D.R. Congo: Researching Death to Save Lives

Editor's Note: Click here for a January 2006 update on the study.

Over the course of three months, dozens of IRC researchers traveled across the vast expanses of the Democratic Republic of Congo to uncover the gruesome toll the war continues to take in the country. In a territory the size of Western Europe, where existing frontlines separate communities, researchers interviewed nearly 20,000 households in one of the most expansive and precise mortality surveys ever conducted in a conflict zone.
 
“The results are staggering,” says the IRC’s Health Director Dr. Rick Brennan, who helped to oversee the project, carried out with the assistance of epidemiologists from the Burnet Institute in Melbourne, Australia.
 
“The survey has established that nearly four million people have died during Congo’s six-year conflict. Thirty thousand people died last month and 30,000 people will die next month. We have documented the scale of this disaster four times over the last five years, yet the international response remains grossly inadequate. It is unbelievable that this enormous humanitarian tragedy receives so little attention from the rest of the world.”
 
Only a fraction of the dead – two per cent in the volatile eastern part of the country – have been killed by war-related injuries. The appalling death toll is largely due to preventable diseases and food shortages following the collapse of much of the country’s health system and economy.
 
“More than half of all deaths are due to malaria, diarrhea, respiratory infections and malnutrition. Children under five years of age accounted for 45 percent of all deaths, although they represent less than 20 percent of the population,” Brennan says.  “One child in six born in Congo does not live to see his or her first birthday.”
 
Survey findings also indicate that several infectious diseases, including measles, are on the increase.
 
Between May and July 2004, researchers visited villages spread evenly across the country, randomly selecting clusters of 20 or 30 households from which people were interviewed about the date and cause of deaths in their families.
 
In some cases, reaching the villages proved extremely difficult. After traveling to the country’s provincial capitals in chartered propeller planes, the eight research teams had to endure days of arduous and sometimes dangerous travel on off-road motorcycles, on foot, in river boats or on trains, to reach some of the most remote corners of the country.
 
“It was very tough,” says Dr. Pascal Ngoy, the IRC’s health coordinator in the Democratic Republic of Congo. “Some of the locations are so remote that you have to wade through rivers for hours before you could even get into a boat.”
 
Dr. Ngoy’s team traveled for three days through a vast river system and dense mangrove swamps in a boat carved out of a tree trunk. After three days of paddling, they reached their destination, a remote village in the rural region of Boso Modanda.
 
“Some of the places we visited are desperately poor, with high degrees of malnutrition and disease,” Ngoy says. “But despite their hardship, people always treated us well and almost everyone was eager to participate in the survey.”
 
Rick Brennan and his team had to walk 20 kilometers to interview households in a chosen village in Adi, in the northeastern part of the country.
 
“At times we were walking through dense forest and creeks,” he says. “When the terrain cleared the sun was scorching, yet our barefoot local guide urged us on every step of the way.” 
 
On one occasion his group was stopped by a child soldier manning a checkpoint, an AK-47 assault rifle at the ready.
 
“He couldn’t have been older than 14 years.  It was a poignant reminder that this conflict is very much ongoing,” Brennan says.
 
“In one village in Katana our goal was to visit 30 households, but a lot of people were out working or at the market that day. We probably walked up and down steep hills to 150 homes to reach our target. It was raining for most of the afternoon, making the slopes extremely slippery and I fell in the mud a couple of times. It was a tough day.”
 
Dr. Ben Coghlan from the Burnet Institute predominantly covered the western zones of the country, working with a group of local IRC staff.
 
“Even by motorbike, it was incredibly difficult to reach the villages we had selected,” he says. “We frequently had to stop and carry the bikes over long stretches of sand, over logs and through streams. We had three flat tires in a week.”
 
“Some of these areas were particularly poor, with shockingly little access to health facilities. The clinics invariably have almost no medications, and the situation worsened the further you got from the central hospital. In one village, a single household reported ten deaths during the previous 14 months. Only five out of 15 family members remained, and they all seemed to have died from the same non-specific illness: fever and cough.”
 
“A seriously sick family member would have to be taken to the hospital tied to the back of a bicycle if there was one available. That could take three to four days in steaming heat. If there was no bicycle, there was no alternative but to stay, untreated. If they had some money, perhaps they would call on the services of a local sorcerer.”
 
The IRC staff collecting the data also had its share of injuries with malaria, lacerated feet and in one memorable incident, a fractured ankle, which was treated by a sorcerer who wrapped the injury in a banana leaf and an unknown paste.
 
The collection of data was brutally interrupted in June when fighting broke out between dissident troops and the regular army in the towns of Bukavu and Kisangani. In the violence, IRC’s office in Kisangani was looted and destroyed by mobs protesting the inability of the United Nations and the army to control the rebels in Bukavu, situated near the volatile borders with Rwanda and Burundi. An IRC team was also arrested and briefly detained by authorities in the eastern part of the country.
 
“Our staff had to be evacuated,” Dr. Rick Brennan says. “Three of our staff were locked inside the IRC office and were saved by arriving U.N. forces from being burnt alive.”
 
Around the same time the capital Kinshasa also saw unrest in what the government claimed was an attempted coup.
 
“It was very insecure time and the mortality survey was halted for three weeks,” Dr. Brennan says. “But all the efforts and problems were worth the results, which flag the tremendous suffering that the Congolese people continue to endure.”