Struggle to revive health services in rebel-held north

The bullets have stopped flying in most of the rebel-held areas of northern Cote d'Ivoire, but health services in the region have all but collapsed, according to relief agencies working hard to support over three million people in the region. Pierre Ryter, the head of the International Committee of the Red Cross in West Africa, told PlusNews that only 25 percent of hospitals and health centres in the northern half of the country were working. All relief agencies working to improve the humanitarian situation in the rebel-held north after seven months of civil war have complained of a poor response by international donors to repeated appeals for money to get doctors and nurses there working again. "The needs of the population are still great, even if the situation does appear to be normalising," Ryter said. "There is still a lot of humanitarian work to do in the west and throughout the country in the post-war period." Health workers particularly fear rising child malnutrition, the outbreak of measles and cholera epidemics and a rapid increase in the incidence of HIV/AIDS. "if nothing is done, serious epidemics are likely the amount of mourning that families have to suffer," said one volunteer worker of the Ivorian Red Cross movement, which is one of the few relief agencies to have got US and European Union money to buy medicines. Relief agencies estimate that between 700,000 and one milion people were forced to flee their homes by the fighting and seek refuge in other parts of the country - mainly the government-held south. According to UN estimates, 500,000 more have fled abroad, mainly to Burkina Faso and Mali, which border Cote d'Ivoire to the north. The conflict has frequently pitched people of local origin against immigrants from other West African countries and their descendants. These made up about 30 percent of Cote d'Ivoire's 16 million population before the conflict began. The rebels seized the northern half of Cote d'Ivoire within days of a failed coup last September. Since then most of the fighting has consisted of skirmishing along a frontline that divides the country from east to west. But even there, the guns have been quiet since March, except in the west, where the presence of Liberian and Sierra Leonean mercenaries, said by diplomats to be fighting for both sides, has complicated efforts to bring peace. The fighting in the west has also taken its toll on the relief agencies. They still find it difficult to gain access to the area around Danane which has now been widely nicknamed Cote d'Ivoire's "Wild West." Four volunteers of the Ivorian Red Cross were kidnapped there in December and were found dead near Toulepleu, a town on the Liberian border, two months later. Ousmane Coulibaly, the rebel military commander in Danane, told PlusNews by telephone on Thursday that MSF Holland was now conducting a measles vaccination campaign in his area, but the region was still seriously short of basic medicines. Water and electricity supplies had now been restored to the area, he added. Since the war began, government services in the rebel-held north have been at a virtual standstill, with most schools and hospitals closed. However, several relief agencies say the rebels do allow them to operate freely. Ryter said the ICRC had helped to provide protection that enabled many doctors and nurses who initially went into hiding to return to their posts. His organisation distributes chemicals to 63 water treatment stations in rebel-held areas each month Several other aid agencies also active in the rebel-held north. They include the Ivorian Red Cross, which conducts public health and vaccination programmes, sends drugs to hospitals and provides basic medical care the victims of conflict, Medecins Sans Frontieres (MSF), which operates a series of mobile clinics, and Action Internationale Contre le Faim (AICF), which is fighting malnutrition. Since the end of January, AICF has delivered 12,000 hot meals a day to adults and children in the rebel capital Bouake. AICF spokesman Michel Meaitta said the organisation is planning to start a second feeding programme in the western town of Man shortly. An MSF official who had just returned from rebel-held areas of the West, said the organisation was particularly worried about rising rates of child malnutrition. The official, who asked not to be named, said MSF recently found that 14.2 percent of children under five were malnourished in Duekoue, a town in central Cote d'Ivoire which has changed hands several times in recent months. MSF found the rate of malnutrition was even higher at 17.8 percent in the nearby government-held town of Guiglo. This hosts Cote d'Ivoire's only official refugee camp, which houses 8,000 people. However, two UN-sponsored appeals for international aid since the end of last year have fallen on deaf ears. The UN is currently seeking US $10 million to finance health projects throughout the country, whose cocoa and coffee exports once made it the wealthiest in the region. But, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Abidjan, to date not a cent has been forthcoming for these programmes. They range in scope from vaccination drives to HIV/AIDS control campaigns. Meanwhile vaccination programmes remain patchy, and with water supplies still unreliable in many towns, health workers fear outbreaks of cholera and the spread of epidemics of meningitis and yellow fever, which have already claimed hundreds of lives in neighbouring Mali and Burkina Faso. Rape and a general increase in promiscuity in the zones of conflict is also causing concern about the possible spread of HIV/AIDS. According to the Ministry of Health, 10 percent of the population of Cote d'Ivoire's commercial capital Abidjan are infected with the virus of the sexually transmitted disease and the infection rate rises to 14 percent in some parts of the interior. For the past month, the Health Ministry has been distributing AIDS kits that include condoms, T-shirts carrying anti-AIDS messages and AIDS prevention booklets to soldiers and civilians in frontline areas.