COTABATO CITY, Philippines—The singing of the national hymn by schoolchildren keeps almost in awe some of the expatriates working in the midst of misery being suffered by hundreds of thousands of people living in shelter camps.

For them, the melody they hear every morning conveys the testament of Filipinos never retreating from any battles in life.

Behind a primary school, the Medicins Sans Frontieres (Doctors without Borders) headquarters in the volatile Cotabato City stands, still optimistic despite images of a fragile child, a hungry mother, a struggling father and the elderly who silently await death in the evacuation centers, thanks to some expatriate doctors who saw what many have overlooked—working at one person at a time in saving a life marred by ruthless war.

One overcast Tuesday morning, three mobile clinics simultaneously prepare for takeoff to three camps across strife-torn Maguindanao. Elizabeth Harding, MSF field coordinator, lays down the action plan for a day-long mission to Poblacion and Bagan in Guindulungan, and Dapiawan in Datu Piang, Maguindanao.

“You’re not going without me,” Harding reassures the three doctors, nine nurses and three midwives wearing the red-stained MSF vests.

Loads of medicines, mostly bottles of antibiotics, pain relievers, multivitamins and emergency therapeutic foods, are slid in boxes transported by four vehicles in a convoy along military-checked roads. “Having these stuff ready allows the group to respond to urgent situation quickly,” says Harding, a former ER nurse in England.

“We have come here to act in response to the crisis, treating the most severe cases,” she says. “But as we work, there are more upsetting problems requiring a larger response.”

The current situation is disturbing: Most “evacuees” now depend on external aid as the camps face a severe nutritional emergency with what local health officials place at more than 100,000 children at grave risk.

According to the National Disaster Coordinating Council, at least 330,140 people have been affected by the war between government and Moro rebel forces in the region. In Maguindanao alone, the number of those displaced has risen to 52,300 families a year after the fighting broke out.

Since it was alerted by the national government in November last year, the MSF medical team has opened eight mobile clinics and undertaken a number of outpatient treatment programs.

Severe malnutrition has struck various camps. In barely 11 months, more than 10,000 children, some of them severely malnourished, have received medical treatment, while a great number who have been suffering health complications needed to be brought to the hospital.

“Medical missions come at least twice a week to each location, providing immediate aid to children with nutrition problems, pregnant mothers and emergency cases, such as surgery, which we refer to hospitals,” says Harding.

For every child suffering from acute malnutrition and vitamin deficiencies, therapeutic food and medical treatment are given.

Free health care

Almost skin and bones, Norohula Sangcupan, at 19 months, only weighs 7.6 kilograms. “He was not this thin before we ran for safety. His health has deteriorated since we arrived here,” his mother Norsalyn weeps.

The Sangcupans have only spent a month in the Poblacion camp where they had sought refuge after fighting erupted in their village while most of the residents were observing Ramadan, the Islamic fasting month.

Inside a shack that serves as temporary clinic, the boy’s excruciating and incessant wailing worries Norsalyn.

Given ready-to-eat therapeutic food, made primarily of peanut paste, milk and vitamin complex called Plumpy nut, Noruhala stops crying briefly, delighted at his bite. But the pain somewhere in his frail body never ceases, so he screams all the more.

The MSF has been giving malnourished children high-energy biscuits and therapeutic food made with peanut paste to recover lost physical development. Most mothers observe that their children quickly gained weight within a few weeks.

“Without the correct amounts of basic nutrients in their diet, these children are susceptible to diseases. They are under threat of dying,” says Harding.

In another camp in Bagan in Guindulungan town, pregnant mothers lugging their equally malnourished children queue for free prenatal checkups and vitamins.

But a woman in Dapiawan, Datu Piang, is not as lucky as other mothers in the camp. With puffed eyes, yellowing skin and thinning frame, Zainab Kaguiomar looks sore. She has been diagnosed with schitosomiasis, a disease caused by parasitic blood flukes found in running streams where the worms lodge in snails, enter the skin, and attack the liver and other organs.

American doctor David Spence, who is in the country for a six-month mission with MSF, has helped Zainab relieve the pain since she presented her case in July. But her illness is now on its late stage.

“There has been irreversible damage to her liver and spleen and she’s extremely anemic,” says Spence. He is not giving up, though. “I am confident we can find ways to treat her through our hospital partners.”

The 40-year-old woman with three school-aged children was one of the first mothers who evacuated the village of Gawang in Datu Saudi Ampatuan the day the war broke out in August last year. Zainab has lost count of the times her family evacuated their home, and she asks: “When can we go home?”

For now, Zainab is waging a different battle, but she is not going to surrender yet. “I have a land to cultivate. I want to grow old with my family by my side. I’m still young to just die here,” she says with an interpreter.

MSF program

Founded by a group of French doctors and a group of journalists in 1971, the MSF, the Nobel Peace Prize awardee in 1991, has become a global aid organization delivering medical support to populations in danger. It provides services to everyone regardless of race, creed, country and religion, and is a politically impartial and neutral organization.

Having independent funding is essential to the MSF mission.

The group has been working in the Philippines since the 1990s, implementing medical programs in various areas. It left in 2005 and restarted activities in November last year following the upsurge of fighting in Mindanao.

Ten expatriate doctors, nurses and logisticians from several countries and 50 local staff members provide regular care in eight evacuation centers in Datu Piang, Datu Odin Sinsuat, Guindulungan, Mamasapano and Datu Saudi Ampatuan, all in Maguindanao, and Pigcawayan in North Cotabato. Currently, the group is scouting for new places to serve.

The MSF-Philippines has performed over 30,000 checkups, treatment and disease prevention measures, which supplies vitamins to every member of the family as supplement to their normal diet.

Common illnesses hounding the population in camps are respiratory diseases, body pain, headaches, fever, diarrhea and injuries from petty accidents. A few children show signs of acute malnutrition.

Some cases of tuberculosis and measles are referred to hospitals in Cotabato City.

To improve sanitary conditions, the MSF has worked on draining water and sewage systems, and has also provided drinking water to over 5,000 displaced people in Mamapasano.

When Maguindanao is under heavy artillery attacks by the government and rebel forces, missions are stopped temporarily. But hopes are up for the MSF to last in the camps since the route to peace is now open between the warring forces.

Expat doctors, nurses

“We’ll be hanging around here until next summer. But we’ll never know what’s going to happen come election time,” says Harding.

While other doctors and nurses work in swanky settings, only a few sign up to labor in the most difficult conditions, such as conflict zones and disaster sites. The MSF allows doctors and nurses to do just that.

Foreign nationals from Austria, Australia, Canada, England, Switzerland and the United States are working in Cotabato City in the midst of armed conflict and wide-ranging diseases. Swiss Bertrand Rossier is the head of Mission in the Philippines.