| Table of Contents |
Health Overview, 2003:
As of 2003, many health facilities in DRC were not functioning because personnel had fled, supplies were unavailable or buildings had been damaged or deliberately destroyed to intimidate civilians. UNICEF had reported that over 70 percent of the Congolese did not have access to formal health care because they were either too poor to afford it or unable to gain access to the facilities. Health conditions and access to healthcare in the East were reportedly far worse than those in the West.
In 2003, the majority of deaths among children under age five were ascribed to preventable causes: febrile illnesses, diarrhea, neonatal mortality, acute respiratory infections, measles and malnutrition, according to the IRC. Low immunization levels were widespread. IDMC reported 41–42 percent global malnutrition rates among children under the age of five in areas controlled by opposition armed forces and by the Congolese government. IRC noted that conditions had also driven the maternal mortality to the abnormally high rate of 2,000 deaths per every 100,000 births in urban areas. Alarmingly, 20 percent of adolescent girls, aged 15 to 19, had at least one child, according to UNICEF.
Update:
Little new information about children and other civilians’ access to healthcare in DRC is available since 2003. The war and accompanying breakdown of infrastructure have left the nation largely without drugs, medical equipment and skilled medical personnel and with the national health infrastructure in a state of collapse. The World Bank reported that in 2003 there was only one physician for every 100,000 Congolese. The nationwide life expectancy at birth is just 41.8 years; childhood mortality is at least double the normal rate; and maternal mortality rates are above 1,800 per 100,000 live births.
Heavy fighting in certain areas continues to impede access to health care. For example, in November 2003, the UN Emergency Relief Coordinator and five UN agencies conducted a mission in Walikale Territory, near the border with Rwanda, after heavy fighting by the RCD-G ended a six-month occupation by local Mai Mai. The mission found that only one of the area’s 24 health centers was fully accessible. They also reported serious problems in obtaining medical supplies given the area’s poor roads and insecurity. Additionally, they found a very low level of vaccination coverage, less than 21 percent.
In January 2006, heavy fighting between soldiers of the Congolese national army and dissident armed groups in the Rutshuru area of North Kivu led to the evacuation of MSF staff, leaving thousands of civilians trapped in the area with no access to medical care.
Although vaccination campaigns have been carried out since 2003 by UN agencies and partner organizations in some of the areas less affected by conflict, large parts of eastern DRC remain inaccessible and have not benefited from these programs, according to local sources. In September 2005, UNICEF and partner organizations initiated a polio vaccine in eight provinces bordering Angola and the Central African Republic after wild polio virus was detected in Angola in 2005.
Local sources have reported to Watchlist that some women and children are “detained” in medical facilities following treatment if they are unable to pay their medical fees, leading to incidents of patients and corpses being held inside medical facilities until their families are able to settle their debts.
On the positive side, observers have also noted improvements in some areas where international aid agencies are operating. For example, in Fizi, South Kivu, there had been a complete lack of access to health care for a number of years with the collapse of the health system and widespread looting of medicine. In mid-2003, several NGOs began working in the area. MSF reported in 2004 that 26 of the 33 health centers in Fizi were operating, although with great difficulties including an absence of basic medical equipment and supplies. A survey in South Kivu in 2005 indicated that there were signs of a decrease in the prevalence of malnutrition among children, according to the UN System Standing Committee on Nutrition: Nutrition Information in Crisis Situations: Report Number VII, August 2005.
UNICEF reported in February 2005 that DRC has one of the highest under-five mortality rates in the world, with more than 200 out of every 1,000 children dying each year from preventable causes, such as malaria, diarrheal diseases, acute respiratory infections, measles, tuberculosis and others. Children under age five are among the most vulnerable to outbreaks of such preventable diseases.
Outbreaks of disease often emerge because of the unhygienic conditions that displaced people experience in the bush when hiding from the militias and in cramped urban areas where they seek security. For example, in April 2005, the UN reported a cholera outbreak in Kafe IDP camp on the shores of Lake Albert, east of Bunia, Ituri District. The camp, which hosts approximately 25,000 local residents, had seen an influx of displaced people fleeing the recent rise in militia attacks against civilians. OCHA officials reported that the outbreak quickly spread to two neighboring camps hosting nearly 100,000 people, including many women and children.
In addition to more common diseases like cholera and measles, rarer diseases such as the Marburg and Ebola viruses and bubonic plague continue to threaten children’s lives. In March 2005, a World Health Organization (WHO) team reported a total of 230 suspected cases of bubonic plague, including 57 deaths, in Zobia, Bas-Uélé District, Orientale Province. In 2004, Damien Foundation, an NGO operating in eastern and western DRC, reported 9,798 new cases of leprosy.
Malnutrition continues to be a leading cause of death among children under five years old in both eastern and western DRC, according to the IRC. The displacement of farmers, the burning of fields and food stocks, tax impositions by armed forces and groups, the destruction of infrastructure and protracted isolation due to insecurity contribute to the widespread malnutrition.
In March 2004, the MONUC Humanitarian Affairs Section found that 44.9 percent of families ate only one meal per day in Gemena, Equateur Province, in northwestern DRC. Among children less than five years old, approximately one-third were found to be experiencing stunted growth; nearly one child in every eight suffered from acute malnutrition and 3 percent from severe malnutrition. In the Rutshuru Territory, North Kivu, World Food Programme supplies of maize-meal reached critically low levels and rations were cut for about 3,180 IDPs as well as for 21,875 persons targeted with safety-net food packages.
In Kalemie, Katanga Province, 10 percent of children aged six months to five years suffered from acute malnutrition and 49.4 percent of children in the same age range suffered from chronic malnutrition, according to a survey conducted by the NGO Solidarités in January 2005, Survey on Nutrition and Retrospective Mortality, Health Zones of Kalemie and Nyemba. One child out of every five was reported to be in an irreversible state of malnutrition, which would most probably lead to death, according to the survey.
In January 2006, MSF reported that the price of the staple food manioc had doubled, while other food items like potatoes and onions could no longer be found in the markets in Dubie and Nyonga, Katanga Province, Running for Their Lives: Reported Civilian Displacement in Central Katanga, DRC. As a result of this food insecurity, malnutrition levels were rising, according to MSF. In Mukubu, Katanga Province, MSF reported admitting 20 severely malnourished children each week at its therapeutic feeding center. Furthermore, an MSF nutritional assessment revealed that 33 percent of the 3,500 screened children were either moderately malnourished or at risk.
The crude national mortality rate for both eastern and western DRC is 2.1 deaths per every 1,000 people per month, according to the IRC’s 2006 Mortality in the DRC: A Nationwide Survey, Conducted April to June 2004. The mortality rate is 40 percent higher than the reported baseline for the sub-Saharan Africa region. This makes DRC the world’s deadliest humanitarian crisis.
Worse still, the crude mortality rates for eastern DRC were significantly higher than those for western DRC, showing the effects of insecurity and violence. In the five most insecure eastern provinces, Orientale, North Kivu, South Kivu, Maniema and Katanga, the crude mortality rate was 93 percent higher than the regional sub-Saharan norm and the under-five mortality rate was 97 percent higher. The four eastern zones, Shabunda Centre, Kalemie, Kalima and Moba, experienced death rates that at a minimum were more than double DRC’s pre-war rate of 1.2 deaths per every 1,000 people per month, according to IRC’s survey.
The majority of deaths for both eastern and western DRC were caused by easily preventable and treatable illnesses, such as fever, malaria, diarrhea, respiratory infections and malnutrition. Such diseases counted for more than 50 percent of the nationwide deaths, IRC reported.
Deaths due to violent injury were concentrated in the East, where nine of 15 health zones reported at least one war-related violent death. In addition, 57 percent of the total reported deaths occurred in the 15 health zones that had also reported violent deaths. This suggests that up to 30 percent of deaths could be attributed to violence. By contrast, only one violent death was reported in the West for 2003–2004, in Kalonda East, which borders former rebel-held territory.
In the zones that reported violent deaths, males aged 15 years and older were at greatest risk of being killed and constituted 71 percent of all violent deaths. However, women (18 percent) and girls and boys under 15 years (10 percent) were not exempt from violent deaths. Violent deaths were reportedly caused by shootings, beatings, throat-cuttings and other forms of torture by military forces.