Almost one-third of Rwanda's population suffers post-traumatic stress disorder 20 years after the genocide. Sue Montgomery of Postmedia News recently returned from the central African country, where she found there are few resources to help these people.
After their parents were slaughtered in Rwanda's genocide, Alain Ntwali and Luck Ndunguye were forced to become adults at an age when most children are beginning school.
Just seven and five years old when their worlds violently collapsed, they grew up in patchwork families of orphans, fearful, confused and unbearably sad, raising children younger than themselves and taking on roles far beyond their years. Now in their 20s, they struggle to keep the pain embedded in their psyches two decades ago, from crippling them completely.
Asked if they feel depressed, the young friends nod and respond in unison: "All the time."
"So you cry, you smoke, you drink," Ntwali says, shrugging.
As Rwanda marks the 20th anniversary of its genocide next week, Canadians and people around the world may think the country has moved on and "gotten over it." And to visit Rwanda, it's not an unreasonable assumption. The country is clean, safe and developing at a dizzying speed. It is one of the few countries in Africa likely to meet the United Nations' eight Millennium Development Goals next year - a list of targets agreed to by all countries in 2000 that includes reducing extreme poverty by half and providing universal primary education, all by 2015.
It's a remarkable feat considering that after the genocide, the country had no phones or electrical lines, or a functioning government.
But survivors of the genocide, many of whom are unable to work because of disabilities or chronic illnesses, feel abandoned by their government and the world. As the country positions itself as an information-technology hub - installing more than 1,600 kilometres of fibre-optic cables and a 4G network that covers 95 per cent of the country - many of its wounded citizens can barely function.
Of great concern are the hundreds of thousands - estimates are as high as 600,000 - who lost both parents in the genocide and have little or no access to psychological support.
Like Ntwali, 27, and Ndunguye, 25, they are still haunted by the past, unable to sleep, plagued by stressinduced headaches and epilepsy, and resorting to alcohol and drugs. Their country is so small its name on maps can't fit within its borders, yet it is an enormous case study in the devastating impact on the fragile human psyche of mass violence, and to what extent a population can truly recover. "You cannot measure the consequences of war and conflict by counting the number killed," said Duncan Pedersen, of the Montrealbased World Health Organization Collaborating Centre for Research and Training in Mental Health. "You have to count the survivors and what happened to them.
"The health outcomes aren't good."
More than a quarter of Rwandans suffer post-traumatic stress disorder, according to a 2009 study by Rwandan psychiatrists, and there are few resources to help them. Each of the country's 43 district hospitals reports seeing between 15 and 25 patients a day for psychiatric problems. The nation's first addiction facility, which opened recently, treats 300 to 400 people a month, some of them as young as 16.
Even Canadian Sen. Roméo Dallaire, who has received the best medical care possible, is still tormented by his time as general of the United Nations peacekeeping mission that failed to prevent or stop the genocide. So are 10 other Canadian soldiers who served with him in Rwanda. An 11th, Maj. Luc Racine, who was with the Royal 22nd Regiment in Valcartier, killed himself in Mali in September 2008 after suffering for years from PTSD.
As one of only six psychiatrists serving 11.4 million Rwandans, Naasson Munyandamutsa's spare time is scarce.
"We're not just starting to see PTSD, we are in the thick of it," he said, his voice low but urgent. "It's an extremely big problem and we're not keeping up with the suffering."
A UNICEF national trauma survey conducted a year after the genocide served as an early warning about the problems to come. An estimated 99.9 per cent of the country's children witnessed violence during the genocide, 79.6 per cent experienced a death in the family, 69.5 per cent witnessed someone being killed or injured, and 31.4 per cent witnessed rape or sexual assault.
But at the time, there wasn't even a word in the local language, Kinyarwanda, for trauma, let alone a way to treat it. Historically, life's problems were addressed within the strong family network, but that, along with everything else in the country, had been destroyed.
The children in the UNICEF study are now young adults, still grappling with trauma and struggling to make sense of what drove their Hutu neighbours, friends and relatives to turn so viciously on a small segment of the population known as Tutsis. Upwards of one million people were murdered in only 100 days - a rate of nearly 300 people an hour. It is even more astounding when you consider most were killed with lowtech weapons such as machetes, nail-studded clubs and spears.
In the years since, hundreds of thousands of orphans like Ntwali and Ndunguy have raised each other. And thousands of teens who are about to enter adulthood are just learning they were conceived through rape. Offspring of the killers - often forgotten victims in the tragedy - have grown up in a toxic mix of shame, confusion and anger. There is concern those suppressed emotions could one day erupt.
Mental illness is of course a global problem, but unlike HIV/AIDS or malaria, it gets short shrift when it comes to donor funding. Rwanda, though, is a particularly dire case, where thousands of "genocidaires," as the perpetrators are called, live among their victims. The situation calls for mass national counselling, says Delanyo Dovlo, the World Health Organization's representative in Rwanda. "The whole thing is just so pervasive, you probably need 10,000 counsellors to even begin to make a difference," he said.
"For most of us in other countries, the problem is anxiety, and this is 10 times deeper than that.
"It's a huge challenge." And that challenge is not only a lack of personnel and training but a cultural reluctance to express oneself outside of the family. The genocide has covered the country in a dark blanket of suspicion and mistrust, leaving people fearful to open their hearts about the past.
Jonathan Nettal, a native of the Montreal suburb Côte St-Luc, whose grandparents are Holocaust survivors, is a psychotherapist working for a Canadian NGO called Hopethiopia/Rwanda, counselling 19-to 23-year-olds on how to help each other, even though they are all traumatized. He teaches small groups of about 10 to 15 people skills they can use when they're in distress so they don't need to depend on professionals, who are in short supply. They can also use the techniques to help when they recognize distress in someone else.
"So you have more calm, people are more supportive, more socially connected, and that's a huge resource in terms of post-traumatic resilience."
After noticing signs of trauma in their schoolmates, Ntwali and Ndunguye started an organization five years ago to support young survivors like themselves. Called Imitali, meaning a protective sword, their members get together to brainstorm about setting up small businesses or financing university. They've established dance troupes and perform Rwandan traditional dance at weddings and other functions. "We also try to get people to open up, to talk, cry and support each other," Ndunguye said.
Reminders of what befell Rwanda are everywhere, especially at this time of year, when everything stops April 7 for a national week of mourning. Across the country, churches and schools - where hundreds of thousands sought refuge but instead were slaughtered en masse - have been converted into stirring memorials. But it's crucial for the nation's mental health for people to get to a point where their memories of their murdered loved ones are of the people they were, rather than the unspeakable ways they were killed.
"Will we come out of it quickly?" asks said psychiatrist Munyandamutsa. "I don't think anyone knows, but we need to work or study or do something that allows us to think of something other than death."
The reporting for this project was made possible by a journalism grant provided by the Canadian Institutes for Health Research.
Colonialization did not help Rwanda
Rwandan society: Unlike most African countries, Rwanda is made up not of hundreds of competing tribes, but rather three castes who share the same religion, language and, more or less, the same culture.
Who are the Rwandans?: The majority are Hutu farmers (85 per cent of the population), the minority Tutsi cattle owners (14 per cent) and the labourer and servant Twa (one per cent) got along relatively well for hundreds of years.
Colonialization: Rwanda came under the colonial control of Belgium during the First World War. Throughout the colonial era, the minority Tutsi were favoured over the Hutu. The introduction of identity cards distinguishing between the groups exacerbated racial tensions.
The Belgian colonizers were happy to let the Tutsi monarchy rule until they started making noises about independence.
Maha Hosain Aziz
