MSF in Democratic Republic of Congo

Last updated: April 2009

MSF activities in the East of the Democratic Republic of Congo (DRC)

The last few months have seen significant shifts in the dynamics of the conflict in Eastern DRC. A split within the National Congress for the People’s Defense (CNDP) rebel group, formerly led by Laurent Nkunda, and a joint Rwandan-Congolese military offensive against the Rwandan rebel group Democratic Forces for the Liberation of Rwanda (FDLR), have further blurred the lines between the warring parties. Despite an overall decrease in the violence, the plight of people across Eastern DRC remains dire. Thousands of people were recently displaced following new violence or rumors of impending violence. MSF is continuing its work in hospitals and health centers, and its mobile teams are struggling to constantly adapt to changing needs. However, several armed attacks on aid workers have forced MSF teams to temporarily suspend outreach activities in certain areas of North Kivu.

North Kivu Province

Joint Rwandan-Congolese military operations in Lubero district, in the northern part of North Kivu, have led to massive displacement of people. The situation is tense, with clashes between the army and the FDLR in several areas. Villages have also been attacked by FDLR and frequent looting has occurred in Kirumba, Kayna and Kanyabayonga, especially in early March. On some roads, trucks have been attacked as well.

As a result, since the end of January some 100,000 displaced people have arrived in the area. In some towns, such as Kirumba, Kanyabayonga and Bingui, the number of internally displaced people (IDPs) stands at around 20,000. MSF therefore extended its program in Kanyabayonga to the Lubero district.

MSF has mobile clinics in several sites. Since the situation is changing every day, MSF’s set-up is adapted accordingly. In March, mobile teams are going several times a week to Vuovo – where MSF conducted 2,200 consultations in February – to Kanyabayonga, Kirumba, Kayna, Lubero town, and Kagheri. In Luofo and Bingui, mobile clinics have been suspended for security reasons.

Severe cases have been referred to Vuovo health center in Kanyabayonga. Additionally, to be in a position to provide secondary health care where there is non-existent or inadequate capacity, MSF has established a flying surgery team which will be in Kayna mid-March.

In Rutshuru district, the situation is more stable. In Rutshuru hospital, teams are conducting normal activities (surgery, maternity healthcare, pediatrics, internal medicine, emergencies, specialized care to victims of sexual violence). To improve the standard of healthcare, MSF is upgrading some parts of the existing buildings. MSF is providing a new laundry, and setting up an additional water supply system with capacity to provide 30,000 liters of water daily.

In Rutshuru city and Kiwanja, MSF is extending the water supply system in two districts in order to improve hygiene conditions and control cholera cases.

In Nyanzale, MSF provides primary and secondary health care in a 60-bed inpatient facility, treats children for malnutrition in the therapeutic feeding center and offers specialized care to victims of sexual violence. MSF treated 100 new victims of sexual violence in February. Two other teams run mobile clinics in Kasoko, Katsiro and Kirima and, when possible, in Mirangi.

In Kabizo, MSF runs a health center with a 22-bed inpatient facility. In addition, the team is conducting mobile clinics in villages and IDP camps in Bambu, Tongo and Kisheshe. In early March, MSF started mobile clinics in Kirumba. MSF teams there are providing consultations and specialized care for victims of sexual violence.

Due to continuing population movement, measles has spread across the whole province. MSF teams are immunizing children under five against measles whenever they see them for consultation. They are treating cholera cases as well, which remain low at the moment.

In Masisi district, MSF continues to provide life-saving surgery in Mweso hospital and works in two health centers in Kitchanga. Five armed robberies targeting aid workers – including two attacks on an MSF vehicle – took place within two weeks in the Kitchanga-Mweso area, the last one on March 2, 2009. As a result, MSF has had to suspend its mobile clinics and support to remote health centers in seven locations, leaving people in these areas without any healthcare. MSF is particularly worried about patients suffering from cholera and measles.

MSF is running a 170-bed referral hospital and is supporting a health center in Masisi town. In order to make medical care accessible to more people, MSF has also been running mobile clinics in four remote locations – Kinigi, Mpanamo, Bukombo, and Nyabiondo. More specifically, MSF has increased its healthcare assistance to an estimated 12,000 newly-displaced people in Nyabiondo, northwest of Masisi, and also in Kinigi, to the southeast, where another 10,000 people have sought refuge following recent violence.

In Masisi town, more than 4,000 displaced people are living in appalling conditions in a camp originally built for 2,000. MSF has carried out a number of urgent works in the camp, such as the installation and rehabilitation of drinking water points and latrines. Due to heavy rains, however, two landslides in February killed eight people in the camp, and more landslides are feared. MSF treated the wounded at the hospital and provided 20 families with psychological support following this incident. While much more needs to be done to ensure minimal living conditions and safety for displaced people in the camp, MSF is currently the only international organization which is working on the infrastructure in the camp.

Further south, near to the provincial capital, Goma, MSF is supporting three health posts in Mushake, Karuba, and Rubaya, and is continuing its work in the hospital in Kirotshe. An MSF team has also assessed the situation in Ngungu village.

South Kivu Province

In South Kivu, MSF is working in another hospital in Kalonge. Over the last few weeks, there have been significant movements of armed groups in South Kivu. Following reports of violence and of people being displaced, MSF has launched a number of evaluations in the area, including in Mwenge, Numbi, Hombo, and Bunyakiri. MSF has offered healthcare assistance to the people and provided drugs and medical equipment in these locations.

In Kalehe district, MSF started mobile clinics in Bushosho at the end of February to provide health care to displaced people who recently arrived in this town located on the shore of Lake Kivu.

Province Orientale

In December 2008, Uganda, DRC, and Sudan launched a joint offensive against Ugandan rebels of the Lord Resistance Army (LRA). A total of 180,000 people have been displaced by violence in Province Orientale.

Despite the return to relative calm in northern Ituri district, and a decrease in attacks by the LRA in neighboring Haut-Uélé district, violence is still ongoing. On February 9, an attack on Aba village forced about 20,000 people to flee – some to Ituri and some crossing the border into Sudan. MSF responded by sending a team to Ariwara, in the Ituri district, to provide emergency assistance and healthcare to displaced people.

Access in the region remains very difficult and MSF is now chartering a plane from Avions Sans Frontières (ASF) to reach insecure places such as Doruma and Faradje. The MSF medical team brings medicines to health facilities and evacuates serious patients to Dungu hospital, where MSF has also started providing surgical care.

MSF mobile clinics are continuing in three locations around Dungu for displaced people who are in urgent need of medical assistance. MSF has also launched a major program of psychological assistance for victims of violence, including people who have been kidnapped or raped.

Publsihed: December 2007

Malnutrition, epidemics and surgical emergencies continue in DRC. Insecurity persists in many regions, particularly in North and South Kivu, where the population is subject to violent attacks and causing continual displacement. Many areas are totally isolated and deprived of any functioning health infrastructures, illustrated by catastrophic health indicators.

Assisting victims of violence

Intense fighting between different armed groups in the Kivu region has caused thousands of people to flee their homes since August. Some sought safety in camps for displaced people in the regional capital, Goma. MSF strengthened existing projects and opened new projects to try and meet the huge needs but in many places the fighting and insecurity forced the evacuation of staff and the temporary suspension of work. In North Kivu, MSF opened a new project in Masisi, about 80 kilometers west of Goma, at the end of August. In response to ongoing violence and displacement, a team started working in the hospital and a health center in Masisi town, focusing on emergency surgery and nutritional care. The hospital’s capacity was increased from 72 to 170 beds. In October, admissions to Rutshuru hospital, where MSF has worked since 2005, increased by 50 per cent. The MSF team added tents to increase inpatient capacity, employed more staff and reinforced the pharmacy with additional supplies. In October, 330 surgical operations were performed, compared to a monthly average of 220 since January.

Repeated displacement, lack of transport and ongoing insecurity mean that mobile clinics are an essential part of MSF’s work. When security permits, mobile teams visit numerous sites in Masisi and Rutshuru districts. In December, MSF carried out 3,299 consultations in Kitchanga, Kilolirwe, and Mweso health zones.

Responding to the needs of victims of sexual violence has long been a key component of MSF’s work. Between January and September, MSF staff treated around 3,000 victims of sexual violence in North and South Kivu. Yet it is not only in active conflict zones where this medical care is so urgently needed. In Bunia, where MSF supports the Bon Marché hospital, teams continue to see around 150 victims of sexual violence every month. In 2007 MSF carried out more than 25,000 consultations in the hospital.

Since 2003, Angolan authorities have on various occasions expelled Congolese migrants working in the Angolan province of Lunda Norte. According to UN estimates at least 44,000 people were deported to DRC in 2007. In October MSF teams set up a health center in Kamako, Western Kasai province, close to the Angolan border. Between November 2007 and January 2008, the center provided medical and psychological care to Congolese migrants, many of whom were women who had been subjected to sexual abuse by Angolan forces. MSF treated about 200 victims of sexual violence and offered primary health care to more than 900 women and children in the Kamako center and through mobile clinics. The teams also collected one 100 testimonies exposing collective rape and physical abuse perpetrated by the Angolan military.

Responding to disease outbreaks

The retreat of humanitarian agencies has left large areas of the country abandoned. Many areas are isolated and the capacity of the new government is often extremely limited. What few health structures exist either do not function fully or are not accessible to the majority of the population living below the poverty line.

In Ituri, MSF responded to a Shigella emergency in Pimbo in May and to a cholera epidemic in Laudjo in June. A new project for sleeping sickness was opened in May in the health zone of Doruma, where this neglected disease is endemic. Within three months, MSF had screened about 10,000 people and treated more than 450 patients.

In August, the influx of an additional 45,000 displaced people to crowded camps with limited sanitation just outside Goma led to a cholera epidemic. In September, MSF opened a cholera treatment center (CTC) in a central location between four of the largest camps. Teams also supported a smaller CTC in Goma hospital, and CTCs in four health clinics: two in Goma itself and two in the neighboring towns of Saké and Kiroche. By the end of November, over 1,500 people had been treated, with only six deaths reported. In the last two months of 2007, MSF responded to another outbreak of cholera in Rutshuru district, treating 1,600 people.

On 10 September, an outbreak of the deadly hemorrhagic fever Ebola was declared in Kampungu, Western Kasai province. Within days, an emergency team had arrived and was isolating and supporting infected people. Over two months, MSF teams admitted 46 people suspected of having the disease. Medical staff tried to trace anyone who had been in contact with the Ebola patients as well as searching for active cases.

Ongoing projects

As well as reinforcing and expanding medical activities in the Kivu region, long-running projects continue to provide HIV/AIDS care in Kinshasa and South Kivu, primary and secondary healthcare in Katanga and Maniema provinces and treatment for sexually transmitted infections in Kisangani. In some areas of Katanga, South Kivu and Dungu in Oriental province, the situation has stabilized to such an extent that MSF has been able to hand over activities to the Ministry of Health and other partner organizations.

MSF has worked in DRC since 1987.

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