"Dry season is usually the time when malaria cases drop but people have been telling me that the last dry season was somehow ‘skipped’. This has meant mosquitoes have continued to do their worst, making adults and children sick, sometimes fatally, in areas where access to health care is extremely limited. We need you to go there straight away."
“20,000 people displaced from the east and heading this way . . . We need to investigate this as a priority.’’
I’m staring at the laptop screen, trying to make sense of the list of Congolese towns and villages people are moving between. I’ve only been here in DRC for two weeks, and the names are heavy with vowels and ‘k’s. I search the crappy map – an A4 print-out with muddy thumb smudges and a classic tea stain - even in the center of the African continent, a Brit is capable of reproducing this quintessential office stamp.
People being forced to flee their homes and workplaces to escape violence is quite a regular occurrence
In a province like North Kivu, people being forced to flee their homes and workplaces to escape violence is quite a regular occurrence. With some 70 armed groups in the province it’s a constant cycle of fighting, displacement, calm, return or more fighting and more displacement.
People fleeing violence can be wounded by combatants or the rush to leave. They often include vulnerable groups, like pregnant women, children and older people. And they can be people with chronic illnesses like TB or HIV who need to be able to access their regular medication. On top of this, wherever they end up may mean they don’t have adequate food, shelter or sanitation. We need to know what’s happened and where they are going so we can assess the security situation and their health needs.
Kikuku…nowhere to be seen. Kanyabayonga …nothing. Katsiru…again, nothing.
I know, Google Maps will find them!
I type ‘Kikuku’ and wait for the satellite internet to whir up the green blur of land, one pixel at a time. Germany? No. Pretty sure it’s not that one.
‘Kanyabayonga’: No results.
OK then, ‘Katsiru’. No network connection: Cancel? Try again?
I walk across the wooden-slatted office that reminds me of some kind of large lake-side cabin in New England, and knock on the door of the project coordinator assistant. I wonder if he can point out these places to me on a map. He can, and it makes my life a whole lot easier.
Our team is always ready, with overnight essentials including an emergency medical kit, mosquito nets, food, drinking water and sleeping bags
This isn’t even my office. As the project coordinator (PC) for the North Kivu Emergency Response Unit (known by most around here as NKERU), I don’t have a full-time base. Our team moves to where the need is within the province and where we can respond, setting up temporary bases where necessary.
I only arrived in DRC a couple of weeks ago and was sent almost immediately here to Mweso, a town where MSF has been supporting a hospital and five health centers in the rural surroundings. In any other situation I could have been sent to a part of the province where no MSF structure exists. Our team is always prepared for such a scenario, ready with overnight essentials including an emergency medical kit, mosquito nets, food, drinking water and sleeping bags which, on this occasion, are not needed.
Thankfully the staff here seems to not mind having us to stay, and from our side, having a team already in place here does make things easier as it brings with it a wealth of knowledge and contacts in the area which, in other situations, we wouldn’t have access to.
Thousands of people have fled, many in our direction.
The emergency situation that brought us to Mweso isn’t specifically about displaced people, although it might affect them. The region has been experiencing very high levels of malaria, pushing our health centers to their limits. Kashuga, to the north of Mweso, has been receiving around 2,000 cases a week for the last few weeks - way longer than just the peak malaria.
Dry season is usually the time when malaria cases drop but people have been telling me that the last dry season was somehow ‘skipped’. This has meant mosquitoes have continued to do their worst, making adults and children sick, sometimes fatally, in areas where access to health care is extremely limited.
“We need you to go there straight away.”
So this past week has been spent treating patients who have already contracted the disease and preparing an intervention to collect more data. And now, just as we were putting plans in place, fighting has broken out to the north east of Mweso, meaning thousands of people have fled, many in our direction.
I immediately call a team meeting. We need a better understanding of the details before we can make a decision on how to act.
We cannot just drive off . . . Armed robberies, violent attacks and kidnaps are not uncommon in this area
We cannot just drive off into these places, as this could put the whole team in danger. Armed robberies, violent attacks and kidnaps are not uncommon in this area, especially during road movements. In fact the Mweso project itself has only reopened again in the last two months after having been forced to close for four months following a critical security incident.
Working with the team who are based in Mweso, we start by making an extensive list of all the contacts in the region that we already have: ministry of health officials, heads of localities, presidents of displaced persons camps, friends of staff, local commercial traders, religious leaders, and of course leaders of armed groups.
It is important that community members, government authorities and armed groups understand our neutral and impartial way of working
As MSF, we always build up a wide network of contacts in every area we work to ensure we keep up to date with the security and humanitarian situation. It is important that community members, government authorities and armed groups alike, understand the work of MSF, our neutral and impartial way of working and that they guarantee our safe access to enable us to continue providing free health care to anyone in need.
I split the list and allocate each team member to various contacts. We set to work, calling people one by one and writing down the information they provide.
“I have a friend who has fled to one of the displaced person’s camps but who is planning to go back to her town today to see if it is safe enough to move her family back,” the team doctor announces in his very calm and matter of fact way. “She’s going to call me later with an update.”
I write it down.
“I asked someone at the hospital and he gave me a list of people living in the areas of the fighting that we can call,” adds another team member. “Some have fled but others are still there.”
Bit by bit we piece together information over the afternoon, some contacts unreachable due to lack of signal, and others cut off half way through their stories. This is the reality here. Communications can be unpredictable and although mobile phone network usually functions in Mweso town, in many of the more remote places we are trying to reach it is either very unstable or non-existent. A colleague told me a story the other day of someone who had walked five hours up a hill just to get signal because he wanted to update her on a situation in his area.
As we reach a lull in the phone calls and bits of the story become clearer, I decide to try other ways of collecting information. It’s vital we have as clear a picture as possible so we know what level of response will be needed. Will we need more nurses? More surgery kits? Is it safe for our staff to stay here? With one of the project drivers agreeing to join us and act as a translator, I walk out into town with him and the Mweso project coordinator to search for displaced people ourselves.
“Look at the door,” the driver exclaims, just two minutes outside the Mweso project base. He is pointing at what seems to be an empty school and I am unsure what he means.
“It’s open. I think there are people inside.”
We walk across the school yard. The building itself is a concrete rectangular structure with crumbling walls and chipping paint. We follow the driver’s lead. It still looks empty. He calls into the open room and we hear shuffles but still see no one. A few minutes later, an elderly man peers out, leaning heavily on a stick that I guess he found at the side of the road. He starts pointing at his knee, bends down to sit on the step and speaks in Swahili.
“They chased us with guns and we ran,” he recounts, through the driver. “I fell and hurt my knee and now it’s hard to walk.”
I then ask about the situation more generally and trust that the driver, as someone from the area, will find the most appropriate way to ask without bringing up anything too sensitive.
“18 people were killed and they threw their bodies into latrines,” the man tells us. We also nod, showing we are listening and ready to hear anything more he has to say.
“There are many families that have fled,” he goes on, listing the names of towns and villages currently filling up with displaced people trying to get their families to safety. What he is saying matches with what we have heard from reports and the contacts we were calling earlier, so this provides us with a level of verification at least for where people are fleeing to.
As much as we may want to, we do not have the resources to do everything.
The man, now standing again and still leaning on his stick, looks at the others congregated around him, eyes fixed on us. He asks if we have food for them.
I always find it difficult to respond to requests from people so desperate for help other than health care. Each time I do though, I remind myself that having MSF’s entire focus on health means we are able to concentrate on providing good quality services that save many lives. As much as we may want to, we do not have the resources to do everything. The project coordinator for the Mweso project reiterates our role as a health organisation, and explains to the now 15 - 20 people grouped expectantly around us, how they can access our free health care in this town. They listen intently, collectively nod, and the man thanks us and confirms they will use our services.
The rest of the day is spent seeking out more information on the situation in the north east of Mweso and the displaced people arriving here and beyond. We go to the pre-existing displaced persons’ camp, visit the head of the locality and speak to people in the street and staff members who are housing people who have fled.
“A lot of people are arriving here but so far it is okay,” we are told.
People explain to us that the community in Mweso is supporting new arrivals with food and shelter. Some are family members of those fleeing the violence. Others are taking people in to live with them just so they have a roof over their head.
Some people are displaced multiple times as the conflict moves from town to town. In some instances, they never return.
After a while we have built up a more extensive picture of what is going on in the area of fighting and in Mweso itself. What is yet to be known, however, is how long people will remain displaced. Most would like to return home when it’s safe.
With so many armed groups in the region, displacements happen regularly here. At times, people flee just for a night before returning home, sleeping in the bush or mountains, or seeking refuge with family members living in safer parts.
In other cases, they are away for longer, living in host families, camps or making their own improvised shelter in areas they perceive to be safe. Some are displaced multiple times as the conflict moves from town to town, and in some instances, they never return.
With all the information we now have, only time will tell what scenario we are faced with on this occasion and if the humanitarian needs warrant an MSF NKERU response, in addition to the free health services MSF is already providing in Mweso and around. So for now, all we can do is continue to follow the situation, build up information and decide if, when and how we are going to respond.