By Alexandra Wilson, Jasmin Somers, and Zachary Horn

A humanitarian crisis is defined as “widespread threats to human life, safety, health, and wellbeing resulting from any range of precipitating and perpetuating factors”.(1) When a humanitarian crisis becomes complicated by a significant or total breakdown of authority and governance due to conflict, it becomes considered a complex humanitarian emergency (CHE).(2) 

The Democratic Republic of Congo

The Democratic Republic of Congo (DRC) is a nation that has remained within the grips of a major humanitarian crisis and complex humanitarian emergencies for decades. These crises have been fuelled by severe and prolonged conflict, devastating infectious disease outbreaks, profound poverty, and longitudinal waning of humanitarian funding and support.(3) 

The DRC continues to be one of the most resource-poor countries in the world.(4) This is due to complex interactions between mismanagement of natural resources, poorly maintained or absent infrastructure, severe food insecurity, malnutrition, and repeated cycles of armed conflict and corruption.(5) 

The DRC has experienced several non-international armed conflicts between the Congolese armed forces and several non-state militia.(6) Reports have estimated that over 900,000 refugees and asylum-seekers from the DRC reside in neighbouring countries, while over 5 million internally displaced people and at least 500,000 refugees reside within the DRC.(3) 

The DRC has also faced several devastating public health emergencies. Even before the COVID-19 pandemic reached the DRC, outbreaks of cholera, measles, malaria, Ebola, and even the reemergence of the plague shaped the humanitarian landscape in the DRC. Cholera outbreaks are recurrent and severe. In 2017-2018, there were 79,000 cases of cholera and a severe outbreak in 2019 affected 20 of 26 provinces.(7,8) The DRC has also seen some of the largest and deadliest measles outbreaks globally(9,10) and, with 25 million cases of malaria in 2017, the DRC had the highest number of malaria cases globally.(11) Concerning, emerging cases of the plague were also identified in 2020.(12) 

The numerous and complex factors contributing to the humanitarian crisis in the DRC offer several valuable lessons for those invested in addressing health needs in humanitarian crises and disasters. 

References

1. Organisation of Islamic Cooperation. Humanitarian crises in OIC countries: Drivers, impacts, current challenges and potential remedies. Ankara, Turkey: Statistical, Economic and Social Research and Training Centre for Islamic Countries; 2017. Available from: http://www.oicred.net/dosya/Humanitarian-Crises-in-OIC-Countries-SESRIC%20Publishing.pdf
2. United Nations High Commissioner for Refugees. Coordination in Complex Emergencies.  2001 [cited May 2021]. Available from: https://www.unhcr.org/en-us/partners/partners/3ba88e7c6/coordination-complex-emergencies.html
3. Swedish International Development Corporation Agency. Democratic Republic of Congo humanitarian crisis analysis 2019. Swedish International Development Corporation Agency [Internet]. 2018. Available from: https://www.sida.se/globalassets/sida/eng/how-we-work/humanitarian-aid/hca-2019/hca-drc-2019.pdf
4. The World Bank. The World Bank in DRC. The World Bank [Internet]. 2020 May 4. Available from: https://www.worldbank.org/en/country/drc/overview
5. Roberts K. Understanding the causes of poverty in the DRC. Borgen Magazine [Internet]. 2018 Sep 6. Available from: https://www.borgenmagazine.com/poverty-in-the-drc/
6. Rule of Law in Armed Conflicts Project. Non-international armed conflicts in the Democratic Republic of Congo. Geneva Academy of International Humanitarian Law and Human Rights [Internet]. 2020 Jan 16. Available from: http://www.rulac.org/browse/conflicts/non-international-armed-conflict-in-democratic-republic-of-congo#collapse2accord
7. Ingelbeen B, Hendrickx D, Miwanda B, van der Sande M, Mossoko M, Vochten H, et al. Recurrent cholera outbreaks, Democratic Republic of the Congo, 2008-2017. Emerg Infect Dis. 2019;25(5):856-864.
8. Potter C. Beyond Ebola: DRC battles measles and cholera. Outbreak Observatory [Internet]. 2019 July 18. Available from: https://www.outbreakobservatory.org/outbreakthursday-1/7/18/2019/beyond-ebola-drc-battles-measles-and-cholera
9. Kagumire R, Bolombo F. Analysis: DRC’s deadly, but ignored, measles epidemic. Aljazeera [Internet]. 2020 Mar 13. Available from: https://www.aljazeera.com/indepth/features/analysis-drc-deadly-measles-epidemic-200312080536405.html
10. World Health Organisation. Deaths from Democratic Republic of the Congo measles outbreak top 6000. World Health Organisation [Internet]. 2020 Jan 7. Available from:  https://www.afro.who.int/news/deaths-democratic-republic-congo-measles-outbreak-top-6000
11. World Health Organisation. World malaria report: 2018. World Health Organisation [Internet]. 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/275867/9789241565653-eng.pdf?ua=1
12. World Health Organisation. Plague – Democratic Republic of Congo. World Health Organisation [Internet]. 2020 July 23. Available from: https://www.who.int/csr/don/23-july-2020-plague-drc/en/