In spite of this spectacular action, the situation remained unchanged in the camps until the emergence of the Alliance des Forces Démocratiques de Libération du Congo-Zaire (AFDL) movement in September 1996 in South Kivu. Laurent D. Kabila led this movement of rebellion against the Zairean state with the support of the governments of Uganda, Rwanda, and Burundi. The support to Kabila was a good opportunity for the government of Rwanda to eliminate the threat at its Western border represented by the refugee camps of Kivu.

In an attempt to evacuate the camps and force the refugees back to Rwanda, AFDL and its allies attacked the camps of Kivu between October and November 1996. As a result, around 900,000 refugees went back to their country of origin, while the remaining (including the ex-FAR) refugees fled into Zaire in an attempt to escape the AFDL forces which were heading towards Kinshasa. For some of them, this second forced migration in their country of asylum would last until May 1997 and bring them into Congo-Brazzaville after a trip of 1,500 kilometers. During their trip, these refugees faced extremely harsh conditions of living and were continuously pursued and attacked by the AFDL forces. In a few places, like in Tingi Tingi camp or along the Ubundu-Kisangani axis, they were able to settle down for some weeks, and external aid was provided until the camps were attacked. But most of the time, the access to this population was almost non-existent and very little information on their situation was available.

The purpose of our study was to review the several acute phases experienced by the Rwandan refugees from the first influx in Kivu in July 1994 until the settlement in the camps in Congo-Brazzaville in May 1997, concentrating on the ways in which mortality figures were collected. The objectives were to examine the importance of mortality data in complex emergency situations and to analyze the feasibility of the organization of a basic surveillance system in the most precarious conditions. Our goal was also to underline the limitations of the retrospective mortality surveys and the caution required in the extrapolation of their results.

MORTALITY DURING THE GOMA INFLUX

The refugees settled down initially in Goma town and later in Kibumba and Katale camps, situated north of the town, and in Mugunga camp to the west ( Figure 2-1 ). During the initial emergency phase, the occurrence of major cholera and dysentery outbreaks and the precarious environmental conditions resulted in high mortality rates, which were recorded by a retrospective survey and a dead body collection system.



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