Democratic Republic of Congo
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.
We are currently responding to the coronavirus COVID-19 pandemic in DRC.
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 2020 in the Democratic Republic of Congo
Data and information from the International Activity Report 2020.
Despite repeated upsurges in violent conflict and restrictions imposed by the pandemic, Médecins Sans Frontières (MSF) provided vital humanitarian and medical assistance in 16 of DRC’s 26 provinces. Our services included general and specialist healthcare, nutrition, vaccinations, surgery, paediatric and maternal care, medical and psychological support for victims of sexual violence and vulnerable people, as well as treatment and prevention activities for HIV/AIDS, tuberculosis (TB) and cholera. In 2020, we also responded to DRC’s largest measles epidemic and two simultaneous outbreaks of Ebola, in addition to COVID-19, which had claimed 591 lives by the end of the year.
The impact of the pandemic was felt in all of MSF’s 14 projects and 28 emergency interventions in DRC. In the capital, Kinshasa, the city hit hardest by the disease, emergency support, including providing treatment, in Saint-Joseph hospital was offered between April and September. In addition, our teams launched a campaign on Facebook to address the lack of information that had led to mistrust, rejection and sometimes violent reactions towards medical staff. In the provinces where we run regular projects, facilities were adapted to ensure continuity of care, including for the 2,093 patients at the MSF-supported Kabinda hospital, which is dedicated to the treatment of advanced HIV/AIDS and TB.
While much of the world’s attention was focused on the COVID-19 pandemic, the DRC was still in the grips of the world’s biggest active outbreak of measles, which started in mid-2018. Although the outbreak was declared over on 25 August, there was a rise in cases after this date in Mongala, Équateur, North Ubangi and Sankuru provinces, and MSF continued to carry out mass vaccination campaigns and treat patients with complications. According to the Ministry of Health, 70,652 confirmed cases and 1,023 deaths were reported between January and August 2020.
In the east, the tenth, and the biggest, Ebola outbreak in the country’s history was declared over on 25 June. By then, it had infected 3,470 people and claimed 2,287 lives. MSF supported the response by providing care in treatment and transit centres, offering non-Ebola care, collaborating in the vaccination programme and distributing health promotion information. When the eleventh outbreak was declared in Équateur province on 1 June, all responders knew from past experience that a high degree of decentralisation and strong logistical resources would be required, due to the widespread distribution of cases, accessibility and acceptance issues, and a strong preference for community-based healthcare.
A decentralised model of care was gradually implemented, in which mobile teams were sent to treat patients in difficult-to-reach areas. The joint response effort used the latest medical tools, increased laboratory capacity and set up temporary isolation units at community level. By the time the outbreak was declared over, on 18 November, there were 118 confirmed cases, and 55 people had died ─ a 42.3 per cent case fatality rate, which was significantly lower than the 66 per cent observed during the previous outbreak. In 2020, MSF treated 199 Ebola patients.
The level of sexual violence remains extremely high in DRC, both in provinces affected by active conflict and in those considered more stable. During 2020, MSF provided medical and psychological care to victims of sexual violence in Kasai-Central, Ituri, North Kivu, South Kivu, Maniema and Haut Katanga. Although the number of victims who seek care in the facilities we support is high, we believe the scale of the problem is significantly under-reported.
In 2020, more than half of the people who received medical and psychological care in an MSF-supported facility, or from MSF community outreach teams, had been assaulted by armed aggressors. In the areas where we work, we observe obstacles that hinder access to care for patients, such as armed conflict, a lack of infrastructure and drugs, stigmatisation, shame, and fear of reprisal. During the third quarter of the year, 66 per cent of victims of sexual violence sought care within 72 hours of the assault. This enabled them to have access to post-exposure prophylaxis to prevent HIV; emergency contraception; antibiotics to prevent sexually transmitted infections; and vaccinations for tetanus and hepatitis B. They also received psychological support and treatment for physical injuries.
General and specialist healthcare
In Ituri and Kivu provinces, which have been plagued by conflict for many years, MSF has maintained general and specialist healthcare in long-term projects, ensuring continuity of lifesaving care while responding to epidemics and mass displacement, among other emergencies. However, the escalation of violence in 2020 and its impact on our teams operating in some of the affected areas led to a reduction in our activities and our ability to reach patients.
In North Kivu’s Masisi territory, where we have worked for more than a decade, the delivery of healthcare through mobile clinics, community-based outreach and ambulance services was reduced after an incident that affected patients and health teams. In South Kivu, MSF teams experienced several incidents in Fizi territory in 2020. These were the latest among many in recent years, and they forced us to make the reluctant decision to reduce our presence in Fizi and hand over all our activities except essential services to the authorities. During 2020, we started to consider how to adapt our way of working so that we can maintain our assistance to people in need, without exposing our patients and staff to the high risks we currently face.