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DRC: Menstruation, conversation, innovation

07 Mar 22 | 09 Mar 22

DRC: Menstruation, conversation, innovation

Alain Kikwaya-Vangi, MSF doctor

Alain Kikwaya-Vangi

MSF doctor

Teams in the Democratic Republic of Congo (DRC) are working with local communities to understand more about the challenges displaced women face in managing menstrual hygiene.

Could a simple idea lead to a potential solution? Deputy medical coordinator Dr Alain Kikwaya-Vangi shares an update.

“I’m surprised,” said the woman. “Surprised that MSF would want to help with something like this. It’s so personal.”

The woman was talking during a discussion group for a new project our team has been piloting in South Kivu, DRC.

The project aims to assess the feasibility of distributing menstrual underwear to displaced women in the region.

Menstrual underwear is made with special fabric so it’s absorbent, washable and re-usable.

The idea came from a colleague who found it the best option for herself in the challenging contexts where Médecins Sans Frontières / Doctors Without Borders (MSF) operates.

If menstrual underwear worked for her, could it work for women living in these contexts full time?

At MSF's out-patient department in Batil refugee camp Gandhi Pant, a nurse, escorts a patient with a possible appendicitis to a waiting ambulance. 

Batil is one of three camps in South Sudan’s Upper Nile State sheltering at least 113,000 refugees who have crossed the border from Blue Nile state to escape fighting between the Sudanese Armed Forces and the SPLM-North armed group. Refugees arrive at the camp with harrowing stories of being bombed out of their homes, or having their villages burned. The camps into which they have poured are on a vast floodplain, leaving many tents flooded and refugees vulnerable to disease. Mortality rates in Batil camp are at emergency levels, malnutrition rates are more than five times above emergency thresholds, and diarrhea and malarial cases are rising.

Help us prepare for the next emergency

South Kivu has seen repeated cycles of armed violence between communities, forcing thousands to flee for their lives.

In their search for safety, people in this remote area often find themselves with no access to essentials like water, food or healthcare.

In December, I met a woman who told us that she’d woken in the middle of the night to find her house on fire around her: her village was being attacked.

"Whatever the final conclusions of the trial, I hope this project has shown how vital it is that menstrual hygiene is a component in every emergency response, especially with displaced people."

Alain Kikwaya-Vangi
MSF doctor

She managed to get out, but there was no time to grab anything. When we met her, she was living in a 10m square schoolhouse with 40 other people and had no bedding, no spare clothes, nothing.

Unsafe materials

In the groups we’ve been running with women who have been through this terrifying experience, they have told us how, in the aftermath of a crisis, they are completely dependent on materials they can find around them to help manage menstruation.

Often these materials are not safe or hygienic, and this can impact both women’s physical health and their mental wellbeing. But menstrual hygiene isn’t always considered in an emergency response.

The women in the groups have shared their views and helped us understand the needs and cultural perceptions around this sensitive topic, which has helped us feel confident to move to the next phase of the pilot.

After several delays because of violence and insecurity in the area, from the first week in February 2022 we’ll be distributing menstrual underwear to 200 women, who have agreed to test it out and share their feedback.

Working with the community

Whatever the final conclusions of the trial, I hope this project has shown how vital it is that menstrual hygiene is a component in every emergency response, especially with displaced people.

Consulting the community from the start has given us the opportunity to learn, to get closer to them, and to optimise our approach, and this is something we’ll be using in future initiatives too.

For now, our team is focused on the distribution, and looking forward to hearing what the women have to say. They have already given us ideas for the next phase of the project!


The second-largest country in Africa by area, the Democratic Republic of Congo is rich in resources but plagued by conflict. It has endured decades of multiple overlapping crises and severe limitations in medical capacity.

Médecins Sans Frontières/Doctors Without Borders (MSF) runs some of its largest programmes in DRC, working in 16 of the country’s 26 provinces. 

We provide services ranging from basic healthcare and nutrition to treatment for victims of sexual violence and people living with HIV/AIDS. In 2020, we responded to DRC’s largest measles epidemic and two simultaneous outbreaks of Ebola, in addition to COVID-19, which had claimed 591 lives by the end of the year.