The intensity of the conflict in the North Kivu province in the DRC has had its ebbs-and-flows since it exploded 24 years ago, but it never abated long enough to bring the type of peace where farmers can sleep soundly at night, forgetting the AK47 buried in their field in case militias attack their village. “Children here can identify the distant sound of a Kalashnikov, a rocket or an AK47 just as easily as they distinguish a goat’s bleat from a cow’s moo”, says André Tshimanga, MSF’s assistant field coordinator. Nonetheless, the overwhelming majority of patients in MSF’s hospital in Masisi are not combatants, but mommies and their babies. Lots and lots and lots of babies. In a place of war, you need to hurry to give life.

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A mother and children wait for a consultation during an MSF mobile clinic in a health centre in the village of Lukweti in Masisi territory. 
Archived image (2015): Phil Moore

In many poor societies women are pressured to bear many children who will help tend the field and take care of their parents at old age. But in a context of war, a family doesn’t only need hands to produce food: it also needs bodies to protect its land.

In the Great Lakes region, high population mobility throughout the 20th century deeply modified the balance between the different populations and ethnicity. In 1993 ongoing conflict in neighbouring Burundi and Rwanda spilled over to the Congolese Kivu, and since then the ethnic background of the people – mostly Hutu, Tutsi, Hunde – has become one of the factors of continued conflict. Today 850.000 people in the province (or 15% of the population) have been displaced from their homes, many of them living in displaced-persons camps that sprinkle the hills, in shabby houses covered by plastic tarp so old that the logo of the UN bodies that distributed it years ago have all but faded away. About 70 armed groups are active in a region twice the size of Belgium, and the dynamics of conflict change incessantly: it depends on morphing alliances based on ethnic differences but also political ones, disputes over land or mines, self-defense... In this context, women’s bellies are a weapon among others: make more children than the other group so you’ll be able to stand your ground and defend yourself.

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Today 850.000 people in the DRC live in displaced-persons camps. Photo: Phil Moore

Giving life to so many infants poses a direct threat to the mother: losing the babies, tearing their uteruses, increasing the likelihood to need a C-section – and if they can’t find a surgeon nearby, how can they give birth safely? Last year MSF treated close to 5.000 children for severe malnutrition in Masisi, a condition that represents 42% of admissions in the emergency room. 74 children under the age of five died of malnutrition in hospital. “Considering the region’s fertile soils we should not have that much malnutrition. But as mothers giving birth less than 2 years apart tend to stop breastfeeding early, the older child receives an unbalanced diet”, Zachary explains. Indeed, 80 to 90% of the mothers of young patients in the malnutrition ward are pregnant, like 28 years old Kumuka, sitting with the youngest of her five children. She’s been living in a displaced-persons camp for years. Her husband has no work. They have no field. They have no income. “I don’t want to be like my aunt who is always praised for having 15 children. I couldn’t support them; look, this one is sick already! It’s God who will decide how many children I have, but now that I heard of family planning here, I’ll try talking to my husband”, she says. Pregnant 28 years old Sarah, sitting in the next bed with her 18-month-old child, is more forthcoming. “This will be my last child. I work in the field every day, from 6 am to nighttime, and I can’t take care of them during this time. Six is not that many, but it’s enough”.

In the pediatric ward Zachary face melts into a smile and he crouches down near the bed of a 7-year-old little girl. “Etoile! How are you today ?” The little girl giggles. It feels good to hear that because you would not think it possible: her entire face and head, her arms, her hands are mummified in bandages. She was burned on 17% of her body and has been hospitalised for two years. Unfortunately, the MSF team often treats such little kids from overcrowded homes who fell on a pot of milk boiling in the middle of the room. “We should be able to release her soon, but I’m so worried. Right now she doesn’t realise how disfigured she is. And what will happen to her in a community where rape is omnipresent, considering that she’s blind and will never be able to identify her assailants?” He sighs. “At least while she’s with us, she’s safe”.

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Women’s inability to decide and control how many children they have, and when, can have dramatic consequences for mothers and
children of very large families in unstable contexts. Photo: Phil Moore

Next door a group of a dozen “mamans conseillères” are trained on how to give information and advice on family planning to the women of their villages. They’re not directly advocating for having less children – this is a very sensitive topic culturally, especially in a war context – but list the benefits of at least spacing births. “If you have less little children you can better feed them all”, says the other. “And send them to school so that they can take better care of you later on”, adds another.

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MSF trains “mamans conseillères” on how to give information and advice on family planning to the women of their villages. Photo: Phil Moore

It’s a harsh world here, and the new mothers from today barely remember a time without mass rapes, displaced-persons camps and the sound of gun fight at night. When the past is chaos and the future muddy, spacing births may not seem like a priority, even though the women’s bodies know it is. “A woman is like a pagne (piece of cloth)”, says one of the maman conseillère. “If it’s used too much, it frays”. The women know; now they need to convince the men too.


Since 2007, MSF in Masisi, DRC offers a full package of care in a very volatile environment:

  • The reference hospital of Masisi (220 beds), includes services of surgery, internal medicine, gynecology, maternity, pediatric, neonatology as well as a « village d’accueil » for women in their third trimester of a risky pregnancy who can stay there to ensure they have access to medicalized support to give birth.
  • Support/management of the health centres in Masisi & Nyabiondo.
  • Mobile clinics with a focus on malaria (curative/preventative) in remote health posts; watsan & health promotion
  • The project will soon start a multiantigene vaccination campaign targeting populations living in very remote areas who have no access to basic healthcare

Find out more about MSF's activities in the DRC