Ivory Coast: “It wasn’t long before I witnessed the suffering caused by war”

I arrived in the city of Abidjan ten days ago as part of Handicap International’s emergency mission, in support of the MSF mission. It wasn’t long before I saw the suffering caused by war.
The armed conflict in the Ivory Coast has left many people injured, often by bullets, who also suffer serious complications. Some injured persons hide themselves away out of fear for their safety. The hospitals were quickly overwhelmed by a flood of patients and ran out of human and material resources (lack of medication, surgical materials, faulty sterilisation equipment, etc). People’s wounds became infected and gangrenous as a result.

Initially, MSF set up its operations in Nana Yamousso hospital in Abidjan, in the district of Treichville. Equipped with around twenty beds, it quickly had to double its capacity. The emergency department is full and three tents have been set up in the courtyard to meet the surgical needs of both patients with war injuries but also gynaecological and obstetrical emergencies. The operating theatres work at full capacity, treating fractures and bullet wounds but also performing corrective surgery, lancing wounds and changing complex dressings (infection, etc).
Most of our patients are men who have been hit by bullets, causing wounds, very comminuted fractures, amputations, etc.

The post-operative physiotherapy service was up and running very quickly, performing early mobilisation, getting people back on their feet again, teaching patients breathing exercises (thoracic damage with pleural drain breaks) and supervising patient positioning, often with the help of improvised devices.
As always in our profession, we’re able to get close to patients and develop a special relationship with them. We spend time listening to them: there’s Michel who laments the loss of his leg or Ouara who remains prostrated. Other people recall their memories of the war, the violence they have suffered and their fear. Some look stunned or exhausted.

A 12-year old girl who has had her leg amputated needs walking sticks; you need to teach her to walk and to use her stump to prepare it for the prosthesis.
Others do not have any clothing, family or resources. Others still cannot go home because it’s not safe in their neighbourhood (Yopougon) or because their house has been ransacked and pillaged.
We also see patients who arrive in the emergency department for factures they sustained two or three months ago, which are either poorly consolidated or in the wrong position, giving rise to ankylosis. This 21-year old in the emergency tent has a comminuted facture of the femur. His leg has been shortened and shows signs of external rotation, causing a lot of pain. We mobilised the limb and helped him find a good sleeping position (using two bags of sand). He also performed muscle exercises – it took a lot of courage. Two days later, with the help of a wooden stick, he stood up again and began to walk. It was a very happy and emotional moment.

After the preparatory stage comes the move to a new facility with 60 beds and primary health centres in the area: Port Bouët. It will be a hospital laid out in separate blocks, making it easier to extend using additional tents. It will benefit from an emergency room, and perform trauma and corrective surgery, follow-up people with war-wounds and handle obstetrical problems.