This time last year in the Uélés, Congo (DRC), the Lord’s Resistance Army (LRA) stepped up their attacks against the local population. The level of violence escalated further following a joint military operation against the LRA by the Ugandan, Congolese and Southern Sudanese armies, with the logistical support of the UN mission in the Democratic Republic of Congo (DRC).
Six months ago, MSF had to close all of its regular projects because the level of insecurity meant it was impossible to access many areas and people were fleeing in fear.
MSF's work to test and treat cases of HAT has been disrupted by the renewed conflict in the Uélés
Photo by Claude Mahoudeau/MSF
The official death toll due to the violence stands at 1,270, according to UN sources. It estimated that 655 children have been abducted and 540,000 people have been displaced with 125,000 driven out of their homes during late August, early September alone.
This death toll is erroneous – MSF fears the number of deaths due to violence exceeds this figure and many more people will have died from contagious diseases. There is no disagreement that excess mortality in conflict ridden and politically insecure areas caused by disease far outweighs the numbers killed by violence. In addition, already scarce health facilities in Provence Orientale have been further degraded by the insecurity.
MSF’s projects had been critical for people to receive healthcare, especially in the more remote and very difficult to access areas. A key component of MSF’s projects was in the diagnosis and treatment of human African trypanosomiasis (HAT) – also known as sleeping sickness.
In the last century, HAT ravaged parts of the African continent, leaving in its wake profound social and economic effects – as well as killing 100 per cent of untreated sufferers (it is more lethal than either cholera or Ebola). But by the 1960s sleeping sickness seemed to be a scourge of the past and attention to HAT declined.
This was a fatal mistake; in the 1970s HAT re-emerged and there were severe epidemics peaking in the 1990s. Concerted efforts since then have brought HAT under better control. The WHO currently estimates that 50–70,000 people are affected by HAT each year in 36 endemic countries. Seven countries represent 97 per cent of all reported cases and the DRC accounts for two-thirds of reported cases.
In many areas, there is a lack of even basic surveillance so the full extent of the problem remains unknown. There are ‘hot-spots’ of HAT and, in particular, HAT surges where there is political instability and conflict.
In Provence Orientale DRC, MSF found that 3.5 per cent of all people screened were positive for HAT. Since July 2007, MSF has been treating patients in Haut Uélé for HAT and had treated 1,570 patients and screened 46,601 individuals. From the high rates discovered, it had projected that more than 3,000 people in this area will have stage 1 HAT and more than 2,000 will have stage 2.
If left untreated, a person with stage 1 HAT will die within two years, and for stage 2 the life expectancy is six to 12 months.
Six months on
So, six months on, besides the terrible toll owing to violence, many more lives have been lost to other contagious diseases such as malaria and diarrhoea. Another 1,000 are probably dead from HAT.
But the problem doesn’t end there, it goes far beyond the borders of the DRC. When people are displaced, the disease and possibilities for transmission move with them. South Sudan and Uganda are also endemic for HAT.
Many areas that have been ‘cleaned’ face being reactivated. This is because, when infected people arrive in an area, the tsetse fly picks up the parasite again, and then the disease cycle restarts.
The violence and incursions by the LRA have also caused instability in the Central African Republic (CAR) and already in some areas there is a problem. Very worryingly, in the northeast of the CAR where MSF is working, away from the main focus of LRA activities, very high rates of HAT have been found (14 per cent) and many patients are also coming over the border from Chad.