Death Toll in Congo War May Approach 3 Million
Conflict Leaves Trail of Starvation, Disease and Carnage
By Karl Vick
LUSHEBERE, Congo -- As foreign armies pull back from Congo's farthest reaches
and aid agencies move forward, the human toll of the country's 32-month war is
being sketched in apocalyptic terms beyond any previously documented in an
African conflict. According to a new "death census" conducted by a private
American aid agency, the number of lives claimed by the Congo war now approaches
3 million. The survey by the New York-based International Rescue Committee (IRC) was
conducted only in the rebel-held eastern half of the country, where most of the
fighting and even more of the accompanying hardship has taken place. The toll
would almost surely be higher if the government-held western half were
included. The survey attributes a relatively small proportion of the deaths -- a few
hundred thousand -- to the battles waged by the Congolese army, its rebel foes
and troops from the half-dozen other African countries that have fought on both
sides of the conflict. The vast majority of deaths have resulted from
starvation, disease and deprivation on a scale emerging only as aid workers
reach areas that have been cut off by fighting and lack of roads. "People are dying of nothing, of everything," said a worker for Pharmacists
Without Borders, after returning from a humanitarian assessment in the Kasai
region. Villagers in the region -- long renowned for its diamond mines, but now
ravaged by hunger -- refer to two kinds of gems: white ones and red ones. The
red ones are peanuts. The IRC's figures are one-third higher than the number of deaths estimated
from 18 years of war in Sudan, and three times the most frequently quoted death
count for the Biafra conflict of the 1960s. "Things are a little worse than the picture we painted last year," said Les
Roberts, an epidemiologist formerly with the Centers for Disease Control and
Prevention who conducted this year's IRC survey and one last year that estimated
the death toll in eastern Congo at 1.7 million. "And last year's estimate turns
out to have been low." Until the IRC sent survey teams into eastern Congo, little was known about
the human toll of a war fought largely out of the world's sight. The conflict began in August 1998, when rebels backed by Rwanda and Uganda
rose up against Laurent Kabila, then the president of Congo. After Angola,
Zimbabwe and Namibia sent troops, warplanes and armor to aid Kabila's army, the
war settled into a stalemate that has left the vast country divided roughly in
half. An agreement to bring in U.N. peacekeeping troops has moved forward since
Kabila's assassination in January put his son, Joseph, in power. The new
President Kabila frequently quotes IRC's first death estimate, calling it
evidence that "this stupid war" verges on genocide. Independent experts who have reviewed both IRC reports say the surveys appear
to be sound. Epidemiologists offer two explanations for the extreme numbers:
Strife in Africa usually goes unmeasured, and the strife in Congo has gone on
for almost three years, perhaps a dozen times longer than the epidemics and
carnage that typically produce the stunning death rates that IRC reports. "It may be that this situation is worse than any of these others," said
Ronald Waldman, a specialist in refugee health at the Mailman School of Public
Health at Columbia University. "This is a more chronic, deeply cutting episode,
I think." Added another Western medical epidemiologist with long experience in
humanitarian emergencies: "My personal belief is these numbers are the absolute
best that could be done in the circumstances, and there's absolutely no reason
to believe any bias of any kind has found its way in. The mortality is so
outrageously high that even if the numbers were half that, the mortality is
still outrageously high." Although a National Academy of Sciences committee approved the methodology of
the original study, IRC concedes that there were structural imperfections in
both tallies. Roberts emphasized the risks inherent in extrapolating a death
rate for a whole province based on house-to-house interviews in sites that
surveyors believe -- but, without solid population data, cannot know -- to be
representative. Yet some of IRC's key findings -- of extremely high mortality among adults
and extraordinary death rates among young children -- were replicated by a
second aid agency in a January survey of one relatively peaceful district of
eastern Congo. Around Kalima in Maniema province, the British medical aid group
Merlin documented 2 1/2 times more deaths than births in a population that
before the war had been growing by 3 percent a year. The group found the result
so alarming it urged further investigation "to ensure these figures are
accurate." The estimates for Congo may be higher than those for other African conflicts
partly because of the country's size. Congo's population is estimated at roughly
50 million -- of whom one-third are vulnerable to starvation and 2 million have
been driven from their homes by fighting, according to the United Nations. While the various studies point to similar conclusions, it is the IRC
findings that beggar belief even among some war zone demographers. "One doesn't know what to do with that kind of estimate except reach down and
pull your jaw up off the floor," said Jeff Drumtra, a researcher for the U.S.
Committee for Refugees, which calculated the death toll in Sudan from a review
of news accounts, aid agency reports and population studies. "I just feel that
if it's 1.7 million -- or even now above that -- either [Roberts is] terribly
wrong or we've all been wrong about the death tolls in every African war.
Ever." Roberts said the surveys would stand up to scrutiny, as the first report
apparently did in briefings to U.S. officials and aid agencies last summer. The
basic approach is a time-tested method of measuring suffering in conflicts. What makes the Congo surveys exceptional is not only their relative ambition,
but how long the conditions they document have been allowed to persist. "Mortality rates this high are common in humanitarian emergencies," said the
Western epidemiologist, who identified similar death rates in Liberia, Somalia
and a handful of other African hot spots. "But they only last a couple of months
and then they lapse into some sort of background rate. Because there's some sort
of intervention." In Congo, the hugely elevated mortality rates have continued for 32 months,
steadily racking up deaths by the hundreds of thousands across a vast region
rendered inaccessible to aid because of fighting and the lack of roads. For its latest estimate, IRC ventured into eight health districts scattered
in the five provinces that historically define eastern Congo, an area of 20
million inhabitants. With the help of IRC country director Michael Despines,
Roberts selected roughly representative zones that could be reached by plane or
secure roads. Asked whether concerns about safety might bias the sample, Roberts
said they surely did -- against finding the worst. Last year's IRC survey showed
the most remote areas were the deadliest. "I am sure there's a self-selection," said Roberts, who grew out his beard to
encourage the protective assumption, common at military checkpoints, that a
white man in Congo must be a priest, "and the self-selection bias is I'm a
freakin' coward!" Once a district is chosen, however, bias should be thwarted by technology. A
hand-held global positioning device generates coordinates that direct
survey-takers to particular houses, leaving no option for being drawn
subconsciously to, say, the doorstep of a malnourished child. IRC sent trained
African staff members to 1,460 homes, where inhabitants were asked: How many
people live here? And have any died in the last year? The results were tallied and compared with the number of deaths that the
Centers for Disease Control and Prevention say should be expected in a country
as decrepit as Congo: 1.5 deaths per 1,000 people per month. The rate assumes
that, in peacetime, Congolese die at three times the rate of Americans. The IRC
teams found the war has multiplied that another two to eight times. Thus total deaths in Congo's five eastern provinces from January 1999 to May
2000 were calculated at 2.3 million -- 1.7 million more than what would have
been expected in the absence of war. This year's survey, though still being
calculated, was on track to add approximately a million more. Children appeared to be perishing at an extraordinary rate. Around Moba, on
the western shore of Lake Tanganyika, last year's survey showed nearly half of
the infants were dying before reaching their first birthday. The figure was so
staggering that Roberts scaled it back when extrapolating the data for the
entire province, Katanga. But last month, when Roberts brought a team back to Katanga, this time
concentrating on the district of Kalemie, he found the situation was worse:
Three of four children were dying before age 2. "It's damn rare we see these kinds of hardship," Roberts said, using famines
as reference points. "Probably in Somalia in the 1990s when we saw these skinny
kids on TV. Probably in Ethiopia in 1984 you saw numbers like that." IRC estimates that 40 percent of Congo's wartime deaths could have been
avoided by access to the kind of basic health care that was becoming scarce even
before the rebellions that have defined Congo over the last five years (an
earlier rebellion took place from 1996 to 1997). At the start of the current
war, only two of 11 provincial health inspectors had working vehicles. Chiza Chilimu, 23, survived on fruits and wild yams for a year in the bush
after Congolese militiamen called Mai-Mai emptied his village, Cibinda. But his
mother died of relentless diarrhea. "She died because she didn't have medicine," Chilimu said. "If we were at
home, I could look for medicine." Further aggravating the situation is Congo's economy, the world's
fastest-shrinking since the war began. Said Roberts: "What's the main killer of
the war? The main killer is people who don't have enough money in their pocket
so they can take their kid to the clinic in time." Even so, IRC estimated that 200,000 of the first 1.7 million deaths were by
violence, almost all of them civilians. Even as a cease-fire has held on the
front lines, massacres have continued behind rebel lines where militias and
rebel armies terrorize some of Congo's more densely populated districts,
attacking villages on the suspicion inhabitants are helping the other side. Some groups are simply homicidal. The men with wild hair and bushy beards who
kicked in the door of Jean Pierre Mushobozi's hut in the village of Buguli one
night in November were Hutu extremists from Rwanda, who are associated with the
group that carried out the 1994 genocide that killed more than a half-million
Rwandan Tutsis and are now fighting for the Congolese government. They slashed to death the two youngest children, slashed the leg of another
and carried away the family's goats, hens, money and clothes -- even the
spoons. Congo's vast jungles are now populated by untold thousands who no longer feel
safe in their homes but are ill equipped for living in the bush. "People hide in the forest," said Claude Jibidar, head of the World Food
Program office in Bukavu, capital of South Kivu province, where 380,000 people
have been driven from their homes, many into the forest. "You don't really see
them. You don't see the bodies." World Food Program workers in South Kivu are returning from newly accessible
villages with reports of more malnourished adults than children. "How come?
Simply because the children are dead," Jibidar said. "Basically, at some point malnutrition will be reduced," he said. "But it
will be because the weakest have died." As assessments of Congo's devastation accumulate, help has been very slow in
coming. A January plea from the World Food Program to more than double its Congo
food aid to $110 million has been barely one-third funded by rich countries.
UNICEF has received just a tenth of the $15 million needed for essential drugs
and therapeutic feeding centers. And despite vows of action from Washington that
greeted the IRC's first survey, U.S. disaster relief to Congo remains at just
$13 million. Halfway through the fiscal year, that sum is already exhausted. The growing prospects for peace mean that "for the first time, people are
optimistic, even myself," said Kees Tuinenburg, head of the World Food Program
in Congo. "Has this translated into more humanitarian assistance? I don't think
so." Waldman, the Columbia professor, said the inattention is one reason the
problem has grown to proportions that challenge belief. "Looking back, we may have been on this slope for some time," he said.
"Africa has been neglected for a long time, politically, economically, in just
about every way possible. What did we expect? Last year is the first time any
serious attention was given to . . . AIDS there. The epidemic has been going on
for 20 years."
Washington Post Foreign Service
Monday,
April 30, 2001; Page A01
Copyright 2001 The Washington Post Company. |
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