Decades of conflict and a lack of government investment have made it hard for people in the Democratic Republic of Congo (DRC) to access basic healthcare. Epidemics have spread unchecked and treatment of deadly diseases has been neglected.

The eastern DRC context is still volatile, marked by shifting alliances between armed groups, ongoing military operations, instability, insecurity, banditry, and violence. Attacks against civilians and aid organisations are rising, making both the population and humanitarian aid workers increasingly vulnerable.

Rape, murder, kidnapping, and random acts of violence are daily occurrences for millions of people. The ability of Médecins Sans Frontières (MSF) to provide free and lifesaving healthcare is at times limited by this instability, which continues to push people from their homes. 

Lack of investment in the healthcare system results in a lack of infrastructure and properly trained medical staff throughout the country. While medical needs are enormous, people are left struggling to access the most basic level of healthcare services.  

“For patients to get access to healthcare, they often have to walk for many hours,” explained MSF Head of Mission Christine Buesser. “Imagine you are a pregnant woman, and you may even have to carry another child on your back. These distances are very difficult to overcome. This is a daily challenge – just to get to a heath facility.”

Decades of neglect of the health system in DRC have resulted in a rise in infant and maternal mortality rates across the country. Life expectancy here is among the lowest in the world.

Epidemics: A permanent emergency

Logistical constraints due to the country’s enormous size, a lack of investment in healthcare facilities, and poorly trained health workers lead to weak national disease prevention measures.

The dysfunctional Expanded Program on Immunization (providing routine immunization) together with the lack of sustained vaccination strategies create a permanent health emergency in the country and preventable epidemics, including cholera, measles, and malaria, take a heavy toll on the Congolese population.

Malaria is the leading cause of illness and death in DRC, and MSF medical teams continue to treat large numbers of patients in 2011. Malaria treatment represents one third of consultations at MSF clinics.

Since late 2010, there has been a measles epidemic in DRC. More than 14 million children have been vaccinated, including more than three million by MSF. However, these urgent efforts have not halted the epidemic, and four out of eleven provinces have not yet been covered by the immunization follow-up campaign.

MSF has been responding to cholera outbreaks along the Congo River and in the capital, Kinshasa, since April 2011, treating patients and building treatment facilities. The threat of a cholera outbreak combined with the start of the rainy season in August is especially worrying in densely populated urban centers without proper sanitation systems.

Commitment is needed to fight AIDS

In DRC, only 12 percent of HIV-positive patients are receiving antiretroviral (ARV) drugs, and 95 percent of women living with AIDS don’t have access to treatment that can help prevent the transmission of the disease to their unborn children.

Despite this situation, DRC is now facing a serious challenge in funding the figth against AIDS. In 2011, the World Bank stopped funding its HIV/AIDS programs in DRC and several other donors still work with very limited funds with regards to DRC’s substantial needs. In addition, the Global Fund, which is the largest financing mechanism in the fight against HIV/AIDS, faces a major funding shortfall from donor countries.

The current donor retreat could leave thousands of patients in DRC without treatment and prevent more people from accessing treatment, threatening to undermine all the progress made since the introduction of ARVs in the country. MSF continues its ongoing lobbying efforts to maintain donors’ support in order to respond to the crisis.

Sleeping sickness a major concern

Half of all cases of the neglected and fatal disease Human African trypanosomiasis—also called sleeping sickness—occur in DRC, particularly in the Haut-Uélé and Bas-Uélé districts of Orientale Province in the northeast. Prevalence can reach five percent in some areas, well beyond the threshold of 0.3 percent needed to consider it a public health problem.

The disease is transmitted to humans through the bite of infected tsetse flies and is fatal if left untreated. Displacement and instability have contributed to its spread, and the lack of roads makes accessing patients difficult.