40,000 Die in Congo Each Month

When pressed to think about death on a massive scale in Africa, one's mind likely focuses on the crisis in Darfur. The Rwandan genocide or Ethiopian starvation may also rate. But for all the (deserved) attention such humanitarian causes have attracted, they seem to have overshadowed a problem that is dwarfing many other crises in terms of lethality: postconflict death in Congo.

Certainly no celebrities have made a pet issue out of the country, and it's not hard to understand why. Congo's problems are tough to sloganize. Death in the large, central African nation is not due to a horrific campaign of ethnic cleansing, or headline-grabbing violence among religious sects. Militia gunplay, while sporadic and increasingly prevalent in the vulnerable North Kivu region, has hardly defined the country overall since the end of the Second Congolese War in 2003. Instead, the country's top killers have been preventable conditions such as malaria and malnutrition--the spread of which has been made possible by a ravaged postwar infrastructure and struggling economy.

In a new report released Tuesday, the International Rescue Committee updated its running total on Congo's dead since the outbreak of war in 1998. Their number, counting surveys through April 2007, now stands at 5.4 million deaths--1.5 million of which have occurred in just over the past two years (a rate they say is 60 percent higher than sub-Saharan Africa overall). According to the IRC, nearly half of those who perished were children under the age of five. NEWSWEEK's Seth Colter Walls spoke with Dr. Richard Brennan, head of global health programs for the IRC, about the association's field work in Congo, the scale of the tragedy, and why it seems to escape greater notice in the developed world. Excerpts:

NEWSWEEK: How do you place Congo's problems in perspective alongside the better-known crises in Africa?
Richard Brennan: Clearly, the total number of deaths surpasses any other humanitarian crises we've seen in recent decades. What's really so disturbing is that [the high mortality rate] is so protracted. Five years after the official end of the [Second Congolese War], 40,000 people are dying every month. We are getting more and more data about deaths in other, smaller countries, like Sierra Leone and Angola, that shows how mortality rates can remain elevated for some time after war. But when you combine those high mortality rates with a country as large as Congo, it ratchets up the numbers to an astounding level. In Rwanda, many deaths occurred in a short period of time. In Congo, years after the official end of war, we're still seeing these rates.

How did you execute the study?
Congo is the size of Western Europe, and allegedly has less than 2,000 miles of paved roads. We chartered aircraft, boats, worked on motorcycles and four-wheel drive. We also walked for miles and miles. Particularly in the east, it's very mountainous. Physically, it's incredibly demanding. The important thing when conducting the survey is to select villages at random, knowing that you're going to be walking up mountains in the blazing sun. When you've randomly selected a village at the top of a mountain, your team might say, "Hey, let's go to some other village!" But you've got to be strict.

A lot of these places are not secure, either, so you don't want to go there in the dark. You've got to start early in the morning. One thing that amazed me was how welcoming people are--and how eager they are to participate. The whole village will cluster around you, and you actually have to ask people to back off, because you're trying to have a personal conversation about the deaths in someone's family.

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 storyits status as the front line for a continental war in the 1990sthat 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.

So what's to be done? Who else besides the IRC is doing particularly valuable work at the moment?
The usual suspects--Catholic Relief Services, World Vision. Doctors Without Borders, of course. There's also always value in advocating with members of Congress, saying, "Let's maintain U.S. government support for the peacekeeping efforts and continue to finance U.N. peacekeepers." Congo also has the lowest expenditure of heath services per capita: $15 per person, per year.

What should the next target above that level be?
To provide for what we would call a "basic package" would cost $32 a year. For Congo, that would mean an additional $1.02 billion dollars.

What about the suspicion that aid money just disappears into the pockets of unscrupulous leaders?
That's an important question, and one that the aid community has been dealing with in recent years. The whole world has professionalized. In the past it was a bigger problem. But it's important to remember that the aid doesn't simply go to the government in a lot of cases. It's not like we write a check to the provincial minister of health. We pay salaries, buy drugs, conduct rehabilitation of health facilities. The problem hasn't gone away completely, and never will. But there are more checks and balances now.

One of the biggest challenges for such monitoring is the huge reduction in that part of the government. Years ago, there were 14,000 people working in the State Department. Now it's just 6,000. Defense Secretary Robert Gates has been talking about this very issue, as a security issue, in that the development of our humanitarian aid is an undervalued part of our foreign policy. It just really is. It's harder to police corruption when you don't have the appropriate workforce. So, just listen to the secretary on that issue. But still, things are much better regarding corruption--a sea change from 10 years ago.

But overall, our mission is to remind people what makes us human. What does it say about us if we're, at best, simply ignorant--or worse, willfully ignorant--of the deaths of 5.4 million people? Also, the fact is that the burden of this crisis is on children, who account for 50 percent of the deaths, and only 19 percent of the population. And most are dying from infectious diseases that people rarely die of in the West.

CORRECTION: (Added on Jan. 25) This story originally said there were 16,000 peacekeepers in Kosovo. The actual number is 60,000.