From the Summer 2000 edition of DISPATCHES (UK office) Frances Stevenson is the Programme Manager for MSF in the UK office.

The town of Kisangani is an island in the second biggest rain forest in the world. It was once a major, thriving commercial centre for the entire north-eastern region of the country (Province Orientale) and was home to over ten thousand expatriates as well as the half-million local population. Now the country is torn apart by civil war, the docks in Kisangani are idle and rusting and the only expatriates living there are the MSF aid workers.

Thirty years of appalling mismanagement and corruption under the rule of President Mobutu has left public services in disrepair. The collapse of the economy and public services has created desperate poverty and chronically poor health. In 1996 Laurent Kabila launched a rebellion that succeeded in ousting Mobutu a year later; Zaire became the Democratic Republic of Congo. But the honeymoon was short-lived since August 1998 Kabila's government has been attacked by rebels from the east.

A disaster for the ordinary people of the Congo, this war is also a dangerous regional conflict threatening the stability of at least eight African countries. Kabila's government is backed by Angola, Zimbabwe and Namibia and the rebels are backed by the forces of Rwanda and Uganda. According to the United Nations there are more than 650,000 internally displaced people in the country and nearly 300,000 refugees from neighbouring countries. Serious human rights abuses are widespread.

Providing assistance in such a conflict is not easy. Access is extremely limited by the near non-existent infrastructure - the few roads that exist test the toughest 4x4 vehicles to the limit. Fighting on the ground, bombing from the air and constantly simmering instability and insecurity pose further obstacles. Only MSF and the International Red Cross have been able to continue working in Kisangani.

In February we began a nutrition programme in Kisingani after a survey revealed 13.4% global malnutrition including over 9% severe acute malnutrition for children under five. (By international standards,anything over 1-2% is considered an emergency.) Over 2,000 malnourished children are now being cared for in our seven feeding centres, but the true scale of the problem could be huge. Some of the parents had travelled up to 150 km to bring their children; all had more children back in their villages, many of whom were similarly malnourished to the drawn, listless ones they held in their arms. MSF is now opening three more feeding centres in the periphery of the town.

Beyond Kisangani, in the vast territory of Province Orientale, around seven million people live in an area the size of France. Small health centres exist to provide basic health care but supplies and trained staff are in very short supply. MSF delivers medical kits to around 150 health centres. In addition, we train local staff in primary health care, drug stock management and health surveillance techniques. Water sources are also being constructed or rehabilitated to give the communities in this cholera-prone area access to clean drinking water.

Ituri District on the border with northern Uganda is a focus of epidemics of everything from cholera, meningitis and measles to plague and the rarer haemorrhagic fevers such as Ebola and Marburg virus. MSF works closely with the local health authorities, the World Health Organization and other specialist bodies such as Centres for Disease Control on epidemiological surveillance and emergency epidemic response.

Successive attempts to negotiate peace in the region have so far failed to halt the fighting and the brutal war continues. There is renewed hope that the Lusaka Accord, originally signed by some parties to the conflict on 10 July, may bring about a workable compromise. Congo needs peace, stability and a chance for the people to recover in the near future.

MSF is also working in North and South Kivu in eastern Congo and in Kinshasa, Equateur, Katanga, Kasai and Bas Congo in the west and south of the country.