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With the deterioration of the political context in Burundi since April 2015 more than 140,000 refugees have arrived in Tanzania. The refugees are hosted in three camps in Kigoma region, together with 83,000 Congolese refugees living in Nyarugusu camp for almost 20 years. The initial influx of Burundi refugees coincided with a cholera outbreak in Kigoma region, which triggered an immediate MSF emergency response in May 2015. This rapidly shifted with the movement of refugees from the lake shore of Tanganyika to the Nyarugusu camp.

This publication was produced at the request of MSF OCG, under the management of the ViennaEvaluation Unit. It was prepared independently by Alena Koscalova and Yann Lelevrier.

A series of failures was the starting point for this analysis. Several outbreaks of hepatitis E, transmitted via the water supply, occurred in refugee and IDP sites in the Sahel (Sudan in 2004, and Chad in 2007) and in central Africa (Central African Republic in 2002, and Uganda in 2007). MSF was responsible for all or part of the water supply, as well as medical care. These outbreaks are a reminder that significant infectious risks persists even after we implement our usual procedures.

Jean-Hervé Bradol, Francisco Diaz, Jérôme Léglise, Marc Le Pape