MSF-USA: DR Congo: In the Heart of Chaos

June 3, 2003
DR Congo: In the Heart of Chaos

Years of conflict in the Democratic Republic of Congo (DRC) have led to one of the worst emergencies in the world today, with millions of people already dead and thousands of others continuing to die from starvation and disease. Peace deals and ceasefires have not stopped the fighting from continuing and poverty from growing.

As this human crisis swells, Doctors Without Borders/Médecins Sans Frontières (MSF) is increasing its programs inside the country. MSF started working in the DRC (formerly Zaire) in 1981. Today, more than one hundred international volunteers are working alongside hundreds of Congolese staff to attend to some of the most urgent medical needs, both in the war-ravaged east of the country and in the poverty-stricken west. The MSF teams are often obliged to use all possible means to reach the population, travelling through the jungle by motorbike and canoe when necessary.

Photo ©Copyright Eva Van Beek/MSF

Nowhere to Hide

Conflict has raged among armies, rebel movements and proxy militias in the Ituri region of northeastern DRC since 1999, claiming 60,000 lives and displacing up to half a million people. Particularly severe fighting erupted in early May, adding to the grim toll of those being maimed, mutilated, and savagely murdered.

The provincial capital, Bunia, has been the epicenter of this recent outburst of violence. Situated next to the Rwenzori Mountains in the lush, green landscape just west of the Ugandan border, the only life in some parts of the near-deserted town were children wielding Kalashnikovs.

Since arriving in mid-May, a team from MSF has been seeing more than 100 patients a day at Bunia hospital, with 15-20 requiring surgeries every day. One young boy arrived after fleeing through the forests, bleeding from a gunshot wound. He had escaped a massacre in a nearby village. His parents did not. "Don't forget us," he said from his wheelchair. "Please don't leave us."

On the road out of the town, hundreds of people leave daily for points north and south, desperate to escape the brutality. Nearly 50,000 have fled to Beni, while no one knows how many are trapped and isolated in the surrounding forests. More than 10,000 people have erected tents near the UN compound and regional airport, hoping the proximity of lightly armed UN personnel will offer at least a measure of protection.

The cramped, unsanitary conditions in the camps have led to cases of cholera. Already, three people have been afflicted by the bacterial infection, and one person has died. MSF constructed a treatment tent in the center of town out of fears that a wider epidemic could occur, and has sent infusions, tents, chlorine and other water and sanitation materials to brace for such a blow.

Photo ©Frida Lagerholm/MSF

The frontlines shift, forcing people to perpetually flee the violence and terror. Reaching people affected by this displacement, who have often fled deep into the forest, proves difficult. MSF teams continue their attempts to bring basic health care to these populations cut off from aid. Their living conditions are shocking: they suffer from a lack of food and health care, and are often victims of forced labor and extreme violence, including rape. In eastern towns like Shabunda, where violence has forced MSF teams to evacuate more than once, MSF continues to support the hospital and the health centers. More to the south, in Katanga province, MSF delivers basic health care to IDPs and isolated communities and runs feeding centers for malnourished children.

Nowhere to Run

Access to health care is a nationwide problem in the DRC. Even if people overcome the limited transportation and poor roads to reach a health structure, they would discover that many of the health centers and hospitals are not functioning. The country's infrastructure has effectively collapsed, and there is a complete lack of medicines and trained health staff. MSF implements a health zones program in Equator, Katanga and Oriental provinces with the aim of ensuring access to quality health care for more than one million inhabitants along both sides of the frontline. MSF mobile teams travel from one health center to another and stay overnight in villages. Besides getting health posts and hospitals up and running again, this also involves improving the prevention and treatment of malaria, severe respiratory infections and sexually transmitted infections, raising awareness about sexual violence and increasing the measles vaccinations coverage. Measles is a major problem as the vaccination coverage in the country is lower than 40%. MSF has therefore decided to organize measles campaigns in all health zones where it is present.

MSF's Congo Emergency Pool (CEP) has bases in Kinshasa, Lubumbashi, Mbandaka and Kisangani and specialises in the rapid detection and response to emergencies, ranging from natural disasters and population movements to the increasing number of epidemics such as measles, cholera and meningitis. On average, CEP conducts over 30 assessments and carries out 20 interventions per year. Currently, CEP is vaccinating 80,000 children between the ages of 6 months and 15 years against measles in Banalia health zone (Oriental province) after it found 507 cases of the deadly disease. Another MSF team will start a vaccination campaign for 30,000 children in Kabalo (Katanga province) at the beginning of June.

MSF also pays particular attention to sleeping sickness with a program in Equator province and to the growing problem of HIV/AIDS. MSF runs an HIV/AIDS pilot program in Bukavu, providing voluntary testing and counselling, and treatment of sexually transmitted infections and opportunistic infections. Similar programs are in place in 33 health structures in Katanga province, 15 in Equator province and 47 in Kinshasa. This year, MSF hopes to expand the Bukavu and Kinshasa programs to include antiretroviral (ARV) treatment.