© Gabrielle Klein/MSF

Democratic Republic of Congo

MSF is running some of its largest programmes in Democratic Republic of Congo


The second largest country in Africa (after Algeria), Democratic Republic of Congo (DRC) is a country rich in natural resources but plagued by conflict.

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 death, rape or displacement by marauding militias and the army.

Médecins Sans Frontières/Doctors Without Borders (MSF) first began working in DRC in 1981 in response to armed conflict, endemic/epidemic disease and healthcare exclusion.

With more than 1.7 million outpatient consultations carried out in 2017, DRC is one of our largest interventions in the world. 

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Ituri crisis

Over 100,000 people are currently displaced from their homes in Ituri province as a result of violence that erupted in the area of Djugu. The current violence started in December 2017, and after a lull in January it flared up again in February of 2018.

Those affected made their way north towards Mahagi or south towards Bunia, whereas others headed for Lake Albert and the relative safety of Uganda.

MSF teams are working in and around Bunia, and also around Mahagi, supporting healthcare, undertaking water and sanitation work and distributing items of basic necessity such as blankets and soap.

MSF’s work in DRC: 2017

Millions of people were displaced in the DRC in 2017 as new waves of violence erupted.Conflict in Tanganyika province has intensified over the last couple of years, which has led to the displacement of over half a million people. In 2017, MSF stepped up its response, providing emergency assistance in Nyunzu and in makeshift camps in Kalemie and the surrounding areas. Many of the displaced are living in and around the town of Kalemie with host families, in makeshift camps or in school compounds. Some are sleeping on the ground with only a mosquito net for shelter. MSF activities included measles vaccinations, mobile clinics offering primary healthcare, as well as reproductive health services and mental health consultations, support to health centres and paediatric inpatient care. Teams also distributed water and built latrines and showers in some of the camps.  

More than 1.3 million people fled extreme violence in Greater Kasai region, with some escaping into the bush and hiding for weeks despite dire medical needs, unable to access care due to insecurity. MSF teams were able to treat some who had suffered severe injuries such as deep machete or gunshot wounds. The conflict triggered an acute nutrition crisis in rural areas and a sharp increase in sexual violence. Teams treated war-wounded patients in a rehabilitated wing of Kananga city hospital, performing 1,204 surgical interventions and provided care for victims of sexual violence. In Tshikapa, MSF supported care in a hospital, three health centres and the prison. On the outskirts of both cities, where many of the health centres had been looted, destroyed or burned, MSF ran mobile clinics.

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Assistance for refugees and host communities

In September, MSF started to assist people who had fled conflict in Central African Republic by supporting hospitals in the northern towns of Gbadolite and Mobayi-Mbongo. Mobile clinics also provided care to some 67,400 refugees and their host communities.

Tens of thousands of South Sudanese refugees have settled in the north of DRC. MSF ran mobile clinics in the villages of Karagba and Olendere, in Ituri province, offering refugees and host communities access to basic healthcare, mental health support, sexual and reproductive health consultations, and referrals. A team also supported the regional hospital.

Providing comprehensive care in the Kivu provinces

The Kivu provinces are still reeling from the devastating Congo Wars of the 1990s and are plagued by ongoing fighting. More than 1.5 million internally displaced people live in the Kivus, where the humanitarian and medical needs only intensified in 2017 as the situation in the provinces deteriorated. Overall, MSF provided almost 1.5 million outpatient consultations and admitted more than 95,000 patients to its facilities in North and South Kivu.

Teams continued to manage four comprehensive projects in Masisi, Walikale, Mweso and Rutshuru in North Kivu. Each supported a hospital, as well as health centres and community treatment sites. A new project was also set up in Bambo.

When violence broke out again in South Kivu in July, MSF treated the wounded, while continuing with its regular activities. In Lulingu, Kalehe and Mulungu, the team focuses on care for children under 15, sexual and reproductive healthcare and treatment for victims of violence. Teams also implement a community-based approach to treat malaria and malnutrition. The main activities in Baraka and Kimbi are paediatric care, HIV and tuberculosis (TB) treatment, sexual and reproductive health, and care for victims of sexual violence.

Response to epidemics 

Due to poor access to healthcare, the average life expectancy in DRC is around 58 years. One in 10 Congolese children dies before the age of five.
Emergency response is a core activity for MSF in the country. Five teams are dedicated to monitoring health alerts and deploying a rapid response to outbreaks of violence, population displacement and epidemics across this vast country. In 2017, MSF launched 62 emergency interventions. During the first half of the year, most were in response to multiple measles outbreaks. In total, teams vaccinated 1,050,315 children against measles, and treated 13,906 for the disease.

From mid-2017 MSF switched its focus to a cholera epidemic that started in the Kivus, where cholera is endemic. It spread to the rest of the country, becoming one of the biggest outbreaks in DRC of the last two decades. Overall, MSF cared for 19,239 cholera patients nationwide.

Mental Health

Sifa Clementine is an MSF mental health supervisor in Mweso, Democratic Republic of Congo. She tells her touching story and how she has coped with the traumatic events in her life.

DRC: "There is no health without mental health"
MSF staff in Democratic Republic of Congo are living through the same trauma as their patients
Enter Microsite

There is no health without mental health

MSF staff in Democratic Republic of Congo are living through the same trauma as their patients

KickerThis is a kicker.

> On the edge of a copse of eucalyptus trees, a play is under way. Its a familiar tragedy with an identifiable cast: a drunk abusive father, a put\-upon wife, and a daughter on the cusp of womanhood.

Whats not so typical about this theatrical display is its actors. When youre displaced from your home, your thoughts can be displaced too, says Sifa Clementine. Sifa oversees MSFs mental health activities in Mweso, a small town in the east of the Democratic Republic of Congo. Today, Sifa and her team are running a theatre production on sexual violence for the local community. The setting is the displacement camp that sits across the road from Mwesos General Hospital, where Sifa and her team work. The actors in the play are all MSF mental health counsellors. Over the course of the next three hours, the team connects with the 200\-strong audience through song, dance and drama. At the end of the play, theres a valuable moment for the audience to reflect on what theyve seen, as a form of group discussion. The event is designed to inform the people of the camp that MSF is in the community, and is there to listen. When we see a problem in the community, we act out these problems and educate in this way. Often, a person's behaviour is affected by what they have gone through. That is when behaviour changes." Referring to the character of the daughter in the play, Sifa goes on to explain: In her village, for example, she didn't drink alcohol, but now she does. She steals food in the house and she sells it for drinks. The sketches show people what can happen, and how they can overcome these problems.

MSFs mental health work in Mweso began in 2009, helping local communities and people displaced by conflict. The North Kivu region of Congo that borders Rwanda and Uganda, and home to Virunga National Park, has been in a state of constant unrest since the Great Lakes Crisis that began after the Rwandan genocide in the mid\-1990s.

The second largest country on the African continent by area, Democratic Republic of Congo is a fragile and conflict\-affected state and receives more aid from MSF than any other country in which we operate. The team of psycho\-social counsellors that Sifa supervises is drawn from the communities surrounding Mweso.

They connect with their clients using empathy, by creating a safe and secure environment where they are able to work through the traumas they have lived. Coming from the same communities as their clients, the Mweso team understand all too well the social taboos around mental health, as well as the traumatic events people are subjected to on an almost daily basis. Conflict, armed robberies, and sexual and domestic violence are just some of issues people face in North Kivu.

Theatre is one of the many interventions the team provides. Along with psycho\-educational activities such as this, Mwesos mental health team also provide therapeutic counselling for trauma related issues \- such as sexual violence, psychological first\-aid, psycho\-social stimulation for nutrition, individual counselling and support groups for people living with conditions such as HIV, TB and diabetes, as well as referrals for psychiatric care.

As counsellors, we help our clients by listening to them, but we can also connect with them over our shared experiences _\- Imani Stanley_

I was constantly worried and still occasionally have flashbacks, says Imani Stanley. Stanley began his MSF career in 2008 as a guard in our Kitchanga project, an hours drive south of Mweso. His intelligence and initiative saw him progress quickly to becoming a counsellor he studied Psychology at university in Goma and speaks six languages, including English, French, and four local dialects. He was recently promoted to an Assistant Administrator. In 2013, Stanley witnessed the horrors that many people in North Kivu have become accustomed to. In February of that year, the conflict reached Kitchanga. I was working in Mweso at the time, but my family were living in Kitchanga. We had two houses, one for me, my wife and children, and one for my mother, says Stanley. Thankfully, most of my family fled before the fighting, but five members of my family werent so lucky. I lost three of my cousins and my two sisters\-in\-law. Both my mothers house and mine were completely destroyed. Everything that we had invested in our family disappeared.

> **As counsellors, we help our clients by listening to them, but we can also connect with them over their shared experiences**

While Mweso and the surrounding area havent seen that level of fighting in the past four years, there is almost constant low\-level conflict between armed groups, and people are regularly subjected to violence. About two weeks ago, says Stanley, two of my cousins and my uncle came face\-to\-face with bandits on their way to their field, next to a small lake near Kitchanga, and were fired upon. They took refuge in the lake, but the bandits surrounded the shore. We found their bodies three or four days later and we buried them there. It hasn't even been two weeks since I experienced a death in my family. Its hard to imagine being able to psychologically come back from these events, but through Stanleys training, hes found ways to cope.

As counsellors, we help our clients by listening to them, but we can also connect with them over our shared experiences, he says. While this might not be common practice elsewhere, this method has helped to break down barriers in Congo, to connect with people initially sceptical to the benefits of mental healthcare. When someone comes to me despairing that he has lost his house, I say, Ah, you have lost a house, I understand that you are very deeply affected. I was like that too. Our sessions are, of course, for the benefit of our clients, but reflecting on our shared experiences allows us as counsellors to be comforted. We are reassured that other people are also affected .

We see that if were faced with the same problems as our clients, we can also cope and life can go on _\- Jaqueline Dusabe_

Jaqueline is a widowed mother of six children, and has been working as an MSF counsellor since 2009. She echoes Stanleys sentiments: Working with our clients really helps us. We see that if were faced with the same problems as them, we can also cope and life can go on. It helps us manage our emotions, especially as were in the same territory as them violence, traumas; we live them, too. In 1996, at the height of the Great Lakes Crisis, Jaqueline and her family were forced from their home. For five months, they slept in the bush, with nothing but a sheet of tarpaulin for bedding.

> **A lot of people \[in Congo\] display \[aggressive\] behaviour that, to the untrained eye, wont be seen as psychologically abnormal**

We slept on the ground, no mattresses, nothing else, Jaqueline explains. My little sister died during the war, along with her baby. We never found her body. At that point I was affected, for sure. I wasnt sure she was dead. I held on to the belief that she was alive. But what makes me happy, what helps me is that she left a son, her first child, who stayed with my father. Hes a big boy now. Thats something that makes me feel better, I can see her presence in him.

As a counsellor, Jaqueline has a fervent belief in the power of mental healthcare. However, shes not oblivious to the fact that mental health problems are sometimes a taboo subject in the community. When we say someone has a mental health problem, people right away begin to talk about madness or craziness. But I see that everyone, nearly all Congolese, are concerned by mental health problems in some way. Its a service thats neglected across the country. A lot of people display \[aggressive\] behaviour that, to the untrained eye, wont be seen as psychologically abnormal. But if services were multiplied all over to help people, perhaps aggressive behaviour and other problems would diminish, and there would be less violence in the community.

Back at the displaced persons camp in Mweso, the play is halfway through its three\-hour run and a distressing scene is taking place. The daughter of the neglectful father is out collecting firewood, when she is approached by two armed men. They chase her through the woods, catch her and hold her down. What follows isn't shown, but many people in the audience know what comes next. Some wipe tears from their cheeks.

> **Not everyone accepts the idea that people can be cured with words**

Sometimes, people cry when we tackle things they have experienced in their own life, says Sifa Clementine. In mental healthcare, when it comes to tears, they are a very good thing. Since they experienced these problems they may not have had time to cry. It is through tears you can relieve yourself. Traumatised, the daughter returns home. The next day, an MSF outreach worker comes to her village to promote the services MSF provides, including counselling for survivors of sexual violence. With the help of her mother, the daughter makes her way to Mweso hospital to talk with an MSF doctor and psychosocial counsellor.

As Sifa says: Not everyone accepts the idea that people can be cured with words. "But I will always say to people that there is no health without mental health.

> [**Find out more about MSF's work with mental health around the world >**](https://www.msf.org.uk/issues/mental\-health)


Addressing longstanding health issues

Malaria is endemic and the main cause of death in DRC. MSF teams treated 856,531 patients for the disease in 2017, more than for any other illness. MSF experimented with new models of care that can be adapted to local settings to improve treatment, for example the introduction of large-scale community-based projects. These are currently running in Baraka and Kimbi, and teams in Bili, Mweso and Walikale are exploring this option.

Women’s health remains an important component of most MSF projects. This includes treating patients who have had unsafe abortions and care for people who have suffered sexual and gender-based violence, especially in Kasai, the Kivus and Mambasa in Ituri.

In 2017, MSF intervened in the Kivu provinces, Uélé and Kasai regions to address high levels of malnutrition among children.

MSF continues to provide comprehensive medical and psychosocial care for people living with HIV and AIDS in Kinshasa, Goma, Baraka and Kimbi, and works with the national HIV programme, partner organisations and patient groups to improve access to testing and treatment. In 2017, 7,185 patients received antiretroviral treatment at MSF-supported health centres in Kinshasa, Goma, Mweso, Baraka and Kimbi. Over 2,990 patients with late-stage HIV were treated in MSF’s AIDS unit in Kinshasa alone.

In Maniema province, an MSF mobile team tested over 18,000 people for human African trypanosomiasis, also known as sleeping sickness, 42 of whom required treatment. While the prevalence of this neglected disease has decreased in the past decade, there are still many presumed hotspots that are difficult to access.


Project closures

In March, MSF closed its Shabunda project in South Kivu. In seven years, 927,000 outpatient consultations were carried out. In April, MSF closed the project in Manono, where teams had worked in the regional hospital’s paediatric department and health centres.
At the end of the year, activities in Rutshuru, Boga and Gety were handed over to the Ministry of Health. During its 11 years in Gety, MSF undertook 573,200 outpatient consultations and assisted almost 13,500 births. 

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.



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