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War's Chaos Steals Congo's Young by the Millions    [

    After Decades of War, Millions of Congolese Seize Chance to Vote
    By Steve Bloomfield
    The Independent UK

    Monday 31 July 2006

    "So many people have died," cried Kabira Masiki, throwing her hands up in the air. "So many people. We have no peace." Mrs Masiki, 55, had been waiting in line outside the school house being used as a polling station in Rutshuru, a small town 70km north-east of Goma, for four hours and was prepared to stand there in the dusty, oppressive heat all day if necessary.

    She had never been able to cast a vote in free and fair elections, but yesterday her opportunity arrived along with more than 25 million people in the Democratic Republic of Congo (DRC) who finally got a chance to choose their leaders for the first time in 40 years.

    They came in their thousands, to more than 53,000 polling stations dotted across a country the size of western Europe. Mothers with babies strapped to their backs, old men shoeless. Young and old, male and female, they came to do something hardly any of them had done before - put a cross on a ballot paper.

    Turnout was predicted to be between 80 and 90 per cent, a proud vote for democracy and a defiant snub to the militia groups that had threatened to disrupt the poll. People leaving the polling stations triumphantly waved their ink-stained thumbs - the sign that they had cast their ballot.

    International observers and the UN forces, known as MONUC, predicted that voting would continue long into the night. In many districts, the sheer number of parliamentary candidates left voters with ballot papers the size of six pieces of A3 paper. Illiteracy and inexperience meant long delays were expected.

    But, by late afternoon, many polling stations in and around Goma, the capital of the North Kivu district that borders Uganda and Rwanda, had finished voting. Some continued for two hours after the polls officially closed at 5pm.

    Since gaining independence in 1960 following 75 years of brutal Belgian rule, the DRC has lurched from one disaster to another. The kleptocratic reign of the US-backed dictator, Mobutu Sese Seko, was ended in 1997 when a rebellion in the east, led by Laurent Kabila and backed by Rwanda and Uganda, drove the ailing Mobutu from power. Kabila swiftly fell out with his former allies and four million Congolese people have died in the regional and civil wars that have raged in the DRC ever since. It is estimated that 1,200 people are still dying here each day from war-related diseases.

    Against this backdrop, Congo's voters have invested a huge amount of hope and expectation in the introduction of multi-party democracy. In Rutshuru, where seven people were killed during an election rally earlier this month, Lumboga Pierre, a father of 10, showed off his voting card as he waited in line. "With this, I can vote," he said. "With a president we will get peace and happiness. Surely there will be peace and the looting and the killing will end." Mr Pierre, who used to work as a tax inspector before the war, said he had voted once before, in elections organised by Mobutu. "It was obligatory to vote for Mobutu," said Mr Pierre. "This is different. This is free and I am very happy." The Catholic Church, a powerful voice in the DRC, had threatened to boycott the elections, claiming fears of widespread vote-rigging. But within days of the poll they publicly backed the vote.

    Not that it would have made much difference. Most Congolese have been waiting for these elections their entire life. It has been impossible to find anyone here who did not plan to vote.

    By 11am, five hours after poll opened, there were still long queues in the village of Buganza, 11km from the Ugandan border. Bahati Kalekezi, a 22-year-old in a fake Arsenal football shirt, had walked one hour the night before and stayed in the village overnight to ensure he was in line at 6am.

    "I will wait until I cast my vote," he said. "I must so that we get a president who can build the country and bring peace. There will be change, we need more schools." UN forces, alongside the Congolese army, were patrolling polling stations in all major towns as well as those areas where militia forces have been active. But even in villages like Buganza there had been no problems.

    With 33 presidential candidates it is unlikely that Joseph Kabila, who became president in 2001 after the assassination of his father, will manage to get more than 50 per cent of the vote.

    Mrs Masiki will wait in line again outside the school house in Rutshuru. Her nine children have known nothing but dictatorship and war, but she is convinced it will change. "After voting we will have peace and the war will end," she said. "The dream is happiness and peace. It will come."

    Front-Runners for the Presidency

    Joseph Kabila

    The son of assassinated president Laurent Kabila, the 34-year-old has been heading the transitional government since his father was murdered by a bodyguard in 2001. He is popular in the eastern provinces where he is credited with ending Congo's civil war in 2002. However, his inheritance of the presidency is considered by some to have been illegal.

    Jean-Pierre Bemba

    Bemba is the main opposition candidate and one of four current vice-presidents. He has been credited with reviving the economy as Finance Minister. The son of a businessman, he has spent £11m on his campaign. He leads the Movement for the Liberation of Congo, a rebel group turned political party whose forces were accused of cannibalism during the civil war.

    Oscar Kashala

    Oscar Kashala, a 51-year-old, Harvard University-educated doctor, is a political novice. The cancer specialist has traded in his life in Massachusetts, his home for 19 years, to run for president in his homeland. He has played up his role as an outsider, saying that his lack of involvement in the country's violent past and his overseas experience offer a fresh start.

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    War's Chaos Steals Congo's Young by the Millions
    By Lydia Polgreen
    The New York Times

    Sunday 30 July 2006

    Rutshuru, Congo - Children die here from the same ailments that needlessly kill children all over Africa - malaria, diarrhea, measles, malnutrition - but on a vast and cataclysmic scale.

    The child mortality rate here in the most volatile eastern provinces is almost twice that of the rest of sub-Saharan Africa, which already has the world's highest rate, according to the International Rescue Committee, a nonprofit organization that has documented the death toll here in a series of detailed mortality studies from 1998 to 2004.

    Though Congo's civil war supposedly ended four years ago, and the nation's first democratic elections in more than four decades are scheduled for Sunday, the fighting and chaos here continue to kill about 1,250 people each day, mostly from hunger and disease. In all, nearly four million people have died as a result of the conflict since 1998, almost half of them children under the age of 5, according to the International Rescue Committee.

    The stakes in the election are highest for those far too young to vote, but even the most optimistic candidates and international observers say there is little chance that the voting will stop the dying anytime soon. In a report released in July, Unicef described the death toll in Congo as a "tsunami of death every six months."

    "It is fair to say that the conflict in the Democratic Republic of Congo has been the deadliest for children in the past 60 years," said Richard Brennan, health director of the International Rescue Committee. "No other conflict has had the same lev- els of excess mortality, and children have borne a disproportionate degree of this burden."

    About 30,000 children have been forced into militias, while untold thousands of girls have been raped, according to the Unicef report. Children labor under toxic conditions in gold and diamond mines. Orphans choke the streets of Kinshasa, the capital, bedraggled platoons in Congo's vast army of want.

    At the hospital here in the troubled province of North Kivu near the Rwandan border, where villages have been ravaged by war, the burden on children is on grim, daily display. One 2-year-old boy, Amuri, struggled to breathe on a hospital bed while doctors and nurses went through the motions - attaching one of the hospital's scarce pulse-oximeters to his tiny index finger, placing an oxygen mask over his gasping mouth. But they knew it was too late.

    A few moments later, Amuri's eyes rolled back in his head, his chest stilled and he was dead.

    "Bring something for us to wrap the boy," a nurse called out.

    His mother, Maria Cheusi, realized that her son's life had slipped away. He was the third child she would bury.

    "Mama, mama," she cried, collapsing to her knees in a contorted pose. "My only son, my only son."

    This is how the crisis in Congo kills, with the most banal weapons: a gantlet of hunger and disease that, here in the country's unstable east, kills one in four children before the age of 5. The day Amuri died of measles, a boy sick with a treatable respiratory infection died, and so did an infant with tetanus, another easily preventable disease. The day before, it was malnutrition and malaria that stole two young lives.

    Mothers come to the Rutshuru Hospital to give birth, only to return later, sometimes walking for days from distant villages, bearing children weakened by hunger and disease. But too often, as in Amuri's case, they simply waited too long, kept from health care by a complex web of violence and poverty that binds them to their villages, far from help.

    Mothers and children here are caught in a conflict that started in 1996, when a rebel group backed by Rwanda and Uganda invaded. In 1997, they overthrew Mobutu Sese Seko, the longtime dictator of Congo, which he had renamed Zaire. The rebels then fell out with their benefactors in 1998, setting off a sprawling war that became the deadliest conflict since World War II and continues in scattered pockets throughout the east, despite a peace accord that was negotiated four years ago.

    The consequence is that a child dies in Congo almost every two minutes, mostly from preventable causes. At the hospital, an oxygen mask slipped off a boy named Musa as his jaw moved from side to side. His eyes were tiny slits, his sticklike limbs jerked. His mother, Susanna, said she had taken him to a traditional healer in her village, but when Musa's health worsened, she finally carried him to the hospital.

    "I could not leave my other children," Susanna said, explaining why she waited so long. "There is no one to take care of them."

    It was too late for Musa. By the end of the day the boy would draw his last blood-choked breath.

    International aid organizations say there are simple steps that could help stem the tide of death among Congo's children. The International Rescue Committee is running a program to train people to recognize and treat three common but potentially deadly diseases - malaria, pneumonia and diarrhea. Even the most illiterate of villagers, with a small amount of training and experience, can administer simple but lifesaving treatment.

    The program, along with an overall decrease in violence in the past two years, has halved the child mortality rate in some parts of eastern Congo, said Emmanuel d'Harcourt, an expert on child health at the International Rescue Committee.

    "It is not hopeless, and as security has improved we have chances to really make gains and save lives," Dr. d'Harcourt said.

    To better reach those trapped in their villages, the hospital operates an ambulance service. Surprisingly, large swaths of this region have cellphone service, which means health workers at clinics can let doctors at the hospital know when they have a particularly grim case. But that is a mixed blessing - just because the clinic can inform the hospital of a sick child does not mean the ambulance will actually be able to come.

    The radius in which the ambulance can work serves as a useful yardstick for the security situation in the region. With Rwandan Hutu militiamen crawling through the jungles here, the ambulance must move with caution, no matter how dire the emergency.

    On a recent afternoon Olivier Caunes, the Doctors Without Borders physician who manages the hospital, set off for the village of Katwiguru, less than an hour's drive on rutted dirt tracks. Along the way he explained how difficult it was to decide which calls to take, and when it was safe enough to pick up sick children.

    "Sometimes we get a call and we know from the condition of the patient that there is no way they can make it," Dr. Caunes said. "So we have to conserve our resources and save those we can."

    A few moments later, a man pushing a boy on a bicycle flagged down the ambulance. The boy, 11 years old and slender, had legs thick like elephant trunks.

    Dr. Caunes pinched his swollen ankles. "Edema," he said. "And infection. It is not an emergency now, but it will be."

    He told the man and the boy to get in. The heavy Chinese bicycle was tied to the roof rack.

    Arriving in Katwiguru, he was immediately met by mothers pressing sick children on him. One boy screamed and struggled to move his stiff limbs - he would earn a precious spot in the ambulance because Dr. Caunes suspected tetanus. A few others would make the cut: a little girl with malaria, a malnourished boy, a girl with an unexplained fever who seemed listless. In all, four children under the age of 5 got into the ambulance, along with the 11 year-old boy. True to eastern Congo's grim arithmetic, by the end of the day one of the four children - the boy with tetanus - would be dead.

    The fate of those left behind - a few children showing signs of malnutrition not yet severe enough and others with unexplained fevers and diarrhea that were not yet life threatening - would have to wait until the ambulance came back.

    "The hardest part is choosing between the patients," Dr. Caunes said. "They are all sick, and all need care, but we cannot take them all."

    Some of the sickest children here arrive at birth, and they are often the hardest to help. The hospital has no ultrasound machine and no incubators for premature babies.

    In the maternity ward at the hospital, women lie two and three to a bed, with expectant mothers moaning in the suffocating heat through labor pains, and new mothers cradling their newborns.

    Esperancia Nyirasafari sat on the operating table awaiting an emergency Caesarean section. Her body transmitted her terror wordlessly, with wide eyes that frantically searched the tiles and a fluttering heart that telegraphed fear pulsing in her neck. Bathed in the operating room lights, she looked like a careworn Madonna.

    "O.K., it is time," said Jean Rijs, a Belgian surgeon working for Doctors Without Borders at the hospital here, his words slicing through the operating room clatter.

    It was three months too soon for the baby. But it could soon be too late for Esperancia. Dr. Rijs suspected placenta previa, a blocking of the cervix by the placenta that would be dangerous anywhere in the world. Here, in this bare-bones hospital, there was no way to be sure other than to slice her open and deliver the baby.

    Dr. Rijs cut down the middle of her belly, following a scar from an earlier Caesarean section. He lifted a tiny infant from her womb, a little girl, and held her aloft by her feet. A few heart-stopping moments of silence passed, then the girl let out a tiny wail. He handed the miniature infant to the maternity nurse, who bundled her up and wheeled her away.

    The operation was messy. Esperancia was losing blood but only a pint of her type was available. Dr. Rijs stitched her up and hoped for the best.

    Esperancia made it through the night, and so did her daughter, who mewled beside an ancient, rumbling heater. Her tiny lungs struggled to get enough air. She weighed less than two pounds.

    But Esperancia was not ready to give up on the girl. "I buried one child already," she said, a protective arm curled around her minuscule, whimpering daughter. "I cannot bury another. She may be small, but she will grow. She will live."

    Dr. Rijs, asked what the girl's chances are, had no such illusions.

    "Zero," he said, making an O with his thumb and forefinger. "This operation was to save the mother. That is the best we can hope for."

    In Rutshuru, doctors do what they can, hoping to put a finger on the merciless scale of life and death. Sometimes they succeed. Mugisha Massimango, 3½ years old, arrived in critical condition and badly malnourished, carried here by his father, Jean Paul.

    When he arrived he could not hold his head up on his reed-thin neck. His body was covered in sores caused by malnutrition. His breath was labored and his slender chest heaved.

    But mercifully for him it was not too late. With the help of a feeding tube and medicine, he was sitting upright, even smiling. His fifth birthday was still 18 months away, but for the moment he seemed likely to beat Congo's grim odds.

    "This one we can save," said Dr. Rose Ange, the pediatrician in charge of the children's ward. "He is going to make it."