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Why Cancer Remains a Death Sentence in Africa

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Cancer death disparities among rich and poor countries are quite significant, and action must be taken immediately to provide accessible and affordable healthcare to those in need. Although many of those deaths can be prevented at relatively low cost, cancer doesn’t seem to be a priority for donors.

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Why Cancer Remains a Death Sentence in Africa
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Often depicted as a rich world disease, cancer is becoming a concerning public health problem in sub-Saharan Africa. More than two-thirds of the people who died from cancer in the past few years lived in low- and middle-income countries. Many risk factors, such as high infection rates of HIV/AIDS, hepatitis B virus (HBV), and human papillomavirus (HPV) or increased tobacco and alcohol consumption are increasing the rates of cancer in many regions.

Cancer death disparities among rich and poor countries are quite significant, and action must be taken immediately to provide accessible and affordable healthcare to those in need. Although many of those deaths can be prevented at relatively low cost, cancer doesn’t seem to be a priority for donors.

Cancer is the second leading cause of death across the world, with 8.8 million deaths every year – nearly one death in every 6. Upto 70 per cent of these deaths occur in low- and middle-income countries, and the numbers keep growing every year. In Africa, the most common cancer types are cancers of the cervix, breast, liver, and prostate, together with Kaposi’s sarcoma and non-Hodgkin’s lymphoma.

Why is cancer becoming a Third World phenomenon? When did the shift in cancer cases to the Global South take place? And why are risk factors more prevalent in low- and middle-income countries as opposed to rich countries?

The current burden of cancer in Africa

Cancer is the name given to a collection of diseases characterised by the rapid multiplication of a group of malignant cells that start spreading into surrounding tissues. It is a multifactorial disease that is caused by the transformation of normal cells into tumours. The disease is caused by the interaction between an individual’s genetics and the exposure to external agents, such as radiation, chemical carcinogens (tobacco, asbestos, arsenic), and certain viruses, parasites, and bacteria. Bad lifestyle habits, such as an unhealthy diet, may also increase the risk of developing this disease. The risk of cancer is much higher in adults than in children. As an individual gets older, the immune system isn’t able to protect the organism against the uncontrolled growth of malignant cells, and cellular repair mechanisms become less effective. At least one death in three from cancer is caused by one of the five principal behavioural risks: high body mass index, lack of physical activity, low fruit and vegetable intake, tobacco use, and alcohol use.

Cancer is the second leading cause of death across the world, with 8.8 million deaths every year – nearly one death in every 6. Up to 70 per cent of these deaths occur in low- and middle-income countries, and the numbers keep growing every year. In Africa, the most common cancer types are cancers of the cervix, breast, liver, and prostate, together with Kaposi’s sarcoma and non-Hodgkin’s lymphoma. Each one of these cancers has at least one specific risk factor that is strongly linked with poverty, endemic diseases, or lack of proper preventive strategies that characterise many regions of the Global South.

Tobacco alone is the leading risk factor for cancer and is responsible for almost one-fourth of cancer deaths. Harmful use of alcohol and tobacco use are running rampant in many African countries. The burden of tobacco-related deaths in Africa has increased by 70 per cent, from 150,000 reported deaths in 1990 to over 215,000 in 2016. And these numbers may very well be the tip of the iceberg, given how comprehensive data on cancer incidence and mortality in Africa is extremely scarce, if available at all.

Since specialised facilities to treat cancer are often not available, and the data to drive cancer policies is sorely lacking, when patients are diagnosed with cancer in Africa it is usually already too late. Many patients only receive a diagnosis when they’re very close to dying.

Infections due to hepatitis B and C viruses and HPV are also a key risk factor for liver and cervical cancer, and many African health systems lack the resources for mass vaccination programmes needed to stop these diseases from spreading. In low- and middle-income countries, these infections are responsible for nearly 25 per cent of cancer cases. Common epidemic diseases, such as HIV/AIDS, malaria, and tuberculosis, are also known risk factors for other cancers, such as Kaposi’s Sarcoma and lung cancer.

Why is cancer a death sentence in Africa?

A diagnosis of cancer is always terrible news, but it can be a much more devastating experience in a country like South Sudan than, say, in Japan, Canada, or Germany. The highly industrialised nations already found that the best way to deal with cancer is not to treat it (although this is still possible), but to prevent it. Or, at least, to diagnose it as early as possible, when it is still possible to stop it from spreading through the body with lethal consequences. In sub-Saharan Africa, where early detection and prevention are not widely available, the risk of getting cancer and the risk of dying from it is nearly the same.

Since specialised facilities to treat cancer are often not available, and the data to drive cancer policies is sorely lacking, when patients are diagnosed with cancer in Africa it is usually already too late. Many patients only receive a diagnosis when they’re very close to dying. Treatment services are available in less than one-third of the cases in low-income countries, compared to 90 per cent in high-income ones. In more than 20 per cent of African countries, access to cancer treatment is not available at all. And even when treatment is available, lack of medical literacy regarding cancer may mean that the treatment received is not the right one. The number of specialised oncologists in Africa is abysmally low, and many doctors are simply not knowledgeable about cancer to provide appropriate care. For example, a past study of breast cancer patients in Nigeria showed how several women kept being treated with antibiotics or other ineffective medications for months or years before receiving a proper diagnosis.

National cancer registries are rarely found, and even when they exist, they must rely on obsolescent technologies, sparse and unreliable data, and underdeveloped facilities. This news is particularly depressing since early detection may easily prevent between 30 per cent and 50 per cent of cancers. Just to name an example, HPV alone is known to be the cause for 70 per cent of all cervical cancers, the most common malignancy in the African region. In North America, a series of massive vaccination campaigns against HPV have reduced this risk at least five-fold. And even when vaccines are not available, routine cervical cancer screening and early treatment can detect this disease while it can still be treated, effectively preventing up to 80 per cent of cervical cancers.

An epidemic coming from the Western world?

It has often been said that cancer is a disease of the industrialised world, and has thus been associated with the Western world more than with the poorest African regions. Following the traditional Western paternalistic narrative, in Africa people die of starvation much before they can reach the age where cancer usually starts manifesting. In a curious and horrible turn of events though, this assumption may hold more truth than we may think. The Western industrialised nations brought cancer to Africa, starting with the wanton exploitation of its land to strip it of its natural resources regardless of the catastrophic environmental consequences.

Environmental factors are important contributors to the burden of cancer, especially in some regions. For example, petroleum spills and over-extensive environmental exploitation of the Niger Delta region caused vast contamination of ground, soil, air, and water. The local population has been exposed for decades to high levels of many dangerous carcinogens, ranging from dioxins to benzene and polycyclic aromatic hydrocarbons (PAHs). Benzene alone was found at levels that are 900 times above World Health Organization (WHO) recommendations. To protect themselves from the acid rains that ravage this region, people must seek shelter under asbestos roofing, which is another known carcinogen that may cause lung cancer. And when the crops and the livestock are contaminated by oil spills, increased risk of cancer of the digestive tract is nothing but an obvious consequence.

Mozambique and cancer: A history of strife

Cancer is a disease, and like any other disease, it becomes much more problematic in all regions affected by poverty and lack of infrastructure. Decades of civil war and struggle left many African countries with no healthcare system or wrecked and devastated the (few) existing facilities. Droughts, insufficient sanitation, and poverty exacerbate the damage already precipitated by civil and military strife, with many health professionals preferring to leave their countries to go to Europe and the U.S. in search of better wages.

For example, during the 1970s, the primary healthcare system in Mozambique was well developed, and the local facilities treated a large number of patients every day. The government had invested substantial resources in vast vaccination programmes that were able to provide coverage to more than 90 per cent of the population, reducing the risk of many types of cancer. Until the civil war exploded. When the anti-communist group RENAMO supported by the CIA and conservative U.S. forces started attacking FRELIMO, they decided that the best way to hit their foes was to destroy the country’s infrastructure. Schools, roads, hospitals, and health clinics were destroyed, and as Mozambique descended into civil war, the government had to make severe budget cuts to the public health expenditure. Corruption started running rampant, and in a country plagued by poverty, paying the bribes required by many doctors and nurses was often impossible.

Many African countries are now taking steps to address the rising cases of cancer in their countries. In 2016, Kenya’s National Hospital Insurance Fund (NHIF) made a commendable choice. Radiation therapy, surgery and four courses of chemotherapy per year are now included among the services provided for free for the 18 per cent of Kenyans covered by the fund.

Today, no radiation therapy centres are available in Mozambique, leaving all patients who suffer from the most common cancer types in this country (cervix, breast, and prostate) without adequate treatment. Without proper infrastructure, natural disaster emergencies, such as cyclones and flooding, also cause the spread of malaria, which rapidly becomes endemic in many areas. The overall health conditions of the population is atrocious, with HIV/AIDS and malaria prevalent among both adults and children. In Mozambique, the rise of cancer is nothing but a consequence of war as HIV constitutes a risk for Kaposi’s Sarcoma, while malaria is a risk factor for Burkitt’s lymphoma among children.

It is time to draw a line

Many African countries are now taking steps to address the rising cases of cancer in their countries. In 2016, Kenya’s National Hospital Insurance Fund (NHIF) made a commendable choice. Radiation therapy, surgery and four courses of chemotherapy per year are now included among the services provided for free for the 18 per cent of Kenyans covered by the fund. Before this plan was launched, the prices for cancer treatment in the country used to be way out of reach for a majority of Kenyans.

However, much more needs to be done, from strengthening the drug supply chain systems in public facilities to prevent stock-outs to dealing with the chronic absence of specialists in a country where there are only 22 oncologists for a population of 46 million. Today, it is very hard for all Kenyans to access those services, and additional costs make long-term cancer treatment hardly affordable for most families. But the Kenyan experience is a prime example of how much can be done even in countries with limited resources.

In November 2017, the National Comprehensive Cancer Network (NCCN) and the African Cancer Coalition (ACC) released new cancer care guidelines that take potential economic constraints into account, as well as focusing on the most commonly diagnosed cancers in each region in sub-Saharan Africa. Countries such a Nigeria established a partnership with the University of Birmingham to teach pathologists how to detect and diagnose cancer over Skype. Evidence-based cancer care can provide more affordable and ethical solutions to treat cancer without compromising health outcomes, such as providing fewer but larger doses of radiation to reduce the costs.

Today, modern medicine teaches us that cancer is a deadly disease that is often resistant to most treatments and that the most effective approach is one that combines education and prevention. Prevention should be at the core of any system that wants to have a chance to win the war against cancer, especially when resources are limited. A focus on primary care and prevention over curative care saves more lives, is less expensive, and is less stressful for people who simply avoid cancer rather than facing it.

Cancer screening programmes, new cancer treatment guidelines, and vaccination campaigns saved countless lives, but it’s still hard to win this fight when so many African countries do not understand that they must allocate their resources to train more specialised healthcare workers and establish more advanced facilities. Any modern nation has the duty to invest its budget on its human capital, the most valuable resource, and rely on local resources instead of seeking help from abroad.

Countries such as Kenya, Rwanda, and Nigeria are trying to make cancer services accessible to their populations, and by doing so, they teach us a fundamental lesson – that fighting cancer isn’t just a battle that is fought inside hospitals; it is a war that is fought at the political table, first and foremost. Only with adequate investments and proper healthcare infrastructure can African countries stand a chance against this deadly disease.

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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

Kenya Chooses Its Next Chief Justice

The search for Kenya’s next Chief Justice that commenced Monday will seek to replace Justice David Maraga, who retired early this year, has captured the attention of the nation.

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Kenya Chooses Its Next Chief Justice
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Since Monday, the 12th of April 2021, interviews to replace retired Chief Justice David Maraga for the post of the most important jurist in Kenya and the president of the Supreme Court have been underway.

The Judiciary is one of the three State organs established under Chapter 10, Article 159 of the Constitution of Kenya. It establishes the Judiciary as an independent custodian of justice in Kenya. Its primary role is to exercise judicial authority given to it, by the people of Kenya.

The institution is mandated to deliver justice in line with the Constitution and other laws. It is expected to resolve disputes in a just manner with a view to protecting the rights and liberties of all, thereby facilitating the attainment of the ideal rule of law.

The man or woman who will take up this mantle will lead the Judiciary at a time when its independence and leadership will be paramount for the nation. He/she will be selected by the Judicial Service Commission in a competitive process.

KWAMCHETSI MAKOKHA profiles the ten candidates shortlisted by the JSC.

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IMF and SAPs 2.0: The Four Horsemen of the Apocalypse are Riding into Town

Stabilisation, liberalisation, deregulation, and privatisation: what do these four pillars of structural adjustment augur for Kenya’s beleaguered public health sector?

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IMF and SAPs 2.0: The Four Horsemen of the Apocalypse are Riding into Town
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The International Monetary Fund’s announcement on the 2nd of April 2020 that it had approved a US$ 2.3 billion loan for Kenya prompted David Ndii to spell it out to young #KOT (Kenyans on Twitter) that “the loan Kenya has taken is called a structural adjustment loan (SAPs). It comes with austerity (tax raises, spending cuts, downsizing) to keep Kenya creditworthy so that we can continue borrowing and servicing debt”, adding that the “IMF is not here for fun. Ask older people.” With this last quip, Ndii was referring to the economic hardship visited on Kenyans under the structural adjustment programmes of the 80s and 90s.

Well, I’m old enough to remember; except that I was not in the country. I had left home, left the country, leaving behind parents who were still working, still putting my siblings through school. Parents with permanent and pensionable jobs, who were still paying the mortgage on their modest “maisonette” in a middle class Nairobi neighbourhood.

In those pre-Internet, pre-WhatsApp days, much use was made of the post office and I have kept the piles of aerogramme letters that used to bring me news of home. In those letters my parents said nothing of the deteriorating economic situation, unwilling to burden me with worries about which I could do nothing, keeping body and soul together being just about all I could manage in that foreign land where I had gone to further my education.

My brother Tony’s letters should have warned me that all was not well back home but he wrote so hilariously about the status conferred on those men who could afford second-hand underwear from America, complete with stars and stripes, that the sub-text went right over my head. I came back home for the first time after five years — having left college and found a first job — to find parents that had visibly aged beyond their years and a home that was palpably less well-off financially than when I had left. I’m a Kicomi girl and something in me rebelled against second-hand clothes, second-hand things. It seemed that in my absence Kenya had regressed to the time before independence, the years of hope and optimism wiped away by the neoliberal designs of the Bretton Woods twins. I remember wanting to flee; I wanted to go back to not knowing, to finding my family exactly as I had left it — seemingly thriving, happy, hopeful.

Now, after eight years of irresponsible government borrowing, it appears that I am to experience the effects of a Structural Adjustment Programme first-hand, and I wonder how things could possibly be worse than they already are.

When speaking to Nancy* a couple of weeks back about the COVID-19 situation at the Nyahururu County Referral Hospital in Laikipia County, she brought up the issue of pregnant women having to share beds in the maternity ward yet — quite apart from the fact that this arrangement is unacceptable whichever way you look at it — patients admitted to the ward are not routinely tested for COVID-19.

Nancy told me that candidates for emergency caesarean sections or surgery for ectopic and intra-abdominal pregnancies must wait their turn at the door to the operating theatre. Construction of a new maternity wing, complete with its own operating theatre, has ground to a halt because, rumour has it, the contractor has not been paid. The 120-bed facility should have been completed in mid-2020 to ease congestion at the Nyahururu hospital whose catchment area for referrals includes large swathes of both Nyandarua and Laikipia counties because of its geographical location.

According to Nancy, vital medicine used to prevent excessive bleeding in newly delivered mothers has not been available at her hospital since January; patients have to buy the medication themselves. This issue was also raised on Twitter by Dr Mercy Korir who, referring to the Nanyuki Teaching and Referral Hospital — the only other major hospital in Laikipia County — said that lack of emergency medication in the maternity ward was putting the lives of mothers at risk. Judging by the responses to that tweet, this dire situation is not peculiar to the Nanyuki hospital; how much worse is it going to get under the imminent SAP?

Kenya was among the first countries to sign on for a SAP in 1980 when commodity prices went through the floor and the 1973 oil crisis hit, bringing to a painful halt a post-independence decade of sustained growth and prosperity. The country was to remain under one form of structural adjustment or another from then on until 1996.

Damaris Parsitau, who has written about the impact of Structural Adjustment Programmes on women’s health in Kenya, already reported in her 2008 study that, “at Nakuru District Hospital in Kenya, for example, expectant mothers are required to buy gloves, surgical blades, disinfectants and syringes in preparation for childbirth”. It would appear that not much has changed since then.

The constitution of the World Health Organisation states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” and that “governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”

The WHO should have added gender as a discrimination criteria. Parsitau notes that “compared to men, women in Kenya have less access to medical care, are more likely to be malnourished, poor, and illiterate, and even work longer and harder. The situation exacerbates women’s reproductive role, which increases their vulnerability to morbidity and mortality.”

With economic decline in the 80s, and the implementation of structural adjustment measures that resulted in cutbacks in funding and the introduction of cost sharing in a sector where from independence the government had borne the cost of providing free healthcare, the effects were inevitably felt most by the poor, the majority of who — in Kenya as in the rest of the world — are women.

A more recent review of studies carried out on the effect of SAPs on child and maternal health published in 2017 finds that “in their current form, structural adjustment programmes are incongruous with achieving SDGs [Sustainable Development Goals] 3.1 and 3.2, which stipulate reductions in neonatal, under-5, and maternal mortality rates. It is telling that even the IMF’s Independent Evaluation Office, in assessing the performance of structural adjustment loans, noted that ‘outcomes such as maternal and infant mortality rates have generally not improved.’”

The review also says that “adjustment programmes commonly promote decentralisation of health systems [which] may produce a more fractious and unequal implementation of services — including those for child and maternal health — nationally. Furthermore, lack of co-ordination in decentralised systems can hinder efforts to combat major disease outbreaks”. Well, we are in the throes of a devastating global pandemic which has brought this observation into sharp relief. According to the Ministry of Health, as of the 6th of April, 325,592 people had been vaccinated against COVID-19. Of those, 33 per cent were in Nairobi County, which accounts for just 9.2 per cent of the country’s total population of 47,564,296 people.

The Constitution of Kenya 2010 provides the legal framework for a rights-based approach to health and is the basis for the rollout of Universal Health Coverage (UHC) that was announced by President Uhuru Kenyatta on 12 December 2018 — with the customary fanfare — as part of the “Big Four Agenda” to be fulfilled before his departure in 2022.

However, a KEMRI-Wellcome Trust policy brief states that UHC is still some distance to achieving 100 per cent population coverage and recommends that “the Kenyan government should increase public financing of the health sector. Specifically, the level of public funding for healthcare in Kenya should double, if the threshold (5% of GDP) … is to be reached” and that “Kenya should reorient its health financing strategy away from a focus on contributory, voluntary health insurance, and instead recognize that increased tax funding is critical.”

These recommendations, it would seem to me, run counter to the conditionalities habitually imposed by the IMF and it is therefore not clear how the government will deliver UHC nation-wide by next year if this latest SAP is accompanied by budgetary cutbacks in the healthcare sector.

With the coronavirus graft scandal and the disappearance of medical supplies donated by Jack Ma still fresh on their minds, Kenyans are not inclined to believe that the IMF billions will indeed go to “support[ing] the next phase of the authorities’ COVID-19 response and their plan to reduce debt vulnerabilities while safeguarding resources to protect vulnerable groups”, as the IMF has claimed.

#KOT have — with outrage, with humour, vociferously — rejected this latest loan, tweeting the IMF in their hundreds and inundating the organisation’s Facebook page with demands that the IMF rescind its decision. An online petition had garnered more than 200,000 signatures within days of the IMF’s announcement. Whether the IMF will review its decision is moot. The prevailing economic climate is such that we are damned if we do take the loan, and damned if we don’t.

Structural adjustment supposedly “encourages countries to become economically self-sufficient by creating an environment that is friendly to innovation, investment and growth”, but the recidivist nature of the programmes suggests that either the Kenyan government is a recalcitrant pupil or SAPs simply don’t work. I would say it is both.

But the Kenyan government has not just been a recalcitrant pupil; it has also been a consistently profligate one. While SAPs do indeed provide for “safeguarding resources to protect vulnerable groups”, political choices are made that sacrifice the welfare of the ordinary Kenyan at the altar of grandiose infrastructure projects, based on the fiction peddled by international financial institutions that infrastructure-led growth can generate enough income to service debt. And when resources are not being wasted on “legacy” projects, they are embezzled on a scale that literally boggles the mind. We can no longer speak of runaway corruption; a new lexicon is required to describe this phenomenon which pervades every facet of our lives and which has rendered the years of sacrifice our parents endured meaningless and put us in debt bondage for many more generations to come. David Ndii long warned us that this moment was coming. It is here.

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East Africa: A ‘Hotbed of Terror’

African states are involved in the War on Terror more than we think. They’re surrounded by an eco-system of the war industry.

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In late January, reports circulated on social media about a suspected US drone strike in southern Somalia, in the Al-Shabaab controlled Ma’moodow town in Bakool province. Debate quickly ensued on Twitter about whether the newly installed Biden administration was responsible for this strike, which was reported to have occurred at 10 p.m. local time on January 29th, 2021.

Southern Somalia has been the target of an unprecedented escalation of US drone strikes in the last several years, with approximately 900 to 1,000 people killed between 2016 and 2019. According to the nonprofit group Airwars, which monitors and assesses civilian harm from airpower-dominated international military actions, “it was under the Obama administration that a significant US drone and airstrike campaign began,” coupled with the deployment of Special Operations forces inside the country.

Soon after Donald Trump took office in 2017, he signed a directive designating parts of Somalia “areas of active hostilities.” While the US never formally declared war in Somalia, Trump effectively instituted war-zone targeting rules by expanding the discretionary authority of the military to conduct airstrikes and raids. Thus the debate over the January 29 strike largely hinged on the question of whether President Joe Biden was upholding Trump’s “flexible” approach to drone warfare―one that sanctioned more airstrikes in Somalia in the first seven months of 2020 than were carried out during the administrations of George W. Bush and Barack Obama, combined.

In the days following the January 29 strike, the US Military’s Africa Command (AFRICOM) denied responsibility, claiming that the last US military action in Somalia occurred on January 19, the last full day of the Trump presidency. Responding to an inquiry from Airwars, AFRICOM’s public affairs team announced:

We are aware of the reporting. US Africa Command was not involved in the Jan. 29 action referenced below. US Africa Command last strike was conducted on Jan. 19. Our policy of acknowledging all airstrikes by either press release or response to query has not changed.

In early March, The New York Times reported that the Biden administration had in fact imposed temporary limits on the Trump-era directives, thereby constraining drone strikes outside of “conventional battlefield zones.” In practice, this means that the US military and the CIA now require White House permission to pursue terror suspects in places like Somalia and Yemen where the US is not “officially” at war. This does not necessarily reflect a permanent change in policy, but rather a stopgap measure while the Biden administration develops “its own policy and procedures for counterterrorism kill-or-capture operations outside war zones.”

If we take AFRICOM at its word about January 29th, this provokes the question of who was behind that particular strike. Following AFRICOM’s denial of responsibility, analysts at Airwars concluded that the strike was likely carried out by forces from the African Union peacekeeping mission in Somali (AMISOM) or by Ethiopian troops, as it occurred soon after Al-Shabaab fighters had ambushed a contingent of Ethiopian troops in the area. If indeed the military of an African state is responsible for the bombing, what does this mean for our analysis of the security assemblages that sustain the US’s war-making apparatus in Africa?

Thanks to the work of scholars, activists, and investigative journalists, we have a growing understanding of what AFRICOM operations look like in practice. Maps of logistics hubs, forward operating sites, cooperative security locations, and contingency locations―from Mali and Niger to Kenya and Djibouti―capture the infrastructures that facilitate militarism and war on a global scale. Yet what the events of January 29th suggest is that AFRICOM is situated within, and often reliant upon, less scrutinized war-making infrastructures that, like those of the United States, claim to operate in the name of security.

A careful examination of the geographies of the US’s so-called war on terror in East Africa points not to one unified structure in the form of AFRICOM, but to multiple, interconnected geopolitical projects. Inspired by the abolitionist thought of Ruth Wilson Gilmore, who cautions activists against focusing exclusively on any one site of violent exception like the prison, I am interested in the relational geographies that sustain the imperial war-making infrastructure in Africa today. Just as the modern prison is “a central but by no means singularly defining institution of carceral geography,” AFRICOM is a fundamental but by no means singularly defining instrument of war-making in Africa today.

Since the US military’s embarrassing exit from Somalia in 1993, the US has shifted from a boots-on-the ground approach to imperial warfare, instead relying on African militaries, private contractors, clandestine ground operations, and drone strikes. To singularly focus on AFRICOM’s drone warfare is therefore to miss the wider matrix of militarized violence that is at work. As Madiha Tahir reminds us, attack drones are only the most visible element of what she refers to as “distributed empire”—differentially distributed opaque networks of technologies and actors that augment the reach of the war on terror to govern more bodies and spaces. This dispersal of power requires careful consideration of the racialized labor that sustains war-making in Somalia, and of the geographical implications of this labor. The vast array of actors involved in the war against Al-Shabaab has generated political and economic entanglements that extend well beyond the territory of Somalia itself.

Ethiopia was the first African military to intervene in Somalia in December 2006, sending thousands of troops across the border, but it did not do so alone. Ethiopia’s effort was backed by US aerial reconnaissance and satellite surveillance, signaling the entanglement of at least two geopolitical projects. While the US was focused on threats from actors with alleged ties to Al-Qaeda, Ethiopia had its own concerns about irredentism and the potential for its then-rival Eritrea to fund Somali militants that would infiltrate and destabilize Ethiopia. As Ethiopian troops drove Somali militant leaders into exile, more violent factions emerged in their place. In short, the 2006 invasion planted the seeds for the growth of what is now known as Al-Shabaab.

The United Nations soon authorized an African Union peacekeeping operation (AMISOM) to “stabilize” Somalia. What began as a small deployment of 1,650 peacekeepers in 2007 gradually transformed into a number that exceeded 22,000 by 2014. The African Union has emerged as a key subcontractor of migrant military labor in Somalia: troops from Burundi, Djibouti, Ethiopia, Kenya, and Uganda deployed to fight Al-Shabaab are paid significantly higher salaries than they receive back home, and their governments obtain generous military aid packages from the US, UK, and increasingly the European Union in the name of “security.”

But because these are African troops rather than American ones, we hear little of lives lost, or of salaries not paid. The rhetoric of “peacekeeping” makes AMISOM seem something other than what it is in practice—a state-sanctioned, transnational apparatus of violent labor that exploits group-differentiated vulnerability to premature death. (This is also how Gilmore defines racism.)

Meanwhile, Somali analyst Abukar Arman uses the term “predatory capitalism” to describe the hidden economic deals that accompany the so-called stabilization effort, such as “capacity-building” programs for the Somali security apparatus that serve as a cover for oil and gas companies to obtain exploration and drilling rights. Kenya is an important example of a “partner” state that has now become imbricated in this economy of war. Following the Kenya Defense Forces (KDF) invasion of Somalia in October 2011, the African Union’s readiness to incorporate Kenyan troops into AMISOM was a strategic victory for Kenya, as it provided a veneer of legitimacy for maintaining what has amounted to a decade-long military occupation of southern Somalia.

Through carefully constructed discourses of threat that build on colonial-era mappings of alterity in relation to Somalis, the Kenyan political elite have worked to divert attention away from internal troubles and from the economic interests that have shaped its involvement in Somalia. From collusion with Al-Shabaab in the illicit cross-border trade in sugar and charcoal, to pursuing a strategic foothold in offshore oil fields, Kenya is sufficiently ensnared in the business of war that, as Horace Campbell observes, “it is not in the interest of those involved in this business to have peace.”

What began as purportedly targeted interventions spawned increasingly broader projects that expanded across multiple geographies. In the early stages of AMISOM troop deployment, for example, one-third of Mogadishu’s population abandoned the city due to the violence caused by confrontations between the mission and Al-Shabaab forces, with many seeking refuge in Kenya. While the mission’s initial rules of engagement permitted the use of force only when necessary, it gradually assumed an offensive role, engaging in counterinsurgency and counterterror operations.

Rather than weaken Al-Shabaab, the UN Monitoring Group on Somalia observed that offensive military operations exacerbated insecurity. According to the UN, the dislodgment of Al-Shabaab from major urban centers “has prompted its further spread into the broader Horn of Africa region” and resulted in repeated displacements of people from their homes. Meanwhile, targeted operations against individuals with suspected ties to Al-Shabaab are unfolding not only in Somalia itself, but equally in neighboring countries like Kenya, where US-trained Kenyan police employ military tactics of tracking and targeting potential suspects, contributing to what one Kenyan rights group referred to as an “epidemic” of extrajudicial killings and disappearances.

Finally, the fact that some of AMISOM’s troop-contributing states have conducted their own aerial assaults against Al-Shabaab in Somalia demands further attention. A December 2017 United Nations report, for example, alleged that unauthorized Kenyan airstrikes had contributed to at least 40 civilian deaths in a 22-month period between 2015 and 2017. In May 2020, senior military officials in the Somali National Army accused the Kenyan military of indiscriminately bombing pastoralists in the Gedo region, where the KDF reportedly conducted over 50 airstrikes in a two week period. And in January 2021, one week prior to the January 29 strike that Airwars ascribed to Ethiopia, Uganda employed its own fleet of helicopter gunships to launch a simultaneous ground and air assault in southern Somalia, contributing to the deaths—according to the Ugandan military—of 189 people, allegedly all Al-Shabaab fighters.

While each of the governments in question are formally allies of the US, their actions are not reducible to US directives. War making in Somalia relies on contingent and fluid alliances that evolve over time, as each set of actors evaluates and reevaluates their interests. The ability of Ethiopia, Kenya, and Uganda to maintain their own war-making projects requires the active or tacit collaboration of various actors at the national level, including politicians who sanction the purchase of military hardware, political and business elite who glorify militarized masculinities and femininities, media houses that censor the brutalities of war, logistics companies that facilitate the movement of supplies, and the troops themselves, whose morale and faith in their mission must be sustained.

As the Biden administration seeks to restore the image of the United States abroad, it is possible that AFRICOM will gradually assume a backseat role in counterterror operations in Somalia. Officially, at least, US troops have been withdrawn and repositioned in Kenya and Djibouti, while African troops remain on the ground in Somalia. Relying more heavily on its partners in the region would enable the US to offset the public scrutiny and liability that comes with its own direct involvement.

But if our focus is exclusively on the US, then we succumb to its tactics of invisibility and invincibility, and we fail to reckon with the reality that the East African warscape is a terrain shaped by interconnected modes of power. The necessary struggle to abolish AFRICOM requires that we recognize its entanglement in and reliance upon other war-making assemblages, and that we distribute our activism accordingly. Recounting that resistance itself has long been framed as “terrorism,” we would do well to learn from those across the continent who, in various ways over the years, have pushed back, often at a heavy price.

This post is from a partnership between Africa Is a Country and The Elephant. We will be publishing a series of posts from their site once a week.
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