Intended for healthcare professionals

Education And Debate

Colombia: the winner takes all

BMJ 1998; 317 doi: (Published 12 December 1998) Cite this as: BMJ 1998;317:1649
  1. Hans Veeken Veeken (, public health consultant
  1. Medecins Sans Frontiéres, PO Box 10014, 1001 EA Amsterdam, Netherlands
  • Accepted 27 July 1998

“At least here I can go to sleep knowing I will wake up next day,” says Carlos. We have just climbed the garbage dump of the city of Carthagena. “Look how we live and how we work.” He gestures widely to emphasise the severity of the situation. On one side of the dump we see the shanty town Nelson Mandela, on the other people are sorting their way through freshly unloaded garbage. Lorries come and go. We are forced to breathe through our mouths; the smell is offensive. “I left my house because of violence,” Carlos tells me as we stroll back to the settlement. “How could I possibly stay when I was threatened? I had a shop and land—I was reasonably well off. I was accused of supporting guerrillas, and it was better to go. There is killing every day; they do not hesitate. I have seen too many people killed. I have nothing, and I might be hungry every now and then, but I am alive.”

Summary points

  • Columbia is rich in resources, yet half its population lives in poverty

  • Killing, kidnapping, cocaine, and corruption are part of everyday life

  • The civil war between guerrillas, military, paramilitary, autodefensas, and drug barons has left hundreds of thousands dead and displaced

  • Innocent poor people in rural areas have suffered most

A plastic refuge

The Nelson Mandela settlement has been in existence for two years, and still new people arrive. There is no shade anywhere. The people erect makeshift huts of plastic and wood. The sun beats down on the plastic—the only protection against the heat and rain— making it toxic.

We speak to a couple who arrived three months ago. “We survive, but no more than that,” the man tells us. “I earn 5000 pesos (£2.45) a day by selling chips in town, but there …

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