Rwandan refugee women

The Rwandan genocide of 1994 is well documented. During what has been described as “one of the most intensive killing campaigns in human history”, over 2 million people fled the country to neighbouring states. As they began to return home, settling in populous refugee villages with limited health support and infrastructure, pre-existing sexual and reproductive health and rights (SRHR) problems grew in volume and severity, and the need for action became ever more urgent.

The Japan Trust Fund set up a project to reach out to 1,500 Rwandan refugees returning from Tanzania. In the end, so desperate was the need, that the project was scaled up massively. It served a total of 42,661 people in 3 refugee villages – Bukora, Kageyo, and Ndego. Designed by the IPPF Member Association in Rwanda, the Association Rwandese pour le Bien-Etre Familial (ARBEF), this was a complex, multi-disciplinary programme designed to tackle a broad range of HIV and SRHR needs.

Pre-project survey of knowledge levels

About 90% of respondents had heard the terms HIV, AIDS and sexually transmitted infections, but:

  • 2% knew about the importance of condom use
  • 2% had been tested for HIV
  • 0.08% had had an STI consultation
  • 3% had used family planning

One of the big issues ARBEF faced was Gender-Based Violence (GBV). It is rarely reported to the authorities and it’s widely tolerated. As one project participant put it, “Being beaten is part of our custom. It’s even believed to be a sign that our husbands care.”

The result is that Rwandan women are routinely denied any right to make informed consent about sexual issues at home. ARBEF set out to tackle this denial of rights through outreach work, peer education and community discussions on contraception and family planning. Outcomes were striking: over the course of the project, across the 3 camps, the prevalence of GBV dropped from 54 to 24%. 

“Being beaten is part of our custom. It is even believed to be a sign that our husbands care”.

GBV work was integrated as one strand in an extensive sexually transmitted infection (STI) and HIV education and service provision programme. Given that knowledge of HIV was low (it was viewed by many as a curse caused by cows’ milk) such education was an urgent priority. In July 2007, the villages had no services for virtually any of the SRH necessities: voluntary counselling and testing (VCT); antiretroviral treatment (ART); prevention of mother-to-child transmission (PMTCT); family planning; condom distribution; or support for people living with HIV (PLHIV). In short, a baseline of zero service provision, right across the SRHR spectrum, and next to no knowledge within the community.

A little over 2 years later, in November 2009, the project had achieved a radical turn around in the SRHR situation in the 3 villages, as the numbers demonstrate.

As Frida Bugingo, Head of the Women’s Association in Kageyo Village says, “If it wasn’t for ARBEF we women would still be in the dark hole we have been in our entire lives.”

Such has been the success of this project that it’s been extended to further strengthen provision and expand the work across the community and surrounding areas for at least another 3 years.  

The outcomes

In the 3 refugee villages (Kageyo, Ndengo and Bukora) between July 2007 - Nov 2009:

  • 4 health workers were trained and working at local health centres
  • 16,096 people (38% of the population) visited VCT centres
  • 82,944 male condoms and 2,000 female condoms were distributed
  • 10,266 people received family planning information and services
  • 4,813 women accessed PMTCT services
  • 1,045 people accessed treatment for opportunistic infections
  • 2,246 people accessed treatment for STIs

There are still some massive challenges in Rwanda. But with so much achieved in taking action on GBV and improving sexual and reproductive health and rights in these vulnerable communities, there are clear signs of hope for the future.
 
You can find out more about the project by viewing the Mainstreaming STIs and HIV/AIDS among refugee populations in Rwanda End of Project Evaluation and the Returning Home, but Stepping Back presentation.