MSF Urgence Nord-Kivu en RDC

Interview with Julien Bartoletti in Bambo.

Défis Humanitaires: Hello Julien Bartoletti. For our readers, can you tell us where you are currently in the Democratic Republic of Congo (DRC) and what your role is?

Julien Bartoletti: Hello, I am an emergency project coordinator for Médecins Sans Frontières (MSF) in Bambo, a health zone located in the west of Rutshuru territory, in the province of North Kivu in the DRC since the beginning of March.

Défis Humanitaires: What is MSF doing in North Kivu?

Julien Bartoletti: MSF has been present in North Kivu for at least 30 years. We manage both regular projects and respond to specific emergencies. A regular project is one in which we are involved for the long term, like in Rutshuru, for example, where we have been supporting the general hospital since 2005. The multiple crises that have affected this province for decades, notably following the genocide in Rwanda and the shift of the conflict to the DRC, explain our long presence in this region.

A few months ago, with the worsening of the conflict and the related increased needs that arose, we decided to increase our activities by sending, in addition to our regular teams, emergency teams of which I am a member.  We came to reinforce the existing projects in Bambo and Kibirizi, a neighbouring health zone on the border of Rutshuru and Lubero territory.

We also opened a project in Kayna, further north in Lubero territory, where it is estimated that more than 150,000 displaced people have taken refuge in recent months, and launched additional activities in Goma in the newly established IDP camps to the west of the city, particularly in response to the measles and cholera epidemics there. MSF has been working in the IDP camps near the city since May 2022, but a new massive influx of IDPs from February onwards has further increased the pressure and needs of the population, which is why MSF has decided to increase its resources and activities.

Défis Humanitaires: What is the humanitarian situation for the people in North Kivu?

Julien Bartoletti: The crisis in the east of the DRC is not new; it has been going on for decades. There is a very high level of violence and enormous needs. The international community and NGOs are all aware of this. This is why MSF has been developing projects for many years, with emergency response mechanisms for conflicts, displacements and epidemics.

But for several months now, MSF teams have realised that the needs have reached another level: there is a crisis within the crisis. This is particularly linked to the numerous and often violent clashes between the M23 movement, the Congolese army and various armed groups present in these territories. This conflict has been progressing for just over a year in the territory of Rutshuru as well as in the territory of Masisi, and near Goma, the provincial capital.

These clashes, which have intensified since October/November, with the use of heavy weapons in particular, have forced the population to flee in mass, mainly towards Goma and further north towards Kayna, in Rutshuru territory.

Many families had to move several times, from one camp to a school or host family, from one territory to another. Our teams have spoken to people who have fled at least five times in the last few months alone and have no resources left. At the end of November, when the armed conflict in the Bambo health zone became very intense, part of the medical team from one of the MSF-supported health centres fled. They walked to Kayna, several dozen kilometres away. They were able to stay with a host family, but because there was no space for everyone, they slept on the ground and ate barely once a day for several months.

In the space of a year, there have been more than a million new IDPs in North Kivu, in a province that now has around 2.5 million displaced people. This has weakened the already failing health system. Access to health care has become more difficult everywhere. Many health facilities are facing serious problems with the supply of medicines, particularly because of the road traffic, which has been severely disrupted in the province due to the conflict and the shifting front lines.

In Bambo, the health zone in which I work, MSF supports the general hospital through the provision of free emergency care, paediatric care, and the intensive malnutrition treatment unit. On the outskirts, we also support four health centres for free primary health care, malnutrition, and victims of sexual violence.

One of our main concerns now is the nutritional crisis we are witnessing. Tens of thousands of families have lost access to their fields, either because of insecurity, or because they have fled, or because their crops have been looted.

Children, but also pregnant and lactating women, are the first to be affected by malnutrition. Most health centres are desperately short of nutritional inputs. But the most worrying thing is that the stocks of the actors who usually supply the medical structures in the DRC are empty, and we don’t know how long this will last. In the structures we support, we are able to ensure supplies, but this is far from covering all the needs in the province. In Bambo, for example, no food or survival rations (BP-5 or BP-100) have been distributed for months.

In terms of water, hygiene and sanitation, the needs are also enormous, particularly in Goma, where it is estimated that more than 600,000 displaced people have found refuge in formal and informal sites. Despite the presence of many NGOs in the city, the response is still far from adequate. As a result, cholera and measles outbreaks have been spreading since the end of 2022 in the various IDP sites around the city. Access to water and latrines is still extremely problematic. MSF has been present since May 2022 in some of the sites and we are constantly adapting our response to meet the growing needs.

The very high number of victims of sexual violence that we treat is also a major concern for our teams. On some sites, it is sometimes twenty or more per day, the majority of whom present themselves within 72 hours.  Victims tell us that the attacks mainly take place when they leave the sites in search of firewood or food, which highlights the need to strengthen assistance in the sites to avoid exposing displaced people to increased risks of violence.

Défis Humanitaires: Do you have problems accessing people because of the insecurity?

Julien Bartoletti: The context is very volatile. When there are major clashes, we sometimes must put our movements on standby, sometimes for several days. In Kibirizi at the beginning of March, we had to temporarily evacuate our teams. That said, in general, for the past year we have managed to maintain all our programmes in North Kivu, despite the shifting front lines. In Rutshuru territory, MSF was for several months the only medical humanitarian actor to continue providing assistance to the population.

As everywhere in the world, it is our neutrality and our contacts with all the actors involved that allow us to intervene with all the populations in need. We also make sure that we are close to the population and explain as many times as necessary how and why we are there in order to ensure a good acceptance of our teams.

Défis humanitaires: According to our information, there are 114 NGOs in North Kivu, including 66 local organisations. And a humanitarian airlift is underway at the initiative of ECHO and Commissioner Janez Lenarcic, and its new Director General Maciej Popowski has gone there with the European Union’s representative in DRC, Jean-Marc Châtaigner.

Julien Bartoletti: Aid has clearly been too slow to be forthcoming, even though massive population displacements began to take place in Rutshuru territory in April last year. The deplorable living conditions in the IDP sites, some of which were established more than six months ago, are proof of this. Beyond Goma, some areas, such as in Rutshuru territory, have been deserted by UN agencies and international NGOs for several months, leaving the population completely abandoned. Since March, we can see that things are gradually moving. It seems that there has been a gradual awareness of the scale of the humanitarian and health disaster underway. But in reality, on the ground, we must continue to accelerate. Food distributions in particular are slow to take place, even though this is the main need that all communities, whether displaced or not, are talking about.

Défis humanitaires: Will humanitarian aid have sufficient means this year to help the population in North Kivu? The budget for the UN and OCHA humanitarian response plan for North Kivu is 468 million dollars, out of 2.5 billion for the whole of the DRC. Are the necessary resources being mobilised?

Julien Bartoletti: MSF is doing advocacy to mobilise other actors and the international community to get things moving. What we are seeing today in North Kivu is a real humanitarian disaster.

In order to provide an adequate response to this crisis, there must of course be substantial funding to meet all the needs, wherever they may be, but the funding mechanisms for humanitarian aid must also be flexible and responsive to the emergency and the fluctuating movements of the population.

The entire international community and NGOs must be able to put the spotlight on this truly major crisis.

Any action that can help to highlight this crisis and strengthen humanitarian assistance is in itself a good thing, but given the scale of the needs, we are still a long way off.

Défis Humanitaires: How would you like to conclude?

Julien Bartoletti: For MSF, the urgent need is to continue to strengthen humanitarian assistance, in the IDP sites in Goma where conditions are catastrophic, but not only there. We see people displaced by this crisis in Masisi territory, in Lubero territory and even in South Kivu; they must all be able to benefit from adequate assistance. In addition, we must not neglect the needs of people who have not been displaced but who are just as affected by the crisis: they are hosting displaced families, and do not always have access to their fields either, while food prices are soaring.

We sometimes sense a certain weariness on the part of donors and the international community in relation to the situation in the DRC, but once again, we can only repeat that the needs are enormous. We need a much more consistent mobilisation of all the actors, both in terms of funding and in terms of flexibility and reactivity.

Julien BARTOLETTI.

After 5 years of studies in Economics at Paris I, and 20 months working for a Foundation as a conscientious objector, Julien Bartoletti went on his first humanitarian mission as a volunteer in 1997 in Northern Iraq as an administrator/logistician with Aide Medicale Internationale. Julien has since worked for several international organisations including Solidarités INTERNATIONAL and MSF in the field as well as at headquarters. Julien has also worked in the medico-social field in Marseille on projects for homeless people, people suffering from psychiatric pathologies, or addiction-related disorders. In 2021, Julien decided to work with MSF again on short missions as a coordinator or head of mission. After 1 mission in Haiti and 2 missions in Afghanistan, Julien arrived in North Kivu in early March 2023 with the emergency team.