Many weapons used in the genocide did not originate in Rwanda, but in many of the political and economic powers of the world. 21 The physical and structural violence of the Rwandan genocide directly affected the spread of communicable disease. Systematic rape during the genocide served as a vector for HIV transmission. 22 The exodus of Rwandans into refugee camps in the Democratic Republic of the Congo without adequate food, water, and sanitation gave rise to epidemics of infectious disease (such as cholera) that resulted in a crude mortality of 20 to 35 per 10,000 people each day. 23 Increased incidences of both malaria and tuberculosis have lasted far beyond the formal end of the genocide. 24 Careful attention to Rwanda's and Haiti's places in global history, economics, and politics shows that the forces of structural violence increase risk of communicable disease for resource-poor populations in ways that are distinct from the behavioral and cultural explanations uncritically circulated in academic literature and the popular press.