A Health Injustice for Congolese
The humanitarian aid organization, Médecins Sans Frontiers (MSF), reports the Democratic Republic of Congo (DRC) is currently fighting its largest measles epidemic since 2011. This past year, MSF reported over 30,000 measles cases and over 320 deaths in the DRC, with numbers steadily increasing due to a lackluster response from local and international communities. After an August report on the dire state of the epidemic by the UN Office for the Coordination of Humanitarian Affairs, the UN released $2.4 million to support efforts. Despite the incidence reports, the DRC has not yet formally recognized the presence of an outbreak. Additionally, other humanitarian aid organizations have failed to supply resources, such as aid workers, despite pleas from multiple non-government organizations (NGOs).
MSF is still stationed in 10 of the 68 health districts in Katanga Province, the area most hit by the epidemic, in order to assist local health authorities with the outbreak. MSF has also dispatched workers in the South Kivu, Equateur, and Maniema provinces for additional support. MSF aims to prevent future cases through a comprehensive vaccination campaign alongside a reactive effort to contain the epidemic by treating infected Congolese. The NGO has currently vaccinated over 300,000 children, a large but inadequate number when compared to the 2.1 million vaccinations it administered in 2011.
Measles can be successfully prevented with proper vaccination. However, vaccines are not being effectively delivered to all communities in the DRC. Rural villages face particular social and economic barriers, increasing the disease’s impact on these communities.
The measles vaccine requires cold conditions and a follow-up booster shot one month after the initial vaccination. The DRC’s hot climate prevents the vaccine from being easily delivered to geographically-isolated communities, forcing most individuals to travel to regional health centers. Rural villagers, especially those located in deep forest regions, would require time and money to make multiple journeys, expending scarce resources for preventative medicine. It should be no wonder that the rates of vaccination are lowest in these rural villages and, consequently, that the rates of infection are highest there as well.
Once infected, other social and economic barriers exacerbate health outcomes for poor and isolated communities. As a viral infection, there is no direct treatment for measles. Some of the symptoms, such as fever, diarrhea, and dehydration, can be treated with supportive care. Fever medication, nutritional supplements, and oral rehydration therapies are commonly used by healthcare practitioners to assist those infected until the virus is naturally removed from the body. These treatments, however, are not readily available for all Congolese, especially those living far from regional health centers. Many poor and rural individuals have to rely on homemade treatments, such as constant rest, large quantities of clean water, and nutrient-rich food; these resources may not be readily available to these communities. Further, some communities may not have significant contact with health authorities, and may not have adequate knowledge on recognizing and treating those infected with measles.
The DRC outbreak can be considered an injustice when examined from a global health perspective. Justice in the context of global health concerns the equitable distribution of health resources. It would be unjust for health to be disproportionately accessed and hoarded by a dominant social, cultural, or economic class. Conversely, it would also be unjust for communities to be neglected due to social, cultural, or economic barriers that prevent adequate access to health resources. The unequal access to health resources for rural and impoverished Congolese communities, both in the prevention and treatment of measles, is a clear example of injustice giving rise to unjust health outcomes.
The idea of health outcomes being unjust is closely tied to health as a human right. Health as a human right has been advanced by international organizations, such as the World Health Organization, and by many humanitarian NGOs, such as MSF, in order to ground their missions and justify their goals. Importantly, this human right serves as both a rallying cry for aid and a pressure point for governments. Specifically, governments are responsible for generating the conditions for the highest attainable standard for health for all individuals. One important aspect of justice, for both healthcare professionals and those in the legal community, is holding governments and institutions accountable for their responsibilities in delivering health resources to all populations.