BOGOTA – Pablo Jiraldo took a bullet through his jaw on his fourth day on the front line. It happened 10 years ago, when he was fighting alongside the Revolutionary Armed Forces of Colombia (FARC) during the country’s decades-long civil war. The 43-year-old says a government soldier fired the bullet.
“I went to get my gun, but he fired,” he says. “I was brave. I lost half my face.”
He survived, thanks to the FARC’s efficient underground healthcare system, but Jiraldo remains disfigured and in need of regular medical attention. He is one of many former combatants suffering from health issues and injuries sustained in years of combat and living as outlaws, according to doctors and humanitarian workers.
Dr. Laura Villa, a former senior FARC commander who led the group’s healthcare system, estimates that more than 10 percent of around 7,000 of the group’s ex-combatants are living with long-term health issues as a result of the conflict.
For years, the FARC provided treatment to its injured fighters in the field. But when the peace deal between the armed group and the government was ratified in November 2016, this provision became the responsibility of Colombia’s public healthcare system. Already limited, it has so far struggled to accommodate FARC cases, despite promises made under the peace accords, says Villa, who is now overseeing re-integration and coordinating NGO-led rural health programmes.
The lack of healthcare services is contributing to mistrust of an agreement that is already on thin ice, following a lack of progress implementing reforms and allegations of corruption with funding allocated for these changes.
Under the terms of the peace deal, the FARC would disarm and demobilize while the government would implement a number of reforms and policy proposals intended to address the root causes of the conflict – widely accepted as stemming from rural inequality. Among proposals for land reform, a coca substitution programme and improvement of infrastructure and services, FARC fighters were also promised access to the country’s healthcare system.
The accords also state: “In exceptional circumstances, in cases of serious high-cost illnesses and the rehabilitation of injuries deriving from the conflict, the government will establish a special system with national and international cooperation … to attend for them for 36 months.”
Healthcare was a “very important part of the package,” according to Ivan Briscoe, Latin America program director at the International Crisis Group. “It’s essential, the sense that the state will take responsibility for these people’s basic needs so that they can become an integrated part of Colombian society,” Briscoe added.
The healthcare issue “raises the fundamental question that goes through the whole implementation of the peace process, which is: how much has the Colombian state oversold itself?”
Analysts warn that continued mistrust in the peace process could fuel dissidence among ex-combatants (an estimated 1,200 FARC members are still active) or increase their vulnerability to recruitment by criminal groups or other armed actors, such as the National Liberation Army (ELN), a separate Marxist guerrilla organization.
The June 17 election as president of Ivan Duque, a right-wing politician who is critical of the country’s historic peace accord, has added to this sense of unease. Legislation related to the deal cannot be annulled for 12 years, but Duque vowed to make some modifications to the agreement.
“There will be changes,” Duque declared in his victory speech.
It remains unclear whether any of these changes will detrimentally affect the FARC’s limited access to healthcare. If it does, that will spell further problems for FARC fighters like Jiraldo who are struggling to receive medical treatment.
“I was happy when the peace process was signed, I thought everything would get better. But I was wrong … I lost all [medical] help I previously got from the FARC,” says Jiraldo, adding that his commander says his injury is now the government’s responsibility.
Jiraldo, who also suffers from PTSD, has endured 18 FARC-funded operations since he was shot, all of which were carried out before the signing of the peace accord. But many were botched – he says one surgeon pulled his eyelid over the space where his eyeball used to be, instead of using a skin graft – and he continues to need frequent medical attention.
He has been unable to secure effective treatment in Colombia’s public health system since the signing of the peace deal and said he was turned away by five different state surgeons. He was only able to receive proper medical attention after meeting Dr. Claudia Luzar, who works with the Comision de Conciliacion Nacional, a peace and reconciliation group partly funded by the German government. With her help, and the group’s funding, he has been able to secure private treatment.
“He had an MRSA [superbug] infection for four years, which I am currently treating him for,” says Dr. Peter Jasinski, from his private clinic in Bogota. Jiraldo was introduced to the Polish-born physician by Luzar, after she heard of his plight. In a bid to rid Jiraldo of the hard-to-manage infection, Dr. Jasinski has been administering daily syringes of saline solution to his wound – which goes through his upper jaw and face – before administering antibiotics.
Jiraldo retches and gasps through every procedure, but they are necessary to prepare him for a potential operation which it is hoped will end the cycle of reinfection. It is not known yet who will carry out the operation, or pay for it.
“Pablo has no trust,” says Luzar. “The peace process was supposed to build trust but has had the opposite effect.”
The sharp switch to a substandard healthcare system was an unexpected aspect of the peace process for many of the FARC rank and file.
“When you were in the FARC you didn’t need to ask for an appointment,” Villa says. “Anything they needed, any camp, there was a professional ready to help.”
She continues: “So when they came out of that and they started being part of the Colombian healthcare system … the transition was really hard.”
But ex-combatants are now simply experiencing the same public healthcare issues as the rest of the population, Villa said.
Analysts echo this view. “Public healthcare within Colombian society is not great as it is,” says Briscoe. “There is a reality of poor public health services in rural areas … this has not changed.”
The healthcare situation also presents a paradox, says Kristian Herbolzheimer of Conciliation Resources. “If the government did respond to ex-combatants and not the rest of population, it could create a grievance,” he explains. “It looks like those who took up arms are being rewarded, and those who didn’t are not.”
For Jiraldo, his ill-health is not the only factor fueling his mistrust of the peace process. He is also concerned about the meagre stipend he is granted monthly – which will end with the new government – and his perceived lack of opportunities for the future.
“I don’t think the peace process is real,” Jiraldo says. “A lot of people are going back to continue fighting,” he adds. “If I had my health, I would go back right now. To continue the war is not the solution, but there is no other way.”
Villa agrees that a return to conflict is a possibility, because of the government’s failure to fulfill its obligations under the accords. But she remains hopeful.
“One of the main characteristics of the revolutionary people is that they are very optimistic,” she says. “The decades of conflict made us strong, and we are now warriors in the search for a long-term peace.”