Insecurity and lack of access to healthcare: the forgotten emergency of Ituri

Since early 2023, Djugu territory in Ituri province, Democratic Republic of Congo (DRC), has seen intense intercommunal violence and armed clashes, forcing an estimated 156,000 people to flee their homes. This is the latest surge of violence in a decades-long conflict, which has seen 700,0001 people displaced within Djugu territory and 1.7 million across Ituri province. The population has been trapped, with no way out, for decades. Victims of various exactions, communities are exposed to extreme inter-community violence – which has had a major impact on people’s access to medical care and on their mental health. When there are attacks or threats in the vicinity of health facilities, patients and medical staff even desert them. Today, our MSF teams are the eyes and ears of communities living with psychological trauma.

Since early 2023, the population of Rho camp, where most humanitarian organisations are concentrated, has almost doubled - from 35,000 to almost 70,000 people. Faced with this situation, MSF has transformed the clinic into an advanced health post and strengthened its capacity. Today, only eight of sixteen health facilities in Drodro health zone are functioning. To continue to provide impartial aid, MSF’s responses has been to deploy additional resources to various health facilities, with the aim of facilitating access to medical care for as many people as possible, and in support of the Minister of Health. ©Michel Lunanga
A group of displaced people from various locations in Ituri, DRC, find refuge in the Dhenja village where they have been hosted by people from their community since the beginning of this year. ©Michel Lunanga

Gunfire crackles, down the hill from the hospital of Drodro, about 2 km away. Panic mounts. A few hours earlier, there had been clashes on the northern route, a few kilometres away.

Now the noise is getting closer. Traumatised by years of chronic violence, patients and hospital staff have only one reflex: to flee. Away from the hospital. Even if that means interrupting their treatment.

Quickly, everyone packs up their belongings. Mothers wrap their sick children in cloths and secure them on their backs, then grab whatever else they can carry and hurry away.

In less than 30 minutes, Drodro hospital, with its 100 beds, is empty. The doors of the wards are closed, and the silence is heavy.

Some patients and their caretakers were able to escape the area quickly, before the roads became too dangerous to travel, but others were too late. They had to turn back in the direction of the hospital. An ambulance driver arrived to give them a lift back in the ambulance.

Back in Drodro hospital, they all squeeze into one room to take refuge. The tension is palpable. The generator has been switched off, to allow the people inside to hear clearly if gunfire is approaching. The only noise is of children crying.

Recurrent cycles of violence have traumatised the population

“I was on the hospital bed with my baby when the other mothers came up to us and said: ‘We have to leave, there’s gunfire’,” says Joécie, mother of 17-month-old Salomon, who is being treated for severe malnutrition and anaemia. “People were running around in panic. Without thinking any further, I wrapped my baby in a blanket and left. But in the panic, I forgot some of my things: his medical records and my kitchen utensils”.

After fleeing, Joécie decided to return to the hospital with her son later that night. “My son was too ill,” she says. “He had a fever and we had nothing to eat. I had no choice but to come back. It was a difficult night – I was panicking and I barely slept.”

Portrait of Joecie playing with her 17-month-old son Saloomon, sitting on the bed in the paediatric unit at the Drodro reference hospital, Ituri, DRC. “The fear of dying and leaving our kids orphans: that's why we don't go back home.” ©Michel Lunanga

Chronic violence, and the fear of further violence, has left people in this area with deep psychological scars, for generations. Many people are fearful of accessing medical facilities, seeing them as potential targets and inherently unsafe. Some would only seek care in an extreme emergency.

Imagine that people have been living through this conflict for years, over several generations, with repeated displacements and few prospects for the future. They are constantly reminded of the massacres of their neighbours and family members. It's difficult to think logically.
Grâce Longa Mugisa
MSF Mental Health Advisor

This is the third time since the beginning of the year that some medical facilities in Drodro health zone have been deserted following clashes nearby.

I've been working with MSF since 2015, in several countries, I've never experienced this type of event - a hospital emptying out like this. When patients flee, what can we do? You can't stop them. Every patient should be able to feel safe in medical facilities. Elsewhere, hospitals are often used by the civilian population as a place of refuge during conflicts, but that's not the case here.
Dr. Kelly Tsambou
MSF’s Head of Medical Activities in Drodro health zone

Insecurity directly hinders access to healthcare

View of a group of patients standing in front of the entrance of the paediatrics and the intensive nutritional therapy unit at the Drodro reference hospital in Ituri, DRC. ©Michel Lunanga

Today, only eight of sixteen health facilities in Drodro health zone are functioning. To continue to provide impartial aid, MSF is endeavouring to respond equitably to needs and provide care to each of the communities. However, chronic violence and repeated displacements are disrupting medical activities. MSF’s responses have been to deploy additional resources to various health facilities, with the aim of facilitating access to medical care for as many people as possible, and in support to the Minister of Health.

Since MSF arrived in the region in 2019, our teams have always had to deal with cycles of violence. But faced with the recent upsurge in violence, we have had to adapt by increasing resources to certain medical facilities to enhance healthcare services and bring them closer to the communities.
Soumana Ayouba Maiga
MSF Project Coordinator

For instance, the mobile clinic set up in Rho camp for displaced people was originally intended to provide basic healthcare and refer patients requiring more specialist care to Drodro hospital. But since the beginning of the year the population of Rho camp, where most humanitarian organisations are concentrated, has almost doubled – from 35,000 to almost 70,000 people. Faced with this situation, MSF has transformed the clinic into an advanced health post and strengthened its capacity.

Portrait of Renestina with her three children, Christian (1 year), Nicolas (3 years), et Gracianne (7 years), being referred from the advanced health post in the Rho IDP site to the Hospital of Drodro by MSF teams to seek more specialized medical care. One of her sons has been diagnosed with severe malnutrition with complications. ©Michel Lunanga

MSF teams are also rehabilitating the health centre at Blukwa’Mbi – where large numbers of displaced people are living with host families – to transform it into a referral centre that can provide specialist medical care. “The construction of an operating theatre, with a solar-powered electrical system, will enable medical teams to carry out procedures such as caesarean sections,” says Maiga. “We want to provide access to more specialist care for people who can’t access the hospital in Drodro.”

Inside view of the intensive care unit that has emptied after patients fled, following an armed attack few kilometers away from the surroundings of the reference hospital, in the province of Ituri, DRC. ©Michel Lunanga
MSF nurse, François Idembe administers an injection to Rutha's son, Bariki with the aim of reducing his high fever and alleviating the infection that is causing discomfort to him. Hospital of Drodro, Ituri province, DRC. ©Michel Lunanga

Enormous humanitarian needs calling for an intensification of assistance

Often ignored by the media and without political or international attention, the 1.7 million displaced people in Ituri province are in desperate need of humanitarian assistance: food, clean drinking water, proper sanitation, shelter, education, and healthcare.

Many people in the area feel that they have been abandoned and have too little than what they need to survive, especially in terms of food. The chronic insecurity makes it impossible for people to reach their fields and tend the crops – the main economic activity in the area.

What worries me most today is access to food. Most of us don't eat every day, even the children. It's not harvest time now, so there's nothing. There's not even any drinking water within easy reach.
Community Leader

Known within her community as ‘leader of the mums’, since the start of the year Micheline has welcomed 10 displaced people into her household, which already consisted of eight people.

A portrait of Micheline, leader of moms in Gokpa, Ituri, DRC. ©Michel Lunanga

Since early 2023, 156,0002 people are newly displaced in the territory; a total of around 700,0003 displaced people for the territory and 1.7 million for the province of Ituri. While some have found refuge in IDP sites, most are staying with host families. The total number of displaced people is difficult to assess because of the volatility of the conflict and the continuous movements of the population. Peace processes have been launched in the past but without success, and the situation has deteriorated since the start of the year.

MSF teams, Dr. Clement Elema (L), Dr. Henry Dhelonga (R), and nurse Robert Nzishama, are performing a lumbar puncture on baby Dori, 1-month-old, in the Drodro reference hospital in Ituri, DRC. Dori was admitted at the hospital with convulsions and a high fever. The lumbar puncture was performed because a meningitis was suspected; diagnosis finally ruled out after the analysis of the fluid collected. ©Michel Lunanga
MSF medical staff administers measles vaccinations to children in Ndjala village, health zone of Drodro Ituri province, DRC. At the Ndjala community health site, MSF teams administered measles vaccinations to 379 children on May 22, 2023. This vaccination is seen as important as the village is distant from the next health center facility, which illustrates the challenges of accessing healthcare for communities in the health zone of Drodro. ©Michel Lunanga
On the health side, in some parts of Drodro health zone, MSF teams are almost alone in responding to people’s medical needs. The humanitarian needs are similar and catastrophic for both communities, and as such, it is essential that humanitarian assistance is deployed in a neutral and impartial manner. This situation, which MSF is witnessing, is only a reflection of the reality in Djugu territory, where healthcare is sometimes even less accessible in other surrounding areas.

MSF teams provide healthcare in Drodro general hospital, as well as two health centres, two advanced health posts and six community health sites in Drodro health zone, in collaboration with the Ministry of Health.

Teams provide general medical care, with an emphasis on paediatric care, including treatment for malnutrition, malaria and respiratory infections. Teams also provide mental healthcare, family planning services and care for survivors of sexual violence.

Since the beginning of 2023, MSF teams in Drodro health zone have provided 25,630 medical consultations, treated 850 children for malnutrition, provided 435 mental health sessions and cared for 165 survivors of sexual violence.

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