1 November 1998
Insecurity jeopardises aid Much of Rwanda's health infrastructure was either destroyed or badly damaged during the period of killing and destruction that began in April 1994. The medical services are understaffed because a large number of trained staff were killed, fled the country or are held in overcrowded prisons in deplorable conditions. In the northwest, the Rwandan army is failing to secure the region against armed groups, and civilians are still being targeted. MSF's objective in Rwanda is to give medical and nutritional assistance to refugees, returnees, IDPs and the general population by providing qualified expatriate, regional and local staff. In some areas team members substitute for missing health staff and in other areas they provide technical assistance, training, supervision, etc. For various periods until the end of 1997, MSF provided medical screening and/or other assistance for returnees in Gisenyi (Petite BarriÃ?¨re and Nkamira transit camps), in Kigali (the airport and Runda transit camp), in Cyangugu (Musange transit centre) and on the Tanzanian border (Nyakarambi transit camp). The district health programmes continue in a collaboration with district medical directors and hospital directors that fully implicates MSF in all planning, budget allocations, supervision and decision-making in regard to the revolving drug fund. MSF provides drugs for prisons in the districts in which we work (two in Kabutare and two in Cyangugu) and ensures that lock-up prisoners receive medical care at local clinics. In Kabutare (pop. around 350,000), the programme has developed towards training for health and supervisory staff, and improvements in health care emphasizing vaccination, maternal health, STD/AIDS control and epidemiological data collection. A revolving drug fund has been introduced, but new returnees and those with very low incomes are exempted. In Bushenge (pop. around 162,000), the focus is on establishing the district health team and committees and setting up a district pharmacy. Other activities are similar to those in Kabutare. Water and sanitation evaluations are carried out in clinics in both places. A programme to renovate health centres and houses accommodating hospital medical staff began in January 1998. MSF cares for around 450 unaccompanied children while tracing the families from whom they were separated during the 1994 exodus or the mass repatriations in November 1996. Although several hundred children have been successfully reunited with their families, when it is impossible to find them, and many of the children were so young that they are unable to contribute useful information, MSF places them with foster families. As the two centres near Gisenyi in which they were being held were in very insecure areas, MSF succeeded in evacuating some of them to another centre in the town itself in March 1998. Others were taken to Gitarama. Another Gisenyi programme assisting street-children was taken over by a local organisation in March 1998. MSF suspended the training and supervision provided for a Gisenyi psychological assistance programme in November 1997 because of the high level of insecurity. MSF has medical responsibility for two camps for Burundian refugees: Musange, near Butare, and Kibangiara, in Cyangugu province.