International Operation Name: N/A
International Operation Dates: N/A
Mandating Organization: Government of Canada
Region Name: Africa
Canadian Operation Name: Operation PASSAGE
Canadian Operation Dates: 1994/07/27 – 1994/10/20
Mission Mandate: To provide medical services to refugees returning to Rwanda
In the decades preceding the genocide, there were more than 1 million refugees and internally displaced persons in Rwanda or just outside its borders. These included more than 500,000 Tutsis from Rwanda who had fled to neighbouring countries after the overthrow of the Tutsi monarchy in 1959; 350,000 Rwandans, mainly Hutus but including some Tutsis, who had fled the Rwandan Patriotic Front fighting with the Rwandan government prior to 1993; and 280,000 Burundians, mainly Hutus, who had fled a failed coup by Tutsi army officers in October 1993 and were now sheltering in southern Rwanda. The sheer numbers alone created problems such as lack of food, shelter, water and medicine for international aid organizations and the United Nations, including the United Nations Assistance Mission for Rwanda (UNAMIR).
After the death of Rwanda’s Hutu president, Juvénal Habiyarimana, in a plane crash on 6 April 1994, Hutu militias in conjunction with Rwandan government forces began killing Tutsis and moderate Hutus. On 8 April, the Rwandan Patriotic Front began an advance that would see them eventually take control of the country. More than 1 million Hutus (some estimates put the figure as high as 2 million), some of whom had committed atrocities, fled northwest towards the Zaire border as the Rwandan Patriotic Front assumed power in early July. Local authorities, and later, international organizations, could not cope with this massive influx. There was no shelter, clean water, or sewage disposal or treatment available to accommodate the estimated 800,000 people who arrived in Goma, Zaire over the course of about one week.
In these unsanitary conditions, cholera was first suspected on 18 July and confirmed two days later, although other diseases, such as dysentery and measles, were also present. On 26 July, 6,000 cases of cholera were reported that day alone. As a result, other refugee camps were created to move people out of the unsafe, unhygienic, and unhealthy conditions at Goma. The World Health Organization, and non-governmental organizations such as Doctors without Borders, began treating the sick and providing fresh water. An Israeli field hospital, and labs from France and the Netherlands, quickly began diagnosing and treating victims. By the start of August, the cholera epidemic was waning. Even with this aid, an estimated 80,000 people were infected and approximately 42,000 had died of cholera by 14 August.
The cholera bacteria, which spreads from human waste into drinking water, can cause death by dehydration, with those infected possibly losing up to 12 litres of fluid or more a day. Oral rehydration was and remains the easiest treatment; however, the provision of clean drinking water is one of the first steps in preventing the spread of the disease.
In late July 1994, Canada responded to a request from the UN High Commission for Refugees (UNHCR) for humanitarian support. This operation, known as Operation PASSAGE, was to provide a medical group, along with integral security and water purification capabilities. While it was independent of the UN’s UNAMIR mission, the medical group reported to the senior Canadian in theatre, Major-General Roméo Dallaire, Commander of UNAMIR until 19 August 1994, and thereafter, to Major-General Guy Tousignant, on Canadian-related matters, coordinating medical treatment and support through the UN and non-governmental organizations on.
A warning order to prepare designated units for the operation was issued on 24 July and a formal tasking order on the 27th. A reconnaissance party of 11 was in theatre on 28 July, meeting with UN officials and non-governmental organizations the next day. It was decided that the best site for the unit would be along the Gisenyi-Ruhengeri corridor in the northwest portion of Rwanda. After a reconnaissance of the area, a field hospital was set up at an abandoned milk processing plant at Mareru, in the western portion of Rwanda. Situated one day’s walk from the Zaire border, this location was determined to be the most suitable choice, given that many refugees returning to Rwanda would be funneled through this area. While the recce team remained in place, the main body of personnel arrived on 10 August.
The bulk of the medical personnel—66 Canadian Armed Forces personnel—for the new unit, named 2 Field Ambulance (Rwanda/Zaire) [abbreviated 2 Fd Amb R/Z], came from 2 Field Ambulance in Petawawa, Ont.; another 27 came from 5 Field Ambulance in Valcartier, Que., with 24 from 1 Field Ambulance in Calgary, Alta. Security was provided by 7 Platoon (36 personnel) from 3 Commando, Canadian Airborne Regiment in Petawawa, while 24 engineers from 4 Engineer Support Regiment in CFB Gagetown provided the engineering capabilities. Eight military police and 25 personnel from 8 Air Communications and Control Squadron in Trenton also participated. In all, 30 units provided the 248 personnel of Operation PASSAGE.
Upon arrival in Mareru, the first order of business for the men and women of 2 Fd Amb (R/Z) was to set up the hospital and accommodations. The facility was to have a screening area where patients were assessed, a treatment centre, wards where patients requiring hospitalization would receive care, and a pharmacy for dispensing medication. The process of declaring the hospital operationally ready was delayed, as not all of the required supplies had arrived. This occurred on 14 August, three days after the arrival of the main body in Mareru.
One facility that the hospital lacked was a surgery, as this was not considered a requirement when the original mission was planned. Patients who required surgical procedures were stabilized at the 2 Fd Amb (R/Z) hospital; once well enough to be transported, they were taken to one of the nearby non-governmental organization hospitals, such as the one run by Doctors without Borders. Even without a surgical capability, the Canadian clinic was unique as it was the only facility in Rwanda that could provide nursing to patients, had a doctor on duty 24 hours a day, and supplied food to its patients.
Coordination with local non-governmental organizations of issues such as food, water, and medical treatment began on 9 August and would continue through the deployment. This coordination went beyond simply determining who would operate where and what could be expected: extra supplies were sent to other hospitals and treatment facilities in the area, and to Goma, Zaire, with 2 Fd Amb (R/Z) both providing medical supplies and receiving them.
As the facility was being set up, personnel came across what appeared to be a shallow grave containing two bodies, uncovered by the digging of wild dogs. The engineers, who had begun to excavate a proper grave for two, soon discovered more than 30 bodies and were required to expand their gravesite. During the reburial, local people began to gather, believing that the Canadians were somehow desecrating the bodies. Only with the assistance of the unit’s padre were tensions eased once he explained what was happening. This was the start of the horrors of the Rwandan genocide and its aftermath witnessed by 2 Fd Amb (R/Z).
On the first day of operations, a larger than expected crowd gathered at the main gate. Over the course of the deployment, the bulk of the patients treated were diagnosed with various intestinal diseases (such as cholera and dysentery), malnutrition, as well as dehydration caused by a lack of water along the route as the refugees left the camps in Zaire and began to head home. One of the first treatments was simply to provide rehydration by giving them clean drinking water produced by the reverse osmosis water purification units the Canadians had brought with them.
Medical treatment was available not only to refugees returning to Rwanda from Zaire, but also to the local population. While the question arose as to whether some were taking advantage of the service to get extra drugs or medication, possibly to sell on the black market, a trial run, in the latter part of the deployment, determined that in a one week period, less than 0.3 percent of patients were repeat visitors. Thus, those receiving treatment undeniably required it.
As soon as medical treatment started, the transport personnel of 2 Fd Amb (R/Z) began using their trucks to pick up refugees at roadside collection points and transport them to non-governmental organizations or the Canadian facilities. On the first day, 450 people were aided in this manner. The transport section would be busy with this task throughout the mission, made more difficult by the fact that spare parts, essential for vehicle repairs, could not always be easily obtained and in many cases had to be delivered from Canada.
The daily routine throughout the entire deployment included seeing patients and admitting those who required additional care; transporting refugees; and providing water, produced by their reverse osmosis water purification units, to refugees and non-governmental organizations. In addition, there were the daily chores to keep the Canadian hospital operating, including meal preparation, maintenance on generators and vehicles, laundry, waste disposal, and communications. However, one of the more important undertakings the section did for the long term was to modify two UNHCR Toyota Land Cruisers into ambulances, of which there was a shortage in Rwanda.
In the aftermath of the war that brought the Rwandan People’s Army to power, unexploded ordnance and mines were common. Victims of grenade and mine explosions were regularly brought in, and although their wounds had partially healed, survivors of machete attacks during the genocide came in for treatment. With bacterial diseases and malnutrition prevalent among those who sought treatment, there would inevitably be some who required hospitalization. Not all of them survived: in the first two weeks, 15 patients died, eight of them children under the age of five. Towards the end of the mission, the most seriously injured patients being seen were those involved in vehicular accidents.
It was not just the deaths of patients that could be disturbing for the men and women of 2 Fd Amb (R/Z). When their personnel went into local communities to assist with clean-ups and repairs to local churches, schools, and other facilities, there was often blood splatter on the walls and other evidence of genocide at these locations. Many of those who came through the clinic were almost skeletal in appearance due to malnutrition, dehydration, and other deprivations. In one case at the start of the operation, an unconscious woman was brought to the clinic, dehydrated and suffering from starvation. She was covered in blood, having delivered a foetus which did not survive.
With the images that the men and women were seeing daily, the Canadian Armed Forces and the leadership of the mission recognized the potential for stress-related injuries. As a result, a five-person critical incident stress debriefing team was deployed, arriving in mid-September. On 17 September, they began section and individual debriefs and were also able to meet with a British officer from 23 Parachute Field Ambulance, Royal Army Medical Corps.
In the midst of deaths, injuries, and illnesses, there was also new life. On 20 August, three babies were born at the hospital, including a set of twins. On 28 September, there were four births in one day and a couple of days later, two more—including one at the reception gate, delivered by a medical assistant—bringing the total to 37 babies born at the unit. One of the most publicized parts of the mission was the incubator built by mission engineers to assist small babies, which received considerable media attention in Canada.
Even before the hospital was operational, its members were treating patients. On 10 August they came upon a vehicular accident involving a truck carrying refugees. First aid was provided and the casualties sent to 23 Para Fd Amb. Within days, they were assisting the members of 23 Para Fd Amb who were deployed at Ruhengiri in northwestern Rwanda. This provided valuable lessons for the members of 2 Fd Amb (R/Z)’s treatment teams as they learned what to expect. When 23 Para Fd Amb moved to Kitabi in southern Rwanda, 2 Fd Amb (R/Z) committed to providing a medical section, support personnel, and defence and security platoon personnel to the small treatment facility at Ruhengiri. The commitment was undertaken until 5 September, at which time Doctors without Borders took over. This particular detachment was often almost as busy as the main hospital at Mareru, regularly seeing up to 200 patients a day. While the detachment saw many patients with intestinal diseases and malaria, there were also more patients with soft tissue damage as a result of gunshot and landmines, than at Mareru.
Once the detachment at Ruhengiri was closed, the success of that facility indicated that an additional detachment might provide better support to refugees and local residents. It was thus decided on 6 September that a detachment at Kora, in western Rwanda, would be created, to start operations on 10 September. At first, this facility operated out of tents, but when non-governmental organization Concern departed from Kora, where it had provided a feeding facility, the detachment was able to move into the newly-vacated buildings. As with the main clinic at Mareru, the majority of individuals seen were intestinal diseases and dehydration cases. The detachment closed on 8 October, shortly before the mission closed down.
Engineers from No. 4 ESR were among the first to arrive in Rwanda, along with their reverse osmosis water purification unit. Arriving in Mareru on 7 August, the unit was primed and operating that day, from a catchment basin near the compound. With water being purified, the engineers then got down to making the compound safe, checking for unexploded ordnance and destroying one grenade in place.
The first week was a busy one as they not only helped set up the camp and ensure it was safe, but also checked for unexploded ordnance at the sites where the UN High Commissioner for Refugees was planning to set up offices in Gisenyi in western Rwanda. Another engineer went to the Save the Children hospital in nearby Nemba in eastern Rwanda and fixed their electrical generator. The gravesite they had prepared within the compound for what was originally thought to be two bodies had to be greatly expanded with the finding and detonation in-situ of three grenades, a sign that the compound had been the scene of fighting. The reverse osmosis water purification unit was also operating in support of refugees, with more than 2,000 passing by the 2 Fd Amb (R/Z) compound each day. All of this went into making the unit operationally ready by 14 August.
Over the course of the deployment, the engineers continued to upgrade the facilities at Mareru. The water catchment basin was inadequate, as demonstrated by the first rains which heavily silted the basin and slowed down the water purification process. It would not be until 20 August before clearance was received from local Rwandan authorities to use the local Lake Karago. The rain also demonstrated that drainage within the compound was inadequate, with most tents becoming home to shallow lakes. As a result, flooring became a priority and was installed in three days. However, drainage would remain a constant problem, and ultimately, required the use of small explosive charges in an effort to break through the tough volcanic rock.
An ambulance crash route was built in the second week and continued to be improved throughout the deployment; electrical wiring of the hospital was also completed and would be continually upgraded. The roads in the compound, especially to the important waste facility, saw continual upgrading as well.
Perhaps of greater import to the clinicians and patients was the incubator that the engineers built, from materials found on hand. As the nights began to get colder, the incubator improved the chances of newborns with otherwise low likelihood of survival. Beginning 30 August, three severely dehydrated and malnourished babies were the first patients to use it. The colder nights also required the installation of portable heating systems in the wards.
It was not just the Canadians at Mareru who benefited from the expertise of the engineers. Not a week went by that they were not checking for unexploded ordnance at non-governmental organization facilities, such as sweeping the future grounds of the Doctors without Borders and CARE food distribution facilities on 16 August, or the building and grounds of the Gisenyi Hospital. There were also engineering tasks, such as repairing plumbing at the Save the Children facility at Kirambo in the Karongi district in western Rwanda as well as improving the security of the doors there, and fixing electrical and water problems at the Americare facility. Other non-governmental organizations and UN organizations received similar assistance.
The local people also received support. The engineers removed wrecked cars from the church grounds in Nyondo, made an estimate of the work required at the church, and laid a water pipe to that house of worship. They also conducted a survey of the proposed site for an orphanage, for which they built a swing. At Mareru, they made repairs to the local water point, carried out improvements to a water source in Matruba so local residents would not need to draw water from a cattle trough, and provided training on how to use water filtration equipment at the water facility in Gisenyi. They also swept the local school grounds for unexploded ordnance.
In the light of the many unexploded ordnance still in the area, and the casualties that were created and treated at local hospitals and clinics, the engineers developed an unexploded ordnance awareness training package for local schools. Beginning 5 October, they provided this awareness training on an almost daily basis to local students. By 14 October, they had provided training to more than 6,500 students in the Mareru and Gisenyi area.
Op PASSAGE also provided for the spiritual needs of its members. Every Sunday, Mass was held in English and French for members of 2 Fd Amb (R/Z). With the staff of 2 Fd Amb (R/Z), the padre organized the restoration of a local church school and the associated church, as well as one other church, and through Our Lady of Peace Church in Trenton arranged for the donation of food and clothing.
The padre also played an important role in developing good relationships between the local community and 2 Fd Amb (R/Z). This helped defuse the tension when a mass grave was discovered in the 2 Fd Amb (R/Z) compound. He also officiated at numerous funerals and christenings – eight of each in the week up to 4 September. On this date he also held his first Mass for local people. Attendance would continue to grow so that on 2 October, he held three Masses for local communities, in addition to the two he held for the personnel of 2 Fd Amb (R/Z). At one of these services, an estimated 2,500 people were in attendance. In his last service, on 9 October, the padre held a special ceremony for the reburial of priests and parishioners who had been killed during the genocide and whose remains had been dumped in a septic pool.
The size of the mission was originally 248 people; however, it was soon realized that with the change in the mission parameters, this was larger than what required. Plans for repatriation began in early September so that on 15 September, 39 personnel were sent to Kigali to begin their return to Canada, including most of the members from No. 1 Fd Amb. At the same time, plans were made to dispose of excess equipment and medical supplies through donations to other organizations working in Rwanda. On 13 October, these deliveries were made: pharmaceuticals, tents, and other supplies went to the UNHCR, and medical supplies to Americare, CARE Canada, Concern, and 23 Para Fd Amb.
By 1 October, the mission was down to 171 personnel, with small groups being sent to Kigali daily for repatriation to Canada. The last day of operations for the hospital was 10 October; however, a small emergency clinic was maintained until 14 October. On 11 October, the emergency clinic delivered a baby, bringing the total number of newborn infants for the mission to 41. By 16 October the last of the personnel arrived in Kigali and the next day were homeward bound.
Originally deployed to fight a cholera outbreak, the personnel of Op PASSAGE provided a positive change in the lives of many people in northern Rwanda. During its 60 days of operation, the mission saw more than 22,000 patients, admitted 690 people and had 1,999 patient bed-days. They also provided support beyond the medical realm – improving water supplies, providing unexploded ordnance awareness training, and supporting spiritual wellness.
Since this operation was a Canadian humanitarian mission, this operation was eligible for Canada’s Special Service Medal with HUMANITAS Bar.
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