The Nduta refugee camp in Tanzania has been empty for nearly seven years, but that is set to change next week, when the camp will reopen and welcome thousands of people from Burundi who have fled political violence in recent months.
For decades, Nduta was one of several camps in the East African country that housed thousands of Burundian refugees. Individuals who fled during Burundi's civil war from 1993 to 2005 accounted for a large portion of the population, although some of the refugees had arrived during an earlier wave of ethnic conflict in the 1970s.
In December 2008, as Burundi went through a postwar period of peace and reconciliation, there were just 10,000 inhabitants at Nduta and the camp was closed. By 2012, the remaining 35,000 Burundian refugees in Tanzania were cleared to return home and the country's last facility for Burundian refugees was also shuttered.
But civil unrest re-emerged in Burundi in response to President Pierre Nkurunziza's controversial decision in April to run for a third term in office, sparking a sudden wave of migration. More than 93,000 people have flowed from Burundi into Tanzania since then, reversing what had been a promising trend and catching humanitarian workers by surprise. The only camp in Tanzania with the capacity for the sudden rush of people was Nyarugusu, a 19-year-old facility in Kigoma that was already home to more than 60,000 refugees from the Democratic Republic of Congo.
The influx increased Nyarugusu's population to 150,000 inhabitants, making it the second-largest refugee camp in Africa. In July, Sita Cacioppe, the emergency coordinator of the international medical charity Doctors Without Borders (MSF), said that the camp had reached its "breaking point."
With continued overcrowding in Nyarugusu and the rainy season fast approaching, the United Nations refugee agency (UNHCR) has worked with the Tanzanian government to reopen three camps, including Nduta, to accommodate the surge in refugees. Hired buses will transfer around 3,000 people per week from Nyarugusu to Nduta with the goal of moving 47,000 to the site by November, according to the UNHCR's representative in Tanzania Joyce Mends-Cole.
"We're so distressed that we have not been really able to provide the refugees in Nyarugusu with the proper standards of services, but that's because of the situation in the camp," she said, referring to the continued flow of refugees into Tanzania as a result of the ongoing crisis across the border in Burundi.
In recent years many Burundian refugees had either been cleared to return home or had been given citizenship by the Tanzanian government, so humanitarian workers were caught off guard by the new reality.
"Unfortunately, we went from a situation where we were really in a solutions mode," Mends-Cole added. "Had that remained the scenario, we would have seen a much reduced situation with refugees."
Watch the VICE News dispatch The Spoils of War: Burundi on the Brink:
Tens of thousands of Burundians fled the country almost as soon as the unrest began and protests turned deadly, with the majority making their way to camps in neighboring nations like Tanzania, Rwanda, and Democratic Republic of Congo. A steady influx continued as Nkurunziza rebuffed calls from the opposition, regional leaders, and the international community to abandon an effort that was widely seen as unconstitutional.
Even as protests subsided at the end of July when the 51-year-old former rebel leader claimed victory at the polls, political violence and oppression continued on a smaller more tactical scale, while hundreds of refugees continued to flee the country.
Mends-Cole said that UNHCR will reduce overcrowding in Nyarugusu by working to first relocate those living in mass shelters or in flood zones, while ensuring that new arrivals are processed in Nduta as well.
"We had to put them in mass shelters and family tents, so those who were in mass shelters are our priority because it is not a dignified way to live," she said.
One of the major challenges for reopening the camps has been the effort to secure a proper water supply for the soon-to-be inhabitants. Nduta is currently the only site that has an obvious water source. Mends-Cole said in the other camps they are still looking for solutions, which are likely to be expensive.
While the new camp opening will relieve overstretched facilities and resources, the International Rescue Committee has raised a concern of its own. According to the humanitarian organization, the relocated women will have reduced access to reproductive healthcare services and family planning, and will be located nearly 20 miles away from the nearest facility capable of delivering a baby.
"What will happen to them if they have nowhere to go? They need access to reproductive healthcare for well-being, control, and especially survival in times of crisis," said Elijah Okeyo, IRC's country director in Tanzania. "Access to reproductive health care is not only critical to women's survival in a crisis, it is a non-negotiable requisite in any humanitarian response."
More than 23,000 women and girls living in Nyarugusu fall within the reproductive age range, according to the organization, with roughly 45 deliveries recorded each week in IRC's maternity ward. Another 2,100 are reportedly signed up to pre-natal medical care.
Beyond maternal healthcare, treating women who have experienced sexual assault has become an integral part of the humanitarian response in the processing of arrivals and the management of medical clinics. IRC has treated 58 women in the last three weeks for violence or sexual assault. Access to medical care for sexual assault victims has become critical, according to Anne Achieng, the organization's women's protection coordinator in Tanzania.
"We have a number of women accessing medical care and treatment of complications arising from sexual assault because they did not receive the services" before arriving, she explained, noting that most of the women experience violence during the period of transit between leaving their homes in Burundi and arriving at the refugee camps Tanzania. Achieng noted that resources for treating sexual violence victims there are already inadequate.
In the transition period between Nyarugusu and the other camps, Mends-Cole acknowledged that there will initially be gaps in some services. She said that MSF will be on staff in the new camp to provide medical services.
"If only the problem could be solved in three months, that we would be able to relocate everybody — we can't do that," she said. "We don't want to have a comparison between healthcare or any kind of service between Nyarugusu and other sites."
Beyond gaps in services, UNHCR has observed a noticeable spike in Burundian refugees arriving in Tanzania in recent weeks. Following the election, the weekly average was down to about 250 people a week, but the agency has lately recorded up to 700 people a day. The growing numbers reflect heightened instability in Burundi, with the agency hearing concerns of revenge attacks and violence against police from new arrivals. Other trends include men who stayed behind during the unrest deciding to join their wives and children after determining that the situation within Burundi has not improved.
With the most recent crisis coming a decade after the end of the war in Burundi, many of the current refugees are returning to Tanzania just years after moving back home. Mends-Cole described a meeting she had with some of the camp residents and international officials, where the refugees expressed their desire to live uninterrupted.
"They said, 'We are tired of running, we are really so tired. We have been to Tanzania two times in some cases and we need a durable solution,' " she said. "They simply appealed to us to find them a solution that will mean they will no longer have to keep leaving their country and be multiply displaced."
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