Politics
Customers, Not Patients: The Nairobi Women’s Hospital Saga
15 min read.How did a hospital dedicated to women’s health end up being managed like a cut-throat business where those seeking medical attention are treated like customers rather than patients, and where the bottom line is more important than healthcare?
From Nairobi, Dr. Felix Wanjala texts the following on a work Whatsapp group: “Team, let’s ensure we don’t let the team down…let’s meet our target.”
Without context, this might appear like a harmless motivational speech from a boss to his subordinates. But the context here is this: Dr. Wanjala is the CEO of Nairobi Women’s Hospital (NWH). In the message immediately before that, he had forwarded a text listing the admission numbers across all the hospital’s branches in the country. “We have the numbers as follows at this hour,” the CEO wrote to his employees, and then listed admissions totaling 288 across the hospital group.
The target, and the context of the war cry not to let the rest of the team down, he went on, was to have 22 more admissions. To do this, the CEO recommended that his team, based at one of NWH’s two branches in Nakuru (called Nakuru Hyrax), “start with looking for referrals”, not miss “any opportunity”, and be “very vigilant in casualty.”
In multiple texts covering different days in 2017 and 2018, the Whatsapp group resembled a trading floor, with Dr. Wanjala and his Chief Operations Officer, Eunice Munyingi, pushing employees to work harder to increase admissions. On the first day of July, for example, Eunice wrote in reply to the nurse in charge of the hospital chain: “Let us increase speed 2 admissions against 13 discharges at this hour not good.”
Two minutes later, the CEO added, “It’s our striking time. Let’s intensify our effort…replace all discharges by 6pm.”
Five days later, at 7:28 p.m., the COO told to the Nakuru branch staff to “get 3 admissions by 9pm.”
Several interviews with whistleblowers describe a corporate culture of being pushed to meet admission targets. “Although it was not said explicitly,” one former member of the NWH said, “the implication was that doctors and nurses in particular had to find reasons to admit patients to meet the hourly and daily targets, even if those reasons were an absolute lie.”
Another added that there was a financial reward paid to clinical officers for each admission; but they still had to write down why they were admitting each patient. This meant they had to get creative to meet targets, both personal ones and those of their employer.
Origins
Founded two decades ago by a young gynaecologist called Dr. Sam Thenya, Nairobi Women’s Hospital began with a unique specialisation. The focus of its first branch in Hurlingham was solely obstetrics and gynaecological services, meaning its primary clients were women. It became particularly known for its Gender Violence Recovery Center (GVRC), a charitable arm that serves survivors of sexual and domestic violence.
“I was working in a hospital and I had pitched this idea to the CEO of that hospital, but he wasn’t very keen on the idea of taking in abused women for free,” the hospital’s founder told Business Daily in November 2016.
“One time he told me that if I thought the idea would work then I should go ahead and open my own hospital because it wasn’t going to work at that hospital and right there I thought to myself, ‘Why not?’”
So at the age of 31, Dr. Sam Thenya took up his boss’s challenge.
The thing that drove him to start the hospital when he had no money, he told the interviewer, was a “certain trigger, madness or passion”. His singular goal, despite the challenges almost as soon as he started, was to build one of the most familiar, respected private hospitals in the capital city.
“Although it was not said explicitly,” one former member of the NWH said, “the implication was that doctors and nurses in particular had to find reasons to admit patients to meet the hourly and daily targets, even if those reasons were an absolute lie.”
For the hospital to survive without taking in more investors or money, it needed to scale up fast, and build solid revenue streams that included donor funding for its GVRC charity. It also had to wade through the rough early 2000s, as Kenyan systems tried to reset themselves.
In 2003, for example, the hospital’s banker, Daima Bank, collapsed. Dr. Thenya, still in the early years of his project, heard the devastating news while he was fuelling his car at a petrol station. “We had just issued suppliers cheques,” he said in the interview.
Despite such and other challenges, Dr. Thenya and the hospital he built surged on.
He transformed from a practising gynaecologist to an entrepreneur. He also sold the hospital for a fortune, and was on his way out as the founding CEO. Although he stayed on after resigning as CEO, his armophous role as Director of Strategy didn’t mean much.
In a scenario that exemplifies the fine line between private healthcare as a business and a service, Dr. Thenya had to fight with politicians, including President Uhuru Kenyatta, and technocrats who had demanded the release of patients (alive or dead) over bills.
Once, he told the interviewer, the President called him and told him someone had sent him an e-mail that the body of his/her mother was being held hostage by NWH over unpaid bills.
“Sam, what do we do?” the President asked.
“Your Excellency, the bill has to be paid,” Dr. Thenya answered.
After the President said he would pay the bill, and asked the body be released while he did it, Dr. Thenya replied, “I need some proof of payment of some pre-payment today.”
“If you want me to release it today,” he went on, “then pay today.”
By this point, a lot had changed.
Born in Nyakihai, Murang’a, in 1968, a much younger Sam Thenya had wanted to be a pilot. But he became a doctor instead. As a young doctor in training, he led a strike at Nyeri Provincial General Hospital in the early 1990s. The issue, which was fixed because of the strike, was bad working conditions for medical practitioners.
“I am not one who stands by and watches things deteriorate,” he told an interviewer in 2011.
What finally drove him to ask his boss to start a wing for victims of sexual violence, and doing it himself when he was challenged, was meeting the victim of a brutal gang rape. Battered, violated, and in need of urgent medical care, she did not have money to pay for admission.
“I paid for her admission and closely monitored her progress.”
The past
As a young doctor, Dr. Sam Thenya was unstoppable in his mission to build Nairobi Women’s Hospital. In October 2000, a hospital called Hurlingham Hospital was on auction for unpaid debts. Dr. Thenya approached the auctioneers with a promise to buy the hospital. It was an attractive deal for both sides: the auctioneers would get rid of an asset few can or want to buy, and the young doctor could build a hospital from scratch.
But there was one problem, a big one. He had no money.
The most he could raise was half a million shillings, which he did by selling his wife’s car. He needed 17 million more, so he got other investors to put in the money and take a share of the repainted hospital’s ownership.
In the world of modern finance, this seemingly brilliant financing strategy has a name. It is called a leveraged buyout (LBO). It works exactly how Dr. Thenya did it: you buy a company by taking in debt and giving up equity, which means you do not need a single coin to start whatever enterprise you want to start. The assets of the thing you are buying, with money that is not yours, serve as the collateral in case the enterprise doesn’t prosper.
The most famous LBO in the world is the hostile takeover of an American company called RJR Nabisco. In 1989, the executives of the conglomerate, which sold tobacco and food products, including the world famous Oreo cookies, started an unstoppable process to acquire the entire company at $75 a share.
The events that followed that ignition are covered in Barbarians at the Gate: The Fall of RJR Nabisco, a book (and movie) written by two American journalists. It covers the executives’ plan to buy out other shareholders, and the marathon that began when other groups of people joined in on the race to acquire one of the biggest companies in the world. One of them finally won, by offering a price higher, by $15 a share, than the management team’s offer.
But the best of this story is that none of them, even the executives who wanted to buy a company for $25 billion, actually had the money. They didn’t need to. In the great game of modern finance where money is an idea, one person quoted in the book says, you need more money to start a shoeshine store than you do to buy a 2 billion-dollar company.
The gist is to start what is called, in modern finance, a fundless fund –simply a corporate body that on the one hand promises to and negotiates to buy something, while asking for money from those who have it to complete the deal. For investors with vast amounts of money on hand, this is an investment for which they expect to see profits.
In the world of modern finance, this seemingly brilliant financing strategy has a name. It is called a leveraged buyout (LBO). It works exactly how Dr. Thenya did it: you buy a company by taking in debt and giving up equity, which means you do not need a single coin to start whatever enterprise you want to start.
Dr. Thenya gave up 40 percent of NWH’s ownership to the investors who gave him the $50 million (in total) to buy the assets of Hurlingham Hospital, and to repaint it afresh as Nairobi Women’s Hospital. As the new hospital grew on the back of its reputation as a niche healthcare provider, Dr. Thenya progressively bought out the investors, and by the late 2000s, owned the entire thing.
As they left, presumably after making a profit, Dr. Thenya expanded his enterprise just in time. The 2008 financial crash was wreaking havoc in Western markets, starting first in the mortgage industry and eventually spreading its tentacles to the heart of multiple economies. For private equity funds, which had had their best years right before the crash, it was time to find other markets to play in.
In 2009, Dr. Sam Thenya acquired Masaba Hospital in Adams Arcade, and turned it into the second Nairobi Women’s Hospital branch. By the end of the next decade, there would be a total of nine Nairobi Women’s Hospitals: four in the capital city and the metropolis; two in Nakuru; and one each in Naivasha, Meru, and Mombasa.
From a single hospital in Hurlingham, Nairobi Women’s Hospital was one of the fastest-growing hospital chains in Kenya by the mid-2010s. But things had changed. In the first decade, Dr. Thenya had quit practising to concentrate on the business side of his hospital.
“I realised that I was not giving my patients full attention because I was often caught up in strategy meetings,” he said in later years, “[so] I had to choose between expanding the hospital and practising.”
And in several transactions beginning in 2010, he had progressively sold his ownership stake in the hospital to the successor of leveraged buyouts in modern finance; a similar but differently named structure called a private equity fund.
The present
A private equity (PE) firm is a leveraged buyout by another name, with very few significant differences. Simply, you get money from wealthy individuals and organisations, such as pension funds and charities, and buy attractive companies. Then you restructure them by cutting costs, expanding as fast as possible, extracting as much revenue as you can, and then selling them for a profit.
The basis of this model of financing is to buy and sell, as opposed to keeping an investment in perpetuity. So PE firms strip their new companies of any sellable assets, change the management, reduce costs by firing professionals and employing cheaper labour, pay executives bonuses for meeting targets, and once the company is attractive enough on paper, sell it to someone else. That new buyer is often just another PE firm.
In the complicated structures of global commerce, private equity funds are used to finance rapid expansion, which increases the value of the assets. Investors, who include funds of funds, where one investment fund invests in another investment fund, expect a return in investment. And investment funds get money by promising exactly that.
PE funds themselves make money in two ways: by charging an annual management fee of the money they have been trusted with, calculated as a percentage, and by taking a cut of the profits they make when they sell the companies they buy. So their primary motivation is to get more investor money, and to restructure companies as fast as possible to attract a higher price than they bought it for.
One of the things PE funds do when they acquire a company is to transition it from a founder-run company into a corporate body that can attract a higher price. This is exactly what happened at Nairobi Women’s Hospital from the first funding round in 2010, where Dr. Sam Thenya’s ownership systematically reduced as the new owners’ ownership stake increased.
In the midst of the “Africa Rising” narrative, and from the ashes of the 2008 global crisis, billionaires and institutional investors in the West turned their investment focus on Africa. The continent’s young population offered an attractive proposition for profit-making ventures; it was expected that not only would these younger Africans be richer than their parents, and willing to spend more on everything, but that there were no modern legal or regulatory structures in place to halt corporate raids of existing companies. And by the time they came, several rounds of investors would have already made enough profits.
In 2010, Dr. Sam Thenya got $2.66 million for part of his stake in the hospital. The buyer, The Abraaj Group, which would collapse in 2018 amidst investigations that its founder and executives had stolen investor funds, was founded by a Pakistani based in Dubai. In addition to Nairobi Women’s Hospital, it also acquired all or parts of other Kenyan companies: Java House (100%); Brookside Dairy (10%); and Seven Sea Technology (21%).
But its most prominent purchases were in private healthcare, where it bought 18 clinics and 10 major hospitals. In addition to its stake in Nairobi Women’s, it also bought part of Avenue Group Hospital, Ladnan Hospital, and Metropolitan Hospital.
Three years later, Abraaj bought more of Nairobi Women’s with a partner PE firm called Swedfund. The Swedish government describes Swedfund, which it funds and owns, as a “development financier and development cooperation actor”; but it works in basically the same way privately-owned PE firms do.
“The objective of the Africa Health Fund is to increase access to affordable and quality health-related goods and services for those at the bottom of the income pyramid,” Swedfund said in a press release dated 22nd November 2013. “At the same time it hopes to provide investors with good long term financial returns.”
This dual-purpose fit into Dr. Thenya’s founding principles, which had been to build a hospital that offered services to abused women for free, while offering other medical and surgical services at a fee. Swedfund, which said it “put a high emphasis on environmental, social and governance issues”, and other investors were investing in the hospital to fund its expansion.
In 2010, Dr. Sam Thenya got $2.66 million for part of his stake in the hospital. The buyer, The Abraaj Group, which would collapse in 2018 amidst investigations that its founder and executives had stolen investor funds, was founded by a Pakistani based in Dubai.
From a single branch, Nairobi Women’s Hospital had expanded to three hospitals: one in Adams Arcade founded in 2009, another in Ongata Rongai founded in 2011, and the Nakuru branch which followed a year later. It also had two medical centers in Kitengela and Eastleigh, both opened in 2012, and two more branches, in Mombasa and Kisumu, on the way.
This was all, the Swedish state investor said, “part of a the grand plan to expand further in the country and the Eastern African region by 2016; and subsequently into the rest of Africa.”
The thoroughfare
While the source of Swedfund’s finances is obvious, the source of The Abraaj Group’s funds is a more interesting story because it led to its death in 2018, and the arrest of its top executives.
Because PE funds run multiple projects at any one time, they structure them as independent funds with their own fund managers. The specific one that invested in private healthcare in Kenya beginning in the late 2000s was called The Abraaj Growth Markets Health (Africa) Fund. It got its $1 billion to invest in Kenya and other countries from multiple sources, the most prominent being the Bill & Melinda Gates Foundation and the World Bank’s private equity fund, the International Finance Corporation (IFC).
The second deal, which reduced Dr. Thenya’s ownership even further, was worth $6.5 million.
The Dubai-based Abraaj Group, founded a year after Dr. Thenya started Nairobi Women’s, was a renowned investor in multiple sectors across the continent. By the time it collapsed in 2018 amidst a dispute with its investors, the Bill & Melinda Gates Foundation had initiated an audit into how its money in the healthcare fund had been used; it had invested an estimated Sh320 billion in 80 transactions across Africa.
Through the fund, part of which the PE firm’s founder, a Pakistani man called Arif Naqvi, was accused of misusing, Abraaj owned private hospitals in Kenya, Nigeria, and Pakistan. In April 2018, around the same time the screenshots of the Nairobi Women’s Hyrax Whatsapp group were revealed, Naqvi was arrested in Britain on a US warrant.
Naqvi had resigned from Abraaj the month before investigators found evidence that he had defrauded investors in two ways: by inflating the price of assets, which included Nairobi Women’s Hospitals and several other Kenyan private healthcare providers, and misappropriating the fund.
The scandal made headlines around the world, as many other similar investment structures had ridden on the Africa Rising wave and bought many companies, in many countries, on the continent. Meanwhile, The Abraaj Group was closed and its assets stripped for parts by other PE firms. A British firm took over its stakes in Brookside Dairy and Java; an American PE firm called TPG acquired the healthcare fund, which counted among its assets several Kenyan hospitals. TPG then renamed the fund the Evercare Health Fund to avoid the negative reputation of its former name and manager.
These high finance events and deals all took place outside of Kenya, but in the end TPG owned Nairobi Women’s Hospital and several other private hospitals in the country.
Meanwhile, Arif Naviq remains in the UK, and not by choice. Last May, after he had spent a year in custody, he was granted a record $20 million bail. By October, he was also being investigated for bribing Pakistani politicians.
While this complicated game of international finance was happening, the private hospitals in Kenya were still operational, and still working to make profits for the fund, as their investors sorted a new PE firm to “buy” and run them.
In a text forwarded to the Nakuru Hyrax staff on 11th September 2018, CEO Dr. Felix Wanjala outlined the revenues so far, and the targets he expected them to contribute during the course of that day. The Nairobi Women’s Hospital group was making Sh12.81 million a day against a target of Sh15.47 million, and cumulatively was Sh33 million off a total target of Sh170 million.
“Team this revenue is too low for the numbers that we have, are we billing,” he posed to the staff.
The shift from Dr. Thenya’s ownership and leadership to the PE funds had launched what was typical corporate behaviour after acquiring a new asset. Nairobi Women’s Hospital had, over time, stopped hiring medical officers (MOs), professionals in waiting who are mostly post-graduate students, to serve outpatient patients. It had instead turned to hiring young clinical officers (COs), who (at the time) only had a diploma earned after three years of training, to do the job.
To staff its rapid expansion, Nairobi Women’s was now depending on COs to serve patients who were not already admitted in the hospital. It was also encouraging them, according to multiple insiders, to meet admission and revenue targets, which were analysed every hour of every day, day and night. While the hospital still hired specialists, it hired less than it required (because MOs demand better salaries) and gave clinical officers the job of determining which patient needed to be admitted. It also gave the COs a financial incentive, at one point 710 shillings per patient they admitted.
This structure meant that while COs would find and push for admissions, even (and especially when) they were unnecessary, more qualified medical officers would only encounter the patients when they had already been admitted, and were already paying for the bed, food, tests, and medicines. They were already, in lingo used frequently in the leaked Whatsapp group messages, customers.
Nairobi Women’s Hospital had, over time, stopped hiring medical officers (MOs) to serve outpatient patients. It had instead turned to hiring young clinical officers (COs), who (at the time) only had a diploma earned after three years of training, to do the job.
Once they were in the hospital, the top management of Nairobi Women’s encouraged the staff, everyone in the Whatsapp group, medical and non-medical staff included, to keep them admitted for longer.
In another text, for example, CEO Dr. Felix Wanjala asked his staff “how did we end up at 18 discharges from 10 planned.” The text included an emoji of a sad face, suggesting he was unhappy with the situation. His COO, Eunice Munyingi, then asked someone called Victoria to answer the CEO. Victoria then passed the question to two other people, before the CEO responded “Vikki calm down…we expect better performance in future. Obviously this is not good for us.”
Medical officers and other specialists who worked at Nairobi Women’s at the time describe multiple instances of being pushed to keep patients for longer than necessary. In a text sent at 8:04 am on 11 November 2018, COO Eunice Munyingi told the staff to “lock discharges at 7” and to “…kindly start now.”
This meant that if you were admitted at this particular Nairobi Women’s Hospital, and should have been released to go home, the decision of whether to let you go was based on revenue and admission targets, not on your health. In the texts, the senior executives ask staff to post hourly updates of the branch’s status, specifically how many people are being served and how much money was made, and cheer them on in language a media practitioner described as “better suited for a trading floor than a hospital management team”.
Courtesy of SHOWTIME
The comparison to a trading floor is poignant, because insiders describe an internal system that fits the script of the popular TV series Billions, with a CEO-COO dynamic similar to that of the characters Bobby Axelrod and Mike “Wags” Wagner in the show.
The similarities with a fictional TV show do not end there because the two characters run a ruthless private equity firm that buys companies, restructures them by any means necessary, legal or otherwise, and sells them over for a profit.
Like a PE firm and any modern enterprise, the top management of Nairobi Women’s also kept tabs on its reputation online. In one screenshot from 2017, the then clinical services in-charge, Victoria Wawira, posted a screenshot of a Facebook post written by a woman who had commented on their hurry to admit her child. Whenever she took her daughter to the hospital, “…The doc sees her and immediately its admission no second thought about medication,” she’d written on a Nakuru Country Mums group on Facebook.
In follow-up messages, Victoria told two clinical officers that the post was “trending on FB” and that they should “vet admissions”. In any other context, this would mean that the two COs should make sure they were admitting only patients who needed to be admitted. But in this particular context, it meant one thing – that they should check that they didn’t admit potentially problematic patients who would be suspicious of the need for them to move from outpatient to inpatient.
Medical officers and other specialists who worked at Nairobi Women’s at the time describe multiple instances of being pushed to keep patients for longer than necessary. In a text sent at 8:04 a.m on 11 November 2018, COO Eunice Munyingi told the staff to “lock discharges at 7” and to “…kindly start now.”
Bad publicity meant not just harm to the hospital’s reputation, but it could also hurt the bottom line if future buyers, well-meaning investors, and nosy reporters found the posts and figured out how Nairobi Women’s was achieving its spectacular service and revenue targets.
The chaos, and reasons why we seek medical attention, meant patients caught up in this great game of corporate greed, and trusting their doctors to know what was best to restore their health, did not know better. They would have sell assets, sacrifice savings, hold fundraisers both online and offline, and do whatever was necessary to pay their hospital bills, without ever knowing that they had been unsuspecting victims of the vagaries of modern finance, and the focus on Africa that followed the 2008 financial crisis.
In Part II, the author examines how we let this happen, how other hospitals do it too, and how other countries have warded off the barbarians at the gates.
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Politics
Risks and Opportunities of Admitting Somalia Into the EAC
The process of integrating Somalia into the EAC should be undertaken with long-term success in mind rather than in the light of the situation currently prevailing in the country.
The East African Community (EAC), whose goal is to achieve economic and political federation, brings together three former British colonies – Kenya, Uganda, Tanzania – and newer members Rwanda, Burundi, South Sudan, and most recently the Democratic Republic of Congo.
Somalia first applied to join the EAC in 2012 but with fighting still ongoing on the outskirts of Mogadishu, joining the bloc was impossible at the time. Eleven years later, joining the bloc would consolidate the significant progress in governance and security and, therefore, Somalia should be admitted into the EAC without undue delay. This is for several reasons.
First, Somalia’s admission would be built on an existing foundation of goodwill that the current leadership of Somalia and EAC partner states have enjoyed in the recent past. It is on the basis of this friendship that EAC states continue to play host to Somali nationals who have been forced to leave their country due to the insecurity resulting from the prolonged conflict. In addition, not only does Somalia share a border with Kenya, but it also has strong historical, linguistic, economic and socio-cultural links with all the other EAC partner states in one way or another.
Dr Hassan Khannenje of the Horn Institute for Strategic Studies said: ”Somalia is a natural member of the EAC and should have been part of it long ago.”
A scrutiny of all the EAC member states will show that there is a thriving entrepreneurial Somali diaspora population in all their economies. If indeed the EAC is keen to realise its idea of the bloc being a people-centred community as opposed to being a club of elites, then a look at the spread of Somali diaspora investment in the region would be a start. With an immense entrepreneurial diaspora, Somalia’s admission will increase trading opportunities in the region.
Second, Somalia’s 3,000 km of coastline (the longest in Africa) will give the partner states access to the Indian Ocean corridor to the Gulf of Aden. The governments of the EAC partner states consider the Indian Ocean to be a key strategic and economic theatre for their regional economic interests. Therefore, a secure and stable Somali coastline is central to the region’s maritime trade opportunities.
Despite possessing such a vast maritime resource, the continued insecurity in Somalia has limited the benefits that could accrue from it. The problem of piracy is one example that shows that continued lawlessness along the Somali coast presents a huge risk for all the states that rely on it in the region.
The importance of the maritime domain and the Indian Ocean has seen Kenya and Somalia square it out at the International Court of Justice over a maritime border dispute.
Omar Mahmood of the International Crisis Group said that ”Somalia joining the EAC then might present an opportunity to discuss deeper cooperation frameworks within the bloc, including around the Kenya-Somalia maritime dispute. The environment was not as conducive to collaboration before, and perhaps it explains why the ICJ came in. Integrating into the EAC potentially offers an opportunity to de-escalate any remaining tensions and in turn, focus on developing mechanisms that can be beneficial for the region.”
Nasong’o Muliro, a foreign policy and security specialist in the region, said: “The East African states along the East African coast are looking for opportunities to play a greater role in the maritime security to the Gulf of Aden. Therefore, Somalia joining the EAC bloc will allow them to have a greater say.”
Third, Somalia’s membership of the Arab League means that there is a strong geopolitical interest from Gulf states like Saudi Arabia, Qatar and the United Arab Emirates. However, Somalia stands to gain more in the long-term by joining the EAC rather than being under the control of the Gulf states and, to a large extent, Turkey. This is because, historically, competing interests among the Gulf states have contributed to the further balkanisation of Somalia by some members supporting breakaway regions.
On the other hand, the EAC offers a safer option that will respect Somalia’s territorial integrity. Furthermore, EAC partner states have stood in solidarity with Somalia during the difficult times of the civil conflict, unlike the Gulf states. The majority of the troop-contributing countries for the African Union Mission to Somalia came from the EAC partner states of Uganda, Kenya and Burundi. Despite having a strategic interest in Somalia, none of the Gulf states contributed troops to the mission. Therefore, with the expected drawdown of the ATMIS force in Somalia, the burden could fall on the EAC to fill in the vacuum. Building on the experience of deploying in the Eastern Democratic Republic of Congo, it is highly likely that it could be called upon to do the same in Somalia when ATMIS exits by 2024.
The presence of the Al Shabaab group in Somalia is an albatross around its neck such that the country cannot be admitted into the EAC without factoring in the risks posed by the group.
According to a report by the International Crisis Group, the government of Somalia must move to consolidate these gains – especially in central Somalia – as it continues with its offensive in other regions. However, Somalia may not prevail over the Al Shabaab on its own; it may require a regional effort and perhaps this is the rationale some policymakers within the EAC have envisioned. If the EAC can offer assurances to Somalia’s fledgling security situation, then a collective security strategy from the bloc might be of significance.
Somalia’s admission comes with risks too. Kenya and Uganda have in the past experienced attacks perpetrated by Al Shabaab and, therefore, opening up their borders to Somalia is seen as a huge risk for these countries. The spillover effect of the group’s activities creates a lot of discomfort among EAC citizens, in particular those who believe that the region remains vulnerable to Al Shabaab attacks.
If the EAC can offer assurances to Somalia’s fledgling security situation, then a collective security strategy from the bloc might be of significance.
The EAC Treaty criteria under which a new member state may be admitted into the community include – but are not limited to – observance and practice of the principles of good governance, democracy and the rule of law. Critics believe that Somalia fulfils only one key requirement to be admitted to the bloc – sharing a border with an EAC partner state, namely, Kenya. On paper, it seems to be the least prepared when it comes to fulfilling the other requirements. The security situation remains fragile and the economy cannot support the annual payment obligations to the community.
According to the Fragility State Index, Somalia is ranked as one of the poorest among the 179 countries assessed. Among the key pending issues is the continued insecurity situation caused by decades of civil war and violent extremism. Furthermore, Human Rights Watch ranks Somalia low on human rights and justice – a breakdown of government institutions has rendered them ineffective in upholding the human rights of its citizens.
Somalia’s citizens have faced various forms of discrimination due to activities beyond their control back in their country. This has led to increasingly negative and suspicious attitudes towards Somalis and social media reactions to the possibility of Somalia joining the EAC have seen a spike in hostility towards citizens of Somalia. The country’s admission into the bloc could be met with hostility from the citizens of other partner states.
Dr Nicodemus Minde, an academic on peace and security, agrees that indeed citizens’ perceptions and attitudes will shape their behaviour towards Somalia’s integration. He argues that ”the admission of Somalia is a rushed process because it does not address the continued suspicion and negative perception among the EAC citizens towards the Somali people. Many citizens cite the admission of fragile states like South Sudan and the Democratic Republic of Congo as a gateway of instability to an already unstable region”.
Indeed, the biggest challenge facing the EAC has been how to involve the citizens in their activities and agenda. To address this challenge, Dr Minde says that ’’the EAC needs to conduct a lot of sensitisation around the importance of integration because to a large extent many EAC citizens have no clue on what regional integration is all about”. The idea of the EAC being a people-centred organisation as envisioned in the Treaty has not been actualised. The integration process remains very elitist as it is the heads of state that determine and set the agenda.
The country’s admission into the bloc could be met with hostility from the citizens of other partner states.
Dr Khannenje offers a counter-narrative, arguing that public perception is not a major point of divergence since “as the economies integrate deeper, some of these issues will become easy to solve”. There are also those who believe that the reality within the EAC is that every member state has issues with one or the other partner state and, therefore, Somalia will be in perfect company.
A report by the Economic Policy Research Centre outlines the various avenues through which both the EAC and Somalia can benefit from the integration process and observes that there is therefore a need to fast-track the process because the benefits far outweigh the risks.
EAC integration is built around the spirit of good neighbourliness. It is against this backdrop that President Hassan Sheikh Mohamud has extended the goodwill to join the EAC and therefore, it should not be vilified and condemned, but rather embraced. As Onyango Obbo has observed, Somalia is not joining the EAC – Somalia is already part of the EAC and does not need any formal welcoming.
Many critics have argued that the EAC has not learnt from the previous rush to admit conflict-plagued South Sudan and the DRC. However, the reality is that Somalia will not be in conflict forever; at some point, there will be tranquillity and peace. Furthermore, a keen look at the history of the EAC member states shows that a number of them have experienced cycles of conflict in the past.
Somalia is, therefore, not unique. Internal contradictions and conflict are some of the key features that Somalia shares with most of the EAC member states. The process of integrating Somalia into the EAC should, therefore, be undertaken with long-term success in mind rather than in the light of the situation currently prevailing in the country.
Politics
The Repression of Palestine Solidarity in Kenya
Kenya is one of Israel’s closest allies in Africa. But the Ruto-led government isn’t alone in silencing pro-Palestinian speech.
Israel has been committing genocide against the people of Occupied Palestine for 75 years and this has intensified over the last 30 days with the merciless carpet bombing of Gaza, along with raids and state-sanctioned settler violence in the West Bank. In the last month of this intensified genocide, the Kenyan government has pledged its solidarity to Israel, even as the African Union released a statement in support of Palestinian liberation. While peaceful marches have been successfully held in Kisumu and Mombasa, in Nairobi, Palestine solidarity organizers were forced to cancel a peaceful march that was to be held at the US Embassy on October 22. Police threatened that if they saw groups of more than two people outside the Embassy, they would arrest them. The march was moved to a private compound, Cheche Bookshop, where police still illegally arrested three people, one for draping the Palestinian flag around his shoulders. Signs held by children were snatched by these same officers.
When Boniface Mwangi took to Twitter denouncing the arrest, the response by Kenyans spoke of the success of years of propaganda by Israel through Kenyan churches. To the Kenyan populous, Palestine and Palestinians are synonymous with terrorism and Israel’s occupation of Palestine is its right. However, this Islamophobia and xenophobia from Kenyans did not spring from the eternal waters of nowhere. They are part of the larger US/Israel sponsored and greedy politician-backed campaign to ensure Kenyans do not start connecting the dots on Israel’s occupation of Palestine with the extra-judicial killings by Kenyan police, the current occupation of indigenous people’s land by the British, the cost-of-living crisis and the IMF debts citizens are paying to fund politician’s lavish lifestyles.
Kenya’s repression of Palestine organizing reflects Kenya’s long-standing allyship with Israel. The Kenyan Government has been one of Israel’s A-star pupils of repression and is considered to be Israel’s “gateway” to Africa. Kenya has received military funding and training from Israel since the 60s, and our illegal military occupation of Somalia has been funded and fueled by Israel along with Britain and the US. Repression, like violence, is not one dimensional; repression does not just destabilize and scatter organizers, it aims to break the spirit and replace it instead with apathy, or worse, a deep-seated belief in the rightness of oppression. In Israel’s architecture of oppression through repression, the Apartheid state has created agents of repression across many facets of Kenyan life, enacting propaganda, violence, race, and religion as tools of repression of Palestine solidarity organizing.
When I meet with Naomi Barasa, the Chair of the Kenya Palestine Solidarity Movement, she begins by placing Kenya’s repression of Palestine solidarity organizing in the context of Kenya as a capitalist state. “Imperialism is surrounded and buffered by capitalistic interest,” she states, then lists on her fingers the economic connections Israel has created with Kenya in the name of “technical cooperation.” These are in agriculture, security, business, and health; the list is alarming. It reminds me of my first memory of Israel (after the nonsense of the promised land that is)—about how Israel was a leader in agricultural and irrigation technologies. A dessert that flowed with milk and honey.
Here we see how propaganda represses, even before the idea of descent is born: Kenyans born in the 1990s grew up with an image of a benign, prosperous, and generous Christian Israel that just so happened to be unfortunate enough to be surrounded by Muslim states. Israel’s PR machine has spent 60 years convincing Kenyan Christians of the legitimacy of the nation-state of Israel, drawing false equivalences between Christianity and Zionism. This Janus-faced ideology was expounded upon by Israel’s ambassador to Kenya, Michel Lotem, when he said “Religiously, Kenyans are attached to Israel … Israel is the holy land and they feel close to Israel.” The cog dizzy of it all is that Kenyan Christians, fresh from colonialism, are now Africa’s foremost supporters of colonialism and Apartheid in Israel. Never mind the irony that in 1902, Kenya was the first territory the British floated as a potential site for the resettlement of Jewish people fleeing the pogroms in Europe. This fact has retreated from public memory and public knowledge. Today, churches in Kenya facilitate pilgrimages to the holy land and wield Islamophobia as a weapon against any Christian who questions the inhumanity of Israel’s 75-year Occupation and ongoing genocide.
Another instrument of repression of pro-Palestine organizing in Kenya is the pressure put on Western government-funded event spaces to decline hosting pro-Palestine events. Zahid Rajan, a cultural practitioner and organizer, tells me of his experiences trying to find spaces to host events dedicated to educating Kenyans on the Palestinian liberation struggle. He recalls the first event he organized at Alliance Français, Nairobi in 2011. Alliance Français is one of Nairobi’s cultural hubs and regularly hosts art and cultural events at the space. When Zahid first approached Alliance to host a film festival for Palestinian films, they told him that they could not host this event as they already had (to this day) an Israeli film week. Eventually, they agreed to host the event with many restrictions on what could be discussed and showcased. Unsurprisingly they refused to host the event again. The Goethe Institute, another cultural hub in Kenya that offers its large hall for free for cultural events, has refused to host the Palestinian film festival or any other pro-Palestine event. Both Alliance and Goethe are funded by their parent countries, France and Germany respectively (which both have pro-Israel governments). There are other spaces and businesses that Zahid has reached out to host pro-Palestine education events that have, in the end, backtracked on their agreement to do so. Here, we see the evolution of state-sponsored repression to the private sphere—a public-private partnership on repression, if you will.
Kenya’s members of parliament took to heckling and mocking as a tool of repression when MP Farah Maalim wore an “Arafat” to Parliament on October 25. The Speaker asked him to take it off stating that it depicted “the colors of a particular country.” When Maalim stood to speak he asked: “Tell me which republic,” and an MP in the background could be heard shouting “Hamas” and heckling Maalim, such that he was unable to speak on the current genocide in Gaza. This event, seen in the context of Ambassador Michael Lotem’s charm offensive at the county and constituency level, is chilling. His most recent documented visit was to the MP of Kiharu, Ndindi Nyoro, on November 2. The Israeli propaganda machine has understood the importance of County Governors and MPs in consolidating power in Kenya.
Yet, in the face of this repression, we have seen what Naomi Barasa describes as “many pockets of ad hoc solidarity,” as well as organized solidarity with the Palestinian cause. We have seen Muslim communities gather for many years to march for Palestine, we have seen student movements such as the Nairobi University Student Caucus release statements for Palestine, and we have seen social justice centers such as Mathare Social Justice Centre host education and screening events on Palestinian liberation. Even as state repression of Palestine solidarity organizing has intensified in line with the deepening of state relations with Apartheid Israel, more Kenyans are beginning to connect the dots and see the reality that, as Mandela told us all those years ago, “our freedom is incomplete without the freedom of Palestinians.”
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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 every week.
Politics
Only Connect: Human Beings Must Connect to Survive
We must fight to remain human, to make connections across borders, race, religion, class, gender, and all the false divisions that exist in our world. We must show solidarity with one another, and believe we can construct another kind of world.
24 November 2021. We wake to the news that 27 migrants have drowned in the English Channel.
“Stop the boats!” cry the Tories. It’s the hill British Prime Minister Sunak has chosen to die on. But there is no political will to stop the wider crisis of global migration, driven by conflict, poverty, persecution, repressive regimes, famine, climate change, and the rest. Moreover, there is zero understanding that the West is behind many of the reasons why people flee their homes in the first place. Take Afghanistan, a useless Allied war that went nowhere. It left the Taliban more powerful than ever. Afghans who worked for the British army, betrayed when our forces pulled out. Now they make up the majority of cross-Channel migrants.
Not for them the welcome we gave Ukrainians. Wrong skin colour, maybe? Wrong religion? Surely not.
Some right-wingers rejoice at news of these deaths. “Drown ’em all!” they cry on social media. “Bomb the dinghies!” There are invariably photos of cute cats and dogs in their profiles. Have you noticed how much racists and fascists love pets? Lots of ex-servicemen among them, who fail to see the link between the failed wars they fought, and the migration crisis these spawned. The normalisation of a false reality is plain to see. Politicians and the media tell folk that black is white, often in meaningless three-word slogans, and the masses believe it. Migrants, especially those who arrive in small boats, are routinely labelled criminals, murderers, rapists, invaders, Muslims intent on imposing Islam on the UK, and “young men of fighting age”, which implies that they are a standing army.
If you bother to look beyond the stereotypes, the reality is very different.
One couple’s story
Riding those same waves, a year or so later, are two Iranian Kurds. A young couple. Let’s call them Majid and Sayran. They have sadly decided not to have children, in 12 years of marriage, because they believe Iran is no place to bring up children. Activists who oppose the regime, they were forced to flee after receiving direct threats. They ran an environmental NGO, and held Kurdish cultural events that are banned in Iran.
The husband, Majid, a writer, first fled to Iraq in 2021. He and his wife were parted for 18 months. She eventually joined him in a Kurdish area of Iraq. They were forced to flee again, when the Iranian regime bombed the homes and offices of political dissidents in Iraq, killing and wounding many of their friends. They decided their only hope was to head for Britain via Turkey, Italy and France. They paid people smugglers around USD30,000 in total. They eventually ended up in a hotel in my home town. Their story continues below.
Feeling powerless
Meanwhile, there I am sitting at home in the UK, getting more and more enraged about my government’s attitude and policies on immigration. I feel powerless. I think about refugees living in an asylum hotel in my town. I’m told many of them are Muslim, now trying to celebrate Ramadan. I picture them breaking their fasts on hotel food, which relies heavily on chips and other cheap junk. I meet some of them in the queue at the town’s so-called community fridge, where I used to volunteer. I chat a little to Majid, who can speak some English. I try to find out why they are there. The “fridge” gives out food donated by supermarkets to anyone in need. The food would otherwise be thrown away because it’s about to reach its sell-by date. The refugees go there, they tell me, to get fresh stuff because the hotel food is so awful. I can sense the growing resentment from locals in the queue, who want to put “Britain first”.
Thinking, thinking. Then I berate myself. I should take action, however small. Get down to the supermarket, buy food for, say, six families. I can’t feed everyone, but let’s start somewhere. Food that people from the Middle East (the majority of the hotel residents) will like. Hummus, flatbreads, dates, olives, nuts, rice. Divide it into six bags. I don’t know how I will be received (I feel rather nervous), but let’s give it a go.
I can sense the growing resentment from locals in the queue, who want to put “Britain first”.
The hotel manager is cagey. (I am later banned. He and his female head of security are rude and hostile, but that’s still to come.) For now, he lets me in to distribute the food. Luckily, I spot Majid, just the person I’m looking for. I recognise him from the “fridge” queue. He can translate for the others, who quickly gather in the lobby. The food is snatched within minutes, people are delighted with it. (It turns out Majid and his wife are atheists. But they get some food too.)
I didn’t do this for the thanks. But I’m glad I made that first move. Taking it further, I invite them both round for a meal. I spend hours making Persian rice, it’s a big hit. My new friends fall on the spread like ravening wolves. One thing leads to another. We start to meet regularly. It helps that they have some English, which greatly improves as the weeks pass and they go to classes. They are thrilled by everyday things – walks in the country, pizza, a local fair, being taken to see the film Oppenheimer. (“We were amazed to see so many British people go to the movies!”) They tell me they are delighted simply to make contact, to see how ordinary people live, to be invited into my, and my friends’ homes. I tell them I have plenty to learn from them, too. We get a bit tearful. I say hi to Sayran’s mum on the phone in Iran. We also laugh a lot. Majid has a black sense of humour.
At first, I don’t ask about their experience of crossing the Channel. All I know is that the entire journey, from Iran to Britain, was deeply traumatic. Until now, months later, when I ask Majid to describe what happened.
Majid picks up the story of their journey in Turkey: “The most bitter memories of my life were witnessing my wife’s tiredness, fear and anxiety as we walked for nine hours to reach Istanbul. I saw my wife cry from exhaustion and fear many times, and I myself cried inside. In a foreign country without a passport, our only hope was luck, and our only way was to accept hardship because we had no way back. The most bitter thing in this or any refugee journey is that no one gives any help or support to his fellow traveller. The smallest issue turns into a big tension.”
To reach the sea, where they would take a boat to Italy, they walked through dense pine forests. “There were about 30 of us in this group and none of us knew each other. We passed through the forest with extreme anxiety and fear of being arrested by the ruthless Turkish police. We were all afraid that some babies who were tied tightly on their father’s shoulders would cry and the police would find us. But as soon as we stepped into the forest, all the children became silent due to their instinct and sense of danger. They didn’t make a single sound all the way. We were in the forest for about 12 hours, and reached the beach by 8 a.m. Here we were joined by several other groups of refugees; by now we were more than 100 people.”
The week-long journey to Italy in a 12-meter “pleasure” boat carrying 55 people was terrifying. “As the boat moved towards the deep parts of the sea, fear and anxiety took over everyone. The fear of the endless sea, and worse, the fear of being caught by Turkish patrols, weighed heavily on everyone’s mind. The boat moved at the highest speed at night, and this speed added to the intensity of the waves hitting the hull of the boat. Waves, waves, waves have always been a part of the pulse of travellers. As the big waves moved the boat up and down, the sound of screams and shouts would merge with the Arabic words of prayers of old, religious passengers. I can say that there is no scene in hell more horrific than this journey. It was near sunset when several passengers shouted: ‘Land! Land!’”
On the way to France, they somehow lost their backpacks. All their possessions gone. Moving fast forward, they found themselves in yet another forest, this time close to the French coast.
“For the first time, I felt that the whole idea I had about Europe and especially the French was a lie. Nowhere in the underdeveloped and insecure countries of the Middle East would a couple be driven to the wrong address at night, in the cold, without proper clothing. But what can be done when you illegally enter a country whose language you do not know? It was almost 2 o’clock in the morning. The sound of the wind and the trees reminded us of horror scenes in the movies. It was hard to believe that we were so helpless in a European country on that dark, cold and rainy night.” He collected grass and tree leaves to make a “warm and soft nest. I felt like we were two migratory birds that had just arrived in this forest.” Eventually they found what they were looking for – a refugee camp. The next step was to try and cross the Channel.
“I can say that there is no scene in hell more horrific than this journey.”
“We reached the beach. The sky was overcast and it was almost sunset. A strange fear and deadly apprehension gripped all the poor refugees in that space between the sky, the earth and the sea.” A smugglers’ car brought a dinghy and dumped it on the beach before quickly driving away. It was no better than a rubber tube. The refugees filled it with air, and attached a small engine. “They stuck 55 people in that tube.” The dinghy went round in circles and ended up on another part of the French coast. Many people decided to disembark at this point, leaving 18 passengers.
“Women and children were wailing and crying. The children looked at the sea dumbfounded. Men argued with each other and sometimes arguments turned into fights. The boat was not balanced. I was writhing in pain from headaches, while my wife’s face was yellow and pale because of the torment.”
At last a ship approached, shining bright floodlights at the dinghy. It belonged to the British coast guard. “When they threw the life rope towards our plastic boat, we were relieved that we were saved from death.”
Hotel life
My friends tell me about conditions at the hotel. Grim. Food that is often inedible, especially for vegetarians like them. They send me photos of soya chunks and chips. Residents are banned from cooking in their rooms, or even having a fridge. Majid and Sayran have sneaked in a rice steamer and something to fry eggs on. (They have to hide them when the cleaners come round.) Kids have no toys and nowhere to play except in the narrow corridors. Everyone is depressed and bored, waiting for months, sometimes years, to hear the result of their asylum claims.
Majid takes up the story: “Due to the lack of toys and entertainment, the boys gather around the security guards and help them in doing many small tasks. The image of refugee children going to school on cold and rainy mornings is the most painful image of refugees in this developed country. In schools, language problems make refugee children isolated and depressed in the first few years. What can be the situation of a pregnant woman, or a woman whose baby has just been born, with an unemployed husband, and poor nutrition, in a very small room in this hotel? Imagine yourself. Many elderly people here suffer from illnesses such as rheumatism, knee swelling, and high blood sugar. But many times when they ask for a change in the food situation or request to transfer somewhere else, they are ridiculed by the hotel staff. One day, a widow who had no food left for her and was given frozen food, went to the hotel management office with her daughter to protest. But one of the security guards took the food container from this woman’s hand and threw it on the office floor in front of her child. Now that little girl is afraid and hates all the security.”
“When they threw the life rope towards our plastic boat, we were relieved that we were saved from death.”
Yet racists rant about migrants living it up in five-star hotels costing the taxpayer £8 million a day. They don’t think or care about how we got here: the Tories let the asylum backlog soar, by failing to process asylum claims in a timely fashion. Some of us cynically wonder if this was deliberate. The number of people awaiting an initial decision is now 165,411. This compares to 27,048 asylum applications, including dependents, between January and September 2015, before the UK left the European Union.
I’ve done what I can. Lobbied the Home office to improve the food and conditions. I eventually got a reply, both from them and the catering contractor. Wrote to my MP, local councillors, inter-agency bodies that monitor conditions in hotels, migrant organisations, the press. We have had some success. There is a lot more to do.
I ask my friends if the threat of being deported to Rwanda (a key plank of the UK’s asylum policy) might have deterred them from coming. Or if anything would have stopped them. Majid replies: “Not at all! Because everywhere in this world is better than Iran for life. Especially for me, I have a deep problem with the Intelligence Organization of the Islamic Revolutionary Guard Corps. They threatened me with death over the phone.”
Making sense of the world
World news has become unbearable to read, watch or listen to. Once a news junkie, I increasingly find myself switching off. I’m equally appalled by the widespread apathy, even among friends who were once politically engaged. Then there is all the dog whistling our government does, in language that echoes that of the far right. Ministers and MPs have shamelessly whipped up suspicion, hatred, and fear of the Other. “Cruella” Braverman was one of the worst offenders, but at least she is no longer Home Secretary. Her “dream” of deporting refugees to Rwanda (her words) has become a nightmare for Sunak. Both are of East African Asian heritage.
Ministers and MPs have shamelessly whipped up suspicion, hatred, and fear of the Other.
This may sound trite, but we must struggle to remain human, and make connections where we can – across borders, race, religion, class, gender, all the false divisions that exist in our world. We have to keep lobbying those in power, and going on protest marches. We must show solidarity with one another. We have to believe we can construct another kind of world, pole pole, from the bottom up. A kinder world would help, for starters. It can begin in very small ways.
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