The weeks-long military conflict between two rival presidential candidates in Ivory Coast may have reached a political resolution in April, but the refugee crisis created by the fighting continues to drag on. And in the neighboring country of Liberia, itself emerging from the ruins of a bloody civil war just over a decade ago, local communities have been deluged with tens of thousands of Ivorians pouring across the border, trying to escape the brutal tactics of militias on both sides.
The former president of Ivory Coast, political strongman Laurent Gbagbo, finally relinquished power a month ago when he was arrested by forces loyal to his opponent, Alassane Ouattara, recognized by most international observers as the legitimate winner of a presidential election last year. His militiamen had been terrorizing the capital, Abidjan, as well as rural parts of the country loyal to Ouattara in a desperate bid to cling to power. But human rights activists say Ouattara’s rebels, too, have brutalized Ivorians loyal to Gbagbo, burning down villages and using rape as a weapon of war, as a means of retribution or intimidation.
Raj Panjabi, a resident physician at Massachusetts General Hospital who has been traveling to Liberia to provide health services to the growing refugee population there, has seen the physical and psychological toll of those tactics firsthand, through his patients at the rural clinics along Liberia’s border with Ivory Coast.
“They tell stories of militia men coming into their villages, deliberately targeting them, even at times calling out the name ‘Gbagbo, You are ‘Gbagbos,’” Panjabi said in an interview from Massachusetts. “They tell these horrific stories where the rebels leave the parents in one room, in the other room rape the children while the parents are alive, so they can hear it, then kill the parents, burn the village down.”
This nightmarish scenario, repeated by both factions across the Ivorian countryside, does not end there, Panjabi said.
“If the kids escape being killed themselves, they’re running for days across the border, only to come into camps or to be put into situations where they’re so crowded, and a situation where their basic needs or resources are short, such as food, that they’re then put into these exploitative cycles,” Panjabi said. “Young girls and women are being forced by men to trade sex for food, in a place where food is already so insecure.”
Panjabi has witnessed such devastation before. He fled Liberia as a young boy during dictator Charles Taylor’s brutal campaign of repression in the early 1990s. The memory that haunts and motivates him, he says, is of waiting in line to board a cargo plane at an airport in Monrovia as Liberia’s civil war raged. In Panjabi’s line were Liberians of lighter skin color. In another, there were darker-skinned residents being restrained by Taylor’s soldiers. Many were likely killed in the conflict that ensued, he said.
That inequality is what drives and consumes Panjabi. In 2007 he founded the nonprofit health organization Tiyatien Health to provide health services to rural Liberians in areas of the country that had been ravaged by the war (“Tiyatien” means both “truth” and “justice” in the local Liberian dialect). The effort employed local Liberians who were charged with providing basic, home-based medical care, and helped establish the country’s first HIV treatment program at a rural public health center. It was also, Panjabi says, an attempt to help rebuild Liberia’s health system and lift the country from the ashes of one of the world’s most neglected conflicts.
“After the war, 90 percent of our clinics and hospitals were either partly or fully destroyed. We had just 51 doctors left for the entire country of just 4 million people,” Panjabi said. The program began by providing care to rural Liberians in the southeastern city of Zwedru, which had seen some of the worst devastation from the war. “When Tiyatien Health first started working there in 2007, founded right there in that community by survivors of the Liberian civil war, there was just one doctor working there for a population of about 250,000 people.”
Now, with the help of the international community, Liberia has made considerable strides toward rebuilding its infrastructure and its rural health system. But those gains are in danger of being eroded by the ongoing refugee crisis on the border with Ivory Coast. The rural health system there has been overwhelmed by the influx of tens of thousands of refugees suffering from everything from trauma injuries, such as gunshot wounds, to malaria and other infectious diseases.
“Oftentimes what happens in any sort of humanitarian emergency is that the host community is negatively impacted by the stain that’s put on them,” Christina Bethke, program director for Tiyatien Health, said in an interview from Grand Gedeh, a county in southeast Liberia that has seen the bulk of the refugee influx. “There’s simply just a lack of resources, not just money but also manpower to respond to it.”
Tiyatien Health has called on international donors and health care organizations to commit more resources to the refugee crisis. The United Nations has requested about $300 million in aid from countries and international donors to help with the humanitarian crisis, but only a “fraction” of that total has been raised so far, Panjabi said. Panjabi, Bethke and others worry that the urgency of the refugee crisis will fade from the front pages now that the political crisis in Ivory Coast has, to some degree, been resolved.
Perhaps the greatest risk, Panjabi said, is the instability of the situation. Even those refugees who have escaped violence fear the anxiety of living in a foreign country, without a safety net.
“I’m sure it’s in the studies, but I just know personally that the most important factor to my family’s ability to recover from losing everything that we had is finding another person on the other side that was willing to tell us that we’re not alone,” Panjabi said. “By focusing on local groups and communities, we’re being able to see that those bonds are being able to be forged in this kind of setting. And that gives us a little bit of hope, that we’ll be able to provide at least some ease to the suffering that people are feeling.”