Inside Congo, An Unspeakable Toll

By Richard Brennan and Anna Husarska
Sunday, July 16, 2006; B03

KAMPALA, Uganda

This month's general elections in Congo, the first in more than 40 years, are raising hopes: that with an elected government in place, real and lasting peace will come to this war-ravaged country, and that after a decade of misery and death, the nation will finally come off the list of chronic humanitarian emergencies requiring extensive outside assistance.

But has Congo -- nominally at peace since a truce in 2002 ended its eight-year civil war, but still suffering spasms of violence -- ever occupied its rightful place on that list? Has the scale of the tragedy engulfing the Congolese people received proper attention? The answer, sadly, is no. Ignorance of the calamity occurring in Congo remains almost universal, even though the numbers that reflect it -- particularly the key indicator "excess mortality," the number of deaths above normal levels -- are staggering.

The International Rescue Committee, which has been providing humanitarian assistance in Congo since 1996, conducted four mortality surveys in the country between 2000 and 2004. We found that in the most affected zones, the mortality rate over the years covered by our studies (1998 to 2004) exceeded the "normal" rate for sub-Saharan Africa by nearly 4 million people. This makes the crisis in Congo the deadliest anywhere since the end of World War II, dwarfing Bosnia, Kosovo, Darfur and even the South Asian tsunami. Yet for the most part, these deaths have gone all but unnoticed.

Perhaps this is because of the nature of the dying. In an era of instant news cycles, more attention is paid to those who die violently than to those who die of disease. In our most recent Congo survey, only 2 percent of the deaths were attributed to the simmering conflict there. The rest resulted from easily preventable and treatable diseases that are the indirect -- but no less devastating -- result of the strife. Our teams were told that the "excess" Congolese deaths were mainly the result of fever (mostly caused by malaria), diarrhea, malnutrition or respiratory problems. Nearly half of the victims were younger than 5, but they still received almost no attention. The disappearance of 4 million Congolese was well-documented (our study was published in the British medical journal the Lancet), but it was viewed as unheroic, seemingly apolitical and therefore untelevisable.

This is all the more lamentable because our survey also showed that death rates plummet when security is assured. The death rate in areas with continuing violence was 76 percent higher than in the more stable regions. For instance, the arrival of U.N. peacekeepers to establish security in the town of Kisangani in 2004 had a dramatic effect: The death rate fell from a catastrophic 6.2 deaths a month per 1,000 to a normal level of 1.4.

Anticipating a slightly increased interest in Congo because of the upcoming elections, the IRC recently went a step further to see whether the international response has been proportional to the identified need for this disaster. Though determining which deaths receive more attention is a gruesome exercise, it is also a revealing one. We investigated the way mortality triggered three types of response -- humanitarian aid, peacekeeping and news coverage -- and compared the results for Congo with other humanitarian disasters. In every category, despite its higher mortality, Congo received far less attention.

A bipartisan relief bill pending in the Senate would authorize $52 million in humanitarian assistance for Congo for the next fiscal year. It recommends strengthening the U.N. peacekeeping effort there and calls for a U.S. special envoy for the Great Lakes region of Africa, which includes Congo. An effort to bring money, mission and media attention to this suffering nation, the bill has not yet reached the floor for a vote.

Responses to a crisis such as Congo's are always linked. When there is media coverage, aid increases. Large donors may be more inclined to press for a greater presence of international peacekeeping forces to protect civilians and humanitarian assistance teams. And the presence of peacekeepers makes it easier for the media to report.

If these factors come together, they accomplish the goal of every humanitarian response: saving lives.

Richard.Brennan@theIRC.org Anna.Husarska@theIRC.org

Richard Brennan is a medical doctor and director of the International Rescue Committee's Health Unit. Anna Husarska is senior policy adviser with the committee.

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