Ivorian Refugees Affecting Liberian Health Care

More than 170,000 refugees have fled the violence in Ivory Coast for neighboring Liberia. Health care is already inadequate for rural Liberians. Dr. Raj Panjabi, a Liberian-born Harvard Medical School physician, co-founded a rural health care organization in Liberia called Tiyatien Health. He spoke with The World's Marco Werman about how the Ivorian refugees are overwhelming the already fragile health care system in Liberia.

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Marco Werman: Liberian-born Raj Panjabi co-founded a Liberian healthcare organization, it’s called Tiyatien Health.  Tiyatien means truth and justice in the local Liberian dialect.  Dr. Panjabi, who’s based in Liberia and Boston, set a straightforward goal for his organization, to help Liberians, but he got more than he bargained for. An estimated 170,000 refugees from neighboring Ivory Coast have fled to Liberia.  They’ve escaped the violence that marked a power struggle in their country.  Now, Dr. Panjabi says many need medical care.

Dr. Raj Panjabi: A lot of them have experienced extreme violence — gunshot wounds, burnings, malnutrition, food shortages — it’s a major problem.  We have a unit where the whole unit is filled with kids that are starving from hunger. And then you see the things that you typically see, like this was a very poor place from the beginning — complications from childbirth, HIV, malaria, tuberculosis — these are the ranking health problems facing both Ivorian refugees and the Liberian relatives that they’re living with now.

Werman: How many months or even years of a setback to Liberia’s healthcare system do you think the Ivory Coast crisis has prompted?

Panjabi: We are at this point really trying to focus on building back the public health sector by investing in training local health workers.  There’s also a need for medical supplies and for building mobile clinics in these hard to reach villages.  We know that medical care alone, treatment and cure, aren’t enough.  We’ve gotta hit at the root of the problem.  And one of the major challenges facing all of the partners and the communities there are the food shortages. Liberian farmers have reached out to the Ivorian relatives in an act of kindness and generosity, housed them, and have been providing food for them.  And they’re using the same seeds and crops to be able to feed both their own families and now their relatives who’ve come over.  Some villages have multiplied five times their own usual number of people, so you can imagine the food shortages are high.  We just lost a two-week old infant after her mother had lost her breast milk because she herself had gone hungry. So we’re trying very hard at this point also to address the food crisis.  There are a couple things that we’ve been focusing — one is to try to advocate for the UNICEF and the World Food Program to get immediate food relief.  That’s gonna help us stave off children from dying acutely from starvation. In the medium term we need also farming materials, and assistance to the local farmers who have used up their seeds and crops for this new incoming population.  And in the long term we’d like to see the U.N. start to procure food locally from these farmers so as to help stir back up the economy.

Werman: It seems as if the violence has subsided a little bit in Ivory Coast since Laurent Gbagbo, the defeated president in November’s elections, stepped down a few weeks ago.  Are there any signs that the refugees are returning to their homes in Ivory Coast now because you’d assume that would take the pressure off Liberia a little bit.

Panjabi: They are continuing to flee across the border.  In fact, there’s a bit of a slow down, but we’re not going yet in the other direction.

Werman: Coming into Liberia.

Panjabi: Coming into Liberia, that’s right.  There’s a lot of fear of reprisal now that Quattara is in power and Gbagbo has been captured; and for good reason, given the massacres that they faced in just recent weeks.

Werman: So it doesn’t sound like you’re very hopeful that there’s gonna be a mass exodus very soon back to Ivory Coast?

Panjabi: What we know from other crises around the world like this is that people have to have a sense of security that’s met; when you’ve seen, like I’ve seen some of my patients in Liberia, lose your husband suddenly while you’re taking cover on the floor of a hut and then escaping with your three children across the border — that puts you in a situation where security has to be recovered.  Part of that means meeting basic needs. A lot of people don’t feel like their needs will be met across the border if they go back.  They still fear a lot of the militias are lurking, and that’s something that has to be resolved first.

Werman: Dr. Panjabi, tell me why you co-founded Tiyatien Health.

Panjabi: Well, I felt a responsibility to my country.  I was born and raised in Liberia and my family and I fled in 1990 when Charles Taylor and his rebels entered Liberia.  We were suddenly evacuated one morning.  There were many people on that tarmac when we were being evacuated that we left behind.  And that was a memory that stuck with me as a child; a memory that eventually lead me to want to come back as a medical doctor.

Werman: Dr. Raj Panjabi, a physician at Harvard Medical School and the co-creator of Tiyatien Health in Liberia, thanks very much for speaking with us and best of luck to you.

Panjabi: Thanks.

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