We run some of our largest programmes in the Democratic Republic of Congo (DRC). In 2019, we worked in 21 of out of the country's 26 provinces and responded to one of the biggest outbreaks of measles in decades. We also worked with people displaced by conflict, and those with health problems such as HIV/AIDS.
People have little access to healthcare, and disease outbreaks are frequent due to poor surveillance and infrastructure. Violence has led to crises in the Kivus, Tanganyika and Kasai regions, and has forced millions to flee. Three of our staff, abducted in North Kivu in 2013, are still missing.
Armed conflict has triggered massive movements of people and their needs are immense. We provide emergency responses in the areas affected, notably currently in North and South Kivu, Kasai, Ituri and Tanganyika among others. We treat the wounded, cover basic health needs and adapt our services accordingly.
We support the national HIV/AIDS programme, which is implemented by the country's health authorities. Our teams work on improving access to screening and treatment, reinforcing treatment adherence, and patient retention. Awareness-raising through community-based activities is an important part of our projects.
According to official statistics in DRC, malaria causes four times more deaths per year than conflict, meningitis, cholera, measles and respiratory diseases combined. Children are the most severely affected. Most of our projects include malaria care. We also carry out emergency interventions to contain outbreaks.
DRC is prone to outbreaks of infectious diseases, such as measles, yellow fever and cholera. We run mobile teams, which can be quickly deployed in emergencies. Among our responses to outbreaks of communicable diseases are vaccination campaigns, case management (including surgeries), health promotion and water and sanitation activities. Ebola outbreaks are also recurrent in DRC, and we support local authorities in the response.Read more on recent Ebola outbreaks in DRC
Many of our projects have an important component of women's health. Sexual violence is also a major issue in DRC, affecting men and boys as well as women and girls. We provide medical and psychological support, organise family planning activities, antenatal and postnatal consultations, and treat patients for sexually transmitted diseases.
In 2017, we observed an increase in admissions for malnutrition in all our medical structures. This is due to violence-triggered displacement, a bad agricultural season, and less funding. We are treating malnutrition in North Kivu, South Kivu and Kasai provinces.
Our activities in 2022 in DRC
Data and information from the International Activity Report 2022.
The humanitarian situation deteriorated further in DRC last year, mainly because of increased levels of armed violence, in particular due to the resurgence of the M23 armed group in North Kivu. The escalation in conflict and insecurity forced nearly 600,000 people to flee their homes, in a province where 1.9 million people had already been displaced.
Responding to violence-related emergencies
Throughout the year, fighting was concentrated in Rutshuru territory, North Kivu. While most humanitarian organisations left the area, MSF maintained regular activities, supporting health facilities in Rutshuru, Binza, Kibirizi and Bambo to provide intensive care, surgery, therapeutic nutrition and treatment for victims of sexual violence. In addition, we set up emergency interventions for displaced communities. As well as delivering healthcare by running mobile clinics and supporting essential care in health centres located in nearby displacement sites, our teams built latrines, and distributed water and relief items such as hygiene and cooking kits.
Due to the violence in Rutshuru, tens of thousands of people fled to neighbouring Nyiragongo territory, near Goma, where they gathered in informal settlements that were totally lacking in basic services such as shelter, healthcare, food and water. MSF was one of the first organisations to launch an emergency intervention in the settlements in Munigi and Kanyaruchinya. Our teams offered general healthcare, treatment for victims of sexual violence, referrals to Goma hospitals, and safe drinking water, while repeatedly calling on the humanitarian community to support the response.
When the first suspected cases of cholera were reported in these settlements in August, we organised an oral vaccination campaign. However, in October, as fighting intensified in Rutshuru territory, there was a huge influx of new arrivals, and a cholera outbreak could not be prevented. For many weeks, our teams were the only healthcare providers responding to this emergency, setting up dedicated treatment centres.
The violence was by no means limited to the areas directly affected by the resurgence of M23. Conflict broke out in other areas of North Kivu, such as Masisi, and deliberate attacks against civilians continued unabated in Ituri province. Although the lack of security guarantees for our teams forced us to close our projects in Nizi and Bambu, in Djugu territory, we maintained our activities in and around Drodro, treating victims of violence and providing access to basic healthcare, as well as water and sanitation activities for displaced and host communities.
Elsewhere in DRC, our teams supported people affected by outbreaks of violence in Tshikula territory (Kasaï Central), and in Mai-Ndombe and Kwilu provinces, where an intercommunal dispute over land quickly spiralled out of control. Here, our teams organised hundreds of medical consultations and referred the seriously injured to the capital, Kinshasa.
Outbreaks of infectious diseases
While the resurgence of M23 was the main focus of public attention towards DRC in 2022, another underreported health crisis was once again a major cause of MSF’s emergency interventions: a new, country-wide flare-up in measles cases. Measles reached epidemic levels in nearly half of DRC’s health zones, with close to 150,000 cases and 1,800 deaths officially reported.
Our teams carried out 45 specific measles responses in the country, while also continuing to run our usual immunisation and care activities in our regular projects. We vaccinated over two million children against measles in the course of 2022.
We responded to other disease outbreaks during the year, including cholera in North Kivu, South Kivu and Kasaï Oriental provinces, where we treated patients and protected tens of thousands of people through oral cholera vaccinations. We also assisted the Ministry of Health’s response to a meningitis outbreak in Haut-Uélé, and to two Ebola outbreaks in Equateur and North Kivu provinces.
Our regular general and specialist healthcare activities
In addition to our emergency responses, we maintained our regular general and specialist medical activities across the country, including HIV and tuberculosis treatment, sexual and reproductive healthcare, safe abortion care, mental health services, and support to marginalised people, such as children living on the streets, prisoners and professional sex workers. We also supported the rehabilitation and construction of several health facilities.
Malnutrition continued to be a key medical issue in several provinces, leading us to launch dedicated interventions in Tshopo, South Kivu and Haut-Uélé. Malaria also remained one of the main diseases treated by our teams in the country. In 2022, we launched specific prevention and treatment activities in South Kivu during the peak season to support the health authorities. We also conducted major indoor household spraying campaigns and mass drug administration activities, the latter consisting of the distribution of a malaria chemoprophylaxis, in Angumu, Ituri, to reduce the high prevalence of malaria in the area.
Meanwhile, the number of patients admitted for sexual violence remained remarkably high in the five provinces where we have dedicated projects for victims, offering them a full package of medical and psychological care. As part of an innovative approach to addressing the high level of sexual violence in Salamabila, our teams worked with the community to set up two ‘husband schools’, spaces where men engage in awareness-raising sessions on sexual violence. The aim is to inform and influence them in a positive way, as they are usually the primary decision makers within their households and their communities.
The extent of activities carried out in DRC by MSF in 2022 once again reflects the magnitude of the medical humanitarian needs in the country. At the end of the year, over 26 million people were in need of assistance, and more than 5.7 million remained displaced, the largest number on the African continent*.