MSF operations in North Kivu have increased considerably since we began working in that region. What changes have been made?

We strengthened our teams in Rutshuru and Nyanzale so that we could provide more extensive medical assistance across wider geographic areas. For example, the Rutshuru hospital had 115 beds when we arrived in 2005. Today, there are more than 200. We still cover pediatrics, internal medicine, surgery and emergency departments and also set up a blood bank.

We began working in maternity in 2007. We share responsibility for this department with the health authorities and handle exclusively caesarian births and post-operative care. Given the high number of women who are undergoing caesarian sections, we had to set up a second operating room.

Surgery represents a major activity. In 2005, we performed two operations per day, while the 2008 average is 12 each day. We do not have time to perform elective surgeries and nearly all are emergencies.

With respect to our work outside the city, we travel out from Rutshuru based on where displaced populations are located. We travel as close as we can to these isolated areas so that we can reach the populations living in insecurity.

Over a two to three month period, mobile teams see patients at health centres located to the north and south of Rutshuru . The flexibility of this modular programming allows us to respond to movement of populations fleeing fighting or to seasonal peaks in malaria or even to epidemics.

How is the situation in Nyanzale, a town located in an area where there are many movements of populations ?

We have stabilized and expanded our program in Nyanzale by increasing our staff there. We treat malnutrition in a therapeutic feeding centre. We also provide consultations to children under the age of 5 and treat malaria, which remains a problem despite the high altitude of the site.

The team covers a large area, reaching as far as Katsiru and Bambu. When patients require surgery, we refer them to a nearby hospital supported by MSF. The other major focus of our work is treating victims of sexual violence. In January, we treated 300 rape victims.

How do you provide care to victims of rape?

We provide consultations in our two health centres in Nyanzale and Rutshuru. Using an ambulance-based system,we are able to also be present in the surrounding areas. MSF pays for the rape victims’ transportation so that they can be treated right away. They must be treated within 72 hours after the attack if prophylactic treatment for HIV/AIDS is to be effective. The population is well-informed: A network of women distributes information and the message is broadcast on the radio, emphasizing the importance of obtaining medical treatment within 72 hours.

Has the security situation improved after the January 21 ceasefire agreement?

The situation has not normalized. The ceasefire agreement has not been fully implemented, and armed groups remain active in the province. Some rebel groups continue to fight for their political demands or to maintain control over income-producing territories. Armed groups attack the population, stealing their resources and food.

For the people who continue to flee violence, nothing has improved. Often the displaced will remain in close proximity to their homes, hoping that they may be able to return. Sometimes as close as two hours’ walk from home, they are attacked on the roads and in the fields. Victims of rape often come under attack on the way to the fields or while they are working there.

What illnesses do the MSF teams treat?

We treat malaria on a cyclical basis, two or three times per year, based on the epidemic’s peaks. In the pediatric department at the Rutshuru hospital, we treat many children suffering from malaria and severe anemia. However, we also work upstream, providing direct support to health centres in the areas most prone to epidemics of malaria. This way, our staff can provide free treatment and ensure that patients do not arrive at the hospital in a severe condition.

Have you also had to deal with epidemics?

In late 2007, we faced an unusually serious cholera epidemic, recording more than 2,000 cases in one-and-a-half months. The problem is rooted in the precarious living conditions of the displaced population. The people gather in villages, which then expand to become cities, but still lack the necessary infrastructure to support the population. In response, MSF set up a cholera treatment centre in the Rutshuru hospital and treatment units on the city outskirts. Other organizations worked on improving access to water because vibrio cholerae is transmitted in water. The number of cases has fallen sharply since January, but is picking up again, with 4 — 20 cases per day, so we are resuming our awareness efforts.

In addition, measles cases have been spotted since early January. Continual population displacement increases the risk of the spread of this contagious illness, which can be fatal, especially for children. We plan to hold a vaccination campaign in first Nyanzale and then Rutshuru areas where measles cases have also been reported.

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