National Commentary

Guest Commentary: Long-Term Solutions to Malnutrition in Rwanda

By Anne Wanlund

For the last two and a half years I have been fortunate to lead a non-profit organization in Rwanda called Gardens for Health International (GHI). We provide training to thousands of rural Rwandan families annually, focusing on essential health, nutrition and agriculture practices designed to prevent chronic malnutrition by addressing its root causes.

Chronic malnutrition, an enormous threat to children in particular, remains the greatest public health challenge in Rwanda. Chronic malnutrition is caused not by lack of calories, but by a lack of sufficient nutrients such as Vitamin A, iron, folate, and calcium, which come from diverse sources of food. The implications of a lack of absorption of key nutrients is particularly alarming for pregnant women and young children. When a child is chronically malnourished in the first two years of life, he/she is at risk for stunting and impaired cognitive development. The condition is almost impossible to detect just by looking at an individual, yet its effects are basically irreversible and manifest in adulthood.

In Rwanda, where diets frequently lack sufficient diversity to provide an adequate range of micronutrients, 38 percent of children are chronically malnourished. Chronic malnutrition remains the greatest public health challenge in Rwanda as 10 percent of GDP losses per year are directly attributable to the condition.

In refugee camps, the situation is even more dire, with Congolese and Burundian refugees seeking safety in Rwanda disproportionately affected by chronic malnutrition. In camps, displaced persons receive food rations, typically staples like rice, corn flour, and beans. These foods are calorie-dense, but lack sufficient nutrients to promote child development. A displaced child is about 20 percent more likely to be chronically malnourished than a non-displaced child, with 57 percent of households having inadequate food consumption.

Although food aid is vital as an emergency measure in refugee camps, such aid doesn’t address long-term food requirements. Emergency operations can garner international focus and donations, but protracted situations are often neglected, despite the fact that they demand enormous support for large populations living under a care-based system year after year.

The Kigeme refugee camp in southwestern Rwanda, where GHI is starting to work this year, is “home” to more than 165,000 refugees fleeing political violence in Burundi and the Democratic Republic of Congo. Until now, the rations distributed to the Kigeme refugees have not provided adequate dietary diversity, contributing to the stunningly high prevalence of malnutrition. A recent study by the UN’s World Food Programme showed that up to 89 percent of families in Kigeme regularly sold elements of their food package in an attempt to purchase more diverse food to meet their needs.

GHI has identified a lack of access to nutritious foods and lack of essential nutrition knowledge as the two primary drivers of malnutrition in Rwanda. These same drivers exist in refugee camps. Over the next year, we will introduce our proven model of integrated health behavior change and nutrition-sensitive agriculture interventions for the most vulnerable refugee populations, emphasizing women and children, in order to improve nutrition outcomes in Kigeme Camp. We will support caregivers to establish nutritious kitchen gardens at their homes while also equipping them with the health knowledge they need to keep their children healthy as they grow and develop. We will also be training camp staff to ensure the gains GHI makes to improve nutrition outlast our direct contributions.

Refugee populations will continue to face a difficult journey. Forced by an intractable threat from their homes, many displaced persons may never have the option of returning. They often face great difficulty entering the formal employment market in their host countries and struggle to feed their families. It is important to recognize the need for long-term solutions that can empower families to take their health and livelihoods into their own hands, and become less dependent on services that cannot meet all of their requirements.

More work is needed to empower displaced families in camps to address the root causes of the challenges they face and break the cycle of malnutrition. Gardens for Health International will be taking a long-term approach to address these issues at Kigeme refugee camp for the next year, and is seeking additional support to do so. If we continue to be successful in our work with refugees this year, we will be in a position to scale our approach to other camps with great need.

If you would like to make a donation to help us in these critical efforts, please visit our website at and click the yellow button “Donate” at the top of the page. Checks can be mailed to P.O. Box 51935, Boston, MA 02205.


Anne Wanlund is a ’04 George Mason High School graduate living in Rwanda and the outgoing Country Director of Gardens for Health International.