Interview: Conflict Exacerbating Deaths From Preventable Causes
By Charles Cobb Jr., allAfrica.com, 4 July 2001
Washington, D.C.—Hosted by Tanzanian President Benjamin Mkapa,
Congo President Joseph Kabila and Ugandan President Yoweri Museveni
met for two hours in Dar es Salaam Wednesday. It was the first meeting
between the two leaders. Afterward, while saying that satisfied is
such a strong word
for describing the talks, Kabila told reporters
that more such meetings like this
will be held.
Meanwhile, a joint World Health Organization and United Nations
International Children's Emergency Fund mission has issued an
bleak assessment of the situation in the Democratic
Republic. According to the report, decades of warfare, plunder,
displacement and insecurity have pushed Congolese households over
the brink.
One of Africa's largest and richest nations is
facing not a disaster in the making, but a fait accompli,
that has
caused the extra deaths of at least two million people.
If the international community focuses exclusively on funding UN
peacekeepers, human rights observers and humanitarian
'projects', essential as they are, in many areas there will be
literally only a skeleton population for whom to build peace,
the
WHO/UNICEF Joint Mission has declared in a just-released report. The
group, which traveled from June 18-29, warns that without increased
household income and reduced barriers to essential social services,
the situation will continue to spiral downward.
AllAfrica's Charles Cobb Jr. reached Hilary Bower in Kinshasa. She is a spokesperson for WHO's Emergency and Humanitarian Action Department, who traveled with the Mission.
What are the dimensions of this disaster in Congo that the report
calls not a disaster in the making
but a fait accompli?
I am referring to a mortality survey done earlier this year by an
American group called the International rescue Committee. Although out
mission went to verify certain things and to look at the situation and
try and make suggestions, obviously actual statistical data takes a
lot more time than 10 days. But we are quite happy to agree with the
International Rescue Committee. They said there were more than two
million excess deaths
—these were two million more than
would have been expected over the past two years.
It has always been thought that people in the Congo die because there has been war here and people die because they are shot at. But what that report, and our report says, is that this is no longer the case. The majority of people in the Congo are dying because they are malnourished; they have very little access to normal basic health services. We are not talking sophisticated theater and operations and so on, we're talking about treatment for malaria, anti-biotics for respiratory disease, prevention of malnutrition—very, very basic things.
Is this surprising information to the Mission?
We have quite a large operation in the Congo but what you've had over the past six to twelve months is an increasing number of statistically strong surveys that show the numbers. And when we came to try and look we said, 'Okay, we accept that these mortality figures are reality. But if you've got people in the Congo living on less than twenty cents a day, even in Africa this is a pittance. And if you've got malnutrition rates of a magnitude that are very unusual in any normal society, then we as a health organization need to look at what you can do to reverse those trends.' So, our mission was not to prove that the mortality was there. We said, 'These people have said this; we agree. Now, what do we do?' We can't stand back anymore and say this is all due to the war and when peace comes everybody will be fine.
Yet the Report says that the DR Congo has a health care system that at
least in its fundamental
structure is better than that of many
African nations.
Yes. In a sense it is like a sort of ghost structure. The idea of it—the way it was set up is very much the model that would be promoted in the developing world now—decentralized health authority, health zones so that you are not just looking at a big hospital in a main city, taking basic health care down to the people and not focusing on high tech care. But, the problem is, if you don't have support for those health zones—and you don't have it now, then you're not getting drugs in; the health workers aren't getting paid so they're having to charge their own patients. And if you're charging patients who are living on twenty cents a day they don't have any money so they don't come. So in effect, it's a collapsed system. But there is a structure there that people have respect for.
How is DR Congo significantly different in this regard than many African countries? Everything you've outlined can be seen in many African nations.
I think it's the magnitude of the deaths—the number of people excluded from health services. We're talking around 75 percent of a population of 50 million. When we're talking about broken-down health services, places like Sierra Leone and Angola would be on a similar level of awfulness to here, but when you look at other African countries like Uganda or Nigeria their situation is significantly better. To me there is a threshold of poor health service below which while it gets worse, it doesn't add to the magnitude of the problem.
The Report calls for Radical Action
for public health. Are
resources there for that?
This is one of the things we are trying to point out. People have put money into the Congo over the past couple of years. There's a peace process running and people are talking about putting money into the Congo. But they are covering a fraction of the country. What happens is when these mortality reports come out all of the international community goes, 'Oh my God! What's happening and why is the humanitarian community not reacting?' But then they balk; they step back from the magnitude of the problem when you say, 'We need 350 million dollars here.' And that [money] would just start rolling back the mortality. That's a lot more than is coming in here now so we are asking for a lot more money. We're also asking for money to come in in such a way that it allows Congolese households to start reviving themselves, to start having income, to start being able to access health care, because they have a little money. The bottom line is that 'yes' we think a lot more money needs to come in here.
And the prospects for 'a lot more money' coming to Congo for health?
Well, there's a donor conference in Geneva on the 9th and 10th of July and this is one of the destinations of this report. I think that people have been really shocked by the mortality figures coming out of here and realize even if there is a humanitarian effort and we're still getting these mortality figures, we have to do something different. I'm not going to tell you that the donors are going to give us 350 million dollars or give WHO the money. We want it fed into the system so that it reaches the household level. We don't want it given to WHO or UNICEF. And I do think there is a change of mentality. One, the peace process is progressing—in the west anyway, not really in the east. The other thing is this feeling that we can't wait another year and see this same survey again. What happens if the International Rescue Committee in twelve months time does this same survey and we see another 2.5 or 3 million people? So I think there is a window here; I am hesitantly optimistic.
Do you run into the attitude that says infrastructure is so shattered, the level of competence so low, how can 'they' manage the kind of money you're talking about putting into the local system?
What we wanted to do was keep the report very brief. The report does not contain all of the answers. If you're going to put that kind of money in, to try to get it to the health workers, you need very strong technical mechanisms, very strong financial monitoring and that means bringing in. We bring people in to work alongside health workers so I don't see why we can't suggest to the government that we bring people in to work alongside them to keep the financial management straight. It's a lot of money. We're not deceiving ourselves; nobody wants to put money into a hole but there must be a way to do this. You can set up controls. You can have people monitoring. I think it takes an accountant and economists and various people like that to work out what it would take to get this money in here and get it used properly.
Is there a timeframe for this that you have in mind?
We accept that this kind of radical change takes some months. We can't actually wait. People are dying all the time. There are two threads. One is the big picture which involves a big input of money and the redirection of the way health workers work. For example, on your job if you were paid to do telephone calls but weren't paid to look at pictures you would only make telephone calls. And that's what's happening to the health workers. They're paid, for example, to do a particular measles vaccine campaign, or they're paid to give out drugs. They are not paid to do pre-natal care4 and lots of women die in childbirth. The deaths could be prevented by better pre-natal care. What we're trying to say is that you need to pay the health worker for the performance of the whole job rather than having them go off doing their specific parts of it for a particular fee which is what does happen at the moment. That's the big picture. We think that with commitment and effort you could probably start getting it off the ground in four or five months.
The other part is, there are some things that you can do in an emergency. In any other country where there's been an earthquake or where there has been a conflict or where you go into a refugee camp there are things you do. One of those things is measles vaccination. Measles vaccination of all under 15-year-olds is not happening in the Congo for many reasons; it's very difficult to work here. What we're asking for is a sort of concerted and strategic action on things like measles vaccination. In the Report, near the end, there is a list of 4 or 5 things that we say should be done now. We need to reorient the way we work here and do these things—do the best we can now on things like that we know do save lives