On Thursday, September 18, heavy fighting broke out between armed groups northeast of Masisi town, North Kivu province, in the Democratic Republic of Congo (DRC). The MSF team working in Masisi hospital provided emergency surgery to 17 civilians and armed men injured in the crossfire. Residents of Masisi town, neighbouring villages, and an estimated 12,000 displaced people in nearby camps, fled first to Masisi and then into the bush as fighting intensified. More than half of the patients and some hospital staff also fled, fearing fighting would reach the town. Despite the insecurity, MSF was able to keep the hospital running, including a nutritional centre with 54 malnourished children. By the following evening fighting ceased and many displaced are now returning to Masisi town. MSF is assessing needs and, following reports of rape perpetrated by armed men, raising awareness of the availability of medical care.

MSF is currently the only international organisation providing assistance in and around Masisi town.

"This situation is yet another illustration of the violence, insecurity and repeated displacement faced by the people of North Kivu," said Anna Halford, MSF Coordinator in Masisi. "Despite a peace agreement reached in January, fighting has increased in violence and frequency. Caught up in the fighting, civilians are again forced to flee their homes in large numbers."

In addition to direct violence from shooting and attacks, the vulnerability of the population is increased by recent looting of health centres, including those in Kachuga and Busihe supported by MSF. Over the past ten days, violence in North Kivu has resulted in the displacement of thousands of people. MSF will send an assessment team to Ngungu, a village south of Masisi town where as many as 17,000 people are said to have congregated.

MSF has also reinforced its programmes in areas like Kitchanga, which is hosting large numbers of people fleeing villages close to the fighting. The population of Kitchanga has doubled in the past nine months and MSF has opened two additional health posts to provide care for the increased numbers. In South Kivu province, 5,000 to 10,000 people fleeing violence have arrived in the Minova area, close to the border with North Kivu. An MSF team is evaluating the situation in the zone. Some wounded are arriving to the Minova Hospital where MSF has donated medical material and drugs.

Since early September, MSF has struggled to provide care in areas of active conflict in North Kivu. MSF had to relocate teams from Nyanzale and Kabizo, and to partially evacuate teams from Rutshuru. Today a reduced team is back in Nyanzale and full teams are back at work in Rutshuru and Kabizo. An emergency team is providing medical care to people newly displaced in Kanayabayonga.

MSF has continued to provide care in Mweso Hospital, though a large number of patients were relocated to protect them from fighting. In North Kivu, MSF provides free primary and secondary healthcare through support to hospitals and mobile clinics in and around Rutshuru, Nyanzale, Kabizo, Kitchanga, Mweso, and Masisi. MSF activities also consist of water and sanitation activities, treatment of rape victims, nutritional support, response to epidemics, and vaccinations.