The ten-year war has yielded inhuman levels of violence. The International Rescue Committee calculated that the war had caused, directly or indirectly, 2.5 million deaths between August 1998 and April 2001. In some areas surveyed, they calculated that 75% of the children never made it to their second birthday.

Violence, killings and massacres like the ones described above have been going on for ten years in the Democratic Republic of Congo (DRC), seemingly unnoticed by the international community. In August 2002 the BBC reported that UN observers recently discovered several mass graves in Ituri Province of north-eastern Democratic Republic of Congo; the one-minute update, telling of scores of bodies found hacked to pieces by machete was buried behind news of roiled stock markets and new peace talks in the Middle East. The victims in Ituri remained unnamed, the perpetrators anonymous. Few newspapers in Europe bothered to note the story. It was an unusual drop of attention, and by the next day it had completely disappeared. Massacres, mass rape and displacement in the DRC have long since ceased to be news for the rest of the world. If anything, it was a surprise that this incident made it to the BBC's back pages.

Ten years of torment

2002 marks the 10th anniversary of ongoing conflicts and violence in the DRC. It is the latest and most tragic part of a painful history marked by the brutality of Belgian colonial domination and the failure of the state in the years following independence. The subsequent chaotic conflicts have followed on from 30 years of the gradual disintegration of the Congolese state under Mobutu, who was deposed in 1997 in the wake of the genocide in Rwanda in 1994. Mobutu's name had become the synonymous with the kleptocratic state. The country's vast mineral resources were sold as concessions to foreign companies but the proceeds rarely if ever filled the state budget. Civil servants went for years without pay during the last decade of Mobutu's rule. Soldiers from the Congolese army turned to looting and extortion to finance both salaries and equipment. Particularly in the later years of his rule, the pillage of state assets and the neglect of the state sector have undermined faith in the possibility of state development in Congo. Conflicts in the eastern DRC started in 1992 in the east of the country in the Masisi plains of North Kivu. Thousands were killed and hundreds of thousands driven from their homes as rival Hunde and Banyarwandan militias fought over the land ownership and political control of the region - the Hunde claiming that the Banyarwandan groups as immigrants from Rwanda had no political rights in the DRC. In 1994, the violence of the Rwandan genocide spilled over the border into Congo, along with millions of refugees and the remnants of the armies and guerrilla groups that conducted the genocide - groups burning with ideologies of ethnic hatred. War had already started in DRC but the spill over from the genocide turned it into the seemingly endless torment of a people. Initially limited to the eastern provinces, the war spread to encompass the whole of the country with the rebellion launched by Laurent Désiré Kabila in 1996. Aimed at sweeping Mobutu from power, but also at eliminating the Hutu militias that played a key role in the Rwandan genocide, the rebellion had strong support from Rwanda and Uganda. This phase of the war was marked by widespread and indiscriminate violence against the civilian population, particularly against Rwandan refugees, who had been seeking shelter in the Eastern DRC since 1994. MSF was witness to horrible massacres against the refugee population which was left without protection or aid. In 1998, Rwanda and Uganda became disenchanted with Kabila particularly as he was not living up to his promise of preventing further incursions of the Hutu militias into Rwanda. They again began to support rebel groups seeking to overthrow the Kabila government in Kinshasa. The attack failed only when Angola, Zimbabwe and Namibia sent troops into Congo to defend Kabila. The influx of foreign forces and the partial division of DRC into rival zones of influence led to the conflict being labelled Africa's First World War.

Killing, torture and rape as weapons of war

The ten-year war has yielded inhuman levels of violence. The International Rescue Committee (IRC) calculated that the war had caused, directly or indirectly, 2.5 million deaths between August 1998 and April 2001. In some areas surveyed they calculated that 75% of the children never made it to their second birthday. The IRC surveys indicated that at least one out of seven of these deaths were the direct result of violence. Almost 20 % of the respondents in a MSF survey in 20013 had witnessed torture in the previous 3 years. The MSF teams on the ground are in touch daily with the personal and physical results of this violence. In Shabunda, South Kivu Province, the militias surrounding the town repeatedly kidnapped local villagers and held them in semi-slavery in the forest. They tortured and raped women who were kidnapped over the course of many months. Some of those who have survived this experience were so mutilated that they required reconstructive surgery. Unable to provide this level of service in Shabunda, MSF has been forced to fly these women to other hospitals where the appropriate surgery is possible. Sometimes the perpetrators are from the same village as the victims, reflecting a corruption of the social fabric which even peace and an end to the war will not quickly remedy.

Displacement and malnutrition as the result of the war Displacement has become a way of life for much of the population over the 10 years of war. Constantly threatened by the violence of the clashes, victims of recurrent attacks and pillaging of their villages, the civilian populations are often forced to flee from their homes until some kind of stability has returned. This can take several hours, several days, or even several years. In the meantime they seek refuge either in the forest, where they generally live in makeshift huts; or in another village, living in very precarious conditions at someone else's house. In July 2002, the UN Office for the Coordination of Humanitarian Affairs (OCHA) estimated that up to 760,000 people were displaced in North Kivu province - some of them have never been able to make it back home since the start of the clashes in 1992-1993. The permanent insecurity, the recurrent pillaging perpetrated by the various armed factions and the resulting displacement are direct causes of malnutrition and lack of access to health care. Of the 503 malnourished children admitted in one of the MSF therapeutic feeding centres in March, April and May 2002, at least 24% were still unable to return to their homes and many others were forced to flee repeatedly to the bush because of the frequent attacks. For many of the displaced in the feeding centres in North Kivu this displacement is only one in a series of displacements and attacks on them over the last decade. Each attack, each displacement cuts further into their ability to survive. If the health care system before the war was already poor outside of the major towns, the last decade of war has destroyed most of what was left.

Lack of access to health care Everywhere in the DRC the chronic lack of investment in the health system and the disruption of the economic activity related to the war have led to an almost complete lack of access to health care. The conflict constantly undermines the local structures, quality drugs are often unavailable and the medical staff is heavily underpaid. If the health care system before the war was already poor outside of the major towns, the last decade of war has destroyed most of what was left. In addition, the war has left the majority of the people without sufficient means to access the little health care still available. According to a 2001 MSF survey, 67.4% of the population in Basankusu area (Equateur) was without access to health care over the eight months covered by the survey.

HIV-Aids in a context of war

Sub-Saharan Africa is home to 90% of the world's 36 million people infected with the HIV virus and the DRC is no exception. In Bukavu, a town in South Kivu where MSF has started an AIDS treatment project, a significant increase in the rate of HIV infection amongst tuberculosis patients - from 15% to 40% - was observed in 1998; an increase likely spread by the massive flow of refugees and soldiers between 1994 and 1996. There are possibly hundreds of thousands of asymptomatic HIV infected persons who in the next 3-5 years will become symptomatic and require extensive medical assistance. The health care system is not equipped to deal with this reality.Without urgent interventions the HIV epidemic will continue to grow, with devastating social and human consequences. Unfortunately, in the context of a war, the poverty and destruction left by behind by the war in eastern DRC is an undeniable vector of the epidemic: "Unsafe sex is better benefit than safe sex - my clients pay one US Dollar to have sex with a condom, and between two and five dollars if I accept not to use the condom. The money I earn is still not enough to live properly - it is only enough to buy food for one meal a day", a young woman working as a prostitute told MSF.

No end in sight?

Although the Lusaka peace process launched in 1999 has generated numerous ceasefire agreements, it has still failed to produce a halt to the violence in the east of the country or a viable political solution to the conflict. The peace process has excluded various armed groups still active in the east of the country, including the Interahamwe, the Hutu militias involved in the Rwandan genocide, different Burundian rebel groups as well as the Congolese "Mai Mai" militias. The peace agreements have done little to stop the violence and repression. In the middle of 2001 the United Nations announced the beginning of a disarmament, demobilization and reintegration process of armed groups, specifically Interhamwe and ex-FAR. However, almost a year later, only a handful of fighters have been demobilized and disarmed in the process. The testimonies included below reflect a small slice of the reality of DRC over the last 10 years. They bear witness to horrendous abuses and crimes on a scale which should have provoked the world's outrage and the world's care. Instead, the Congolese have been left largely to the famous Congolese ability to survive, to create hope in the midst of despair. In September 2002, as we finalize this publication, Rwandan and Ugandan troops have effectively started to withdraw from the eastern DRC following bilateral agreements between DRC and neighboring governments. The international community warmly welcomes the initiative, but people in DRC are worried that the power vacuum will only lead to more bloodshed and conflict. For the people of Shabunda the latest troop movements have meant yet another flight from their homes in fear.