The town of Datu Piang in Central Mindanao, southern Philippines, is overwhelmed by the influx of 25,000 displaced people who have found refuge here since fleeing the fighting in their villages. The telltale blue tarpaulins that characterize their flimsy shelters are everywhere: in the mosque, in the church, under the bridge and in the park, where an old "Keep our park clean" sign has been supplanted by a bigger banner that says: "Evacuation centre".
Under a thatched roof supported by wooden pillars, the five patients - all on a drip - lie on very basic beds. "Because this shelter has no walls, the patients are sometimes forced to move into the rural health clinic when it rains," Ulambay Lidasan, the doctor in charge of the clinic, says with a tired smile. "But they have to lie on the floor because there is no space for beds in the building."
Datu Piang's rural health clinic is a miniature of this scenic marshland town. It plays a crucial role in the lives of the displaced. Dr Elizabeth Samama, deputy health chief of Maguindanao province, the region hardest-hit by the conflict, remembers the events that transformed the clinic. "It was on 21 August that the trouble began. Since then, we have been working around the clock, and are not allowed holidays. We do our best, with limited resources".
Health services overstretched
Dr Lidasan stresses that the clinic's staff are overworked. She gestures towards the young doctor attending to a toddler with diarrhoea. "He has come to help and we are very grateful." Together with another colleague, she works 24-hour shifts, takes two days off and then starts all over again. Five medical staff from other municipalities have come to help the ten staff employed here.
Dr Lidasan's statistics are telling: "In these past seven weeks, we have made 6,769 consultations and admitted 280 patients. We referred 11 of them to the hospital in Cotabato City, the regional capital." The number of casualties could easily have been higher, given the intensity of the fighting.
The tiny clinic in Datu Piang has already had to treat eight victims of shelling in a single day. "It was the end of the fasting month of Ramadan, and I was brewing coffee when shrapnel hit me in the back," recalls Samira Endosan, a pregnant mother of seven. She is worried the incident may have harmed her unborn baby.
The shell had exploded in the marsh near Datu Gumbay Piang elementary school, currently used as an evacuation centre, where the Endosans share one classroom with three other families. The shrapnel also hit three young children who were playing outside. With so little shelter, the 'evacuees', as they are called here, huddle even under the stilts supporting the school's main building.
"All public schools have suspended classes for over a month now because of the evacuees," says Musib Uy Tan, a municipal official, uncomplainingly, echoing the sentiment of Dr Samama , who says, "We have to give our displaced the help they need".
But his, and Dr Lidasan's greatest concern, given the congestion, is the risk of epidemics. There have been sporadic cases of measles, and more frequent diarrhoea, upper respiratory-tract infections and skin diseases, but the dreaded typhoid and cholera have not materialized. "The key is constant vigilance, and good hygiene," explains Dr Lidasan.
Twice a day, her teams of health volunteers tour the 23 evacuation centres in Datu Piang "to monitor the situation". The ICRC's engineers help keep outbreaks at bay by providing clean water containers and building latrines in evacuation centres.
Help from friends
Dr Samama is concerned about the future. "If this situation drags on, our resources will be depleted and health workers drained." She points out the need for external help if this poor region of the Philippines is to cope adequately with the influx of displaced people. "We need funds and more human resources, logistics, medicines and medical supplies."
The ICRC's medical coordinator in the Philippines, Dr Robert Paterson, was in the field from the early days of the fighting. He is "impressed both with the dedication and professionalism of the national medical staff. This is no mean feat given that the influx of displaced people has doubled the population in some municipalities".
The Ministry of Health launched an immunization campaign against measles almost immediately after fresh fighting began. Dr Paterson underscores the campaign's critical role. "Given the congested conditions in which displaced people are forced to live, there is a risk of an outbreak of measles, which can cripple or even kill children, particularly since many of them are already weakened." By early October, 75% of children aged between six months and five years had been immunized.
The ICRC, says Dr Paterson, stands ready to support the national health system in responding to the emergency situation. "We are supporting eight health facilities and plan to increase our efforts in the months to come. The ICRC was the very first partner to arrive in Datu Piang," Dr Samama notes. "They give us medical emergency supplies and drugs, as well as anti-tetanus drugs. In brief, they bridge our gaps."