“Last month my parents’ village was attacked and they tried to run but my mother was too unfit and could not flee. They cut her with a machete and killed her. My father ran but he was shot and killed. In that village they counted 11 people killed with machetes but there were many others burned in their houses and they could no longer count the bodies.” 

- Woman, 30, with 5 children who fled an attack on her village in North Kivu, May 2012.  Her husband and one child are missing

The population of the Kivu provinces in the east of the Democratic Republic of Congo is fighting an incessant war of survival, not only against the bullets flying in the latest peak of this long-running conflict but also against the vacuum of infrastructure and health resources. In an environment sodden with fear and instability, people are suffering the repercussions that come from living in the middle of this maelstrom.

Since April 2012, Médecins Sans Frontières (MSF) has treated over 200 people wounded due to clashes between armed groups. Yet simply counting the number of patients admitted to our hospitals with bullet wounds or machete cuts cannot convey the widespread impact this conflict is having on the health and well-being of people living in this troubled region.  

Forced to flee

Over the past few months, many families have been forced to flee to refugee camps and transit centers, afraid of being attacked during the night in their homes. More unsettling than seeing lines of people carrying mattresses on the road is passing through village after village, usually teeming with life, completely silent. No chickens pecking at spilled grain. No children napping in the shade. No women selling fried sweet potatoes and boiled corn by the side of the road.

Thousands of people are living with host families – strangers who share their homes, and their food, with those on the run. Many more are hiding in the forest, sheltering under plastic sheeting that they cover with leaves so as not to be visible from a distance. These people are rarely counted in official tallies because they are not registered in an established location for the displaced.

“A mass of people were running towards us. We started to flee as well. I put one child on my back and took the older one by the hand. My wife carried the baby. We are in war and we don’t know where to turn.” 

- Man, 28, with 5 children, two of whom are missing since an attack on his village in North Kivu in May 2012

“We fled our village Sunday, a week ago. On that day the attackers arrived in our village. If a house had a roof of metal they threw gasoline on the house to make it burn. If the roof was of leaves/grass, they threw fire on the house and burned the people inside. 

I lived this story. I hid with my children in the bush while they were burning our house. My sister-in-law, brother-in-law and mother-in-law were burned alive in their house.” 

- Woman, 30, with 4 children who fled an attack on her village in South Kivu in May 2012

Scared to seek healthcare

In a growing number of cases at MSF facilities, the decision by patients or their families to delay seeking healthcare because of the threat of violence or extortion while travelling has contributed to patients arriving in a life-threatening condition.

“A woman began miscarrying late at night; the bleeding was severe. But with all of the military and armed groups on the roads, her family was too scared to travel during the night, so they waited until the morning to walk the few hours to our hospital. She arrived at noon. By then she had lost too much blood and there was very little we could do. She died within minutes of arriving.” 

- MSF nurse at Mweso hospital in North Kivu, April 2012

One woman was attacked and raped by a group of armed men while walking to the hospital with her sick child. When she finally arrived, she was in more urgent need of medical care than her child was.

In some places we see a huge increase in patients – more than 40% at one health center – because the fighting has pushed people into the area. In other places, we see a decrease in patient numbers because they have fled or are in hiding.

In spite of the fertile and green surroundings, the weakest and most vulnerable are susceptible to malnutrition, as people are scared to harvest crops or go to market.

“I arrived today at the hospital with my daughter who is suffering from severe malnutrition. We live in a village three hours walk from here. Because of the insecurity over these last few weeks we no longer sleep in our house but in the fields or in the bush. During the night, bandits attack the village and during the day there are military clashes. It is difficult to find food with the bullets flying and preventing us from going to the fields. 

- Mother of a 4-year old patient in MSF feeding center in North Kivu, April 2012

Victims of violence

MSF is treating people who have been mistaken for combatants and attacked with machetes or shot. Patients and staff tell of relatives who have been abducted and forced by armed groups to carry supplies and pillaged items.

“I left my village with my family at the beginning of the fighting. On Wednesday, having no food, I returned with some friends to my field to harvest vegetables. We heard weapons fire, and during the shooting a bullet lodged in my left arm. I returned with my friends who were not wounded to the village where they made a stretcher out of branches to carry me to the main road where we then able to find a motorcycle to the next town. We waited until the next day to come to the hospital because we did not want to travel at night.” 

- Man, 28, with 3 children, North Kivu, May 2012

“Last Sunday we heard gunshots in the village so the people all took shelter in their houses. My little girl was the last to hide because, with the crowds, it was difficult to enter the house. She was shot in the thigh. She cried and screamed a lot. We brought her to the health center, where she stayed one day. Then, on Tuesday, we brought her to the hospital by motorcycle.

My biggest fear is for my children and what will happen to them if the war continues because when we flee, we cannot carry food or clothes, and we are often harassed by the armed groups.” 

-  Mother of 5 children, North Kivu, May 2012

The current peak in instability in North and South Kivu is part of an ongoing cycle of violence in the east of the Democratic Republic of Congo that continues to have severe health and humanitarian consequences for people living in the area.