Pandemic Pressures: Medical Risks

The past year has highlighted the importance of various risks that we analyze at Riley and has shone a new light on the importance of certain risks. Specifically, the importance of analyzing the status of medical infrastructure in a location, and the presence of acceptable health care. As we are all well too aware by now, the pandemic has applied extra stressors to the world’s medical systems (to say the least), but some countries have been hit harder more than others. Those that have been hit particularly hard are typically systems that are already under enormous medical pressure from preexisting issues and are typically found in countries fighting other socio-economic issues simultaneously. Throughout this description, quite a few countries may have popped into your mind, but today I’d like to focus on a specific country’s health infrastructure and how they’re faring during the pandemic (I’ll give you a hint, it’s not well). The Democratic Republic of the Congo (DRC), formally known as Zaire, is the second largest country in Africa. It is a country that has been plagued by instability for almost two decades, with the first major strain on the system happening after the Rwandan Genocide. In this installment, I’d like to show some insight on medical risks that go beyond the mere presence of a disease in a country. After a year of the pandemic, so many of us have been exposed to what can happen to an over inundated medical system, but here at Riley we have been considering the complexities of medical risks since our inception, and I’d like share some of our considerations.

The DRC became an independent nation in 1960, and up until the early 1990s the country was dealing with conflicts that mostly stemmed from internal leadership, and proxy conflict brought on by the Cold War. The medical system left something to be desired, sure, but it was not collapsing. And then, in 1994, genocide and conflict broke out in the neighboring nation of Rwanda. A direct result of this conflict was an influx of refugees coming into the DRC, adding strain on a system that was already not totally up to western standards. Now let me stop here and say that this is a key consideration when looking into the status of a healthcare system. Regardless of where you are looking, whether it be a city or an entire country, the proportion of available beds to population is something that can greatly affect the quality of medical care. Another key consideration as to the quality of medical care is the presence of conflict, and this is for multiple reasons. Of course, the most obvious strain on the system is that capacity will be consistently partially taken up by those fighting in the conflict, a certain percentage of beds will be out of use throughout the conflict. After this more obvious consideration, conflict also makes it more difficult for key medical supplies to make it to areas affected by conflict, which has always been an issue for the DRC. After the 1994 inundation of refugees, the DRC, Uganda, and Rwanda engaged in semi-consistent conflict from 1997-2003 with the first and second Congo Wars. Even after the end of the Second Congo War, in 2003, the DRC has been engaged in an internal conflict with rebel and terrorist groups – particularly in the North and South Kivu provinces.

The former components that I have mentioned would more so be thought of as external pressures to a health care system, but there are also internal pressures that present just as much of a threat. Lower education rates can also present a higher risk of catching diseases and certain illnesses, in fact one study claims that additional higher education can help lower five-year mortality. Findings from a 1999 study show that the mortality rate of high school dropouts were more than twice as high as those with some higher education. Now, this was obviously a western study which does not directly apply to the situation in the DRC, but it does show that education provides individuals with the tools/knowledge to combat certain illnesses and to obtain better medical care. In many cases, part of medical aid work is simply informing local populations of medical risks in an area. While we do not have controlled studies that present statistical findings to show the correlation between education and health, we can make assumptions based on this research. Data from RSC-Africa states that 70% of Congolese individuals aged over 18 years do not have a high school diploma or higher education. Another internal factor that can impact healthcare status in a country is the local perception of western medicine, which is typically the type of healthcare that is brought over by aid workers. Thankfully, in the DRC, western medicine is generally accepted by citizens, but barriers such as the care’s expense and inaccessible regions makes it difficult for healthcare to reach the willing citizens.

The point of presenting various risk factors is to highlight the medical situation in the region prior to the COVID-19 pandemic. This is to show you that the pandemic is the proverbial straw that broke the camel’s back. One physician, Dr. Immaculée Mulamba Amisi, was quoted as saying “When the pandemic arrived, no one was expecting it, and no one knew how to manage it.” One of the biggest impacts of the pandemic on the healthcare system was the fact that in order to accommodate COVID-19 patients, other medical services had to be cut or suspended. Another issue is that, as is the case in many developed nations as well, proper equipment was not always readily accessible, but unlike some nations there was no simple way for the DRC to obtain more equipment or facilities. And, as I mentioned earlier, geographic barriers and barriers due to conflict exist so that health care cannot penetrate certain areas of the country. And although it was known that COVID-19 was in the country, testing is also not easily accessible. Within 90 days of the pandemic being in the country there were more than 4,500 positive cases across the country, but medical aid groups understand that this number is not accurate due to the fact that testing is not affordable, accessible, and in some cases is not even available.

My intentions today were not to present a grim situation, as we have had enough of that over the course of the last year. Today, I wanted to present some insight as to the thought process of risk analysis, and what we specifically consider when we determine the medical risk in any particular country. Something that has been interesting during my time here at Riley is that I have not conducted a medical risk assessment where COVID-19 hasn’t played a part in the results, as I began my time here at the same time of the start of the global shutdowns. This is a perfect example of how risks are always changing, and how analysists have to adapt to every new situation being thrown at them in order to provide the most accurate security information.