceptable for any country to face the deterioration of its entire health care system. However, it is worse to witness such a rapid increase in inequities. It is urgent that all players – national and international – acknowledge this fact and make every effort to join forces to ensure that health care is provided for everyone, regardless of the group to which an individual belongs. It is through these displays of solidarity, and by reducing the more appalling inequities, that not only will health improve, but will also represent a strong bridge for peace.

Disasters, No. 82, PAHO, October 2000