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Periódico UNAL
Physical and mental diseases: The traces of war in Bojayá

In May 2 of 2002, combatants of the José María Córdoba Block of the former terrorist guerilla FARC and paramilitaries of the Élmer Cárdenas Block faced-off in the metropolitan area of the municipalities of Vigía del Fuerte, Bojayá, and Bellavista, in the Province of Chocó.
 

FARC fighters launched a gas pipette or “cylinder bomb” full of shrapnel destroying the church and killing 117 people of the 300 that were there seeking refuge. According to figures of the Coroner's Office and Forensic Services, among the deceased, there were 47 children; 19 with serious injuries and 95 people with mild injuries.
 

After almost 20 years of that bloody episode, the epidemiological profile of the surviving community (67 people) showed that as a lack of care and inadequate follow-up, many of these people still endure physical and mental impacts, being post-traumatic stress disorder (PTSD) the most prevalent (56%) among the survivors.
 

Bacteriologist and Universidad Nacional de Colombia (UNal) M. Sc. in Public Health,Natalia Moreno, claims in her research project that 33% of the survivors still has shrapnel embedded in their bodies; 40% has psychosocial disabilities and 85% hearing loss as a consequence of the strong blast.
 

The project is part of a solidary extension project known as “Laboratorio Salud Rural y Comunidad de Bojayá, Chocó”, (Laboratory of Rural and Community Healthcare of Bojayá, Chocó) headed by UNal Department of Public Health Professor Zulma Urrego.
 

Urrego says they carried out public health, physicals, physiotherapy, phonoaudiological, psychological, and psychiatric examinations, and in a collective component, they carried out discussion panels with the community.
 

“In Colombia, Afro-Colombian communities are not researched as much as indigenous communities and this was a challenge because the information was scarce. We gathered information regarding assessments related to living conditions, health status, and the perceptions, and consequences as a community,” she said.
 

However, there was minor reported official epidemiological information. They discovered statistical data in epidemiological profile bulletins and accessed two individual periods -2002 and 2018- showing what happened with the survivors during this time.
 

Moreno says that supported on clinical epidemiology they observed the economic, social, and state aspects that impacted the health of people; from the particular realm, they took into account how the community and communitarian support turned into protecting factors that impacted their social and cultural living conditions. And also, due to security issues, in 2019 she could not carry out her fieldwork due to the pandemic. This situation compelled her to make a methodological change.
 

The Government ignored the red flags
 

From the socio-political perspective and a series of documents discovered during the research, they confirmed that the Government was alerted since 1997 on the presence of illegal armed groups in the territory without these alerts being acted upon.
 

The Diocese of Quibdó was one of the first to accuse the armed groups of the responsibility of the attack in its commitment to support the community and the survivors in face of the scarce governmental guarantees provided to the community.
 

“Both priests, as well as volunteers, helped the survivors pass the Atrato River and picked-up people injured along the way, cleaning and protecting them as at the moment there was no possibility of entering the area with help or medical brigades,” she said.
 

Before this, the people of Bojayá had a rural economy of activities such as fishing and hunting, among others. However, after the massacre, the territory turned dangerous and they could not even mobilize securely, so women became heads of family.
 

What the war left
 

After the attack, and despite being relocated, the community continues to face issues such as home precariousness, lack of access to healthcare services, and public utilities. There was marked overcrowding, mostly in Quibdó, where the survivors took possession of rural areas without access to water.
 

“Most of these people are in the subsidized regime, without formal employment, uneducated and the prevailing occupation for women is care of the household, while 66% of the men are devoted to informal jobs such as street sales and transporting people in motorboats,” she said. Likewise, due to the lack of healthcare services, the community has had to recur to traditional medicine as a last lifesaving resource.

Regarding protecting processes, they discovered active participation of communitarian leaders from the moment of the massacre to now; they also identified the presence of armed actors, threats, constant displacement, violation of economic, social, cultural, and environmental rights of people.
 

On the other hand, the organizing processes are shown as a form of resistance in face of the violence and the use of traditional medicine which has helped treat healthcare complications both physical and emotional.
 

Comprehensive care without barriers
 

According to Urrego, it is necessary to have strategies for facing the difficulties of the survivors, such as the community of Bojayá, as without information such as epidemiological profiles it is impossible to follow up on comprehensive health repair within the framework of the Peace Agreement.
 

“The community of Bojayá was among the prioritized community to victim repair strategies; however, there are other groups that do not have this support and we need to know what are their health conditions, not only after the event but to see how there have evolved, how are their living conditions. Without this information, it is not possible to plan comprehensive strategic healthcare plans,” she added.
 

One of the main barriers for these strategies to materialize is the perception that Government institutions do not assume their obligation to be in charge of care and healthcare of the population in the Colombian territory.

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