A2 · Elementary
10 min
public healthhumanitarian crisisarmed conflictglobal health security
Health in War: Congo and the Invisible Cost
La Salud en la Guerra: El Congo y el Costo Invisible
Rebel ADF forces killed 87 civilians in Congo's Ituri Province last month. We talk about health, violence, and the collapse of medical systems in conflict zones.
Las fuerzas rebeldes ADF mataron a 87 civiles en la provincia de Ituri, en el Congo, el mes pasado. Hablamos de la salud, la violencia y el colapso de los sistemas médicos en zonas de conflicto.
8 essential A2-level terms from this episode, with translations and example sentences in Spanish.
| Spanish | English | Example |
|---|---|---|
| herido | wounded / injured | El soldado está herido. |
| enfermo | sick / ill | El niño está muy enfermo. |
| huir | to flee / to run away | Muchas personas huyen de sus casas. |
| peligroso | dangerous | El ébola es muy peligroso. |
| valiente | brave / courageous | Los médicos son muy valientes. |
| vacuna | vaccine | La gente no tiene vacunas. |
| enfermedad | illness / disease | Una enfermedad nueva puede viajar por todo el mundo. |
| frontera | border | Las enfermedades no tienen fronteras. |
I've been sitting with a number this week.
Eighty-seven.
That's how many civilians the United Nations says were killed last month in Ituri Province in the Democratic Republic of Congo, by a rebel group called the Allied Democratic Forces.
Eighty-seven people in a region most people couldn't find on a map, killed in a month, and the news cycle barely blinked.
Sí.
Yes.
El Congo tiene muchos problemas.
Congo has many problems.
La violencia es muy antigua allí.
The violence there is very old.
Ancient is the right word.
And I want to get into all of that.
But I want to start somewhere that might seem like a detour: health.
Because when you dig into this story, the violence and the health crisis in Ituri aren't separate things.
They're the same thing.
Claro.
Of course.
Cuando hay guerra, la salud es muy mala.
When there is war, health is very bad.
Los hospitales no funcionan.
Hospitals don't work.
Walk me through who the ADF actually are, because I think most listeners are hearing this name for the first time.
Las ADF son rebeldes.
The ADF are rebels.
Vienen de Uganda, pero están en el Congo.
They come from Uganda, but they are in Congo.
Right, and that backstory matters.
The ADF, the Allied Democratic Forces, started in Uganda in the 1990s as a militant Islamist group trying to overthrow President Museveni.
They got pushed out, crossed into eastern Congo, and they've been there for thirty years now, operating in some of the densest jungle on earth.
Sí.
Yes.
Y en esos años, matan a muchas personas.
And in those years, they kill many people.
Muchos civiles.
Many civilians.
The UN estimates somewhere north of six thousand civilians killed by the ADF in the last decade alone.
And Ituri Province is particularly brutal ground.
You've got the ADF, you've got other armed groups, and you've got a Congolese army that doesn't have the resources to hold territory.
La gente tiene mucho miedo.
People are very scared.
Muchas personas huyen de sus casas.
Many people flee their homes.
And that flight from home is where the health story really begins.
Because the moment people are displaced, their health falls apart fast.
Clean water, sanitation, medicine, the basic infrastructure of staying alive.
All of it goes when you have to run.
En el Congo, muchas personas no tienen médico.
In Congo, many people don't have a doctor.
Es muy difícil.
It is very difficult.
The numbers are staggering.
The DRC has roughly one doctor for every ten thousand people.
For comparison, Spain has around forty.
The United States has about thirty.
Ituri Province is even worse than the national average.
And that's in peacetime.
In a region with active insurgency, it essentially collapses.
Y cuando no hay médico, la gente muere de cosas pequeñas.
And when there is no doctor, people die of small things.
Una infección, por ejemplo.
An infection, for example.
A wound that gets infected.
A woman in labor with no one to help.
A child with a fever that would be nothing in Austin or Madrid but is fatal in a jungle village with no clinic.
These are the invisible deaths.
The ones that don't make the UN report because nobody counted them.
Es verdad.
That's true.
Hay muchas personas enfermas.
There are many sick people.
Nadie cuenta eso.
Nobody counts that.
Octavio, most people who know anything about the DRC and disease probably know one name: Ebola.
And Ituri is actually ground zero for some of the worst Ebola outbreaks in history.
Sí, el ébola es muy peligroso.
Yes, Ebola is very dangerous.
El Congo tiene muchos brotes.
Congo has many outbreaks.
The 2018 to 2020 outbreak in North Kivu and Ituri was the second largest Ebola outbreak ever recorded in history.
Over three thousand cases.
And health workers were trying to fight it in the middle of an active conflict zone.
ADF fighters attacked health clinics.
They killed doctors.
There were eleven attacks on health facilities in the first few months alone.
[gasp] ¿Los rebeldes atacan los hospitales?
The rebels attack the hospitals?
Eso es terrible.
That is terrible.
Deliberately.
Targeting health infrastructure is a tactic.
When you destroy the clinic, you create panic, you deepen suffering, and you make it harder for the government to function.
It's not random violence.
It's strategic.
And the WHO had to pull personnel out for their own safety at several points.
Sin hospitales, la gente no puede luchar contra una enfermedad.
Without hospitals, people cannot fight a disease.
El ébola se expande.
Ebola spreads.
Exactly.
And what's chilling is how close it came to spreading much further.
The outbreak reached the border with Uganda, which is a transit point for goods and people moving toward Rwanda, Tanzania, the rest of East Africa.
The reason it didn't become a truly continental catastrophe is largely because of Congolese health workers who kept showing up despite the attacks.
People who had every reason to flee.
Esas personas son muy valientes.
Those people are very brave.
Trabajan con mucho peligro.
They work with a lot of danger.
And they get almost no recognition.
I covered enough of these crises to know that the international attention focuses on the outbreak itself, the fatality rate, the vaccine trials.
And the local nurse who's working twelve hours a day while her village is getting shot at doesn't make the headline.
En España, cuando hay una crisis, el gobierno ayuda.
In Spain, when there is a crisis, the government helps.
En el Congo, no es igual.
In Congo, it is not the same.
Not even close.
The DRC is the size of Western Europe with a GDP smaller than the city of Toledo, Ohio.
The central government in Kinshasa is twelve hundred miles from Ituri Province.
That's not an administrative challenge.
That's a different world.
Y hay muchos grupos armados.
And there are many armed groups.
El gobierno no controla todo el país.
The government doesn't control the whole country.
This is important context that I think gets lost.
People ask why the DRC doesn't just fix this.
The answer is that the Congolese state barely reaches most of its own territory.
The east of the country, including Ituri, has been controlled in patches by various armed factions for the better part of thirty years.
And every time a health system tries to rebuild, another attack sets it back.
La gente no tiene vacunas.
People don't have vaccines.
No tiene agua limpia.
They don't have clean water.
Vive con mucho miedo.
They live with a lot of fear.
And fear itself is a health problem.
There's a substantial body of research on what chronic exposure to violence does to the human body.
Elevated cortisol, disrupted sleep, cardiovascular stress.
Children who grow up in conflict zones show measurable developmental differences.
The damage isn't only from bullets and machetes.
It's from the years of terror that precede and follow them.
Los niños en el Congo tienen una vida muy difícil.
Children in Congo have a very difficult life.
Muchos niños están enfermos.
Many children are sick.
Malnutrition alone.
The DRC has one of the highest rates of acute malnutrition in the world.
And again, conflict is the driver.
When people flee, they leave their crops.
When armed groups move through, they loot food supplies.
The 87 civilians killed last month, that number is real and it's horrific.
But the number of people who will get sick and die in the aftermath, from hunger, from untreated wounds, from disease spreading in a displacement camp, that number is bigger and we'll never know it.
Es un problema muy grande.
It is a very big problem.
El mundo no mira mucho al Congo.
The world doesn't look much at Congo.
That's the part that honestly keeps me up sometimes.
During the Ebola outbreak I mentioned, there were days when that story was competing for space with the early COVID headlines coming out of Wuhan.
And Ebola lost.
Because COVID was coming toward us, and Ebola was over there.
The geography of media attention is brutal and not particularly fair.
Pero las enfermedades no tienen fronteras.
But diseases don't have borders.
El ébola puede viajar también.
Ebola can travel too.
COVID made that point rather definitively, didn't it.
What starts in one place doesn't stay there.
And that's the argument that global health experts have been making for decades: investing in health systems in the DRC isn't charity, it's self-interest.
A functioning clinic in Ituri Province is part of the global early warning network for the next pandemic.
Destroying it is everyone's problem.
Sí.
Yes.
Una enfermedad nueva puede comenzar allí.
A new disease can start there.
Y después llega a todo el mundo.
And then it reaches the whole world.
Precisely.
And the ADF attacks aren't only killing people in those villages.
They're punching holes in a global health infrastructure that humanity depends on.
That's why I think this story deserves more than the four paragraphs it gets when the UN releases a quarterly report.
¿Hay organizaciones que trabajan allí?
Are there organizations that work there?
¿Como Médicos Sin Fronteras?
Like Doctors Without Borders?
MSF has been in the DRC for decades.
They're extraordinary.
But they've also had workers kidnapped, killed, had facilities ransacked.
The conditions they operate in are unlike almost anything else in humanitarian medicine.
I have enormous respect for those people, and enormous anger that they have to work that way because the international community hasn't found a way to stop the violence that makes their work necessary.
Trabajar con peligro todos los días es muy duro.
Working in danger every day is very hard.
Son personas muy fuertes.
They are very strong people.
You know, actually, something came up when I was looking at the UN report this week, and I've been meaning to ask you about it.
The Spanish word for wounded, herido.
Is that different from enfermo?
Because in English we'd use sick for both sometimes, but they feel like different words.
Sí, son palabras diferentes.
Yes, they are different words.
Herido es por un golpe o una bala.
Herido is from a blow or a bullet.
Enfermo es por una enfermedad.
Enfermo is from an illness.
So herido comes from the outside, something that happens to you, and enfermo is something internal, something your body does.
Exacto.
Exactly.
Puedes decir: el soldado está herido.
You can say: the soldier is wounded.
O: el niño está enfermo.
Or: the child is sick.
Son cosas distintas.
They are different things.
That's actually a cleaner distinction than English makes.
In English you can say someone is sick from a gunshot wound and it's technically correct and also completely absurd.
Spanish is more precise here.
Herido for the wound, enfermo for the illness.
I'm writing that down.
[chuckle] Bien, Fletcher.
Good, Fletcher.
Y no digas que estás embarazado si estás herido.
And don't say you are pregnant if you are wounded.
One mistake.
One time.
And I will never hear the end of it.
Herido for wounded.
Enfermo for sick.
The DRC story in two words, honestly.
And a reason to pay attention the next time the UN releases one of those quarterly reports that disappear by lunchtime.