January 31, 2006
Despite a heavy deployment of a UN peacekeeping contingents in the Democratic Republic of Congo's North Kivu province, insecurity and violence have set the whole region ablaze. In just over one month, heavy fighting in the Rutshuru and Beni regions have lead to more than 80,000 people being displaced either within North Kivu or across the border as refugees in Uganda. Though the fighting has stopped around Beni, and the displaced and local residents have access to basic medical care, the ongoing harassment and insecurity by the armed groups prevents them from moving freely to harvest their fields.
In Rutshuru, the situation is still critical, as combat continues and tens of thousands of people are cut off from any form of help. Doctors Without Borders/Médecins Sans Frontières (MSF) teams, who evacuated Rutshuru nearly two weeks ago, have been unable to return, yet thousands of people remain trapped in the area with no access to medical care.
Since the January 19, fierce combat has erupted in the Rutshuru district of North Kivu province. The fighting which started in the village of Bunagana, has currently spread north on the route to Kayna to the towns of Kibiridzi and Rwindi, where UN peacekeepers have also taken part in the fighting. Government soldiers and dissident groups are now also fighting over the control of Rutshuru town, after the town was taken over by dissident groups more than a week ago.
Some 50,000 people from Rutshuru district have fled either towards Kanyabayonga and Ishasha or have crossed the border to neighboring Uganda. Rutshuru town is now empty, apart from 1,000 people who have sought refuge in the general referral hospital since the fighting started two weeks ago. Tens of thousands of other people are hiding in the bush not far from their villages around Kibiridzi. Some have been able to reach Kanyabayonga, but many others have been blocked from accessing the town by the raging battle. Several hundred displaced people are also starting to arrive in Goma.
From January 20 to January 29, more than 30 wounded have been taken care of in Rutshuru Hospital and another 20 wounded have been operated on in the Kayna general hospital where MSF teams are working. MSF is worried about the lack of access to relief aid and medical help for the populations in Rutshuru district who have been deprived of any form of assistance for the past two weeks.
Upsurge of terror
Even since the official end of the DRC's war in 2002, North Kivu has been the setting of violence, fighting, and looting by a mixture of armed groups operating in the region. Throughout the past year, the population has been subjected to harassment, racketeering, rape, and forced displacement. In 2005 alone, MSF treated more than 1,200 victims of rape in Beni, Kayna, and Rutshuru areas, where men in arms committed most rapes.
The territory of Rutshuru has been particularly violent and unstable, leading MSF to open a project in August 2005 to support the surgical, pediatric, and internal medicine wards of the general referral hospital in Rutshuru, and to provide much needed primary health care and a referral system to the population of Katwiguru health zone. However, it has been more than a year since such heavy fighting erupted in the region provoking so much displacement.
This most recent upsurge of fighting in Rutshuru comes only a month after military operations in the territory of Beni provoked the displacement of 36,000 people. In December 2005, military operations by the Congolese armed forces (FARDC) and the MONUC (UN peace keeping mission) to flush out Ugandan rebel fighters (NALU) provoked forced displacement along the Beni — Erengetti road. MSF has now returned to work in this area, bringing medical care to the town of Linzo where 2,200 displaced families are residing.
Though most of the displaced population in the area is being provided with medical and basic relief aid, they are living in overcrowded conditions and are increasingly finding it difficult to access food provisions. Attacks by armed groups have hindered people's access to their fields in order to start the harvest, depleting their food resources, and increasing prices in the market. The arrival of the displaced also coincides with an outbreak of cholera in the village of Liva, where 950 displaced families have recently arrived. Since December 2005, 42 patients have been treated in a cholera treatment unit set up in the village, with 2 people dying of cholera.
Trapped by violence and deprived of assistance
However, the situation for the population in Rutshuru is particularly difficult as heavy fighting continues and humanitarian access to the population has been impossible since hostilities started two weeks ago. Looting by armed groups has lead to protests by local youth, however combats have not yet stopped, putting the local population at great risk.
"The population doesn't know who is fighting who or what is going on. They are terrified and completely at a loss," says Frédéric Delmavoisine, MSF field coordinator for Rutshuru. "A man we know who has been displaced in the bush has been calling me several times. He can hear the fighting, the use of heavy weaponry, but doesn't know where to go or how to seek protection."
MSF teams who were working in the Rutshuru referral hospital, have evacuated and have only been able to return twice in the past week in order to provide the hospital with much needed medicine and medical material. Before the fighting, MSF and hospital teams carried out an average of 25 surgical interventions a week, and saw over 100 patients a week in the emergency room. Around 80 patients a week were also taken care of in the pediatric and internal medicine wards. Currently, the hospital activities remain stable though lower than average.
The MSF team working in Katwiguru health center has also evacuated but has been unable to return. Prior to the evacuation, MSF doctors carried out an average of 300 consultations a week in Katwiguru, with 50 percent of consultations being due to malaria. Nearly 20 patients a week were transferred to the referral hospital due to complications, mostly related to malaria but also for gynecological and obstetrical secondary care. The health center in Katwiguru, which provided care for more than 17,000 people, is now closed due to lack of medicine, and the referral system is not functional. The people who remain in the area are subject to looting and harassment by armed groups.
Subject to increased insecurity, unable to work
"We are extremely worried about all the people who remain hiding in the bush with no access to care," says Jean Sebastian Matte, the MSF head of mission currently in Kayna. "The population of Kibiridzi is spending its fifth day in the bush, living in terrible conditions. All the 10 health centers on the axis between Kiwanja and Ishasha are not functioning as they have no medicine left, and we are unable to supply anymore. In this zone we used to refer many children for complications linked to malaria, 60 percent of them requiring blood transfusions. The MSF ambulance which was referring an average of 50 patients a week no longer works, which means that people are dying at home without any chance to reach the hospital."
MSF teams continue to work in Kayna general hospital and are still receiving wounded. MSF teams have also started providing medical care for more than 25,000 displaced people in Kanyabayonga. The resident population is also under considerable strain, as each household is hosting two to three displaced families in their homes. MSF teams are also providing medical care for 5,000 people who fled to Uganda. But MSF is still unsure when it will be able to return to work in Rutshuru.
As Jean Sebastian says, "The situation is so confusing for us that we don't know when we'll be able to bring assistance to the population that is still trapped in Rutshuru. Unfortunately there is no security for our teams to work properly, yet the civilians are at high risk and their situation is dramatic. Currently all we are able to do is to continue to supply the hospital in Rutshuru with medicine and medical material, and bring attention to the plight of these people so that their situation is not ignored".
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)