a1 Human Nutrition Unit, National Institute for Research on Food and Nutrition, via Ardeatina 546, 00178 Rome, Italy
a2 Consultant for Food Security and Agricultural Development, Rome, Italy
a3 European Centre of Humanitarian Health, Lyon, France
a4 Consultant for Public Health and Humanitarian Aid, San Paulo, Brazil
Objective To describe the case of Congo as an example of the assessment and appropriateness of donor operational and sectoral strategies in a complex emergency.
Design and setting The paper reports the findings of an external evaluation of operations financed by the European Commission Humanitarian Office in the Democratic Republic of Congo (DRC).
Results The Congolese health system is suffering from severe deterioration. What is functioning in the public health context is donor-dependent with high costs and limited coverage. Despite a relatively favourable agro-climatic situation, food shortage and famine severely affect the nutritional status of large population groups. In this context, humanitarian programmes have generally improved access to health care and the nutritional status of beneficiaries. The reduction of malnutrition in project areas is often demonstrated even though the context did not permit consolidation of these results. Malnutrition continues to claim a massive cost of lives owing to the effect of widespread food insecurity that follows a circular cause-and-effect pattern of very low food production and extreme poverty.
Conclusions The current context in DRC does not correspond yet to ‘post-crisis’: neither at population level with regard to indicators of poverty, malnutrition, disease and death, nor at institutional level, with regard to state support to institutions. In these situations, the international community is often called upon to replace the state as service provider. Integrated humanitarian actions should be the future of relief projects in DRC. Health, nutrition and food security components should be considered a standard public health intervention strategy representing the most sensible approach to address the needs of the affected population.
(Received August 31 2005)
(Accepted December 15 2005)