Civil war all but wiped out health care, HIV/AIDS facilities in north

Cote d'Ivoire’s civil war all but wiped out the health sector in the rebel-held north, dramatically reducing the number of available doctors and significantly harming HIV/AIDS care and prevention, a new study shows. The departure of health staff and the decline of functioning clinics and hospitals in urban rebel-held areas after war broke out in September 2002 is likely to lead to an increase in HIV infections and sexually transmitted diseases (STI's), Swiss and Ivorian researchers warned in a report released on Friday. The study, financed by the Global Fund to Fight AIDS, compared health facilities and human resources in the public and private health sector in March 2004, 19 months after rebels took control of the northern half of Cote d'Ivoire, to the pre-war situation. Researchers found that the number of medical doctors in central Cote d'Ivoire had dropped from 127 to 3, or a decline of 98 percent. In the west and north, the decline was respectively 91 and 95 percent. Many medical practitioners left fleeing fighting, while some civil servants fled to the loyalist south where salaries continued to be paid after the country split into two. The study said that in addition, nearly 80 percent of health facilities in rebel territory were looted or destroyed, and remaining clinics lacked equipment and essential drugs, including anti-retroviral treatment (ARVs) and diagnostic kits for STI's. Use of the most widely distributed condom among adults in northern and central Cote d'Ivoire had also dropped, the report said, while the number of STI's had markedly increased in the west. In contrast, the number of NGO's in rebel-held territory claiming to combat the spread of HIV/AIDS had almost doubled. But the study stressed that most NGO's on the ground were local organisations without means or equipment to implement care and prevention programmes. The picture was slightly different in the central rebel capital of Bouake, where several international NGO's and UN agencies were involved in awareness and education projects. "The negative impact of Cote d'Ivoire's armed conflict on human resources and health facilities provides a legitimate concern that this constellation can fuel the HIV/AIDS epidemic," the study says. "In view of efforts already made by NGO's, international agencies and UN agencies to cope with the HIV/AIDS epidemic, it will be of pivotal importance that these emergency activities are carried through the post-conflict period." HIV/AIDS prevalence was estimated at just over seven percent in 2003 by UNAIDS, which is one of the highest rates in West Africa, but experts warn that the figure could be at over 10 percent in parts of the north.