Workshop in Bukavu, eastern DRC, Aug 2024 on the implications of the departure of the UN peacekeeping force for the humanitarian crisis and mpox response.
GEC-SH, August 2024

In eastern Democratic Republic of Congo (DRC), bordering Burundi, Rwanda and Uganda, the March 23 Movement (M23) rebellion against the DRC Government has spread rapidly. The violence has exacerbated the humanitarian situation in the provinces of North and South Kivu, with more than 2.5 million people internally displaced in the North alone.

The M23 controls several territories and towns in North Kivu and is trying to suffocate the provincial capital, Goma. The conflict has expanded to South Kivu, increasing communal tensions. Meanwhile, the United Nations Organization Stabilization Mission in the DRC (MONUSCO) is gradually withdrawing from North and South Kivu.

The spread of disease, including the mpox outbreak, increase the suffering and the scale of the challenge facing humanitarian actors and authorities. How can the response to mpox, with vaccines finally arriving in the DRC, navigate this polycrisis?

Exploring the context for response

On 30 August 2024, the Groupe d’Etudes sur les Conflits et la Sécurité Humaine (GEC-SH), a partner of the Social Science in Humanitarian Action Platform (SSHAP), hosted a workshop in Bukavu, the capital of South Kivu, to examine the current state of the humanitarian and security crisis in the province as the context for an urgent response to the present mpox outbreak.

The workshop, featuring participants from provincial government, civil society, and researchers, set out to address the following concerns:

  • To analyse the factors underlying the challenges facing humanitarian aid six months to one year after the departure of MONUSCO from eastern DRC.
  • To analyse the means used by NGOs to overcome the challenges they face in an area where they are caught between the fire of armed actors, the mistrust of the government and the need́ to intervene for the victims.
  • Understand the role of the local authoritý in protecting displaced people and NGOs.
  • Propose ways around the challenges for both NGOs and national and provincial governments.
  • To identify the extent of the spread of mpox in South Kivu and the risks of its spread at regional level.
  • To propose strategies to national and provincial governments to combat and eradicate mpox.
  • To examine the prerequisites for a potential mpox vaccination campaign in a social and cultural environment marked by multifaceted crises and repeated conflicts.

Through presentations and discussions, workshop participants identified several issues concerning the current situation.

A security and infrastructure vacuum

MONUSCO’s withdrawal from South Kivu has had obvious security consequences: roadblocks manned by soldiers and other armed actors have returned, acts of kidnapping have resumed on South Kivu’s Ruzizi plain, and some humanitarian organisations have been attacked by armed actors.

Even though MONUSCO’s impact has been questioned, the withdrawal of the UN structure does mean a loss of earnings for local humanitarian workers and important logistical infrastructure.  For example, in the event of a vaccination campaign against mpox, the vaccination campaign will encounter a serious challenge without MONUSCO logistics to ensure the mobility of the vaccination teams and to move vaccines to and from storage – issues that were faced in South and North Kivu during the COVID-19 pandemic.

The security vacuum left behind by MONUSCO is currently occupied by the Wazalendo (armed groups associated with the government armed forces), or by the local self-defence forces (groups of vigilantes in the service of certain local chiefs), or by the Balala rondo (youth organisations involved in providing security).

This diversity of actors means that access must be negotiated in rural areas affected by conflict and the mpox outbreak, such as in Kamitunga, Kalonge and Kakonge. The presence of foreign armed groups in the area (especially the Ruzizi plain) could also act as an accelerator of a cross-border spread of mpox.

Mpox and communities

The mpox outbreak continues to spread. Eighty five percent of health zones are already affected.  Rural populations are not sufficiently informed about the danger posed by the virus, the barrier measures to be applied, or the need to take part in any vaccination campaign.

Local perceptions of mpox – including that it’s a form of witchcraft; the disease has always existed in the area; it is a disease of sex workers; traditional remedies are effective; and Westerners are looking for another opportunity to exterminate us with their vaccines – are not likely to make a vaccination campaign easy.

With lack of communication about mpox, community resistance is already building, and many affected people do not go to hospital for fear of being stigmatised.

Actions needed

Workshop participants drew consensus on a set of key actions needed within an urgent response:

  • Urgent action is needed to get the government involved in providing security, especially in areas ‘abandoned’ by MONUSCO. An Interprovincial Transition Team should take over from MONUSCO. Unfortunately, this team has never functioned.
  • Médecins Sans Frontières should play a central role in the organisation and coordination of humanitarian organisations operating in the areas affected by mpox as it has a proven experience of deployment in isolated and hostile areas.
  • A pre-vaccination campaign against mpox is necessary. The involvement of respected opinion leaders in their communities is essential, including traditional chiefs, religious leaders, health professionals, and civil society organisations.
  • Social science researchers and NGOs need to work together amongst communities to deconstruct the rumours and misinformation surrounding mpox. Such a team should analyse the local social and security context, shape culturally sensitive messaging, and propose deployment strategies to ensure the success of any vaccination campaign.
  • The vaccination campaign could be made safer through intensive community involvement supported by civil society organisations. Safe participatory dialogue sessions in communities where community members can ask questions and share their personal experiences with vaccination. The involvement of women is vital for the awareness campaign.
  • A public health approach based on equity is required to raise awareness of the importance of vaccination as a means of achieving equity in health, encourage all communities to be involved, and guide a roll out of vaccination campaigns in the most affected and vulnerable areas to show that vaccination is a priority for everyone, without discrimination.

Regional coordination and advocacy

The participants were clear that a regional response to the mpox outbreak was critical. There is significant cross-border movement between Rwanda and the DRC, and between Burundi and the DRC. There is a risk of major spread throughout the region.

Finally, to make the mpox vaccine available and accessible in the DRC, the workshop participants recognised the need for multi-pronged advocacy, drawing in epidemiological and economic data, and messaging at national, regional and global levels reflecting the emergency as a humanitarian, human rights and economic crisis. Advocacy should also focus on the need for enhanced diagnostic capacity and sustained supplies of laboratory consumables to support the response over time.