Death Aid - French Imperialism and the Pre-Ebola Depopulation of Rwanda

President Kagame Accuses France Over Rwanda Genocide
from Spike EP on Vimeo.

"France has no friends - only interests." - French President Charles DeGaulle

"Frenchmen trained and armed the soldiers and militia that would commit the genocide. They knew there would be genocide. The French saved those murderers later on and did not protect the victims. They were courageous enough to remain here without any apologies as well." - Rwandan President Paul Kagame

Death Aid - The Depopulation of Rwanda and the French from Spike EP on Vimeo.
"The primary means of killing at speed in this genocide was the mobilization of Rwanda’s unemployed youth into a militia called the Interahamwe, an estimated 30,000 young men taken from the streets and trained to kill at speed with agricultural tools and indoctrinated with a racist anti-Tutsi ideology. Now, these former Interahamwe leaders say that they were in part trained by French military officers. "

AMY GOODMAN: Can you name names? Can you talk about the French leaders, past and present, who they have pointed the finger at, who they are saying are responsible?

"Well, this pointing the finger at individual political figures in France is problematic. The French policy towards Rwanda had been largely decided by Francois Mitterrand, the French president, in his second term. And it is worth remembering that the France’s own inquiry into this in 1998 determined that Francois Mitterrand had been in overall control of the policy and that it had been completely unaccountable — and I think that this is one of the most important points of all — that this policy had been completely unaccountable to either Parliament or the French press and that French politicians had not been adequately informed. And the Senate recommended better control by Parliament over military operations.

And I think that this is the aspect which makes it so difficult to know who made the decisions in — you know, whether it’s the Ministry of Cooperation, whether it’s the Ministry of Defense or the Ministry of Foreign Affairs. It does seem that overall control rested with Francois Mitterrand and through a network that was traditional in France, when it came to French Africa policy, through a network of military officers, politicians, diplomats, senior intelligence operatives, and I must say French mercenaries were involved, as well. "

"France has no friends - only interests."

- French President Charles DeGaulle

"Frenchmen trained and armed the soldiers and militia that would commit the genocide. They knew there would be genocide. The French saved those murderers later on and did not protect the victims. They were courageous enough to remain here without any apologies as well."
- Rwandan President Paul Kagame

IT IS a principle of diplomacy, universally recognised, that just as there are no friends, only interests, so there are no humanitarian motives - only longer-term interests. Thus, everyone asks, what is the reason for France sending 2,500 troops to Rwanda? Particularly when the winning side in the dispute has vigorously opposed the intervention.

The answer lies in the relationship France maintains with its former colonies in Africa, a unique and complicated one that it is hard, maybe impossible, for British people to understand. In country after country in the late Fifties and early Sixties, the Union Jack was hauled down from flagpoles as Britain's colonies became independent. Plumed-helmeted governors moved out of each capital's Government House, it was renamed State House and the new presidents moved in. The new British high commissions had to make do with less salubrious buildings - in Khartoum, offices over the Shell garage. It truly was the end of empire.

The French did things differently. Although the flags changed in 1960 when most of French Africa became 'independent', French officialdom did not leave. Until recently almost all former French colonies had a senior French official behind the door in every key office of the new governments. It was called co-operation, but it meant that Paris retained influence, if not control, in 16 African countries. In some cases, a single French official became an eminence gris to the president, controlling everything from the budget to his personal security.

While the new leaders of former British colonies defined their existence by their anti-colonialist, anti- British stance, presidents such as Leopold Senghor of Senegal or Felix Houphouet-Boigny of Ivory Coast were as proud to be French as they were to be African. Even now, Africans from francophone countries talk of Paris as their second home. As a result you can buy fresh baguettes and today's Le Monde on the streets of Abidjan and Dakar, and Africans there speak accentless French.

Afraid of accusations of neo-imperialism, Britain has been nervous about deploying military force to further its ends in post-colonial Africa. Its emergency contingency plans for Africa consist of sending in the Paras to get Britons out of trouble spots.

France maintains full-scale military bases in the Central African Republic and Djibouti, and smaller deployments of French troops elsewhere. It is not afraid to use them to further its local interests or to protect a friendly government. In 1990, for example, Paris sent paratroopers to Rwanda, ostensibly to protect foreigners, but in fact to bolster the Hutu government of Rwanda at a key moment, and to turn back the Rwandese Patriotic Front, made up of exiled Tutsis.

But what is in it today for France? [Uranium] From London, where Africa is often seen as little more than an expensive basket case, it is a puzzling question. Much of it has to do with language and culture. English is the main language of communication in the world - a phenomenon most British people barely notice, let alone care about.

But the French care deeply about their language, and their government spends much of its 'aid' to developing countries on spreading French and French culture. The equivalent of the Commonwealth is the Francophonie, a yearly meeting of all French-speaking heads of state in the world, presided over by the French president. How much has French intervention in Rwanda been prompted, perhaps subconsciously, by the fact that the advancing rebels, most of whom grew up in exile in Uganda, speak English rather than French?

While the British empire in Africa was a mixture of colony and protectorate, ruled piecemeal and pragmatically through traditional local systems, the French empire in Africa was based on the grandiose concept of France overseas, ruled directly according to universal precepts of French law. The broad British imperial plan was to make its subjects literate, Christian, perhaps soldiers or cricketers - but not Englishmen. Under French guidance and education, the inhabitants of French African colonies would, in the fullness of time, become full French citizens.

Today these countries stay close to France, voting for it at the United Nations in exchange for aid and military support - and often personal support for the president and his family. France is loyal to its allies in Africa, even though leaders such as Sese Seko Mobutu of Zaire, Martin Bongo of Gabon and Gnassingbe Eyadema of Togo are not known for good records on human rights, democracy or good government. African leaders visiting France are given full ceremonial treatment, and can always meet the president.

Africa has always been a French president's personal preserve and therefore a battleground for the foreign ministry. Many French presidents have dealt with Africa directly, picking up the telephone to talk to an African head of state on first-name terms. President Francois Mitterrand appointed his son, Christophe, to run his African policy. He was known in Africa as 'Papa m'a dit'. In return for this lavish attention, African presidents fund French politicians and French political parties, and give special concessions to French companies, which operate in Africa as little more than an arm of French foreign policy.

Until recently, the cost of these cosy friendships in Africa was borne by the French treasury, which underwrote the the Communaute Financiere Africaine (CFA), the currency of 14 African countries. It had maintained parity with the French franc since the early Sixties, but in January [1994] the franc- CFA rate was halved at the insistence of the International Monetary Fund.

At the same time, French foreign ministry officials began to talk more of a pragmatic approach to Africa, emphasising that the relationship would be 'less personal'. To the distress of Mr Mitterrand, his personal stage was being reduced and France's claim to be a world power much diminished. He needed a grand gesture to show his friends in Africa that France could still act an imperial part.

Mr Mitterrand chose Rwanda. But as the Americans found in Somalia, the grand gesture sometimes sinks into a inexplicable - and inextricable - quagmire.

"French Congo. Natives from Gabon": 

Colonial postcard c.1905

CDC - Atlanta Centre for Disease Control Weekly Digest

May 19, 1995 / 44(19);381-382

Outbreak of Ebola Viral Hemorrhagic Fever -- Zaire, 1995

On May 6, 1995, CDC was notified by health authorities and the U.S. Embassy in Zaire of an outbreak of viral hemorrhagic fever (VHF)-like illness in Kikwit, Zaire (1995 population: 400,000), a city located 240 miles east of Kinshasa. The World Health Organization and CDC were invited by the Government of Zaire to participate in an investigation of the outbreak. This report summarizes preliminary findings from this ongoing investigation.
On April 4, a hospital laboratory technician in Kikwit had onset of fever and bloody diarrhea. On April 10 and 11, he underwent surgery for a suspected perforated bowel. Beginning April 14, medical personnel employed in the hospital to which he had been admitted in Kikwit developed similar symptoms. One of the ill persons was transferred to a hospital in Mosango (75 miles west of Kikwit). On approximately April 20, persons in Mosango who had provided care for this patient had onset of similar symptoms.
On May 9, blood samples from 14 acutely ill persons arrived at CDC and were processed in the biosafety level 4 laboratory; analyses included testing for Ebola antigen and Ebola antibody by enzyme-linked immunosorbent assay, and reverse transcription-polymerase chain reaction (RT-PCR) for viral RNA. Samples from all 14 persons were positive by at least one of these tests; 11 were positive for Ebola antigen, two were positive for antibodies, and 12 were positive by RT-PCR. Further sequencing of the virus glycoprotein gene revealed that the virus is closely related to the Ebola virus isolated during an outbreak of VHF in Zaire in 1976 (1).
As of May 17, the investigation has identified 93 suspected cases of VHF in Zaire, of which 86 (92%) have been fatal. Public health investigators are now actively seeking cases and contacts in Kikwit and the surrounding area. In addition, active surveillance for possible cases of VHF has been implemented at 13 clinics in Kikwit and 15 remote sites within a 150-mile radius of Kikwit. Educational and quarantine measures have been implemented to prevent further spread of disease. Reported by: M Musong, MD, Minister of Health, Kinshasa, T Muyembe, MD, Univ of Kinshasa; Dr. Kibasa, MD, Kikwit General Hospital, Kikwit, Zaire. World Health Organization, Geneva. Div of Viral and Rickettsial Diseases, and Div of Quarantine, National Center for Infectious Diseases; International Health Program Office, CDC.

Editorial Note

Editorial Note: Ebola virus and Marburg virus are the two known members of the filovirus family. Ebola viruses were first isolated from humans during concurrent outbreaks of VHF in northern Zaire (1) and southern Sudan (2) in 1976. An earlier outbreak of VHF caused by Marburg virus occurred in Marburg, Germany, in 1967 when laboratory workers were exposed to infected tissue from monkeys imported from Uganda (3). Two subtypes of Ebola virus -- Ebola-Sudan and Ebola-Zaire -- previously have been associated with disease in humans (4). In 1994, a single case of infection from a newly described Ebola virus occurred in a person in Cote d'Ivoire. In 1989, an outbreak among monkeys imported into the United States from the Philippines was caused by another Ebola virus (5) but was not associated with human disease.
Initial clinical manifestations of Ebola hemorrhagic fever include fever, headache, chills, myalgia, and malaise; subsequent manifestations include severe abdominal pain, vomiting, and diarrhea. Maculopapular rash may occur in some patients within 5-7 days of onset. Hemorrhagic manifestations with presumptive disseminated intravascular coagulation usually occur in fatal cases. In reported outbreaks, 50%-90% of cases have been fatal (1-3,6).
The natural reservoirs for these viruses are not known. Although nonhuman primates were involved in the 1967 Marburg outbreak, the 1989 U.S. outbreak, and the 1994 Cote d'Ivoire case, their role as virus reservoirs is unknown. Transmission of the virus to secondary cases occurs through close personal contact with infectious blood or other body fluids or tissue. In previous outbreaks, secondary cases occurred among persons who provided medical care for patients; secondary cases also occurred among patients exposed to reused needles (2). Although aerosol spread has not been documented among humans, this mode of transmission has been demonstrated among nonhuman primates. Based on this information, the high fatality rate, and lack of specific treatment or a vaccine, work with this virus in the laboratory setting requires biosafety level 4 containment (3,7).
CDC has established a hotline for public inquiries about Ebola virus infection and prevention ({800} 900-0681). CDC and the State Department have issued travel advisories for persons considering travel to Zaire. Information about travel advisories to Zaire and for air passengers returning from Zaire can be obtained from the CDC International Travelers' Hotline, (404) 332-4559.

References

1. World Health Organization. Ebola haemorrhagic fever in Zaire, 1976: report of an international commission. Bull WHO 1978;56:271-93.
2. Baron RC, McCormick JB, Zubeir OA. Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread. Bull World Health Organ 1981;61:997-1003.
3. Peters CJ, Sanchez A, Rollin PE, Ksiazek TG, Murphy FA. Filoviridae: Marburg and Ebola viruses. In: Fields BN, Knipe DM, Howley PM, eds. Field's virology. 3rd ed. New York: Raven Press, Ltd, 1996 (in press).
4. McCormick JB, Bauer SP, Elliott LH, Webb PA, Johnson KM. Biologic differences between strains of Ebola virus from Zaire and Sudan. J Infect Dis 1983;147:264-7.
5. Jarling PB, Geisbert TW, Dalgard DW, et al. Preliminary report: isolation of Ebola virus from monkeys imported to USA. Lancet 1990;335:502-5.
6. CDC. Management of patients with suspected viral hemorrhagic fever. MMWR 1988;37(no. S-3).
7. Peters CJ, Sanchez A, Feldmann H, Rollin PE, Nichol S, Ksiazek TG. Filoviruses as emerging pathogens. Seminars in Virology 1994;5:147-54.
   
   

Ebola Zaire Outbreaks

• 1972. Retrospective Serologic Identification
  
  In February 1977, serum from medical personnel who could have come in contact with Ebola were tested for Ebola antibodies. The serum from a Tandala Hospital physician tested positive. In May of 1972, this physician had lacerated his finger while performing an autopsy on a Zairois bible school student. The student died of a hemorrhagic illness that was clinically diagnosed as yellow fever. The physician became ill 12 days after lacerating his finger. In 1977, his hospital records were reviewed, and his symptoms were characteristic of Ebola Hemorrhagic Fever.
  
  
  References:
  • Heymann, D.L. et al. "Ebola Hemorrhagic Fever: Tandala, Zaire, 1977-1978." Journal of Infectious Diseases. Vol. 142. No. 3. September 1980. 372-376.

• 1976. Yambuku, Zaire. 
  
  EBO-Z surfaced shortly after the first Ebola outbreak in Sudan and killed 280 of the 318 people it infected. On September 1, 1976, four days after returning from a tour of northern Zaire, the index case, a 44 year-old male teacher at the Mission School, sought medical intervention for a febrile illness he thought to be malaria. He received a parenteral injection of chloroquine (an anti-malaria drug) from Yambuku Mission Hospital (YMH). YMH did not use disposable needles or sterilize the needles between uses. Parenteral injection was the primary mode of administering nearly all medicines, and Ebola-Zaire (EBO-Z) was quickly disseminated into the surrounding villages serviced by YMH. After 11 of its 17 staff members fell ill with EHF, YMH closed on September 30, 1976, 29 days after the index case received his injection of chloroquine. The WHO International Commission was formed on October 18th, and research teams were mobilized on October 30th. The last case of EBO-Z died on November 5, 1976. Transmission of Ebola during this outbreak occurred mainly through the use of contaminated needles to administer medicine.
  
  
  References:
  • International Commission. "Ebola haemorrhagic fever in Zaire, 1976." Bulletin of the World Health Organization, 56(2):271-293 (1978).

• 1977. Tandala, Zaire.
  
  In June of 1977, a 9 year-old girl with a 3 day history of fever, abdominal pain, and hematemesis (the vomiting of blood) was admitted to Tandala Mission Hospital. Prior to her admission to the hospital, she lived with her family in a small village, Bonduni, 20 km from the mission was in good health and had not traveled outside of the Bonduni area. When she was admitted to the hospital, she had a 39.5°C body temperature (normal body temperature is 37°C) and after physical examination, she had a clinical diagnosis of hemorrhagic fever. 28 hours after admission to the Tandala Mission Hospital, she lost consciousness and died. None of her family members tested positive for Ebola antibodies.
  
  
  References:
  • Heymann, D.L. et al. "Ebola Hemorrhagic Fever: Tandala, Zaire, 1977-78." Journal of Infectious Diseases. Vol. 142. No. 3. September 1990. 372-376.

• 1994. Minkebe and Makokou, Gabon. 
  
  This epidemic began in December 1994 and had two different waves of patients (December 1994 and January-February 1995).
  
  First Wave, December 1994
  All of the cases in were from 3 gold-panning encampments (Andock, Mékouka, and Minkébé) located in small forest clearings (2000-3000m²) bordering the rain forest. This region of Gabon is sparsely populated; a total of 350 people live in these three villages (20 in Andock, 30 in Mékouka, and 300 in Minkébé). 32 people from the 3 forest encampments contracted EHF (4 from Andock, 23 from Mékouka, and 5 from Minkébé) and traveled 100 km south via boat to Mekouka General Hospital for medical treatment.
  
  Second Wave, End of December 1994 to February 1995
  The patients that comprised the "second wave" were secondary or tertiary cases from the first wave and did not originate from the encampments. The first case in the second wave, end of December 1994, was from a small village near Makokou that was far from the encampments, Mayela. This person lived near a traditional healer, "nganga," and probably was infected from contact with a hospitalized patient who sought the medical help of a nganga. In mid January, 16 additional cases occurred near the road that runs south towards Fanceville (one case at Makokou General Hospital, 12 cases from Mayela, one case from Ekatiabe, and two cases from Ekobakoba). None of these 16 patients had been in the area affected by the first wave of the EBO epidemic in Gabon (Mékouka, Andock, and Minkébé) during the previous three months. All 16 patients had been either in direct contact with ill relatives (patients hospitalized at Makokou General Hospital or sleeping in the nganga's home) or with people caring for patients. The last reported case occurred at Ekobakoba on February 9, 1995 and was infected with Ebola while caring for an ill relative at Makokou General Hospital. The Gabonese health officials declared the epidemic officially over on 17 February 1995. The Gabonese authorities declared the epidemic over only eight days after the last case, leaving time for additional infections to occur. In previous Ebola outbreaks, an outbreak was not declared over until a period of 42 days (twice the longest incubation period) has lapsed since the last known infection.
  
  Overall, 49 people were admitted to Makokou General Hospital with suspected HF between December 1994 and February 1995 during these two waves. 29 of the 49 patients had fatal cases of EHF (case fatality rate of 59%). 26 of the EHF patients were male and 23 were female. The mean age of the patients was 37. Whether the number of infected people reflects the true number of EHF cases during this epidemic is not known. Some of the patients who were admitted with suspected EHF could have had a different type of HF or a different disease all together. Some cases who did have EHF could have sought the care of a nganga without seeking hospital care or could have died in their village or in the bush without the EHF investigative team being informed.
  
  The exact origin of the virus during this epidemic is unknown. During this outbreak, there was more than one point of contact with Ebola. This led to a longer duration of the epidemic than if there was only one point of contact with Ebola (as in the Spring 1996 outbreak; see below).
  
  References:
  • Georges, Alain-Jean, et al. "Ebola Hemorrhagic Fever Outbreaks in Gabon, 1994-1997: Epidemiologic and Health Control Issues." Journal of Infectious Diseases. 1999; 179 (Suppl 1):S65-75

• 1995. Kikwit, Zaire.
  
  
  Image supplied by the World Health Organization.
  
  
  
  Image from Outbreak
  
  On January 6, 1995 the first EHF case-patient, "GM", had the onset of illness and was admitted to Kikwit General Hospital. He was a 42-year-old male charcoal worker, a Seventh-Day Adventist and had not eaten monkey meat or been in detectable contact with another EHF case-patient prior to becoming ill with EHF (1, 10). His charcoal plot was on the edge of a dense forest and under a dense forest canopy. During his woodcutting forays and charcoal burning pit diggings, he was exposed to a wide array of possible vectors and, presumably, the natural reservoir (1). He directly, fatally infected at least three members of his family and an additional 10 members of his extended family over a period of 9 weeks and an area encompassing Kikwit and three surrounding villages. Some of the ill people from this family and secondary and tertiary cases in other families who provided nursing care or who had participated in the ritual burials of GM's family went to Kikwit II Maternity Hospital (10).
  
  On April 9, a 36 year-old male laboratory technician who worked at Kikwit II Maternity Hospital went to the Kikwit General Hospital, Zaire because of fever and bloody diarrhea. Suspecting a perforated bowel from typhoid, he underwent surgery on April 10 and 11 (10). He died four days after the onset of symptoms. On April 14, the medical personnel who cared for the laboratory worker in the operating theater or hospital wards became ill with fever, headache, back, joint, and muscle aches, extreme asthenia (clinical definition for physical weakness), and, in some cases, hemorrhagic manifestations. Over 70% of the first generation cases were hospital personnel. One of the ill people who had provided care for the laboratory technician was transferred to a hospital in Mosango (75 miles west of Kikwit). Some of the people who had provided care for this individual developed similar symptoms on approximately April 20 . 10 days after the first-generation cases, a second generation of cases occurred among family and friends of the first-generation cases. Transmission during this outbreak was mainly person-to-person through contact with bodily fluids and ritual cleansing of bodies before burial (usually performed by women). To limit the spread of EHF, the Zairian government closed all schools in Kikwit. The Kinshasa airport remained open during most of the outbreak (5, 7, 8).
  
  The unusual nature of the laboratory technician's death and the medical personnel who cared for him prompted a local ad hoc committee to meet to discuss the nature of these deaths. J.J. Muyembe-Tamfun, Ministry of Health, Zaire, who had participated in the follow-up of the 1976 outbreak of Ebola-Zaire in Zaire (for information about that outbreak, please see 1976 Zaire above) suggested that these illnesses may be caused by a viral hemorrhagic fever. On his prompting, specimens were obtained for analysis and were sent to the Institute of Tropical Medicine, Antwerp, Belgium on May 4th. On May 9th the CDC received portions of these samples for confirmational diagnostic analysis. The CDC confirmed EBO as the etiologic agent responsible for the disease in all 14 patients (the index patient and the medical personnel who subsequently contracted it nosocomially from him) (10).
  
  Based on the preliminary findings of the Institute for Tropical Medicine, on May 6, 1995, the Zairian government sought the assistance of the CDC with an outbreak of a viral hemorrhagic fever (VHF)-like illness that was occurring in Kikwit, Zaire. The population of Zaire in 1995 was approximately 400,000. Kikwit is located approximately 240 miles east of Kinshasa. The CDC's and the WHO's investigation of this outbreak was primarily retrospective (6).
  
  Four separate hospitals were implicated in the outbreak. The first hospital and the center of the outbreak was Kikwit General Hospital (the hospital that treated the laboratory technician). The second was Kikwit II Hospital. The third was the hospital in Mosango, where one of the medical personnel who cared for the laboratory technician was transferred. The fourth hospital was in Yassa Bonga, approximately 250 km. from Kikwit (8).
  
  
  
  Image from Khan et al. (10)
  
  The last identified case of EHF during this outbreak was a 27-year-old housewife from Nzinda, Kikwit. She was admitted to Kikwit II Maternity Hospital on 24 June 1995 for the management of a septic abortion. She was discharged on July 14 and died at home on July 16 (10). On August 24, 1995, the 1995 outbreak was declared over, twice the maximum known incubation period (42 days, 21x2) lapsed without any new cases of EHF(1).
  
  More than 1400 samples of different fauna were collected for reservoir testing (4).
  
  Overall, there were 315 cases, 244 of which were fatal (77% case fatality rate). 166 cases were female and 149 were male. 123 female cases were fatal (74% fatal) and 121 male cases were fatal (81% fatal). The cases of EHF ranged from three days to 71 years, with a mean age of 35 years. 26 of the EHF cases were less than 17 years old and 13 were over 60. Median age of the survivors was 29 years; median age of the fatal cases was 35 years. Of the 286 cases where the professional occupations were known, 90 (32%) were health care workers and 61 (21%) were housewives (usually nursed sick or performed the ritual cleansing and burial preparation practices for dead family members). Approximately 73% of the first 70 patients in the epidemic were medical personnel, and the case fatality rate among them was high (1, 6, 9).
  
  266 of the EHF cases were reported to have lived in Kikwit North and South Zones de Sante, the remaining in the Zones de Santeof Bulungu (13 cases), Feshi (1), Gungu (4), Idiofa (1), Mosango (23), Mokala (1), and Vanga (6). All of the cases of EHF were in the Kikwit and Kwilu administrative Sub-Regions, except for 1 case in the Kwango Sub-Region, Bandundu Region. None of the cases were acquired outside of the Bandundu Region (1).
  
  References:
  
  1. WHO Ebola Update August 24, 1995 
  2. Sanchez, A. et al. Reemergence of Ebola Virus in Africa. Emerging Infectious Diseases 1995:1(3)
  3. Clancy, Jim. Fear among us: Deadly Ebola virus lurks in the shadows. CNN October 18, 1995.
  4. Rybicki, Ed. "Ebola:comments by C.J. Peters. Source: Report on VTH INTERNATIONAL CONGRESS ON THE IMPACT OF VIRAL DISEASES ON THE DEVELOPING WORLD, South Africa." PROMED. 21 August 1995.
  5. Musong, M. et al. "Outbreak of Ebola Viral Hemorrhagic Fever--Zaire, 1995." Morbidity and Mortality Weekly Report. Vol. 44, No. 19. 19 May 1995. 381-382.
  6. Musong, M. et al. "Update: Outbreak of Ebola Viral Hemorrhagic Fever--Zaire, 1995." Morbidity and Mortality Weekly Report. Vol. 44, No. 25. 30 June 1995. 468-69, 479.
  7. Muyembe, T. et al. "Ebola haemorrhagic fever in Kikwit, Zaire." The Lancet. Vol. 345. 3 June 1995. 1448.
  8. WHO. "WHO Press Release: WHO Team in Zaire Sends First Report on Ebola Virus Outbreak." WHO Press Release WHA/11. 11 May 1995.
  9. WHO. "WHO Team in Zaire Reports Further Rise in Ebola Cases." Press Release WHO/33. 17 May 1995.
  10. Khan, Ali et al. "The Reemergence of Ebola Hemorrhagic Fever, Democratic Republic of the Congo, 1995." Journal of Infectious Diseases. 1999; 179 (Suppl 1):S65-75 

• 1996. Mayibout, Gabon.
  
  
  Geographic Distribution of 3 Ebola Outbreaks in Gabon. Image taken from: Marie-Claude Georges-Courbot, et al. "Isolation and Phylogenetic Characterization of Ebola Viruses Causing Different Outbreaks in Gabon." EID 1997: 3(1).
  Bernard Massika and his wife with ill son (AP Photo).
  
  On January 24, two men butchered a dead chimpanzee they found dead in the forest. On February 5-6, 19 original cases showed signs of EHF (high fever, bloody diarrhea, and severely reddened eyes) and were admitted to Makokou provincial hospital. The average age of the 19 original patients was 18 years. Rapid identification and the implementation of appropriate control measures brought the outbreak quickly under control and prevented further amplification. The last case of EHF died on 12 March 1996. Outbreak officially declared over by the WHO (World Health Organization) on 23 April 1996; 42 days (twice the incubation period) after the last EHF patient death. Total number of EHF cases was 37 (17 females, 20 males), and the mean age of the EHF patients was 27 years (range seven months to 70 years).
  
  References:
  
  • Ebola virus kills 13 in Gabon. CNN February 20, 1996
  • Press Release WHO 16 February 1996. Medical Team Investigates Outbreak of Suspected Ebola Haemorrhagic Fever in Gabon
  • Marie-Claude Georges-Courbot, et al. "Isolation and Phylogenetic Characterization of Ebola Viruses Causing Different Outbreaks in Gabon." EID 1997: 3(1).
  • Garrett, Laurie. "Killer virus strikes Africa for the third time in a year/ Killer Virus Strikes in Gabon." Newsday. 17 February 1996. A07
  • "Ebola Haemorrhagic Fever in Gabon." WHO Press Release 19 February 1996.
  • "WHO: Disease Outbreaks Reported. Ebola Haemorrhagic fever in Gabon- Update 3. 26 April 1996."
  • Georges, Alain-Jean et al. "Ebola Hemorrhagic Fever Outbreaks in Gabon, 1994-1997: Epidemiologic and Health Control Issues." Journal of Infectious Diseases. 1999; 179 (Suppl 1):S65-75

• 1996. Booué, Gabon and Johannesburg, South Africa (transported).
  
  Outbreak in Booué
  First case occurred on 23 July 1996 in Booué. The index case was a 39-year-old hunter who lived in a forest camp in the Booué area. He died on August 7. The second case was a close friend of the index case and died in August. The third and the fourth cases of EHF (also fatal) occurred in late September and were in a traditional healer and his assistant who treated the healer. During the beginning of the outbreak, a dead chimpanzee was found in the forest and tested positive for Ebola. On October 18, three of four new cases were in children who had been in close contact with previous EHF cases. Some patients were transported to Libreville for treatment. The outbreak was brought under control by the international team by 13 November 1996. Last patient died on 18 January 1997. A total of 60 EHF cases, of which 45 were fatal (75% mortality rate). Booué area: 44 cases, including 33 deaths. Libreville: 14 cases, including 10 deaths. No documented secondary transmission. Lambarene: one fatal case. WHO officially declared this outbreak over on 2 March 1997.
  
  Transport from Libreville to Johannesburg
  On October 27, a 40 year-old Gabonese doctor infected with Ebola in Libreville from a patient who was linked to the Booué outbreak flew to Johannesburg, South Africa for treatment. The patient who transmitted EBO to the male physician died on 5 November 1996. The physician was accompanied on a commercial plane to South Africa by a nurse. He arrived to the Morningside Medi Clinic with a diagnosis of rhabdomyolysis (a clinical and biochemical syndrome resulting from an injury which damages the integrity of the sarcolemma of skeletal muscle, leading to the release of potentially toxic muscle cell components into the circulation). He had swinging temperatures of 42°C (normal body temperature is 37°C, was very ill, and had signs of hepatitis. During the course of his treatment, a muscle biopsy was performed (presumably to test for rhabdomyolysis). At the 300 bed hospital in Libreville, he worked as a "resuscitator." On October 19, he developed a febrile illness, which he treated with antimalarial drugs. Two to three days later, he developed a high fever and diarrhea. He was not aware that any of the patients he treated had Ebola. He recovered from EHF and returned home to Gabon on November 20. Mrs. Marilyn Lahana, a 46-year-old theater/anesthesia nursing sister, treated the Gabonese physician at Morningside Clinic, Johannesburg and became infected nosocomially with Ebola from the Gabonese physician. She was exposed to his blood while performing a procedure for placing a central line on him. She was exposed to a great deal of blood when she cleaned up after the procedure. She became ill (slight fever) on November 2. She developed a severe headache on November 6 and was admitted to Sandton Medi Clinic with suspected encephalitis. On admission to the hospital, she had a moderately low platelet count (105x10E9/L). Suspecting a bacterial infection, she was placed on antibiotics. Over the next few days after being admitted to the hospital, she developed a fine confluent macular rash and diarrhea, which was attributed to a possible reaction to the antibiotics. By November 9, her platelet count fell from 105 to 37, had marked leukopenia, and had elevated AST and ALT levels (her liver transaminase levels were initially normal). On November 9, suspecting viral hemorrhagic fever (low platelets, rash, and fever), her blood was submitted for analysis. On November 14, her blood tested positive for Ebola. Mrs. Lahana had developed hematemesis (bloody vomit), high AST and ALT levels (general liver function test), and slightly elevated leukocyte counts by November 14. November 16, she was moved to Johannesburg Hospital where strict barrier-nursing care was implemented. She died on November 24 from a brain hemorrhage. 

References:

• Clinch, David. Woman dies from Ebola in South Africa. CNN November 26, 1996
• Streiker, Gary. Improve public health to control Ebola. CNN March 10, 1996
• "WHO: Disease outbreaks reported. 15 October 1996. Ebola haemorrhagic fever in Gabon (new outbreak) - Update."
• "WHO: Disease outbreaks reported. 18 October 1996. Ebola haemorrhagic fever in Gabon (new outbreak) - Update 2."
• "WHO: Disease outbreaks reported. 16 January 1997. Ebola haemorrhagic fever in Gabon (new outbreak) - Update 13."
• "WHO: Disease outbreaks reported. 8 January 1997. Ebola haemorrhagic fever in Gabon (new outbreak) - Update."
• "WHO: Disease outbreaks reported. 2 March 1997. Ebola haemorrhagic fever in Gabon (new outbreak) - Update 16."
• Swanepoel, R. "Ebola - South Africa (02). 17 November 1996." PROMed.
• Baggaley, Paul. "Rhabdomyolysis."

August 18, 1996

IDEAS & TRENDS

Was the Plague of Athens Really Ebola?

By ANTHONY RAMIREZ

MORE than 2,400 years ago this summer, a mysterious plague swept through ancient Athens. In five years flat, it killed perhaps a quarter of the population of the city-state, then under siege by Sparta. Thousands of Athenians died a dreadful death -- first suffering a maddening fever, then bloodshot eyes, inexplicable vomiting and bleeding, followed by skin lesions and diarrhea.

Sudden, lethal and tenacious, the strange plague hastened the end of Greece's golden age, setting back civilization for centuries. Pericles, the statesman who symbolized that age, was one of many who succumbed to the epidemic. History has never seen such a scourge before, or since. Or has it?

Over the years, a small number of scholars have proposed dozens of modern diseases as the one that felled Athens -- cholera, malaria, smallpox, bubonic plague, even herpes simplex and toxic shock syndrome.

Now three medical researchers and a classics professor are suggesting that the Plague of Athens (circa 430-425 B.C.) was, in fact, an attack of Ebola, the modern world's most vicious virus (up to 90 percent of those stricken with Ebola die) and, for a while, the world's most celebrated. Ebola has inspired front-page headlines, best-selling books and a big-budget Hollywood movie, ''Outbreak.''

Dr. Patrick Olson, an epidemiologist at the Naval Medical Center in San Diego, and his colleagues wrote about their Ebola theory in the most recent issue of the journal ''Emerging Infectious Diseases.'' They argued that Ebola's symptoms in modern-day Zaire mirror those of the Greek plague reported by Thucydides in his ''History of the Peloponnesian War,'' the most complete account that has survived.

The researchers noted that most victims in ancient Greece, like those in modern Africa, died in seven to nine days, and the Athenian caretakers, much like African doctors, fell ill, while the Spartans laying siege a few hundred yards away survived. That indicates that the ancient disease was, like Ebola, spread by blood, saliva or feces, rather than by airborne microbes.

Thucydides also asserted that the disease was African, from somewhere south of Ethiopia. Ebola also has African origins. And there is even evidence that suggests the way the virus might have traveled from Africa to Greece in ancient times. On Santorini, a port island near Athens, a Minoan fresco depicts African green monkeys, which are known to be modern carriers of Ebola. Even more intriguing is the report of hiccuping among 15 percent of the victims in Kikwit, Zaire, Dr. Olson noted. Thucydides mentions hiccups.

Not everyone is ready to declare the plague of Athens an attack of Ebola, though. David Morens, an epidemiologist and leading researcher on the Athenian plague at the University of Hawaii at Manoa, said in an interview that reading modern diseases into Thucydides was a mistake.

Thucydides, an Athenian general who survived the plague, lacked even the rudimentary medical vocabulary of his contemporary Hippocrates, Dr. Morens said. So his descriptions of symptoms are, at best, vague. Thucydides's word ''phlyktainai,'' for example, can be variously translated as blisters, which have fluid, or as calluses, which do not. Blisters might suggest smallpox, which is one of the candidates favored by many plague scholars, but they would rule out bubonic plague, another favorite candidate.

Dr. Morens and his colleague at the University of Hawaii, Robert J. Littman, a classics professor, focus not on symptoms (which they consider unreliable evidence) but on place and time. For example, they note that the length of the Athenian plague, five years, would rule out a virus like influenza, which lasts only months. And the origin of the Athenian plague, Africa, would rule out a virulent disease like Ebola. In the ancient world, they point out, there was no means of transportation that could convey a virus-carrying monkey from Africa to Athens in less than a week. That is, by the time the boat made it to Greece, both the monkeys and their keepers would likely have died.

There is another big question raised by the thesis that Ebola caused the plague of Athens. The Ebola virus was discovered only 20 years ago, and re-emerged in Zaire only last year. If the Athenian plague was Ebola, where has it been all these years?

Frank Ryan, a British physician who writes about plagues, suggests that humans and microbes are much like soil and seed. Most of the time, they live together without incident. But change the conditions of the human population, or soil, then viruses, the seeds, will change, too, making for a sometimes deadly collision.

''Plagues are still with us,'' said Dr. Ryan, ''because refugees, the lack of hygiene from overcrowding, political chaos -- all the things seen in Athens -- are still with us.'' So we ignore historical plagues at our own peril.

The biggest obstacle to knowing whether Ebola caused the Athenian plague is that modern doctors know so little about Ebola itself. On a scale of 1 to 10, ''we know 3 about Ebola, maybe less,'' said Karl Johnson, the retired chief of the Special Pathogens Branch of the Centers for Disease Control and Prevention, who saw Ebola at its first outbreak in Zaire, near the Ebola River, in 1976.

Viruses like Ebola are mysterious and frightening for the same reason: they evolve at a furiously accelerated pace. It took eight million years or more for simian primates to change 2 percent of the genetic structure to become human beings. By contrast, the polio virus can change 2 percent of its genetic structure in five days -- the time it takes to pass from the human mouth to gut. Imagine what a virus could do with 2,400 years.

Photo: ''The Death of Pericles,'' an engraving depicting the statesman succumbing to the Plague of Athens in 429 B.C., may turn out to be a picture of death by Ebola. (Culver Pictures)

FRANCE AND RWANDA; FASHODA COMPLEX

There is a significant page on the near history book of France who is
holding countless European and World championships in human rights
and democracy. "Rwanda" is the title on that page. A genocide in real
sense was experienced in our world at the end of the 20th century.
The genocide in Rwanda also was memorised as a picture of double
standards, immorality and the European diseases of our times.

Rwanda's Head of State Paul Kagame said on the genocide took place in
his country on April 7th, 1994 as follows:

"Frenchmen trained and armed the soldiers and militia that would
commit the genocide. They knew there would be genocide. French saved
those murderers later on and did not protect the victims. They were
courageous enough to remain here without any apologies as well."
- Rwandan President Paul Kagame

What the Rwandan Head of State Paul Kagame mentioned is the
"Turquoise Operation" that France was running in Rwanda in June 1994. Paris, after a short time following that statement condemned Rwanda for the
"untrue allegations". French Defence Minister Michelle Alliot-Marie
claimed that the "Turquoise Operation" of France was a chance for
Rwanda and it blocked a genocide.

According to the data given by researcher Bernhard Schmid, 10.000
people were massacred everyday for three months in Rwanda. 937 000
bodies were identified. It is a known fact that the total number of
victims was more than one million. Rwanda's population was over seven
million before the genocide and only one fifth of it was Tutsis who
were targeted by the genocide.

Rwanda paid very heavily for the division of its people into two as
Hutus and Tutsis in a very long colonialism era. Belgium which was
under intensive French influence divided Rwanda into various
artificial ethnic identities by force while it was also declaring the
self-invented Hutus and Tutsis as enemies. The words "Tutsi" and
"Hutu" were even put on the ID cards as ethnic origins and the
genocide which damaged Rwanda greatly was carried out very easily.
Murderers set up check points on streets and found their victims
through "ID check".

Following the genocide, Paris hosted frequent demonstrations of
Rwandans and French people who were embarrassed of the genocide.
Paris
government showed halls for commemoration ceremonies and locations
for
demonstrations. At the end of the day there was a democracy in France
and people could voice their reactions in France to the genocide took
place in their country. France, after all, was the human rights and
democracy champion of Europe and the world of all times. The genocide
took place in Rwanda - according to the official statements of Paris
-
was made up by Rwanda.

BBC of Britain prepared a documentary called "Three Bloody Colours" -
being inspired from the French flag - on France's sins in Rwanda. As
understood from the name of the documentary, it was evidencing the
role in the genocide that a nation had to take on, of the capital of
love and romance, Paris. BBC included interviews held with many
leading French politicians as well in the documentary. Jean-
Christophe
Mitterrand, the shameless son of former French President Françoise
Mitterrand was on of the interviewees. His father had put Jean-
Christophe Mitterand in charge with the "African affairs" in 1982.
Jean-Christophe Mitterand, thanks to this post, gained fame in Paris
and in the world as "Papamadit" (My father told me that...).

BBC asked Jean-Christophe Mitterand during the interview whether the
genocide nights in Rwanda interrupted his sleep. Jean-Christophe
Mitterand smiled and replied to this question: "No". Of course what
was going on in Rwanda was tragic but he did not feel responsible.
Even his close friendship with Rwanda's genocide planner Head of
State
Habyarimana's son was irrelevant to the issue.

BBC asked Paul Baril, a gendarmerie officer and the presidency
consultant, about what Rwandan Head of State Kagame said. Barril's
reply was as follows:

"He can not even speak French. Not even a word. He only understands
English". It might sound surprising for readers but it was
astonishingly important for France that Kagame and his followers
could
not speak French because a person in Africa should only speak the
language of the country he would obey.

In French influenced Rwanda, French friendly Hutus could speak
French.
But Tutsis who sought refuge in Uganda due to pressures were speaking
English. That is why France believe that Rwanda Patriotic Front (RPF)
under the leadership of Kagame, since they spoke English, would
separate Rwanda from France and bring it closer to the Britain

French Foreign Minister visited Kagame in Quai d'Orsay in 1992 and
told him that if he returned to Rwanda, he would not be able to find
any surviving members of his family there. The family the French
minister mentioned was Tutsis. While the French minister was saying
these, France was giving an intensive military training to Hutu
militias and soldiers.

French parliament had to establish a research commission in 1998 as a
result of continuous publication of documents and information by the
French journalist Patrick de Saint-Exupery. But the commission report
failed to come to a conclusion about "who was responsible" but only
contributed the sweeping the French role under the rag.

Patrick de Saint-Exupery left no suspicion in his articles and
publications about who the responsible was. Patrick de Saint-Exupery
was in Rwanda in June 1994 and witnessed the "Turquoise Operation"
with his own eyes.

He saw the arrival of French Special Forces, air deployment troops
and
anti-terror unit GIGN to Bicecero hill, the stronghold of those who
tried to resist the genocide, on June 27th, 1994. French soldiers
told
those who were still alive that they came to help but they did not.
The journalist never saw that the French soldiers helping the
surviving people but witnessed that French soldiers fighting against
the genocide-resisting RFP.

Obviously, as Françoise Mitterand said -off the record- during an
interview that "genocide does not mean much in those countries" and
"people's perception of death in those countries was different than
ours" as claimed by Charles Pasqua, the conservative-nationalist
Interior Minister responsible of France's policy implementation in
Africa.

Both French statesmen, in fact, try to tell as follows: "We French
are
different than them. It is natural for them to die, to kill and to be
killed. If the deaths are excessive, that might be called genocide.
But for Africans, death and genocide are natural. It should not be
exaggerated."

When these words are looked at, it is understood that genocide is
actually natural for France. There was nothing that French could not
do to reach its targets as France has always been under the shadow of
London in sharing and colonialist moves in Africa and never been the
first power in the continent. This French complex against Britain is
named Fashoda Complex. If there was not a Fashoda Complex, maybe more
than one million Tutsi would not see the genocide. But it is too late
to discuss all these.

Journalist Patrick de Saint-Exupery does not think that what happened
in Rwanda was not only linked to the Fashoda Complex. According to
him, France had developed a "counter-revolution technique" against
the
insurgents in Vietnam and Algeria after it was inspired from Mao's
"revolutionary war theory". Civilians and people should be under
control in this technique. A semi-military militia organisation
should
be established and people in risky regions should be evacuated
obligatorily. This method was used by the USA in Argentina later on.
The operators of this technique were tutored by French officers at a
US Military School, Fort Bragg.

Patrick de Saint-Exupery thinks that France was testing the technique
it developed while training Hutus in militia groups and sending them
over Tutsis. For this reason, French officers before and during the
genocide did not only give consultancy but also took part in the
centre of the operation.

According to the French press, what happened in Rwanda was Rwanda's
responsibility and Rwandans should not look for the criminal in
France
but in their own soil. Most probably, French readers believed the
newspapers, Mitterand and the reports composed by their parliament.

But one of the exceptional journalists, Colette Braeckman penned an
important article on Le Monde Diplomatique's March 2004 release. The
article titled "The Clumsiness of International Society" underlined
some milestones in the Rwandan history.

Arusha Peace treaty was signed between Rwanda and RFP in Tanzania in
August 1993. According to the treaty, an UN peace force would be
deployed in Rwanda. The peace force would auspice the Rwanda's
interim
government and the RFP's accession to the political life.

Meanwhile Rwanda would receive foreign aid as well. The UN deployed 2
548 soldiers instead of 4 500. The UN peace force was given the duty
of "protecting peace" but not "establishing peace". It meant that the
UN soldiers could not use weapon even when it was necessary.

A great crisis broke out in Rwanda in 1994. While the world was
turning a blind eye, France and Belgium were unsurprisingly ready for
peace and calmness in Rwanda. Arusha Peace Treaty was not in
application and Hutus started propagating hatred through the TV
channel they established. It was understood that even in the middle
of
February militia forces were being trained in Hutu military camps.

In the following months, the French Bank Credit Lyonnais gave a
massive loan to Rwanda for the purchase of weapon and ammunition from
Egypt. Political murders came one after another in October 1993. The
UN Peace Force was amazed when it learnt in January 1994 that Hutus
were searching Tutsis one by one and making a record of them. The
inquiries found out the existence of a Hutu militia organisation
called "Interahamwe". The name of the organisation meant "Joint
Killers of Them". The organisation had a massive weaponry depot.

In following days, an arm storage in the central offices of the Hutu
Head of State Habyarimana's party was discovered. The UN peace force
asked permission from the centre to confiscate the arm storages on
January 15th 1994. This permission request was never replied. Head of
State Habyarimana, however, moved the weapon storage to another place
for a short time.

The only reaction that the international society gave to those
developments was the Belgium's Foreign Minister Willy Claes's partial
criticism of Rwanda with a carefully worded statement in February
1994. Meanwhile political murders continued without any breaks and in
following days, the UN decided that there was no need for an
extension
duty period for the UN Peace Force in Rwanda.

In fact, on the same days, the UN Security Council in a statement
said
that "the situation in Rwanda was worrying". Koffi Annan was the
responsible person of the UN peace forces and peace operations in
that
period. Kofi Annan received the greatest support from Chirac when he
was forced to resign during his general secretariat because of his
son
Kojo's great corruption allegations.

The genocide, as being inevitable under all those conditions, started
on April 6th, 1994. The Hade of State Habyarimana was killed in a
plane crash. With this strange assassination, Hutus attacked Tutsis
and Tutsis attacked Hutus with great hatred. The hatred and hostility
stored for years in society came to the surface. Streets were flooded
by corpses in one day.

France and Belgium, of course, could not remain silent. They sent
their troops to Rwanda immediately. If Paris and Brussels had sent
those soldiers as contribution to the UN Peace Force, there would not
be a genocide. They preferred to deploy their troops in Rwanda after
the genocide started. French and Belgian soldiers were interested in
the evacuation of foreigners in Rwanda instead of stopping the
clashes. They preserved their "neutrality". The neutrality was
between
the murdering Hutus and murdered Tutsis.

On April 12th, Belgium decided to withdraw all its troops from Rwanda
after it saddened with the loss of 10 soldiers and called on all
other
countries to do the same. Meanwhile France accelerated its weapon
flow
into Rwanda.

France stated on June 22nd that it would intervene with the situation
in line with the UN charter. The genocide was continuing meanwhile.
The French intervention did not come for the favour of the genocide
target Tutsis. France declared 1secured zones" but could not prevent
massacres in those secured zones. Not a single person was arrested.
Radio Mille Collines that run the hatred campaign against Tutsis was
not shut down.

Thousands of French soldiers were helpless with their aeroplanes,
assault helicopters and nearly 100 tanks. RFP forces found a
demolished and deserted city when they entered capital Kigali on July
4th. While more than 300 000 orphaned children were walking around
without knowing what to do, the French Foreign Minister's words he
said in Uganda to the leader of RFP in Uganda were confirmed right:

"If you return to Rwanda, you would not be able to find any surviving
members of your family there."

Most of the Hutus involved in the genocide sought refuge from Zaire,
settled down in a camp and went under the protection of the
international aid organisations. Kagame tried to tell the UN
officials
that those camps were threats for his soil and people. Finally RFP
moved against those camps. The international society was quite yet
once more.

The Zaire's Head of State Mobutu, despite the Frech support up until
the last minute, was ousted seven months later. The war that lasted
until 1998 spread the genocide to Zaire (Congo). Some sources claim
that three million people were killed in joint operations of Rwandan
and Zairian armies during the war.

The UN Secretary General Koffi Annan made a speech at a UN general
session ten years after the genocide. Annan in his speech said that
the international society was insufficient and unwilling. He even
said
that the same tragedy should not be repeated. He did not criticise
France, of course. A report of thousands of pages was released by a
research commission of the Belgian parliament in 1997. Vorwaerts of
Switzerland and Le Figaro of France released parts of the report in
1998. According to the news and quotations, the French contribution
to
those who committed the genocide is undeniably true.