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AFRICA’S MEDICAL POVERTY TRAP: Why the continent is getting sicker and poorer

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Corruption, waste and a reliance on Western charity have conspired to leave Africa dealing with 25 per cent of the world’s diseases with under 1 per cent of global health resources. By CLAUDIO BUTTICÈ

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AFRICA’S MEDICAL POVERTY TRAP: Why the continent is getting sicker and poorer
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Medicine never stops evolving, and the never-ending efforts of millions of researchers around the world have provided humanity with some amazing technologies in the last few years. From artificial intelligence (AI)-based doctors that can outperform their human counterparts to the development of “smart” cancer vaccines, the race for medical innovation never stops.

However, these technologies come at a steep price, and very few countries – namely, the most industrialised ones – can afford to use them and make them accessible to the general population. Treatment disparity between the richer Western countries and the poorest African regions becomes wider every day. Countless Africans keep falling into the so-called “poverty trap”, generating a vicious circle of deterioration where ill health, epidemics, and poverty interact and mutually reinforce each other.

In an ideal world, everyone should have access to medical treatment regardless of his or her ability to pay. The reality, however, is much grimmer. When sickness occurs in a low-income household, not having the capacity to pay for medical expenses can have devastating consequences for the patient and the entire family. If access to healthcare and treatments is lacking (such as if there are no hospitals in a rural area), the individual right to health is violated, and his or her ability to work is denied. When access is granted, but the medical expenses are too steep, the consequences are no less catastrophic.

Treatment may come at the cost of financial and social well-being: the family may have to pull children out of school and push them into labour; food spending may be cut with obvious detrimental effects; and adults could be forced to work under strenuous conditions, increasing the risk of additional health issues. People who are more vulnerable to poverty are the same ones exposed to a higher risk of falling sick, such as the elderly, children, and women. Poverty increases the likelihood of becoming sick, and ill people are at a greater risk of becoming poor, generating a vicious circle that widens the disparities between the poor and the rich. When people are forced to sell what assets they have, such as livestock and land, to pay off medical debts, a financial disaster ensues, and a household may face poverty that can be dragged across the next generations. The outcome – known as the “medical poverty trap” – is a self-reinforcing mechanism that causes poverty to persist.

The medical poverty trap is particularly persistent in sub-Saharan countries such as Uganda, where low-productive agriculture, high transport costs, and small markets make the high number of rural households even more vulnerable. High economic growth rates are not sufficient to defuse the issue, however, as the cycle of health and poverty is influenced by many factors other than just economic ones. Less educated population groups are often those who have the lowest incomes, and cultural barriers can prevent them from seeking proper medical treatment when access is scarcely available. Superstition, religious beliefs, and social customs may convince them into preferring a shaman or quack over a real doctor. Ritual and herbal remedies may somewhat be part of the so-called “traditional medicine”, but they are practised with no regard to scientific procedures and are often ineffective when not directly harmful. And if the main earner of the family dies because he or she is not properly treated, the consequences for the household could be even more dramatic.

The medical poverty trap is particularly persistent in sub-Saharan countries such as Uganda, where low-productive agriculture, high transport costs, and small markets make the high number of rural households even more vulnerable. High economic growth rates are not sufficient to defuse the issue, however, as the cycle of health and poverty is influenced by many factors other than just economic ones.

Africa and healthcare – An overview of the numbers

Just a handful of few lucky individuals around the globe have access to life-saving medications and adequate healthcare. Sixteen per cent of the entire world’s population consumes a whopping 78 per cent of the total medicines produced. According to the World Health Organization (WHO), however, usage of essential medicines is similar across all countries regardless of the income category, at about between 25 and 35 per cent. This means that in low-income countries, essential medicines are used at similar rates as in higher income countries, no matter how high their price is or how burdensome it is to buy these drugs for a household. For example, to purchase the basic 7-days course of treatment with ciprofloxacin required to treat an adult respiratory infection, in Kenya a worker must pay the equivalent of over a month’s salary. In Italy, the cost of this same treatment is roughly €6, less than the hourly pay of the average unskilled labourer.

In the Millennium Development Goal (MDG) 8-E, the global community, in cooperation with pharmaceutical companies, committed to ensuring that access to essential affordable drugs would be achieved in most low- and middle-income countries by 2015. An increase in public expenditure or a widening of health insurance coverage were deemed necessary to reach this goal. Only a government may, in fact, possess the economic power to provide an entire population with sufficient coverage to afford (at least) essential drugs and treatments.

Today, in 2018, the current situation is not particularly encouraging, and most African governments are quite distant from achieving this goal. In highly industrialised countries, the average health expenditure per capita is estimated at $3100 – more than one hundred times more than in sub-Saharan Africa, where the average per capita expenditure is just a meagre $37. A single regional health centre serving 100,000 patients in a developed country administers a budget which is roughly equivalent to the budget of a country with a population of 10 million. In South Africa, to intensively treat only 60 per cent of all diabetes patients, the volume of metformin and sulfonylureas distributed by the public sector should be increased, respectively, by 366 per cent and 495 per cent. When essential drugs are not available in the public sector, patients must necessarily purchase them in the private sector at a much higher price, or forgo treatment altogether.

When only wealthier people can afford to pay for treatment, richer patients quickly become those who use the most healthcare. At the same time, newer medical technologies increase the number of treatable diseases and improve productivity by reducing illness, therefore widening socio-economic disparities. Does that mean that in low-income countries medical technologies and advancements are an enemy of equality instead of ameliorating the quality of life of the general population? The answer is no, but let’s dive in a little deeper.

The perfect recipe for disaster

Fifty per cent of children under the age of five who die of pneumonia, tuberculosis, malaria, diarrhoea, measles, and HIV across the world are in Africa. All these diseases are defined as “preventable” since they could have been easily treated if the patient had access to adequate health care services and affordable drugs or vaccines. But the average African patient must face several barriers to have access to what the international community defines as “adequate care”.

According to the World Bank, about 80 per cent of low- and middle-income Africans need to rely on public health facilities, whose situation is dire at best. Most primary care facilities suffer from a constant shortage of fundamental medications, such as in Zimbabwe, where painkillers are administered to patients suffering from all kind of diseases as a “treat-all-drug” since they are the only ones available. Patients are frequently referred to the big hospitals, but these larger facilities are limited in number, and very few families can afford to pay for their services. Many of them are inaccessible to those living in remote rural areas since they require many hours of walking in those regions where transport infrastructure is severely lacking.

Fifty per cent of children under the age of five who die of pneumonia, tuberculosis, malaria, diarrhoea, measles, and HIV across the world are in Africa. All these diseases are defined as “preventable” since they could have been easily treated if the patient had access to adequate healthcare services and affordable drugs or vaccines.

Some facilities, on the other hand, simply do not exist. Except for South Africa, in all of sub-Saharan Africa, a region where over 650 million people live, there are hardly any facilities specialising in neurology. A population that is equivalent to Europe’s and Russia’s together has little access to facilities that can be found in almost every medium-sized German, British or Spanish city.

Skilled personnel will never be available if proper training is unavailable. Even the few fortunate (and wealthy) ones who can afford the higher education required to become a specialist choose to emigrate and live in richer countries where they can hope for better wages, a superior quality of life and more chances of career growth. Still, shortage of resources and the lack of skilled personnel are just the tip of the iceberg.

For years, many African governments relied on charity projects financed by the international community to help them improve their healthcare systems. However, these plans have been mired by a constant lack of coordination, and frequently became an occasion for corrupt governments to siphon funds. The amount of resources wasted is simply depressing. For instance, over 75 per cent of all medical devices sent by Western countries remain unused because they cannot properly function outside of their natural context. The more advanced a medical technology is, the lower is the chance of it to be used properly in hospitals where no personnel have the technical expertise needed to understand its function. What’s the use of advanced digital technologies in facilities where there’s no Wi-fi or even just Internet connectivity available? The vast majority of medical devices and drugs sent cannot be transported into inaccessible areas such as deserts or inland regions, or just expire and become unusable because of the improper storage conditions. In the last decades, the “Western helping hand” did nothing but fill large warehouses with expired drugs, deteriorated vaccines and unused medical devices.

Skilled personnel will never be available if proper training is unavailable. Even the few fortunate (and wealthy) ones who can afford the higher education required to become a specialist choose to emigrate and live in richer countries where they can hope for better wages, a superior quality of life and more chances of career growth. Still, shortage of resources and the lack of skilled personnel are just the tip of the iceberg.

Most of the solutions offered by the many non-governmental organisations (NGOs) that operate in Africa seem nothing but failed attempts to patch over the shortcomings of a system that is not looking to solve its problems in the long term. For example, every time a humanitarian health crisis or a natural disaster occurs, the International Red Cross quickly implements a large mobile field hospital and dispatches many medical units to address it effectively. That’s nice, but these solutions can only momentarily solve an epidemic outburst, but cannot improve the country’s medical infrastructure or address any of its underlying issues. All those foreign specialists who voluntarily offer their services as doctors, nurses, pharmacists, and technicians may seem like angels and heroes, but their presence is too volatile to fix any of the complexities of the existing situation. As soon as the Western angels are gone, public health facilities face their usual shortages of critical drugs and devices once, and countless patients die of easily curable diseases.

Getting to the heart of the issue

Almost 20 years after the Abuja Declaration of 2001, very few African Union countries have been able to reach their target of allocating 15 per cent of their GDP to improve the health sector. Some of these countries have even reduced it. And when the funds are so low that just salary and personnel expenditures eat up to 70 per cent of hospital resources, it’s no surprise if there’s nothing left for other expenditures, such as purchasing essential drugs and medical devices, especially when the price of these medications and medical technologies is much higher in Africa than in every other well-developed country.

Understanding why this happens is the only way to cut this Gordian knot. Today, Africa produces less than 2 per cent of the drugs it consumes. Imported medications cost more than locally produced ones, and if the money invested in healthcare by the governments stays the same, this means that hospitals can buy fewer drugs, and that more sick people will die because they will not have access to the treatments they need. Africa has almost no capacity for pharmaceutical research and design (R&D) and local drug production. The only exception is South Africa, where some active pharmaceutical ingredients are produced. In every other country, even the ingredients must be imported. And the devil is in the details, because importing these ingredients would be already costly in Europe and North America, but it is ten times more in Africa, where procurement practices are plagued by a terrible transport system and general lack of adequate storage facilities.

Today, Africa imports 70 per cent of its pharmaceutical products, and many governments must spend a disproportionate amount of their already meagre resources on inefficient procurement procedures. But why can’t Africa can’t produce its own drugs like every other country (even developing ones, such as India)? Once again, there’s nearly not enough specialised personnel available. (High-scale drug production requires a high level of technical specialisation that must be supported by strong financial and educational investments – investments that repay themselves in due time, as happened in Cameroon where the $24 million-worth local generic drug manufacturer Cinpharm-Cameroon started producing antibiotics that are now much more affordable even for low-wage earners.)

Today, Africa imports 70 per cent of its pharmaceutical products, and many governments must spend a disproportionate amount of their already meagre resources on inefficient procurement procedures.

As a side note, the international community doesn’t seem to be so happy about Africa gaining its own economic independence. The biggest global pharmaceutical companies that are often so vociferous when they spend a minimal amount of their enormous fortunes to appease Africa with charity rear their ugly heads when their interests are threatened. Back in 2001, 40 pharmaceutical companies (yes, forty), among the world’s largest and most influential, dragged the South African government to court to stop it from producing generic HIV/AIDS drugs that would have significantly reduced their exorbitant prices. Eventually, most of these companies dropped the case, but thinking that they would have left millions of Africans to face certain death only to keep their profits intact is nothing less than a monstrosity.

A few words to the wise

Africa deals with 25 per cent of the world’s disease burden by spending less than 1 per cent of global health expenditure. There’s no need to assess how insufficient this amount is, especially knowing how much of it is wasted by inefficiency. Sickness means poverty; health brings growth and socio-economic well-being. It’s just as simple as that. If Africa wants to grow, it must invest in healthcare. And it must do it today, no matter how many challenges it may (and will) face.

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Dr. Claudio Butticè, Pharm.D., has written on topics such as medicine, technology, world poverty and science. Many of his articles have been published in magazines such as Cracked, Techopedia, Digital Journal and Business Insider. Dr. Butticè has also published pharmacology and psychology papers in several clinical journals, and works as a medical consultant and advisor for many companies across the globe.

Politics

From Shifta to Terrorist: A Shifting Narrative Of Northern Kenya

A section of Kenyan citizens has been labelled dangerous to the main body of the country and denied a national identity and equal status with their fellow citizens.

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As Kenya was celebrating her independence in 1963, the people of the Northern Frontier District were mourning the death of their dream of self-governance under British rule. In the spring of 1962, at the Lancaster House Conference, the region’s delegation had demanded self-determination for the NFD. The colonial government appointed an independent commission to look into the question and a referendum to determine the region’s future was subsequently held. The results of the plebiscite were however cancelled under suspicious circumstances even though they indicated that the overwhelming majority supported self-determination. The people felt cheated, and the north exploded in rebellion.

Northerners, especially those from the northeast, accuse the British colonial government of craftily handing over the region to Kenyatta. The colonialists had promised the separatists’ leaders that they would delay independence for the region to facilitate the orderly transition from colonial rule to self-rule.

The British played both sides after the Northern Frontier District delegation rejected the terms of independence and demanded a different path for the district. The colonial government decided to disregard the wishes of most of the inhabitants and handed over the region to the post-independence Kenyan government. Somalia protested the move, which further complicated the north’s struggle for independence.

What had been a people’s quest for self-rule became a political tussle between Kenya and Somalia.  This issue has yet to be settled six decades later, and the north has become a victim of unending sabre-rattling. Kenya became independent on the 12th of December 1963 with Jomo Kenyatta as its Prime Minister. A State of Emergency was declared for the north-eastern region on the 27th of December 1963.

The Shifta war

The rebellion that followed the declaration of independence was, to the separatists, a struggle for self-determination. To the Kenyan government, the separatists were Shifta, the name used to reduce the separatists and the NFD population to bandits, outlaws, thieves, criminals, and murderers.

The Shifta label has stuck, although the events surrounding the coining of the term have been carefully erased from the history books. The Shifta narrative was meant to unite the rest of Kenya against the menace of the separatists. The media effectively adopted the new term as a standard reference to the rebels. Newspaper headlines reported shifta attacks almost daily throughout the period of the conflict.

The “war” was mainly skirmishing between the ill-equipped ragtag army of northern rebels and the Kenya military backed by British planes and tanks. It is the population in the north that bore the brunt of the fighting. The nomads had to sustain the fighters in their midst with their meagre resources while dodging the military operations and bombings.

The conflict began on the 22nd of November 1963 when NFD rebels burnt down a camp in Garissa. The rebellion took its toll on the inhabitants, forcing them to flee in droves to the neighbouring countries of Somalia and Ethiopia. Kenyan security forces considered everyone a rebel and the Shifta label was liberally applied without discrimination to men and boys from the region. Villagisation and shooting of camel herds were used extensively by the government to force the nomadic pastoralists to settle.

Somalia’s support

The secessionists expected to receive arms and ammunitions from Somalia, but Somalia’s loud noises were more bark than a bite. Nothing of material import came from Somalia in the four years of the war.

While fanning the conflict through declarations and radio broadcasts, Somalia was unwilling to train, arm and fight alongside the secessionists. The significant material support provided to the Kenya government by the British and the superior training of the military forces eventually turned the tide of the war in Kenya’s favour.

The end of the war began in 1966 with the exodus of the nomadic population. By 1967, the secessionists were out of arms and had no resources to rely on as the nomads crossed the border into Somalia in droves in what is known as John kacarar (escaping John). The secessionists surrendered in groups throughout 1967.

Realising that the rebels were at the end of their tether, Somalia accepted peace terms with Kenya mediated by Zambian President Kenneth Kaunda. An agreement to end their differences and restore diplomatic relations was signed on the 14th of September 1967. The secessionist war effectively ended without any agreement with the secessionists themselves, without demobilisation, without any concession to the suffering population of the north and on terms that were never declared public to the residents of the NFD. Four years of bombings, shootings and plunder had left the northeastern region — where the fighting was concentrated — destitute.

Once the war was over, reconstruction failed to begin. The schism remained in place. The military went on with operations aimed at clearing the region of “shifta elements”. The cost of the war was never enumerated. The hopelessness that descended on a defeated community required leadership, which never came.

Collective punishment 

A new narrative of bandits roaming in the unsafe wild north began to take shape. Collective punishment was the modus operandi during this period. Whenever armed criminals committed a crime, the nearest settlements were decimated by the soldiers.

In the late 1970s, an incident occurred along the Kenya-Ethiopia border where a military vehicle was burnt. The locals claimed the action was perpetrated by armed Ethiopian militia. In what came to be known as the Malka Mari Massacre, the Kenyan military detained over two hundred men and stoned them to death. None of the men was armed, and the military did not fire a shot.

In the period that followed, poaching became rampant as the stockpiles of small arms fell into the hands of poachers. Overnight, the “Somali Poacher” was born. The parks were now under threat from a new breed of armed men motivated by nothing more than money, and allegedly backed by influential people close to the government. Throughout the 1970s, the Somali poacher terrorised Kenyan elephants, rhinos, and cheetahs.

The secessionist war effectively ended without any agreement with the secessionists themselves, without demobilisation, without any concession to the suffering population of the north.

In 1980, the security forces burned down Garissa after detaining and killing many of its inhabitants. This was an incident directly resulting from a disagreement between poachers and their contacts in government. A disgruntled poacher took matters into his own hands and killed several soldiers and other government officials.

The 1980s also saw the infamous Wagalla Massacre of 1984, where thousands were tortured and killed at an airstrip in Wajir, ostensibly during a military operation to curb banditry.

While Shifta and poachers were the competing narratives used by the government to explain its inability to bring the northern region under proper government control, the region suffered wanton neglect and underdevelopment.

The Somali-Ethiopia war ended in 1978, sparking the return of thousands who had fled the region during the war of secession as Somalia descended into clannism and corruption under military dictatorship. That same year, Vice-President Daniel Arap Moi gave a speech that sparked the alien debate when he threatened that the government would register all Somalis and deport anyone found to have allegiance to Somalia. It took 11 years for this policy to be implemented.

But the alienation of Somalis had begun earlier as it is recorded that police had raided Eastleigh and arrested Somali foreigners as early as 1970. Traders from the north-east were deemed vagrants and deported from areas in the Rift Valley and Central Kenya back to their home region.

Citizenship documents were tightly controlled, and a system of verification was put in place to make it impossible for the region’s inhabitants to register as citizens. The police were given orders to stop and ask for IDs from anyone looking like a Cushite, a Somali or other related tribes who were distinctively identifiable.

The pink card

In 1989, the famous Kenya-Somali verification and registration took place. The system was designed to catch anyone who could not be linked to a sub-location and known clan.

People had to state their family tree up to their sub-clans, and a pink card with these details was issued to the successful ones. The system was designed to force out of Kenya those unaffiliated to any of the groups “indigenous” to the country.

It is estimated that at one point hundreds were crossing the border into neighbouring countries daily. People were detained, women with young children appeared in court accused of being in the country illegally. Suspected aliens were loaded on military lorries and dropped off in Liboi across the Kenya-Somali border. Many families, especially those elites with businesses, crossed into Uganda and left for Europe or America. The pink cards eventually became available for a fee, and it is believed registration officials took hefty bribes in the process. The verification and registration were suspended after two harrowing years during which homes were raided, their inhabitants detained, and property was lost when entire families were deported with nothing more than the clothes on their backs.

As the “aliens” narrative waxed and waned, a new event triggered the updating of the terminology.

In 1991, the Somalia government of Siad Barre collapsed, spilling hundreds of thousands of refugees into the neighbouring countries. Kenya was grappling with its fear of Somalis and now had to face the eventuality of hosting desperate refugees, including the deposed president.

But the alienation of Somalis had begun earlier as it is recorded that police had raided Eastleigh and arrested Somali foreigners as early as 1970.

The refugees were allowed in and settled in camps where they were fed and housed by the UNHCR and other humanitarian agencies. Throughout the 1990s, Somalia was controlled by warlords who divided the country into green zones, fought viciously among themselves and continued to spill out new refugees.

Apart from participating in efforts at reconciliation and in hosting refugees and facilitating their resettlement in Europe and America, Kenya stayed out of Somalia’s affairs. As the refugees were too many to be housed in the sprawling camps in Dadaab, Dagahaley and Kakuma, some ended up living in towns with the alien cards issued by the UNHCR as identification.

The idea of controlling the movement of refugees soon became fashionable. For the security forces it is difficult to differentiate between locals and refugees and soldiers engaged in random stop-and-searches and nighttime raids in the main towns to flush out illegal aliens.

Human trafficking 

The controls placed on refugees living in towns illegally sparked lucrative human trafficking where the police and traffickers facilitated the movement of people from the Somali border to the interior. IDs and passports became available for those who could pay but were impossible to acquire for genuine inhabitants of northern Kenya.

While Somalis and their Cushite cousins were getting used to the “alien” idea, a new term landed on Kenya’s shores: terrorism. International terrorists bombed the American embassy in Kenya in 1998. The perpetrators had names similar to those of the northerners and the refugees. The “terrorist” label did not stick for another decade and during this period Somali businesspeople invested heavily in the Eastleigh suburb of Nairobi, creating a vibrant market where initially had been an unremarkable residential estate with a few wholesale and retail shops.

This economic boom coincided with the emergence of piracy on the Somali shores of the Indian Ocean. Suddenly the Kenyan media were reporting that piracy money was flooding the markets and making life costly for the residents. The Somali pirates were real, but this was part of international piracy having its operations on the lawless Somali coast. How the piracy money was siphoned into Kenya was never explained. The piracy issue occasionally crops up when overzealous reporters make disparaging references to piracy and the real estate boom in Kenya.

Al Shabaab

In 2011 Kenya sent troops into Somalia in an operation dubbed “Linda Nchi” after a tourist was kidnapped at the coast and probably taken across the border. There were other cross-border raids. However, significant Al-Shabaab attacks in Kenya began in 2012 when Kenyan forces were integrated into the forces of the African Union Mission in Somalia (AMISOM). As Kenya became embroiled in state-building in Somalia, with the creation of Jubaland floated as the reason for the invasion, Al-Shabaab started bringing its terrorism into Kenya.

In 2013, the Westgate Mall shootings led to the death of 67 people. More than 67 others also died in attacks in Mpeketoni in Lamu in 2014. The attacks on Garissa University attack were the worst, leading to 150 dead, many of them students. These brazen attacks were attributed to Al-Shabaab. Although the terror group had already internationalised and was recruiting with no regard to ethnicity, Kenyan Somalis became the target for blame, name-calling, and arrests.

In 2013, Human Rights Watch released a report titled “You are all terrorists”. The terrorist narrative drives xenophobia, arbitrary arrests, detention, and torture. After the terror attacks in 2014 in Eastleigh and Mpeketoni, the security forces conducted an indiscriminate door-to-door operation targeting anyone who did not have an ID card to hand. This security operation was dubbed Usalama Watch. Those who did not have the document were taken to Kasarani Stadium and held there for two weeks. About 900 people were taken to the stadium, the majority being young people who could not acquire IDs due to discriminatory bureaucratic procedures , and a haphazard and corrupt system that barred genuine citizens from receiving the document.

The verification and registration were suspended after two harrowing years during which homes were raided, their inhabitants detained, and property was lost.

Over half a century of negative portrayals of people from the north means that the official government policy is skewed when it applies to them. The acquisition of a passport is generally a straightforward process. To ensure that aliens from the north do not acquire this critical document, the immigration department and security agencies have an illegal and discriminatory step in place for border communities — vetting. It is not enough that a northerner provides sufficient genuine documentation. The applicant must appear before a group of government officials, security officers and appointed individuals to prove their citizenship. To pass this step, one must know their location chief, the genealogy of ones’ clan and other trivialities that are ordinarily unnecessary in life.

The emergence of one label does not lead to the dropping of the existing labels. Shifta, Poacher, Refugee, Pirate and Terrorist shape the thinking behind public actions. These negative portrayals have an impact on how national matters are debated and resolved.

A section of Kenyan citizens is considered as dangerous to the main body of the country. The secession war that ostensibly ended in 1967 is still being fought; the terms of the agreement that ended the war have never been the subject of a national conversation. Did the agreement include such important matters as citizenship, identity, development, and non-discrimination? The security agencies have not discarded their belligerent attitude towards the population and the civil service retains the policies of the 1960s towards the people of the north.

One must know their location chief, the genealogy of one’s clan and other trivialities that are ordinarily unnecessary in life.

National identity is at stake as those who rejected becoming part of Kenya at independence cannot have equal status with everyone else. They are aliens, and “they all look like”. The most dangerous portrayal is the association with terrorism; poachers and pirates are small fish compared to terrorists. In the last few years, enforced disappearances and extra-judicial killings related to the war on terror have become commonplace. It is hard to fight for the rights of one who is labelled a terrorist and is disappeared or killed.

Public association with a terror suspect is a stigma that nobody is willing to be associated with. Crimes are committed under cover of fighting terrorism, and there is nothing the targeted community can do about it. That is the power of a label; it obscures the truth, gives authorities cover to commit genocidal crimes and permits the practice of xenophobia in public.

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Politics

The End of Abiy-Mania

When he ascended to power in April 2018 Abiy Ahmed elicited goodwill inside and outside Ethiopia but the continuing humanitarian crisis in the Tigray region is losing him friends.

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The End of Abiy-Mania
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Ethiopia will go to the polls on June 22, buffeted by various crises domestically and abroad. But the upcoming election has many echoes of the May 15 2005 election, whose impact continues to shape Ethiopia’s domestic politics and politics in the Horn of Africa. Central to Ethiopia’s current domestic crisis and the border dispute with Sudan, is the Abiy-Amhara compact.

The 15 May 2005 elections were the third national elections to be held under the 1994 constitution following the ouster of the Marxist-Leninist Derg. In the 1995 and 2000 elections, the Ethiopian People’s Revolutionary Democratic Front (EPRDF) government harassed the opposition parties, forcing the influential ones to boycott the polls, with the result that the EPRDF won both elections with over 90 per cent of the seats.

Ahead of the 2005 election, the EPDRF signalled the significant participation of the opposition parties so that Western observers—whose support was critical for Meles—would declare the elections to have been free and fair. The incumbent party acceded to the pre-election demands of some opposition parties, allowing in international election observers and giving the opposition parties a chance to sell their manifestos on the national broadcaster. These conditions were absent in the previous elections. While these were not among the chief demands of the opposition parties prior to the polls, they indicated reasonable good faith on the part of the government compared to previous elections.

As a result, for the first time in Ethiopia’s history, a nationwide multiparty competition seemed possible; neither the ruling party nor the opposition had ever faced a competitive election before.

Internal turmoil within the EPRDF preceded the election. The Central Committee of the Tigray People’s Liberation Front (TPLF)—Prime Minister Meles Zenawi’s core support base—broke up into two rival factions in 2001. With his base in the Tigray heartland at risk, Meles took advantage of his central position within the broader EPRDF coalition and outmanoeuvred his rivals. He sacked several senior officials and successfully weathered the storm, but the fault line remained and emerged during the 2005 elections.

Post-election 

The pre-election period saw the unprecedented participation of the opposition parties and civil society organisations in the campaigns. Election Day went peacefully, and the early results in Addis Ababa and other major urban areas showed the opposition parties making significant electoral gains. According to unofficial preliminary results, the opposition had won 172 parliamentary seats—its most considerable showing yet in the 547-member assembly. On the night of the election, Prime Minister Meles Zenawi declared a one-month ban on public demonstrations in the capital and brought the Addis Ababa security forces (which would have come under the opposition’s command had they been sworn in) under the control of the Prime Minister’s office.

Opposition parties boycotted their seats in parliament, alleging rigging by the incumbent. Their refusal to take up their seats in parliament handed Meles Zenawi and his party a third term in office. Meles interpreted his “mandate” as a licence to take the authoritarian path. Hundreds, if not thousands, of political opposition and human rights activists were arbitrarily detained, with some facing the spurious charge of treason. Ethiopian security forces killed almost 200 demonstrators in post-election protests in June and November 2005 and arrested tens of thousands of people.

With the domestic front “sorted”, Meles turned to regional matters. In December 2006, Ethiopia’s military intervened in Somalia to root out the Union of Islamic Courts (UIC), which had brought stability for the few months they were in charge. The Ethiopian forces captured Mogadishu in less than a week, and the UIC dissolved and surrendered political leadership to clan leaders.

Ethiopia’s ouster of the UIC tapped into a deep historical hostility between Somalia and Ethiopia, something Al Shabaab, the youth wing of the UIC, exploited with a mix of latent Somalia nationalism and anti-imperialism.

Ethiopia’s actions provided Al Shabaab with an opportunity to translate its rhetoric into action. Al Shabaab began targeting the nascent Somalia government, Ethiopian forces, the Transitional Federal Government security, political figures, and any Somalis collaborating with Ethiopia. Ethiopia’s and TFG’s heavy-handed counterinsurgency responses played into the hands of Al Shabaab.

Ethiopia’s incursion into Somalia took place three weeks after General John Abizaid, the commander of US forces from the Middle East to Afghanistan, had met with then Ethiopian Prime Minister Meles Zenawi.

Sixteen years later, Ethiopia goes into another election whose consequences could transcend Ethiopia.

The limits of Abiy-Mania

When he ascended to power in April 2018, Prime Minister Abiy Ahmed elicited a groundswell of collective goodwill inside and outside Ethiopia. He embarked at breakneck speed on reforms that just a few years earlier would have sounded far-fetched.

At home, Abiy released political prisoners, appointed the country’s first female as the ceremonial president and a cabinet half-filled by women. He nominated a once-jailed opposition leader as the new chairwoman of the electoral board. In the Horn of Africa region, Abiy had a rapprochement with Eritrea, a country with which Ethiopia had fought a bloody war between 1998 and 2000. Abiy also attempted to mediate the Sudan political crisis.

The Nobel Committee awarded Abiy the 2019 Nobel Peace Prize “For his efforts to achieve peace and international cooperation, particularly for his decisive initiative to resolve the border conflict with neighbouring Eritrea.”

Federalism vs centralisation

While the trigger for the Abiy-led military operation against the Regional Government of Tigray in the north of the country is the alleged attack of the federal army base by the Tigray Peoples Liberation Front (TPLF), the attack was only a symptom and not the actual cause.

The battle between Abiy and the TPLF and other groups is a battle between those who champion the multi-ethnic federalism constitution and those who prefer a centralised state. Abiy favours centralisation to federalism.

The Tigray region is not the first to bear the brunt of the military and federal security forces to achieve Abiy’s centralisation agenda. The Oromia and Sidama regions have also been at the receiving end of the violence of the federal security authorities.

Abiy embarked at breakneck speed on reforms that just a few years earlier would have sounded far-fetched.

Throughout its long history of state formation, Ethiopia was for thousands of years ruled by emperors under a monarchy with a unitary system of government. The last emperor, Haile Selassie, was deposed in 1974 and from then on until 1991, the country came under a dictatorship with a unitary system of government.

The creation of the EPRDF in 1989—an ethnic coalition of the Tigrayan Peoples’ Liberation Front, the Amhara National Democratic Movement (ANDM; later Amhara Democratic Party), the Oromo Peoples’ Democratic Organization (OPDO; later Oromo Democratic Party), and the Southern Ethiopian Peoples’ Democratic Movement (SEPDM)—had changed that.

Abiy’s shot across the bow was the dissolution of the EPDRF and the launching of the Prosperity Party (PP) on December 1 2019. The OPDO, ANDM, and SEPDM voted overwhelmingly to join the party, while the TPLF rejected the idea as “illegal and reactionary”. The timing of the move was convenient, coming just a few months before the election that was postponed because of the COVID-19 pandemic.

The EPDRF’s multi-ethnic federalism and the inclusion in the constitution of the right to secede for all “nations and nationalities and peoples” of the country were innovative breakthroughs in a country with 80 different ethnic groups. But the constitution was also a product of ideological foment and political necessity. The leaders who revolted against the Mengistu junta had emerged from the student movement that had adopted the “nationalities and the land question”, redefining Ethiopian statehood.

The Oromia and Sidama regions have also been at the receiving end of the violence of the federal security authorities.

While the multi-ethnic federalism has been imperfect, especially its implementation and the domination of the EPDRF by the TPLF, in a multi-ethnic country with historical and contemporary grievances against the state, federalism has acted as a safety valve against ethnic tension.

Abiy and Amhara expansionism 

The Amharas are Abiy’s vociferous supporters at home. They, especially their elites, have an axe to grind with the TPLF for diluting their decades of uninterrupted state power and control. Amhara language and culture are the state’s language and culture, and the language and culture of the Orthodox Church which wields unfettered power. But with its political nous, its deep bureaucracy and know-how, the TPLF was always a challenging prospect for Abiy, a political novice with limited federal-level experience and hardly a political base. The connecting tissue of Abiy-Amhara unity is the lowest common denominator that is the fear and loathing of the TPLF. After dissolving the EPDR, a coalition in which the TPLF was a strong partner, the next step was to defeat the TPLF militarily. Even before the November military incursion into Tigray, Amhara militias were massed at the border with Tigray. If Abiy’s anti-TPLF move was intended to destroy them as a political force, for the Amharas this was an opportunity to regain some of the territories they had lost to Tigray in 1991.

Sudan

Ethiopia also has a boundary dispute with Sudan. The dispute centres on the al-Fashaga region, Sudan’s fertile breadbasket located in Gedaref State, which borders Ethiopia’s Amhara region in the north-west. According to the Anglo-Ethiopian Treaty of 1902 the area belongs to Sudan and, unlike the regime of Omar al-Bashir, for the transitional government of Prime Minister Abdulla Hamdok, settling this dispute is a priority. However, the Abiy-Amhara alliance has made resolving the dispute complicated.

Sudan is also a critical factor in resolving the Tigray crisis; the country is the only remaining supply route for the TPLF as Eritrea is closed to them and bringing in supplies and fuel through other routes is risky. Sudan could also determine how the GERD dam conflict will be resolved. Unlike Egypt, Sudan could benefit from cheap electricity if the dam is filled, but the country will not countenance losing al-Fashaga. Abiy faces difficult choices: cede al-Fashaga to Sudan and gain a partner in the dam negotiations while also denying the TPLF a supply route or keep al-Fashaga and lose Sudan in the GERD dam discussions, leaving the TPLF to use the Sudan border for supplies.

The Tigray conflict, which Abiy initially promised would be a straightforward law enforcement operation, has instead metastasised into a slow-grinding counterinsurgency operation. The continuing humanitarian crisis in the Tigray region is losing Abiy friends.

On May 23, the US State Department announced visa restrictions for any current or former Ethiopian or Eritrean government officials, members of the security forces, or other individuals—including Amhara regional and irregular forces and members of the Tigray People’s Liberation Front (TPLF)—responsible for, or complicit in, undermining the resolution of the crisis in Tigray.

In a multi-ethnic country with historical and contemporary grievances against the state, federalism has acted as a safety valve against ethnic tension.

America’s sanctions came on the heels of the European Union’s suspension of budgetary support worth €88 million (US$107 million) until humanitarian agencies are granted access to people in need of aid in the northern Tigray region.

On the 7th of June 2021, Representatives Gregory Meeks (D-NY) and Michael McCaul (R-TX), who is also Chairman and Ranking Member of the House Foreign Affairs Committee, together with Karen Bass (D-CA) and Christopher H. Smith (R-NJ), respectively Chairwoman and Ranking Member of the House Foreign Affairs Subcommittee on Africa, Global Health and Global Human Rights, issued a joint statement after tabling a resolution condemning violence and human rights abuses in Ethiopia.

The sanctions come as Ethiopia awards its first telecom licence for US$850 million to a consortium that includes the UK’s Vodafone in what could herald the opening up of Ethiopia’s closed economy.

Before the EPDRF came into power, Ethiopia was a posterchild of famine and incessant conflict, especially under the Derg regime. Abiy and Amhara nationalism is bringing back the echoes of the Derg era and the upcoming June election is unlikely to resolve current crises; if anything, it will exacerbate them.

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We Still Can’t Breathe: Chauvin’s Conviction Maintains the Status Quo

Chauvin is simply a cop who committed an action so ugly that he had to be made an example of so that America could get back to normal.

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We Still Can’t Breath: Chauvin’s Conviction Maintains the Status Quo
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Sometimes even the “biggest” victories can ring hollow. That especially seems to be the case several months into 2021, and 11 odd months after George Floyd had his life snuffed out in front of a red-brick grocery store in South Minneapolis, around the corner from the “Little East Africa” neighbourhood. That Derek Chauvin, the cop who laid his blatancy in the form of a knee across Floyd’s neck in a gutter finally faced some form of consequence in the form of a guilty verdict, may, in and of itself be of little consequence in the grandest of schemes.

Yes, right now it seems as though the verdict that has come down harshly on Chauvin is a rebuke of all things heinous, nothing less than a massive moral victory for racial progress, black America and global equality.

Indeed, rainbows shall now shine through and if you listen to many pundits within the American (and for that matter, Western) broadcast media, racism against Black America has been solved once and for all —  à la the presidential election of Barack Obama way back in those heady days of 2008.

Chauvin will be sentenced on June 25th of this year. Much of Black America is already lowering their expectations away from the 40-year maximum prison sentence.

Life is full of disappointments.

In itself, the Chauvin verdict is not one of them; it is just another opportunity for a larger collective sadness, another opportunity for an eventual letdown, a reminder of the global system of injustice that is, frankly, far as hell from ever being permanently resolved.

I haven’t been in Minneapolis since the end of May 2020, the Saturday following the Floyd killing, when the very landscape and fabric of the “Twin Cities” of Minnesota and Saint Paul were irrevocably changed. Walking around that day, the sense of despair was palpable. All of Lake Street — all seven kilometers of it — seemed to have been hit by varying degrees of madness. Some buildings were completely burnt out, husks of their former selves; others had smashed windows or had “BLACK OWNED BUSINESS: DON’T BURN!” scrawled in graffiti across the boarded-up doors. Thousands of people trudged around with shovels, cleaning up debris ahead of the inevitable next night of chaos.

In the weeks that followed, the protests spread across the United States, and even took root on a global scale, spreading as far as Nairobi, London, Kampala, Rome and dozens of other cities. In Minneapolis, all the tension of a tense superpower seemingly dying of its own hubris during the chaotic early months of the COVID-19 pandemic descended on an idyllic neighbourhood. By the day I arrived, May 30th, the United States National Guard was being deployed to put down any form of violence with their own forms of violence. But the damage had been done and the rest of the country was experiencing its own varying levels of chaos. At least two people were killed in Minneapolis alone (and at least 19 across the rest of the US, though this number seems to be low). Dozens of people were injured in Minneapolis alone (although the exact numbers are hard to confirm; personally I talked to at least three people who had sustained non-lethal injuries during the protests, so the real number could be much higher).

Thousands were injured across the US, with hundreds more incidents of police brutality filmed and shared widely. In Minneapolis there was approximately KSh 53 billion worth of damage related to the unrest. Bob Kroll, the president of the Police Officers Federation of Minneapolis who allegedly had white supremacist ties retired at the beginning of 2021. The Minneapolis Police Department was defunded following the reckoning that fell upon the Twin Cities in those warm early summer weeks.

Among pundit across America, talk of alliance and “listening” rapidly became the norm. Many leading neo-liberals put out statements, Republicans and Democrats alike. Trump ordered the beating up of peaceful protesters in front the White House and goodhearted liberals were shocked and appalled. Everyone said it was a “sea change” in American race-relations.

Less than three months after the George Floyd protests kicked off there was a “monumental change” — Jacob Blake was shot in the back by police in the city of Kenosha, in my home state of Wisconsin. The NBA boycotted games, more conversations were had and the world kept right on turning, same as it ever has.

When it comes down to issues of inequality, racism and oppression the status quo is always maintained, especially in America. Two steps forward and three steps back seems to be the pattern, one that is only reinforced by the pattern of police getting away with the murder of Black Americans — whether on tape or merely under “suspicious” circumstances in which “the officer felt their life was threatened and required a response of lethal force”.

Perhaps it is this constant pattern of impunity that has caused the most damage, a pattern that in the US can be traced to well before the 1992 Rodney King riots in Los Angeles, California. The riots were sparked off by the acquittal of cops who had been caught on film beating and kicking King senseless on the shoulder of a freeway.

It’s the same as it ever was.

Over the years since, especially in this age of social media ubiquity, incidents police violence against Black men, women and children have been caught on camera with horrifying regularity.

Horrifying, but not at all surprising. Everyone within the Black community in the US has long known the score. “Officers under threat” deaths, cases failing to be investigated, rumours of pistols being planted, delays in emergency responder times, ties to white supremacy, “warrior cops” getting more military equipment, stop-and-frisk policies, higher incarceration rates among Blacks, continual harassment, talking to children about keeping hands visible when dealing with police, media bias, fetishisation of police, the “Blue Lives Matter” movement — the list of systemic issues within US police forces could fill the remainder of this article.

In this age of social media ubiquity, incidents of police violence against Black men, women and children have been caught on camera with horrifying regularity.

The American judicial system itself is inherently flawed. The narrative among much of the “upstanding” upper middle-class elements of society is that somehow race relations were, if not solved outright, repaired with a sustained “upward” trajectory somewhere around the funeral of civil rights leader Martin Luther King Jr. after his assassination in 1968.

They paint a rosy picture of race-relations in the US in which all segregationist judges were replaced with forward thinking progressives, where all cops with KKK ties were unceremoniously fired, where the ghosts of “Jim Crow” laws (designed to suppress, segregate and subjugate post-slavery Black America) simply faded into the distant memories of a bygone era. The result was a sort of racial Cold War, where proxy wars were fought through the war on drugs, mass incarceration, neoliberalism and police impunity.

“At least segregation is illegal now”, says White America when pressed, as if cities, schools, hospitals and police actions were not still segregated sans overt painted signs.

Such sentiments bled into the politics of the US’s two major parties, Republicans spearheading the “War on Drugs” under the Reagan presidency of the 1980s and the Clinton administration cutting social programmes and accelerating mass incarceration during the 90s under the all-American ideal of “pulling oneself up by your bootstraps”. Such proponents of America’s neo-liberal ethos cared little whether there were any boots to begin with.

Slowly the technology caught up with the reality, and the anger felt across the marginalised communities in America had a focal point on which to pour out their frustrations. The images were there on film, little snippets sent into cyberspace by countless onlookers. The anger was in the bloody and lifeless body of Michael Brown lying for hours in a Missouri street. It was in Eric Garner pleading that he couldn’t breathe while being choked to death by cops in New York City. It was in Philando Castille being shot and killed in his car seconds after telling the officer who had pulled him over that he had a licensed gun in the car and reached for his wallet. (This shooting also happened in the Twin Cities area of Minnesota.) It was in Breonna Taylor being shot dead on a no-knock warrant in Louisville, Kentucky only for the officers to be charged with “wanton endangerment” for firing bullets into a neighbouring apartment.

None of the officers in the above incidents were convicted. Some were never even brought into a courtroom.

On April 11th 2021, Daunte Wright was shot and killed by a cop during a traffic stop in a suburb of Minneapolis, Minnesota. Details and footage of the incident are scant. The officer involved has been charged with second-degree manslaughter (a lesser charge than homicide in the US court system). Protests have sprung up around the US, youth wearing surgical masks — the hallmark of the smoldering COVID-19 pandemic — clashing with police and facing arrest, and “non-lethal weapons being deployed by officers to quell pockets of unrest”. This killing occurred at the epicentre of the “defund the police” movement — Minneapolis.

The cycle continues same as ever, two steps forward and three steps back in Black America’s quest for equitable treatment.

The police are just the visible agents of the systemic suppression of Black people that stretches far beyond the shores of the US.

If COVID-19 has shown up anything, it is the brutality of police worldwide. Most times their actions go on with impunity. Cops in Kenya beat up people without mercy and enforce curfew by leaving motorists stranded on highways. In Uganda cops extort commuters under threat of jail. In Rwanda the stranglehold on the nation continues to tighten under threat of harsh penalties.

There is no equality when it comes to the Global South, particularly for much of Africa whose suffering at the hands of the police echoes the oppression faced by the Black community in the US.

The cycle continues same as ever, two steps forward and three steps back in Black America’s quest for equitable treatment.

Through this lens of warranted cynicism, the “guilty” verdict handed down to Derek Chauvin by a jury in Minnesota is not a massive turning point. The very pundits stating that the verdict is such a monumental moment of change inherently prove that it is nothing remotely close to such a trend. There will be other failed indictments, other cops walking away, more cases of mysteriously “lost” body-cam footage. More will die, protests will spring up and be quelled with extreme prejudice.

Chauvin, the smirking killer that he is, did prove one thing and one thing only: where the “line” truly is, where the grey areas that the police hide behind blur over into black and white, from a “justified act of lethal self-defense from a frightened officer” into outright murder. His actions were so unquestionably heinous that they had to be dealt with. What Chauvin did derives directly from an ugly history; he lynched that man and at the time thought he would get away with it, hands in pockets, cocky half-smile on his face while his bodyweight cut off George Floyd’s air supply in that street gutter. Bystanders begged him to stop as the other officers watched in idle complicity. Paramedics were not allowed to give medical aid and Chauvin continued to apply pressure for minutes after Floyd had become non-responsive.

The systems, after all, stay much as they are in America. Profit margins must be maintained and “order” by way of the status quo must be upheld. The Twin Cities, of which Minneapolis is the more visible twin, would have simply exploded if the verdict had come back anything less than guilty. After a year of protests, COVID-19 lockdowns, electoral strangeness, Trumpian policies, political divisions, economic challenges and continued incidents of police violence, the tinderbox that was Minneapolis could not have handled Chauvin walking free out of the courthouse to appear on Fox News to “thank God”.

If that had happened the resulting violence would have dwarfed any incidents of unrest in America’s past. It is likely that weeks later clashes with police would be continuing on a nightly basis in dozens of cities across America. Minneapolis, where major corporates are headquartered, would have been engulfed in flames so huge the smoke would have been seen in the neighbouring state of Wisconsin.

The tinderbox that was Minneapolis could not have handled Chauvin walking free out of the courthouse to appear on Fox News to “thank God”.

Chauvin’s true legacy is that of an outlier, the ultimate talking-head example that “things are different now”, that something has truly been accomplished on a systemic level when it comes to police treatment of Black America.

In reality, Chauvin is simply a cop who committed an action so ugly that he had to be made an example of so that America could “get back to normal”.

For Black America in 2021 however, normal life is chockful of disappointments.

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