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Great Lakes refugee crisis

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The Great Lakes refugee crisis is the common name for the situation beginning with the exodus in April 1994 of over two million Rwandans to neighboring countries of the Great Lakes region of Africa in the aftermath of the Rwandan genocide . Many of the refugees were Hutu fleeing the predominantly Tutsi Rwandan Patriotic Front (RPF), which had gained control of the country at the end of the genocide. However, the humanitarian relief effort was vastly compromised by the presence among the refugees of many of the Interahamwe and government officials who carried out the genocide, who used the refugee camps as bases to launch attacks against the new government led by Paul Kagame . The camps in Zaire became particularly politicized and militarized. The knowledge that humanitarian aid was being diverted to further the aims of the genocidaires led many humanitarian organizations to withdraw their assistance. The conflict escalated until the start of the First Congo War in 1996, when RPF-supported rebels invaded Zaire and sought to repatriate the refugees.

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66-542: The categories Hutu and Tutsi have an origin in pre-colonial Rwanda . However, with the arrival of the Germans in about 1900, and particularly after the arrival of the Belgians in 1920, the categories began to "rigidify" and become thought of as ethnic. The modern history of Rwanda has in many ways been one of tension between the majority Hutu and minority Tutsi " ethnic " groups. While there has been much scholarship about

132-548: A genocide to rid the country of the Tutsis. The assassinations of Habyarimana and Cyprien Ntaryamira on 6 April 1994 became the pretext for the start of the Rwandan genocide, which resulted in the deaths of several hundred thousand people, mostly Tutsi, over the next three months. Most murders were carried out by, with the cooperation of, or in the absence of protest by Hutus who lived in the same communities as their victims. At

198-781: A Hutu-dominated government was established. This replaced the colonial government of Belgium, which had ruled through a favored Tutsi royal family. One of the consequences of the Hutu victory was sporadic attacks against Tutsis that led to over 300,000 Tutsis fleeing the country over the next several years. Anti-Hutu attacks in neighboring Burundi by the Tutsi-led government there led a renewal in attacks against Tutsis in Rwanda in 1973, resulting in even more refugees, many seeking asylum in Uganda . The land formerly owned by these thousands of refugees

264-529: A cholera epidemic that swept through the camps. The refugees near Goma were located at Mugunga on a plain of volcanic rock, which was so hard that the French troops and aid workers were unable to dig graves for the bodies that began to line roads. The situation led the UN Representative to Rwanda Shahryar Khan to call the camps a "revision of hell". The international media coverage of the plight of

330-473: A failed RPF invasion of Rwanda in 1990, as both a reward to an ally and in the hopes that the large Rwandan refugee population in Uganda would return home. The invasion, and the subsequent occupation of parts of the northern prefectures of Byumba , Umutara and Ruhengeri , internally displaced many Hutus and heightened ethnic tensions. The 1993 Arusha Accords attempted to offer a diplomatic solution to both

396-434: A front for the real leaders and were able to secure control of the humanitarian aid. The leadership could punish their enemies by withholding aid, reward their supporters by giving it and even make money either by reporting more refugees than actually existed and selling the surplus or by forcing the refugees to pay a food tax. The political elite and ex-FAR soldiers were given preferential treatment. This led, for example, to

462-430: A further 300,000 remained in internally displaced person camps. On 18 July 1994, RPF forces captured the northwestern town of Gisenyi and declared a new government with Pasteur Bizimungu as president and Kagame in the newly created position of vice-president. Gisenyi was the center of the provisional government and its fall caused over 800,000 Rwandans to cross into Goma , Zaire, over four days in late July. This outflow

528-564: A senior UNHCR staff member in the refugee camps, wrote, "Discussions with refugee leaders...showed that exile was the continuation of war by other means." The result was dramatic. An estimated 500,000 Rwandans fled east into Tanzania in the month of April. On 28—29 April, 250,000 people crossed the bridge at Rusumo Falls into Ngara , Tanzania in 24 hours in what the UNHCR agency called "the largest and fastest refugee exodus in modern times". The apparent organization of this Rusumo evacuation

594-511: A shorter underclass, but with little relation to the gene pools that had existed a few centuries ago. The social categories are thus real, but there is little if any detectable genetic differentiation between Hutu and Tutsi. Tishkoff et al. (2009) found their mixed Hutu and Tutsi samples from Rwanda to be predominately of Bantu origin, with the Tutsi having only minor gene flow from Afro-Asiatic communities. Rusumo Bridge Rusumo Bridge

660-404: A spectrum of physical variation in the peoples, Belgian authorities legally mandated ethnic affiliation in the 1920s, based on economic criteria. Formal and discrete social divisions were consequently imposed upon ambiguous biological distinctions. To some extent, the permeability of these categories in the intervening decades helped to reify the biological distinctions, generating a taller elite and

726-751: Is a major issue of controversy in the histories of Rwanda and Burundi , as well as the Great Lakes region of Africa . The relationship among the three modern populations is thus, in many ways, derived from the perceived origins and claim to "Rwandan-ness". The largest conflicts related to this question were the Rwandan genocide , the Burundian genocide ( Hutu and Tutsi ), and the First and Second Congo Wars . Ugandan scholar Mahmoud Mamdani identifies at least four distinct foundations for studies that support

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792-662: Is an international bridge across the Kagera River linking Rwanda and Tanzania . Designed by Luigi Corradi and assembled previously in Turin , Italy . The bridge was completed in 1972 as a single-deck steel bridge over a span of 64 metres (210 ft). The structure was the first road bridge across the Kagera River in Rusumo area. The bridge is an arch bridge whose construction commenced in 1966. On 28 April 1994, during

858-744: Is highly prevalent in European populations, but the Bantu tribes were lactose deficient, similar results and conclusions were reached by the geneticist Sarah A. Tishkoff in 2007. Modern-day genetic studies of the Y-chromosome generally indicate that the Tutsi, like the Hutu, are largely of Bantu extraction (80% E1b1a , 10% B , 4% E3 ). Paternal genetic influences associated with the Horn of Africa and North Africa are few (less than 10% E1b1b ), and are ascribed to assimilated southern Cushites. However,

924-516: Is seen as evidence that the collapsing government was behind the large refugee outflows. By May 1994, a further 200,000 people from the provinces of Butare , Kibungo and Kigali-Rural had fled south into Burundi. As the RPF captured the capital of Kigali , the military of France set up a safe zone in southwest Rwanda in June 1994 in what was dubbed " Opération Turquoise ". It was ostensibly done to stop

990-455: Is the Hutu, consisting mostly of farmers. The second largest group is the Tutsi, mostly pastoralists, warriors and aristocrats. The smallest group is the Twa, which is a group of pygmy that hunt game to trade for agricultural products from the farmers. All three groups speak Kinyarwanda , which is a Bantu language. There is disagreement as to when and how each group appeared in Rwanda. Some suggest

1056-515: The Rwandan genocide , more than 200,000 people crossed the bridge at Rusumo Falls into Tanzania within 24 hours in what field workers described as " the largest and fastest refugee exodus in modern times ". Given the restrictions on the axle load and the use of only a single lane at a time, a new bridge, the Rusumo International Bridge , adjacent to the single lane bridge, was opened in 2014 to cope with expected increase of

1122-535: The Second Congo War , the world's deadliest conflict since World War II . While peace was officially declared in 2003, ethnically inspired violence continues to afflict the Kivus . Rwanda continues to struggle with the aftermath of genocide and large-scale forced migration . The International Criminal Tribunal for Rwanda (ICTR) and community gacaca courts exist to punish those who planned and carried out

1188-633: The cycle of poverty that had led Rwanda into crisis originally. The AFDL continued its offensive until it reached Kinshasa and overthrew Mobutu in 1997. Mobutu fled Zaire and soon died in exile four months later. Afterwards, Kabila named himself the new president and changed the name of the country to the Democratic Republic of the Congo . However, the relationship between Kabila and his Rwandan and Ugandan backers turned sour. An attempt by Rwanda and Uganda to overthrow Kabila in 1998 grew into

1254-561: The "distinct difference between Hutu and Tutsi" school of thought: phenotype and genotype , cultural memory of inhabitants of Rwanda, archeology , and linguistics . Most Tutsis and Hutus both carry the Haplogroup E1b1a paternal haplogroup which is common among Bantu and most other Niger-Congo -speaking populations. When Europeans arrived in Rwanda to begin documenting traditions, Rwandan society consisted of three ethnicities that also serve as social castes. The largest group

1320-496: The "forest people" could have developed in the millennia since the Bantu expansion , as happened also with Bantu domestic animals in the rainforest. Perhaps there was additional selective pressure from farmers removing the tallest women from the pygmy population by taking them back to their villages as wives. More recent studies have de-emphasized physical appearance, such as height and nose width, in favor of examining blood factors,

1386-520: The Children and CARE , completing the departure of the largest and most professional humanitarian aid organizations upon which UNHCR relied heavily. A secondary reason given by some of these organizations is that they hoped that this dramatic action would prompt the international community to disarm the camps. Despite repeated calls by the UN for international intervention to separate the armed elements from

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1452-512: The French-Israeli medical quarters. CARE Deutschland supplied ambulances, and Merlin of Ireland supplied trucks and heavy equipment to distribute food and supplies to the refugee camps. The country of Germany was the sixth largest donor to the intervention, Ireland was 16th. The first goal of the political leadership was to gain control of the food supply. This was accomplished by a system of "elected popular leaders", who acted as

1518-574: The RPA threat and the internal tensions, but it was not implemented. Ethnic tensions became even greater following the murder of Burundian President Melchior Ndadaye , a Hutu, in October 1993, an event that sparked the Burundian Civil War in which large numbers of both Hutus and Tutsis were killed. Hutu militants, known as Interahamwe , and elements in the government in Rwanda began to plan

1584-475: The RPF. To aid the ground forces, Israel conducted the largest medical mission in its history, and, although their supplies were not as abundant as those of the other forces, their all-volunteer force of military surgeons was composed both of specialists and sub-specialists, including well-known surgeons. The two units established a unique and constructive method of operation which relied on France's abundant medical supplies and Israel's medical expertise. Japan

1650-536: The Tutsi and Hutu who are therefore brothers. The Hutu origin myth holds that Kigwa (patrilineal ancestor of Ruhanga and the first Tutsi) fell from the sky on an earth inhabited by Hutu. The colonial scholars who found complex societies in sub-Saharan Africa developed the Hamitic hypothesis . The now rejected hypothesis posits that the Tutsi were of Hamitic stock whom originated from the Horn of Africa , and subsequently conquered Rwanda and brought civilization to

1716-555: The Tutsi appear to share a close genetic kinship with neighboring Nilotic populations, particularly the Maasai . It is unclear whether this similarity is primarily due to extensive genetic exchanges between these communities through intermarriage or whether it ultimately stems from common origins. ... generations of gene flow obliterated whatever clear-cut physical distinctions may have once existed between these two Bantu peoples – renowned to be height, body build, and facial features. With

1782-483: The Tutsi have considerably more haplogroup B paternal lineages (14.9% B) than do the Hutu (4.3% B). Trombetta et al. (2015) found 22.2% of E1b1b in a sample of Tutsis from Burundi, but no bearers of the haplogroup among the local Hutu and Twa populations. The subclade was of the E-M293 variety, which suggests that the ancestors of Tutsis in this area may have been remnants of South Cushitic pastoralists. In general,

1848-438: The adult Tutsi of Rwanda and Burundi have a high ability to digest lactose, while only 5% of the adults of the neighboring Shi people of eastern Congo can. Among Hutu, one in three adults has a high capacity for lactose digestion, a surprisingly high number for an agrarian people, which Mamdani suggests may be the result of centuries of intermarriage with Tutsi. In the 1988 UNESCO General History , Bethwell Ogot says that

1914-533: The beginning of the genocide in April 1994, the Rwandan Patriotic Front began an offensive from territory in northern Rwanda that it had captured in previous fighting and made rapid progress. Hutus fled the advancing RPF forces, with French historian Gérard Prunier asserting, "Most of the Hutu who had stayed in the country were there because they had not managed to run away in time." In the midst of

1980-430: The chaos of post-genocide Rwanda, over 700,000 Tutsi refugees, some of whom had been in Uganda since 1959, began their return. Contrary to refugee flows in other wars, the Rwandan exodus was not large numbers of individuals seeking safety, but a large-scale, centrally directed initiative. The refugees settled in massive camps almost directly on the Rwandan border, organized by their former leaders in Rwanda. Joël Boutroue,

2046-411: The civilians in need of assistance, there was little response. Of over 40 countries that UN Secretary-General Boutros Boutros Ghali approached to provide peacekeepers, only one replied affirmatively. The UN eventually resorted to hiring Zairean soldiers to provide a minimum level of security, a situation that everyone realized was far from ideal. In light of their abandonment by its trusted partners and

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2112-423: The crowded refugee camps, ultimately killing tens of thousands. Soon, the problem was exacerbated as rain began to fall and many people contracted septic meningitis . By then, France had established a field hospital at the area of Lake Kivu in an attempt to help the large numbers of refugees. Some of these refugees were Interahamwe leaders and members of the government who fled the country fearing retaliation from

2178-463: The emergence of these separate ethnic identities, particularly through the colonial governance structures, before and after independence in 1961, people within Rwanda acted within the parameters of the Tutsi-Hutu division. Regardless of the historical validity of the division, Rwandans in the late 20th century acted as if they were real. Belgium began to withdraw from Rwanda in 1959, and in 1961

2244-408: The endangered mountain gorilla , were badly damaged by the demands for firewood and charcoal made by the refugees. Two years after the arrival of the refugees 105 km of the park's forest had been affected, of which 63 km had been razed. The outside world, at the time focused on the wars of the former Yugoslavia , turned its attention away from the happenings of central Africa. The exception

2310-472: The first three months after the original exodus. The UNHCR was forced to halt its efforts to repatriate refugees after both their staff and the refugees were threatened by Interahamwe under the orders of the exiled leadership. However, by September 1994 rumors of violence by the RPF within Rwanda, combined with tightened control by the Hutu leadership of the camps, has drastically reduced the rate of return and eventually stopped it altogether by early 1995. In

2376-410: The first week of July, deaths among the refugee community were occurring at a rate of 600 per week, and two weeks later had reached 2000 per week as the refugee population increased and the health situation worsened. Mortality rates reached a height during a 24-hour period in late July when the death toll near Goma from cholera , diarrhea and other diseases was 7000. Over 50,000 people died, mainly from

2442-567: The former Armed Forces of Rwanda ( French : Forces Armées Rwandaises, ex-FAR ), fully armed with an intact officer corps and transport unit, as well as almost all of the politicians. The only other camp complex to host significant numbers of leaders of the former government was the large Benaco camp in Tanzania, which held a small number of the exiled military and political leadership. The exiles chose to base themselves mainly in Zaire because of

2508-681: The fossil record of a tall people with narrow facial features several thousand years ago in East Africa, including locations such as Gambles Cave in the Kenya Rift Valley and Olduvai Gorge in northern Tanzania, Hiernaux argues that while there was a migration, it was not as dramatic as some sources have proposed. He explicitly attacks the Hamitic theory that migrants from Ethiopia brought civilization to other Africans. However, in light of recent genetic studies, Hiernaux's theory on

2574-693: The genocide, but the French/European forces prohibited the entry of RPF forces that were already stopping the genocide and the Hutus who fled there included militants and members of the ousted government, as well as Hutu civilians. The French soon ended their intervention, leading to the flight of 300,000 people from the Zone Turquoise west towards the Zairean town of Bukavu in July and August, while

2640-400: The genocide, but the scale of violence forced the Rwandan people into an occasionally uneasy coexistence. The Rwandan government has been generally credited with encouraging economic development and national reconciliation, though it has also been criticized for oppression of its critics. The crisis had a massive impact on the ecology of the region. The forests of Virunga National Park , home to

2706-411: The importance of the pastoralist migrations. Still other studies point out that cultural transmission can occur without actual human migration. This raises the question of how much of the changes around the fifteenth and sixteenth centuries was the result of an influx of people as opposed to the existing population being exposed to new ideas. Studies that approach the subject of racial purity are among

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2772-536: The infrastructure to handle the initial influx of Rwandan refugees. However, facilities there were also eventually overwhelmed by the sheer number of people fleeing across the border, requiring emergency humanitarian intervention. The UN, in the absence of any serious military aid from the US, was forced to open its communication pathways wider than before and urge other countries to join the efforts. The US agreed to support these efforts with finance and some equipment. Early in

2838-405: The insecurity, High Commissioner Sadako Ogata was asked why UNHCR did not simply leave as well. She replied: There were also innocent refugees in the camps; more than half were women and children. Should we have said: you are related to murderers, so you are guilty, too? My mandate — unlike those of private aid agencies — obliges me to help. Both for those organizations that left and that stayed,

2904-435: The militia to control the refugees on their behalf. Those refugees who tried to protest were either beaten into submission or killed. The relief operation began to be accused of "feeding the killers", causing a crisis of conscience among the agencies, who began to leave what some have called "the messiest humanitarian quagmire ever". The first to leave was Médecins Sans Frontières , who stated that "this humanitarian operation

2970-588: The most controversial. These studies point out that the pastoralist migrants and pre-migration Rwandans lived side by side for centuries and practiced extensive intermarriage. The notion that current Rwandans can claim exclusively Tutsi or Hutu bloodlines is thus questioned. Roger Blench has proposed that Twa originated as a caste like they are today, which became endogamous and consequently developed into separate ethnic groups with their own languages. A mismatch in language between patron and client could later occur from population displacements. The short stature of

3036-420: The number of pastoralists in Rwanda increased sharply around the fifteenth century. Although Luis et al. (2004) in a more general study on bi-allelic markers in many African countries found a statistically significant genetic difference between Tutsi and Hutu, the overall difference were not large. According to data from 1969, the Tutsi and Hima groups possessed the enzyme of milk sugar lactose tolerance, which

3102-599: The origin of Tutsis in East Africa appears doubtful. It has also been demonstrated that the Tutsis harbor little to no Northeastern African genetic influence on their paternal line. On the other hand, there is currently no mtDNA data available for the Tutsi, which might help shed light on their background. One school of thought noted that the influx of pastoralists around the fifteenth century may have taken place over an extended period of time and been gradual and peaceful, rather than sudden and violent. The key distinction made

3168-456: The otherwise curious finding of one humanitarian aid study that 40% of refugees in Kibumba camp ate less than 2,000 kcal per person, while 13% received over 10,000 kcal per person. Refugees who disagreed with the structure, who tried to return to Rwanda or were too frank with aid workers in discussing the situation were subject to intimidation and murder. As the initial acute humanitarian crisis

3234-487: The post-Rwandan genocide refugee crisis became a watershed event that prompted an extensive reevaluation of their mandates and procedures, and the relative ethical cases for abandonment and continuing aid were hotly debated. At the same time, France and the World Bank withheld development aid from the new government of Rwanda until the refugees were repatriated, prompting accusations that the donors were simply repeating

3300-467: The presence of the sickle cell trait , lactose intolerance in adults, and other genotype expressions. Excoffier et al. (1987) claimed that the Tutsi and Hima , despite being surrounded by Bantu populations, are "closer genetically to Cushites and Ethiosemites ". Another study concluded that, while the sickle cell trait among the Rwandan Hutu was comparable to that of neighboring people, it

3366-606: The refugees eventually led U.S. President Bill Clinton to call it the "world’s worst humanitarian crisis in a generation" and large amounts of relief was mobilized. Attention quickly focused on the refugees around Goma. Over 200 aid organizations rushed into Goma to start an emergency relief operation comparable to that seen in the Yugoslav wars . Until December, the UN High Commissioner for Refugees (UNHCR) received over $ 1 million monthly. The resources dedicated to

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3432-465: The refugees led to a rapid drop in the mortality rate in late 1994. The American military formed an emergency logistical operation, based out of Entebbe International Airport in Uganda, to ferry supplies and relief personnel to the crisis regions. While several humanitarian organizations expressed concern about mixing the military in humanitarian operations, it quickly became clear that only the military could create large centralized logistical support with

3498-497: The region. Supporters of the migration theory also support the idea that Tutsi came from the Horn of Africa, a later theory proposed that the Tutsi had instead migrated from nearby interior East Africa , and that the physical differences were the result of natural selection in an arid climate over millennia. Among the most detailed theories was one put forward by Jean Hiernaux , based on studies of blood factors and archeology. Noting

3564-428: The relief process, US relief planes began to drop large food packages from the air in hopes of alleviating the suffering in the camps below. Instead, the opposite occurred, as people were slaughtered by mobs trying to reach the precious food. Due to the perils of such chaos in the refugee camps, the US refused to bring its aid closer to the ground, and, as time went by, dysentery and cholera began to spread rapidly through

3630-400: The speed and scale needed to alleviate a massive humanitarian emergency. The humanitarian situation was not as acute in the other nations bordering Rwanda, though still very challenging. Tanzania had a number of refugee camps that had been created for the civilians fleeing the onset of the Burundian Civil War . Most of these Burundians had returned to their home country by 1994 so Tanzania had

3696-427: The support given by President Mobutu Sese Seko . The five camps around Goma, among others, would eventually take on a certain permanence, eventually containing 2,323 bars, 450 restaurants, 589 shops, 62 hairdressers, 51 pharmacies, 30 tailors, 25 butchers, five ironsmiths and mechanics, four photo studios, three movie theaters, two hotels and one slaughterhouse. About 140,000 refugees returned, mostly on their own, in

3762-473: The three groups diverged from each other while others suggest each group arriving in separate migration waves, first Twa, then Hutu, and finally Tutsi. In the separate arrival story, there is dispute in where the groups came from, when and how they arrived, and whether the arrival of some groups brought with them certain social development. Starkly contrasted, the Tutsi origin myth holds that Kanyarwanda had several sons, including Gatutsi and Gahutu, ancestors of

3828-646: Was Paul Kagame , whose family had fled to Uganda during the violence of 1959. In 1985, Kagame helped form the Rwandan Patriotic Front (RPF), an armed group aligned with the National Resistance Army (NRA), a Ugandan rebel group led by Yoweri Museveni . Kagame became the head of NRA military intelligence and a close ally of Museveni. In 1986, the NRA rebellion succeeded and Museveni became President of Uganda . Museveni then supported

3894-413: Was a total ethical disaster" as it rewarded those responsible for the genocide rather than punishing them. The International Rescue Committee , a long-standing implementing partner of the UNHCR, then left stating that "humanitarianism has become a resource and people are manipulating it as never before. Sometimes we just shouldn’t show up for a disaster." These two organizations were joined by Oxfam , Save

3960-427: Was almost non-existent among Rwandan Tutsi. Presence of the sickle cell trait is evidence of survival in the presence of malaria over many centuries, suggesting differing origins. Regional studies of the ability to digest lactose are also supportive. The ability to digest lactose among African adults is widespread only among desert-dwelling nomadic groups that have depended upon milk for millennia. Three quarters of

4026-752: Was also highly organized, with administrative structures simply transferred across the border. By the end of August, UNHCR estimated that there were 2.1 million Rwandan refugees in neighboring countries located in 35 camps. Around Goma , the capital of North Kivu in Zaire , five huge camps— Katale , Kahindo , Mugunga , Lac Vert and Sake —held at least 850,000 people. To the south, around Bukavu and Uvira , thirty camps held about 650,000 people. A further 270,000 refugees were located in nine camps in Burundi, and another 570,000 in eight camps in Tanzania. The new population around Goma included 30,000 to 40,000 soldiers of

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4092-504: Was stabilized, aid workers and others began to raise concerns about the presence of armed elements in the camps. Soldiers of the former and the Interahamwe militia created armed outposts on the outskirts of the refugee camps, while the camps themselves came under the control of officials of the former government. Humanitarian workers reported that former government officials, especially near Goma, were passing out large amount of money to

4158-556: Was subsequently claimed by others, creating another politically charged situation. By the 1980s, the Rwandan government of Juvénal Habyarimana claimed that the country could not accommodate the return of all refugees without the help of international community because Rwanda was said to be among most densely populated countries on the African continent . Throughout the 1970s and 1980s, Rwandan exiles formed political and military alliances, particularly in Uganda. The leader of one of these

4224-403: Was that migration was not the same as conquest. Other scholars delinked the arrival of Tutsi from the development of pastoralism and the beginning of the period of state building. It appears clear that pastoralism was practiced in Rwanda prior to the fifteenth century immigration, while the dates of state formation and pastoralist influx do not entirely match. This argument thus attempts to downplay

4290-581: Was the international humanitarian aid community and the United Nations, for whom the Great Lakes crisis was an agonizing dilemma that has been the topic of extensive analysis and ethical arguments. As a result, UNHCR reworked its procedures to try to ensure greater international commitment in its interventions. Origins of Tutsi and Hutu The origins of the Hutu , Tutsi and Twa peoples

4356-720: Was the third largest donor to the intervention: Japan also deployed the Japan Self-Defense Forces assets, including the Japan Ground Self-Defense Force units for medical and water supply activities, and the Japan Air Self-Defense Force aircraft to transport personnel and supplies, including NGOs'. The Netherlands had sent a small contingent of mostly medics and nurses , which was beneficial for rehabilitation efforts and ambulatory care after patients left

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