Illnesses, Violence, Forced Displacement and Differentiated Citizenship Among the Hitnü People from Arauca, Colombia

This article is an ethnography of the Hitnü, a nomadic Indigenous people who, due to killings and threats, sought refuge in the city of Arauca, on the border with Venezuela (northeastern Colombia). It examines the urban experience of poverty and exclusion in a context of Indigenous rights and differentiated policies offered to the displaced and Indigenous peoples and demonstrates how different forms of violence affect their health and limit effective responses to illness.

A four-month ethnographic study (2023-2024) was carried out, during which one of the authors lived with 68 members (12 families) of the El Alcaraván settlement in Arauca, Colombia. The data provide insight into the settlement's living conditions, the experience of illness in the urban context, the search for medical care, and the manifestations of violence.

Respiratory infections and diarrhea are common among the Hitnü, and cases of tuberculosis and Chagas disease were also identified. So-called "mild illnesses" are managed through family-based self-care and treatment provided by the cacique, whereas "difficult illnesses" require biomedical intervention. Structural violence shapes both the burden of disease and the ways the Hitnü treat their ailments, particularly due to food insecurity, lack of drinking water, and inadequate sanitation. Venezuelan migrants, despite being foreigners, receive greater humanitarian assistance, generating tensions with the Hitnü. Physicians' practices tend to be hegemonic, highly medicalized, and revictimizing.

Health services must be grounded in the actual needs of the Hitnü and guided by an intercultural approach based on the findings of this study. Ensuring a safe territory would prevent the reproduction of direct, structural, and symbolic violence, and reduce health inequities.