War, malnutrition leave many parents in Congo with more dead children than living ones

Congo pastor loses 9 out of 10 children in war

MWESO, Congo — First, the rebels killed four of Joseph Munyaneza’s children in 1997. The family fled to another village.

The following year, that village came under siege. Another four children died of gunshot wounds. Then the baby, from malnutrition.

Today, Munyaneza, a 52-year-old Protestant pastor, tenderly cares for his 17-year-old daughter, who is in hospital after being kidnapped by rebels a month ago. When the rebels tired of raping her skinny body, they forced a stick up her vagina until it protruded through her side.

“She is the only child left out of 10 I had with my first wife,” Munyaneza says, holding the moaning teenager’s hand and clucking sounds of comfort as one would to calm a baby.

In the east of this vast country of nearly 63 million people, ongoing rebel attacks and poor health care have produced a generation of mourning mothers and fathers, many of whom have lost more children than they are raising.

More than half a million children die each year in Congo, one out of every five before they reach the age of 5, according to the U.N. Children’s Fund. Of those who survive, 40 percent are stunted, according to the World Health Organization. There is only one doctor and five nurses or midwives for every 10,000 people in the country.

And that’s before factoring in deaths from war fueled by massive mineral resources that have brought misery instead of development. UNICEF estimates that children account for half of the more than 4 million deaths blamed on conflicts in east Congo that have raged for more than a decade.

Millions of people have been forced from their homes in recent years by fighting between the government and rebel groups, including those from Uganda and Rwanda. The United Nations in April counted nearly 2 million displaced people. In areas where fighting continues, roughly 10 percent of the population is dying each year, according to the U.S. Agency for International Development.

“It’s the extent of the violence here that hits me most,” says Joelle Depeyrot, a mental health officer on secondment from MSF-USA to Mweso Hospital, where Munyaneza told his story. “Every single patient we see is directly or indirectly a victim.”

Many of her adult patients have lost children as well as lived through trauma. Depeyrot says it’s easier to treat those who have surviving children.

“Someone once told me that children are the ‘wealth’ of the family,” she says. “Those who are left without children are very alone and isolated … They often report feeling useless and end up ‘waiting for death,’ as they often say.”

Nyirahabimana Nyirashirambere, a 45-year-old who lives at the refugee camp at Kashuga, has had 11 pregnancies. Five children survive.

Nyiragasigwa Busabimana, 43, gave birth to eight children. Five are living.

Mukeshimana Nyirarukundo, 25, has had six children and one stillbirth. Three children are left.

“We have many pregnancies, but children? The mortality rate is exceptionally high,” says Esperance Habjumimana, a maternity nurse at a clinic run by Medecins Sans Frontieres, or Doctors Without Borders, at Kashuga. Among her patients was a pregnant woman who has had 12 children, of whom only three are living.

In Mweso Hospital, flower beds gay with exotic red and yellow blooms belie the horror stories from parents nursing wounded and malnourished children, worrying how to keep them alive. People walk for hours to reach the hospital, which MSF kept open even when shells pounded overheaded during a 2008 rebellion.

Gabaye Msebimana, 6, survived a four-hour operation to remove four bullets in her hip and thigh.

She’s lucky. Her 5-year-old brother was killed. Soldiers who mistook the family for rebels also wounded her grandmother and her mother as they tried to flee last month.

In the pediatric ward, two children lie in beds facing each other. Three-year-old Yamuremiye Bahati weighs just 6 kilograms (13 pounds), a little skeleton covered with papery flesh. Wivine Bakarani, 9, is so bloated that her eyes are just slits in a rotund face. Both children suffer severe malnutrition, Wivine’s a case of kwashiorkor or lack of protein.

It’s a cruel state to be in amid lush, mountaintop vegetation with a bounty of vegetables and fruit — trees dripping with mangoes, bananas, plantains, avocado pears and coconuts, fields filled with yams, sweet potatoes, beans, tomatoes and corn.

But there’s no land here for the children’s mothers, who live in the refugee camp a few kilometers away at Kashuga, a village of 4,000 people overwhelmed by 15,000 displaced by fighting. The refugees’ huts stand apart from the square mud homes or wood cabins of residents. Children as young as three know how to build them, with the heavy work done by teenage siblings who have known nothing but war all their lives.

The few women at the camp who put money together to rent a small field say they stopped going two weeks after soldiers sent to protect them instead attacked, raped and robbed them.

“They must go home,” an elderly man whispers fiercely in the village. “We helped them at first but they drain our resources. There’s nothing left to give.”

“I want to go home, but there’s fighting, it’s not safe,” Wivine’s mother, Migisha Tuyambaze, counters at the hospital. “At home, I have a field, I can grow what I need to keep my children healthy.”

She is breastfeeding a feisty 1-year-old, Diem Bertin, who tried smiling and making faces at his sister, then pouted when she would not play. Wivine lay down, holding her stomach, then threw up on the floor and got out of bed to allow a flow of diarrhea to escape into a plastic basin.

Wivine has been sick for months, Tuyambaze says. It’s her second time being treated for malnutrition. Three months ago, she was on a high-nutrition diet provided at an MSF outpatient clinic. She returned home well, only to get sick again.

Once they leave the hospital, Wivine will be fed the same protein-less diet of yam porridge and leaves. Tuyambaze worries how long her son can stay well, especially since she herself is not eating well so the milk does not always flow.

Like many women in eastern Congo, she has more dead than live children. Two died soon after their birth and two of malnutrition, all before they were five years old. Her husband deserted her after the last death, accusing her of not being a good mother.

She is just 25.

Pastor Munyaneza now gets by renting a patch of land to grow vegetables for meals and making palm oil for sale. He says his first wife died of dehydration and diarrhea while they were fleeing fighting in 1994. He remarried and now has 12 children with his second wife.

He calls himself a master of the “blinde” — the igloo-shaped refugee hut of stick supports covered with banana leaves that he has built many times in eight places he has fled to, trying to keep ahead of the conflicts that rage in eastern Congo.

Asked how he copes, Munyaneza gives a sad smile and a surprising response: “I’m lucky,” he says, giving his daughter’s hand a squeeze. “We’ve been on the run for more than 10 years but we manage. We survive.”