Banatvala N, Roger A J, Denny A, Howarth J P
Medical Emergency Relief International (MERLIN), London, UK.
Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):17-21. doi: 10.1017/s1049023x00030107.
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.
To study patterns of mortality, morbidity, and health care associated with the Rwandan refugee population repatriation during November 1996.
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.
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.
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.
1996年9月底新一轮种族暴力事件发生后，图西族叛军与扎伊尔军队之间的冲突蔓延至扎伊尔的北基伍省，1994年种族灭绝事件后约70万卢旺达胡图族难民居住在此。11月15日叛军对难民营的民兵组织发动大规模进攻后，一场大规模的难民潮开始通过北基伍省首府戈马镇向卢旺达涌去。如此大规模的人口流动很可能伴随着大量的死亡和发病情况。
研究1996年11月卢旺达难民遣返期间的死亡率、发病率及医疗保健情况。
本研究观察了卢旺达吉塞尼区和扎伊尔戈马区医疗设施的运转情况，并对从扎伊尔返回卢旺达的卢旺达难民的死亡率和发病率进行了调查。死亡率、发病率及医疗保健情况主要通过死亡率和医疗中心就诊率来衡量。
1996年11月15日至21日期间，55.3万难民返回卢旺达，边境诊疗所进行了4530次（每1000名难民中有8.2次）诊疗（水样腹泻占63%；血性腹泻占1%）。在随后的两周内，吉塞尼医院有129例（每1000人中有0.2例）外科住院病例（72%为软组织创伤）。同期13个医疗中心的平均每日诊疗次数为500次。总体而言，记录的死亡率为万分之0.5（均与腹泻有关）。在戈马的难民营及周边地区共发现3586具尸体，几乎都是外伤所致。许多人在大批难民离开前几周就已死亡。医疗中心不堪重负，1994年发现的许多医疗保健方面的不足再次显现出来。
非暴力死亡率较低，这反映了移民前人群的健康状况以及从1994年霍乱疫情中获得的免疫力。医疗设施不堪重负，主要原因是与1994年种族灭绝事件相关的当地医护人员数量减少。与现有医疗保健系统并行的医疗设施运转最为有效。
