A five-person MSF team has been working with three local associations since August 2000 to provide psychological help to survivors of the 1994 genocide. The team offers support to women, many of whom who were raped during the violent civil war and have subsequently contracted HIV.

MSF is expanding its mental health care programme in Rwanda by training 150 local people to act as psychological and social support workers in rural areas. The development has been partly motivated by a recent government decision to release from detention around 40,000 people implicated in perpetrating the 1994 Rwandan genocide.

Many of the freed ex-prisoners are expected to return to their local communities to live alongside survivors of the atrocities, prompting serious concern about the psychological effect on the victims. MSF has been working with three local associations since August 2000 to provide psychological help to survivors of the 1994 genocide.

The team of five psychologists mainly offers support to women, many of whom who were raped during the violent civil war and have subsequently contracted HIV. Since the conflict nine years ago the fabric of society in Rwanda has largely disintegrated, leaving today's survivors fearful of trusting those around them.

The mental health care programme gives the women support in expressing their anxiety and anger. Group therapy sessions aim to help them cope with their emotions and start to rebuild social connections.

In January 2003, the Rwandan government released certain categories of genocide suspects from prison on bail. Around 40,000 prisoners were released out of an estimated 115,000 detainees who have been imprisoned since the killings.

These people will still have to face trial under a citizen-based justice system called "Gacaca" which involves village courts trying the accused. The Gacaca process will mean that many of the victims of genocide will be called to testify. MSF is concerned by the psychological impact that this sudden return of ex-prisoners to the community will have on the victims of the genocide.

"The emotional pressures on these already traumatised people are enormous," explained Luc Nicolas, MSF operations coordinator for the region. "Victims now live in terror of coming face to face on the street with the very people who attacked and raped them.

The Gacaca system means that they may be asked to testify against someone in their own community so they fear for their lives. For these reasons MSF decided that it was crucial to expand our psychological support network in Rwanda.

We need to reinforce the ability of people within communities to cope with the emotions reawakened by the forthcoming Gacaca judicial process." With as many as 1,300 women supported by the programme affected by HIV/AIDS, in addition to mental health care provision MSF is ensuring access to basic health care for AIDS patients.

The team is training nurses of partner associations and providing transport to specific medical centres. When needed, MSF also supplies food to widows left without resources.