The Democratic Republic of Congo (DRC) is often characterised as one of the most if not the most neglected humanitarian crises in the world. The often-cited International Rescue Committee (IRC) mortality survey updated in 2008 estimates that, between August 1998 and April 2007, armed conflict and state collapse led to 5.4 million excess deaths (Mortality in the Democratic Republic of Congo: An Ongoing Crisis, IRC, January 2008). Following the signing of peace accords in 2003, a gradual shift from humanitarian relief to post-conflict recovery has occurred. The resumption of armed conflict in 2007 between forces loyal to General Laurent Nkunda and the Congolese army (FARDC) in the province of North Kivu, a conflict which escalated in October 2008 to international attention, has revealed the fragile state of the transition process. With the country stuck between war and peace, targeting humanitarian assistance has become increasingly difficult. While the humanitarian community has been actively engaged in the North Kivu crisis, it has failed to address adequately the humanitarian crisis in other parts of the country, where mortality levels and other indicators have refused to improve despite the end of conflict in these areas. Humanitarian planning and the allocation of funding have become skewed. This article argues for a more systematic, data-driven approach to humanitarian action in DRC.
Where are the needs?
While the existence of a humanitarian crisis in DRC is not disputed, debate is growing over where the need is greatest, what is causing this need and what kind of response is required. During the large-scale wars in the country between 1996 and 2003, there was a straightforward correlation between armed conflict and risk to human life and livelihoods. For example, during the period 19992001, the IRC survey found crude mortality rates in rebel-held territory nearly five times higher than the Sub-Saharan average. This classic definition of a humanitarian crisis (i.e. death and human suffering caused by war) served as a straightforward cue to orient the efforts of aid agencies. With the end of the war in many parts of the country and the return of many internally displaced people (IDPs) and refugees, however, the boundaries of humani-tarian action have become more difficult to draw.
In fact, there is evidence shown in Table 1 that North Kivu, where most of the recent armed conflict has occurred, is not, overall, experiencing similarly high levels of child mortality, malnutrition and food insecurity as other parts of the country. Provinces that have not been affected by armed conflict for a number of years have far higher recorded levels of need. According to the IRC survey, between 2004 and 2007 mortality rates fell from 2.9/1,000/month to 2.6/1,000/month in the eastern provinces (North Kivu, South Kivu, Oriental, Maniema and Northern Katanga), while in parts of the country where there had been no conflict, levels of mortality either rose slightly or stayed roughly the same (Mortality in the Democratic Republic of Congo: An Ongoing Crisis, IRC, January 2008).
There are a number of caveats to this data. For example, the results presented concern provinces as a whole, while humanitarian action in North Kivu is predominately focused on the more than one million IDPs in the province who have been severely affected by the loss of livelihoods and could be in a worse position than the provincial average. Some of the data also predates some (but certainly not all) of the worst insecurity in North Kivu. Nevertheless, the data does seem to show that there is no obvious correlation between war-affected areas and humanitarian needs.
This is not to argue that humanitarian aid to eastern DRC is somehow misdirected. Far from it. Although there is not sufficient data available, it would be reasonable to hypothesise that the massive response of the humanitarian community in North Kivu and other places in the east has had a significant impact in addressing humanitarian need and has caused a reduction in human suffering and loss of life. What is of concern, however, is that many parts of DRC, where there is no armed conflict, are still experiencing levels of vulnerability that exceed emergency thresholds. In provinces such as Maniema, Katanga, Kasai Oriental and Kasai Occidental, for example, global acute malnutrition rates still often surpass 10%, a widely accepted threshold for humanitarian action. The Water and Sanitation Cluster has found that 70% of all recorded cholera cases in DRC in recent years have occurred in Katanga, again a province that has not experienced major armed conflict since 2005. Katanga also probably has the largest concentration of mining activities to exploit DRCs copious natural resources, and is thought to be a relative economic success. Yet in early 2008 it suffered its worst cholera epidemic in years (even in large towns such as Lubumbashi), killing hundreds of people. The Governor of the province has reportedly commented, albeit facetiously, that he would be well advised to organise a war in order to secure humanitarian aid.
A similar conclusion can be drawn in terms of the impact of displacement on humanitarian need. According to the Office for the Coordination of Humanitarian Affairs (OCHA) there are, as of June 2008, 1.3m IDPs in the DRC (Population Movements in Eastern DR Congo, OCHA DRC, July 2008). Clearly, displacement renders populations more vulnerable and makes them key candidates for a humanitarian response. It would be difficult to argue that displacement does not cause humanitarian need on a large scale, at least in the acute phase as people are displaced and before they are assisted. Taking a longer-term view though, and as Table 1 again shows, many provinces are still experiencing significant humanitarian needs despite the fact that they contain no IDPs. Furthermore, multisectoral assessments being undertaken by the UNICEF Programme of Expanded Assistance for Returnees (PEAR) in eastern DRC have shown that, even a long time after IDPs have returned home, they can still experience significant humanitarian problems, in some cases, beyond emergency thresholds (Quarterly Analytical Report: Humanitarian Situation in IDP Return Areas, JanuaryMarch 2008, UNICEF). An analysis of the data collected has shown that the recentness of return is not a very good predictor of vulnerability. That is to say, IDPs that have returned home as long ago as a year are often as vulnerable as those that have come back more recently. Contextual factors, rather than the process of displacement and return itself, are probably more important in explaining humanitarian needs.
Is a humanitarian response warranted?
It could be argued that, although the situation is clearly bad outside conflict-affected eastern DRC, it falls outside of the remit of humanitarian crises and therefore an emergency response is not appropriate. The absence of basic social services across the DRC is the best explanation of the deplorable situation of much of the population. State collapse over decades has decimated the health structure, education system and water infrastructure. The wars in DRC between 1996 and 2003, and the insecurity that persists today, are but one part of the countrys downward trajectory, which started decades ago as a result of the catastrophic mismanagement of the country under President Mobutu Sese Seko after independence in the 1960s. At the current growth rate, it is estimated that it will take until 2060 for the country to reach the level of GDP per capita it had in 1960 (UN Country Assistance Feamework, DR Congo 1997).
If state collapse is the real issue, then obviously more longterm developmental responses that address the structural rather than proximate causes of the problem are required. While this may be desirable, and is argued for by many humanitarian actors and donors, there is little evidence that the development aid that is flowing into the DRC is having a significant impact on humanitarian needs in many parts of the country. It is unlikely that the Congolese government, even with donor support, will be in a position to respond effectively for a very long time. Long-term, structural assistance is essential to the countrys future, but its progress has to be measured in decades. In the meantime, there is a clear need for humanitarian action in the face of wide-scale, immediate threats to human life. Even though they may only be able to provide temporary solutions to what are long-term problems, humanitarian actors should retain their funding and mandate to respond to the terrible situation that many Congolese find themselves in. Many humanitarian donors do not like the idea that their money may be paying for development, but this is an unavoidable necessity. That total humanitarian funding for the DRC rose from $137m in 2002 to $497m in 2007 would seem to suggest that donors tacitly accept this.
What does this mean for humanitarian planning?
The planning of humanitarian programmes increasingly reflects this complex picture of what might be considered a humanitarian crisis in the DRC. The evolution of the Humanitarian Action Plan (HAP) the main strategic framework for aid agencies in DRC illustrates how conceptions of the humanitarian crisis have changed over time. The HAP in 2007 (as with the previous year) was framed around two key strategies: a) emergency response to crisis; and b) support to a return to self-sufficiency, i.e. aimed at differentiating between the acute needs of IDPs and the reintegration needs of IDP returnees. The Mid- Term Review of the 2007 HAP, though, drew attention to the protracted nature of the humanitarian crises in the DRC and the fact that they were not always located in areas affected by armed conflict. A strong push was made to redirect humanitarian assistance to the west of the country. However, there are very few agencies in many of the western provinces and, despite funding being made available, projects have not always been forthcoming.
Ross Mountain, Humanitarian Coordinator, HAP 2008
The HAP for 2008 went further by incorporating the notion of sector thresholds, beyond which a humanitarian response should be launched. For example, in the area of health, an infant mortality level of two deaths per 10,000 children per day meant that a remedial programme would be considered, regardless of where in the country this humanitarian need may have been recorded. While the lack of available data is likely to skew such decisions, this was at least an important effort to better direct assistance. In addition, the two strategies for displacement and return in the previous years HAP were expanded to five crosssector strategies, which were not restricted necessarily to areas affected by conflict and displacement.
As part of this new approach, geographical areas were given a ranking according to key criteria, thereby decoupling the proxy causes of conflict and displacement by introducing objective means of measuring humanitarian need. However, the majority of humanitarian action as defined in the 2008 HAP continued to be directed to the east the country, where there has been strong political pressure to support efforts to bring about peace in the region, particularly in North Kivu, where most humanitarian action is still focused. While UN agencies, as part of the Integrated Mission of MONUC, have experienced this pressure in more explicit terms, NGOs face equally strong incentives from donors, the media and their own headquarters to play a visible role in an increasingly visible conflict.
Although still in draft form at the time of writing, the 2009 HAP has retained the approach of thresholds and crosssector strategies. The assessment undertaken in preparation for the 2009 HAP shows more clearly the dispersed nature of the humanitarian crisis in DRC. One of the joint strategies also now focuses more explicitly on early recovery, recognising that more long-term approaches are necessary to address the many humanitarian problems in DRC.
Where is humanitarian financing being channelled?
Despite these laudable initiatives within the HAP and elsewhere to ensure the objective targeting of humanitarian action in DRC, these efforts have not arguably affected decisions about how humanitarian financing is being channelled. The Pooled Fund with contributions from a range of donors is the largest source of humanitarian funding in DRC, providing more than $100m per year. The allocation of Pooled Fund money is directly linked to the humanitarian needs identified in the HAP, and decisions about where money is spent are primarily decided within the Clusters. In this way, humanitarian strategy and financing are inextricably linked. This is a very positive development and should theoretically be leading to better targeting. However, as Table 2 shows, funds do not always seem to be channelled to the provinces with the greatest amount of measurable humanitarian need.
At least for nutrition and food security, there is a large disparity between the amounts of money being allocated by the Pooled Fund and the level of recorded malnutrition and food security shown by relevant surveys. In Kasai Occidental, for example, the 2007 DHS survey found more than 170,000 children suffering from acute malnutrition more than twice the number in North Kivu, yet while the North Kivu nutrition cluster was allocated roughly $12 per malnourished child, the nutrition cluster in Kasai Occidental received less than 60 cents per head. Similar examples exist for food security. This analysis only looks at humanitarian financing from the Pooled Fund and does not take into account development assistance targeting provinces not experiencing classic humanitarian crisis. As stated earlier, development aid is not yet having a noticeable impact on the humanitarian situation in many parts of the country. At a time when humanitarian financing to DRC is increasing year by year, it is important that it is better directed. While money is frequently made available from the Pooled Fund to address needs in the western and southern provinces, agencies are not developing interventions in these areas, and instead continue to focus on the east.
James Darcy and Charles Antoine-Hofmann, According to Need? Needs Assessment and Decision-Making in Humanitarian Action, HPG Report 15, September 2003.
Demographic and Health Survey of the DRC 2007, Macro International, Ministries of Health and Planning, August 2008.
Mortality in the Democratic Republic of Congo: An Ongoing Crisis, International Rescue Committee, January 2008.
Comprehensive Food Security and Vulnerability Assessment, World Food Programme, 2008.
Quarterly Analytical Report: Humanitarian Situation in IDP Return Areas, JanuaryMarch 2008, Programme of Expanded Assistance to Returnees (PEAR), UNICEF.
In the context of DRC, the end of conflict and displacement do not always spell the end of the need for humanitarian assistance. According to objective humanitarian indicators, many parts of the country not affected by armed conflict and displacement are still experiencing humanitarian needs at least as bad as the east of the country, if not worse. The post-conflict transition in DRC must include a mix of approaches: development on the one hand, but also humanitarian assistance, often targeting the same areas. As this article has argued, there is a humanitarian imperative to continue targeting humanitarian assistance in areas not experiencing classic humanitarian crises, if the continued major loss of life is to be averted. Although there is an implicit acceptance of this in terms of humanitarian planning, more needs to be done to ensure that this translates into decisions about where funding and assistance is being targeted, using all the available data to support this approach.
Damian Lilly and Alex Bertramwork for the United Nations Childrens Fund (UNICEF) in DRC. This article has been written in a personal capacity and the views expressed do not necessarily represent those of the UN.