Around the town of Pinga, the frontlines between different armed actors constantly shift, and local people are trapped in the middle. Those displaced from their villages by the fighting hide in makeshift shelters in the forest, not knowing where the next danger will come from and often cut off from all medical care.Tom is an MSF project coordinator who has returned from North Kivu, in the east of the Democratic Republic of Congo, where violent conflict persists between government forces and an array of military groups.

For some, even travelling to town for provisions as basic as salt is too dangerous, as they run the risk of robbery, extortion and harassment. “In one village I came across, people had no salt. We’re a medical organisation, but we can still barely imagine that people are desperate to get salt.”

Huge health needs

In such an insecure and unstable environment, where many lack the most basic of necessities, people’s health needs are huge. Despite the enormous challenges of working in a conflict zone, across shifting frontlines, MSF is running a therapeutic feeding centre for malnourished children in Pinga town, supporting two health centres in the surrounding area, and running mobile clinics on motorbikes. MSF staff in Pinga carried out 40,000 consultations in 2010.

Continual conflict

Most people – even old people – don’t know what it’s like to live without conflict, it has always been part of daily life. But still, the people who live in Pinga town have a far different experience from somebody who lives just five kilometres away, on the other side of the frontline. Whole villages are often burnt to the ground by non-government militias to deter nearby government forces from advancing and occupying them. When this happens, the villagers are forced to hide in the forest in makeshift shelters, without mosquito nets.

Malaria is endemic

It is no surprise that in the hot, rainy, densely forested hills around Pinga, malaria is endemic. In 2010, the team in Pinga treated more than 6,500 cases. Children with malaria are particularly likely to have life-threatening complications, but getting these children to a doctor in town is far from straightforward.

Trying to cross the frontline

To get medical care or reach the hospital in Pinga town, villagers “have to cross frontlines and land controlled by different military groups. They are accused by all sides of being sympathisers. If they follow the main road they’ll run into checkpoints. And if they take a back road through the woods, they’re going to run into the military – either government or non-government forces – and then they’ll be forced to explain why they’re travelling on the back road and it will look even more suspicious. When there’s all-out fighting, the military suspects everybody. These are serious cases: these are parents with a dying infant who has got malaria maybe with anaemic complications. They’ll move, they’ll get harassed, they’ll turn around and the result is their child won’t make it.”

Mobile clinic by motorbike

With so many people prevented from going to find a doctor, MSF’s mobile teams are crossing the frontlines themselves, and travelling on motorbikes into the dense bush to find the sick and traumatised people who are so desperately in need of help. “Road conditions are horrible; we do our mobile clinics with motorcycle convoys because cars can’t go there.”

Transferring patients

For many patients, on-the-spot treatment is not enough, and they need to be transferred to the nearest hospital, which may be across two frontlines and territory controlled by three different warring groups. In these cases, “the endeavour of trying to transfer a patient is about as lifesaving as the medical care itself. We cannot just transport sick patients on motorbikes for hours over rough terrain – children cannot hold on, neither can pregnant women. We fill out a referral form and try to get them to meet us at the checkpoint so we can cross together with them. We tell the armed men at checkpoints the names of those patients who will attempt to cross that day, and we tell them we will follow up on these people. But still, some never arrive at our clinics on the other side of the frontline.” MSF teams are trying to find ways around these difficulties.

Treating rape survivors

MSF also provides specialised medical care to women and girls who have been raped. Treatment includes post-exposure prophylaxis, which can help protect against the HIV virus and other sexually transmitted infections. Sexual violence is a terrible part of the war in eastern Congo that is perpetrated by military groups on all sides of the conflict. Many women are afraid to seek treatment because of fear of being stigmatised by their families. They also risk further harassment when attempting to cross military checkpoints in search of medical care. In 2010, the team provided specialised medical care to more than 200 women and girls who managed to reach MSF’s clinics against all the odds.

Maternal healthcare

Providing maternal healthcare is another major priority, as women living in the bush who suffer complications during pregnancy and childbirth have no access to doctors or trained midwives. In and around Pinga in 2010, MSF carried out 4,000 antenatal consultations and 65 babies were delivered within an MSF facility.

MSF’s added value

Despite the difficulties of travelling by motorbike on muddy jungle tracks, of being held up at checkpoints, of negotiating access across frontlines and having to deal with various armed groups, MSF is capable of working in these conditions. “Our reputation on the ground is better than good. We’ve got the maximum amount of space you could have under these difficult circumstances. We are still reaching people in need and our work is respected across the lines.”