AFRICA, Beyond the bullets and blades

By MARC LACEY, The New York Times

BUNIA, Congo, Mar 20, 2005 — There were two ailing boys, both appropriately named Innocent, at a makeshift hospital here. They didn’t know it but they represented the two different ways of dying in Africa’s wars.

Muburak Sheik sits in the shade of a hospital tent Monday, March 1, 2004 in the Chadian border town of Tine. Sheik’s left foot was amputated after he was struck by shrapnel in his village in western Sudan’s Darfur region, where fighting has forced more than 600,000 people to flee their homes. (AP).

The older of the two Innocents, at 14, was a victim of the most obvious killer – violence. He had machete wounds to his neck, suffered as he tried to escape the tribal militiamen who swooped down on his village recently. Innocent’s mother was killed. The men with machetes tried to sever Innocent’s head, as well, but for some reason never finished the job. Innocent’s neck had a series of deep hack marks when he arrived at the hospital in the arms of his father.

Doctors at the hospital, which is run by Doctors Without Borders, rushed him to surgery and managed to bind the wounds. They are not yet sure if he will survive.

The younger Innocent, just 12, was from another village overrun by tribal fighters, albeit several years ago. He got out in time to avoid injury. But ever since, this Innocent has lived in a camp, huddled together with other displaced people. Still, his survival is in doubt. His arms are covered with mosquito bites and his blood is full of plasmodium parasites. Malaria kills if left untreated, which it often is in war zones like eastern Congo.

This Innocent will likely survive for now because he made it to a hospital. But he will get malaria again, and the wars that surround him will continue, and who knows if he will have access to a doctor then? And if it is not malaria that kills him, maybe it will be meningitis or measles or AIDS. Those scourges already kill far too many Africans, even in tranquil areas where a fragile social order holds together. Add war to that picture, and the death toll rises calamitously.

That is the second way of death in Africa’s wars.

Horrible though the genocidal spasms in Rwanda and the aerial bombings in Sudan have been, the vast majority of those who die in African war zones are not done in directly by warriors. Rather, it is the disruption that a few thousand armed men in ragtag militias can create in the lives of millions of civilians that send so many innocents to their graves.

In recent months, aid workers have begun providing a clearer picture of exactly why so many Africans die when conflict flares. Studies of two different war zones, by Physicians for Human Rights and by the International Rescue Committee, concluded separately that the major blame lies with the conditions created by wars in extremely fragile societies.

The first killer is flight. Desperately poor people are driven from their subsistence existence into even more hostile environments as they seek safety – deep into the forest in the case of eastern Congo, across the desert into Chad to escape the unfolding violence in Darfur. Typically, the few hospitals that may exist are emptied, their supplies are looted and members of their staffs are forced to run, alongside everyone else. Fields that once fed families lie fallow. Livestock die. Relatives and neighbors who depend on each other become separated.

Dependency and depression can come to many who find their way to the relative safety of camps, and when these uprooted souls return to razed villages, there is little time to rest from the trauma. Life begins again, and now their social network of neighbors and health workers and people to trade with – the thin fibers that knit lives together for survival – may have been torn beyond repair. The numbers who die in Africa’s wars are almost too high to contemplate. The fighting in Congo – an amalgam of rebel insurgencies, tribal rivalries, competition for resources and just plain butchery without a cause – has taken an estimated 3.8 million lives since 1998, making it the most deadly conflict since World War II, the International Rescue Committee estimated. Another two million lives have been lost in southern Sudan, where a war between the government and rebels ground on 21 years before a peace deal was signed in January. And Sudan’s Darfur region, in the west, has lost more than 200,000 additional lives over two years of tribal pillaging. Fighting in northern Uganda, where rebels who purport to fight for the Ten Commandments abduct children to reinforce their ranks and chop off the lips and ears of those who dare resist, has taken an estimated 100,000 lives.

Gathering health data in war zones is obviously a risky enterprise. But the I.R.C. was able to conduct four mortality surveys in Congo over the last five years, each a little more extensive than the last. In the most recent one, covering January 2003 to April 2004, investigators surveyed 19,500 homes spread over every Congolese province (although they skipped some especially insecure parts of the country). They estimated that 31,000 people die every month from causes connected to conflict, most of them in the unstable east and most of them from disease. They found a mortality rate in eastern Congo that was 80 percent higher than the average rate for sub-Saharan Africa, where it is high in the best of times.

Most deaths, the survey found, were due to maladies that are easily preventable and treatable in other parts of the world, such as malaria, diarrhea, respiratory infections and malnutrition. Less than 2 percent of the deaths were caused by violence.

“Life is a nightmare for these people,” said Patrick Barbier, the chief of mission in Congo for Doctors Without Borders, which sees the same statistics borne out in its clinics. “Militias prey on the girls. Militias take the people’s food. On top of that, they demand weekly taxes. In most areas there is little or no access to health and even if there is a clinic, people have to pay but have nothing to pay with.”

That is not to say there is no remedy. In Darfur, aid agencies are pushing for a compensation commission to help restore some of what the displaced people there have lost. More health workers familiar with disease are badly needed in most war zones. But the only way to finally stop the loss of life is to stop the fighting.

In Kanyabayonga, near Congo’s border with Rwanda, an entire town of 30,000 people was emptied of its population last December. Soldiers, who were fighting other soldiers from the same army, looted each and every hut. They emptied the pharmacies and carried away any food they could find. This is the way soldiers who are rarely paid make ends meet.

It is also the way civilians die. They run into the forest and live amidst the trees. In the case of Kanyabayonga’s population, they stayed away for weeks. They ate what little they could scrape together. Some of the most vulnerable, particularly the children and the elderly, succumbed to diseases. They are now buried in the bush. The town has been reinhabited, but the desperately poor are now poorer than before. The question is whether they can rebuild their lives somewhat before the next attack.

Farther north, outside Bunia, where militias of the Lendu tribe are rampaging through villages inhabited by rival Hemas, a similar scene is unfolding. Civilians run for their lives. The slowest are killed on the spot. Most make it to safety and huddle together in camps. Last month, United Nations peacekeeping troops were protecting one of those camps, about 20 miles north of Bunia, when nine Bangladeshi soldiers were killed and mutilated by tribal fighters. The United Nations launched a counterattack. And in all the fighting, aid workers were blocked from reaching the camps.

Doctors Without Borders made it to one camp in Tche recently and found that 25 people died during the eight days when no relief supplies could get in. At another camp, Kakwa, near Lake Albert, aid workers said, two or three people were dying each day in a camp of 5,000 people, a dangerously high rate of mortality. There were many cases of severe diarrhea with dehydration, which is a leading killer in places without proper medical care. A woman who delivered a baby and then bled for several days eventually just stopped breathing.

The weather and landscape are different in Darfur, the site of a continuing rebellion, but the dying is the same. Because there is no forest to hide in, local Sudanese Muslims fleeing militiamen linked to the Arab-led government in Khartoum head out into the harsh desert-like terrain. They, too, huddle together in camps, where they, too, continue to be harassed. (The camp population is now estimated to be approaching two million. Their deaths, too, come partly from violence and more often from what violence begets.)

Jan Egeland, the United Nations’ top emergency relief official, estimated last week that 180,000 people may have died in Darfur of illness and malnutrition, far more than the estimated 50,000 who may have been shot, stabbed, bombed or burned. He now ranks Darfur as the second worst humanitarian crisis in the world, after Congo.

In Darfur, Physicians for Human Rights has studied the plight of one village near the border with Chad, a place called Furawiya that in mid-2003 and early 2004 was a stronghold for one rebel group and the site of repeated attacks by government troops and allied militias. Nobody knows for sure how many of the 13,000 people who once lived in and around Furawiya, and who now are displaced in camps, will outlive the fighting and eventually find their way home. But the study showed that the deaths would likely continue for years.

The village and everything in it that once kept people breathing are destroyed. The livestock, a form of wealth in East Africa, were killed, stolen or butchered on the spot. Crops were eaten or destroyed. Huts were burned. Wells were polluted. For now, most of the people are too scared to go back home. Even if they do, their social structures will be gone, food will be hard to come by, medical care will be absent and their bodies will be sapped of strength.

No bullet may pierce them, but they will be war victims just the same.