International staff: 10
National staff: 85
Rwanda's health system and its medical personnel were devastated by the mass inter-ethnic killings of 1994, in which one million Rwandans died. MSF is now participating in the country's nascent reconstruction by supporting a health district and responding to emergencies.
There have been recent reforms in the health sector, including some decentralization and the partial institution of a cost recovery system, and even the growth of health insurance. Yet in an impoverished country with fewer than 200 doctors, many people are at risk of being left without adequate access to medical care or the means to pay for it.
The primary MSF activity in Rwanda is the support of the Bushenge health district in Cyangugu Province, in southwestern Rwanda. MSF has been working there since 1997. The health district includes a hospital and nine associated health centers; the services reach about 190,000 people. Working with the Ministry of Health, MSF trains medical staff in malaria and sexually transmitted disease (STD) treatment and prevention and prenatal care. MSF also supplies the district with medicine and helps supervise local health care workers.
In addition to its work with the hospital and health centers, the MSF team intervened in several emergencies over the last year: From January through August 1999, MSF ran two therapeutic feeding centers for severely malnourished children in Ruhengeri province. Teams have also responded to cholera epidemics in Ruhengeri and Cyangugu provinces.
In late 1999, MSF was able to turn over one of its projects, support of the Kabutare health district, to another NGO more focused on long-term development. MSF also wound down work in two refugee camps located near Cyangugu and Kibogora, where refugees from Burundi and Congo had been living after fleeing violence in the own countries. Many of these refugees returned home, and others moved away from the camps.
One of MSF's priorities in Rwanda is increasing its dialogue with the Rwandan people by implementing new projects in partnership with civil society. Possibilities for future projects include psychological and mental health work and AIDS prevention and treatment. At the same time, MSF continues to raise awareness in Europe of the trauma the country has suffered, through a travelling photo exhibit commemorating the genocide (see photo, page 7).