An estimated 5.4 million people were killed by conflict and its fallout in Congo from 1998 until April 2007, says a report released Tuesday by the International Rescue Committee.

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A three-year-old malnourished boy looks on at an emergency feeding centre in Rutshuru, Congo, last year. ((Themba Hadebe/Associated Press))

Most of the deaths were due to the humanitarian crisis caused by the war, which badly eroded health-care services and caused famine, says the report by the internationally recognized non-governmental aid organization. The report found that outbreaks of easily treated diseases such as malaria, diarrhea, pneumonia, malnutrition, measles and whooping cough have been major killers in Congo, especially among children.

Nearly half of the fatalities were among children under the age of five, even though they make up only 19 per cent of the total population.

The report was released the same day UNICEF's State of the World's Children report was released, naming Sub-Saharan Africa as the region with the highest child mortality rates in the world.

The International Rescue Committee study found that roughly 45,000 Congolese continue to die each month, even though a peace accord formally ended the war in 2002. Fighting among various factions has continued but in 2006, Congo, which has a population of 66 million people, had its first democratic election in more than four decades.

"The conflict and its aftermath, in terms of fatalities, surpass any other since World War II," said the aid group's president, George Rupp.

Congo's monthly death rate of 2.2 for each 1,000 people is essentially unchanged from the last survey, released in 2004. The death rate is nearly 60 per cent higher than the average for sub-Saharan Africa, according to the study.

The eastern and most tumultuous region of Congo was one of the few areas in the country where mortality rates decreased since the last survey. The eastern part of the country has seen some 800,000 people flee their homes in the past year.

The change may be related to the increased UN presence and funding from humanitarian agencies in the region, speculated Richard Brennan, one of the study's lead authors.

"These small but statistically important declines coincided with improvements in security, a more robust peacekeeping effort and an increase in humanitarian aid," Brennan said. "Unfortunately, the gains in the east have been threatened by the violence in North Kivu."

The study period ended just a few months after violence began to escalate in the province of North Kivu in December 2006.

Ceasefire being negotiated

The report was released just a day after Congolese government and representatives from armed groups active in eastern Congo agreed, at least in principle, to end decades of conflict in the region. Details of the ceasefire agreement are still being negotiated.

"This is the best chance for peace that I have seen for the people of eastern Congo," said Anneke Van Woudenberg, a Human Rights Watch researcher who has followed issues in Congo for about a decade.

But the International Rescue Committee's report on mortality rates in the country points to a tough road ahead.

"It's going to require years of engagement from the Congolese people, the Congolese government and the international community" to reduce deaths, said Brennan.