Philippines: “It’s very exhausting being displaced—always on the run.”

Hundreds of thousands of people have been forced to flee their homes since fighting resumed last August between the Philippine government forces and the Moro Islamic Liberation Front (MILF) rebels on Mindanao island. Settled in evacuation centers or simply along the roads, these displaced populations live in dire conditions and have very poor access to medical care. Since last November, MSF teams have visited the settlement areas with mobile clinics and provided the villagers with much needed access to water.

Bai Ali is 14 years old. She left her house near the highway when fighting hit her village in August. Fighting had already spread to the first village her family fled to for shelter, forcing them to circle around again through forested areas. They finally reached the town of Datu Piang and settled in a camp for internally displaced people (IDPs) where MSF teams are providing assistance. “It’s very exhausting being an IDP—always on the run”, Bai Ali says.

While most of her friends from her village are here in the IDP camp, and she’s made new friends, both Bai Ali and her playmates say there are things they do not like about the camp. For example when it rains, she points out, water leaks through the plastic-sheeting which makes the roof of the shelter.

Last August, the suspension of peace talks led to the intensification of hostilities between the Philippine army and autonomist elements. In the past five months, an estimated 300’000 to 500’000 people have been forced to leave their villages to escape violent clashes and bombings. Many of them are now living in “evacuation centers” near main towns or have simply settled in informal camps along the roads. Some have no place to go back to, because their villages were burnt down.

Living conditions in the IDP settlements are dire, with little hygiene, very poor access to clean water resources and medical care. Since November, MSF teams have been active around the conflict zone on Mindanao island to assist the populations affected.

Mobile clinics and support to local health structures

MSF doctors and nurses have set up mobile clinics and regularly visit evacuation centers and IDP camps. By the end of December, they had conducted over 3000 medical consultations in more than 10 locations, notably in the areas of Datu Piang, Pikit and Mamasapano. More than 26% of patients are suffering from respiratory diseases, due to the damp and precarious conditions they face. Others are diagnosed with body pain/headaches, fever and stomach problems.

Some of the children seen by MSF’s medical teams show signs of acute malnutrition. From early 2009, teams from MSF and the Philippine Department of Health will undertake a mass nutritional screening for children under five years old. Those diagnosed with severe and moderate acute malnutrition will be treated.

A few cases of tuberculosis and measles have also been reported. Severe cases are referred by the teams to the main regional hospital in Cotabato.

MSF support has also been given to local health centers, thanks to good collaboration with the Department of Health. “Due to the massive influx of displaced populations, health structures are overloaded and can’t face the situation in terms of human resources and drug procurement. For instance, Datu Piang town has seen its population grow from 42’000 to 82’000 in just a few months”, says Helmi Mekaoui, MSF deputy program manager for the Philippines. “That’s why we help the local clinics with human resources and give them some drugs, in order to maintain a necessary level of medical assistance”.

To improve sanitary conditions, MSF logisticians have worked on draining water sewage systems in some IDP camps. In January they also provided drinking water to over 5,000 displaced people in Mamapasano. 

In early January, as fighting between government forces and MILF rebels show no sign of reprieve, thousands of Mindanao villagers are still on the move to find a better and safer place to stay. “In the Gundulugan area, we saw a camp set up near the highway in only two days”, tells Bertrand Rossier, MSF Head of Mission in the Philippines. “5’000 people have moved in right away. They had been living in another camp further from the road where they received no assistance and decided to come closer, but the place where they settled is swampland and sanitary conditions are minimal”.

As the current crisis on Mindanao island leads more and more people to flee their homes, MSF teams are getting ready to engage in more activities in the coming months, to respond to the most urgent needs.

"This time is different"

Sapita is a 50 year old mother of three from a village near Datu Saudi, a town in the province of Maguindanao heavily affected by the ongoing hostilities between government and rebel forces.  She is among the tens of thousands who have crowded themselves here in the town centre to seek refuge from the fighting in the nearby surrounding villages. She and her children have been in the camp at Datu Piang since August.

When we met Sapita, she was mixing a bubbling pink concoction in a metal bowl over a smoking fire in the middle of the blazing heat – shrimp paste she’s hoping to sell locally to support her family and to compliment the relief items they have been receiving from aid agencies.

Sapita and her neighbors received no warning when clashes erupted suddenly in their area.  Around 9am, as the shells were falling on their village, Sapita and her neighbors hurried to find safety – with time only to collect their children.  They left behind all their belongings, clothes, appliances, crops and farm animals.  “We ran like hell”, she says.

Stirring her shrimp paste, Sapita and fellow IDPs have gathered to discuss their experience.  They no longer know how many times they’ve evacuated before, but this time is different.  Previous evacuations were usually only for a week or a couple of days in the past. Displaced since August, they don’t know when they can go home.

Until then, Sapita, her neighbors, and thousands of others live here in Datu Piang with their children.  Sapita’s oldest daughter Asama (13) and Sema (9) were in elementary school before they evacuated.  Her youngest, Farneda (6) had tried to start school, but was told she was too young.  But for now all of the children have had to stop going to school.  Some have also got sick.  And some who became sick, have died.