The five-month-long armed conflict in Marawi City in southern Philippines was a devastating blow to the lives and properties of people living in the city and the neighbouring municipalities. The conflict displaced over 350,000 people in 2017, with around 73,000 people still displaced in evacuation centres, transition sites or relatives’ homes.
A year since the conflict began, the health needs of the affected population remained a top priority in 2018. To address this, the World Health Organization (WHO) worked alongside the Integrated Provincial Office (IPHO) of Lanao del Sur and City Health Office (CHO) of Marawi to ensure the access of internally displaced populations (IDPs) and host populations to essential health services and strengthen disease surveillance and outbreak control. This is with funding support from the United Nations Central Emergency Response Fund (UN CERF) and in coordination with the Department of Health (DOH).
WHO joined UNFPA, UNICEF and WFP in a convergence of health and nutrition outreach projects to deliver maximum impact in the areas affected by the conflict – Marawi City and the municipalities of Bubong, Ditsaan-Ramain, Marantao, Piagapo and Saguiaran.
Delivering essential health services
Displaced resident Amenor-ain Pundato and her two children Atikah, 6 years old, and Jaish, 2 years old, are living in a transition site in Marawi City. All three of them trooped to the mobile health clinic to consult with a doctor and get appropriate medicines.
A health worker dispenses medicines to Amenor-ain Pundato during a mobile health clinic visit at a transitory site Sarimanok Camp 1 in Marawi City. Photo: WHO/F. Tanggol
“The situation has been challenging for our health. It is cold at night and extremely hot during the day. Right now, we have no livelihood so it's difficult to get sick because we have no money to buy medicines. If you are not here and there is no offer of free check-ups and medicines, what will happen to us?” shared Amenor-ain.
Amenor-ain Pundato together with her two children at the transitory site Sarimanok Camp 1 in Marawi City. Photo: WHO/F. Tanggol
They are just three of the over 17,000 people served by the mobile health teams that provided health services in 244 barangays (local villages) with remaining displaced communities. The health services provided include maternal and child care, immunization, deworming and vitamin A supplementation, family planning, health promotion, and psychosocial support and referrals remaining displaced and host communities. The mobile health teams were led by the city health office of Marawi and municipal health office in Lanao del Sur, supported by WHO and implementing partner Mindanao Organization for Social and Economic Progress (MOSEP).
Repairing health facilities
Many health facilities were in poor condition after the conflict because they were either directly hit by the crossfire or the facilities became temporary housing for displaced families.
The barangay health station in Barangay Tuca, Marawi City was damaged and inaccessible during the conflict. The health facility is centrally-located and caters not only to the residents in this barangay but eight other surrounding barangays.
“Before the siege happened, our facility was working well that we were even up for Philhealth accreditation. Then the siege happened, and it was shot by unknown elements. The roof, rooms, windows and tiles got destroyed,” explained Jaida Lakkian, a nurse at the Tuca barangay health station.
WHO, with implementing partner Muslim Youth Religious Organization, Inc. (MYROI) repaired six health facilities affected by the conflict – the barangay health stations in Tuca, Marawi and Pawak, Saguiaran, as well as the municipal health centres in Bubong, Ditsaan-Ramain, Marantao and Piagapo.
City Health Officer Ali Dalidig, Midwife Calima Mangate, Nurse Jaida Lakkian and WHO Philippines Project Coordinator Julie Villadolid during the turnover of the repaired barangay health station in Barangay Tuca, Marawi City. Photo: WHO/F. Tanggol
The repairs included installation of piped-in water supply to improve water, sanitation and hygiene in the health facilities. The facilities were also equipped with primary care medicines.
“On behalf of the city health office of Marawi and the people of Barangay Tuca and neighbouring barangays, we would like to thank WHO because the repairs have been a huge help,” said Jaida.
A health worker washes his hand in the newly-repaired barangay health station in Barangay Tuca, Marawi City. Photo: WHO/F. Tanggol
Building the capacity of health workers and monitoring and evaluation
To help strengthen the delivery of health services and disease surveillance in the affected communities, WHO built the capacity of local health workers through various workshops. Over 140 local health workers were trained on mental health and psychosocial support, health emergency management and health planning in disaster risk reduction. Over 60 health staff were also trained on disease surveillance and specimen handling for cholera.
A participant of the Strengthening Disease Surveillance training held in Cagayan de Oro City. Photo: WHO/F. Tanggol
As part of the CERF-funded health and nutrition projects, WHO and other health partners also had joint monitoring and evaluation activities in the project sites.
“We had a unified assessment tool as one of the convergence activities among the health CERF partners. So, all agencies converged to do one monitoring. We evaluated and monitored the challenges we faced during project implementation, how far have we covered, and if we reached our targets,” said Julie Villadolid, WHO Philippines’ project coordinator for the Marawi conflict.
WHO Philippines’ Julie Villadolid checks the water, sanitation and hygiene situation in the barangay health station in Barangay Bagoaingud, Saguiaran. Photo: WHO/F. Tanggol
Other than the joint monitoring and evaluation activities, WHO also conducted client feedback interviews during the health and nutrition outreach.
“So far we had positive responses from the clients we interviewed. They were very thankful for our activities,” added Julie.
While the health system is returning to normal, the affected communities will continue to need support for their health needs and longer-term rehabilitation.
As Julie explained: “We still have remaining IDPs who have not yet returned to their areas either from the evacuation centers, the transitory sites, the transfer sites and the home-based IDPs. There will still be health needs among the internally displaced population and the host communities.”