Mortality Study, Eastern D.R. Congo (April-May 2000)
Background and Synopsis
The most recent crisis in the eastern region of the Democratic Republic of Congo dates from August 1998 when rebel forces, backed by Rwanda and Uganda, launched a drive to overthrow the government of President Laurent Kabila. Nearly two years later, the conflict continues to ravage the region. The death toll from this war has been consistently and woefully underestimated and the humanitarian response remains disproportionately small compared to other recent crises.
The International Rescue Committee conducted a series of five mortality surveys in eastern DRC between April 18 and May 27, 2000 in order to quantify the levels of civilian death and violence and to guide health programs for war-affected populations. The survey teams were led by Dr. Les Roberts, a veteran epidemiologist with extensive experience in conflict settings.
The areas surveyed included: the city of Kisangani (in collaboration with MSF Holland) in Orientale Province, Katana and Kabare Health Zones in South Kivu Province, Kalonge Administrative Zone in South Kivu Province and approximately 1000 square kilometers surrounding Moba in Katanga Province. These sites represent three of five eastern provinces in DRC and have a collective population of 1.2 million people. The estimated population living in all five eastern provinces is nearly 20,000,000.
From these surveys, Dr. Roberts and the IRC calculate that over 2,300,000 people died in these five provinces between August 1998 and May 2000. Using a middle mortality rate of 1.5/1,000/month as suggested by the Centers for Disease Control, (a conservative rate compared to that of UNICEF in its report The State of the World’s Children 1999) 600,000 people would be expected to die in this area, during this time. The shocking conclusion is that the war in eastern DRC has directly or indirectly caused 1,700,000 additional deaths.
Dr. Roberts provides som background information for the methodology used to support these numbers.
Of the 1.7 million excess deaths, 200,000 were attributable to acts of violence. The vast majority was due to the war-related collapse of the region’s health infrastructure and delivery of health and nutrition services. Today, most health centers in the DRC do not have drugs. Maternal and child health services are grossly inadequate. Vaccination programs have ceased. Many health professionals have fled the region. Health facilities are looted or destroyed by the warring groups. This breakdown allows common illnesses such as malaria, diarrheal diseases and respiratory infections to run rampant and kill. The tragedy is that these deaths are preventable when help is available.
The major findings of the survey are as follows:
- 1.7 million excess deaths or more have occurred over the past 22 months as a result of the fighting in the eastern DRC. This equates to 77,000 deaths per month and the IRC believes this is a conservative estimate.
- Young children are missing from the demographic profile. Some 34 percent of the excess deaths are children under five and, depending on the location, 30 to 40 percent are children under two years of age. In addition to the violent deaths of children in battles zones, it is presumed that excessive infant mortality rates and high maternal death rates have contributed to this troubling discovery.
- Violent deaths and "non-violent" deaths are inseparable. In eastern DRC, war means disease. In areas surveyed, the higher the number of victims of violent deaths, the higher the number of victims from infectious disease and malnutrition. Access to any kind of health service is severely limited in areas where there is a high level of violence or for populations forced to flee unrest.
- Eastern DRC is an unchecked incubation zone for disease. In the five surveys conducted, both endemic and epidemic illnesses were rampant, with major outbreaks of cholera, shigella, and meningitis reported by households. Suspected polio was reported in two of the five areas.
- Violence against civilians is inflicted by all sides in the war. Among the deaths attributed to violence, family members and witnesses reported that killings were committed at a similar frequency by both government and rebel forces.
- Violence against civilians is indiscriminate. Women and children constituted 47 percent of the violent deaths reported.
- The overall mortality rate in the year 2000 is higher than it was in 1999. The numbers appear to be climbing and none of the collected information indicates a decline in the foreseeable future.
The International Rescue Committee is calling for:
- Increased humanitarian assistance in proportion to the horrific level of death and suffering in the Democratic Republic of Congo.
- Unconditional and unrestricted access to needy populations in order to facilitate the delivery of life-saving humanitarian aid.
- International support for a robust UN peacekeeping mission in the DRC.
- An immediate ceasefire by the warring parties and a renewed commitment to resolve the conflict.
Until then, 2,600 excess civilian deaths per day will mark the time spent waiting for peace.
Congo Crisis Special Report
Learn more and view archived surveys here.