1 November 1998
International Staff:54 National Staff: 441 NUTRITIONAL PROBLEMS EMERGE Although the government announced peace and reconstruction for 1998, rebel groups and the army maintain pressure on the civilian population, violence continues and no political solution is in sight. However, international pressure and the need to get people back to work, led to half the "regroupment" camps being dismantled by the end of 1997. The health situation is deteriorating because of insecurity, population displacements, the continuing economic embargo, lack of access to health care for those unable to pay and transport difficulties for medicines and sick patients. MSF has been present in eight of the country's 15 provinces on behalf of an estimated 2.3 million people (37% of the total population). The main activities were support for surgical services in provincial hospitals, drugs supplies and technical assistance from expatriate medical staff, support for surgical services in provincial hospitals, and emergency health care for the displaced and returnees. Nutritional programmes are another important element and increased in 1998 in response to the deteriorating food situation, particularly in the war zones. Supplementary feeding was initiated in four IDP sites in Nyanza-Lac and Vugizo, Makamba province, in December 1997, and a therapeutic feeding centre for 250 children was added in February 1998. MSF has taken over a nutritional programme in Karusi province for 150 severe cases and 1,500 moderately malnourished. Nutritional programmes are also running in Matongo, Kayanza province, and in Cankuzo province. A feeding centre for the IDP population in Kamenge (Bujumbura province) covered 300 severely malnourished in May 1998. The centre had to be extended to cope with the growing numbers. MSF is responsible for drugs supplies in Kayanza province and for surgery in the provincial hospital. In Makamba province, a team provides support for surgery and anaesthesia in the hospital, and ensures drugs supplies, medical supervision in 21 health centres and epidemiological monitoring. In Kirundo province, where the situation has been improving, MSF started to reduce similar support provided to 15 health centres and by February 1998, the only remaining responsibility in the provincial hospital was for Caesarean sections. MSF continued to manage the 50-bed Kinyinya hospital, Ruyigi province, until its hand-over to the Ministry of Health at the end of 1997. A team still provides staff training, particularly in surgery. Surgical support and drugs supplies continue for the provincial hospital here and in Cankuzo province, where the maternity department is also supported. The health centres in Cankuzo are also supported. District health programmes are conducted in Ruyigi, Ngozi and Karusi provinces, as well as surgery in the 220-bed Ngozi hospital (the fourth largest in the country). MSF provides support to two health posts in Ruyigi; one in an orphanage and the other in a transit camp for returnees (Gisuru) In Bujumbura, MSF's support for a hospital emergency department involved volunteers in caring for scores of injured civilians following an attack near the airport at the start of 1998. A team is also working in a transit camp for returnees in near-by Gatumba, on the border with the Democratic Republic of Congo.