Before MSF worked there, circumstances were dreadful. In the last decades, hardly any supplies had come and, at best, there would be one part time doctor present for the whole health zone of 500,000 people.

MSF teams have re-established a permanent team in Shabunda, a town in the southern Kivu province of the Democratic Republic of Congo (DRC), following a near eight month period where a long term MSF presence has been impossible.

The MSF team was first evacuated on April 13, following clashes between governement troops and the Mai Mai. There had been sporadic visits throughout the spring and summer where temporary visits, often lasting just a few days, afforded the team enough time to renovate a badly damaged hospital.

The hospital was opened in August this year but the team was obliged to evacuate again on September 21 because of violence and insecurity.

At the end of November, an MSF team managed to return as assess the conditions there and decided to return with a permanent team. MSF reestablished operations in Shabunda on December 6 and have started work in the renovated hospital.

Shabunda has between 15,000 and 20,000 inhabitants and is the centre of an extended, forested zone, with limited physical access, where an estimated 500,000 people belong to. The area used to be known, and rich, for palm oil and gold but the last ten years of violence has left it abandoned in the forests.

The withdrawal of Rwandan troops from the eastern Democratic Republic of Congo in early October had further destabilized the volatile situation in the area. Various local militias launched offensives to seize towns abandoned by the Rwandan troops and their Congolese allies. As a result, fighting erupted in several places where MSF works.

Mai Mai militias took Shabunda after the withdrawal of the DRC military. During the team's absence, limited activities continued with the few stocks remaining and some members of the local staff who were still present.

Finally after more than two months of intensive lobbying, the MSF team had an agreement with the two warring parties - the DRC military and the Mai Mai - to fly into Shabunda, crossing the political and military division lines, and continue their work.

Conditions on the return

"The roads to (Shabunda) are devastated, a truck hasn't gone there for years," said MSF country manager Vincent Hoedt. "In the past years, the people had to flee their houses due to extreme violence several times to live in very poor conditions in the wood. The re-opening of the only hospital in the region by MSF was quite a happening.

"Before MSF worked there, circumstances were dreadful. In the last decades, hardly any supplies had come, the staff was hardly ever paid and, at best, there would be one part time doctor present for the whole health zone of 500,000 people. Due to bombings during the fights, the roof partially collapsed and the hospital was nearly abandoned. Patients were only treated against high payment.

"There were four to five patients in the hospital that had to stay for weeks as they weren't able to pay a bill of 40 to 50 dollars. For people who barely can earn half a dollar a day, that is of impossible."

Gamaliel, a Congolese logistician remembered what happened when the hospital, repaired and painted, re-opened.

"It was a world of difference," he said. "The people were treated for free, there was motivated personnel and there were medicines. In no time the 30 beds were full.

"'This hospital means for us the difference between life and death'", was the people's reaction. In the hospital all different kinds of illnesses are treated; meningitis, malaria, or people who broke a leg after falling out of a tree.