Measles has reappeared in the remote and turbulent eastern province of South Kivu in the Democratic Republic of Congo (DRC). Médecins Sans Frontières (MSF) recently deployed emergency teams in the region, where the difficult terrain and presence of armed groups make access to healthcare a challenge.

In the middle of December, the MSF emergency team in South Kivu had been alerted that there were 10 people with measles.

"I was afraid," says Sarah Lutz-Simon, head of the MSF emergency team in South Kivu.

"When we arrived at the health centre, all the sick children had been together in the only room, in the dark. There must have been around 40 of them in there and the image was hard to take in: they were weak, with red eyes, runny noses and rashes. I was part of the first team to arrive in the area and we didn't really know how many cases we were dealing with."

The sight that greeted the team at the health centre indicated that there had been a very rapid increase in cases.

The team also recently faced an outbreak of measles in Mulungu, a remote area in the turbulent eastern province of DRC, and vaccinated 4,165 children. Measles has reappeared at an alarming rate, with alerts of outbreaks in different parts of the country.

"While we waited for confirmation of the tests, we started creating isolation zones. First, in the village of Itanga, so that we could free up the health centre and start treatment," says Sarah.

There is no antiviral treatment for measles, so the medical staff try and prevent dehydration, monitor fever and manage any complications that may arise, including eye and ear infections.

The temporary isolation centres created by MSF are basic, consisting of 10 wooden beds with plastic. Three centres were built in different areas in the space of a month, as six teams were deployed to begin vaccinations in villages as soon as possible. The vaccinations served as firewalls against infection to eventually halt the spread of the disease.

The challenges

For the emergency teams, one of the toughest challenges in dealing with the alerts is the area's terrain.

"From Bukavu, the capital of South Kivu, it took us two days to drive to Bisisi, and from there we had to walk along trails for at least five hours to get to Idunga", says Sarah. "And that was the easy part. Some of the teams had to walk from Idunga for three days to reach the most remote areas."

A helicopter offered the best guarantee for maintaining the vaccines' cold chain. The rivers were swelling and staff safety needed to be assessed, as people were going to have to cross a bridge made of vines and doubts were raised over its stability.

MSF recruited several hundred local residents to work as porters, and everyone managed to cross the bridge with all the equipment. The teams helped the Ministry of Health with the vaccinations, securing a coverage of 94 per cent. They also treated the most complicated cases.

In addition to the geographical distances and obstacles, the presence of armed groups in South Kivu makes access to healthcare difficult for the population. MSF spoke to all of the small armed groups based in each area in order to gain access so that they could vaccinate and treat the sick.

An immediate impact

"The impact is immediate. We've saved many lives", says Sarah. "People were very happy because they were also really worried about the outbreak and they had only received aid sporadically. Seeing the number of affected people decrease in such a short time following vaccination is the best thing."

In total, 352 children were treated and two deaths were recorded: one on the day that MSF arrived in Itanga and another in the case of a child whose family had resorted to local healers.

Besides measles, children in the Mulungu area were vaccinated against pneumococcus, hepatitis, haemophilus bacteria, diphtheria, tetanus and whooping cough, with a new combination of antigens used for the first time in the province. The teams are now prepared to tackle new alerts of measles, which is one of the diseases that causes the most child deaths, despite being easily preventable.