Excess mortality, absence of medical care, and exclusion from care for a majority of patients where it does exist: Although peace has returned to much of the DRC, the health situation of the Congolese people today remains alarming.
Far from improving, it has worsened in certain regions of the country, as MSF highlights in its latest report, 'Access to healthcare, mortality and violence in the DRC'.
In 2001, as war raged in the DRC, MSF called on the international community to respond to the people's catastrophic health situation. A series of MSF surveys conducted in five health zones throughout four provinces of the Congolese territory had revealed just how dramatic the situation was at the time.
In 2005, the findings of five new surveys conducted in peacetime show an even darker picture than what was observed four years ago1.
Catastrophic mortality rates
The findings of the surveys are disturbing: the mortality rates indicate an ongoing emergency situation in four of the five zones surveyed. Even more worrying is that the indicators for three of the five zones point to a catastrophic health crisis, including in regions unaffected by conflict and violence2.
"Excess mortality in the DRC is not confined only to areas of ongoing conflict", says Meinie Nicolai, MSF Director of Operations for the Great Lakes region. "Abject poverty and hardship are claiming just as many lives."
Most of the victims are suffering and dying from infectious diseases such as malaria, respiratory diseases and diarrhoeal diseases, all of which are avoidable.
Fewer than one in two patients has access to even the most basic healthcare
According to the MSF report, between 45% and 67% of the people interviewed had no access whatsoever to basic medical care. The financial burden for the existing health services rests essentially on the shoulders of the patients. As most Congolese have to survive on the equivalent of 0.30 USD per person per day, the costs for primary health care are well beyond a Congolese family's meagre budget. As a result, people only seek health care when it is often too late.
Against this background, it is totally unacceptable to expect from this already destitute population that they make even a nominal financial contribution. "Even a very low flat fee contribution remains an insurmountable barrier for many people," adds Meinie Nicolai.
Cost is not the only hurdle. The health sector as a whole has been left to fend for itself and cannot hope to cover the healthcare needs of the Congolese people. Just as neglected as those they are supposed to be caring for, the country's medical personnel do not have decent working conditions.
On top of that, given the vast distances and lack of infrastructure, patients struggle just trying to get to a health centre. If and when they get there, they often find that medicines are not available. These factors add to the difficulties the patients face when they need to access health care.
At a time when DRC and the international community are busy working on political transition and economic reconstruction, it is of the utmost importance that national and international actors do not turn away from the emergency situation in the country. The catastrophic health situation of the Congolese people persists today and should be addressed as a matter of urgency.
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These five surveys were conducted according to the model used for the 2001 studies. The five zones covered were: Kilwa and Bunkeya (Katanga), Inongo (Bandundu), Basankusu (Equateur), and Lubutu (Maniema). Three of these zones had already been surveyed in 2001.
The crude mortality rate (CMR) dayfor a stable population in developing countries is estimated at around 0.5/10.000/day (for industrialized countries, this rate is around 0.3). A CMR of more than 1/10,000/day indicates a state of emergency. A humanitarian catastrophe is deemed to be reached when the rate exceeds 2/10,000/day. In Basankusu, the overall mortality rate is 2.3/10,.000/day, in Inongo 2.2/10,000/day, and in Lubutu 3.4/10,000/day.