The Rwandan healthcare system now covers over 90% of the population, the highest coverage rate in Africa. The informal community-based health insurance (CBHI) scheme, known as Mutuelle de Santé, focuses mainly on maternal and child health. According to the East African, the scheme is one of the most successful on the continent and it is credited for the country’s lower maternal and infant mortality rates of over 70% since 2000.
CBHI was originally voluntary and when contributions became compulsory, many saw it as paving the way to national coverage. Rwanda’s potential model for Africa is pivotal to development, as the WHO estimates that 100 million people are pushed into poverty and 150 million suffer financial catastrophe because of out-of-pocket expenditure on health services every year. Kenya is now using the CBHI model in pilot programs, while Tanzania and Uganda are openly considering it.
Benjamin Chemouni argues that Rwanda’s expansion of health insurance coverage is made possible by the concentration of power in the ruling coalition. He says the CBHI policy and its implementation are forged through both political interests and ideology. Kenya, Tanzania, and Uganda are certainly different milieus than Rwanda, so time will tell how the CBHI programs would fare in other countries.
If any country could make this model a success, however, it’s Rwanda. I have written about Africa’s innovation leaps forward and Rwanda is at the fore. Pretty impressive from a country that has done so much rebuilding in just a few decades since massive conflict. We can’t help but root for Rwandans.
In reviewing some cases of conflicts in sub-Saharan Africa, I was reminded that I could not name a single one in which some form of natural resource, e.g. land, precious metals or other tradable commodities, did not undergird the fighting. I was fascinated anew in rereading about the histories of four conflicts in particular and will be making various posts that describe these in a nutshell. This is the first, and it will cover the issue of land scarcity in the Rwandan Genocide. The other four cases to follow—Liberia, Sierra Leone, and the Niger Delta—are about overabundance rather than scarcity. For a great narrative about land scarcity’s role in the 1994 genocide, you can also read Chapter 10, “Malthus in Africa,” of Jared Diamond’s “Collapse.” This title refers to the Malthusian dilemma in which human population tends to exceed the capacity for food production to feed that population.
The cases demonstrate four possible hypotheses about what might cause, sustain, and give form to civil conflicts in Africa. No conflict is ever driven by a single factor and conflict is always the interaction of many factors. Note that these conflicts arose in the era after the Cold War of comparably informal warfare and thus were quite different from most previous conflicts in the 20th century. As opposed to traditional wars, these are examples of “new” or “hybrid” conflicts because they A) involve many non-state actors, B) were based on identity more than ideology, C) used fear to garner political control, and D) were financed through predation rather than taxes. Modern conflicts in developing countries, particularly in Africa, can often be partially explained along these lines.
Rwanda and the “Green War” Explanation: This points to environmental degradation and scarcity as a source of poverty and cause of conflict. For example, rising population pressure and falling agricultural productivity may lead to land disputes. Lack of water may provoke conflict, e.g. Sudan. Environmental stress like that in 1990s Rwanda tends to make people prone to violence as they seek alternatives to desperate situations. In the Rwandan context, lack of access to farming land—necessary to food production and even securing marriage for young men—helped impel the violence (in combination with other historical and geographic factors).
My Relatively Quick Summary of the Rwandan Genocide: The mountainous country of Rwanda in Central Africa was controlled first by Germany and then after WWI by Belgium until its independence in 1962. Belgian rulers systematically favored the minority Tutsis over the majority Hutu groups, which sowed the seeds of ethnic tensions that were a significant factor in later conflicts for Rwanda. A 1959 Hutu revolution forced 300,000 Tutsis to flee and Hutus officially took over when they ousted the last Tutsi monarch in 1961. Ethnically motivated violence ensued in the following decades, including after the installment of a moderate Hutu, Major General Juvenal Habyarimana, as head of state. He ruled through his party, the National Revolutionary Movement for Development (NRMD), for the next two decades as he ossified his power in elections in which he was the sole candidate. During this time, hundreds of thousands of Tutsis refugees were living in Uganda and attempting to re-enter the country through the forces of their Rwandese Patriotic Front (RPF). From 1990-1993, PRF fighters attempted a takeover of the capital of Kigali until Habyarima agreed to the creation of a transition government that would include the Tutsis, an agreement inflaming Hutu extremists. In this context, the Rwandan Genocide was a single three-month phase of the larger Rwanda Civil War (1990-1994).
Environmental conditions were ripe for conflict by the spring of 1994. Rwanda was a landlocked and impoverished country that relied, as it does today, on agriculture. Fluctuating world prices for coffee on the world market in the 1980s began a sustained economic crisis that peaked in 1990 with the International Monetary Fund’s (IMF) structural adjustment program for the national economy. The average Rwandan farmer was earning less for their crops in one of the most population dense countries in Africa. There was not enough farmland or resources to sustain working-age Rwandans, including large swathes of unemployed and unpropertied men, and land disputes arose along ethnic lines. Conditions of environmental stress and poverty were extreme.
The single incident that inflamed the genocide occurred in April of 1994, when the plane carrying Habyarimana and the Burundian president was shot down over the capital city of Kigali, killing all occupants. Some blame the RPF and others the Hutu extremists for the assassination. Quickly thereafter on the same day, the Presidential Guard, the Rwandan armed forces (RAF), and Hutu militias–the Interahamwe and Impuzamugambi—began indiscriminately slaughtering Tutsis and moderate Hutus in Kigali. The Rwandan media, specifically government-sponsored radio programs, played a pivotal role in spreading the rallying crying for violence across the rest of the country. Radio broadcasters called for the killing of Tutsi “cockroaches” and encouraged all Hutus to take up arms. This was particularly dangerous in a population-dense environment in which neighbors lived so closely together. Pressure among Hutus to engage in killings quickly spread in clusters within tight-knit communities.
An estimated 850,000 Tutsis were individually killed by hand in a 90-day period, which exceeds the per-day killing rate of any other genocide in world history. Around ¾ of the Tutsi population was killed, along with 1/3 of the Batwa Pygmy population, while ¼ of Hutus engaged in violence. Family members were forced to kill their own family members and join the violence. Génocidaires systematically targeted Tutsi and moderate Hutu women for sexual violence as a weapon of war with the goal of sexual mutilation and spreading AIDs. The sexual violence was so extensive that it became the first event in which rape as a weapon of war would later be prosecuted as an official war crime by the International Criminal Court (ICC) in The Hague, Netherlands.
The End of the Genocide: The genocide came to an end in July 1994 when the Tutsi-led RPF finally took military control of Kigali and the rest of the country and installed a coalition government. Over 2 million Tutsis were refugees across the border in what is now DRC (then called Zaire) and many returned. Only after the killing ended did the international community respond, and the Rwandan Genocide is often cited as the worst example of global apathy in the face of a clear humanitarian crisis. There were some UN and European peacekeepers on the ground but their mandate did not permit them to use force against the Hutu extremists and there is evidence that some humanitarian zones they created were used a gateway for génocidaires to escape the country. Because of the logistical challenges of prosecuting thousands of violence participants, the RPF established community justice courts called Gacaca courts, a form of transitional justice meant to aid communal healing, closure, and forgiveness on a grassroots level after a collective trauma.
Today, Rwanda is perhaps the greatest example of a country that chose to rebuild positively after mass violence and is an example of constructive change. It has the highest number of female parliamentarians in the world, outlawed reference to tribe or ethnicity (even in casual conversation) to avoid discrimination, hosts a monthly community service day nationwide, was the first country in the world to ban plastic bags as a green initiative, and hosts the most expensive building on the continent. It is a land of surprises today.
