Over the past few months new waves of fighting in the North Kivu province of eastern Democratic Republic of Congo have caused the massive displacement of an already weakened civilian population. While no precise number can be given, several hundreds of thousands of people are thought to have been displaced by the violence since the beginning of the year. Many are said to be living in the forest without adequate shelter, water, medical care or food and under the continuous threat of insecurity, too scared to travel to health clinics.
In response, MSF teams have reinforced their activities to try to meet the increasing medical needs. New projects have opened in Masisi, Kitchanga and Mweso, additional mobile teams are working in Rutshuru district, and three new cholera treatment centers have been set up in the Goma area.
But fighting and insecurity make it very difficult for humanitarian workers to deliver assistance to the population. Huge areas of land remain inaccessible with many roads simply cut off by the insecurity. In the past few weeks, MSF has had to temporarily evacuate teams from Mweso, Kitchanga, and Nyanzale. Getting supplies and materials to the MSF clinics is also challenging. After days of trying, an MSF truck finally reached Masisi hospital — an area badly affected by the fighting — from Goma on October 18. The truck contained four metric tons of wound dressing material, blankets, soaps, and logistical materials. MSF is now trying to transport drugs and more medical material to Masisi.
MSF currently has projects in Rutshuru, Masisi, Lubero, Walikale, and Goma districts, with a total of 475 Congolese staff and 45 international staff in the province of North Kivu. One project was handed over in late September.
Rutshuru District
Rutshuru Town Area
MSF has been working in the 200-bed Rutshuru reference hospital since August 2005. Medical staff provide secondary health care, including surgical, medical, and pediatric care. Between January and September 2007, more than 6,200 patients were admitted to the hospital's emergency room, including 2,535 children under five. There were 1,405 surgical operations performed at the hospital, of which 1,160 were emergencies. The main pathologies are malaria, severe upper respiratory infections (pneumonia), and diarrhea. The hospital also provides an ambulance service to surrounding areas with 55 to 300 referrals per month depending on access.
In Rutshuru hospital, MSF has provided specialized care to more than 600 victims of sexual violence since January 2007. This includes giving antiretroviral post-exposure prophylaxis (PEP) within 72 hours of any exposure to reduce the risk of HIV infection, prophylactic antibiotics to protect against the most common sexually transmitted infections (syphilis, gonorrhea, and chlamydia), tetanus and hepatitis-B vaccinations, the morning after pill, treatment of physical trauma such as lesions, wounds, or other injuries, and counseling.
In October 2006, MSF opened a project providing emergency care in Nyanzale, in Birambizo health zone treating more than 9,200 patients suffering from malaria, 1,250 malnourished children, and 1,200 victims of sexual violence since January 2007.
In recent weeks MSF teams vaccinated over 37,000 children between 6 months and 15 years of age against measles in 5 health areas, including 2 camps for displaced people. Due to insecurity, several areas could not be reached and at least 10,000 children could not be vaccinated.
Recent developments: increased mobile clinics and support to health centers
With massive new displacement since August, MSF has tried to assist people by starting mobile clinics throughout the Rutshuru district. In recent weeks, MSF teams have provided medical consultations in Kabaya, Kinyandoni and Rugare, but access is seriously hampered by the fighting.
In the Binza health zone, MSF reopened 3 rural health centers which had been closed due to fighting since February 2007 in Buramba, Katwiguru, and Kiseguru. In this area, large parts of the population had fled violence repeatedly since early 2007. Each center conducts approximately 120 consultations a day, mainly for malaria. MSF offers support in terms of supplying essential drugs, referrals, and training.
A team based in Kisoro, Uganda, has just started cross-border mobile clinics two times a week in three locations: Jomba, Chengerero, and Bunagana. During its first days of operations last week the team carried out 140 consultations per day. Earlier this week, mobile clinics inside DRC were suspended as most of the people being served by the team have dispersed. Approximately 30,000 have fled to Rutshuru and 10,000 to Goma. As of October 24, 5,000 refugees had fled east and gathered in a camp in Nyakabanda in Uganda, roughly 15 km from the border with DRC. An additional 3,000 were massed at the border. MSF has constructed shelters and latrines, and is providing water and sanitation and basic health care in the camp.
Masisi District
Masisi Town
At the end of August, MSF started working in Masisi hospital, about 80km west of Goma. Currently, an estimated 24,000 displaced people are living in precarious conditions in Masisi town and the neighbouring areas (Masisi, Lushebere, and Buguri). An MSF team of about 100 Congolese and five international staff, including a coordinator, two nurses, a surgeon and an anaesthetist, are working in the hospital and in a health center nearby. Following several waves of intense violence the MSF surgical team has treated approximately145 people wounded in the fighting. They also provide caesarean sections and obstetrical emergency surgery. On average the MSF team carries out up to150 consultations per day, mainly for malaria, urinary and respiratory infections, obstetrical emergencies, worms and malnutrition. The 120-bed hospital is running at full capacity most of the time.
In order to identify children in need of nutritional assistance, MSF has also conducted a rapid nutritional assessment measuring the mid upper arm circumference of 1,000 children under 5 years old around Masisi and in the neighbouring locality of Buguri. The MSF team found that an average of 1.9 percent of the children suffer from severe malnutrition and 7.6 percent from moderate malnutrition. Sixteen severely malnourished children have been immediately referred to the therapeutic nutritional center of Masisi hospital. A total of 40 children suffering from severe malnutrition are currently hospitalized at this nutritional structure, run by a partner organization.
MSF also plans to start an ambulatory feeding program targeting about 1,200 vulnerable children among the displaced and the local population around Masisi, Lushebere and Buguri. The program will aim at both moderate and severely malnourished children, with distribution of therapeutic food and additional rations for families.
MSF has had a permanent team in Walikale town since December 2004. The teams support the town hospital, providing emergency surgery, tuberculosis support and a small feeding center in the pediatric ward, as well as antenatal care and integrated HIV/AIDS care. MSF also supports more than nine health centers and two health posts in the zone. So far the fighting in Masisi has not affected the Walikale region.
Mweso and Kitchanga Area
MSF started working in Mweso health zone in February 2007, supporting four Ministry of Health centers — Bukama, JTN, Kashuga, and Kalembe — in the provision of maternal care, outpatient care, treatment for victims of sexual violence, and training health center staff to improve the quality of diagnosis and treatment. Three of the clinics have ambulatory nutritional centers. The program targets displaced people in various camps as well as the host population. Since early September, the continuing violence has meant that these centers have either been closed or have been unreachable by teams based in Kitchanga. Both the camp population and the host population have fled in some parts of the area. This continued displacement, along with the fact that a planned measles vaccination was cancelled because of the insecurity, makes MSF very concerned about the health status of this population.
MSF teams based in Kitchanga have been subject to temporary evacuations since September. On October 17, MSF staff went back to Kitchanga. Five international staff are planning to start providing basic health care in St. Benoit hospital and have temporarily increased support to the existing sexual violence treatment program in Kitchanga. The team is also preparing to visit Kasuga and Kalemba clinics and have seen displaced people passing through and settling in the town.
In Kayna, MSF had run a 70 bed-hospital, providing treatment for malnutrition and care for victims of sexual violence since 2004. On average MSF staff would treat approximately 66 victims of sexual violence each month. In September MSF handed over the malnutrition and care for victims of sexual violence to the Ministry of Health and to several NGOs.
Goma District
Up to 80,000 people are thought to have fled towards Goma and settled either in the camps around the city or with host families. A number of organizations are providing primary health care in the camps. MSF has been monitoring the medical situation with regard to disease outbreaks. As living conditions in many of the camps remained very basic and cholera season approached, MSF was concerned about a cholera outbreak. Working with the Ministry of Health, MSF teams started a cholera treatment center in a central location between the camps, Buhimba, on September 24. Another four cholera treatment centers have since been opened inside Goma. As of October 25, MSF had treated 356 people for cholera and had started building an extension to the treatment site in Buhimba.
MSF has been working in the Democratic Republic of Congo since 1981.
