Marawi: Rebuilding healthcare in a shattered city

It’s been a year since the eruption of a devastating conflict between the Philippines’ army and insurgents, which lasted five months. MSF is committed to rebuilding primary health structures in a heavily destroyed city – while supporting those still unable to come home.

A view of Marawi City’s ‘Ground Zero’, formally called the ‘no return area’, following five months of heavy combat. (Rocel Ann Junio/MSF) 

A year ago, when groups supporting the so-called ‘Islamic State’ took over a major city in the southern Philippines, many locals assumed the crisis would come and go.

Marawi City and the region, Mindanao, are familiar with armed insurgency. A civil conflict with another Islamist movement lasted for more than 50 years, until 2014. And judging from recent incidents with smaller armed groups, people believed the Philippines’ military would dislodge fighters from Marawi City in days, maybe weeks.

Instead the siege of Marawi lasted five months: from May to October 2017, causing 370,000 people to flee their homes.

A majority of people stayed in makeshift camps: in garages, schools and mosques, not knowing when their former lives could start again.

Putting your life on hold: during the siege, only one in ten people could seek refuge in an official camp. Most stayed in informal settlements, such as garages. (Baikong Mamid/MSF)

How did MSF respond?

In informal camps, MSF provided emergency psychological care in the early stages of the crisis. Our teams then focused on access to water and sanitation for thousands of families.

Feeling like kids again: during the siege, MSF conducted play sessions in informal IDP settlements as part of its emergency psychological care program. (Rocel Ann Junio/MSF)

By October 2017, the Philippines army finally declared the siege of Marawi over.

Shortly after, an MSF team was surveying the damage to the city’s quiet streets when they came across a colorful mural.

It was from before the war. It read: ‘PRAY FOR ALEPPO’, a sign of solidarity for the heavily bombed city in Syria, some 9,000 km away.

But that day, what the team saw of Marawi looked a lot like those infamous images of Aleppo.

Abandoned streets in the outer neighbourhoods of Marawi City, weeks after the end of the siege. Slowly, some families have been able to come home. (Rocel Ann Junio/MSF)

The previously bustling center of town was so critically damaged that it was off-limits. They could only observe it from across the lake.

These central neighborhoods, or ‘barangays’, are currently labelled ‘no-return areas’ and commonly called ‘Ground Zero’.

Although the fighting stopped in October 2017, many IDPs from these areas, estimated at 27,000 families, have remained in camps for months and may do for years.

Many aid groups have packed up and left since the end of the fighting. The humanitarian response is stretched.

Targeting the most neglected IDP camps, MSF is still working to improve the sanitation conditions, constructing latrines and shower facilities in 13 settlements for around 5,700 people.

What about those returning to the city?

People from the outer barangays of Marawi City center have mostly returned.

Like the Hassan family, whom MSF met in November:

Many of Marawi’s health facilities were located in today’s Ground Zero, and the primary health infrastructure suffered massively.  Only 1 of 2 rural health units, 6 out of 15 health centers and 7 of 28 health posts were able to re-open. They are barely functional.

Moreover, 31 of the 45 health facilities existing before the conflict are still completely closed.

Overall, 70 percent of the local health structures were destroyed.

Equipment and facilities were looted or damaged. Many of the medical staff themselves were forced to flee, and are still not able to come back to work.

Working with the Marawi City Health Office, MSF is planning to rebuild the primary health structures to care for the estimated 180,000 to 200,000 returnees, including those who remained in the outskirts of the city and those in IDP camps located within it.

From typhoons to measles: when disaster keeps on striking

As MSF teams have stayed in the region to support vulnerable populations, they were called on to respond to two further crises.

In late December, Typhoon Tembin (locally known as Vinta) smashed into the Philippines’ Mindanao region.

According to Philippines government estimates, more than 200 people died in flash floods and mudslides, with many more reported missing. Around 797,000 were affected by the tropical storm and its lasting aftermath.

MSF teams travel along destroyed roads and distribute non-food items such as water and hygiene kits in Lanao del Norte, in the immediate aftermath of Typhoon Tembin. (Hana Badando / MSF)

Most of the hardest-hit areas were difficult to reach due to distance and access issues. Teams were typically traveling four to five hours, often by motorbike or foot because of badly damaged bridges and roads.

MSF distributed non-food items such as water and hygiene kits to around 930 families in six most affected barangays in Lanao Del Norte. Mental health experts also delivered grief counselling sessions to those who lost loved ones.

“My grandmother drowned. She was sleeping at that time and was not able to flee. I still have injuries from the logs that hit me. I swam and brought seven children back to safety,” explained Saddam, a resident of Pansur village, in Lanao Del Norte.

“I had to save them even if I died doing so.”

A crumbling health system, and an epidemic

One shock followed another: in January, a measles outbreak struck the Mindanao region.

Measles is extremely contagious: an infected person is likely to further infect 90% of people around them. It can be very serious and sometimes deadly in children.

Working with the Marawi City Health Office, MSF helped to vaccinate 5,638 children during Mindanao’s recent measles outbreak. (Shinjiro Murata/MSF) 

With the health structures in the region still reeling from the aftermath of conflict and natural disaster, MSF gave its support to local vaccination efforts.

In February, MSF worked in close collaboration with the Marawi City Health Office to vaccinate 5,638 children under 5 years old.

This collaboration will continue as MSF sets out to help rebuild the city’s primary healthcare infrastructure.

Marawi residents, meanwhile, can focus on putting a catastrophic year behind them, and rebuilding their lives.