The situation in the Kasai region is a very volatile one. It is a region where tradition plays a dominant role, and where people have a deep-seated belief in magic. The traditional rulers are the “tribal chiefs”. These chiefs were placed under supervision in 2015, following the enforcement of a law stipulating that tribal chiefs must be designated as such by the State.
In August 2016 a tribal conflict worsened and eventually spread across five provinces, with serious human rights violations by armed forces on all sides.
Following the death of tribal chief Kamuina Nsapu, who bore the same name as his native village, a relative of his was recognised as his successor by the people but was not approved by the State, and the village mounted resistance. After an eventful period, the army killed Chief Kamuina Nsapu and prevented his body from receiving a proper traditional burial.
Health center in Kamuina Nsapu. DRC. November 2018. © Olivier Pirot
The Kasai region as a whole then erupted and was the theatre for some extremely violent events and acts of violence against the local people, not only by the regular Congolese armed forces and the militia supporting them, but also by the Kamuina Nsapu militia.
After a massive push in the Kasai region towards the north and west, the militia have now once again regrouped on their original territory. This is making for a very unstable situation, with numerous armed groups concentrated in a small area, a large quantity of weapons (knives, rifles and AK-47s) in circulation, and the State trying to re-establish its authority during the run-up to the elections* (a presidential election and national and regional legislative elections are due to take place in late December 2018).
MSF is now the only international humanitarian organisation with an ongoing presence in the Kasai region.
The health system has deteriorated, with Kasai having long since been consigned to oblivion by central government owing to its being perceived as an opposition stronghold, and access to healthcare is fraught with difficulties. A great many healthcare facilities, which were already in a worrying state, have been destroyed or looted during the fighting, and the infrastructure is extremely precarious.
A delivery room Kasai region. RDC. November 2018. © Olivier Pirot
MSF is working to restore various community healthcare centres, as well as healthcare provision within a proper general hospital. In healthcare centres we are providing support in the form of general primary healthcare (outpatient treatment, maternity care, vaccinations, training, access to water, etc.), and assisting with transfers to the general hospital.
At the hospital we are managing a paediatric department, including a nutritional unit and a maternity unit, and are providing support to other departments such as surgery, blood bank, etc. We are also taking action with regard to water, hygiene and sanitation. In the community we are treating malnutrition and malaria (the rainy season is well underway in a region where seasonal bites are endemic), and taking responsibility for adults and children referred to the general hospital.
Significant cultural considerations mean MSF has to adapt to the needs of the local people. In maternity, for example, women do not want to leave before their baby’s umbilical cord has fallen off (6-7 days after delivery!), for fear of bringing bad luck to their household.
As Head of Mission, my role was quite wide-ranging and very varied.
Firstly, the Head of Mission has to set up the mission by liaising with the authorities and other stakeholders, and to initiate various partnerships. He or she represents MSF at national level. For me, this included meeting the Prime Minister.
Next, the Head of Mission has to define the Mission’s operating strategy, in partnership with the Operations Cell and the Coordination Team, by drawing up action plans for a range of scenarios. I had to analyse events (such as, for example, the huge influx to the Kasai region of Congolese refugees expelled from Angola during my Mission), explore possible needs, and devise intervention scenarios. Lastly, I was responsible for coordinating effective project implementation.
The Head of Mission also needs to have a thorough grasp of the context, no matter how complex, in order to provide a strategic vision for the future. One of my priorities was to provide mine for the next part of the Mission in 2019.
Another reason why understanding the context is extremely important is that the Head of Mission is ultimately responsible for the safety of the Mission and must ensure that strategies are in place for applying in crisis situations. The DRC’s current pre-election* context is making an already very volatile situation even more complex.
Next, on a day-to-day basis, I had to rule on decisions and problems in my role as the ultimate authority for all MSF policy and management issues on the Mission (Administration, Logistics, Finance, Human Resources and the MSF Association).
Lastly, and this is one of the aspects of being a Head of Mission that is closest to my heart, I provided a framework and support for the Funding Coordination Team and the Field Coordinators. I try to be available and ready to listen to them, not only concerning technical issues, but also as a way of monitoring morale and trying to create a good team dynamic.
There are indeed a lot of challenges in an already unstable context, in which MSF is encountering talk of secession and suggestions that humanitarian activity may be shut down.
We are having to negotiate constantly with the authorities to keep our activity going and to ensure access to free healthcare.
The safety of staff and patients is also a daily preoccupation, and my Mission has had quite a few incidents.
In a context like this, keeping a positive dynamic among the staff is something you have to work at, day in and day out.
Lastly, the December 2018 elections* are adding a measure of uncertainty to our reading of the context and we have to be ready to act in the event of any confrontation.
On a visit to the field, I was accompanying a delivery of building materials for restoring the health centre in the village of Kamuina Nsapu. All the children in the village were clustering around the truck, which was dangerous given the materials we were unloading. So I improvised a “magic” trick to get them to move away: I “took off” part of my thumb, then stuck it back on. It was a lovely bit of interaction with the villagers, with everyone, adults and children alike, asking me to do the trick again. At one point a man came up to me, observed me, then finally told me that I was a great sorcerer ... but that the Village Chief was an even more powerful sorcerer, as he can remove and put back not just his thumb but all 4 of his fingers too!
Kids in a DRC village. November 2018. © Olivier Pirot
Another really memorable, special moment on my Mission was when I met the Prime Minister, as I mentioned above. It was the first time representatives of MSF had met this Prime Minister, who was appointed in December 2016 following the New Year’s Eve agreements and whose main task was to hold elections and ensure a democratic transfer of power following the results of the elections.
* The interview was conducted in early December 2018