Ivory Coast: Overwhelming emergency medical needs continue

While the post-election violence that wracked communities in Ivory Coast ended almost a month ago in most of the country, emergency medical needs remain at critical levels. In Abidjan, health centres and hospitals are overwhelmed with patients, including the newly wounded, and medical and drug supplies in the city are still dangerously low. In the west of the country the situation remains extremely tense as many villages still lie empty and people continue to hide in the bush. While some Ivorians are slowly beginning to return to their homes to try and resume their lives, more than a hundred thousand people remain as refugees in Liberia and thousands more are still displaced in overcrowded camps in western Ivory Coast.

Abidjan: Health facilities battle to cope
As Ivorian medical staff slowly begin to return to work in many areas across the city, drug and medical supply shortages continue and the health system remains unable to cope with the immense needs for emergency healthcare. As the national health system tries to recover, Médecins Sans Frontières (MSF) continues to support several hospitals and clinics across Abidjan, providing drug donations, as well as running primary and secondary healthcare projects. MSF teams continue to treat patients with fresh wounds from ongoing violence in a number of communities, but they are also dealing with a serious backlog of medical emergencies. Many people wounded during the fighting as well as people suffering from different diseases were unable to seek treatment for days, even weeks, and are now in serious need of surgical care. As news of the free services that MSF is offering spread, the teams struggle to deal with the vast influx of patients seeking healthcare, including for obstetric emergencies and general healthcare. As a result, MSF will open new projects to further meet urgent needs for life-saving and emergency healthcare.

Yopougon: Violence continues to cause serious injuries
In the general hospital in Yopougon Attié in western Abidjan, an MSF team is handling emergency admissions, surgical and post-surgical activities. In the past three weeks, 307 new patients were admitted, 125 of whom had gunshot or shrapnel wounds as a result of continuing violent clashes in the neighbourhood. In the last two weeks, the intensity of the violence has begun to decrease and the number of consultations in the hospital has quadrupled as people have finally been able to leave their homes to seek urgent treatment. As well as emergency surgery, the teams also set up primary healthcare consultations and a referral system. The biggest healthcare needs are treatment for malaria and respiratory infections. MSF is also supporting the hospital’s maternity ward and MSF staff have helped deliver 25 babies.

MSF is also providing free healthcare to the 400 people who remain displaced in the St. Laurent camp, where medical teams have provided 869 consultations. Close to Yopougon, MSF offers support for primary and reproductive healthcare at Attécoubé medical centre and facilitates access to care for survivors of sexual violence.

Abobo Sud: Less violence, but exploding numbers of medical and obstetrical patients
In the northern Abidjan neighbourhood of Abobo, MSF still receives between five to 10 people with gun shot injuries in  Abobo Sud hospital each day. Medical and obstetrical cases are exploding with a massive influx of sick people and pregnant women with complications. On average, the MSF teams provide 350 consultations and assist 40 deliveries of babies each day. In addition, MSF carries out between 80 and 90 blood transfusions every week because of the high numbers of anaemic children with malaria.

MSF is also working in collaboration with a physiotherapist from Handicap International who is helping patients in the orthopaedic ward after their surgeries. In addition, a MSF psychologist provides support to the wounded and those who had a limb amputated. In the near future, MSF plans to extend psychological support to the medical staff who have been profoundly shocked by the violence they witnessed.

In addition, in the Avocatier medical centre in Abobo, MSF is providing drug donations, paying medical staff and providing supervisory support as the centre resumes activities. Through this assistance, 250 consultations have already been carried out, and the clinics prenatal consultations and deliveries, in addition to its HIV/AIDS programme, were all able to resume.

Many facilities packed to bursting point
Every day there are queues of people waiting outside the Abobo Sud hospital. This small facility originally had a 20-bed capacity, but today more than 130 beds are now packed into every available space – including the inpatient department, the lobby and even two tents MSF set up in the outside yard.

Abobo Sud is not the only facility that is packed beyond capacity to try to meet people’s medical needs. Further south, in the Treichville area of Abidjan, MSF took over the 25-bed Nana Yamoussa clinic in mid April and began providing emergency surgery in two operating theatres to the high numbers of wounded and pregnant women in need of obstetrics care. In the first two weeks MSF conducted 531 consultations. The surgical team works 24 hours a day to try to meet the needs, performing 10 to 12 surgeries per day. On the first day, Monday, April 18, 42 people needed trauma surgery. However, after a number of days, the number of obstetric emergencies increased, as there was no other place in the city’s south to refer pregnant women with complications. Today, 50 people are crammed into the 25-bed facility, and there is no more space to take new patients who need surgery.

In the Koumassi general hospital, in the southeast of Abidjan, MSF gave 2,000 primary healthcare consultations the first week of May, part of a total of 6,140 consultations conducted since the past month. In the maternity ward, a total 467 deliveries were performed since the activities began. As some suspect measles cases have been identified, an MSF team has deployed a mobile clinic to monitor the situation.

Opening new structures to relieve pressure
To decrease some of the pressure and treat more patients, MSF has started to support new activities in several neighbourhoods. On April 18, MSF helped reopen the hospital in Anyama, a northern suburb of the city located not too far from Abobo Sud. The hospital performs surgeries and provides post-operative care to orthopaedic patients referred by the Abobo Sud hospital. MSF also provides paediatric and general healthcare assistance here. Already, as with Abobo Sud and Nana Yamoussa, people line up outside Anyama’s structure from 5 a.m. to try to make sure they can get medical attention.

On May 3, MSF started providing outpatient consultations and paediatric care in Houphouët-Boigny general hospital in Abobo neighbourhood. MSF also plans to start maternity services in this facility. Again, this should help relieve some of the pressure on Abobo Sud hospital and increase the number of patients receiving life-saving and emergency healthcare.

To help relieve pressure in the south of the city, MSF is opening a new project in the general hospital of Port Bouët, close to the airport. MSF staff have already started to rehabilitate both of the operating theatres in this hospital, and this week will start referring patients who need post-operative care to Port Bouët from Nana Yamoussa clinic in Treichville. When the operating theatres are fully rehabilitated, MSF will run an emergency room, in addition to providing trauma and emergency surgery, obstetric care (including emergency Caesareans) and post-operative care in Port Boué.

Western Ivory Coast: Many still displaced or hiding in bush for fear of violent attacks
In western Ivory Coast, thousands of displaced people continue to live in camps in overcrowded and harsh conditions. Many villages remain deserted, particularly in the areas closest to the Liberian border north and south of Toulepleu, where there are reports that people are still hiding in the bush. To reach isolated groups of people, MSF has increased its number of mobile clinics across the western part of the country, while continuing to provide support to the displaced where they’ve gathered and to local health centres.

In Duékoué, a MSF team continues to support the general hospital and is increasing its secondary healthcare activities. MSF also delivers primary healthcare to the 25,000 displaced people in the Catholic Mission camp. In addition, MSF is increasing the number of mobile clinics in villages northeast of Duékoué.

In Guiglo, MSF is present in two health centres and is providing primary healthcare to the 4,800 displaced people living in a camp around the Nazareth Church. In the inpatient medical ward of the Nikla hospital, MSF treats children suffering from acute malnutrition or severe anaemia linked to malaria. In the last three weeks, MSF carried out 400 consultations, 40% of which were for malaria cases and refers medical or surgical emergencies to Duékoué Hospital.

Mobile clinics try to reach those still hiding in the bush
Many people are still hiding in the bush as they fear reprisals or further attacks, especially on the road between Guiglo and Bloléquin where some villages are still empty and have been burned or destroyed. MSF is continuing to run mobile clinics along this road to reach the people in the bush and to respond to their medical needs. More assessments are also being conducted south of Guiglo, particularly in Tai, where there are reports that people are still hiding in the bush and need assistance.

Near the Liberian border
MSF is doubling the number of mobile clinic teams near the border with Liberia, between Danané and Toulepleu  with medical teams visiting 10 sites twice a week. In addition, MSF will also start to run an inpatient department in a local Ministry of Health clinic in Bin Houen, to ensure that the mobile clinic teams have somewhere to send people in need of hospitalisation.

Assessments in the southwest
There have been reports of killings at the coastal town of Grand Lahou in the southwest of the country, carried out by mercenaries reportedly fleeing Abidjan and heading towards Liberia. MSF was already planning to donate medical supplies to local health structures nearby, and is currently assessing other needs. In addition, MSF is also conducting an exploratory mission to assess needs in Tabou, another town at the border with Liberia and in Daloa, in the centre of the country.

Liberia: Refugees reluctant to return
In the last two weeks, the number of Ivorian refugees crossing to Liberia decreased dramatically, yet people continue to arrive, many searching for family members who fled before them. Some have started to move back, but many thousands more are still too afraid to return, while others have planted seeds in Liberia and need to wait for the harvest before they go back to Ivory Coast.

There are still an estimated 120,000 refugees in Liberia, though numbers are difficult to confirm. Among them, a vast majority of these refugees continue to be hosted within Liberian families and communities, particularly in two counties near the Ivorian border – Grand Gedeh and Nimba counties. Many of the Liberian families hosting Ivorians had themselves been refugees before – within Ivory Coast – when they were forced to flee as a result of the long Liberian civil war that ended in 2003.

MSF has set up 16 mobile clinics in Grand Gedeh county, where there are approximately 60,000 refugees. Staff provided 4,500 consultations during these clinics in April alone. These teams also vaccinated 835 people for measles. In neighbouring Nimba county, where another estimated 50,000 Ivorians have sought refuge, MSF also runs mobile clinics in 11 different locations along the border area, providing an average of 220 consultations per day. The main diseases that people need treatment for are malaria, respiratory tract infections and diarrhoea. Malaria, representing up to 30 per cent of all consultations, is a key concern for the team, with numbers rapidly increasing due to the rainy season.

In addition to the mobile clinics at the border, MSF is running a health post in Bahn refugee camp, where 4,500 Ivorians have sought refuge. Here MSF conducts an average of 50 to 65 consultations per day, the majority for malaria and respiratory tract infections.  In addition, MSF is supporting the outpatient department of the nearby Ministry of Health clinic, as well as carrying out screenings at the transit camps in New Yourpea.