scholars provide varying views on the origins of Burundi’s
12-year civil war; that is to say, on why Burundi’s civil war
broke out at that particular place and time.
without doubt, was an ethno-political war. By 1993, politics were
solely determined along ethnic lines. This was the result
of the colonial legacy and the post-colonial struggle for power. For
many Tutsis, the struggle against Hutus was rooted in the “social
revolution” in Rwanda from 1959 to 1962 where the majority gained
control of the government. For Hutus, it was rooted in the massacre
of tens of thousands of Hutu intellectuals in 1972 by the Tutsi controlled
military. By either accord, the “tipping point” was reached
in 1993 when Melchoir Ndadaye was elected the first ever Hutu president
of Burundi and, after 100 days in office, was assassinated by the Tutsi
in Burundi is sometimes termed a “popular” conflict.
This means that not all actors responsible for acts of violence were
members of the military or ‘extremist’ or ‘ideological’ rebel
groups. Many so-called “perpetrators” were ordinary citizens
who, under extreme pressure, chaos, and destruction, did things they
would never imagine doing under ordinary circumstances. Neighbors killed,
looted, and raped their neighbors. The question is: why?
Burundi context, the meeting point between politics and chaos cannot
down. On the night of Ndadaye’s assassination,
the Tutsi military also assassinated most of Ndadaye’s cabinet
and party leaders. The majority Hutu population woke up to learn that
the first ever democratically elected leadership of the country was
dead. Retaliatory actions by Hutus—mostly in the countryside—killed
thousands of Tutsis and, from there, the “kill-retaliate” nature
of the war began.
However, the escalation of ethnic conflict was also deeply structural.
Burundi is one of the poorest countries of the world. The GDP per capita
is estimated at $138 per year, even though in poor urban communes and/or
rural areas, a person may see less than $60 pass through their hands
in any given year.
the war began in 1993, Burundians faced short life expectancies due
the effects of poverty, often dying from treatable and preventable
diseases. Infant and maternal mortality rates were high and the emerging
HIV/AIDS crisis was just beginning to wash through Burundi’s
urban neighborhoods. Despite the existence of effective treatments
for nearly all of these causes of death, the average Burundian did
not have access to them.
of pre-war Burundi was that people could not provide for their families.
They did not have access to basic health services and
deeply mistrusted a juridical sector which was controlled—or
was feared of being controlled—by someone of another ethnicity.
Perhaps the saying “desperate times require desperate measures” provides
an accurate analogy, especially when people’s lack of personal
health, safety, and security is placed in the context of extremely
polarized local and national politics.
however, the 12-year civil war, or “crisis” as
it is called by the Burundian people, only exacerbated the extreme
poverty and public health crisis faced by the country before 1993.
Deadly conflict has a huge health impact on communities. Approximately
300,000 people were killed in Burundi between 1993 and 2005 as a direct
result of armed conflict. Many more were physically injured by gunshot,
machete, or grenade attacks. And this says nothing of the health consequences
caused by people fleeing their homes, hiding in the bush, or living
in overcrowded internally displaced person (IDP) or refugee camps.
Under these conditions, lack of water, malnutrition, and communicable
diseases became major public health concerns.
of sexual and gender based violence also rose dramatically during
of the war. In some instances, rape was deliberately
used by the military and rebel groups to perpetuate fear among the
population. However, instances of “civilian” rape also
above, the war in Burundi was a “popular” war
and was perpetrated at all levels of society. Risk of HIV and other
STI transmission becomes much higher under such circumstances. Poverty
is already a main risk factor for HIV transmission. This risk is multiplied
when a concentrated group of individuals such as soldiers, rebels,
or members of one community aggressively (which, among many other implications,
implies without protection) have sex with many people. HIV positivity
rates therefore grew dramatically in Burundi throughout the war, especially
in areas like Kamenge which were epicenters of violence. Today, a moderate
estimate for HIV positivity in Kamenge is 16% of the adult population.
these issues—physical wounds, malnutrition, communicable
disease, rape, HIV and STI transmission—took place on the backdrop
of an overtaxed and deteriorating medical system. Amidst losing everything,
Burundians did not have the ability to meet their basic health needs.
Therefore, many more people died—unnecessarily—as a result.
The deterioration of health services had a particularly devastating
effect on women. Women who experienced sexual violence could not seek
physical or emotional support. Women, who were frequently becoming
single heads of households, could not provide for the health needs
of their children. Lastly, even on occasions when medicines and treatment
were available, women did not receive them due to on-going gender inequality
day, Burundi feels the effects of war on its public health system.
increases in health needs the country has less
than 300 medical doctors to treat its population of 8.6 million—this
is the equivalent of the state of Maryland having 137 doctors instead
of its actual 13,500. However, this is still an improvement from the
years of the war when the number of doctors was only half of what it
at Burundi’s experience, it goes without saying that
war had a devastating impact on health. But what we at the Friends
Women’s Association are asking is: What impact does health have
article:Health and Peace