The proliferation of small arms and armed violence in the Democratic Republic of Congo have had a devastating effect on public health, argue Robert Muggah, a fellow of the New York-based Social Science Research Council and a senior researcher at the Geneva-based Small Arms Survey, and Nicholas Florquin, a researcher at the Small Arms Survey. Without a sustained and strategic multinational effort to effectively disarm competing factions, they say, the agonising cycle of violence in the Congo is likely to continue.

The death toll from the most recent round of conflict in the Democratic Republic of Congo (DRC) is the highest ever attributed to war in Africa -- or indeed, anywhere in the world since World War II.

The International Rescue Committee (IRC) reported in a mortality study released in April that between 3 and 4.7 million excess deaths occurred between August 1998 and December 2002 in the five eastern provinces of the DRC alone. Its findings were sobering.

Between 1999 and 2001, it observed a strong correlation between violence -- especially firearm-related violence -- and death from infectious diseases and other non-violent causes.

This confirmed what public health specialists and epidemiologists have long known: that armed conflict has dramatic implications for public health, particularly crude mortality rates and birth rates, as well as measles-related and HIV-reported deaths.

Small arms availability and misuse have played a significant role in exacerbating the lethality of the conflict.

A survey released this year by Pax Christi, a Catholic organisation that promotes peace, indicates that the majority of weapons available in the DRC, from AK-47s and FAL assault rifles to rocket propelled grenade launchers, can be traced to Uganda, Sudan and Rwanda, as well as to countries outside the Great Lakes region.

In addition, small arms have been recovered from fleeing combatants.

Militias are known to be moving weapons to and from the Republic of Congo and the Central African Republic.

Despite the arrival of the French-led multinational force, called Artemis, on June 6, 2003, the situation continues to deteriorate.

While the IRC survey registered a dramatic decrease of violence -- with death rates declining from 540 per 100,000 per month in 2001 to 350 per 100,000 per month in 2002 -- the crude mortality rate nevertheless remains alarmingly high.

The combination of a violence-driven economy and a legacy of arms proliferation means that armed violence persists.

For example, the survey found that all reported deaths attributed to violence in Kisangani Ville, an area of Kisangani, were attributed to firearm injuries.

What is perhaps most extraordinary about the current crisis is the lack of interest from the international community.

In addition to the shocking death toll, the DRC also has one of the highest rates of forced displacement in the world, with some 2.7 million internally displaced people and more than 336,500 refugees in other countries.

And yet, the DRC is habitually overlooked by the media and avoided by donors.

Though a Government of National Unity and Transition was formed on June 30, 2003, the situation is precarious.

The newly inaugurated ministers of the transitional government have resolved to make the unrest in the eastern part of the country a major priority.

But, as the authors of the IRC study note, with this war in its fourth year " ... policy makers would do well to examine what made it so deadly ..."

Some multilateral development agencies are seeking to address these factors, especially the role of armed combatants.

The World Bank, for example, supports an ambitious multi-country demobilisation and reintegration programme (MDRP) for nine countries in the Great Lakes, including the DRC.

Its strategy has called for the so-called disarmament, demobilisation, reinsertion and reintegration (DDRR) of over 350,000 ex-combatants between 2002 and 2006.

Though no national programme has yet been established for the DRC, some 300 child soldiers have been demobilised by the U.N. Development Programme and U.N. Children's Fund.

Yet the World Bank's own operational policy insists that no funds be devoted to the first "d" of DDRR, disarmament, or to small arms control.

The World Bank's inability to directly support disarmament is paradoxical and could affect the regional initiative's chances of success.

Fortunately, on July 28, 2003, the U.N. Security Council authorised the United Nations Mission in the DRC (MONUC) to assist the transitional government in disarming and demobilising Congolese combatants within the framework of the World Bank's MDRP.

It also called for an international arms embargo for 12 months to prevent foreign and Congolese armed groups and militias operating in North and South Kivu and Ituri.

There can be little doubt that the human cost of the protracted conflict in the DRC has been cataclysmic.

Yet despite the U.N.- and World Bank-inspired interventions in the region, the situation continues to deteriorate.

Without a sustained and strategic multinational effort to effectively disarm the multitude of competing factions, the agonising cycles of violence are likely to continue.

The transitional government and the international donor community must recognise the long-term consequences of arms availability and its pivotal importance to the future security and stability of the region.

The IRC report on the Democratic Republic of Congo can be found on the IRC website.