Democratic Republic of Congo
Key medical figures:
• 1,654,100 outpatient consultations
• 106,600 patients admitted to hospital
• 1,223,300 measles vaccinations (outbreak)
• 10,900 patients treated for cholera
Owing to a dysfunctional health system, people in Democratic Republic of Congo (DRC) lack basic healthcare, and in 2013 suffered numerous, preventable outbreaks of cholera, malaria and measles. The conflicts in the eastern provinces were also ongoing, displacing thousands.
Decades of conflict, lack of investment in the healthcare system and ongoing violence cause extreme hardship. Humanitarian aid is concentrated around big cities and places that are considered secure, but there is a need for a rapid, flexible humanitarian response to acute needs throughout the east of the country. Teams from Médecins Sans Frontières (MSF) are working to increase the availability of healthcare and respond to health emergencies.
While on an exploratory mission in July, Chantal, Philippe, Richard and Romy, four Congolese MSF staff, were abducted by an armed group during an attack on Kamango, North Kivu. At the time of writing, a dedicated team is still actively searching for them.
In 2013, measles epidemics continued to proliferate. Some health zones were overwhelmed by the number of cases, and MSF launched emergency campaigns, vaccinating more than 1.2 million children aged between six months and 15 years.
A health centre in Mugunga III camp for displaced people provided basic healthcare, dressings and aftercare for victims of sexual violence, carrying out more than 41,800 consultations and treating some 840 people for injuries resulting from sexual violence. A team focused on cholera prevention and treatment in Goma treated 1,660 patients. Displaced people at spontaneous sites around Bulengo also received healthcare from MSF, including psychosocial support for victims of sexual violence wanting to take legal action. In the hospital in Rutshuru territory – a region controlled by M23 rebels until they were forced to pull out in October – MSF continued to offer comprehensive healthcare, including surgery, intensive and emergency care, and treatment for victims of sexual violence. More than 7,600 surgical procedures were performed during the year.
In Masisi, MSF provides full support to the general hospital (internal medicine, surgery, gynaecology, maternity services, paediatrics and neonatology) and to two health centres in Masisi and Nyabiondo. There is a 76-bed maternity village for women in their third trimester of high-risk pregnancies. MSF also works with community advisors to counsel victims of sexual violence. Until June, healthcare was provided to people in Rubaya camp and to the host population.
Comprehensive healthcare is provided at Mweso hospital, with psychiatric services integrated into the basic healthcare programme. The nearby Kitchanga project closed mid-year. The mental health and sexual violence programmes were absorbed into the Mweso-based project, which alsotook over activities in Mpati and Bibwe. Other activities were handed over to Merlin. Security incidents caused the suspension of the Mweso project twice in 2013, but the teams at Mweso hospital provided more than 140,000 consultations, carried out more than 1,300 surgeries and assisted more than 4,500 deliveries. Basic healthcare, including the prevention of, and response to, epidemic outbreaks, and integrated psychosocial care were provided in Pinga. A security threat caused the suspension of the project there in July and activities had not resumed by year’s end. More than 34,389 outpatient consultations, 5,100 consultations for malaria and over 900 mental health sessions had been conducted in Pinga. In March, an emergency measles vaccination campaign in Vuhovi reached more than 51,000 children.
South Kivu hosted more than 800,000 displaced people in 2013, most of them in the Kalehe and Shabunda territories, where MSF provides basic and specialist healthcare in Kalonge, Shabunda and Matili hospitals and in 15 health centres in the surrounding areas. MSF supports a hospital and three health centres in Minova, an area regularly affected by conflict and influxes of displaced people, and conducts mobile clinics to assist victims of violence.
In Fizi territory, MSF provides comprehensive basic and specialist healthcare, including surgery, reproductive health services, neonatal treatment, prevention of mother-to-child transmission of HIV, tuberculosis and cholera treatment, vaccinations, nutritional support and sexual violence aftercare at Baraka and Lulimba hospitals and six health centres. In addition, MSF supports two permanent cholera treatment centres (CTCs). A new 100-bed hospital was also built in Lulimba
MSF emergency teams responded to a number of outbreaks of malaria, measles, rabies and cholera in South Kivu. Six cholera interventions were carried out in the province, more than 160,000 children were vaccinated against measles, and in Lemera over 100 people were vaccinated against rabies. During the malaria outbreak, 64,000 patients were treated in Fizi and 43,000 in the isolated Shabunda area. More than 565,000 outpatient consultations were completed in South Kivu in 2013.
Those in Katanga province receive very little humanitarian aid and suffer from a lack of quality health services and fees they cannot afford. MSF treats children in the paediatric unit of Kabalo hospital and 15 peripheral health centres, mainly for malaria. As a result of a measles outbreak in Kabalo, MSF provided hospital treatment and undertook a targeted vaccination campaign. When a nutritional survey indicated extensive malnourishment, one inpatient and three outpatient feeding centres were opened. In April, MSF completed a cholera intervention in Lubumbashi that had begun the previous November. The team built an 80-bed CTC and treated a total of 5,904 patients. Comprehensive health services continued in Shamwana and the surrounding area. Teams responded to cholera outbreaks in Kaiseng and Lukanzola and vaccinated over 150,300 children against measles in Moba. A project in Kalemie aimed at reducing cholera was suspended in November after two consecutive attacks on MSF. A cholera vaccination campaign was also cancelled.
In Geti, South Irumu, MSF continued to support the health centre and provided 59,567 consultations, an increase of 41 per cent on the previous year. Violent clashes between government and rebel forces in August caused massive population displacement in the area, and from September, MSF supported the maternity unit and operating theatre of Geti hospital to guarantee adequate healthcare for an increasing number of patients. During this time, teams assisted 726 births and operated on 106 trauma patients with conflict-related injuries. MSF also ran two mobile clinics, improved water and hygiene for displaced people, distributed 10,000 relief kits and conducted two measles vaccination campaigns, reaching a total of 42,567 children under 15.
MSF continued to work in the emergency department at Dingila hospital, and with Ministry of Health staff, screened and treated people for sleeping sickness at Ganga-Dingila and Ango, Bas-Uélé. Some 73,336 people were screened and 1,358 received treatment.During an outbreak of measles in Bas-Uélé, MSF treated 30,200 patients in the health zones of Ganga-Dingila, Buta, Aketi, Bondo, Likati, Titule and Poko, and vaccinated 189,000 children in the health zones of Ganga-Dingila, Buta, Aketi, Bondo and Likati.
The HIV programme based at Kabinda hospital has been increasingly decentralised and a community-based programme manages the distribution of antiretroviral (ARV) medication to stabilised patients. More than 5,500 patients are on treatment.
52 years old
I did not want to tell anyone about my HIV status. After the screening, I had to start treatment, US$200 treatment. But I had no money, not even US$10. A doctor referred me [to MSF] for free care. I am a salesman in a store; this is how I feed my wife, my daughter and my son. I was already working in this shop before, but I was sick all the time, I was no longer useful. So I was fired. I stayed at home. When I started ARVs, gradually I regained my health. But I had nothing to eat. A friend advised me to go to my ex-boss and explain. I told him that I was sick with HIV, but that I was taking the free drugs and had regained strength. The boss thought it brave that I came to talk to him like that, and gave me my job back.
No. staff end 2013: 3,604 | Year MSF first worked in the country: 1981