Colombia: Life in the shadow of violence

In Colombia hundreds of thousands of people are constantly on the move, and live in a state of permanent displacement. The violent conflict to which the country’s population has been subjected to for decades has left deep marks in the society, forcing thousands to uproot their families.  The conflict is a result of many factors, fuelled by natural resources such as oil or the narco-trade, and involves many different groups, such as the paramilitary or other illegal armed groups.

Nurse Thomas PROCHNOW has just returned from his second assignment for Medecins sans Frontieres in Colombia, during which he coordinated mobile clinics in the Norte de Santander region of the country.

What does it mean to live as a displaced person in Colombia?
Internally displaced people in Colombia often describe themselves as being “refugees for life”.  On the one hand, this stigmatises them. On the other, the conflict has penetrated deeply into the social fabric of society. Inhabitants of the same village become extremely mistrustful of each other; no-one knows whom to trust because 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 of them are attracted by the idea of life in the city, but going there deprives them even of the limited opportunity they had of growing rice or vegetables. This means that displaced people in cities often end up in even greater poverty.

What are the people on the run from – what has happened to them?
Fighting between rebel groups, government forces and paramilitary organisations leads to massive waves of displacement, in the course of which whole regions are abandoned.

People are also often forced to flee by direct death threats or blackmail. Some flee from one place to the next and from there to yet another region.  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.

Colombians have long been forced to live in a climate of total unpredictability. Many when they were children grew up with experiences of unimaginable brutality – having had to watch public executions by firing squad on the village square or witness point blank the murder of their own parents. Traumatic events from the past continue to have an effect.

Added to the mix are social problems, domestic violence, rape and abuse. Sexual violence is commonplace, and perpetrators of rape will often follow it up with threats such as: “If you say a word I will kill your brother.” There is a long list of consequences, including psychosomatic problems and severe depression.

A ten-year-old patient told us: “When I grow up I’m going to shoot the ones who shot my parents.” His grandmother brought him to the clinic because he was acting very aggressively.

How does Médecins Sans Frontières assist them?
Many of those affected 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. In many cases they suggest a further discussion with the psychologist.

Sometimes the discussion is as far as we get. Some patients however come back for more consultations, months on end, each time taking several hours to get there. Road closures or fighting however make this impossible at times, as the teams from Médecins Sans Frontières can’t always reach the project locations.

More recently, some women are now coming because they have heard from friends that it can help to talk to a psychologist, to get things off their chests. Whenever we open a clinic in a village for the first time we always introduce the team members individually and explain that the psychologist isn't just there for the "crazy people" but can also help with everyday difficulties, such as, for example, trouble with the neighbours. The psychologists use this to try to create a basis of trust, making it possible to start addressing the traumatic events themselves.

Do the displaced people see any possibility of returning to their home villages?
Those villagers who do go home are often again confronted by the trauma that caused them to flee in the first place. Four years after a massacre in a town called Saiza the villagers have returned.  They found that the place had been reclaimed by the jungle. It took months to make the village habitable and to get some way towards rebuilding what used to be there.  And even after years of renewed communal existence with former neighbours there is no real evidence of the emergence of any genuine social structures.

What can Médecins Sans Frontières do in these places?
The presence of Médecins Sans Frontières 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. Some people gratefully leave the clinic, never to return. The teams also conduct workshops adapted to the age of the children in schools and kindergartens. Teachers and teaching assistants participate in separate workshops and are partly integrated into others. In addition to this Médecins Sans Frontières does information work in schools and kindergartens to help prevent sexual abuse.