Emergency Preparedness

The registration process for refugees is a slow process.  I am convinced that this way the United Nations buys time to continue honing its contingency plans against the last contingency.  NGO’s in turn get to count the people to whom they give full sets of empty pots and pans, straws mats so families don't have to sleep on dirt and large collapsible water bottles to fill with water from the dirty river that flows by.  This count will be used to justify NGO expenditures for future donors.  I’m just hoping that the chlorine tablet people have talked to the water bottle people. 

All of these things are known as NFI’s, or non-food items.  The Liberian Ministry along with the United Nations High Commissioner for Refugees (UNHCR) have decided to not give food out at the border because this will supposedly incentivize the tens of thousands of refugees to stay.  It’s certainly not an easy organizational decision, but the fact remains that with or without food, people are staying.  An estimated 90,000 Ivoirians have now entered Liberia along two axes:  Buutu and Gghorplay.  39,784 refugees are individually registered, 32,872 refugees are emergency-registered, and a remaining 19,290 are unverified meaning there wasn’t enough time to register them.

The distinctions between individual, emergency, and unverified refugee registration illustrate the bureaucratic nature of large organizations and what people have to endure in order to receive services within them.   It’s the same in the United States where the average wait time to see a doctor in the emergency room is 4 hours.  Now add ninety degree weather, an hour or two a day of torrential rain, no bathrooms, a little PTSD, no food or clean water and the urgency/abuse/challenge/ conundrum becomes clearer.  Last week when I was in Beolooyah, the wait time for NFI’s was about 6 hours and this was a casual 1,000 refugees.  The next day during a visit to one of the neighboring clinics, which would soon receive Ivoirians along their immigration path, the wait was 3 hours to be seen.  Sure, there were only two nurses seeing patients, making only 150 dollars a month.  But half the patients were waiting for the registrar whose recording instruments resembled that of a grand 17th century Cartier.  I will admit that her parchments and pens seemed grand.   

The current plan for the refugees is a change from the previous plan and the plan two weeks before that.  It moves 70% of the growing 90,000 refugees into 5-6 camps of 15,000 – 20,000 located throughout Liberia’s Nimba county.  One camp called Bahn has been built (with a school and 100 latrines!).  Gawee in remote Nimba is nearing completion.  Camps 3, 4, 5 are….being planned!  Transportation of refugees will take place via transition centers located about 30 km from the refugee entry points in Karnplay and New Yourpea.  The high official at UNHCR has been unable to explain exactly why refugees can’t just go directly from the border to the camps.  As of yesterday, 163 refugees have been moved to Karnplay, 122 to New Yourpea, and 495 have finally made it to Bahn.  At the current rate, it will take at least a ½ a year to move the present number of refugees. 

90,000 people staying in a place where 90,000 were not previously means a lot of problems.  As one of my MSF colleagues put it to a group at the Health Ministry, people are shitting everywhere.  People after walking 3 days to Liberia are hungry.  The river from where people drink coincides with where people bathe and wash their clothes.  It’s begun to rain and it is not yet the rainy season. 

Peter is a twelve year old Ivorian who I met last week at the bridge leading up to the border town of Blemieplay.  By the time our mobile team arrived having endured a 4-wheel drive along a bumpy, crevasse filled, simultaneously muddy, hard road powerful enough to cure any man or woman’s chronic constipation, it was almost time to go.  In the confusion and explanation to the villagers of our simultaneous arrival and departure and truck turn around time, I had a few moments talk with Peter who was with his new friends swimming at the river. 

Peter arrived 3 weeks ago with his mom and sister.  Unlike many, Peter and his family did not have relatives in the area and were sleeping in the woods in a direction to which Peter pointed.  All I saw was a collection of dense trees.  Peter described his family’s motivation to leave the Ivory Coast simply as “We were scared.”  He described sporadic gun-fire and armed men in jeeps zooming down the street.   I dropped terms like Gbagbo, Ouatarra and Forces Nouvelles on Peter and he nodded but it was obvious that he did not understand.  I had forgotten because of his posture and matter of fact mode of conversation that Peter was only twelve years old!  When I was twelve, I did a lot of things, but never did I walk three days to get to a border nor was I preoccupied with my political affiliation.  Peter wants to be an engineer when he grows up so he can make clean water flow.  During our conversation, he grimaced and perked his ears simultaneously at my French but listened carefully.  He asked when I would be back.  He asked if we had food.

I try to remember Peter and others like him when I attend the emergency response coordination meetings at UNHCR headquarters in Monrovia-- the boys who ran naked from the river and excitedly asked me to take a picture of them with an assertiveness that made me feel overdressed, the boy with the nameless pet rat who laughed at my suggestion that he name the rat Wilson, the matriarch with four well behaved children walking behind her from tall to short each with progressively lighter loads on their heads.  Here in Monrovia, it’s a different world.  It’s still a little sweaty but instead of villagers there are NGO heads and bureaucrats.  Instead of black there is white (and one Asian!).  Instead of reality there are plans.  The people around the table are smart.  There are good ideas.  Many have been in Liberia for years.   Yet, it is interesting to watch the group dynamic to see what individual, humor, fact or resolve produces decisions.  One must study this dynamic so as to be able to control it, manipulate it.  I have witnessed the group absorb candidly the risk of cholera due to lack of water and sanitation in Ghorplay, then change the subject quickly to the subject of roads.  One woman told of the long arduous walk from the border to a transition site and the next day there were 200 tents placed along the immigration path to give passersby’s shade and respite.  I am close but not quite there.  I am still a stranger.  Too many words from me and I can be branded a know-it-all without experience.  Wait too long and I risk being type cast as a silent, a shadow next to the strong persona of my country director. But there is an even greater danger that I observe.  Numbers and stories can wield like knives, but away from a context of events on the ground they dull quickly.   One must be literally be in the action for things to stay fresh and important.  It is why I schedule visits to our hospitals and clinics and mobile teams once a month despite 12 hour drives in each direction; why I still sweat it up in the morning to see very sick patients on the ward though my “work” is not really there.  The policy of setting up systems that structure healthy behaviors begins with the self.  When negotiations get too hard, when problems get too big, instead of being able to run away in a chauffeur driven air-conditioned car, best to think things over on the public bus.  When I hear that we are short of milk and Plumpy Nut supplies for starving children, I want to be able to actually lift the bottle to the light to see that it is empty and look down at the child resting in my other arm and know how I am going to find his next meal.  For me, it’s about being honest, doing my part and staying focused amidst shortcomings.  It's an every day challenge and I commit to staying on top of it like one has to do to achieve momentum when biking uphill.