The silent death

It also tells something of Ireland’s role in bringing humanitarian aid to poor countries. Irish humanitarian agencies are well known — Concern, GOAL and Trocaire, to name three — as is the Irish experience of hunger during the Great Famine.
In the early 20th century, Ireland sent many missionaries to devastated parts of the world, and then later developed a strong commitment to humanitarian work that is the direct descendant of the work of the early missionaries.
But above all, the story of Asande and Yohali is the story of the 33 million people in central and southern Africa who, while the world eyes Iraq and the possibility of war there, a nuclear standoff with North Korea, and turbulent economic situation globally, are in danger of starvation this year alone.
Hunger and poverty at first glance seem relatively simple concepts to understand. For Irish people in Ireland and around the world, there is a collective historical memory of the Famine of the 1840s. It is a memory that the Irish today continue to campaign to make sure that it is never forgotten. And it seems simple: the potato crops failed and, thanks to British government policy, perhaps one million people died of starvation.
This year, under the auspices of its president, Ned McGinley, the Ancient Order of Hibernians in the U.S. has asked members to promote the first AOH Hunger Project, to highlight poverty in the U.S., to educate Americans about the Great Famine in Ireland and to make special mention of the work local AOH chapters do to alleviate poverty.
When we think of famine, people in the West think of mass starvation, like the Irish Famine.
The reality today is often different. Paul Harrison, in his 1993 book “Inside the Third World,” writes: “Though malnutrition is almost everywhere among the poor, the traveler in the Third World rarely sees people who are nothing but skin and bone. . . . The everyday reality of malnutrition in the Third World is less dramatic. It is adults scraping through, physically and mentally fatigued and vulnerable to illness. It is children — often dying, not so frequently of hunger alone, as of hunger working hand in hand with sickness; but more often surviving impaired for life.”
This was the case in January 2003, in the Democratic Republic of the Congo, where a team from the Irish humanitarian agency Concern made a trip into the countryside outside the eastern Congo town of Kasongo.
On a 45-kilometer trip over devastated roads that frequently dwindled to mud tracks and gullies, the team passed through 10, 15, 25, eventually more than 30 small villages, where cheerful children ran in waves to meet the strangers as they passed through one of the world’s most war-torn and neglected regions.
War — “Africa’s World War,” it has been called — has raged here since the mid-1990s and war and its age-old companions, famine and disease, have killed perhaps 3 million people. No one will ever know just how many.
These children, with adults waving in the background, ran toward the Concern vehicles with all the energy of children in any school playground in America, yelling greetings with gusto.
But among these crowding children came parents holding other children, kids wizened and frail, motionless in blankets under the hot African sun: the results of malnourishment.
In Swahili, the parents begged for help.
“Please help my child,” one said. In one village alone, more than 10 children were presented and examined by a Concern nutritionist, Moise Kabongo.
Teams such as Concern’s must make the heart-wrenching decision as to whom they can help. Some children are deemed not ill enough. Resources are still severely limited, with the therapeutic feeding program in Kasongo only a few months old and already its capacity overflowing.
On that day, Concern’s team brought back two children for therapeutic feeding in the hospital at Kasongo. These were Asande, a boy, and Yohali, a girl.
“If we’d had the space [in the vehicles] we could have brought back 20,” said Auriol Miller, Concern’s country director for the Eastern Congo, who was on the trip.
This is the face of starvation in Africa today. It is a pandemic. Some regions scrape by — dreadfully poor but surviving, just. In other areas, children and adults die sporadically. And, as one Irish humanitarian worker put it, “They die very quietly.”

Drop in the ocean
In 1982, “Famine,” a book edited by Kevin Cahill, stated: “The era in which we live has the odious distinction of being the period when more people will die of famine than in any other previous century.”
We have entered another century, and aid workers from the ground in Africa and other poor parts of the world warn that the situation is getting worse, much worse.
Frequently, when speaking of humanitarian aid, people who have experience of working in the field use the expression that the need is so great that what is achieved is a “drop in the ocean.”
And a challenging opinion has been expressed for some years now by some academics and experts who have studied the humanitarian enterprise around the world. They criticize humanitarian work, at least at the macro level of the World Bank and the UN, and point out that often money and food aid disappears into the hands of corrupt governments, rendering projects futile, perhaps even damaging to those in most need. One such critic is Peter Uvin, Henry J. Leir Associate Professor of International Humanitarian Studies at Tufts University in Massachusetts.
Studying the situation in Rwanda, once considered a model of international humanitarian aid work, Uvin suggests that, at the very least, the genocide of 1994 was exacerbated by foreign humanitarian aid, and offers a gloomy critique: “The development enterprise directly and actively contributes to inequality and humiliation,” he writes in his 1998 book, “Aiding Violence.”
The suggestion seems implicit, that if Western aid intervention can do more harm than good, why bother helping developing countries except in proven cases where immediate betterment can be produced, such as in the wake of earthquakes, flooding or other natural disasters?
One observer, Andy Storey, who worked with the Irish humanitarian agency Trocaire in 1994-95, opined: “[Development] constantly reinvents itself. It never says, ‘we haven’t got it right’ if mistakes are made. It never admits this, but the basic paradigm that remains is the right to intervene in the lives of poor people.”
Storey also noted that the interaction between non-governmental organizations (NGOs) and developing countries is a vastly complicated one that few people understand. As an example, he noted that NGOs need talented local staff to help them work in the field of need. These people, the country’s brightest and best, are therefore no longer available to the country’s economy as aspiring entrepreneurs or professionals — a middle class — because they become essential to the NGO work.
“It’s very hard for anyone to have a moral argument against humanitarian aid,” Storey said in a recent interview. “But NGOs have acknowledged that it is often impossible to tell who is who in which faction on the ground in a conflict situation.”
Another NGO worker described wading through the complexities in Kosovo as “nightmarish,” because locals frequently lied so that their relatives or group could get more aid than their adversaries.
While no one seriously suggests that the developed world simply turn its back on the developing world, even committed humanitarian workers face the question daily, in places like the Congo: Does this make a difference? Is helping a handful out of hundreds of thousands actually going to make a difference? Is it just a drop in the ocean?

Born in a forest
Back in Kasongo, the two children, Asande and Yohali, were checked into the hospital’s therapeutic feeding program as the sun set over this former Belgian colonial outpost near the banks of the Congo River. Here the river gleams red in the evening glow, as it flows placidly by on its near-2000 mile journey to the Atlantic Ocean.
Kasongo’s feeding program was formally opened only a few days previously by the local Roman Catholic bishop, Abbe Tata, who praised the work of the NGOs such as Concern and others in the area, reminding listeners that for nearly 100 years the only “NGO” in the area had been the Catholic Church.
Already, however, the program was overflowing with malnourished children and their mothers. Outside one of the wards, in a hallway, a mother smiled up at visitors from a rough mattress where she rested with her recently born triplets.
Asande, who seemed sicker than Yohali, was taken with his mother, Safi, to a separate ward with only four beds.
Yohali, 2 months old, had been born in the forest because one of the many warring groups in the eastern Congo had plundered her village and her parents had had to flee into hiding. Her mother died shortly after childbirth in the forest, so she had come to Kasongo with her father, Munganga, a small, nervous man with a kindly smile.
By Congolese standards, 40-year-old Munganga was an old man: the average life expectancy for a Congolese male is 47. Here in Kasongo, these two parents seemed happy that their infants would get help.

Lighting a candle
“When you see poverty and famine, you want to jump out of your skin to tell people,” said Fr. Aengus Finucane, one of the founders of Concern and for years a missionary in Africa and Bangladesh. “I saw famine first in my own parish, in Biafra [a region of Nigeria]. Then I saw it again in Bangladesh, in Sudan, in Uganda.
“It is aggravated by drought, by cyclones, by floods, war. And when it hits, it’s the poorest who suffer, and with the poor, that means women, children and the old.”
Asande and Yohali’s experience bears testament to Finucane’s words. But he rejects the criticism sometimes aimed at NGOs.
“I won’t defend or pretend that all the aid gets to the end of the line intactl it doesn’t,” he said. “Yes, sometimes relief work seems like the proverbial drop in the ocean. A lot of NGO’s may be inept, may act like cowboys on the ground. But there is another proverb, what Mother Teresa said: ‘Light a candle, don’t curse the darkness.’ “
Concern’s director of U.S. operations, Siobhan Walsh, addressed the same issue in a recent interview.
“NGOs have a certain role,” she said. “We can’t solve the problems of governments and governance. You need the United Nations to go in and lobby with presidents, not the NGOs.”
Concern’s oldest-running program is in Bangladesh, where it and other Irish humanitarian agencies are still at work. The agency started relief work there 31 years ago.
“It may take that long,” Walsh said. “The key question is, are you going to commit for that long?”
Such commitment has to come with the certainty that funding will be available to keep programs running for years to come. That can often mean NGOs starting small programs rather than overly ambitious ones. Few things make NGO workers more anxious than the thought of promising a resource to a local community and then failing to deliver it.
As one put it: “If we said we’d get something for this hospital and then failed to deliver, that leaves us compromised to help in any way.”
Finucane spoke with warmth about one aid program in Bangladesh, which, he notes, started small in 1973 and is still small, but which, he says, has been a success. The point he made was that humanitarian aid does work. But it can take an exceptionally long time to bear fruit.
“We started a handicraft program when it was realized that many of the women had skills,” he said. “First you give them the resources to spin and weave. Later you go back and charge them a little for the thread. Then you start to buy the products back off them, and then you buy it back only if it is of a certain quality. It’s gradual.”
Today, he said, “you go there and you will be talking to those women’s daughters, who are making the handicrafts.”
The day after the two children were admitted to Kasongo hospital, both seemed stable. Asande had vomited blood during the night but now lay in bed, watched lovingly by his mother, Safi, who was 19.
Asande, no larger than a rag doll and just as limp, had big brown eyes that stared at his visitors from his pinched face. There in the hospital, those eyes showed a resolute will to live.

Emails from the Congo
Some weeks after the Concern team brought just these two desperately needy children back for treatment at Kasongo, the nutritionist Moise Kabongo emailed an update: “The baby [Asande] we brought to the [feeding center] is doing well. He started at 1.4kg with an abscess on his back, which is now treated and cured. He also had a wound on his neck, which is also treated, and he’s now 2kg. He’s eating well and his evolution seems to be good.”
Then, a few days later, another email: Asande died. Not even the therapeutic feeding center had been able to save him from the jaws of malnutrition.
On the last day of February, Concern’s Auriol Miller emailed from the Congo: “Sad news about the other child, too, I’m afraid, as Yohali died on 25th February at 1 a.m. She’d put on about 2kg of weight and had had ‘flu, but that had been cured.”
She added: “The hospital team don’t know what went wrong at the end.”

Resolute
The rescue of Asande and Yohali looks like it ended in failure. But this sad story overlooks the other children at the hospital who did benefit from the therapeutic feeding program and got better.
Asked if tragedies like this represented defeat, Concern’s Aengus Finucane and Siobhan Walsh responded strongly.
“In some ways,” Walsh said, “it’s a copout to say the problem is too large to solve.” She added that the brief lives of Asande and Yohali should make people more resolute than ever to defeat the curse of poverty that stalks Africa, producing statistics that no one can comprehend — what does 33 million people starving mean? — except when seen through the experience of one or two individuals, like these little children.
Finucane agreed.
“You are not going to save everyone,” he said. “To say that it’s a failure, though, is a copout nonsense. You do what you can do, but you must do something.”