Post-election responsibilities for public health in the Democratic Republic of the Congo

Since gaining independence in 1960, the Democratic Republic of the Congo (DRC) has faced a complicated series of challenges marked by armed conflict, political instability and economic hardships. Tensions in the DRC are on an escalating trajectory as the Congolese army and its allied militias battle with the March 23 Movement group in North and South Kivu. Attempts to restore peace through the Nairobi and Luanda Processes have stalled, and the United Nations has expressed concerns over escalating regional conflict since the controversial presidential election in December 2023¹.

Amid the ongoing turmoil in the DRC lies a severe humanitarian crisis. Since 1 October 2023, United Nations agencies have reported more than 3,000 human rights violations in the country, including arbitrary civilian murders, abductions, sexual violence towards women and forcible recruitment of children into armed groups. In addition, 25.8 million DRC citizens face food insecurity amid widespread famine, and more than 450,000 people have been displaced by the conflict in the past two months alone. Disease outbreaks compound the health crisis, with more than 30,000 cases of cholera being reported in the first few months of 2023, and the recent outbreak² of a lethal clade I mpox virus that has infected more than 500 people as of 22 November 2023.

Despite these challenges, international support to the DRC has fallen short, and the conflict concentrated in the eastern regions of the country continues to intensify. However, the re-election of President Félix Tshisekedi’s administration presents an opportunity for the DRC to end the effects on innocent human lives; humanitarian relief for the people of the DRC is an international imperative. A public health viewpoint can provide recommendations to protect DRC citizens and promote peace amid this decades-long crisis.

First, global funding to the DRC must be increased to establish short-term relief efforts. As of November 2023, the United Nations Children’s Fund (UNICEF) reports that a US$2.3 billion humanitarian response plan for the DRC is only 37% funded, leaving the most affected DRC populations without access to aid. Amplified news and social media attention on the ongoing crisis in the DRC should be encouraged to increase donations to relief organizations such as UNICEF. Increased funds could then facilitate the entry of essential resources, including food, personnel and medical supplies, to the most severely affected provinces, especially North Kivu and South Kivu. In these regions, the existing shelters operated by UNICEF can be fortified and expanded with stringent ceasefire directives to provide civilians with a secure haven from the conflict and access to necessities such as food, clean water and sanitation. Basic medical care, encompassing trauma care, vaccinations and antibiotics, can be provided in these facilities to address the increasing burden of injury and disease. Specialized personnel, such as United Nations peacekeepers, can also be deployed to establish protection services focused on safeguarding vulnerable populations.

There is a need to secure aid for internally displaced populations, refugees and asylum seekers. Decades-long conflict in the DRC has obstructed the country’s main roads, cutting off supply routes for 6.1 million displaced people³. Shelters in cities such as Goma and Bakuvu should be connected to central hubs (where displaced citizens seek refuge) via secure routes. For example, a shelter in Goma could forge a westward pathway to Kisangani, situated at the confluence of the Congo, Tshopo and Lindi rivers, streamlining the import of medical supplies and aid from Kenya, Uganda and Tanzania. Shelters and camps at these locations can offer immediate aid to the displaced eastern populace.

The United Nations Refugee Agency (UNHCR) and other organizations have facilitated the passage of nearly 1 million refugees and asylum seekers from the DRC into Angola, Burundi, Uganda, Tanzania and Zambia³. However, these efforts must be further expanded in light of the increased number of people needing safe refuge. Funding and incentives from the new presidential administration should be allocated to African nations to support an influx of DRC refugees, and high-income nations should increase immigration quotas to accommodate the growing number of asylum-seekers from the region. Given that these populations have endured human rights violations such as gender-based violence, they must have access to trauma-informed medical and psychological care upon finding refuge abroad.

The DRC presidential administration should prioritize long-term solutions for stability. Despite efforts by the East Africa Community to establish lasting peace in DRC through the Nairobi and Lendua Processes, ceasefire operations have faltered and tensions have resurfaced between DRC, the March 23 Movement and Rwanda. Given the promise of these initiatives, the DRC presidential administration should ally with political leaders from neighboring countries such as Tanzania, Kenya and Uganda to reinvigorate momentum from the Nairobi and Lendua Processes and initiate peace negotiations with Rwanda and rebel organizations like the March 23 Movement. This alliance of regional governments could also support DRC in establishing regional leadership that prioritizes the responsible management of the DRC’s resources, including minerals such as coltan and tin. Coalitions comprising political, industry and community leaders should oversee the sustainable extraction of minerals, safeguard against foreign exploitation, mitigate resurgence in conflict, and ensure that revenues generated from mineral resources are allocated for local redevelopment.

A stabilized DRC can focus its efforts on capacity building for health care. The country’s civil unrest has pushed an already underdeveloped health care system to near breaking point, and the World Health Organization (WHO) estimates that 7.4 million people are now in desperate need of health assistance. WHO and the US Agency for International Development (USAID) operate health services in the DRC, but further financing is needed to build upon the existing health infrastructure to expand access to care and a range of services. Rwanda’s health care model, in which more than 90% of citizens have health insurance through a community-based program through which citizens pool funds from the Rwandan government and international donations to cover health care expenses, is a model that could be copied. To emulate this, the presidential administration in the DRC would need to establish a similar healthcare financing method. The allocated funding can then be used expand access to displaced populations, provide more comprehensive primary care, and implement data systems for communicable disease surveillance to address ongoing challenges with cholera, mpox, malaria and yellow fever⁴.