Epidemics, lack of healthcare creating ongoing emergency   Decades of conflict and a lack of government investment have made it hard for people in Democratic Republic of Congo (DRC) to access basic healthcare. Epidemics have spread unchecked and treatment of deadly diseases has been neglected. Eastern DRC is still volatile, marked by shifting alliances between armed groups, ongoing military operations, instability, insecurity, banditry and violence. Attacks against civilians and aid organizations are rising, making both the population and humanitarian aid workers increasingly vulnerable.

Rape, murder, kidnapping and random acts of violence are daily occurrences for millions of people. The instability continues to push people from their homes and at times limits MSF’s ability to provide free, lifesaving healthcare. Lack of investment in the healthcare system results in a lack of infrastructure and properly trained medical staff throughout the country. While medical needs are enormous, people are left struggling to access the most basic level of healthcare services. “For patients to get access to healthcare, they often have to walk for many hours,” says MSF head of mission Christine Buesser. “Imagine you are a pregnant  woman, and you may even have to carry another child on your back. These distances are very difficult to overcome. This is a daily challenge – just to get to a heath facility.” Decades of neglect of the health system in DRC have resulted in a rise in infant and maternal mortality rates across the country. Life expectancy here is among the lowest in the world.


Democratic Republic of Congo © Ben Milpas
A young patient is seen by an MSF staff during a mobile clinic in the Dungu area of Haut-Uele, DRC.
Epidemics: A permanent emergency
Logistical constraints due to the country’s enormous size, a lack of investment in healthcare facilities and poorly trained health workers lead to weak national disease prevention measures. The dysfunctional Expanded Program on Immunization (providing routine immunization) together with the lack of sustained vaccination strategies create a permanent health emergency in the country and preventable epidemics, including cholera, measles and malaria take a heavy toll on the Congolese people. Malaria is the leading cause of illness and death in DRC, and MSF medical teams continue to treat large numbers of patients in 2011. Malaria treatment represents one third of consultations at MSF clinics. Since late 2010, there has been a measles epidemic in DRC. More than 14 million children have been vaccinated, including more than three million by MSF. However, these urgent efforts have not halted the epidemic, and four out of 11 provinces have not yet been covered by the immunization follow-up campaign. MSF has been responding to cholera outbreaks along the Congo River and in the capital, Kinshasa, since April 2011, treating patients and building treatment facilities. The threat of a cholera outbreak combined with the start of the rainy season in August is especially worrying in densely populated urban centres without proper sanitation systems.

Democratic Republic of Congo © Ben Milpas
A camp for internally displaced people near Ibuga, DRC. MSF has been providing healthcare in the camp and sharing information about malaria and cholera prevention.
Commitment is needed to fight AIDS
In DRC, only 12 per cent of HIV-positive patients are receiving antiretroviral (ARV) drugs, and 95 per cent of women living with AIDS don’t have access to treatment that can help prevent the transmission of the disease to their unborn children. Despite this situation, DRC is now facing a serious challenge in funding the figth against AIDS. In 2011, the World Bank stopped funding its HIV/AIDS programs in DRC. Several other donors still work with very limited funds with regards to DRC’s substantial needs. In addition, the Global Fund, which is the largest financing mechanism in the fight against HIV/AIDS, faces a major funding shortfall from donor countries. The current donor retreat could leave thousands of patients in DRC without treatment and prevent more people from accessing treatment, threatening to undermine all the progress made since the introduction of ARVs in the country. MSF continues its ongoing lobbying efforts to maintain donors’ support in order to respond to the crisis.
Sleeping sickness a major concern
  Half of all cases of the neglected and fatal disease Human African trypanosomiasis – also known as sleeping sickness – occur in DRC, particularly in the Haut-Uélé and Bas-Uélé districts of Orientale Province in the northeast. Prevalence can reach five per cent in some areas, well beyond the threshold of 0.3 per cent needed to consider it a public health problem. The disease is transmitted to humans through the bite of infected tsetse flies and is fatal if left untreated. Displacement and instability have contributed to its spread, and the lack of roads makes reaching patients difficult. Since 2007, MSF has treated an average of 1,000 patients per year. For the next three years, teams are planning further exploratory missions to reach more patients and diminish the prevalence of sleeping sickness in the region. In 2011, more than 2,500 MSF staff have worked in 10 of DRC’s 11  provinces to provide free and lifesaving healthcare.  MSF has been working in the country since 1981.