Pierre, how would you describe the security situation in the Uélés at the moment?

There’s still a lot of insecurity. Attacks, killings, armed offensives and kidnappings still run rife. The population lives in a constant state of tension, always ready to flee en masse at the slightest rumour of an attack by the rebels from the Lord’s Resistance Army, or LRA. Tens of thousands of people have been displaced over the last few months in different parts of Haut-Uélé and Bas-Uélé. People only have very limited access to medical care, except for those who have taken refuge in the main towns. In Niangara, one of the places where MSF works, we saw people who’d travelled between 50 and 60 km to get to the hospital. In the first three months of 2010, the surgical team at the Niangara hospital had already operated on nearly 150 patients, two thirds the number of emergency operations carried out by MSF in 2009.

Apart from surgery, what are MSF’s main activities?

MSF mostly carries out medical and psychological programmes in areas sheltering the displaced. In Niangara, where half of some 20,000 inhabitants are displaced, we support the general hospital and a primary health centre. In Niangara, we carry out around 4000 consultations and hospitalise 200 patients every month. To reach the populations cut off by insecurity, we send out teams to conduct mobile clinics whenever security allows. After some serious and deadly attacks and huge new population movements, we ran mobile clinics in Tapili, to the West of Niangara, between January and March. The team regularly goes to Nambia, a settlement about 15km north of Niangara and provides on average 200 medical and psychological consultations a day.

Psychological support is an important part of MSF’s activities…

You’re right; it’s an essential part of what we do. The mental health programmes not only target the direct victims of kidnappings and violence, but also the many people living in a state of constant fear. Some have lost their family, some have witnessed atrocities, the rape of young girls, and find themselves all alone, and there are those who haven’t seen extreme violence firsthand but have fled far from home for fear of attacks and can’t provide for themselves or their families. In 2009, 416 people received psychological support from MSF in Niangara, either through individual consultations or collective sessions.

How do the populations survive in such circumstances?

They often take refuge in the regions’ main towns which have become enclaves, such as Niangara, Nambia, Bangadi or Doruma. There’s no way the displaced can return home at the moment because of ongoing insecurity in the outlying areas. This part of the DRC has been torn apart by extreme violence and clashes for almost two years now. The populations can see no end in sight. It’s really dangerous even to leave the village to tend their fields. Very few of them dare to venture out and some who did have never come back.....What’s more, the presence of thousands of displaced people puts increasing pressure on local resources. The result is that both the displaced and resident populations are ever more vulnerable and remain fully dependent on external humanitarian aid to survive.

In 2009, MSF called for humanitarian assistance to be stepped up in the region. What is the level of aid being provided to the populations today?

Over the last months of 2009, humanitarian organisations increased their presence in the region, above all in the main towns. While people’s needs are better met, the humanitarian response can only provide the bare minimum - health care, food, water, basic household goods - and only in the towns where security is better. However, in the more far flung and isolated settlements, people sometimes have little or no access to food, hygiene and medical care. In Bangadi, for example, MSF evacuates the seriously wounded to the hospital in Dungu by air. In Nambia, MSF can only run mobile clinics from time to time – insecurity holds us back. Very little information is available about the people living in the areas where humanitarian organisations are not present. There’s more aid than there was a few months ago, but there are still many, many challenges to be met.