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Continuing Crisis in the DRC: The Unheralded Death Toll and Its Implications

Thu. October 12th, 2000
Washington, D.C.

On October 12, 2000, the Carnegie Endowment for International Peace International Migration Policy Program hosted a breakfast briefing to discuss a recent survey on mortality in the eastern part of the Democratic Republic of Congo and its implications for the humanitarian and policy-making communities. The speakers were Dr. Les Roberts, an epidemiologist and environmental engineer who conducted the survey for the International Rescue Committee, and Dr. Ronald Waldman, Director of the Program on Forced Migration and Health at the Columbia School of Public Health. Kathleen Newland, co-director of the International Migration Policy Program, was the moderator.

Dr. Les Roberts presented the results of a survey, completed four months ago, which mostly calculated the crude mortality rate (CMR) in five areas in the eastern part of the Democratic Republic of Congo (DRC, also known as Congo-Kinshasa). Most scholars believe the CMR is the best measurement to use in understanding the amount of human suffering in an area. It is calculated by the number of deaths per given population per unit of time. He found that, typically in the region, the CMR was 1.5 deaths per 1000 per people per month.

CMR in Areas of Survey
Kisangani
2.6
Katana
2.7
Kabare
2.7
Kalonge
8.7
Moba
12.2

The CMR is high in every region, but particularly in Kalonge and Moba. Both areas have experienced intense fighting. Moba has the highest death rate; Kalonge has the highest percentage of deaths due to violence. Non-governmental organizations (NGOs) have a greater presence in Kisangani, Katana, and Kabare. It is unclear what the causal link, if any, is between the lack of violence and the presence of NGOs.

Dr. Roberts presented figures on the mortality rates of children. The causes of death in children vary from region to region, but in general the greatest causes are diseases such as malaria and diarrhea and malnutrition. In Katana, the number one cause of death among adults is violence; the number one cause of death among internally displaced people in Kalonge is also violence. Overall, the causes of death are:

Malaria

24%

Non-Infectious

15%

Diarreah

13%

Violence

12%

Malnutrition

9%

Respiratory

3%

Maternal Mortality

2%

Dr. Roberts noted an abnormal age distribution of young children, with fewer children under one year old than three to four year olds. Normally the number of children diminishes with age as "normal" mortality takes its toll. In Moba, 47% of children died before the age of five years. Dr. Roberts fears that the abnormal numbers indicate that young children are dying at an extraordinary rate; they are the greatest victims of the conflict. Women also experience disproportionate suffering. In eastern Congo, adult malnutrition is almost exclusively a female problem.

Eastern DRC has an alarmingly high rate of excessive deaths, although Dr. Roberts pointed out that other conflicts have produced higher rates. He estimated the Democratic Republic of Congo's CMR at 5.7. For comparison, Kosovo had a rate of 3.25; Liberia was 7.1; Somalians in Ethiopia suffered a rate of 14.0. However, most of the conflicts with very high rates of mortality lasted from 30 days to as much as 90 or 180 days. The conflict in the DRC, however, has lasted for two years.

Dr. Roberts briefly the addressed the question: What can NGOs do? Health clinics face at least two major problems. One is that families bring in patients who have been ill too long to be helped. Another is that patients who live far from clinics lack the strength to walk a long way for assistance. Malnutrition is difficult to treat, although Dr. Roberts mentioned an organization that had a successful nutrition and food program because it had a plane and staff dedicated only to addressing malnutrition and was located in a city; their program is not feasible in many rural areas. He thought there was some hope for reducing deaths from malaria and diarrhea - the two biggest single killers. He felt that averting 20% of excessive deaths would be an extraordinary humanitarian accomplishment.

Dr. Ronald Waldman then addressed the broader implications of data and the issues it raises for the humanitarian action community. He emphasized the importance of using reliable data and working for political solutions. He said that a recent report issued by a reputable NGO working in the DRC conceded that the NGO had little idea of what has actually happening to the people it was trying to help, despite its attempt to gather information. Dr. Waldman found the lack of information alarming. In his view, the idea of gathering hard data rather than relying on impressions has not taken root in the humanitarian community. NGOs need a longer-term investment in research, what he called a "data culture." More organizations need to gather good data.

Dr. Waldman also stressed the importance of achieving an end to conflicts. In a "complex humanitarian crisis" you cannot only call the humanitarian, you must also call the diplomat. Addressing the problem of excessive mortality through purely humanitarian means, such as immunizations, drugs, and food centers, will only reduce deaths at a minimal rate. A stable environment is necessary to implement broadly successful programs. In the Middle East and the Balkans, the U.S. government talks about stopping conflict. In Africa, the government talks about humanitarian missions. The humanitarian sector of government is driving policy in Africa, but that sector cannot stop the conflicts which cause the suffering.

Questions, Answers, and Comments

  • A representative from the International Committee of the Red Cross (ICRC) agreed that humanitarians often use soft and inaccurate numbers. He specifically mentioned a problem he encountered in Bosnia, where he tried to get information on the number of rapes of Bosnian women. He discovered that the information was nearly impossible to attain, partly due to ICRC's lack of women staff workers to collect such sensitive information. He felt that many of the numbers used were simply made up. Humanitarians need to learn from the epidemiologists' method of gathering data. He also agreed that political solutions are necessary, although they probably will not happen soon.
  • Dr. Roberts replied that he was concerned about rape in the DRC as well. When he returns he would like to include the number of women raped in his surveys, but there are no tools by which to get the numbers. He feels that among the internally displaced in eastern Congo the rate of rape is higher than the rate of murder.
  • Courtney O'Connor commented that the work of NGOs and international governmental organizations builds trust in areas of conflict, which creates an opening for diplomats to come in. Organizations need to work more closely with diplomats.
  • Dr. Waldman agreed that health care and other forms of humanitarian work are peace-making activities. He emphasized, however, that it only takes a few bad incidents to drive humanitarians away. For example, when foreign NGO workers are killed or supplies are stolen, NGOs tend to leave. Many humanitarian workers feel the burden is on their shoulders; peace negotiators come in too late.
  • Dr. Roberts disagreed. Some NGOs worry about becoming political pawns, and so they avoid coalitions with political actors. Often in such a coalition, humanitarian parties have only a minor voice. The International Committee for the Red Cross (ICRC) model is good; they provide assistance wherever there is a need. The United States goes in where it has political interests; it is not neutral.
  • Dr. Waldman said he did not necessarily disagree with Dr. Roberts on this point.
  • An audience member agreed that plans should be based on data, but what should assistance groups do when security is so bad that they can't get data?
  • Dr. Roberts said that the International Rescue Committee (IRC) is dealing with that issue. He has no answer.
  • A member of the INS refugee resettlement office said that NGOs need to work with governmental humanitarian people and keep talking to security people in the State Department. Also, don't stop there. Humanitarian NGOs should become more politically involved, such as talking directly with political institutions in Africa. Organizations should go to African embassies and talk with them. Don't rely so much on the State Department.
  • Dr. Roberts agreed that humanitarian groups need to improve their advocacy efforts.
  • An audience member asked what steps NGOs should take to focus on data? Dr. Waldman gave two answers: 1) Tie government funds to performance evaluations. This would both improve accountability and compel humanitarian actors to collect data. 2) Professionalize the humanitarian field. There is lots of good will and volunteerism but not enough professionalism.
  • Dr. Roberts said that many good international NGOs get much of their funds from donations. American NGOs have worked to keep their overhead low. This may be overdone, precluding investment in data collection and analysis.

Report by Kerry Boyd.

Carnegie does not take institutional positions on public policy issues; the views represented herein are those of the author(s) and do not necessarily reflect the views of Carnegie, its staff, or its trustees.