Dying Under the Radar

How many villages did your team visit?
We visited 700 villages in Congo. And we talked to 20 households per village, so 14,000 households in all. In the village of Rwanguba in the North Kivu province--where there's now increased violence--we found 15 deaths in 20 households from the previous 16 months. Can you imagine that? On the street where you live? Three women in a row had each lost two of their children in that time. But not one of those deaths was due to violence. They were due to diarrhea, malaria and other diseases.

But the diminished health-care infrastructure is a result of war violence, correct?
That's true. In our previous study we'd shown a strong association between violence and deaths from those types of causes. You don't have to have people shooting or dropping bombs. There's ongoing insecurity in the east. The peacekeeping troops up there have done a good job in reducing attacks, but there's still a lot of below-the-radar violence. The level of insecurity is still resulting in the complete disruption of services. That's why in our recommendations, we say we've got to continue the peacekeeping. The troop levels cannot be reduced.

Eighteen different countries are contributing to the mission, but the balance of forces is completely out of proportion to the size of the problem. It's politics. In Kosovo, which you can drive in a day, they had 60,000 peacekeepers. To have 19,000 in a country the size of Congo is completely out of proportion.

Is it the complexity of the Congo back story—its status as the front line for a continental war in the 1990s—that keeps people from identifying with the cause?
I think there are a number of different reasons. First, there's no constituency for the Congolese in America, or in the West, generally. There's not a large diaspora that's gathering around the issue, as in the constituency for Darfur, for example. Sudan is actually a good comparison. To a lot of evangelical Christians, that conflict was seen as being between Arab Muslims and Christian Africans. There was a lot of attention paid to that, and the Bush administration, to their credit, got engaged and helped advance the peace efforts there.

In Darfur, it was a more dramatic event. A lot of violent deaths. And again, there was a constituency of evangelical Christians who were already familiar with the situation in Sudan. And once the word "genocide" came into use, there was a strong Jewish constituency that took an interest, as well. The fact is, there are no easy wins in Congo for politicians to rally around. The question for them is, first, "How do I explain this?" Then, "do I want to hitch my wagon to something that's going to be this protracted when there's no great obvious economic or political security interest there?"

Finally, I think there is such a thing as compassion fatigue. It's also hard for people to understand. I've given lectures in universities where even the global health experts are pretty ignorant of what's going on in Congo.