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Struggling to Survive in North Kivu, DRC
August 8, 2006
Today, even more than three years after the conclusion of the war, much of the road is impassable due to insecurity. Armed groups with diverse backgrounds and aims still plague this strategically and economically important region, making any journey treacherous and bringing misery to the lives of the population.
In the health zones of Rutshuru and Kayna, located along the road to the north of the provincial capital Goma, Doctors Without Borders/Médecins Sans Frontières (MSF) supports secondary health care in two general hospitals, which also act as referral centers for more than 20 outlying health facilities linked by regular ambulance services. The medical needs for this estimated population of 330,000 are staggering.
Combined, the two hospitals treat in excess of 1,200 inpatients per month. More than a quarter of these admissions are children and the pediatric ward in Rutshuru hospital is so full that a temporary shelter has been set up to deal with the overflow.
Malnutrition also abounds, but the cause is not a shortage of food. The MSF therapeutic feeding center (TFC) in Kayna admits more than 150 severely malnourished children per month.
"The link between violence and malnutrition is striking," says Bernard, a nurse. "These children often come from recently displaced families or from an area where one armed group or another has pillaged the food stocks. For a small child, such a sharp shock can bring about severe malnutrition within just a few weeks."
Every Thursday, an ambulance arrives at the Kayna TFC bringing malnourished children from the area south of Kibirizi. Arriving late afternoon, it spills out a human cargo of color and noise. On this particular day only seven children arrive, most manifesting the swollen features that are the trademark of the Kwashiokor form of malnutrition (symptomatic of diet low in protein and accompanied by swelling of the belly and limbs). "This is a good day," says Julie, the MSF doctor, "last week there were 16 of them."
For Fred Demalvoisine, the MSF head of mission, it is an imperfect system. "Our pick-up point with the ambulance is in Kibirizi, because at the moment this is as far as we can go due to security constraints. But most of the cases come from the zone to the south which is particularly insecure. This means the mothers have to walk to get to us, which can be dangerous. The result is most likely that many don't take the risk, so the children we treat are probably only the tip of the iceberg."
This is not just the case for malnutrition. The amount of children that have succumbed to diseases such as malaria and measles due to the lack of access to health care can only be guessed at.
High levels of sexual violence
The direct effects of the continuing violence are no less alarming. In sexual violence clinics integrated into the MSF programs in Rutshuru, Kanyabayonga, and Kayna, MSF treats an average of 160 new cases of sexual violence every month.
In Kanyabayonga, a similar situation prevails. Sitting next to nurse Elysee in the MSF clinic, a woman in her mid thirties tells her story as she cradles her nine-month-old child on her lap.
This was the second time she had been raped, the first incident had happened three years previously.
"This is not unusual," says Elysee, "one woman who came recently had been raped on five separate occasions. But they have to feed their families so there is no choice but to go back to the fields to cultivate."
For MSF, it is vital that the patients come to the clinics as quickly as possible after a sexual assault. "If they arrive within 72 hours we can begin a post-exposure prophylaxis (PEP) which can avoid transmission of HIV," says Elysee. "If not we treat for any physical injuries they have, start antibiotic prophylaxis for sexually transmitted infections such as chlamydia and vaccinate against tetanus and hepatitis B. If they arrive within five days, the patient also has the possibility to get drugs to prevent unwanted pregnancy."
For the PEP, an ongoing public awareness campaign around Rutshuru has ensured that by June, 80 percent of cases were arriving within 72 hours, up from 54 percent in April.
In addition to treating cases of sexual violence, MSF surgery teams also deal with conflict-related injuries. Between July 17 and July 23, 10 patients were treated for gunshot wounds in the Rutshuru hospital, including a five-year-old child whose left leg had to be amputated below the knee.
"The elections currently taking place are a source of hope for the people of this area," says Demalvoisine. "But even if they are a success, an end to the violence which is responsible for so much suffering is a distant light in the tunnel."
And like the infamous road passing through the mountains of North Kivu, hope for the future is fraught with insecurity.