South Kivu, a province in the east of the Democratic Republic of the Congo (DRC), has been plagued by armed conflicts and civil unrest since the First Congo War in 1993. A battleground for a number of armed groups, the conflict has resulted in the displacement of civilians, human rights abuses, and atrocities against the local population.
Among the forgotten victims of the conflict are survivors and disenfranchised youth, who sometimes resort to drug consumption to mitigate the after-effects of decades of violence. After the launch of the World Drug Report 2024, the UN Office on Drugs and Crime (UNODC) sat down with Dr. Amani Busane Philippe, founder of the “Candidates for change clubs” for people who use drugs, to discuss the impacts of the drug problem in South Kivu.
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Since 2018, Dr. Amani Busane Philippe has been working with Panzi Hospital, established by Nobel Laureate Dr. Mukwege. He was tasked with developing the hospital's psychiatry program, addressing a critical need in South Kivu where such services were previously nonexistent. The program focuses, but not exclusively, on victims of sexual gender-based violence (SGBV – either conflict related or not) with severe post-traumatic stress disorder or psychotic and bi-polar symptoms.
Among them was a young teenage girl, 17, who was heavily addicted to heroin.
“Her mother was a sex worker. One of her mother’s favorite clients raped her in her mother’s absence. Given his status with her mother, she couldn’t address it openly, which led her to start using cannabis.
After meeting local users, she started taking heroin, hoping to overdose, but as she told me: she never succeeded.
Another case was the son of a Mwami (traditional leader) whose son started using heroin to address lingering childhood trauma. As the heir to the throne, his dependency was never addressed.
Instead, he was “protected”; his issues too taboo to discuss. His father sent him abroad to study, but nothing helped. When he came to the hospital, we tried treating his symptoms, but he kept relapsing.
As a psychiatrist, I realized that their problem was not substance use, and that we needed to address the roots of why they used.”
Dr. Busane wasn’t always attracted to sciences. He started off in law, but veered towards medicine after three months, eventually specializing in psychiatry.
“I left the DRC, as advanced psychiatric studies were not available, and moved to Senegal where I studied at the Hopital Fann. While there, I came across CEPIAD (Centre de Prise en charge des Addictions a Dakar), an addiction treatment center which first introduced me to harm reduction approaches (opioid substitution, needle substitution, psychosocial support and reintegration skills), that aren’t available in the DRC.
In Dakar, there are associations run by peer-users who work in tandem with the hospital. These didn’t exist in the DRC. This led me to open a club in Bukavu, where users can meet and discuss their issues, understand how addiction works, why they keep relapsing and how to help themselves.
Lacking opioid substitution treatment, medical treatment is used to make families feel comfortable, but it’s in the clubs where we provide an enabling environment for healing to happen. I called them “Clubs des candidats au changement” because I believe that users must be willing to change for change to occur.
I started with one and we have 12 throughout Bukavu today, supporting 144 users of various substances like alcohol, cannabis, heroin, and others. Most heroin users don’t inject here, but sniff and smoke heroin, thus its local nickname of “sniff”.
Several are former Panzi hospital patients. Not all patients come from Bukavu, some come from Goma, Uvira or even Burundi.
The absence of specialized treatment is a real problem. I have observed an increase in drug use over the last few years. In Bukavu, there are 30 known sales points;, 10 in the central district of Ibanda alone.
I conducted a study in 2018 identifying 1119 substances users. Today, my clubs could easily count over a thousand members, and I wouldn’t even be scratching the surface of the actual extent of use.”
Dr. Busane believes that the active participation of family is essential to recovery. His own compassionate approach may come from his family background.
“My father is a Pastor, and my mother organizes women’s groups. I consult with them for advice on how to bring people in.
My father always told me, healing starts with reaching out to the other. Always. I changed his slogan into “saving” the other. They have always supported me, never pushing me in a direction that wasn’t my own, and I try to apply that philosophy to the clubs.
Eastern Congo is home to multiple armed conflicts. What we are facing with drug use is a silent attack on our youth, no less deadly and damaging than armed conflict.
Drug trafficking and harm reduction are not a priority for the government, nor the international community, who focus rather on the conflict. As such, we lack the essentials of medical treatment.
Given the DRC’s geographic location, with the Swahili coast where heroin enters the continent, paramilitary groups facilitating traffic and our lack of regulation at the borders, substances are easily accessible. And so, we risk losing an entire generation to drug use. Because even if the conflict ended tomorrow, we would not have the means to address the surge in post-conflict use.
We need policies that help us address trafficking, use and reintegration. We need to focus on prevention and addressing trauma early. You can’t wait for someone to be 18 and addicted to resolve childhood issues. We need more awareness, especially given the realities of Eastern Congo.”
In efforts to enhance public health across Africa, UNODC focuses on several key strategies. These include bolstering data collection and analysis capabilities, strengthening responses to drug trafficking, and improving initiatives for drug and HIV prevention, treatment, and care.
Additionally, UNODC aims to facilitate better access to and medical utilization of controlled medicines containing narcotic drugs and psychotropic substances. Another critical objective is to safeguard populations from counterfeit medical products. Through these multifaceted approaches, UNODC strives to promote a balanced and effective drug control framework that positively impacts health outcomes throughout the region.
