Anne, what does the MSF team do for people wounded in the fighting?
"When there is fighting, like recently near Masisi, we try to treat the many wounded people who arrive at the hospital in a very short time. Since the end of August, our surgeon and anaesthetist have performed surgery on 145 patients with bullet wounds.
"I remember one woman who was caught in the crossfire at the beginning of October. She was carrying her child on her back, but miraculously neither her nor the child were badly hurt. The bullet passed between her spine and her baby's head. It made a deep burn on her back but the medical team was able to treat her. I've also seen several civilians who have been shot in the leg and were taken to the surgical ward.
"In addition to the war victims, the health needs are also huge among the displaced and the local population...
"Since the end of August, when the MSF team started working in Masisi, the hospital's various departments have worked at full capacity. There are many caesareans - up to 20 per week - and other obstetrical problems.
"The health centre that MSF supports carries out an average of 1,000 consultations a week, mainly for malaria, respiratory and urinary infections, diarrhoea, and malnutrition problems. There are a number of reasons that we see so many patients.
"First, the care MSF offers is free of charge. Second, a number of the region's health's posts have been closed, either because the staff have fled or because these structures have not been supplied with drugs. Patients come from far away and often walk for several days in the hills, where they risk meeting various armed groups, to get to the MSF clinic. Many people arrive at the hospital in a critical condition."
What are the living conditions like for the displaced people in the Masisi region?
"There are an estimated 24,000 displaced people in Masisi and in the neighbouring localities of Lushebere and Buguri. Most of the time, they are hosted in families who give them some wood and reeds and the men then work to build some kind of temporary makeshift shelter for their families. For this reason, we often see women alone with their children at the hospital.
I have seen a number of houses where 10 or 12 persons had to sleep in spaces of about 16 square metres. Host families share kitchen utensils, jerry cans or food, but we can see that both the displaced and the local population are increasingly struggling.
It's the rainy season now and torrential rains are a daily occurrence. At an altitude of 1,600 metres, the nights are cold. In our consultations, we see a number of people with pneumonia, flu, but also diarrhoea, cases of dehydration and of malnutrition. All this suggests that these people live in extremely precarious conditions.
Is malnutrition a problem in Masisi?
"At the moment there are 40 children suffering from severe malnutrition in the nutritional centre of the hospital, which is run by a partner organisation. Last week, MSF conducted a rapid nutritional assessment among a thousand children under five years of age in Masisi and Buguri, based on the measurement of their arm circumference. This assessment indicates that about 10% of these children are suffering from malnutrition.
"Some of them are going to die because they're not getting enough food. Therefore, we have decided to launch an ambulatory nutritional programme targeting 1,200 particularly vulnerable children. This programme consists of three distributions per week, both in Masisi and Buguri, of therapeutic food for malnourished children and of additional rations for their families.
"The fighting has shut down the existing health system and nutritional support in the whole region. This often has terrible consequences for the people. Last week, three children died at the hospital. They had arrived in such critical conditions that we couldn't do anything for them.
"I remember one child who was brought by his mother, suffering from severe malnutrition with medical complications. The mother couldn't feed her son in addition to her other nine children at home. The child wasn't doing well at all, so she decided to take him to the church, but the church had been burnt down... Then she came to the hospital, but unfortunately it was already too late. I am worried about the people who survive in the more remote locations."