Doctors Without Borders/Médecins Sans Frontières (MSF) runs some of our largest medical humanitarian programs in Democratic Republic of Congo (DRC), where 4.1 million people were internally displaced last year alone due to longstanding crises in the east and new emergencies developing in other parts of the country.

MSF works in 20 of 26 provinces, responding to diseases outbreaks, conflict and displacement, along with health problems such as HIV/AIDS. In 2018, we have responded to two Ebola outbreaks, in Equateur and North Kivu provinces respectively.

The population has little access to healthcare, and outbreaks are frequent due to poor surveillance and infrastructure. Violence has led to crises in North and South Kivu, Tanganyika and Kasai regions, and has forced millions to flee. Three of our staff, abducted in North Kivu in 2013, are still missing.

 

Rape in Democratic Republic of Congo: MSF reports shocking levels of sexual violence in Kasai region

Between May 2017 and September 2018, Doctors Without Borders/Médecins Sans Frontières (MSF) treated 2,600 victims of sexual violence in the town of Kananga in Kasai Central province, Democratic Republic of Congo (DRC).

Eighty per cent reported having been raped by armed men.

“These figures are an indication of the high level of violence that has persisted throughout the past year,” said Karel Janssens, MSF head of mission in DRC. “The shocking testimonies from survivors that we have heard on a daily basis describe how people’s lives and communities have been torn apart, making it very difficult for them to rebuild and move forward.”

MSF teams provide psychological care in group sessions, and one-on-one for the most traumatized patients. Between March and September this year, 835 people benefited from individual consultations. Half of them reported that at least one member of their family had been killed and/or that their homes and belongings had been pillaged or destroyed. One in 10 spoke of having directly witnessed a murder or other act of violence.

Of the 2,600 people treated by MSF since May 2017, 32 were men, some of whom reported having been forced under armed threat to rape members of their own community. Another 162 were children under the age of 15, including 22 under the age of five.

 

Ebola outbreak continues in Democratic Republic of Congo

On August 1, an outbreak of Ebola was declared in the North Kivu province of Democratic Republic of Congo (DRC). It is the second Ebola emergency in DRC this year, and was declared shortly after the outbreak in the country's Equateur province was officially pronounced to be over. Read more at the link below or follow @MSFcongo on Twitter for more details.

As of October 10, the epidemic was not yet under control; new cases have appeared more than one hundred kilometres away from the epicentre. While the ongoing conflict in the region can represent an added challenge to the intervention, the response to the outbreak was immediate and some medical innovations may help to make the intervention more effective.

MSF Pulse: Ebola in Democratic Republic of Congo

Right now, our medical teams are on the ground in Democratic Republic of Congo responding to an outbreak of Ebola. In this episode of MSF Pulse, we look at what Ebola is, how it spreads and what we’re doing to respond to the current outbreak.

Doctors Without Borders/Médecins Sans Frontières (MSF) activities in Democratic Republic of Congo

Conflict and Violence

Armed conflict has triggered massive movements of people and their needs are immense. We provide emergency responses in the areas affected, notably currently in North and South Kivu, Kasai, Ituri and Tanganyika among others. We treat the wounded, cover basic health needs and adapt our services accordingly.

HIV/AIDS

We support the national HIV/AIDS program, which is implemented by the country's health authorities. Our teams work on improving access to screening and treatment, reinforcing treatment adherence, and patient retention. Awareness-raising through community-based activities is an important part of our projects.

Malaria

According to official statistics in DRC, malaria causes four times more deaths per year than conflict, meningitis, cholera, measles and respiratory diseases combined. Children are the most severely affected. Most of our projects include malaria care. We also carry out emergency interventions to contain outbreaks.

Outbreak response

DRC is prone to outbreaks of infectious diseases, such as measles, yellow fever and cholera. We run mobile teams, which can be quickly deployed in emergencies. Among our responses to outbreaks of communicable diseases are vaccination campaigns, case management (including surgeries), health promotion and water and sanitation activities. Ebola outbreaks are also recurrent in DRC, and we support local authorities in the response.

Women's Health

Many of our projects have an important component of women's health. Sexual violence is also a major issue in DRC, affecting men and boys as well as women and girls. We provide medical and psychological support, organise family planning activities, antenatal and postnatal consultations, and treat patients for sexually transmitted diseases.

Malnutrition

Last year, we observed an increase in admissions for malnutrition in all our medical structures. This is due to violence-triggered displacement, a bad agricultural season, and less funding. We are treating malnutrition in North Kivu, South Kivu and Kasai provinces.

Democratic Republic of Congo: From the 2017 MSF International Activity Report

MSF's activities in Democratic Republic of Congo last year included:

  • 1,772,000 outpatient consultations
  • 856,500 patients treated for malaria
  • 122,800 patients admitted to MSF hospitals
  • 42,700 patients treated in feeding centres
  • 38,300 births assisted
  • 19,200 patients treated for cholera
  • 15,800 major surgical interventions
  • 7,300 patients treated for HIV
  • 4,700 patients treated after incidents of sexual violence

Millions of people were displaced in the Democratic Republic of Congo (DRC) last year as new waves of violence erupted.

Conflict in Tanganyika province has intensified over the last couple of years, which has led to the displacement of over half a million people. In 2017, MSF stepped up its response, providing emergency assistance in Nyunzu and in makeshift camps in Kalemie and the surrounding areas. Many of the displaced are living in and around the town of Kalemie with host families, in makeshift camps or in school compounds. Some are sleeping on the ground with only a mosquito net for shelter. MSF activities included measles vaccinations, mobile clinics offering primary healthcare, as well as reproductive health services and mental health consultations, support to health centres and paediatric inpatient care. Teams also distributed water and built latrines and showers in some of the camps.  

More than 1.3 million people fled extreme violence in Greater Kasai region, with some escaping into the bush and hiding for weeks despite dire medical needs, unable to access care due to insecurity. MSF teams were able to treat some who had suffered severe injuries such as deep machete or gunshot wounds. The conflict triggered an acute nutrition crisis in rural areas and a sharp increase in sexual violence. Teams treated war-wounded patients in a rehabilitated wing of Kananga city hospital, performing 1,204 surgical interventions and provided care for victims of sexual violence. In Tshikapa, MSF supported care in a hospital, three health centres and the prison. On the outskirts of both cities, where many of the health centres had been looted, destroyed or burned, MSF ran mobile clinics.

Assistance for refugees and host communities

In September, MSF started to assist people who had fled conflict in Central African Republic by supporting hospitals in the northern towns of Gbadolite and Mobayi-Mbongo. Mobile clinics also provided care to some 67,400 refugees and their host communities.

Tens of thousands of South Sudanese refugees have settled in the north of DRC. MSF ran mobile clinics in the villages of Karagba and Olendere, in Ituri province, offering refugees and host communities access to basic healthcare, mental health support, sexual and reproductive health consultations, and referrals. A team also supported the regional hospital.

Providing comprehensive care in the Kivu provinces

The Kivu provinces are still reeling from the devastating Congo Wars of the 1990s and are plagued by ongoing fighting. More than 1.5 million internally displaced people live in the Kivus, where the humanitarian and medical needs only intensified in 2017 as the situation in the provinces deteriorated. Overall, MSF provided almost 1.5 million outpatient consultations and admitted more than 95,000 patients to its facilities in North and South Kivu.

Teams continued to manage four comprehensive projects in Masisi, Walikale, Mweso and Rutshuru in North Kivu. Each supported a hospital, as well as health centres and community treatment sites. A new project was also set up in Bambo.

When violence broke out again in South Kivu in July, MSF treated the wounded, while continuing with its regular activities. In Lulingu, Kalehe and Mulungu, the team focuses on care for children under 15, sexual and reproductive healthcare and treatment for victims of violence. Teams also implement a community-based approach to treat malaria and malnutrition. The main activities in Baraka and Kimbi are paediatric care, HIV and tuberculosis (TB) treatment, sexual and reproductive health, and care for victims of sexual violence.

Response to epidemics

Due to poor access to healthcare, the average life expectancy in DRC is around 58 years. One in 10 Congolese children dies before the age of five.

Emergency response is a core activity for MSF in the country. Five teams are dedicated to monitoring health alerts and deploying a rapid response to outbreaks of violence, population displacement and epidemics across this vast country. In 2017, MSF launched 62 emergency interventions. During the first half of the year, most were in response to multiple measles outbreaks. In total, teams vaccinated 1,050,315 children against measles, and treated 13,906 for the disease.

From mid-2017 MSF switched its focus to a cholera epidemic that started in the Kivus, where cholera is endemic. It spread to the rest of the country, becoming one of the biggest outbreaks in DRC of the last two decades. Overall, MSF cared for 19,239 cholera patients nationwide.

MSF also responded to an Ebola outbreak in remote Likati province in May; four people died during the outbreak, which was quickly contained.

Addressing longstanding health issues

Malaria is endemic and the main cause of death in DRC. MSF teams treated 856,531 patients for the disease in 2017, more than for any other illness. MSF experimented with new models of care that can be adapted to local settings to improve treatment, for example the introduction of large-scale community-based projects. These are currently running in Baraka and Kimbi, and teams in Bili, Mweso and Walikale are exploring this option.

Women’s health remains an important component of most MSF projects. This includes treating patients who have had unsafe abortions and care for people who have suffered sexual and gender-based violence, especially in Kasai, the Kivus and Mambasa in Ituri.

In 2017, MSF intervened in the Kivu provinces, Uélé and Kasai regions to address high levels of malnutrition among children.

MSF continues to provide comprehensive medical and psychosocial care for people living with HIV and AIDS in Kinshasa, Goma, Baraka and Kimbi, and works with the national HIV programme, partner organisations and patient groups to improve access to testing and treatment. In 2017, 7,185 patients received antiretroviral treatment at MSF-supported health centres in Kinshasa, Goma, Mweso, Baraka and Kimbi. Over 2,990 patients with late-stage HIV were treated in MSF’s AIDS unit in Kinshasa alone.

In Maniema province, an MSF mobile team tested over 18,000 people for human African trypanosomiasis, also known as sleeping sickness, 42 of whom required treatment. While the prevalence of this neglected disease has decreased in the past decade, there are still many presumed hotspots that are difficult to access.

Project closures

In March, MSF closed its Shabunda project in South Kivu. In seven years, 927,000 outpatient consultations were carried out. In April, MSF closed the project in Manono, where teams had worked in the regional hospital’s paediatric department and health centres.

At the end of the year, activities in Rutshuru, Boga and Gety were handed over to the Ministry of Health. During its 11 years in Gety, MSF undertook 573,200 outpatient consultations and assisted almost 13,500 births.

Our missing colleagues

On 11 July 2013, four MSF staff were abducted in Kamango, in the east of DRC, where they were carrying out a health assessment. One of them, Chantal, managed to escape in August 2014, but we are still without news of Philippe, Richard and Romy. MSF remains committed to obtaining their liberation, including through the mobilisation of a crisis management team. On 30 September 2017, a member of the crisis management team was sentenced to 10 years’ jail for his involvement in trying to solve the crisis. MSF is working to resolve this situation in the best possible way.

More about MSF's activities in Democratic Republic of Congo