In the east of the Democratic Republic of the Congo, civilians have borne the brunt of more than a decade of violent conflict. Villages have been pillaged and destroyed, armed men have forced people to flee, and rape has been used as a tool of war. In 2010, thousands more people were displaced from their homes by violence. Throughout the country, decades of neglect of the health system have resulted in a rise in infant and maternal mortality rates and, according to the World Health Organization, life expectancy is among the lowest in the world.

Providing healthcare in conflict zones

The project in DRC – in terms of programmes, staff and budget – is Médecins Sans Frontières’ biggest.

Teams offer general and specialised medical care in hospitals, health centres and mobile clinics in various provinces, including the capital city Kinshasa and the wartorn east of the country. In 2010, our staff carried out more than one million medical consultations, performed more than 10,000 surgeries and assisted 19,200 births. Staff treated patients for HIV/AIDS, tuberculosis, cholera, haemorrhagic fevers, measles, malaria, sleeping sickness (human African trypanosomiasis) and more. Teams carried out vaccination campaigns and emergency surgery, ran nutrition programmes and offered paediatric care. Mental healthcare was also offered, as well as women’s healthcare, including specialised assistance to victims of sexual violence.

After three years of relative stability in the Bunia region, Ituri province, Médecins Sans Frontières handed its activities in Bon Marché hospital over to the Ministry of Health. SOFEPADI, a Congolese non-governmental organisation that specifically helps female victims of sexual violence, will take on responsibility for the women’s health department. Teams provided care for 675 women in the six months before the handover process began.

In other places, conflict intensified, and poor infrastructure made accessing remote areas even more difficult. Around the town of Pinga in North Kivu, where the community is trapped by fighting across a constantly shifting front line, teams used motorbikes to hold mobile clinics and provide medical supplies. In Hauts Plateaux, a very isolated and mountainous part of South Kivu, teams walked for up to six hours to reach displaced communities and carried out close to 13,800 medical consultations. Supplies can only reach Shabunda by cargo plane, and our teams then used bicycles and motorbikes to bring medical care to 22,000 displaced people. In the Uélé area, in Orientale province, insecurity means that many displaced people can only be reached by plane.

Staff at mobile clinics, health centres and hospitals in Bunia, North and South Kivu, and Haut-Uélé and Bas-Uélé provided medical, psychological and social support for almost 6,000 victims of sexual violence. In North Kivu, where it is difficult to reach the more remote settlements, we also trained a network of women counsellors to respond to the needs of victims of sexual violence and, where necessary, to refer patients to the hospital for further care.

Rapid response units

In the capital Kinshasa, Kisangani in the north, Lubumbashi in the south and Mbandaka in the west of the country, our teams work closely with the Ministry of Health to monitor the epidemiological situation in DRC. Evaluation teams investigate any claims of infectious disease outbreaks or other quick-onset medical emergencies, and are prepared to respond within days. In 2010, the units responded to ten crisis situations, including yellow fever and measles outbreaks, and supplied emergency medical aid to people caught up in fighting in Equateur Province.

Responding to outbreaks of disease

Measles epidemics occurred throughout the country in 2010. Médecins Sans Frontières teams vaccinated 2,700 children in Nyanzale, North Kivu, nearly 90,000 in the Baraka area in South Kivu, 103,000 in Sakania, 40,000 in Dilolo and 8,000 in Bendera in Katanga province.

The poor living conditions in displaced persons camps and the lack of clean water also facilitated the spread of cholera in South Kivu in 2010. Médecins Sans Frontières emergency teams set up cholera treatment centres and treated more than 1,600 patients in Kabizo, Makobola, Minova, Mwenga and Shabunda. Our staff supported the response to cholera outbreaks in two displaced persons camps in Kalemie, Katanga province, providing case management expertise and medical supplies.

Malaria is among the leading causes of illness and death in DRC. Our teams treated 27,000 patients in Katanga province, 26,000 in North Kivu, and 19,000 in South Kivu. Many were children under five.

Haut-Uélé and Bas-Uélé are two of the areas in Africa most affected by sleeping sickness. Our staff treated 829 patients for this deadly disease, which is transmitted to humans through the bite of the tsetse fly.

Obstetric fistula surgery

In Masisi hospital in North Kivu, and in surgical “camps” in Shamwana and Manono in Katanga, more than 130 operations were carried out on women suffering from obstetric fistula. Fistulas are injuries to the birth canal which can occur as a result of complications in childbirth or, occasionally, extreme sexual violence, and which can cause incontinence and crippling social stigma.

Specialised emergency burns intervention

In July, Médecins Sans Frontières launched a specialised emergency intervention when a fuel tanker crashed and exploded in Sange in South Kivu. More than 230 people died and 96 were seriously injured. Teams provided medical care and mental health support to 52 patients with severe burns in two hospitals in the region. Surgeons conducted skin grafting (a skin transplant that encourages rapid healing), and teams provided burns patients with individual intensive nursing care and physiotherapy.

HIV/AIDS

Teams started more than 850 new patients on antiretroviral treatment (ARV) in Médecins Sans Frontières’ HIV/AIDS project in Centre Hospitalier de Kabinda in the centre of Kinshasa in 2010, bringing the total number of patients receiving the medication to 2,631.

Médecins Sans Frontières also began supplying medication, financial and technical assistance to “Postes de Distribution”. These are community-based ARV distribution points that give patients responsibility for their own care. The centres were set up and are managed by people living with HIV/AIDS who are members of the Réseau National d'Organisations Assises Communautaire (RNOAC), a nationwide patient support group.

Médecins Sans Frontières has worked in the Democratic Republic of the Congo since 1981.