A resurgence of violence in the Democratic Republic of Congo (DRC) has strained health care facilities already stretched thin by decades of conflict. One of those facilities is Masisi general hospital in North Kivu, where children share beds in the malnutrition ward while patients with gunshot and stab wounds are treated in tents. Located five hours’ drive away from Goma, North Kivu’s provincial capital, Masisi general hospital is the referral structure for all 26 surrounding health areas. With its 310 beds, this MSF-supported facility is the place to go for patients in critical condition or with medical complications. Within its walls, women, men and children coping with years of daily violence receive much-needed care, day after day.

Twice as many patients than beds

The malnutrition unit at Masisi general hospital has an 18-bed capacity, but over the past weeks, up to 40 children have been hospitalized at the same time. Nursing staff are trying to create extra space by setting up new beds and moving others to an adjacent place.

Following armed clashes that occurred in January, at least 41,000 people fled to the Masisi health zone within weeks. Thousands of families were suddenly cut off from their fields and moved to camps for displaced people in Masisi-Centre, Lushebere, and Katale, which were already hosting tens of thousands of people. Some have been there for years.

Louise* and her infant son are among the displaced. They fled armed clashes in Kitchanga and settled in the Masisi-Centre displacement site in March. Just a few weeks after their arrival, her son started developing malnutrition. He was admitted to Masisi hospital a few days ago.

“In Kitchanga, I used to grow beans, manioc, sweet potatoes. But here, I can only earn a little money by carrying firewood,” says Louise. “I don’t earn enough to make more than one meal a day. Sometimes, we just go to sleep with an empty stomach. War brought us this life of misery.”

Two years after a state-of-siege was declared in the provinces of North Kivu and Ituri, violence and the proliferation of weapons continue unabated in the Masisi territory. From January to March 2023, 110 gunshot wounded have been treated at Masisi general hospital. Among them are Agathe’s* two young children, aged 2 and 3 respectively, who lay on a bed with their legs in plaster.

“Bandits came to threaten our neighbor. It turned ugly and they started shooting blindly in the street,” recalls Agathe. “Bullets pierced the floorboards of my house and hit my two children, who were asleep in the same bed. One was shot in the shin and the other was shot twice in the heels. I feel dizzy seeing them suffer so much. I can’t understand how we got there.”

A never-ending emergency

MSF began supporting the Masisi general hospital in 2007, when the area was the scene of violent clashes between armed groups. Fifteen years later, peace is still elusive in this part of DRC. According to recent estimates, the Masisi territory is now home to 470,000 displaced people, or one-fifth of all displaced people in North-Kivu province. Over the years, almost all humanitarian organizations left the area despite continuing instability and urgent need.

After a relative period of calm in 2021, violence erupted again in 2022. Sexual violence has been particularly prevalent, as is often the case during periods of instability. At Masisi hospital, MSF teams treated more than 740 survivors of sexual violence in 2022; this year, there were 165 patients in the first three months alone. Meanwhile, MSF is responding to an alarming increase of sexual violence elsewhere in North Kivu. Our teams working in displacement camps in and around Goma provided sexual violence care for an average of 48 people a day during the last two weeks of April alone.

“Some [survivors] are coming back for the second or third time already” says Alice, a psychosocial counselor at Masisi hospital. “Sexual and physical violence, displacement, loss of loved ones, lootings … There is a constant repetition of traumatic events. We all end up living in in fear of the next violent episode.”

Day after day, Alice and the other psychosocial counselors try to alleviate the invisible wounds that often accompany physical ailments. “Living in Masisi is extremely stressful. No one is safe. Most people we treat suffer from anxiety, hypervigilance and sadness. Some have suicidal thoughts. Many have just lost all hope,” she says.

As a thunderstorm roars over Masisi, rain falls heavily on the sheet metal roof of the hospital. Patients hurry back to their beds. For a few more days, Agathe and Louise will benefit from the precarious shelter offered by the hospital while their children recover. Afterwards, they will have to go back home. “I am afraid to go back there,” says Agathe. “But what can I do? We have no choice, we have nowhere else to go.”

*MSF currently supports all services at the general referral hospital in Masisi, which admitted more than 14,500 patients in 2022. In order to facilitate access to free medical care, including for the most isolated communities, MSF teams also support four health centers in Masisi, Nyabiondo, Muheto, Ngomashi. Our teams also regularly respond to outbreaks of cholera and measles, two endemic diseases in the area, which spread rapidly during frequent population movement. *

*Names have been changed

Distributed by APO Group on behalf of Médecins sans frontières (MSF).