PARIS, France, March 3, 2014 – For years, Democratic Republic of Congo (DR Congo) has been in the grip of an emergency. Persistent conflict in its eastern provinces and instability in other regions have led to recurrent humanitarian crises and outbreaks of disease.
In areas affected by conflict, members of numerous militias and armed groups do not appear to distinguish between civilians and combatants – and neither do the soldiers of the Congolese national army (FARDC).
There is little respect for the neutrality of medical facilities, for humanitarian principles or for medical ethics. In the country’s eastern provinces, MSF has seen armed men enter hospitals and harass patients; clinics abandoned as medical staff flee violence; health facilities looted and health workers threatened; patient records confiscated in violation of patient confidentiality.
Meanwhile, a heavily armed United Nations intervention brigade (MONUSCO, formerly known as MONUC) has been authorised by the UN Security Council to neutralise armed groups that oppose the authority of the state. This seriously compromises the perception of humanitarian and medical aid as a neutral activity, as these offensive operations by the UN are being carried out in transports that resemble those of humanitarian organisations.
Millions of people living in conflict areas have been forced from their homes by the fighting. As of December 2013, the UN estimates that 2.96 million people in the country are displaced, with the vast majority (around 90 percent) residing in North Kivu, South Kivu, Orientale and Katanga provinces. Large numbers of displaced people are beyond the reach of humanitarian organisations, living with host families or hiding in forests or in scrubland. They struggle to obtain food and drinking water and receive little or no medical care and humanitarian assistance.
Aid to displaced people in eastern DR Congo goes largely to the small proportion of people who have managed to reach camps near urban centres. Even then, distributions of food and essential goods in these camps are often carried out in an irregular manner and are generally insufficient to cover the actual needs.
Aid organisations operate within an inflexible humanitarian system that does not allow a rapid and effective response to critical needs. They are heavily concentrated in urban centres, and are conspicuously absent in the remote, rural areas where the majority of the population lives.
Outbreaks of diseases such as malaria, cholera and measles occur year after year in eastern DR Congo. In most cases, however, the health system is unable to prevent them or to respond.
Patients are expected to pay for every aspect of medical care, with the national healthcare system and many health programmes run by non-governmental organisations (NGOs) based on a cost recovery system. At the same time, the vast majority of people lives on less than US$2 per day, and only one in four lives within five kilometres of a health facility.
Although the national health system theoretically guarantees free healthcare in the case of emergency, the authorities in eastern DR Congo have proven unable to assure this. As a result, a woman in obstructed labour can be expected to pay a minimum of US$50 for a lifesaving caesarean section, despite living in a conflict zone.
In this report, MSF seeks to expose, through its medical data and the testimonies of patients and staff, the true extent of the medical and humanitarian emergency lived through every day by the people of DR Congo, in particular those who reside in the conflict-affected eastern provinces, one of the areas where we work.
Much of this human suffering could be prevented. There are a number of measures that, if taken, would have a real impact on reducing the number of unnecessary deaths and improving the daily lives of people in eastern DR Congo.
Respect for civilians, humanitarians and medical facilities
• Civilians must not be harmed
In MSF’s experience, armed groups and militias appear not to distinguish between civilians and combatants. MSF has seen the consequences and received first-hand accounts of abuse, harassment, targeted attacks, counter-attacks and massacres carried out by a variety of armed groups on civilians. MSF urges respect for civilians and for humanitarian and medical facilities from all armed groups, including MONUSCO and the Congolese army. The neutrality of humanitarian action must be respected by all parties to the conflict, including the UN, by clearly distinguishing all military assets from civilian functions.
• Medical facilities must be respected
The sick and the injured are not combatants. In order for medical staff to act impartially and prioritise the delivery of care solely on medical grounds, the places where they work – ambulances, mobile clinics, health posts and hospitals – must be safe, neutral spaces. The neutrality of medical facilities must be respected by all armed groups, including MONUSCO, the new UN intervention brigade and the Congolese army.
Better humanitarian aid provision
• Focus on needs
The provision of humanitarian assistance in DR Congo should be timely, flexible and appropriate, especially in emergencies. Aid should be provided based on people’s actual needs, rather than on their location or on any kind of political agenda such as stabilisation or enhancing the authority of the state.
• Reach out to the ‘hidden’ displaced
More efforts must be made to reach the large numbers of ‘hidden’ displaced people. Temporarily living with host families or hiding in forests and fields, they are a highly vulnerable group whose needs are being neglected by humanitarian organisations focused on providing services to people in camp settings and in urban areas.
Remove financial barriers to healthcare and improve response to disease epidemics
• Stop making vulnerable patients pay for healthcare
Making people pay even a small fee for healthcare in DR Congo is enough to prevent many of the most vulnerable from accessing health services, particularly in areas affected by conflict. Health providers in DR Congo – and particularly those with programmes in conflict-affected regions – must act to reduce financial barriers for patients.
• Do more to prevent and respond to epidemics
In addition to comprehensive routine immunisations and better healthcare infrastructure in DR Congo, there needs to be greater transparency and accountability when reporting coverage rates and better cooperation when faced with a disease outbreak.
SOURCE: Médecins Sans Frontières (MSF)