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lunes, 18 de enero 2021
18/01/2021
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The Health Sector, an Invisible Victim of the Armed Conflict

by Juan David Ospina Sánchez
Journalist

A study carried out by Universidad de Antioquia for the Truth Commission (Comisión de la Verdad) reveals how the armed conflict was brutal not only with millions of Colombians but those who worked for their health and wellbeing. Between 1958 and 2019, for example, 2,419 attacks on the medical mission were recorded.


Paulina Mahecha, mother of Nurse María Cristina Cobo Mahecha, victim of paramilitary groups in Guaviare. Photo: courtesy of Comisión de la Verdad.

In the early hours of February 20, 2002, FARC-EP's ninth front blew up the bridge Danticas, between the municipalities of San Carlos and San Rafael, in Antioquia. Minutes later, in the same place, an ambulance transporting a woman in labor fell into the abyss. The fog prevented the driver from seeing that the structure had been knocked down. That resulted in the deaths of Flor Emilse García Muñoz —who was about to give birth— her sister Yanet and Elvia Guarín, auxiliary nurse.

That event, which was widely covered in the media and shook the entire country, is a good example of the armed conflict’s impact on the dynamics of healthcare workers in Colombia. Universidad de Antioquia, after a research process during which it traced events such as this one, pointed out that every two weeks between 1958 and 2019, the country underwent an average of 1.5 attacks on the medical mission.

The number is in the report prepared by the National Faculty of Public Health (Facultad Nacional de Salud Pública—FNSP) as part of the process promoted by the Truth Commission to recognize the armed conflict’s effects and impact on the health of the population, on healthcare workers and on those who took care of communities in remote regions. "The armed conflict's impact on the health of communities is an essential point to determine the truth, make reparations and provide guarantees of non-repetition", explained Nicolás Dotta Ibañez, general coordinator of Doctors of the World, Colombia Mission.

According to Yadira Borrero Ramírez, Public Health PhD, "The armed conflict has violated the right to health in its most important aspects: availability, accessibility and service quality." Borrero was a member of the National Faculty of Public Health (FNSP) research team that investigated what happened in the country in three specific situations for the Truth Commission: attacks on the medical mission, socio-political violence against healthcare providers and damage to rural areas. The project drew on databases and interviews to diverse sector actors and victims in various rural areas, among other sources of information.

Attacks on the Medical Mission

Attacks on a medical mission are considered a violation of the international humanitarian law. According to Esperanza Echeverry López, professor and FNSP researcher, such violations include damage to healthcare workers, inappropriate use of or attacks to health facilities, attacks to and hijack of means of transport, breach of professional secrecy, obstruction of healthcare delivery and damage to health’s institutional structure. Regarding the last point, the report highlights that, between 2002 and 2010, some 530,000 million pesos worth of health resources was diverted to armed actors.

The research indicates that, between 1958 and 2019, 2,419 attacks on the medical mission (AMM) were documented. They left 2,093 individual and 444 collective victims. One of the cases addressed by the researchers took place on April 19, 2004, on a road in Calamar, a municipality in Guaviare. Nurse María Cristina Cobo Mahecha was abducted by paramilitaries and, according to the official report, was tortured, sexually assaulted and disappeared. "31.3% of the attacks on the medical mission concentrated in rural areas, and 27.5% in urban areas. No data were found for the remaining 41.2%, which is a sign of great under-reporting", warned Echeverry López. "The interviews we collected in the rural areas show us that healthcare workers normalized these events in the areas most affected by the conflict."

Dismantling of Unions and Effects in Rural Areas

Infographic: courtesy of Comisión de la Verdad.

The study defined the period between 1988 and 2019 as the years to document the impact of socio-political violence on health. This has to do with retaliation from legal and illegal armed actors for corruption allegations, attacks on promoters and ancestral knowers, repression of protest and dismantling of unions. Between 1990 and 2019, there were 334 cases of anti-union violence against healthcare workers, 355 conflict-associated incidents and 415 individual victims.

"The armed conflict brought along the withdrawal of most union members, which was closely related to the labor reforms in the healthcare sector. They were promoted by illegal groups so they would have a bearing on the rural areas", stated María Victoria Jiménez, executive of Colombia's National Union Association of Healthcare Workers, Comprehensive Social Security and Complementary Services (Asociación Nacional Sindical de Trabajadores y Servidores Públicos de la Salud, la Seguridad Social Integral y Servicios Complementarios de Colombia—ANTHOC).

Health promoters in rural areas were also a target of socio-political violence. They were severely affected by the crossfire. "It hurt their social role in terms of social cohesion and solution of health problems in their communities", Echeverry López explained. "The violence against them went beyond the attacks on the medical mission."

Between 1988 and 2019, 84 rural health promoters were attacked, 24 of which were murdered, and 4 were disappeared. In addition, in parts of Antioquia, Sucre and Bolívar, armed actors forbade them to go into rural areas. "This causes severe damage to the possibility of building democracy and constitutes an extermination of critical thought in the healthcare sector", the professor stated.

Ancestral knowers —who are essential to the physical and spiritual wellbeing practices of indigenous communities— were also attacked, which not only weakened key leadership positions, but brought about the loss of important traditions, such as the use medicinal plants and the preservation of sacred sites. Displacement and plundering, moreover, generated ruptures between the communities and their ancestral territories. The researchers warned that this means a disconnection from life, food insecurity and the loss of something intangible as important as identity.

An emblematic case in this regard is that of Abelardo, an Indian of the Jiw people, which lives between Meta and Guaviare. This ancestral knower began his apprenticeship at 14. His father gave him the spirit to handle yopo, a shaman medicine. However, that connection with the spirit began to disappear in 2002, when the guerrilla group FARC-EP was merciless with his community, and he was displaced to Mapiripán. Stories such as his should make Colombian society question itself, according to the researchers. "The war put us in a very difficult spot, and we trivialized death", said Researcher Borrero Ramírez. "Urban dwellers have to be more empathetic with those who have been affected. We need a project of society that puts a decent life and, obviously, the right to health at the center of it."

It is expected that the Truth Commission will publish its final report on Colombia's internal conflict in November 2020. The researchers hope that the forms of violence that affected the health sector and its actors, a study that other universities and institutions also contributed to, will be included in that report. José Pablo Escobar Vasco, dean of FNSP, warned about the importance of this project since most Colombians aren't aware of the serious violations of healthcare workers' rights, and it is troubling that many of those violations are still being committed. "Education about the subject is needed, even within academic circles, to guarantee that that will stop", he said.

Colombia signed the United Nations' International Covenant on Economic, Social and Cultural Rights, which states that the signing states "recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health".

 

 
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