Editor’s Note: When the infamous Marawi Siege—a dark chapter that one prays will never be repeated—happened in 2017, one of the major responders to the crisis was the Doctors Without Borders/Médecins Sans Frontières (MSF). The siege lasted five months, with over 350,000 locals forced out of their homes. In the aftermath of the siege, Doctors Without Borders responded with access to free and clean water, mental health and psycho-social support, and primary healthcare. It has worked in clinics in three transitory shelters, as well as in the main City Health Office, providing primary healthcare from 2018 onwards. As emergency needs decreased, health issues from long before the siege resurfaced, mostly non-communicable diseases like hypertension and diabetes. Still, MSF notes, local authorities now have better capacity to provide for people’s health needs. In December 2022, five years after the siege, Doctors Without Borders closed its project and handed over its activities to local health authorities. Here, they share their experience in Marawi.
IT has been five years since the siege of Marawi displaced 98 percent of the city’s population. Since the conflict, Doctors Without Borders/Médecins Sans Frontières (MSF) has provided care for the people of Marawi, and adapted our activities to the changing needs of the communities.
In December 2022, with the acute and post-emergency phases of our medical response over, Doctors Without Borders decided to close its project and hand over activities to local health actors.
As activities come to an end, Doctors Without Borders patients and staff look back at five years in Marawi.
The Marawi siege
FIVE months of armed conflict completely destroyed the city center. “Marawi’s city center, called ‘Ground Zero’, looked like pictures in the news from Mariupol or Mosul,” says Aurélien Sigwalt, head of mission for Doctors Without Borders in the Philippines.
The conflict and destruction had a great impact on the local population. “I only really got sick after the Marawi siege, because of our problems and fears,” recalls Doctors Without Borders patient Rasmia Magompara. “We had evacuated during the siege, with no belongings, no money. All we had was what was in our pockets and what we were wearing. With all our fears and problems, every time I hear a motorcycle, I thought it was a helicopter. Next thing I knew, it was morning, the sun had risen, and I hadn’t been able to sleep.”
Supporting the displaced
BY July 2017, Doctors Without Borders launched a project to assist people who had been forced to flee their homes in the fighting. Doctors Without Borders provided support with water and sanitation and psychological first aid for a total of 11,000 people living in evacuation centers in Marawi and the surrounding region.
Dr. Natasha Reyes was the emergency response support manager at the time. “The first part of the Doctors Without Borders response was to make sure people had access to free and clean water,” she says. “We distributed jerry cans and water purification tablets, repaired pipes and toilets, put up showers and built reservoirs so communities could store their water.”
“Our other priority was mental health support. We organized psychosocial activities for the children. The stress of their parents also affected them: our teams organized play therapy to make them feel like kids again. We also held one-on-one sessions for adults and children who needed it.”
From observer to health promoter
AMELIA PANDAPATAN was one of the displaced people who received support from Doctors Without Borders in 2017. “I saw Doctors Without Borders going to the shelters, doing a mental health program, giving out hygiene kits,” she recalls.
When she heard that Doctors Without Borders was hiring, she applied to be a health promoter right away. She recalls the challenges they faced in 2017: “The medical team started with a small group of local staff. We had one doctor, one pharmacist, two nurses and one health promoter. We managed to do our daily activities in the clinic, but it was a bit of a challenge. Health promoters would help with registration, checking vital signs. I became a translator between doctors and patients.”
Considering the region’s history of weak health indicators, the work of a health promoter is critical, and this is something Pandapatan can be proud of. “As health promoters, we deliver health education to our patients and community. I think that’s one of our achievements, seeing our patients with the ability to manage their own health.”
Disrupted lives and health needs
SLOWLY, the situation stabilized. Displaced people moved from tents to evacuation centers and temporary shelters, with the last families moving to shelters in January 2020. But many Marawi residents have been unable to move back to the city center, remaining in shelters until now. Many have not been granted a permit to return home, or they face challenges in rebuilding or repairing their houses due to financial constraints.
Of the 39 health facilities in Marawi and the surrounding areas, 15 were functioning by 2020; the others had been destroyed or were unable to reopen. Doctors Without Borders supported the rehabilitation of the Marawi Rural Health Unit (RHU) and City Health Office (CHO) facilities and clinics, as well as clinics in three of Marawi’s shelters.
In 2018, Doctors Without Borders started working in clinics in three transitory shelters, as well as in the CHO, providing free consultations and free medication for primary healthcare.
As the emergency needs decreased, health issues that persisted long before the siege resurfaced. Hypertension and diabetes have since ranked among the 10 leading causes of mortality in Lanao del Sur, which is why Doctors Without Borders started a program focused on non-communicable diseases in 2019.
In addition to providing consultations and medication, Doctors Without Borders health promotion staff also conducted patient education sessions, where patients learned about non-communicable diseases and what they could do to stay healthy.
“When Doctors Without Borders started working at the clinic in the Rorogagus shelter, my wife and I were very thankful because it was close to us, and we received free medicine,” says patient Said Abdullah, aged 76. “We followed the advice given to us. I’ve been exercising and avoiding foods that are not advised for those with high blood pressure, and now I’m much better. The daily dizziness is gone.”
Between 2018 and 2022, Doctors Without Borders teams conducted 30,000 primary health-care consultations and over 10,000 non-communicable disease consultations in Marawi.
Handing over medical activities to local health actors
“FIVE years after the siege, Marawi health authorities have a better capacity to manage patients with non-communicable diseases, and to provide primary healthcare to the people of Marawi,” says Sigwalt. In anticipation of the project closing, Doctors Without Borders has worked closely with the Marawi CHO to enhance local capacity to support health needs and has donated medicines to support the continued care of patients.
Patients who have been in the care of the Doctors Without Borders non-communicable disease program have gradually been transferred to the CHO over the past few months. Sarah Ambor, Doctors Without Borders health promotion supervisor, explains: “We conducted monthly meetings with the CHO to provide updates regarding the patients, their medication and their needs in order for the patients to continue to receive the care they need.”
In 2021 and 2022, Doctors Without Borders also implemented a mentorship program for 67 RHU staff members in the province of Lanao del Sur to transfer technical skills and knowledge on the management of non-communicable diseases.
Five years later, the city of Marawi still bears the scars from the siege. Many structures remain in ruins at Ground Zero. Patient Said Abdullah’s wish is simple: “All I can say is that we hope the Marawi siege never happens again, and for Marawi to be peaceful.”
Doctors Without Borders remains in the Philippines, running a tuberculosis program in Manila, and will continue to assess the support needs in the country in 2023.
Image credits: MSF/Ely Sok, MSF/Regina Layug Rosero