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Democratic Republic of Congo

Tens of thousands of people were affected by a huge measles epidemic in 2015

The Democratic Republic of Congo (DRC), an immense country the size of Western Europe with the fourth largest population in Africa, is in the midst of one of the world’s most complex and long-standing acute humanitarian crises. 

The eastern part of the country is still reeling from the devastating Congo Wars that claimed an estimated 6 million lives from the mid-1990s to the early 2000s. Over 1.5 million internally displaced people live in the Kivu provinces still plagued by active fighting involving a myriad of armed actors.

Since 2016, two new crises – in Kasai and Tanganyika regions – have added a strain on the country and triggered massive movements of people with 4.1 million people internally displaced in the country in 2017, including as a result of newer crises in the Greater Kasai area and Tanganyika region.

Despite its vast natural resources (lush rainforests, enormous deposits of copper, gold, and diamonds, tin, tantalum tungsten and 50 percent of the world’s cobalt), the DRC remains one of the poorest countries in the world, ranked 176 out of 188 in the world’s human development index. Few investments have been made since the 1960s to improve poor infrastructure. Congolese people have little access to basic services, including health, and as a consequence life expectancy at birth hovers around 58 years old. One in ten Congolese children dies before the age of five.

Due to extremely high humanitarian needs, the DRC is one of MSF’s main countries of intervention in the world in terms of the number of beneficiaries and the investment in HR and budget; the organization started working in DRC in 1976 and established a permanent operational presence in the country since 1985. Its large array of projects tackle acute problems deriving from conflict and crises (displacements of populations, conflict-related trauma, surgery) but also gaps in, and barriers to care for health problems such as HIV/AIDS, sleeping sickness, sexual violence, malnutrition, malaria, as well as epidemic outbreaks that often affect the country due to poor surveillance and infrastructure such as cholera, measles, yellow fever, typhoid fever, plague and hemorrhagic fevers such as Ebola.

In 2016, MSF provided two million consultations in Congo and conducted 64 emergency interventions of various sizes and nature. MSF is working in 20 of the 26 provinces of the country. 

MSF’s work in DRC: 2016



The country has until recently been at the centre of what some observers call "Africa's world war", with widespread civilian suffering the result.

The five-year conflict pitted government forces, supported by Angola, Namibia and Zimbabwe, against rebels backed by Uganda and Rwanda.

Despite a peace deal and the formation of a transitional government in 2003, people in the east of the country remain in fear of continuing death, rape or displacement by marauding militias and the army.

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Medical Issues in DRC

Access to health services in the DRC is challenging due to the very obvious barriers of armed conflict in some areas of the country, but also by the inability of the health system to respond to alerts and crises, as well as numerous systemic obstacles to accessing healthcare such as the lack of infrastructure, staff and/or medicines in some areas; and the financial barriers to care considering that most basic health services are to be paid by the patients, which is often unaffordable due to the high levels of poverty.

Our ongoing operations are currently addressing all these issues, whether through vertical targeted projects or larger transversal programs. 

Malaria

Globally, the fight against malaria is often touted as a success since early 2000 with a global decrease of cases. However malaria remains the main killer worldwide, and sub-Saharan Africa is the most affected continent. Over 40 percent of the African deaths attributed to malaria occur in Nigeria and the DRC. Official statistics show that in DRC, malaria causes four times more deaths per year than the combined toll of the conflict in the east, meningitis, cholera, measles and respiratory diseases. Children are the most severely affected.

Much remains to be done to lessen the impact of malaria in the DRC and MSF is a key actor in this domain, whether in the frame of its regular project activities or during emergency interventions to contain outbreaks. In 2016, the organization delivered malaria treatment to 922,000 Congolese patients.

Infectious diseases

The DRC is prone to outbreaks of infectious diseases. MSF supports the ministry of health and local authority for health surveillance in the country, and its highly mobile teams can be quickly deployed to respond to emergencies. Every year MSF investigates several dozen health alerts obtained through its own surveillance system and, when pertinent, conducts operations in response to outbreaks of communicable diseases which may vary in nature, from vaccination campaigns to contain outbreaks; case management for sick people (including surgeries when needed); health promotion activities; water and sanitation activities; or lighter donations of medical equipment or training of local staff. In 2016 the organization launched 64 emergency interventions of various breaths.

  • Measles outbreaks often occur in DRC despite the national vaccination system declaring high rates of vaccination coverage.       Large-scale MSF interventions occurred in 2011, 2013, and 2016/2017. 
  • Cholera is endemic in some areas (bordering lakes) of the country due to poor sanitation. Epidemic peaks often occur, but 2017 has witnessed one of the worse outbreaks in the last decade, with 20 of the 26 provinces of DRC affected. 

Nutrition 

All MSF section in DRC had noticed an increase in admissions for malnutrition in 2017. Mweso, Itebero, Masisi, Waliakle, Kibirizi, Bambo are the zones de santé receiving the highest number of cases in North Kivu. For the first semester of 2017 only, 26,133 new cases had been recorded on the whole province, with the children under two years as the most affected.

In October, NKERU confirmed the deterioration of the nutritional situation in a wider area of Masisi territory, with a pocket of SAM up to 6 – 8%. This deterioration is due to a decreasing number of humanitarian actors in the midst of the conflict and a bad agricultural season, the decrease of funding and the lack of supervision of the donation.

In parallel, following a sharp increase in cases of malnourished children admitted to the pediatric unit at Rutshuru hospital, MSF decided to support 5 out-patient facilities for the management of malnourished children in ambulatory care for nearly 7 months. Malnutrition was one of the main reasons to open a new program in Bambo health zone. MSF is also treating malnutrition cases in Bili-Uele area and Kasai province.

In South Kivu and following an intervention of measles in Kalonge (South Kivu), MSF teams had to react in July to an alert of malnutrition with the enrolment of more than 1,000 children in malnutrition programs. Teams in South Kivu have warned of lack of actors to tackle emergencies such as an increase of malnutrition or cholera or measles outbreaks.

Operations in Kasai province also have an important malnutrition component.

MSF’s work in DRC: 2015

The Katanga region in the Democratic Republic of Congo (DRC) was hit by a huge measles epidemic in 2015, and tens of thousands of people were affected.

Such health emergencies occur with alarming regularity in DRC, a result of poor infrastructure and inadequate health services, which are unable to prevent or respond to outbreaks of disease.




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Clémentine >

Sandra SmileyField Communications Manager

Vaccinations against measles in Katanga

We launched activities in April in Malemba Nkulu health zone, eventually deploying multiple teams and intervening in over half of the affected health zones. Teams carried out vaccinations and supported measles treatment for patients at over 100 health centres.

By early December, they had vaccinated over 962,000 children against measles and supported the treatment of nearly 30,000 who had caught the disease.

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North Kivu

In Walikale, Mweso, Masisi and Rutshuru, we continued our comprehensive medical programmes supporting the main reference hospital and peripheral health centres to provide both basic and secondary care to people affected by recurrent violence who would otherwise have little access to medical services.

Almost 35,000 children suffering from malnutrition and/or other diseases were admitted to MSF-supported hospitals.

Over 270,000 outpatient consultations were provided in the Mweso area alone, nearly half of which were for malaria.

More than 7,500 surgical interventions were performed at Rutshuru hospital.

We continued to support five health facilities in Goma, offering screening and treatment for HIV/AIDS.

In 2016, the team provided care for over 2,600 patients living with HIV/AIDS.

South Kivu

We support two hospitals, several peripheral health centres and different community points for the identification and management of malaria and malnutrition in Lulingu and Kalehe, with a focus on malaria and malnutrition, for children and pregnant women.

Over 284,000 outpatient consultations were carried out, 10,800 people were admitted to the hospitals, more than 10,700 malnourished children were treated and more than 10,000 deliveries assisted.

We also continued to support Shabunda and Matili hospitals.

We have seen a huge increase in malaria cases in recent years and the hospital we support in Baraka is struggling to cope. A 100-bed facility we built was in full use again, and more community-based sites were set up to treat 200,000 children for malaria, pneumonia and diarrhoea.

Staff carried out over 450,000 outpatient consultations and admitted more than 17,000 patients to the hospital.

Maniema

In March 2015, MSF opened a new project in Bikenge city, a remote city in the mining area, focusing on the needs of vulnerable groups: pregnant women, children under 15, victims of sexual violence and surgical emergencies. The team carried out around 24,710 consultations, treated 116 victims of sexual violence, and assisted 1,090 births.

Ituri, Haut-Uélé and Bas-Uélé

MSF opened a project to assist returnees and displaced people in Boga health zone. The team supports Boga general regional hospital and Rubingo health centre, offering reproductive, emergency and intensive health care. The team’s health education and information activities reached over 25,000 people this year.

The Bunia Emergency Pool works throughout Ituri, Haut-Uélé and Bas-Uélé and this year responded to 12 emergencies including outbreaks of cholera, meningitis and measles.

Equateur

An emergency intervention responding to an influx of refugees from the crisis in the Central African Republic evolved into a new project in 2015.

Teams worked in Bili and Bossobolo health zones, and mobile clinics delivered basic healthcare to Boduna, Gbagiri, Gbangara, Nguilizi and Gbabuku. More than 62,500 outpatient consultations were provided.

Kinshasa

MSF’s Kinshasa-based project has been ensuring comprehensive medical and psychosocial care for people with HIV/AIDS since 2002. Staff working at an MSF hospital and seven partner facilities supported the health ministry in managing a cohort of over 5,300 patients in 2015. They carried out 43,000 outpatient consultations and 32,600 educational sessions.

The Pool d’Urgence Congo, an MSF emergency team, received 171 alerts and intervened in seven emergencies for malnutrition, measles, cholera and refugee crises that benefited over 300,000 people across the country.

On 11 July 2013, four MSF staff were abducted in Kamango, in the east of the Democratic Republic of Congo, where they were carrying out a health assessment. One of them, Chantal, managed to escape in August 2014, but we are still without news of Philippe, Richard and Romy. We remain committed and ready for their release.

find out more in our international activity report

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