Josephine's Journey
There was no maternity ward or flowers for Josephine Nyirandayimana when her child was born. Instead there was a flight from danger, clinging onto her other child while leaving their village near Masisi behind. They arrived in a makeshift camp set up in a muddy field some 35 km away to the south, near Shasha. Josephine's baby was born soon after by caesarean section at Kirotshe Hospital where she now is recuperating.
The current crisis in North Kivu is having a major impact on the health of the thousands of people who have fled their homes, by disrupting access to what should be readily available health services, such as safe deliveries. Reproductive and maternal health services, immunizations, basic hygiene and sanitation - all essential areas if health care that many of us take for granted but that are under extreme threat in the Kivus.
Current Health Situation
The major threats facing Josephine and the hundreds of thousands more like her are communicable diseases, malnutrition, sexual-based violence, sanitation, weak health services and psychosocial health trauma.
Between early October and early November, there has been a tripling of cholera cases in the health zone of Goma, the provincial capital of North Kivu. From July to August, there was a weekly incidence of less than 20 cases in Goma. But in the first week of October, there were 40 cholera cases, which increased to about 150 in early November. In all of North Kivu, there have been at least 997 cases reported in that time, with most recorded in Rutshuru (466), Goma (263) and Karisimbi (145). In South Kivu during the same period, 855 cholera cases have been reported, most of them in Minova (371).
Goma has a tragic history linked to cholera. In 1994, 50 000 people died in a dual outbreak of cholera and dysentery.
Thanks to strong interventions by health partners, the cholera situation in and around Goma is stable, but throughout the region, the number of cases are increasing.
But cholera is not the only fatal disease threatening the displaced. Malaria and measles are major killers, particularly for young children and other vulnerable people. Malaria is responsible for 45% of child mortality, while the region's below 80% measles vaccination coverage places thousands of children at grave risk. In complex emergencies, the case fatality rate for measles can be as high as 30%.
Other endemic and epidemic-prone diseases include acute lower respiratory tract infections, African trypanosomiasis, HIV/AIDS, tuberculosis and yellow fever.
Compounding the problems are the poor standards of monitoring for diseases and other health risks and the country's chronically weak health system, which is now disrupted by violence.
WHO Response to Date
Since 26 October, WHO has deployed eight international staff to support the efforts of its offices in Goma and Bukavu, the capital of South Kivu province. Fourteen national staff are operating in both provinces, including epidemiologists, public health experts and logisticians. WHO is working in the following four areas:
1. Assessment and surveillance
- On 19 November, WHO (Health Cluster), WFP (Logistics Cluster) and UNHCR (Protection Cluster) undertook a joint evaluation mission to the town Rutshuru, an area behind the front line in southern North Kivu. Results are expected shortly.
- On 5 November, WHO and its partners began a joint needs assessment in and around Rutshuru. Merlin is examining the possibility of re-opening some health centres it is supporting in the area.
- The region's surveillance and early warning systems have been affected due to the violence. WHO has deployed an epidemiologist to help re-establish basic disease surveillance and senior epidemiologists from its headquarters to help strengthen the monitoring and assessment systems.
2. Addressing immediate threats
- WHO has flown 60 tonnes of medicines and other supplies donated by Italy and Norway into Kampala from where they are being trucked and distributed into eastern DRC.
- Materials being sent by WHO into North Kivu include 15 000 litres of Ringer lactate (IV fluid) for the treatment of 2000-3000 severe cholera cases. Oral rehydration salts and antibiotics are also being sent for cholera control. Eight water purification units donated by Norway that can provide clean drinking water for tens of thousands, are being sent into the affected area with logistics support provided by WFP. Health Cluster experts are leading an epidemiological investigation of the cholera outbreaks, particularly in displaced people's camps.
- Oxfam-UK is supporting the chlorination of water supplies.
- WHO, UNICEF and the Government's provincial inspection unit are vaccinating children under five against measles in Kirotshe.
- The cholera situation in and around Goma is stable but continued provision of clean water and appropriate sanitation, as well as strengthened assessment, is crucial.
- Merlin and WHO are training health staff in Karisimbi on cholera case management.
- The International Medical Corps and Merlin are carrying out medical screening of displaced people in Goma and surrounding areas.
3. Gap filling and capacity strengthening
- Drugs warehoused in Goma are being distributed to various areas of North Kivu, as well as to non-governmental partners and the Ministry of Health.
- WHO medical supplies have started arriving by Logistics Cluster-organized trucks from Uganda. The supplies available in Goma could suffice for three months as long as the situation remains stable.
4. Coordination of health actors
- WHO is chairing meetings of the Country Health Cluster in Kinshasa as well as in Goma. Health Cluster situation reports are being distributed and inter-cluster meetings being conducted.
- WHO's own internal clusters and departments are working on a cross-cutting plan to best utilize their respective assets.
- A major breakthrough has been WHO's creation of a distribution plan for 10 tonnes of Belgian supplies warehoused in Goma. The Logistics Cluster will distribute these supplies within the Goma health zone and to Karisimbi, Rutshuru, Kirotshe, Mweso, Masisi, Pinga, Walikale, Beni and Dungu.
Health Priorities and Needs
The Governments of Italy and Norway have provided in-kind contributions of health supplies valued at more than US$ 1 million. The Government of Australia has also provided Aus$ 500 000. Cash needs now for the next three months are estimated at US$ 2.2 million.
WHO's health priorities include:
- Organizing health assessments, deploying additional staff with greater outreach capacity, to identify groups and communities at higher risk and identifying life-saving solutions.
- Strengthening disease surveillance, analysing and disseminating data, and deploying additional epidemiologists to support an early warning system.
- Convening partners and coordinating health interventions to improve coverage, quality of care and results.
- Identifying and filling health gaps, making available expertise and supplies, e.g. to prevent/address cholera and dysentery, malaria, measles, acute malnutrition, maternal and newborn risks, assist rape survivors, physical and psychological trauma, HIV/AIDS and non-communicable diseases.
- Strengthening and repairing systems and building capacities of both the Government and of international partners, in turn aiming to address this crisis by means of a sustainable health systems approach, including disseminating national health guidance and protocols to partners.
- Ensuring a safe and strong WHO programme by deploying additional international staff and security equipment to reinforce its presence in North Kivu.
For more information:
The Democratic Republic of the Congo
Dr Matthieu Kamwa, WHO Representative
Tel: + 47 241 39 001 - kamwam@cd.afro.who.int
Geneva
Jukka Sailas, External Relations
Health Action in Crises
Tel: +41 22 791 1887 - Fax: +41 22 791 4844 - sailasj@who.int