One of the most horrific tales of mass violence ever began just 20 years ago this week. During the 100 days after Easter 1994, ethnic Hutu extremists killed 1 million fellow Rwandans. The surviving 80 percent of the population reeled from health crises.

Health workers fled or were killed. Many who remained had been complicit in the genocide, seeding distrust in medical establishment. An estimated 250,000 women were raped. HIV became a weapon of war. Refugee camps fell to one of the century’s largest cholera outbreaks. Rwanda was left with the world’s highest child mortality and lowest life expectancy at birth. Fewer than one in four children were vaccinated against measles and polio.

“Whether survivor, perpetrator, or member of the diaspora, no Rwandan emerged unaffected,” writes Rwandan minister of health Agnes Binagwaho in The Lancet today, in a study co-authored with Dr. Paul Farmer and a team of international public health experts. “Much of the rest of the world stood idly by.”

Few imagined that Rwanda, a country the size of Maryland, would so soon—if ever—serve as an international model for health equity.

Just two decades later, that life expectancy has doubled. Vaccination rates for many diseases are now higher than those registered in the United States—more than 97 percent of Rwandan infants are immunized against ten different diseases. Child mortality has fallen by more than two thirds since 2000. New HIV infection rates fell by 60 percent between 2000 and 2012, and AIDS-related mortality fell by 82 percent. HIV treatment is free.

“In the last decade, death rates from AIDS and tuberculosis have dropped more steeply in Rwanda than just about anywhere, ever,” said Farmer. Perhaps the most renowned name healthcare delivery to the world's poor and marginalized, Farmer says he can think of no more dramatic example of turnaround.

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