How to intervene in Ivory Coast

Why did Handicap International decide to intervene in the current crisis in the Ivory Coast?
Faced with a crisis such as this, as an NGO specialising in emergency action, Handicap International establishes a presence in the field and evaluates both the situation and the needs of victims as best as possible, with a view to supplying an immediate and appropriate response. That's why we performed an evaluation in Liberia this week. More than 77,000 refugees from the Ivory Coast have crossed over into neighbouring Liberia since 28 November, the date the results of the presidential election were announced. The United Nations expects an extra 200,000 refugees to join them very soon.

The vast majority of the refugees are being hosted by communities in the area, while others are staying in a camp managed by the UN High Commission for Refugees. Our fear is that, due to a lack of resources, the communities will not to able to cope with these refugees over the long-term, further weakening their situation and leading to greater tensions.

Inside the Ivory Coast, the number of victims continues to grow and the United Nations estimates that almost 500 people have already died. There are fears that the current crisis between two political factions will escalate into a full-blown civil war, in which the general population, because of their particular ethnic or religious background, will be the first victims of the violence.

In Abidjan, the violence has intensified over the last five days. This is expected to lead to a rapid increase in the number of injured persons and increase the likelihood of a local exodus. The UNHCR now estimates that one million people have already left the city. Only one hospital remains open in the capital. It is located in Abobo, the scene of fighting between the supporters of Alassane Ouattara and those of Laurent Gbagbo. The working conditions for the medical personnel who have stayed behind are particularly difficult because the economic embargo has prevented supplies of medicine and consumables from getting through. Some medical NGOs are in a position to provide emergency medical care but post-operative care is never or only rarely performed, particularly once an injured person has left hospital.

The follow-up of these injured persons over the long-term is, however, essential. When an injured person is rapidly discharged from hospital to free up a place for one of the many new victims pouring into the hospital, they often find themselves without any care at all, despite a heightened risk of infection due to extremely poor sanitary conditions. Depending on the seriousness of their injuries, they even risk losing their lives if gangrene or generalised infection takes hold. The absence of rehabilitation care can also give rise to serious or permanent disabilities. Handicap International has extensive experience of providing post-operative follow-up care to the injured in conflict situations, which we believe is a priority scope of action.

Given this background, what shape will Handicap International's intervention take?
In Liberia, we expect to perform local actions in aid of the most vulnerable groups (persons with disabilities, pregnant women, the elderly, etc.) among the refugee population and those staying with host families in Liberia. Our task will consist of identifying them and evaluating their needs in order to supply them with specific and responsive aid, in association and in support of other humanitarian operators in the field. Handicap International may also take part in group distribution activities. Lastly, we understand that in such as volatile situation, needs change and move around. This requires us to permanently adapt our activities.

Faced with a lack of security in Abidjan, we are not planning to perform distribution activities there of any kind. At this stage, we expect our intervention to centre around the immediate post-operative, trauma-based and orthopaedic case-management of the injured in hospitals, in support of medical NGOs. This includes early rehabilitation, respiratory physiotherapy care, and the supply of orthoses, technical aids (sticks and crutches), anti-sore mattresses, etc.

What factors could hinder your activities?
In general terms, as in any crisis situation, different parameters need to be taken into consideration: the relevance of our response to the needs identified, our operational deployment capacity, the security situation, and funding possibilities. Once in the field, it is possible that obstacles such as poor security or access problems will make it impossible for us to intervene. It is also possible that, having arrived in the area, we realise that the needs initially identified are being adequately met by other local or international operators, as was the case recently in Libya. It is based on these rational considerations that we will decide on the continuation, expansion and content of our intervention.

In the Ivory Coast, the climate of insecurity poses the biggest difficulty to international aide operators. The situation is highly chaotic in some districts of Abidjan, like Abobo, Williamsville and Yopougon, undermining our ability to plan ahead and control risks. In such a sensitive situation, every professional humanitarian organisation must very carefully weigh up the level of risk to which it is prepared to expose its staff against the practical impact of its actions. Once we have achieved this balance and identified qualified staff who want to travel to the Ivory Coast, and who are familiar with conflict situations, we can begin our work.

Why has the crisis in the Ivory Coast generated so little attention?
The presidential election in November only worsened a crisis that has dragged on for more than ten years, fuelled by internal strife and political tension. Public opinion has grown weary of this situation, as it has grown weary of the chronic instability in Africa in general.

The current international context has not made it easy to draw attention this situation either. The sudden uprisings in the Arab world and the succession of disasters in Japan have monopolised the attention of the international community and the media.

Little present in the Ivory Coast, international aid operators have not been able to size up the situation. Since they are unable to closely monitor the crisis, which worsens everyday, they are incapable of bearing witness to the realities on the ground and drawing the public's attention to the fate of the civilian population, which risks being the conflict's first target and the victim of the very worst acts of violence.

Despite all of this, to paraphrase the Liberian president, the crisis in the Ivory Coast must not drop off the radar: as a humanitarian organisation, we are duty bound to intervene immediately in the Ivory Coast and Liberia to aid the injured, people fleeing violence and the Liberian communities playing host to them. The humanitarian situation experienced by the victims of this crisis is a cause for major concern.