DR Congo: Violence in Masisi territory causes severe malnutrition

This year, severe acute malnutrition is surging among children in parts of North Kivu, where armed conflict has forced many people to flee their homes and agricultural lands.

Violence, displacement, and malnutrition care in Masisi’s territory

Democratic Republic of Congo 2023 © MSF/Laora Vigourt

GOMA, Democratic Republic of Congo, October 26, 2023—Armed conflict is causing a sharp increase in children with malnutrition in the Masisi territory of North Kivu province, Democratic Republic of Congo (DRC), Doctors Without Borders/Médecins Sans Frontières (MSF) said today, after clashes between armed groups have forced many people to flee their homes and agricultural lands. 

Since January, hospitals supported by MSF teams in Masisi and Mweso have together admitted an average of 800 children per month with severe acute malnutrition, which is nearly double the monthly average in 2022. 

Masisi territory is known for its fertile green hills, around 12 miles northwest of the provincial capital Goma, and agriculture is the main economic activity. It has been affected by armed conflicts for years but the situation has deteriorated further since 2022 due to clashes between the March 23 (M23) Movement, Congolese armed forces, and various other armed groups. 

In recent months, access to the land has become more restricted by armed men setting up checkpoints and "tax points" on the roads. People have difficulty reaching their lands and are often forced to abandon them, leaving their crops unharvested. 


Violence, displacement, and malnutrition care in Masisi’s territory
Fahida plays with her son Joel, 12 months, who was admitted for acute severe malnutrition in the Intensive Therapeutic Feeding Center.
Democratic Republic of Congo 2023 © MSF/Laora Vigourt

"Because of the armed men, I can't get to the fields every day," said Fahida, the parent of a boy admitted to Masisi hospital. "When we take the road, we are afraid of meeting armed men along the way. They demand money and may even kill or rape us.”  

Health centers need support to treat malnutrition 

There are few functional medical facilities and those that are open are often short of essential medical supplies. The health authorities struggle to support local medical facilities and supply them with medications and Plumpy’Nut, the peanut-based therapeutic food used to prevent and treat malnutrition.  

When children with moderate malnutrition do not receive proper treatment in health centers, they are more likely to become severely malnourished and suffer medical complications, which are much more difficult to cure. 

“Today, there are almost as many admissions to hospital intensive care units as there are to outpatient malnutrition programs in health centers,” said Dr. Nadine Neema Mitutso, medical activities manager at Masisi Hospital. “Yet most of these hospital admissions could be avoided if children were treated in a preventive manner in health centers."   

After a child leaves the hospital, families are faced with the same difficulties of obtaining regular and therapeutic food, so the risk of relapse is high. 

"To put an end to this vicious circle, a holistic response is needed from all actors in the region,” said Carole Zen Ruffinen, MSF project coordinator in Mweso. “Sustainable solutions need to be found to meet the growing nutritional needs of the population.”  

MSF calls on other organizations working in North Kivu to ensure a sustainable operational presence to prevent the disastrous consequences of malnutrition, and on Congolese authorities and donors to strengthen the medical response capacity of health facilities, particularly in terms of malnutrition treatment.  

Parents struggle to feed their children 

With people’s access to markets hampered, there has been a reduction in trade, while food shortages have led to a significant rise in prices. Last year, a bag of cassava flour cost around 500 Congolese francs (less than 20 cents USD); since then it has quadrupled in price and now costs the equivalent of a day's work in the fields, even though it is not enough to feed a family for a day. 

A displaced mother and child inside their tent made of wood and tarpaulin sheets in the displacement site of Katale.
DRC 2023 © Laora Vigourt/MSF

Children now receiving treatment for severe malnutrition have also had harrowing experiences. 

"My daughter started to swell gradually—first her face and then all over her body,” a local man named Mandela explained. “I took her to the health center where they gave her some peanut-based paste, but not enough to allow her to recover. On the fourth visit, as her condition had worsened, the doctors referred her to Masisi hospital."   

Testimony - Micheline
Micheline, 23, holds her son Daniel, 10 months, who was admitted to the Intensive Therapeutic Feeding Center of the general referral hospital of Mweso, North-Kivu.
Democratic Republic of Congo 2023 © MSF/Laora Vigourt

Micheline, a displaced woman whose son was hospitalized in Mweso, said: "My child fell seriously ill, but what struck me most were his eyes—they were sunken and empty. I rushed to the health center and they transferred him to hospital. It's the first time one of my children has suffered from malnutrition." 

MSF's longstanding work in Masisi territory 

For 15 years, MSF has been providing medical care in Masisi territory, supporting two general hospitals and 12 health centers in collaboration with the Ministry of Health. MSF teams also treat malnourished children in three inpatient therapeutic feeding centers, including one in the health center of Nyabiondo in the Masisi health zone, as well as nine outpatient centers in Masisi and Mweso health zones. MSF also provides supplies of therapeutic food and essential medicines to treat malnutrition, while its health promotion teams raise awareness among local communities about the signs of malnutrition and the importance of receiving timely treatment.