A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 17: SEARCHING FOR SOLUTIONS
The largest short-term refugee migration in world history
On April 6, 1994, an airplane was shot down over Rwanda during the final leg of its flight from Tanzania to the Rwandan capital, Kigali. Aboard the plane were the Presidents of Rwanda and Burundi. Three weeks later the carnage following the deaths of the two heads of state was staggering. Long-standing ethnic, economic, political, and cultural hatreds between the two nationalities living in the region, the better-educated Tutsis and the far more numerous and historically less advantaged Hutus, erupted in Rwanda and threatened the stability of neighboring Burundi. By April’s end the United Nations estimated that up to 500,000 civilians had been slaughtered and more than a million had fled their homes in search of safe havens. On April 29 more than a quarter of a million Rwandan refugees poured across the corpse-laden Kagera River into Tanzania during a twenty-five-hour period, making it the largest short-term refugee migration in world history.
People drew water from rivers clogged with rotting corpses
People poured into areas of Tanzania and Uganda that ranked as the most hard-hit rural AIDS centers in the entire world. If populations remained uprooted for weeks or months on end, and refugee poverty promoted prostitution, another explosive surge in the already horrendous AIDS epidemic would ensue. Before that could transpire, however, cholera would come, spread as people drew their water from rivers clogged with rotting corpses. What else lurked in the refugees’ new environs? If a novel epidemic appeared, was the international public health community prepared to handle the crisis? Before it was even noticed, ailing individuals could have traveled to all parts of the globe. In November 1989 Ebola broke out in a primate colony located in Reston Virginia. Fortunately the Reston Ebola outbreak involved a strain that was harmless for Homo sapiens, but it shocked experts into taking the question of readiness very seriously. The failings, weaknesses, and gaps in preparedness were enormous.
The monkeys carried two viruses, one of which was Ebola
On October 21, 1989, one hundred monkeys were shipped from Manila to New York. By December over 50 had died and 300 euthanized to control the epidemic. The monkeys carried two viruses, one of which was Ebola. Panic reigned among the scientists trying to figure out what was causing the monkey die-off. Testing in the Philippines was delayed because of a rebel uprising. Word came of an unusual die-off of monkeys in Philadelphia. Effective March 23, 1990 no more monkeys could come through facilities located in the state of New York without 60 prior days of quarantine outside the United States and an additional 60 days quarantine before commercial sale or research. There were loud calls for a full ban on the importing of wild monkeys.
Disease emergence was inextricably bound to human rights
In 1993 21 million people on earth were living under conditions ideal for microbial emergence: denied governmental representation that might improve their lot; starving; without safe, permanent housing; lacking nearly all forms of basic health care and sanitation. The situation worsened in 1994 as more than two million Rwandans fled their country, most of them ending up in perilous refugee encampments Lacking even the most rudimentary sanitation or safe water supplies. On June 17, 1993, Médecins Sans Frontières filed an official protest with the United Nations Security Council documenting examples in war-torn areas of relief workers being endangered by local military forces, outlaw gangs, or United Nations troops. Civilians were routinely denied access to hospitals and medical care – in some cases hospitals were deliberately targeted by warring forces. Disease emergence was inextricably bound to human rights.