Five months have passed since the Acteal massacre and eight months since some refugees left their homes. How do they survive?  What is the health situation?  How have they been helped by humanitarian aid? A group of health promoters from Las Abejas described to CIEPAC the living situation at the camps, including aspects such as water, food sanitation, medical services.  Their account is a denunciation on the quality of the help received to date.

Housing: seeking protection

The first criterion for constructing a shelter for the displaced is security and protection. When the EZLN bases found refuge at Polhó, they sought the protection of the municipality against military aggressions. When the Abejas settled in Acteal, they did so confiding that the temple's neutrality would be respected. And those who sought refuge at X'oyep did so because it is distant from the paramilitary groups and not easily accessible. The security-protection criterion is so fundamental that other aspects, such as water resources, camp conditions, and the difficulties to receive aid are less important.

Insecurity: No detailed census of age groups has been made at the camps that would allow specific needs to be identified. No one knows how many persons are disabled, how many have significant limitations that require special care or nutrition programs. Only general data are available: There are 1,098 refugees at X'oyep and 750 at Acteal. Eight months after the massacre, family groups are still arriving in both communities, fleeing from the military, quietly hiding in the hills to avoid being detained by soldiers and delivered to the paramilitary groups.

According to the  promoters the population does not feel secure. The main reason that motivates families to settle in the camps -that is, the need for security- is not being fulfilled. The camps are being surrounded by the military. At Acteal there is talk about bursts of machine-gun fire from public security vehicles. Fear and impotence are permanent feelings. At X'oyep, on January 3, the population's protest against the military presence in the vicinity of their well -their only water resource serving both the community and the displaced- was answered by anti-riot military police protected by a helicopter. That night everyone at X'oyep cried their impotence.

Crowding: The 1968 "Manual for Emergency Situations", published by the United Nations High Commissioner for Refugees (UNHCR) mentions that "the location (of refugee camps) must provide enough useful space for the refugees. The World Health Organization (WHO) recommends 30 square meters as the minimum global area per person, plus the surface required for collective and agricultural needs and for cattle. It adds that the absolute minimum per person in situations of emergency shelter must not fall below 3.5 square meters". Nevertheless, at the refugee camps the estimated space per person ranges around 1.2 and 1.8 square meters at X'oyep and around 1.0 and 1.4 square meters at Acteal.

The same document indicates that a 7x10 meter construction should not house more than 20 persons and that when multi-family units are needed, any given construction should house no more than 35 persons -7 families at most.  Nevertheless, at X'oyep 10 to 15 families -65 to 90 persons- live in the same 10 or 15 by 5 meter shelter. And, after 8 months, the shelters are still frame structures with earth floors and nylon "roofing". Refugees sleep on the hard soil floor, wrapped in blankets -one for the parents, one for the children-, without the protection even of mats or wooden planks. According to the promoters, at Acteal the population survives in haphazardly constructed shelters of 10 or 12 by 5 meters, without doors and sometimes without walls, housing some 8 to 10 families, sleeping with light blankets on the humid ground. There is talk that at Polhó blankets are rather used as roofing.

The document warns of the risk of contagious illnesses that increases greatly in collective shelters, particularly when minimum space criteria are not respected. Besides the outbreak of epidemics, there are risks of confrontation among the displaced, of the shelters rapidly deteriorating, and of other social and environmental problems. Lacking a roof for protection, a space to live and to keep one's belongings, providing a sense of intimacy and emotional security, are factors that also contribute to increased diseases such as: colds, throat ailments, bronchitis, pneumonia, tuberculosis, measles and others that exact a toll on undernourished children.

Of the 23 minimum conditions to avoid illnesses in shelters for the displaced (COPAL, "Manual for the Health of the Displaced " 1998, pp. 5-7), the refugee camps at X'oyep and Acteal only fulfill 9 and 10, respectively.

Water: source of life

Providing water for the displaced "demands immediate attention at the onset of an emergency situation; the purpose is to attain a sufficient water supply and guarantee its potability". The assurance of water availability is of such high priority, that its scarcity should lead to serious consideration about settling the camp elsewhere.

Since water needs vary according to the weather, physical exercise, etc., UNHCR considers that to avoid illnesses the minimum necessary "is 15 to 20 lt. per person, per day", an amount that increases to 40-60 lt. for each sick person in health centers per day, and to 20-30 lt. per person/day in feeding centers.

According to the promoters, at the X'oyep camp there is no water: the water source is scarce and has been contaminated by the soldiers using it.  To launder, refugees must walk two hours to the river, wait for their clothes to dry since the ones they wear are all they have, and then walk back another two hours. For this reason they can bathe only once a week or a fortnight. According to its president José Barroso, the Mexican Red Cross spends 700 thousand pesos (US$78,000) weekly in Chiapas (La Jornada, 12/03/98; page 6) and was scheduled to receive 1.5 million dollars in international aid for the displaced of Chiapas (Cuarto Poder, 21/03/1998). Yet the MRC swears that it has no money for gasoline and can provide only 5,000 liters of water per day (when it arrives), an amount that must be shared with the military and the PRI members that camp in army facilities. In all the refugees can fill only one or 1.5 water tanks, reducing what should be their minimum 20-liters-per-person requirement to 1.5 liters per person per day. At Acteal there is a similar situation, with refugees receiving only 2 liters per day per person, and not every day.

Under such conditions, the promoters wonder (in words of the refugees) "if we cannot bathe, wash dishes, wash our hands before eating or after the latrine, if we cannot boil water because we have no pots, how can we not become ill? If the Red Cross distributes more water to the army than to us, what can we expect? Through illness they are pushing us to our death, and this is a fact that doesn't attract the attention of the press or TV."  In fact, illnesses caused by the lack of water, such as fungi, skin infections, conjunctivitis, lice, white flea, scabies, etc. are already sprouting at the camps. Nevertheless, the worst illnesses come from not having drinking water.

 Sanitation: an emergency

A priority for the displaced is to avoid pollution of the very scarce water available. When it becomes contaminated or when hygiene is affected because of the lack of water, the illnesses that result may provoke epidemics. Besides the not-so-infrequent parasitosis and dysentery, there is risk of typhoid fever, cholera and hepatitis which can cause havoc to an undernourished population.

 Particularly important is protecting water holes and storage tanks to avoid contamination by human feces. There is a crying need to build latrines, keeping in mind that they are meant to control pollution and need to be cared for, at least minimally.

The promoters stated that existing latrines are deficient; neither lime, ashes or petroleum are used so that bad smells spread widely, and insect-borne diseases become unavoidable. Latrines are made without covers, many of them out of tree trunks, and there are already two cases of people falling into them, one of them a child and, as a result, few people dare use them. Consequently, feces are scattered all over the place.  Since some latrines are roofless and unprotected, when it rains they flood over and become a true source of infection instead of a means to control pollution. The situation is worse when latrines are placed near eating areas or other public places. No latrines have been designed for humid terrain.

The UNHCR norm is one latrine for every 20 persons. At X'oyep there is only one for 10 families (50-60 persons), and at Acteal one for 23 families (1 for 35 persons). A similar situation exists at Polhó, where the displaced are demanding aid to solve the problem. Another important condition to avoid contamination of water sources is a distance of over 15 meters between the latrine and the well, and the placement of wells above the terrain where latrines are located. None of these conditions is fulfilled at Acteal: 10 meters is the maximum distance from the well to the latrine, and the elevation is reversed with the latrine placed higher than the well. This means that when rains make the latrines flood over, the well itself shall turn into a latrine.

There have been discussions regarding correctly constructed and finished wells that could last some 2-4 years, where presently they last only two months.  An aggravating factor is that the owners lending terrain for the camps refuse to have any more latrines built.  And unfortunately, the health institutions working at the camps do not supervise either sanitation or latrine maintenance.

Food: a priority

UNHCR recommends that "in emergency situations when the refugees’ food depends totally on external sources, an immediate priority is to asses the number of refugees and their health situation". No one has done so and there are no data regarding malnutrition, not even among children.

At X'oyep the promoters observed that the displaced receive 2-3 kg. of corn a day for a 6 member  family, while at Acteal each person receives 2 cups a day, allowing them to eat twice a day. Many displaced are lacking cooking pots and today, 8 months since the massacre, they still eat from  their hand or leaves. Meat and vegetables have been absent for the last 6 months. The only animals that made it to the camps with their owners were dogs and very few horses. Fowl, pigs and others remained behind.

Some humanitarian institutions have stated that they have no means to provide support, while others, that do respond to petitions for food, are unable to provide the quantities required, either because of insufficient funds or from fear of creating dependency. Meanwhile, the official institutions declare that all requirements are being met. "To feed the 10,500 refugees at Polhó, Acteal and Poconichim, the requirement is 3.5 tons of maize daily. There is a cost of 8 thousand pesos a day (US$ 889), so that tortillas and pozol may be tasted at refugee camps" (Ramírez, J. La Jornada, Ojarasca. 2/V/98 page 2).

Lacking a census and an assessment of the displaced, two main tasks have been impossible: the identification of the most unprotected population groups (children under 5, pregnant women, infants, the elderly, and the injured, sick and handicapped), as well as the assessment -after 8 months- of the aid received regarding its caloric adequacy. Additionally, there is no government program to feed the undernourished adequately. Apparently there in only one  civil organization offering support to mothers and children with nutritional programs.

The deterioration of nutrition among the displaced population creates a serious situation: weakened defenses against all kinds of illnesses. The precariousness of their living conditions can cause contagious illnesses to spread rapidly. The promoters have observed many cases, although they have not quantified those "of insomnia, weakness, dizziness, general ill-being, tiredness, under-nourishment in children, anemia, avitaminosis, gastric conditions, ulcers..."

 Medical attention: Under emergency situations UNHCR recommends that "from the onset, sanitary services must tend to prevent as well as to cure illnesses, that is, to cure the displaced and keep them in good health. (...) Only the combination of preventive measures and control of contagious diseases can maintain good health and reduce new cases of illness. Drinking water, environmental health measures, adequate nutrition, control of contagious diseases, mother and child care, education and sanitary training for the displaced are integral elements of a sanitary attention.  It has been proved that, as time passes in the camps, the number of sick grows when attention is limited to sanitary measures, and that preventive measures are the only way to reduce illness. Promoters declare that at X'oyep there is a daily average of 20 sick persons (equal to 600 a month, that is 54.5% of a population of 1,098) and one or more deaths every month. At Acteal 350 persons were sick in April (46.6% of a population of 750). According to its president's declarations in March, the Mexican Red Cross was providing care to 200 patients a day (some 6,000 a month, equal to 57% of a population of some10,500 displaced people).

While the Polhó promoters asserted a few months ago that some medicines, such as antibiotics, antiparasites, analgesics, iron and others were lacking from the medications received as donations, X'oyep and Acteal  promoters are worried that the lack of medicines is forcing doctors to undertake incomplete treatments and that they do not have enough anti-parasites. Within the camps, health organizations only lend medical attention, and the MRC barely supplies water, as mentioned above, but takes no interest in sanitation.

Promoters emphasize that they have been displaced from their role by doctors offering services, so that now they do not provide health attention but serve only as the doctors' translators. They state that they have lost control over health services, since doctors provide attention, prescribe and keep the patients’ registry.  They complain that the information is not shared with them and that some doctors chide them for asking about the diagnoses.  The Humanitarian Aid Program in Chenalhó, promoted by the Ministry of Health, measures its success exclusively on the basis of patients seen and, as stated by Minister De la Fuente, declares that in "a little over a month after the program started (...) we have provided 5,171 medical consultations, caused mainly by  acute respiratory infections, parasitosis and acute diarrhea conditions; 64 persons have been hospitalized and more than 10,000 vaccines have been applied to children". (Gallegos, E. La Jornada 12/02/98 page 12).

Nevertheless, since we know that Las Abejas and refugees sympathetic to the EZLN are not receiving any government aid, we may infer that these reports include the aid provided by health agencies to the municipalities’ capitals, where PRI member are in the majority, as well as that provided by the Mexican Red Cross and the health services of the army to its 30 military camps at Chenalhó and to an equal number of PRI-dominated communities where the paramilitary also reside. 

UNHCR has stated, however, that "the only vaccine indicated for the first weeks of an emergency situation is the measles vaccine to small children”.  This is a high priority measure,(...) all other necessary vaccines should be applied within the framework of the expanded vaccination program." And, UNHCR explains that although “pressure frequently exists favoring a massive and immediate vaccination program, there are powerful reasons, both medical and practical, to resist such pressures (...). The most common causes of disease and death during the emergency phase are not prevented by vaccines", except measles.  Conclusion: vaccination campaigns respond more to political than to health reasons.

The promoters conclude that some of these forms of "humanitarian aid" have disorganized the displaced. They have insisted on the need of a  collective work, and are starting to feel the dependency on others’ decisions, even in the training they receive. Although there is a lack of coordination among the different commissions, it is the displaced who should be petitioning for aid to third parties and organizations who, unfortunately, are disorganized and don’t coordinate among themselves.  The lack of promotion and support of self-management forms of organization could lead shortly to internal problems among the displaced, and to disorganization, leading them into a vicious circle of dependency on external aid. This is a challenge for which we, the civil organizations, are not prepared and have not reflected upon.

A population considered an "object", fearful, without sufficient water, clothes, food, with deficient and contaminating latrines, living in overly-crowded conditions, over half of whom are sick, receiving "hand outs", without the power to decide, to whom no solutions have been offered regarding their precarious mental health after the massacre at Acteal (the only efforts in this respect have been from a civil organization and individuals, since it is a factor not included either in official health aid nor compensation programs), will find its capacity for resistance and organization undermined, thus aiding counter-insurgency programs. A further symptom of the situation: heavy drinking, absent until recently, is now present in some camps.           

With conditions for disease everywhere, getting healthy again becomes a first objective and an immediate necessity. But there is a risk that while great effort is needed to simply survive, the demands for justice will take a back seat.

Many of us ask ourselves how it is possible that these living conditions can continue after all the caravans and humanitarian aid that the displaced at Chenalhó have received.  One explanation is that the displaced share the aid received with the people of the locality that sheltered them, who are themselves surviving in extremely precarious conditions, or through sharing with neighboring populations.  But there are probably other reasons. Besides, this is the opinion of the health promoters and there's a need to listen to the institutions that provide aid to these communities.

Still, if these are the health conditions in the refuges camps for the displaced by the war, where tremendous support has been received, we can imagine the situation for thousands of other people displaced, dispersed throughout the municipalities of Ocosingo, Tila, Sabanilla, Tumbalá, Salto de Agua, Amparo Aguatinta, etc., where most of them have been living as displaced for over a year or, worse, in the Northern region of Chiapas, in places of quite difficult access, that hinder the arrival of aid from civilian and humanitarian organizations.

Rain is finally falling in some areas of Chiapas. Illnesses will now sprout easily: cholera, measles  and other diseases will affect the undernourished children at the refugee camps. For some external observers this poses several questions: to what degree will the possibilities of returning home be hindered by bettering the camps’ conditions?  To what point should large amounts be invested to better an expensive and permanent infra-structure when it is best to create conditions for the return of the displaced to their homes?  How might we avoid humanitarian aid from turning into mere handouts that lead to passivity among the beneficiaries?  To what degree can we accept that delivering aid implies coordinating with people or institutions that directly or indirectly have caused the displacements, such as the government, the army or the PRI-dominated communities?  The municipalities sheltering the displaced share common features: they are located in geographic areas that are strategic in military terms to both armies.  They are presently “home” to the military, the paramilitary and different police corps in great numbers, of PRI politics, the EZLN and some autonomous municipalities. And there is another factor that has not been much considered: what are their strategic resources?  What resources (oil, minerals) lay beneath the land from which the indigenous population was displaced?

"THE UNBEARABLE LIGHTNESS OF THE LAW: Impunity" (extract, Part V)*

a)     The attempts against the life, health and physical and mental integrity of the people, especially homicide and cruel treatments, such as torture, mutilation and whatever form of corporal punishment (are prohibited). 

"When the police arrived at the road they found 10 of our companions and without motive they started to strike them with the butt of their firearms, and it was when the young felt  fear and headed for the hill, but the policemen fired at them and now we don't know if they are injured, if they are dead or alive, because they have not appeared. Others of the group dispersed but they have already "appeared":

(...)Afterwards "the only thing found was the pastures burnt by the bombs and one police cartridge, but the two youths were not there and we continued searching for them”.  The shoot-out took place near the community of Acteal (municipality of Chenalhó) (Henríquez, E. La Jornada, 10/06/97, page. 8.)

According to representatives of the Polhó autonomous municipality, during the night members of the PRI blockaded the road that links San Cristóbal de las Casas to Pantelhó, to hinder the transit of any person not belonging to their organization.  Armando Pérez Pérez, 16 years old, was dragged all the way to the school and then beaten to death by the PRI members yesterday afternoon at Los Chorros, where he had gone to the house of his father, Miguel Pérez Gutiérrez. (Henríquez, E. La Jornada, 20/09/97, page. 10).

At communities such as Chimix, Aurora Chica, Pechiquil, Tzajalucum, Tulantic and La Esperanza, among others, half a dozen murders have been reported, that have caused some 100 families to flee to the mountains, and that most houses inhabited by EZLN sympathizers be abandoned.

Houses destroyed, produce and electronic goods stolen and silence is the everyday reality  observed while traveling through population centers in this area of Chenalhó, dominated by paramilitary groups, that control the roads with the support of public security police. (Balboa, J.  La Jornada, 23/11/97, page. 5).

"What happened at Acteal was brutal, but in the Northern zone there have been more deaths. We have over 200 persons disappeared. There, a massacre is underway but in slow motion, gradually, selectively, declared Heriberto Cruz Vera, parish priest of Tila (Petrich, B. La Jornada, 24/01/98, page. 11).

Gunmen ("white guards") financed by farm owners of the Chilón municipality attacked a group of indigenous people killing a 12-year-old child, Manuel Jiménez Méndez. They have also started a hostile campaign against communities of the Northern region (Balboa, J. La Jornada, 24/10/97, page. 15).  Members of the Paz y Justicia group presumably killed Diego López López, member of the Zapatistas support bases at Tila municipality. The murder happened yesterday at Nuevo  Limar, where the paramilitary group carried out different movements after the Acteal massacre, threatening the indigenous population with another Acteal.

(...) The inhabitants said that this action was carried out in front of public security agents, who "only observed the violent attitude of the armed group" (Mariscal, A.  La Jornada, 03/01/98, page. 3).

 The indigenous organization Kichañob indicated that one of the most recent violent actions happened at the Cruz Palenque community, municipality of Tila, "where Paz y Justicia assassinated two persons and robbed 133 houses of EZLN sympathizers" (Balboa, J. La Jornada, 07/01/98, page. 5).

*Extract of the document "The unbearable lightness of the law: Impunity; three months after Acteal", by "Comunicacion Popular Alternativa, Grupo de Trabajo", 11/04/98

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