Violence takes toll on medical and food aid operations across country

As medics in Abidjan dodged punches and stones to deal with the hundreds wounded during days of mob violence, humanitarian workers in northern Cote d'Ivoire warned of a cholera outbreak unless electricity and water supplies were quickly restored. The World Food Programme also sounded the alarm, saying food stocks would be stuck in warehouses if conflict continues in the world's top cocoa producer, where as many as 800,000 of its 17 million people receive food aid. And in a reminder of the risk Cote d'Ivoire's problems pose to the wider West Africa region, the UN refugee agency UNHCR announced that more than 1,300 Ivorians had fled across the border into eastern Liberia in the last week. Cote d'Ivoire had enjoyed an eighteen-month ceasefire until last Thursday when Ivorian troops from the government-controlled south launched an offensive on the rebel-held north, first cutting power lines and knocking out water pumps. "If water is lacking for another couple of days, we’ll be confronted with the risk of an epidemic," Antoine Foucher, from MSF in Cote d'Ivoire, told IRIN on Tuesday. In the rebel-held town of Bin-Houye, in the west near the border with Liberia, Vanessa Van Schoor of MSF said cases of diarrhoea were already on the rise, especially among the 200 or so people who had fled their homes and were camped out by the river or in abandoned buildings. "A lot of them are using pond water," she told IRIN by phone from MSF's regional centre at Danane. "It's an area where cholera is endemic and the lack of running water or clean water means an outbreak is a definite risk. We are trying to get chlorine and water containers out there." But getting out onto the ground is easier said than done given the uncertain security situation. Although MSF is still working in Danane’s hospital and a health centre in Bin-Houye, it has been forced to suspend its mobile clinics. "Normally we do 21 clinics and we cannot get out to any of them right now," Van Schoor said. "That's 600 consultations a day that are not being done - patients with malaria and respiratory infections, women who need antenatal care." Even before the latest trouble erupted, health and water facilities in the north were in a battered state because many health professionals left the area when civil war broke out in September 2002. Seventy percent have not returned. The UN Office for the Coordination of Humanitarian Affairs (OCHA) reported recently that one region had a single doctor for 200,000 people, and that four out of five water pumps in rural areas were out of action. "Cote d'Ivoire has been in a humanitarian crisis for two years. A prolonged suspension of aid programmes would endanger thousands of lives," Jan Egeland, the UN's Emergency Relief Coordinator, said last Thursday when the ceasefire collapsed. Aid workers threatened Back in Abidjan, MSF said it was scaling back operations after three days of mob violence in the country's commercial hub. Ivorians began rampaging and looting their way through Abidjan's streets on Saturday, angry at former colonial power France, which in retaliation for a deadly airstrike on one of its bases, wiped out almost the entire Ivorian airforce. "Hate messages" against French people and other foreigners filled the air waves and French troops fired into the air to keep back thousands of demonstrators in the streets. "We evacuated around 15 people today," Foucher said. "We are a reduced squad but safety is the priority. Our national staff are going out onto the streets, but our international staff are not." The International Committee of the Red Cross said its workers had been targeted, hampering the organisation's ability to respond to emergencies. "Volunteers have been threatened physically, they've been punched, their cars have been shaken around and stoned," Kim Gordon-Bates of the ICRC in Abidjan told IRIN on Tuesday. "It's a chicken and egg situation. Threats mean no work and no work means more threats." Meanwhile, hospitals in the city were feeling the strain from injured people pouring through the door since the rioting and violent protests started. The ICRC said the number of casualties was well into the 600s, while MSF-France put the injured toll at around 700 but stressed it was difficult to confirm. "We've seen a continuous stream of people injured by bullets, or with fractures or bruises. The medical staff is exhausted and volunteers have been coming to help," said the director of a hospital in the upscale neighbourhood of Cocody, where two people have died and another 205 have been treated since Sunday. "Transport is causing enormous problems. We don't have enough petrol so we have to wait until there are several injured people in one place before we go and collect them." Many UN missions suspended The United Nations has moved to Phase Four, the last phase before evacuation. Agencies have suspended missions in the field and many staff are sheltering at UN military bases, Ibrahima Barry, an OCHA official in Abidjan said. The WFP, one of the affected UN agencies, warned that the food security situation was likely to deteriorate for the most vulnerable sections of the Ivorian population, if the violence continued.

The WFP has temporarily suspended most of its activities in Cote d'Ivoire

"If the current conflict is not resolved within the next 10 days, WFP may be unable to finalise local procurements in progress and transport food supplies from its main warehouses in San Pedro and Abidjan to the worst-hit areas, expected to be around Bouake, Korhogo and in the north and west of Côte d'Ivoire," West Africa spokesman Ramin Rafirasme told IRIN on Tuesday. The WFP provides food aid for up to 800,000 people in both north and south Cote d'Ivoire, including half a million primary school children. Cote d'Ivoire was once the West African success story, with a roaring economy and a stable political framework. But now analysts fear the renewed fighting there could spill across borders into volatile neighbouring countries like Sierra Leone, Guinea and Liberia. UNHCR said on Tuesday that 1,327 Ivorian refugees had already sought refuge in and around the Liberia border town of Butuo since the peace process back home began unravelling last week. "The majority of the new arrivals are women and children, with a few elderly people. They appear traumatised but otherwise in good condition," UNHCR said in a statement. "UNHCR has called for emergency supplies of food and relief items to ease the burden on the local community."