A survey released earlier this week by the International Rescue Committee reported that the rate at which people are dying in the Democratic Republic of the Congo (formerly known as Zaire) is virtually unchanged. Five years ago, a brutal civil war ended in the Congo, but despite the end of the carnage the death toll still staggers the imagination.  Forty-five thousand people a month are dying.

The New York Times this week reported on the survey:

Almost all the deaths come from hunger and disease, signs that the country is still grappling with the aftermath of a war that gutted its infrastructure, forced millions to flee and flattened its economy.

In all, more than 5.4 million people have died in Congo since the war began in 1998, according to the most recent survey’s estimate, the latest in a series completed by the International Rescue Committee, an American aid organization. Nearly half of the dead were children younger than 5 years old.

Perhaps most alarming, while the death rate has slightly decreased in eastern Congo, the last festering node of conflict, it has actually increased in some parts of central Congo, though the area has not seen combat in several years.

While strife in Darfur and Kenya continue to grab headlines around the world, the Congo’s humanitarian crisis goes largely unnoticed.  In 2006, the Democratic Republic of the Congo won international praise for holding its first nationwide democratic elections since independence was declared in 1961, but Congo remains a country more governed by demography than democracy.  

Foreign Policy magazine and the Fund for Peace ranked Congo in seventh place on their list of failed states in 2007.  Congo scored very high (9.4 on a scale of 1 to 10) for “demographic pressures.”  Here’s what their report had to say:

Although demographic pressures began to improve slightly from the previous year, this indicator still received a score of 9.4 in the Failed States Index (FSI) 2007 because of the country’s large youth bulge (47% of the population was under 15), high population growth rate of 3%, and high infant mortality rate of 88 per 1,000 births.

The International Rescue Committee’s report released earlier this week, indicated that the country’s mortality rate is 57 percent higher than the rest of sub-Saharan Africa.  Violence accounts for less than one-half of one percent.  Children are among the hardest hit by death and disease.  Children: 

….are especially susceptible to diseases like malaria, measles, dysentery and typhoid, which can kill when medicine is not available. In one village in North Kivu Province, a hot spot of continued fighting, three women of the 20 households surveyed had lost two children each in the 16 months covered by the survey period, Dr. Brennan said.

The Congo is a country rich in natural resources, but its democratically-elected government is struggling under enormous demographic pressures. Despite the high mortality rates, Congo’s total fertility rate (TFR) remains among the highest in the world.  The average number of children born to a woman during her lifetime in the Congo is 6.7, a TRF well above the average for sub-Saharan Africa (5.5). Congo’s population, currently estimated at 62.6 million, is expected to climb to 186.8 million by 2050. But what kind of world are these children being born into?  Thirty-four percent of children under the age of five are underweight. The New York Times story reports:

The Congolese government spends just $15 per person each year on health care, according to the World Health Organization, less than half of what is recommended to provide the most basic but lifesaving care, like immunizations, malaria-fighting mosquito nets and hydration salts.

Population pressures and poor health delivery systems are not the only thing holding the Congo back from its vast potential.  Corruption, for example, is rampant. It also suffers from a long legacy of ethnic warfare among its 254 ethno-linguistic minority groups. But lack of access to family planning and reproductive health services is a major problem. Only 31 percent of women (ages 15-49) use contraceptives, only 4 percent use modern methods of contraception.  Congolese women wishing to limit the number of children they have or to space their children farther apart are being denied the right to control their fertility.  As a result maternal and child health suffers…and so does the country.