Never before had MSF teams been the direct witnesses of genocide and repeated mass violence on such a huge scale. The method of observation adopted for this book was, as matter of priority, to focus on the work of field teams and reconstruct their perceptions, decisions and actions. The following sources were used: numerous reports submitted to MSF head offices by MSF teams; witness statements published by the Rwandans; public documents from international organisations and research studies based on field surveys. The history of Rwanda is also told through a series of events which shed light on the political dynamics of the 1990s. Lastly, a summary of MSF’s activities in the Great Lakes region since 1980 is also included.Three very specific questions about Rwanda and the Great Lakes region during the period 1990 to 1997 are formulated:Where were MSF’s teams working?What work were they involved in?Which of the obstacles they encountered became the subject of debate, and which of these went on to be made public?

In the first chapter, we look at the years 1980 to 1994, which are divided into four periods and start with the provision of aid to Rwandan Tutsi exiles in Uganda during the 1980s. We then examine how MSF, between October 1990 and April 1994, delivered assistance to people internally displaced within Rwanda after fleeing the military advance of Tutsi exiles (led by the Rwandan Patriotic Front) and to the 260,000 Burundian refugees living in camps as of October 1993. Next we look at the period of the genocide and the medical assistance the organisation provided – during which time more than 200 of MSF’s Rwandan employees were executed. And to finish, we analyse the call for armed intervention in Rwanda and, more specifically, the French military operation launched mainly in southwest Rwanda in June 1994.

The second chapter focuses on the Rwandans who began fleeing their country in April 1994 and ended up in vast camps, notably in Tanzania and Zaire. Humanitarian organisations and UNHCR were quick to step into action. MSF’s assistance mainly focussed on the frequent health emergencies, especially when the camps first opened. Events required taking decisions of a political nature as the refugees included those who had led and carried out the Tutsi genocide in Rwanda. The archives show that MSF field teams and head offices soon came to realise that these leaders continued to exert their influence over those who had sought refuge in the camps. Aid workers in the field found themselves forced to choose between pulling out from the camps and delivering medical aid; they either had to abandon their relief to avoid supporting those responsible for the genocide, or carry on providing assistance to civilians who could in no way bear the burden of collective guilt.

The final chapter puts the spotlight on some of the problems humanitarian workers had to tackle in the situations described above. It’s focusing on three issues that all humanitarian workers working in places where mass violence was being committed were forced to address:How to comprehend, in the midst of an emergency, the political and social dynamics unique to each situation of extreme violence?How to avoid falling victim to or becoming accomplices of criminal forces?How to remain effective in such situations?Humanitarian relief operations in this region had been the topic of evaluations that had led to debates and reforms at the international level.

The fourth chapter focuses on Rwandan refugees in Zaire. Between 1994 and 1996, all international attempts to persuade them to return failed. In October 1996, Rwanda and the movements opposing President Mobutu launched a military offensive in east Zaire and then advanced towards Kinshasa. How were the refugees affected by this offensive? How did they react? A great many of them were repatriated to Rwanda, whereas countless others fled into the interior of Zaire. This chapter examines the humanitarian operations deployed during this period – from the destruction of the refugee camps in October and November 1996 to the final wave of refugees who walked 2,000 km to the border between Zaire and Congo-Brazzaville to escape their pursuers.