As the republic of Congo's Pool region slowly emerges from years of civil war, the lack of health services, ongoing insecurity and logistics problems have made it extremely difficult for HIV-positive people to access care and treatment.
The national AIDS programme does not yet provide services in Pool, in the south of the country, and people living in the Mindouli district travel 140km to the capital, Brazzaville, for antiretroviral (ARV) medication.
Others, if they are lucky, are cared for by medical humanitarian agency Medecins Sans Frontieres (MSF), which operates an HIV/AIDS centre in the Mindouli hospital, which is struggling to cope.
"We have no qualified personnel, the basic hospital and the centres on the periphery are being run by volunteer workers," said Dr Guy-Emmanuel Bafounda, the doctor in charge. "We have about a dozen people who have HIV/AIDS. They are being cared for by MSF."
HIV/AIDS statistics for the Pool region are hard to come by. In 2003, health officials could not carry out the national prevalence surveys in the area, due to fears of insecurity, but experts have warned that the humanitarian crisis could have contributed to an HIV infection rate much higher than the national 4.2 percent.
LITTLE IMPROVEMENT, DESPITE PEACE
Peace was signed between the Congolese armed forces and the Ninja rebels at Mindouli in 2003, and people hoped that war was now a thing of the past.
But three years later, peace remains elusive, with violence continuing despite large numbers of members of "all the security services, police, gendarmerie, army, land surveillance division, headquarters of specialised units and armed forces," according to Paul Goma, the permanent ministerial representative in Mindouli.
Victorine Milandou, a social worker from the Mindouli social services, said many women and girls had been victims of sexual abuse during the war, and since the hostilities ended. NGOs working in the region believe that at least 20 percent of the women of the Pool have been subjected to sexual violence.
Before the fighting, Mindouli had around 18,000 inhabitants, but according to 'The Pool, a neglected humanitarian crisis', a report by the United Nations Office for Humanitarian Affairs (OCHA), there were only 11,000 people living in the district in 2005.
Most of the health workers who fled the war did not return, in spite of the repairs to some of the 11 Integrated Health Centres (CIS) run by regional authorities. "These CIS are like monuments because a they lack nursing staff and equipment," explained Bafounda. Health structures also lack the financial resources they need to function.
The International Committee of the Red Cross (ICRC), in partnership with the local health authority, has started reproductive health and HIV/AIDS training for the staff at nine of the health centres in the Pool.
Apart from treatment, people are also unable to feed themselves, and 15 percent of the population suffers from severe malnutrition, the highest rate in the country, according to the World Food Programme.
ANXIETY AS NGOs PLAN PULLOUT
Although the situation in the strife-torn Pool region is gradually normalising, people are worried about the eventual withdrawal of humanitarian organisations.
"I am sure that when all the humanitarians decide to leave here, we will have a situation worse than war," said Alphonse Koukanguissa, the respected head of an area of Mindouli.
NGOs have warned that withdrawal could be accelerated if the state does not tackle the problem of lack of security. In January, the Dutch arm of MSF announced the progressive reduction of its activities in some districts, in protest against the regular acts of violence against NGOs.
Persistent violence forced the medical organisation to call a halt to its activities in May, after three years of treating people living with AIDS or suffering from tuberculosis in Kinkala, the main health centre in the Pool region.
MSF left medical supplies and trained personnel to allow the local authorities to continue treatment, but will continue working in other districts of the Pool, like Kindamba, where it runs a programme for treating HIV and tuberculosis.
//This article is part of an IRIN/PlusNews series on HIV/AIDS and communities of humanitarian concern. Visit: PlusNews. //
The national AIDS programme does not yet provide services in Pool, in the south of the country, and people living in the Mindouli district travel 140km to the capital, Brazzaville, for antiretroviral (ARV) medication.
Others, if they are lucky, are cared for by medical humanitarian agency Medecins Sans Frontieres (MSF), which operates an HIV/AIDS centre in the Mindouli hospital, which is struggling to cope.
"We have no qualified personnel, the basic hospital and the centres on the periphery are being run by volunteer workers," said Dr Guy-Emmanuel Bafounda, the doctor in charge. "We have about a dozen people who have HIV/AIDS. They are being cared for by MSF."
HIV/AIDS statistics for the Pool region are hard to come by. In 2003, health officials could not carry out the national prevalence surveys in the area, due to fears of insecurity, but experts have warned that the humanitarian crisis could have contributed to an HIV infection rate much higher than the national 4.2 percent.
LITTLE IMPROVEMENT, DESPITE PEACE
Peace was signed between the Congolese armed forces and the Ninja rebels at Mindouli in 2003, and people hoped that war was now a thing of the past.
But three years later, peace remains elusive, with violence continuing despite large numbers of members of "all the security services, police, gendarmerie, army, land surveillance division, headquarters of specialised units and armed forces," according to Paul Goma, the permanent ministerial representative in Mindouli.
Victorine Milandou, a social worker from the Mindouli social services, said many women and girls had been victims of sexual abuse during the war, and since the hostilities ended. NGOs working in the region believe that at least 20 percent of the women of the Pool have been subjected to sexual violence.
Before the fighting, Mindouli had around 18,000 inhabitants, but according to 'The Pool, a neglected humanitarian crisis', a report by the United Nations Office for Humanitarian Affairs (OCHA), there were only 11,000 people living in the district in 2005.
Most of the health workers who fled the war did not return, in spite of the repairs to some of the 11 Integrated Health Centres (CIS) run by regional authorities. "These CIS are like monuments because a they lack nursing staff and equipment," explained Bafounda. Health structures also lack the financial resources they need to function.
The International Committee of the Red Cross (ICRC), in partnership with the local health authority, has started reproductive health and HIV/AIDS training for the staff at nine of the health centres in the Pool.
Apart from treatment, people are also unable to feed themselves, and 15 percent of the population suffers from severe malnutrition, the highest rate in the country, according to the World Food Programme.
ANXIETY AS NGOs PLAN PULLOUT
Although the situation in the strife-torn Pool region is gradually normalising, people are worried about the eventual withdrawal of humanitarian organisations.
"I am sure that when all the humanitarians decide to leave here, we will have a situation worse than war," said Alphonse Koukanguissa, the respected head of an area of Mindouli.
NGOs have warned that withdrawal could be accelerated if the state does not tackle the problem of lack of security. In January, the Dutch arm of MSF announced the progressive reduction of its activities in some districts, in protest against the regular acts of violence against NGOs.
Persistent violence forced the medical organisation to call a halt to its activities in May, after three years of treating people living with AIDS or suffering from tuberculosis in Kinkala, the main health centre in the Pool region.
MSF left medical supplies and trained personnel to allow the local authorities to continue treatment, but will continue working in other districts of the Pool, like Kindamba, where it runs a programme for treating HIV and tuberculosis.
//This article is part of an IRIN/PlusNews series on HIV/AIDS and communities of humanitarian concern. Visit: PlusNews. //
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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