D isasters visit Eastern Congo on a continual basis: war, volcanic eruptions, ethnic strife, epidemics, refugee inflows and perhaps worst of all, for most people, a lack of hope. Expatriates who initially work there with idealistic goals tend to leave the region seeing it as a place where life only gets worse. The region barely knows a government or governance system, unless one calls warlord politics and a war economy functioning gov- ernance systems. The war and absence of a well-functioning state have exacted a terrible toll on the health of the people living in Eastern Congo. Mortality and morbidity are extremely high, probably the highest in the world. This article studies the current health system in Eastern Congo. Based on field research conducted during the summers of 2001 and 2002, it explains the overall politi- cal situation and its relationship to the ailing health system. Four non-governmental organizations (NGOs)—the Association Régionale d’Approvisionnement en Médicaments Essentiels (ASRAMES), International Rescue Committee (IRC), Malteser and Medical Emergency Relief International (MERLIN)—are attempting to improve this system and bring down mortality and morbidity, which in turn has implications for strengthening governance in Eastern Congo. FROM MOBUTU TO WAR During his long reign, Mobutu Sese Seko slowly hollowed out the Congolese state. From the 1960s to the late 1980s, Mobutu used the Congo’s immense natural wealth, as well as Cold War support, especially from the U.S., France and Belgium, for an extensive FALL 2003 | 183 Journal of International Affairs, Fall 2003, vol. 57, no. 1. © The Trustees of Columbia University in the City of New York DENNIS DIJKZEUL Healing Governance? Four Health NGOs in War-Torn Eastern Congo The most that health organizations can hope for is to contribute indirectly to better governance. But they can continue to save lives. Dennis Dijkzeul is professor in the Management of Humanitarian Crises at the Institute for International Law of Peace and Armed Conflict (IFHV) at the Ruhr University in Bochum, Germany. He has worked as a consultant for international organizations in Africa, Central America, Europe, and the US.