It is 10:13 in the morning and the Apartadó ICRC sub-delegation mobile health unit (MHU) team is ready to set off from Turbo, a small municipality in Antioquia on the Gulf of Urabá. They will travel by boat, along the Atrato and the Opogadó rivers, to Baquiaza, a small community of Emberá natives living in a remote region of Colombia.
The logistics are impressive. A 175hp twin-motor craft, which reaches a speed of 36 knots (70 kilometres) an hour, carries a doctor, a nurse, a dentist and his assistant, a water and sanitation coordinator and the MHU coordinator. The boat is piloted by a seasoned sea wolf who knows every twist and turn of the rivers and all the secrets of these turbulent waters.

In addition to the medical team, the boat carries a whole battery of equipment, including a generator - electricity is rare in this part of Colombia - a complete set of dental equipment and cold boxes containing vaccines and medicines to treat the most common diseases in this area.
After a seven-hour journey along the Atrato River, the team must change boats, because the Opogadó has become very shallow in many places. The medical team, along with the equipment and supplies, are now transported by canoe and, although it is powered by a 50hp motor, the members of the crew have to jump out and give it a push from time to time.

After many hours on the river, tackl-ing the difficulties imposed by nature, the MHU team arrives at its first destination, Baquiaza. In no time at all, the boxes of equipment and supplies are unloaded and promptly converted into a doctor's surgery and a fully equipped dentist's surgery.

After a day's work in the community - vaccinating children, checking on pregnant women, examining children whose skin has been affected by the river water and monitoring the rainwater treatment projects - the team packs up and sets out for its next destination: Mesopotamia. The programmes carried out by the MHUs also include health promotion and prevention activities.

After a long journey along the Opogadó, the ICRC team reaches Mesopotamia, an Afro-Colombian community with health needs similar to those of dozens of other municipalities in Colombia.

Four years ago, all the inhabitants of Mesopotamia fled from their homes because of the armed conflict. Two years ago they returned to their lands and tried to reconstruct what had been destroyed.

The people of the community begin to arrive very early to be treated by the medical team. The water and sanitation coordinator meets with local authorities to decide on locations for the community's new water tanks. She also reminds them how important adequate water treatment is to the health of the people in the community. The day's work involves treating children who have had minor accidents, vaccinating new-borns and examining elderly people with a variety of complaints.

In 2001 the mobile health units provided medical and dental treatment to 18,220 individuals and vaccinated 15,733.

As the boat driver concentrates on the difficulties of navigating the river, the MHU team discusses the details of their next mission, which will take them to another destination in this part of the country in two days' time.

One of the biggest problems for the civilian population living in areas affected by armed conflict and for displaced people is access to basic health-care services.

The armed conflict and geographic isolation suffered by thousands of Colombians have led to a breakdown in the health system. One consequence of this has been a surge in the incidence of immuno-preventable diseases in the areas most seriously affected by the conflict.

The MHUs are focusing their efforts, in coordination with local authorities at all levels, on providing primary health care (general medicine, dentistry, health promotion/prevention activities, vaccination and water treatment and sanitation) to communities.
In 2001 and the first part of this year, the ICRC mobile health units and the municipal authorities provided primary health care in various parts of the country. The projects are being carried out by four National Societies - Canadian, German, Norwegian and Swedish - which are providing the required funding and human resources. It is important to note that armed groups have allowed the MHUs to provide medical attention to the civilian population affected by the conflict in the four regions in Colombia where they are operating.

Acceptance of the ICRC medical mission has made it possible to frame strategies to provide primary health care and carry out health promotion and prevention activities, and the involvement of local authorities and communities has permitted a continuous expansion of these activities.

The internal conflict in Colombia started in 1948, interrupted by sporadic lulls. According to various sources, about 300,000 people have died and more than 1.5 million have been displaced.

The ICRC has been permanently based in Colombia since 1980. It presently runs 17 offices throughout the country.
In Colombia, armed conflict results in humanitarian needs that require a rapid response. Tens of thousands of people are forced to abandon their homes and to seek greater security in towns or rural areas. No part of the country is unaffected. Since they are often forced to leave without warning, these people have to drop everything and flee with nothing but the clothes on their backs. They lose their means of subsistence and are unable to meet their basic needs such as food. The ICRC strives to provide emergency humanitarian assistance that is both effective and in proportion to the population's priority needs. Assistance is closely linked to the protection work carried out all over the country.

Since 2001, the ICRC has reinforced its role as a neutral intermediary between all parties to the conflict while developing medical programmes in affected areas, visiting detainees and working to secure greater respect for international humanitarian law by all parties to the conflict.

Carlos Rios
Carlos Rios is an ICRC communication delegate based in Colombia.