Thousands of people in northern Congo (DRC) are in danger of dying from a disease they cannot get treatment for because insecurity in the area is holding them hostage.
Since an attack on the MSF project in Banda in northern DRC by an armed gang in February of 2009, people suffering from human African trypanosomiasis (also known as sleeping sickness) are no longer being treated in a region infested by the disease’s carrier, the tsetse fly. The insecurity in Banda means it is impossible for MSF to continue to care for patients with the disease.
"The situation is unacceptable because thousands of people are in danger of dying"
Says Sophie Signoret, the last MSF doctor forced to leave the project six months ago.
"The last site where MSF was working in this area of DRC was the small town of Bili in Bas Uélé. MSF arrived there at the end of last year after a quick assessment by the team, which was completing the first phase of treatment in the Banda region. The attack on Banda, further east along the Uéré River, signalled the end of the entire MSF intervention. That day a group of attackers, probably former LRA rebels, looted the project and captured two MSF workers who, by chance, were able to escape into the bush, bringing several hostages, including children, with them.
At the treatment centre in Banda, MSF doctor, Delphine Berthod, examines a sleeping sickness patient.
Photo by Claude Mahoudeau
"Bili is a small town with approximately 7,000 residents thinly spread across the forested region. The town has no electricity and no running water. There is an old cotton factory that has been closed for more than 15 years. Neither the police nor the military are present. Even if the town is not at the heart of the insecurity, anything could happen without anyone doing anything about it. There is a real sense of abandonment, especially at the hospital which has become simply an empty house with three nurses and no supplies.
Tests on the population of the small town of Bili confirmed the MSF's staffs' worst fears about the spread of HAT
Photo by Claude Mahoudeau/MSF
The disease was unknown
"What really surprised me when I arrived in Bili was the population’s complete lack of knowledge about sleeping sickness. Yet, it turned out that many people had been affected by it. They did not understand why we wanted to treat them for a disease they did not know about even if, in talking with them, some people could already identify the symptoms in themselves.
"Their attitude changed completely the day the local chief tested positive for trypanosomiasis and was successfully cared for at our treatment centre. This incident resulted in a radical change in the people’s attitudes and led to everyone accepting MSF.
"Having been made aware of the disease, people slowly began to agree to be tested. We still had to quell a rumour that we were trying to infect people with HIV. That is to say, the mistrust ran deep and the disease was unknown.
"Unfortunately, the results of testing quickly showed that MSF’s experts on sleeping sickness had been right. In just a few weeks, between early February and late March 2009, we identified and treated no less than 176 people with sleeping sickness. It is tragic to find so many people infected with the disease so far from its epicentre near Doruma, a city more than 300 kilometres east of Bili as the crow flies. It confirms that the disease is spreading inexorably, a logical progression since nothing is checking its movement.
"MSF organised its first project in Doruma along the border with Sudan in mid-2008. After six months workers had to leave because of rumours about attacks; they set up shop further away in Bokoyo. Then Banda. And finally Bili.
As soon as the situation allows, MSF will go back
"It must be noted that even if we are able to identify and treat hundreds, maybe even thousands of people as we did during the six months we were there, we cannot say they have really been cured. To be certain of the results, we have to be able to monitor patients following treatment once every three months for two years, which has not possible anywhere since the beginning of our intervention.
"Because we have only been able to be present for such short periods of time, it would be an illusion to think that we can affect transmission. We are still finding infected patients; therefore the tsetse fly continues to transmit the disease. A project of only a few months starts to feel futile when it comes to containing the disease.
"Of course, MSF is not gone forever from the region. Yet time passes, and infected people die while nothing can be done. In six months, at least 1,000 people have died of sleeping sickness in the region. It is unacceptable. We cannot stand here with our arms crossed and let people die that way. As soon as the situation allows, MSF will go back. That is for sure.
"Sleeping sickness is still a highly neglected disease, and we cannot forget that it is 100 per cent deadly when left untreated. You can understand the impatience we feel as healthcare workers and our refusal to allow armed groups to take an entire population hostage this way."
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