Episode: "Caught In The Crossfire"

Burundi

Country Background

In Burundi, as in neighboring Rwanda, competition for political influence and scarce natural resources has been played out on a chessboard of ethnic division. In 1970, roughly eight years after Burundi’s independence from United Nations trusteeship, ethnic Hutus began a campaign against the Tutsi-led government. The national army retaliated massively against Hutus throughout the country – all told, the struggle killed more than 100,000 over the course of two years.

As destructive as that war was, it pales in comparison to the current stage of fighting – a prolonged guerrilla war touched off in 1993 by the assassination of Melchior Ndadaye, a Hutu and the country’s first democratically elected president.

The initiation of a peace process and power sharing agreement between the primary Hutu and Tutsi political parties in 2001 has given Burundi a false appearance of calm in the eyes of many outsiders. Meanwhile, the nation’s humanitarian crisis continues unabated, and in Burundi’s cities and countryside the war grinds on.

A Capital City Under Siege

For ten years, Hutu guerilla groups and the army of the Tutsi-led Burundian government have waged a form of low-intensity combat that has no discernible frontlines. In order to sustain the ability to fight a perpetual war, both sides have targeted civilians, looting their belongings and treating those who resist with indiscriminate brutality. The result is a people whose lives have been structured around constant threat of violence.

In the rural east, many highland farmers have adopted the strategy of nightly mass-migration to lowland villages because their families risk murder, rape and looting if they stay in the hills overnight. At the crack of dawn, they pack up their belongings and leave the churches and municipal halls in which they slept, marching back into the hills in caravans of people and cattle that stretch for miles.

In this type of war, although all major cities and most small towns are controlled by government
forces, civilians living even in the very heart of the nation’s capital city have not been safe from the fighting.

The Kamenge Project: Treating War-Wounded Civilians in Bujumbura

This episode of Doctors Without Borders: Life in the Field follows MSF Doctor Heidi D’Hert and Psychologist An Michels as they treat physical and psychological war-wounds in the Kamenge district of Bujumbura, Burundi’s capital. The project was opened in 1995, two years after MSF started working in Burundi.

The hospital in Kamenge receives a constant stream of injured men, women, and children who have been injured in fighting between rebel and government forces. In a fairly typical month (May of 2003), MSF’s doctors and nurses at Kamenge treated 37 gunshot wounds, three landmine accidents, and 32 victims of other assorted forms of war-related violence.

During this period, approximately one quarter of the injuries treated by MSF were inflicted upon women and one out of five patients were below the age of 16, statistics that illustrate the effects of the violence upon civilians.

The psychiatric branch of MSF’s Kamenge project is just as busy. In May, MSF’s counselors received approximately 160 patients per week. One out of five were diagnosed with Post-Traumatic Stress Disorder (PTSD).

Project Update: No One is Safe

In the year since the episode was filmed, the steady pace of civilian war-wounded in the Kamenge district has only been interrupted once; in July 2003, Bujumbura was shelled by rebel forces, producing more than 170 casualties, by UN estimates. The attack lasted 10 days and displaced tens of thousands of people.

The attack on Bujumbura in July came several months after a transition from the former Tutsi leadership to Hutu president Domitien Ndayizeye – a landmark moment in the peace process that was expected to ease tensions between Burundi’s armed groups. It was the worst assault to hit Burundi’s largest city in ten years and underlined a sad truth about the ongoing conflict: in spite of a two-year-old peace process, no one is safe.