A Conflict's Deadly Ripple Effects
Fighting in Congo Has Killed Millions, Most of Them Succumbing To Displacement, Flights Through Harsh Jungles and Lack of Care

By Stephanie McCrummen
Washington Post Foreign Service
Sunday, August 2, 2009

WALIKALE, Congo -- Death came quietly for Bahanuzi Mihigo.

Unconscious from a soaring fever, his body full of infection, the 36-year-old farmer lay under a white hospital tent in this tiny village, a place that floats like an island in a vast sea of roadless jungle.

It was a cool evening, and the fighting that had chased Mihigo from his home was far away now. Still, its aftermath surrounded him in the tent, where ants crawled up the wooden posts of beds occupied by others weak or dying from their own jungle odysseys: three babies listless with malaria; a woman wheezing from tuberculosis; another with a raging infection ballooning her left arm.

Justin Balaluka, Mihigo's friend, sat with him into the night, noticing how he had changed. He looked old, exhausted. Just before 11 p.m., Mihigo trembled slightly and, as Balaluka put it, "lost the spirit."

Though doctors listed the cause of death as suspected typhoid fever, Balaluka, 26, who fled through the jungle for weeks with Mihigo, named another.

"I blame the war," he said.

By some estimates, at least 5 million Congolese have died in more than a decade of conflict touched off by the 1994 genocide in neighboring Rwanda, which sent a flood of militiamen across the border into mineral-rich eastern Congo. Although the conflict has surged, receded and changed over time -- at some points involving eight countries and at others breaking into smaller conflicts among a mess of armed groups -- the cumulative death toll in eastern Congo is the largest since World War II.

For the most part, though, people in eastern Congo have not died in a blaze of bullets or in large-scale massacres. More often, the conflict has set off a chain reaction of less spectacular consequences that begins with fleeing through an unforgiving jungle and ends with a death such as Mihigo's. In eastern Congo, people die from malaria and diarrhea, from untreated infections and measles, from falling off rickety bridges and slipping down slopes, from hunger and from drinking dirty water in the hope of surviving one more day.

Arguably, people die because of the wider social impact of the conflict. Entire villages have been scattered across hundreds of miles, atomizing extended family networks that people depend upon in difficult times. The conflict has overwhelmed already-dysfunctional government hospitals and left roads rutted and overgrown, isolating people in villages like Walikale from help.

At the moment, the conflict in eastern Congo is surging once again. Since January, at least half a million people have fled a U.N.-backed Congolese army operation targeting Rwandan rebels, which Secretary of State Hillary Rodham Clinton is expected to discuss in a visit to Congo this month. The rebels are retaliating against villagers with whom they have lived for years.

In early May, one of those attacks ravaged the village of Busurungi, where Mihigo lived with his wife and three children, about 75 miles from here. In many ways, the story of his death -- pieced together from interviews with neighbors, doctors and nurses who treated him -- begins there.

Despite the occasional menace of rebels who lived in the village, Mihigo led a relatively healthy life. He ate decently, drank from spring water taps and could go to a local health clinic for basic medicine. He was known as one who shared what he had, and as a mentor to young men tempted to take up the AK-47.

"He would tell us we'd have a better life farming," said Amisi Tumusifu, 22, a neighbor. "He was a good man."

When the military operation began this year, soldiers chased the rebels from Busurungi but soon abandoned the village. U.N. peacekeepers mandated to protect civilians did not fill the void, and the rebels returned in a fury, burning hundreds of houses and shooting people as they fled. Mihigo saw his wife and children killed, but he managed to escape with about 20 others, including Tumusifu and Balaluka. He ran off only with the clothes he was wearing: a pair of jeans, a plaid button-down shirt and flip-flops.

The group spent days walking along muddy, rocky footpaths or clearing new ones through tangles of green, at times silently, afraid the rebels might hear. They crossed rivers and eased down slopes, scraping bare arms and ankles. At night, they often slept on leaves.

"We got bitten by so many mosquitoes," Tumusifu said. "When it was raining, we got wet and cold. We were eating like pigs."

If they were lucky, they ate roots and cassava leaves and drank river water. They came upon tiny villages where people would help with a meal, and some in the group would stay behind. After a while, the group dwindled to three -- Tumusifu, Balaluka and Mihigo. They were all getting thinner, especially Mihigo.

"He looked so tired," Tumusifu said. "He was talking about so many things: the war, his children, his wife. To lose your wife and children, it's not simple. I think that created pains in his heart."

Mihigo began complaining of headaches and fatigue, but the three pressed on, finally reaching the village of Ndjingala, about 25 miles from Walikale, in mid-June. A family offered them an 8-by-8-foot room, where they rested a few days. But with no money or family for support, Mihigo, who could not even afford aspirin, decided they had to find work quickly.

"We had no soap, no clothes -- nothing," Balaluka said. "We were tired, but we had no choice."

In this area, one of the few readily available jobs is hauling 100-pound loads of sugar, beer and other supplies on a two-day trek to a huge mining pit, and hauling out loads of the mineral cassiterite, used in cellphones, the illicit profits from which have fueled Congo's conflict for years. And so, for a few dollars per trip, the three exhausted men returned to the jungle as porters.

Mihigo managed for a week or so but was soon too sick to walk. His headaches worsened. He complained of pains in his chest and abdomen. His fever soared until he finally fell unconscious.

Tumusifu and Balaluka carried him to a local health center, which treated him for malaria. But his condition worsened, and nurses transferred him to the government hospital in Walikale. His friends pooled money for transportation and, around noon one recent Monday, carried his frail body into the tent annexed to the hospital: a one-story, whitewashed building shaded by palms and relatively unchanged from when it was built in 1977.

Since February, the hospital has been overwhelmed with thousands of displaced people pouring into Walikale from surrounding villages. They have been treated for free, but by the time Mihigo arrived, the hospital was nearly out of supplies.

The hospital director has been pleading for more medicine, but the government has not yet provided any, and the resupply route is daunting. The most direct route between Walikale and the provincial capital of Goma is one deep, muddy trench after another, often crawling with rebels; though the distance is only 250 miles or so, the journey can take as long as a month. Instead, trucks travel a 2,500 mile, four-day horseshoe route.

Last month, the hospital's doctors -- most of whom scrape by on charity, having never been paid by the government during their employment there -- began telling patients to buy their own medicine.

Salumu Luhembwe, the doctor who examined Mihigo, quickly suspected advanced typhoid fever, probably acquired from drinking water contaminated with feces. His intestines had holes and his abdomen was full of puss. "We needed to operate on him," said Luhembwe, 35. "But we didn't have all the materials."

If Mihigo's friends could find it, they needed to buy fuel for a generator, anesthesia, antibiotics, rehydration fluid, blood and a long list of other items whose cost totaled more than $200.

"For displaced people, it's impossible," said Luhembwe, who has bought medicine for patients but could not manage this time. "Usually in these cases, family would collect money to help. He had no family. Really, it was very sad."

And so three days passed, Mihigo got worse, and Balaluka could only watch when his friend trembled and faded away, becoming part of an increasingly staggering statistic.

"He died from an association of so many things -- because he left his farm, because he got sick in the jungle, because he reached an area without any means," Luhembwe said. "Even if he died from typhoid fever, the genesis was fleeing."

There was no money for a funeral, so a hospital worker dug a grave amid the tall grass and palms behind the hospital, where there were many other freshly dug mounds. In the early morning, Balaluka and Tumusifu offered a prayer before Mihigo's unmarked grave, some words, Tumusifu recalled, about "finishing the trip peacefully."

Their friend was buried in the same clothes in which he had fled two months before.

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