Documenting the impact of violence, displacement and Ebola disease in Plaine Savo, DRC
New photography from MSF teams on the ground documents the conditions experience by the 76,000 people now living in the Plaine Savo site for internally displaced people in Ituri Province, Democratic Republic of Congo. They cannot leave because of violence outside the camp, and they are forced to live in harsh conditions without the most basic services.
Displaced people in Plaine Savo face severe danger, crowding, hunger, poor sanitation and limited healthcare after fleeing violence in Ituri Province. MSF is providing medical care, water and sanitation support, and Ebola treatment capacity, but needs remain urgent as the outbreak threatens to spread in the camp. Aid response must urgently scale up to protect people's lives, dignity and safety.
Plaine Savo: A daily struggle to survive amid violence, displacement and Ebola disease
Fleeing Violence in Bule
"Our houses were set on fire. The day we left, there were gunshots everywhere."; "People fled without taking anything with them. Some were killed, others raped or abducted."; "Until today, we do not know where those who have disappeared are. We do not know whether they are dead, in prison or still alive."
Antoinette, 60, sits in front of the small shelter where she has slept for the past eight months. Last December, the nearby village of Bule, where she used to live, became the scene of clashes between the armed group Convention pour le révolution populaire (CRP) and the Armed Forces of the Democratic Republic of Congo (FARDC). The fighting emptied the town. It was the second time Antoinette had been forced to flee in a few years.
Arrival in Plaine Savo
Most of the people who fled settled near a base of the Ugandan army, which is in Ituri under a cooperation agreement with the Congolese government. They hoped the area would be safe. Antoinette remembers the first days in what later became a camp for tens of thousands of displaced people. 'When we arrived here, we spent about two weeks with no shelters or plastic sheets, exposed to the rain. We finally built small huts with pieces of wood, plastic and straw,' she said.
Overcrowding, Hunger and Danger
Since then, life has barely improved. The site is crowded and ringed by armed men who, until recently, stopped people from leaving to reach fields, markets and water sources. Most residents still fear the trip outside and remain cut off from the means they need to survive. Danger and access limits also make it hard for aid groups to work. Since December, only two food distributions have taken place.
"The supplies are finished and we are still waiting for the next one. We have almost nothing to eat and the children are suffering. Life here is very hard."Antoinette said.
MSF Health Post and Essential Care
In February, MSF set up a health post to provide basic healthcare to the population. At the time, it was one of the very few aid groups present at the site. Alphonsine works there as a nurse supervisor. She used to work in Bule before fleeing violence. When she first arrived in Plaine Savo, she saw diarrhea, scabies, typhoid fever and parasite infections spread fast, mostly because there was no clean water.
"There were illnesses and deaths. Since MSF has been here, the number of deaths has really gone down." she said.
Today, the health post provides:
- Primary healthcare
- Child care
- Maternity care
- Mental health care
- Care for survivors of sexual violence
- Care for acute malnutrition cases that come in every day
Medical Records Reflect the Level of Violence
The level of violence that people in Plaine Savo face is clear in the health post's records.
In the last six months:
- An average of 60 survivors of sexual violence were treated each month.
- Seven people injured by gunshots or blades were treated each week.
- In most cases, people were assaulted or hurt while trying to leave the site.
- An average of nine malnutrition cases were admitted each week.
"Getting the right nutrition is hard because people cannot go to the fields and farm. If safety was better, the population could grow food and we would not face hunger." Alphonsine explained.
Emergency Referrals to Fataki Hospital
For the most severe cases needing surgery, MSF has obtained approval for its ambulance to transfer patients from Plaine Savo to the Fataki General Referral Hospital, about 15 km away by road. The hospital is also supported by the medical group. The measure saves lives, especially for patients with gunshot wounds and pregnant women. 'There used to be many maternal deaths in the camp because we could not take the mothers to the hospital,' Alphonsine said. 'But we have not recorded any since the MSF vehicle can take them to Fataki at any time.'
Ebola Outbreak Worsens the Health Situation
The Ebola outbreak, declared by national authorities in May, has badly worsened the health situation in Ituri. Over the past months, 36 confirmed cases were moved to the 24-bed Ebola treatment unit MSF set up at Fataki General Hospital, which will soon grow to 32 beds. But the risk to staff forced MSF teams to stop providing surgical support to the hospital, showing how deeply the outbreak has affected the wider health system.
So far, three confirmed cases have been found in Plaine Savo. Thanks to community support and MSF help, all were referred early, diagnosed and treated in Fataki hospital.
But the threat of Ebola is still hanging over the camp, and everyone knows how severe the impact could be if the virus spread further. 'We are very afraid. Some of us have family members who have died in Mongbwalu and Bunia,' Alphonsine said, naming Ebola hotspots. 'Shelters in Plaine Savo are crowded and often not even separated by half a meter from each other. If the disease arrives here, people could die in large numbers. That is why we are raising awareness among the population.'
In the fight to prevent the Ebola disease from spreading – it is transmitted through direct contact with sweat, excrement or other bodily fluids - access to clean water, sanitation and hygiene is key. Since February, MSF teams have been restlessly working at improving the situation in the camp: building 311 latrines, and providing an increased quantity of water to the population through water trucking, while digging nine new boreholes.
But more work needs to be done, as the both the number of latrines and the daily amount of drinkable water available per person in the site remain critically low. Timelier non-food item (NFI) and food distributions are needed, and protection activities aimed at sheltering the most vulnerable from abuse.
“This is the worst humanitarian situation I have seen in years” testifies Trish Newport, Emergency coordinator for MSF. “To preserve the lives, dignity and safety of displaced people in Plaine Savo, as well as to help better protect them against Ebola disease, the response must be urgently scaled up. This means more actors on the ground with a greater capacity to intervene”. She concludes.
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