[The health situation in Nicaragua: between a desire to change and aggression]

Before 1979, the health situation in Nicaragua was characterized by a high infant mortality, a high morbidity and mortality related with infectious causes in most cases preventable, as well as by a health care system with multiple non-coordinated institutions, a low coverage and deep social and geographical inequalities in the provision of services. The revolution develops a new regionalized model with an extension of the coverage especially through primary care services, preventive and curative programs targeted at risk groups and health problems, with a large community involvement. The achievements of this new policy are assessed by an increase and a greater equality in the availability and utilization of health resources, by a reduction in morbidity due to transmissible diseases, and by a spectacular decrease in infant mortality. The externally promoted war is having a strong impact on health care and has been slowing down the improvements observed from 1979 to 1983; it violates the principles of the Geneva Convention, it has been condemned by the Tribunal of the Hague, and deserves condemnation from Public Health professionals.