MSF teams are seeing large numbers of malnourished children in some districts. Thousands of people have been displaced and are either living in camps with very little food, or with host families, stretching what were already quite limited resources.

Many people who have not been displaced are afraid to go to their fields to farm. As a result many people are almost completely dependant on the ability of aid organisations to reach them and distribute food.

With different groups controlling different parts of North Kivu, it is often difficult for MSF teams to travel around. At times, teams have to be evacuated for security reasons and medical activities suspended. Mobile clinics operate when possible and MSF staff supply health centres in different districts with materials and drugs. However these centres are often looted and the materials either stolen or destroyed.

Medical teams continue to assist people who have been wounded in the fighting. The situation is tense and civilians often bear the brunt of the violence. On 10th November a town in Masisi District, where MSF supports a health centre and hospital, was attacked. Seven people were killed and six wounded, all of them civilians. On November 13, fighting caused people living in Mugunga camp, just outside Goma, to flee. When they returned many found that their temporary homes had been systematically looted. Amongst other things, the plastic sheeting that is there sole protection from the rain and wind was gone.

MSF ACTIVITIES IN NORTH KIVU

MSF is currently working in the Rutshuru, Masisi, Lubero, Walikale and Goma Districts of North Kivu, with a total of 425 Congolese staff and 45 international staff. In October MSF opened a new project in Nyakabanda camp, Uganda, providing assistance to the estimated 13,000 refugees who had fled there from eastern DRC.

RUTSHURU DISTRICT

Rutshuru Town Area

MSF has been working in the 200-bed Rutshuru reference hospital since August 2005 providing secondary health care, including surgical, medical, paediatric care and specialised care to victims of sexual violence.

In the third week of October, admissions to the hospital increased by 50 percent. The MSF team responded by adding tents to increase inpatient capacity, employing more staff and reinforcing the pharmacy with additional supplies. 330 surgical operations were performed in October, compared to a monthly average of 220 since January 2007.

Since early September, MSF has rehabilitated and helped reopen three health centres, in the Binza health zone, that had been closed since February. In Buramba, Katwiguru and Kiseguru 5,800 consultations have been provided to date.

With thousands of displaced persons constantly on the move, MSF has dispatched medical teams to establish mobile clinics in schools, abandoned health centres, or tents to provide basic health care and refer severe cases to Rutshuru hospital. MSF's mobile medical teams have conducted more than 2,000 consultations in Kabaya, Kinyandoni, Rugare, Katale, and Karembi. As measles cases have been reported in some parts of North Kivu, MSF started a campaign to vaccinate children against measles in mid-November. Due to ongoing violence in Rutshuru District the campaign is currently on hold.

MASISI DISTRICT

Masisi Town 

In response to outbreaks of violence and increasing displacement, MSF opened a new project in Masisi, about 80km west of Goma, at the end of August. The emergency response initially focused on surgery for people wounded in the fighting. MSF also worked on improving conditions in the hospital. The showers and latrines were repaired, electricity was installed and a new pharmacy and nutritional centre were opened. The capacity of the hospital was increased from 72 beds to 120.

A team of five international staff work in the hospital and a health centre in Masisi town, focusing on emergency surgery and nutritional care. The surgical team have completed 278 operations since September - 163 of these were for war related injuries. On November 10, an attack on the neighbouring town of Lushebere left seven people dead and six wounded. MSF transferred the injured patients to Masisi hospital where they were operated on and are now recovering in the inpatient department.

In the health centre MSF supports Ministry of Health staff who have done over 7,000 consultations since the beginning of October, mainly for malaria, urinary and respiratory infections and worms.

In October an assessment of children under five in Masisi revealed that 10% of those screened were suffering from malnutrition. MSF has responded by opening an ambulatory nutritional programme targeting 1,200 children. A lack of transport and insecurity on the roads makes it difficult for some people to come to Masisi hospital, so an MSF mobile team is also visiting towns around Masisi - Bugari, Mushaki and Lushebere - to provide food and medical care to malnourished children.

Mweso and Kitchanga Area

MSF staff have been forced to suspend activities several times since teams started working in Mweso health zone in February 2007. On October 17, a small team was able to return to the area and provide support to St. Benoit hospital, in Kitchanga.

A full team of five international staff and eight Congolese staff are now back in the hospital, working together with the Ministry of Health staff to provide basic health care and medical care for children with malnutrition. Over 100 consultations are done a day. MSF also supports a Congolese organisation, SOPROP, which provides medical care and counselling for victims of sexual violence.

Until October, MSF supported four Ministry of Health clinics in Bukama, Kashuga, Kalembe and Jardin Thécole de Ngeri (JTN). However, these clinics have been looted on several occasions so MSF has decided to limit supplies. When security permits, mobile teams visit the clinics twice a week to provide medical care and supply drugs and other materials.

MSF teams have not been able to get to JTN for the past two months and have been told that the entire population has fled. MSF has also recently started supporting a clinic inside Kilolirwe IDP camp, providing health care to the displaced and the host population. As Mwezo health zone is not stable MSF will adapt its support to the rapidly changing situation.

GOMA DISTRICT

An estimated 45,000 are thought to be living in camps outside Goma, with several thousand more finding accommodation with host families. MSF is working with the Ministry of Health to treat and contain cholera. Cholera is endemic in DRC and MSF teams will normally see a number of cases in North Kivu every year. However, this year, the influx of an additional 45,000 living in a crowded camp situation with limited sanitation means that there have been far more cases of cholera than normal.

MSF opened a cholera treatment centre (CTC) in a central location between four of the largest camps on 24 September. Teams also support a smaller CTC in Goma hospital, as well as CTCs in four health clinics - two in Goma itself and two in the neighbouring town of Saké. So far over 1,100 people have been treated, with only four deaths reported.

UGANDA

Cross border mobile clinics from Kisoro, Uganda, to three locations in eastern DRC - Jomba, Chengerero and Bunagana - had to be suspended following violent clashes on 19 and 20 October. The teams hope to resume these activities on 3rd December. Staff continue to assist approximately 13,000 people who have fled to Nyakabanda camp in Uganda, roughly 15km from the border with DRC.

Six international staff and around 50 Congolese staff constructed shelters, latrines and provide clean water and sanitation facilities. MSF is the only organisation providing medical care in the camp. Staff at MSF's health clinic do between 100 and 150 consultations a day, primarily for diarrheao and respiratory infections. Seriously ill patients are transferred to Kisoro hospital, a 20 minute drive away.

Outreach workers follow up patients, including children who are suffering from malnutrition and need supplementary food. MSF teams recently helped the local health & sanitation authorities to vaccinate 5030 children, aged between six months and fifteen years old, against measles and polio.

MSF has been working in the Democratic Republic of Congo since 1981.