North Kivu, DRC: In Rutshuru, spike in violence impacts medical care

Increased displacement makes civilians more vulnerable

Clashes have forced tens of thousands to flee in search of safety, with many settling in the Rutshuru area. At the town hospital, MSF is handling a sharp increase in the number of patients.

Over the past few months new waves of fighting in the Democratic Republic of Congo's North Kivu province have caused the massive displacement of an already weakened civilian population. The latest clashes in this eastern province, on October 19 and October 21, have forced tens of thousands of Congolese civilians to flee combat areas in search of safety, with many settling in the Rutshuru town area. During the same period, Doctors Without Borders/Médecins Sans Frontières (MSF) has seen a sharp increase in the number of patients arriving at the Rutshuru hospital.

"The civilian population of North Kivu is going through yet another episode of a protracted war," says Jane Coyne, head of mission for MSF in North Kivu. "While forced to leave their homes, they endure harsh living conditions, limited access to their fields for food, and increased risk of health problems. In this context, the medical needs of the displaced and local population can only be expected to increase. The fighting is reducing people's access to medical care when they need it most."

Increased number of patients admitted at Rutshuru Hospital in October

In Rutshuru, MSF has been running a 200-bed hospital since August 2005. MSF provides emergency surgical and medical care, pediatric care, and specialized care for victims of sexual violence through this facility. In recent weeks, the caseload has increased significantly at the MSF hospital.

"The weekly admissions to our emergency room went from an average of 155 to 236 during the third week of October—a 50 percent increase," says Augustin Augier, project coordinator in Rutshuru. It is, however, difficult to draw a direct connection between the increased caseload and the latest influx of displaced persons. "Still, we are concerned about access to several pockets of populations that have been completely cut off from assistance by the recent fighting." In October 2007, 330 surgical operations were performed, compared to a monthly average of 220 since January 2007.

While the fighting is forcing people to flee, common diseases are taking the heaviest toll on the displaced population. More than half of the patients admitted to Rutshuru hospital are suffering from acute malaria. This deadly, but easily curable, infectious disease is the biggest killer of children admitted to the pediatric ward. Severe upper respiratory tract infections (such as pneumonia), malnutrition, diarrhea, and obstetrical complications are also very prevalent.

"Mortality in North Kivu is strongly related to a general state of low immune reserve in a population who suffers from poor nutrition, living conditions and little access to medical care," says Dr. Maria Guevara, medical coordinator for MSF in North Kivu. "A concrete medical indication of this is the high prevalence of chronic anemia—low blood cell level—we see in a large number of patients. When such patients are then faced with having to fight against malaria, for example, or of any other conditions — respiratory infection, or diarrhea — their already low reserves are quickly overwhelmed and their condition becomes severe and often fatal, especially among children under five."

Mobile clinics and support to health centers

Much of the displaced people are said to be living in the forest without adequate shelter, water, medical care or food and under the continuous threat of insecurity. Often they are too scared to travel to health clinics or the local clinics are closed because the health care staff has fled the violence as well.

With thousands of displaced persons constantly on the move, MSF has dispatched medical teams to establish mobile clinics in schools, abandoned health centers, or tents to provide basic health care and refer severe cases to Rutshuru hospital. MSF's mobile medical teams have conducted more than 2,000 consultations in Kabaya, Kinyandoni, Rugare, Katale, and Karembi.

"Mobile clinics allow us to be flexible in reaching a displaced population," says Coyne. "Yet the insecurity limits our ability to reach the most affected areas on a consistent basis. In addition to basic health care the mobile clinic allows us to assure that the severest cases are referred back to the hospital to receive secondary health care. The mobile teams also play a critical role in identifying the first signs of epidemics."

Following fighting, many health centers were not functioning because either medical staff had fled or drugs had been depleted. Since early September, MSF has therefore rehabilitated and helped re-open three health centers in the Binza health zones that had been closed since February. In Buramba, Katwiguru, and Kiseguru MSF has conducted a total of 5,800 consultations to date.

MSF is currently operating seven projects in the province of North Kivu with a total of 475 Congolese staff and 45 international staff. MSF has been working in the Democratic Republic of Congo since 1981.