On the front lines of the Ivorian crisis

By PopTech
April 21, 2011

Tubman Hospital Refugee Patient

By Andrew  Zolli
The opinions expressed in this article are those of the interviewer and interviewees.

The post-election crisis in Ivory Coast has been transformed from a political standoff to a humanitarian catastrophe. Ethnic groups loyal to strongman Laurent Gbagbo and those loyal to president-elect Alassane Ouattara have clashed with horrifying results: so far the Red Cross has discovered 800 bodies in one village alone; the U.N. discovered another 118, many burned alive.

While Gbagbo’s arrest on April 11 represents a turning point in the crisis, this shockwave of violence has created a refugee crisis in neighboring Liberia, as an estimated 100,000 Ivorians have poured over the border into the country in recent weeks. Their arrival has overwhelmed the already fragile and under-resourced rural public health system in southeastern Liberia.

2010 Social Innovation Fellow Dr. Raj Panjabi and his colleagues are on the front lines of this unfolding crisis. Their community-based health organization, Tiyatien Health, is working with the Liberian Ministry of Health and other partners at one Liberian district hospital and sixteen clinics in some of the areas most seriously affected. We spoke to Panjabi and Dr. Yesero Kalisa, Tiyatien Health’s Clinical Director, who are heroically trying to provide care at the only hospital in the county, Tubman Hospital.

PopTech: What are you seeing on the ground right now?
Yesero Kalisa: There are now more than 30,000 Ivorian refugees in Grand Gedeh, the county where we operate on the border with Ivory Coast. We’ve been seeing a rapid increase in refugees since January. Our small rural hospital, with only 80 beds, has been overwhelmed. People have been arriving with all manner of problems: gunshot wounds, injuries suffered in the wilderness, severe malaria, diarrhea, and worst of all, malnutrition. We’re running dangerously out of food.

Raj Panjabi: We lost a two-week old child last night in the hospital from hunger because the mother could not afford food and her breast milk had ceased.

YK: And that doesn’t begin to address the mental health issues. People are profoundly traumatized.  Some of our patients have told stories of witnessing their relatives massacred, raped and burned alive in a report just released by Human Rights Watch from Grand Gedeh.

Raj and Kalisa at Tubman Hospital

PT: What do you need most urgently right now? How can people help?
RP: Immediately, we need help in three areas: we urgently need 2-3 international medical volunteers to help support our team on the ground. We need cash and airline miles to help get them into the field. And we critically need resources to help us purchase a vehicle to provide ambulance services to refugee mothers suffering from obstructed labor and those with gun shot wounds. Our community health worker teams are identifying these individuals in camps and villages, but we need a way to get them to hospitals and clinics.

Right now, $75,000 would transform our efforts. Unfortunately, we’re putting all of our resources into providing care, so we don’t have a lot of additional bandwidth for fundraising and advocacy. Anyone interested in helping us can learn more on our website Tiyatien Health.

PT: Raj, you’ve described this as “refugees taking care of refugees”. Can you elaborate?
RP: Sure — but to do that, I need to provide a little history:

People may know that Qaddafi supported and trained Charles Taylor in the 1980s to spark Liberia’s civil war, which sent my family and many of the people who now work with us at Tiyatien Health fleeing into exile for over 14 years.

In 1990, when Taylor attacked in southeastern Liberia, nearly 90% of the people in our region were displaced into Ivory Coast — just the reverse of what’s happening today. These Liberians spent 15 desperate years as refugees in Ivory Coast.  Only recently, have they started to return to rebuild our country.

Our organization, Tiyatien Health, was founded in 2007 by these former Liberian refugees who survived our civil war.  Many were our patients, but have since become trained as community health workers. And, today, they — as former refugees — are providing health care and other basic services to refugees from Ivory Coast who once housed and sheltered them.

Refugees Crossing River From Ivory Coast to LiberiaYK: Because of this shared history, the reception the Ivorians have received has been very warm. For example, many nurses in the hospital, who are otherwise working around the clock, are hosting refugees with their families. But there are limits to what they can do. The hospital and the surrounding communities are suffering a critical food shortage.

PT: Beyond the humanitarian dimensions, what do you see as the larger consequences of this crisis?
RP: Five years ago, Liberians told the world they were tired of war when they elected Africa’s first female President, President Ellen Johnson Sirleaf. In five short years, President Sirleaf has turned the country around — from hell on Earth to what has become a place of hope. The international community views Liberia as a model for post-conflict recovery — an opportunity to get it right in Africa.

In six months, President Sirleaf will be up for re-election, but the conflict in Ivory Coast threatens to destabilize the election. Inaction on this crisis now threatens this progress and stands to rebuke all who would dream of similar progress in other post-conflict regions.

The Q&A can also be found here on PopTech’s website.

Photos, top to bottom: Ivorian refugee at Tubman Hospital; Dr. Raj Panjabi (left) and Dr. Yesero Kalisa (right) at Tubman Hospital in Zwedru, Liberia; Ivorian refugees crossing the border into Liberia. Credit: Tiyatien Health

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