Rwandan Sorrow

By Karl Taro Greenfeld/Kibungo

The Musuhura refugee camp was literally a purgatory, a place of suffering and expiation, where 40,000 Rwandan Hutu like Joseph Havamungo, 29, and Nereciana Mushankwano, 20, wandered amid the huts strung together of relief-agency donated blue plastic sheeting, trash-can fires and hastily dug pit latrines and sought to scavenge the one thing that could sustain life in this place: hope. They were between countries. Host Tanzania didn't want them, and if they returned to Rwanda, they feared Tutsi would seek revenge for the genocide perpetrated by Hutu extremists just two years before. The landscape around the camp symbolized the prospects for the internees in it, scrubby hills that had been denuded of arboreal life, every twig and branch gathered for cooking-fire fuel. Yet Joseph still roamed the hills most days, seeking wood to sell for Tanzanian shillings that he could trade for precious food.

The sameness of his days, however, ended when he met Nereciana. They were from adjacent districts in Kibungo prefecture, Rwanda. She had a round, happy face, full cheeks, short, curly hair and good, straight teeth. She wore silver bangles, which jingled as she and Joseph walked together around the road that marked the perimeter of the camp, talking about home, about the avocado and eucalyptus trees, the rolling, verdant hills and the cooler air of Kibungo. Nereciana had sharp, slightly downcast, eager, probing eyes. When she spoke, Joseph detected a confidence in her tone; she knew what she was saying when she told of her desire to have a family. And when she talked about God, Joseph became very quiet, for he was Catholic but not so devout as she.

In Rwandan tradition, if a boy meets a girl and decides he loves her, he finds her father, and negotiations begin. It is called an inkwano--the price a prospective bridegroom must pay the bride's family. Since this was a refugee camp, though, and personal survival, never mind personal wealth, was hard to come by, the bridal price was below market: one cow, payable in some distant future when Rwandan Hutu would have cows and land to graze them on. A Catholic priest presided over the ceremony, attended by the other refugees from Havamungo's Rwankogoto village and sealed in the eyes of the community by the Bourgemeister, who wished them bountiful loins and strong children.

For Joseph and Nereciana, their relationship was a reprieve, a warm place in the heart of this darkness. And even when Tanzanian troops surrounded the camp, launched tear gas into the compound and ordered the refugees onto the roads back to Rwanda, Joseph and Nereciana, holding hands as two links in a 40-mile chain of humanity, could go with hope, believing--despite rumors that Tutsi were waiting at the other end of the Rusumo bridge over the Kageva River to castrate returning Hutu males--that God would watch over them and return them to safety. There were some positive signs: the Red Cross had set up biscuit and water stations to feed the procession of 400,000, some of whom had wrapped plastic bags around their bloody feet. "The camp was so terrible, and the trip back was so terrible--nothing that was waiting for us could have been worse," Joseph says of the return to Rwanda.

The country to which they returned was a wasteland. Rwanda, a landlocked nation squeezed between Tanzania and the Republic of the Congo, has always been among the most crowded countries on earth--6.7 million people packed into a country the size of Vermont, not a good thing for an agrarian society whose primary economic unit is the family farm. The overpopulation is among the first things a visitor notices--and it has been cited as a sociological cause for the genocide. Rwanda is one of those countries, like India, where you are almost never out of sight of another human being. The entire country has been stripped of its jungle, savannah and bush to make way for handkerchief-size plots of manioc or peanuts or the prize cash crop, coffee.

Yet, all those factors aside, Rwanda today can be understood only through the harsh prism of the genocide that ravaged it in 1994. That bloodbath, fueled by an incendiary combination of misguided Belgian colonial policy, divisive domestic politics, ethnic stereotyping and tragic French foreign policy, took the lives of 800,000 of the minority Tutsi. The genocide, and the concurrent civil war during which the Tutsi minority took control of the country, devastated the infrastructure and exterminated the professional class. There were fewer than a dozen doctors within Rwanda's borders in 1997, and no more than 100 nurses. Hospitals were destroyed by retreating Hutu forces, as were power plants, factories and government buildings. The country that had once been a bastion of orderly if somewhat squalid agrarian capitalism was reduced to Stone Age living standards. In 1993, before the genocide, 53% of households were below the poverty line; by 1997, that figure had risen to more than 70%. Women's life expectancy was down to about age 43. "We needed to start from the beginning again," says Antoinette Uwimana, subprefect for the Kibungo region. "We had no infrastructure, no education, no water, no roads. All needed to be rebuilt, and we didn't even have an executive class. Agriculture was our only resource."

Returning refugees such as Joseph and Nereciana found the fields lying fallow, the last few harvests still rotting on the stem. This wave of humanity could have precipitated a disaster had not the new Tutsi government headed by Paul Kagame secured international aid and, even more miraculously, somehow managed to bridge the bloody tribal divide. There were Tutsi reprisals against Hutu, but for the most part the reintegration of Hutu refugees into Rwandan society went smoothly.

Joseph and Nereciana reinhabited a familial plot in Rwankogoto and began the process of building their dirt-floor, four-room hut from bamboo, reeds and mud. The house, perched on a hillside overlooking a fertile valley, catches morning sun and stores the warmth all day within its thick stucco walls. They built a thatched-roof outhouse, a rabbit hutch and a chicken coop. They cleared four acres of farmland and sowed their first crop: manioc, beans, peanuts, pineapples and sweet potatoes. Her sisters lent Nereciana pots and empty jerricans that she filled with bananas, yeast and hops to ferment banana beer.

"A new beginning was happening," Joseph says. "We built this house together with our bare hands." In the mornings Nereciana would don her black-and-white igitenge (a sort of floral skirt) and rubber flip-flops and head out with Joseph to work the fields. Nereciana, a talkative woman, loved recounting the tales of Bakame, a mythical rabbit who is always playing tricks on humans and other animals. And for Joseph, hunched over, listening to his wife, it seemed that even though life was hard, "this was, for us, a time of great hope."

In the spring, Nereciana walked up the hill to visit an ababyaza (traditional midwife) for a consultation. The woman felt Nereciana's stomach and pelvis, asked her questions about her menstrual cycle and then deduced what the couple had begun to suspect: Nereciana was pregnant.

One of the ironies of suffering a national tragedy on the scale of Rwanda's is that once the crisis is off the front pages of the world's newspapers, the emergency-relief money stops flowing--precisely when the country needs ever larger foreign contributions to restart a moribund society. Particularly hard hit has been Rwanda's medical establishment, which is grappling with some of the most pressing public-health issues on the planet. At least 11% of the population is HIV positive. Malaria, cholera and other diseases are rampant and periodically spike to epidemic levels. Malnutrition is a chronic problem here as in much of Africa, with 10% of the children afflicted. And infant mortality rates at 125 deaths per 1,000 births are at double the world average. For such doctors as Emmanuel d'Harcourt, 34, a program manager for the International Rescue Committee, that means having to build a health-care system in the midst of a full-blown health crisis, improvising with scarce foreign aid and an overburdened Ministry of Health. "There is so little room for error," he says. "The resources are so scarce. It's like parking a car in a space with a millimeter of clearance on each side."

The issue of maternal mortality--mothers dying in childbirth--is particularly perplexing to D'Harcourt. In Rwanda becoming pregnant is tantamount to a death sentence. The lifetime risk of death from labor complications in this part of Africa is 1 in 9. The risk in the U.S. is 1 in 4,000. Numerous factors including nonexistent prenatal care, malnourishment and unsanitary delivery conditions jeopardize the health of mothers and babies. "It's impossible to predict complications," says D'Harcourt. "That's the difficulty with maternal mortality. You can't predict what will go wrong. Certainly, quality of care and treatment play a huge role here." What that means is that even when complications ensue, with the right medical care, lives can be saved. But in Rwanda, where the causes of infection run the gamut from dirty swaddling cloth to unclean razors used to cut umbilical cords, lack of even the most rudimentary measures means that such commonplace complications as pre-eclampsia or sepsis can turn fatal. "Our resources are so limited, we can't put in an IV just in case there is hemorrhaging," says Silas Ruberandinda, director of the Mutenderi Health Center. "We can't even spare the catheters."

More than 90% of the deliveries in Rwanda are facilitated by traditional midwives. These women often learn their trade from their mothers, by watching other village women give birth and by giving birth themselves. "I had no formal training," says Modesta, a traditional midwife. "I'm only learning now how to recognize risk factors and to decrease the risk of infection." Their equipment often consists of little more than cloth, an old blade and a string to tie off the umbilical cord. While the Rwandan government hopes eventually to have most women deliver in hospitals, that is wishful thinking in a country with only a few thousand hospital beds. The best chance of lowering maternal and infant mortality is equipping midwives with a few simple tools: razor blades, cloth, swaddling, disinfectant, soap and rubber gloves, plus training in hygienic techniques. The cost of the kit is $8.

When a baby is born in Rwanda, a traditional ceremony takes place on the eighth day of the child's life. Banana beer is served, and the community gathers as the newborn is brought out and held up to the sky. The infant is scrutinized, and names are suggested by family, friends and neighbors until the father hears one that sounds right.

Nereciana had been looking forward to this ceremony. It is considered bad luck in Rwanda to think up names for a baby before birth; too many don't make it out of the womb alive. But as Nereciana grew heavy with child and finally could no longer waddle out to work in the fields, she imagined the ceremony, the party, the happy times ahead. Joseph was laying in a supply of banana beer. Ripe pineapples, Nereciana's favorite fruit, were abundant. The birth and the naming ceremony would be, after the camp and the long march back, a new beginning.

On a bright evening in early spring, the villagers of Rwankogoto gathered in and around the couple's tiny hut, sipping banana beer, speaking quietly among themselves. Joseph entered the dirt-floor living room. He looked dazed. He had been weeping.

He hadn't been expecting a funeral.

A few hours after her contractions began, Nereciana was racked by spasms and began complaining of violent abdominal pain. At first Joseph and neighbor Beatrice Nyirahabimana thought the severe contractions of first labor caused her pain. But after eight hours, it was clear that some vital force was leaving Nereciana. Joseph went to seek help. "I'm too weak," Nereciana said to Beatrice. "I'm dying, aren't I?"

The fetus' heart may already have stopped beating when Nereciana died. The cause of her death remains unknown: pre-eclampsia may have brought on seizures, or her uterus may have ruptured. But a larger cause is blisteringly clear: Rwanda is a nation so poor in goods and so weak in spirit that it cannot even give birth to a future. Nereciana's death, a tragedy that still lives in Joseph's sad eyes, was part of the slow genocide of hope, a sin that can be undone only by the miracle of an outside world that cares.

For more of James Nachtwey's photos, visit www.time.com/time/daily/special