A Refugee Camp In The Heart Of The City

For the 42 million refugees, life isn't easy. Their lives are truly a daily struggle for survival teetering between life and death. For a fleeing refugee uprooted because of conflict, nothing is certain.

During conflict, some people leave their villages and occupy ones that are abandoned or add on to previously existing settlements. "This kind of displacement exposes people to the elements, removes them from their sources of food and water and cut them off from even the most basic of medical care," Doctors Without Borders physician Dr. Matthew Spitzer said.

Some internationally displaced people might settle in a camp set up by an international aid organization. Doctors Without Borders is an example of an aid group that sets up refugee camps. These are regimented establishments, "where there are already tents set up with numbers with the correct registration with the correct distribution," Addy Romme, a DWB physician said.

Last Wednesday, "A Refugee Camp in the Heart of the City" gave Los Angeles residents a glimpse into refugee life. DWB set up a re-creation of a refugee camp in Griffith Park to show the challenges that IDPs face. "[The event] bring[s] home awareness of the world's refugees and internally displaced persons, and how precarious their lives are," Spitzer said. "We refuse to accept war as normal or the violence to civilians as mundane."

The camp was set up in different compartments, each revealing a different challenge facing refugees and aid workers. People working for DWB ushered around small groups of visitors and explained each exhibit. Romme asked, "Did anyone take any materials to build a house?" In front of the group stood a small tent and a one room tin house that a whole family could reside.

The doctors guiding each tour attempted to mentally transport everyday Americans into a completely foreign situation. For most Americans, getting access to food isn't a problem. Refugees living in a camp receive a strict ration of rice, beans, oil, salt and sugar that equal 2100 calories. Sometimes in very dire situations aid workers ration out BP-5 cookies. This cookie shaped like a brick is full of calories and tastes like buttery shortbread.

People need more than cereals to live a healthy life. After a while refugees start growing their own vegetables and setting up a local market to trade food, Romme said. Most of the time refugees never eat meat while in camps. In post-war conflict in Congo there weren't any animals left, DWB nurse Michelle said. All the animals were eaten by IDPs while fleeing.

Getting water makes running a refugee camp very complicated. "We end up in an area that is dry with no water or orange trees," Romme said. "If you're lucky you might end up near a lake." Each refugee is rationed out five liters of water a day. Two hundred refugees use the amount of water that an average American uses on a daily basis. Once the water is arranged, it's made ready for consumption with chlorine tablets. Boiling water is too expensive and energy intensive, Romme said.

Once refugees get settled then they start reflecting on what just happened. Romme asked, "Luckily you didn't die, will you forget it?" When refugees think about seeing war, poverty and even death they suffer from post-traumatic stress and anxiety, Romme said. DWB supplies refugees counseling to help them express their feelings and elevate stress. Unfortunately, there is a high rate of suicide in the camps. "I'm sure that the rate is very high," Romme said. "Those people face so many problems."

After setting up the basic necessitates for maintaining life, DWB starts their medical operations. The first medical action is massive immunizations for children. "This is the most important tool," Romme said as she held up a bullhorn. The hardest part of a successful vaccination operation is letting everyone know that medicine is available and keeping children in line. On average 40 percent of children in refugee camps get measles. Measles is the first vaccination given by DWB. Polio and tuberculosis vaccines are secondary.

Some children enter the camps so malnourished that their arms are thinner than a soda can. Their arms are little more than skin, connective tissue and bone, Buddhi Lokuge, head of DWB's malnutrition team said. Mothers can treat their malnourished children at home by feeding them Plumpy Nut, a high-energy peanut based paste. "From a medical stand point I love malnutrition," Romme said. "It's easy to treat." Even though it's easy to treat, being a malnutrition doctor is tough mentally. "You'll probably see some children die."

For adults, cholera is a serious problem disease in refugee camps. "Once you hear a cholera tent you can recognize it," Romme aid. "Patients are so weak they can't move." Severe cholera patients lie on a bed with a hole cut in their cots so they can discharge stool cleanly without using a latrine. A doctor keeps safe from this highly contagious disease by wearing plastic from their neck to their feet. "I didn't like all those plastic clothes," Romme said. "Sierra Lione gets up to [104 degrees]."

For doctors, wearing plastic clothing is a cosmetic hardship in a myriad of psychological difficulties. Most DWB doctors come from Western nations where the standard of living is much higher. "If you are the first one to open a project then you will end up in a tent with very basic living conditions," Romme said. "If you have an emergency you can run in and do your thing for twenty hours a day."

Doctor's work for a specific period of time in a refugee camp because they can get burned out easily, Romme said. "I'm crying every day," Romme said about the end of an eight-month stay in a refugee camp. "You see a lot of poverty of victims, people living in very very poor living conditions.

"You are far away form your own family and friends...then often basic conditions are lower than you're used to. There's the heat, there's the sand of the desert. I'm a doctor used to working in hospitals where everything is there...[These] are stressors of not knowing, not having."

In some cases, being a doctor for DWB isn't so bad. "In a setting which is more stable you can find yourself in a nice comfortable house with a veranda with a fridge," Romme said. During this same comfortable project in Nepal, Romme said she heard gunshots and explosions at night once. "We often work in settings where there is a war or a conflict. I always trust that the decisions which were taken were correct."

Back at home, being a DWB doctor isn't financially glamorous. "I don't have a husband, kids, car, [or] house," Romme said. She's 31 and lives with mom and dad, but she doesn't mind. "I think it's the work we do on one hand that's very interesting. On the other end we really save lives, we really alleviate suffering." Prospective nurses that observed Romme's tour agreed that the low pay was worth helping others. "Helping people in situations like this is more rewarding," Mark Sambilay, a Rio Hondo nursing student said. "When you think about the people that you help, [the lower pay] is okay," Kristine Fanganiban, another Rio Hondo nursing student added.

If everyone is lucky, doctors and refugees get to go home after six months. This usually isn't the case. Vietnamese refugees are still living in a DWB camp since they were displaced in 1975. "People are surviving and that means they need food and water," Romme said. "This happens to ordinary people like you and me."

A Refugee Camp in the Heart of the City continues on to the Santa Monica Pier beginning Friday, Oct. 31 to Sunday, Nov. 2.

Additional reporting for this story by Stephanie Yee.