Kinshasa/Bunia/Geneva - Despite an overall decrease in the intensity and recurrence of conflicts in the district of Ituri in eastern Democratic Republic of Congo (DRC), civilian populations there are still subjected to high levels of violence.

Based upon four years of medical work in the region, Médecins Sans Frontières (MSF) has issued a report titled "Ituri: Civilians Still the First Victims", emphasizing the persistence of sexual violence as well as the direct humanitarian consequences of military operations in 2007 during a "pacification process" in the region.

Today, 50 to 120 people who have suffered sexual violence arrive every month at the Bon Marché hospital in Bunia, capital of the Ituri region. MSF has treated 7,400 rape victims over the last four years. More than one-third of these people were admitted over the last 18 months.

"At the Bon Marché Hospital where we work, the number of consultations as a result of rape remains high," said MSF Director of Operations, Bruno Jochum. "Other forms of violence are also associated with these sexual assaults, notably acts of humiliation and torture. One patient in five affirms having been held captive between two days and several years."

All patients who have been subjected to sexual violence and humiliating treatment stress the extreme problems they have in going back to a normal existence.

Military operations linked to the pacification process have been, and are still, a source of direct violence against civilian populations, such as rapes, brutality, house destructions, looting and induced displacement of populations. In Laudjo village, 85 percent of the houses were destroyed during military offensives in early 2007.

Violence is the main cause of mortality over that period for people over five years of age.

"Civilians pay a heavy toll for these pacification operations," said Jochum. "They are accused by each warring group of supporting the other side and are therefore the victims of indiscriminate retaliation or punitive actions."

In the Djugu territory of Ituri, the violence has provoked the flight of tens of thousands of people who are now simply trying to survive.

Today in Ituri, 150,000 internally displaced persons (IDPs) are still unable to go home. In a state of utter destitution, they remain vulnerable to exploitation and assaults. This population will remain heavily dependant on humanitarian aid until conditions are set for a safe return to their place of origin.

In the Laudjo area, a study conducted by Epicentre, the epidemiological research arm of MSF, found that one third of children between zero and four years of age were missing. This reflects the disastrous and long-term effects of several years of abnormally high death rates among children due to armed conflict and the discontinuation of health services.

Extending health care and social services through an adapted medical and mental care is an absolute necessity in Ituri. Faced with populations living in an acute distress, local authorities must do everything in their power to ensure the end of all types of violence as the relapse of heavy fighting in Kivu illustrates the great instability that reigns in the east of the country.