title: Mortality and morbidity among Rwandan refugees repatriated from Zaire, November, 1996.
abstract: BACKGROUND
  Following renewed ethnic violence at the end of September 1996, conflict between Tutsi rebels and the Zairian army spread to North Kivu, Zaire where approximately 700,000 Rwandan Hutu refugees resided following the 1994 genocide. After a major rebel offensive against the camps' militia groups on 15 November, a massive movement of refugees towards Rwanda through Goma town, the capital of North Kivu, began. Massive population movements such as this are likely to be associated with substantial mortality and morbidity.
  
  
  OBJECTIVE
  To study patterns of mortality, morbidity, and health care associated with the Rwandan refugee population repatriation during November 1996.
  
  
  METHODS
  This study observed the functioning of the health-care facilities in the Gisenyi District in Rwanda and the Goma District in Zaire, and surveyed mortality and morbidity among Rwandan refugees returning from Zaire to Rwanda. Patterns of mortality, morbidity, and health care were measured mainly by mortality and health centre consultation rates.
  
  
  RESULTS
  Between 15 and 21 November 1996, 553,000 refugees returned to Rwanda and 4,530 (8.2/1,000 refugees) consultations took place at the border dispensary (watery diarrhea, 63%; bloody diarrhea, 1%). There were 129 (0.2/1,000) surgical admissions (72% soft tissue trauma) to the Gisenyi hospital in the subsequent two weeks. The average number of consultations from the 13 health centres during the same period was 500/day. Overall, the recorded death rate was 0.5/10,000 (all associated with diarrhea). A total of 3,586 bodies were identified in the refugee camps and surrounding areas of Goma, almost all the result of trauma. Many had died in the weeks before the exodus. Health centres were overwhelmed and many of the deficiencies in provision of health care identified in 1994 again were evident.
  
  
  CONCLUSIONS
  Non-violent death rates were low, a reflection of the population's health status prior to migration and immunity acquired from the 1994 cholera outbreak. Health facilities were over stretched, principally because of depleted numbers of local, health-care workers associated with the 1994 genocide. Health-care facilities running parallel to the existing health-care system functioned most effectively.
authors.affiliation: Medical Emergency Relief International (MERLIN), London, UK. banatvala@merlin.org.uk
authors.forename: N
authors.initials: N
authors.lastname: Banatvala
authors.forename: A J
authors.initials: AJ
authors.lastname: Roger
authors.forename: A
authors.initials: A
authors.lastname: Denny
authors.forename: J P
authors.initials: JP
authors.lastname: Howarth
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution; D006801:Humans; D007223:Infant; D009017:Morbidity / Q000639:trends*; D009026:Mortality / Q000639:trends*; D012036:Refugees / Q000706:statistics & numerical data; D012432:Rwanda / Q000208:ethnology; D014754:Violence / Q000706:statistics & numerical data; D014857:Warfare