August 25, 2005

Conflict, neglect cripple healthcare for Congo poor

By David Lewis

MUVULE, Congo (Reuters) - Nearly 200,000 people in a remote
corner of Congo share one doctor, three nurses and a hospital
most cannot reach, let alone afford, aid workers said on

The collapse of the state health system, violence by
militia and government soldiers and a lack of outside help have
raised death rates in Mitwaba territory in northern Katanga to
five times levels usually found in Africa, the relief workers

Mitwaba's predicament is similar to that of much of Congo,
where, two years after a peace deal was signed, war-related
hunger and disease continue to kill 1,000 people a day, on top
of 3.8 million that have died since the conflict began in 1998.

"The main reason for the dire situation is the gradual
collapse of the state health system," said Doctor Arsene
Enyegue, a doctor working with the organization Medecins Sans
Frontieres (MSF, Doctors Without Borders) in Katanga.

"But this precarious situation has, of course, been
exacerbated by the insecurity, which has reduced healthcare to
virtually nothing," he said in the remains of Muvule health
center, 75 km (50 miles) southwest of Mitwaba town.

Muvule is one of a string of villages that have been
attacked by Mai Mai gunmen who were used by the Kinshasa
government to fight Rwandan-backed rebels but are now out of
control and roaming around Katanga, looting and killing.

Some 6,000 residents fled when gunmen torched their
village, lined with bougainvillea blossoms, in June.

Although the health center is still standing, its door was
kicked in and everything looted but for a pile of used
syringes, an upturned table and posters promoting a Vitamin A

Attacks like the one on Muvule have forced thousands in
northern Katanga to flee their homes, but MSF is the lone aid
agency assisting 15,000 displaced by the violence in Mitwaba.


The aid agency is also looking after the severely
malnourished but can only afford to treat 260 cases per month.

"The main causes of death are malnutrition, malaria and
acute respiratory infections -- all easily treated in normal
circumstances," Enyegue said. "But here in Mitwaba we have a
mortality rate that is four or five times higher than the
accepted level in developing African countries."

The International Rescue Committee, a U.S.-based medical
charity, established the figure of 3.8 million deaths in the
war by surveying 19,500 households in Democratic Republic of

It found almost half of those who died were children under
five and 98 percent of people were killed by disease and
malnutrition rather than guns or machetes.

Countless civilians flee attacks in Katanga and do not make
it to camps, abandoning their charred homes and looted fields.

While on the road, they are often robbed or taxed by the
ill-disciplined and poorly paid government soldiers who have
been sent to tackle the Mai Mai fighters.

"This means hardly anyone can afford to come to the
hospital, if they can get here," said Tshiband Mukaz, the
administrator of Sampwe hospital, the territory's only
hospital, an impeccably kept-up but empty collection of
buildings 100 km south of Mitwaba.

"Some bring a bike, or their sewing machines. But if they
produce no money, they are sure candidates for death, even if
they are urgent cases," he said.

The hospital's sterilisation equipment is intact and
fridges keep drugs cool but the two trained doctors have not
been seen for two months and just seven of the 110 beds are

"Treating malaria costs at least 500 francs," Mukaz
explained. "But if minor surgery costs 40,000 francs and
farmers are selling their maize at 50 francs a bucket, how many
buckets is that? An entire field."