Permanent Emergency in North Kivu

In Nyanzale and Rutshuru, North Kivu (eastern Democratic Republic of Congo), Médecins Sans Frontières teams are faced with recurring emergencies, including malnutrition, surgical emergencies and epidemics. Insecurity persists in the region, where the population is subject to violent attacks and continues to flee. Romain Gitenet, our head of mission in DRC, provides an update on Médecins Sans Frontières’s work there.

Médecins Sans Frontières operations in North Kivu have increased considerably since we began working in that region. What changes have been made?

We strengthened our teams in Rutshuru and Nyanzale so that we could provide more extensive medical assistance across wider geographic areas. For example, the Rutshuru hospital had 115 beds when we arrived in 2005. Today, there are more than 200. We still cover the pediatrics, internal medicine, surgery and emergency departments and also set up a blood bank.

We began working in maternity in 2007. We share responsibility for this department with the health authorities and handle exclusively caesarian births and post-operative care. Given the high number of women who are undergoing caesarian sections, we had to set up a second operating room in 2007.

Surgery represents a major activity. In 2005, we performed two operations/day, while the 2008 average is 12/day. We do not have time to perform elective surgeries and nearly all are emergencies.

With respect to our work outside the city, we travel out from Rutshuru based on where the displaced populations are located. We travel as close as we can to the landlocked areas so that we can reach the populations living in insecurity. 

During two to three months, mobile teams see patients at health centers located south and north of Rutshuru . This flexible and adjustable program allows us to respond to the movement of populations fleeing fighting, to seasonal peaks in malaria and even to epidemics. 

How is it in Nyanzale, a town located in an area where there are many movements of populations?

We have stabilised and expanded our program in Nyanzale by assigning more staff people there. We treat malnutrition in a therapeutic feeding center. We also provide consultations to children under the age of 5 and treat malaria, which is still found even though the site is located at a high altitude.

The team covers a large area, reaching as far as Katsiru and Bambu. When patients require surgery, we refer them to a hospital supported by a Médecins Sans Frontières section. The other major focus of our work is treating victims of sexual violence. In January, we treated 300 rape victims.

How do you provide care to this group?

We provide consultations in our two health centers in Nyanzale and Rutshuru. There, too, we are present in neighboring areas thanks to a system of ambulances. Médecins Sans Frontières pays for the rape victims’ transportation so that they can be treated right away. They must be treated within 72 hours after the attack if prophylactic treatment for HIV/AIDS is to be effective. The population is well-informed. A network of women distributes information and the message is broadcast on the radio, emphasising the need to obtain medical treatment within 72 hours.

Has the security situation improved after the January 21 ceasefire agreement?
The situation has not normalised. The ceasefire agreement has not been fully implemented because armed groups remain active in the province. Some rebel groups continue to fight for their political demands or to maintain control over income-producing territories. Armed groups attack the population, stealing their resources and food. Nothing has improved for people, who continue to flee violence. The displaced persons often stay close to the area where they live because they continue to hope to return home. They might be two hours’ walk from home, but are attacked on the roads and in the fields. Rape victims are often attacked while working in or returning from the fields.

What illnesses do the Médecins Sans Frontières teams treat?

We treat malaria on a cyclical basis, two or three times/year, based on the epidemic’s peaks. In the paediatric department at the Rutshuru hospital, we treat many children suffering from malaria and severe anemia. However, we also work upstream, providing direct support to health centers in the areas most exposed to malaria. That way, they can treat the population at no charge and patients do not arrive at the hospital in a severe condition.

Have you also had to deal with epidemics?

In late 2007, we faced a cholera epidemic of unusual proportions and we recorded more than 2,000 cases in 1½ months. The explanation lies in the precarious living conditions of the displaced population. The villages where they are concentrated are growing and becoming cities, but lack the necessary infrastructure. In response, Médecins Sans Frontières set up a cholera treatment center in the Rutshuru hospital and treatment units on the city outskirts. Other organizations worked on improving access to water because vibrio cholerae is transmitted in water. The number of cases has fallen sharply since January, but is picking up, with 4 – 20 cases/day, so we are resuming our awareness efforts. In addition, measles cases have been spotted since early January. Continual population displacement increases the risk of the spread of this contagious illness, which can be fatal, especially for children. We plan to hold a vaccination campaign in the Nyanzale and, next, Rutshuru areas, where measles cases have also been reported.