Dr. Rick Brennan, who conducted the study and manages the IRC’s health programs in more than 20 countries, hopes the research will raise awareness of this “forgotten” crisis and help people understand the dire circumstances of life in Congo. “We want people to give a damn,” he says. Watch this video to find out how you can get involved.

To learn about how the IRC helps in Congo, visit theIRC.org/congocrisis.

The story continues in Liberia, where Ann is blogging on Mondays and Thursdays into February.

Monrovia, Liberia In Cote d’Ivoire, village women protested that their husbands treat them like slaves.  Husbands force them to do hard labor, at home and on the farms, day in day out.  Women want their husbands to help with the work.  They need rest.

In Liberia, women say just the opposite.

In Montserrado County I meet with Women’s Action Groups in West Point, Slipway, Paynesville, Topoe Village, Chocolate City, and more.

Everywhere women say, “We sit idle.  We have nothing to do.”

It turns out on closer questioning that “nothing to do” is not exactly nothing.  Women run the home and look after the children. They get food and the firewood or charcoal to cook it.  They wash dishes and clothes and children and floors; and they haul the water to do these things.  But being urban women, they don’t have to plant swamp rice or dig cassava tubers.  They just do housework.

Don’t underestimate the labor involved in that.  The Slipway community, not far from the center of Monrovia, has no safe water at all.  Every day women walk long distances and wait in line to buy drinking water at 20 LD a gallon.  (That’s nearly fifty cents, no small amount for a poor family.)  Another long walk in another direction brings them to a polluted well where they buy water for cooking and bathing and laundry at 5 LD a gallon.  Often the water is rationed, and they return to a family of six or seven with only a gallon.    Here near the heart of the capital city, women spend hours every day, morning and evening, hauling water.  Slipway women say their husbands beat them, but given a choice between ending domestic violence and gaining a source of clean water, they would choose water.

Still they say they have nothing to do.  What they want, as the Global Crescendo photographers told us at our very first meeting is “skills.”  They want someone to teach them to be taxi drivers or carpenters, but they’ll settle for less profitable occupations like tailoring or hairdressing.  They want to learn to read and write and do sums and manage a business.  They want jobs and money to feed their children and send them to school.  Even a free government school costs money, for school uniforms and shoes; and free schools are few and far between.

Almost every member of the Logantown Women’s Development Association on Bushrod Island 
has something to sell. Photo: Patience Walker

Women say, “When you are poor, you have nothing to do.”  What they mean is, “When you are a poor woman doing housework, you have nothing to show for it.”
 
I go to Bushrod Island to visit the “Logantown Women’s Development Association.”  They have a big sign on the store front where they meet.  The group was established on July 3, 2005, by a woman named Christina W. Cummings (Executive Director) who worked for twenty-five years in the Ministry of Finance.  She thinks about money.

Women in Bushrod Island suffer from familiar problems—no clean water, no sanitation, habitual wife beating, and abandonment—but the Logantown Women’s Development Association is focused on just that: economic development.  The members work against violence too, raising awareness in the community and bringing survivors to the IRC social worker.  But the bigger problem, Christina Cummings says, is that women of Bushrod Island have nothing to do.

They introduce themselves.  Patience, the community’s photographer in the Global Crescendo Project, is married with four children.  She sells soap.  The group secretary Margaret is married with three children.  She sells fried and baked goods.  Elizabeth, the community mobilizer has six children and a husband out of work.  She sells water and soft drinks.  Martina, the peer educator, sells dry goods.  Patricia, whose husband isn’t working, sells fried cookies.  Blessing, whose husband is “away,” sells dry goods.  A widow who takes care of her grandchildren sells peanuts to pay their school fees.  Two other women, each with three children, have nothing to sell.  As the introductions continue, I see that these two are the only women in the group who are not already in business.  Almost every woman at the meeting is the sole breadwinner in her family.

These idle women with nothing to do think big.  They want a vocational school where they can learn skilled trades.  They want capital to upgrade their businesses and increase their income, which is never enough to go around or get ahead.

In their meeting hall, one member of the Logantown Women’s Development Association
teaches others how to do hair plaiting, a potentially profitable skill one step up from
selling water or peanuts. Photo: Patience Walker

I’m still puzzled, as I was at our first meeting with the Montserrado photographers, by why these women’s action groups, supposedly devoted to ending violence against women, are so eager to make soap.  But I’m beginning to get it.

To acquire skills is to acquire a trade that trumps selling fried cookies.  You can send all your children to school; you don’t have to pick and choose among them.  You can buy uniforms and shoes.  You don’t have to ask your boyfriend or your husband for money, which he probably wouldn’t give you anyway.  He will see for himself that at last you are doing something.  You are not “idle.”  He will have respect for you.

He will have so much respect for you that he won’t abandon you and the children for another woman in another part of town.  Or if he has already gone, he will come back.  He will stay with you forever, and he won’t hit you anymore.

A previous IRC survey found that nearly four million people have died from war-related causes in Congo since 1998–making it the world’s deadliest documented conflict since WW II. The new study about to be released shows the numbers steadily rising.

Part 1  l  Part 2  l  Part 3: Misoke

At the crack of dawn, the mortality survey team led by IRC’s Maxim Bushiri starts interviewing people about their health status, deaths in the households and the types of disease the people of Misoke suffer from. The early morning mist is still rising as the team splits up and, note pads in hand, begins to knock on doors. The team is using a technique called proximity sampling, with interviewers moving from one household to the next nearest household until the pre-determined quota of 20 households is reached.

Meanwhile, I walk over to the local clinic in Misoke, a simple brick building with a corrugated iron roof. The nurse, Ngegele Masasa, tells me that it is equipped to deal with minor ailments only. If someone here is seriously injured or stricken by the many lethal tropical diseases so common here, there is a real risk that they will die before they receive treatment. The last IRC mortality study from 2004 showed that life-saving interventions such as immunizations, antibiotics and transportation to medical centres for surgery are unavailable to millions of people in war-torn Congo, due to ongoing insecurity and a widespread breakdown of the overall health infrastructure. Less than two percent of deaths were directly due to violence; the vast majority was caused by preventable and curable diseases, such as malaria, diarrhea, pneumonia and malnutrition.

The shelves of the Misoke clinic are virtually empty of medication, except for the most basic painkillers. A handful of patients lie in the ward on simple and dirty bamboo stretchers. A young man, hooked up to a drip bottle with saline solution, grimaces in pain.

“He fell ill with malaria and self-medicated with quinine,” Ngegele Masasa says. “But he overdosed and now he is very sick.”

Like in Misoke, clinics and hospitals in most rural areas across Congo are in a serious state of disrepair and neglect. The IRC’s health teams in Congo describe operating theaters with leaking roofs, dirty wards and unskilled health staff. The few drugs in the dispensary are often out of date. Disposable syringes are used several times and ‘sterilization’ often means washing surgical equipment in cold water and soap. Health facilities without support from humanitarian groups are in the poorest condition.

Outside I meet Idumbo Mokina, a 47-year old villager. He tells me that his sister Ngalia Laini was rushed to the clinic last year after becoming ill with headaches and cramps.

“They kept her overnight,” he says. “In the morning, they told us that it was meningitis and that we had to take her to the clinic in Moga, 12 hours walk from here. So I made a stretcher and organized a group of 17 villagers to carry her. After four hours on the road she died. She was 45 years old.”

Ngalia’s fate is frighteningly common. The 2004 survey showed that more than 1,000 people die every day in excess of what is considered normal mortality. As many as one in 15 women die as a result of complications of pregnancy and child birth, compared to the United Nations estimate of only one in every 2,800 in the developed world. And almost half of the casualties in Congo, according to the 2004 study, occur among children under five.

Sitting in the shade of her mud hut, a middle-aged woman called Therese Tchausi tells me that four children living in her household died in the past two years.

“They had high fever. The nurse told us it was from malaria, measles and diarrhea,” she says shaking her head. “This is life here in Misoke.”

Peter Biro (left) with Congo mortality team leader Maxim Bushiri (on the back, right) and Rafael Jedi. Photo: Peter Biro/The IRC

A previous IRC survey found that nearly four million people have died from war-related causes in Congo since 1998–making it the world’s deadliest documented conflict since WW II. The new study about to be released shows the numbers steadily rising.

Part 1  l  Part 2: Deeper into the jungle - Kalima to Misoke  l  Part 3 

Having eventually made it to Kalima following an emergency stop at the Maloani Isungo’s house in the small village of Kio, we were ready for the next leg of our journey. The IRC mortality survey team has randomly picked a village called Misoke, where the population will be interviewed about their health and any recent deaths in their households. There are no maps available, but we are joined by Merveille Njolombe, a local health official, who will guide us through the bush.

“It will take many hours to reach our destination,” he says vaguely as he kick-starts his motorbike.

Once again we have to cross a river before we can start our trip in earnest. The Ulindi, a tributary to the Congo River, used to separate two of the main combatants in this region: the dreaded Mai-Mai militia and the Rwanda-allied rebel Rally for Congolese Democracy (RCD).

“The Mai-Mai used to cross here to attack the RCD who used an airstrip near Kalima,” Merveille says as our canoe, unsteady by the weight of our three motorbikes, follows a lazy current to the opposite river bank. “For a long time it was impossible to cross this river because Mai-Mai controlled all villages on the other side.”

As we unload the motorbikes, the boatman shakes his head.

“You will fall a hundred times,” he grins. “The road is very, very bad.”

He is right. The next ten hours prove to be a seemingly never-ending ordeal across an extremely bad jungle road. We are sliding around in mud, lifting the bikes over large fallen trees and balancing them precariously over wild rivers. These crossings become the curse of the journey. Each obstacle seems hazardous and countless times I have to jump off the bike and push it across. It is easy to understand why motorbikes bigger than 125cc are seldom used here; they would simply be too heavy and cumbersome to drive and lift through this terrain.

Driving for hours without hardly any sign of life, we eventually come across a little clearing where a small group of people are cooking meat over a coal fire. We stop and are soon invited for lunch. A woman introducing herself as Azama lifts the lid of the boiling pot and I find myself staring down at three monkey heads, facial expressions frozen in an agonizing scream.

They are the local macaque variety, I am told, cooked in palm oil, tomato and pepper and served with fufu, the local staple made from mashed cassava.

“The animals are fresh, I shot them today,” Azama’s husband Kingombe says, showing me his homemade shotgun.

It tastes much like beef, but stringier.

As we continue our journey, the track gets narrower and narrower with each passing kilometer. It is as if the forest devours everything in its path here. I am caked with mud and the jungle vegetation whips me in the face and arms from both sides of the path. Thick vines keep getting stuck on my feet or on the bike’s footrests and the sound of the cicadas grows increasingly ear-splitting as we penetrate the bush. Everything seems to be alive in the Congolese forest; we pass through clouds of large, colourful butterflies, and birds and monkeys screech in the canopy. Suddenly, Merveille hits the brakes just in time for me to see the thick end of a menacing-looking snake sliding into the undergrowth.

“Black mamba,” he says, referring to one of the deadliest reptiles in the world.

Just as I am beginning to think that we might make our destination before sunset, we are forced to drag the bikes through a large, black, mosquito-infested swamp. It takes over an hour to move three motorbikes less than 200 meters. It is situations like these that makes one understand that seriously ill patients in Congo often actually die en route before they can reach proper health care. Patients are typically carried on homemade stretchers, sometimes for days, on small jungle paths like these, before they get to a doctor.

Finally, after a full day of gruelling dirt road, reach Misoke. Darkness is already upon us and the lack of electricity makes the moon and the stars glow in the calm still night. A group of villagers gather around us and we are soon offered a bed in a small hut.

Exhausted, I fall asleep with my clothes on.  

A previous IRC survey found that nearly four million people have died from war-related causes in Congo since 1998—making it the world’s deadliest documented conflict since WW II. The new study about to be released shows the numbers steadily rising.

Part 1: The beginning of the road - Kindu to Kalima  l  Part 2  l Part 3

The plane touches down with a heavy thud and as the doors open, a rush of warm, humid, tropical air hits me in the face. This is Kindu, the provincial capital of Maniema, a rural, war-torn and neglected province in the east of the Democratic Republic of Congo. I have joined one of five IRC teams tasked with conducting a mortality survey in Congo and this is where our journey begins.

The IRC has documented the magnitude of the humanitarian crisis in Congo in four previous mortality surveys. The latest, conducted in 2004, showed that from August 1998 to April 2004, more than 3.9 million people died as a result of the war here, making it the deadliest conflict since World War II. Ninety-eight percent of the deaths were due to preventable and curable diseases. Now the survey teams are trying to understand if things are improving in Congo or if it has indeed gotten worse.

The teams will interview the population in 31 randomly selected health zones across all of Congo’s eleven provinces. The leader of the team I have joined is Maxim Bushiri, a Congolese IRC staff member who normally works with public health in our office in the capital Kinshasa.

The first stop in the town of Kindu is a small shop where we rent motorbikes and stock up on fuel, food and water. Old bicycle inner tubes are used as luggage straps to attach our bags to the back of the motorbikes. As we prepare to leave, my beat-up 125cc cross bike sits heavily on its rear wheel, with backpacks, jerry cans for spare fuel, camera bags and other bits of luggage occupying most of the rider’s seat. This leaves little space for my colleague, Amaka Megwalu, on the seat behind me. An IRC information officer in Kinshasa, Amaka is here to help with translations and, as it will turn out, endless dealings with police officers and local authorities.

It is early afternoon as we set off for our first destination, the town of Kalima about five hours drive east. During the dry season when road conditions are favourable, that is. When it rains, this trip can take days. In addition to obstacles caused by weather, roads are extremely poor at the best of times. Congo, the size of Western Europe, has only somewhere between 500 and 1,500 kilometres of paved road and millions of people are separated from hospitals and clinics by endless stretches of jungle paths, destroyed roads and demolished bridges.

From Kalima, the team will begin to survey a number of isolated villages in the region over the next two weeks. Our first obstacle is the mighty Congo River, the country’s main trade and transportation artery. We load our three cross bikes into a pirogue, a local dug-out canoe, and slowly make the crossing.

On the other side of the Congo River the real journey begins. After a few kilometres of potholed tarmac road we soon find ourselves on a narrow dirt track with huge craters and rocks in it. The road is so poor that we soon realize that it will take us much longer than expected to reach Kalima. As the last rays of the sun disappear, the situation deteriorates further when a tropical storm explodes overhead. The road turns into a veritable river in less than half an hour. My bike soon takes a nose dive into a pool of muddy brown water and the over-heated engine begins to hiss and cough. The rear wheel digs me in deeper and deeper with each fruitless spin. Overhead, the lightning crashes and I am completely soaked. My team mates help me get up and we try to continue our journey with water up to our upper thighs. We soon realize it is no longer possible to continue and decide to stop at the next house we see. It turns out to be that of Maloani Isungo, a man in his early 60s who lives with his children and a dozen relatives in two small clay huts by the side of the dirt track.

We soon get a taste of Congolese hospitality. Maloani and his son Axel light a coal fire in the middle of the dirt floor and, although the family is clearly very poor, insist on offering us dinner. We soon share rice and sardines over a candle-lit table as the torrential rain continues its ferocious pounding on the thatched roof. Axel tells me that his wife gave birth to a daughter by a caesarian-section in Kalima earlier that day.

“She lost a lot of blood, and she’s not feeling well,” Axels says. “But the baby’s fine. I went with my wife to the hospital a month before she was due to give birth. She has stayed there ever since and I brought her food every day. I am lucky; we are only three in this village who own a motorbike. The others have to walk if there’s an emergency. And sometimes people die on the way.”

With no sign of the tropical storm letting up, we are offered a bed for the night. My body is aching from trying to control the bike on six hours of slippery mud. My left index finger has grown to twice the normal size, the result of a bite from a nasty black ant. It has been a dramatic day, I think to myself as I drift off to sleep in Maloani’s bed in a tiny, damp room dominated by two old suitcases and a stack of cardboard boxes.

As I am about to find out, this is merely the beginning.