Humanitarian Aid and Health Services in Eastern Kivu, Zaïre: Collaboration or Competition?

The population of eastern Kivu, like that of Rwanda, has been surviving in critical conditions for many years. The Rwandan refugees of 1994 fled into an area with its own serious problems. The Zairean health services in the health districts of Rutshuru, Kirotshe and Masisi, in spite of the political and socioeconomic disintegration of the country, were still functioning, and the local hospitals and health centres, although overwhelmed, contributed to a large extent to the disaster response. Prominent among the major problems facing the local health services were their limited adaptability, the inadequate coordination and collaboration offered to them by the humanitarian aid agencies, and the discrimination between the direct and secondary victims of the emergency. The public health consequences of the Rwandan refugee crisis for the Zairean population constitute an integral part of the disaster.