North Kivu, Democratic Republic of Congo

Violence in the North Kivu province of the Democratic Republic of Congo (DRC) has intensified since August 2007, displacing hundreds of thousands of people and creating major obstacles for people to access health care. Jane Coyne, Doctors Without Borders/Médecins Sans Frontières (MSF) head of mission in DRC, provides an update of situation in North Kivu, and explains the toll that lack of basic health care is taking on the people of this region.

Can you give us a sense of what civilians in North Kivu are facing in terms of medical needs and access to care?

In this latest round of fighting, which started in mid August, we've seen another wave of massive displacement. We don't really know what the numbers are; they change every day. According to some estimates, between 100,000 to 150,000 people were displaced since mid August on top of the already 300,000 to 500,000 people displaced. Yet it is extremely hard to know given the fact that many are displaced several times. In any event, this is displacement on a large scale and the reality is that people who are displaced from their homes are living in really marginal conditions. We are now seeing more people living in camps than we've seen in North Kivu in the last 10 to 15 years. These people are living in small huts that are covered with plastic sheeting in an attempt to shelter themselves from the rain. They are unable to go to the fields to harvest their crops. Their access to food is almost completely dependant on the ability of aid organizations to reach them and distribute food.

In the displaced persons camps, people are living in relatively cramped conditions, which can increase the risk of communicable diseases. In the last few months our teams have treated cholera and measles. We had a large-scale measles epidemic in our program in Nyanzale and we've had an increase in the standard pathologies we see in normal times and an increase of the severity of diseases like malaria and respiratory infections and diarrheal diseases.

What are our teams seeing or treating on a typical day?

We have both primary care activities and secondary care activities. In Rutshuru, for example, we run a 200-bed hospital that provides internal medicine, pediatrics, surgery, and emergency care. And in the hospital we had a 50 percent increase in admissions in the third week in October. In response, we added tents to increase our inpatient capacity, increased shifts, and reinforced the pharmacy with additional supplies. We can do all those things, but it obviously presents challenges to maintain the quality of care. From a primary health care perspective, we also have mobile clinics based with our team in Rutshuru and those mobile clinics are going to where those displaced populations have regrouped. For a day in a mobile clinic team, you're packing up the car with doctors, nurses, and medicine and then going to these locations. We perform maybe 100 to 150 consultations a day and most of those consultations are with children under five. We try to focus on the most vulnerable.

Where are these people you can't access? Why is access such an issue?

The conflict in North Kivu has multiple armed groups involved, so every time you cross into one of the frontiers controlled by an armed group, it's more complicated for access to the population. There are places in North Kivu where no international organization has been in a long time, so there are places where we don't really know what the state of the population is.

What is most striking about what is happening in North Kivu right now?

The most striking feature of North Kivu right now is just the scale of the problem, the scale of displacement, the magnitude of disease. I mentioned before that we had a measles epidemic. Measles is a disease we don't see any more in western countries because everyone is vaccinated. So the problem right now is just pure vaccination coverage. We had 500 cases of measles in a small health center in a relatively small population and there is just no reason for children to die of such an easily preventable disease.

What is the most important message you would convey to the public about the medical situation in North Kivu?

People are not dying from complicated things; they're dying from completely preventable problems. With the current displacement we have, they are living in terrible conditions, children are getting respiratory infections, the respiratory conditions aren't treated, they come into the hospital with pneumonia and it's too late. The long-term impact of violence in Congo is that people can't get access to basic health care and that's what we're fighting to do every day. And where we're working, I think we're doing a fine job, but there are a ton of places where we're not working. People are dying from things that are completely preventable.