The impact of war and genocide on the long-term physical and mental health of civilians and their communities cannot be overestimated. People fleeing to overcrowded refugee camps put an intolerable strain on basic infrastructure. Lack of sanitation, clean water and immunisation lead to outbreaks of waterborne and communicable diseases. Unemployment leads to poverty; shortage of nutritional food exacerbates disease; inadequate health services lead to a rise in maternal mortality; widespread depression and anxiety lead to alcohol abuse; systematic rape and sexual violence lead to a rise in HIV and sexually transmitted diseases; the paralysing effects of post traumatic stress disorder prevent communities from starting again.