Despite the efforts of the world’s largest peacekeeping force, billions of dollars in international aid and a historic election that revived democracy after decades of violence and despotism, death rates in Congo remain higher than elsewhere in Africa, according to a new survey released on Tuesday.

The report, made by the International Rescue Committee (IRC), estimated that 45,000 people continue to die every month in Congo, where the mortality is 57 percent higher than the rest of sub-Saharan Africa. Overall, more than 5.4 million people have died since the war began in 1998, more than 8 percent of the country’s population of 66 million, the report found.

The study was based on a sample of 14,000 households surveyed in 700 villages and towns across Congo from January 2006 to April 2007 and found that nearly half of all the deaths were of children under the age of five, who make up only 19 percent of the population.

“The majority of deaths have been due to infectious diseases, malnutrition and neonatal- and pregnancy-related conditions. Increased rates of disease are likely related to the social and economic disturbances caused by conflict, including disruption of health services, poor food security, deterioration of infrastructure and population displacement. Children ... are particularly susceptible to these easily preventable and treatable conditions,” the IRC survey says.

The IRC is blaming the breakdown of health care systems and programs for all the deaths.

“When you do have ongoing conflict, when you do have bad guys walking around with guns, it can still cause major disruptions in what we would call the livelihoods of communities. Clinics don’t work; vaccination programs don’t operate; farmers can’t work their land,” Dr. Richard Brennan, director of the IRC’s global health programs and one of the lead author’s of the mortality study said, according to Voice of America.

The report came as 14 militia groups and the Congolese government were meeting in the eastern city of Goma to try to complete a regional peace deal on Tuesday. The country has been under a continuous state of conflict and civil war for the last 13 years. Although, formally ended in 2003, the Second Congo War, also referred to as the African War, still continues in the east of the country, where the Ituri conflict and the Democratic Forces for the Liberation of Rwanda in Kivus caused hundreds of thousands of people to flee their homes.

After nearly four decades, Congo held its first democratic elections in 2006, but unfortunately, even those were violent, as President Joseph Kabila’s opponent refused to admit defeat and his supporters started a new wave of street fights. Congo longs for a period of peace after more than a decade of internal unrest, and this week’s historical agreement might finally bring calm and tranquility to its inhabitants.