Reaching victims of India’s hidden war

A MSF health worker treats a child in Injaram camp in Chhattisgarh state. India 2007 © Erwin Vantland/MSF

In the heart of India, clashes between Naxalites—the local Maoists—and the Indian government have displaced tens of thousands of people. The fighting, which affects large swaths of Chhattisgarh state, flared up in 2005, and since then an estimated 56,000 civilians caught in the conflict have been forced to move to government-run camps. Thousands of others are hiding in the dense forest in the south of the state in Naxalite-controlled areas, or have taken refuge in settlements for the displaced near villages across the state border. Living in fear, they are left destitute and have difficulty accessing health care. MSF is among the very few humanitarian organizations that are supporting these people, and is striving to provide medical assistance on both sides of the conflict.

Violence lurks behind a peaceful façade

In the early hours of the morning, an MSF four-wheel drive vehicle is speeding along the bumpy road that leads to Injaram, one of 23 internally displaced persons (IDP) camps scattered throughout Chhattisgarh. The team runs a weekly therapeutic feeding program for malnourished children in three IDP camps and provides basic health care to their families.

The drive along the Chabari River offers a peaceful glimpse of India's rural life—vast stretches of land with mango trees lining the road and hills looming in the distance. Groups of women are bent over in rice fields, while young boys guard cows, goats, or buffaloes. Yet, just a few kilometers away, a violent guerrilla warfare has claimed scores of lives, displaced tens of thousands, and is spilling into several neighboring states, including Andhra Pradesh.

Tribal people, or Adivasis, who belong to one of the lowest castes in India, bear the brunt of the conflict that remains largely ignored in the rest of the country. The Koya and Gothy Koya tribes who inhabit the area led a secluded and traditional life until recently. Cut off from modern life, they eked out a living in the forest to the rhythm of harvests and festivals. But guerrilla warfare has torn them from their land and even turned them against each other. While the government is pushing villagers to leave their homes and go to the camps, thousands have decided to flee and hide in the forest.

"Everyone needs to accept that we are not taking sides in this conflict. We provide health care to all victims whatever side they're on and we need to have unhindered access to all those who are affected."

—MSF Field Coordinator Robert Rowies

Communicating neutrality

MSF strives to provide medical assistance to all those affected by the conflict and one of the biggest challenges has been to make all parties involved understand its mandate.

"Explaining our neutrality and impartiality is critically important in this context, both for our security and for being able to work efficiently," says field coordinator Robert Rowies, "Everyone needs to accept that we are not taking sides in this conflict. We provide healthcare to all victims whatever side they're on and we need to have unhindered access to all those who are affected."

Running malnutrition programs in the camps, as well as bringing mobile clinics to the people who have fled into the forest, is part of MSF's balanced effort.

As the car approaches the camps, the military presence becomes more obvious. Attacks around the camps have intensified in recent months. Along the way, groups of women and men from the camps are busy doing road work while others are loading some wood into trucks under the escort of armed men in black and army fatigues. Further away, young men in civilian clothes are guarding the entrance of the camps with 1940s Enfield rifles slung across their shoulders. Called Salwa Judum, they are young tribal people who are trained and armed by the government.

MSF staff measures a child at Injaram camp to help determine if he is malnourished during a visit by MSF's mobile therapeutic feeding program. India 2007 © Erwin Vantland/MSF

Nutritional care in the camps

With its red-brick roofs and 3,000 inhabitants, Injaram looks more like a village under construction than a displaced camp. MSF has been running a therapeutic feeding program here since November 2006. Children enrolled in the program come every week to have their weight checked or to receive consultations for basic health problems. The peanut-based food used in the nutritional programs has sometimes posed problems. "If the children have diarrhea they tend to stop taking it," says health promoter Parvez Pasha, who visits the families each week to make sure the therapeutic food is taken properly. "Parents often leave in the morning to go working on road works around the camps and leave their children unattended."

Through its presence in the IDP camps, MSF also aims to stress that those living there are also victims of this conflict. They have lost their homes and suffer from a radical change of life. Muttamma is one of the women who have brought their children to the clinic. After a series of attacks on her village, she was forced to leave everything behind. Like most of the refugees, she longs for her old life and waits in the hope of coming back to her village. "We used to be happy in our village. We sold our harvest, and celebrated the festivals, and were free," she says. "Here, there is no freedom; we wait, doing nothing. I'm scared to go to the forest; it's too dangerous. If I go to pick up some wood, the Naxalites will think I'm with the police because I live in the camp and the police will think I have contacts with the Naxalites," she says. "Our children are getting killed; there is no happiness here."

Reaching those who are hiding

Those who refuse to join the camps have fled into the dense forests of Chhattisgarh or to villages in Andhra Pradesh where the Naxalites have a strong presence. Red flags are a common sight in this area. MSF provides a weekly mobile clinic in what it calls a grey area, a zone off-limits to the police for security reasons. Providing basic health care to this part of the population has proven challenging.

"The most difficult part was to find the people who are hiding but need health care. We felt we were chasing ghosts for a long time," explains Robert Rowies. "The people are very scared. At the beginning, when our mobile clinic visited them, they would flee," he remembers. "Gaining people's trust was difficult, but the team has seen improvement and has worked hard raising awareness of their work."

"Our work at the border indicates that more medical assistance is needed deeper
in the forest where more people are hiding. We hope we will soon have access to all those affected by this conflict."

—MSF Field Coordinator Robert Rowies

After months of screening the area to reach the most affected populations, MSF now sets up its weekly clinic at a border crossing, just inside Andhra Pradesh, in Mallempeta, where tribal people come from Chhattisgarh to trade their harvest in the nearby villages. The Adivasis stop on their way to the market for a health check. Some will bring their children to the feeding program.

As MSF's staff hang up the weight scales for babies in a mango tree, silhouettes slowly trickle from the forest; men, sometimes so thin they buckle under the weight of the bags hanging from a pole slung across their shoulders, and women carrying baskets of fruits and seeds on their heads. Some come cycling through the forest. They rest their bikes against the trees and huddle together on a rug waiting patiently for their turn.

The queue can be long. MSF doctors see on average 50 to 60 patients a day. Most of them come for rashes, scabies, malaria, and malnutrition. "This morning, I saw a child who was nearly disabled. His scabies was so bad, he could hardly use his hands," says MSF doctor Jorund Aswall, who supervises the team.

A little tent is set up to provide a bit of privacy to the patients during the consultations. Behind the plastic sheet, they talk about their health problems, the living conditions, the scorched villages, and about those who are not fit enough to trek the 30 to 40 kilometers (20 to 25 miles) through the forest to come for a consultation.

Currently, MSF is able to work in the camps, as well as along the border
with Andhra Pradesh and in other areas of Chhattisgarh. "Our
work at the border indicates that more medical assistance is needed deeper
in the forest where more people are hiding," says Robert Rowies. "We hope we
will soon have access to all those affected by this conflict."

Docters with Out borders