KIGALI, Rwanda — For a decade, April has been a time of sadness and emotional trauma for survivors of the Rwandan genocide.
In April 1994, Rwanda's majority ethnic group, the Hutus, targeted the minority Tutsis for death. The United Nations estimates that 800,000 Rwandans--mostly Tutsis--died in about 100 days, most of them hacked to death with machetes.
Since then, survivors have suffered trauma-related hypertension, gastrointestinal problems, depression and hallucinations every year, beginning in March. Hospital workers and survivors say the symptoms usually surge around April 7, the date the genocide began.
Experts in Rwanda say that after a decade of a slow drop in genocide-related mental trauma cases, survivors' symptoms are spiking dramatically.
"We've got the same recurring patients, plus lots of new ones," said Jean Damascene Iyamurenye, 39, director of the Psychosocial Consultation Service in Kigali, who saw his center's March caseload jump 50 percent from a year earlier.
"If you want to know why this will be the most disturbing April for survivors, you have only to look at the gacaca," said Jean-Claude Desmarais, 60, country director for International Rescue Committee in Rwanda.
The cause for concern
Gacaca (pronounced ga-CHA-cha) is a system of community trials scheduled to begin nationwide in June. The trials are designed to finally bring reconciliation to a nation that for 10 years has been trying to find unity. From a mental health point of view, the most salient element of gacaca is its required confrontation between survivors and alleged attackers.
Survivors will accuse alleged attackers, many of whom have spent most of the last decade in prison, to their faces. And the accused will, in theory, admit to crimes.
Experts and survivors agree the specter of these confrontations is opening old mental wounds.
Panic about confrontation
"There is a form of panic among the women of how they will deal with the people who did this," said Jeanne Mukamusoni, 43, the psychosocial program manager for Avega, Rwanda's association of genocide widows. "Gacaca is like a bomb that will come into their life."
No one can predict gacaca's effect.
But, in areas of Rwanda where a pilot gacaca has taken place, indicators are grim. Adorata Ukundagusaba, 38, the chief of trauma counseling for the national assistance fund for survivors, estimates that a quarter of survivors who have testified in pilot gacacas have had severe resurgent trauma.
"They have suffered loss of consciousness and flashbacks," she said. "People who were buried prematurely in mass graves report seeing and smelling the bodies again. Many have to go to psychiatric hospitals right afterwards."
With the help of myriad groups including the International Rescue Commission, the Rwandan government is training 3,000 trauma counselors to help with the distress caused by the confrontations.
But many are unconvinced this will help. "The trauma will be horrendous," said Benoit Kaboyi, 30, executive secretary for Ibuka, a victims' rights group.
One source of skepticism is the fact that mental health in Rwanda has usually been done on the cheap. A resigned Kaboyi admits, "We cannot prepare. We have no means."
At Kigali's mental health facilities, tranquilizers are not used.
"First, because we don't have the financial means," said the Psychosocial Consultation Service's Iyamurenye. "But also, tranquilizers cover symptoms. They do not help with the therapy we want to do."
Iyamurenye, who is not a medical doctor, said he is aware of only one psychiatrist in Rwanda. Iyamurenye's staff treats victims most often with "listening and compassion."
Girls suffer flashbacks
"Just this week, five girls, all 16 to 18, at a local school had flashbacks," he said. "We brought them in, and slowly, simply by talking to them alone, we brought them back after two or three hours."
Annonciata Nyiratamba, 34, who founded Avega but has since left the organization, dismisses the preparations of the government and survivors' communities.
"They will be overwhelmed," she said. "Because the `how' is as difficult as the `what.' I can know my sister is dead, but when I am told `I raped your sister before I killed her,' I will have not the support I need."