288 - Ending a Spreading Pandemic Means Curtailing Civil Wars

The Congo and Beyond

            It is hardly a surprise that the globe’s most recent pandemic started in the eastern region of the giant Democratic Republic of Congo (DRC). Malevolent disorder and humanitarian crisis are the norm in that region, especially the three war-torn provinces of Ituri, North Kivu, and South Kivu that have been plagued for a decade with harsh episodes of internal conflict.

            Already, in 2024, at least 17,000 Congolese have suffered from the fevers, damaged tissues, blisters, and skin ulcers that typify mpox (clade 1b).  More than 550 Congolese have died from the spreading disease, and – in Congo – all numbers are probably undercounts since many cases and deaths have occurred far from Congolese cities and far from places where enumerating persons with mpox might by now be routine.  Many incidents of mpox (as with malaria and tuberculosis in Africa) go undiagnosed, untreated, and officially unacknowledged. 

            Deaths from mpox are particularly cruel, often affecting under-nourished children who starve because painful lesions in their throats and mouths prevent them from eating and swallowing normally.

            The Congolese variant of mpox (clade 1b), spread by intimate personal contact, has now traveled from its endemic central area in the eastern Congo to fourteen mostly nearby African states --- the Central African Republic, Burundi, Rwanda, Kenya, Tanzania, Uganda, Mozambique, the Republic of Congo, Cameroon, Cote d’Ivoire, Ghana, Nigeria, and South Africa. Visitors coming from Africa have also taken the clade 1b lethal strain of mpox to Sweden, Pakistan, the Philippines, and Thailand.  The discovery of more cases in Europe and the Far East is likely, given the lethality of the clade 1b strain of mpox.  The World Health Organization has declared a global health emergency; mpox could develop into a proliferating pandemic as virulent as HIV-AIDS.

            Another 100 countries have also reported cases of the milder strain of mpox called clade 2, which broke out originally in the DRC in 2022 and has a much lower fatality rate. It is probably endemic to large parts of Africa, being transmitted from animals and then from human to human.

            Among the important factors giving rise to this year’s virulent strain of the disease are the absence of medical facilities in the three most acutely affected Congolese provinces, an acute shortage of health workers there and elsewhere in the Congo, and the several dangerous civil insurgencies that are contributing to the impoverishment and chaos of the Kivus and Ituri.

            Whether or not we can directly implicate unsettled, warring, conditions in the eastern DRC in the latest spread of mpox, there can be little doubt that columns of M23 and Allied Democratic Forces (ADF) warriors devastating much of Ituri and North Kivu provinces and harassing its people have hardly eased the movement of affected individuals to where they can obtain medical attention. Sexual violence by rebels marauding through villages also contributes mightily to the pandemic. Preventing villagers from harvesting staple crops also leads to vast hunger and, fatally, to the weakness of children. Clade 1b spreads heterosexually whereas clade 2 has spread homosexually.

            The eastern DRC is a place of overlapping civil wars driven more by greed than ideology. The availability of gold, diamonds, coltan (tantalite and columbite), cobalt, and copper dug out of the ground by local artisanal miners has attracted plunderers, particularly the M23 rebel group that is led by Tutsi from Rwanda and funded by the Rwandan government.  The ADF also raids in the same general region, and has Islamist affiliations. There are at least another twenty-five warlord led perpetrators of disorder in the three provinces.

            In recent years, at least 350,000 eastern Congolese civilians have lost their homes and their abilities to grow and find food. Moreover, throughout the entire Congo – Africa’s second largest nation -- a staggering 23.4 million Congolese suffer from severe hunger, making the Congo the world’s most food insecure country. Hunger enables mpox.

         The World Food Program says that the Congo’s hunger crises combine with raging violence against villagers to make the eastern Congo a region of immense risk and suffering. The WFP further estimates that nearly 3 million children in the region are acutely malnourished.  In addition to mpox, cholera and measles are rife, and epidemics of Ebola recur.

            Several times in recent weeks, the ADF machine-gunned three different villages in North Kivu Province, killing at least eighty hapless dwellers caught up in the civil strife. ADF affiliates itself to the Islamic State in West Africa and also claims ties to the youthful Islamist insurgency in northern Mozambique. But its overall goal is gaining spoils from the efforts of miners.

             M23’s origins are more evident, starting about five years ago as a Tutsi offshoot of the government of Rwanda. It has since been menacing villagers in North Kivu, going as far as surrounding the major Congolese city of Goma, on Lake Kivu across from Rwanda. M23 threatened at one point earlier this year to capture Goma from both the UN peacekeeping forces that theoretically protect the city and from the army of the Congo which – again theoretically – is still lamely trying to exert control in the Kivus and Ituri. 

M23 was established by Rwanda to oppose former Hutu who had fled Rwanda and opposed that nation from bases in the Kivus.  To support itself, M23 takes minerals mined in the DRC to Kigali, Rwanda’s capital, and sells them to official buyers. Subsequently, coltan, gold, and the other Congolese products join the world market via Dubai.

Widespread vaccinations could lessen the impact of the eastern Congolese wars and help to limit the spread of mpox. But although vaccines stockpiled against the return of smallpox, a relative of mpox, are available and could and should be employed against mpox, especially in the DRC, bureaucratic rules and unnecessary caution have so far prevented the shipment of anti-mpox vaccines from Denmark, France, the United States, and Japan to the impacted African areas.

Only with the very recent WHO declaration of a health emergency is it possible to begin shipping vaccines to areas of need.  A WHO meeting early next month will presumably free up supplies at affordable prices. But it is a great crime that it took so long for the WHO officially to declare an emergency and for international health bureaucracies and GAVI – the global vaccine alliance -- to begin to organize the transfer of vaccines. 

The vaccines have worked well on the milder strain of mpox and will presumably work on clade 1b victims.  It is past time that Congolese were helped to limit its spread and its fatalities.

Importantly, too, much more could be done to prevent Rwandan funding of M23 and the sale of pilfered minerals in the United Arab Emirates. The official Congolese national army also needs major assistance if it is to overcome the disruptive power of the ADF and M23.  Washington could lend its weight in a manner that has so far been lacking.