Ivory Coast – MSF faces overwhelming needs in Abidjan

The situation in Abidjan had been very tense until April 13, two days after the Gbagbo regime fell. Since that time, the improvement has been palpable. Some fighting broke out on May 3 and 4, in the Yopougon district, the stronghold of forces loyal to outgoing President Gbagbo, the main thoroughfares have reopened and wooden stalls have reappeared along previously-deserted roadsides. And after remaining inside during the long weeks of the crisis, the city’s ill inhabitants—many now in serious condition—are streaming to the hospital.


The teams are focused on medical emergencies at the Abobo Sud hospital, Médecins Sans Frontières (MSF) reopened in late February. During the fighting, with the front line close by, they had primarily treated injured people. But every day, three or four people with bullet wounds continue to arrive, as they do in Abidjan’s other hospitals in Yopougon and Treichville, where MSF is also working. “We still hear gunfire every day,” says Caroline Séguin, project coordinator in Abobo.


MSF teams are working in several Abidjan hospitals and providing assistance in health care centers. The crowds press in across the city. Starting at 5 a.m., women wait with their children at the door of the Abobo Sud hospital to see a doctor. The MSF teams treat an average of 300 patients/day, with priority to very urgent cases and then to children under 15.


“The rainy season has just started,” Séguin explains. “Eighty percent of patients who come for medical visits or who are hospitalized have malaria, often a severe form.” Children are particularly affected. Many suffer from anemia due to malaria. Given the crisis, their illness has gone untreated and has thus continued to plague them. For these small patients, and others, treatment involves a blood transfusion. As an indication of the breadth of the needs, MSF performed 146 transfusions last week. That represents a real challenge, given the minimal blood supplies during the crisis.


Every unit in the hospital, located in a working-class neighborhood, is overflowing. In the maternity ward, midwives deliver some 50 babies every day, plus the three or four cesareans performed in the operating room. Medical needs in the metropolitan area are huge. Both the economy and the health care system were seriously disrupted by the post-electoral crisis and the armed confrontations in Abidjan. When the city’s residents were once again able to move about, in order to expand access to medical care, MSF opened the hospitals that had closed or had been operating on a limited basis. Over the last month, MSF teams have been treating medical and surgical emergencies, providing general medical care and working in maternity departments in the Anyama, Abobo Nord, Treichville and Yopougon neighborhoods.


To function properly, one facility needed an electrosurgery unit in its operating room, generators had to be installed in another to ensure electricity in the event of power outages, while others required water supplies and additional hospital beds. MSF is involved in a major construction project in southern Abidjan to complete three operating rooms at a new building at the Port-Bouët hospital. The MSF team is already providing post-operative care to transfer patients and will soon also be treating trauma, pediatric and OB-GYN cases.


Many MSF teams are thus working in several Abidjan hospitals, as most Ministry of Health employees were unable to reach their workplaces or had fled fighting. Now, most health care workers have returned, but given the current situation, the influx of patients must be managed and triaged carefully. Before the crisis, 30 to 50 patients might have been seen in a hospital outpatient unit every day. Today, those numbers have risen to 250-300.


In addition, shortages of medicine remain a serious problem. “Although medical care is free by government order from April 16 to May 31, patients are flocking specifically to MSF facilities,” says Xavier Simon, MSF’s head of mission in Abidjan. “We are completely overwhelmed.” For example, people began arriving as soon as MSF reopened the Anyama hospital on April 18. The information had circulated even although the team had not made an announcement. “MSF is there, it’s all free, they have medicine.” Patients came, and are still coming, to MSF facilities.


In the West of Ivory Coast, people are still afraid


“We left the village on February 28,” Honorine says. The fighting in western Ivory Coast had drawn close to their home, near Toulepleu, and she and her family decided they had no other choice. “We spent two weeks in the brush and then walked for 10 days to get here, toGuiglo. We came with the entire family, 28 people.”


Since arriving in Guiglo, Honorine has not left the displaced persons’ camp, which sits behind the Notre-Dame de Nazareth church.Honorine’s parents, her children, even her sister-in-law and her seven-month-old twins, are sleeping outdoors. But for the time being, the family does not expect to return home any time soon. “If everything is OK, we’ll go back,” says Honorine. “But our house burned, so….”


Many families like Honorine’s have taken refuge in this camp in Guiglo and the one in Duekoué, 30 kilometers [18 miles] away. The worst of the fighting that broke out earlier this year ended in late March, several days before the fall of the regime of Laurent Gbagbo, the former president whose refusal to accept his electoral defeat trigged the violence in the first place. The normal pace of life has returned in most of the towns in the region, but deserted villages and burned-out homes show evidence of what happened in this area, and many fear that violence could start anew. “People are still afraid,” says a manager at the Duekoué camp.


Approximately 15,000 people have settled there. Others are living with families in the area. Still others are hiding in the brush. The rainy season has just started as well, bringing malaria with it. Many mothers have been taking their children—the first to be affected by the illness—to the clinic that MSF opened in early January in the Duekoué camp. Between January and April, MSF held more than 13,300 general medical visits. Serious cases, such as children with severe anemia with malaria, are sent to the Duekoué general hospital, where MSF reopened the operating room and the pediatric and maternity units. The MSF team working in Guiglo and neighboring villages also refers patients who need surgery or hospital treatment to the Duekoué hospital because Guiglo’s hospital was ransacked during the fighting.


“Many of the medical facilities in the western part of the country are not functioning because health care staff has not returned to work and because they lack medicine,” says Xavier Simon, MSF’s head of mission. “That is why we are providing health care in areas where access remains difficult.”


Mobile MSF teams are providing care in villages near Toulepleu, Bloléquin, Bin-Houyé and others. However, after hiding for so long, many patients arrive too late to be treated. Children suffering from severe anemia, a complication of malaria, is a particular problem. When the teams encounter patients in serious condition in the area along the Liberian border, they transfer them to the Bin Houyéhospital, which MSF is supporting, and hope they get the treatment they need in time.