Burundi: Fever, hunger, and war

© Didier Ruef Click on image for full size After a medical consultation with MSF, mothers and their babies rest outside the village health center in Rutongo, in Burundi's Bujumbara Rural province. The peaceful scene belies a country scourged by war, malaria and hunger
Feeding centers in several provinces fill to capacity. Nurses don masks against the stench of death, attending to wounded and sick people in the capital after a violent surge in the civil war. The people of Burundi faced no shortage of violence and hardship this year. Since 1992, MSF has continued to provide medical aid to stricken civilians in this war-torn country. An unprecedented malaria epidemic... Malaria hit Burundi in September 2000. The disease rose to epidemic levels in nine of the country's 16 provinces. In November alone, 720,000 people fell ill countrywide. To help the overwhelmed health system cope with the outbreak, MSF put in place a vast emergency response effort that, by late 2000, stretched to Kayanza, Karuzi, Cancuzo, and Ngozi provinces. Nearly 50 additional volunteers were brought in for the emergency effort, along with many additional local staff. Click on image for full size
MSF worked in numerous health centers, diagnosing and treating the disease as well as providing medical material and drugs. Mobile teams fanned out to bring care to malaria sufferers in isolated villages. In December, at the peak of the outbreak, MSF teams held over 75,000 consultations a week. Between the onset of the epidemic and the end of its crisis level in April 2001, MSF treated over 1,200,000 patients and sprayed over 30,000 homes in an effort at vector control. As of July, the caseload was still 6,000 patients a week in some areas. If the epidemic's direct causes were natural - the parasite-carrying mosquito and climatic factors - its indirect causes were man-made. Virtually all vector control was stopped in 1993, the year the country fell into war. MSF field studies also showed that the parasite prevalent in the outbreak was resistant to the standard Burundian treatment protocol for simple cases, chloroquine-FansidarÃ?® - adding to the virulency of the epidemic. MSF pushed for months for a more effective medicine to be accepted by the Burundi health ministry. after resistance studies by MSF and other organizations, in July 2001 Burundian authorities and the World Health Organization finally accepted the use of another drug, CoartemÃ?®, a more effective drug using artemisinine derivatives, in case of another epidemic. MSF is continuing to study the feasibility of other malaria protocols in Burundi and is pushing for more effective treatments to be adopted as the nationwide protocol. ....and malnutrition In the midst of the malaria epidemic, the nutrition situation in northern Burundi began to deteriorate. MSF was already running long-term feeding programs in Karuzi and Cancuzo provinces. With the first alarming signals, MSF opened new therapeutic feeding centers (TFCs) for the severely malnourished and supplementary feeding centers (SFCs) for those suffering from moderate malnutrition. MSF also called on the World Food Program and its donors to effect a general food distribution to help alleviate hunger. During the peak of the crisis, from November 2000 through March 2001, MSF opened seven TFCs and ten SFCs in Karuzi province, and one TFC in Ngozi province. Feeding centers in Cankuzo province expanded to meet increased need during the crisis. MSF also supported four SFCs run by the Burundian health service in Ngozi. At one point, the SFCs in Karuzi were treating nearly 20,000 children and pregnant and breastfeeding women at a time, while the TFCs provided aid for several thousand people. A TFC in Kamenge, where MSF also set up a cholera treatment center, aided 60 - 90 children at a time. The bitter fruits of conflict In the Bujumbura area and in Kayanza, MSF continues to provide surgical care to civilians wounded by the war. Access to the Bujumbura neighborhoods of Kamenge and Kinama was cut off for several weeks in March 2001 by fighting. Mobile teams worked in Kamenge during the fighting, and a center for war-wounded treated 80-100 patients. After once again gaining access to Kinama, MSF launched two clinics there. MSF also assisted 2,000 families who fled Bujumbura Rural during the fighting for refuge in the Mubone area. In Makamba, a region in southern Burundi that is home to a large displaced population, MSF was finally able to restart its medical program in May 2001 after being denied access to the area for almost a year. An MSF surgeon works in the hospital. In Bujumbura, Bujumbura Rural, Karuzi, and Cancuzo, MSF continues its ongoing preventive and curative programs that provide basic medical care, vaccinations, mother-and-child care, and nutrition support, through a network of hospitals, health posts, and mobile clinics. International staff: 44 (plus 48 additional staff during malaria epidemic) National staff: 825 (plus 1,100 additional staff during malaria epidemic and malnutrition crisis)