Today, in addition to the classical problems affecting many developing countries, Rwanda is confronted with the consequences of the genocide that erupted ten years ago. Although the figures vary, approximately 800,000 people of the country's eight million inhabitants were killed during this conflict.

The genocide has resulted in an unbalanced gender pyramid (86 men for every 100 women), a large number of female widows heading households and a lack of trained professionals such as judges, doctors, technicians and administrators.

The genocide had a major impact on the lives of Rwandans. Many lost family members during the genocide itself, in the massacres that took place as part of the counter-insurrection in the northwest or during the population movements that followed it.

HIV/AIDS care

In 2002 MSF developed an HIV/AIDS project including both preventative and curative aspects of the disease. Initially covering the zone around the health centre in Kimironko, since June 2003, the project has also included patients from a second health centre in Kinyinya. These projects, both in Kigali, include voluntary counseling and testing (VCT), home-based care delivered through local association partners, care to prevent the development of AIDS, treatment of opportunistic infections and drug therapy to prevent mother-to-child transmission.

In October 2003, MSF introduced antiretroviral (ARV) drugs in Kimironko and began using them in January 2004 in Kinyinya. By March 2004, 120 patients were following the regimen. MSF plans to have at least 500 people receiving ARVs by the end of 2004 and hopes to enroll at least 40 new patients a month to reach this figure. Following significant financial injections from donors such as the Global Fund, the Rwanda government has the willingness and the resources to begin AIDS programs. The problem now lies in surmounting the lack of qualified staff and experience available in the country.

Reproductive health care

In October 2002, MSF began a reproductive health program in Ruhengeri province. This region offers inadequate reproductive health services as a result of the internal conflict that afflicted the area from 1996 to 1998. This situation leads to high risks for an already vulnerable population. Child mortality rates in Rwanda have increased during the last few years, while maternal mortality rates are estimated to be 75 percent higher than they were from 1985-1990.

Working closely with local community actors, this program has three main areas of intervention: obstetrical emergencies, implementation of family planning in the health centers and maintenance of all general reproductive health services (e.g. staff training, sexually transmitted infections prevention, delivery and post-natal care, and improving health during pregnancy). The program is now developing components on AIDS and sexual violence.

Cholera prevention

In September 2002, MSF launched the first phase of its cholera prevention programme on the islands of Nkombo, Ishywa and Gihaya in Cyangugu province. MSF initiated the program here as cholera is endemic in the area due to a lack of safe drinking water. Our activities aim to reduce the incidence of cholera and its risks of transmission.

They include educating the local population about hygiene and progressive rehabilitation of water points (pumps and sources). MSF collaborates with the Ministry of Water, Energy and Natural Resources as well as other health authorities in constructing wells, rehabilitating water sources, promoting hygiene, providing training and conducting epidemic surveillance.

MSF has been working with three local associations - Avega, Icyuzuzo and Urunana - since August 2000 to provide psychological help to survivors of the 1994 genocide. A team of five psychologists offers support to women, many of whom who were raped during the genocide and have subsequently contracted AIDS.

After the genocide, Rwanda's social fabric largely disintegrated, leaving survivors afraid to trust those around them. The mental health care program gives 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.

The MSF team supervises 14 MSF-trained trauma counsellors from the partner associations who manage a group of 496 psychosocial assistants (local people trained in basic psychosocial care) who work in villages around the country and organize therapeutic discussion groups.