Inside Africa: Healthcare Dwindles In Rural Parts Of Congo

Hush Naidoo Jade Photography

Roads become very muddy between September and November when the Congo’s second rainy season occurs. It is a time when transport and circulation to the many remote communities which stretch across the Congolese rainforest becomes especially difficult. As the rain falls heavily, roads are turned into sludge which, as the terrain comes loose under tires, traps vehicles on roads immersed by the jungle. Sometimes this causes people to be late. Recently, it affected technicians carrying important medical samples.

In the Panzi health zone, the southwestern part of the country on Angola’s border, the rains caused delays in the identification of a mysterious illness in rural communities, which last month killed 143 people in the region. Mainly young children and infants were afflicted to fever, headaches, a cough, and a runny nose, as well as body aches. As the illness multiplied to almost 600 reported cases, testing began in early December. Yet, because the capital city of Kinshasa is 700km away (a two-day drive), and the nearest laboratory is 500km away in the town of Kikwit, diagnosis of the disease was held up.

When eventually the DRC’s health ministry confirmed the results of the tests, they announced: “the mystery has finally been solved. It’s a case of severe malaria in the form of a respiratory illness.” It proves an underwhelming explanation for the illness and death of many in the region - malaria is common in young children that experience the infection for the first time, when it’s at its most severe (malaria provides partial immunity after infection - most African’s experience Malaria multiple times throughout their lives, but it is most dangerous for first-time infections).

In fact, what points to a more obvious explanation of the mortality rate - which is at 6.2% - is a pivotal increase in the regions food insecurity. The Integrated Food Security Phase Classification changed in Kwango (the broader province) between April 2024 and September 2024 from IPC 1 (acceptable food insecurity) to IPC 3 (crisis level food insecurity).

According to the World Health Organization, “all severe cases were reported to be severely malnourished”. It comes as no surprise that infants and children of the region, immune suppressed by malnutrition, should also become more vulnerable to malaria, an otherwise common illness. In fact, all this really demonstrates is the DRC’s continued struggle to run a functional healthcare system.

There are many hills and mountains across the Congo Basin, and the rainforest stretching across it is thick. It covers almost 70% of the Democratic Republic of Congo, the largest country in the region of central Africa, whose total area is larger than half the size of the European union. For many of the remote communities living across this vast landscape, access to healthcare is not always a given. In a different part of the country, this has become especially apparent in the past year.

MPox is endemic in many parts of the northern DRC. The virus has existed in the country since 1970, when the first human case was recorded in an infant from the Équateur province. Since, there have been regular small outbreaks of what is known as the clade 1a strain in young children in and around that part of the Congo.

Unlike the name suggests, Monkey Pox is believed to be transmitted from African squirrels and rodents, not monkeys (the disease was discovered in a Copenhagen lab in Asian Monkeys in 1958). Clade 1a is passed from animals onto humans, and then spreads among humans, but not enough to cause an epidemic.

Nonetheless, in the past year, the DRC has seen a vast MPox outbreak in its eastern regions, particularly the southern and northern Kivu provinces. This epidemic strain, known as clade 1b, is more contagious among humans, and, as the symptoms of most affected suggest, is often transmitted through sex.

The outbreak originated in Kamituga, a small miner’s town on the edge of the rainforest in the national reserve Massif D’itombwe in late 2023. The virus spread throughout the region, many of the infected displaying lesions around their genitals. There were also many sex workers among initial patients, which led health experts to conclude a common cause of transmission was through sexual contact. By august, the spread had become so large that the World Health Organization declared a Public Health Emergency of International Concern.

Since, the DRC has reported 9247 official cases in 2024 (as of 15th December). Neighboring Burundi and Rwanda are behind with 2650 and 1027 cases respectively, and the virus has also spread to countries bordering the north and the south of Congo. The figures are deceptive though - it is believed that “over half of suspected and confirmed cases do not go on to be tested”, and that in general, the real numbers are much higher. This includes the number of people who have died from the disease, which the official count claims is 43, while the suspected count reaches up to 1138 dead.

Charted data from the world health organization backs this up: there is a significant oversight in the number of cases confirmed in November, which was just below 300, while an aggregate of suspected and confirmed cases rose to over 2000. In truth, the real number is simply unknown.

What is known is that health centers have been overwhelmed with cases. While many aren’t severe, and the mortality rate of MPox is generally low in epidemic provinces, at around 3.6%, the situation has still exacerbated already difficult lives for many. To a large extend, the remoteness of the affected regions plays a role. Probably to an even larger extent though, is the DRC’s political situation.

Since the start of the epidemic, the government has received international aid and deployed vast testing, prevention measures and a vaccine rollout to contain the further spread of the disease. However, vaccine distribution in many affected communities is still low, and according to Science, the containment, hygiene and education efforts remain “spotty”. The DRC’s government is accused of having neglected the importance of a strong response in the initial phases of the epidemic, which is the leading cause in the current exacerbation.

Vaccine doses have only started rolling out since September, almost a year after the first case, since it took regulators until June 5th to approve the MVA vaccine (a commonly used treatment which was effective in a 2022 outbreak in Nigeria). There is also the account of 50,000 doses of MVA which USAID proposed to send in early 2023 (when MPox was spreading across the rest of the globe). These were delayed due to “administrative and contractual requirements” not being met.

A torn Congolese state is to blame for much of this. It cannot be overlooked that governance issues in the DRC lie hand in hand with the continued fight against rebel uprisings in the eastern Kivu provinces (where the MPox epidemic is also happening). Mouvement du 23 Mars (M23) is a notorious group of rebels - predominantly of Tutsi origins - which fights for independence in the eastern parts of the country. The group is known for destabilising local governance, sacking villages and towns and recruiting children into the rebel militia. They are also known for the high instances of rape which occur alongside attacks.

This additional strain on the country’s ability to tackle health concerns such as epidemics, malnutrition and common illnesses such as malaria - but more importantly the country’s vast landscape and remote communities - are part of the reasons why the DRC unfortunately retains the title as the world’s leading humanitarian crisis.

And yet, this is not a case of tackling Ebola or HIV. It is agreed among experts and medical professionals operating in the region that MPox is a relatively easy virus to contain, and that its danger is relatively low. It is simply a matter of the DRC’s government paying attention and taking action. Across the Congo, doctors and nurses treating patients are still waiting for that to happen.