Ambulances of the Medecins Sans Frontieres in Rutshuru, Democratic Republic of Congo. The country is the MSF's most expensive operation. Photo by: Roberto De Vido / CC BY-NC-ND

North of the Democratic Republic of Congo lie two of the biggest humanitarian crises that currently concern many in the aid community: South Sudan and the Central African Republic.

But unlike those emergencies, which flared up in recent years, the crisis in the DRC, particularly in its eastern provinces, has been ongoing for almost two decades — and there is much room for improvement on the aid part in order to find a long-term solution, according to Medecins Sans Frontieres

“I think in [the] DRC because the conflict has been ongoing now for almost 20 years, there is a bit of a DRC fatigue, like ‘yeah, oh yes, it’s Congo. There’s always something going on in Congo’,” Annemarie Loof, MSF operations manager for the country based in Amsterdam, told Devex after the launch of the aid group’s report ”Silent Suffering in the Democratic Republic of Congo.”

But “please don’t forget the people in Congo, because they are suffering immensely everyday,” she said.

NGOs operate in ‘inflexible’ system

The DRC is MSF’s most expensive operation, and among the ten countries where the aid group spends more than 50 percent of its operational budget. The organization does not rely on donor government funding for its work in conflict situations, but other NGOs do — which tends to cause problems in their aid response in the country.

Aid organizations, the report notes, operate in an “inflexible humanitarian system … that does not allow a rapid and effective response to critical needs.”

This means most humanitarian organizations apply for donor funding only when a crisis occurs. They first make an assessment, then a proposal that donors take time to review before approval. So by the time the money arrives, they are “already at least 6 weeks to three months down the road,” Loof explained.

This however is not the only problem facing the aid community in the conflict-torn country.

Because of the unsafe environment and logistical challenges, most organizations limit themselves to urban areas, where it’s relatively safer. But the problem is most of the people displaced by fighting are in the countryside and often don’t reach the big urban centers, therefore leaving them out of aid’s reach.

Sometimes, coordination among aid groups help address their needs, but this is mostly on a case to case basis.

“People there are not seen because there is nobody there to witness what they are going through. But they also need equally the help that people near the urban centers get more easily,” Loof argued, adding donors could play a role by having an influence on what kind of programs they fund and where, and calls on aid groups to “revise their operational priorities.”

Another concern for organizations in DRC relates to the U.N. Intervention Brigade, which while helps in maintaining peace in the country is also putting aid missions at risk.

“They are using white land cruisers and white helicopters. And so it is very confusing for people, because if the helicopter comes they don’t know if it’s bringing them bread or bringing them bullets,” Loof said.

It’s unclear if such fear has already happened. In October, an unarmed helicopter by MONUSCO, whose mandate is only limited to peacekeeping, was fired at by M23 rebels. But MSF claims the helicopter was with a U.N. humanitarian mission as well.

The problem with health care

Another huge concern and priority for the aid group is the current medical care setup in the country.

The conflict is already delaying health care for those in need of it; health facilities are left abandoned, health workers are intimidated, and the risk of diseases is on the rise.

But what’s really troubling MSF is that state-run hospitals and private healthcare providers continue to charge patients for every medical care received. This may be acceptable under certain circumstances, but not currently in the DRC, according to Loof, who said the current situation is not stable enough for people to have access to money, or rely on their crops or cattle.

And it’s not helping that other aid groups choose to do the same.

“What’s happening in Congo is not the same as what’s happening in South Sudan. South Sudan was stable for a period of time, now there’s a major crisis. And it was the same in the Central African Republic … In the DRC, the crisis is at a different level, but it ongoing for a long long time. So we cannot say that it is a major crisis, like in CAR, but we can also not say [the situation] is stable,” Loof argued, adding that the cost-recovery system “is an obstacle for people to seek health care if they have to pay.”

The report claims that when hospitals provide free medical care, like a hospital in South Kivu did in 2011, the number of people who seek and receive health care rose. In 2010, for instance, not one individual received treatment for HIV/AIDS, tuberculosis and had been vaccinated for measles in the hospital. But in 2012, when it dropped fees for medical care, people started to show up.

That’s why Loof hopes the cost-recovery system will be abolished altogether, or at least in the conflict-affected areas of DRC — however, how this can be accomplished remains to be seen.

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About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.