Published in the journal Conflict and Health last April, the report suggests that the world’s deadliest humanitarian crisis in 2022 was not in Afghanistan, Ukraine, or other places featured regularly in the news — but in CAR.
The Central African Republic has neither reliable birth and death registries nor regular censuses. To figure out how many people were dying, Karume’s team traveled by car, boat, motorcycle, and foot to conduct interviews across the country. When they analyzed their survey data, they estimated that nearly 6 percent of CAR’s population died within 2022, in a country with a median age around 15. Scaling for population size, this toll would amount to a loss of more than two New York Cities.
When the numbers were in, the team found that violence wasn’t the most common cause of death, although the team blamed it for indirectly eroding living conditions. The country appeared to be on the brink of famine, with 82 percent of adults and 73 percent of children eating only once a day or not at all. Malnourishment renders people vulnerable to ailments. And a lack of basic health care means they die from curable conditions, like malaria and bacterial infections. Nearly a fifth of deaths were attributed to malarial fevers. Diarrhea and vomiting accounted for 9 percent of deaths. Violence comprised 6 percent.
If powerful countries had any attention to spare when the team’s study was published last April, Karume fears it is now spent on the growing conflict in the Middle East. To the list of why CAR goes ignored, add its lack of geopolitical and financial consequence. Russia’s invasion of Ukraine pushed oil prices to a 14-year high across Europe in 2022, and strained wheat supplies for more than 20 countries. If conflict in the Middle East spreads beyond Israel and Palestinian territories, analysts warn of a spike in gas prices that will inflame inflation worldwide.
With that, the researchers mapped out areas across CAR that would lend them a representative sample of the country. Balancing a drive for large numbers with a responsibility to ensure the team survived the mission, Roberts aimed for data from at least 4,000 people. Jennifer O’Keeffe, an epidemiologist who had worked in conflict zones around the continent, now at Johns Hopkins, joined the team. And Karume set about recruiting Central Africans who spoke local dialects and understood terrains beyond roads and the rule of law. With consent from local leaders and interviewees, team members would ask scripted questions: How many people who live in this household have died since January? Did they sleep under this roof most of the 30 days before they died? “We went above and beyond to get an accurate number of deaths for each household,” Roberts explained.
Reaching households turned out to be the hardest part. Before heading into one town held by rebels, one of Karume’s local contacts warned that motorcycle drivers “from outside” would be killed and their bikes stolen. “What I’ll do is give you former combatants who are now motorcycle taxi riders. Everybody knows them, and they’ll take your guys,” his colleague offered. Karume accepted, and stayed behind while Central African interviewers went on without him. “They sampled the town in two days and came back,” he said. “That is heroism.”