Doctors fear rising cost of Rwanda life-saving

MUGUNGA - A virulent strain of dysentery is spreading like wildfire among Rwandan refugees languishing in Zaire, threatening to push the cost of saving lives beyond the means of relief organisations, doctors say.

Rwanda's Prime Minister, Faustin Twagiramungu, speaking in his capital, Kigali, said his country had no money and would have no chance of recovery until an estimated 2 million refugees returned to rebuild its economy.

The contagious, bloody diarrhoea, which is proving resistant to cheap antibiotics in use in the refugee camps, has replaced cholera as the main killer of Rwandans in eastern Zaire. 'Antibiotics we use still seem efficient but the bacteria has quickly developed other levels of resistance, and we have to resort to more sophisticated and more expensive medicine,' said Dr Michel Piperno of Medecins du Monde (Doctors of the World) at Mugunga camp.

'You can be using an antibiotic one day and three days later it can prove completely useless,' said Colonel Francois Merouze, head of the French military medical emergency unit, Bioforce, which is operating at Goma airport in eastern Zaire.

He said the drug most commonly used by health workers cost around 75 francs ( pounds 9) per head for a five-day treatment. 'We already face a cost problem so you can imagine what it would be with doses costing up to 200, 300 francs,' he added.

The United Nations High Commission for Refugees (UNHCR) says at least 25,000 people have died over the past three weeks in Goma from malnutrition, dehydration, cholera, dysentery and other diseases. It fears 300,000 people might contract dysentery.

The World Health Organisation estimates that up to one-third of the population could already be infected with dysentery.

Unlike a cholera epidemic, which lasts on average six weeks, dysentery would not be 'immediately spectacular', Colonel Merouze said. 'You won't have 25,000 deaths in four weeks but it could take months, even years.'

At Mugunga, where 300,000 people are stranded, including thousands of soldiers of the defeated Hutu government, French military medics are spraying tents and patients with disinfectant. Dr Piperno said it was to kill body lice and did not rule out isolated cases of typhus, which causes fever, delirium, rashes and death.

In Kigali, at his government headquarters in the bullet-pocked Meridien hotel, Mr Twagiramungu said Rwanda did not expect a harvest this year or next and would depend on international food aid. 'We cannot pretend we are going to have a stable country until we have a stable population,' he said. 'It is impossible. And we cannot pretend to have an economy or political situation without a population.'