Decades of under-investment by the Congolese authorities have resulted in unpaid salaries, dilapidation of health centres and hospitals and poor distribution of essential medicines and supplies. Development indexes place the DRC among the world's leastdeveloped countries: the infant mortality rate is estimated at 128 per 1,000 live births (compared to seven in the US); under-five mortality rate is 207 per 1,000 live births (eight in the US); and 55 percent of the population have no access to improved water services (UNDP, 2001).
The withdrawal of multi- and bilateral aid initiatives since 1992 has left the health system in the sole hands of NGOs, churches and private assistance. Conservative estimates show that at least 37 percent of the population (approximately 18.5 million people) have no access to any form of formal health-care; other figures suggest this figure is as high as 75 percent (Oxfam, 2001; WHO, 2002).
A mortality survey by the International Refugee Committee (IRC) in 2001 estimated the death toll for the 'eastern Congo' since 1998 to exceed 2.5 million (IRC, 2001). While alarming in themselves, these figures represent only a fraction of the country (North and South Kivu, Maniema, Katanga and Orientale provinces). A lack of scientific data from western and central regions equally affected by conflict should not result in a disproportionate amount of funding and assistance to eastern regions.
MSF has been providing medical assistance in the DRC since 1981 and is currently working in both government- and rebel-held territory. Activities include supervising and training health staff, vaccinations, antenatal care, epidemiological surveillance and water and sanitation improvement. Between August and October 2001, MSF conducted a survey in each of five regions to determine mortality rates, access to care, vaccination coverage and exposure to violence in five health zones in provinces not covered by the IRC survey. This survey of five regions also aimed to complement existing mortality figures from the eastern regions, and thus to create a more balanced picture of mortality and its causes in the Congo crisis. The additional aims of this project were to assist with programme planning and to inform advocacy efforts.
The collection of quality epidemiological data amid the chaos of conflict is a difficult but necessary task: such surveys are invaluable for documenting the plight of forgotten populations; they assist aid agencies in programme planning; and they provide a platform for advocacy towards the international donors for a community in desperate need of greater humanitarian assistance (Legros and Brown, 2001).
© Frida Lagerholm/MSF
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MSF has been providing medical assistance in the DRC since 1981 and is currently working in both government- and rebel-held territory. Activities include supervising and training health staff, vaccinations, antenatal care, epidemiological surveillance and water and sanitation improvement.