Civilians trapped a war rages in eastern Democratic Republic of Congo

Since September 2007 renewed fighting in North Kivu has caused massive displacement in the region. A ceasefire agreement signed in January 2008 was not respected, and by the end of August large-scale fighting had broken out again in the region between various armed groups and the Congolese armed forces (FARDC), despite the presence of the world's largest UN peacekeeping force, MONUC.

Hundreds of thousands of people fled in all directions throughout the region, desperately in search of safety. The displaced, many of whom have been forced to flee multiple times, have little or no access to health care, food, water or basic shelter. They find shelter in camps or with host families, or hide in the forest where they are under threat of attack from all armed groups. Few aid agencies have established humanitarian programs with a continued presence outside the provincial capital, Goma.

The displaced are also extremely vulnerable to easily treatable conditions and diseases such as measles, malnutrition, respiratory infections, diarrhea, and obstetrical complications. In addition, cholera cases are reported in different areas including places where this diarrheal disease is not usually a major health threat. Risk factors for contracting cholera include poor sanitation, lack of clean water, the constant movement of populations, and crowded conditions in displaced camps.

Despite its UN mandate, MONUC has not been able to protect civilians from violence and forced displacement. In November, after rebel forces took control of Rutshuru, where MSF runs a surgical hospital, MONUC lead an armed “humanitarian relief” convoy into this town, a move that threatens to further blur the lines between military and humanitarian action in the region.

MSF is running projects throughout North and South Kivu provinces, providing emergency medical assistance, as well as primary and secondary health care, water and sanitation assistance, and distribution of essential items such as shelter materials and blankets. In particular, MSF is operating the hospital in Rutshuru and in November the MSF team did not stop working when fighting broke out in the city and in the nearby town of Kiwanja.  MSF increased its emergency response in the region to cope with the deteriorating situation. As one of the few humanitarian organisations with teams based and working outside of Goma, MSF is exploring ways to increase its response to the crisis to meet the needs of the population. But due to insecurity and fighting, some areas remain inaccessible and people remain removed from any access to health care. Local families, who often take in those forced to flee, are bearing a huge burden to assist their displaced neighbors.

While media attention has focused on the fighting in North and South Kivu province, civilians living in Haut-Uele district have fallen prey to a series of cross-border raids by the rebel group, Lord's Resistance Army, since October. Fighting in September forced some 50,000 people to flee their homes. And the Congolese population in other regions of the country endures a perpetual lack of access to health care and recurring epidemics, such as the cholera outbreak that sickened more than 4,000 people in Lubumbashi and Likasi in Katanga province, and a measles outbreak to which MSF responded with a vaccination campaign reaching more than 225,000 children between 6 months and 15 years old.