Today there are several sites in and around Mitwaba, including three camps; there are three camps around Dubie, and scattered displaced families around Pweto, Kabalo and Upembe Park.

Supposedly safe and secure, the camps and their surroundings lack assistance and security.

Despite efforts by MSF and the host communities, the camps that exist are over-crowded, with few facilities, limited shelter and poor hygiene conditions. Around Upembe Park, thousands of people live in mosquito-infested swamps or on small floating islands on the lake itself. MSF is currently providing emergency medical care, shelter, non-food items and water/sanitation facilities across the displaced of Mitwaba, Dubie, Kabalo and Pweto; however, the effective presence of other national and international actors is thin despite the ever-increasing need.

There are large medical needs ranging from malaria through respiratory infections to diarrhea - all of which are common and treatable problems and exacerbated by pre-existing vulnerability, over-crowding and unhygienic conditions. Food remains a major challenge, with malnutrition - also preventable - rising. And the threat of violence and the reality of theft persist. The host communities have also been significantly affected.

Pressure on host communities

The displaced have found refuge in areas ill-equipped to receive them with little prepared for their arrival. Having arrived with nothing, they have largely been dependent upon the goodwill of host communities - for food, clothes, shoes, shelter... Yet as much as they try local populations lack the capacity to help, affected in their turn by the insecurity around them, poor infrastructure and limited resources.

Food insecurity and food distributions

"My daughter went with the Mai-Mai. She was sixteen years old when one of them saw her and asked to marry her. What could we say? If we refused, we would die. She went for the family honour. Her dowry was a bead, but you can't do anything with a bead." Female, 36 yrs
In Mitwaba, the last distribution of food rations from the World Food Programme (WFP), took place in August, with the displaced receiving three months worth of food each. Since then, they have not received anything - and due to current military operations, have limited access to fields for cultivation.

Over the last 12 months in Mitwaba, the displaced have accounted for 50% of the 1,026 patients treated for malnutrition by MSF, among them a number of breast-feeding mothers. With the remaining 50% being made up of the host community, the situation can only be described as precarious. Moreover, since mid-November, local communities in Mitwaba have reported the military imposing taxes on their food and taking crops from them so as to meet their own needs.

In Dubie and Pweto, local communities have allowed the displaced to take manioc from their fields and/or to plant small areas of their land in return for cash that they can use to buy food such capacity is becoming increasingly scarce. In Dubie in particular, with the influx of more than 17,500 displaced persons at the time of writing, further land to cultivate is in short supply and food prices have rocketed. Items such as potato, onion and lettuce can no longer be found on the market, while others such as bean and tomato are rare. The price of manioc, the staple food, has doubled; the price of meat has tripled.1

"There were lots of them each time. They came with fetishes around their necks - male genitals and human hands - wearing bracelets and with faces painted red. They sowed panic wherever they went: people could do nothing." Male, 37 yrs
While food distributions have now arrived in Pweto, in Dubie they have been erratic. A local NGO began these in August/September when the displaced population only numbered a few thousand, but subsequently withdrew. Since then, WFP has committed to one month's food ration by re-allocating food from Mitwaba to Dubie, but distributions have been marred by logistical problems, bad planning and under-estimation of the problem and the resources needed.

No food distributions have taken place around Lake Upemba. It takes at least two days to make the trip from Lubumbashi to Dubie or to Malemba Nkulu. Today thousands of displaced survive on only one meal a day, insufficient in either quantity or quality. The numbers of children under five years old in MSF Therapeutic Feeding Centres have been swollen by the newly arriving displaced - with numbers from the host populations significant too.

In Mukubu, MSF has admitted between 15-20 severely malnourished children each week for the last six months. On the road near Pweto, of the 21 serious cases transferred to the hospital, 14 were displaced children. In Dubie, of the 56 admissions to the TFC in December, 28 children were diagnosed as having kwashiorkor - an acute lack of protein from foods such as eggs, beans, meat, and fish. Most of them are displaced.

1 While in September, the price of five manioc roots was 50 Congolese Francs (CF); today only three roots can be bought for the same price. One tomato now costs 50CF, compared to 25CF in September.

Public health and medical needs

'In April, when I was coming to the health centre with my sisters, I met an armed military man. He got hold of me and forced me into the bush. He raped me... The man was called up by his commander, but he was only scolded...and ... freed'. Female, 17 yrs, Displaced 'My husband, my children and I fled...in March...Our eldest son was arrested by the military. He was freed a few days later but other family members died in prison...My husband was also arrested. He was accused of being an informer for the Mai-Mai. He left prison covered with wounds. Because of the torture, he has difficulty walking now'. June 2005, Female, 38 yrs, Displaced
On top of Dubie town's normal caseload, MSF is now seeing an additional 70 displaced persons per day. Many of the displaced are coming to MSF seeking healthcare for fevers and chesty coughs, suffering from malaria, worm infections, acute respiratory infections and diarrhea. These pathologies are all linked to poor living conditions.

Having survived with few or no clothes, blankets or shelter in the fields and in the bush, living in unsanitary conditions with little nutritious food, they are even more vulnerable now in the camps.

Although MSF (with some support from UNICEF) has been distributing blankets, soap, plastic sheeting, cooking sets and jerry cans, and plans to distribute mosquito nets, it is far from enough.

Shelter materials and cooking sets for instance, have been distributed to over 17,000 persons across Kabalo and Dubie, but even more is still required. At present in Dubie, the displaced receive between 5-15 litres per person per day.2 Around Park Upemba, a measles vaccination campaign is being conducted for 8,000 children, but even more displaced have sought refuge in the surrounding forests and remain inaccessible to our teams. In Pweto, only those along the main road can be reached.

The IDPs remain in temporary shelters, protected by a few blankets and threadbare clothes. The current rains are exacerbating the situation. The graph below is indicative of the health situation in Dubie, a town where residents are now outnumbered by the displaced by 5:9.

"We were back in the fields for the second time when we saw smoke coming from the village. My husband went to see. The Mai-Mai had burned the house - but the kitchen was still standing. All the houses had been burned and looted so we left. We weren't able to take anything: cooking pots, mattresses or clothes." May 2005, Female, 39 yrs
Moreover, not being built or equipped to cope with the sudden influx, Dubie's Referral Health Centre is experiencing severe over-crowding. In areas such as Kizabi near Pweto, after the health centre was looted and destroyed, MSF has been obliged to run a regular mobile clinic. A similar situation exists around Mitwaba and Mazombwe after health posts there were burnt to the ground.

In addition, December is the beginning of the cholera season, with MSF already treating cholera in Moba, Kabalo, Ankoro, Kinkondja, north of Lake Upemba and around Malemba Nkulu. In Kikondja health zone alone, MSF treated 770 new cholera cases since the 6th January. There have been 34 deaths. In Kabalo, 190 cases were reported between 15 November and 12 January. MSF is racing to construct latrines and ensure safe water supplies to avoid further outbreaks amidst already weakened populations. It can be imagined that further displacement due to conflict or an unprepared return to home villages would only further exacerbate their dire situation. Concerns of forced returns by either party to the conflict are increasing.

2 Five litres of water per person per day is the absolute minimum which can be sustained for 1-2 days during an emergency situation. Otherwise the minimum objective is the provision of 20 litres of water per person per day.]

Diversion of assistance and violence

'The military harass people at night. They come to inspect our homes, make the children leave and then help themselves...when there are distributions, I'm frightened: there are always military who come to take what we've been given'. December 2005, Female, 40 yrs, Displaced
Already dealing with health problems, the IDPs are also having to struggle with the fear of theft and violence. A number of IDPs in both Pweto, Dubie and Mitwaba, as well in the Kabalo area, regularly report that the military loot their cooking pots, blankets and any other possessions they might own.

Diversion of food by the military is also regularly mentioned in Mitwaba and has been seen in the past in Dubie. In Mitwaba in the past, both residents and displaced, men and women also complained of sexual violence and torture. In many cases, the perpetrators went unpunished.

More recently, in mid-December alone, seven women and one girl of 14 years were treated by MSF following rape by military. Due to taboo and stigmatisation, sexual violence may well be under-reported. Attacks by militias have not only occurred in Mazombwe and Kizabi but more recently in Kibondo and Kyubo, further adding to the insecurity felt by the displaced.

This general insecurity restricts access by MSF to the displaced as well as the provision of assistance. As a preventive measure, near Park Upembe, MSF has suspended Non-Food-Item distributions as these appeared to increase the likelihood of attacks. In the last several weeks, roads have also been cut-off due to military operations or attacks by militias.

In January, a private truck, often used by MSF was attacked and looted while returning from Mitwaba. Truck drivers are now refusing to travel to Mitwaba.