Background Briefing

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Humanitarian Consequences of the “No War No Peace” Impasse

As the political crisis deepens, government services that were once provided to ordinary Ivorians, particularly healthcare, public education, and water and sanitation, are steadily deteriorating, with the result that basic social and economic rights of Ivorians are being undermined. The decline is most acute in the rebel-held north, where the delivery of basic services has been crippled by the absence of qualified personnel and resources—after the rebellion started in September 2002, the bulk of civil servants fled to the government-controlled south.

Lack of Health Care

After three years of political and economic instability many Ivorians are unable to access or afford adequate health care. Ivorians have the sixth highest infant mortality rate in the world, and average life expectancy is only 41 years, both phenomena almost certainly reflecting the negative impact of decreased access to health services.114

Most hospitals and clinics in the north remain cut off from government funding, and a majority of the northern health sector workers fled to the south. In 2003 the International Committee of the Red Cross (ICRC) estimated only 25 percent of hospitals and health centers to be operational in the northern half of the country.115 Throughout the country, the high cost of transportation, medical appointments, and drugs exceeds the means of most families.116  This has led to an increased prevalence of such diseases as cholera, yellow fever, meningitis, measles, and poliomyelitis. U.N. and international humanitarian agencies have been active in the health sector, battling the soaring national rates of malnutrition and disease. According to the United Nations Children’s Fund (UNICEF) and other international aid organizations, up to 15 percent of children in the rebel-held north and government-controlled west suffered from malnutrition in 2005.117 

Also of serious concern is the stalemate’s impact on HIV/AIDS prevalence in Côte d’Ivoire. HIV/AIDS has flourished amidst the Ivorian conflict, fueled by instability, widespread displacement, and deteriorating health standards. With the highest rate of HIV prevalence in West Africa (conservatively estimated at 7 percent), HIV/AIDS has become the main cause of death in Côte d’Ivoire.118 A 2004 UNAIDS report detailed rising HIV infection rates, listing widespread increases among populations affected by malnutrition and food insecurity.119 In the northern town of Korhogo, over 10 percent of residents were found to be infected with the virus in 2001, before the conflict began, and a recent informal investigation suggested that this already high infection rate has risen dramatically since the rebellion: in January 2005, when a local doctor tested 60 patients for HIV/AIDS at the Korhogo hospital, 35 were found to be positive for the virus.120 As updated estimates become available, three years of continued displacement, sexual violence, and limited prevention campaigns throughout the entire country almost certainly will have led to a notable rise in infection rates. 121


The availability and quality of education in the north has severely deteriorated since the start of the rebellion in 2002. Due to the ongoing conflict and regional instability, tens of thousands of Ivorian children will likely become permanently excluded from the nation’s education system, leaving them with limited career options and thus at very serious risk for recruitment and abuse by the armed groups operating in West Africa.122

Humanitarian workers told Human Rights Watch that because thousands of government employees, including teachers, fled the north—some under instruction by the government—schools have been forced to function with the help of unpaid volunteer teachers.123  In addition to widespread looting and destruction of schools in the north and west, UNICEF reported the closure of numerous schools.124 As a result, an estimated 700,000 children were out of school in 2005. Girls without access to schooling in particular were extremely vulnerable to sexual abuse and exploitation. An example was reported by a community leader in rebel-controlled Man, where 2,000 girls between the ages of twelve and fifteen engaged in prostitution following the closing of local schools in this part of western Côte d’Ivoire.125

Since the rebellion in 2002, thousands of students in rebel-controlled areas have also been unable to sit annual school examinations. UNICEF estimates that 60,000 students were affected by the postponement of exams in the north during 2005.126 If children do not take end-of-year exams, they cannot progress from primary to secondary education, and at the age of fifteen, if secondary school exams are not completed, children are considered too old to continue in the education system. Education Minister Amani N’Guessan presented several reasons for the failure to hold exams, including the lack of security and of adequate financing and oversight of the examination process. In response to the minister’s concerns U.N. and humanitarian agencies offered their concrete logistical and financial support to ensure examinations took place. However, at this writing the Education Ministry had yet to take concrete steps (either alone or in partnership) to move the examinations forward.  

Water Shortages and Poor Sanitation

Several towns in the rebel-held north, such as Man and Korhogo, experienced acute water shortages during 2005.127 A 2005 study by the ICRC found that a considerable percentage of water samples analyzed in several towns were deemed unsuitable for human consumption, and that 7 percent of those same samples were seriously contaminated by agents responsible for typhoid fever and dysentery.128 This is primarily due to the lack of maintenance of water pumps and installations caused by the absence of qualified personnel. 

[114] Côte d’Ivoire Country Profile, IRIN PlusNews [online],

[115] “Côte d’Ivoire: Struggle to revive health services in rebel-held north,” IRIN PlusNews, May 8, 2005.

[116] European Union/UNICEF project: Support with the health facilities affected by crisis, 2005.

[117] Ibid.

[118] “Côte d’Ivoire: Roadmap against AIDS needs re-think due to war, poverty,” IRIN PlusNews, February 14, 2005.

[119] Annual activity report, Direction de Coordination du Programme Elargi de Vaccination (DCPEV), 2004.

[120] “Côte d’Ivoire: More than half of the patients tested in rebel hospital HIV positive,” IRIN PlusNews, January 27, 2005.

[121] “Côte d’Ivoire: Doctor concerned by high HIV prevalence rate in forgotten northeast,” IRIN PlusNews, March 15, 2005.

[122] “Children’s Rights Not Respected in Côte d’Ivoire’s Ongoing Military and Political Crisis,” UNICEF Press Release, November 21, 2005.

[123] Human Rights Watch interviews with humanitarian aid workers, Abidjan and Bouaké, September-October 2005.

[124] “UNICEF Urges Côte d’Ivoire Government to Hold Annual School Exam Throughout the Country,” UNICEF Press Release, October 5, 2005.

[125] “Côte d’Ivoire: More than half of the patients tested in rebel hospital HIV positive,” IRIN PlusNews, January 27, 2005.

[126] “Children’s Rights Not Respected in Côte d’Ivoire’s Ongoing Military and Political Crisis,” UNICEF Press Release, November 21, 2005.

[127] Human Rights Watch interviews with humanitarian aid workers, Abidjan and Bouaké, September-October 2005.

[128] “Sixth Progress report of the Secretary-General on the United Nations Operation in Côte d’Ivoire,” September 26, 2005, S/2005/604, p. 11.

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