Camp management and funding

Four agencies are responsible for managing the two camps where I work. A branch of the Rwandan government is responsible for registration and food distribution. Save the Children is a nongovernmental organization (NGO) responsible finding lost family members. The United Nations High Committee for Refugees is responsible for overall monitoring, referrals for specialty medical care, materials for construction and basic food supplies. ARC is responsible for primary health care, maternity, immunizations, family planning, HIV counseling and testing, income generation projects (loans for small businesses and group savings programs), water and sanitation (latrines, one per 20-25 people), gender based violence programs, roads and construction of buildings. There are a few other NGOs that play minor roles such as providing scholarships to students for secondary schools.

Funding for these programs comes from many sources. The United Nation’s funds have been reduced due to nonpayment of some members including the US. ARC’s worldwide budget is slightly over 30 million dollars and the budget for Rwanda is 2.5 million dollars. Approximately 99 % of the funding for Rwanda comes from the United Nations and from various US agencies. Small amounts are funded from private foundations and OPEC. Reductions in funds paired with increasing numbers of refugees from the Congo during the past few years has, reduced the quality of some services. A peace agreement was signed in the Congo early this year, however the security there is poor and refugees are still entering Rwanda. This is leading to discussions about expanding some camps.

Limited resources of the NGOs delivering services and of the residents of the camps leads to multiple delays, inefficiencies and hardships. A woman with a fractured ankle was transferred to the local hospital for a cast because casting materials are not available in the camp, though knowledge of cast application is known by personnel. She needs crutches but none are available or affordable. If she leaves the ward and walks on the cast, the cast will soon be ruined in the wet weather and the healing of the fracture may be suboptimal. Another woman needed a pelvic exam but it was delayed for two days, first due to other women in labor and using the room and secondly by lack of sterilized speculums. This week we were out of referral forms and couldn’t print more as the computer was not available, so those patients who needed a referral had to return the next day. The forms were not available so return on the third day was necessary. Several people have had poor distant vision, and have been prescribed glasses, but these are not paid by any of the organizations so are usually are not obtained. The clinic does have a selection of reading glasses free for refugees.

Despite these difficulties, the staff and refugees continue to work and study for a better future. During the drive to work each day in a crowded Land Cruiser (record of 18 people) over bumpy roads, the staff are usually kidding each other (in Kinyarwanda) and laughing. I can’t understand the jokes, but admire their ability to find humor.