What Saves Lives? Security, Access to Health Services

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

Surrounded by dense jungle and with most of the roads in the area in extremely poor shape, the Congolese village of Mbwele is cut off from communications and medical services. There are no telephones, no electricity. The only way to reach the village is by foot from the town of Kabalo, 135 kilometers away. The narrow, overgrown path through the jungle is infested with tsetse flies and blocked by fallen trees. Torrential rains often turn the path into a river of mud, isolating the village even more.
 
The situation in Mbwele is far from unique. Life-saving interventions such as immunizations, antibiotics and transportation to medical centers for surgery are unavailable to millions of people in war-torn Congo, due to ongoing insecurity and a widespread breakdown of the overall health infrastructure.

As a result, over 30,000 people die every month from easily preventable and treatable diseases such as diarrhea, malaria and measles, according to the IRC’s latest Congo mortality study. And in reverse, in places where the security situation allows for the IRC and other humanitarian organizations to operate, mortality rates are significantly lower. For example, the survey shows that death from infectious diseases and malnutrition dropped dramatically after the fighting was halted and stability returned to the city of Kisangani.
 
“The Democratic Republic of Congo is a country affected by extreme poverty and where the economy and social structures have collapsed,” says IRC’s health director Dr. Rick Brennan. “The ongoing war and the resulting lack of access to health services is the main problem. Our study shows that increasing security is definitely the most effective way to reduce excess mortality in Congo. Once peace is established, clinics re-open, farmers return to their fields, markets commence operating and life begins to return to normal. Babies can then be immunized, parents can feed their families, children return to school, and death and disease reduce dramatically.”
 
Although Congo is diverse, with a population one quarter that of the United States and made up of several hundred ethnic groups and four official languages, most people outside the bigger cities lives in simple dwellings made from mud and sticks. Clinics and hospitals in most rural areas are in a serious state of disrepair and neglect. Operating theaters have leaking roofs, the wards are dirty and basic medicines are often lacking. Health facilities without support from humanitarian groups are in the poorest shape. One IRC team visiting a health center in the western Bas-Congo province reported that the one-room thatched hut was extremely dirty, the drugs in the dispensary were all out of date and the surgical instruments were black from having been ‘sterilized’ in a coal fire. The doctor was not present, leaving his 17-year-old assistant in charge of patients.
 
“Hygiene is a big problem,” says IRC’s health coordinator in Congo, Dr. Pascal Ngoy, who regularly visits rural health centers across the country. “Most health staff is forced to use disposable syringes several times, and ‘sterilization’ means washing equipment in cold water and soap. Using non-sterilized equipment can easily lead to the spread of serious infections, including HIV.”
 
Many deaths also stem from complications of pregnancy and child birth. Approximately one in every 15 women dies from complications in Congo – compared to only one in every 5,600 in the United States. 
 
“Women are often delivering babies in the bush with great risk for infections,” Ngoy says.
 
Ambulances are scarce, and the majority of the population moves around on foot, with few having access to a bicycle and even fewer to a motorcycle.
 
While on a recent visit to a small, isolated health post in Kasai Occidentale province, IRC staff happened upon a woman who had been in labor for two days. The situation was life-threatening, and until the IRC team arrived, the only method of transport would have been a bicycle.
 
“There was a severe danger of the woman’s uterus rupturing,” says Willy Mvita, project manager for Demba, one of over 500 health zones in the country. “The woman was brought out to the IRC vehicle and rushed to a hospital some 40 kilometers away where a caesarean section was performed. The mother and child are now doing well, but both would have died had it not been for the coincidence of a vehicle.”
 
The IRC is active in 24 health zones – each with several health centers and hospitals – in five of Congo’s ten provinces. And many areas where the IRC operates show a dramatic reduction in mortality with an increase in health center attendance of as much as 300 percent. IRC’s health programs save lives largely due to the additional training, medicines and equipment health staff has received. A few months ago, a mother arrived with her child at the IRC-supported health center at the Nkondo refugee camp in Bas-Congo after a grueling 50-kilometer trek through the bush. The child was very pale, weak and struggling to breathe.
 
“The child was in urgent need of a blood transfusion,” recalls Dr. Adrien Nsiala, health project manager for the Nkondo camp. “The mother hoped that she would get assistance in transporting the child to a hospital. But since the staff was well-trained and equipped the team was able to conduct the life-saving transfusion in the health center.”
 
The IRC’s mortality study shows that whenever security improves in an area, death from preventable diseases often dramatically decreases. In North Kivu’s Oicha health zone, with some 250,000 inhabitants, insecurity had resulted in disruptions to food supplies, medical care and clean water, resulting in higher rates of morbidity and mortality. The past year has seen an improvement in security in the health zone, which immediately resulted in a dramatic drop in mortality, according to local health officials.
 
“Our colleagues in Oicha say that the situation is like night and day,” says Dr. Brennan. “Aid groups have moved in, clinics and schools have opened and the mortality rates are now normal.”
 
To reverse the deadly trend in Congo, an urgent boost in foreign aid is required, according to the IRC. In spite of Congo being the deadliest conflict since the Second World War, the entire world’s humanitarian response in 2004 was a mere three U.S. dollars per person, or a total of 188 million dollars in aid. In contrast, it is estimated that the international community is spending $530 billion in Darfur, Sudan, or $89 per inhabitant.
 
“The international response to the humanitarian crisis in Congo has been grossly inadequate in proportion to need,” says Dr. Brennan. “Our findings show that improving and maintaining security and increasing simple, proven and cost-effective interventions such as clean water, immunizations and basic medical care would save hundreds of thousands of lives in Congo.
 
“There’s no shortage of evidence. It’s sustained compassion and political will that is lacking.”