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A Nigerian Story: How Healthcare is the Offspring of Imperialism and Corruption

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As a Nigerian, the greatest scorn often finds you when you argue for Nigeria. Other Nigerians will mock you, denounce you as impractical or a dreamer, when you say that Nigeria is where your future lies. But why?

Nigeria as a heritage that separates the Nigerian from the Black American is awarded a loud (though false) superiority. The Nigeria that is evoked in jollof rice debates is praised. Even the Nigeria that must beat Ghana in the football match is supported. Yet, it remains that the Nigeria that will gain a Nigerian’s abuse is the real Nigeria – with its abusive civil servants, its police haggling for bribes and its megachurches auctioning salvation. This real Nigeria is the child of a mean parent called corruption. It’s useful to trace the family tree of this corruption but also useful to think about the way corruption earns Nigeria scorn to the degree that anyone who argues for that Nigeria is unworthy in some way—or should we say, she who argues for Nigeria is worthy of its corruption?

The Nigeria-corruption association has been repeated so often that it has long since become the small talk of world leaders; David Cameron’s aside to Queen Elizabeth II about “fantastically corrupt” Nigeria is but one example. That corruption touches every facet of life in Nigeria is a banality. As Michael Ogbeidi, a history professor at the University of Lagos, put it so accurately in his article, Political Leadership and the Corruption in Nigeria Since 1960, “Indeed, it is difficult to think of any social ill in [Nigeria] that is not traceable to the embezzlement and misappropriation of public funds, particularly as a direct or indirect consequence of the corruption perpetrated by the callous political leadership class since independence”.

Bureaucratic corruption affects healthcare and this is a very old problem both in Nigeria and throughout the formerly colonized world. When Nigeria was incorporated by Imperial Britain, it was conceived of as a repository of natural minerals and riches that could be exported for the benefit of the master race and country. The profits of colonial exploitation are so large they inspire disbelief. For instance, the British Ministry of Food made profits of 11 million pounds sterling in some years, according to Walter Rodney. As Rodney’s seminal text, How Europe Underdeveloped Africa, so clearly explains: this obscene figure of 11 million pounds sterling per annum was the result of artificially low prices set by private capitalist investors in Britain. The British government allowed dummy organizations, like the West African Cocoa Control Board (est. 1938) to lie to and bully African farmers, while pretending to advocate for them. Moreover, farmers were mandated to sell their crops no matter what price they were given. The farmers did not have the might to stand up against the military and political power of the British government. They did not have a choice. They were not economic players in the game, just chess pieces to be thrown around the board. At any rate, 11 million pounds accounts for the profits of just one body, the British Ministry of Food, so we can only imagine the cumulative profits enjoyed by the British Empire.

When Nigeria was incorporated by Imperial Britain, it was conceived of as a repository of natural minerals and riches that could be exported for the benefit of the master race and country.

Whatever the final profits, the people of Nigeria didn’t share in the wealth generated from such exports. The people were simply the machinery of the capitalist endeavor. They were machinery in the sense that the colonial political and economic government had absolutely no consideration for their physical well-being. Instead, by allowing missionaries to overrun the landmass, they rid the country of traditional doctors and what is now referred to as homeopathic medicines. For all the superstition and abuse that occasionally accompanied it, traditional medicine functioned as a rudimentary healthcare infrastructure across the African continent. Aspects of these so-called primitive practices have real and proven benefits.

For instance, West African medical practice is the foundation for inoculation and vaccination. In fact, when inoculation was introduced in colonial Boston during the 1721 smallpox epidemic, the origins of inoculation were so widely known that it was derided as “African” medicine and “Negroish thinking” in the press. Cotton Mather, who is credited with introducing inoculation into North America, wrote extensively about how a West African born slave, Onesimus, told him about inoculation practices. After learning from Onesimus, Mather began interviewing other enslaved Africans who backed up Onesimus’ testimony of being inoculated as children. Mather then tested inoculation on slaves born outside of Africa and when it proved successful, he introduced it to the white population. But as the practice of inoculation became widespread throughout colonial America, and the rest of the West, its origins were conveniently forgotten.

Once the traditional healer was undermined by new religious concepts, Imperial Britain continued to loot the land and exploit the people. Never was there any real investment in an alternative healthcare infrastructure. There are those who quote the 19th century European lie: they brought us civilization; they brought us religion and railways and doctors! But the numbers don’t bear that out. Rodney notes that in the 1930s, the British colonial government maintained a 34-bed hospital for Ibadan when the city had a population of 500,000 people! The colonial government later expanded their medical facilities, but this was only after pressure from nationalist movements set up by people tired of economic and political exploitation.

For instance, West African medical practice is the foundation for inoculation and vaccination. In fact, when inoculation was introduced in colonial Boston during the 1721 smallpox epidemic, the origins of inoculation were so widely known that it was derided as “African” medicine and “Negroish thinking” in the press.

It’s obvious that the dearth of medical and healthcare infrastructure was inherited by the national government in the 1960s. Understanding this history, it can be easy to excuse Nigeria and the Nigerian elite. In fact, this is precisely the hope of the Nigerian political and economic elite.

But we can’t let this excuse win the day since the post-1960 era hasn’t seen a marked continual commitment to the healthcare infrastructure system. The initial investment in healthcare wasn’t bad. In fact, as AO Malu, of Benue State Teaching Hospital, points out, when the Ashby Commission on Higher Education recommended the expansion of educational facilities in 1960, the year of Nigeria’s independence, Medical Faculty at the London College of Ibadan (now known as the University of Ibadan) was expanded and new medical schools were established in Lagos and in Northern Nigeria. The newly independent government continued to found and support teaching hospitals, particularly in the southwestern and northwestern region of Nigeria (Malu).

These teaching hospitals were instrumental in educating the vast majority of licensed nurses and doctors in Nigeria. Up until the late 1980s, they were known for professional teaching quality, their rigor, cleanliness and commitment to medically-appropriate technology. There is many a “middle class” Nigerian that can testify to their own birth or treatment in a Nigerian teaching hospital. Graduates in this 25-year span, from 1960 to 1985, also willingly testify to the maintenance of the facilities, which is no small thing since it both reflects and demands pride from the facilities’ users. It also reflects real material investment and demands it as well. But all of these testimonies are historical. The testimonies are about what the teaching hospitals used to be. Neglected by federal and state governments, the hospitals are today decrepit artifacts that are stuck with the technology of the last decade. I know one doctor who cried when she visited her alma mater in Rivers State, such was the state of the place with debris and rats. Another physician I know refused to discuss her medical school; she stammered, shook her head in anger and walked away. When she returned to the subject, she said only, “It was never, never like that before. The standard has really fallen.”

These teaching hospitals were instrumental in educating the vast majority of licensed nurses and doctors in Nigeria. Up until the late 1980s, they were known for professional teaching quality, their rigor, cleanliness and commitment to medically-appropriate technology.

But these “historical” hospitals are still hospitals. They still admit patients and attempt to treat them; they still admit students and attempt to educate them. Their treatment is curtailed by the lack of technological investment, the deteriorating facilities and the stagnated curriculum that Nigerian medical students are afforded. This is not the doing of some late 19th century Briton. It is the result of the rampant and insidious corruption executed by the political elite and their counterparts in the financial sector. As Professor Ogbeidi, notes in his article, citing this 2004 Reuters interview with then anti-graft chief Nuhu Ribadu, “Incontrovertibly, corruption became endemic in the 1990s during the military regimes of Babangida and Abacha, but a culture of impunity spread throughout the political class when democracy returned to Nigeria in 1999. In fact, corruption took over as an engine of the Nigerian society and replaced the rule of law”. In other words, the neglect of healthcare infrastructure is a product of recent and present-day choices that continually disregard the health of the people who are the machinery of the nation.

The teaching hospital model was never capable of nor adequate in caring for Africa’s most populous nation. It was a step in the correct direction, but a step that has been halted. As Professor Ogbeidi puts it: “As a consequence of unparalleled and unrivalled corruption in Nigeria, the healthcare delivery system… [has]become comatose and [is] nearing total collapse.”

So what are Nigerians left with? The vast majority of Nigerians who were never able to access teaching hospitals must rely on book doctors and unlicensed and unregulated pharmacies. A book doctor is a person who has learned about the practice of Western medicine solely from books. This book doctor never attended medical school, never sat for a medical certification or license exam and never completed a residency or rotation under the supervision of more experienced medical practitioner. Book doctors are common in areas outside of the major Nigerian cities. Having been to one myself, I can attest to the fact that they are not clandestine operations, but clearly marked persons with public enterprises. Neither the federal nor state governments make any attempt to investigate them in the interest of the people.

My experience with the book doctor was fine. He was affable. All the materials I observed were clean and unused. His nurses were well-trained and products of nursing schools. Yet the facility did not have electricity from the Nigerian energy grid, running water, nor a toilet. (Outside of major Nigerian cities, it is not rare to go 2 or more months without electricity from the Nigerian energy grid, this is despite the fact that Nigeria sells energy to Togo, Benin, and Niger.) The book doctor instead powered his facility with a generator and bathroom functions were undertaken in a darkened room at the back of the property. The patients brought their own water.

Book doctors are common in areas outside of the major Nigerian cities. Having been to one myself, I can attest to the fact that they are not clandestine operations, but clearly marked persons with public enterprises.

Despite my benign experience, Nigerians die daily from inadequate care from book doctors, just as they die from the inadequate healthcare system throughout Nigeria. Death is the fruit of corruption.

The other fruit of corruption is the bankruptcy of Nigeria’s national wealth.

In making adequate healthcare difficult or impossible to access, the political class is making it an absolute necessity for people to seek medical help outside of Nigeria’s borders. This drives those people who can afford it, to go to African countries like Ghana and South Africa, or ever further to Europe, India, the Middle East or the Americas for medical care. This is an insane situation for a citizen of an oil-rich country.

The Nigerian government acknowledges that sending medical tourists abroad is a real problem that has cost the country at least 1₦ billion –the equivalent of 690 million pounds sterling. This is money that was made in Nigeria but spent elsewhere; money that should be circulating in the Nigerian economy. Bu a real investment of capital into the construction and maintenance of medical infrastructure would not only stem this but also enrich the country, especially if the construction materials were purchased from Nigerian companies and Nigerians were employed in the labor.

But the same government that is legislating against “medical tourism” is led by President Mohammed Buhari who has become the “face of medical tourism.” President Buhari spent 7 weeks, from January to March, in London before offering up a vague explanation about his health. The lack of specificity was an allusion that was meant to be understood in the mind of the Nigerian citizen as you know we no get oyibo (white man) medicine na. Buhari left Nigeria for London again in May. When the Nigerian populace, aided by journalists, demanded that the President return and govern after an absence of more than 3 months, the president reluctantly returned. He has refused to say how much money the Nigerian government spent on his almost 5-month stay in London. No matter. The failing Nigerian healthcare system is implicit in the president’s long stay in high-priced London and the unstated, exorbitant price tag is yet another example of political corruption.

The Nigerian government acknowledges that sending medical tourists abroad is a real problem that has cost the country at least 1₦ billion –the equivalent of 690 million pounds sterling.

This drama, of course, comes after the 2010 death of President Umaru Musa Yar’adua whose 3-month medical stay in Saudi Arabia ended when the Nigerian government sent a delegation to “check on his health.” Yar’adua’s absence was explained to the Nigerian people as medical treatment, but during those 3 months, he was not seen in public and this fueled both rumor and a real leadership crisis in the federal government.

The travels of Yar’adua and Buhari demonstrate in a practical, evidentiary manner that the Nigerian healthcare system has been abandoned by its political elites. They seek their health and medical care elsewhere and as a result, they have left the funding and maintenance of the healthcare infrastructure to the birds.

Yet, still the middle class, takes the political and financial elite as “leaders” and follows them abroad. They are not leaders; they are elites by virtue of being on top of the capitalistic structure and because they are elitist, believing that only those at the top should have access to what are now called “basic human necessities,” including electricity and running water. If they were not elitist, they wouldn’t rob the country to the detriment of the health and very life of the people.

In going abroad, middle-class Nigerians are increasingly identifying service sectors and medical acumen with the West. This is dangerous because such identification alleviates the pressure to improve the facilities within Nigeria. The determination to go abroad should instead be replaced by the determination to improve the healthcare infrastructure at home.

The travels of Yar’adua and Buhari demonstrate in a practical, evidentiary manner that the Nigerian healthcare system has been abandoned by its political elites. They seek their health and medical care elsewhere and as a result, they have left the funding and maintenance of the healthcare infrastructure to the birds.

The portion of the Nigerian middle-class that does utilize the healthcare system have little encouragement. Added to the corruption that robs the system is the dearth of physicians who might otherwise provide superior care and demand attention from the political and financial elites. It is not that Nigerian isn’t training medics, but the problems already noted drive them to ply their trade abroad.

A 2013 article by the Foundation for the Advancement of International Medical Education and Research (FAIMER) is titled “Nigerian Medical School Graduates and the US Physician Workforce” and the title says it all. Despite the corruption and deteriorating conditions, Nigerian-educated medical professionals are skilled physicians who are able to practice throughout the world. This is good for them but bad for Nigeria.

According the statistics of the Educational Commission for Foreign Medical Graduates, at least 4300 Nigerian medical graduates were certified to practice in the United States between 1980 and 2012. That is 4,300 doctors who are not practicing in Nigeria. What would Nigeria be like with 4,300 more doctors? Before answering, consider that this is only one type of certification program doctors in the United States and Canada; it does not account for the medical graduates who have emigrated to mainland Europe, the UK, Australia, the Caribbean nations, India, or the increasingly, alluring South American republic of Brazil. Now consider that President of the Healthcare Federation of Nigeria, thinks that the correct estimate of Nigerian doctors practicing abroad is closer to 37,000. This is a real exodus with dangerous ramifications.

With the flight of medical graduates, Nigeria must educate another person to become part of the healthcare infrastructure. With the flight of medical graduates, Nigeria loses another bloc of people capable of putting pressure on the political class to fix the healthcare infrastructure. With the flight of medical graduates, Nigeria loses people who might create real national wealth by buying Nigerian made goods and supporting local industry, rather than the cheaply made, imports – the shine shine – that litter the market stalls of the subsistence worker and the Instagram pages of the so-called middle class. With the flight of the medical graduate, Nigeria is left stagnant.

Now consider that President of the Healthcare Federation of Nigeria, thinks that the correct estimate of Nigerian doctors practicing abroad is closer to 37,000. This is a real exodus with dangerous ramifications.

It is this stagnant Nigeria that earns a Nigerian the ridicule of his countrymen. At home, everyone (or so it seems) wants to travel abroad. Abroad, home is just a green-and-white outfit, a party theme on October 1st. Healthcare in Nigeria is a fatal casualty of continued political corruption. Medical tourism will cease only after the government has demonstrated sustained and responsible investment and maintenance of healthcare schools and facilities. Until then, the middle class will follow its political and economic elites in seeking medical treatment abroad; they will spend their hard-earned money in other countries and continue to wonder why death and bankruptcy follow them home to Nigeria.

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Maurine Ogbaa is a Nigerian writer based in the USA.

Politics

Dadaab: Playing Politics With the Lives of Somali Refugees in Kenya

Somali refugees in Kenya should not be held hostage by political disagreements between Mogadishu and Nairobi but must continue to enjoy Kenya’s protection as provided for under international law.

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Dadaab: Playing Politics With the Lives of Somali Refugees in Kenya
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For several years now, Kenya has been demanding that the UNHCR, the UN Refugee Agency, close the expansive Dadaab refugee complex in north-eastern Kenya, citing “national security threats”. Kenya has argued, without providing sufficient proof, that Dadaab, currently home to a population of 218,000 registered refugees who are mostly from Somalia, provides a “safe haven” and a recruitment ground for al-Shabaab, the al-Qaeda affiliate in Somalia that constantly carries out attacks inside Kenya. Threats to shut down have escalated each time the group has carried out attacks inside Kenya, such as following the Westgate Mall attack in 2013 and the Garissa University attack in 2015.

However, unlike previous calls, the latest call to close Dadaab that came in March 2021, was not triggered by any major security lapse but, rather, was politically motivated. It came at a time of strained relations between Kenya and Somalia. Kakuma refugee camp in Turkana County in north-western Kenya, is mostly home to South Sudanese refugees but also hosts a significant number of Somali refugees. Kakuma has not been included in previous calls for closure but now finds itself targeted for political expediency—to show that the process of closing the camps is above board and targets all refugees in Kenya and not only those from Somalia.

That the call is politically motivated can be deduced from the agreement reached between the UNHCR and the Kenyan government last April where alternative arrangements are foreseen that will enable refugees from the East African Community (EAC) to stay. This means that the South Sudanese will be able to remain while the Somali must leave.

Security threat

Accusing refugees of being a security threat and Dadaab the operational base from which the al-Shabaab launches its attacks inside Kenya is not based on any evidence. Or if there is any concrete evidence, the Kenyan government has not provided it.

Some observers accuse Kenyan leaders of scapegoating refugees even though it is the Kenyan government that has failed to come up with an effective and workable national security system. The government has also over the years failed to win over and build trust with its Muslim communities. Its counterterrorism campaign has been abusive, indiscriminately targeting and persecuting the Muslim population. Al-Shabab has used the anti-Muslim sentiment to whip up support inside Kenya.

Moreover, if indeed Dadaab is the problem, it is Kenya as the host nation, and not the UNHCR, that oversees security in the three camps that make up the Dadaab complex. The camps fall fully under the jurisdiction and laws of Kenya and, therefore, if the camps are insecure, it is because the Kenyan security apparatus has failed in its mission to securitise them.

The terrorist threat that Kenya faces is not a refugee problem — it is homegrown. Attacks inside Kenya have been carried out by Kenyan nationals, who make up the largest foreign group among al-Shabaab fighters. The Mpeketoni attacks of 2014 in Lamu County and the Dusit D2 attack of 2019 are a testament to the involvement of Kenyan nationals. In the Mpeketoni massacre, al-Shabaab exploited local politics and grievances to deploy both Somali and Kenyan fighters, the latter being recruited primarily from coastal communities. The terrorist cell that conducted the assault on Dusit D2 comprised Kenyan nationals recruited from across Kenya.

Jubaland and the maritime border dispute 

This latest demand by the Kenyan government to close Dadaab by June 2022 is politically motivated. Strained relations between Kenya and Somalia over the years have significantly deteriorated in the past year.

Mogadishu cut diplomatic ties with Nairobi in December 2020, accusing Kenya of interfering in Somalia’s internal affairs. The contention is over Kenya’s unwavering support for the Federal Member State of Jubaland — one of Somalia’s five semi-autonomous states — and its leader Ahmed “Madobe” Mohamed Islam. The Jubaland leadership is at loggerheads with the centre in Mogadishu, in particular over the control of the Gedo region of Somalia.

Kenya has supported Jubaland in this dispute, allegedly hosting Jubaland militias inside its territory in Mandera County that which have been carrying out attacks on federal government of Somalia troop positions in the Gedo town of Beled Hawa on the Kenya-Somalia border. Dozens of people including many civilians have been killed in clashes between Jubaland-backed forces and the federal government troops.

Relations between the two countries have been worsened by the bitter maritime boundary dispute that has played out at the International Court of Justice (ICJ).

The latest call to close Dadaab is believed to have been largely triggered by the case at the Hague-based court, whose judgement was delivered on 12 October.  The court ruled largely in favour of Somalia, awarding it most of the disputed territory. In a statement, Kenya’s President Uhuru Kenyatta said, “At the outset, Kenya wishes to indicate that it rejects in totality and does not recognize the findings in the decision.” The dispute stems from a disagreement over the trajectory to be taken in the delimitation of the two countries’ maritime border in the Indian Ocean. Somalia filed the case at the Hague in 2014.  However, Kenya has from the beginning preferred and actively pushed for the matter to be settled out of court, either through bilateral negotiations with Somalia or through third-party mediation such as the African Union.

Kenya views Somalia as an ungrateful neighbour given all the support it has received in the many years the country has been in turmoil. Kenya has hosted hundreds of thousands of Somali refugees for three decades, played a leading role in numerous efforts to bring peace in Somalia by hosting peace talks to reconcile Somalis, and the Kenyan military, as part of the African Union Mission in Somalia, AMISOM, has sacrificed a lot and helped liberate towns and cities. Kenya feels all these efforts have not been appreciated by Somalia, which in the spirit of good neighbourliness should have given negotiation more time instead of going to court. In March, on the day of the hearing, when both sides were due to present their arguments, Kenya boycotted the court proceedings at the 11th hour. The court ruled that in determining the case, it would use prior submissions and written evidence provided by Kenya. Thus, the Kenyan government’s latest demand to close Dadaab is seen as retaliation against Somalia for insisting on pursuing the case at the International Court of Justice (ICJ).

Nowhere safe to return to

Closing Dadaab by June 2022 as Kenya has insisted to the UNHCR, is not practical and will not allow the dignified return of refugees. Three decades after the total collapse of the state in Somalia, conditions have not changed much, war is still raging, the country is still in turmoil and many parts of Somalia are still unsafe. Much of the south of the country, where most of the refugees in Dadaab come from, remains chronically insecure and is largely under the control of al-Shabaab. Furthermore, the risk of some of the returning youth being recruited into al-Shabaab is real.

A programme of assisted voluntary repatriation has been underway in Dadaab since 2014, after the governments of Kenya and Somalia signed a tripartite agreement together with the UNHCR in 2013. By June 2021, around 85,000 refugees had returned to Somalia under the programme, mainly to major cities in southern Somalia such as Kismayo, Mogadishu and Baidoa. However, the programme has turned out to be complicated; human rights groups have termed it as far from voluntary, saying that return is fuelled by fear and misinformation. 

Many refugees living in Dadaab who were interviewed by Human Rights Watch said that they had agreed to return because they feared Kenya would force them out if they stayed. Most of those who were repatriated returned in 2016 at a time when pressure from the Kenyan government was at its highest, with uncertainty surrounding the future of Dadaab after Kenya disbanded its Department of Refugee Affairs (DRA) and halted the registration of new refugees.

Many of the repatriated ended up in camps for internally displaced persons (IDPs) within Somalia, with access to fewer resources and a more dangerous security situation. Somalia has a large population of 2.9 million IDPs  scattered across hundreds of camps in major towns and cities who have been displaced by conflict, violence and natural disasters. The IDPs are not well catered for. They live in precarious conditions, crowded in slums in temporary or sub-standard housing with very limited or no access to basic services such as education, basic healthcare, clean water and sanitation. Thousands of those who were assisted to return through the voluntary repatriation programme have since returned to Dadaab after they found conditions in Somalia unbearable. They have ended up undocumented in Dadaab after losing their refugee status in Kenya.  

Many refugees living in Dadaab who were interviewed by Human Rights Watch said that they had agreed to return because they feared Kenya would force them out if they stayed.

Camps cannot be a permanent settlement for refugees. Dadaab was opened 30 years ago as a temporary solution for those fleeing the war in Somalia. Unfortunately, the situation in Somalia is not changing. It is time the Kenyan government, in partnership with members of the international community, finds a sustainable, long-term solution for Somali refugees in Kenya, including considering pathways towards integrating the refugees into Kenyan society.  Dadaab could then be shut down and the refugees would be able to lead dignified lives, to work and to enjoy freedom of movement unlike today where their lives are in limbo, living in prison-like conditions inside the camps.

The proposal to allow refugees from the East African Community to remain after the closure of the camps — which will mainly affect the 130,000 South Sudanese refugees in Kakuma —  is a good gesture and a major opportunity for refugees to become self-reliant and contribute to the local economy.

Announcing the scheme, Kenya said that refugees from the EAC who are willing to stay on would be issued with work permits for free. Unfortunately, this option was not made available to refugees from Somalia even though close to 60 per cent of the residents of Dadaab are under the age of 18, have lived in Kenya their entire lives and have little connection with a country their parents escaped from three decades ago.

Many in Dadaab are also third generation refugees, the grandchildren of the first wave of refugees. Many have also integrated fully into Kenyan society, intermarried, learnt to speak fluent Swahili and identify more with Kenya than with their country of origin.

The numbers that need to be integrated are not huge. There are around 269,000 Somali refugees in Dadaab and Kakuma. When you subtract the estimated 40,000 Kenyan nationals included in refugee data, the figure comes down to around 230,000 people. This is not a large population that would alter Kenya’s demography in any signific ant way, if indeed this isis the fear in some quarters. If politics were to be left out of the question, integration would be a viable option.

Many in Dadaab are also third generation refugees, the grandchildren of the first wave of refugees.

For decades, Kenya has shown immense generosity by hosting hundreds of thousands of refugees, and it is important that the country continues to show this solidarity. Whatever the circumstances and the diplomatic difficulties with its neighbour Somalia, Kenya should respect its legal obligations under international law to provide protection to those seeking sanctuary inside its borders. Refugees should only return to their country when the conditions are conducive, and Somalia is ready to receive them. To forcibly truck people to the border, as Kenya has threatened in the past, is not a solution. If the process of returning refugees to Somalia is not well thought out, a hasty decision will have devastating consequences for their security and well-being.

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Politics

The Assassination of President Jovenel Moïse and the Haitian Imbroglio

As CARICOM countries call for more profound changes that would empower the Haitian population, Western powers offer plans for “consensual and inclusive” government that will continue to exclude the majority of the citizens of Haiti from participating in the running of their country.

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The Assassination of President Jovenel Moïse and the Haitian Imbroglio
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On Wednesday 7 July 2021, the President of Haiti, Jovenel Moïse, was assassinated in his home. His wife was injured in the attack. That the president’s assassins were able to access his home posing as agents of the Drug Enforcement Agency of the United States (DEA) brought to the fore the intricate relationship between drugs, money laundering and mercenary activities in Haiti. Two days later, the government of Haiti reported that the attack had been carried out by a team of assailants, 26 of whom were Colombian. This information that ex-soldiers from Colombia were involved brought to the spotlight the ways in which Haiti society has been enmeshed in the world of the international mercenary market and instability since the overthrow of President Jean-Bertrand Aristide and the Lavalas movement in 2004.

When the French Newspaper Le Monde recently stated that Haiti was one of the four drug hubs of the Caribbean region, the paper neglected to add the reality that as a drug hub, Haiti had become an important base for US imperial activities, including imperial money laundering, intelligence, and criminal networks. No institution in Haiti can escape this web and Haitian society is currently reeling from this ecosystem of exploitation, repression, and manipulation. Under President Donald Trump, the US heightened its opposition to the governments of Venezuela and Cuba. The mercenary market in Florida became interwoven with the US Drug Enforcement Agency (DEA) and the financial institutions that profited from crime syndicates that thrive on anti-communist and anti-Cuba ideas.

But even as Haitian society is reeling from intensified destabilization, the so-called Core Group (comprising of the Organization of American States (OAS), the European Union, the United States, France, Spain, Canada, Germany, and Brazil) offers plans for “consensual and inclusive” government that will continue to exclude the majority of the citizens of Haiti from participating in the running of their country. Elsewhere in the Caribbean, CARICOM countries are calling for more profound changes that would empower the population while mobilizing international resources to neutralize the social power of the money launderers and oligarchs in Haitian society.

Haiti since the Duvaliers

For the past thirty-five years, the people of Haiti have yearned for a new mode of politics to transcend the dictatorship of the Duvaliers (Papa Doc and Baby Doc). The Haitian independence struggles at the start of the 19th century had registered one of the most fundamental blows to the institutions of chattel slavery and colonial domination. Since that revolution, France and the US have cooperated to punish Haiti for daring to resist white supremacy. An onerous payment of reparations to France was compounded by US military occupation after 1915.

Under President Woodrow Wilson, the racist ideals of the US imperial interests were reinforced in Haiti in a nineteen-year military occupation that was promoted by American business interests in the country. Genocidal violence from the Dominican Republic in 1937 strengthened the bonds between militarism and extreme violence in the society. Martial law, forced labour, racism and extreme repression were cemented in the society. Duvalierism in the form of the medical doctor François Duvalier mobilized a variant of Negritude in the 50s to cement a regime of thuggery, aligned with the Cold War goals of the United States in the Caribbean. The record of the Duvalier regime was reprehensible in every form, but this kind of government received military and intelligence assistance from the United States in a region where the Cuban revolution offered an alternative. Francois Duvalier died in 1971 and was succeeded by his son, Jean-Claude Duvalier, who continued the tradition of rule by violence (the notorious Tonton Macoute) until this system was overthrown by popular uprisings in 1986.

The Haitian independence struggles at the start of the 19th century had registered one of the most fundamental blows to the institutions of chattel slavery and colonial domination.

On 16 December 1990, Jean-Bertrand Aristide won the presidency by a landslide in what were widely reported to be the first free elections in Haiti’s history. Legislative elections in January 1991 gave Aristide supporters a plurality in Haiti’s parliament. The Lavalas movement of the Aristide leadership was the first major antidote to the historical culture of repression and violence. The United States and France opposed this new opening of popular expression such that military intervention, supported by external forces in North America and the Organization of American States, brought militarists and drug dealers under General Joseph Raoul Cédras to the forefront of the society. The working peoples of Haiti were crushed by an alliance of local militarists, external military peacekeepers and drug dealers. The noted Haitian writer, Edwidge Danticat, has written extensively on the consequences of repeated military interventions, genocide and occupation in the society while the population sought avenues to escape these repressive orders. After the removal of the Aristide government in 2004, it was the expressed plan of the local elites and the external forces that the majority of the Haitian population should be excluded from genuine forms of participatory democracy, including elections.

Repression, imperial NGOs and humanitarian domination

The devastating earthquake of January 2010 further deepened the tragic socio-economic situation in Haiti. An estimated 230,000 Haitians lost their lives, 300,000 were injured, and more than 1.5 million were displaced as a result of collapsed buildings and infrastructure. External military interventions by the United Nations, humanitarian workers and international foundations joined in the corruption to strengthen the anti-democratic forces in Haitian society. The Clinton Foundation of the United States was complicit in imposing the disastrous presidency of Michel Martelly on Haitian society after the earthquake. The book by Jonathan Katz, The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster, provides a gripping account of the corruption in Haiti. So involved were the Clintons in the rot in Haiti that Politico Magazine dubbed Bill and Hilary, The King and Queen of Haiti.

In 2015, Jovenel Moïse was elected president in a very flawed process, but was only able to take office in 2017. From the moment he entered the presidency, his administration became immersed in the anti-people traditions that had kept the ruling elites together with the more than 10,000 international NGOs that excluded Haitians from participating in the projects for their own recovery. President Moïse carved out political space in Haiti with the support of armed groups who were deployed as death squads with the mission of terrorizing popular spaces and repressing supporters of the Haitian social movement. In a society where the head of state did not have a monopoly over armed gangs, kidnappings, murder (including the killing of schoolchildren) and assassinations got out of control. Under Moïse, Haiti had become an imbroglio where the government and allied gangs organized a series of massacres in poor neighbourhoods known to host anti-government organizing, killing dozens at a time.

Moïse and the extension of repression in Haiti

Moïse remained president with the connivance of diplomats and foundations from Canada, France and the United States. These countries and their leaders ignored the reality that the Haitian elections of 2017 were so deeply flawed and violent that almost 80 per cent of Haitian voters did not, or could not, vote. Moïse, with the support of one section of the Haitian power brokers, avoided having any more elections, and so parliament became inoperative in January 2020, when the terms of most legislators expired. When mayors’ terms expired in July 2020, Moïse personally appointed their replacements. This accumulation of power by the president deepened the divisions within the capitalist classes in Haiti. Long-simmering tensions between the mulatto and black capitalists were exacerbated under Moïse who mobilized his own faction on the fact that he was seeking to empower and enrich the black majority. Thugs and armed gangs were integrated into the drug hub and money laundering architecture that came to dominate Haiti after 2004.

After the Trump administration intensified its opposition to the Venezuelan government, the political and commercial leadership in Haiti became suborned to the international mercenary and drug systems that were being mobilized in conjunction with the military intelligence elements in Florida and Colombia. President Jovenel Moïse’s term, fed by spectacular and intense struggles between factions of the looters, was scheduled to come to a legal end in February 2021. Moïse sought to remain in power, notwithstanding the Haitian constitution, the electoral law, or the will of the Haitian people.

So involved were the Clintons in the rot in Haiti that Politico Magazine dubbed Bill and Hilary, The King and Queen of Haiti.

Since the removal of Aristide and the marginalization of the Lavalas forces from the political arena in Haiti, the US has been more focused on strengthening the linkages between the Haitian drug lords and the money launderers in Colombia, Florida, Dominican Republic, and Venezuelan exiles. It was therefore not surprising that the mercenary industry, with its linkages to financial forces in Florida, has been implicated in the assassination of President Moïse. The Core Group of Canada, France and the US has not once sought to deploy the resources of the international Financial Action Task Force (FATF) to penetrate the interconnections between politicians in Haiti and the international money laundering and mercenary market.

Working for democratic transition in Haiti

The usual handlers of Haitian repression created the Core Group within one month of Moïse’s assassination. Canada, France and the United States had historically been implicated in the mismanaging of Haiti along with the United Nations. Now, the three countries have mobilized the OAS (with its checkered history), Brazil and the European Union to add their weight to a new transition that will continue to exclude the majority of the people of Haiti. It has been clear that under the current system of destabilization and violence, social peace will be necessary before elections can take place in Haiti.

Moïse sought to remain in power, notwithstanding the Haitian constitution, the electoral law, or the will of the Haitian people.

The continuous infighting among the Haitian ruling elements after the assassination was temporarily resolved at the end of July when Ariel Henry was confirmed by the US and France as Prime Minister. Henry had been designated as prime minister by Moïse days before his assassination. The popular groups in Haiti that had opposed Moïse considered the confirmation of Ariel Henry as a slap in the face because they had been demonstrating for the past four years for a more robust change to the political landscape. These organizations mobilized in what they called the Commission, (a gathering of civil society groups and political parties with more than 150 members), and had been holding marathon meetings to publicly work out what kind of transitional government they would want to see. According to the New York Times, rather than a consensus, the Core Group of international actors imposed a “unilateral proposal” on the people of Haiti.

Haiti is a member of CARICOM. The Caribbean community has proposed a longer transition period overseen by CARICOM for the return of Haiti to democracy. With the experience of the UN in Haiti, the Caribbean community has, through its representative on the UN Security Council, proposed the mobilization of the peacekeeping resources and capabilities of the UN to be deployed to CARICOM in order to organize a credible transition to democracy in Haiti. The nature and manner of the assassination of President Moïse has made more urgent the need for genuine reconstruction and support for democratic transition in Haiti.

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How Dadaab Has Changed the Fortunes of North-Eastern Kenya

Despite the hostile rhetoric and threats of closure, the presence of refugees in the camps in northern-eastern Kenyan has benefited the host communities.

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How Dadaab Has Changed the Fortunes of North-Eastern Kenya
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In the 1960s, Kenya had a progressive refugee policy that allowed refugees to settle anywhere in the country and to access education. This approach created in Kenya a cadre of skilled and professional refugees. However, the policy changed in the 1990s due to an overwhelming influx of refugees and asylum seekers escaping conflict in Somalia, Ethiopia and South Sudan. Kenya switched to an encampment policy for refugees, who were mainly confined to camps.

Although there are refugees living in urban and peri-urban areas elsewhere in the country, for over two decades, northern Kenya has hosted a disproportionate number of the refugees living in Kenya. The region has been home to one of the world’s largest refugee camps, with generations of lineage having an impact on the economic, social, cultural, and ecological situation of the region because of the support provided by the government and by non-governmental organisations (NGOs) in education, health and security services.

Mandera and Marsabit counties, both of which boarder with Ethiopia, Wajir County which borders with both Ethiopia and Somalia and, Garissa County which borders with Somalia, have hosted refugees and migrants displaced from their countries of origin for various reasons. In 2018, the town of Moyale, which is on the Ethiopian boarder in Marsabit County, temporarily hosted over 10,000 Ethiopians escaping military operations in Ethiopia’s Moyale District.    

Elwak town in Wajir County occasionally hosts pastoralist communities from Somalia who cross into Kenya seeking pasture for their livestock. While the movement of refugees into Marsabit and Wajir counties has been of a temporary nature, Garissa County has hosted refugees for decades.

Located 70 kilometres from the border with Somalia, the Dadaab refugee complex was established in the 1990s and has three main camps: Dagahaley, Ifo, and Hagadera. Due to an increase in refugee numbers around 2011, the Kambioos refugee camp in Fafi sub-county was established to host new arrivals from Somalia and to ease pressure on the overcrowded Hagadera refugee camp. The Kambioos camp was closed in 2019 as the refugee population fell.

According to the UN Refugee Agency, UNHCR, and the Refugee Affairs Secretariat (RAS), the Dadaab refugee complex currently hosts over 226, 689 refugees, 98 per cent of whom are from Somalia. In 2015, the refugee population in the Dadaab refugee complex was over 300,000, larger than that of the host community. In 2012, the camp held over 400,000 refugees leading to overstretched and insufficient resources for the growing population.

Under international refugee and human rights law, the government has the sole responsibility of hosting and caring for refugees. However, there is little information regarding the investments made by the Kenyan government in the refugee sector in the north-eastern region over time. Moreover, the government’s investment in the sector is debatable since there was no proper legal framework to guide refugee operations in the early 1990s. It was only in 2006 that the government enacted the Refugee Act that formally set up the Refugee Affairs Secretariat mandated to guide and manage the refugee process in Kenya.

While the Refugee Act of 2006 places the management of refugee affairs in the hands of the national government, devolved county governments play a significant role in refugee operations. With the 2010 constitution, the devolution of social functions such as health and education has extended into refugee-hosting regions and into refugee camps. While devolution in this new and more inclusive system of governance has benefited the previously highly marginalised north-eastern region through a fairer distribution of economic and political resources, there is however little literature on how the refugees benefit directly from the county government resource allocations.

The three north-eastern counties are ranked among the leading recipients of devolved funds: Mandera County alone received US$88 million in the 2015/2016 financial year, the highest allocation of funds after Nairobi and Turkana, leading to developmental improvements.

However, it can be argued that the allocation of funds from the national government to the northern frontier counties by the Kenya Commission on Revenue Allocation—which is always based on the Revenue Allocation table that prioritizes population, poverty index, land area, basic equal share and fiscal responsibility—may not have been taking the refugee population into account. According to the 2019 census, the population of Dadaab sub-county is 185,252, a figure that is well below the actual refugee population. The increase in population in the north-eastern region that is due to an increase in the refugee population calls for an increase in the allocation of devolved funds.

The three north-eastern counties are ranked among the leading recipients of devolved funds.

Dadaab refugee camp has been in the news for the wrong reasons. Security agencies blame the refugees for the increased Al Shabaab activity in Kenya, and even though these claims are disputed, the government has made moves to close down the camp. In 2016, plans to close Dadaab were blocked by the High Court which declared the proposed closure unconstitutional. In 2021, Kenya was at it again when Ministry of Interior Cabinet Secretary Fred Matiang’I tweeted that he had given the UNHCR 14 days to draw up a plan for the closure of the camp. The UNHCR and the government issued a joint statement agreeing to close the camp in June 2022.

The security rhetoric is not new. There has been a sustained campaign by Kenya to portray Dadaab as a security risk on national, regional and international platforms. During the 554th meeting of the African Union Peace and Security Forum held in November 2015, it was concluded that the humanitarian character of the Dadaab refugee camp had been compromised. The AU statements, which may have been drafted by Kenya, claimed that the attacks on Westgate Mall and Garissa University were planned and launched from within the refugee camps. These security incidents are an indication of the challenges Kenya has been facing in managing security. For example, between 2010 and 2011, there were several IED (Improvised Explosive Devices) incidents targeting police vehicles in and around Dadaab where a dozen officers were injured or killed. In October 2012, two people working for the medical charity Médicins Sans Frontières (MSF) were kidnapped in Dadaab. Local television network NTV has described the camp as “a womb of terror” and “a home for al-Shabaab operations”.

There has been a sustained campaign by Kenya to portray Dadaab as a security risk on national, regional and international platforms.

Security restrictions and violent incidents have created a challenging operational environment for NGOs, leading to the relocation of several non-local NGO staff as well as contributing to a shrinking humanitarian space. Some teachers and health workers from outside the region have refused to return to the area following terrorist attacks by Al-Shabaab, leaving behind large gaps in the health, education, and nutrition sectors.

However, despite the challenging situation, the refugee camps have also brought many benefits, not only to Kenya as a country but also to the county governments and the local host communities.

Education

According to the Intergovernmental Authority on Development (IGAD) half the refugee population in the IGAD member states are children of school-going age, between 4 and 18 years.

In Garissa, the education sector is one of the areas that has benefited from the hosting of refugees in the county because the host community has access to schools in the refugee camps. Windle Trust, an organisation that offers scholarships to students in secondary schools and in vocational training institutes, has been offering scholarships to both the refugees and the host communities. In July 2021, over 70 students benefited from a project run by International Labour Organisations (ILO) in partnership with Garissa county governments, the East African Institute of Welding (EAIW) and the Kenya Association of Manufacturers (KAM) to give industrial welding skills to refugees and host communities.

However, despite the measures taken by the Kenyan government to enrol refugees in Kenyan schools, there is a notable gap that widens as students go through the different levels of education. Statistics show that of the school-going refugee population, only a third get access to secondary education of which a sixth get to join tertiary institutions. This is well below the government’s Sustainable Development Goal (SDG) 4 target that seeks to ensure that all girls and boys complete free, equitable and quality primary and secondary education. This also reflects the situation of the host community’s education uptake. Other investments in the education sector that have targeted the host communities include recruitment and deployment of early childhood education teachers to schools in the host community by UNHCR and other non-governmental organizations (NGOs).

Non-governmental/intergovernmental support 

The presence of refugees has led to NGOs setting up and running projects in the camps. According to Garissa County’s Integrated Development Plan, there are over 70 non-governmental organisations present, with the majority operating around the Dadaab refugee complex and within the host communities. The UNHCR estimates that it will require about US$149.6 million to run its operations in Dadaab Camp this year. However, as of May 2021, only US$45.6 million—31 per cent of the total amount required—had been received.

The decrease in humanitarian funding has had an impact on the livelihoods of refugees and host communities in north-eastern Kenya.  According to the World Bank, 73 per cent of the population of Garissa County live below the poverty line. In the absence of social safety nets, locals have benefited from the humanitarian operations in and around the camp. The UNHCR reports that about 40,000 Kenyan nationals within a 50km radius of the Dadaab refugee camp ended up enrolling as refugees in order to access food and other basic services in the camps.

In 2014, the UNHCR reported that it had supported the Kenyan community residing in the wider Daadab region in establishing over US$5 million worth of community assets since 2011. The presence of refugees has also increased remittances from the diaspora, and there are over 50 remittance outlets operating in the Dadaab camp, increasing economic opportunities and improving services. Using 2010 as the reference year, researchers have found that the economic benefits of the Dadaab camp to the host community amount to approximately US$14 million annually.

The UNHCR reported that it had supported the Kenyan community residing in the wider Daadab region in establishing over US$5 million of community assets since 2011 since 2011.

To reduce overdependence on aid and humanitarian funding in running refugee operations, the County Government of Garissa developed a Garissa Integrated Socio-Economic Development Plan (GISEDP) in 2019 that provided ways of integrating refugees into the socio-economic life of the community to enhance their self-reliance. The European Union announced a Euro 5 million funding programme to support the socio-economic development plan, thus opening up opportunities for development initiatives including income generating activities such as the flourishing businesses at Hagadera market. The recent announcement of the planned closure of the camp has put these plans at risk.

A voice

The host community is increasingly involved in issues that affect both the locals living around the Dadaab refugee complex and the refugees themselves, with the voice of the community gaining prominence in decision-making regarding the county budget and sometimes even regarding NGO operations. NGOs periodically conduct needs assessments in and around the camp to guide the budgeting and planning process for subsequent years and the host community is always consulted.

Interest in governance issues has also increased. For example, between 2010 and 2015 the host community successfully lobbied for increased employment opportunities for locals in the UNHCR operations. With experience in the humanitarian field, some from within the host communities have secured positions as expatriates in international organizations across the globe, adding to increased international remittances to Garissa County.

Health

Research reveals that, compared to other pastoralist areas, health services for host communities have improved because of the presence of aid agencies in Dadaab. Hospitals managed by Médicins Sans Frontières and the International Red Cross in Dagahaley and Hagadera respectively are said to be offering better services than the sub-county hospital in Dadaab town. The two hospitals are Ministry of Health-approved vaccination centres in the fight against the COVID-19 pandemic.

Despite the massive investments made in the health sector by humanitarian organisations in and around Dadaab, both UNICEF and the World Health Organisation have identified the camp as an entry point for infectious diseases like polio and measles into Kenya. There was a confirmed case of WPV1 (wild poliovirus) in a 4-month-old girl from the Dadaab refugee camp in May 2013. This is a clear indication of the health risks associated with the situation.

Researchers have found that the economic benefits of the Dadaab camp to the host community amount to approximately US$14 million annually.

Other problems associated with the presence of the camps include encroachment of the refugee population on local land, leading to crime and hostility between the two communities. These conflicts are aggravated by the scramble for the little arable land available in this semi-arid region that makes it difficult to grow food and rear farm animals, leading to food shortages.

While it is important to acknowledge that progress has been made in integrating refugees into the north-eastern region, and that some development has taken place in the region, more needs to be done to realise the full potential of the region and its communities.  Kenya’s security sector should ensure that proper measures are put in place to enhance security right from the border entry point in order to weed out criminals who take advantage of Kenya’s acceptance of refugees. The country should not expel those who have crossed borders in search of refuge but should tap fully into the benefits that come with hosting refugees.

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