April 1, 2024
Algeria: Exiled Sahrawi population faces critical shortages in healthcare and food
The Democratic Republic of Congo is facing a multitude of compounding crises with serious consequences for the civilian population.
Political instability, chronic conflict, and natural hazards, like volcanic activity and flooding, have left a large part of the population in need of humanitarian assistance.
Doctors of the World (DotW) has drawn its attention to one region where populations are left vulnerable to a variation of health and security disasters. In the Fizi Highlands, civilians have found themselves trapped between two conflicting territories: the Minembwe and Itombwe. The region has endured violence and armed conflict for over a decade, however in the spring of 2020, there was an escalation in violence between the Mai-Mai and the Banyamulenge communities. Civilians have been further targeted as human rights organizations report cases of murder, rape, burning of villages, and looting of livestock. In response, the Armed Forces of the DRC have mobilized in the areas of violence, in order to put an end to the fights between armed groups.
The consequences of the conflict have also resulted in forced displacement, lack of access to essential services like healthcare and sanitation, as well as impacted the population’s food security. The situation remains tense as this conflict has caused division of the population by ethnicity, and individuals are forced to continuously move between territories to avoid further violence. According to OCHA, about 39,700 persons (approx. 7,940 households) were displaced during the violence in this region. Many internally displaced persons (IDPs) have been separated from their homes since 2019 and returns remain very low.
In response to these conflicts, Doctor of the World ran a project, funded by USAID, that used multi-sectoral lifesaving interventions targeting the most vulnerable conflict-affected individuals in Itombwe and Minembwe territories in. The sectors of focus for this project included health, nutrition, water, hygiene and sanitation (WASH), and protection.
Health Sector
Doctors of the World has mobilized its team to address the gaps in healthcare that have resulted from this difficult situation. The main objectives of our program focused on increasing access to quality life-saving primary care, with particular attention for children (ages 0-5), women, IDPs, and victims of sexual and gender-based violence (GBV).
To reach our goal, DotW focused on capacity-building and supporting 10 local health centers in the region. Our teams further provided training on major health topics as well as management of potential epidemics. In the facilities that DotW supported, the community had access to free primary health care, sexual and reproductive healthcare, as well as mental health and psychosocial support. DotW also worked alongside local community health workers (CHW), so that they may disseminate important health information as they conducted home visits. Besides, free secondary care was available for obstetric and pediatric emergencies.
DotW Health Results in 2021
- 65,934 consultations were carried out for communicable diseases with a predominance of respiratory infections (42% of consultations). The high rate of respiratory infections is mainly due to the altitude and temperature of the environment. The case fatality rate among the project’s beneficiaries is less than 2%.
- 4,637 pregnant women have benefited from at least two complete prenatal consultations.
- Referral of 1,263 major obstetrical complications to the two referral hospitals, where they were all treated.
- 3,385 birth deliveries, including 1,263 with major complications. Distribution of hygienic delivery kits to 2,760 pregnant women during the third trimester of their pregnancy.
- Provision of medical and psychosocial care to 432 survivors of sexual violence (402 women and 1 man) in the supported health centers. Of these, 45 survivors (10.4%) were treated within 72 hours of the incident.
- Care for 3,467 people in a state of psychological distress through mental health and/or psychosocial support.
- Care for 14,669 patients for non-communicable diseases.
- Care for 1,771 injuries caused by knife or firearm attacks.
Nutrition
Across the DRC, food insecurity has affected nearly 27 million people. Reliefweb reports that nearly 900,000 children under 5 are acutely malnourished, with 200,000 severely malnourished and in need of urgent care. To address the concerning rates of malnourishment in the Itombwe and Minembwe health zones, DotW has procured all necessary equipment and materials to ensure good quality Severe Acute Malnutrition (SAM) treatment and follow-up. Furthermore, ready to use therapeutic food (RUTF) and therapeutic milk were distributed to the supported health centers based on their needs. Community health workers were also included in our response to malnutrition: training and discussions were organized at the community level to raise awareness on malnutrition and its treatment. Healthcare staff were also trained by PRONANUT, a national nutrition program that teaches about the treatment of acute malnutrition (PCIMA), infant and young child feeding (IYCF), WASH in Nutrition (WiN), and pre-school consultations (PSC).
DotW Nutrition Results in 2021
- 2,021 children under five years old with SAM were admitted for out-patient treatment in Ambulatory Therapeutic Nutrition Unit (ATNUs), and 173 children with complications were referred for in-patient treatment in Intensive Nutritional Therapeutic Unit (INTUs).
- 2,593 malnourished persons were part of the treatment program and were treated.
- 1,030 households with SAM cases received a follow-up visit. CHWs advised households on good nutrition, health and WASH practices. The key messages were tailored to the needs of each household.
- Monthly support groups were established by CHWs gathered over 1,130 people to discuss topics such as infant feeding practices, and other good practices in WASH and health were discussed.
- CHWs and community mobilisers facilitated 190 sessions in different villages.
Water, Hygiene and Sanitations (WASH)
WASH was specifically incorporated in DotW’s program to provide quality healthcare and support the health centers in Itombwe and Minembwe. By ensuring that the health centers WASH measures were up to standard, patients would face much smaller risk of infection when seeking care. This is particularly important when treating immunocompromised patients, which is often the case when dealing with cases of malnutrition, non-communicable diseases, and infectious disease.
Wash kits were distributed to all ten of the supported health facilities. These kits contained hand-washing stations, buckets, garbage cans, soap, disinfectants, and more. Thanks to donations, DotW was also able to install new WASH infrastructure for the health centers including gender-segregated latrines, showers, water tanks, incinerators, sewage system for wastewater disposal, and much more. In total DotW WASH intervention assisted 86,672 beneficiaries.
Protection
As the conflict remains constant in the region, it is often the most vulnerable populations (women and children) that are caught in the crosshairs. It is of utmost important that survivors sexual and gender-based violence have access to specialized care. However, GBV services are redundant if communities don’t first address the stigma that surrounds this issue. To work on this particular subject, DotW has collaborated with local communities to raise awareness, to encourage individuals to disclose their cases, and to seek health services to help them through this traumatic experience. The Protective Community (PC) was established in each supported area which implemented various measures to ensure that survivors had access to care and support they need, as well as teach the community about gender, positive masculinity, sexual and reproductive rights, the Maputo Protocol, child protection, GBV legislation and more. With PC, monthly and quarterly meetings were set up to find common solutions on the prevention of GBV. Overall, this intervention assisted 32,922 beneficiaries, through awareness, destigmatisation, care, and more. DotW additionally supported 950 cases of sexual violence (291 men and 659 women), by providing GBV services and psychological first aid.
Photography
Olivier Papegnies
MdM Belgium
Kristof Vadino