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In Kasai, “even the birds had stopped singing”

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MSF international president Joanne Liu has recently returned from a visit to Kananga city, in Kasai Central province, Democratic Republic of Congo. She shares her impressions of the ongoing crisis there.  

Dr Joanne Liu examines a baby during the daily round in the feeding centre in Gwange. Maiduguri, Nigeria, February 2017.
Malik Samuel/MSF

During my recent visit to Kasai I went with our teams to a rural part of the region that has been particularly affected by violence. Villages and fields have been burned, and several mass graves have been discovered. A man approached us and said very simply, “The violence here was so terrible that we didn’t hear the birds sing for days.”

Yet when I first arrived, I got the impression that nothing had happened there. Kananga is a fairly typical, bustling Congolese town of around 750,000 people. The markets were full and loud music played from the small shops.  This was not the same situation that my colleagues discovered in March. Back then, silence filled the town. Not a single school or shop was open. Fear was everywhere. In the end, I realised that the normality I was witnessing in the town was similar to the experience someone has visiting a loved one’s grave a year after their burial, when the grass has started to regrow over the tomb. Life has taken hold again. 

I remember seeing a teenage girl laughing and running after other children along the hospital corridors. It was as if nothing had happened to her. But several weeks before, her sister had been decapitated in front of her eyes. The armed men took her away and kept her tied up on the floor for ten days. They raped her so many times it’s impossible to count. “If you speak, we’ll cut your head off like we did to your sister” they told her. What is clear is that the people of Kasai have lived through so much, it’s barely imaginable. 

The crisis in Kasai started a year ago, but it’s taken a lot of time for us to comprehend its magnitude. During the worst months, no humanitarian aid arrived there – and it’s still extremely limited. Why didn’t communities ask for help earlier? A village elder replied: “When you are lying on the ground and people are shooting at you, you can’t get up and run.” MSF only started to work in Kananga in March – very late, too late – and today we are still conscious that we are only just scratching the surface of the problem.

The wounds of the patients that we treat tell us about the extreme levels of violence that the people of Kasai are facing. Out of fear, some seriously injured people have waited days, or even weeks before trying to see a doctor.  One of the patients our surgical team treated had his hand cut off. He hid in the bush for several weeks, afraid of being found and killed, and treating his stump with traditional medicines. By the time he arrived at our hospital, an abscess had formed and a serious infection had developed in the bones of his forearm. His chances of avoiding further amputation are slim.

Fleeing from Kasai
A refugee who fled Kasai in the Cacanda camp, Angola, July 2017.  
Bruno Fonseca

If our mental health teams ask what has happened, our patients never tell us who has inflicted this violence – the fear is always there.  But they tell us their stories, which are invariably awful: your husband decapitated in front of your eyes; your wife raped in front of you and your children while you are tied up, forced to watch. But they only tell us their story once. Afterwards, they always ask the same questions: how can I earn a living, feed my family, rebuild a home. What is my future?

The crisis in Kasai is like a forest fire during the driest summer months; one spark in August 2016 has ignited the whole region. Millions of people have been caught in the crossfire of militia attacks, army repression, and even localised conflicts which have nothing to do with the initial spark, but have exploded due to the chaos that has reigned. And if today Kananga is returning to normal, very worrying sounds are still coming from other places in this region which is the size of Italy. The lack of access due to security issues makes it difficult to tell the difference between rumour and reality. What is for certain is that, even if from the outskirts it seems as if nothing has happened, a human tragedy has unfolded – and is still unfolding.

MSF independently manages the 70 bed trauma wing of the Kananga General Hospital (Kasai Central province). The team rehabilitated the operating theatre and offers free care for victim of violence and accidental trauma. Since April 2017, 238 patients have been hospitalised and 550 surgeries have been performed. MSF also runs mobile clinics in the countryside around Kananga which have to date provided 9,146 consultations.

Since June 2017, MSF has been supporting three health centers and one general reference hospital in different areas of the city of Tshikapa, in Kasai province. These focus on providing assistance to children under five years of age, to pregnant and lactating women, the wounded, and people with medical emergencies caused by the violence and its consequences. In July, the teams expanded activities to different rural areas around Tshikapa.

MSF teams are also carrying out mobile clinics in rural areas surrounding Dibaya and Tshimbulu, in the south of Kasai Central. The original epicentre of the crisis, many villages have been destroyed and populations fled into the bush, leaving people in an extremely precarious health situation.

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