The Rwandan genocide began 20 years ago, and in articles assessing the consequences, one surprising fact stands out: In public health, Rwanda has risen from the ashes to become Africa’s biggest success story.

From April to July 1994, 800,000 to one million people died in an explosion of hand-to-hand slaughter orchestrated by extremists in the Hutu-dominated government. Millions fled across the borders into refugee camps. With the health system in tatters, deaths from tuberculosis, AIDS and other diseases climbed for years afterward.

But slowly under the sometimes brutal but efficient administration of President Paul Kagame, head of the Tutsi-dominated military force that overthrew the 1994 government, and with large influxes of foreign aid that has not been lost to corruption, all that has turned around.

According to World Health Organization data, child mortality has fallen by more than two-thirds since 2000. Vaccination rates are higher than those in the United States, and very few children are reported to be dying of tetanus, whooping cough, diphtheria or measles. Ninety-seven percent of pregnant teenagers see a health worker at least once before giving birth, and 83 percent give birth at clinics or with a health worker present.