Democratic Republic of the Congo: more than 25 years of humanitarian crises
2022
“The levels of urgent need caused by armed conflict and epidemics are highly alarming, and are increasing year after year as humanitarian actors struggle to mobilise resources to respond.”
Daniele Gulizia, General Coordinator of Doctors of the World France in DRC
The Democratic Republic of the Congo (DRC), Africa's second largest country in terms of land area, has for more than two decades been plagued by chronic and complex humanitarian crises in the north, east and centre of the country. Its humanitarian crises are the result of internal and external armed conflicts, inter-communal tensions, mass population displacements, mass influxes of refugees from neighbouring countries, and climatic conditions which lead to floods and landslides.
Levels of humanitarian need are enormous and continue to grow every year: 15.6 million people needed emergency humanitarian assistance in 2020, 19.6 million people in 2021 and 27 million people in 2022.
Armed conflict and climatic conditions are the main causes of mass population displacement: the DRC has the highest number of internally displaced persons on the African continent, with an estimated 5.5 million reported in 13 of the DRC's 26 provinces by the end of 2021. This is a significant increase compared to the 5.2 million displaced persons that were confirmed in 2020. In addition, more than one million have fled the DRC: 1,013,339 people were identified as refugees in 2022, mainly in Uganda, Burundi, Tanzania, Zambia, Kenya and Angola. The DRC also hosts 521,082 refugees from neighbouring countries (mainly the Central African Republic, Rwanda, South Sudan and Burundi).
The levels of humanitarian need are alarming in the provinces of Ituri, North Kivu, South Kivu, Tanganyika, Kasai, Kasai Central, Kasai Oriental and Equateur.
The main reasons for humanitarian aid remain:
- Food security and population displacement jeopardising people's livelihoods.
- The protection of human rights, women's rights and children's rights violations in armed conflicts are very common.
- The health, physical and mental well-being of the population is threatened and access to basic services is very difficult.
Indeed, chronic humanitarian crises in the DRC have a substantial impact on the health of affected populations. The DRC is dealing with multiple epidemics and infectious diseases, which are exacerbated in areas affected by conflict and mass population displacement.
Measles: From January to September 2022, 106,896 suspected measles cases were reported, including 1,338 deaths (1.3% case fatality), compared to 39,355 suspected cases and 593 deaths (1.5% case fatality) reported at the end of the same period in 2021. The outbreak was confirmed in 25 out of 26 provinces in 2022, with one third of cases in the provinces of Sankuru, Haut-Lomami, Sud-Ubangi, but also in the provinces of Tanganyika and South Kivu, where Doctors of the World is involved in efforts to respond to this crisis.
Cholera: From January to September 2022, 9,414 suspected cases of cholera were reported, including 172 deaths (1.8% case fatality), compared to 4,654 suspected cases, including 107 deaths (2.3% case fatality) during the same period in 2021. Epidemic curves remain similar each year, with an increase after the return of the rainy season in May. The highest number was recorded in the provinces of North Kivu, South Kivu, Haut-Lomami and Tanganyika province, where Doctors of the World is involved in efforts to respond to this crisis.
Monkeypox: From January to June 2022, 1,664 suspected cases of monkeypox were reported, including 71 deaths (4.3% case fatality) in 20 provinces. Sankuru, Tshopo, Maniema, Tshuapa and Sud-Ubangi provinces have reported about three quarters of the suspected cases.
Malaria: Since January 2022, 13,603,676 suspected malaria cases have been reported nationwide, including 8,281 deaths (0.06% case fatality), compared to 11,401,902 suspected cases and 9,308 deaths (0.08% case fatality) recorded at the end of the same period in 2021. The increase in cases reported in 2022 is explained by the improved monitoring system in several health zones.
Ebola virus disease: An outbreak of EVD was declared between August and September 2022, with only one death. However, this is the fifteenth Ebola outbreak since 1976 in the DRC, seven of which have occurred since 2018. The risk of a resurgence of the disease is high, especially in the eastern and northern provinces of the country.
Plague: A total of 583 suspected cases of bubonic plague and 10 deaths (1.7% case fatality) were reported in Ituri province between January and August 2022, while 118 suspected cases of bubonic plague and 13 deaths (11.0% case fatality) were reported in the same province in 2021. There has been both an increase in the number of cases and a decrease in case fatality due to the improved monitoring system.
Epidemics and the fragile food security situation in conflict-affected provinces are giving rise to alarming rates of acute malnutrition: 6.1 million people are estimated to be in need of nutritional care in 2022, the vast majority of them children and pregnant and breastfeeding women. Doctors of the World is integrating malnutrition care for children and pregnant and breastfeeding women into its emergency responses in Tanganyika province. It is also conducting a "One Health" pilot project on the edge of the Kahuzi-Biega National Park in South Kivu, which analyses the impact on the health of people living in this area from the point of view of the interactions between human health, animal health and the environment.
The context of armed conflict and population displacement in provinces where extreme poverty has become the norm exacerbates the vulnerability of women and girls. Gender-based violence (GBV) is widespread. Between January and September 2021, 74,275 cases of GBV were reported, an increase of 73% compared to 2020. Rape, sexual and physical assault, forced marriages and psychological violence are perpetrated by members of the armed forces, but also within the community itself. The fight against GBV is led by Doctors of the World, in partnership and collaboration with the Panzi Foundation, created by Dr Mukwege and established in different provinces. A major problem related to this type of violence is the under-reporting of cases due to lack of access to services, lack of qualified personnel, but also due to the reluctance of survivors to come forward for fear of reprisals from attackers or the community and feelings of shame.
To address this complex scenario, Doctors of the World has integrated GBV-specific case management activities into its interventions in Tanganyika province. Psychosocial assistants are deployed in villages around health centres and they organise awareness and listening sessions to improve case detection and referral to appropriate services. Beyond medical care within the health structures supported by Doctors of the World, and depending on the needs of each survivor, referral to partner organisations is possible for legal/judicial care, in-depth psychological care, care for economic or school reintegration, and reparative surgical interventions.
While gender-based violence is very common in provinces affected by humanitarian crises, it is a national issue. GBV is a consequence of the substantial gender inequalities that persist in Congolese society, rooted in a patriarchal paradigm. In terms of opportunities and rights, there are many structural disparities for men and women, with direct implications for women's health. Women and girls do not enjoy the right to health, including sexual and reproductive rights (SRHR). The national average is 6.2 children per woman (and reaches 8.3 in some provinces). The maternal mortality rate is one of the highest in the world, with 473 deaths per 100,000 live births in 2017.