Month in Focus - September 2008

DRC: Tension mounts again in North Kivu The peace process faces serious threats in North Kivu. Despite the signing of the January 2008 Goma agreement between the government and several rebel groups, frequent fighting has continued in the eastern region of the Democratic Republic of Congo. In late August, tension mounted further and heavy weapons fighting broke out between General Nkunda's rebels and the regular army. No official statement has been issued, but the situation is causing increasing concern, particularly for the displaced populations. Coralie Lechelle, DRC program manager: "The front continues to move north, so all the displaced populations with whom we were working over the last months -- estimated at 250,000 people in camps in this very small area of North Kivu - they're evacuating further north. So we set up an additional team to assist the displaced populations that are constantly moving and for whom we are still lacking detailed information. We wanted to see where they would gather and try to provide them the minimal level of aid that they urgently need." Most of the team at the Rutshuru hospital, where Médecins Sans Frontières has been working for three years, had to evacuate - only a doctor, nurse and field coordinator remain. Coralie Lechelle, DRC program manager: "We chose to evacuate part of the team and maintain just a minimal presence so that we could still treat the wounded -- who remain a priority - along with medical and surgical emergencies. The field coordinator stayed, too, to keep us informed on what is happening in the area." MSF mourns the loss of Dr. Samuel Bamoueni, who died in an airplane accident in the Democratic Republic of Congo. Originally from Congo Brazzaville, he was working as a surgeon for MSF in North Kivu. He was among 17 people on board a humanitarian flight that crashed outside Bukavu. GAZA: Health Held Hostage to Politics Health care workers in the Gaza Strip have been on strike since August 30. The Palestinian health workers union called for action in protest at Hamas' firing of 46 medical workers affiliated with Fatah. Annette Heinzelmann, Gaza Program Manager: "Today, there are two governments in charge of the Gaza Strip. On one side, there's the government based in Ramallah and then there's the Hamas government in Gaza, and so the health system in the Gaza Strip is governed by these two. This makes the situation very, very difficult for the health care workers, who are caught between two very different sets of instructions." Although a minimum of service has been maintained, the strike has received wide support. Absenteeism among medical staff ranges between 50 and 80%, severely restricting access to care for the more than 1.5 million residents who are already deeply affected by the Israeli-Palestinian conflict. Annette Heinzelmann, Gaza Program Manager "We noted a sharp rise in consultations, particularly in our pediatrics project in the north of the Gaza Strip, so we expanded the program, adding staff to be able to treat patients, to treat children according to their needs." Specialized surgery has been suspended throughout the Gaza Strip and external referrals are very limited. Médecins Sans Frontières continues to provide mental health and post-operative care and treats many wounded, for the most part victims of the intensified inter-Palestinian clashes. ETHIOPIA: Lack of food draws crowds This is the Oromiya region, in southern Ethiopia. Dr. Roberta Petrucci is making her morning rounds in the Kuyera emergency nutritional center. Rahima is 7 months old and is suffering from pneumonia and acute malnutrition. Other children like her - malnourished, with medical complications - have also been hospitalized. Interview with Dr. Roberta Petrucci (in English): "They are prone to infections because they are very weak. Their immune system is not working like the ones of the others children. So they cannot react like everybody else to the infections. They cannot produce enough antibodies so they cannot fight the infection themselves and they need extra support, extra medical support." Malnourished children, even those suffering with moderate acute malnutrition like Rahima, need nutritional and medical care. Until mid-July, MSF teams faced a massive influx of severe cases. More than 23,000 patients have already been admitted to the approximately 50 nutitional centers opened in response to the emergency. Over the last few weeks, the teams have also been able to treat the many children with moderate malnutrition. In some areas, they represent a third of the children under five. In addition to free medical care, people need assistance in terms of food. Hiam El Zein, field coordinator: "We provide a monthly ration of 25 kilos of Famix and 5 liters of oil; Naturally you're going to get large crowds like this because the people here in this region need food. And now that they know we're treating cases of moderate malnutrition, everyone is rushing here to get their share." These families, who are already very poor, have been without food for many months. They have got into debt to feed themselves and some have even sold their livestock. The next harvest, expected between late September and November depending on the area, should finally provide relief. GEORGIA: Assisting the displaced persons This young woman's daughter suffers from a neurological illness. Originally from the Gori region, they had to flee their home as Russian troops advanced into Georgian territory. Several days earlier, on the night of August 7, the Georgian army launched an attack in southern Ossetia, driving people from their homes. Amidst the panic, this mother did not have time to gather her daughter's medications. Like her, more than 200 families are living in this abandoned building, a former Tbilisi military hospital. Most of the displaced persons in the Georgian capital have gathered in public buildings -- schools, child care centers or, here, in this geophysics research institute. Several days after fighting broke out, Médecins Sans Frontières' medical teams began their medical consultations. Most of the patients are women, children and elderly people. Dr Nana Chiochvili: "When we analyzed the data, we could see that the most common complaints were anxiety, weakness, sleep problems and high blood pressure, plus we've had cases of decompensated diabetes, due to interruption of treatment. It's the same thing for young children. They're having sleep problems - they are young, but they are very anxious. They've been exposed to bombings, explosions and fear." Although the situation has eased since the August 12 ceasefire, MSF continues to provide medical assistance to the displaced persons who are still in Tbilisi. So far, the team has provided 900 consultations and distributed nearly 800 hygiene kits, which include soap, detergent and buckets. In Gori, the authorities have set up a camp offering tents as accommodation for the displaced persons who have returned. MSF is supporting the town's medical centre by providing consultations, and three mobile teams visit the various sites set up for the displaced, primarily in child care centers, and the surrounding villages.