Beyond the Headlines: Top ten under-reported stories of 2005

The immense human toll caused by conflicts in the Democratic Republic of Congo (DRC), Haiti, Chechnya, and northeast India are among the "Top Ten" Most Under-reported Humanitarian Stories of 2005, according to the year-end list released Thursday by international humanitarian medical aid organisation Médecins Sans Frontières (MSF).

The eighth annual list also highlights the lack of media attention paid to the plight of people trapped by chronic wars in Colombia, northern Uganda, and Ivory Coast, unrelenting crises in Somalia and southern Sudan, as well as the utter lack of research and development devoted to new HIV/AIDS tools adapted for impoverished settings.

"Media coverage can have a positive impact on relief efforts – just look at the nutritional crisis in Niger last year," said Nicolas de Torrente, Executive Director of MSF in the United States. "Although relief was far too late for many, the only reason aid efforts increased at all was the media attention at the peak of the crisis."

According to Andrew Tyndall, publisher of the online media-tracking journal The Tyndall Report, the 10 stories highlighted by MSF accounted for just eight minutes of the 14,529 minutes on the three major US television networks' nightly newscasts for 2005.

Natural disasters like the south Asia tsunami and the war in Iraq dominated international reporting. But in a year that Tyndall said had an unusually high amount of international coverage, only six minutes were devoted to DR Congo and two minutes to Chechnya. The remaining stories highlighted by MSF were not covered at all. The AIDS crisis received 14 minutes of coverage, none of which, however, was devoted to the lack of R&D.

"AIDS coverage never touches upon the near-total lack of research and development into tools specifically adapted for patients most affected by AIDS," de Torrente said. "One example is the fact that there are no pediatric versions of easy-to-take antiretroviral (ARV) combinations like those that exist for adults. Without research and development into such medicines, hundreds of thousands of children will continue to die needlessly every year."

Even though there was a general increase in international reporting, insecurity in war zones again contributed to preventing journalists from reporting on some of the world's most dangerous regions.

"People all over the US tell us how much they want to show solidarity and do more to help others in crisis around the world. But how can they when a crisis is virtually invisible?" de Torrente said. "Millions of people are struggling through crises in places that rarely, if ever, get mentioned in the US news, and in our experience, silence is the best ally of injustice."

Congolese ravaged by war and disease

A man suffering from malaria at a camp form internally displaced in Lukona. The level of health care in Congo is very low, while the demand is high and many families flee from their compounds after clashes between army troops and Mai Mai. © Petterik Wiggers/HH

The extreme deprivation and violence endured by millions of Congolese goes virtually unnoticed to the rest of the world.

Since mid-November, renewed fighting between the Congolese Army (FARDC) and the Mai-Mai rebels has caused the displacement of tens of thousands of people throughout Katanga province, in southeast Democratic Republic of Congo (DRC). In one instance in early December, armed men attacked a camp for displaced people in Katanga, forcing some 3,000 people to once again flee for their lives. This spate of violence is just the most recent endured by people in the DRC.

More than a decade of war and devastation has collapsed an already weak public health system and caused widespread misery for people throughout the country. During the past year, the northeastern regions of Ituri, North Kivu, and South Kivu were again the epicenter of violence, with multiple factions fighting for the control of the area's resources, preying on civilians, and committing appalling sexual violence against women.

Between January and May, MSF assisted many of the 80,000 civilians who had fled their homes in Ituri because of fear and insecurity. Emergency relief programs in the DRC represent MSF's largest mobilisation of aid in the world today, and recent MSF surveys found staggeringly high child mortality rates in several regions – more than six times the emergency threshold in the violence-plagued town of Lubutu and more than five times in the relatively stable town of Inongo.

The surveys also revealed that few people have access to health facilities let alone treatment, even in areas not ravaged by violence, in part because they cannot afford the fees, leading to an even greater human toll taken by easily treated diseases like malaria and cholera. While the war officially ended in 2003, peacekeeping and political efforts have not translated into better living conditions for most Congolese and the situation remains dire in many parts of the country.

Staggering needs, insecurity, and dismal response for Chechens living in fear

Caught in a stranglehold between Russian Federation forces and Chechen armed groups, traumatised civilians continue to bear the brunt of this conflict of attrition and find they have nowhere to go to be safe.

Driven back to Chechnya out of tented camps in Ingushetia, thousands of reluctant civilians returned to their devastated homes only to find what they had fled: fear, violence, and an ever-growing feeling of isolation. Officials claim that the situation in Chechnya has "normalised", but so-called sweep operations to round up suspected rebels, landmine accidents, disappearances and violence perpetrated by local militias are all too common.

With a limited international aid presence because of the insecurity, MSF has found ways to support health structures, surgical programs, and start assistance projects in several regions of Chechnya with Chechen staff. At the MSF-supported Hospital Number Nine in Grozny, the largest trauma center in Chechnya, staff treated hundreds of patients for violent trauma last year, including many gunshot and land-mine victims.

Many Chechens who have returned live precariously as internally displaced because their homes were destroyed or their towns are still insecure. The living conditions for the tens of thousands of Chechens remaining in Ingushetia vary from difficult to unbearable, with many inhabiting overcrowded, dank, dilapidated buildings that enable diseases like tuberculosis (TB) and pneumonia to flourish.

"Recently, it is the absolute sense of despair and hopelessness which is proving hardest to treat," said an MSF nurse in Ingushetia &ndsh; herself displaced from Chechnya. While insecurity persists in the entire region, there is an extremely limited international aid response and the Chechen conflict has all but disappeared from the international political agenda.

Haiti's capital wracked by waves of violence

Before MSF started to work in Cité Soleil, the majority of the population were effectively excluded from health care. Those who were able to move outside Cité Soleil to look for care often faced high fees charged in the Haitian health system. In December 2004, MSF opened the 56-bed trauma centre at St. Joseph's Hospital in Port au Prince to provide free emergency medical and surgical services to the growing number of people injured by violent acts who had little or no access to care. © Gael Turine

Many people in Haiti's capital, Port-au-Prince, are trapped by the widespread violence that has hit the city in waves since President Jean-Bertrand Aristide was pressured into exile in February 2004.

People have been shot and killed, deliberately and unintentionally, by all of the armed factions fighting in the seaside slums, or "quartiers populaires," and the violence – both politically motivated and criminal – is spreading throughout the city.

MSF treated more than 2,250 people for violence-related injuries in 2005 at a trauma center set up in the capital, including nearly 1,500 gunshot victims. Half of those treated are women, children or the elderly, underscoring the toll the violence has taken on civilians. Appalled by the deteriorating security situation, in July MSF called on all armed groups to respect the safety of civilians and to allow the wounded to access emergency medical care. The following day, however, the trauma center received 27 gunshot victims – three-quarters of them women and children – who were wounded during a day-long military operation launched by the UN Stabilisation Mission in Haiti (MINUSTAH) in Cité Soleil, the most violent part of the capital.

In August, MSF reopened Choscal Hospital and the Chapi Health Center in the heart of Cité Soleil, where 250,000 people live in abject poverty and were effectively excluded from any health care. In just three months, MSF performed nearly 12,000 medical consultations and treated more than 800 patients needing emergency care.

"Civilians in many parts of Port-au-Prince are struggling just to survive," said Ali Besnaci, head of mission for MSF in Haiti. "Everyday, people throughout the city tell us that they have never experienced such levels of violence before."

No R&D for HIV/AIDS tools adapted to impoverished settings

A man in despair is praying by his wife's body in the Kapiri Mposhi hospital, in Zambia, a few minutes after she passed away. She was HIV positive and had tuberculosis. © Julie Remy

The overall picture is well-known. More than 40 million people worldwide have HIV/AIDS, and every day, 8,000 people die of AIDS-related illnesses – 1,400 of them children.

While the HIV/AIDS pandemic receives regular media coverage, almost no attention is paid to the near-total lack of research and development (R&D) into new tools specifically adapted for patients most affected by the AIDS crisis: those living in poverty in the developing world.

Diagnosing HIV infection in infants, for example, currently requires extremely resource-intensive technology, so few HIV-positive infants can initiate life-prolonging treatment and half die before their second birthday. Even if children are diagnosed in time, there are no pediatric versions of easy-to-take antiretroviral (ARV) combinations like those that exist for adults.

Slowing the pandemic's toll will also require substantial investment into diagnostic tests that identify tuberculosis (TB) infection – the leading cause of death among people living with HIV/AIDS. The current sputum-based test is more than 100 years old and fails to detect TB in HIV-AIDS co-infected patients.

Tools are also needed to help clinicians recognise when current ARV treatments are failing so patients can be switched to more effective drug regimens, and there's a dire need for patient-friendly combinations of second-line drugs so patients are not faced with an increased pill burden when changing treatment regimens.

Without such R&D into new HIV/AIDS diagnostics and medicines adapted to the realities of people in impoverished areas the HIV/AIDS catastrophe could, astonishingly, become even more devastating.

Clashes in northeastern India take a heavy toll on civilians

Civilians in India's northeastern Assam and Manipur states continue to be affected by recurring outbreaks of political violence along religious and ethnic lines, as well as by long-lasting conflicts between the Indian government and militant groups.

More than 90 people were massacred in Assam's Karbi Anglong district during the latest outburst of violence and retaliatory killings in October 2005. The clashes – all too common in India's northeast – drove an estimated 40,000 people from their homes in Karbi Anglong and nearby North Cachar district to seek safety in nearby hills. Over the last five years, more than 150,000 people have fled their homes in the region because of such violence.

Without food, shelter, and other resources, the displaced often have no choice but to gather in overcrowded camps set up by the state government, where the general lack of provisions has led to outbreaks of measles, diarrhea and other illnesses. Authorities have kept thousands of people in deplorable conditions in such camps for more than eight years.

In Goiramari, the displaced became so desperate that they threatened to hunger strike. Government neglect, terror from armed groups, and grinding poverty have also wrecked the region's existing health care system. Malaria has inflicted a terrible burden and few people have access to effective treatment, and MSF expects to treat as many as 50,000 people in Assam for malaria alone in 2006.

The dire state of health care is also reflected in the mounting toll taken by HIV/AIDS and the growing number of people living with tuberculosis (TB) in Manipur. Despite the existence of treatment for both diseases, the vast majority of civilians caught up in the conflict zone cannot get the medical care they need.

War is officially over, but urgent needs go unmet in southern Sudan

A malnournished child in an intensive care unit at an MSF primary health centre in Akeum, Bahr El Ghazal, Southern Sudan. © David Levene

When the government of Sudan and the southern Sudan People's Liberation Army (SPLA) signed a peace agreement in January 2005, Africa's longest-running civil war officially came to an end. But hope – as well as media attention – was short-lived.

One year later, those most affected by the twenty-year conflict have yet to witness any real improvement in their abysmal living conditions. Recurrent medical emergencies, sporadic fighting (most alarmingly in Upper Nile and Western Equatoria), and a potential massive return of people to areas with little or no access to care means that many people will depend on humanitarian aid for some time to come.

The near-total lack of infrastructure means that even basic health care is beyond the reach of most, leading to a heavy burden from vaccine-preventable diseases like measles and treatable endemic diseases like malaria and tuberculosis (TB). Many patients walk for days to Akuem, Bahr-El-Ghazal in order to reach MSF's hospital – one of the only functioning hospitals in the entire province. MSF also provides treatment for kala azar in Upper Nile and for sleeping sickness in Western Equatoria.

And with six million people largely relying on food assistance, it takes little for families to fall into an acute nutritional crisis.

In 2005, failed rains combined with the return of tens of thousands of displaced people and refugees from neighbouring countries, aggravated the region's chronic food insecurity.

Throughout the year, MSF treated thousands of children for severe malnutrition in Upper Nile, Jonglei, and Bahr el Ghazal, while little has been prepared for the hundreds of thousands of people expected to return to southern Sudan this year. This may only worsen the dire situation faced by people in a region where resources are stretched thin and the infrastructure lays in ruins.

Somalis endure continuing conflict and deprivation

Every month, hundreds of mothers with children show up at the nutritional screening in the small village of Istorte. MSF checks children for malnutrition and refers the severe cases to MSF's therapeutic feeding centre in Huddur. © Espen Rasmussen

Since 1991, Somalia has been a state without a functioning central government. Fourteen years of conflict has precipitated the collapse of public health structures and a total absence of health care services.

In most parts of the country, clinics and hospitals have been looted or seriously damaged by armed groups, while the UN estimates that there are only four doctors and 28 nurses or midwives for every 100,000 people. Sometimes, people travel 500 miles just to reach one of the few existing health centers. The result of this situation has been catastrophic, with malnutrition, extreme poverty, and drought just some of the many scourges faced by Somalis.

Last year's lack of rain – one of the worst droughts to hit the country in twelve years – may expose nearly two million people in the south to acute food shortages in the next six months.

Few aid agencies, though, choose to work in Somalia because violence is so widespread and the country's clan structure so complex, yet with no state medical services, there is a desperate need for assistance. MSF has been working in the country since 1986, and provides emergency assistance in the worst-affected areas in south and central Somalia.

In addition to primary health-care services, MSF teams perform surgery, treat tuberculosis (TB) and kala azar, and provide pediatric care and therapeutic feeding for severely malnourished children. But the assistance falls far short of what is needed, and thousands of Somalis continue to die in the shadows of this forgotten disaster.

Colombians trapped by violence and fear

Don Gabrielo has been operated for hernia. His wife now cares for him at home. She couldn t afford to buy the necessary medicines. MSF s team pays a visit to follow up the treatment. Don Gabrielo is in hard pains and can t eat. The stomach is inflamed and swollen, the black wound smells. © Pieter ten Hoopen/MOMENT

The situation for Colombians affected by the country's 40-year-old civil conflict did not improve in 2005. For decades, government military forces, paramilitary groups, and armed guerrillas have fought against the backdrop of the narcotics trade and conflict over natural resources, terrorizing and targeting civilians in both rural and urban areas.

Violence continues to be the leading cause of death in the country and more than three million people have fled from their homes. Colombia now has the third highest number of internally displaced persons (IDPs) in the world, behind Sudan and the Democratic Republic of Congo, with many seeking safety and anonymity among the masses in shantytowns outside major cities where poverty, disease, and violence are rampant.

Up to 62,000 people were displaced in the first part of 2005 alone – a 10 percent increase from the previous year. More recently, MSF teams in Cordoba and Norte de Santander brought emergency assistance to people affected by attacks and subsequent displacements.

Armed groups involved on all sides exploit the displacement of civilians as a war strategy, while continuing violence against civilians throughout the country, including executions and kidnappings, causes multiple displacements and debilitating psychological anxiety. And even though the displaced are eligible for medical and social benefits from the Colombian government, fear and lack of information cause many to remain unregistered, thus without access to assistance.

In an effort to alleviate some of the suffering, MSF provides essential medical services in Caqueta, Chocó, Cordoba, Sucre, Bolivar, Nari