CNADocument_FINALDOC (1)

Community Needs
Assessment
Goma, Democratic Republic of Congo
DePauw University
May 2016
Paige Bagby, Lizzy Gering, Amata Giramata, Peter Gorman

Table of Contents

EXECUTIVE SUMMARY ………………………………………………………………….. 5

Part I: Community Backdrop ……………………………………………………….....5
Part II: Community Health Analysis …………………………………………………..6
Part III: Community Diagnosis and Interventions ……………………………………6

PART 1: COMMUNITY BACKDROP ……………………………………………………...7

CHAPTER 1: Geographic Location, Population Characteristics & Distribution ……….8

Public Health Relevance …………………………………………………………….....8
Geographic Location and History ……………………………………………………..8
Population Characteristics and Distribution ………………………………………....10
History of the Population ……………………………………………………………..11
Gender/Age Distribution ……………………………………………………………...12
Public Health Implications ……………………………………………………………13
References ……………………………………………………………………………..14

CHAPTER 2: Sociodemographic Characteristics …………………………………………..16

Public Health Relevance ……………………………………………………………....16
Household Characteristics…………………………………………………………….17
Marital Status ………………………………………………………………………....18
Native and Language Spoken at Home ……………………………………………….18
People in Poverty ……………………………………………………………………..18
Educational Attainment ………………………………………………………………19
Food at Home ………………………………………………………………………...19
Public Health Implications ……………………………………………………………20
Resources ……………………………………………………………………………...21

CHAPTER 3: Physical and Natural Environment …………………………………………22

Public Health Relevance ………………………………………………………………22
Physical Environment/Geography …………………………………………………….22
Weather and Climate …………………………………….……………………………24
Land Details …………………………………………………………………………...27
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Volcanism ………………………………..…………………………………………...28
Air Quality ……………………………………………………………………...……29
Water Resources and Quality …………………………………………………………31
Public Health Implications …………………………………………………………...36
Resources ……………………………………………………………………………..36

CHAPTER 4: General Economics and Labor Force……………………………………….38

Public Health Relevance………………………………………………………………38
Employment Rates & Labor Force…………………………………………………….39
Employment & Major Industries………………………………………………………41
Income & Economic Development…………………………………………………….45
Public Health Implications…………………………………………………………….46
References……………………………………………………………………………...47

CHAPTER 5: Government and Politics……………………………………………………..49

Public Health Relevance………………………………………………………………49
Precolonial and Colonial Governance……………………………………………….49
The Congo Wars and Politics…………………………………………………………53
21st Century Democratic Republic of Congo Politics………………………………..54
Politics of Goma in Democratic Republic of Congo………………………………….55
Effects of 1994 Genocide Against Tutsi on Health…………………………………....55
Public Health Implications…………………………………………………………...56
References…………………………………………………………………………..…57

PART 2: COMMUNITY HEALTH ANALYSIS…………………………………………...59

CHAPTER 6: Community Resources……………………………………………………...60

Public Health Relevance ……………………………………………………………..60
Hospitals ……………………………………………………………………………..60
Grocery Stores………………………………………………………………………..61
Community Center……………………………………………………………………61
Schools………………………………………………………………………………..62
Religious Resources…………………………………………………………………..62
Public Health Implications…………………………………………………………...63

CHAPTER 7: Behavioral Health…………………………………………………………..64

Public Health Relevance…………………………………………………………….64
Mental Health……………………………………………………………………….64
Sexual Violence and Substance Abuse………………………………………………65
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Public Health Implications………………………………………………………....65
References…………………………………………………………………………..66

CHAPTER 8: Vital Statistics and Disease Burden……………………………………...67

Public Health Relevance …………………………………………………………67
Birth Rates ………………………………………………………………………..67
Death Rate………………………………………………………………………...68
Infant Mortality Rate………………………………………………………………69
Maternal Mortality Rate…………………………………………………………..70
Disease Burden……………………………………………………………………71
Measles……………………………………………………………………………71
Cholera……………………………………………………………………………72
HIV/AIDS………………………………………………………………………….72
Malaria…………………………………………………………………………….75
Public Health Implications………………………………………………………..75
References…………………………………………………………………………76

CHAPTER 9: Healthcare System ……………………………………………………...77

Public Health Relevance……………………………………………………………77
General Overview…………………………………………………………………..77
Healthcare Infrastructure ………………………………………………………….78
Healthcare Facilities………………………………………………………………..79
Healthcare Providers……………………………………………………………….82
Women and Children Healthcare Services…………………………………………85
Public Health Implications…………………………………………………………86
References………………………………………………………………………….87

CHAPTER 10: NotforProfit Assistance………………………………………………..89

Public Health Relevance …………………………………………………………89
Nutritional Assistance …………………………………………………………….89
Family and Children Services …………………………………………………….91
Public Health Implications ……………………………………………………….93
References ………………………………………………………………………...94

PART 3: COMMUNITY DIAGNOSIS AND INTERVENTIONS……………………96

CHAPTER 11: Community Diagnosis ……………………………………………………97

Priority Health Issues ………………………………………………………………97
Selected Health Issue ………………………………………………………………100
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Magnitude of the Problem ………………………………………………………….100
Severity of the Problem……………………………………………………………..101
Feasibility of an Effective Intervention……………………………………………..102
References …………………………………………………………………………..104

CHAPTER 12: Interventions ……………………………………………………………..105

References…………………………………………………………………………..110

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Executive Summary

Part I: Community Backdrop

The city of Goma is part of the North Kivu province in the northeastern Democratic
Republic of the Congo, a country in central Africa. Goma is located south to an active volcano,
Nyiragongo, and north of Lake Kivu. Goma is located west of Rwanda. After the
Genocide against the Tutsi in Rwanda, many refugees entered Goma and this influenced the
health care system and the conflict structures. The influx of thousands of Rwandan refugees into
the North Kivu region continues to overwhelm the healthcare system and the overall population.
The country itself is rich in resources such as cobalt, copper, oil, diamonds, gold, silver, and
other mineral deposits. In 2002, Goma was destroyed by lava from the Nyiragongo volcano
which buried most of the town, including health facilities.
The population of Goma is approximately 1.1 million people. This number is a rough
count including internationally displaced persons, refugees, asylum seekers, and the native
populations. Seventy percent of the population is considered to be in poverty, and education rates
are as low as thirty percent.  A majority of the population suffers from food insecurity.
The Democratic Republic of Congo has incurred various wars such as the Congo crisis
and Congo wars that affected the populations severely. Goma particularly has continued to be
home to various rebel conflicts that cause social unrest among the citizens, influence the health
of the populations and affect the allocation of resources.

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Part II: Community Health Analysis
In order to for public health practitioners to construct proper healthcare systems and
provide effective services, it is important to understand the statistics in Goma, D.R.C regarding
the quality of life and disease burden. Overall, D.R.C has shown lowering death rates, birth rates,
infant mortality rates and maternal mortality rates. However, considering the population of the
country, these rates are significantly affecting large numbers of people. Some of the most
pressing disease issues in D.R.C. and particularly in Goma are Diarrheal diseases, malaria,
Trauma (mental health) and HIV/AIDS. Again, even though D.R.C has shown tremendous
decrease in the negative effects of some of the diseases, they are still affecting large populations.

Part III: Community Diagnosis and Intervention

Goma has a high prevalence of malaria, HIV/AIDS, diarrheal diseases, malnutrition and
mental health. D.R.C has one of the highest infant mortality rates in the world and continues to
be affected highly with malaria. Even more mental health issues in Goma continue to increase.
Mental Health disorders stem from trauma of experiencing different wars and trauma from
surviving sexual violence. Due to the fact that mental health disorders are not viewed as health
issues culturally, people are discouraged to seek the necessary help. In effect, the disorders are
growing and affecting the communities further and influencing the increase of other diseases
such as HIV/AIDS, malnutrition and strokes as well as the high cases of sexual violence.

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Part I: Community Backdrop

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Chapter 1: Geographic Location,
Population Characteristics &
Distribution

Public Health Relevance

The health and wellbeing of the population of Goma are heavily influenced by the
population’s location and history.  Specifically, its proximity to Rwanda and resulting influx of
refugees impacted the area’s overall public health.  This chapter identifies the location of Goma
as well as significant geographical features and historical events. Additionally, this section will
identify the population characteristics and distribution of Goma’s residents. In order to develop
public health interventions, it is important to asses the population and where they are living for
the most efficient planning, programming, or projection.
Geographic Location and History
The Democratic Republic of the Congo (DRC) is one of the largest countries in Africa
and is almost entirely landlocked (harambeeusa.org, 2016).  The country is divided into eleven
provinces (mapsofworld.com, 2012).  Goma is the capital of the North Kivu province on the
eastern border of the country.
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The city of Goma itself has thirteen districts (JIPS.org, 2014) and sits between Lake Kivu
to the south and the active Nyiragongo Volcano to the north.  Lake Kivu serves as an important
resource but also poses a threat to the public health of Goma. This is because it holds huge
quantities of dissolved gas at pressure.  This gas could explode, causing the lake to erupt and
release catastrophic amounts of carbon dioxide into the air of the city.

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Mount Nyiragongo erupted in January of 2002, destroying forty percent of Goma and
leaving 200,000 people homeless as the lava ran six and a half feet deep through the center of the
city all the way to the shore of the lake.  Some casualties occurred due to asphyxiation from the
carbon dioxide emissions from the eruption, but most people were able to evacuate with
adequate warning.  Mount Nyiragongo is still active and being monitored by scientists in Goma.
Goma lies on the eastern border of the country, right next to Rwanda.  The city center is
less than one mile away from the Rwandan border.  This proximity made Goma the center of the
refugee crisis caused by the Rwandan Genocide in the 1990s.  Between the 13th and 14th of July
in 1994, between ten and twelve thousand refugees crossed the border from Rwanda into Goma
every hour.  This massive influx of people created a humanitarian crisis including public health
problems due to a lack of adequate shelter, food, and water.  By the time one million refugees
had arrived in Goma, a cholera outbreak killed thousands of people in the camps.  Since Goma
was the host to Rwandan refugees, it became a target for Rwandan government forces.  During
the First and Second Congo wars, the Rwandan military attacked the camps in Goma, resulting
in thousands of more deaths.  Tensions and fighting between militias still persists, and in 2012
the M23 movement, a rebel military group, seized the city and tens of thousands of citizens fled.
Goma was then retaken by government forces.

Population Characteristics and Distribution
The total population of the Democratic Republic of the Congo is 67.5 million people. As
of 2012, the capital of the North Kivu Province, Goma, is home to about .73% of the population
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of the country, with approximately 1.1 million people (World Bank). There are no accessible
statistics on the distribution of people throughout Goma. There remains little knowledge of the
population displacement because of the influx of refugees (IDPs) attracted to the fact that Goma
has regional security, which is more than most places. The inhabitants of Goma live wherever
sleeping is suitable but lack any kind of sanitation or plumbing system to remove waste from
homes. Many homes are shanty houses which are built over the sedimentary rock from the
volcanic eruption of Nyiragongo.

History of the Population
The current population of Goma, DRC is 1.1 million. In 1994, the Rwandan genocide
lead to a refugee crisis, and the population has been unstable ever since. Because of the relative
security in Goma, it became an ideal destination for refugees from Rwanda looking to escape
conflict. In 2011, the population underwent a sharp increase from 400,000 to the current 1.1
million residents (FXB). Out of the current 1.1 million people living in Goma, 70 percent of
them live in poverty because of irregular income and lack of education (World Health
Organization).
The fluctuation of the population of Goma is also very rooted in the cultural beliefs and
political structures regarding borders. Like many African countries, D.R.C. has open border
policies for citizens in neighboring countries. The process of entering and leaving the country is
easy, affordable and accessible to many people. This is unlike the beliefs of western countries
when it comes to immigration laws and policies and the processes of immigration. The easy
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immigration processes of D.R.C allow for the population to fluctuate and are important in
providing refuge for other citizens.

Gender/Age Distribution
The distribution of DRC’s age structure highlights the key socioeconomic issues.
According to the World Fact Book, “Countries with young populations need to invest more in
schools, while countries with older populations need to invest more in the health sector” (The
World Fact Book).

The Democratic Republic of Congo’s population indicated that education should be the
key target because of the dramatic difference between old versus young age groups in the
country. However, only around thirty percent of the population receives a formal education
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(FXB).  As shown in Figure 1.7 (above), the distribution of men and women is relatively equal,
which may indirectly result in the high heterosexual marital status.  Goma’s childhood death rate
is very high. 140 out of every 1,000 children die before they are one year old. Of those who
survive past the age of one, an additional 93 out of every 1,000 will die before the age of five
(FXB). The leading causes of infant mortality are high fever and Malaria (Babbo et al).

Public Health Implications
Geographic location and history are both important factors in the health and wellbeing of
individuals.  Goma’s volcano, toxic lake, shared border with Rwanda, and history of war and
conflict complicate its access to medical treatment facilities and programs.   It is important to
consider both the geographic location and important historical events of Goma when designing
and executing public health interventions.  It is normal for populations to fluctuate due to births
and deaths.  In Goma, however, the influx of International Displaced People, constant conflict,
and natural disasters make it extremely difficult to keep accurate population statistics for the city
or the country as a whole. The lack of statistics such as age or where people are living leads to
difficulty developing proper healthcare. In order to develop the most effective public health
interventions, it is vital to know how many people are living in a city and where. Not being able
to identify where people are living makes it impossible to know if they have transportation to
healthcare services or information, or where these programs should be implemented in the future.

13

References
Babbo Dominique, Martín, Karla Bil, Antonio Isidro Carrión, Corry Kik, Papy Salumu, Annick Lenglet,
and Jatinder Singh. "Mortality Rates above Emergency Threshold in Population Affected by Conflict in
North Kivu, Democratic Republic of Congo, July 2012–April 2013." PLoS Neglected Tropical Diseases.
Public Library of Science.
Retrieved March 14, 2016 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169374/

FXB "Democratic Republic of the Congo FXB English." FXB. N.p.,
Retreived on March 16, 2016 from: https://fxb.org/programs/democraticrepubliccongo/

Gray, Richard. "Into Hell: Photos Capture Smouldering Lakes of Lava and Shifting Crust INSIDE the
Crater of Active Volcano Mount Nyiragongo." Mail Online. Associated Newspapers, 27 May 2015.
Retreived on May 16, from:
http://www.dailymail.co.uk/sciencetech/article3098946/IntohellPhotoscapturesmoulderinglakeslava
shiftingcrustINSIDEcrateractivevolcanoMountNyiragongo.html

Harambee USA Foundation."DRC: School Improvements."  N.p., 2016
Retreived on May 16, 2016 from:
http://harambeeusa.org/projects/currentprojects/democtraticrepublicofthecongoschoolimprovements

JIPS. Goma DRC. East Hiroshima: Daisō Sangyō, n.d. Joint Profiling Services. 2015.
Retrieved on May 16, 2016 from:
http://www.jips.org/system/cms/attachments/1026/original_P_GGomaweb.pdf

Nyiragongo Volcano Eruption Destroyed The City Of Goma, Congo...." Getty Images. N.p.
Retrieved May 16. 2016 from:
http://www.gettyimages.com.au/detail/newsphoto/nyiragongovolcanoeruptiondestroyedthecityofgo
manewsphoto/162732425

"Political Map of Democratic Republic of the Congo." Maps of World. N.p., n.d.
http://www.mapsofworld.com/democraticrepublicofcongo/democraticrepublicofcongopoliticalmap.
html

REUTERS. "Rwanda Launches Power Plant That Uses Methane Gas." The East African. N.p., 17 May
2016. Web. 17 May 2016.
<http://www.theeastafrican.co.ke/business/Rwandalaunchespowerplantthatusesmethanegas//2560/
3207650//item/0//uxdf3l//index.html>

The World Bank. (2016) “Congo, Dem. Rep.” Retrieved March 14, 2016 from:
http://data.worldbank.org/country/congodemrep

14

World Health Organization. "DRC WHO." English. N.p., Nov. 2012.
Retrived March 16, 2016 from: http://www.who.int/hac/Donor_alert_DRC_27Nov2012.pdf

15

Chapter 2: Sociodemographic
Characteristics

In order to supplement existing infrastructure and create healthcare interventions, it is
important to understand a community's needs. These statistics generally identify what is most
pressing in the target audience. Knowing who lives in a household could be an indicator of
where people are living and contributing to paying for expenses such as rent or healthcare. Being
able to address what a household consists of could identify where the population’s children are
living and who is taking care of them. Close household ties are shown to positively affect the
health care of an individual, especially if there are older relatives to act as an influence. A higher
rate of participation in healthcare is also seen amongst people who are married or living with a
steady partner than with those who are single or in an unstable relationship (UN). Identifying
poverty rates is a proxy for addressing who has the ability to afford an adequate food supply and
education. These aspects factor into the everyday quality of life for each individual.

Household Characteristics
The people of Goma live in a variety of environments throughout the thirteen districts.
These locations include but are not limited to urban sites, IDP camps, military bases, and rural
villages (Slegh, 2012).
16

Due to the influx of IDPs, household compositions are very irregular. A housing
arrangement may consist of refugees hosted with a nuclear family, extended families, solely
refugees, and any combination or variation of these groups. Regardless of who lives in a house,
the actual structure of the house does not significantly differ between groups of people. Homes
are located anywhere in the city, which could include over the sedimentary rock from the
volcanic eruption of Nyiragongo in 2002. Property ownership is relatively low because of the
lack of tangible housing leases and agreements. On average, only ten percent of IDPs own
property in comparison to fiftyone percent of Goma’s original residents (Joint IDP Profiling
Services).

Marital Status
The Joint IDP Profiling Service (JIPS) conducted research in Goma in 2013 and 2014 in
which they surveyed four diverse locations in Goma. This research was able to provide a glimpse
into the city of Goma where demographics are not always available.
17

In Figure 2.1 (above), the graph indicates that more than forty five percent of men and
women are legally married, followed by fifteen percent living with a partner. In Goma, women
are more likely to be widowed or separated than men and very little of the population is single,
never married, or have no stable partner (Slegh, 2012). Marriage may be more widely practiced
because of the economic stability it offers and the lack of housing throughout Goma.

Native and Languages Spoken at Home
There are more than 200 languages spoken in the DRC. The official languages of Goma
are French and Swahili. Citizens of the DRC are expected to know both because they are both
universally spoken throughout the government, schools, and general population. In addition to
French and Swahili, Kituba, Lingala, and Tshiluba are often spoken among various ethnic groups
(Knapp Sawyer, 2013).

People in Poverty
With the influx of refugees, jobs are scarce and inconsistent, causing seventy percent of
the population to live under the poverty line. Some examples of everyday jobs in Goma include
vending, loading vehicles, and cleaning compounds. Irregular income causes the majority of
households to struggle to obtain proper nutrition and adequate food. The importance of feeding a
family is superior to educating one (FXB).

18

Educational Attainment
With jobs being inconsistent, it remains difficult for families to pay for students to attend
school when they are still struggling with providing three meals a day (JIPS). The average rate of
education is thirty percent as of 2012 (Slegh, 2012). Of those educated, the percent of men
receiving an education is relatively higher at 58.5 percent leaving women at only 41.5 percent.
Like the homes in Goma, the schools are run down and structurally unstable. In Goma, all
education costs must be paid for by families outofpocket. At the primary level, education can
cost between two and five dollars per year. At the secondary level, yearly costs range closer to
ten dollars (FXB). If families cannot pay for education, the cycle of low education and high
poverty rates continues. Again, food will always take precedence over education due to the
importance of nutrition in order to survive.

Food at Home
The food that goes into one’s body affects their ability to perform and function on all
scales such as simple everyday tasks or exerting energy. As previously mentioned, food is
inconsistent because of the unstable work force and lack of education in Goma. The fear of the
incapability of feeding a family is shown below in Figure 2.2.
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Figure 2.2 (above) shows that the most significant concern for food insecurity are IDPs.
Although all groups of people have trouble feeding their families, 59% of IDPs have frequent
trouble feeding their families (Fig 2.2 mostly and often in combination) in comparison to the
37% of residents with food insecurity.

With seventy percent of the population living in poverty, education rates are very low and
many people are failing to meet adequate nutrition. These two factors are lowering the quality of
life for these individuals. Education will continue to be a secondary concern after food because
one must eat in order to survive. Because displaced people are the most vulnerable to food
insecurity, there is a greater need for a nutritional assistance program in refugee camps and host
families, specifically IDPs. One option could be a program that facilitates teaching IDPs to grow
20

their own food and harvest it. This would create sustainability, adequate food, and lower the
percent of households having trouble satisfying its needs.
References
Babbo Dominique, Martín, Karla Bil, Antonio Isidro Carrión, Corry Kik, Papy Salumu, Annick Lenglet,
and Jatinder Singh. "Mortality Rates above Emergency Threshold in Population Affected by Conflict in
North Kivu, Democratic Republic of Congo, July 2012–April 2013." PLoS Neglected Tropical Diseases.
Public Library of Science.
Retrieved March 14, 2016 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169374/

FXB "Democratic Republic of the Congo FXB English." FXB. N.p.,
Retreived on March 16, 2016 from: https://fxb.org/programs/democraticrepubliccongo/

Knapp Sawyer, Kem. "In FarAway Congo, a Girl's Life Focuses on School and Family." Pulitzer Center.
N.p., 26 Oct. 2013.
Retrieved March 17th, 2016 from:
http://pulitzercenter.org/reporting/africacongoeducationyouthchildrenGomaschoolpublichealth

Slegh, Henny. "Eastern DRC." Gender Relations, Sexual Violence and the Effects (n.d.): n. pag. Save the
Children. June 2012.
Retrieved March 14, 2016 from:
http://resourcecentre.savethechildren.se/sites/default/files/documents/6945.pdf

"The World Fact Book." Central Intelligence Agency. Central Intelligence Agency, 2014.
https://www.cia.gov/library/publications/theworldfactbook/fields/2010.html

World Health Organization. "DRC WHO." English. N.p., Nov. 2012.
Retrived March 16, 2016 from: http://www.who.int/hac/Donor_alert_DRC_27Nov2012.pdf

21

Chapter 3: Physical and Natural
Environment

Understanding the physical and natural environment of a community is vital to
completing a community needs assessment. Public health experts, architects, and others in the
livable communities field are examining the ways in which the built environment can affect
health. Encouraging physical activity, reducing air pollution, and preserving the natural
environment are important for public health (AIA 2015). This chapter will provide details about
the physical and natural environments of Goma from geography, weather, and climate to land
details, air quality, and water resources, while discussing the associated public health
implications.
Physical Environment/Geography
The Democratic Republic of Congo is located in central Africa. The Democratic
Republic of Congo is bordered by the Central African Republic and Sudan to the north, Uganda,
Rwanda, Burundi, and Tanzania to the east, Zambia and Angola to the south, and the Republic of
the Congo to the west. Goma is a city in the eastern Democratic Republic of Congo. It is located
on the northern shore of Lake Kivu, next to the Rwandan city of Gisenyi. The city centre of
Goma is approximately 0.6 miles (1 km) from the Rwandan border, and approximately 2.2 miles
(3.5 km) from the centre of Gisenyi (King and Cole 2008).
22

Goma is the capital of North Kivu province, ethnically and geographically similar to
South Kivu. Goma has many landmarks which include Mount Nyiragongo, Virunga National
Park, Lake Kivu, Kisantu Catholic Cathedral, Zongo Falls, the Congo River and the Goma
International Airport (King and Cole 2008). Goma has five lakeside wharfs, which are level
quayside areas to which a ship may be moored to load and unload. As Figure 3.1 shows, the city
of Goma lies only thirteen to eighteen kilometers due south of the crater of the active
Nyiragongo Volcano. The vast, lowlying central area of Goma is a basinshaped plateau sloping
toward the west and covered by tropical rainforest. This area is surrounded by mountainous
terraces in the west, plateaus merging into savannas in the south and southwest, and dense
grasslands extending beyond the Congo River in the north (King and Cole 2008).

There are major environmental issues in the Democratic Republic of Congo, and
especially in the city of Goma. The mining of minerals, water pollution, deforestation, wildlife
poaching and soil erosion all cause environmental damage, eventually leading to public health
23

concerns. The influx of refugees are responsible for significant deforestation, soil erosion, and
wildlife poaching. In addition, the roads in Goma are in poor repair, and many roads are heavily
damaged from recent volcanic lava flow disasters.  The natural hazards that are present to the
people of Goma are periodic droughts in the south and flooding from the Congo River. Due to
human conflict, Goma’s physical and natural environments are suffering (King and Cole 2008).
Weather and Climate
Goma’s central location on the north bank of Lake Kivu and the northeastern part of the
country dictates much of its weather and climate. The Democratic Republic of Congo lies on the
equator, with onethird of the country to the north and twothirds to the south. The climate is hot
and humid in the river basin and cool and dry in the southern highlands (ClimateData.org 2012).
Goma has a tropical savanna climate or tropical wet and dry climate which corresponds to the
KoppenGeiger climate classification of “Aw” (Snow, 2013).
24

Tropical savanna climate or tropical wet and dry climate is a type of climate that
corresponds to the categories “Aw” and “As.” Figure 3.2 shows the different KoppenGeiger
climate map. The Democratic Republic of Congo is in the lightest shade of blue signifying that
Goma is within the classification of “Aw,” meaning they are a tropical savanna climate or
tropical wet and dry climate.
Goma’s regular weather and climate are full of constant average temperatures, while on
average, Goma gets about five hours of sunshine per day, and twelve hours of daylight per day.
Precipitation is quite evenly spread out over the year with a slightly drier period from June until
August. When compared with winter, the summers have much more rainfall. The average annual
temperature in Goma is 68°F (19.8 °C) (Snow, 2013). On average, the warmest month of the
year is January or February, with average temperatures between 6872°F. October also sees the
maximum average precipitation in this area, with an average of 5.63 inches. The average coolest
month of the year is June or July, with average temperatures between 5966°F (Snow, 2013).
Figure 3.3 below shows the average high and low temperatures and Figure 3.4 shows the average
rainfall for the city of Goma; both figures are the monthly averages throughout the years 2000 to
2012.

25

As Figure 3.5 outlines above, the variation in the precipitation between the driest and
wettest months is 5.67 inches. The variation in annual temperature is around 33.8°F. In addition,
26

the maximum UV Index is around 1011+ and the heat and humidity are, on average, low to
none throughout the year (Sliwski, 2013). Data on average high temperature, daily mean
temperature, average low temperature, average precipitation, average rainy day, and mean daily
sunshine hours appear below.

Land Details
The Democratic Republic of Congo is widely considered to be the richest country
in the world regarding natural resources. Its untapped deposits of raw minerals are estimated to
be worth in excess of US $24 trillion (Tupy, 2015). The geology of Democratic Republic of
Congo consists of many natural and mineral resources. Goma specifically has many natural
resources in and around their inner city. Cobalt, copper, niobium, tantalum, petroleum, industrial
and gem diamonds, gold, silver, zinc, manganese, tin, uranium, coal, hydropower, and timber are
all found throughout Goma and the Democratic Republic of Congo. The Congo no doubt boasts
some of the richest mineral deposits in the world, as the Congo has over 70% of the world’s
coltan, a third of its cobalt, more than 30% of its diamond reserves, and a tenth of its copper
27

(Tupy 2015). Goma in particular is well known for housing the largest resource of tin, as
Congo’s lucrative tin mining industry is centered in the North Kivu province. Congo’s
government is unable to exert much control over tin mining activity; as a result, armed groups
fight over tin ore mines. Much of the area’s tin is then smuggled out of Goma to other countries.
The Democratic Republic of Congo’s mineral wealth and natural resources continues to fuel
longsimmering conflicts across the country, especially in Goma.
Volcanism
Two of Africa’s most active volcanoes are located in the Democratic Republic of Congo.
Nyamuragira is one of the most active volcanoes in Africa. Nyiragongo was the scene of a
natural disaster in 2002 when over 400,000 people were displaced by an eruption (Seach 2015).
Nyiragongo, at an elevation of approximately 11,385 feet, has been experiencing ongoing
activity, posing a major threat to the city of Goma, home to over a million people. The volcano
produces unusually fastmoving lava, having the world’s fastest flowing lava, known to travel up
to, on average, 62 miles per hour (Seach 2015). Nyiragongo has been deemed a “Decade
Volcano” by the International Association of Volcanology and Chemistry of the Earth’s Interior,
worthy of study due to its explosive history and close proximity to the Goma population.
Nyiragongo’s neighbor is the Nyamuragira, another active volcano which last erupted in 2010,
and seen as Africa’s most active volcano. Visoke is another historically active volcano, that is
located on the border between the Democratic Republic of Congo and Rwanda. Figure 3.6 below
shows the lava flow from Mount Nyiragongo toward the city of Goma, and throughout the rest of
the providence. During Mount Nyiragongo’s eruptions, the lava flows move toward and through
the city of Goma to the shores of Lake Kivu. In 2002, the lava flow destroyed 13% of the city
28

and approximately 12,000 to 15,000 homes, displacing hundreds of thousands of people, and the
lava flow entered Lake Kivu and posed a threat of releasing the CO2 and CH4 stored within the
lake. To this day, constant activity, seismic tremors and smaller eruptions continue to threaten
Goma’s population (Cottrell et. al. 2015).

Air Quality
The most significant environmental problem in Goma is the substantial increase in urban
population, in which Goma’s urban centers are hampered by air pollution from vehicle and
29

volcano emissions. The high altitude of the volcanic crater means that the volcano acts like a
huge stack, so that plume emissions get carried away from ground level around the volcano. A
concern about air quality in Goma, particularly in dry weather, is the effect of the dust generated
by traffic driving on roads created after the eruption by bulldozers levelling the rough surface of
the lava flows. Measurements of PM10 concentrations at the roadside (using a DustTrak
analyser) showed rapid rises and falls with vehicle movements, but the effect on the ambient air
was small and lasted only briefly. The background air quality in Goma, as measured in the WHO
office garden, was good (< 50 µg /m3). This was helped by the fresh winds blowing from Lake
Kivu and occasional rainfall, which dampens down dust (Baxter 2002). The Pollution Index of
the Democratic Republic of Congo is 108.05 and the Pollution Exp Scale is 198.17 (Baxter
2002). The Pollution Index is an estimation of the overall pollution in the city. The biggest
weight is given to air pollution, then to water pollution and accessibility two main pollution
factors. Pollution Exp Scale is using an exponential scale to show very high numbers for very
polluted cities, and very low numbers for unpolluted cities. Figures 3.7 3.8 below represents the
pollution, and the purity and cleanliness in Goma. As shown, the air pollution is very high,
among many other pollution aspects throughout the city. The overall air quality in Goma is low
due to many environmental volcanic ash emissions, vehicle emissions and other pollutants and
allergens present.

30

Water Resources and Quality
As a result of ongoing volcanic activity, people are continually affected by hazards such
as acid rain, endemic fluorosis, diarrhea, and other diseases caused by polluted drinking water.
Lava ash and gas emissions from volcanic eruptions make water resources scarce and water
quality very poor. Contaminated food and drinking water in Goma are exacerbated by many
geological features. Lake Kivu is the main, if not only, supply of drinking water, but the
31

sanitation system of the area presents a constant source of potential contamination of the lake
with cholera and shigella organisms which are not rapidly destroyed by the freshwater (Baxter
2002). The eruptions of Nyiragongo’s lava flows into the Lake and other natural water resources
which contributes to the poor quality of water.
REGIDESO, the Goma water company, found rising fluoride levels between
approximately 4.8 ppm to 7.5 ppm. At the lava front the level was approximately 17 ppm. To put
this in perspective, normal tap water is supposed to have anywhere from 0.7 ppm to 1.0 ppm.
Thus, the water quality in Goma poses many threats to the population (Partow 2011).
Figure 3.9 shows the water network that was put in place by the REGIDESO throughout
the city of Goma, in which some of the main water network pumps and locations were destroyed
by lava. The water network across the city continues to be damaged by lava flows. Both of the
main supply pumping stations for the city continue to be out of action because the power
supplies are disrupted by the eruption.

32

Over half of Africa’s surface waters flow through the Democratic Republic of Congo.
Possessing an estimated 52% of Africa’s surface water reserves (rivers, lakes, and wetlands), the
Democratic Republic of Congo is the most waterrich country in Africa (Partow 2011).
Furthermore, the DRC accounts for an estimated 23% of Africa’s internal renewable water
resources. The vast majority of the population depends on springs located in dense forests,
highlighting the importance of the forest ecosystem for services to local community water
supplies. Despite the abundance of surface waters, the majority of the DRC’s population is
dependent on groundwater and springs as sources of safe drinking water. Groundwater is
estimated to comprise almost 47% of the DRC’s internal renewable water resources (Partow
2011).
The United Nations Environment Programme continues to assess the overall
Environmental Assessment of the Democratic Republic of Congo. There are many key drinking
water challenges by subsectors of urban versus rural areas. Despite its immense freshwater
resources, the overriding challenge for the DRC water sector is to improve its rapidly growing
population’s low access to safe drinking water. Based on the most recent estimates (2010), only
around 26% of the DRC’s population of 67.8 million – equivalent to 17.6 million people – have
access to safe drinking water, well below the approximately 60% average for Sub Saharan
Africa. This means that almost 51 million people do not have access to potable water in the
country of DRC today (Baxter 2012). In regards to emergency health measures, this includes the
provision of chlorinated water along evacuation routes and in refuge areas, and adequate medical
cover for the treatment of cholera and other diseases.
33

Figure 3.10 shows the evolution and prospects for safe drinking water coverage in the
DRC. Until recently, the deteriorated state of the country’s water infrastructure and rapidly
growing population (estimated at 3%) meant that water coverage was on a negative and declining
trend as shown in Figures 3.11 of rural areas versus urban areas. Urban centers have a larger
percentage of population with safe drinking water access, whereas rural centers have a
significantly lower percentage of the population with safe drinking water.

34

Goma’s dilapidated and badly damaged water system simply cannot provide enough
water for the city’s inhabitants and increasing population. A lot of smallscale projects in the
community (NGOs or government programs) and communitybased water supply systems have
been trying to bridge the gap between urban and rural access to safe, clean, drinking water, but it
is not enough. The most endangered water source areas include springs, wellheads, river intake
zones, lakes and reservoir segments. The water sector is on the brink of undergoing fundamental
reforms driven by numerous factors. Highlevel political commitment and donor support have
reinvigorated the sector, but poor construction and maintenance in Goma prevent water resources
and qualities from improving over time.

35

When developing public health programs and interventions in Goma, Democratic
Republic of Congo, the unique physical and natural environment characteristics of the area are a
vital part to be considered. It is critical that public health officials have a complete understanding
of the impact that the Nyiragongo Volcano has on the overall population’s health from air and
water quality to temperatures and climate patterns. The effect that the environmental factors play
adds to the uncertainty of future public health interventions. From physical and natural factors
that pose numerous challenges, public health officials can use these to their advantage for many
intervention opportunities. The DRC’s abundant water resources are a major asset for public
health officials and for national development that can solve many future health related problems.
Additionally, land use and the need for continuous water and air quality are vital to the health of
the Goma community. To establish and improve the overall health of Goma and the Democratic
Republic of Congo, prompt and appropriate actions and intervention management needs to be
carefully thought out when engaging in relief efforts in the rapidly changing physical and natural
environments of the city.

Resources
"About The AIAPrograms & Initiatives." AIA RSS. 5 Aug. 2015.
Retrieved on May 17, 2016 from: http://www.aia.org/about/initiatives/AIAS075431

Baxter, Peter. "Human Health and Vulnerability in the Nyiragongo Volcano Crisis." World Health
Organization. 1 Jan. 2002.
Retreived on May 16, 2016 from: http://apps.who.int/disasters/repo/7828.pdf

"Climate: Goma." Climate Graph, Temperature Graph, Climate Table. 3 July 2012.
Retrieved on May 17, 2016 from: http://en.climatedata.org/location/1074/

36

Cottrell Liz, Sally Sennert, and Ben Andrews. "Global Volcanism Program | Visoke." Global Volcanism
Program | Visoke. 23 Oct. 2015.
Retrieved on May 16, 2016 from: http://volcano.si.edu/volcano.cfm?vn=223050

King, Angela, and Brad Cole. "Democratic Republic of the Congo Map Democratic Republic of the
Congo Satellite Image." Geoscience News and Information. 2 Feb. 2008.
http://geology.com/world/democraticrepublicofthecongosatelliteimage.shtml

Partow, Hassan. "Water Issues in the Democratic Republic of the Congo." United Nations Environment
Programme. 17 Feb. 2011.
Retrived on May 17, 2016: http://postconflict.unep.ch/publications/UNEP_DRC_water.pdf

Seach, John. "Volcano Live." Visoke Volcano, Democratic Republic of Congo / Rwanda. 8 Dec. 2015.
Retrieved on May 17, 2016 from: http://www.volcanolive.com/visoke.html

Sliwski, John. "Goma Climate Info | What’s the Weather like in Goma, the Democratic Republic of the
Congo." 18 Aug. 2014.
http://www.whatstheweatherlike.org/democraticrepublicofthecongo/goma.htm

Snow, Jillian. "Goma Monthly Climate Average, Democratic Republic of Congo." World Weather Online.
4 Jan. 2013.
http://us.worldweatheronline.com/gomaweatheraverages/nordkivu/cd.aspx

Tupy, Marian. "Rule of Law and the Future of the Congo Harvard International Review." Harvard
International Review. 25 Nov. 2015.
Retrieved on May 16, 2016: http://hir.harvard.edu/rulelawfuturecongo/

37

Chapter 4 : General Economic &
Labor Force

Health problems result from a complex interplay of a number of forces. An individual’s
healthrelated behaviors, surrounding physical environments, and health care (both access and
quality), all contribute significantly to how long and how well we live. However, none of these
factors are as important to population health as the social and economic environments in which
we live, learn, work, and play (Bernstein, 2009). The economy shapes the complex interactions
among employment, health coverage and costs, and financial access to care and health outcomes.
The effects of economic stress can play a dominant role in health care and population health. A
person’s health is a product of their education, financial resources, and social status. Economic
factors affect the use of health services and health outcomes, so the interactions among access,
healthrelated behavior, and use of health services can be difficult to define (Bernstein, 2009).
Included in this section is a description of Goma’s economic and labor conditions. This
discussion includes the city’s employment statistics, labor force, income, cost of living, expected
job growth, and expected economic development.

38

Employment Rates & Labor Force
The unemployment rate in the Democratic Republic of Congo and other countries is
defined as the number of unemployed people as percent of the labor force. The labor force
includes the people who are either employed or unemployed, i.e. who don’t have a job but are
actively looking for one. The labor force does not include people who are not looking for work,
children, and the retired (Trading Economics, 2016). As Figure 4.1 shows, the unemployment
rate as of the latest data (2013), is 46.1%.

Due to weak institutional framework, informal urbanization and high contested
economic, social and political urban areas, an international humanitarian presence has become a
significant factor in reinforcing economic patterns. The result of informal jobs and years of
mismanagement, corruption and war, the economy of Goma continues to suffer. Unemployment
rates in the Congo decreased to 46.10% in 2013 from 49.10% in 2012. Unemployment rates in
Congo averaged 52.07% from 1999 until 2013, reaching an all time high of 66.90% in 2000 and
a record low of 45.40% in 2004 (Trading Economics, 2016).
39

In 2014, the Democratic Republic of Congo made a moderate advancement in efforts to
eliminate the worst forms of child labor. The Government took steps to implement a UNbacked
action plan to end the recruitment and use of child soldiers, however, children in the Congo
continue to engage in child labor, including domestic work in the worst forms, such as forced
mining of gold and other minerals. As shown in Figures 4.2, 73.0% of employment throughout
the Democratic Republic of Congo is agriculture and fishing, while education and health are
4.2%. The employment opportunities in the Congo do not give much room for stability and
employment security.

40

The GDP is $68.691 billion, as of 2015 and the GDP growth of the Democratic Republic
of Congo is 9% in 2015, continuing to increase each year. As Figure 4.3 shows the GDP by
Economic Activity Branch, agriculture is tied with manufacturing at approximately 27% of the
GDP. Unemployment is high among men and women throughout Goma because of informal
with work being the most common source of income. This includes agriculturebased activities
and informal selling. The effects of poverty and unemployment most definitely affect the people
of Goma and the overall health of the population.
Employment and Major Industries
Integrating into the urban landscape, the humanitarian sector has contributed to various
processes of transformation in Goma. While create new opportunities, their presence has
reinforced patterns of conflict and competition over the urban political and socioeconomic space
(Buscher and Vlassenroot, 2013). The growth of the humanitarian presence in Goma has led to a
high demand for housing, shopping malls, private cars and other amenities. Due to the influx of
humanitarian agencies, total urbanization has created jobs for locals in Goma. Although waves of
conflict over the past two decades had led to the presence of some 500 aid agencies, around 100
of them are international; the rest depend largely on foreign funding. In 2012, the United Nations
and its partners appealed for $718 million to meet humanitarian needs in the Congo, much of it
for programs in the east (IRIN, 2013). The growing rates of average economic growth is driven
by robust extractive industries and related investments despite the global economic slowdown
and the decline in the demand and price for minerals exported by the DRC. Public investments
have also helped spur growth (World Bank, 2016).
41

There are numerous main primary products throughout the Democratic Republic of
Congo that influences the employment and major industries in Goma: bananas, cobalt, coffee,
cotton, ground nuts, maize, cassava, cocoa, copper, diamonds, gold, plantains, palm oil and
kernels, rubber, sugarcane, and tea. In addition to the main primary products that influence
employment in the DRC and Goma, there are major industries and companies that do as well.
The major industries that are in the Democratic Republic of Congo that directly impacts the local
economy in Goma include: Agriculture, Clothing, Foodstuffs, Forestry, Mining, Oil Refining,
and Textiles (Clarke, 2011).
In Table 4.4, it shows the major industries and the companies that employ people in the
Democratic Republic of Congo. There are numerous industries that employ people in the Congo,
but these large companies employ people in major cities such as Kinshasa, the capital and largest
city of the Democratic Republic of Congo; not rural communities that are in need of the
employment.

42

INDUSTRY EMPLOYERS / COMPANIES
Agriculture Feronia Inc.
Airlines Air Kasai, Air Tropiques, Compagnie Africaine d’Aviation, Congo
Express, FlyCongo, Malift Air, Wimbi Dira Airways, Free Airlines,
Korongo Airlines
Banks Central Bank of the Congo, Commercial Bank of Congo, RawBank, Trust
Merchant Bank
Energy Cohydro, Societe nationale d’electricite
Forestry Sodefor
Media Groupe L’Avenir
Mining Camrose Resources, Mwana Africa, Societe Generale de Belgique
Transportation Congo Railway, Office National des Transports
Telecommunications Radio Television Groupe Avenir, Supercell (mobile network), Orange RDC
Textiles TEXAF
Utilities Regideso

Lastly, it is notable that the Democratic Republic of Congo has many main trading
partners that continues to influence employment, economic development and major industries.
The Democratic Republic of Congo’s main trading partners are Belgium, Luxembourg, France,
the United States of America, Canada, Germany, the Netherlands, Japan, and the United
Kingdom (Clarke, 2011). As Figure 4.5 shows the diagrammatic map of the transport system in
the Democratic Republic of Congo, waterways, railways, paved highways, most gravel
43

highways, and main tracks were influential on trading partners with other countries. Ground
transport has always been difficult especially in Goma since it is quite a large city, with not
enough resources.
Furthermore, the DRC has thousands of kilometers of navigable waterways, and
traditionally water transport has been dominant means of moving around approximately
twothirds of the country (Clarke, 2011). Many of the routes listed in Figure 4.5 are in poor
condition and can only operate at only a fraction of their original capacity. The First and Second
Congo Wars caused great destruction of transport infrastructure from which the country has not
yet recovered. A major infrastructure program was implemented in 2007, as China agreed to lend
the Democratic Republic of Congo $5 billion for two major transport infrastructure projects to
link a major mineralrich railway to an ocean port, and then a road to the river port, improving its
links to the transport network of Southern Africa in Zambia (Duncan, 2007). Overall, the terrain
and climate of the Congo Basin present serious barriers to road and rail construction, and the
distances are enormous across the vast country.

44

Income and Economic Development
The monthly average incoming in Luxembourg is more than 18 times the annual average
salary in the Democratic Republic of Congo. That is how huge the gap is between the richest and
the poorest. The number one country with the lowest household average salary according to The
World Bank, the Democratic Republic of Congo’s average household average salary is $422
(Said, 2013). This is with the correct amount of data, since more than half of the population is
45

not formally employed, so the average data is not an accurate “average.” The result of informal
jobs and years of mismanagement has caused the average annual salary in Goma to continue to
suffer.
Despite its rich resources, the Democratic Republic of the Congo has battled violence,
poverty, and systematic corruption after gaining its independence from Belgium in 1960.
Congo’s economy is growing at a relatively rapid clip of 6% to 7% a year as it recovers from
years of internal conflict over the nation’s substantial resources including tin, ore, and
diamonds. Congo occupies the final spot on the IMF’s list of per capita gross domestic
production, with a total production of just $231 per person. Much of the nation’s economic
activity takes place in the informal sector, and is not counted in official GDP estimates. In
addition, prospects for local economic development are limited due to restricted marketability as
a consequence of the poor infrastructure and because of lack of access to credit as well as lack of
mastery of skills and access to tools (Said, 2013). After an economic slump in 2009 that brought
the growth rate down to 2.8% due to the global financial crisis, the DRC posted an annual
average economic growth rate of 7.7% during the 20102014 period, well above the average in
SubSaharan Africa. (World Bank, 2016).

While the unemployment rate is at 46.1%, the recent job growth has been positive, as the
Congo’s economy continues to grow at a relatively rapid rate of 6% to 7% per year as it recovers
from years of internal conflict over the nation’s substantial resources (well above the average in
SubSaharan Africa). In order for the Democratic Republic of Congo, specifically Goma’s
46

economy to build, expand, and grow, the people must continue to have a vision for economic
vitality. Even though it can be hard to have a vision of economic growth, the economy must
provide entry points and opportunities for diverse types of workers to participate in. In addition,
working with leaders, officials, NGO’s and other humanitarian agencies can facilitate
opportunities for increasing collaboration between Goma, its cities, rural communities, and
health organizations to support economic strategies that promote economic growth of the entire
country.
Something to note is that statistic and data indicate that the most of the economic growth
that occurs throughout the country comes from major employers and industries that employ
people in major cities. With this in mind, there are no larger employers and companies in smaller
cities and rural communities such as Goma to promote local businesses in order to ensure their
longterm growth across the entire country. In the end, this will help not only the economic and
business sector within the country, but the overall health and wellbeing of the citizens of Goma
as well.
References

Bernstein, Jill. "Impact of the Economy on Health Care." Academy Health. 1 Aug. 2009.
Retfrieved on May 15, 2017 from: https://www.academyhealth.org/files/HCFO/findings0809.pdf

Buscher, Karen, and Koen Vlassenroot. "The Humanitarian Industry and Urban Change in Goma."
OpenDemocracy. 21 Mar. 2013.
https://www.opendemocracy.net/opensecurity/karenb%C3%BCscherkoenvlassenroot/humanitarianind
ustryandurbanchangeingoma

Clarke, Latimer. "Democratic Republic of the Congo Atlapedia® Online." Democratic Republic of the
Congo Atlapedia® Online. 3 Apr. 2011.
Retreived on May 16, 2016 from: http://www.atlapedia.com/online/countries/DemRepCongo.htm

IRIN. "Goma's Aid Economy a Blessing and Curse."  11 Sept. 2013.
47

http://www.irinnews.org/news/2013/09/11/goma%E2%80%99saideconomyblessingandcurse

Said, Sammy. "Countries with the Lowest Household Average Salary." The Richest Countries with the
Lowest Household Average Salary Comments. 24 Sept. 2013.
Retrieved May 16, 2016 from:
http://www.therichest.com/business/economy/countrieswiththelowesthouseholdaveragesalary/?view
=all

"Trading Economics: Republic of the Congo Unemployment Rate | 20102016 | Data | Chart." Republic
of the Congo Unemployment Rate | 20102016 | Data | Chart. 4 Mar. 2010.
Retreived on May 16, 2017 from: http://www.tradingeconomics.com/congo/unemploymentrate

"World Bank: Democratic Republic of Congo Overview." Democratic Republic of Congo Overview. 8
Apr. 2016.
Retrieved on May 16, 2016 from: http://www.worldbank.org/en/country/drc/overview

"World Data Atlas: World Development Indicators, Democratic Republic of the Congo Unemployment
Rate." Knoema. 3 Oct. 2015.
Retreived on May 16, 2016 from: http://data.worldbank.org/country/congodemrep

Duncan, Blake. "Transport in the Democratic Republic of the Congo." CongoForum.
Retrieved on May 16, 2016: from:http://www.congoforum.be/en/congodetail.asp?subitem=17

48

Chapter 5: Government and Politics
Understanding the history and evolution of government structures and systems of politics
of an area allows us to identify the roots to some of the public health concerns in that particular
area. It allows us to understand how certain public health interventions may be received or how
best to implement them. Also, in many areas of the world, the government is heavily involved in
the allocation and distribution of resources to the citizens. Therefore, it is important to know the
historic relationship between the government and public health because this allows us to see how
best the government can support its citizens through interventions.

Precolonial and Colonial Governance
What is now as the Democratic Republic of Congo (DRC) was previously known as the
Kingdom of Kongo during the precolonial era. As shown in Figure 5.1, the Kingdom of Kongo
was made up of what are now D.R.C and some parts of Gabon and Angola, which are
neighboring countries. This Kingdom operated as a monarchy from the 1300s to the early 1900s
(Africa Federation). The structure of the Kingdom was based on the King having all the power
and a group of elders who helped the king make decisions.

49

The coming of European missionaries and explorers brought various changes in the
communities. The introduction of new religions, beliefs and new government structures. The late
1800s, came King Leopold II of Belgium who used humanitarian and missionary work to claim
many parts of the Kingdom of Kongo (Hochschild). King Leopold II is responsible for what is
known as the genocide of the Congolese, which is not formally listed as a genocide under the
Humanitarian Intervention Acts. Leopold II used forced labor policies on indigenous people in
order to collect raw materials such as rubber and ivory. Indigenous people were mistreated if
they did not meet the required or expected labor outcome through beatings, mutilations and
50

many times death. King Leopold II is responsible for approximately 1 to 15 million indigenous
Congolese during his expansion. Indigenous Congolese people were exposed to hazardous
conditions when working in mines owned by King Leopold II and his officials (Hochschild).
Many diseases, infections and numerous deaths were a result of the health conditions of millions
of Congolese being undermined by this government structure.

After many years of ruling, King Leopold II ceased to have power after the Scramble of
Afrika between 188485. From 1908 Belgium became the formal colonizer of the Kingdom of
Kongo (World History). Similar to the rule of King Leopold II, the health of indigenous people
51

was still not a priority to the Belgian government. Additionally, the coming of Europeans,
brought various new diseases into D.R.C. Diseases that the Africans were not resistant to thus
killing millions of them. Furthermore, under the colonial rule, majority of healthcare services
offered were under missionaries. This attachment of healthcare to missionary work limited the
access Congolese had to healthcare resources. Even today, majority of the health care services
are owned by either missionaries or NGOs, which are located mainly in the capital city; Kinshasa
thus most people living in less urban areas are disadvantaged.
The Democratic Republic of Congo became an independent state in 1960 like many
subsaharan countries. The first elected prime minister of the Congo is a well known
PanAfrikan, Patrice Lumumba (Cordell). Lumumba was heavily involved in the fight for the
Congo to gain independence and was a part of the Mouvement National Congolais
(Cordell). Unfortunately, within twelve weeks after independence, Lumumba was imprisoned
and assassinated.
52

The assassination of Lumumba is known as one of the most significant assassinations of
the 20th century due to the presumed influence and response of the United States and the United
Nations, who have continued to have a lot of influence in the politics and governance of the
Democratic Republic of Congo (NzongolaNtalaja 2011).

The Congo Wars and Politics
The Democratic Republic of Congo’s politics today have very strong roots in the politics
of the governments during the different wars that have occurred in the past. The Congo Crisis
followed the death of Patrice Lumumba in 1960 until 1966 (The Office of the Historian). The
end of this war led to the the election of Mobutu Sese Seko as president.

Mobutu Sese Seko was involved in the military that fought during the Congo crisis. He is
also responsible for changing the name of the country to Zaire. He was in power for 31 years and
53

during this time he institutionalized corruption (Britannica). Additionally, during Mobutu’s
presidency, the corruption led to any economic collapse that affected the country for a long time
(Gettleman 1997). This corruption affected the healthcare sector because it reduced the money
going into healthcare from the national budget and influenced the allocation of resources across
the country as well as who was able to access and afford good healthcare.
The First Congo war from 19961997 led to the end of Mobutu Sese Seko’s reign and the
name was changed from Zaire to the Democratic Republic of Congo (French). The Second
Congo War occurred from 1998 2003 and is known as Afrika’s deadliest war as it involved
numerous Afrikan countries (World Without Genocide). These wars were also heavily fueled by
the politics that were occurring in neighboring country Rwanda during the 1994 genocide.

21st Century Democratic Republic of Congo Politics
In 2001, current president, H.E. Joseph Kabila
became president. In 2004, H.E. Kabila introduced the
International Criminal Court into D.R.C (CIA World
Fact Book). This was seen as a progressive move
because he showed his passion for justice and fixing the
politics witht the wars that were occurring at that time
especially since there was the issue of a certain
population of genocidaires in the Congo. In 2006, H.E.
Joseph Kabila ran for a second term and these were the
first free elections in the Democratic Republic of Congo (CIA World Fact Book).

54

After the 2006 elections, D.R.C became a stable presidential democratic republic (CIA
World Fact Book). At this time, the government had established a bicameral legislature with a
senate board and National Assembly (CIA World Fact Book). The government of D.R.C is
currently a Republic. The legal system used today is based upon the the civil law developed by
the Belgians during the colonial era.

Politics of Goma in Democratic Republic of Congo
Goma being at the border of Rwanda had a large population of refugees coming into the
country seeking refuge. Currently, Goma’s internal conflicts are influenced by the high number
of rebel groups in the area. The eastern province where Goma is located has highest numbers of
members of the M23, a local rebel group (BBC).

Effects of 1994 Genocide Against Tutsi on Health
After the 1994 genocide against Tutsi in Rwanda, many Rwandans sought refuge in
Goma, D.R.C. This increased the population of Goma and increased the need and demand for
55

healthcare resources. However, the government was unable to meet the high demand of
resources. For example, with the increased population, there was still the same number of
hospitals and healthcare centers tending to almost three times more people.
Some Rwandan women who had come into Goma had been sexually abused during the
war thus being infected with HIV/AIDS and many came pregnant with their unborn child also
having high chances of being born with HIV/AIDS. In the refugee camps, there was a high
prevalence of sexual violence from either local people or the officials. This led to even more
people being exposed to HIV/AIDS thus an increase in HIV/AIDS and increase mental health
issues stemming from trauma. Living in refugee camps made it easy for diseases to spread
because of the high number of people living in the area. The number of diarrhoeal diseases
increased because of lack of resources to cater to the number of people present.

Considering the power and influence of the government in allocating resources,
understanding the history and structure of the government should be primary to public health
practitioners. From the colonial times to when D.R.C was named an independent state, the
structures of government have influenced the health sector tremendously. From the hazardous
working conditions that exposed Congolese to different health threats to the new diseases
exported by the European colonizers to the corruption in the healthcare system that limited
access; the health of Congolese at large and especially in Goma has continued to show much
need for improvement. Goma’s health sector in particular was affected by the 1994 Rwandan
genocide and its effects continue to show today. The prevalence of HIV/AIDS, high rates of
56

sexual violence and the high rates of mental health issues can be attributed to the immigration of
Rwandan refugees in Goma.

References
BBC News."DR Congo Soldiers and M23 Rebels Clash near Goma."  N.p., n.d. Web. 17 May 2016.
Retrieved on March 16, 2016 from: http://www.bbc.com/news/worldafrica24675814

The Editors of Encyclopædia Britannica. "Mobutu Sese Seko." Encyclopedia Britannica Online.
Encyclopedia Britannica, July 2014.
Retrieved on March 16, 2016 from: http://www.britannica.com/biography/MobutuSeseSeko

The Congo, Decolonization, and the Cold War, 1960–1965." US Dept. of State. N.p., n.d. Web. 17 May
2016.
Retrieved on March 17, 2016 from: https://history.state.gov/milestones/19611968/congodecolonization

Cordell, Dennis D. "Patrice Lumumba." Encyclopedia Britannica Online. Encyclopedia Britannica, Oct.
2015.
Received on March 17, 2016 from:  http://www.britannica.com/biography/PatriceLumumba

"THE DEMOCRATIC REPUBLIC OF CONGO." THE DEMOCRATIC REPUBLIC OF CONGO. N.p.
http://www.historyworld.net/wrldhis/PlainTextHistories.asp?ParagraphID=ozo

"Forgotten History: King Leopold and The Congo Global Black History." Global Black History. N.p.,
29 Feb. 2012.
Retrieved on March 16 from:
http://www.globalblackhistory.com/2012/02/forgottenhistorykingleopoldand.html

French, Howard. "Mobutu's 32Year Reign." NY Times. N.p., n.d. Web. 17 May 2016.
Retreived on March 16, 2016 from:
https://partners.nytimes.com/library/world/africa/051797zairemobutu.html

Gettleman, Jeffrey. "The World’s Worst War." The New York Times. The New York Times, 15 Dec.
2012.
Retrieved on March 16, 2016 from:
http://www.nytimes.com/2012/12/16/sundayreview/congosneverendingwar.html?_r=0

"History Kingdom of Kongo." Federation of the Free States of Africa. N.p.,
Retrived on March 16, 22106 from: http://www.africafederation.net/Kongo_History.htm

Hochschild, Adam. "Leopold II." Encyclopedia Britannica Online. Encyclopedia Britannica, Mar. 2016.
57

http://www.britannica.com/biography/LeopoldIIkingofBelgiumhttp://www.walkingbutterfly.com/2010
/12/22/whenyoukilltenmillionafricansyouarentcalledhitler/

NzongolaNtalaja, Georges. "Patrice Lumumba." The Guardian. Guardian News and Media, 17 Jan. 2011.
http://www.theguardian.com/globaldevelopment/povertymatters/2011/jan/17/patricelumumba50thann
iversaryassassination

World Fact Book. "DRC." N.p., n.d. Web. 17 May 2016.
http://www.ciaworldfactbook.us/africa/democraticrepublicofthecongo.html

World Without Genocide."Democratic Republic of the Congo « World Without Genocide Working to
Create a World Without Genocide." N.p.,
Retrieved on March 16, 2016 from: http://worldwithoutgenocide.org/genocidesandconflicts/congo

58

Part II: Community Health
Analysis

59

Chapter 6: Community Resources

Goma does not offer a wide variety of community resources, especially after the
destruction caused by volcanic eruption.  The resources that are available are important for
supporting the health and social needs of the community.  This chapter identifies the community
resources available within Goma, DRC.  More specifically, information regarding hospitals, food
providers, community centers, schools, and churches in Goma will be discussed.

Hospitals

Goma has several general
hospitals and health clinics.  One that is
particularly important to note is the
HEAL Africa Hospital, which is
discussed in detail in Chapter 12; there
is one maternity center and one
psychiatric center within the city.

60

Grocery Stores

Inside the city limits of Goma itself,
there is only one supermarket and one butcher
shop. However, there are two nearby
supermarkets across the border in Rwanda.

Community Center
Goma has one prominent community center:
Centre Culturel de Goma Maison des Jeunes. It is a
youth performance venue that provides music
production, lessons, and instruction to the
community. The group has a social media presence
through Facebook.

61

Schools
Goma lacks public libraries, but has
several schools ranging from preschool and
primary education to three colleges within the
city, as well as a neighboring university in
Rwanda.  Several of the schools for younger
children are run by churches and religious
organizations.

Religious Resources
Goma is home to several Christian
churches.  These churches represent different
sects of Christianity, including Catholic,
Protestant, Baptist, and several unspecified
denominations.  There is one nearby mosque in
Rwanda, but none within Goma.  There are no
synagogues.

62

Goma’s relative lack of community resources, especially functioning hospitals, is a
public health concern. By improving these resources and rebuilding what was damaged by the
volcanic eruption, Goma can optimize resources to support individuals within the community,
especially those who were physically, socially, and psychologically affected by the Rwandan
genocide and the Congo Wars.
The religious resources within Goma provide a strong Christian presence to unify the
community. The musical youth house provides young citizens with mentorship and social
support. Overall, however, Goma lacks a solid foundation of community development.

63

Chapter 7: Behavioral Health

Behavioral patterns within a community heavily influence the overall health of the
population. This chapter will focus on behaviors and circumstances that affect Goma’s public
health, specifically in regards to posttraumatic stress disorder, depression, and sexual violence
as results of the refugee crisis and the internal political conflicts of the DRC. Suicide is a
preventable health disorder largely caused by this PTSD, depression, and anxiety.

Mental Health
The psychological impact of the Rwandan Genocide, refugee crisis, and Congo Wars was
grave. Witnessing and/or experiencing rape, sexual violence, displacement, kidnapping, death,
and murder led to high rates of posttraumatic stress disorder, depression, and anxiety. According
to Alexa Hassink, “Approximately 70 percent of men and 80 percent of women reported at least
one traumatic event due to the conflict, including being displaced, being injured, having family
members injured or killed, or being forced to have sex” (Hassink, 2014).
Suicidal thoughts and behaviors became prevalent as a result of these traumas, and Goma
lacks the psychological resources to treat mental health disorders, especially those that are not
immediately lifethreatening. Since mental health disorders cannot be physically seen, they are
often overlooked or intentionally ignored. Most carers of the mentally ill consult their local
church leaders, rather than licensed or certified medical professionals. With few other
64

alternatives in a region already lacking even the most basic health infrastructure, exorcisms are
keenly sought after. It doesn’t help that many of these traditional health practitioners believe that
mental and physical disorders are the result of witchcraft or demonic possessions, and thus use
highly orthodox methods to cure the illness or extract what some believe are demons (Hassink,
2014).

Sexual Violence and Substance Abuse
Sexual violence in Goma is prevalent, and relates to depression and issues of masculinity
within the male population. Many men were displaced and unemployed as a result of the
Genocide and the Congo Wars, and their resulting economic upheaval. They are unable to
provide for their families, and sink into depression based on feelings of inadequacy and reduced
masculinity. “Men tended to cope with vulnerability, extreme stress, and trauma through alcohol
and substance abuse and often through continued violence” (Hassink 2014). Feelings of a loss of
manhood also stem from injuries sustained during conflict. Systematic rape and unleashed sexual
brutality against females is used by soldiers and other combatants as a weapon of war and has
become known as the “war within the war” (Baelani and Dunser 2011).

Mental illness is an easily overlooked but very grave epidemic in Goma. Depression and
suicide as triggered by PTSD, anxiety, and loss of self lead to countless invisible public health
concerns. The repeated catastrophes Goma has endured have been detrimental to the
population’s mental health. More mental health resources are necessary for the population to lift
65

itself out of the damage caused by war and trauma.

References
Baelani, Inipavudu, and Martin Dünser. "Facing Medical Care Problems of Victims of Sexual Violence in
Goma/Eastern Democratic Republic of the Congo." Conflict and Health. BioMed Central, 6 Mar. 2011.
Retrieved May 16, 2016 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059296/>

Hassink, Alexa. "Finding Peace for Men in the DRC." Alliance for Peacebuilding. N.p., 2014. Web.
http://buildingpeaceforum.com/2014/03/findingpeaceformeninthedrc/

66

Chapter 8: Vital Statistics and Disease
Burden

This chapter on Vital Statistics and Disease burden covers statistics on birth rate,
mortality rate and the prevalence of different health issues such as Cholera, HIV/AIDS and
Malaria in Goma, DRC. By analyzing, studying and recording data, we help public health
practitioners and donors to identify the major issues that a community faces. The statistics also
help in identifying what health issues have continued to grow and become more threats in the
community and what issues have declined. This in turn helps to understand how to better provide
health care and allocate resources in order to tend to the needs of as many people as possibly.

Birth Rates
The birth rate of a place is the number of children born in a year calculated per 1000
people estimated halfway through the year. This is called the crude birth rate. The birth rate of
the Democratic Republic of Congo has been affected by various factors such as the Congo wars,
the 1994 genocide and the volcanic eruption. Figure 8.1 shows the trends of birth rates in D.R.C.
Overall, from 2000 2014, the birth rate has decreased from 46.44 to 42.26.

67

Death Rate
The birth rate is the number of deaths that occur in a year per 1000 people estimate mid
year. Similar to the birth rates, the death rates in D.R.C have been and continue to be influenced
by the Congo wars, 199e Rwandan genocide, the volcanic eruptions and the prevalence of
different diseases. After the 1994 Rwandan genocide, there was an increase in death rates to 5 to
8 per 10,000 per day by the second month of the crisis (NCBI). Figure 8.2 illustrates the overall
death rates of the country due to all causes (Index Mundi 2015).
68

Infant Mortality Rate

69

Infant mortality is the number of deaths in children under the age of one year old
calculated per 1,000 live births, and is estimated midyear. In 2009, the infant mortality rate as
recorded per 1,000 live births was 126 (NCBI). Figure 8.3 illustrates the infant mortality rate of
the DRC, which over the span of 14 years has decreased.
Maternal Mortality Rate
Maternal Mortality Rate is the number of deaths of mothers as calculated per 100,000
live births. In 2008, the maternal mortality ratio (per 100,000 live births was recorded as 670
(NCBI). In 2015, the maternal mortality rate had fallen significantly to 442 (Global Health
Observatory). Figure 8.4 illustrates the linear decrease of MMR in DRC from 20082010.

70

Disease Burden
There are various diseases prevalent in Goma, DRC. The World Health Organization in
its case study of the Democratic Republic of Congo, indicates that cases of diarrheal diseases,
hemorrhagic fevers, acute respiratory infections, polio and meningitis were also reported. Almost
97% of the population are exposed to malaria. More than 6.16 million cases were reported in
2011 and 12 680 deaths (World Health Organization 2012). Figure 8.5 shows the biggest threats
in this community and percentage of people it is affecting. Diarrhoeal diseases are the diseases
most affecting the community, affecting 12% of the community, malaria at 7% and HIV/AIDS at
3%.

Measles
As investigated by the World Health Organization, the measles vaccine coverage varies
from 10% to 97% depending on the zone, with a national coverage estimated at 64% and
71

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