Healing the hidden
wounds of Tumaco

Providing mental health services in response to urban conflict in Tumaco, Colombia

MSF has been working with communities ravaged by violence in Colombia for many years, caring for the psychological wounds of people living amid violence and fear.

Tumaco is a city of 200,000 people in the Nariño department in south-west Colombia, near the border with Ecuador. Its location and thriving port have made it a hot spot for the trafficking of illegal arms and drugs.

For 15 years, the Colombian army, the leftist Revolutionary Armed Forces of Colombia (FARC) movement, paramilitary groups and drug cartels fought for control of the territory. The conflict has left the city devastated and its people traumatised.

Photo: Fabio Basone \/ MSF

Photo: Fabio Basone / MSF

Amidst this violence, those who suffered most were local communities. The violence has claimed more than 80,000 lives in the past 50 years.

Levels of violence have dropped since the government and the FARC movement signed a peace accord in 2016. However, violence is still endemic and has become more chaotic as criminal gangs move in to fill the vacuum left by the FARC.

Poverty, high unemployment and a sense that crimes can be committed with impunity fuel the continuing violence.

While the conflict is mainly between armed groups, it is the people of Tumaco who have borne the brunt of the violence. The pervasive sense of fear and insecurity it creates have had a devastating impact on people’s health.

They have suffered threats, extortion, displacement, injury, torture, sexual violence, forced recruitment and other abuses, and have seen family and friends lose their lives. This has led to high levels of anxiety, depression and other mental health problems.

MSF in Tumaco

© Fabio Basone / MSF

MSF began providing primary healthcare services in Nariño in 2010, and started offering mental health services in urban areas of Tumaco in 2014, following a surge in urban and sexual and gender-based violence (SGBV). The pervasive violence in Tumaco had a brutal impact on the physical and mental health of its people.

IN 2016: 11,000 INDIVIDUAL MENTAL HEALTH CONSULTATIONS

IN 2016: 11,000 INDIVIDUAL MENTAL HEALTH CONSULTATIONS

Our primary goal is to provide comprehensive medical care, including mental healthcare, to victims of violence, in particular to survivors of sexual and gender-based violence.

Our team in Tumaco provide individual counselling and group sessions, as well as working to raise awareness about mental health issues among the local community.

IN 2016: 2,800 GROUP MENTAL HEALTH SESSIONS

IN 2016: 2,800 GROUP MENTAL HEALTH SESSIONS

By providing the community with free, high-quality mental healthcare, MSF has helped the wider community recover from the violence of both past and current conflicts.

Our team is made up of 11 psychologists, two medics and four mental health promoters.

Igniting La Negra Ardiente

Photo: Fabio Basone / MSF

MSF is there to help the people of Tumaco survive their darkest moments. With the support of an MSF psychologist, a woman known as La Negra Ardiente – ‘the Burning Black’ – has walked through the darkness and emerged as a strong and inspirational figure.

"If you come to me to do me good you won't get burned. But if you come to do me harm, I will light the flame and you might get burned. That's where the Negra Ardiente was born."

"If you come to me to do me good you won't get burned. But if you come to do me harm, I will light the flame and you might get burned. That's where the Negra Ardiente was born."

Her history is one of conflict and trauma. La Negra Ardiente was born near Tumaco, in an area that deteriorated as conflict consumed the region. As an adult she was beaten, abused and raped. She suffered severe depression and suicidal thoughts.

"After the armed conflict arrived, [life] became very stressful. You always lived in fear. There were always grenades going, boom, boom. It became unbearable to be here."

La Negra Ardiente

But through workshops and one-to-one counselling with an MSF psychologist, she was able to put the traumas of her past behind her. Inspired by the play of light from vigil candles, she adopted her new name, 'La Negra Ardiente' to honour this.

A community event, hosted by La Negra Ardiente
Photo: Fabio Basone / MSF

A community event, hosted by La Negra Ardiente
Photo: Fabio Basone / MSF

La Negra Ardiente is now a community leader, watching out and supporting her neighbours, who she refers to as her ‘family’. She is dedicated to helping other people.

"I try to contribute something good to the family. We are training young people, children, adolescents. Teaching them dance, teaching them how to sing - to dilute, to lessen the fear."

La Negra Ardiente

Rebuilding lives: Betty's story

Photo: Fabio Basone / MSF

"My emotional problems began one morning. I was at my sister-in-law’s house and at that exact moment my brother-in-law was murdered in the house. From that moment, my life completely changed."

Betty’s husband was the one who came looking for help. After hearing about the services that MSF provided, he arrived at the clinic one morning in August 2016, extremely distressed.

If MSF didn’t help Betty, he said, he didn’t not know what he would do. Betty began counselling sessions with Dr Yeni, an MSF psychologist, soon after.

Betty was diagnosed with post-traumatic stress disorder (PTSD). Seeing her brother-in-law murdered had triggered a psychotic depression.

When she first began to receive help from MSF, Betty didn’t know where she was or what day it was.

She had not left her room in days. She cried constantly and didn’t eat. She was about to lose her job, and could no longer take public transport because she was afraid that people would harm her.

Betty

Betty

Through her sessions with Dr Yeni, Betty's learned to understand and control these feelings. The psychologist gave her tips on how to control her emotions and her negative thoughts.

"Now I feel much better, thank God, because I am living my normal life again. I can walk alone. I feel that things have improved from that time to now."

With the community: Elva's story

Photo: Fabio Basone / MSF

As a community leader and women’s rights activist, Elva Gonzalez has dedicated her life to helping others.

She did this even at the expense of her own mental health, as her role exposed her to suffering as well as threats and abuse.

She lost many friends and colleagues to the violence that has ravaged the streets of Tumaco for so many years.

“Many have died working for the community. People who wanted their community to change, to have a different future, to better their knowledge.”

Elva Gonzelez

Elva lives in the Once de Noviembre neighbourhood of Tumaco, an area previously controlled by paramilitary groups who ruled people’s lives and killed with impunity.

Elva at a memorial to her fallen friends in the House of Memories
© Fabio Basone / MSF

Elva at a memorial to her fallen friends in the House of Memories
© Fabio Basone / MSF

“Those were terrible days, they were filled with sad, painful moments, where women lost their husbands and children at the same time. Some families had their children and grandchildren killed at the same time.”

Elva’s exposure to so much suffering began to affect her own wellbeing.

“I did not sleep at night. I thought that when I heard something like a stone fall, it was a grenade.”

Elva Gonzelez

Elva received counselling from MSF, which helped her come to terms with her experiences and regain her mental and physical health.

Young people from Tumaco at a community event
Photo: Fabio Basone / MSF

Young people from Tumaco at a community event
Photo: Fabio Basone / MSF

“I thank God for MSF arriving. When you talk, you unload those things that pinch you inside the stomach. And when you recount your life, some of those bad energies that are in your body come out.”

Mental health problems can have a profound impact on people and communities. People experiencing these conditions can feel less able to function within their families or as part of society.

When treating mental health conditions, MSF teams focus on understanding the social, political, economic, spiritual, cultural and moral points of view of our patients.

Our approach targets the individual and community factors that influence mental health.