Anguish of Rwandan Hutu Refugees Echoed in a Baby's Cry Top of Form

Published on January 28 2009 by HAGANIRIMFURA

By JAMES C. MCKINLEY JR.

Published: February 21, 1996

Exhausted from hours of labor in a hospital tent at the center of the sprawling refugee camp, Jacqueline Nyiranza held her first baby, a scrawny and wrinkled infant, close to her breast. The baby, born prematurely, was weak, and she held it as if it were the most fragile thing imaginable, as if it were the only hope she had to rebuild a life shattered by war and flight.

"I was living alone and I didn't have any help, so I got married," whispered Mrs. Nyiranza, 23, a Hutu refugee from northwestern Rwanda, who said her parents and siblings were killed in the civil war there. "I chose to have the baby rather than go into family planning, because so many people were killed. My husband wanted to have it also to replace the family members who died."

Then she sighed, her forehead crumpling in worry: "But I can't give birth again. I have no way to feed this one."

Outside the postnatal tent in the maternity hospital where Mrs. Nyiranza was resting, hundreds of new mothers cradled squirming infants in their arms. For hours, they waited on wooden benches to have a nurse from Goal, an Irish aid group, examine and vaccinate their children.

In another tent here in the Kibumba refugee camp, five women were struggling through labor pains on army cots while two midwives prepared for them in makeshift delivery rooms. Nearby, the shortest line was outside a small tent where a nurse was demonstrating the use of condoms and giving injections of Depo-Provera, a birth control drug. Ten women showed up this morning to get injections. All had babies with them.

Despite meager food rations and rugged living conditions in the camps, the refugees are giving birth to thousands of new babies a month. The five camps near Goma have a birth rate high even by African standards, with between 50 and 60 births for every 1,000 people last year, United Nations officials said. More than 2,800 infants are born every month. Most weeks the number of newborns outstrip the number of refugees deciding to go back to Rwanda.

The birth explosion in the camps has been fueled by boredom, loneliness and the desire among young women to rebuild their families after the ravages of war, aid workers said, and it has not been curbed by warnings that AIDS is rampant among the refugees. In dozens of interviews, many new mothers voice the conviction that the 710,000 Hutu refugees living near Goma must replenish their numbers, which they say have been decimated by the civil war that began with an uprising by Tutsi rebels in 1990 and led to the Hutu-led massacre of an estimated 500,000 Tutsi and Hutu moderates in the summer of 1994.

The refugees here crossed into Zaire in July 1994 after the Tutsi rebels routed the former Hutu Government and put an end to the massacres.

But some refugees and relief workers say there are other less obvious reasons for the trend. One is a deep resistance among most men in the camps to using birth control devices. Another factor, they say, is the longstanding belief, common in Africa, that large families mean prosperity, even if there is not enough food to go around. And most women are afraid to go against their husband's wishes, aid workers said.

"When you ask them, the women always say they don't want to be pregnant at the moment, because they do not have enough food," said Anne Tolsma, the director of the Memisa Health Center in the Mubunga camp. "But they can't refuse their husbands. And the men do not use condoms."

Other nurses who dispense birth control devices say they find themselves fighting the misperception in the camps that contraceptives render women sterile.

"They all know that the methods exist but they simply do not want to use them," said Jeannette Uuimfura, a nurse who was dispensing birth control information at the Goal maternity hospital in Kibumba. "Many worry that the contraception will keep them from having babies in the future."

Another spur for the rising birth rate is the unending tedium of living in a tent city. There is not much to do in the camps at night after curfew. Sexual promiscuity is common, while the number of women using birth control devices is low, according to nurses and doctors who work in maternity wards.

United Nations officials have decided not to do a study to determine how many people in the camps are infected with H.I.V., the virus that causes AIDS, arguing that such information would not change measures to slow the disease. But doctors working with the refugees say it is one of the most common causes of death, rivaling malaria and dysentery.

Surveys in Rwanda before the exodus had found one of the world's highest rates of H.I.V. infection, with one in three women who gave birth in some urban hospitals carrying the virus. Based on research elsewhere, infected mothers have perhaps a one in four chance of giving birth to infants with the deadly virus. Health experts believe that H.I.V. must have continued spreading rapidly during the last two years of violence, flight and life in the refugee camps -- a time when prostitution and casual sex have increased.

In one section of the Mugunga Camp, which has a population of about 42,000, social workers were visiting up to 60 terminally ill people each day, according to Memisa, a Dutch aid group. At least 40 of them were dying from complications of H.I.V., Memisa nurses said.

The United Nations is distributing condoms and has started education programs in the camps. Health workers put on morality plays about AIDS and give lectures. But the message is not reaching everyone and many refugees seem indifferent to the disease, which takes several years to incubate, aid workers say.

"When we talk to them, they come up with 'Yeah, but my husband doesn't want to use condoms,' " Ms. Tolsma said. "They have so many other problems to think of, why should they think about something that kills you in 10 years?"

Even before the war, Rwanda was a densely populated and predominately Roman Catholic country with the highest birth rate in Africa, 8.4 children per woman.

Now, fewer Rwandan women are using birth control devices in the camps than were using them in Rwanda before the war, despite a public relations campaign started a year ago by the United Nations to boost the use of contraceptives. At the end of December, only about 4,300 of the 177,000 women of child-bearing age in the camps were taking advantage of the birth control methods available, United Nations officials said.

Dr. Claire Bourgeois, the United Nations medical coordinator for the camps, said that as a matter of policy health workers were told to advise women to spread out their births, but not to actively discourage refugees from having children if they want. "The aim of the United Nations is not to limit the births," she said.

Victoire Mukamwezi, a 26-year-old refugee, was one of the few women seeking a contraceptive at the Kibumba clinic today. She said she was single when she came to the camp with her sister's family in 1994, but her sister died of cholera, and in desperation, she married her sister's husband. Five months ago, her first baby was born. She was initially ecstatic about the birth, but she has found it harder and harder to feed the family.

Still, Ms. Mukamwezi said she was having trouble convincing her husband to let her use a birth control device. She had come to the hospital to get a contraceptive injection and was not sure if she would tell him.

"It doesn't matter if I have only one child, but what I can't do is have another," she said. "He has to understand. He knows how the situation is."

But many other mothers at the hospital said they were scared to try the birth control shots or opposed to them on religious grounds.

Leocadie Nyiraturinabo, a 34-year-old mother of five, said she had no idea how she would feed her latest infant boy. The day before, she had given birth in her family's tiny hut and was bringing the baby in for a check-up. She and her husband were having a hard time making ends meet as it was. To supplement the United Nations rations of grain, they had been working long days hoeing weeds on a nearby Zairian farm in return for a few potatoes or two cups of beans.

"I trust in God only," she said. "I am afraid to go to family planning because I heard from some women who went there that they had trouble with the drugs."

A few yards away, Demitria Nyirabahutu, 34, was sitting on an overturned gas canister behind the delivery tent. She had been in labor for four hours, and her face was covered with perspiration. This would be her sixth child, she said, but the only one born in the refugee camp.

She said she had not planned to have the baby and had even tried birth control injections for the first year she lived in Kibumba. But once she became pregnant again, she was happy. She lost her other children when soldiers from the Rwandan Patriotic Army, a Tutsi rebel group, attacked the camp inside Rwanda where she and her husband were living in 1994. In the chaos of the attack, she became separated from her children and ran for her life, she said. She does not know if they are alive or dead.

"I want to replace these children," she said, gritting her teeth through another contraction. "It was a terrible situation. We were living in a displaced person's camp. We were encircled by the fighters and they were shooting. I had no choice. I had to save my own life."

When she is asked if she misses her lost children, she averts her eyes and her face hardens, like a warrior's, as if giving birth again were an act of defiance. "Crying has no meaning to me," she said. "It is useless to cry."