Wracked by disease and hunger, and forgotten by the state, survivors of a rebel raid on Cianciamka struggle to survive

At the end of the gravel road is a dirt track. At the end of the track is a muddy trail leading through the scrub. At the end of the trail is the village – or, more accurately, the place where the village was before the rebels came.

There was little warning, just shouts and shots shortly after dawn. Most of the thousand or so inhabitants of Cianciamka grabbed their children, a spoon and a cooking pot and escaped into the forest. Some were too slow and were killed, or forcibly enlisted as fighters and porters.

Eighteen months later the community is still recovering. The rebels burned the houses, butchered the animals and stole all the food. Survivors are ravaged by disease and hunger. There is no school and the nearest clinic, a four hour walk away, has no antibiotics; operations are performed on a couch in the doctor’s office.

“I have seen a lot, but this is the worst. Here, this is hell,” said Dr Papi Mundade, who works in a mobile clinic, run by Save the Children, that provides basic healthcare in Cianciamka one day a week.

On a plastic chair in the battered shelter used by Mundade, two other doctors, a midwife and a nutrition specialist, Annie Nalula and her seven-year-old son Roger are waiting. Both are suffering fevers and joint pains, suggesting malaria.

“We don’t have anything. Nothing to eat. No mosquito nets,” said Nalula, 38. “The rebels burned everything, took everything. Lots of men were killed. And then, when we hid in the bush, many of our children died. We buried them there.”

Cianciamka lies on a forested ridge among green hills, close to the border between two southern provinces of the Democratic Republic of the Congo (DRC), Kasai Central and West Kasai. About 1,000 miles from the capital, Kinshasa, the region had long been known as a poor but peaceful one, reputed for the diamonds that creuseurs, or artisanal miners, scrabble from its watercourses and hillsides rather than the conflict endemic to other parts of the vast country.

This changed in 2016, when a chief rebelled against President Joseph Kabila, in power since 2001. Both insurgents and the army terrorised local populations, with thousands dying in massacres and more maimed or raped. The dead have been buried in at least 50 mass graves.

Though a fragile peace has largely returned, millions remain in dire distress.

The husband of Mari Ntumba was killed after being captured in the Cianciamka raid. He refused to eat “magic medicine” made of bones and ash in an initiation ceremony, and was shot.

“We were caught in the middle of the attack. I ran into the bush with the three children. They killed him in the fields,” Ntumba, 31, said.

Ntumba spent months in the bush, before returning to what remained of the village. Now she tries to stave off hunger and disease – and persistent nightmares. Specialists say that at least half of the children in East Kasai are severely malnourished and deeply traumatised.

Ntumba’s five-year-old daughter died four weeks ago, probably of a gastric infection that her weak body could not resist.

There is little evidence of the Congolese state. The ministry of health provides three helpers at the Cianciamka clinic but Leonard Luboya Kanyinda, a local administrator, spends his days sitting idle at a wooden desk in a soot-stained brick hut. The rebels burned most of the furniture and all the district records.

“At least it is safe now. We have the army to protect us,” he said, indicating the detachment of poorly-equipped troops sheltering under a plastic sheet nearby.

Others are filling the vacuum. The road back to Mbuji Mayi city is partially maintained by a Chinese diamond mining company operating nearby.

Save the Children runs a $30m (£24m) operation across the country. “There are over 13 million people out of a population of 76 million in need across the DRC. It’s the worst I’ve seen anywhere, especially for the children,” said country director Heather Kerr.

Kerr stressed there were many “very good, able and smart” medics working in the Congolese government health services, but said the funding “does not reach the right people”.

Facebook Twitter Pinterest A baby sleeps on her mother’s lap before a malnutrition assessment at a clinic in DRC’s troubled Kasai region. Photograph: Kate Bartlett/dpa/Alamy

Many fear further violence around the presidential elections on Sunday. The rebel militia has gone to ground, but not disarmed.

Dr Marie-Albert Tshizemba, a senior provincial health officer, said: the election campaign could lead to tensions. “It is very fertile ground for score-settling,” she said. “There is a lot of enmity between people here. The election could set old fights going again, and create new ones.”

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Midway between Cianciamka and Mbuji Mayi is the small town of Miambi. In the paediatric malnutrition ward of the decrepit hospital, mothers nurse ailing children on fetid foam mattresses laid over broken beds.

“Malnutrition levels are rising. The children are very weak when they come to us. Often there’s not much we can do any more,” said Serge Kalonji, the senior doctor, who last received his salary “a very, very long time ago.”

On one bed is Rose Patto. A year ago, her policeman husband was posted elsewhere in DRC. She has not heard from him, and cannot feed their five children. She has walked for four days to bring in Ngandu, four, who is suffering from acute malnutrition and malaria.

“We have no hopes for the future,” Patto, 42, said. “Just to live.”