Conflict in Burundi : Public health implications

   When two elephants fight,it is the grass that suffers says a popular African adage.

This currently is the case in Burundi, where fear of electoral violence has made about 30,000 civilians take to their heels, leaving their homes and means of livelihood into neighbouring Rwanda and Democratic Republic of Congo.

One would imagine that the leadership of this nation would still be threading carefully and try to avoid flammable issues that may arouse or trigger the anger of a slowly healing nation and not begin to stoke again the embers of an already dying flame of civil unrest and war.

At this point in the history of Africa as a continent, it is time for national and community leaders to realize that it is the people first and not their own personal ambitions or opinions.

Democracy has been described as the government of the people, by the people and for the people.

Everything should be centred around the people's good and well being.

Photo credit: WFP / Tom Haskell

People over the past week have had to flee into neighbouring countries to avoid the pre electoral violence that may grow in intensity if President Nkurunziza continues to thread his current path.

The question one would ask is this; what are the Public Health implications of all of these? :

The mass displacement of people for whatever reason(s); be it war, terrorism, natural disasters or pestilence brings with it dire consequences and preventable causes should be avoided by all means.

- Loss of shelter : come rain storms, strong winds or sunshine, there is no sure place to take refuge from the elements. Death toll may rise from injuries due to this exposure, or from attacks by other humans and wild animals.

- Loss of source of food: many of the people in these communities are subsistence farmers. As people flee from their homes they live behind their farms and gardens untended. Planting season may pass, leading to a poor harvest season which further worsens existing food insecurity.
Farm animals; such as goats and cattle are also often left behind in this scramble for safety.
Usually at the end of it all, these animals may never be recovered as they may die due to lack of care, be stolen or just wander away.

- Loss of source of income and means of livelihood : people are deprived of their rights to go about sourcing for various means of livelihood by engaging in businesses and careers that may boost their standard of living. Hence, widening the poverty gap.

- Gender related violence: cases of rape and sexual exploitation are often reported in refugee camps and the usual culprits are children; male and female alike. Since people may have to live outside in the open or in temporary make shift shelters, there is a limit to what parents and care givers can do to protect their little ones from these scavengers. An example is the Chikali camp case of Malawi where a 6 year old girl was sexually molested by a 23 year old man.
Some cases were also reported at the Central African Republic refugee camps in Democratic Republic of Congo.
It has been said that these cases are often times under reported.

- Distorted Immunization schedules : the national calendar for Immunization is no longer followed and this may lead to the re emergence of vaccine preventable diseases and set backs of already achieved feats in immunization programs.

Lack of adequate health care for women and children: this often affects the under five population and pregnant women more.
There is often little or no access to antenatal care and medications for common childhood ailments.
Recently, two Nigerian women delivered babies in the forest as they fled from suspected Boko Haram terrorists in Bauchi Nigeria.
There have also been cases of deliveries in the Nigerian refugee camps.

- Food Insecurity : for the displaced people and the host community. Food availability and malnutrition were existing problems in Rwanda and parts of Democratic Republic of Congo, further influx of people into these areas may worsen the food insecurity as more people scramble for the already limited resources.

Malnutrition: in varying degrees have been observed in the past amongst refugees, and especially amongst the under 5 population. Parents are no longer able to put meals on the table, let alone bother about the nutritional value of the food available.

Education often takes a major hit, as schooling stops pending the time the refugees are able to settle down to a near normal life.

Price hikes: with more people competing for limited resources, the prices of almost everything spike: which includes housing, food, clothing and transportation.

The International community, the UN and humanitarian organizations are doing their best to alleviate the suffering of displaced people.
Let us bear in mind that their best may never be enough, as there is no place like home.

We hereby appeal to the International community and World leaders for timely intervention in this on going crisis in Burundi so as to avoid the looming disaster.
Peaceful resolution of conflicts is the way to go.