War and Health: Conflict, Health Outcomes and the Role of Emergency Medicine in the Democratic Republic of the Congo

¹Mayo Clinic Alix School of Medicine. 13400 E. Shea Blvd., Scottsdale AZ 85259, USA

²Mbarara University of Science and Technology, Department of Emergency Medicine, Mbarara-Kabale Highway, Mbarara City, Uganda

³Mayo Clinic Hospital Department of Emergency Medicine, 5777 E. Mayo Blvd., Phoenix AZ 85054, USA

*Corresponding author: Douglas Rappaport, MD, Mayo Clinic Hospital Department of Emergency Medicine, 5777 E. Mayo Blvd., Phoenix AZ 85054, USA, Phone: 4133134882, E-mail: [email protected]

Received Date: March 28, 2026

Published Date: June 08, 2026

Citation: Andrew H, et al. (2026). War and Health: Conflict, Health Outcomes and the Role of Emergency Medicine in the Democratic Republic of the Congo. Mathews J Emergency Med. 10(1):71.

Copyrights: Andrew H, et al. © (2026).

ABSTRACT

Background: The Democratic Republic of the Congo (DRC) has experienced prolonged, repeated periods of armed conflict alongside substantial challenges with healthcare infrastructure and outcomes. We aimed to evaluate whether the number of combat casualties in each year was associated with changes in public health outcomes, and if regional intensity of conflict was associated with reduced density of healthcare infrastructure. Emergency Medicine as a specialty is still grossly underdeveloped in the DRC. In 2017, the first national Association of Emergency Medicine, the Association de Medecine d’Urgence Republique Democratique du Congo (AMURDC), was established. Despite this, according to a 2024 study, emergency and resuscitation systems and pre hospital care systems are essentially non-existent in the country. Methods: We constructed a cross-sectional provincial dataset combining publicly available estimates of conflict-related casualties, healthcare facility counts (including non-public facilities), 2019 population data, national GDP, and selected health indicators. We calculated casualties per 100,000 people and persons per healthcare facility for each province. Using univariate regression, we assessed whether conflict deaths or GDP was more strongly associated with five health outcomes: maternal mortality, neonatal mortality, under-five mortality, and reported cases of tetanus and measles. Heatmaps and bar plots were used to visualize provincial variation. Results: Conflict deaths were not significantly associated with either healthcare facility density or any of the five health outcomes. In contrast, GDP demonstrated strong negative associations with neonatal mortality (R² = 0.75, p < 0.001), under-five mortality (R² = 0.70, p < 0.001), and a moderate negative association with maternal mortality (R² = 0.36, p < 0.001). Visual analysis confirmed that provinces with the highest conflict burden did not consistently exhibit the worst healthcare infrastructure density or lowest numbers of non-governmental healthcare facilities. Conclusion: In the DRC, healthcare outcomes are more strongly associated with economic development as measured by GDP than conflict intensity year-on-year. Conflict burden does not appear to be a primary driver of the density of healthcare facilities by province. These findings suggest that conflict in the DRC, which has been highly local and cyclic in nature, has not been the primary driver of public health in the nation despite the tremendous challenges it poses. Policy aimed at improving health in the DRC should account for broader development factors alongside the impact of conflict. This should include strengthening and establishing robust emergency medicine infrastructure including dedicated emergency departments, prehospital care systems, and specialty specific training in emergency medicine. Investment is such systems will be essential for improvement of population-based health outcomes and is a public health imperative in the DRC. 

Keywords: War and Health, Conflict, Emergency Medicine, Emergency Medicine Systems, Health Systems Development