Conflict and Displacement in DRC Fuel an Acute Humanitarian Emergency in Uganda

In December, violence flared between communities in the Ituri province of northeastern Democratic Republic of Congo (DRC). The conflict intensified in February when fighting broke out in the Djugu area.

Houses were burned, people were killed, and tens of thousands fled their homes in search of safety. Some of these displaced people made their way south to Bunia, while others traveled north to Mahagi or crossed Lake Albert into neighboring Uganda. Many, however, remain stranded in areas that are currently inaccessible to aid organizations. Doctors Without Borders/Médecins Sans Frontières (MSF) is working on both sides of Lake Albert, offering medical humanitarian assistance to those in need.

In the past two weeks, MSF has treated thousands of displaced people in DRC and is responding to a cholera outbreak in Hoima district in Uganda, where new arrivals are hosted.

Uganda: Tackling Cholera and More in Hoima District

In the past several weeks more than 40,000 Congolese people displaced by the violence have paid to cross Lake Albert to neighboring Uganda, where the facilities in place to welcome the displaced are already overwhelmed and the dire conditions have had disastrous health consequences. On February 23, Ugandan authorities confirmed a cholera outbreak affecting both displaced and host communities in Hoima district.

The outbreak has resulted in least 1,000 severe cases requiring hospitalization and led to more than 30 deaths since mid-February.

"The situation in Uganda is extremely alarming, with the trend in cholera cases still increasing and a very high mortality rate,” says MSF emergency coordinator in Uganda Ahmad Mahat. "In addition to dedicated cholera treatment centers, we are scaling up our response as quickly as possible, setting up a water treatment plant at Sebagoro landing site to increase access to clean water for the refugees as well as communities living along the shores, putting in place oral rehydration points, surveillance, [and] water trucking, and building additional latrines."

However, access to clean water alone will not be enough to curb the spread of the disease; MSF is also urging the launch of a mass vaccination campaign to prevent more cases.

"To control this deadly outbreak and protect those most at risk, it is really urgent to undertake a cholera vaccination campaign in the coming days,” says Mahat. "This must be a part of the routine response for such epidemics. After discussing with global partners, a stock of vaccines has been made available for this emergency campaign and MSF stands ready to assist the Ministry of Health as soon as the green light is given."

In Sebarogo, a small fishing village in Hoima, MSF teams have set up a 50-bed cholera treatment center (CTC) in the town’s health center, which MSF also supports with supplies and resources, in addition to a mobile health post at the landing site to refer the most urgent cases to the health center. MSF also opened a 50-bed CTC in Kasonga health center near the reception center in Sebarogo.

Crossing the Lake

Refugees who leave DRC for Uganda make the journey in rickety, overcrowded fishing boats and canoes. The trip can take between six and 10 hours, and there have been reports of refugees drowning after their boat capsized.

Many people see no choice but to flee, however.

"New arrivals tell us of attacks at night, and a small number have deep cuts and wounds," Mahat said. "Many arrive traumatized and exhausted, with sick children. Those using small canoes sometimes had to paddle for almost three days to reach safety here."

Congolese refugees who cross the lake disembark in Sebarogo. The village’s landing site was quickly overwhelmed in mid-February when up to 3,000 people started landing each day during the height of the current refugee influx. Numbers have now decreased, partly because of weather conditions and prohibitive prices for passage across the lake, but hundreds of refugees still arrive daily.

New arrivals quickly leave Sebarogo for Kagoma reception center, which is managed by Ugandan authorities and UN partners. There they await registration and humanitarian assistance before moving to a refugee camp, usually Kyangwali settlement or other camps in midwestern Uganda. However, bus transportation and the registration system were at times so overwhelmed in February that the refugees stayed at the landing site for several days and up to a week with barely any assistance: there were no latrines, and the only available water source was the lake. Some moved on to Sebarogo town to join relatives and host families.

Kagoma reception center and Marutatu settlement (part of Kyangwali) are currently unable to cope with the influx of refugees. New arrivals already made vulnerable by their flight and the violence in Ituri end up sleeping in the open air, exposed to the rains and with inadequate access to water and food. Hygiene and sanitation conditions are appalling.

In Kagoma reception center, MSF teams vaccinated 5,263 children against polio and measles and 2,160 women of childbearing age against tetanus. MSF also opened a 24/7 outpatient clinic where over 2,000 patients have been treated since mid-February, for conditions including diarrhea and cholera, malaria, and respiratory infections. This clinic also provides antenatal care and assistance to survivors of sexual violence.

DRC: Addressing the Needs in Ituri

In mid-February, OCHA estimated that around 20,000 people were sheltering in Bunia town in DRC. Most are living with friends and family, and 2,000 more have gathered at a temporary site at the regional hospital. MSF supports basic health care in three health centers in Bunia, Bigo, Kindia, and Lembabo, and helps refer severe cases to two nearby hospitals.

In the last two weeks, MSF teams saw 2,117 outpatients—783 were children under five years old and 349 were pregnant women—mainly suffering from malaria, respiratory infections, and diarrhea. MSF teams also offer mental health consultations, as many arriving in Bunia are traumatized by the violence they witnessed or experienced. There are unaccompanied children among them, and people who lost everything in their flight.

Additionally, MSF has undertaken water and sanitation work at the hospital site, installing a water supply and erecting 20 latrines and 10 showers. Teams distributed 1,200 kits of non-food items such as blankets and soap and continue to support the distribution of food such as flour, salt, and rice to the displaced.

"Most of the displaced people in Ituri are living with host families, but some are sheltering in schools, churches, or small informal camps," says MSF emergency coordinator in DRC Florent Uzzeni. "Many in Bunia are women and children who are totally reliant on aid for their most basic needs, such as food and water. We know that there are many displaced people in the areas we can’t yet reach due to insecurity, and every effort needs to be made to bring them the assistance they so desperately need."

An MSF team is also present in Mahagi, further north, where exploratory missions are ongoing. Additionally, MSF has been providing remote support to harder-to-reach areas like Drodro, including through donations of drugs and equipment and kits for treating the wounded. As very little help is available to these people, many are gradually making their way north in search of food, medical care, and shelter.

The situation in Ituri province remains unpredictable, and new waves of violence could cause further influxes of people to Uganda. At present, insecurity is preventing many people displaced within DRC from accessing lifesaving assistance. MSF is working to reach them. But the deadly cholera outbreak and inadequate provision of humanitarian aid in Uganda mean that a new, acute emergency is now developing on the shores of Lake Albert.