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Democratic Republic of Congo
MSF in Democratic Republic of Congo, 2004
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After years of war in the Democratic Republic of the Congo (DRC), efforts to end the conflict moved ahead in 2003-4. A transition government is now in place and elections are scheduled for June 2005. Yet the path to a lasting peace is fraught with obstacles and little has been done to alleviate the miserable conditions in which most civilians live.
Throughout the country, medical services are woefully inadequate if they exist at all, and much of the country remains in a state of emergency in terms of health. MSF continues to witness massive humanitarian needs in many of the places where it works. Since 1998, the International Rescue Committee estimates more than three million people have died as a result of the war, mainly from malnutrition and disease. Parts of the DRC continue to be inaccessible to humanitarian aid due to fighting, forcing the population to live under the specter of violence, displacement, malnutrition and disease. In reality, few civilians can get the medical care and health services they urgently need.
The eastern district of Ituri, in Orientale province, which last year became notorious for instances of mass murder, remains volatile even after European Union troops and later United Nations troops pacified parts of the region, re-establishing law and order in at least some of the main towns. In May 2004, seven armed militia groups from the embattled district signed an agreement with the government to disarm and participate in the country's transitional democracy process. However, renewed fighting broke out shortly thereafter between armed factions in Ituri, with mass pillaging and rape sending thousands of civilians on the run again.
Long-term conflict in the DRC has left people in most provinces vulnerable, and hundreds of thousands depend on external assistance for basic medical care and food. The end of active fighting between most of the belligerents has enabled MSF to travel into areas that, until recently, were too unsafe to enter. New projects have opened, and the quantity of humanitarian assistance being provided has increased. Greater stability has also made it possible for Congolese people to travel farther from home or from their area of displacement to seek assistance.
MSF continues to provide hospital and basic health care, nutritional assistance to malnourished children, care of war-injured civilians, and psychological counseling. In many areas, the organization has been treating patients affected by outbreaks of infectious diseases such as cholera, meningitis and measles which are endemic in many parts of the DRC. MSF has launched vaccination campaigns to tackle such outbreaks, having vaccinated 500,000 children against measles in the Equateur and Orientale provinces. In these two provinces, the transportation infrastructure is appalling, and many areas can only be reached by dug-out canoe or motorbike. MSF is running basic health care clinics there, serving some 700,000 people. Some of these clinics are among the most remote in the country.
In the Equateur province and in the village of Isangi, in Orientale province, MSF is also working to combat sleeping sickness, a deadly disease that is extremely prevalent in the region. The project in Isangi includes a research component aimed at introducing more efficient drugs to treat those with the disease. In 2003-4, national health authorities agreed to allow MSF to carry out several research studies examining the efficacy of various antimalarial drugs. The results should aid MSF's efforts to advocate for the national malaria protocol to be changed to artemisinin-based combination therapy (ACT), a more effective therapy, in 2005. Teams that are treating malaria in the DRC have already introduced ACT in their projects.
Treating survivors of sexual violence
During the past year it has become increasingly clear that sexual violence, mostly against women, has been a terrifying reality for people during the years of war. MSF is now working in several areas including Baraka, in South Kivu province (see page 25) and Bunia, in the Ituri region, to help survivors of this violence by treating their physical symptoms and providing counseling to address trauma. Hundreds of patients have received medical care and counseling from the MSF teams in Baraka, and more than 1,600 women have been treated since July 2003 in Bunia. MSF has also treated patients who have experienced sexual violence in Kinshasa and Kisangani, and the organization makes such treatment a part of the integral care it provides in North Katanga, North Kivu and Equateur. MSF hopes that a national protocol will be developed to ensure proper treatment for survivors of sexual violence.
Giving AIDS care
HIV/AIDS is beginning to take a massive toll on the DRC. There is very little data on the prevalence of the disease let alone adequate treatment for those living with it. MSF has been treating people with AIDSrelated opportunistic infections, providing testing and counseling services and raising awareness about HIV prevention. The organization has developed a comprehensive program in Lubumbashi, Kisangani, Mbandaka and the nation's capital, Kinshasa, to fight sexually transmitted infections among those carrying out highrisk behavior, especially commercial sex workers. In October 2003, MSF started a treatment program using life-extending antiretroviral (ARV) medicines for severely ill AIDS patients in the eastern town of Bukavu, located in South Kivu province near the Rwandan border. MSF is the only organization providing such treatment in eastern DRC. Similar programs have been launched in Kinshasa and Lubumbashi. By the middle of 2004, 66 people were enrolled in the treatment program in Bukavu and 250 were enrolled in Kinshasa, while thousands of medical consultations were done each month.
In late May 2004, renewed fighting broke out in Bukavu, and tension quickly spread to the surrounding regions. The upsurge of violence forced MSF temporarily to evacuate most of its staff from five project sites in the Kivu provinces, but local staff managed to keep the programs running. MSF provided crucial medical care to approximately 32,000 Congolese who fled to Burundi following this outbreak of violence. Displacement caused by fighting north of Bukavu prompted MSF to bring medical assistance to civilians near the town of Kalehe who had been forced to flee their homes.
In Kitenge, in the province of North Katanga, more than 40,000 people were displaced and 50 villages set ablaze in the first five months of 2004 amid fighting among various militias and government troops. Since June, displaced people have started returning to their villages, yet they have few if any resources now that their crops have been destroyed by armed groups. MSF has been working in the region since 2002 providing medical care and treating severely malnourished children.
Admissions to MSF's therapeutic feeding center doubled to 200 in April 2004 with 60 percent of the children from families that had been displaced recently. Two of the health centers in which MSF works were closed due to nearby violence. One of them, in Kaloko, was looted and partially destroyed during fighting. The other, in Kileo, was reopened in March 2004. MSF is now strengthening the referral hospital in the town of Ankoro to respond to emergencies in North Katanga. While sporadic outbreaks of extreme violence capture headlines in the media, huge swathes of the DRC exist in a constant state of catastrophe. MSF has four permanent emergency teams covering the length and breadth of the country. These staff members respond to emergencies ranging from measles and cholera outbreaks, to displacements due to violence, to nutritional crises.
The transition process in the DRC has continued to be severely tested in 2004, and there is concern that war may resume. MSF is again launching interventions to respond to the needs of the newly displaced. From east to west, needs in the DRC remain vast and while it is clear that the transition represents a step forward, it is only an early step on a long road.
MSF has worked in the Democratic Republic of Congo since 1981.