Orderly lines of homes and shelters stretch far down crowded, uniform roads at Mahama Refugee Camp in southeastern Rwanda, where more than 55,000 people have arrived since 2015 after fleeing political unrest and violence in Burundi.
The turmoil has displaced more than 400,000 Burundians across Rwanda, Tanzania, Uganda, and the Democratic Republic of the Congo, according to the United Nations High Commissioner for Refugees. The U.N. agency oversees Mahama, in conjunction with the government of Rwanda’s Ministry of Disaster Management and Refugee Affairs.
Dr. Agnes Binagwaho and about 20 students from the University of Global Health Equity (UGHE) visited Mahama on a hot day in mid-September. UGHE is a Partners In Health (PIH) initiative, with several sites in Rwanda. Binagwaho is the university’s co-founder and vice chancellor, senior lecturer in global health and social medicine at Harvard Medical School, and former Rwanda Minister of Health.
She said raw emotions from people’s displacement were starkly evident at the camp.
“This is a crisis of recently traumatized people, and it’s still ongoing,” Binagwaho said. “Even if we are happy that they have a house, that they have access to basic sanitation and basic care, it is row upon row of people who are suffering, and you can feel it.”
For students in UGHE’s new cohort, the visit to Mahama was a powerful introduction to global health equity, and inequity, during their first week of class. The visit was part of students’ intensive opening to the semester. The week also included a visit to a malnutrition treatment site—and homes of families with children in a malnutrition program—near PIH-supported Rwinkwavu Hospital, a few hours northwest of Mahama.
“The field visits are part of an overall active learning principle, getting students engaged in communities around them,” said Kamille Beye, teaching and learning manager at UGHE. “I think the (Mahama) visit helped expose the students to things that are going on in their own country…I think it opened their minds to a wider view.”
Mahama spans about 120 acres near the Akagera River, which borders Tanzania and is part of the upper headwaters of the Nile. A U.N. guide and camp director met the university group early on the day of the visit and brought them around Mahama 1 and Mahama 2, the camp’s two halves. The group saw sites including a clinical laboratory, a food distribution center, a water filtration area, and an entrepreneurship center for women and girls.
PIH co-founder Ophelia Dahl joined the visit. She praised the forward-looking vision of UGHE and Inshuti Mu Buzima, as PIH is known in Rwanda.
“It was good to meet with colleagues and new master’s students, to meet the people who will implement, on a grand scale, the details of global health equity,” Dahl said.
Mahama is proving to be a potential model for delivering equity in a setting with very limited resources.
All of the children at the camp have access to education, and there are two health centers, which Binagwaho said provide a level of care that’s comparable to what can be found across Rwanda. The Ministry of Health is also training displaced Burundians at Mahama to be community health workers, so displaced people can have links to care through people they know and trust.
“If you want the lives of refugees to be protected… you create social capital, you create trust, and you create safety,” Binagwaho said. “This camp is something new, because community health doesn’t exist (in refugee camps) elsewhere. This is a good practice that should be replicated.”
Class of 2019 student Dr. Charles Nkurunziza, a resident in obstetrics and gynecology at the University of Rwanda’s College of Medicine and Health Sciences, said conditions at Mahama were better than he expected.
“What I saw, it’s not what I thought it would be,” he said. “The health centers are really amazing.”
Andre Ndayambaje expressed a similar view. Ndayambaje, also a new student, lives in Kigali and has a bachelor’s degree in nursing sciences and midwifery, from the University of Rwanda. He’s worked for 11 years at Kigali’s King Faisal Hospital, as a midwifery nurse in the neonatal intensive care unit.
UGHE students continue their full-time jobs while earning graduate degrees in global health delivery. The university opened in 2015—the same year as Mahama, coincidentally—and held its first graduation last May. Seventeen students have received a master’s of science degree so far.
Ndayambaje has just begun pursuing his MGHD, as the master's in global health delivery is known. He said many of the practices at Mahama help create stable communities—by providing broad access to food, water, shelter, health services and education—and could be implemented outside the camp’s borders.
“They are not solely for refugees,” Ndayambaje said of the camp’s services and infrastructure. “They can be done even for local systems.”
Mahama also faces significant challenges, amid its successes. A September report by the U.N. refugee commission said the Burundian upheaval has created “one of the least-funded refugee crises in the world.” At Mahama, the commission added, space is nearing capacity and expansion efforts are underway, while more displaced people continue to arrive every day.
Beye said UGHE hopes “to build an ongoing relationship with the camp, and possibly other camps, as well,” to help students shape their roles as future global health delivery leaders and have ongoing impacts in the region.
One of UGHE’s first students already is doing just that.
Binagwaho said Dr. Angeline Mumararungu, a health program manager for Gardens for Health International and a member of UGHE’s first cohort, visits Mahama weekly to oversee and support several nutrition-related programs. Mumararungu has helped integrate health, gardening and nutritional education, along with related counseling for more than 400 displaced Burundian families. She trains people at Mahama to provide health and nutrition education, as well.
Binagwaho said Mumararungu’s work reflects UGHE’s vision.
“We want more of our students to go and provide services to the most vulnerable,” Binagwaho said. “The more our students are spread across the world to serve vulnerable populations, the more we will be able to change the world.”