People are reaching the end of the line

June 10th, 2008

More than four months after the peace agreements were signed at the end of the Goma conference, Josephine and her seven children are still struggling daily for survival in the Masisi refugee camp.

Last October, when the sound of gunfire first broke out in her village near Kitchanga, Joséphine fled, taking her children with her. After walking for two days, the 50-year-old woman and her children were among the first to arrive in Masisi, where a camp for internally displaced persons was swelling as the days passed.

“Since October,” Joséphine explained, “we have been forced to live in these difficult conditions. We were given tents, and latrines and showers were built. But our life here is still very hard. Food isn’t distributed regularly.”

To make up for this, Josephine and the other members of the 2,300 displaced households in Masisi cultivate small plots of land that are provided to them. “I grow beans and manioc.” Thrice a week, this woman, and so many others like her, walk three hours to till their little piece of land. “Sometimes,” she explained, “security is good. Sometimes it isn’t.”

Medical care after rape

For many women who risk going to the fields, insecurity is another word for rape. “Each month, we receive on average ten women who are victims of sexual violence,” explains Francine Bayanga Bora, the nurse handling cases of sexual violence at the Masisi hospital, supported by MSF. “This figure does not at all reflect the actual situation. Some women are afraid of coming for treatment, because rape is still taboo in the community. Others don’t know that medical care is needed and that it’s available for free at the Masisi hospital. Still others live too far away, in places that are too remote and closed off, with no medical facilities.”

For these reasons, last May MSF launched a vast informational programme for women in Masisi and four other areas. Women villagers are brought together, and MSF’s speaker explains the importance of medical treatment within 72 hours of a rape, during which it is still possible to give HIV/AIDS prophylaxis.

She also tells them about the Masisi hospital, where treatment is free. Even after 72 hours, women who are victims of sexual violence need to be treated for sexually transmitted infections. The speaker reassures them that treatment is provided in full confidentiality, in the “women’s health” department of the Masisi hospital. Moreover, mother-counsellors are identified and trained. They are the ones who, on a daily basis, continue to give this information to the women in the region.

Always taking flight

For the inhabitants of Nord Kivu, insecurity is also illustrated by daily clashes between armed groups, stray bullets, and ransacked villages. Over three months ago, next to Bukombo, north-east of Masisi, thousands of people fleeing the combats and forced conscription into armed groups set up a camp for displaced persons a few hundred meters from the village of Bukombo. They received no assistance. Faced with these almost unbearable living conditions, some of them settled in the surrounding villages, with host families. All in all, more than 1,500 households were added to the local population.

“The displaced persons and the so-called host villages are reaching the end of the line,” explained Anna Halford, an MSF co-ordinator at Masisi. “As the months go by, their survival mechanisms, which consist of repeated departures and all their consequences, are reaching their limits. These people are exhausted, increasingly weak, and consequently, increasingly ill.”

Epidemics

The repeated departures and weakness fling the door wide open for epidemics, such as measles which is once again making an appearance in the Masisi region. “We vaccinated more than 30,000 children in March,” added Anna Halford. “A new epidemic broke out south-east of Masisi, and we’ll be vaccinating some 45,000 children in coming days.”

In Lushebere, several kilometres from Masisi, the displaced persons camp is in front of the market, which is organised twice a week. The food, the shouts of vendors, the stands of loincloths give the impression that daily life is going back to normal in this area, which is no longer in the front line of combat.

But in Masisi’s surgical department, the MSF medical team continues to operate on patients with bullet wounds. Like this man, hit in the lung by an armed man as he was coming back from the Lushebere market.

Displaced to the Masisi camp for eight months now, Joséphine and the others live in a makeshift way, under a tent. Going home remains a dream: “It would be much too dangerous. Battles continue to rage there. But we’re really not proud of having to stay here.”

MSF has been helping the Masisi hospital since August 2007. The hospital has 180 beds, divided between paediatrics, labour rooms, surgery, measles beds, a centre for cholera treatment, and a therapeutic nutrition centre, managed by a partner NGO. Every month, 400 patients are hospitalised and 4,500 consultations are performed at the hospital and at the Masisi health centre, also supported by MSF.

A programme to support and build awareness of medical treatment for victims of sexual violence was started in May at Masisi and the areas of Lushebere, Kitsule, Buguri, Bukombo and M’bitsi. A host village for women with risky pregnancies is being constructed. A vaccination campaign for 45,000 children in the area around the village of Langira, in the south-east, is currently being launched.