Information dated 01.11.2000 Democratic Republic of Congo (DRC): Complex emergency, human catastrophe Impoverished despite their country's riches, forgotten by international actors who could possibly offer help, the Congolese people are living out an overwhelming humanitarian catastrophe. From the MSF 2000 International Activity Report International staff: 36 National staff: 450 The Democratic Republic of Congo is ground zero of what has been called an "African world war." Nearly 20 armed groups - both Congolese and foreign - are vying for political advantage or economic gain. Attempts to curb the war, through peace accords signed in Lusaka, Zambia, have been desperately inadequate, as has the small United Nations force meant to keep the "peace." The intractable war comes on the heels of decades of misrule and the misappropriation of the country's vast natural wealth. Impoverished despite their country's riches, forgotten by international actors who could possibly offer help, the Congolese people are living out an overwhelming catastrophe. Congo's infrastructure and health system are in ruins. Of the 300 health districts in the country, 79 are more than 100km from their referral hospital. The lack of government funds and foreign aid means that 100 districts are left without any outside funding. Human resources fare no better: the country's 50 million people have only 2,000 Congolese doctors to serve them. Life expectancy is 45 years, and one in four children will die before they reach the age of five. Large parts of the country are inaccessible to humanitarian assistance. Against this backdrop, MSF provides medical relief in several provinces, working in government-held areas as well as territory controlled by rebels. Teams work side by side with Congolese health professionals, in a climate of urgency and insecurity. Controllable diseases are spreading The disintegration of the health system and the ongoing ravages of war have encouraged an explosion of disease in the country. Continual outbreaks of meningitis, cholera, shigellosis (bloody diarrhea) and measles are coupled with periodic outbreaks of diseases such as polio, Marburg disease, and the plague - nearly eradicated in the West - and the mounting scourge of AIDS and African sleeping sickness. In order to respond quickly to disease outbreaks, MSF has helped set up a national emergency response team, made up of Congolese doctors, in Kinshasa. There are similar teams in Lubumbashi, Mbandaka, Kisangani, Goma and Bukavu. MSF runs a program combating sleeping sickness in several health zones in Equateur province. A similar program in Bas Congo was suspended because of security concerns. To help stem the spread of AIDS, MSF opened a health clinic in Matonge, an area of Kinshasa, to attend to prostitutes with sexually transmitted diseases (STDs). The center treats about 20,000 people a year. In Katanga province in the southeast, an HIV/AIDS program covers five rural health zones. A pilot STD/HIV program, targeting prostitutes and other at-risk people, is scheduled to begin in Bukavu in late 2000. Basic health care in several provinces In Orientale province, in early summer 2000, fighting erupted between Ugandan and Rwandan forces near the Congolese city of Kisangani. MSF teams, which run primary care, nutrition and mental health programs in the city, were forced to take cover, emerging only six days after the peak of the fighting. After responding to the immediate needs of the stricken population, the organization resumed its regular programs. MSF currently has 16 feeding centers in the area, feeding over 2,500 malnourished children. MSF also supplies medicine to 13 health zones in the province. In Katanga province, MSF works in 38 health centers and five hospitals spread over five health zones, covering a population of about 700,000. In Equateur province, the organization works in eight health zones that reach over one million people. In Bas Congo, MSF works in two health zones. In all of these provinces, MSF teams supervise health workers, provide drugs, training and logistical help, and often help pay staff salaries. MSF is also present at several health centers in Kinshasa. In June 1999, insecurity forced the halt of work at hospitals in Zongo and Libengue, in Equateur province. In early 2000, work in the Shabunda area of South Kivu province and in Bunia, in Orientale province was suspended, also because of insecurity. Primary care and water and sanitation projects continue in other parts of South Kivu and in North Kivu. Care for refugees and the displaced Congo is both country of origin and place of refuge for many refugees. At least 200,000 Congolese have sought refuge in neighboring countries. At the same time, a vicious civil war in Angola has caused people from that country to flee to Congo. And it is estimated that over one million Congolese are displaced within the country. In the Kilueka refugee camp for Angolan refugees in Bas Congo, MSF offers basic health care and ensures the supply of clean water, and also works within the region's health system. In April 2000, in Sicotra on the outskirts of Kinshasa, MSF launched a program to care for internally displaced Congolese arriving from Equateur and Orientale provinces, and for refugees returning from Sudan and the Central African Republic. In many of its programs in the provinces, MSF cares for internally displaced people as well as local residents. Waging public information campaigns in Congo and abroad Given the dire state of the Congolese health system and the worsening situation in the country, lobbying and public awareness campaigns outside of the country are increasingly important. In summer 2000, MSF sponsored an exhibit of photographs by Belgian photographer Roger Job, entitled ‘Santé d'Etat, Etat de Santé' (The Poor Health of the Health System). In an effort to make itself better known among the people and the authorities, MSF has also been reaching out to the Congolese. The organization puts out periodic press releases, organizes television and radio stories and publishes a small newsletter destined for the general public. Médecins Sans Frontières, active in Congo since 1985, is one of the few aid organizations still working in the country.