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Rwanda counts the cost of atrocities

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6969.1601 (Published 17 December 1994) Cite this as: BMJ 1994;309:1601
  1. Claudia Court
  1. BMJ Rwanda 1994, a report of the genocide is available from Physicians for Human Rights, c/o University Department of Forensic Medicine, The Royal Infirmary, Dundee DD1 9ND.

    As many as one million Rwandan men, women, and children were murdered between April and June this year—an event described in a new report from Physicians for Human Rights as “one of the nastiest episodes of human behaviour ever to take place.”

    The report is the result of an investigation that sought to record human rights abuses as well as instances of medical staff “participating or colluding with human rights abuses.” Two delegates from Physicians for Human Rights spent 12 days in July travelling through Rwanda, examining and recording evidence from witnesses as well as sites of massacres. Their report says: “It is not possible to remain neutral in the face of such unremittingly repeated tales of this order of cruelty and brutality. Most of those who survived did so entirely though luck.” The report continues: “There are a number of valid human responses to witnessing [a tiny part of] the evidence of that loathsome 100 days in Rwanda; one is a very deep sustained anger.”

    Up to one in seven Rwandans were killed between April and June, and the report concludes that “the tendency of the international community to erroneously label the killings as tribal, compounded by confused responses on the part of the United Nations, allowed the impetus of the slaughter to develop a critical momentum that only the slaughter of most Tutsis and moderate Hutus or the military defeat of the [Rwandan] government forces could end.”

    The report refers to two doctors who were senior members of the interim government of Rwanda, which conducted the mass slaughter: “It is not easy to accept the reality that two doctors have contributed in an executive capacity to one of the nastiest episodes of human behaviour ever to take place—maleficence amounting to an utter and total abrogation of the ideals that underpin medical practice and medical ethics.”

    But doctors were also killed, sometimes while helping others to survive. Rwanda's health minister, Dr Joseph Karemera, on a visit to the BMA last week, said that the combination of those killed and those who, having killed, had fled the country meant that there was now a serious shortage of qualified medical staff. Dr Karemera said that priorities were immunisation, sanitation, and prevention of disease.

    “The whole infrastructure of our health system was destroyed. It is difficult for us to treat patients or to vaccinate children,” he said. “One particular problem is the camps, which we hope to phase out as soon as possible because they are a real health hazard.”

    Dr Karemera said that AIDS was also a big problem and that efforts were being made to produce educational material. “It has become rampant as a result of the problems of rape which have gone on—they were even taking young girls and giving them to HIV positive soldiers on purpose.”

    The report from Physicians for Human Rights speaks of the ethical vacuum in which doctors operated during the atrocities and says that had there been a medical professional organisation in place in the years preceding the holocaust it might have helped.—CLAUDIA COURT

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