Better medicine, worse surveillance, and the same structural barriers
In the aftermath of the Rwandan Civil War, a cholera outbreak arose among Rwandan refugees in the town of Goma in neighboring Zaire. An estimated 50,000 deaths occurred from cholera, dysentery and exhaustion during a 3 week period in 1994. Daily case estimates were reported and investigations of suspected typhus, haemorrhagic fever, and orphanage failures were investigated swiftly and analytically. Yet, so little evidence was recorded about how many were killed in the Civil War, and by whom, that an evidence supported 2014 BBC documentary (Rwanda the Untold Story) questioning which side did more killing triggered criminal inquiries of the BBC and their expulsion from Rwanda. In contrast, a 2013-14 outbreak of Ebola in West Africa killed over 11,000 people. It was accompanied by surveillance now estimated to be only 1/3rd complete, that was very biased against detecting rural cases, laboratory sample recording took months to become reliable, and mandated death monitoring was intermittent at best. Yet, post crises analyses and characterizations have likely been accurate and insightful.
By chance Les Roberts worked for some months as an epidemiologist for WHO in both outbreaks and will contrast and compare the humanitarian responses.
Speaker: Les Roberts is a Professor at Columbia University’s Program on Forced Migration and Health. He holds a Ph.D. in Environmental Engineering and did a post-doctorate fellowship in epidemiology at CDC’s Refugee Health Unit. Les was Director of Health Policy at the IRC from 1999-2003, and has been involved in the field work of over 50 mortality surveys in conflict settings including in DRC, Zimbabwe, CAR, and Iraq. His present research focuses on developing methods to document human rights violations, and on statistically representative community-based surveillance methodologies.
The lecture will be livestreamed with a recording available here.
Admission
Contact
