Democratic Republic of Congo

Almost one fifth of all MSF outpatient consultations take place in Congo

The second largest country in Africa (after Algeria), Democratic Republic of Congo (DRC) is a country rich in natural resources but plagued by conflict.

The country has until recently been at the centre of what some observers call "Africa's world war", with widespread civilian suffering the result.

The five-year conflict pitted government forces, supported by Angola, Namibia and Zimbabwe, against rebels backed by Uganda and Rwanda.

Despite a peace deal and the formation of a transitional government in 2003, people in the east of the country remain in fear of death, rape or displacement by marauding militias and the army.

Médecins Sans Frontières/Doctors Without Borders (MSF) first began working in DRC in 1981 in response to armed conflict, endemic/epidemic disease and healthcare exclusion.

With more than 1.9 million outpatient consultations carried out in 2016 – almost one fifth of all MSF outpatient consultations – DRC is our largest intervention in world.

Ituri crisis


Over 100,000 people are currently displaced from their homes in Ituri province as result of violence that erupted in the area of Djugu. The current violence started in December 2017, and after a lull in January it flared up again in February of this year.

Those affected made their way north towards Mahagi or south towards Bunia, whereas others headed for Lake Albert and the relative safety of Uganda.

MSF teams are working in and around Bunia, and also around Mahagi, supporting healthcare, undertaking water and sanitation work and distributing items of basic necessity such as blankets and soap.
DRC: "There is no health without mental health"
MSF staff in Democratic Republic of Congo are living through the same trauma as their patients

There is no health without mental health

MSF staff in Democratic Republic of Congo are living through the same trauma as their patients

KickerThis is a kicker.

> On the edge of a copse of eucalyptus trees, a play is under way. Its a familiar tragedy with an identifiable cast: a drunk abusive father, a put\-upon wife, and a daughter on the cusp of womanhood.

Whats not so typical about this theatrical display is its actors. When youre displaced from your home, your thoughts can be displaced too, says Sifa Clementine. Sifa oversees MSFs mental health activities in Mweso, a small town in the east of the Democratic Republic of Congo. Today, Sifa and her team are running a theatre production on sexual violence for the local community. The setting is the displacement camp that sits across the road from Mwesos General Hospital, where Sifa and her team work. The actors in the play are all MSF mental health counsellors. Over the course of the next three hours, the team connects with the 200\-strong audience through song, dance and drama. At the end of the play, theres a valuable moment for the audience to reflect on what theyve seen, as a form of group discussion. The event is designed to inform the people of the camp that MSF is in the community, and is there to listen. When we see a problem in the community, we act out these problems and educate in this way. Often, a person's behaviour is affected by what they have gone through. That is when behaviour changes." Referring to the character of the daughter in the play, Sifa goes on to explain: In her village, for example, she didn't drink alcohol, but now she does. She steals food in the house and she sells it for drinks. The sketches show people what can happen, and how they can overcome these problems.

MSFs mental health work in Mweso began in 2009, helping local communities and people displaced by conflict. The North Kivu region of Congo that borders Rwanda and Uganda, and home to Virunga National Park, has been in a state of constant unrest since the Great Lakes Crisis that began after the Rwandan genocide in the mid\-1990s.

The second largest country on the African continent by area, Democratic Republic of Congo is a fragile and conflict\-affected state and receives more aid from MSF than any other country in which we operate. The team of psycho\-social counsellors that Sifa supervises is drawn from the communities surrounding Mweso.

They connect with their clients using empathy, by creating a safe and secure environment where they are able to work through the traumas they have lived. Coming from the same communities as their clients, the Mweso team understand all too well the social taboos around mental health, as well as the traumatic events people are subjected to on an almost daily basis. Conflict, armed robberies, and sexual and domestic violence are just some of issues people face in North Kivu.

Theatre is one of the many interventions the team provides. Along with psycho\-educational activities such as this, Mwesos mental health team also provide therapeutic counselling for trauma related issues \- such as sexual violence, psychological first\-aid, psycho\-social stimulation for nutrition, individual counselling and support groups for people living with conditions such as HIV, TB and diabetes, as well as referrals for psychiatric care.

As counsellors, we help our clients by listening to them, but we can also connect with them over our shared experiences _\- Imani Stanley_

I was constantly worried and still occasionally have flashbacks, says Imani Stanley. Stanley began his MSF career in 2008 as a guard in our Kitchanga project, an hours drive south of Mweso. His intelligence and initiative saw him progress quickly to becoming a counsellor he studied Psychology at university in Goma and speaks six languages, including English, French, and four local dialects. He was recently promoted to an Assistant Administrator. In 2013, Stanley witnessed the horrors that many people in North Kivu have become accustomed to. In February of that year, the conflict reached Kitchanga. I was working in Mweso at the time, but my family were living in Kitchanga. We had two houses, one for me, my wife and children, and one for my mother, says Stanley. Thankfully, most of my family fled before the fighting, but five members of my family werent so lucky. I lost three of my cousins and my two sisters\-in\-law. Both my mothers house and mine were completely destroyed. Everything that we had invested in our family disappeared.

> **As counsellors, we help our clients by listening to them, but we can also connect with them over their shared experiences**

While Mweso and the surrounding area havent seen that level of fighting in the past four years, there is almost constant low\-level conflict between armed groups, and people are regularly subjected to violence. About two weeks ago, says Stanley, two of my cousins and my uncle came face\-to\-face with bandits on their way to their field, next to a small lake near Kitchanga, and were fired upon. They took refuge in the lake, but the bandits surrounded the shore. We found their bodies three or four days later and we buried them there. It hasn't even been two weeks since I experienced a death in my family. Its hard to imagine being able to psychologically come back from these events, but through Stanleys training, hes found ways to cope.

As counsellors, we help our clients by listening to them, but we can also connect with them over our shared experiences, he says. While this might not be common practice elsewhere, this method has helped to break down barriers in Congo, to connect with people initially sceptical to the benefits of mental healthcare. When someone comes to me despairing that he has lost his house, I say, Ah, you have lost a house, I understand that you are very deeply affected. I was like that too. Our sessions are, of course, for the benefit of our clients, but reflecting on our shared experiences allows us as counsellors to be comforted. We are reassured that other people are also affected .

We see that if were faced with the same problems as our clients, we can also cope and life can go on _\- Jaqueline Dusabe_

Jaqueline is a widowed mother of six children, and has been working as an MSF counsellor since 2009. She echoes Stanleys sentiments: Working with our clients really helps us. We see that if were faced with the same problems as them, we can also cope and life can go on. It helps us manage our emotions, especially as were in the same territory as them violence, traumas; we live them, too. In 1996, at the height of the Great Lakes Crisis, Jaqueline and her family were forced from their home. For five months, they slept in the bush, with nothing but a sheet of tarpaulin for bedding.

> **A lot of people \[in Congo\] display \[aggressive\] behaviour that, to the untrained eye, wont be seen as psychologically abnormal**

We slept on the ground, no mattresses, nothing else, Jaqueline explains. My little sister died during the war, along with her baby. We never found her body. At that point I was affected, for sure. I wasnt sure she was dead. I held on to the belief that she was alive. But what makes me happy, what helps me is that she left a son, her first child, who stayed with my father. Hes a big boy now. Thats something that makes me feel better, I can see her presence in him.

As a counsellor, Jaqueline has a fervent belief in the power of mental healthcare. However, shes not oblivious to the fact that mental health problems are sometimes a taboo subject in the community. When we say someone has a mental health problem, people right away begin to talk about madness or craziness. But I see that everyone, nearly all Congolese, are concerned by mental health problems in some way. Its a service thats neglected across the country. A lot of people display \[aggressive\] behaviour that, to the untrained eye, wont be seen as psychologically abnormal. But if services were multiplied all over to help people, perhaps aggressive behaviour and other problems would diminish, and there would be less violence in the community.

Back at the displaced persons camp in Mweso, the play is halfway through its three\-hour run and a distressing scene is taking place. The daughter of the neglectful father is out collecting firewood, when she is approached by two armed men. They chase her through the woods, catch her and hold her down. What follows isn't shown, but many people in the audience know what comes next. Some wipe tears from their cheeks.

> **Not everyone accepts the idea that people can be cured with words**

Sometimes, people cry when we tackle things they have experienced in their own life, says Sifa Clementine. In mental healthcare, when it comes to tears, they are a very good thing. Since they experienced these problems they may not have had time to cry. It is through tears you can relieve yourself. Traumatised, the daughter returns home. The next day, an MSF outreach worker comes to her village to promote the services MSF provides, including counselling for survivors of sexual violence. With the help of her mother, the daughter makes her way to Mweso hospital to talk with an MSF doctor and psychosocial counsellor.

As Sifa says: Not everyone accepts the idea that people can be cured with words. "But I will always say to people that there is no health without mental health.

> [**Find out more about MSF's work with mental health around the world >**](\-health)

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MSF’s work in DRC: 2016

Our teams undertook more than 30 emergency interventions this year, tackling outbreaks of measles, yellow fever, cholera, typhoid fever and responded to violence and refugee crises.

Poor infrastructure and inadequate health services continue to restrict access to medical care in DRC. The eastern provinces remain insecure, as the Congolese army and several armed groups fight for control of resource-rich territory.

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North Kivu

In Walikale, Mweso, Masisi and Rutshuru, we continued our comprehensive medical programmes supporting the main reference hospital and peripheral health centres to provide both basic and secondary care to people affected by recurrent violence who would otherwise have little access to medical services.

Almost 35,000 children suffering from malnutrition and/or other diseases were admitted to MSF-supported hospitals.

Over 270,000 outpatient consultations were provided in the Mweso area alone, nearly half of which were for malaria.

More than 7,500 surgical interventions were performed in Rutshuru hospital.

We continued to support five health facilities in Goma, offering screening and treatment for HIV/AIDS.

In 2016, the team provided care for over 2,600 patients living with HIV/AIDS.

South Kivu

We support two hospitals, several peripheral health centres and different community points for the identification and management of malaria and malnutrition in Lulingu and Kalehe, with a focus on malaria and malnutrition, for children and pregnant women.

Over 284,000 outpatient consultations were carried out, 10,800 people were admitted to the hospitals, more than 10,700 malnourished children were treated and more than 10,000 deliveries assisted.

We also continued to support Shabunda and Matili hospitals.

We have seen a huge increase in malaria cases in recent years and the hospital we support in Baraka is struggling to cope. A 100-bed facility we built was in full use again, and more community-based sites were set up to treat 200,000 children for malaria, pneumonia and diarrhoea.

Staff carried out over 450,000 outpatient consultations and admitted more than 17,000 patients to the hospital.

Ituri, Haut-Uélé and Bas-Uélé

In early 2016, we opened a project to assist victims of sexual violence in Mambasa region, a mining area in Ituri where there have been recurrent attacks by armed groups and bandits.

Teams provided care for over 1,100 victims of violence and treated 11,900 patients with sexually transmitted infections in nine MSF-supported health centres.

We continued to support Boga and Gety regional hospitals and several health centres, offering treatment for pregnant women and children, and emergency and intensive healthcare.

Overall, our teams treated 3,300 patients in the emergency room and intensive care unit and over 280 victims of sexual violence.

More than 600 deliveries were assisted in Boga and over 2,200 children were admitted to the paediatric ward in Gety hospital.

MSF teams also responded to outbreaks of cholera and malaria, and offered assistance to displaced people. In Haut-Uélé, more than 84,000 patients were treated for malaria during an outbreak between May and August.


Our teams supported two hospitals and several health centres in Manono and Kabalo during a nutrition emergency. By late August, the Kabalo project had closed, but our staff continued to work in the paediatric ward in the hospital and several health centres in Manono.

More than 6,000 children, suffering mainly from malnutrition and malaria, were admitted to the paediatric unit. At the end of 2016, there was an escalation in intercommunal violence and the team treated over 200 wounded patients in the hospital.

We also continued to work to bring cholera under control in four health areas around Kalemie. In Nyunzu, we responded to a measles outbreak and vaccinated around 90,000 children.

We handed over our activities to the health authorities in Shamwana territory at the end of August. For 10 years, we had been providing comprehensive healthcare in the hospital, seven health centres and at a number of specialised community-based sites for the treatment of malaria.

© Borja Ruiz Rodriguez/MSF

North Ubangi

Our project in Bili and Bossobolo continued to provide care to refugees from Central African Republic and the host communities. More than 80,000 consultations were carried out and 9,300 patients were admitted to hospitals we support.


We offer comprehensive medical and psychosocial care for people with HIV/AIDS in the capital. Our teams support several hospitals and health centres, and have been piloting innovative ways of managing patients, such as patient community groups, and providing three-month supplies of antiretrovirals.

In 2016, Over 2,500 patients with advanced HIV were admitted to hospital and 68,000 consultations were carried out.

On 11 July 2013, four MSF staff were abducted in Kamango, in the east of the Democratic Republic of Congo, where they were carrying out a health assessment. One of them, Chantal, managed to escape in August 2014, but we are still without news of Philippe, Richard and Romy. We remain committed and ready for their release.

Find out more in our International Activity Report

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