Ivory Coast lurches toward civil war

The situation in Ivory Coast continues to deteriorate.

Escalating violence is blamed for 400 deaths and fears are growing that Ivory Coast will return to the civil war of 2002 that divided the country into the rebel, mainly Muslim north and Christian south. Some 400,000 people have fled the country, most for Liberia, according to the United Nations.

Ivory Coast's current crisis began at the end of November when President Laurent Gbagbo lost the election but refused hand over power to his rival Alassane Ouattara, who won the poll according to international observers.

Now both men claim to be president. Gbagbo is running the country from the presidential palace and has the backing of the police and army.

Ouattara has his offices in the Golf Hotel in the commercial capital, Abidjan, which is protected by some of the 9,000 United Nations peacekeepers in Ivory Coast. Ouattara is recognized by the international community and has called for a ban on cocoa exports to starve Gbagbo of funds.

Clashes between armed supporters of Ouattara and Gbagbo have killed more than 400 people and the pace of violence appears to be escalating, according to the U.N. and Doctors Without Borders.

One person died and 18 were injured, including a baby, when a grenade was thrown in the town of Attecoube on Tuesday night, according to the United Nations. Four pro-Gbagbo youths were also killed by unidentified gunmen in an Abidjan suburb.

The fighting has caused large numbers of people to flee including the staff who have abandoned hospitals in Abidjan, said Doctors Without Borders. The organization has provided staff to work at a hospital in the Abobo district.

"Over the course of two weeks, we treated 129 people in the emergency room, including 81 with gunshot and knife wounds, and we operated on 31 serious cases," said Dr Mego Terzian, emergency manager for Doctors Without Borders.

"In this context of difficult access to care and population displacement, our teams must be able to reach people, particularly so that they can conduct epidemiological monitoring," said Renzo Fricke, emergency coordinator for Doctors Without Borders.

Armed conflict is not the only obstacle to treatment.

Commercial and financial sanctions imposed by the international community against Ivory Coast, coupled with transportation problems, have led to shortages in medicines and medical supplies. Health facilities in many regions of the country lack basic medicines and treatment supplies for chronic and acute illnesses, particularly for kidney dialysis.

Increasing insecurity, including roadblocks and outbreaks of fighting, has stopped people in need of medical treatment from reaching hospital, according to Doctors Without Borders.

Neither international sanctions nor African Union mediation efforts have convinced Gbagbo to hand over power to the internationally recognized Ouattara.

The standoff has caused Ivory Coast's economy to crumble and the escalation in violence has prompted the UN and other observers to warn that the country may be heading back to civil war,

The northern rebel group New Forces has seized control of three towns in western Ivory Coast, although its forces are still largely confined to the northern areas it controls.