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In Mbuji-Mayi, the administrative centre of the Kasaï-Oriental province in the Democratic Republic of the Congo, the prosperous years of diamond mining have gradually been replaced by considerable structural poverty, which has deteriorated the quality of life of its three million inhabitants.
A lack of access to drinking water, prohibitively high food prices due to the isolation of the city and an absence of local agricultural production, and irregular income have led acute malnutrition rates among Congolese families to surpass the alert threshold. Since 2020, the Action contre la Faim teams have been working alongside local health care structures to prevent and treat this condition.
If you look at it from above, the geography of this city is intriguing. In the south, a set of concentric circles surround the MIBA Club: a vestige of Mbuji-Mayi’s golden era. It is the heart of the company of the same name – Société Minière de Bakwanga, or Bakwanga Mining Company – and its notable features include a theatre, still used today, and an abandoned pool, invaded by weeds. Two residential areas branch off from this old nerve centre. Large houses surrounded by gardens, with plenty of privacy, line up alongside roads sprinkled with potholes. They have so much space that you could fit around a hundred dwellings from less privileged areas on the outskirts of the city here.
But the appearance of these luxury homes, designed by MIBA and provided for its senior management, has gradually deteriorated as the mining company has collapsed. In the 1980s, it was the biggest employer in the area, providing a living for 40,000 people, counting both employees and their families. MIBA was part of life in the city, contributing to societal development and provision of services by building and maintaining hospitals, schools and roads and giving its employees permanent homes. However, following the financial crisis of 2008 and a collapse in 2020 that led to various suspensions of activity, the mining company is struggling to resume its business: a situation which is depriving the population of regular income and services that had been provided up until now.
Now, in a city where diamond mining is a major part of life, miners are utilising their expertise on a smaller scale. In the Nzaba health zone, in the south-west part of the city, 95% of the population carries out artisanal diamond mining. These ill-equipped miners without technical resources cannot compete with mining companies’ heavy equipment or access unmined deposits. They very rarely find diamonds, and the working conditions are dangerous. Everyone knows someone who has been caught in a mine gallery when it has collapsed. Some of them lived to tell the tale, others did not.
One day, Dorcas’s husband came home maimed from a mining accident. Since then, he has been bed-bound most of the time due to back and leg pain. Holding her seven-month-old twins against her chest, she speaks about her day-to-day life as a mother of nine children who must now find a way to feed them all on her own. ‘Less than two months after Kabongo and Mpongo were born, I left to take sacks of gravel to the river. I was paid 200F for a sack of sand. I needed to transport at least 10 sacks to have 2000F. But even 2000F wasn’t enough to feed the whole family’.
Kabongo, one of Dorcas’s twins, is suffering from severe acute malnutrition. He is receiving care at the outpatients’ therapeutic nutritional unit of the Grâce de l’Eternel medical centre, one of thirty-four supported by Action contre la Faim. According to Alex Muamba Tshihemba, the head nurse at the centre, there are multiple causes of malnutrition: ‘First of all, it’s poverty. Then diseases that affect children, like rubella. On top of that, there’s a problem in our community. Around 90% of young people are diamond miners, and these days there are very few diamonds to be found. That’s why there are so many malnourished children. Diamond miners don’t farm, so essential, basic foods like corn are hard to come by here. The diamond miners have no money, and then on top of that, there’s a food shortage’.
Despite the risks and uncertainty, diamond miners cling to this way of life due to a lack of alternative in terms of jobs. Dorcas sighs: ‘I would rather my children not be diamond miners. I would prefer them to have another job. Diamond miners suffer. Just look at their dad. He studied a lot, but he didn’t find any work after his studies’. For families, everyday life is all or nothing, alternating between days with empty plates and days where food is plentiful. But the abundance never lasts long and is reserved for the lucky and stubborn. Scarcity is the norm, but every find gets people’s hopes up that they might one day strike it rich and lift their loved ones out of poverty.
Though Mbuji-Mayi is the country’s third city, in this isolated metropolis, the population’s needs are clear to see. Without any crops, it is dependent on neighbouring provinces for its food. The roads around it are in a poor state, while the railway station, though still operating, is kilometres away. Its airport is in the process of being expanded. On the tarmac, the billboards thanking President Félix Tshisekedi – originally from the province – stand alongside images of the model of the new airport. Banners announce that work will begin in November 2021. In the enclosure, two lonely diggers move around reddish dirt, preparing for the future runway. The hope here is that this work will open Mbuji-Mayi up a bit more to investors, as well as facilitating trade.
As most everyday products and food arrive by air or road, they are expensive because of transport costs and the recent hike in fuel prices. These factors have led to a substantial rise in prices. At the market, a measure of corn now costs 3,500 Congolese francs (FC) or even 4,000 FC, instead of 2,500 FC. Alongside cassava flour, corn is one of the most key ingredients for the people of Mbuji-Mayi. A meal is not considered complete without corn fufu: a white ball the size of a fist made by pouring flour into boiling water until it becomes a compact preparation. Cassava is sometimes mixed in or eaten on its own, in the form of a fermented dough cooked in leaves. Though they fill the stomach and ease hunger, these foods cannot fulfil people’s nutritional needs.
The price of water has also increased: a jerrycan of 20 litres that used to cost around 200 Congolese francs is now sold for 1,000 or even 1,500 FC. Now, at the end of the dry season, the city is short of water. Its water network has been shut off because of power cuts, as without electricity, this precious liquid cannot be extracted from the source and provided across the network. Jerrycans therefore have to be filled up at the water fountains that are still working in the city centre or on the outskirts. Mayis – adapted bikes that carry jerrycans of water – are ridden up and down the city’s roads. On them are mainly children, who sell the water collected to families who cannot travel to the fountains, though they risk drinking water contaminated by containers that have not been disinfected properly.
Indeed, a cholera epidemic was declared in mid-August. A lack of access to clean drinking water increases the probability of catching a potentially lethal waterborne disease. This is the case of diarrhoea, which can lead to severe acute malnutrition in children under five. In late August, the central government gave 20,000 litres of fuel to the water management company so that its network would work, but this amount only guarantees the supply for a fortnight. In Mbuji-Mayi, water shortages and power cuts are commonplace and highlight the city’s dependency on fuel and support from neighbouring provinces, as well as revealing just how fragile its essential infrastructures are.
The fall in income following the collapse of diamond mining, a lack of access to water and hygiene facilities and high food prices have damaged communities’ living conditions and health in Mbuji-Mayi, especially in terms of nutrition. The Democratic Republic of the Congo, where 45% of deaths of children under five are linked directly or indirectly to malnutrition, is equipped with a nutritional monitoring system. In each of the country’s health zones, two or three medical centres – monitoring centres – share data on their admissions with Pronanut. This Congolese organisation then publishes a quarterly bulletin, the SNSAP, which defines the zones on high alert.
In 2020, following one of these alerts, Action contre la Faim’s emergency nutrition teams intervened in Mbuji-Mayi, with a six-month emergency response. According to our survey, 17.9% of children aged under five examined were suffering from acute malnutrition, and 6.9%, from severe acute malnutrition. Given the magnitude of the needs seen in the field, a decision was made to continue beyond the six months, with a longer-term operation to help local medical centres and the population in their struggle against severe acute malnutrition, as part of the Emergency Nutrition Programme by Humanitarian Coalition (PUNCH, by its acronym in French), funded by the FCDO.
One of the first stages of the operation was to renovate or build water, sanitation and hygiene facilities in medical centres, including latrines, showers, impluvia, waste pits and incinerators. Then, the teams provided these structures with medical equipment and trained health care professionals in the detection and treatment of severe acute malnutrition.
Today, thirty-four medical centres and two general referral hospitals – Bonzola Hospital and Tudikolela Hospital – dispense free treatments for children aged under five and pregnant and breastfeeding women in the health zones of Nzaba and Bonzola. This free system – not just for severe acute malnutrition, but also for childhood diseases and sexual and reproductive health – has given the vulnerable populations of Mbuji-Mayi access to care that they would not have been able to afford otherwise.
In July, 999 children with severe acute malnutrition were treated for free, and 7,380 children attended medical consultations and received care relating to childhood diseases, also for free. Meanwhile, 5,500 pregnant women attended medical centres for their pre-natal consultation, 1,400 women gave birth with assistance, and 1,412 women used family planning services.
These activities are made possible by partnerships built with local health services and associations. Among these structures is the association Promotion de la Femme Paysanne [Promotion of Women Farmers], whose members have been trained by Action contre la Faim to raise awareness and organise cooking demonstrations.
As indicated by Démagoré Gnamou, the Nutrition and Health Programme Manager in Mbuji-Mayi, ‘We are here to treat emergencies, meaning to treat the problem that is there, but at the same time, we have to think about the future. We have to work with partners so that they have the tools to take over from us. These associations will be able to maintain these activities and continue to prevent malnutrition in the Mbuji-Mayi area’.
For Mbuji-Mayi, the city where few diamonds are found now, the key lies in reflecting on new livelihoods for its inhabitants, through the development of other sources of income. In the eyes of Action contre la Faim and other humanitarian organisations, if malnutrition rates suggest a chronic emergency, projects must be built to help vulnerable populations to escape the vicious circle of poverty and malnutrition. ‘We need to help parents to have an income source, so that they can lift themselves out of the crisis. Once diseases are treated, parents must be able to feed their children; pregnant and breastfeeding women must be fed, too’, Démagoré concludes. Today, as we approach the end of 2022, only 37% of the humanitarian response in the Democratic Republic of the Congo is funded.
In late 2022, our teams conducted a nutritional survey in Bonzola and Nzaba. The results of Bonzola having evolved positively, we withdrew from this area. We continue our nutritional and health intervention in the Nzaba zone. In addition, our teams now cover the Muya zone. Due to a lack of funding, reproductive health activities can no longer be carried out. However, community health workers are still raising community awareness on those topics to continue informing and accompanying people. Last year, only 51% of the humanitarian response in the Democratic Republic of Congo was funded.
Democratic Republic of Congo
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