Months of conflict between armed groups in the province of North Kivu, Democratic Republic of Congo (DRC), have exposed civilians to extreme levels of violence. Many people have sustained life-threatening injuries, lost family members in the fighting, and have been forced to flee their homes. As well as the physical trauma caused, these events have left people with psychological scars that are often less evident than physical wounds and therefore risk going untreated.

Over the past year, thousands of families have sought refuge in the displaced persons’ camps of Bibwe, North Kivu. Between January and August 2013, the population of the area nearly doubled in size from approximately 8,000 to more than 15,000 people. In response to the mental health needs in the area, MSF teams have integrated psychosocial care into their existing medical activities in Bibwe.

Violence and displacement

Bibwe is a town of a few thousand people located approximately 135 kilometres northwest of Goma, in the conflict-affected North Kivu province of DRC. Though Bibwe has itself been the site of inter-ethnic clashes in the past, ethnically-motivated violence in neighbouring areas has caused an influx of more than 3,000 displaced families to Bibwe in the last year.

MSF teams were prompted to carry out a mental health needs assessment in the area after hearing the disturbing accounts of the newly displaced people there. The results were alarming:  of 600 respondents, more than 80 percent reported being the victim of direct violence and nearly 90 percent reported having witnessed an act of violence.

The consequences of violence on people’s psychosocial wellbeing are significant. Seventy-one percent of respondents said that they had nightmares, and 74 percent said they had flashbacks of violent events they had experienced.

“In the morning I saw the body parts of people everywhere – I could not tell which leg belonged to which head,” said a 38-year old man who saw 30 people – including his four brothers – being hacked to death. “Now the images of what I saw are always coming into my head during the day and during the night.”

Responding to humanitarian needs

To respond to the considerable mental health needs in the Bibwe area, MSF has trained counsellors to work with survivors of violence in the camps. The team runs support groups and provides individual, family and group sessions.

“The vast majority of these people have either directly witnessed violence or had their own lives placed in danger, and many have lost immediate family members,” explains Isabel Rivera, MSF’s psychologist responsible for the mental health programme. “The need for mental healthcare in Bibwe is great and should be considered a vital component of the humanitarian response in this area.”

Many other elements of the humanitarian response have been lacking in the camps. Few humanitarian organisations are present in Bibwe. Most of those that are have been unable to regularly access the area for months due to poor road conditions, landslides and rock falls caused by the rainy season. Many families explained that they still lack food, water and cooking supplies and don’t have the money to buy seeds or tools that would enable them to grow their own food. The shelters are basic and do not adequately protect from the rains.

“The poor conditions the people are living in makes them even more vulnerable to psychological problems like stress, as well as illness,” says Rivera. “While certain areas of North Kivu are currently experiencing a period of relative peace, we can’t forget that many areas continue to be affected by violence and displacement and the people there still need help. We must recognise and respond to the psychological distress the people here have been through.”

MSF offers basic healthcare at the Bibwe health centre and specialist healthcare in nearby Mweso general hospital. In North Kivu province, MSF is running medical programmes in the areas of Goma, Walikale, Masisi and Rutshuru. Nearly 3,000 national and international staff are currently working in more than 20 project sites in Kinshasa, North Kivu, South Kivu, Katanga, Maniema, and Orientale provinces. MSF has worked in DRC since 1981.